Insurance company?

[bersaguy]

I have a question regarding Presription Insurance company. My insurance company call my Pharmacy last Thursday and told them I needed to be put on a colesterol medication. Walgreens in turn filled a prescription for Lovastatin and notified me that is was filled and ready for pick up. I called them and told them that my doctor had not ordered a Colesterol Medication for me and they told me my insurance company did. I told them to just put it back on the shelf cause I would not be picking it up until I saw my doctor and had her run tests to see if I needed it. Walgreens took it upon themselves to call my doctor and ask them if I should be put on it. I am sure they did not talk to my doctor but probably one of her nurses because they got an approval to do it.

I know my doctor as she has been my doctor 20 + years and she never does anything like this with out doing all the blood work first and non was ordered.

My question is has anyone else ever experienced anything like this between their insurance company and their pharmacy and by passing the doctor?

[KahrMan]

An insurance company would not have done that unless they had a prescription from a doctor.  They are under to much regulation to try and pull a scam like this.  I bet it will turn out to be a careless paperwork mix up or something like that.  

[peejman]

I would not say they're bypassing the doctor, they're bypassing your doctor. 

The insurance company sees your test results and has someone presumably qualified to do so, review them and make recommendations. In theory, one would expect they'd consult with your doctor prior to issuing new prescriptions.  But as you said, perhaps the insurance company spoke with someone in your doc's office who agreed with the recommendations.  

The fact that you're entirely unaware all this is happening is distressing but likely par for the course these days, and they call it a service. 

[bersaguy]

1 hour ago, peejman said:

I would not say they're bypassing the doctor, they're bypassing your doctor. 

The insurance company sees your test results and has someone presumably qualified to do so, review them and make recommendations. In theory, one would expect they'd consult with your doctor prior to issuing new prescriptions.  But as you said, perhaps the insurance company spoke with someone in your doc's office who agreed with the recommendations.  

The fact that you're entirely unaware all this is happening is distressing but likely par for the course these days, and they call it a service. 

The Insurance company didn't call my doctor. Walgreens did after the insurance called them and told them I should be on a statin drug and even recomended which one. Sounds to me like someone is getting a kickback from a drug company. I am going to pick them up to keep Walgreens and the insurance company happy but not going to take them until I speak face to face with my doctor next month. I know she is going to order bllod tests first before I start anything.

[Garufa]

Insurance companies do not prescribe medicine.  They pay their limit based on the formulary or possibly recommend a substitute at the most.

Strange things are afoot here.

[bigun]

Bersa when you pick it up check to see whos name is on the script

[Garufa]

Why pick it up?  Tell Walgreens to put it back on the shelf.

[Wingshooter]

Nothing surprises me anymore with insurance companies... NOTHING! I would not pick it up until you and your doctor talk about it. Both the insurance companies and the pharmacy are in the business of making money off drugs. What you really need to be prescribed is a private matter between you and your doctor not Walgreens and your doctor. I would want to know if my dr really signed off on this over a phone call and if so, why.

I'd tell them to put it back on the shelf because that's an odd scenario.

[Sam1]

Insurance company isn't going to have access to your medical records to know what your cholesterol levels are, they will only see the charges submitted for the tests performed... not the results.  HIPAA.

I would assume it's just a paperwork mishap of some sorts, maybe an old medicine that was refilled or someone just clicked on the wrong name... could be a million things, but I doubt it is a conspiracy of sorts and your insurance company can not prescribe medications.

[bersaguy]

Well, I went up to Walgreens today and told them that they need to put it back in their inventory.  I was not going on any medication that (MY ) doctor has not ran tests on first and then handed me a written prescription for me to bring to you. The Pharmacist seemed a little pi$$ed. I guess she felt I did not trust her and she guessed correctly if that is what she thought. I have been doing business with them since I moved here almost 19 years ago but there is a CVS right across the street that I'm sure would love to have my business. I go see my doctor next month and we will get this all straightened out then..............

[bersaguy]

24 minutes ago, Sam1 said:

Insurance company isn't going to have access to your medical records to know what your cholesterol levels are, they will only see the charges submitted for the tests performed... not the results.  HIPAA.

I would assume it's just a paperwork mishap of some sorts, maybe an old medicine that was refilled or someone just clicked on the wrong name... could be a million things, but I doubt it is a conspiracy of sorts and your insurance company can not prescribe medications.

Yea, I know Sam. It is things like this that make my doctor so mad. It makes her so mad that they allow Pharmacudical(spelling) companies to advertise at all on Television. She said the FDA and FCC is doing nothng more than allowing the companies to practice medicine without a license. She went through 12 years of schooling and student loans to earn the priviledge to practice medicine and it is free to them. She has lost quite a few patients over the years because if a patient comes in her office and requests a prescription for anyhting they saw on TV she will tell them that she does not prescibe that particular medication and they get mad and leave. She will prescribe some of them but not if the patient asks for it right from the get go without tests first.

[tnhawk]

32 minutes ago, bersaguy said:

Well, I went up to Walgreens today and told them that they need to put it back in their inventory.  I was not going on any medication that (MY ) doctor has not ran tests on first and then handed me a written prescription for me to bring to you. The Pharmacist seemed a little pi$$ed. I guess she felt I did not trust her and she guessed correctly if that is what she thought. I have been doing business with them since I moved here almost 19 years ago but there is a CVS right across the street that I'm sure would love to have my business. I go see my doctor next month and we will get this all straightened out then..............

I would not accept the medication without my doctor prescribing it.

My pharmacy tried to give me a refill  prescription after my doctor no longer prescribed it for me.  

[peejman]

2 hours ago, Sam1 said:

Insurance company isn't going to have access to your medical records to know what your cholesterol levels are, they will only see the charges submitted for the tests performed... not the results.  HIPAA.

I would assume it's just a paperwork mishap of some sorts, maybe an old medicine that was refilled or someone just clicked on the wrong name... could be a million things, but I doubt it is a conspiracy of sorts and your insurance company can not prescribe medications.

Depends on the details of your plan. The fine print may have given them access to some type of info.  Worth a call to see what their version of the story is.