> The specific meds he prescribed were chosen as these are what the insurance company would prefer from a clinical perspective although they were extremely unlikely to help.
I work close enough to healthcare that I can say that while insurers do take cost of treatment into account they are looking to minimize ongoing treatment costs - if there is a 5$ pill and a 500$ pill available for treatment the insurer may prefer to trial you initially on the 5$ pill if it's been proven effective for a good proportion of patients, but they do use calculations to minimize those ongoing costs that includes costs from condition escalation (i.e. if you have a boil you're absolutely going to get antibiotics covered since dealing with a septic boil is an emergency room visit.
That's pretty much what I described. I was prescribed antibiotics for a chronic issue. It made no sense at all, but the DR said it's what he must to do to follow the hospitals guidelines (which are determined by what the insurers want to see). I have gastro issues and modern antibiotics cause me all sorts of problems, so of course I had to deal with the pain and discomfort for 2 weeks all for something that made no difference whatsoever.
Did you try saying no, that you weren't comfortable with this solution, and you'd like to discuss other options? You can always discuss what options are available with your doctor and then reach out to your insurance to see what and why they will do about it. You may not get the answer you want, and it will use up a lot of your time, but it is an option.
Note: I've spent on the order of 30 hours on the phone over the past couple months trying to get things sorted out between my doctor, my insurance, and the provider of the drug that I need for my vision. The folks at the insurance can't always help, but they've always been willing to discuss things and see what they _can_ do.
Given the issue I'm dealing with, I'm more interested in getting it resolved than dealing with debates between insurance, dr, etc. This was the quickest path to getting an ultrasound scheduled, so I complied.
What should have happened is that they should do the ultrasound right there, on the spot. But, the dr's office can't do ultrasounds. That has to go to the imaging department, which had to be scheduled 4 weeks out. Sigh... I won't keep going, but this whole situation is stupid and engineered to extract as much money as possible.
I'm sorry to hear it was so difficult for you. I agree that it seems like every step along the way is there just to add more money (to what they can charge you or, for the insurance, what they can get you to pay instead of them). The long hours on the phone I mentioned are another expression of that (maybe if we keep giving him the runaround, he'll just go away). The fact that you're dealing with said issues just makes you more likely to give up, and they know that.
The next time something like this comes up, if you're feeling up to it, try pushing back. If you have the time to throw at it, the worst outcome of trying is usually just staying where you started.
At the end of my many hours on multiple phone calls getting everyone to agree to pay for treatment I need... the company in charge of making it called to let me know they've been retasked to making COVID vaccine and won't be making the drug I need for at least 3 months. So no treatment for at least that long. So that's fun.
I work close enough to healthcare that I can say that while insurers do take cost of treatment into account they are looking to minimize ongoing treatment costs - if there is a 5$ pill and a 500$ pill available for treatment the insurer may prefer to trial you initially on the 5$ pill if it's been proven effective for a good proportion of patients, but they do use calculations to minimize those ongoing costs that includes costs from condition escalation (i.e. if you have a boil you're absolutely going to get antibiotics covered since dealing with a septic boil is an emergency room visit.