Behind Your Back

Detail of building in San Antonio

So. 

One of the biggest time drains in my life is sorting through paperwork from insurance companies telling me that Mr. or Ms. So-and so is not filling their medication and therefore “likely noncompliant”. 

My question to you good people is this:

Do you want your doctor calling you to say your insurance company sent us this message and you need to take your meds, or else? Or do you prefer that we pretend that never came across our desk?

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122 thoughts on “Behind Your Back

  1. Are the medications covered by insurance? If not, I can tell you why they aren’t filling their prescriptions, they don’t have the money. Maybe the insurance companies should be covering that too.
    Leslie

    Liked by 6 people

  2. πŸ˜€ It used to be my job to sort that mailβ€”for both the small office single practitioner and for the multi-multi practitioner practice at Behemoth. I would pre-sort it for the round file. In both jobs the drs rifled through it, grumbling and swearing. Tremendous waste of time and paper and other resources.

    Liked by 2 people

      • my doc will go off on a rant sometimes…he will stick up for pharmaceutical companies but he HATES insurance companies. Says if they won’t pay for my son’s knee-injections, they can just pay for surgery! He’s great though, I spent so many nights in the ER with my son’s breathing treatments that Doc said “enough” and ordered a nebulizer at home. There is another story…the supplier refuses to sell us a nebulizer, they insist on renting on for $25.00 a month FOREVER. I called and complained and the person asked me why I was complaining since the insurance company was paying the charge…grrrr.

        Liked by 2 people

  3. If my insurance agency called or sent mail to my doctor about my medications I would have an utter hissy fit! It is ultimately up to ME as to whether I am taking certain meds or not. It is not their job to determine my healthcare needs, it is MINE and my doctor’s and pharmacists job.

    Liked by 5 people

  4. If such an unlikely event ever happened here, one of my doctor’s staff would call and tell me I need to make an appointment to see doctor. Would 3:45 on Thursday be suitable? But America is probably different .

    Liked by 1 person

  5. The only time I ever got that was in error. I had filled a prescription every month on the dot and I got that call and had to make an extra appointment to see the provider. The drug in question was one that would have made me really sick to just not take it. When I saw the provider, I was totally healthy and happy. So the insurance company had to cover an extra visit because somehow the info that the prescription was filled never got from the pharmacy to the insurance company

    Liked by 1 person

  6. No. I don’t want you calling me, even more, I don’t want the insurance company messaging you. Enforcement is not in their realm, and should not be in yours. If I am non-compliant and refuse to be, send me away, but don’t harass me.

    Liked by 2 people

  7. Since my insurance company’s prime motivation is profit, I’d like them to be removed from the equation.

    Their “concern” is based on averages and actuarial tables. I’d prefer to come back to you and explain why I stopped taking the meds or why I never started. I trust my doctor, I do NOT trust my insurance company.

    Liked by 3 people

    • So to clarify, you don’t want your insurance company calling you to ask for an explanation but you are cool with the doctor’s office calling you? Or do you prefer not hearing from anyone? The insurance company gets the info based on claims processed from the pharmacy and then they communicate that to us. The only way you Doctor can know is if they notify us.

      Liked by 1 person

      • Interesting issue: why so much non-compliance? I would think that persons trust their doctors enough to keep taking prescribed medications, or at least tell the doctors why they want to stop taking them. As for the insurance companies, the more communication the better. If I had overlooked a prescription, I would consider it a benefit if they let me know directly. If my doctor knows via that kind of letter, why not bring it up as a polite question at the next appointment? No doctor should be expected to call the patient about this matter, but it makes sense to discuss it at a scheduled appointment.

        Liked by 1 person

      • There is increasing distrust of medicine and physicians. We have been painted Time and again as the bad guy by pharmacies, insurance companies, the news, etc. so there is that. And then, it is hard for patients to communicate easily. Sit on hold for ten or fifteen minutes just one time and you won’t try that again. There are better portal systems that help but only if patients trust them enough to use them. Most noncompliance is not a malicious thing, though. It is a matter of subconscious or conscious denial or time. With our lives moving faster and faster and meds having different refill dates, who has time to wait at the pharmacy every other week? Not me. I would prefer insurance companies send the same letter to the patient. For me to make note of it in the chart so we can address it at the next visit is dang near impossible. In my old EHR we had pop ups that we could make to address something like that. In this, no such option. Those kinds of notes get buried in the rest of the chart. We would have to call on all of the letters at the time of receipt or we would likely loose the opportunity.

        Liked by 2 people

  8. Well that is a hard question to answer as we do not have insurance companies spying on us about our medication!
    Two points, why would genuine patients not take their meds, 1 they can’t afford it,2 they don’t need it?
    As things stand in your country , maybe your patients should be informed .
    I would hate to have to have a system where if you can’t pay you don’t get treated. Mind you our NHS is failing so it may come to that here soon.

    Liked by 1 person

    • Tons of patients just cannot be bothered to fill their meds. Seriously. That is what I hear the most often. Even when they know not taking it is going to hasten their death. I kinda get that. It is hard keeping track of multiple meds. I am not sure me harassing them will make them any more compliant. They get an earful from me as it. That being said, I have not tried alerting patients when I get these letters, either. I am sorting of testing the waters here, seeing what the opinion is. Personally I would hate it as a patient but would it make me more compliant? Maybe.

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  9. I would want to know if I was the MD and had prescribed something and the patient was not taking it… but the insurance company calling the MD is all about the money. I have had on my med list at least three drugs, very expensive drugs that I stopped taking by order of the MD. The pharmacy kept refilling one drug and sending it to me in the mail. And then I was liable for the bill. Fortunately, that drug was only $10.00 but it went on for three months. The insurance company needs to stay out of the personal lives and let us work directly with the MD and the MD alone. You can imaging the hoops I go through to get a drug I need…..

    Liked by 1 person

  10. My doctor and my insurance put me down as non-compliant for refusing metformin and choosing to treat my type 2 diabetes with diet, exercise and weight loss. My hgbA1C is down to 5.7 from 7.5. Still, my husband’s life insurance company refuses to insure me 1) because of the diagnosis of diabetes, and 2) history of non-compliance for refusing metformin. My father was in the insurance business for more than fifty years. He said they are just the mafia in suits with a license to do business. I hate them. But to answer your question. It should be the pharmacy that informs the physician, if anybody, and the physician and patient should be able to comfortably discuss reasons for non-compliance. Insurance companies should not even be part of the equation. I have to agree with Dan. I suppose to simply ask the patient if they are tolerating their medication could be a simpler approach that could open the topic for discussion. I certainly wouldn’t want my physician telling me that the insurance company was threatening them or me.

    Liked by 2 people

  11. Good grief. Really? I dunno. I don’t refill mine. Like, I got a 30 day Ativan and it takes me a year to use those 30, and I never refill the other 60 days… Same with Celebrex. I might take half of one scrip… And like, I don’t get the pain pills filled at all… and you’re sayin my dr may be in trouble about it?!? She only complains to me if I complain to her. Heh. We know where we stand. Her, helpful and me, non-compliant. Some of us will do anything to avoid pills. I enjoy reading you, but I swear, sometimes I wish I just stayed ignorant.

    Liked by 2 people

  12. Interesting. My doctor could call if he had time, he could ask at my next appointment. I’d be happy to share the why. Sometimes there are reasons you don’t stick with a program. Sometimes it is fears. Sometimes complications. Sometimes it is insurance issues. Sometimes you just need to be convinced it is worth it. Sometimes you need to feel in control. Is it important enough to find out?

    Liked by 1 person

    • There is the thing. Is it important? Dunno. I can tell if people have been refilling their med correctly and address it at the visit. Well. I used to. This new system makes that quite a bit harder. But I find people respond better to face to face discussions with me rather than communication through office staff. Would it improve compliance? I don’t know that anyone has studied that. We are becoming less and less free to make our own stupid decisions, though. Is that a good thing? I am not sure.

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  13. It seems to me there are two issues here. Apparently if you’re non-compliant you can be refused cover? I wasn’t aware of that! And, of course, non-compliance can have health issues. I think it would be better for the insurance company to send me a copy of the letter they send my doctor, and tell me about possible penalties I might suffer for non-compliance. Then it would be up to me to call and discuss it with my doctor, for instance if I’m not enjoying the side-effects or I’d rather try a drug-free approach; or my doctor could raise it during my next visit; since they’d have the information it would presumably be in my file. I certainly don’t think my doctor has the time to nag me about it, though!

    Liked by 1 person

  14. I admit to being non compliant. I didn’t know this happened. I need to apologize to my doctor when I see him next week. I also have to tell him my new BP med is giving me horrible side effects, but it is lowering my BP. I hope he accepts my apology and addresses my concerns. Thank you so much for the awareness.

    Liked by 2 people

  15. The only calls I get are from the pharmacy because I sometimes forget to take my monthly bone meds which I just explained again tonight for the second time, and then the pharmacist? said, “I see you’re 61, have you gotten your shingles shot?” I said, “No, I’ll talk to my doctor about it.” Then he said, ” 1 in three people have nerve damage from shingles.” I repeated, “I’ll talk to my doctor about it.” This was SOOOO annoying. Sometimes the pharmacy calls because my doc writes for 1/2 to one tablet a day of something and I take 1/2 so I don’t need the refill that soon, and I’ve explained this to the pharmacy repeatedly, but they still like to call or text me anyway. So, to get to your question, at this point, I don’t want any calls from anybody. It’s my responsibility. AND another thing, somebody’s going to get paid to do this calling and letter writing stuff, so is that going to increase the cost of the insurance? Duh. Just another layer of bureaucracy. Thanks for asking and for caring.

    Liked by 1 person

  16. If there ever was a pass-the-buck opportunity, this is it. People like their doctors. And they hate their insurance company. It’s practically an American imperative. So I’d totally say notify the patient, throw the insurance company under the bus, and claim the high ground for yourself (if you don’t mind mashing a few metaphors along the way).

    And much as I try to do my duty as an Insurance Company hating American, I do have to say that it’s their job to cut unnecessary costs such as paying for unused meds. Certainly those costs won’t be absorbed by the “humanitarian” insurance companies–we all know whose premiums will be going up instead. Plus I’m guessing that the info about not covering costs of “noncompliance ” meds is actually sent to patients too–buried somewhere in those incomprehensible benefits statements they’re constantly generating .

    Liked by 1 person

      • Usually called an EOB (explanation of benefits). As head of HR, I was responsible for buying medical insurance back in the day, but I haven’t done that for several years and much has (obviously) changed.

        Liked by 1 person

  17. Well, that’s tricky business. Obviously, it’s useful information and something I should know. But now you’re setting yourself up as the go-between between the insurance company and patient. Do you want that role/responsibility? What’s the consensus been? I haven’t parsed all your comments.

    Liked by 1 person

    • The vast majority of people here prefer not to have their physician or insurance company delving into medication compliance. In med school there was much railing against the paternalism of medicine. We don’t get to decide for our patients. We make the suggestions. The patients get to decide. Now physicians are measured based on how well we can bend a patient to our will… Flu shots and other preventive care? It is not enough to simply discuss and recommend. The patient has to actually get that shot or procedure or it is counted against the physician. Meds compliance? Time will tell where that is heading.

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  18. It has kind of a Big Brother ring to it. Is the insurance company going to pay you for the call? Live or via telephone, you’re on the clock here. I can’t talk to an attorney or accountant without a bill for the call.

    Liked by 2 people

  19. I hate to say it’s a judgment call, but I kind of feel it is. I know that doctors don’t have a lot of time and people are free to take their meds or not, but with an elderly patient, it may make sense to have someone in the office follow up. Just my two cents.

    Liked by 1 person

  20. So the insurance companies want you to be the big, bad enforcer. I would make a note of it, and when the patient comes in the next time, look them straight in the eye and ask them – Are you taking your meds?
    Not much more you can do, if they want to be non-compliant.

    Liked by 1 person

    • I pretty much stick with generics which are fairly affordable. I am sure for some, though, cost is still an issue even so. But if the answer IS that they cannot afford it, resources are difficult to find to help them. We don’t have social workers available to us for the most part. I have asked and been told no, only certain insurance plans can have access to that. And self pay, the most vulnerable? Nothing. The social workers that we have access for the few covered patients are awful. It is a symptom of our terrible system.

      Liked by 1 person

      • Dang. More obstacles to affordable drugs. We’re dealing with a similar issue on our Rx with 3 generics for treating diabetes. The generic diabetes therapy, metformin ER (extended –release), is available under three different brand names, Glucophage XR, Fortamet and Glumetza. All three brand name products are now available generically. We’re told that the main difference in the three products is the actual tablet formulation- all three products release drug over 24 hours (extended release), all three products contain the same drug and strengths (Metformin). There is no significant clinical benefit to the extended-release formulations of Fortamet and Glumetza over Glucophage XR. The generics for Fortamet and Glumetza are limited source generics and their prices are considerably higher than the generic of Glucophage XR.
        Β§ Generic Fortamet costs~$25/day
        Β§ Generic Glumetza costs ~$110/day
        Β§ Generic Glucophage XR costs < $0.05/day You see what we have to deal with? Ugh, healthcare!

        Liked by 1 person

      • I have run into a notorious national chain even going so far as to fill brand name Lipitor or crestor despite the fact that I wrote for generic. I don’t find out about what they are doing until the patient calls me, angry because their insurance company is now refusing to cover the hundreds of dollars a month RX. Dang right they’re not. Shameful.

        Liked by 1 person

      • It’s ridiculous and I tell employees and retirees that you can’t be unaware of your health and prescription drug coverage anymore. Too many changes and you need to know what is going on.

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  21. My pharmacy has a really annoying recording that calls and hassles me. It reminds me when my prescriptions are due to be filled….I call in and order myself. It is one of those terrible recordings that has a way-too-perky voice on a multi-choice call. I admit that I am NOT polite to this recording and say some very nasty things to it. Rude! Last week there was a call which had to be routed through me by my son…and I fully expected the damn recording. But it was a real person calling to hassle and I was THIS CLOSE to saying some bad words while I still thought it was a recording. What SHE wanted was to tell me that son could get his prescriptions 90 day prescriptions. Good idea…”yes, do that please.” Then went to the pharmacy where they stared at us increduously and said “your insurance company won’t DO 90 days on this prescription.”

    Liked by 2 people

    • The 90 day local pharmacy insurance refusal thing drives me batty. Then, there is the chain pharmacy that constantly kicks back new prescriptions stating “patient requesting a 90 day supply.” No they are not. They are still sitting here in my office and we agreed to do a 30 day trial before they paid for 3 months worth. Makes me hit half a dozen more clicks for each one to deny it. Makes me soooooo angry when I have to do more clicks…..

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      • my local pharmacy people are afraid of me…not really, but I have been known to have a small fit at some general infraction. I absolutely hate driving all the way up there and prescriptions are not ready, not available, or whatever…but that’s a whole other story. πŸ™‚

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  22. Since my pharmacy will request a refill on my behalf (without even asking me most of the time) and expect me to pay for it, even if it’s not something I asked for and don’t take, I don’t suppose that situation would ever come up with my insurance company.

    Could your computer software not notify you when at-risk patients (thinking elderly, underage, etc.) aren’t filling their meds or following up or whatever so your office can contact them and check in? I can see the benefit in having that information from insurance for certain patients, but seems like that could be handled in a more efficient manner so y’all aren’t having to go through all that paperwork.

    Liked by 1 person

    • You know, there is a helluva lot of things our EHR ought to do for us that it does not.notifying us of that is one of them. It tells me if they filled a prescription that I did not write at a pharmacy so you think that would be possible but no.

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  23. I have a problem with the term non-compliant. I don’t think it really is constructive. I did not know insurance companies tracked whether or not patients filled prescriptions, but I would say this is between the doctor and the patient. There can be many reasons why someone does not fill a Rx or continue to fill it. One big one is cost. I have actually have patients tell me they can not afford the medicine. Another is side effects, the person may not be tolerating the medicine. It is probably good for the doctor to know if it prompts a discussion with the patient. I feel the person has to be involved in the decision over their care and they have a right to be non-compliant.

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  24. This is eye-opening. I didn’t know insurance companies did this and I would think it would make more sense to send these communications directly to the patient. To the point made in some of the comments, there’s been plenty of times I couldn’t afford to get the Rx at the time it was due to be refilled. And during some of those times, it also means having to stretch the medication until I’m able to fill it. It’s an awful situation to be in but for many it’s their reality.

    Liked by 1 person

  25. Here’s where the PBM’s coming in again (see my link in your previous post’s comments). Because they aggressively steer patients to mail-order (looking at you Express Scripts) schemes, patients get no direction. Studies have shown that people want personal contact with pharmacies and doctors. So, while it means more work for you and your staff, my initial reaction would be yes it would help for patients to hear from their doctors. Yet, there are probably factors I’m not considering.

    Liked by 1 person

    • The PBMs make money by filling prescriptions so they have a vested interest. And it is funny that you point it out because the PBMs are the ones sending the notices and not the insurance company itself in most instances.

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