Member-only story
Every American System is Un-American
Prior authorizations, people as profit, and the pursuit of happiness, liberty, and justice for all.
Let me tell you a story about the American healthcare system that I get to live each and every year.
Every year around this time, I have the joy of wrangling my Nurse Practitioner, the pharmacy, and the health insurance company that covers my meds. The issue at hand? Whether or not the insurance company will continue to pay for my medications. The ones that I need to, you know, live. This is the fifth year that I have the absolute fucking joy of dealing with this.
For those of you lucky enough to live in a civilized nation with nationalized/single payer healthcare, here’s a brief crash course in American health insurance. The short version is that it sucks.
The long version is that everything is privatized, unless you fall into one of a handful of groups that qualify for some sort of government-issued health plan. That means that the insurance companies set prices for what customers pay for everything health-related. This could be anything from a $10 copay (what is owed up-front) for a regular doctor visit to $250 for a 30-day supply of meds.
You should feel lucky to pay $250, by the way, since those meds cost $1,700 without the insurance coverage. Why do they cost so much? Because the insurance company needs to get paid, of course!
The American health insurance system is built around unnecessary middle-men who have a profit incentive, meaning that they are for-profit corporations, often publicly-traded and beholden to shareholders. This means that patients, who should be the primary stakeholders in their health, are instead profit points.
And, whenever an insurance company can save a buck, they’ll deny a claim and work on the (generally correct) assumption that most people don’t have the energy to fight it.
A “prior authorization” is, in general, the insurance company asking the prescribing doctor “are you sure that the medication that you prescribed is really the medication that you meant to prescribe? Like, super-sure? It’s pretty expensive, so maybe prescribe something, you know, less expensive, so we don’t have to…
