Duty · Fun And Games · Fun With Suits! · Pains in my Fifth Point of Contact

Moar! Random Thoughts!

The other day, I saw some soul, who was vexed by an itchy rash. I interviewed said soul, examined, and prescribed a steroid cream to soothe the rash. My instructions, in the prescription, were “Apply thin layer to rash twice a day”

Later that day, my MA fielded a call from the pharmacy inquiring where the rash was? (as in, I suppose, where on the patient’s body). I therefore had to complete the thought that I was charting on a completely different patient, find the chart for the patient, open that chart, review my note from several hours ago, and answer the query.

Foolishly, I had assumed (…yeah, I know. AssU-ME.) that “the rash” was specific enough, but, it seems, no…

In a similar vein, I continue to receive prior authorization requests. This is maddening, because (a) I typically attempt to prescribe the exact same thing previously prescribed. For, say, asthmatics, that means I attempt to prescribe the-flavor-of-the-month of albuterol inhalers. In addition, (b) years and years ago our Fly Over State Legislature passed legislation mandating substitution of generic, equivalent, medications unless the brand is specified, with the specific instruction of “dispense as written”. Silly me, I had supposed that when I prescribed albuterol, which is the generic name, that this generic substitution law would allow the pharmacist, who has access to the “menu special of the day” that the insurance company will subsidize, could then think, so to speak, “Hmm. McFee wants albuterol, but the insurance company will only subsidize Youcallwehaul brand of albuterol inhaler. Howzabout I simply fix that, and dispense the Youcallwehaul inhaler, just as if it were not a BRAND of ALBUTEROL, but, indeed could be considered equivalent to the generic albuterol inhaler that Our Hero had indeed prescribed?”

Had that occurred, I would not get a paper note spending pages and pages to tell me that the Useless Insurance Company Inc., would not pay for the generic inhaler, but would, rather, pay for the Youcallwehaul inhaler, no doubt reflecting the proud legacy of pharmaceutical excellence that has characterized the Pashmir Valley since January of 2022!

And receive that note several days AFTER my patient encounter.

All the while telling me that they would not pay for a non preferred inhaler until two other inhalers had been employed, and had failed.

So, that means that my patient has NOT had their freaking inhaler for (lessee, now: Friday visit, Monday denial, Thursday, if they are attentive (scoff!), mailing date for the voluminous tutorial on the pharmaceutical excellence of Bagwan’s Pharmacy And Weapons Factory, which I finally see, perhaps as soon as a full week after my patient encounter.) So, something like 8 days, more or less.

Let’s paw through the old chart, and review previous prescribed inhalers, shan’t we? Lessee, there is Ventolin, and then there was that time this soul received…Ventolin, and, of course, the last time when one of my colleagues prescribed…..er, Ventolin. So, imagine my surprise when I prescribed (lessee: what was that stuff?)…Oh, yes. Ventolin!

And I receive the previously described voluminous correspondence detailing why the Behemoth Insurance Company would not pay for the prescription of….er, Ventolin.

I really try to embrace the suck, but geez, ya know…

5 thoughts on “Moar! Random Thoughts!

  1. ” if they are attentive (scoff!)” My, did we get up on the cynical side of the bed this morning?
    Oh, wait, that attitude comes from simply observing peoples’ behavior. Nevermind.

    Related to your main complaint: why, oh why, do my clients with permanent, congenital conditions have to quadrennially reaffirm to the State that yes, their condition has continued to exist after X number of friggin’ decades? Bureaucracies thrive on paperwork, I suspect.

    My pet peeve: “Sure, repeatedly run your power wheelchair’s batteries completely flat; they love the abuse. That single blinking red light is for your amusement. Arrgh.”


    1. I wonder if the run-your-battery-flat thing related to derp, or intellectual disability: inability to grok the concept of finite battery life?

      Perhaps a similar question ref poly-tic-ians who espouse electric vehicles, is appropriate.

      Liked by 1 person

  2. Wait to you have to order finger test strips and insulin which you have been on since 1990 and every year prove you are still a diabetic and would you kindly sir may I have another? Don’t get me started on maintenance meds I have been on since time immortal… I too use Ventolin as a rescue inhaler, yes I know, but it works. Strong chemical smells and exposure and some wimmins that have to dunk themselves in a 55 gallon drum of cheap assed perfume. Slams my bronchials right tight.


  3. I have half a mind to copy and send your summary to my physician friends for their entertainment, but they are already too busy wading through the swamp of health insurance nonsense and other regulations such as warning of consequences if they prescribe ivermectin or hydroxychloroquine after seeing their patients.

    The gubmint fouls up everything it touches. Why, I wonder, every month now after I turned the magic age and changed from a perfectly good big corporation retiree health insurance, plan do I receive a 6 page, printed on both sides, 8 point times new roman font explanation of “your monthly premiums have changed” (when mysteriously the amount paid is exactly the same as the month before). Ditto said 6 page summary every time I get a prescription refilled and receive the payment from my health savings account VIA PAPER CHECK in this tubes of the internet world with explanations of blah blah blah an warnings such as “do not take if you are allergic to the active ingredient”, and then a week or more later the paper check arrives. The last one was in the amount of $0.46. While I am not a financial genius, I would wager the cost of sending me the paper check for $0.46 plus the cost of the subsidized postage, the paper to print the 6 page explanation on, and the ink plus whatever time to reimburse a human for some miniscule aspect of overseeing my accounts . .. . . .


  4. Did I mention that my wonderful gubmint post-age-65 health insurance costs about 3X as much as the previous retiree plan? There’s that “Affordable Care Act” in action !!!!


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