You pay your insurance premiums on time, and you know exactly what kind of medical and prescription coverage to expect. But what happens when your insurance company decides it doesn’t want to provide the same coverage anymore?
That’s exactly what happened to “Mark,” one of my patients suffering from osteoarthritis and a serious lower-back injury. Without treatment for the severe, debilitating pain, Mark simply could not function. As a 60-year-old man living by himself, Mark has been completely self-reliant. He has no one in his household to help him deal with the pain, so pain management has been critical to his quality of life and ability to function.
For years, Mark underwent physical therapy and a full range of interdisciplinary treatment to restore his quality of life. Thankfully, his pain has been consistently managed with medications. I prescribed a specific dosage of painkillers that provided adequate pain relief without any sedation or adverse side effects. Although not perfect, Mark’s situation was manageable. And as important, he was paying his insurance premiums on time — to a major Florida insurance company — until suddenly, he received a notice that this unscrupulous company planned to arbitrarily limit the amount of pain medication he could receive in any given month.
As Mark’s doctor, I had to find a way to provide him with a new prescription that fell within the limits of this new, arbitrary insurance-coverage limit. Sadly, it also meant that I had to reduce his dosage from 90 milligrams per day to 80 milligrams, which meant that Mark would have less pain relief and an increase in the level of sedation because of the insurance company’s interference with my patient’s treatment.
Why would an insurance company interfere this way? Was it just plain greed, a simple case of trying to save a few bucks so it could pocket more profits?
Unfortunately, Mark’s case is not unique. In 2011, Florida lawmakers took steps to fight “pill mills” that were thriving in our state and allowing people to abuse prescription drugs. Unscrupulous people from around the country would drive here to buy pain medication and sell it on the black market.
Since passage of new laws aimed at fighting pill mills, doctors and pharmacists, working closely with law enforcement, were able to reduce the number of pill mills and prescription drug-abuse incidents. But the unfortunate side effect is that legitimate patients, in desperate need of pain-management treatment, are getting shafted by insurance companies who use the new law as an excuse to alter insurance coverage and boost their profits.
They are playing games with patients, forcing them to jump through hoops, fill out mountains of paperwork to justify even the slightest adjustment to a sleeping-pill prescription or an arthritis treatment. And when they get called on it, they point to the laws passed in 2011 that were designed to fight criminals and illegal drug abuse.
No insurance-company executive should have the right to tell a doctor what to prescribe for a patient, nor should they be able to impose arbitrary limits that could radically affect a patient’s well being. Most of all, insurance-company executives should never be allowed to interfere with treatments they previously agreed to pay for. Such meddling can only be ascribed to one motive: greed and profiteering on the backs of patients who have dutifully paid their premiums.
The Legislature was right to combat prescription-drug abuse in 2011. But now greedy insurance companies are abusing the law. Until state lawmakers do something, patients will continue to suffer.
Albert Ray, M.D., is the medical director at The LITE Center and clinical associate professor at the University of Miami Miller School of Medicine.