An appeal for sanity

I’m finding the financial insanity of our health plan hard to look away from. Start from the premise that the health plan covers a $6000 medication, taken every 4 to 8 weeks.

Another provider might have a negotiated price of $3000 or $9000. The providers know their list prices, but not their negotiated prices. The health plan knows the negotiated prices, but that information isn’t available to the patient. So much for the patient being able to choose a less expensive provider.

Some patients find out after a year of pointless treatment that the medication is no longer working. Leaving aside the damage to the patient’s health, the health plan has just wasted $39,000 to $78,000. There’s a test that can show ahead of time that the medication is no longer working, but that test costs $300 and isn’t covered by the health plan, so doctors often don’t order it. From both a fiscal and a medical point of view, it should be done every time the $6000 medication is given. Instead, it’s done rarely.

We can appeal the decision not to cover the test, but Cigna requires a ton of paperwork from us and from the lab and from the doctor’s office, refuses to use any information already on file, and refuses to provide any response in the end. I have a confirmation number to that effect from 6/14/2014 of 3406, which I know from experience will do me just as much good as any random number. We can supposedly ask for preauthorization for the test, but Cigna won’t even acknowledge that request (let alone approve it).

How does any of this make sense?