Tuesday, October 26, 2010

Ms Sparrow commits insurance fraud!

Yesterday, I went to my Cub Pharmacy to pick up a prescription for blood pressure medication. My doctor prescribed it over a year ago. At the time, she ordered me to take one pill a day but to start out with half a pill a day. If my blood pressure exceeded 130/80, I should take a whole pill, otherwise continue with one half.

The half dose worked fine, so I kept splitting pills. I was getting a three-month supply of 90 pills for my three-month insurance copay of $30 a month or $90. That was a dollar a pill. When I split the pills, it actually provided medication for six months.

Three months ago, the pharmacy tech asked to verify the information in their system and I explained that I was splitting the pills per doctor's orders. She corrected the dosage information they had shown.

When I picked up my new bottle of meds, I had only 45 pills but the copay was still $90. I said that wasn't right as I was now paying $2 a pill. The pharmacist explained that the copay applied to the daily dosage not the number of pills. She said splitting the pills actually constituted insurance fraud!


I don't know when that changed, but I remember that doctors used to prescribe higher doses so patients could save money by splitting pills. There's no more compassion for people on fixed incomes, I guess. While the cost of meds goes up, Social Security benefits are frozen for yet another year. That wouldn't be so bad if the electric bill didn't jump $24 a month and gas prices at the pump are at an all-time high (and on and on).

So anyway, I am now on the straight and narrow path with Health Partners and a little poorer for it,


Kittie Howard said...
This comment has been removed by the author.
Kittie Howard said...

I can't get my comment to post....grrr!

Kittie Howard said...


What happened was a real bummer! It frosts me that the insurance companies always win.

Linda Myers said...

Phooey. Great that half a pill does the job, though!

Teresa Evangeline said...

I am seething over this kind of "healthcare reform" BS, oh, excuse me, health Insurance reform......so I best not say anymore. I agree with Linda: Phooey.

Nancy/BLissed-Out Grandma said...

I think some doctors will still prescribe the higher dose, knowing you will save money by splitting the pill. And some people tell their doctors they need the higher dosage. I'm just saying.

Pearl said...

Be sure to tell them the next time around that the doctor has reinstated the original prescription's dosage.



Linda Starr said...

What a bunch of phooey is for sure. I remember one time I had a prescription and it was less if I paid cash than if submitted it through my insurance company and paid the copay. The drug companies are in business to make money, not get people well. I think doctors still say to cut some pills in half, but I know some are best not split since there is no assurance that half the amount of medication is one half and half in the other, all might be in one half and no medication in the other half, guess it depends upon the type of med. I'm with the last two commenters, I think you need the full dose just in case your blood pressure should go up again.

Barbara Blundell said...

Hi Ms Sparrow,
I read your post with interest and it's made me appreciate how fortunate we are. Prescriptions are free and I've just been fitted with a hearing aid- a neat little digital job -again no charge. I did pay into the NHS all my working life so suppose I am reaping the benefits now

Cheryl Kohan said...

Well, that just sucks! I actually quit taking a prescription because the price practically doubled. Really. Isn't that just pathetic?