Urgent Care by Minda Wilson: Insurance Companies They Should Be Shot

Today, CIGNA announced that they will not cover the opioid OxyContin for customers who are insured through a job, starting in 2018. CIGNA last year said it wanted to cut opioid use by 25 percent among its customers by 2019.

What about those who suffer from bone cancer? While Angela was sick the pressure from her cancer cracked open her bones. She uses opioids, including Oxy-Contin, every day to cope with the pain. She tried marijuana, it wasn’t enough. Prior to taking her current medication, each day the pain of putting weight on her broken bones would send her into spasms until she curled up into a ball.

She suffered terribly while she was sick. After months of treatment, a miracle occurred and she went into remission.

After struggling to survive cancer, she still needs these drugs. The bones in her feet and ankles were broken beyond repair. Every time she put any kind of weight on them, excruciating pain would shoot up her legs. She found that by taking opioids she could manage the pain and even walk with a walker. Being mobile allowed her to get out of the house on her own, resume a semi-normal life, and be happy. Take the pills away and she returns to a life of suffering, the pain of walking on broken feet and breathing with broken ribs that cannot be repaired.

Angela is covered under her husband’s plan which means that she can, starting in 2018 be denied coverage for her opioid prescription. Who is her insurance company to say that she is not entitled to the drugs that make her able to play with her grandkids, read a book, or watch TV without curling into a ball of pain?

The insurance companies say that OxyContin is addictive and by not allowing access to the drug, they are preventing people from becoming addicts.

"Our focus is on helping customers get the most value from their medications — this means obtaining effective pain relief while also guarding against opioid misuse," said Jon Maesner, Cigna's chief pharmacy officer on Wednesday.

They said that they “might” allow prescriptions to be honored that they determine are medically necessary? What this means is that people like Angela, who are in horrific pain, will have to wait each month until the insurance company decides its OK to give her her medicine. Who are they to determine what is medically necessary and what is not? They are not doctors, they have not seen any of the patients whose treatment they are denying? Does this mean that if they don’t want to pay for it you can still get the prescription if you pay for it yourself? Isn’t that just another way of insurance companies avoiding payment for things you thought you were covered?

Because some bad doctors and some bad people have abused their prescriptions, CIGNA is deciding they are going to deny life-saving treatment to those who are in need. When did the insurance company staffers start practicing medicine? How is it possible that in most states, it is illegal for people to practice medicine without a license, criminal to write prescriptions without a license, and yet, these companies are deciding how much of what drug you can take and for how long?

Maybe the real issue is that they want to save money? Did anyone consider that? Doctors who comply with the law provide oversite to try and determine whether their patients have become addicted to opioids. Today, doctors write prescriptions one month at a time. If they want their prescriptions renewed, they have to visit their doctor monthly; urine tests must be run to assess the level of drugs in their system. In addition to the prescription, all this costs money that the insurance company is under an obligation to support. Perhaps instead, they should monitor doctors who do not put people on a monthly cycle by checking visits and urine test charges? I thought doctors were supposed to determine how sick you were, and prescribe accordingly?

CIGNA is clearly making medical decisions about what treatment patients should receive. What insurance companies are supposed to do if a doctor deems a treatment is medically necessary is pay for it. That is why you bought the insurance in the first place.

That they do what they are supposed to so should not be the exception rather than the rule. Of course you have to meet your deductible and pay your co-pay if those things apply; but, otherwise, insurance companies are not supposed to step into the shoes of your doctor and decide what is medically necessary and what is not.