Why Insurance Companies Suck

I prescribed Androgel (generic) for a patient with very low testosterone (total and free). He also has the accompanying symptoms. He tried to use his insurance and I needed to waste time doing a prior authorization. Here was their response:

You requested the drug listed above for your late-onset (age-related) hypogonadism. A drug is covered when the diagnosis and the criteria for use is compendia supported. The accepted use of this drug for your illness requires you to have either primary hypogonadism (congenital or acquired)- testicular failure from conditions such as cryptorchidism, bilateral torsions, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter syndrome, chemotherapy; or toxic damage from alcohol or heavy metals; or testicular hypofunction (non-age related); OR hypogonadotropic hypogonadism (congenital or acquired)- idiopathic gonadotropin or luteinizing hormone-releasing hormone deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation. The safety and efficacy of testosterone therapy have not been established in men with late-onset (age-related) hypogonadism. Humana decides if the use of a drug follows accepted standards on a case-by-case basis. We take into consideration the major compendia (drug guides). Humana has determined that the off-label use of this drug for your condition is not medically accepted and is excluded from the members benefit.

What a bunch of horseshit. Why do people need insurance when they can hardly ever use it and it costs as much as a house mortgage? It’s time to break away from their teat.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Why Insurance Companies Suck

  1. October 18, 2019 at 1:01 pm

    Declare independence. Examples at aapsonline.org/freedom

  2. Jennifer Hollywood
    October 17, 2019 at 9:58 am

    The insurance companies were getting so restrictive on topical testosterone that I had to stop prescribing it. The local urologist is having the same issue. All the patients are getting converted to IM testosterone. For some reason, the insurers will cover that.

  3. R Stuart
    October 16, 2019 at 1:05 pm

    Don’t worry. The patient will blame you.

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