02/20/2025
⚓️Insurance does NOT equal healthcare⚓️
Breaking my social media hiatus to share a DITL of a doctor battling insurance on behalf of her patients.
A long-time patient with genetic high cholesterol and severe plaque buildup leads a very healthy lifestyle but needs lipid-lowering therapy. After 15 years of trial and error, she finally found a tolerable and effective combo: fluvastatin 40mg + ezetimibe. She has been stable on this for several years and is doing great.
Now, her insurance has deemed fluvastatin “non-formulary,” increasing her cost to $300+/month.
Cue the prior authorization nightmare:
* 20 minutes of online forms → redirected to phone
* 72-minute hold → gave up.
* Patient calls → gets me a “special physician number” → voicemail says “Thank you for calling Irvine Apartments Management Group.”
* 48 more minutes on hold the next day → I finally get a representative to say“You need to fill out this faxed form instead.” —> Fax is received at 5:30pm. It contains the same forms I submitted online. Great, I’ll fill it out tomorrow.
* Log in at 5:00am next day to new fax —> “your request has been denied due to failure to submit forms in a timely fashion.”
* Submit forms anyway with full documentation of office notes, labs, imaging, specialist notes. (Photos 1 and 2)
* 6 hours later —> Denial! (Photo 3)
4+ hours wasted fighting for a generic med. The appeal is next.
As a DPC doctor with only 200 patients, I have the time and bandwidth to fight for them like family. But remember: when insurance says your doctor “didn’t do something,” it’s often by design—to create friction, delay care, and avoid paying for treatments their members already fund with massive premiums.
⚓️Insurance ≠ Healthcare⚓️
