Why Do I See a Doctor, When My Health Insurer Knows What is Right for Me?

My health insurance provider certainly seems to know what is best for me. Either that, or they are trying to kill me, and slowly torture me in the process. I can’t be sure. Yesterday two separate incidents made me wonder why I bother going to the doctor at all.

First, a little background.

I started having knee pain in my right leg over 10 years ago. It was gradual, and typical of middle-aged males I ignored it. Then, in 2016 while at a conference in Salem, OR, something happened to my left knee. I had no idea what, as there was no defining moment of injury. When I sat down at a table for dinner, I was fine. When I stood up, I could barely walk. The pain was extreme, and I hobbled my way through that conference and another in California immediately following. On my return I had MRI’s on both knees, revealing slight tears in the root of both meniscus, as well as arthritis. An orthopedic surgeon at the time told me I needed to engage in “unrelenting cardio exercise” and lose weight. 

It was clear to me then that I needed a different orthopedic surgeon. The gall of suggesting personal responsibility was beyond the pale.

Anywhoo, being a conservative person (both politically and medically), I opted for cortisone shots, which provided me pretty decent relief for about 3 years. This past year the pain has been increasing, and after a move this summer, I have been in a great deal of pain in both legs. The orthopedic surgeon I saw yesterday only needed my old MRI’s and a new x-ray to diagnose the problem. In the technical term he used, I have “crappy knees.” I wish doctors would speak in terms we lay people could understand. I must look up “Crappy Knees” on WebMD when I get a chance. 

The surgeon, who I liked a great deal, offered a variety of alternatives to surgery, telling me there was no rush to the ultimate fix. However, he did assure me that at some point, I will be getting new knees. I suppose I’ll check to see if those are available on Amazon Prime. For the short term, he offered, and I opted for “gel shots,” which I thought at the time would be served with pretzels and make me somewhat inebriated. It would be a unique way to address the discomfort. It turns out instead that it is an injected lubricant that may help ease the pain. 

Now we are up to speed and at the point of this rambling post. The doctor needed to get approval from my health insurer for the treatment. He said they would call me to schedule the follow up appointment once they had that approval. Within two hours I received a call from his office. It seems my health insurer, who I will not name here but have been assured they are united in my healthcare, denied the requested medicine. It seems the preferred product my doctor wanted to use can be administered in one single injection. Instead, my health insurer, who clearly knows better than my doctor, approved either of two different products, both of which must be administered in three injections over three weeks.

So, instead of a single visit to the doctor’s office with a single injection to each knee, my health insurer prefers I have three visits, and undergo 6 painful injections under my kneecaps.

Thanks for that. I don’t know what I did to piss them off, but clearly, they are not happy with me.

Just an hour after that call, I received a call from my wife. She had opened a letter from my health insurance company’s PBM. Again, I will not name them. Let’s just say I find them not quite optimum for my needs at this point. The letter informed me that the asthma medication I have been taking for years with outstanding effect will no longer be available in their network. That is a fancy way of saying, “we ain’t paying for this anymore.” Instead, my health insurer’s pharmacy benefit manager recommended several other medications they feel would be better suited for me. 

I do so appreciate their consideration in telling me what medicine I should be taking. Very thoughtful of them. I must be certain to admonish my immunologist when I see him again. He very certainly has not been providing me the very bestest of care. Even though I have not had a hint of a problem in the years I have been taking the medicine he prescribed, he must have missed something that my health insurer better understands. I may not even go back to him.

In fact, I don’t think I will go to any doctor anymore. Whenever I don’t feel well, or have some malady, I will just call my friendly health insurance company and ask them for a diagnosis. It will certainly streamline the process and eliminate a lot of time wasted in medical facilities. 

After all, why go to a doctor when the health insurance company knows best?

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