Licensed personnel are bound by privacy standards.
When a consumer calls their insurance company about issues like changing tiers of medication, they’re not talking to people qualified to even speak to the issue. Most customer service personnel at insurance companies are trained by the company. They are more than likely don’t have a degree or experience within the industry where they’re working.
Example: The drastic tier change of Diltiazem CD. The customer service representative doing their absolute best to answer a subscribers question is a clerk. That clerk has no medical background. So when the subscriber is upset by the fact that he or she is receiving recommends to ask the doctor to change the medication to a different medication that is probably cheaper, they are giving medical advice without a license.
Why is that important?
Those medication‘s were ordered by a physician or a physicians assistant that takes a look at the entire picture in regards to the patient’s health. That means if that patient has a specific medical condition addressed by the prescribed medication, no one should be recommending the subscriber to speak to the doctor about changing medication. A licensed pharmacist would know that.
Additionally, if a subscriber is taking more than one type of medication, there’s the issue of interaction. If the subscriber is taking multiple medication’s during the day that complicates the picture even further. So a physician or a physicians assistant has looked at the overall picture and made sure that the medication’s this patient is taking are not interacting with each other in a way that’s going to make the patient ill or worse.
The point is when a subscriber interacts with a health care insurance company they should not be receiving medical advice. If the insurance company has licensed personnel with medical background answering questions for their subscribers, there is no reason to complain. But that is not what is happening with the healthcare insurance companies in the United States of America right now. Customer Service is a clerk with absolutely no permission to talk about medications. But that is what is going on.
Most healthcare insurance companies are doing just fine and they’re having good returns on their investment to their stockholders. However, those profits are being made at the cost of expertise and good service and good outcomes to their subscribers.
