As a practicing physician, I always hated the months of September and October.  In the medical world, autumn is when insurance and pharmacy plans started selling their newest products to the public and the business world. Patients are either given the opportunity to change or are forced to change by their employers.  On the surface, the changes are meant to decrease the financial impact of the ever-rising cost of insurance and medications.  In reality, the changes counterproductive and sometimes dangerous.

Patients who are well controlled on their current treatment regimen are often forced to change their medications as they are not on their new company’s formulary.  They may also be forced to change their doctors as their doctors may not be on their new insurance’s panel of approved physicians.  Along with the above-mentioned changes, patients will often need to come in to the office to discuss the changes and the possible side effects or drug interactions that may result from the change in therapy.  Further, there may be a change in preferred hospitals and pharmacies. 

Tampering with long standing, successful treatment protocols never made sense to me.  Insurers and pharmacy benefits managers actively sell their products as being new and improved.  Last night, I watched a Medicare Advantage commercial on TV.  I wanted to scream!  The insurer touted a host of free services that “MAY” be available to individuals who sign up for their policy.  According to the commercial, the policy “MAY” have a “ZERO” dollar copay and “MAY” provide for glasses and dental.

So, how does the insurer provide so much free stuff?  They don’t!  Instead, they “MAY” provide some freebies, but they take away freedom.  At a minimum, they tend to have restrictive physician panels, medication panels and copious amounts of meaningless data collections.  A year prior to my retirement, I inherited a very complex patient who needed three tests and four specialist referrals.  The patient had switched to a Medicare Disadvantage policy and was shocked to find that it took my office 6 months of work to finally get approvals for the referrals and tests ordered. Needless to say, he was furious.  Luckily, the 6-month delay in care did not result in any harm.  It could have!

Remember, if it sounds too good to be true, it probably isn’t.  Before you make a switch in coverage, review it with your doctor or his billing department.  Obviously, if your employer forces the change, there probably is nothing you can do and you’ll probably need to comply with the new rules.

One last point.  When you hear the word “MAY,” think “MAY NOT.” “May” and “may not” always go together.   Make sure you know what you are getting and what you are losing.  Can you live with what “MAY NOT” be a covered option?

Here’s your music and a joke.  

30 Nasty Things A Woman Can Say To A Naked Man
1. I’ve smoked fatter joints than that.
2. Ahhhh, it’s cute.
3. Why don’t we just cuddle?
4. You know they have surgery to fix that.
5. Make it dance.
6. Can I paint a smiley face on it?
7. Wow, and your feet are so big.
8. It’s OK, we’ll work around it.
9. Will it squeak if I squeeze it?
10. Oh no… a flash headache.
11. (giggle and point)
12. Can I be honest with you?
13. How sweet, you brought incense.
14. This explains your car.
15. Maybe if we water it, it’ll grow.
16. Why is God punishing me?
17. At least this won’t take long.
18. I never saw one like that before.
19. But it still works, right?
20. It looks so unused.
21. Maybe it looks better in natural light.
22. Why don’t we skip right to the cigarettes?
23. Are you cold?
24. If you get me real drunk first.
25. Is that an optical illusion?
26. What is that?
27. It’s a good thing you have so many other talents.
28. Does it come with an air pump?
29. So this is why you’re supposed to judge people on personality.
30. I guess this makes me the early bird!!!


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2 Replies to “MAY OR MAY NOT”

  1. Because of my 20 year career with a local council on aging, I continue to encourage people to get help making decisions regarding insurance plans from an independent objective advisor…NOT a person or agency who has something to sell. I’m so tired of seeing Joe Namath…and also Tom Selleck (I think he’s the one hawking reverse mortgages). Medicare Advantage plans are not for everyone and I don’t think there is valid data to show that Prevagen saves your memory. Thanks for letting me vent!😀

    1. I couldn’t agree more. I’m sick of Tom’s, “This is not my first rodeo. What the hell does that mean?

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