Why Can Insurance Deny Necessary Prescriptions?

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- About Dr. Mary Claire Haver and The Galveston Diet -
Dr. Mary Claire Haver is board certified in Obstetrics and Gynecology and is a Certified Culinary Medicine Specialist from the American College of Culinary Medicine. She is a Louisiana State University Medical Center graduate and completed her Obstetrics and Gynecology residency at the University of Texas Medical Branch (UTMB). She is also a Certified Menopause Specialist through The Menopause Society.
Dr. Haver was a clinical professor at UTMB and The University of Texas Health Science Center at Houston. Dr. Haver has served as a Hospitalist, Associate Residency Director, and Assistant Professor in her career. In 2021 she opened Mary Claire Wellness, a clinic dedicated to caring for the menopausal patient.
Dr. Haver has amassed over 3 million followers across social media by posting advice for women going through menopause. She understands that menopause healthcare is in dire need of change and is proud to be leading the conversation.
Her educational background and her own experience led Dr. Haver to develop the national bestselling book and online program, The Galveston Diet, and is the New York Times #1 Bestselling Author of The New Menopause, a quintessential guide to navigating the menopausal transition and life after reproduction ends.

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[prudencesawyer]

You mean, why are we allowing insurance companies to practice medicine without a license?
It’s absolutely ludicrous and it should’ve been stopped years ago

[sarascott]

Because the health care industry’s main goal is to make as big of profit as possible, not to provide the best medical care.

[las]

Insurance companies should have ZERO say in what a patient can and cannot be prescribed if it’s something they need to better their health, period.

[annefitz]

Corporate greed! This is not new! I’m an NP and 20 years ago I made 22 phone calls to get a patient a different BPmed because he had a reaction to the 1st tier med ! Ridiculous!

[hollycampbell]

Because here in the US healthcare is a business and the goal of every business is to make money, not to help people stay or get healthy.

[niko_rob_GenX]

I'm learning that it's not just insurance companies, but it is the pharmacies and the PMB's that dictate what they will fill or not fill. The whole system is corrupt. Top to bottom. Oh, and follow the money.

[nadiaranguelova]

Thank you for being our voice and for understanding

[wednesdaybeach]

It’s not a health paradigm, it’s a profit paradigm.

[LucyDunt]

Thank your congressman and the lobbyist

[lezliesecundaGLP-RD]

I had to downgrade my insurance to increase my FSA to pay out of pocket for my care. I also have to go to Mexico about once every 2 years. I work for a big healthcare company also.

[loyetteminkler]

Insurance does not deem the medication medically necessary. I cannot understand why HRT would not be covered when it actually could save the insurance company money. It makes no sense when some insurance companies will pay for bariatric surgery but not GLP’s for weight loss. Prevention of diseases and overall health should be considered and covered.

[alheli]

So frustrating! I was prescribed pain meds from my doctor after trying four other meds that weren't working, and if I wanted to use it, it would be $2, 500 because insurance wouldn't cover it. Lord knows it doesn't cost that much to make. And the fact that insurance can decide how much pain in is bananas.

[xEllieRose]

It's like how dental isn't considered healthcare when it absolutely is. Our systems have been boiled down to profit first because for whatever reason people think a country should be run as a business. We are just cash cows for them so they have money to do their bidding. I don't think we'll see much change in that in our lifetime unfortunately.

I think about how this often on how this current time will be perceived in the future and what will be deemed unacceptable in hindsight.

[bestlifeever]

Absolutely 💯 and so glad its coming from another physician. I have said same thing both as a practioner and patient.

[lorenarmenti]

Ooooff. That's a DEEP rabbit hole with MANY tenticles. If you have the courage to research the answer, it's like pulling a thread on a sweater -- it doesn't end. It always comes down to money & power.

[veronicacarmody]

Good question! I’m on HRT, and it costs 400.00 per treatment because the medications are not covered. I was just told by my OB/GYN that their clinic would no longer provide HRT via pellets. So, today I get to see a new provider. The healthcare system just sucks for women!

[Livingwater]

I'm glad the question is coming from you the Physician, maybe you can get the answers we ALL want to know. My guess is their in the sick business-less profits are in me being well, whole, or maintaining a lifestyle that promotes healing.

[K-E]

Just one look at the CEOs pay/ perks and now we know .

[dawnsodini]

Yes! We are losing glp1 meds because we are not diabetic. I have personally lost 125 pounds and my family another 100 pounds. It has been life changing for me and my family! Thank you for fighting the good fight for all of us!

[marcywise]

🤬Seriously!!!! As a member of the rare disease community AND a 53 year old woman, I fight this fight every January when I have to get a prior authorization for my meds🤬