Insurance Company Logic: Reject First, Then Overdose

I have not often talked about the myriad ways that insurance companies interfere with the practice of good medicine, in part because I don't have enough time to recount every story.  I had an infuriating dealing with a company this past week, though, that I think speaks volumes.

The short story is this:  The patient is a two-month-old breastfed baby with gastroesophageal reflux which has not been controlled with "reflux precautions" (feed smaller volumes, burp well, keep upright after feeds, and elevate head of bed to 30 degrees) or with Med A.  Med B has a number of negatives as an alternative or adjunctive medicine, so the next most appropriate medicine is Med C.

Since this is a young infant, I prescribe a dose appropriate to the baby's size and, surprise of all surprises, the insurance company denies the prescription because it will cost them more money.  Never mind that it is the appropriate medicine at the appropriate dose in an appropriate form for an infant.

So, what is the insco's reasoning?  The patient must first try OTC Med C.

Oh, you say, that's not so bad.  Shouldn't patients try OTC meds first anyway?

Well, maybe in some situations, but the OTC med in this situation would be a dose about 8 times higher than the patient should have (and would require the two month old to swallow pills).

To bypass the INSURANCE COMPANY'S RECOMMENDED OVERDOSE of my infant patient, I have to spend my time waiting on hold with the insurance company, so that I can eventually talk to their employed physician, who does not actively practice medicine and is most likely not a pediatrician, and try to convince him or her that it is bad medicine to overdose my patient.

Oh, the joys of practicing medicine in the U.S.