The ethics of double-dipping

If you’re worried about the future and being without medicine, and if your doctor won’t give you extra, what can you do?

Do doubt the thought of finding a different or second doctor has crossed your mind.  But does this thought make you feel guilty?  Will your insurance object?  Is it even legal to do so?  And who will find out?  Is anyone keeping track?

As I’ve said before, if your doctor believed TEOTWAWKI was around the corner, he or she would be encouraging you to procure enough medication for some time to come.  But assuming this isn’t the case, and that you cannot find a like-minded doctor, you’ll need to find another way to protect your family and yourself for an uncertain future.  No one thinks it’s unreasonable to have an evacuation plan if you live along the coastline.  Making future plans for potential medical needs is entirely reasonable and should be addressed before a crisis arises.  The government is stockpiling antibiotics and emergency medications for who-knows-what crisis.  Is it wrong for you to do the same?

So as for feeling guilty, there is no need to feel guilty about responsible behavior to protect your loved ones. But what constitutes responsible behavior?

The first part of responsible behavior is telling the truth – or at least not lying.  If you are receiving medications from two different doctors, they both need to be aware of every drug that you take.  Also, your insurance is only effective for a certain coverage period and is only obligated to pay for enough medication to cover this period.  Therefore, if you visit two different doctors to obtain extra medication for, say, diabetes, you should expect to pay one of these doctors out-of-pocket, and to pay cash for the extra medication as well.  Also, you need to be clear with each doctor how much medication you are taking each day.  This can be a difficult situation, and if either doctor believes you are not telling the truth about what you are doing, they can dismiss you as a patient.

As far as I know, obtaining extra medication for use in an uncertain future is not illegal, except for controlled drugs (narcotics, certain anxiety medications, stimulants, and the like).  If you are taking a controlled medication, it would behoove you to try to switch to alternative treatment.  Many patients find they can do without these medications if they are forced to do so.

If you want to have an extra year of medication on hand, this will take some time to procure – possibly as long as a year, since pharmacies cannot dispense medications for more than a year into the future.  If you obtain the same medication from two different doctors, eventually you will build up a stockpile (which soon would be considered outdated, but that’s a different discussion).  Is this legal?  To my knowledge it is not illegal (except again for controlled drugs).  Likely this would also require visiting two unrelated pharmacies, which again cannot dispense medication that is expected to be used beyond a year from sale date.  If asked, you cannot lie about what you are doing.  That is a sure way to cause problems for everyone.

Another thing you cannot do is to go to another physician within your network and say you’ll pay cash.  Physicians sign contracts with insurance providers, including Medicare and Medicaid, saying they will only take the negotiated (reduced) payment and comply with terms of their insurance.  It is actually illegal for doctors to take payment from Medicare patients for care that would normally be covered.  If you are on Medicare and visit a doctor who cares for Medicare patients, that doctor is obligated to submit claims to Medicare for covered services (which would include treatment for diabetes, asthma, hypertension, heart disease, and nearly everything else except cosmetic surgery).  Likewise, if you’re in an HMO, doctors within the network are legally required to comply with all terms of this arrangement, which precludes simply paying cash for services.

Let me emphasize:  for routine medical care, it IS best to see only one physician and to use one pharmacy.  It would be far better to find one physician who is willing to help you plan for future emergency medical needs.  (But I do recognize this is a problem.)  If my child had Type 1 diabetes, I would want to have enough medication and blood glucose testing supplies on hand for many months into the future. Your doctor would likely be willing to help you in this matter IF you behave responsibly.  If he or she gives you extra medication for emergency use and requests to see you again in three months, but you don’t show up again for a year, that will be the end of extra medication.  Doctors are only legally responsible to prescribe enough medication until your next appointment is due, and physicians are required to see you often enough to provide the best, state-of-the art recommended care.  The same is true whether you are seeing one doctor or multiple physicians.

Do your best to work within these guidelines and plan ahead to provide a secure future for your family and loved ones.

Copyright © 2013 Cynthia J. Koelker, MD

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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2 Responses to The ethics of double-dipping

  1. Michael says:

    I want to build up a supply of Synthroid, because I had Thyroid cancer and had a total thyroidectomy in 2007. Unfortunately, my Dr. dismisses my concerns out of hand, telling me he also is hypothyroid and “there’s too many people in need of this medication, millions of people take it, so a supply disruption is not realistic”, and further, “if it happens, we’ll all be miserable together”

    Where can I go to get some longer term supply than 90 days that I get from the pharmacy, because I don’t want to be without?

    [A common question . . . again I’ll refer you to my self-study course on the topic available at – Doc Cindy. Also search this site for additional articles on hypothyroidism.]

  2. The Wild Hare says:

    Let’s not forget the ‘Canadian Pharmacy Option’ here in getting back-up meds once you do get a prescription from your US doctor. I’ve done this for diabetes and blood pressure meds and it cut the cost in half from what I’d have had to pay in the US. Note: As I was advised by the Canadians and it did turnout, US Customs holds up your order for approximately one-month; not sure why. But don’t wait till the last minute.

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