Page 7 of 7 FirstFirst ... 234567
Results 121 to 128 of 128
  1. #121  
    Quote Originally Posted by cellmatrix View Post
    Who's not allowing a patient to get a 90 day supply of a chronic med he's been using for years? The doctor?, the pharmacist? No, your insurance company is the one requiring the additional layer of authorization and keeping the patient from his meds.

    Its amazing that you choose not to see that its just this nickel and dime-ing by the insurance companies, that creates so much wasted effort and money by everyone involved.

    Whether its trying to get more than a 30 day supply of a med, or paying for a more effective but more costly med, insurance companies typically throw up all of these additional authorization hoops, hoping the providers or the patients will give up and stop asking them for stuff, which they often to.

    One thing not mentioned to date, is that most doctors offices hospitals and clinics, have to hire many full time office personnel (authorization specialists) whose sole job is to keep insurance companies honest and not allow them to delay or deny authorization. This is certainly contributing to the cost of health care in the US.
    Exactly. One of my patients is a department chair. He went to part-time and his insurance changed. In order to get one of his medications approved by his new insurance company, I actually had to personally call them, was sent to several different numbers, and then the person I spoke with expected me to have with me all his demographic information...like his home address, etc. I told her she was welcome to get that info in a fax if she would just send it to my office and I would provide it, but that wasn't sufficient. It took me over 30 minutes on the phone to get a simple prescription approved. My patient was infuriated and called and complained bitterly to the supervisor, who apologized and said it wouldn't happen again. Most people don't go that much trouble; they just waste the time. You hit it on the nose; it's not the providers that throw up all these barriers to patients getting what they need...it's 100% due to the insurance companies.
  2. #122  
    Quote Originally Posted by clemgrad85 View Post
    If a patient gives up in frustration for a medication, then he/she probably didn't need it. By the way, I have never known someone to get so frustrated with the insurance company they decided against a needed medication.
    I can't tell you the time I have spent arguing on behalf of my patients for particular therapies only to have them arbitrarily denied, even after appeal. Its frustrating to say the least, for the doctor and especially for the patient.
  3.    #123  
    Had a client about 8 months ago whom I had switched to UHC from Principal, get furious at me because she was being questioned about requiring her doctor to explain why brand name medications were required. The insurance company was simply trying to see if generics would work better. Well, my client explained that she simply could not try different medications because it had taken her awhile to find the right combination that worked. One was for depression while the other was to help her sleep. Seems like those might contradict each other...but....whatever. Anyway, I had to get the physician to call the insurance company and she (the client) was not happy. Well....a couple of months go by and I hadn't heard anything so I called the office manager (who handled everything for this client) and I asked what was going on. Well, turns out that not only were the generics working, the were working even better (according to the client) than the medications she was previously taking AND at a much lower cost (to both her and the insurance company).

    Funny....everyone complains about costs being too high, and they blame the insurance company for this. But when the insurance company is proactive about trying to get costs down, and it is a little inconvenient, suddenly it's time to blame the insurance company. It's like when my doctor tried to put me on Tekturna for my HBP and after I found out it was about $85 per month, I questioned as to whether there was a less expensive medication. So, instead she put me on Lisinopril....about $5.50 per month. So you tell me....who was jacking up the cost of medical care? By the way....been on the medication for about 4 years and all under control. Sometimes one just has to be proactive and not let the greedy providers try and rip you off. Unfortunately, I run across similar circumstances all the time.

    And good grief good doctor, the mean ole insurance company wanted information about your patient? How dare they!!!! Why, they should just listen to what a doctor says as gospel....I mean....just like my doctor trying to push an $85 pill on me because she liked the young pharmaceutical rep calling on her? Yup....I know how that game goes....LOL.
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  4. #124  
    I think that rather than let you or anyone else define me, I think its best that I more fully explain why I feel the way I do in more detail, so there are no misconceptions made.

    I agree that pharmaceutical companies have too much influence on doctors. Personally I avoid interactions with them, use generics meds whenever possible and also teach my students to make choices of therapy based on the peer reviewed medical literature, not from drug company recommendations.

    I also agree with you that the medical profession is in many ways too pre-occupied with keeping physicians salaries high. Thats why I am not a member of the AMA, because of this issue. Personally, I made my choice of job not based on income but because its what I like to do. I've been in academics my whole career mainly because I like to teach and do research. I know I could make twice what I am making and work far fewer hours if I chose to go into private practice, but to me, being able to train future doctors and even leaders of our profession, and the chance to make a big discovery that could help thousands of patients, thats what gets me out of bed every day.

    When I am not teaching, or directing research, and when I'm in the clinic, its the patient who I hold alligance to. With every patient I put myself in their shoes and make every decision based not on what the insurance or pharmaceutical company would want, but what I would want if I were that patient. I do everything I humanly can for them, and if it takes 30 minutes to explain to them why the drug ad they saw on TV was not right for them, or if I have to write a couple letters or otherwise deal with some bean counter from the insurance company to get my patient the therapy they need, so be it.

    Don't get me wrong, there are many insurance interactions that I have which go just fine, they listen to my arguments, my journal references, and other justifications for particular therapies. But when they try to force my hand to do things that would be harmful to my patient. I don't mean use a brand name over a generic, I mean therapies that increase toxicity but which are cheaper (yes this is a very common scenario I deal with), I will go to bat all the way for the patient, and God help you if you stand in my way.

    I will not allow the insurance industry, like I won't let the pharmaceutical industry, like I won't let organized medicine influence what I do, its the patients who I serve and thats the attitude I try to instill in my medical students and residents, as well.

    So you see clemgrad, I think we have a lot in common, we each see the individual forces at play which can influence the delivery of quality care. We each in our heart are trying to do the best we can for our patients/clients, and while we do see limitations in what we can overall give them in terms of medical care, we nonetheless go to bat for them as best we can.

    I think the only difference we have is a philosophy of who is best suited to oversee the delivery of health care. You believe it is the private insurance industry who is best suited to oversee this, I have my doubts.

    I have a dual appointment for my professorship and am an attending physician both at the Veterans Administration med center, as well as the university med center, so I've seen both sides of the picture, government and privately run health care. For my own personal experience, the VA med center is much easier place to get my patients what they need, much easier than dealing with private insurers at the university clinic. The medical literature also supports the idea that the VA is more cost efficient and provides better health care than the private sector does, below are a few of many references on this.

    Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries — Ann Intern Med
    The Health Care System for Veterans: An Interim Report
    The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care

    So to summarize, I am for what serves the patient the best, and because its my job, I will work in whatever system I can to be able to get my patients what they need, whether in a government run or a private run system. My personal experience with the VA tells me that government run health care is much more positive than you make it out to be, but regardless I can and will work in either system.
  5.    #125  
    Quote Originally Posted by cellmatrix View Post
    I agree that pharmaceutical companies have too much influence on doctors. Personally I avoid interactions with them, use generics meds whenever possible and also teach my students to make choices of therapy based on the peer reviewed medical literature, not from drug company recommendations.

    I also agree with you that the medical profession is in many ways too pre-occupied with keeping physicians salaries high. Thats why I am not a member of the AMA, because of this issue. Personally, I made my choice of job not based on income but because its what I like to do. I've been in academics my whole career mainly because I like to teach and do research. I know I could make twice what I am making and work far fewer hours if I chose to go into private practice, but to me, being able to train future doctors and even leaders of our profession, and the chance to make a big discovery that could help thousands of patients, thats what gets me out of bed every day.

    When I am not teaching, or directing research, and when I'm in the clinic, its the patient who I hold alligance to. With every patient I put myself in their shoes and make every decision based not on what the insurance or pharmaceutical company would want, but what I would want if I were that patient. I do everything I humanly can for them, and if it takes 30 minutes to explain to them why the drug ad they saw on TV was not right for them, or if I have to write a couple letters or otherwise deal with some bean counter from the insurance company to get my patient the therapy they need, so be it.

    Don't get me wrong, there are many insurance interactions that I have which go just fine, they listen to my arguments, my journal references, and other justifications for particular therapies. But when they try to force my hand to do things that would be harmful to my patient. I don't mean use a brand name over a generic, I mean therapies that increase toxicity but which are cheaper (yes this is a very common scenario I deal with), I will go to bat all the way for the patient, and God help you if you stand in my way.

    I will not allow the insurance industry, like I won't let the pharmaceutical industry, like I won't let organized medicine influence what I do, its the patients who I serve and thats the attitude I try to instill in my medical students and residents, as well.

    So you see clemgrad, I think we have a lot in common, we each see the individual forces at play which can influence the delivery of quality care. We each in our heart are trying to do the best we can for our patients/clients, and while we do see limitations in what we can overall give them in terms of medical care, we nonetheless go to bat for them as best we can.

    I think the only difference we have is a philosophy of who is best suited to oversee the delivery of health care. You believe it is the private insurance industry who is best suited to oversee this, I have my doubts.

    I have a dual appointment for my professorship and am an attending physician both at the Veterans Administration med center, as well as the university med center, so I've seen both sides of the picture, government and privately run health care. For my own personal experience, the VA med center is much easier place to get my patients what they need, much easier than dealing with private insurers at the university clinic. The medical literature also supports the idea that the VA is more cost efficient and provides better health care than the private sector does, below are a few of many references on this.

    Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries — Ann Intern Med
    The Health Care System for Veterans: An Interim Report
    The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care

    So to summarize, I am for what serves the patient the best, and because its my job, I will work in whatever system I can to be able to get my patients what they need, whether in a government run or a private run system. My personal experience with the VA tells me that government run health care is much more positive than you make it out to be, but regardless I can and will work in either system.
    Thanks for a calm explanation, and no insults! I'm used to being insulted by another physician in here, so it is refreshing. For the record, I don't believe insurance companies should dictate health care over the physician. If that was the interpretation, than I apologize. While it sounds like you try to provide the proper coverage at the least cost, there are apparently many physicians who don't necessarily follow that path. The insurance companies, as it relates to the pharmacy issues I described, were simply trying to see if there were other less expensive options available. In my case, the $85 medication would have gone through and I would have been paying that out of my pocket had I not asked for a less expensive option. It seems like if all physicians would be as diligent as you, and be willing to look for and try the less expensive route, this would be a step towards reducing health care cost.

    I gave this example before, but I went for my annual physical a couple of years ago and I had an odd reading on my EKG. My physician referred me for a thalium stress test. I thought it was just a typical stress test but when I called to set the time I quickly discoverred it was not the normal test as it would take about 4 hours and cost in excess of $2,100. I was a bit shocked by this, investigated what this test was for, and was a bit taken back by it being advised for patients who might have blockage or possibly suffered a stroke. I am an avid swimmer, getting in 3000 - 4000 yards a day, 4 days a week, and am in very good health. So I called my physician (she had no idea how much one of these tests cost) and we agreed to send me to a cardiologist first. Well, after the doctor saw me, ran another test (the odd result showed up again), and discussed my exercise history, he said I did not need a thalium stress test. Oh sure, the doctor visit cost around $400, but that was better than $2100 plus! Now, in my personal physician's defense, she was watching out for her ****....however, she should have referred me to the cardiologist first. So, yet another example of where a physician almost had me paying more than I needed to.

    All I'm saying is it isn't as straight forward as getting rid of insurance companies to solve the problems. Can insurance companies do things better? Oh sure. But where we might disagree on is I don't think the insurance companies are the problem. They can be part of the solution, but there are many pieces of the puzzle that need to be fixed and I believe in many instances physicians can do a better job of controlling costs.
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  6. #126  
    Quote Originally Posted by cellmatrix View Post
    I think that rather than let you or anyone else define me, I think its best that I more fully explain why I feel the way I do in more detail, so there are no misconceptions made.

    I agree that pharmaceutical companies have too much influence on doctors. Personally I avoid interactions with them, use generics meds whenever possible and also teach my students to make choices of therapy based on the peer reviewed medical literature, not from drug company recommendations.

    I also agree with you that the medical profession is in many ways too pre-occupied with keeping physicians salaries high. Thats why I am not a member of the AMA, because of this issue. Personally, I made my choice of job not based on income but because its what I like to do. I've been in academics my whole career mainly because I like to teach and do research. I know I could make twice what I am making and work far fewer hours if I chose to go into private practice, but to me, being able to train future doctors and even leaders of our profession, and the chance to make a big discovery that could help thousands of patients, thats what gets me out of bed every day.

    When I am not teaching, or directing research, and when I'm in the clinic, its the patient who I hold alligance to. With every patient I put myself in their shoes and make every decision based not on what the insurance or pharmaceutical company would want, but what I would want if I were that patient. I do everything I humanly can for them, and if it takes 30 minutes to explain to them why the drug ad they saw on TV was not right for them, or if I have to write a couple letters or otherwise deal with some bean counter from the insurance company to get my patient the therapy they need, so be it.

    Don't get me wrong, there are many insurance interactions that I have which go just fine, they listen to my arguments, my journal references, and other justifications for particular therapies. But when they try to force my hand to do things that would be harmful to my patient. I don't mean use a brand name over a generic, I mean therapies that increase toxicity but which are cheaper (yes this is a very common scenario I deal with), I will go to bat all the way for the patient, and God help you if you stand in my way.

    I will not allow the insurance industry, like I won't let the pharmaceutical industry, like I won't let organized medicine influence what I do, its the patients who I serve and thats the attitude I try to instill in my medical students and residents, as well.

    So you see clemgrad, I think we have a lot in common, we each see the individual forces at play which can influence the delivery of quality care. We each in our heart are trying to do the best we can for our patients/clients, and while we do see limitations in what we can overall give them in terms of medical care, we nonetheless go to bat for them as best we can.

    I think the only difference we have is a philosophy of who is best suited to oversee the delivery of health care. You believe it is the private insurance industry who is best suited to oversee this, I have my doubts.

    I have a dual appointment for my professorship and am an attending physician both at the Veterans Administration med center, as well as the university med center, so I've seen both sides of the picture, government and privately run health care. For my own personal experience, the VA med center is much easier place to get my patients what they need, much easier than dealing with private insurers at the university clinic. The medical literature also supports the idea that the VA is more cost efficient and provides better health care than the private sector does, below are a few of many references on this.

    Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries €” Ann Intern Med
    The Health Care System for Veterans: An Interim Report
    The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care

    So to summarize, I am for what serves the patient the best, and because its my job, I will work in whatever system I can to be able to get my patients what they need, whether in a government run or a private run system. My personal experience with the VA tells me that government run health care is much more positive than you make it out to be, but regardless I can and will work in either system.
    As we both have almost exactly the same attitude, I will echo your feeling exactly. However, I have no problem being more directive. It's nice to be able to concentrate only on your patient and how to best provide care for them. But as you mention, there are direct interventions, primarily by pharmaceutical companies and by insurance companies, that make providing quality care much more challenging. Frankly, I am NOT convinced that either of these entities have the best interest of the patient in mind. In fact, I'm reasonably sure about that. I've published papers and presented workshops about the influence of Big Pharma on clinical care, research and education,most of which I consider negative. In spite of that, pharmaceutical companies at least provide something material; it's the way they are protected by congress (again, see Medicare Part D) that results in our astronomically higher prices for drugs than anywhere else in the world. That is a political and economic issue; their misleading advertising, on the other hand, is a medical issue as you point out.

    Insurance companies, on the other hand, provide no care. Yes, the very best have disease management programs, and on-call nurses, and critically appraise the approval of new technology. I know that because for several years I donated my time to a health plan to serve on their tech assessment board. But by and large, the cost of all of those services are a pittance compared to the massive increase in profits that insurance companies have been handed in the past few years. I don't need a disease management plan, or an on-call nurse for my patients. I don't need a three month delay in getting my rightful fees. I don't need to hire multiple people just so I can bill five different companies, all of whom use different forms and have different requirements. I don't need to have my patients and myself support the absurdly excessive overhead of the private insurers. I don't need to support vast numbers of people who sell my care to others for their profit.

    I too have worked in VA hospitals. They have a limited formulary, negotiate with pharmaceutical companies, and except for a few instances in the past, their patients are very very satisfied with their care....just like Medicare recipients. And most importantly, as your references show, they provide very high quality care.

    I can justify the existence of pharmaceutical companies. I can't justify the existence of insurance companies as the major provider of health care services. Their involvement should be limited to gap plans or second tier plans. While there is no doubt doctors are way too interested in making a whole lot of money, by simply negotiating drug costs and doing away with insurance companies as the major providers, we would save a massive amount of money. Combine that with some limits on Medicare reimbursement, and we would have an actual health care system,unlike the non-system we have now.
    Last edited by davidra; 02/15/2011 at 05:53 PM.
  7. #127  
    Quote Originally Posted by davidra View Post
    As we both have almost exactly the same attitude, I will echo your feeling exactly. However, I have no problem being more directive. It's nice to be able to concentrate only on your patient and how to best provide care for them. But as you mention, there are direct interventions, primarily by pharmaceutical companies and by insurance companies, that make providing quality care much more challenging. Frankly, I am NOT convinced that either of these entities have the best interest of the patient in mind. In fact, I'm reasonably sure about that. I've published papers and presented workshops about the influence of Big Pharma on clinical care, research and education,most of which I consider negative. In spite of that, pharmaceutical companies at least provide something material; it's the way they are protected by congress (again, see Medicare Part D) that results in our astronomically higher prices for drugs than anywhere else in the world. That is a political and economic issue; their misleading advertising, on the other hand, is a medical issue as you point out.

    Insurance companies, on the other hand, provide no care. Yes, the very best have disease management programs, and on-call nurses, and critically appraise the approval of new technology. I know that because for several years I donated my time to a health plan to serve on their tech assessment board. But by and large, the cost of all of those services are a pittance compared to the massive increase in profits that insurance companies have been handed in the past few years. I don't need a disease management plan, or an on-call nurse for my patients. I don't need a three month delay in getting my rightful fees. I don't need to hire multiple people just so I can bill five different companies, all of whom use different forms and have different requirements. I don't need to have my patients and myself support the absurdly excessive overhead of the private insurers. I don't need to support vast numbers of people who sell my care to others for their profit.

    I too have worked in VA hospitals. They have a limited formulary, negotiate with pharmaceutical companies, and except for a few instances in the past, their patients are very very satisfied with their care....just like Medicare recipients. And most importantly, as your references show, they provide very high quality care.

    I can justify the existence of pharmaceutical companies. I can't justify the existence of insurance companies as the major provider of health care services. Their involvement should be limited to gap plans or second tier plans. While there is no doubt doctors are way too interested in making a whole lot of money, by simply negotiating drug costs and doing away with insurance companies as the major providers, we would save a massive amount of money. Combine that with some limits on Medicare reimbursement, and we would have an actual health care system,unlike the non-system we have now.
    To be perfectly frank, if I had a difficult patient who required some complex care, and I had to choose working through the VA or working through private insurance, I would choose the VA every time. With the VA, you know where you stand, and you can talk to your med center chief or head pharmacists directly about planned therapies and procedures and make decisions on them right away.

    In contrast, working through the private insurance, its the extra layer of authorization, approval, denial, appeal, etc, and all of the extra staff to fill out all of the different types of forms and the need to follow up every step of the way to make sure that insurance is not needlessly delaying or bring unresponsive, thats whats so cumbersome. I agree with you on that point.

    Also, what you say about big pharma driving up drug prices in the US, thats absolutely the case. Thats why people who live on border states go to mexico and to canada to get prescriptions filled, as they are much cheaper.
  8.    #128  
    Quote Originally Posted by davidra View Post
    As we both have almost exactly the same attitude, I will echo your feeling exactly. However, I have no problem being more directive. It's nice to be able to concentrate only on your patient and how to best provide care for them. But as you mention, there are direct interventions, primarily by pharmaceutical companies and by insurance companies, that make providing quality care much more challenging. Frankly, I am NOT convinced that either of these entities have the best interest of the patient in mind. In fact, I'm reasonably sure about that. I've published papers and presented workshops about the influence of Big Pharma on clinical care, research and education,most of which I consider negative. In spite of that, pharmaceutical companies at least provide something material; it's the way they are protected by congress (again, see Medicare Part D) that results in our astronomically higher prices for drugs than anywhere else in the world. That is a political and economic issue; their misleading advertising, on the other hand, is a medical issue as you point out.

    Insurance companies, on the other hand, provide no care. Yes, the very best have disease management programs, and on-call nurses, and critically appraise the approval of new technology. I know that because for several years I donated my time to a health plan to serve on their tech assessment board. But by and large, the cost of all of those services are a pittance compared to the massive increase in profits that insurance companies have been handed in the past few years. I don't need a disease management plan, or an on-call nurse for my patients. I don't need a three month delay in getting my rightful fees. I don't need to hire multiple people just so I can bill five different companies, all of whom use different forms and have different requirements. I don't need to have my patients and myself support the absurdly excessive overhead of the private insurers. I don't need to support vast numbers of people who sell my care to others for their profit.

    I too have worked in VA hospitals. They have a limited formulary, negotiate with pharmaceutical companies, and except for a few instances in the past, their patients are very very satisfied with their care....just like Medicare recipients. And most importantly, as your references show, they provide very high quality care.

    I can justify the existence of pharmaceutical companies. I can't justify the existence of insurance companies as the major provider of health care services. Their involvement should be limited to gap plans or second tier plans. While there is no doubt doctors are way too interested in making a whole lot of money, by simply negotiating drug costs and doing away with insurance companies as the major providers, we would save a massive amount of money. Combine that with some limits on Medicare reimbursement, and we would have an actual health care system,unlike the non-system we have now.
    Once again, just your opinion. When I bring several examples of the physician attempting to charge me for a product or service I don't need, you just seem to over look that. I actually don't go to the doctor all that much, so if I have been a victim of these outrageous over charges (again, at the provider level) with the little bit of personal exposure to the medical market that I have had, I can only imagine what the real cost of unneeded products and services are costing the health care market that go undiscovered. Of course, the real blame should be pointed at the patient who just blindly takes the advice of the physician without occasionally saying, "but is there another option that might not cost as much?" This reminds me of the comment from the little medical assistant when I commented how expensive the $1500 back brace was, and she said, "Oh, don't worry, the insurance company has already approved it." I must admit I was angry at my insurance carrier for agreeing to pay $804 as there is no excuse for paying that much for that product. But....I guess you would prefer to just point fingers at the greedy insurance executives rather than your own greedy colleagues.
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
Page 7 of 7 FirstFirst ... 234567

Posting Permissions