Text 17344, 114 rader
Skriven 2014-09-25 09:53:00 av NANCY BACKUS (1:123/140)
     Kommentar till en text av MICHAEL LOO
Ärende: Re: health 986
======================
-=> Quoting Michael Loo to Nancy Backus on 09-22-14  23:05 <=-

 ML>> that MGH doctors have to undergo is how to convince
 ML>> insurance companies to pay for expensive stuff.
 NB>> I'm rather ambivalent on that... I can see some need for allowing
 NB>> certain tests, even though they are expensive, when they are called
 NB>> for... and I think that generally, the doctor should be the one to
 NB>> determine whether or not it is called for...  With the adversarial
 NB>> system, doctors are more inclined to try for something not as needed,
 ML> Problem is that the doctor (I agree, it's his or her call,
 ML> with informed patient consent) has other concerns than
 ML> patient necessity. It may be appeasing the malpractice
 ML> lawyers or making numbers for a new piece of equipment.

So, you figure that the insurance companies are trying to rein in that
sort of thing...?   I think it sad that malpractice (prevention) ends up
being a factor in deciding to do treatments or tests, rather than simply
the actual needs of the patient.... although I do understand to some
extent the concept behind it...

 ML> I can understand both, even the latter - what if there's
 ML> a diagnostic tool that needs 100 uses a year to justify
 ML> buying, during which time it will save 5 patients. What
 ML> does one do - the administrators won't buy it unless 100
 ML> uses are guaranteed, so what's to do.
 
I do have more sympathy with that aspect...  especially since I can see
that in some cases, you couldn't even know if it could save the patient
until after you had run the diagnostic... so while there might not be
complete justification for 100 uses, there probably would at least be
that for maybe half of them.... once it's bought, besides, you then have
it for when you do need it... and don't have to ship a critically ill
patient to some farther place that does happen to have the tool...

 NB>> just because, though...  Like doctors and hospitals charge way more,
 NB>> expecting the insurance company to come back with, no, we'll only pay
 NB>> you this much... and by inflating they get more than if they started
 NB>> reasonably...  Yeah, a little jaundiced here...  ;)
 ML> Not all that jaundiced. See the NYT article on the guy who
 ML> got billed something like 117K for the services of a doc
 ML> he didn't meet? To be fair, the doc may have performed a
 ML> useful function at some point, but over 100K, doubtful.
 
Didn't see the article... that does have a bogus/fraud feel about it...
particularly the amount being billed...  Admittedly, with a hospital
stay or procedure, there will be doctors that one may not actually
remember having come into contact with, and there will be radiologists
(for example) that one never really does meet, but other than that, I'd
expect to have at least shaken hands with a doc that bills me... ;)  And
over 100K... that's an awfully high-priced specialist...!

 NB>> That sounds like CVS is making the process worse  ...
 NB>> When Wegmans does a partial fill, it is clearly set up that way, and
 NB>> even the insurance company recognizes that it isn't a new fill...
 ML> Problem is that in a year I might have prescriptions
 ML> filled in 8 locations in 6 states. CVS is the outfit
 ML> with the reach I require.

I do understand your special-case dilemma... (Hmmm... how close IS
Wegmans to hitting the states/locations you might need them...?  Maybe
someday...)  I haven't actually used CVS myself; before I was using
Wegmans, I was using neighborhood pharmacies.  When I later did price
comparisons locally, it turned out that Wegmans was better than the drug
chains, so I (mostly) went with them.  MJ had been using Rite-Aid for
her meds, but the pharmacist there started really messing up her fills,
so I eventually moved her over to Weggies, too...  

 ML> There are cavillists who claim that Walgreen has more
 ML> stores, which may or may not be true, but they don't
 ML> have as many in the places I want to be.

Other cavillists might point you to Walmart, under similar reasonings...
but I'd not exactly endorse that one, either...  

 NB>> The bottle might say 23 of 180, for the first, and when you pick up
 NB>> the rest, it would say 157 of 180.  One might almost wonder if CVS
 NB>> was complicit in the black market... [g]
 ML> No grins there - the thought did cross my mind.

If true, that should be grounds for prosecution... if nothing else, it's
fraud, but even more so, illegal...  Part of my problem with MJ's
Rite-Aid pharmacist was the controlled substance pills that didn't make
it into her bottle... making me wonder who DID get them...  I am a bit
surprised, though, that CVS doesn't make partial fills explicitly marked
as such, both on the bottle and in their computers... even Rite-Aid
managed to do that properly...  
 
 NB>> I'm sufficiently paranoid over not getting my Prilosec that I've
 NB>> hoarded close to a month's supply, which I change out with new
 NB>> pills every so often, just to make sure that some administrative
 NB>> snag doesn't do that to me...
 ML> I have a backup script for something that does all the
 ML> good things that my fancy stuff does, plus it causes
 ML> fainting and urological problems that made it worthwhile
 ML> for me to get something that up until recently cost almost
 ML> 50x as much at retail. Now that the good stuff has gone
 ML> generic, I figure the insurance and the pharmacy won't
 ML> conspire in their stupidity to make me use it, but it's
 ML> still there just in case.

As long as the generic works for you just like (or at least as well as)
the brand, that works...  and at least the insurance should be happy. 
Some of the alternatives to my Prilosec are like your backup... they
seem to work ok, but they also have not so nice side effects that I'm
not willing/able to live with or put up with... and in my case, that
even includes the generic for the real thing..
 
ttyl        neb

... "Another plate of steamers all around!" Tom clamored.

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