by Dr. G. Pepper | Nov 4, 2009 | general health & nutrition, health, metabolism, misc, thyroid
LA lives in rural America and has no health insurance. After 30 years of effective therapy with Armour Thyroid she is unable to obtain this medication any longer. Her story is a sad reminder of just how far we need to go to provide meaningful health care to the citizens of this country.
LA tells her story like it is:
I knew nothing about this problem of non-availability of Armour Thyroid. I have been on Armour since 1978 and it has worked just fine. I had my annual prescription renewal in June and because I do not have insurance, I was able to get 200 pills at a time for a price break. I take 3 60 mg tablets a day and have been on this dosage for about 6 years, up from a previous dosage of 2 60 mg tablets. Today, 4 Nov 09, I went to pick up a refill that I called in a week ago. I was informed at the pharmacy that Armour Thyroid is no longer being made. Period. I took my last pills on 2 November so I have no medication at all. I have a call in to my doctor but he has not yet returned that call. We contemplated a switch to Synthroid a couple of years ago (for a variety of reasons, none of which are relevant here) but the doctor said it could be a very slow process of finding out exactly what dosage of synthetic hormone would adequately replace the natural Armour. At that time I had insurance that would have covered the lab tests required to determine the proper dosage. I am now without insurance due to the death of my spouse, and because of the hypothyroidism I am unable to obtain health insurance that is even remotely affordable. Therefore I can’t afford all the tests, all the doctor visits, all the rest of the hoopla that woudl go with switching medication. I’ve been fortunate so far that I’ve been able to keep my same doctor, and that he gives me a bit of a break paying cash for my once-a-year-visit, but he’s 60 miles away and I can’t even afford the trips back and forth if I have to start “nudging†a new medication. It’s bad enough to be without the medication for a while, but to think that it will never be available again? I honestly don’t know what to do.
I knew nothing about this problem of non-availability of Armour Thyroid. I have been on Armour since 1978 and it has worked just fine. I had my annual prescription renewal in June and because I do not have insurance, I was able to get 200 pills at a time for a price break. I take 3 60 mg tablets a day and have been on this dosage for about 6 years, up from a previous dosage of 2 60 mg tablets. Today, 4 Nov 09, I went to pick up a refill that I called in a week ago. I was informed at the pharmacy that Armour Thyroid is no longer being made. Period. I took my last pills on 2 November so I have no medication at all. I have a call in to my doctor but he has not yet returned that call. We contemplated a switch to Synthroid a couple of years ago (for a variety of reasons, none of which are relevant here) but the doctor said it could be a very slow process of finding out exactly what dosage of synthetic hormone would adequately replace the natural Armour. At that time I had insurance that would have covered the lab tests required to determine the proper dosage. I am now without insurance due to the death of my spouse, and because of the hypothyroidism I am unable to obtain health insurance that is even remotely affordable. Therefore I can’t afford all the tests, all the doctor visits, all the rest of the hoopla that woudl go with switching medication. I’ve been fortunate so far that I’ve been able to keep my same doctor, and that he gives me a bit of a break paying cash for my once-a-year-visit, but he’s 60 miles away and I can’t even afford the trips back and forth if I have to start “nudging” a new medication. It’s bad enough to be without the medication for a while, but to think that it will never be available again? I honestly don’t know what to do.
LAWHilton@yahoo.com
LA
1
by Dr. G. Pepper | Feb 7, 2009 | general health & nutrition, health
Talk is building about the excesses of the health insurance industry in the U.S. In the last year, while the rest of the economy is faltering, the brains behind the private health insurance industry in the U.S. have found a way to make their profits grow. Under the cover of the government’s newly instituted Health Savings Accounts (HSA) the insurance industry has quietly been increasing the “deductible” levels of their policies. If you own an HSA you will wind up paying a much greater amount of your own money toward medical services before the insurance company pays a penny. In many instances this means the owner of a health insurance policy must pay up to $3000 or more in a year above the premium (yearly cost of owning the insurance policy) before the insurance company has to pay anything toward medical claims. Insurance policies with an HSA provision are supposedly cheaper to carry due to a lower yearly premium, but when family insurance premiums can routinely cost between $1000 to $1500 per month even with an HSA, the premium savings don’t add up to much.
The increased amount families and individuals are paying out of pocket as deductibles along with the higher premiums they pay to own their insurance policy is only part of the profit story. The largest health insurance plans have also negotiated lower and lower payments to their physician panels. In some cases they are managing to pay doctors only 60% of the customary payment allowed by medicare.
While the rest of the country is having a harder time making ends meet, the insurance companies are finding a “sweet spot” by generating higher revenue from those they insure while making lower payments to the service providers. As the middle men in this equation they are quietly reaping greater and greater profits. Wall Street may be suprised when these companies inevitably come under the glare of public scrutiny and questions begin to be asked by the new government about where all these profits are coming from. Can it be the same old story of corporate greed? Only time will tell.
Do you have a story about the excesses of the insurance industry? Share your experience with readers of metabolism.com by posting here right now.
by Gary Pepper M.D. | Aug 23, 2008 | general health & nutrition
I have this pet peeve. Well, actually it’s one of many pet peeves, but this one concerns medical insurance billing. How come I spend a third of my time at the doctor’s office filling out an insurance questionnaire and submitting my co-payment, only to get a bill from a lab or diagnostic center two weeks after my appointment?
What’s going on here? Isn’t the doctor’s office supposed to supply these other providers with my insurance information? Or am I not filling in the forms properly? And what’s the point of using a doctor or medical group that is a “participating member” of your insurance plan, if it isn’t using labs or diagnostic centers, which are also participating members?
This makes me crazy. So, one recent morning I spent 20 minutes on the phone following up on bills I received – one from my physician’s office, and two for lab procedures. My question for all three medical establishments was the same, “Why are you billing me?” The bill from my physician was “an oversight.”
They would bill the insurance company directly. Okay, good answer. Now what about the others? They told me they were “non-participating facilities,” and I would have to submit the claims myself to the insurance company, or pay them and wait for reimbursement.
The same question popped into my already confused brain again. How come I’m using a “participating” doctor, but being billed by “non-participating” labs?
I thought about this for a few minutes, then decided to find out if perhaps I was doing something wrong. I called my physician’s billing department and asked why my lab work was being sent to “non-participating” labs. The billing person didn’t know, (and I really shouldn’t have expected her to, but I had to start some place). She said it was the nurse who decided where the lab work went. I asked if the nurse knew who my insurance carrier was, and if she had a list of “in-network providers.” The billing lady didn’t know. She said to ask the nurse, but she wasn’t available.
Not being a very patient person, and anxious to get to the bottom of this dilemma, I dialed up a few friends who are nurses or who work in a doctor’s office to get some hands-on, user friendly information. My nurse friends told me this; it is the doctor’s nurse who is responsible for sending lab work out to be evaluated. Usually, he or she is familiar with the area labs that are covered by certain insurance companies. However, sometimes they don’t know who some of the smaller, or lesser known insurance companies allow, so they send their diagnostic work to the labs who are covered by the majority of insurance companies.
Another point these nurses made, is that sometimes they see more patients than the doctor does in one day, and it can be very overwhelming, not to mention time consuming, to check every patient’s chart for insurance information, then call the insurance company for participating labs. They told me that not all insurance companies supply a list of providers, since they change so frequently.
They recommend that before your next office visit, take the time to check with your insurance company to see who are “accepted providers.” Get the name, address and telephone number of the labs or diagnostic centers and ask your doctor’s nurse to note this in your chart so the information will be readily available the next time you have any diagnostic work done.
After talking to my nurse friends, I checked back with my doctor’s office and her nurse told me the same thing. This got me back on the phone with my insurance company getting the names of the labs and diagnostic centers they will accept in my area. I made copies of the names, addresses and phone numbers to give my primary care physician’s office, as well as my children’s pediatrician’s office, and a copy to keep with my own records at home.
So, take a few minutes now to get this information from your insurance company. A little time on the phone now will save a lot of aggravation and confusion later, not to mention make your nurse’s workload a little lighter.
