PCP 'subscription' charge

[RetMD21]

The obvious result is what can't be coded won't get done. Need help appealing an arbitrary rejection of a prescription that should be covered? There's no code for that...you're on your own. Ah, but the insurance company will only talk to the doctor that wrote the prescription! Then the doctor's corporate boss comes down on the doctor for "wasting time". The lesson to the doctor: "I won't do that again" and so writes a different prescription or none at all, despite that being obviously sub-optimal

Yeah, the insurance company knows that throwing up barriers to expensive meds or tests will decrease utilization. Even if they ultimately end up losing appeals they can decrease requests

 

[Mark1]

Yeah, the insurance company knows that throwing up barriers to expensive meds or tests will decrease utilization. Even if they ultimately end up losing appeals they can decrease requests

Yes it sucks, but so does Pharma basically telling people that if they take a little pill (e.g. Jardiance) for type 2 diabetes they can be extremely obese, but yet dance without running out of breath and have lots of friends. Wow, that would be awesome.

Basically just Pharma and Insurance doing battle with only their self interest in mind. I guess I side somewhat with insurance on this one, since in the end we're all indirectly paying for these expensive meds.

 

[Koolau]

Yeah, the insurance company knows that throwing up barriers to expensive meds or tests will decrease utilization. Even if they ultimately end up losing appeals they can decrease requests

Yeah, welcome to the brave new world. When your provider becomes your enemy rather than your partner, then we have forgotten what modern medicine is really for.



Now that I'm on MC with a supplement, it's much simpler. If there will be a problem with payment, I usually know it up front.

 

[RetiredHappy]

Yes it sucks, but so does Pharma basically telling people that if they take a little pill (e.g. Jardiance) for type 2 diabetes they can be extremely obese, but yet dance without running out of breath and have lots of friends. Wow, that would be awesome.

Basically just Pharma and Insurance doing battle with only their self interest in mind. I guess I side somewhat with insurance on this one, since in the end we're all indirectly paying for these expensive meds.

My husband who is type 2 diabetic cannot stand the ad. He works hard to manage his diabetes and had it for more than 2 decades and keeps his a1C down to about 6.0.

 

[athena53]

My husband who is type 2 diabetic cannot stand the ad. He works hard to manage his diabetes and had it for more than 2 decades and keeps his a1C down to about 6.0.

I'm glad to see this; I have a dear friend who was diagnosed as Type 2 after a stroke and with a keto diet he's gotten his a1c to a healthy level and, with his doctor's agreement, is off of meds.

"You are What you Eat", currently on Netflix, includes interviews with NJ Senator Cory Booker and NYC Mayor Eric Adams, both of who are trying to raise awareness of how much we can improve our health through diet, and the reasons so many people live in "food deserts" and don't have access to healthier options. Adams reversed his own diabetes (sometimes Dr. Google is right). His doctor was astounded and when she read the book he recommended, she called him and said, "Why didn't I learn this in medical school?".

It's unrealistic to think that everyone can be free of Big Pharma if they change their lifestyle, but it would sure help.

 

[swakyaby]

A few years ago we went on a Galapagos trip on a 16 pax boat. Another couple was English doctors, he a hospital executive and she a pulmonologist. We had lots of interesting discussions over evening drinks. The manager had spent a year at NIH early in his career and his comments were about his amazement that in the US system everything was about money.

If you’re talking about England’s healthcare, it’s a completely different type of medical structure. They have plenty of issues about funding healthcare there as well. In fact, the unionized doctors in the NHS (National Health Service) have been voting to go on strike both in December and in January over issues of chronic understaffing and others.

 

[Koolau]

My husband who is type 2 diabetic cannot stand the ad. He works hard to manage his diabetes and had it for more than 2 decades and keeps his a1C down to about 6.0.

Congrats to him! That's pre-diabetes level.

My Cardiologist has me on Jardiance for off-label protection of my heart. No dancing for me. Of late, I've been on a low-carb diet and my fasting glucose was below 80 last it was checked. I'm looking forward to see if my a1C is below 6 which is about what I've been running for a few years. I've also lost 40 pounds in less than a year. PCP is "concerned" about my weight loss. Go figure.

Tell your husband to keep the faith and stay the course!

 

[RetMD21]

If you’re talking about England’s healthcare, it’s a completely different type of medical structure. They have plenty of issues about funding healthcare there as well. In fact, the unionized doctors in the NHS (National Health Service) have been voting to go on strike both in December and in January over issues of chronic understaffing and others.

Their system has major underfunding issues. It's my impression that physicians can go about their work doing the best they can with the limitations imposed on them. In the US many physicians and other workers have to participate in efforts to maximize charges. Some of this is in the nature of doing x and y on different days so that both can be billed. Even if not directly participating we were aware of these practices. For example, a local independent radiology group would do a non-contrast CT of the abdomen one day and have the patient come back the next day for the contrast part. This maximized billing but slowed reporting of results and was inconvenient for the patient.

 

[Koolau]

Their system has major underfunding issues. It's my impression that physicians can go about their work doing the best they can with the limitations imposed on them. In the US many physicians and other workers have to participate in efforts to maximize charges. Some of this is in the nature of doing x and y on different days so that both can be billed. Even if not directly participating we were aware of these practices. For example, a local independent radiology group would do a non-contrast CT of the abdomen one day and have the patient come back the next day for the contrast part. This maximized billing but slowed reporting of results and was inconvenient for the patient.

Sounds like the doctors are doing what they must to get around the restrictions set by gummint. I often wonder if that is why I average a doctor appointment roughly every 40 days or so. That's spread over several doctors (PCP and specialists) but doesn't include dental. Perhaps gummint forgets just how smart doctors really are.