Category Archives: Insurance

Who are the Beneficiaries of Prescription Medications?

Certainly not the person who pays for prescriptions and ingests them. Yes; it’s the drug companies and it’s only getting worse. As I age I seem to have more prescription drugs recommended, mostly for minor and /or temporary, diagnoses. And when I ask for generics, I find that their cost is no less, or maybe not much less, than the prescribed medications. I was told today by a reputable pharmacist that generics, when they are first developed, do in fact cost the same as the usual medications. So what’s the benefit in buying generics. Oh sure, I could drive for miles to the big box stores in nearby cities to get a bit of a discount. But what’s the discount in wasting money and stress on fuel to drive around for comparison shopping?

The consumer is certainly not the beneficiary in all of this asking for generics and driving around.

I have been spending on the average of about $500/month on medications, some generic, and some with pharmacy discounts. And I do not have several diagnoses. These are for hypertension, and bladder muscle insufficiency. And a temporary edema of my cornea. And due to lay offs from work in my profession, I have no insurance coverage of any sort, and have finally resorted to living on nothing but Social Security benefits, having exhausted my retirement savings, after only 5 years into a forced “retirement”.

I don’t think I am the only one in this dilemma. Any ideas to share with me and others? Yes, AARP offers plans to somewhat solve these problems, but they can be costly as well, deducted from my Social Security benefits!

I recognize two societal problems that need to be dealt with, though both are long term problems ingrained in the core of our economic system.

First, physicians are “trained” by the pharmaceutical industry to treat every ailment with drugs when a sometimes simple lifestyle adjustment can solve a problem. An example: prescribing laxatives and stool softeners when an ounce or two of prune juice is just as effective. Another example is recommending an over the counter drug like prilosec when avoiding acidic or fatty food might be just as effective.

Secondly, some action, perhaps governmental, must be taken to control the costs charged by the pharmaceutical companies. Why do they choose to WAIT before lowering the cost of a new generic? Obviously to make more money awhile longer, certainly for no reason that benefits the consumer.

Do you really have cataracts?

It started out as a simple, easy, routine visit to the optometrist, maybe the ophthalmologist as well…to see if I needed an updated prescription for contact lenses.

When I arrived I inquired as to whether Medicare covered any of the anticipated expenses. “No”, I was told. The newly graduated optometrist immediately halted the exam for contacts because she informed me that I had cataracts and she could not proceed in examining me for new contacts until I had the cataracts evaluated and removed. She referred me to an ophthalmologist of her choice.

I was out of “fresh” new contacts, so she was kind enough to give me a pair of contacts to wear while waiting for my cataract surgery! But only after insisting that one of my contacts surely must be for “distant” vision and one for “proximal” vision. I had never been told this before in my approminately 15 years of wearing contacts. But because she insisted, I guessed which eye was which to satisfy her.

Since I was not willing to undertake any surgical procedures without significant thought, I gave this some thought. I ardently believe that everyone MUST be their own best advocate in undertaking any medically related evaluations and procedures. (I am a well educated health professional.) I scheduled appointments with two optometrists who practiced with ophthalmologists. Medicare would cover some or all of the expenses for the evaluations I was told. And Medicare did cover these expenses.

The conclusion of both othphalmologists was that i did not need a new prescription for contact lenses, just a supply. AND I had no cataracts!!!

BE YOUR OWN ADVOCATE.

health care insurance?

being unemployed and not yet 65, how does one pay for health care? AARP just informed me that at their coverage for me had been “used up”. and the basic health plan (charity care) in the state in which i live also informed me that i have used my allotted $1500 and would be placed back on the “waiting list” for further health care coverage. who knows where or when? this state, like i am sure others have done, have cut back on any and all funding for health care. now what? i am trying to beg the social worker in my orthopedics office for one last  “free” appt to check on the fractures of my femur and pelvis.

the victim, the guinea pig caught in a web

4 months ago i moved to a new community, and now cannot wait to leave. not my idea of where to live. nevertheless, i have had to find a new provider for health care. he is drug happy and referral happy. so now i have been seen by a hemotologist to correct a mild anemia (with diet) and a orthopedist (have a fractured  femur  and pelvic bone, thanks to a fall in my own house! ) to be corrected by use of the leg and prn pain pills. at any rate, be careful not to get caught in the web of health care that you may never really and truly need. for an expense…see next post.

lost your work and insurance?

i have some ideas to share. things that i have had to figure out.

  • reconstiting contact lenes. oh sure, the manufactures say throw them out every few days. guess why? i have found that when i accidently lose a lens, and find it, i put it in solution for a day and it is reconstuted. can’t afford to keep buying these…
  • can’t afford your rx meds? first check around with drug and grocery stores and ask them their prices for a specific medication. also call or email or write to the manufacturer. some are willing to give you a free or reduced suppy for a few months.
  • need to see a health care provider? ask your state for what options are available for reduced cost care, or supplementing your contribution.
  • last but not least, if you need an expensive procedure like i just had, don’t be above asking the provider if “charity care” is available. do not be humiliated. you have paid your dues to our society.
  • lastly, for now anyway, network with people, friends in the same situation for ideas.

The wheel goes round and round

It goes round and round.

Just got a message from a dr’s office (spinal pain). Not willing to see me; “nothing more to offer me” how does he know? Hasn’t seen me for over a year! WHAT? That means he doesn’t want to do charity care. His office bills independently. Nice. I just wanted a damn consult about pain and budding incontinence. And the muscle relaxants he prescribed are outdated. He can’t even do that? Oh I get it. He came to this country to get rich. I forgot. So if I can’t pay 5k out of pocket, why should he bother seeing me? So I left another message for his scheduler. I will run her ragged. Who cares? I just want a damn consult, paid for thank you, by charity care for which I was approved till june of 08. His message was for me to see my usual provider. Well, thank you, fool, but my PA at the cheap clinic is not a spine pain specialist, and referred me to YOU. And I have no insurance. So I get no help anywhere?

Not sure what to do next. I am my own patient now…after all these years of advocating for others, no one advocates for me. screwed. I am really angry.

I have been a health professional, an advocate, for nearly 40 years. And now I find myself living like a health care indigent. NO INSURANCE AND NO WORK after being laid off twice in the last 7 years. So the clinic admin person just called. She will talk to the doc again. yah sure. We shall see.

Do We Really Need These Drugs?

Until I was hospitalized 1 1/2 years ago for a perforated ulcer,  I was only on one daily Rx medication: the  one pill for keeping my hereditary “borderline” blood pressure under control. However, my “provider” felt she needed to add a calcium supplement to prevent osteoporosis and aspirin to prevent a heart attack and a decongestant, in lieu of just standing upright and blowing my nose. And then, during the hospitalization, Protonix was added (I can live with that). As was Norvasc which resulted in severe hair breakage and loss. I just dumped that one. And a bunch of drugs that caused fluid retention and more drugs to cope with constipation (which I never experienced). Lots of drugs prescribed; few that I took.

Now why did I need all these drugs, and even more that I just didn’t take? Well you know my bandwagon about the pill pushers in this country. And why did I even have a perforated ulcer? Too many inappropriate drugs prescribed for back pain., osteoporosis, nasal congestion!  (I have idiopathic scoliosis and a spinal fracture which didn’t bother me at all for many years when I lifted heavy  bags of books).

So now, without health insurance (yes; one of the 47 million Americans), I am trying more and more to reduce any of this junk, these chemicals, that I put into my body. Why? The side effects. And the cost!  Maybe it is my BP med that is making me a little tired , not the aging process? By the way, the insurance company DID NOT PAY FOR ALL OF MY HOSPITALIZATION AND MEDICAL CONSULTANT EXPENSES.  Surprised? I had to. After a “lay off” due to downsizing at work, with no income, and no insurance. (even though I had worked as a manager for a HEALTH insurance company!). Who pays for all these medications? I go to a local neighborhood clinic that is low cost, for the blood pressure med. But anything else? Well check into Partnership for Prescription Assistance (PPA). They have been most helpful with the drug that will prevent another ulcer.

 As a health professional, I have encountered patients/clients/members who are on as many as 21 medications each day. This is incredible. Who is monitoring this regimen? How can  people keep this straight? How do you do this? And what is really necessary? And what interacts with what other medications?   Contraindications? And what are the side effects? And who is helping to monitor this? No one. Does your doctor/provider/”prescriber” have time to do this? Of course not. And what if all these medications have the resultant side effect of confusion?

 Oh! The answer! Health insurance companies are now providing programs like healthy living support programs that  have nurse case managers who give advice to “members”. The nurse case managers are the gate keepers who help the “members” manage their medications (often from many states away) and keep costs down for the insurance companies (don’t go back to your doctor’s office! that will be a bill that the insurance company will be expected to pay). Just call me, your case manager. the nurse case manager  can talk with you after he/she enters your data into 47 computer  screens.

 So what to do? Think about who you vote for in the next election, and why. No; we don’t need another layer of bureaucracy. We need a WELL THOUGHT OUT PROGRAM FOR NATIONAL HEALTH INSURANCE. So that we can be as progressive as other developed countries. This is just one little step. Think about this.  Don’t just go along with a candidate who says she/he supports health care. You need to look way beyond that kind of statement. What is really in mind? What kind of program? Managed by whom? Who will be in charge? Who will do the oversight? THINK!

More About Diagnoses And Pharmaceuticals

To those of you who have read my blog, I apologize for repetition. But some issues just don’t go away.

I just heard an ad on tv for health insurance plans to supplement what medicare offers. First of all, just what does medicare offer? And what about the 47 million of us who have no health insurance and are not yet ready for medicare? The ad was about a certain supplemental insurance company, and it was recommended that you discuss this plan with your “doctor” who will help you decide if this plan it right for you. Yah sure! Since when do “doctors” recommend health insurance plans? Well, someone is getting a kick back here from an insurance company. You need to count on your friends and colleagues for this kind of advice: not your “doctor” and not the insurance companies!

All research must be taken with a grain of salt. I was recruited, years ago, for the Nurses’ Health Study. After filling out their questionnaire, I received a letter informing me that I was ineligible as a participant since I had taken steroids. I had  never taken steroids in my life! I didn’t write back because I didn’t have the time (full time working mom, grad student, with two little boys). So now I look at all health care research with more acute skepticism.

As for HRT (Hormone Replacement Therapy), I did that for about 5 years, then quit cold turkey because my gynecologist told me she could not in good faith prescribe it anymore. I have a friend who has been “tapering off” HRT for the 3 years I have known her. Tapering off HRT? No need to. Doing this will not affect your blood pressure and heart rate, and will probably do nothing except have you discontinuing HRT.  I can only suspect that her gynecologist is her age as well, and the looks of skin and hair are more important than the total health picture? Or maybe not? Maybe it doesn’t matter if we do HRT or not? Once again, conflicting conclusions from research.

There is a lot of spurious, and confounding, information in these studies…I am a medical professional, but also a skeptic. I have attended prestigious universities, have worked at prestigious universities. But that doesn’t mean anything. What is important is the integrity of their representatives,  their scientists, of their reporting of results of their studies. They need to be honest, not just writing what the public wants to hear.

So now we need drugs to fall asleep, drugs to stop restless leg, drugs to make us “regular”? Soon we will need drugs to wake up, get our legs going, and be able to use the bathroom normally?

Have we forgotten to eat a normal, well balanced diet, with fiber,  that would prevent some of these “problems” in the first place? Have we forgotten to just go to sleep to some nice music at 10pm after walking the dog in fresh air? And though I am lax myself about taking vitamins, popping a pill or two each day, if it doesn’t burn up your stomach (drink plenty of water), you won’t have legs that fly around or get stiff and achy, most likely.

Be Your Own Advocate

As you have probably noticed, due to the constraints of health care costs due to the insurance industry wanting to make profits, health care providers have less and less time to spend with you: their patients, clients, members. The average time is 10 minutes or less. Can you have your questions answered? Your needs met? Maybe. Maybe not.  And thanks to the pharmaceutical companies and their agenda, it is easier for a provider to say “take this” and “take that” rather than LISTEN to you and discuss alternatives.

 I had the recent experience of going to a clinic. I left with 2 prescriptions. I ran out the door, prescriptions in hand, to avoid a parking ticket. When I got home, I noticed the prescriptions were for someone else…not for me. This means that someone else very likely received my prescriptions.

 What are the issues here? Safety and Privacy. Just suppose I wasn’t a health care professional myself and didn’t recognize the error. Just suppose I had taken medications not meant for me. Not to mention HIPAA VIOLATIONS.  Please see http://www.hhs.gov/ocr/hipaa/

And this all extends to our pet companions as well. I took my dog to the veterinarian this week. Her allergies were acting up. I was given the usual antibiotic and steroid to get this under control. I knew what the medications were. This was discussed with the veterinarian and stated in my bill. However, I noticed that the bottle of medications DID NOT give the name of the medication or the dosage. Danger! Just suppose my dog had a middle of the night emergency. Just suppose I grabbed her medications and ran out the door. Just suppose the emergency veterinarian asked what meds she was on. Just suppose I couldn’t remember at the time. I called my veterinarian, not to complain, but to express my concern. I believe this is a legal violation. You don’t dispense drugs without labeling the name of the medication and dosage. Sure, you could say, it’s just a dog. Oh well. Suppose my 2 year old grandson had gotten a hold of these?

The bottom line, the important lines:

  • Please be aware of what medications you are getting; check for your name and the name of the medications, and the dosage. While you are doing that, check the expiration date too. Medications, which are chemicals, can change  their composition over time. And some expire; check the date.
  • Please make sure the medical record that is being reviewed, and recorded into, on a paper medical record, or on a computerized record, is indeed yours.
  • Please make sure that your privacy is not being violated. When you are called from the waiting room, your first name is all that needs to be used.
  • Please keep records, at home, of all of your transactions with health care providers and pharmacies.
  • Please extend these reminders to your  family, friends, neighbors, colleagues. and to anyone else that you know is encountering the health care system. Which is everyone.  And don’t forget your pets’ veterinary records. (not long ago I had to have a very old dog euthanized. Never easy. The medical record showed that my younger healthy dog had been euthanized).
  •  BE CAREFUL. YOU ARE YOUR BEST ADVOCATE!  AND YOU MAY BE YOUR ONLY ADVOCATE!

No Health Insurance

Thankfully the democratic party candidates are in tune with the fact that we have 47 million Americans without health insurance, sometimes due to job elimination, like myself. And health insurance is not affordable without assistance from an employer, except for the very wealthy, and those that have spouses and domestic partners whose insurance they can tag on to.

And why is health insurance beyond our reach? Obviously, the insurance industry wants profits by driving up rates. And I believe that the pharmaceutical companies are creating diagnoses, and recommending drugs, that we all “need! “Just ask your provider,” whoever that is…

And who are two strong lobbies: the insurance industry and the pharmaceutical companies? And who is helping to finance most of the presidential aspirants?

What on earth is a “nervous breakdown”? why can’t people sleep at night? what is “restless leg syndrome”? Where did this stuff all come from? We should all be taking 21 drugs each day? Oh, and you need a stool softener, and laxative for breakfast that may make you “regular”. And a daily decongestant, whereas just being in a vertical position and blowing your nose in the morning may work just fine. Why? Why not choose a healthy lifestyle instead?

Why not jog or walk your dog (you would both benefit), stretch, swim, eat properly i.e. a diet rich in fruits, veggies, grains? Try to avoid anything but the essential drugs that you really need to stay alive.

All of these drugs, too many drugs, interact with each other, and can kill you. Less is better.