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Fighting the System -- the Medical System 

By: Decomposed in 6TH POPE | Recommend this post (2)
Thu, 03 Feb 22 11:50 PM | 48 view(s)
Boardmark this board | 6th Edition Pope Board 		Msg. 29066 of 58678
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Long story. Hopefully worth the read.

In the last ten years (primarily in the last 2 years), I've gone from taking no medicines or supplements to taking more than I can easily track. I now take:

• Gabapentin (For extremity pain that affects my sleep. I may not stay on it since it hasn't been effective.)
• Warfarin (To prevent blood clots resulting from my artificial heart valve.)
• Baby Aspirin (To prevent blood clots.)
• Tamsulosin (Kidney stone avoidance and enlarged prostate.)
• Omega 3 Fatty Acids (To lower my triglycerides.)
• D3 (To strengthen the immune system.)
• Rosuvastatin (To lower cholesterol. It's a better drug than Lipitor.)
• Calcium
• Magnesium
• Vitamin C
• Complete Multivitamin (25 essentials, some redundancy given all the other crap I take.)
• Immune C Plus (12 essentials, some redundancy given all the other crap I take.)

That's quite a bit, imo. Additionally, I have to stab my finger every 1 to 2 weeks to measure the level of coagulation. Warfarin can be dangerous so it's important to closely watch the blood. Checking the blood is what the rest of this post is about.

Following my surgery, I had to go to the hospital every two weeks to have my finger pricked by a nurse. The output was put onto a strip that a small meter was able to analyze. In January '20, my cardiologist suggested I look into at-home monitoring. He considered me a strong candidate and understood that it would save me a lot of time and inconvenience. I contacted my insurance company and it said "No." It would only cover at-home monitoring of patients for whom getting to a hospital was a major inconvenience. For instance, those who lived 50 miles away or are bedridden. I explained that blizzards could put me in that situation. They still said "No."

By April, Covid-19 panic was at its zenith. Even the hospital didn't want me coming in. I contacted my insurance company again and told them I did not feel safe continuing to visit the nurse every two weeks and would they reconsider my claim? This time they said yes... on a 6-month trial basis. (BTW, the 6-months came and went and they never mentioned it again.)

The next question was HOW to begin at-home monitoring. Between (A) my doctor (who writes the prescription), (B) my hospital (which analyzes results, adjusts my warfarin dosages and schedules my tests), (C) my medical supplier (which rents the test meter to me and provides the test strips), and (D) a go-between company since my insurance company doesn't have a contract with the medical supplier but does with the go-between company), would you believe I wasn't able to start at-home testing until September? Five months! Not very efficient.

But for the next 15 months, everything was hunky-dory. I stuck my finger every two weeks or so, got the results from the meter, provided the results to a web site run by (C), waited for (B) to get faxed results from (C), talked to (B) to find out what adjustments I needed to make and when to test again, had my prescription renewed annually by (A) and ordered new supplies when needed from (D). Piece of cake.

But in December 2021, my insurance company decided to mess with this smooth-running machine by terminating its contract with (D). That ended my relationship with (C). That meant I had to find a new medical supply company, return my meter to the old medical supply company since it's only rented, get my doctor to write a new prescription, get a new, identical meter and, basically, start anew. Now it's February and I'm not yet up and running. Good thing I haven't returned the old meter yet.

In itself, that wouldn't be much of a story. I did have a hard time finding a new medical supply company that was acceptable to my insurance company but I finally found one, sent it a new prescription from my doctor and got things rolling again. Yesterday the new medical supply company told me that when I get my meter, I will be required to do weekly testing. That threw me.

"What?" I asked. "Why?"

"It's our policy," they said.

"Its not what *I* want," I replied. "Your policy is about money. If I test more often, you sell more product and you pass more reports to the hospital and you get more money."

"Oh, no," they said. "There won't be any additional charge."

"Not to ME," I countered. "But you'll certainly bill my insurance company for more tests. And so will my hospital when they get all these extra reports from you. And I have to pay a portion of that. And, in the long run, my insurance premiums will rise."

"Well, sir," they said, "We follow the best standards and practices as recommended by Medicare."

"I don't care about what you follow. Neither you nor Medicare have examined me. Neither of you are are in a position to be dispensing medical advice! Take your stinking paws off me, you damned dirty ape! (No, not really. But it's what I was thinking.) I want to be tested when my doctors and nurses advise me to be tested. They are the ones who have seen me, after all. They are the ones who know my medical history and condition. My last supplies company was okay with bi-weekly testing. Why aren't you? My doctor is okay with bi-weekly testing. My nurse is okay with bi-weekly testing. Moreover, I don't WANT to be sticking my finger every week unless I have to. It's time consuming, it scars up my fingers and it's not exactly pleasant, you know?"

I explained that it wasn't my intention to cause problems and said that I would do what I had to do but that I wasn't at all happy with their money-grubbing policy. The person I'd been speaking with then transferred me to her supervisor who took the same position. At some point I asked, "What happens if I get the meter but don't test every week?"

"Then we will require the meter be returned," she said.

Nice.

"What if I just buy a meter?" I asked.

"We do sell them to our customers for $1,500," she replied. She had that price handy so it must be a question that pops up pretty regularly.

Then she added that many insurance companies require patients to go through a 3rd party (meaning them) when reporting results. In other words, she was warning me that I can't just call my results in directly to the hospital nurse. I think this was her way of saying that if I don't rent their meter, they won't act as the 3rd party my insurance company requires. FORTUNATELY, I've been phoning my results directly to the hospital already, ever since the old medical supplies company lost its contract with my insurer. So I already knew that the veiled threat being made did not hold water.

LOL. So that's where the conversation ended.

Early this morning, I took a look into meter prices and found that the meter the supplies company is willing to sell me for $1,500 is available used on Ebay for $159. The test strips I use are also on Ebay for $130 for a set of 24. Basically, a year's worth.

The new medical supplies company would have forced me to do twice as much reporting as my nurses recommend... at $20 to me per report it would be an additional $260 per year - nearly enough in the first year to cover the cost of buying my own meter AND a year's worth of test strips.

I called my insurance company to talk things over, to let them know that this medical supplier they'd steered me to was trying to force me into doing medical testing for which I do not have a medical need, and to help figure out what options I have. The things of value I learned from the insurance company are that my insurer will not intercede on my behalf, that they do NOT require me to go through a 3rd party to report test results, and that if I opt to make an "out of network purchase" of a meter and supplies, they will reimburse me for 65% of the expense so long as I provide yet another prescription from my doctor.

Here's what I'm going to do. My new meter is already on its way. When it arrives, I'll contact the new medical supplies company to get instructions on how they want me to report my results. I'll send them my results for Week 1. Then again for Week 3. Then again for Week 5. Etcetera, testing as often as my nurse advises. I fully expect the supplies company to pitch a fit, calling repeatedly to tell me that I did not submit results. Each time, my response will be "I have been told by the doctors who have examined me that I do not have a medical need to be tested weekly. I follow their advice."

They'll eventually either demand their meter back and lose me as a customer or they'll decide that they'd rather keep me as a customer along with the money my insurer pays them. Personally, I think it would be stupid of them to dump a paying customer, but it's their call. I will, of course, write an extremely nasty letter to them, cc: my insurer, if they demand their meter back. My feeling is, WHO ARE THEY TO COUNTERMAND AND OVERRIDE THE RECOMMENDATIONS OF THE MEDICAL PROFESSIONALS WHO HAVE EXAMINED ME?

If the supply company drops me as a customer, I'll have to pay a little money and buy a meter and test strips. Or maybe I'll find a different, in-network supplier that doesn't play God with its customers. Either will be good with me. But I will NOT let some two-bit medical supplies company dictate how often I have to draw blood so that it can further stick it to both my insurance company and me. It can just kiss my a$$.





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Gold is $1,581/oz today. When it hits $2,000, it will be up 26.5%. Let's see how long that takes. - De 3/11/2013 - ANSWER: 7 Years, 5 Months

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