tag:blogger.com,1999:blog-5883634615775822475.post2169915585997836924..comments2024-03-18T09:00:31.992-04:00Comments on Doctor Grumpy in the House: Annie's SongGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger68125tag:blogger.com,1999:blog-5883634615775822475.post-55410400361264622592010-08-07T18:09:33.869-04:002010-08-07T18:09:33.869-04:00I think I love Annie.
When I worked at a psych hos...I think I love Annie.<br />When I worked at a psych hospital, one of my colleagues asked an insurance reviewer for his full name and address so we'd know who to put down on the police report when the patient left and blew his brains out after his insurance company refused to pay for him to be admitted. The admission was then approved.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-16395573631259614692010-03-27T19:57:28.658-04:002010-03-27T19:57:28.658-04:00@Db - So am I to assume that you've made every...@Db - So am I to assume that you've made every right choice, never went 1 calorie over your standard daily intake, never shared a room with anyone who might have smoked and walk or ride a bike where-ever you go?<br /><br />I lived with a smoking family for 26 years before the last one, my father, gave up smoking because of work. He's had at least two heart attacks and has been doing a damn good job of keeping my stress levels up.<br /><br />My luck with my weight has not been great, but it's something that I've been working to try to keep under control. <br /><br />I admit that I'm not the healthiest person in the world, but I try. I shouldn't be denied care because some self important jackass thinks s/he is more important then any other living being on this world. Guess what, you AREN'T.<br /><br />If we spent money to educate people on how to live a more healthy lifestyle, or hell, even to have a doctor scream at some people to EXERCISE on a regular basis, then maybe we would be better off. But you know what? Every person with an attitude of 'I don't want to cover people who might not have lived the most healthy of lifestyles' doesn't make things better. In fact, that kind of lifestyle isn't very healthy at all, it leads to people going 'I deserve this cake, I've worked hard', or 'I don't need to exercise today, I've worked hard'. Holier then thou attitudes are part of the reason we as a people have so many damn problems in the first place.Twilight Bardhttps://www.blogger.com/profile/18164521700986625255noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-54944970713111389052010-03-18T03:07:28.811-04:002010-03-18T03:07:28.811-04:00Yes, the health care industry is a mess, whether t...Yes, the health care industry is a mess, whether the government is running it, or the insurance companies are. How about this - if people took responsibility for their own health, we wouldn't be having this discussion. It's the crux of this biscuit. If the public simply practiced a healthy lifestyle, good nutrition, and adequate exercise, obesity wouldn't be a major national health crisis. Nor would lung cancer, "Syndrome X" diseases, etc.. And we have Big Pharma, catering to the public's lack of responsibility and providing a pill for everything under the sun, without any thought of treating the cause rather than just the symptoms. Why should they? They're making tons of money on those drugs. <br />When I look around at all the obese people (of their own bad health choices, most of them), heavy smokers, couch potatoes, et al, I ask myself- why should I subsidize, with my tax dollars, the bad health habits of these irresponsible idiots?Unknownhttps://www.blogger.com/profile/14689779382718827731noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-56625710604645617882009-10-08T02:52:14.970-04:002009-10-08T02:52:14.970-04:00*MJH, CPhT said...
I'm sorry, but if you thin...*MJH, CPhT said... <br />I'm sorry, but if you think Medicare is one of the better to work with I'd like you to spend a day in a pharmacy. Medicare is simply awful to pharmacies with their "let's pay them less than it cost them to buy the drug!" policy. Ugh.*<br /><br />Also a CPhT here, Dr. Grumpy's staff gets to deal with Medicare... We in the Pharmacy usually don't. Remember when dealing with Part D (which unless you're dealing with DME its what you're billing) it is NOT government run. its still Aenta, Medco, WHI, and the like. And government plans like DoD Tricare aren't allowed to negotiate for better prices because of the Drug Companies Lobby. The government plans actually have better reimbursement rates than the 3rd parties, and they're faster about it too.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-17255579533337939802009-09-27T20:29:35.646-04:002009-09-27T20:29:35.646-04:00Just to clarify a point on the Australian system -...Just to clarify a point on the Australian system - if your prescribed drug is on the Pharmaceutical Benefit Scheme, the maximum co-pay is capped. If it's not, then it's more. I know we pay $35(ish) AUD for Nexium, for example.<br /><br />That being said, as an American expat living in Australia and a nurse, I much prefer the Aussie system. It's not perfect but it's a far sight better than the US. And Annie totally rocks!Mooselethttps://www.blogger.com/profile/16874418427786990740noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-54532955452806427072009-09-26T21:30:35.707-04:002009-09-26T21:30:35.707-04:00Three cheers for Annie!! And as to your main poin...Three cheers for Annie!! And as to your main point, hear hear. When I hear people talking about losing their "freedom of choice," I suppose they have never had crappy HMO insurance--or gone without entirely.PickyHistorianhttps://www.blogger.com/profile/13500487513256575244noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-10542173171422439302009-09-24T16:15:34.431-04:002009-09-24T16:15:34.431-04:00Bravo Annie!!
That we in the US don't think o...Bravo Annie!!<br /><br />That we in the US don't think of healthcare as a right for all is just a sad indictment of our current capitalistic society. Anything to make the most money possible on the backs of those who cannot adequately advocate for themselves. <br /><br />@ Double Standard: WOW, that was harsh. So the unfortunate lower class that cannot afford any type of insurance on their own, many times through no fault of their own, including losing their job to the recession, car accidents, being injured at work, or having congenital defects, deserves to be treated as less than you? I'm guessing you're not a Christian and have never known any hardship in your life. <br /><br />@ Anon 5:49: Don't I wish that I could leave. I would gladly move to Australia, Canada, the UK or any other country in the world where people believe that healthcare is a RIGHT and not a PRIVILEGE of the rich in order to get universal health care. Unfortunately it's not as easy as that.sadiehttps://www.blogger.com/profile/00175608252110118793noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-77707986731012151632009-09-24T14:35:47.274-04:002009-09-24T14:35:47.274-04:00@ double standard.
Er. You're not really sayi...@ double standard.<br /><br />Er. You're not really saying everyone on Medicare or with no coverage is a "Mr. Deadbeat with no job or desire to contribute to society" are you? <br /><br />Because if you are, I think a few folks out there with some hard luck may have a word with you.scixualhttps://www.blogger.com/profile/00444905237025739290noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-89210666611639490232009-09-24T00:08:53.428-04:002009-09-24T00:08:53.428-04:00Great Post! Thank you.Great Post! Thank you.Reality Roundshttps://www.blogger.com/profile/11489382111809964841noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-10822350115077205072009-09-23T22:30:09.661-04:002009-09-23T22:30:09.661-04:00I think Annie deserves a raise. A biggggggggggg on...I think Annie deserves a raise. A biggggggggggg one.Easily Losthttps://www.blogger.com/profile/09927848478898228492noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-77718301254661401842009-09-23T20:49:23.618-04:002009-09-23T20:49:23.618-04:00If the American health system is so messed up then...If the American health system is so messed up then leave! I live in Australia, the government run the health system, if I need an MRI or any other test I get it. There might be a couple of days wait for non-urgent cases, but in the main its simple, If a doctors says you need it, you get it!!they are the experts! <br />What does it cost? Well, just over 1% of our taxable income is the Medicare levy, and this entitles us to 85% of our doctors bill paid by Medicare, and for a vast majority NO ADDITIONAL COSTS for tests. There are waiting lists for elective surgeries but so what. I've had two kids in hospital and two other hospital stays and have never received any bills for these stays. Any medication prescribed costs a maximum of just over $AU20. I think the Australian Government has one of the best healthcare systems in the world.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-316627806669062312009-09-23T16:59:27.370-04:002009-09-23T16:59:27.370-04:00I've always thought you Americans had a weird ...I've always thought you Americans had a weird way of doing things - your health care sounds even more screwy than I thought it was.<br /><br />In England when we're ill, we get treated; true we bitch about having to pay a few quid for prescriptions but we do like to have something to moan about when it's not raining :)<br /><br />Over here, when you need medical care, you get it. You guys really need an NHS or similar, hope you get it.Roobarbhttps://www.blogger.com/profile/04975883853213411477noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-39850262498241572522009-09-23T14:52:14.803-04:002009-09-23T14:52:14.803-04:00OK, what this post brilliantly demonstrates is an ...OK, what this post brilliantly demonstrates is an example although we (the patients) buy health insurance because most of us can't possibly afford any kind of serious illness, the fact of the matter is that the insurance company is acting in its own best interest, not in ours. There is no way that can work, no matter how many ombudsmen, competent peer reviewers, whistleblowers, etc. the world manages to come up with. The flip side is that as a patient, I want the best care, regardless of price--too frequently, having insurance means I don't necessarily know what the price _is_ because I dont have to pay it.<br /><br />Basically, any purchasing decision (and choosing what tests and meds to use is fundamentally a purchasing decision) involves tradeoffs--price vs. usefulness. The tradeoffs I'd make if I were paying myself are not the same as the ones I make given that I have insurance. And the tradeoffs the insurance company chooses are not the same as the ones I would choose in any case.Abraham Fisherhttps://www.blogger.com/profile/06191573168990662137noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-30598355055814946402009-09-23T12:37:55.987-04:002009-09-23T12:37:55.987-04:00Ohh, this was all kinds of awesome, I salute you s...Ohh, this was all kinds of awesome, I salute you sir! And Annie, I am in awe of a most excellent & wry turn of the tables on the bozo insurance minion! "You are basically a worthless automaton"... ROTFL! You've made my day/week/month, a bow to you and your wit!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-70252914905838950032009-09-23T11:30:05.673-04:002009-09-23T11:30:05.673-04:00I run the pharmacy at one of our cancer center'...I run the pharmacy at one of our cancer center's satelite locations and I have to say that I spend more time verifying insurance authorizations than anything else, which is a damn shame, as it leaves me with substantailly less time to check for interactions/allergys/compatibility/etc. The thing that really gets to me is that the ones who are actually are paying for insurance always get the short end of the stick. They must fail certain lines of treatment before getting approval for the plan originally intended. Prior auth for this and that and everything in between (yes, they will go out of their way to not respond to a prior auth for a drug until AFTER the 3 day window to give the drug has passed) Some will only pay a percentage of the treatment. Who can even afford to pay 20% of chemo cost? These drugs are not cheap… no shame, these companies have and it makes me absolutly sick. No one should be forced to go bankrupt because they have cancer. Have you really gained anything when you overcome a disease, but are left with no house, no money, no nothing?? <br /><br />Now, take the patient on Medicaid, who basically has no out of pocket expense. Medicaid was originally a wonderful idea, in my opinion, but now has become out of control and heavily abused. We had a Medicaid patient recently and the doctor wanted to change his treatment. He asked me if this would be authorized, so I called up the billing dept and started asking about approval of this treatment. The billing girl basically cut me off stating, “does not matter, he is Medicaid, doctor can prescribe whatever he wants, it will be covered”<br /><br />Wait. Really? So the patient who works hard and goes out of their way to make sure they have insurance coverage gets less than ideal, substandard care, but the one who contributes nothing gets everything under the sun?? How does this make sense?? Isn’t it the working class who pays taxes to support these government funded programs?? This is strictly only what I have seen from a pharmacological point of view, not sure if it is different with tests, doctors visits, etc, but it seems absolutly crazy. Why should I continue to pay for insurance (and payroll taxes for that matter!) when Mr. Deadbeat with no job or desire to contribute to society is receiving top of the line care for free?? (This obviously does not pertain to individuals who can rightfully justify usage of these kind of assistance programs)<br /><br />I have an extremely open mind regarding attempts at solving the healthcare issues we are facing today. If a cartain attempt fails, at least we know what does not work and can improve on that. To me, the end result will be more effective than continuing to do nothing at all.double standardnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-14910624997975922132009-09-23T09:17:36.728-04:002009-09-23T09:17:36.728-04:00I am very close to someone in the insurance indust...I am very close to someone in the insurance industry - a physician who occasionally does reviews/approvals/denials. Through this person I have now seen both sides to the debate. One the one side is the unfortunate need to be profitable as a company (after all we are capitalists), on the other, the need to serve the individual. These are not easy to reconcile. My friend does lots of research out of his original field to better understand the requests of physicians and does not summarily deny cases. Often, there is no way to properly get an idea of what the situation is without directly calling the MD. Just "indication: headache" for MRI, MRA, MRV, PET scan, CT angio, etc is simply not enough to approve such expensive tests. That said, the insurance industry has to realise that health care is not like any other industry as there is an ethical need for it. You can't just treat it like some other commodity. Clearly, getting rid of pre-exhisting conditions has to happen to maintain fairness. Second, healthy young people must be forced to buy insurance - either privately or debatably via some public, basic, low cost option taken out in pretax dollars. This would offset the expense the insurance industry would incur by not jacking the rates to people with diabetes. Also, I think we are headed to a two tier system. A basic public option where there are out of pocket costs for most things (but affordable costs like the poster from South Korea describes), and also private supplementary insurance where the out of pocket costs are mostly in the premiums. We shall see what happens and if in fact the government remains as incompetent as we all think it is.ERPhttps://www.blogger.com/profile/15973334581468131595noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-68137704159208290182009-09-23T07:22:16.448-04:002009-09-23T07:22:16.448-04:00Great post, Dr. Grumpy! Annie is my hero!
I la...Great post, Dr. Grumpy! Annie is my hero! <br /><br />I laughed (while shaking my head) about all the dang forms, filling them out, being denied, and having to resubmit them in quadruplicate for further disapproval, because that's what I put up with as a legal assistant in an insurance defense law firm. I was a government employee for 9 years, and it NEVER got that ridiculous!<br /><br />Insurance companies even get away with scrutinizing bills from their attorneys and paying less for legal representation than everyone else. I'm not saying this hurts lawyers much, if at all, as it's obvious the ones who can put up with insurance companies' bureaucracy can make a sh'load of money. <br /><br />Anon 7:34 pm's comments reminded me that doctors also have outrageous premiums to pay for malpractice insurance! It just never ends! btw, the attorneys I knew who no longer work in the insurance defense are now representing plaintiffs in personal injury or medical malpractice because that's where the REAL money is. I could go on, but I've already added more than 2 cents here. <br /><br />We need more critically thinking nurses like Annie. She's too awesome for words!IndyDinahttp://www.twitter.com/indydinanoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-68624246554931358772009-09-23T06:38:55.867-04:002009-09-23T06:38:55.867-04:00Thank God I live in a communist country (Norway).
...Thank God I live in a communist country (Norway).<br /><br />Great story, though.OJnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-81311604527873100922009-09-23T00:34:30.794-04:002009-09-23T00:34:30.794-04:00Actually, there was a docu-drama
about 7ish years ...Actually, there was a docu-drama<br />about 7ish years ago about this<br />very thing. It was about a whistle-blower doctor who went to<br />work for an insurance company. She<br />blew the whistle and became an<br />activist. We can see that things<br />haven't changed since then, and have only gotten worse! It seems<br />that knoweledge has bred apathy!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-28479202361720820752009-09-22T23:15:14.334-04:002009-09-22T23:15:14.334-04:00amen and amen!!! my ins,. co. allowed me to go thr...amen and amen!!! my ins,. co. allowed me to go through all the clearances for gastric bypass surgery. the day of surgery i show up at the hospital, only to find out my surgery was denied. my bmi was 42 and at 5'3", i weighed 250lbs. i have many health issues and take many meds. the surgery as you well know would've eliminated alot of these issues and meds. ultimately saving alot of money at the end of the day. the surgeon and hospital did everything to talk to the moron dr., who didn't know me from atom. his reasoniing was i had lost 42lbs. several yrs ago. I was in my early 30's! I tried many weight loss programs, but at 45,this wasn't happening. by the way, these idiots spent $23,000.00, not including my meds. i took 12 different meds then. that was 7/2005. i was diagnosed with type 2 diabetes in 5/07. this year by may, i have been dignosed with diabetic neuropathy and mild arteriosceloris. i have been hospitalized at least 1-2x each year with asthma, diabetic and heart issues. i now take 17 meds. each day. i was hospitalized again in august. it's nice to know this expert dr. has a hand in deciding the length of my life. people are worried about "death panels"? the insurance companies have had them for years. i know this comment is long-winded, but this is shirley's song.shirley g.noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-25248215528868211202009-09-22T22:34:44.543-04:002009-09-22T22:34:44.543-04:00FABULOUS! Loved every word!
To nurse K and other...FABULOUS! Loved every word!<br /><br />To nurse K and others with like opinions, <br /><br />"Well, with costs out of control, doesn't it make sense to try to keep costs down on the most expensive drugs in their class and the most expensive imaging?"<br /><br />YES...the question is not whether you do it, but HOW you do it. <br /><br />"I wish some peer reviewer would just park in my ER and tell Dr. Controlfreak and Big Work-Up 3x/shift that every knee pain doesn't need an MRI and every 20 y/o with a headache doesn't need one either so your stroke patients can get an MRI w/o question. Every 18 y/o with pleurisy doesn't need a CT scan to rule out PE. Also, NovoSeven at 8K/pop on a patient actively herniating with GCS of 3 x 2 doses, maybe let's peer review that sh*t."<br /><br />OK...Obviously you don't have people telling you on a daily basis that they are gonna SUE you if you don't do X, Y and Z. Let's see...I'm $200K+ in educational debt. I have a family to support and know that an attorney that's hungry enough, unethical enough and sleezy enough, I could cause me to go broke. It may be a 1 in 10,000 chance, but here's the decision - order the test that you don't pay for or roll the dice. Thanks to the corpo-go to guys we have in Congress, the ins company can't be sued for saying no, but I can. I say bring on universal health care, develop best practices and use it as benchmark to measure whether the care delivered was appropriate or not. Health reform without tort reform is useless.<br /><br />Dr Controlfreak and Big Work-Up are responding to the greedy, morally bankrupt lawyers, insurance companies and Congress looking out for themselves at the expense of health care providers, patients and the public at large.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-57367298668965040192009-09-22T21:53:33.291-04:002009-09-22T21:53:33.291-04:00Awesome.Awesome.PinkPiratehttps://www.blogger.com/profile/04836730330550252772noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-66532677343332118272009-09-22T21:48:43.215-04:002009-09-22T21:48:43.215-04:00Dear Anonymous at 12:39pm:
1. I do try to elect ...Dear Anonymous at 12:39pm:<br /><br />1. I do try to elect politicians who will be fiscally responsible....my fellow citizens don't always vote my way (and too bad, too!)....<br /><br />2. I'm a hospice nurse, and I understand that 'death panels' is hyperbole. I am completely behind not aggressively treating those who will not benefit from it.<br /><br />We should really just get government out of it. I don't want some gubmint flunky deciding rationing decisions (although I'm not necessarily against it, the problem is WHO is going to be deciding these things!)....<br /><br />I will never believe that government should have this level of interference in our lives.<br /><br />Again, I say I would welcome a universal system that works....I just don't believe that the Government can ever sustainably do it. Not ever.Liznoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-90707267745491922422009-09-22T20:09:17.442-04:002009-09-22T20:09:17.442-04:00"A fantastic entry that really drives home ho..."A fantastic entry that really drives home how improperly informed many people are; especially the loudest ones. <br /><br />The plan currently in debate might not be the best alternative, but it sure as heck burns my bacon to hear people swat it down and then provide no meaningful alternative and say the system is fine as it is.<br /><br />If you don't think people have the basic right to be healthy and not become deeply indebted (and therefor have their quality of life massively reduced through no fault of their own) because they got bad genes, or just had an unlucky accident, well. Maybe this whole equality/freedom/America thing isn't for you.<br /><br />At the end of the day, though, I thank you guys for doing what you do. Three cheers for Annie especially!"<br /><br />What s/he said!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-4606170980410104702009-09-22T20:08:23.364-04:002009-09-22T20:08:23.364-04:00I'm sick of sniveling liberals. Why don't ...I'm sick of sniveling liberals. Why don't you people think about someone besides yourself? Maybe you could learn something from this:<br /><br />http://www.funnyordie.com/videos/041b5acaf5/protect-insurance-companies-psaThe Republicannoreply@blogger.com