Tuesday, February 11, 2014

Patient Advocacy: Healthcare on your side


Patient Advocacy: Healthcare on your side

   by Martine G. Brousse
Healthcare Specialist, Patient Advocate, Certified Mediator
ADVIMEDPRO



 Three Programs for Seniors 
you may never have heard of
                               (Part I: Prescription Drugs)

It is neither news nor a surprise that prescription drug costs have reached levels that render them unaffordable for too many, and especially for Seniors. Pill cutting, the late renewal of refills, non-compliance due to the inability to pay the share of cost, have become all too commonplace, jeopardizing health, creating severe or more complications and forcing many to choose between paying a pharmacy or a utility bill. 
Eventually, all of us will pick up the tab, whether in accrued Medicare payments, in a rise in ER visits or for the longer treatments of conditions once easily treatable and now chronic. 

While assistance is available through manufacturers' programs, discount cards, charitable organizations, free clinics, samples and offers, its access, and information, are often too difficult and time-consuming to track. When a medication is needed right away, who has time to contact every pharmacy in town to get the better price? 

Thanks to your tax dollars, several programs are in place to help seniors better afford these costs. Others are offered by charitable organizations Checking them out may save you time, effort and cash

1. Low-Income Subsidy Program ("Extra Help")

If you are already receiving Medicaid (MediCal in CA) as your secondary coverage, you have already been enrolled in this program. If you are buying your own secondary or Part D coverage, or are receiving coverage through a past employer or the US Military, you may still be eligible for low-cost prescriptions, and assistance to cover the premiums. You may qualify, based on your income, even if you are still employed
Drug costs for most people on this program are set at a few dollars for generic or brand-name drugs. For some, financial assistance to cover premium and/or deductible costs will be available.  
Assets such as your home, car or life insurance do NOT count toward your eligibility, though investment accounts will. Your application will be processed by the social Security Administration, which will help you choose a Part D plan if you qualify. 


2. Medication Therapy Management (MTM)

Every Part D insurer is required to offer you this service. Designed to lower costs, reduce the risk of dangerous drug interactions, avoid duplication of prescriptions and therapies, educate patients to benefits, alert them of possible reactions and confirm the effectiveness and need of each treatment, this service should be used by every eligible senior, once a year. 

A pharmacist will help create an up-to-date personalized medication list, which every one of your treating physicians you should get copied on. You will get detailed information on every prescription and over-the-counter medication, including use, dosage and curative intent. Advise on when and how to best take these medications will be provided. Unnecessary, similar and ineffective treatments will be pointed out, for your physician to review. Switching to a new generic version, or stopping an obsolete treatment will save you money. 
This is an excellent time for questions, and to make sure you are getting the most appropriate and cost-effective prescriptions.  


3. Patient Assistance Programs ("PAPs")

Visit this website to find out about programs available in your state of residency. Search for any program, state or corporate, for your expensive prescriptions and create a up-to-date, personalized list of resources. 
This website also maintains an extensive and detailed list of all manufacturers', co-payment and saving cards programs, and are not exclusive to seniors. 

For more info, visit: 
http://www.pparx.org/en/prescription_assistance_programs/list_of_participating_programs


While other options and websites are available, these 3 suggested programs should go a long way toward helping you cover your prescription drug costs. 


©  [2016] Advimedpro.
©  [2016] Martine G. Brousse.
All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements



AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330
                                         www.advimedpro.com           contact@advimedpro.com

Monday, January 27, 2014

Patient Advocacy: Healthcare on your Side


Patient Advocacy: Healthcare on your side

   by Martine G. Brousse
Healthcare Specialist, Patient Advocate, Certified Mediator
ADVIMEDPRO


Tips on Five Common Labs 

As a Patient Advocate, I often encounter bills and statements showing commonplace labs performed in various settings (office, outpatient, inpatient). I keep getting surprised, and often outraged, by the differential in pricing for those simple tests.
Patients should realize that these are the some of simplest tests, often requiring minimal clinical experience to interpret and very inexpensive. Yet they routinely overpay. Even if the price is considered "acceptable", chances are they were  overcharged anyway. 

Here are some basic information on 4 common labs and their usual reimbursement rates. If your Dr sends your samples to a non-contracted lab, or if you are out-of-network due to unforeseeable circumstances, you will now be better informed when negotiating those fees down. Hint: never pay the full price unless it amounts to your insurance allowable and you are directed to do so by your Explanation Of Benefits. 

1. CBC (Complete Blood Count) Code 85025

This is probably the most common lab test, routinely used by General Practitioners and Specialists alike. This test gives the clinical staff an overview of the health of your blood, and can detect certain underlining conditions (anemia, neutropenia) or acute needs (infection). 
It usually covers these readings: 
  • hematocrit
  • hemoglobin 
  • mean corpuscular volume (MCV) 
  • mean corpuscular hemoglobin (MCH) 
  • mean corpuscular hemoglobin concentration (MCHC); 
  • red cell distribution width (RDW) 
  • percentage and absolute differential counts 
  • platelet count (RBC) 
  • red cell count 
  • white blood cell count (WBC)
Learn more about this test at: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm

The average reimbursement rate is around $ 15.00 to $ 30.00. You should never pay more than 
$ 40.00 for this test if you are paying cash. 

2. CMP (Complete Metabolic Panel) Code 80053

This test is more detailed and provides your physician with a clearer picture of your organs' health. These are tested: 
  • Alanine aminotransferase (ALT/SGPT); 
  • albumin:globulin (A:G) ratio; 
  • albumin, serum; 
  • alkaline phosphatase, serum; 
  • aspartate aminotransferase (AST/SGOT); 
  • bilirubin, total; 
  • BUN; 
  • BUN:creatinine ratio; 
  • calcium, serum; 
  • carbon dioxide, total;
  • chloride, serum; 
  • creatinine, serum; 
  • eGFR calculation; 
  • globulin, total; 
  • glucose, serum; 
  • potassium, serum; 
  • protein, total, serum; 
  • sodium, serum
Learn more about this test at: http://www.nlm.nih.gov/medlineplus/ency/article/003468.htm

The average reimbursement rate if $ 20.00 - 40.00. You should never pay more than $ 50.00 for this test if you are paying cash. 

3. PT (Prothrombin Time) Code 85610

Those patients on blood thinning medication such as Coumadin or Warfarin are well acquainted with this test. It does not require blood to be drawn, and many patients can test at home via a device that sends the results to the lab and your physician. Used to monitor your blood's speed of coagulation, its long-term and regular use is necessary to adjust your medication dosage. 


The average reimbursement is $ 10.00 to 20.00. You should not pay more than $ 35.00 for this test if you are a cash patient.


4. Lipid Panel with LDL/HDl ratio (Cholesterol) Code 80061

Used as a screening tool for various conditions (hyperlipidemia, heart disease, obesity, renal or liver disease, and many others), this test is invaluable in evaluating risk factors as well as the effectiveness of a prescribed treatment. While they are more complex lipid tests, this is a most commonly used. 

To learn more about this test, visit: http://www.nlm.nih.gov/medlineplus/ency/article/003491.htm

The average reimbursement for this test is $ 25.00 to $ 40.00. You should never pay more than $ 60.00  for this test is you are a cash patient. 

5. Urinalysis (urine test) Code 81005

The most basic urine test, it uses special strips to detect bilirubin, and to screen for possible billiary, liver and other abnormalities and diseases. 


The average reimbursement is  less than $ 10.00. As a patient paying cash, you should never pay more than $ 20.00 for this test. 

NOTE: You may also be charged for a venipuncture (code 36415). Although most commercial insurance carriers deny payment as it is considered part of the service, Medicare allows reimbursement in the $ 4.00 range. You should not pay more than $ 10.00 if paying cash. 

Some of these tests do not require a MD to immediately review the results. For example, the ProTime test is routinely interpreted by nurses or medical assistants, who only consult the physician if the test results are out of the range that was determined at the time of the prescription of the medication. 
In any case, patients should not be put in a position of refusing or postponing a basic test such as those listed because of an exhorbitant pricing. Other labs can perform the same service, and many offices have the appropriate lab machines. Your PCP (Primary Care physician) may be able to perform a test prescribed by a specialist at low or no cost to you. It might be a good idea to ask when you are seeing that needle. 


©  [2016] Advimedpro.
©  [2016] Martine G. Brousse.
All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements



AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330
                                         www.advimedpro.com           contact@advimedpro.com