Re: Re: pharmacies

[Guest guest]

I'm with you 100% on that rant Grace!

CCote

To: Sent: Tuesday, July 3, 2012 8:13:02 PMSubject: Re: pharmacies

insurance companies negotiate with pharmacies and make their own formularies.... they have the patients thinking that we, doctors are not giving them the right meds theyve been on for five years because it just needs to be changed and it's $3 for venlafaxine instead of pristiq at $60 for a month, and that we, the doctors, should call, write letters to get our patients on the meds hence the prior authorization game that ive ranted about before.....i hate them all. medco, express scripts, cvs, right source, meds by mail... etc. and the robots they have which answer the fone.i only love ice cream....grace>> please excuse the venting but I just had to express that I hate all local> chain and mail order pharmacies (except medco)> > thank you for your time>

[Guest guest]

I feel for you Sharon, have dealt with hospice people like this all the time. Many don’t understand that care by a physician for a condition other than their hospice qualifying diagnosis is allowed and covered by most insurance plans including Medicare. The proper modifiers have to be on the claims to get it paid, but they do get paid. Had a patient last year with small cell CA lung in hospice who was actually doing quite well who developed acute cholycystitis with gallstone pancreatitis and needed surgery. The hospital UC argued it wasn’t covered, but we got a statement from Medicare that care not related to terminal diagnosis was indeed covered. I would talk to the medical director for the hospice service, perhaps this woman was misinformed and needs some retraining. Good luck to you. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of Sharon McCoy Sent: Thursday, July 05, 2012 5:19 PMTo: Subject: Re: Re: pharmacies Amazingly enough, my parents still have a " mom & pop " pharmacy they use in Missouri in which the staff pretty much all know them by name. It is just bizarre to go there and hang out....a pharmacy like the old days. I currently enjoying the 108 degree heat (!) in Missouri with my parents and having a tough time getting my dad on a hospice program that makes sense. The one that sent a nurse out today to do intake would not take back her statement that every doctor visit is an " aggressive medical procedure intended to cure " (her words) and thus not covered by hospice. It is crazy. They complain that people sign up for hospice too late, but this one won't cover PT (which was really decreasing pain in this case) or a visit with his oncologist in 3 months (who knows where we'll be by then, but certainly not necessary to tell my dad he can't go see him then). She actually told me if further radiation for pain control was needed, they would do that based on nurse home assessment and no doctor visit. Clearly not true, but what do families do that don't have a primary care doctor as an involved member??After this, I understand why people are afraid of hospice. Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com I'm with you 100% on that rant Grace!CCoteTo: Sent: Tuesday, July 3, 2012 8:13:02 PMSubject: Re: pharmacies insurance companies negotiate with pharmacies and make their own formularies.... they have the patients thinking that we, doctors are not giving them the right meds theyve been on for five years because it just needs to be changed and it's $3 for venlafaxine instead of pristiq at $60 for a month, and that we, the doctors, should call, write letters to get our patients on the meds hence the prior authorization game that ive ranted about before.....i hate them all. medco, express scripts, cvs, right source, meds by mail... etc. and the robots they have which answer the fone.i only love ice cream....grace>> please excuse the venting but I just had to express that I hate all local> chain and mail order pharmacies (except medco)> > thank you for your time>

[Guest guest]

Definately. Add the GV to medicare and my visits get paid because I am the primary -- so even if I am caring for the "hospice" diagnosis I get paid. Of course Hospice has a fit when I order antibiotics for pneumonia with my cancer/copd'er but that's their problem. Yes, the Hospice nurse are VERY AGRESSIVE and have been outright hostile to and undermine me all the time. Patients have learned to call me. We stick with hospice because they send 1.5 hours of aid time 3x weekly and pay for 75% of the meds. Otherwise most of my families would ditch 'em. To: Sent: Saturday, July 14, 2012 11:05 AM Subject: RE: Re: pharmacies

I feel for you Sharon, have dealt with hospice people like this all the time. Many don’t understand that care by a physician for a condition other than their hospice qualifying diagnosis is allowed and covered by most insurance plans including Medicare. The proper modifiers have to be on the claims to get it paid, but they do get paid. Had a patient last year with small cell CA lung in hospice who was actually doing quite well who developed acute cholycystitis with gallstone pancreatitis and needed surgery. The hospital UC argued it wasn’t covered, but we got a statement from Medicare that care not related to terminal diagnosis was indeed covered. I would talk to the medical director for the hospice service, perhaps this woman was misinformed and needs some retraining. Good luck to

you. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of Sharon McCoy Sent: Thursday, July 05, 2012 5:19 PMTo: Subject: Re: Re: pharmacies Amazingly enough, my parents still have a "mom & pop" pharmacy they use in Missouri in which the staff pretty much all know them by name. It is just bizarre to go there and hang out....a pharmacy like the old days. I currently enjoying the 108 degree heat (!) in Missouri with my parents and having a tough time getting my dad on a hospice program that makes sense. The one that sent a nurse out today to do intake would not take back her statement that every doctor visit is an "aggressive medical procedure intended to cure" (her words) and thus not covered by hospice. It is crazy. They complain that people sign up for hospice too late, but

this one won't cover PT (which was really decreasing pain in this case) or a visit with his oncologist in 3 months (who knows where we'll be by then, but certainly not necessary to tell my dad he can't go see him then). She actually told me if further radiation for pain control was needed, they would do that based on nurse home assessment and no doctor visit. Clearly not true, but what do families do that don't have a primary care doctor as an involved member??After this, I understand why people are afraid of hospice. Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: http://www.sharongeorgemd.com/ I'm with you 100% on that rant Grace!CCoteTo: Sent: Tuesday, July 3, 2012 8:13:02 PMSubject: Re: pharmacies insurance companies negotiate with pharmacies and make their own formularies.... they have the patients thinking that we, doctors are not giving them the right meds theyve been on for five years because it just needs to be changed and it's $3 for venlafaxine instead of pristiq at $60 for a month, and that we, the doctors, should call, write letters to

get our patients on the meds hence the prior authorization game that ive ranted about before.....i hate them all. medco, express scripts, cvs, right source, meds by mail... etc. and the robots they have which answer the fone.i only love ice cream....grace>> please excuse the venting but I just had to express that I hate all local> chain and mail order pharmacies (except medco)> > thank you for your time>