Re: prescription drugs - restrictions

[Guest guest]

My daughter Janene worked as a multi-disciplinary lab technician (including

microbiology, immunology, sexually transmitted diseases etc.) for ten

years. Now is technical manager of the AIDS laboratory here.

Chris.

Jan Kirsten <jkirsten@...> on 20/07/99 13:19:52

Please respond to jkirsten@...

AP List <rheumaticonelist>

cc: (bcc: Adlard/AUST/CSC)

Subject: Re: rheumatic prescription drugs - restrictions

Content-type: text/plain; charset=iso-8859-1

Content-transfer-encoding: quoted-printable

From: Jan Kirsten <jkirsten@...>

I worked as a paramedic from 1978-1980. Worked in molecular biology lab=

(not

medical setting) from 1993-1998.

Jan K

>

> RTC@... wrote:

> >

> > From: RTC@...

> >

> > In a message dated 7/11/99 6:07:41 AM Eastern Daylight Time,

KPSB2@...

> > writes:

> >

> > > A quick poll:::: How many of us have worked

> > > at one time or another in the health care profession.

> > Psychologist in hospital & outpatient setting.

> >

> > ---------------------------

[Guest guest]

In a message dated 7/7/99 4:32:27 PM Eastern Daylight Time, MHOLMES@...

writes:

<< Anyone else here taking Celebrex whose prescription plan tried to block

it? I guess they would prefer I put a hole in my stomach, pay for that

operation (maybe they figure I'll just kick the bucket and they'll be done

with me!), rather than give me a medication that might lessen the chances of

me developing a problem. Weird.

Bet they wouldn't let me have Enbrel either if I wanted it , if I hadn't

tried methotrexate or other Dmards. >>

Hi Mark,

I am not so fortunate to have prescription insurance. Anyway my

Internist last week, gave me 12 samples of Celebrex. Didn't do a thing until

last night when I took the second dose for the day. Best night sleep I've

had in 2 months and was not as stiff or sore when I got up. Anyway, the Docs

want to combine Enbrel with Mtx. So I'm not going to go that route.

Cute hey? They just want to kill us off twice as fast.

Anita

[Guest guest]

Mark how does your doc order the zithromax?? Does he order A z-pac or 30

caps or and does he say how to take it..monday and friday or does he say

as directed. It makes a big difference. Or you could have him call the

pharmacy. Pharmacy's are different too..try changing pharmacies.

cooky

> " HOLMES, MARK T. " wrote:

>

> Has anyone had trouble getting prescriptions for Zithromax for longer

> than 5 days at a time? I have Blue Cross insurance and they will only

> give me 5 days at a time (pharmacist explained that normally a 5 day

> course treats most people's symptoms, especially since this drug stays

> in one's system for a long time - (not sure what a long time means

> here,but..) This means I have to make a 60 mile roundtrip voyage

> every 5 days to the drugstore , which is a royal pain.

>

> I also do not think they will allow me to have Celebrex either. They

> faxed a form to my doctor and it was asking if I had bleeding problems

> from current nsaids and my age, etc. The nurse suspected they would

> not approve it due to the fact that I didn't meet criteria for the

> drug -( bleeding or stomach problems from other drugs, age,etc).

> Anyone else here taking Celebrex whose prescription plan tried to

> block it? I guess they would prefer I put a hole in my stomach, pay

> for that operation (maybe they figure I'll just kick the bucket and

> they'll be done with me!), rather than give me a medication that might

> lessen the chances of me developing a problem. Weird.

>

> Bet they wouldn't let me have Enbrel either if I wanted it , if I

> hadn't tried methotrexate or other Dmards.

>

> Mark

>

>

>

>

> http://members.tripod.com/~Mark_Holmes

> http://www.bbonline.com/va/foxhill (Work)

> Member of the World Photo Gallery at http://www.WorldPhotoGallery.com

>

>

[Guest guest]

Mark - I had the same problem when I first started

Zithromax. I got the same run-around from the pharmacy. I

had Dr. Franco's office contact them and now I get a months

worth at a time. Try having your doctor call the pharmacy.

It worked for me. Good Luck!

Lea

HOLMES, MARK T. wrote:

> Has anyone had trouble getting prescriptions for

> Zithromax for longer than 5 days at a time? I have Blue

> Cross insurance and they will only give me 5 days at a

> time (pharmacist explained that normally a 5 day course

> treats most people's symptoms, especially since this drug

> stays in one's system for a long time - (not sure what a

> long time means here,but..) This means I have to make a

> 60 mile roundtrip voyage every 5 days to the drugstore ,

> which is a royal pain. I also do not think they will allow

> me to have Celebrex either. They faxed a form to my

> doctor and it was asking if I had bleeding problems from

> current nsaids and my age, etc. The nurse suspected they

> would not approve it due to the fact that I didn't meet

> criteria for the drug -( bleeding or stomach problems from

> other drugs, age,etc). Anyone else here taking Celebrex

> whose prescription plan tried to block it? I guess they

> would prefer I put a hole in my stomach, pay for that

> operation (maybe they figure I'll just kick the bucket and

> they'll be done with me!), rather than give me a

> medication that might lessen the chances of me developing

> a problem. Weird. Bet they wouldn't let me have Enbrel

> either if I wanted it , if I hadn't tried methotrexate or

> other

> Dmards. Mark http://members.tripod.com/~Mark_Holmes

> http://www.bbonline.com/va/foxhill (Work)

> Member of the World Photo Gallery at

> http://www.WorldPhotoGallery.com

[Guest guest]

Mark , call your doc and tell him your problem and that you would like

him to call in a script for 30 pills instead of every other day. As for

what I meant about the pharmacy ...some pharmacists like to go strickly

by the book (like in school) and they know that this is a long acting

drug. So you might try a different pharmacy. Tell the new pharmacy to

call the old one and transfer the script. (ask them first how they would

fill it ).

cooky

" HOLMES, MARK T. " wrote:

>

> It just says QOD (every other day). The pharmacist said he could give me 3

> pills for a 5 day period but that was it. I don't think it would matter

> which pharmacy since I have a prescription card and it goes through a

> company called PAID.

> Re: rheumatic prescription drugs - restrictions

>

> > Mark how does your doc order the zithromax?? Does he order A z-pac or 30

> > caps or and does he say how to take it..monday and friday or does he say

> > as directed. It makes a big difference. Or you could have him call the

> > pharmacy. Pharmacy's are different too..try changing pharmacies.

> > cooky

> >

> > > " HOLMES, MARK T. " wrote:

> > >

> > > Has anyone had trouble getting prescriptions for Zithromax for longer

> > > than 5 days at a time? I have Blue Cross insurance and they will only

> > > give me 5 days at a time (pharmacist explained that normally a 5 day

> > > course treats most people's symptoms, especially since this drug stays

> > > in one's system for a long time - (not sure what a long time means

> > > here,but..) This means I have to make a 60 mile roundtrip voyage

> > > every 5 days to the drugstore , which is a royal pain.

> > >

> > > I also do not think they will allow me to have Celebrex either. They

> > > faxed a form to my doctor and it was asking if I had bleeding problems

> > > from current nsaids and my age, etc. The nurse suspected they would

> > > not approve it due to the fact that I didn't meet criteria for the

> > > drug -( bleeding or stomach problems from other drugs, age,etc).

> > > Anyone else here taking Celebrex whose prescription plan tried to

> > > block it? I guess they would prefer I put a hole in my stomach, pay

> > > for that operation (maybe they figure I'll just kick the bucket and

> > > they'll be done with me!), rather than give me a medication that might

> > > lessen the chances of me developing a problem. Weird.

> > >

> > > Bet they wouldn't let me have Enbrel either if I wanted it , if I

> > > hadn't tried methotrexate or other Dmards.

> > >

> > > Mark

> > >

> > >

> > >

> > >

> > > http://members.tripod.com/~Mark_Holmes

> > > http://www.bbonline.com/va/foxhill (Work)

> > > Member of the World Photo Gallery at http://www.WorldPhotoGallery.com

> > >

> > >

[Guest guest]

Mark,

I have Blue Cross and they covered Celebrex with no problems and I get 10

days of Zithro at a time ( 20 pills ).

At 04:31 PM 7/7/99 -0400, you wrote:

> Weird. Bet they wouldn't let me have Enbrel either if I

>wanted it , if I hadn't tried methotrexate or other Dmards. Mark

>http://members.tripod.com/~Mark_Holmes

>http://www.bbonline.com/va/foxhill (Work)

>Member of the World Photo Gallery at http://www.WorldPhotoGallery.com

[Guest guest]

I was able to appeal to my insurance company - they asked for a letter

from the doctor indicating what other drugs I had tried and why it was

necessary to prescribe celebrex. Went thru a lot of hassle but got it

done. Payment was approved. However, the stuff darn near killed me so

I would have been better off not getting it! Sharon

-----

>From: M Carroll <LCARROLL@...>

>

>Mark,

> I have Blue Cross and they covered Celebrex with no problems and I

get 10

>days of Zithro at a time ( 20 pills ).

>

>

>At 04:31 PM 7/7/99 -0400, you wrote:

>> Weird. Bet they wouldn't let me have Enbrel

either if I

>>wanted it , if I hadn't tried methotrexate or other Dmards. Mark

>>http://members.tripod.com/~Mark_Holmes

>>http://www.bbonline.com/va/foxhill (Work)

>>Member of the World Photo Gallery at

http://www.WorldPhotoGallery.com

[Guest guest]

Insurance plans, except indemnity plans, have formularies with protocols of

which drugs can be used to treat what. They also have deals with drug

companies to get low prices on the formulary drugs

MInocin isn't even in the formulary for Blue Cross where I live. I suspect

it's cause it's used for acne, maybe, which is considered cosmetic. Also,

since minocin is not approved by FDA for use in RA (for RA it's an " off-label

use " as they call it), it is not in formulary and must be petitioned for by

doctors (and probably denied).

Fortunately, I don't belong to Blue Cross now. But so many of them are doing

this with all categories of drugs. Patients are guinea pigs and must

" suffer " through side effects before a more benign and gentler drug can be

prescribed. No, it makes no sense as they end up spending more money treating

patients for side effects!

I am joining a local advocacy group to make health care fairer and more

available in my state. I can't wait till the first meeting in July!

h

[Guest guest]

Another use for Minocin in our population besides acne is bronchiectasis

(sp?). , let me share a bit of good news about insurance coverage in

general. I started AP before that magical 65th birthday. When I went to

Iowa for treatment and had outpatient IV's at the Hospital, only a small

part of it was covered by my BC/BS policy.

Then, after I was on Medicare, the same scenario was true. But, one day

when I was talking to Medicare on the phone, I asked why was it not covered

since I had a positive mycoplasma finding and the IV was the appropriate

treatment for it. She said she thought I was correct and looked into.

Guess what? Now it has been covered for the last two visits (every six

months). .So, that mycoplasma report is very important -- if positive.

Billie

Re: rheumatic prescription drugs - restrictions

>From: SEG14@...

>

>Insurance plans, except indemnity plans, have formularies with protocols of

>which drugs can be used to treat what. They also have deals with drug

>companies to get low prices on the formulary drugs

>MInocin isn't even in the formulary for Blue Cross where I live. I suspect

>it's cause it's used for acne, maybe, which is considered cosmetic. Also,

>since minocin is not approved by FDA for use in RA (for RA it's an

" off-label

>use " as they call it), it is not in formulary and must be petitioned for by

>doctors (and probably denied).

>Fortunately, I don't belong to Blue Cross now. But so many of them are

doing

>this with all categories of drugs. Patients are guinea pigs and must

> " suffer " through side effects before a more benign and gentler drug can be

>prescribed. No, it makes no sense as they end up spending more money

treating

>patients for side effects!

>I am joining a local advocacy group to make health care fairer and more

>available in my state. I can't wait till the first meeting in July!

>

> h

>

>---------------------------

[Guest guest]

Carol wrote:

>

> My insurance is Blue Shield and it will not pay for over 6 pills at one

> time. Dr. Francos office even spoke with the insurance company and they will

> not do it because it is not the " conventional " way that RA is treated. So, I

> either have to pay for the other 16, which I'm afraid to ask how much that

> will be, or we are waiting to see if the mycoplasma comes back positive and

Carol,

If it's Zith, mine was $50 for 6 caplets - at discount

(Costco/PriceClub)! I did a one-time shot but can't afford them on a

regular basis. If Zith was the only thing that would help, that'd be it

for me. Thankfully, that doesn't seem to be the case. The RA Spes at

$45/30 and Doxy at $12/60 seem to be doing the job. Whew!

--

Regards,

Geoff Crenshaw, ACC ----------------------

Managing Partner ** No Disclaimers **

Captain Cook's Cruise Center ----------------------

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geoff@...

" Behold now, Behemoth, which I made as well as you; He eats grass like

an ox. Behold now, his strength in his loins, and his power in the

muscles of his belly. He bends his tail like a cedar; The sinews of his

thighs are knit together. His bones are tubes of bronze; His limbs are

like bars of iron. He is the first of the ways of God. "

God speaking to Job...

[Guest guest]

Hey gang, I starting to feel like we need to make a concerted effort to

solve these hassles with the prescriptions. I see 3 recurring problems

1. Insurance wont pay for drug.

2> insurance wont pay for enough of drug.

3. insurance wont pay for iv.

Can we brainstorm here. These are my thoughts, please add to them.

!. If insurance wont pay,contest and appeal. You may also contest medicare

and medicaid decisions. Maybe by cost comparing other treatments to AP Or

presenting a copy of a medical study.

2. Most drug companies have an indigent drug program. You can get certain

drugs at little or no cost if you meet income guidelines. I have the book

at work including all the companies and there phone #s. I'll post the

address to request the book.

-3. Purchase the drugs through mail order programs, its cheaper.

4. Get samples from your GP.

5. For IVs , there is info in the Faq about purchasing supplies. People who

can administer might be public health, your gp, a nurse friend or a home

infusion agency if insurance wont pay.

Please add to my list of suggestions.

bvaughan@...---------

> From: Carol <carscott@...>

> rheumaticonelist

> Subject: Re: rheumatic prescription drugs - restrictions

> Date: Friday, July 09, 1999 8:35 AM

>

> From: Carol <carscott@...>

>

> Hi Mark,

> My insurance is Blue Shield and it will not pay for over 6 pills at

one

> time. Dr. Francos office even spoke with the insurance company and they

will

> not do it because it is not the " conventional " way that RA is treated.

So, I

> either have to pay for the other 16, which I'm afraid to ask how much

that

> will be, or we are waiting to see if the mycoplasma comes back positive

and

> hit them with that. I might of known someone would throw a monkey wrench

> into this new treatment. Oh and he did not ask for one of those zip packs

> either. He just ordered 20/4 per week. Dr. Francos nurse called me at

work

> with the great news.

> Regards,

> Carol **

>

>

>

> " HOLMES, MARK T. " wrote:

> >> > >

> >> > > Has anyone had trouble getting prescriptions for Zithromax for

longer

> >> > > than 5 days at a time? I have Blue Cross insurance and they will

only

> >> > > give me 5 days at a time (pharmacist explained that normally a 5

day

> >> > > course treats most people's symptoms, especially since this drug

stays

> >> > > in one's system for a long time - (not sure what a long time means

> >> > > here,but..) This means I have to make a 60 mile roundtrip voyage

> >> > > every 5 days to the drugstore , which is a royal pain.

> >> > >

> >> > > I also do not think they will allow me to have Celebrex either.

They

> >> > > faxed a form to my doctor and it was asking if I had bleeding

problems

> >> > > from current nsaids and my age, etc. The nurse suspected they

would

> >> > > not approve it due to the fact that I didn't meet criteria for the

> >> > > drug -( bleeding or stomach problems from other drugs, age,etc).

> >> > > Anyone else here taking Celebrex whose prescription plan tried to

> >> > > block it? I guess they would prefer I put a hole in my stomach,

pay

> >> > > for that operation (maybe they figure I'll just kick the bucket

and

> >> > > they'll be done with me!), rather than give me a medication that

might

> >> > > lessen the chances of me developing a problem. Weird.

> >> > >

> >> > > Bet they wouldn't let me have Enbrel either if I wanted it , if I

> >> > > hadn't tried methotrexate or other Dmards.

> >> > >

> >> > > Mark

> >> > >

> >> > >

> >> > >

> >> > >

> >> > > http://members.tripod.com/~Mark_Holmes

> >> > > http://www.bbonline.com/va/foxhill (Work)

> >> > > Member of the World Photo Gallery at

http://www.WorldPhotoGallery.com

> >> > >

> >> > >

> >

> >---------------------------

[Guest guest]

In many cases the Drs. won't even prescribe the drugs you need to medi-cal

pts. I have not had a scan to see what has fused in 15 years. If my condition

worsens my drs don't tell me. I am being cut off of the medications I need.

Brainstorm idea to go with my whine. The AMA just voted to unionize to

fight the hmos. One of their issues is insurance companies dictating quality

of health care.

We could try and contact them. Another possibility We could approach Harvey

Rose, MD, recently got a bill passed in Calif. saying Dr.S will not

sanctioned for prescribing long term drugs to ease pain of crionic diseases

that they have no known cure for. We couldapproach Harvey is we can find him.

Now Do not know where to find him, but if we are very lucky he could be the

same Harvey Rose I dated when I was 18 and worked at the county hospital

where he did his internship at. A quick poll:::: How many of us have worked

at one time or another in the health care profession. I was a reg dental

assistant. I worked in hospitals as a nurses Aide. If we can show that enough

of us worked in some way with the sick, before we got sick, or the elderly,

perhaps we could get someone like Harvey rose and his legistrative

connections to bring this subject up. Just a thought. Clinton is reforming

health care. I would urge you all to let him know your wishes on this as

well. Well all out of brain cells off to bingo and a smoothie

[Guest guest]

, Good idea!

Here is a link to indigent meds program info: www.needymeds.com and there

are others on the web.

One thing that insurance companies don't consider is the cost down the road,

if the disease is not treated aggressively enough. Joint replacements,

costly tests and other treatments will be more likely if early treatment is

neglected. Perhaps this could be factored in to an argument for more

agressive treatment, like IV's. Liz G

[Guest guest]

Hi Gang! Geoff Crenshaw here.

I don't have insurance so this little routine won't help me. But I DO

have decades of experience with bureaucracies, both government &

insurance that can help you. There is a way to make a fundamental change

in the way they choose to deal with these cases, and it does work. Call

this " insider info " ... but to do it you have to be willing to:

Be a bit insidious;

Be extremely organzied;

Be patient; AND

Be apparently unrelated in any obvious way...

BRIAN VAUGHAN wrote:

>

> From: " BRIAN VAUGHAN " <bvaughan@...>

>

> Hey gang, I starting to feel like we need to make a concerted effort to

> solve these hassles with the prescriptions. I see 3 recurring problems

>

> 1. Insurance wont pay for drug.

> 2. insurance wont pay for enough of drug.

> 3. insurance wont pay for iv.

>

> Can we brainstorm here. These are my thoughts, please add to them.

>

> 1. If insurance wont pay,contest and appeal. You may also contest medicare

> and medicaid decisions. Maybe by cost comparing other treatments to AP Or

> presenting a copy of a medical study.

This is conceptually close to what would work

> 2. Most drug companies have an indigent drug program. You can get certain

> drugs at little or no cost if you meet income guidelines. I have the book

> at work including all the companies and there phone #s. I'll post the

> address to request the book.

Different issue - don't mix the two, stay on track with one objective.

If *this* is the objective, abandon all others. Of course I have to ask

the obvious, if you are indigent how can you afford insurance?

> 3. Purchase the drugs through mail order programs, its cheaper.

Again - different issue, this time unrelated to the insurers.

> 4. Get samples from your GP.

Again - different issue, this time unrelated to the insurers.

> 5. For IVs , there is info in the FAQ about purchasing supplies. People who

> can administer might be public health, your gp, a nurse friend or a home

> infusion agency if insurance wont pay.

Again - different issue, this time unrelated to the insurers.

As far as insurers go, items 2, 3, 4, & 5 are unrelated and irrelevent.

If you want them to begin covering the protocol openly, here's your

drill:

POLL

1. Poll the members and determine how many

insurers you are working with. This would

be in the form of a brief question to the

existing list and to signups as part of the

signup routine...

*Do you have health insurance? Y / N

*If yes, with whom _________________

*This data is for statistical purposes only.

INTELLIGENCE

2. Determine inter-relatedness of the insurers,

e.g., do they have the same re-insurers, do

they operate under the same holding companies,

etc.?

Who are your legislators? Findout and store

info for all involved. Who are antagonistic

to insurers, who favor?

Who are the registered lobbyists? They all have

to be registered and those registrations show

whom they represent.

ASSESS

3. Depending on how many you are and how spread

out you are re: # of insurers dictates how to

go to step 4...

COORDINATE

4. If you are adequate numbers with few insurers,

e.g., 500 with BC, 200 with Kaiser, rest

miscellaneous:

Create a submission time table. Say there are

500, then 10 on day 1 submit (doubtless different

local offices).. 10 day THREE, 10 day FIVE.

Every other BUSINESS day spanning at least

three months (like last 2 weeks, full mo, first

2 weeks) and varied by week - wk 1: M/W/F (you can

all do that, right? Dope day is letter day?), next

week Tu/Th, next M/W/Th, next Tu/Th/F then back

to M/W/F and repeat the routine.

Track EVERYTHING, phone calls, turn downs, etc.

What you are doing is creating the " impression "

of a broad spread groundswell of medical support.

The idea here is that eventually in the process,

these claims will all get to the same general place.

(This is one time to be gratefull for consolidation.

With some insurers, the claims will all hit the same

same bldg, regardless of where you are, the claim

center!)

PHASE I

5. Once you have got evertyhing planned and settled,

once you have a CENTRAL REGISTRY to whom all

data will be submitted and from whom assignments

will come forth, THEN start.

PHASE II

6. Keep this going until 80% of submissions have

gone in. You will probably have isolated approvals,

lots of disapprovals, etc. It is important to

keep a central registry of EVERYTHING. The approvals

will be very important later.

At 80% submitted, begin the appeal process. Use

the approval data (not names - but local office

info like BS/BC Kentucky) to reinforce the appeal.

PHASE III

7. While continuing submission of the remaining 20%

of claims, begin the SAME process on the appeals

but slip the submission dates 1-day to a different

schedule. Now the companies are clogging down.

they are getting gobs of claims and appeals and

they appear to be falling out of the sky like

rain drops with no end in sight.

REINFORCE

8. Poll new members to the list, join them in the

endeavor.

PROPAGANDA PHASE I

9. Enlist the aid of your legislators (saber rattling)

to make at least an ever-so-slight noise at your

state Capitol (NOT national)...

At 30% of the appeals submitted, start writing

letters to your legislators. Follow the same

sequence and process. Offer up about 20:1 nonemotive

to emotional. Nonemotive stress loss of productivity,

harm to economy, society, burden to business. Emotive

stress pain, loss, family, etc.

PROPAGANDA PHASE II

10. Pass the legislators info about amongst yourselves

after writing to yours, next time write to somebody

elses. Use their return address. The appearance

here is lots of *MY CONSTITUENTS* with this problem.

What you are banking on is that these letters are

handled on an alpha routine (filed by names) vs situs

(filed by address) -- which they are.

So maybe there is only 1 of us in Doe's

district. By the time we're done, we are 3 (no

more than 3 from the same address - spread by

weeks).

Truly insidious? Use somebody elses address - you

really don't care about the response - you want

them to gossip at lunch during sessions.

DAMAGE ASSESMENT

11. By now you should have three things going well,

1. wheels of bureaucracy slowed to near stop

2. attention of bureaucrats at insurers

3. saber rattling on capitol hill

INFILTRATE & EXTRACT

12. Now write letters to those legislators who are

pro-insurance, and to the insurers lobbyists.

Complain that you are hearing about your profits

being impacted by all of these claims - assert

pain & anger at your dollar loss and suggest there

be a " deal " brokered to smooth this whole thing

out and make it go away.

*IF* you have done this right, all else will flow without intervention,

i.e., policy changes will come forth, legislators will generate " I am

great " letters and you will have your treatments paid for.

According to the posts I've watched here the last year or so,

collectively the concepts are right, but you lack a coordinated and

cohesive plan. You may not have enough people to make it all work

though. That's really the problem.

You can appear to be more than you are to the politicians by swapping

mail stuff - no crime in that. But you *CANNOT* swap claims with

insurers as that would be fraud so there is no practical way to increase

your apparent numbers there. You do need a fairly good number of people

with a common insurer. If you don't have the people, forget it. Then you

have to do the Joan of Arc routine and we all know what happned to her.

BTW, some of the intelligence, re-insurers and the like, lends itself to

knowing which insurance company to target for the campaign. Once one

drops, the movement on others following will be easier as the one that

changed policy can be pointed to as the Judas goat. It will also open

avenues to corporate BOD (Board Of Dircetors) intervention and a

slightly different style of campaign.

BTW, the BOD are the folks concerned with profits - not the clerks we

deal with. Our clerks, be they adjusters, managers, clerical, doctors,

nurses, appeal supervisors, whatever - just want to get paid, go home,

watch TV, buy the new car and be left alone -- like most of us.

Your tax dollars at work.

--

Regards,

Geoff Crenshaw, ACC ----------------------

Managing Partner ** No Disclaimers **

Captain Cook's Cruise Center ----------------------

----------------------------------------------------------------------

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geoff@...

" Behold now, Behemoth, which I made as well as you; He eats grass like

an ox. Behold now, his strength in his loins, and his power in the

muscles of his belly. He bends his tail like a cedar; The sinews of his

thighs are knit together. His bones are tubes of bronze; His limbs are

like bars of iron. He is the first of the ways of God. "

God speaking to Job...

[Guest guest]

Gee, I feel rather simple minded. It sounds a little like the Alices

Restaraunt Thanksgiving Day Massacree. Pretty soon the whole nation is

singing " you can get anything you want " .

Well its not impossible. But there are 300 active support group members,

from all over the place. I imagine some are on medicare/medicaid, some on a

socialized medicine plan, some on HMO Kaiser style, some on Blue

Cross/BlueShield style, Some with self insured companies(like myself), snd

some with none. Complicating this is the variety of plans within the single

company. So if there is enough interest we could conduct a poll. I get the

impression that many of us are being covered for care at least in part.

My thoughts were to look for options if your insurance company would not

pay. Is this just to much of a task for this group? Geoff, perhaps you

ought to head up a non-profit, at least -assist Ra;lph Nader in some

capacity.

---------

> From: Geoff Crenshaw <geoff@...>

> RA Support Group <rheumaticonelist>

> Subject: Re: rheumatic prescription drugs - restrictions

> Date: Sunday, July 11, 1999 8:14 AM

>

> From: Geoff Crenshaw <geoff@...>

>

> Hi Gang! Geoff Crenshaw here.

>

> I don't have insurance so this little routine won't help me. But I DO

> have decades of experience with bureaucracies, both government &

> insurance that can help you. There is a way to make a fundamental change

> in the way they choose to deal with these cases, and it does work. Call

> this " insider info " ... but to do it you have to be willing to:

>

> Be a bit insidious;

> Be extremely organzied;

> Be patient; AND

> Be apparently unrelated in any obvious way...

>

> BRIAN VAUGHAN wrote:

> >

> > From: " BRIAN VAUGHAN " <bvaughan@...>

> >

> > Hey gang, I starting to feel like we need to make a concerted effort to

> > solve these hassles with the prescriptions. I see 3 recurring problems

> >

> > 1. Insurance wont pay for drug.

> > 2. insurance wont pay for enough of drug.

> > 3. insurance wont pay for iv.

> >

> > Can we brainstorm here. These are my thoughts, please add to them.

> >

> > 1. If insurance wont pay,contest and appeal. You may also contest

medicare

> > and medicaid decisions. Maybe by cost comparing other treatments to AP

Or

> > presenting a copy of a medical study.

>

> This is conceptually close to what would work

>

> > 2. Most drug companies have an indigent drug program. You can get

certain

> > drugs at little or no cost if you meet income guidelines. I have the

book

> > at work including all the companies and there phone #s. I'll post the

> > address to request the book.

>

> Different issue - don't mix the two, stay on track with one objective.

> If *this* is the objective, abandon all others. Of course I have to ask

> the obvious, if you are indigent how can you afford insurance?

>

> > 3. Purchase the drugs through mail order programs, its cheaper.

>

> Again - different issue, this time unrelated to the insurers.

>

> > 4. Get samples from your GP.

>

> Again - different issue, this time unrelated to the insurers.

>

> > 5. For IVs , there is info in the FAQ about purchasing supplies. People

who

> > can administer might be public health, your gp, a nurse friend or a

home

> > infusion agency if insurance wont pay.

>

> Again - different issue, this time unrelated to the insurers.

>

> As far as insurers go, items 2, 3, 4, & 5 are unrelated and irrelevent.

> If you want them to begin covering the protocol openly, here's your

> drill:

>

> POLL

> 1. Poll the members and determine how many

> insurers you are working with. This would

> be in the form of a brief question to the

> existing list and to signups as part of the

> signup routine...

> *Do you have health insurance? Y / N

> *If yes, with whom _________________

>

> *This data is for statistical purposes only.

>

> INTELLIGENCE

> 2. Determine inter-relatedness of the insurers,

> e.g., do they have the same re-insurers, do

> they operate under the same holding companies,

> etc.?

>

> Who are your legislators? Findout and store

> info for all involved. Who are antagonistic

> to insurers, who favor?

>

> Who are the registered lobbyists? They all have

> to be registered and those registrations show

> whom they represent.

>

> ASSESS

> 3. Depending on how many you are and how spread

> out you are re: # of insurers dictates how to

> go to step 4...

>

> COORDINATE

> 4. If you are adequate numbers with few insurers,

> e.g., 500 with BC, 200 with Kaiser, rest

> miscellaneous:

>

> Create a submission time table. Say there are

> 500, then 10 on day 1 submit (doubtless different

> local offices).. 10 day THREE, 10 day FIVE.

> Every other BUSINESS day spanning at least

> three months (like last 2 weeks, full mo, first

> 2 weeks) and varied by week - wk 1: M/W/F (you can

> all do that, right? Dope day is letter day?), next

> week Tu/Th, next M/W/Th, next Tu/Th/F then back

> to M/W/F and repeat the routine.

>

> Track EVERYTHING, phone calls, turn downs, etc.

> What you are doing is creating the " impression "

> of a broad spread groundswell of medical support.

>

> The idea here is that eventually in the process,

> these claims will all get to the same general place.

> (This is one time to be gratefull for consolidation.

> With some insurers, the claims will all hit the same

> same bldg, regardless of where you are, the claim

> center!)

>

> PHASE I

> 5. Once you have got evertyhing planned and settled,

> once you have a CENTRAL REGISTRY to whom all

> data will be submitted and from whom assignments

> will come forth, THEN start.

>

> PHASE II

> 6. Keep this going until 80% of submissions have

> gone in. You will probably have isolated approvals,

> lots of disapprovals, etc. It is important to

> keep a central registry of EVERYTHING. The approvals

> will be very important later.

>

> At 80% submitted, begin the appeal process. Use

> the approval data (not names - but local office

> info like BS/BC Kentucky) to reinforce the appeal.

>

> PHASE III

> 7. While continuing submission of the remaining 20%

> of claims, begin the SAME process on the appeals

> but slip the submission dates 1-day to a different

> schedule. Now the companies are clogging down.

> they are getting gobs of claims and appeals and

> they appear to be falling out of the sky like

> rain drops with no end in sight.

>

> REINFORCE

> 8. Poll new members to the list, join them in the

> endeavor.

>

> PROPAGANDA PHASE I

> 9. Enlist the aid of your legislators (saber rattling)

> to make at least an ever-so-slight noise at your

> state Capitol (NOT national)...

>

> At 30% of the appeals submitted, start writing

> letters to your legislators. Follow the same

> sequence and process. Offer up about 20:1 nonemotive

> to emotional. Nonemotive stress loss of productivity,

> harm to economy, society, burden to business. Emotive

> stress pain, loss, family, etc.

>

> PROPAGANDA PHASE II

> 10. Pass the legislators info about amongst yourselves

> after writing to yours, next time write to somebody

> elses. Use their return address. The appearance

> here is lots of *MY CONSTITUENTS* with this problem.

> What you are banking on is that these letters are

> handled on an alpha routine (filed by names) vs situs

> (filed by address) -- which they are.

>

> So maybe there is only 1 of us in Doe's

> district. By the time we're done, we are 3 (no

> more than 3 from the same address - spread by

> weeks).

>

> Truly insidious? Use somebody elses address - you

> really don't care about the response - you want

> them to gossip at lunch during sessions.

>

> DAMAGE ASSESMENT

> 11. By now you should have three things going well,

> 1. wheels of bureaucracy slowed to near stop

> 2. attention of bureaucrats at insurers

> 3. saber rattling on capitol hill

>

> INFILTRATE & EXTRACT

> 12. Now write letters to those legislators who are

> pro-insurance, and to the insurers lobbyists.

> Complain that you are hearing about your profits

> being impacted by all of these claims - assert

> pain & anger at your dollar loss and suggest there

> be a " deal " brokered to smooth this whole thing

> out and make it go away.

>

> *IF* you have done this right, all else will flow without intervention,

> i.e., policy changes will come forth, legislators will generate " I am

> great " letters and you will have your treatments paid for.

>

> According to the posts I've watched here the last year or so,

> collectively the concepts are right, but you lack a coordinated and

> cohesive plan. You may not have enough people to make it all work

> though. That's really the problem.

>

> You can appear to be more than you are to the politicians by swapping

> mail stuff - no crime in that. But you *CANNOT* swap claims with

> insurers as that would be fraud so there is no practical way to increase

> your apparent numbers there. You do need a fairly good number of people

> with a common insurer. If you don't have the people, forget it. Then you

> have to do the Joan of Arc routine and we all know what happned to her.

>

> BTW, some of the intelligence, re-insurers and the like, lends itself to

> knowing which insurance company to target for the campaign. Once one

> drops, the movement on others following will be easier as the one that

> changed policy can be pointed to as the Judas goat. It will also open

> avenues to corporate BOD (Board Of Dircetors) intervention and a

> slightly different style of campaign.

>

> BTW, the BOD are the folks concerned with profits - not the clerks we

> deal with. Our clerks, be they adjusters, managers, clerical, doctors,

> nurses, appeal supervisors, whatever - just want to get paid, go home,

> watch TV, buy the new car and be left alone -- like most of us.

>

> Your tax dollars at work.

> --

> Regards,

>

> Geoff Crenshaw, ACC ----------------------

> Managing Partner ** No Disclaimers **

> Captain Cook's Cruise Center ----------------------

> ----------------------------------------------------------------------

> Over 3,000 daily cruise & tour specials > Top 5% of Web Sites

> http://www.800-800-cruise.com [specials] > Top 100 Travel Sites

> . > Top Web Sites for

> Cruise tips New Zealanders

> http://www.800-800-cruise.com [tips]

>

> USA PH: 800-800-CRUIse PH: 559-636-8413 FAX: 559-734-1420

> ----------------------------------------------------------------------

> geoff@...

>

> " Behold now, Behemoth, which I made as well as you; He eats grass like

> an ox. Behold now, his strength in his loins, and his power in the

> muscles of his belly. He bends his tail like a cedar; The sinews of his

> thighs are knit together. His bones are tubes of bronze; His limbs are

> like bars of iron. He is the first of the ways of God. "

>

> God speaking to Job...

>

> ---------------------------

[Guest guest]

BRIAN VAUGHAN wrote:

>

> Gee, I feel rather simple minded. It sounds a little like the Alices

> Restaraunt Thanksgiving Day Massacree. Pretty soon the whole nation is

> singing " you can get anything you want " .

...at Alice's res-tow-raunt. (ha, ha, ha)

> Well its not impossible. But there are 300 active support group members,

> from all over the place. I imagine some are on medicare/medicaid, some on a

> socialized medicine plan, some on HMO Kaiser style, some on Blue

> Cross/BlueShield style, Some with self insured companies(like myself), snd

> some with none. Complicating this is the variety of plans within the single

> company. So if there is enough interest we could conduct a poll. I get the

> impression that many of us are being covered for care at least in part.

Too much diversity, not enough people. Unless there is commonality the

concept wouldn't work. 300 would be hard anyway, unless all same

company...

> My thoughts were to look for options if your insurance company would not

> pay. Is this just to much of a task for this group? Geoff, perhaps you

Much better idea than mine.

> ought to head up a non-profit, at least -assist Ra;lph Nader in some

> capacity.

No, no, no - not me - you've got the wrong Geoff. I'm busy trying to

sell enough vacations to pay the bills and keep the doctors at bay!

--

Regards,

Geoff Crenshaw, ACC ----------------------

Managing Partner ** No Disclaimers **

Captain Cook's Cruise Center ----------------------

----------------------------------------------------------------------

Over 3,000 daily cruise & tour specials > Top 5% of Web Sites

http://www.800-800-cruise.com [specials] > Top 100 Travel Sites

.. > Top Web Sites for

Cruise tips New Zealanders

http://www.800-800-cruise.com [tips]

USA PH: 800-800-CRUIse PH: 559-636-8413 FAX: 559-734-1420

----------------------------------------------------------------------

geoff@...

" Behold now, Behemoth, which I made as well as you; He eats grass like

an ox. Behold now, his strength in his loins, and his power in the

muscles of his belly. He bends his tail like a cedar; The sinews of his

thighs are knit together. His bones are tubes of bronze; His limbs are

like bars of iron. He is the first of the ways of God. "

God speaking to Job...

[Guest guest]

In a message dated 7/11/99 9:13:31 AM Pacific Daylight Time,

bvaughan@... writes:

<< It sounds a little like the Alice's

Restaurant Thanksgiving Day Massacre. Pretty soon the whole nation is

singing " you can get anything you want, " >>

Wow I sure hope so! Geoff I saved your list of how too cause I know a

progressive Calif. town like mine can sure use this plan to get ahead! Good

footwork! when ya get to the part in the Alice's restaurant movie /

song where the hot tub is available for bathing in the church, let me know

I'll bring the Epsom salts:::::and my own towel LOL

[Guest guest]

In a message dated 7/11/99 6:07:41 AM Eastern Daylight Time, KPSB2@...

writes:

> A quick poll:::: How many of us have worked

> at one time or another in the health care profession.

Psychologist in hospital & outpatient setting.

[Guest guest]

Hi, I worked in many different hospitals as a RN over the last 35 or so

years.

cooky

RTC@... wrote:

>

> From: RTC@...

>

> In a message dated 7/11/99 6:07:41 AM Eastern Daylight Time, KPSB2@...

> writes:

>

> > A quick poll:::: How many of us have worked

> > at one time or another in the health care profession.

> Psychologist in hospital & outpatient setting.

>

> ---------------------------

[Guest guest]

I worked as a paramedic from 1978-1980. Worked in molecular biology lab (not

medical setting) from 1993-1998.

Jan K

>

> RTC@... wrote:

> >

> > From: RTC@...

> >

> > In a message dated 7/11/99 6:07:41 AM Eastern Daylight Time, KPSB2@...

> > writes:

> >

> > > A quick poll:::: How many of us have worked

> > > at one time or another in the health care profession.

> > Psychologist in hospital & outpatient setting.

> >

> > ---------------------------

[Guest guest]

Wow that makes 4 of us. BTW my best friend a got her MS from working in

Dacha an immunology lab that worked on making imugoblinsvshe became ill when

a vial broke and cut her hand also she was working with no gloves or masks.

:-)So I guess that makes 5 of us.

[Guest guest]

From Mado:

I worked for only 6 months in a hospital and I have RA for 7 yrs.

Re: rheumatic prescription drugs - restrictions

>From: RTC@...

>

>In a message dated 7/11/99 6:07:41 AM Eastern Daylight Time, KPSB2@...

>writes:

>

>> A quick poll:::: How many of us have worked

>> at one time or another in the health care profession.

>Psychologist in hospital & outpatient setting.

>

>---------------------------

[Guest guest]

Hi Mark,

My insurance is Blue Shield and it will not pay for over 6 pills at one

time. Dr. Francos office even spoke with the insurance company and they will

not do it because it is not the " conventional " way that RA is treated. So, I

either have to pay for the other 16, which I'm afraid to ask how much that

will be, or we are waiting to see if the mycoplasma comes back positive and

hit them with that. I might of known someone would throw a monkey wrench

into this new treatment. Oh and he did not ask for one of those zip packs

either. He just ordered 20/4 per week. Dr. Francos nurse called me at work

with the great news.

Regards,

Carol **

" HOLMES, MARK T. " wrote:

>> > >

>> > > Has anyone had trouble getting prescriptions for Zithromax for longer

>> > > than 5 days at a time? I have Blue Cross insurance and they will only

>> > > give me 5 days at a time (pharmacist explained that normally a 5 day

>> > > course treats most people's symptoms, especially since this drug stays

>> > > in one's system for a long time - (not sure what a long time means

>> > > here,but..) This means I have to make a 60 mile roundtrip voyage

>> > > every 5 days to the drugstore , which is a royal pain.

>> > >

>> > > I also do not think they will allow me to have Celebrex either. They

>> > > faxed a form to my doctor and it was asking if I had bleeding problems

>> > > from current nsaids and my age, etc. The nurse suspected they would

>> > > not approve it due to the fact that I didn't meet criteria for the

>> > > drug -( bleeding or stomach problems from other drugs, age,etc).

>> > > Anyone else here taking Celebrex whose prescription plan tried to

>> > > block it? I guess they would prefer I put a hole in my stomach, pay

>> > > for that operation (maybe they figure I'll just kick the bucket and

>> > > they'll be done with me!), rather than give me a medication that might

>> > > lessen the chances of me developing a problem. Weird.

>> > >

>> > > Bet they wouldn't let me have Enbrel either if I wanted it , if I

>> > > hadn't tried methotrexate or other Dmards.

>> > >

>> > > Mark

>> > >

>> > >

>> > >

>> > >

>> > > http://members.tripod.com/~Mark_Holmes

>> > > http://www.bbonline.com/va/foxhill (Work)

>> > > Member of the World Photo Gallery at http://www.WorldPhotoGallery.com

>> > >

>> > >

>

>---------------------------