a letter from my insurance

[helloos]

I am not sure where to put this post so if you must move it please do.

I just received a letter from my insurance company - I am in USA and it is a program they have that they assign a nurse to you for your chronic problem as they put it. It lists some illnesses like ms, lupus, etc. and says if you have one to check off and mail back or the nurse will call you. The nurse is to help you with prescriptions, understand your disease, there 24 hours a day to answer your medical questions, help keep you healthy so you don't need to spend money on co-pays, etc. and have unnecessary testing, etc. and to give you information about your illness. Now, here is my thought on it. The part about unnecessary visits to the doctors, etc. of course they are trying to save themselves money but do you think that they could regulate your visits and go over your doctor's choice? If you don't mail back the nurse is going to call you to discuss all of this. It is suppose to be a support system with your own nurse to HELP you. Why am I seeing the negative end of this and has anyone ever had this before? I just don't want some nurse telling me, don't go to the docs, don't take this, don't take that, not necessary or am I wrong and it won't be like that?

[Clare.T]

Paula, this sounds the same sort of thing as this thread

http://www.thelupussite.com/forum/index.php?showtopic=29117

Clare

[helloos]

Clare !

It is the same thing. The same company too. I just didn't want to write the name on here because I didn't think we could.

So I think from what I read, it probably is for their benefit. I am going to decline this when the nurse calls and just state that I am happy with my doctor and they answer all my questions.

I think once we open up the door to the insurance company talking to you about your health and assigning you someone you may be opening up the door to an undiagnosis, or denial of proper treatment if they choose what you are doing is not right.

Very interesting and thanks for you fast response. You have a good memory.

[wifajax]

Hi Paula!

I was the HR manager for a large company until earlier this year. Our insurance company approached us with this type of program, too, on both the pharmacy and medical sides. Their goal was to save money (duh!) by making sure your doctor was prescribing generics whenever possible, for example. But, in their defense, the program was also designed to help safeguard the patient. The nurse was there to make sure the doctor was providing the generally accepted "best" care for the disease. So, if your doctor didn't prescribe Plaq for your lupus, the nurse contacted the doctor to find out why. Or if the doctor doesn't run all the "right" tests, they ask why. They make sure your medicines don't interact dangerously. However, they DID NOT tell your doctor what he can and can't do to treat you. (At least not the one I was familiar with.)

Their selling point was they they have the time and manpower to keep up with the latest research on disease management and drug therapies. Many doctors don't have the time (or desire) to keep up with the latest technology. As we all know, patients can suffer because of that.

Yes, it seems like they want to interfere in the relationship between you and your doctor. If you have a great doctor that you are happy with, then why on earth would you want them involved? But, if you have a doctor that doesn't listen to you, or treat your symptoms, or is padding his pockets by running a million tests, the program can be a good way for you to have someone looking over his shoulder.

Of course, I don't know the specifics of your program, but a lot of insurance companies are going to this kind of thing.

Terri

[zara]

Personally, i wouldn't want some nurse in the mix who doesn't know me, hasn't seen me and has not had the training that my primary has had. They may claim to be up on the latest and greatest research, but I trust my doctor to interpret the research and how it relates to my case in particular. My primary has had years more education and clinical experience than an admin nurse and I wouldn't want her bothered by this program.

[raggedyann1]

Hi all,

As I said on the other thread Medicare is running a more extensive pilot program along these lines, their program includes a doctor who does housecalls and it is just the sickest patients who are involved in the pilot.

Cigna also has a program like the Accordant one.

I personally at this point wouldn't get involved in one as I have an excellent team of doctors and have my diagnosis. I am also fairly well educated in my diseases and their complications and treatments.

I think for many of our members here who are struggling to get diagnosed or having problems getting adequate care for their disease could benefit from a program like this. Unfortunately most GP's are totally under educated with Connective Tissue Diseases as a whole. Even most rheumatologists are totally uneducated in Connective Tissue Diseases. That is why 20% of the rheumatologists in the usa diagnose 80% of all lupus. So if a company is including a disease like lupus in their program their nurses are being educated pretty thoroughly in the disease. They can do this since they are going to be focused on just a few diseases unlike nurses elsewhere.

I know there is the whole sense of Big Brother and it makes us jump back and think about it. The insurance companies already know what we are dx'd with and what medications we are taking. They know what doctors we are seeing.

I am not saying that Paula should sign up for the program. What would it hurt for a patient to try it out and then later on down the line say that it is only taking up your time talking with the nurse once a month. The majority of patients are not well educated in their disease and treatments.

Karen

[helloos]

I got the call last night. A woman who started to say where she was from, blah blah, if I still had the same insurance, blah, blah and then said you can be eligible for our services if you have been diagnosed with RA, Lupus, - I cut her off and said I got your letter, I am not interested at this time, and the reason I did not call is I am not 100% diagnosed. Figure that is a good end to that one. She said ok, do you want our newsletter? I said no thank you. Ended it like that. Of course I don't know what my medical records say as for if 100% Lupus diagnosis or 99% Lupus diagnosis and don't really care, it got me out of the situation quite quickly.