Received a letter from health insurance company
Posted 15 January 2011 - 01:56 PM
A form to fill out to "enroll" was enclosed. The letter lists some conditions that qualify for this service which includes scleroderma.
I don't know whether this is a good thing (I would love to have some tell me what's what) or a bad thing (is the point to interfere with expensive treatment.)
Anyone involved in something like this?
I have a real problem in that I have a very good internist as my primary physician but he is in a group that includes the rheumatologist I see (I find her very unhelpful) and the gastroenterologist (who I also like.) It would be good to get more information on stuff but are they supporting the insurance company or me? I will ask my primary doctor what he thinks before I sign up no matter what- he is a sort of authoritarian type doctor but has been better than any I've seen in years.
Posted 15 January 2011 - 04:18 PM
The most recent event was a booklet from the company that makes the pulmonary hypertension drug I am on giving me info on how to argue with the insurance companies and/or Medicare/Medicate to get them to cover the drug AND appointing a case manager for me to liaise with. Do they know something I don't? Very alarming, to say the least.
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Posted 15 January 2011 - 05:48 PM
On one occasion I got a call to help me with my "congestive heart failure", which I don't have. They probably drew a false conclusion from pulmonary hypertension.
They don't seem sneaky - but seemed meant more for patients who aren't researching common conditions.
When we consider the importance of finding an expert, and how few doctors have experience with this disease, it seems unlikely that a telephone nurse would have anything to offer. At least that's how it seems to me...
Posted 16 January 2011 - 12:28 AM
Reading your posts makes me realise how lucky we are here in Australia to have a "free" medical system.
Our members can go to an expert scleroderma specialist at a public hospital with no out-of-pocket expenses. The hard part is finding the right "expert".
Recently my daughter visited the emergency department of a large hospital in the western suburbs of Melbourne. The young doctor recognised immediately that she had scleroderma and the nurse on duty, without asking, offered her an extra blanket! They took into account all her special needs.
Scleroderma Victoria helps fund two scleroderma specialty clinical nurses at two scleroderma clincis who are available on the phone or for visits regarding wound care and other issues. We feel that this is a great way of supporting our members. They also ensure that when a patient visits their doctor that all appointments for tests, ie lung function, scans, bone density, are arranged for the same day. It certainly goes a long way to helping with stress.
When reading some of your posts I can see that your medical system can be very hard for those with a chronic disease.
Posted 16 January 2011 - 05:12 AM
I assume I got a nurse case manager in response to the very unusual event of an asthma attack. I guess they are there just to keep track of you in an attempt to reduce costly interventions such as the E.R. I probably got a black mark against my name when I opted out. Like others here I am doubtful it would be a helpful service if you already have good care.
Posted 16 January 2011 - 05:20 AM
My issue with the original post is whether this "service" will be a help or a hinderance to getting the care I need. I'm still hoping to hear from someone who has used it- so far most people seemed to have been cautious in using this sort of thing.
Posted 16 January 2011 - 09:45 AM
I just posted an article on the success of Team-based treatment for chronically ill patients like us, so be sure to take a look at it. It might provide you some information as well.
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Posted 16 January 2011 - 01:42 PM
Posted 17 January 2011 - 07:18 AM
Will you let us know what becomes of this, and whether you find the service helpful, or not?
I haven't had any offers like this, but my health insurance company has a nurse's hotline which I find very helpful. They are great on advising how serious symptoms are, whether I should go to ER or self-treat or go to the doctor, and so on. Especially with chronic illness, sometimes there's quite a quandary as to how soon you need to be seen for certain things, or which doctor or specialist to consult about it first. This sounds very different from what you are describing, though. So I'm curious as to how it turns out for you.
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