Am I a "special" patient?

[sfbaygirl]

Had another consult with a hepatologist through my ins. co yesterday when they decided they won't pay for CPMC. I thought I would go and do my due diligence to get ammo for my appeal for them to pay for whom I want to go to. This dr. said he believes my 10 week PCR was UND (although he actually read it and said maybe it is written incorrectly and is conflicting) He said it doesn't matter anyway, because I had at least a 2 log drop and that is all they care about. I said this is old research and I knew it. I showed him my binder and reports, stating I should extend to 60 weeks. I think he is a buddy of my GI and said he agreed with him that I go 48 weeks. He said anything else is NOT FDA approved and I will have a hard time getting approval for scripts. After awhile he said, he may consider letting me extend and said I was a very special patient. He said he has never heard anyone WANT to extend. I said I don't, but with that 10 week PCR plus Dr. F's report I am concerned about relapse and repeating tx givin studies showing that do it the first time, better chance of SVR. Why does such a network-HeathNet have such backwards ways? They won't go by the new reseach, but the SOC that was approved a long time ago. He also said I could just pay CPMC for the extension, since the group I am in won't do it most likely....It's scary that this is what we have to deal with, not new findings, but the ol' 2 log drop at 12 weeks? No PCR's until then etc. What do you guys think?

PS. How do I get to the otherside?

[MissMiss]

You have really hit several nails right on!

When I first went to my PCP asking about cryo, he said he just had a patient who had it pretty bad and was researching it further.  He had already referred the fella to another doctor and actually found someone in my small neck of the woods familiar with cryo.  

That's one reason to keep him around.  Other reasons abound to start looking for someone else.  lol

miss

[jmjm530]

Talking about lazy and stupid -- or let's say overworked and uninformed -- I saw a very good ENT for LPR GERD during tx. When I asked at the first meeting how the tx drugs might affect GERD he said he really didn't know much about HCV treatment. Fair enough, lots of diseases to keep up on these days. BUT... I continued to see him for close to a year and when I asked the same question six months later, his response was identical -- I really don't know much about HCV treatment.

Now, in the real world this type of attitude would get the doctor fired by all his patients and he'd end up living in a dumpster. If one of my clients ask me something I don't know about, guess what I do next -- hey, I do a little research and find the answers. In all too many cases doctors simply don't do this. Here I am, his patient for over a year treating for HCV and you would think that at some point he'd spend an hour or two researching out the treatment I'm on and how it may relate to my ENT symptons. Keep dreaming, Jim, keep dreaming. And I should mention again that this was one of the *good* doctors I saw.

[mikesimon]

You said: "guess what I was saying in a long-winded way is that many doctors offices are lazy and stupid -- or in nicer terms, overworked and underinformed. Be sure that when someone in the doctor's family needs a test or drug, approvals will be had."
I agree with you 100%. I would only add that it's not just the doctors' offices that fit this description - it's also the doctors themselves who are at times lazy and stupid and/or unwilling to educate themselves and do what is best for the patient. Sometimes they just flat out don't know what's going on with HCV and I can only imagine what they know about the treatment of other chronic diseases.
Mike

[jmjm530]

While I'm on this rant, I should say that I have the utmost sympathy for those stuck with an inflexible doctor either because of geography, insurance or other reasons. I consider myself very lucky that I was able to choose among several and end up with one who basically became a partner in my tx as opposed to someone laying out the law. I ran into the latter with a well known dermatologist who I saw for some skin problems. After asking him to run a couple of reasonable blood tests -- Lyme, Syphillis and an automimmune panel I believe -- (which my hep doctor ran a week later as he thought they all were a good idea ) the derm said  "I will not run any blood tests on you, I have made my diagnosis". Then he went on to call the idea of running the tests "stupid". You can imagine how well that flew while I was flying on riba. LOL. Well, from what I read here, it appears that some have this type of doctor and all I can say is that I'm sorry because there is no way this type of doctor will do anything but what they want to. I stuck with him while I needed him cause he did have some very specific knowledge I needed but then dumped him as soon as I could. That's it for my doctor rant of the day and fortunatly there are as many exceptions as the rule. Did I mention I had drinks with my hep doc the other day :) Hopefully no one else is reading this far down. LOL.

-- Jim

[jmjm530]

guess what I was saying in a long-winded way is that many doctors offices are lazy and stupid -- or in nicer terms, overworked and underinformed. Be sure that when someone in the doctor's family needs a test or drug, approvals will be had.

-- Jim

[jmjm530]

FR: Say - have you pushed that 59 to 60 yet?????
------------------------------------------------
For some reason, I don't think that is going to happen for another ten years or so. I mean aren't they saying that "60" is the new "40". Well, I'm kinda of a cutting edge guy so I'll go with the new numbers :)
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Back to the insurance companies -- in most cases they will do whatever tests and treatments the doctors prescribe, assuming the doctor's office follows the necessary protocols. The problem is that some doctors not experienced in extended treatment, etc, stop trying after they hit the first hurdle which is usually simply administrative. Actually, the doctors don't stop, it's usually some secretary who was promoted to  insurance liasion who stops, who then tells the nurse who tells the doctor who then tells all the patients that the insurance company will not do it. I remember running into this problem when I needed double Nexium for my LPR GERD. My GP's office told me they wouldn't approve the double dose. My ENT's office got it approved. That's because they made the extra one or two calls and understood the criteria for getting a double dose approved. Same thing happened with my HCV tx. I was initially told I'd have to "fight" for a 4-week PCR. Then I switched doctors -- not insurance companies mind you -- and low and behold I got WEEKLY PCR's without any problem. The new doctor didn't have any pull with the insurance company, simply had enough experience to know that the tests would be approved if he wrote the rx and filled out whatever requistie paperwork was needed and in the case of the viral load tests I don't believe there was any extra paperwork.

-- Jim