Dr refused to order 4 wk post labs

[amberegg]

I am 4weeks post and asked my doctor for pcr. She refused saying that it was not necessary. Where is the study that states UND @ 4weeks post statisticly increase SVR rate. She wants to wait until 6 months! I can't believe that she won't order one just to ease my mind.Other that that doing great

[Drarig]

My doc wasn't going to do 24 wk pcr (when I was halfway thru tx) & I pleaded with him to do one so I didn't have to go another whole 24 weeks without knowing if it came back.  Not only did he agree to do it, but he also stated he would do it for other patients as well.   I finished tx end of January & he did do a post 4 wk pcr which came back still und.  He told me he did not believe in doing anything now until 6 months because if it came back, there's nothing we can do anyway for awhile.  So I really feel for you, it's a long wait to find out if it worked.  Maybe ask your doc again & tell him it will really help you not to worry, maybe he'll change his mind.  Sometimes they don't because of insurance reasons.  Try to keep your chin up & stay positive. Good luck.

[Kit07]

Hi this an excerpt form a recent technical article in the Journal of the American Medical Association.  You can search www.natap.org and www.pubmed.gov for EVR and RVR (early virological response and rapid virological response.)  Also Google.  I  can't believe your doctor wouldn't at least order a 12 week PCR!

Good luck
Kit

Molecular diagnostics of hepatitis C virus infection: a systematic review.
JAMA. 2007 Feb 21;297(7):724-32

"Recent studies suggest that the rate of response to therapy is also important. For example, conversion to an HCV RNA negative test result after 4 weeks of therapy constitutes a rapid virological response and is a strong predictor of treatment success.....Monitoring HCV RNA during treatment provides important information on likelihood of sustained virological
response. "

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17312292&query_hl=7&itool=pubmed_docsum

[amberegg]

I am post tx. She ordered the PCR's with no problem throughout treatment. She just doesn't seem to believe that at 4 weeks after tx if complete that it would indicate SVR

[mremeet]

If your doctor won't listen to reason and/or take into account the published studies on the value of a 4 wk PCR, then go to a GP. I wouldn't mention to the GP that you're being treated for HCV and that you wish to override your existing doctor's stance. Just tell the GP you tested positive for hepC antibodies a long time ago, but were never tested for the virus itself at that time. You now want a PCR test to establish your infection status. You might also want to consider changing doctors and get a more experienced/competent hepatologist for the remainder of your care. A GI who treats those with HCV should darned well know by now what the value of a 4 wk PCR is. The fact that she doesn't know this, and is defiantly refusing to allow you to be tested, is grounds for outright and immediate dismissal.

[Kit07]

Sorry Amberegg I misread your post. I didn't catch it that you were looking for a post-treatment PCR.  I misunderstood your post to say you had just begun treatment and were looking for a 4-week PCR.   It seems like most doctors order a PCR right after the end of treatment and then sometimes at 3 months, then 6.  I don't know that there is any study to support the 4 week test (?).  Finding out that you are undectectable at the end of treatment can support your emotional well-being, on the other hand the doctor may have bad experiences with relapsers.  It almost seems like an ethical issue.

Kit

[mremeet]

Aahh, I didn't catch the post tx part either. Like Roseanna roseanna danna used to say - never mind. ;-)

[jmjm530]

Yes, just go to another doctor but make sure you get a very sensitive test like "Heptimax" from Quest Diagnostics. Or, Plan "B" -- you could simply tell her that you understand her position, but you as a patient have a right to know your HCV status at 4 weeks post treatment and will gladly pay for the test if insurance won't cover it. Of course, first check with your insurance company but from what I understand, as long as your doctor prescribes the test, they will pay. Anyway, plan B is worth a two minute phone call.

[amberegg]

Yesterday when I spoke with her she said the labs done tone week after completion looked good SHe even did a Qualatative which was negative. I asked her then I she was going toi order a 4 week PCR, she said no. I asked if she would, she said that she didn't see the value. So I just left her a message asking again and I added, just for my own piece of mind. We will see.

[jboyhk]

I think you are confusing the 4week PCR at start of treatment vs end of treatment.

Is that the case? You are done with treatment?

If yes, then the dr is correct in waiting 6 mths.

[bobbyullc]

6 months will not due. the benchmark is 12 weeks at least -2 log. if not at 12 weeks you shoud stop tx as the svr rate is 2 %. 4 weeks is much better. if you have to collect cans to get it do it.

[Kalio1]

Your peace of mind is very important even if it isn't "medically necessary" that you have a 4 week post treatment PCR, the doctor should be willing to give you a lab slip for it solely for your peace of mind!
I think the "important" one you are referring to is at the 4 week mark during treatment. Post treatment is for your mental health.
If she isn't able to see the importance of it in my view she is terribly insensitive and I'd get another doctor to get me one.

[jboyhk]

Its not a question of the Dr wanting to do. It is a question of the insurance company investigating the dr for frivilous tests.

The patient can at any time demand to have any test out of his/her pocket. The dr will always accomodate.

If the patient wants the insurance to pick up the check then there are issues. These tests are not cheap. You can't demand to have a 300 USD test every day for your peace of mind and expect the insurance company to pick up the tab. Insurance companies look very closely at scrips dr's write and the last the a dr wants is to be investigated.

[jboyhk]

Amber is post (done) with her treatment. Your advise assumes she is at the start of treatment. That is where the points you raise are valid.

[bobbyullc]

sorry, i missed the post tx also. a 4 week test may alieve your worry but i was told at 4 weeks it most likey will be und. so 6 months is standard. i think my residuel brain fog is kicking in.

[Kalio1]

I didn't say anything about ins.
I wouldn't assume the ins. company would deny her the test, mine didn't. If they do deny her, that doesn't have anything to do with the doctor ordering the test. If the doctor bends to the whims of the insurance company rather than the patient, I'd fire the doctor. Of course the doc can say, I can order the test but it won't be covered  but I sure would not want my doctor to deny me the test our of hand due to insurance coverage! He should offer me the test, how it's paid for is another matter.

[jboyhk]

Look I don't want to get into an argument. My brother is a dr and I can't tell you the amount of times patients refuse to pay for tests they wanted ordered when the insurance companies don't pay.

The dr should make it clear and ask for the money upfront from the patient if they think the insurance company is not covering it. If a dr gets burnt alot from his patients you should understand why they may adopt a certain attitude.

[jmjm530]

The 4-week post treatment PCR is not frivilous. A negative correleates around 90% with SVR and a positive correlates 100% with relapse. This gives both the patient and doctor valuable information.

For the doctor, early notification of relapse gives them an opportunity to advise the patient on possible re-treatment scenarios, or in selected cases, re-treatment may even start right away. For the patient, earlier notification of relapse gives them more time to research out future options as well as get their ducks in order -- financial or otherwise -- for future treatments. As to a negative result at week 4, this gives the patient a certain degree of confidence and can be especially important in cases where one feels increasing anxiety either because of elevated enzymes, liver "pain", or just generalized anxiety that they may have relapsed.

I tested at both 3 and 6 weeks post treatment, with my next viral load scheduled for week 12. When I went to my docs office at week 6, he said, "look, if you start feeling anxious, you can test earlier than week 12 if you want". Now, that's what I consider a good doctor who is looking out not just for the physical, but for the psychological well being of the patient as well.

As to insurance, in the vast majority of cases, the insurance company will pay if the doctor writes a prescription. The problem is that some doctors take it upon themselves to withhold tests like these for a number of reasons (often plain ignorance) that have nothing to do with the patient's benefit.

It's not a frivilous test at all. Why would someone want to wait six months to find out they relapsed when most relapses occur within the first month? To me, it's the medical equivilant of hiding your head in the sand.

-- Jim

[jmjm530]

Regarding some more on payment/insurance, etc. Again, in most cases insurance will pay if the doctor writes an rx. In terms of tests like these, never heard of a doctor having to justify it to the insurance company, but assuming he does -- any doctor that can't put together a compelling arugment -- that would stand up to review -- why he wants a post treatment 4-week test, well, that doctor just doesn't know enough to be treating Hep C patients. As to being stuck with the bill, as Kalio says, that's another issue and between doctor and patient. I know for example, with Quest labs -- which are all over the place -- you can go to any center with an rx and pay for the tests yourself, or otherwise indemnify Quest if your insurance doesn't pay.  This takes the doctor entirely out of the payment loop if that is what the patient and doctor want. In reality, the reason many doctors withold tests like these is either out of ignorance or arrogance. Ignorance in that they're not aware of the diagnostic value of testing early and arrogance because they're not taking into consideration all of their patients needs as discussed in previous thread.

John, sorry for the rant, and it's not directed to you one bit. It's at some of these doctors. We just see all too many times here, doctors witholding either tests, helper drugs, etc, because of those two things -- ignorance or arrogance and often both!

-- Jim

[Kalio1]

Good point, in my case that PCR test in the first few weeks following the end of tx was important because I planned on restarting therapy. Had I waited 6 months for a PCR to find out it had returned, the viral load would have had a chance to gain a foothold and replicate into the stratusphere again. As it was, I was able to hit it hard again with the treatment drugs while the virus was still very low.

You are right about the ignorance and arrogance, I too am fed up with that attitude. If a doctor displays this type of ignorance and arrogance, Im gone. With the prices I pay I want his ego left at the door and I want him to know enough about his JOB, which is to know all about my disease and treat me with the most current tx and info.

Never should a doctor bow to the insurance company or let them influence his "doctoring" in any way. We should not be subject to health care via insurance company policy! Sure we might have to pay out of pocket at times, but that shouldn't be any concern of the doctor, it isn't as if HE is paying for it. His decisions should be based only on the best medical course of action and not on the desires of an insurance corporation.

[jmjm530]

Worse -- or lets say equally bad -- to doctor's bowing to the insurance company, is doctor's 'mind-reading' the insurance company. How many times have we heard here that "my doctor told me it wouldn't be covered by my insurance" only to have the person call their insurance company and find that it IS covered. Happened to me, happened to lots of it.

Truth is, how many doctors do you think ever picked up the phone and talked to someone at the insurance company. Like maybe one out of a thousand.LOL.

No, it's usually some underpaid overworked assistant or secretay who makes the call. And if she gets any guff at all from the first line of defense, there's a good chance she just won't bother to speak to a supervisor, or try and pursue what actually is needed to get the test or procedure approved. Much easier simply to tell the doctor and patient, "they're not going to pay". So that gets relayed to the doctor, and the next patient who asks for this and that simply gets a "the insurance company won't pay" without even the courtesy of a phone call. LOL. And do you really think the doctor even knows what insurance company an individual patient has? It may surprise some of them that one insurance company may pay for something that another insurance company rejected. Well, I could go on and on with this sort of inefficiency and stupidity.

Where I came out is that there's only one solution. Either you're lucky enough to have a doctor who will order tests and procedures and follow up with the insurance companies if necessary -- and yes, there are those good doctors and offices out there cause I've been to several. Or, in the other cases, we as medical consumers really have to proactively take the matter into our own hands. Call the insurance companies ourselves, spend as much time "on hold" as necessary to get to a supervisor, and then find out what is and what is not covered and if it's not covered, what kind of documentation and/or criteria is needed for it to be approved. Prepared thus, we can tell the doctor and/or his staff exactly what is what and what is needed. Takes time but it does work. Even got the doctor on a conference call with the insurance supervisor once to get a drug approved.

-- Jim

[nygirl7]

JEZ that makes me mad I mean WHAT DOES THE STUPID DOCTOR CARE FOR ANYWAY - IT'S NOT LIKE SHE HAS TO PAY FOR IT!!!!!!!!!!!!!!!!!!!!!!!!!!

Mental health and well being is JUST as important as physical so it's my opinion she is causing you DAMAGE by not doing it and she should be reported for ABUSE of a PATIENT!!!!!!!!!!!!!

Well...maybe I never had riba rage and I am just insane and that isn't exactly true but - why should she CARE? I'd think the more information we have the BETTER?

These little things are WAY bigger than this doctor seems to think - ask her if WHEN she gets HepC if she thinks she might like a test to tell her if she still doesn't have it after all the pain and time and aggravation!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

(Sorry - blood is BOILING! Can't take one minute and check off a box on a piece of paper? Gimme a break!)

[jmjm530]

OK, but what do you really think? No need to hold back. LOL.

[jmjm530]

Hey, what don't you print out this thread and bring it to your doctor. But you might consider waiting until you found another one just in case :)

-- Jim

[jboyhk]

I don't understand the statement 'its not like he is paying for it'.

If the dr orders a test he is pretty sure insurance won't pay that the patient demands, and the patient decides not to pay, then who pays for the test? Its the dr in the end.

Who do you think pays for the test when the patient and insurance doesn't?

[Kalio1]

That's ridiculous, the doctor doesn't pay for it. The test is issued in your name, not your doctor's. Doctors aren't libel for their patients payment arrangements with any service outside their office. He has nothing to do with the insurance company other than getting HIS bill paid!

If your brother is a doctor, it seems you'd know that his ordering of tests should be based on the patients need not on who is paying for it! No doctor should ever decide on the necessity of any test based on it's cost effectiveness. Geez, even the idea of that is offensive. Talk about compromised medical care, if the doctor judges your need for a test based on who's paying for it, we are in more trouble than I thought.

[jmjm530]

As I posted earlier, all the doctor has to do is give the patient an rx with the name of the test and the diagnosis code. From that point the patient can have blood drawn at any lab, and make payment arrangments with or without involving the insurance company. The doctor is totally out of the loop. Totally.

[jboyhk]

Ok, u seem to know it all so I will tell my brother he is a liar.

[jmjm530]

No one is saying your brother is a liar and I'm sure doctors have gotten stuck with patient's lab bills -- but not if they write an rx and have the patient make their own lab arrangements.

I'm talking from personal experience. I've gone into Quest Centers with both lab requistion forms as well as just rx's and filled out the forms myself. The billing choices are either to the insurance company or the patient.

The only time I imagine the doctor would be liable is if the blood is drawn in the doctors office and on the doctors account.

[jboyhk]

Yes, that is the case of how I do it with my dr.

So one cannot generalize that the way one person does it is the same for all (i.e. saying my insurance covered it so ipso facto should yours).

[Kalio1]

No one said anything like that, but I suspect rather than your "brother being a liar" it is that you are misunderstanding how it works, doctors issue you a lab slip in YOUR name, therefore you are the paying party. It just is not common practice for doctor's to be responsible for paying for patient's lab tests, I've never heard of such a thing. The reality is MOST doctors do not do the testing in the doctor's office, they send you, with your lab slip, to the lab. If your brother is paying for his patients' lab tests, something is off there unless he is doing the actual testing in house, which is not common. Only Hemotologists do that around here. Virtually everyone in the US goes to LabCorp or Quest or a few other huge testing companies. The blood is drawn and sent to the lab to be tested, they aren't tested in house.

[poetic_wax]

I feel like a burning bush is speaking.