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Originally Posted by ProfessorDave
Help! I' assisting a 100% disabled veteran in The Villages who has been on a significant pain medication for several years. His Dr. at Lady Lake Pain And Spine Centers of Florida (Dr. Pinnamaneni) won't take the time to do a simple "pre-authorization" which lowers the price by over $200 per month. Publix Pharmacy recently contacted the Dr. and asked twice. This veteran drove to the practice twice this week to ask the receptionist for help - and was promised swift action. The Dr's office has been called three times this week by me - and no response.
I checked with the insurance company - and the story get's worse! The insurance company (Blue Cross Federal) shared two things: 1) they personally put in a request to the Dr. for the preauthorization - and got no response and 2) it would also cost less if the Dr. provided a 90 day refill - but won't, because he bills more money by requiring the patient to come in once a month for a new 30 day prescription - and has been doing that for years. Ethical? Morale? You be the judge.
As a result, the prescription has cost this vet over $500 this year - which he frankly doesn't have! Because of the financial situation - he has been in pain for several days - until I found out about it.
Two requests to consider: 1) Recommendations for a new Pain Doctor to help a 100% disabled vet - with very little money? 2) Please tell friends and family to write to Dr. Pinnamaneni and ask WHY he would leave a war hero in both physical and financial unnecessary pain!!!
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There are some types of “significant pain medication” that are not supposed to be prescribed in ninety day quantities because they are highly addictive and are often abused or resold. Sometimes doctors are expected to require certain lab tests of the kidneys and liver, too, lest there be damage. Is it possible that you don’t know the rules for this medication? Is it possible that this doctor is following the rules, where some doctors don’t?
I don’t know what the VA pays doctors who agree to work with them, but I do know that my combination of Medicare and the Blue Cross I pay for through my retirement benefits pays doctors, hospitals, and imaging centers around a dime on the dollar and usually doesn’t allow them to charge me anything at all. I don’t know how doctors can pay for office rent, employees, bookkeeping, taxes, and insurance on what may turn out to be a payment of only $6 to $10 for an office call.
Sometime, medications are more expensive because of a new, more convenient formulation or delivery method for which the pharmaceutical company charges a lot of money. For example, an easier way of giving an insulin injection or an epinephrine injection or a slow release capsule. Sometimes, less fancy forms of the same med are much cheaper. Pharmacy fees vary a lot. For example, often CVS is much more expensive, but sometimes it is cheaper. Get the App GoodRX and find out what the various pharmacies around here are charging for the drugs you take. (That doesn’t help you know what your insurer actually pays, however—sometimes they get highly discounted rates.)