Quote:
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!!!
|
I am a recently retired R.N. of 44 years and the last 21 of those year was employed as a primary care R.N. case manager at my local VA Hospital in R.I. You posted multiple issues regarding this Veteran which I will try to address from my professional experience and perspective.
If this Veteran is 100% SC, regardless of income he is exempt from payment for all medications and copays for all tests and services done within and without the VA as long at the VA authorized this Veteran to receive care outside the VA. You note that this Veteran's insurance is Federal BC/BS which is a completely different entity than VA coverage. Likely at some point this Veteran worked for a Federal Government agency non military service related and was able to keep this coverage if he is now retired. I have Federal BC/BS and I never served, it was a benefit I earned working for the Federal Government which I continue to pay premiums to retain this coverage in retirement which the Federal Government subsidizes. That being said, if this Veteran is using his Federal BC/BS as the payer source for the community pain management doctor he is seeing, than the VA did not authorize this service because they are not the payer source. And the VA will not preauthorize for services that they had no input in coordinating and have ongoing oversight.
With regards to pain management which includes the prescribing of opioids, on occasion if a Veteran does not feel the VA is managing his/her pain appropriately, and if they have health insurance coverage outside the VA which seems to be the case with this Veteran they will and have every right to do so seek care outside the VA. If a Veteran chooses to do this and are not happy with the community care services they sought on their own the VA has absolutely nothing to do with these negative outcomes because they had no part in the coordinating of and overseeing this care.
I can not assume what were the motives of why this patient sought pain management care outside the VA, but I can tell you from 1st hand experience if it is medication related the VA has gotten very strict with prescribing of opioids. And I can't think of one patient and I case managed many which includes end of life cancer patients receiving hospice level of care that received a 90 supply of opioids. Although most of these hospice patients are exempt from random drug tests, most patients prescribed ongoing opioids are required sometimes monthly to be drug tested prior to getting a refill, and a computer search is done to see if a patient has received or is receiving an opioid from another pharmacy. These checks are done for several reasons. If a patient is prescribed daily use of opioids and are taking them as prescribed we want to see them test positive for the prescribed opioids in their drug screen because if it does not show up there is a suspicion that the opioid is being sold by the patient or a family member for significant $$ on the street which happens more than you think. And the suspicion of this is increased if a patient or family member consistently requests an early refill with more excuses for this than I can count. Secondly, if non prescribed med such as Fentanyl, Benzos, etc. show up in patient's drug screens, adding a prescribed opioid to this drug cocktail can literally end a patient's life from an OD and it will be the prescriber who will be held accountable.
To be honest, as a former VA R.N. I very much resent your assumption that the VA is responsible for leaving this Veteran in pain and financially burdened with the costs of his pain medication prescribed by a non VA provider which it is more than highly suspicious this Veteran sought this care without VA authorization. Yes, I will be the 1st to admit the VA has it's ongoing issues and there are bad apple providers that work for this agency. But, the majority of those that provide care to Veterans which included myself jump through every hoop possible to relieve the pain and suffering of Veterans which more often than not puts us at odds with a dictatorship VA administration that sadly cares more about the bottom line than the Veterans they are supposed to be serving.
If you truly want to help this Veteran put him in touch with the DAV or other Veteran advocacy groups that have the expertise to assist him that you do not.