Help For 100% Disabled Vet - Is Dr. Pinnamaneni Ethical or Morale?
 

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!!!

If the person is 100% disabled providing it is a disability caused by his military service to his country he should qualify for VA benefits prescriptions are included in his benefits.

wow, sounds like an awful situation. 1st thing that comes to mind is he needs a new Dr. For the short-term, maybe a walk-in clinic might help him get the pills he needs now. are you able to get a used bottle of his meds with name & info on it? bring it with him to the appt. if he has medicare, i think there's no charge, if he's insurance free, visit is about $120. i hope you get this worked out, there's many good pain dr.'s here, pls keep us updated

Thanks. His injuries are from the war. Lucky to be alive - he was a "tunnel rat" in Vietnam (most I'm told came home in a body bag). I'll call around for pain Drs on Monday. A few I called Friday are not taking new patients. Any recommendations in the meantime? THANKS!

Good grief! Take him to the VA here in the Villages. They will take care of him. Done!!!

Oh come on.
70 percent disability rating: $1,529.95 per month. 80 percent disability rating: $1,778.43 per month. 90 percent disability rating: $1,998.52 per month. 100 percent disability rating: $3,332.06 per month.

Unfortunately - the VA sent him to THIS doctor!

If he has VA coverage and they referred him to an outside doctor , the VA should pay all charges. I have a disabled relative (not 100%) who has been referred to private local doctors for specialty care.

Google it for rules/restrictions

Thanks for suggestions

I read this a few times. Helpful? Cruel? Sarcastic? Bored? Missing the point? Educated - or not? But - they can. I'll assume just naive?

Thanks

I don't understand. Why is he n to going to the VA? There is an outpatient clinic in the villages, there is a new clinic in Ocala, and the is Malcom Randell VA hospital (one of the best in the country) in Gainesville.

Unless there is a good reason to not go there, the hospital is Gainesville is better than any civilian healthcare around.

My understanding from him - was that the VA sent him to this specialist. I'll check. Sometimes - this person can be confused. He's had a tough life.

Due to the opioid problem the government has placed restrictions on what pain meds you can have based on your ailment and limits on how many pills you can get at one time. My wife takes pain meds for her rheumatoid arthritis and has had the strength of the meds reduced and the number she can get at one time. It's not the doctor requiring the patient to come back monthly for another prescription so they can make more money. If the doctor's office isn't doing what they are requested to do and what they are required to do, the VA needs to be notified about the situation. Maybe this doctor needs to be taken off their provider list.

This vet should be able to get his pain meds filled by the VA pharmacy at no expense to him. He is also able to obtain prescriptions from Express Scripts who mail the meds directly to his mailing address. There is a small co-pay but it is very reasonable. A meeting with a VA rep should provide all the answers to your questions.

I feel you are not really taking care of this vet or you would have had him at the VA facility in the Villages. Your story sounds awfully fishy.

Apparently you neglected to read the entire thread. The VA referred this vet to this doctor.

Is the VA on 42 able to help

Has he tried medical marijuana or Microdosing
Both work great pain

Oh come on.
 

What the hell does this have to do with anything?

Along with the referral the appointments should be made through the VA's Community Care office. That way the billing goes directly to the VA.

This war hero with a disability rating 100% should be getting
free care and prescriptions at the
VA or the VA sends the veteran to a private doctor under what the VA terms it Community Care . The VA pays the provider who accepts VA
insurance ( Tri Care ) for service related injuries .
I have VA healthcare not Tri Care , and make a little bit more money than most veterans and am charged co-pays . $9 or $15 dollars for prescriptions.
$15 for a primary care doctor . $50 for a specialty doctor . Although if you see more than one doctor in the same day the copay covers all VA doctor visits .
Alternatively since turning 65 my Medicare , Medicare part D and supplemental turn out to be less expensive than the VA . I have a $208 deductible for the whole year
I suggest calling or visiting the
the office of Patient Experience. They will make it happen, I guarantee.
Call Florida department of veteran affairs to get a briefing on his benefits.
If the veteran is low income he can apply for a VA pension.
His Primary care VA doctor is the
gatekeeper for prescriptions and specialty doctors .
If the VA sent him to a private doctor they would be paying his bill . Tri Care is a wonderful thing for our war hero’s . Thank him for his
service.

Years ago I had lower back pain and my pcp sent me to that doctor. His office staff were the worst. Bad attitude on one hand. A few months passed after my treatment (that didn't help the issue---but that's not his fault) and we got a bill from our "former" insurance---I think what we had BEFORE we retired and moved here. I personally took it to the office and spoke with the person that handled it. It's been 12 yrs so I can't remember all the details now but I will say I decided "IF" I needed another pain dr. it wouldn't be that one. He's fine but it's his office staff that's lacking. I'm so sorry you're friend is dealing with this!!!

Call Richard Blair Veteran Service Officer 352-689-4400 email va@sumtercountyfl.gov . He is at 7375 Powell Rd in Wildwood (building with the library). He is great and will get this straightened out for your vet.

How frustrating. This is not as uncommon as one would think. I have a friend who was a caregiver to a loved one and went through the same thing.

I would find another doctor. Quickly.

Has your friend gone to the VA to apply for VA benefits? If not he should give it a try. It takes time and is a process, but in the end worth it. It is not a perfect process but cost of meds is determined by income. If your friend is in a low tax bracket this could be a tremendous help with the cost of prescription meds and more.

If your friend goes this route once he has applied for benefits have him go the local VA to register. Call first to find out if he is in the system yet. Once he is head down to register immediately. This speeds up the process and will get your friend in to see a VA primary care physician quicker.

I am a caregiver to a disabled veteran and am still learning to navigate the VA system. It's not always easy and is time consuming. Sometimes I just don't get answers, ever. I spend a tremendous amount of time and energy getting through the mess. But I did before my loved one applied and was approved for VA benefits too.

Your friend could reach out to the United Way. Within the United Way is a department (volunteer based) that helps veterans.

I wish your friend the best with this.

Read the thread before responding. He’s already with the VA care.

As far as doctors and filling out forms, mine is also a pain in the butt on this. I have little patience with needing to constantly follow up. Truth, I stick my wife with this because after 3x I am no longer polite. I've asked around-THEY ALL ARE LIKE THAT.
EXCUSE? Thanks to Medicare etc they are so overworked they cannot spare the time to do a good job.

I of course do not know all the details. Pain meds? In an effort to control FROM excessive use of OPIOIDS, the government has clamped down on pain meds. Prescriptions are for 30 days. The problems with OPIODS is they are habit forming and while they are the most effective pain killers, it takes higher and higher dosages to get the same relief. The mentioned $500 for the year, have it or not, is not much money. ADVICE TO YOUR FRIEND, he should contact VA MEDICAL. My dad did two tours of COMBAT duty in WWII. He got cancer. His prescriptions were like $600 a week. The VA would fill his prescriptions at, it I recall, a flat rate of $20. ASIDE-with cancer, the hidden reality. It is not the cancer that kills you, though it would eventually.
It is the poisons and pain killers they give you that kill you.

TO REPEAT-prescriptions, if they are OPIODS are 30 days and not refillable.

Well, if this is the case then he should contact the VA and let them know he needs a new doctor. They can assign him a new one through community care. I'm not sure if there is a doctor at the VA in Gainesville who can help him but there might very well be. If so it could be worth the trip depending on his pain level for travel.

Transportation the VA reimburse Veterans portal to portal mileage is determined by address if you like the scenic route no it’s the most direct.

Dr. P. writes my husband’s pain script every month. (Tricare). It is $3.00 at Walgreen’s

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.)

The OP implied that the vet was poor. Actually the VA disability payment for a 100% disabled individual is a bit over $3,600 a month which is tax exempt. If the vet is drawing Social Security, he should be receiving about $1,600 a month. By my math that is $5,200 a month income. Now if he is drawing retirement pay for his military service that could be another $1,500 or so a month. How many villagers have that much income?

If the vet is eligible for Tri Care medical coverage, he should not have any out of pocket expense for medical care.

So "what the hell does this have to do with anything"? This vet is not destitute.

Insulting at the least - but - you have a right to your opinion. And - your opinion shares what may be within your heat. God knows the various things I've done for this man over the years.

Great suggestion. No - he has not tried those approaches. I'll discuss with him this week.

Insulting at the least - but - you have a right to your opinion. And - your opinion shares what may be within your heat. God knows the various things I've done for this man over the years.

You clearly did not read the entire thread - including my comments regarding the VA (which he has been to - and they referred him to this Doctor (is my understanding - I plan on confirming tomorrow) - but - that wouldn't stop you from insulting remarks.

I've learned in the past several years as an MBA Strategy professor (a top business school) - philanthropy (involved in multiple initiatives in Africa and the US) and my career (including currently on the Board of a $ Billion dollar company) that there are CRABS in this world. CRABS try to pull people down who actually strive to be positive and get things done. I'm proud of what I have done with this vet - and the cynicism and insults will not deter me from working to assure that the world is better off because I was here.

Very helpful. Will follow this up.

Awesome. Thanks so much. First call tomorrow morning!

Pure ignorance. Do you know what other issues are in this person's life? Do the facts of his personal wealth or lack of it have anything to do with the issue? If a millionaire received poor medical service - would it matter any less that the Dr. is unethical and lack character?

I share with my students (over 1,000 MBA's - Leadership & Strategy): "Some people that are great Devil's Advocates perceive they are always adding value; sometimes they are - and sometimes they are not. They are often driven to enhance their sense of worth by offering alternatives views. Sometimes those views have value - so listen. Often they are driven by only the individual's personal self esteem - and demonstrating their perception of their own intelligence. The solution? Be an "advocate" as a Devil's Advocate if you have that talent - but the world is better off if you just stay quite if your motive is not advocacy but rather self indulgent."

I asked the community for help - with a man I've invested a great deal of time with (mostly financial - which is my wheelhouse) - healthcare just supportive. This situation was new to me - and I've received a great deal of GREAT advice and counsel - so THANKS! I will follow up - and feel better about The Villages overall - (but not entirely).

At 100%, he gets a nice pension plus no property tax on his home. ALL medical fees including prescriptions are paid by the VA as well as any procedure done as well as outside doctor care. Seems if he has SS or another retirement income he’s living beyond his means and should see a financial advisor as well as an advocate at DAV. Problem solved. One last thing: there’s lots of posers among us so ask for a copy of his DD 214 and the VA letter of benefits. Just in case.

Thanks. Good advice.

The pure ignorance is on your part. You don't even know if he is really a 100% disabled veteran. All you have is his word, that and a couple bucks will get you a cup of coffee. As I pointed out what monetary benefits he is possibly receiving places him far from being financially destitute. Sounds more like poor money management skill. He isn't the only one who has had hardships and heartache in their life so spare me the tears.

It has been pointed out by myself and others that the VA needs of intercede in the problem with the doctor. Again ignorance on your part for not getting the vet to the VA counselors to rectify the situation. I would think some who has taught 1,000 MBA students in Leadership and Strategy would been able to figure that one out.

Your "accomplishments" in your life you brag about apparently impresses you but I find it quite arrogant and condescending.

There are too many holes in this vet's story for me to give him any credence.

Did you read the posts about prescribing opioids? The government has cracked down quite hard on what strength levels can be prescribed and a patient can only obtain 30 days worth at a time. Hence the required visit to the doctor for a new prescription, not that the doctor is trying to fleece the government and patient for personal financial gain. Did you actually talk to the pharmacy to see if this claim that the doctor wasn't providing a form that could save the patient money or is it what he is saying?