Dr. Thompson's Blog

Ways To Fight Huge Medical Bills

Not long ago it was reported that medical bills were the cause of fifty percent of bankruptcy cases. Now that figure is apparently rising. However, there are ways that medical bills can be reduced. First of all you need to know exactly what an insurance policy will pay if you have insurance. Then if you receive a medical bill you must check it over very carefully. If you don't understand what some of the a abbreviations stand for, either ask a medical friend or call the doctor's offce, lab, or hospital billing department. If you think that you have been unfairly charged there are people who can help. You can file a complaint or appeal with the insurance company and with Medicare a good resource is www.medicareadvocacy.org. Each state also has people who can help. Another resource is www.patientadvocate.org. Also www.kff.org/consumerguide is a Web site to help with appealing insurance medical claims.

A young mother who had just come from overseas after a divorce took her son into a local emergency room. The boy had abdominal pain and although no diagnosis was made, the bill was over $5000. When I got the ER report and looked at the bill, I was truly appalled. Unncessary tests were done and the most important test was not done. I wrote a strong letter to the CEO of the hospital and he cancelled the entire bill. He also said he would arrange for more pediatric training for his ER staff. ER doctors are great for emergencies usually, but not for a ten-year-old with a stomach ache. My diagnosis was stress and if the doctor had taken an adequate history, he might have made the same diagnosis. It turned out to be the corect one.

One friend wrote her Senator and Representative about a large hospital bill with a copy to the CEO of the hospital. Her bill was quickly reduced. Medical mediators are available, but may charge, so I would be careful about using them unless you are clear about their fees. Their Web site is www.billadvocates.com

Obtaining Expensive Drugs without Increasing Greedy Drug Co. Profits

I am seeing more and more news about individuals who have devastating diseases, but are unable to pay for their needed drugs. Then I read about the profit, salaries, and bonuses of the drug company CEO's and I see red.

There are some ways that these greedy companies can be circumvented. Drugs from Canada are reliable and there is help available from different sources.  One of these is a Pharmacy Discount card available at the Web site: www.healthcarebluebook.com. Another good source is www.themedicineprogram.com.  Walmart and Target in some areas have $4.00 prescriptions available, though these are generally for generic drugs.

If you cannot afford the medicine a physician prescribes, tell the doctor. Some of the drug companies have programs that can help needy people. Doctors also have samples and there are different drugs that may be available at less cost. Most important of all,  you need to speak up and not be embarrassed. We all have to keep insisiting on better health care for  everyone that includes affordable drugs. Expensive drugs are just a symptom of the terrible health care problems we have in this country.

Medicare Readmissions

As the Obama administration is working on a new plan for health care, I hope they are looking closely at what happens to elderly people needing long-term medical care. An editorial in the April 16, 2009 New YorkTimes notes that one-fifth of Medicare patients who have been discharged from the hospital have to be re-admitted with 30 days and one-third are re-admitted after 90 days. This is partly due to a lack of well trained, experienced social workers and the new breed of doctors called "hospitalists."

I had a year long expereince with this problem involving an elderly relative in Las Vegas. The medical care there is probably some of the worst in the U.S. and to make it even more serious, there were  young, inexperienced social workers sending my relative home to an essential empty house with no plans for follow-up medical care, home health care, and no family member or friend close by. The individual had increasing dementia and the follow-up care was atrocious. Yes, he had to be readmittied three times to the hospital in the year before he died. At the very last, I found a marvelous. older social worker who monitored his medical care and kept in touch with the hospitalists. The private doctor said she didn't go to the hospital and she essentially wrote off her patient. The young doctor told me that she "worked from nine to five and didn't have time to go to the hospital!"

If the government can find a way to help standardize medical care and eliminate the insurance companies, the money saved (400 billion in administrative costs) could be used to hire more social workers, provide  better oversight of the hospitalists and home health agencies and private physicians could be paid more adequately to care for sick elderly patients, as well as the rest of us.

Cancer and Radiation

The journalist and author, Ellen Leopold, has written an eye-opening book about what the government and the medical profession have done in respect to cancer and radiation. Her new book is entitled, Under the Radar, Cancer and the Cold War. I recently interviewed the author and the interview can be accessed at this location.

The premise of Ellen Leopold's book is that radiation as a spinoff of cold war research has done considerable good, but also great harm. There is not one agency that regulates the use of radiation. Instead, there are a dozen agencies. Individual doctors still  make serious mistakes in the way they use radiation and particularly in the doses they give. The most important thing for any patient diagnosed with  cancer is to always get a second opinion if a doctor says radiation treatment is needed. 

The author said that networking is particularly important for cancer patients to find the best cancer centers and support systems. She added that we all can make a difference for cancer patients by insisting that our legislators pass better laws to regulate radiation, as well as drug trials. She had great praise for the Breast Cancer Action group in San Francisco. They have a newsletter that patients  find helpful.

Medical Care for Teenagers

Medical care has become so fragmented that by the time kids become teens, their medical care may leave a lot to be desired. One my my former parents called this morning to ask what a visiting relative's daughter should have before she attended a local summer sports camp. The woman was rightfully concerned that since she would the one responsible for the teen and her friend that she wanted to be sure no preventable medical problems arose.

This wise mother realized that the first thing she needed was a letter signed by both parents giving her the authority to make emergency medical decisions. These days, if a friend or relative takes a child who is not theirs to a doctor, ER, or hospital, such a letter is imperative. The next thing she wanted  to check on was what immunizations were needed. I asked her to be sure  the teen and her friend had had meningococcal immunizations. These are crucial for teens because this form of meningitis can be lethal within 24 hours.

The other immunizations that are important for teens are a current diptheria-tetanus injection, as well as Hepatitis A. Also a TB skin test is wise to have to be sure there has been no recent  exposure to tuberculosis. I find doctors are not often careful these days about checking to see if immunizations and especially TB tests are current. Thus parents have to be very viligant about watching that immunizations are up to date. Many doctors don't even bother to give TB tests. Yet TB is very present overseas and can  easily come to the U.S.with our rapid airline travel. I had a patient referred to me who had  Duchenne dystropy. He had recently come from overseas and was found to have active TB once he had arrived. So parents and friends in charge of teens must always be on the alert when they have the life of a teen in their hands.

Escaping from Bad Medical Care in an HMO

When people ask me how to find better medical care than they get in their HMO  while not having to pay enormous amounts of money, I tell them that help is available. Yes, they may need to make a few calls, but if your health and even you life may be at stake, what choice do you have?

Recently, I watched a good friend slowly lose her ability to get around  because of the very bad care she was receiving in a low cost HMO. She had had quite severe back and leg pain and saw two different orthopedists. The back doctor sent her to an exercise center that was connected with his office.  A young woman, who was not a physical therapist, had her use some machines, one of which caused a twisting motion. My friend's leg and ankle became very swollen after the use of this machine and she could hardly walk. I suggested that she see an ER doctor at our local excellent hospital. The doctor spent almost an hour with her and thought she had had an injury from the twisting machine.

The woman finally became convinced that she had to get out of her bad, low-cost HMO and asked me about how she could get good medical care without having to pay large premiums. I turned to the resource section at the back of my last book, 101 Ways To The Best Medical Care and called the Patient Advocate organization at 1-800-532-5274. I also called the Medicare Rights Center. Both referred me to the Health Insurance Counseling and Advocacy program. This excellent program is run by volunteers and I found a woman who immediately mailed information to my friend and to me. Because of this the woman is now paying a small monthly fee to receive care from any doctor at our local excellent hospital. She couldn't be more grateful and has sadly learned how bad, low-cost HMO care can change your life. I just hope that with her better medical care she will once again be able to get around easily and travel widely as she has previously.