<p>My elderly parents have supplemental health insurance and also drug coverage. Today one of the insurance companies called my parents to say that they are sending a representative to their home on Saturday morning. My parents either didn’t ask the reason for the visit or forgot what was said, but Mom thinks it has something to do with their medications. Between them, they take about 25 prescription meds.</p>
<p>I’ve never heard of such a thing. I have made plans to be there for the visit, but does anyone have an idea what this might be about?</p>
<p>LasMa, My guess would also be that several of their medications and/or care are/is expensive which probably “flagged” them for case management. The goal of the case manager would be to assess their use of prescriptions and medical care and determine any inefficiencies. Of course, the insurance company is looking for cost savings, but in my experience, they are often great resources for the family and the medical care providers.</p>
<p>Grrrrrrr! IMO a case manager “assessing” medications and care is practicing medicine without a license. Yes, my parents are heavy users of health services, which is why they need insurance. And why the company would be interested in having them shed some of those services, I’m sure.</p>
<p>What if the case manager decides that a medication is unnecessary? Can the doctor override the case manager? Or does the case manager have the final say, which would mean, I assume, that they would no longer cover that med?</p>
<p>In my experience, drug coverage can be denied for many reasons - not on formulary, cheaper generic equivalent, not medically proven for diagnosis etc. Many patients do not get the drugs that their doctors have written. And not to be too political, but haven’t you heard that these doctors “only” write the drugs because they have been improperly influenced by the big bad drug companies, who are ripping off america? (In case I have not been clear, I do not for a minute believe that the foregoing sentence is in an way materially correct.)</p>
<p>One other thought that I might have would be that they are checking to see that all of these medicines are in the house and being used by the patients who are submitting prescriptions.</p>
<p>Last thought - a sales call for other services?</p>
<p>Insurance companies deny medications and services all the time. Yes, many times some person in an office without a medical license determines such things. I’m surprised it hasn’t yet happened to you or your parents. I could recite a long saga about the way my mother in law, who died yesterday, has been mistreated in the last few months by her Medicare Advantage plan (private HMO with premiums partially funded by Medicare and additionally subsidized by taxpayer dollars. I could go on…). There were many fights with her case manager. </p>
<p>But, then again, a sales call is a strong possibility.</p>
<p>It doesn’t sound like she’s in a medicare advantage program… those type of plans you really have to be careful with. It sounds like she has a medicare supplement plan as well as a part d rx plan. If she has a part d rx plan already, then it’s more then likely not a sales call. She can’t switch prescription drug plans till oct 15-dec 7 of this year and that would be for coverage starting next Jan 2012… Unless she falls under some certain criteria which would allow her to switch early, but they wouldn’t know that to schedule a visit with her. </p>
<p>If it’s a case manager… they usually are registered nurses so it’s not like they don’t know what they are talking about… and it’s not always a bad thing. If that’s what it is, they could very well just be meeting with your parents to review their care and see if there is anything they else they can do to help them. Who knows if it’s medications or additional programs or what. It could be that certain rx’es or certain medical claims triggered a call. I would suggest going to the meeting if you can and just hear them out and see what they have to say. 25 Medications between two people isn’t really all “that” many when it comes to people on medicare so they may not be trying to reduce them…</p>
<p>Thanks everyone. Oh yes, I’m very aware that insurance companies deny claims all the time. And I also thought that maybe they’re just trying to verify that all of those pills really do exist; if that’s the case, we’re fine. </p>
<p>My parents were forced to change their supplemental on Jan. 1; Dad’s former employer terminated the contract with the old insurer. I suppose I won’t give the name of the new insurer, but they’re well-known out here for improperly denying claims, rescinding coverage, pitting patient against doctor, massive premium hikes, etc. They are fined by the state and sued by their subscribers on a regular basis (and generally lose those suits). I seriously doubt that this company would pay someone to visit elders at home unless it were to see if there were some way to cut costs. But we shall see.</p>
<p>I’ve actually seen case managers follow up to make sure people are taking their medications as they are supposed to… because not taking them could cause more of a cost to the insurance company in the long run. Say you aren’t taking your heart medications correctly and a month later you wind up with a heart attack or something along those lines.</p>
<p>Fendergirl - I hate to be such a cynic, but preventive care isn’t necessarily less expensive. We all will have some sort of end-of-life care. A 70 year old who dies of a heart attack may be “cheaper” than a healthy 90 year old who dies from cancer. The person who takes their medications faithfully and avoids the heart attack, requires a lot of chronic illness care and are probably more expensive.</p>
<p>I agree with fendergirl, try to be at the meeting (with an open mind) so that you can assess what the insurance company is up to. It could be that they are trying to help or they could be up to no good. Come back and let us know.</p>
<p>They might also, with 25 meds, be taking some that are flagged to conflict with others. With so many different specialists often involved, it is possible that there are some issues with taking certain medications together. Maybe that is what the case mgr checks on?</p>
<p>^A pharmacist would be better qualified to check on drug interactions.</p>
<p>I take a med that the doc insists needs to be the real thing, not generic. Every so often my insurance company sends me a reminder that it would be “cheaper” for me to take the generic. Maybe for them!</p>
<p>GTAlum, it is true that we will all die sooner or later however I would rather live to be 90 with being preventative throughout my life as opposed to dying at 70 with something I could have possibly prevented. Wouldn’t you? I’d much rather take a 5 dollar a month rx for HBP for my entire life if it means I can attempt to live 20 years longer. If I muck around with it and have a heart attack and am in the hospital there would be like a 100k hospital bill. Insurances companies love preventative care because it saves them money. I work for one… that is something we stress to our customers every day… take care of yourself… get your physicals… go for your mammogram, pap, psa test, etc… catch things early before they become a problem… it’s better for everyone all around… </p>
<p>mommusic, they probably are just making you aware… You would be amazed by how many people don’t even know there are generic versions or generic equivalents to the drugs that they are taking. If you were able to take the generic it would more then likely be cheaper (as far as the cost of the drug) for them AND for you. That being said, if the doctor won’t prescribe it or doesn’t think it works quite as well or isn’t right for you, then it’s in your best interest for both you and the insurance company to pay more for the brand name drug… and they obviously have no problem with that as you are still getting it and they are still paying for it. Those are just reminders and they are pretty much standard procedure. If any of our customers who call us in regards to taking out drug insurance… we ask them if they are taking medications… we ask them what they are taking and we enter all their drugs in the computer as given to us, and if a possible generic substitution comes up we ask them if it’s something they or their doctor have ever discussed and are okay with. If not, we leave the brand name in there. We then calculate up all their current medications over the course of a year, compare them under all of the prescription drug plans that we have available, and we tell them which plan is cheaper for them as a consumer. We don’t look at how much it’s going to cost us as a company at all… it’s all about the customer having what fits them the best. Who knows, maybe I just work for the one honest company out there.</p>
<p>We don’t use case managers for too many things. We do have them for people who have transplants and things like that - they follow up with them to make sure they are getting all the care that they need pre and post op. Those are expensive and they want to make sure that the people are taking care of themselves otherwise it could all have been done for nothing, unfortunately.</p>
<p>I’m curious to hear what the visit turns out to focus on.</p>
<p>The insurance company may be a pain, but I have seen case management work very well on behalf of patients – case managers often (sometimes?) have the flexibility to get approval for things that are normally not included in the health plan but which, if employed, might overall reduce expenses such as hospital readmissions. That’s often to the significant benefit of the patient.</p>
<p>Twenty-five medications is a huge number of drugs, especially in a geriatric patient. I’d be surprised if there weren’t drug interactions.</p>
<p>She said between them they have 25 drugs, not 25 drugs each. Many seniors take 10-12 RXes a month. I don’t know the percentages but that actually isn’t that alarming (to me anyway, I’m not a doctor). I talked to someone last week who had about 25 drugs just for herself.</p>
<p>I think something like two out of every five seniors don’t regularly take their medications properly that are prescribed to them. They either say they cost too much, they don’t like the side effects, etc. That’s why the companies sometimes use case managers for things like that.</p>
<p>Yes…and if they are getting all their prescriptions filled at the SAME place that would happen. Sometimes folks get their prescriptions filled at multiple places where pharmacy A doesn’t even know what pharmacy B, C or D has prescribed. BUT the insurance company would have all of that info if they are paying some of the costs.</p>
<p>I agree that you should try to be with them at this meeting. One of us goes to EVERY meeting with the parents these days (doctors appointments included) because there can be a lot of confusion and sometimes the “translation” isn’t what really happened.</p>
<p>Of course Fendergirl I believe in preventative care. But, from the perspective of the insurance company, they may not care if your taking the HBP med.</p>
<p>Most insurance companies want you taking your preventative meds. They’d much rather pay for that then the 100k heart attack. I’ve actually seen plans that cover preventative meds at 100 percent - no deductible, no copay. Pretty much anything asthma, blood pressure, cholesterol, diabetic, osteoporosis, etc related falls under them… brands and generics.</p>
<p>Again, thank you for your info and input. I’ve been intimately involved in the 'rents lives for almost a year now, and have gotten a crash course in all kinds of geriatric issues, including medical care. Complicated!</p>
<p>The visit, as it turned out, had nothing to do with the supplemental insurance/drug coverage. (Dad took the call yesterday, and he’s not exactly a reliable reporter.) Mom was discharged from a hospital stay on Friday, and her orders included at-home nurse visits and PT. This meeting was with a Medicare rep, essentially doing intake and setting up a care plan. She didn’t say so, but I think she was also assessing their living conditions, compliance with medical orders, etc. So my panic attack this morning was unnecessary.</p>
<p>thumper, I also try to be at every significant meeting (I can’t make them all – I’d have to quit my job to do that). As usual, it was good that I was there to ask and answer questions, give an accurate history, and remember what was said, because they really cannot do that anymore.</p>
<p>I know that drug interactions can be a problem, but Mom & Dad have an excellent primary doc who regularly reviews all of their meds for overlaps, inefficiencies and interactions. I also know that they’re taking all of their meds exactly as prescribed because they’re in assisted living, and the med staff has custody of their drugs and handles dispensing them. In fact, one of the main reasons they’re in AL is that Dad had been overdosing on his sleep and pain meds.</p>