February 27, 2010

How We Manage Health Care Costs & Quality of Care

This is the story of how we have worked with our doctor to manage the costs and quality of care for Sean's rare condition and our families medical care.

To control our costs we utilize a few simple but effective practices:
  • We make sure our general practitioner (GP) has records from all other doctors and that we never have a test or receive new medicine without our GP's knowledge. This not only controls costs but keeps us from endangering a life by having conflicting prescriptions.
  • We take our insurance Rx formulary (a list of prescriptions covered by our insurance) with us to all appointments and check to make sure any perscriptions given are on the formulary. If they are not listed we find a comparable Rx that is on formulary. Note: we have always been able to find a comparable Rx that is on the formulary or have been able to work with the insurance company to get the Rx approved.
  • We retain copies of all tests, x-rays, scans, and doctor files. We take these with us to any new doctor so that scans etc. do not need to be repeated.
  • Two people attend every appointment. This assures we hear and understand everything and that the doctor receives the full picture of our sickness from our and our family's point of view.
  • We ask questions and understand our conditions and the treatments available as well as the risks and benefits of every treatment.
These simple practices have not only kept our costs down but they have also assisted us and our doctors in improving our quality of care. We take personal responsibility for our health care and do not rely on our doctors to be alone in understanding our conditions or our treatments.

I realize at this time it is popular to hate private insurance companies but we can not engage in that activity. During the five years that we have had private insurance we have received much more than we have given. When we have worked with the insurance company we have always been able to find a common ground that allows us a great quality of care while allowing them to control costs. We view this as a civic duty to assure that our friends, neighbors, and fellow countrymen do not have to pick up costs we could avoid.

Our experience with private insurance stands in great contrast to Sean's previous experience with the military and our private insurance has provided many options and speed of care that we do not see with our family members that have VA, or Medicare.


How Government Health Care Regulations/Practices are Ruining my Quality of Life

My name is Sean Cowlishaw and I have a rare condition (fibrous dysplasia of the skull). In short my skull has never quit growing and bone is surrounding my optic nerves, has filled my sinus cavities, and is putting pressure on my brain. My condition is extremely rare in that the bone growth did not end in puberty and the bone continues to grow to this day (I am in my thirties).

About three years ago I finally found a doctor that not only helped me find answers but that works closely with me and my family to assure us a high quality of life. I have also been blessed in that I have had good insurance (for the past five years) and a wife that understands the health care system. My wife and I have worked closely with our doctor to keep costs down for both us and the insurance company and to maintain a high quality of care (see my blog entry about cost containment).

As the Health Care Reform debate heated up in 2009 my quality of life was significantly lowered. The first blow was that my costs for specialists were raised due to the media and Congressional blitz about high quality insurance plans. At first this was not a huge issue for me as I have seen ever specialist possible and there is nothing they can do for my condition. The specialists had sent me back to my general practitioner for pain management and for almost a year my quality of life was the best it had been for a long time. I had one doctor managing my care and he took all aspects of my quality of life into consideration as well as doctoring my full person not just my fibrous dysplasia.

In February of 2010 the second and worst blow fell. I was called into my general practitioner's office and told he was no longer allowed to practice pain management. The clinic management has determined that because of the DEA practices of treating pain management doctors as drug dealers it was too big of a risk for their doctors to prescribe pain medicines. The clinic was only able to give us the names of two practices that are still willing to prescribe pain meds. One option will cost us and our insurance three time as much as our general practitioner. The other option costs over $1000 more a visit and is not covered by insurance. We have our first visit with the new doctor on Tuesday and will update this blog continuously.