My Experience As A Patient

        I found myself in the emergency department of a local hospital late the other evening with an acute problem that couldn’t wait until morning.  As usual, the experience of being a patient was a real eye opener.

         One of my contact lenses popped out of my eye while I was driving.  The resulting scramble in an attempt to put the lens back in my eye may have caused more problems than simply losing the contact. 

        As my eye got progressively worse over the next couple of hours it was obvious I wasn’t avoiding a trip to get the eye checked out.  And of course, it was just late enough on a Sunday where my options were severely limited. 

        This meant a trip to the emergency department at a local hospital.  And as anyone who has gone through a trip to the E.D. themselves can tell you, it was going to be an interesting evening. 

         The first thing I noticed is the streamlined process for being seen.  You check in, wait for the triage nurse, get assessed, and then wait to be seen by a provider. 

         I’ve always been guilty of playing the “what do the other people here have?” game.  I can’t help but wonder what brings others to the waiting area of an emergency department.  Plus, it is something to do while you wait to get to your room.

           I finally make it back to my room which is separated from the other rooms by those pull-away curtains only.  There are people in the next room I can hear.

          I’m able to hear the issues and problems of the two patients in adjacent rooms even with my mental attempts to block out their conversations with the E.D. staff.  HIPPA is apparently more of a concept than a practice in many areas of our healthcare system. 

          I’m finally seen and evaluated as best they can for an eye issue that is difficult to explain.  I’m given a prescription for Vigamox (an antibiotic opthalmic drop) as a precaution and sent on my way. 

          It is already past time to go to one of the locations where I work.  All of my employer’s pharmacies are closed.  Time to find a 24-hour pharmacy so I can start my antibiotic eye drops that same night. 

          I find a store and give them the prescription and my prescription insurance card and wait.  It is odd for me to be outside a pharmacy, waiting for someone else to fill a prescription for me.  It is a role reversal that I’m just not used to as a community pharmacist. 

          I’m paged back to the pharmacy department.  They tell me my insurance wants me to use one of my employer’s pharmacies or an affiliate pharmacy only for coverage.  The problem is there aren’t many options for 24 hour pharmacies and I don’t want to wait until the next morning to get started on my antibiotics. 

         This means I pay full price for an expensive antibiotic eye drop even though I have active prescription coverage.  Maybe I can file a claim later and recover some of that money?  Well, it was a fleeting thought that was more a wish than a viable option. 

         In the end I only waited a couple of hours to be seen in the emergency department that night.  It looked like an average volume night for them.  That actually isn’t bad compared to what the wait time could have been. 

         As I think back on my experience, I’m thankful it turns out my eye will be fine.  I’m also struck by all of the intricacies of our complicated healthcare system from the vantage point of being a patient rather than a provider. 

         How do we improve things for patients?  What contributes to E.D. wait times?  And why are there so many insurance blunders like the one I experienced late that evening? 

        I guess I will have time to digest these questions as I wait for my bill to arrive.  It’s an experience for a healthcare provider to become a patient.  I just hope it doesn’t become a regular occurrence for me. 

The Redheaded Pharmacist

5 Comments to “My Experience As A Patient”

  1. By pharmacy chick, October 15, 2012 @ 9:40 pm

    lets see if I can help with some of these questions:

    what contributes to ED wait times? things that arent emergencies. there is an entire populace of people who use the ED for their primary care. There is another populace who refuse to take care of themselves and find themselved in ED constantly…get stable…get released….ignore their med/directions..end back up in ED. Ask any ED doc or nurse. that will probably be your answer. Thats what my mother would have told you after her stint in ER, before she moved to Surgery.

    Insurance blunders? Because the doc at the ED is looking to fix your problem, not comply with an insurance company formulary, restriction, etc. That is pretty much the basic issue in an emergency room. they aren’t going to be concerned with getting an PA or an Override,…they are going to fix YOUR problem and move on to the next one. The doc on duty seeing you probably doesn’t even care IF you have insurance..that is the responsibility of the desk. The patient should know something about his/her insurance. My spouse has similar coverage to you…must go to certain places only . when he got sick on vacation and we needed a Z-pak, I knew we were out of luck, we had to pay. I knew it ahead of time. You may have asked ” Vigamox is expensive, can we have a 2nd alternate if Vigamox isnt covered?” Ive actually seen rx’s written like this from ED…First then a back up if not covered. clever if you ask me.
    and lastly, improve things for patient? Have a patient intimately involved in his/her own health care. its a responsibility. Most patients..as YOU know…are stupid and ignorant to their own policies. they really have no idea what they are supposed to know about what is covered/notcovered/formulary/ copays. Many think “covered:=free. I am not sure we can fix that as pharmacists.

    hope your eye feels better soon!

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  2. By The Redheaded Pharmacist, October 16, 2012 @ 7:12 am

    Yes PC, I could have pursued an alternative to the prescribed medication. I wasn’t upset about paying. It did bother me that my insurance penalized me because of the time of day. In my opinion, there should be no such thing as a “wrong” pharmacy from an insurance perspective. Patients should be able to go wherever they want without financial penalty. The preferred pharmacies on my insurance’s list were all closed and I had a time sensitive Rx. I think the power needs to return to the patient which means a lot of different things. Decouple insurance from employment, reign in the PBMs, and return the provider choice to the patient!

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  3. By Pharmaciststeve, October 16, 2012 @ 4:18 pm

    The easiest/cheapest thing for an insurance company to do is say NO.. My wife has many medical issues and her PCP and me wanted to try something off label for her… she is disabled and has part D… the PDP said, NO.. made suggestions that were either contra indicated with her other medical issues or not tested in her age group and WAS ALSO OFF LABEL.. I paid for the med ..to see if it would work… and started thru the appeal process. Every appeal was denied and we were now some three months into therapy and it was showing a positive clinical outcome… My next step was ALJ ( Administrative Law Judge) generally a retired attorney that hears Medicare appeals and will approve 50%+ to be paid/covered… I called the insurance company one more time… and told them .. you do understand that the appeal is going to be handled by a PHARMACIST going up against a ALJ and I have already a inch worth of documentation of this particular drug being used successfully off label and my wife has demonstrated positive clinical outcome.. what do you think your chances of prevailing are ? It took them a couple of days to decide that approving a PA for this drug for her was APPROPRIATE. In talking to some people “in the know” they said they had never heard of an insurance company to reconsider an appeal once all the their appeal processes had been exhausted. I have had other insurance situations.. and have found that if they push and you push back.. they have second thoughts..

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  4. By LDPlaceboeffect, October 17, 2012 @ 10:13 pm

    In appealing the decision of insurance coverage for my son’s treatment and medication, I reviewed the credentialing agency and ‘expert’ physician’s credentialing as well as standard clinical practices, and the standards guidelines for decision-making in the branch of medicine for which my son’s illness fell under. I assessed what he had received against what was recommended, what treatment was available within 100 miles within my locality, and the serious sequelae resulting from inappropriately withheld care which had already occurred (two suicide attempts), as well as examined all reports of side-effects of drugs in their step-wise process and personal ethnic factors (his ethnic group is associated with slow metabolism of specific and particular agents that were prescribed). Every piece of evidence I could dig up. Plus, I signed my letter as ‘Doctor of Pharmacy’, threatened letters to State Attorneys, Dear Annie’s Mailbox, and since I was working for a non-profit Catholic hospital, contacted the CEO with regard to subsidiarity and ‘care of one’s own’, and gained ground on what should’ve been covered, but then the PBM company cancelled my insurance. I feel as if I should be involved in rewriting the telling of David and Goliath. All this encumbrance erected by folks that are NOT even pharmacists!!!

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  5. By txpharmguy, October 17, 2012 @ 11:37 pm

    If you have a good relationship with a nearby urgent care or pediatrician’s office, you might call the nurse to see if they have a manufacturers coupon for Moxeza. I’ve seen it work for Vigamox too and for people without insurance: $20. Call or stop by other pharmacy, if close, and see if they can direct bill the coupon and possibly get a refund.

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