Friday, November 27, 2009

Dr Medicaid, when is your next appointment?

So I have a patient with Diabetes which has recently become poorly controlled. She was on Glyburide / Metformin 2.5/500 BID and her blood glucose was in the mid 300s. HgA1C was almost 9. She tells me how she is drinking 6 or so sodas daily and not eating right. I advise her on healthier eating habits and have her double her pills for the next few weeks (2 in the am and 2 in the pm - I don't like for my patients to waste pills every time a dose is changed). She comes back for follow up a few weeks later. I review how she is eating and taking her meds and she has been doing as advised for the most part, however, her accucheck was 400. So I write a script for the higher dose of Glyb/Met (so she no longer has to double her previous script) and give her samples of and write a script for Januvia - another diabetic med.

No sooner is she out the door that we get a call from the pharmacist - her insurance requires prior authorization before filling the Januvia. Basically meaning I have to get permission from the insurance company before I can treat the patient with this med. So my nurse calls Medicaid and answers their 'screening questions' only to be told that they will not cover that until she has been on the glyb/met 5/1000 BID x 3 months. I am livid! They don't even include the past few weeks of her doubling her pills because it didn't show up in their system since it wasn't an official script.

So now she has to run around with blood sugars in the 300-400s for 3 months before they will pay for her med! And if she has to go in the hospital with DKA or hyperosmolar nonketotic diabetic coma, her insurance will have to pay way more for that hospitalization!

I wonder if I can set her up with an appointment for Dr. Medicaid's clinic since they can so easily dictate patient care. What is the point of having doctors if we cannot even treat the patient without permission?

Wednesday, November 25, 2009

My Baby Girl was sick...

Well, my baby girl (20 months old) got sick. Saturday, she started coughing nonstop. Dry, but almost nonstop.

Sunday morning I noticed upper airway noise but listened with my stethescope and her lungs were clear. She was breathing kinda fast. It reminded me of when she had Croup last year. I called one of my colleagues who looked her over and thought she didn't look that bad. We gave her some Prelone syrup. Later that day she got fever 103.

Monday, she was worse. This time the wheezing was all in her lungs and she was retracting some. I was trying to give her her albuterol but she would have none of it - not enough anyway. I took her to the ER (the ER Doc on is a close friend of the fam and I worked with her during my Residency a few times) and we gave her a few updrafts (without officially checking her in and doing lab work, etc as I didn't have my new insurance card with me). She got a little better but was still wheezing some. I figured since she was on steroids, it would continue to get better. I was wrong. Oh, and she was not eating much at all.

Tuesday morning she was worse, wheezing everywhere (I could hear her across the room). Retracting some, breathing fast. Looked ill. So I paged her Pediatrician who happened to be on call. She told me to take her to get a chest Xray and bring her to the office at 10am.

When the Ped listened to her, she had her Nurse Practitioner and Student Doc listen too - her wheezing was so bad. She also had a bad ear infection. Flu and strep tests were negative. She had to go in the hospital for scheduled updrafts, IV steroids and IV fluids.

I don't know why it surprised me that she'd have to be hospitalized. It broke my heart though. They had to stick her 3xs to get a line which came out before her first meds were given, then they had to stick her 3 more times. She ended up having to get it in her foot.

She tested + for RSV, a virus that affects the lungs and in many cases just causes cold like symptoms but for an unlucky few, like young kids prone to wheezing, it can make them very ill - as it did my little girl.

We were there overnight. She was a real trooper. We're home now. She's still sick, but much better. Still on a lot of meds.

Soon as we pulled up to the house and I started getting stuff out the car, she said "Momma! Momma!" and I looked at her and said "What baby?" And she says, "French fries? French fries?" So I get back in the car and head McDonalds. How can I say no to that face?