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Medical Forum / Diseases and Disorders / Lupus / April 2004

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Has anyone had any experience with this?

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saggums - 04 Apr 2004 00:30 GMT
I am fortunate enough to still be able to work full-time (with my employers accommodation of two days per week from home).  As an IT person, this works out well since I can log onto the network and do everything I would do at work - except run myself ragged.

I am also fortunate that I have (what I believe to be) a fantastic insurance plan.  It's a Blue Cross/Shield of Massachusetts PPO.  (I don't live in Mass., that's where the "parent company" resides.)  

I count my blessings every day for what I do have and know that others aren't so fortunate.

Here is the dilemma -
Today in the mail I received a letter and brochure from BC/BS of MA describing a "joint program" with Accordant Health Services asking if I had one of 14 chronic diseases.  You guessed it, SLE was on the list.  I was officially diagnosed almost five years ago.  

Included was a questionnaire asking things like "how many meds are you on", "how many ER visits have you had in the past year" and "how would you rate your current health".  I had two ER visits last year - more than likely due to the fact that aside from caring for myself, I also care for my 82 year old blind mother who had quadruple bypass surgery. Mom's little episode also prompted a 2 month hiatus from work - disability, which I feel guilty about every day since I am very "work oriented".

Now I am just a TINY bit leery of this letter and questionaire.  They say that it is so they can "help" with my care, but my Rheumatologist is absolutely fantastic and he sees me regularly (every three months and whenever a crises arises).  Plus, he is always at hand to guide me to the "extras", Nephrologists, Pain management, Pulmonary Specialist, Ophthalmologist, getting my Dexascan, etc., when called for.  My GP is also very much in the loop and the two of them communicate well to coordinate my treatment.  For the most part, I try very hard to take care of myself, and my Rheumy promotes me taking an active role in my treatment.  

Has anyone ever heard of these people, and/or had any kind of experience with them?  I hate the thought of   jeopardizing my current "well cared for" status just by being duped by my insurance company - whom I generally trust.  But somehow there are RED FLAGS going off here saying that I should cautiously proceed
RhondaM - 04 Apr 2004 01:03 GMT
I think you should find out if it is mandatory that you fill this out. If it isn't than throw it away and ignore it. I would ask you state insurance commissioner if this is legal for them to do this.
 I am fortunate enough to still be able to work full-time (with my employers accommodation of two days per week from home).  As an IT person, this works out well since I can log onto the network and do everything I would do at work - except run myself ragged.

 I am also fortunate that I have (what I believe to be) a fantastic insurance plan.  It's a Blue Cross/Shield of Massachusetts PPO.  (I don't live in Mass., that's where the "parent company" resides.)  

 I count my blessings every day for what I do have and know that others aren't so fortunate.

 Here is the dilemma -
 Today in the mail I received a letter and brochure from BC/BS of MA describing a "joint program" with Accordant Health Services asking if I had one of 14 chronic diseases.  You guessed it, SLE was on the list.  I was officially diagnosed almost five years ago.  

 Included was a questionnaire asking things like "how many meds are you on", "how many ER visits have you had in the past year" and "how would you rate your current health".  I had two ER visits last year - more than likely due to the fact that aside from caring for myself, I also care for my 82 year old blind mother who had quadruple bypass surgery. Mom's little episode also prompted a 2 month hiatus from work - disability, which I feel guilty about every day since I am very "work oriented".

 Now I am just a TINY bit leery of this letter and questionaire.  They say that it is so they can "help" with my care, but my Rheumatologist is absolutely fantastic and he sees me regularly (every three months and whenever a crises arises).  Plus, he is always at hand to guide me to the "extras", Nephrologists, Pain management, Pulmonary Specialist, Ophthalmologist, getting my Dexascan, etc., when called for.  My GP is also very much in the loop and the two of them communicate well to coordinate my treatment.  For the most part, I try very hard to take care of myself, and my Rheumy promotes me taking an active role in my treatment.  

 Has anyone ever heard of these people, and/or had any kind of experience with them?  I hate the thought of   jeopardizing my current "well cared for" status just by being duped by my insurance company - whom I generally trust.  But somehow there are RED FLAGS going off here saying that I should cautiously proceed
blader - 04 Apr 2004 02:31 GMT
As there's a medical information bureau where insurance companies can
get information on patients, you might not want to rush into that before
checking it out.

MIB is at http://www.mib.com/html/about_us.html
FBIWoman - 06 Apr 2004 06:47 GMT
> As there's a medical information bureau where insurance companies can
> get information on patients, you might not want to rush into that before
> checking it out.
>
> MIB is at http://www.mib.com/html/about_us.html

I have received a similar questionnaire from "One Health", affiliated
with my state insurance plan about once a year.  I just ignore them
and toss them, as I too feel my pk doc, rheumy, & kidney doc have me
under control.  It's a cost control thing and I don't fret.

I work in IT and recently changed jobs so I could work from home.  I
used to be a sys admin for about 40+ systems/6 servers.  I wore all
hats (web developer, database admin, sys admin, and manager of my 1
person staff!).  My new job is in GIS development, and I work from
home most days (travel to office about 45 miles away 3-4 times a
month).  The reduction in stress is a lifesaver (literally, I
believe).  I have a great photo of my kitty cats asleep on both
keyboards one day in my home office.  I need to get it developed and
hang it up!  They are great helpers!
Susan
Charlotte - 04 Apr 2004 04:08 GMT
Here's a news release.   Will also take you to the company website.

http://www.accordant.net/press/20011126.html
Cindy - 04 Apr 2004 18:56 GMT
I am thinking that all the information that they are asking for should
already be in your insurance file...
So why are they bothering asking you....
I would also..Ask if it were mandatory...
We do get some questioneres from Caremark..our prescription drug insurance.
They want to give Mike help with his asthma...Like he doesn't already see a
pulmonary doctor 1 time a month...hmmm.
Cindy
Kristin - 04 Apr 2004 20:05 GMT
First, let me congratulate you on finding an employer that will
accomodate you and let you work at home!  That is wonderful!

As far as the letter goes- Is there any legal reason for you to fill it
out?  Are they demanding the answers for BC/BS?  I have BC/BS FEP PPO
and they have never sent me anything like this...
If there is no reason other than some sort of idle curiousity or
something more sinister like pre-existing condition clauses, etc., I
would chitcan that letter in a New York second.

Just my 2c...
Good luck!
-Kristin

> I am fortunate enough to still be able to work full-time (with my
> employers accommodation of two days per week from home).  As an IT
[quoted text clipped - 98 lines]
>
> ------=_NextPart_000_0022_01C419A9.B2E92DD0--
saggums - 04 Apr 2004 22:09 GMT
Thank you all for your input.  I'm glad that I'm not the only person that
found this a little odd.  I did check out the website (www.accordant.com)
and can't say that I was feeling a whole lot better having done so.  Their
sales pitch to employers is to "reduce insurance costs by better managing
the care of people with chronic conditions".  Sounds OK on the surface.
Their pitch to physicians is that they will "help the physician" determine a
sensible care plan and help make sure the patient implements it.

This may be fine if my primary care physician for this was a GP and wasn't
real familiar with the treatments. But after reading through all angles of
their pitch, have pretty much decided that:

1) It didn't really apply to me since my care is already being managed
admirably by a whole team of specialists.
2) Someone was overstepping their bounds just a little and it wasn't me.
After all this time, I don't need someone that doesn't know me telling me
that I no longer need celebrex BID which is a fight that my rheumy and GP
both make for me on an annual basis.

RE: Note to Kristin:
Yes, I am delighted that I am able to work from home two days per week.  My
cats love it as well.  I have a pillow alongside my computer for Nick to
lounge on so he can keep me company while I'm working.  Because of this (I'm
sure) I've only had 1 sick day in the last 6 months.  The reduction in the
stress level has been astronomical and my body has really responded
positively (maybe I should share this with Accordant...).  I think it helps
that I work for a company that tests pharmaceutical compounds for adverse
effects.  Probably 10-15% of our employees are Ph.D. scientists who should
understand these things.

As a humorous interjection - about four months ago, our HR director sent me
an e-mail - copying my boss who happens to be the top person at our
division.  She wanted to know when I was coming back to work "full time".
While I sat and contemplated how to handle this question (since I DO work
full time), my boss whipped back a response that I did work full time, and
that in his opinion I was far more productive being able to work from home
two days a week than I was being run ragged five days per week.

As I said earlier, every day I wake up and am grateful for what I have
because I know that there aren't a lot of other people who are as fortunate.
My cup is definitely half full and not half empty.

> First, let me congratulate you on finding an employer that will
> accomodate you and let you work at home!  That is wonderful!
[quoted text clipped - 112 lines]
> >
> > ------=_NextPart_000_0022_01C419A9.B2E92DD0--
Andy - 05 Apr 2004 10:11 GMT
>Thank you all for your input.  I'm glad that I'm not the only person that
>found this a little odd.  I did check out the website (www.accordant.com)
[quoted text clipped - 3 lines]
>Their pitch to physicians is that they will "help the physician" determine a
>sensible care plan and help make sure the patient implements it.

Sounds like their remit is to save someone else money at the cost of
your health.
Signature

Andy Taylor [Chair, N E Lupus Group]
See http://www.northeastlupus.org.uk for more!

Wesley - 05 Apr 2004 15:50 GMT
> >Thank you all for your input.  I'm glad that I'm not the only person that
> >found this a little odd.  I did check out the website (www.accordant.com)
[quoted text clipped - 6 lines]
> Sounds like their remit is to save someone else money at the cost of
> your health.

The timing here is wierd.  I have Select Blue from Western PA BC/BS (I
always liked that BS part :).  They have something called "Blues On
Call" where I get to speak with a nurse if I have a problem/question.
This program has been of very great use to me, and the nurse has been
terrific.  I called her the other day, because I felt that I was
getting nowhere fast with my docs.  I wanted to switch PCPs, but I
didn't want to wait until May 1st to be able to do so.  She said that
she would check into that, and she suggested a case manager for me if
I wanted one.  She wasn't sure I could get one though, but she was
willing to try if I wanted.  I said sure, why not.  Now, after reading
all this, I'm not so sure.  Do you think they will place extra
restrictions on me?
Kristin - 05 Apr 2004 21:04 GMT
They can't place any extra restrictions upon you because of your illness
unless there is a clause that restricts pre-existing conditions and you
didn't tell them about it, or if they change coverage (at an open
enrollment time) for everyone. If they pick you out simply because of your
illness, and you have followed all of the rules, they can get into big
trouble.  I think that the questionairre that was sent out was to get
"other opinions" that might negate her care, but not sure.  I don't know
how a case manager would help you- have you considered an internist?  See
if your insurance would pick up a good one (in Encino Dr. Sogol's office is
good) for your pcp, I think that would be best.

Good luck!
-Kristin

>> >Thank you all for your input.  I'm glad that I'm not the only person
>> >that found this a little odd.  I did check out the website
[quoted text clipped - 20 lines]
> all this, I'm not so sure.  Do you think they will place extra
> restrictions on me?
saggums - 06 Apr 2004 02:23 GMT
Wesley -

In your case, this could be a perfectly legitimate option.  You are unhappy
with the care being provided by your PCP.  In my case, I am being monitored
by no less than 7 or 8 specialists.  I live in the Philadelphia Metro area
and medical care is abundant if you have a good policy (i.e. not an HMO).  I
am monitored by a Rheumatologist (my Lupus PCP), a GP (my regular PCP), a
Neurologist, a Pulmonary Specialist, a Nephrologist, a Cardiologist, a
Gastroenterologist, etc., each for specific medical issues.  And the result
of all this treatment is that I am able to continue to work full-time and
lead a somewhat normal life.

Plus, I have benefits in or out of network, so can see anyone, anytime, and
it is still covered.  After being covered for 14 years by an HMO, I can
certainly appreciate this.  This sounds like a luxury that you - or anyone
else - would benefit by.

In essence I have two PCPs monitoring and coordinating my care who together
do an excellent job.  My feeling is that if my insurance company wants to
bring (my) costs in line, they will somehow discourage the treatment that I
am currently receiving by discouraging or denying treatment by all these
specialists, and/or somehow reducing the prescriptions that I am currently
taking.  To me, this would be unacceptable.  I love my job and would miss
the intellectual stimulation that it provides.  Not to mention that by going
out on disability again, I would ultimately be inflicting greater costs on
my employer in the long run, thereby negating the principal argument to
employers which justify their use of Accordant.  It would just be costs in a
different column, not healthcare.

I think that we each need to evaluate carefully the options presented to us
and make the best decisions based on our current situation.  I have the
luxury of making decisions based on concepts, whereas you need to be more
practical in your decisions.

Saggums

> > >Thank you all for your input.  I'm glad that I'm not the only person that
> > >found this a little odd.  I did check out the website (www.accordant.com)
[quoted text clipped - 19 lines]
> all this, I'm not so sure.  Do you think they will place extra
> restrictions on me?
Beverley - 06 Apr 2004 03:15 GMT
Ok, let's see how small the world really is. I grew up up there. Lower
Moreland High School. Where are you from?
Bev

> Wesley -
>
[quoted text clipped - 62 lines]
> > all this, I'm not so sure.  Do you think they will place extra
> > restrictions on me?
saggums - 06 Apr 2004 03:53 GMT
I grew up in Upper Gwynedd on a farm (many moons ago - there is no longer
such a thing as a farm in Upper Gwynedd).  Graduated from North Penn High
School.  Did my rounds upon graduating from college (Temple - Tyler School
of Art, B.F.A.), moved to Montana for a year, then to Seattle for four
years, moved back home, lived in Ambler for a year, bought a house in North
Wales, and have lived here ever since (18 or 19 years), approximately 2
miles from where I was born and raised.  Nothing anyone ever expected of me.
In 1998, I got my MBA in IT Management, also from Temple.

Had to look it up but Lower Moreland is a hop, skip and a jump away.  I work
in Horsham, which you should be familiar with.

> Ok, let's see how small the world really is. I grew up up there. Lower
> Moreland High School. Where are you from?
[quoted text clipped - 77 lines]
> > > all this, I'm not so sure.  Do you think they will place extra
> > > restrictions on me?
Norman & Wende - 06 Apr 2004 22:44 GMT
I would question why the letter was sent to you unsolicited. I also would not complete the form and return it unless it is related to your current insurance plan.  Is your employer making a change in insurance plans? You will need to contact your employer's insurance dept. and ask if there is a change in insurance plans in the works for your company. You can also contact your current insurance provider customer service dept. and ask why this form has been sent to you. With the Health information portability act, insurance companies, really can't solicit personal health information from you or your physicians.  Without your permission. If you are changing plans and haven't been informed yet, I can tell you that many insurance plans will not"pick up" a person with a diagnosis of SLE, and many other auto immune/connective tissue/rheumatoid type diseases. Even on open enrollment the insurer does not have to cover us. On the other hand if you exclude the fact that you have been diagnosed with anything, the insurance company can rescind your coverage as misrepresentation. Then your medical expenses are not going to be covered period. Wende
 I am fortunate enough to still be able to work full-time (with my employers accommodation of two days per week from home).  As an IT person, this works out well since I can log onto the network and do everything I would do at work - except run myself ragged.

 I am also fortunate that I have (what I believe to be) a fantastic insurance plan.  It's a Blue Cross/Shield of Massachusetts PPO.  (I don't live in Mass., that's where the "parent company" resides.)  

 I count my blessings every day for what I do have and know that others aren't so fortunate.

 Here is the dilemma -
 Today in the mail I received a letter and brochure from BC/BS of MA describing a "joint program" with Accordant Health Services asking if I had one of 14 chronic diseases.  You guessed it, SLE was on the list.  I was officially diagnosed almost five years ago.  

 Included was a questionnaire asking things like "how many meds are you on", "how many ER visits have you had in the past year" and "how would you rate your current health".  I had two ER visits last year - more than likely due to the fact that aside from caring for myself, I also care for my 82 year old blind mother who had quadruple bypass surgery. Mom's little episode also prompted a 2 month hiatus from work - disability, which I feel guilty about every day since I am very "work oriented".

 Now I am just a TINY bit leery of this letter and questionaire.  They say that it is so they can "help" with my care, but my Rheumatologist is absolutely fantastic and he sees me regularly (every three months and whenever a crises arises).  Plus, he is always at hand to guide me to the "extras", Nephrologists, Pain management, Pulmonary Specialist, Ophthalmologist, getting my Dexascan, etc., when called for.  My GP is also very much in the loop and the two of them communicate well to coordinate my treatment.  For the most part, I try very hard to take care of myself, and my Rheumy promotes me taking an active role in my treatment.  

 Has anyone ever heard of these people, and/or had any kind of experience with them?  I hate the thought of   jeopardizing my current "well cared for" status just by being duped by my insurance company - whom I generally trust.  But somehow there are RED FLAGS going off here saying that I should cautiously proceed
 
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