(To view the case of the original post, go to Case 1.)

Follow-up care is essential to assure good outcomes, but for some people getting a ride to the doctor can be a problem.  So, put yourself in Susan’s shoes.  If you couldn’t drive yourself, what would you do?  Here are some options:

• Most would jump at the chance to be of help.  After all, some day you may be able to return the favor. 
• Depending on where you live that could be quite expensive or cumbersome. 
• Contact them to find out.
• The social workers there are aware of all sorts of programs in the community to help its citizens with a variety of needs, such as transportation. 
• He may know of another way to address your transportation difficulty.

I used Case 1 under Cases To Consider to describe an actual situation that a real person faced after she came home from the hospital.  I named her Susan and outlined the problems she encountered getting the care she was supposed to get along with how I would overcome those obstacles.   I hope you found these to be useful in understanding some of the important components of a hospital discharge and how to work within the healthcare system to stay your healthiest.  I welcome your comments and questions. 

For Your Health – Dr. Bob

(To view the case of the original post, go to Case 1 under Cases To Consider on the home page.)

Though Susan said she couldn’t get the medicine that her doctor prescribed for her which worked in the hospital, that isn’t quite correct.  The reality was her health care insurer wouldn’t pay for that medicine.  She could have gotten it if she paid for it herself but did not want to spend the money.  That doesn’t sound fair.  After all it helped her feel better.  Why wouldn’t they pay for it?  The answer is simple, it is an over the counter (OTC) medication available without a prescription and health care insurance policies don’t usually cover OTC medications even if your doctor writes a prescription for them.

So what are Susan’s options.  She could just pay for the medicine herself. This medication is relatively inexpensive, costing under $6.00 for a 16 day supply of the generic, meclizine, at one of the national retail pharmacy chains.  A brand is slightly more, still under $9.00 when I checked.  In view of how bad she was feeling without it, buying it now seems to be the most logical choice. 

She could also appeal her health insurer’s decision.  To do that she would call the Member Services number on the back of her health insurance card.  Unless they agree to handle this as an expedited appeal, she may wait weeks for a decision.  State regulations dictate how rapidly they must respond to both regular and expedited appeals.  She could appeal it before or after she has purchased the drug, too.  In my experience, under these circumstances the insurer would probably not agree to pay for the drug even with an appeal, but she could try.  Her health care insurance policy is a contract that defines what is a covered benefit and what is not.  For consistency and fairness to everyone they insure, they must adhere to those definitions unless there are extenuating circumstances.

So, given how bad she feels without the medicine, I would urge her to buy the medication and submit an appeal to her insurer.

I’ll talk about how to deal with one of the other issues with her discharge plan that went wrong on my next post.

For Your Health – Dr. Bob

The post, When Plans Go Wrong, shows why it’s important to learn how to use the health care system and be an advocate for yourself to safeguard your health.  (For your convenience you can find a copy of it under Cases To Consider.)  This post is all about Discharge Plans.

A word about Discharge Plans:  Transitions from one health care setting to another are always risky.  Whether it’s going into the hospital from home from the hospital back to home, mistakes in communication are more likely to happen.  To try to prevent these miscommunications from happening in the transition from hospital to home the attending physician, the doctor who cared for the patient in the hospital, gives the patient a Discharge Plan.  It is a written plan that tells the patient what medicines to take, what diet to eat, any limitations of activity, what tests they need to get and where they are to get them, any physical therapy they may need and from whom they should get it, any referrals to specialists they need to have, and finally, when the attending doctor wants to see the patient in their office.

When Plans Go Wrong outlines several issues that went wrong with the implementation of Susan’s discharge plan:

1. Susan couldn’t get the medicine that worked for her in the hospital
2. Her physician hasn’t called back
3. She is unable to get to her doctor visit

I heard about a situation the other day that I’d like to share with you to get your thoughts:

It seems a 62 year old woman, I’ll call her Susan, had been in the hospital for a few days due to vertigo.  She would feel the room spinning when she moved her head in certain positions.  It was so bad that she could hardly walk let alone drive, and she lived alone.  The vertigo was also accompanied by nausea and vomiting.  While in the hospital she was given a medicine, meclizine, that controlled her symptoms.  Her doctor discharged her with a prescription for the medicine.  He also wanted a home health nurse to visit her several times a week and a physical therapist to come to her home to give her some treatments that usually help control the symptoms as well.  Finally, her doctor wanted her to come to his office a week after discharge from the hospital to make sure she was progressing.  All in all, it sounded like a great Discharge Plan.  The trouble is – it just didn’t happen.

First, since meclizine is available over the counter, her insurer wouldn’t pay for it even though she had a doctor’s prescription for it.  Next, though she went home on a Friday, by the following Wednesday she had yet to have a visit from the home health nurse.  When Susan called the nursing agency to find out why the nurse hadn’t visited, she was told they had not received an order faxed to them from the attending physician.  And because the nurse was going to arrange for the physical therapist, she had not had any physical therapy either.  Susan called the physician’s office when she learned of this, but hadn’t received a call back from the doctor after several days.  Finally, because she didn’t get the medicine that was prescribed she was feeling worse since coming home and couldn’t drive herself to the doctor’s office for her Thursday follow up appointment.

For Your Health – Dr. Bob