Obamacare Begins to Trickle Down

We are starting to see the aftereffects of Obamacare starting to trickle down to patients, and there are some things that are both odd and curious.  Obamacare goes full-blown in 2014, and in 2012 some doctors started the transition process by writing electronic prescriptions, but 2013 is already turning out to be the Big Obamacare Year of Change.

The first change we’ve noticed is our insurance company no longer supports 90-day prescriptions for maintenance medication via local pharmacies.  If you want the super-cheap 90-day supply, you are forced to get your pills delivered through the USPS.  I discovered that change last month during my latest refill in the New Year when I was only given 30 pills in a 90-day supply.

When I asked why I was getting only 30 pills, my pharmacist told me the insurance company refused to fill the 90-day prescription.  My local pharmacy takes a 90-day prescription and breaks it into much more expensive 30-day “partial refills.”  When I called my insurance company to find out why this change was made, they merely confirmed the change was now “90-day supply via mail only” and that applied to every medication they cover.

Doctors who used to rely on paper are now forced to evaluate you electronically via computer.  Your doctor will ask you a bunch of questions that are entered into a computer.  The patient-written paper screening is out, your doctor entering your responses on a computer is in, and the doctors are not thrilled about that!  The questions are endless.

You will also be weighed every time you visit any doctor — it doesn’t matter if you’re seeing your primary care physician or heart doctor or GYN or psychiatrist — you get on the scale, and they all deduct differing pounds for the clothes you’re wearing, so it’s possible to lose and gain seven pounds a day, just by visiting different doctors! ll your weights are measured by being entered into a computer.

Another interesting thing I’ve noticed in this young year of Obamacare changes is that the idea of “referrals” are not longer being used.  “Prescriptions” is the new buzz word.  You get a “prescription” to go to the lab, you get a “prescription” to have radiology and other procedures done.  I’m not sure if this change is because being “in” and “out” of network will no longer apply under Obamacare or not, but you really can’t do anything in or out of your doctor’s office without an elaborately written, and computer generated, full-sheet, prescription.

As well, if you haven’t been to the doctor yet this year, make sure you bring a photo ID and your insurance card because they will need to scan them into their computer system.  They will also likely take a photograph of you to accompany your patient file.

Our doctors haven’t yet start palm scanning –

PLEASE put your hand on the scanner,” a receptionist at a doctor’s office at New York University Langone Medical Center said to me recently, pointing to a small plastic device on the counter between us. “I need to take a palm scan for your file.”

I balked.

As a reporter who has been covering the growing business of data collection, I know the potential drawbacks — like customer profiling — of giving out my personal details. But the idea of submitting to an infrared scan at a medical center that would take a copy of the unique vein patterns in my palm seemed fraught.

– and I hope that creepiness never finds a rest in the heart of my hand.

We’re getting a taste of Obamacare now and it does seem to be more intrusive and electronic and perilously fraught with a loss of HIPAA expectation of security and privacy — paper lives once in one place; electronic medical records live a million lifetimes across a thousand servers forever — but that’s the way healthcare will work everywhere from 2014 onward, and we’d better be prepared to play along or get left behind.

19 comments

  • One very good thing about EMR is that when your specialist needs a copy of your records, you don’t have to wait days for your files to be sent over!

    From my work with my previous company, I know that EMR is actually quite a bit more secure than paper records. Anyone can open a folder and have a look and photocopy to their heart’s delight — but if you have military grade encryption on your files and need a strong password to access files, it’s a lot more difficult if not nearly impossible! :)

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    • Those are comforting thoughts, Gordon, thanks for sharing! I can see the advantage of having your entire medical history available to you throughout your life without ever having to mess with paper copies.

      We’ve had lots of doctors throughout the years, and we’ve moved a lot, and I can’t think of one time when we went into the old doctor’s office to give our records to our new doctor. We just start all over with new baseline tests and go from there.

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  • As much as I’m not a fan of Obamacare at all, I find two of these complaints about it rather attenuated. The 30-day / 90-day supply thing was a function of the insurance companies long before Obamacare … this was going on back when I worked in a pharmacy in the 1990s. As for the complaint about electronic medical records … seriously? It’s such a better system of organizing all the information about a patient. As a lawyer, I haven’t a single printed case file … I do everything electronically, and an electronic standard for medical records is well needed.

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    • Thanks for the comment, Michael. For 15 years, our insurance company allowed 90-day prescriptions at local pharmacies. In 2013 that changed. Asking around with co-workers, it’s an “Obamacare Transition” — whatever that means — but there is no such thing as a coincidence.

      I still prefer paper over digital for privacy. A few eyes in your MD’s shop might take a peek if so inclined, but online, the entire world can scrape you and recreate you.

      I don’t believe there is any digital security system that is actually secure enough to never be broken.

      As a lawyer, aren’t you required to submit documents electronically by the courts? Is paper even still an option?

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      • I file patents and trademarks, and paper is still an option, but most filing today is done electronically. For the local courts, you can still only file on paper.

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        • I have a couple of good NJ attorney friends who, 10 years or so ago, were complaining about the move to file all bankruptcy documents electronically with the court. Their computer systems, at the time, were also cheap and they had no offsite backup plan — but their offices sure did look expensive and beautiful. SMILE!

          I visited your fine website, and speaking of electronic mishaps, are you aware the hotlink to your Manhattan office — http://patentlawny.com/directions/ — currently takes you to a Google Map placing you on 150th Street and 7th Avenue?

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  • The Portuguese system uses the “prescription for everything ” method as opposed to the UK system of we will refer you to the hospital consultant/department who will then contact you with an appointment date within the next week/month /12 weeks depending on what length the waiting list is – unless you pay privately in which case you will get you appointment as soon as you give us your credit card details.

    Once we have our “script” we can then choose which hospital we want to have our tests at. Some tests like simple blood and urine tests can be done locally – others you have to travel for.

    You attend the hisoital have your test done and YOU are given the test results. YOU hold your own medical records here at present.

    Everyone makes some contribution to medical and dental care except for children , those over 65 and those with life long conditions such as diabetes , disability etc. I am not sure yet quite how these contributions are calculated but I do know that all medical and dental costs paid up to a certain amount are allowable against tax.

    I paid privately here to have all my teeth to be removed prior to having implants in the near future. I had them removed under a general – before hand I had a very specialised MRI scan of my mouth that wizzed around twice for about ten seconds took the picture and then took 15 minutes to print out images of top and bottom jaw and then every individual tooth and root – amazing … my wallet was 100 euros lighter – but still amazing – and I have all the pictures to prove it ! The real joy is with those pictures and resultant post op scans I can go to any dentist and get a quote for my implants – much more freedom of choice for me.

    Back in the UK I opted for my medical records on a computer with my medical history is was a pertinent decision to make. I was able to specify medical personel only when I signed up for it – otherwise all kinds of people could have had access – anyone from local government etc etc etc.

    I can get two month refils for my meds here – in the UK they clamped down on two or three month scripts – put an end to compassionate doctors helping you out by saving you the charge. The do still tell you if you can buy the medicines cheaper over the counter.

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  • Wonderful analysis, Nicola! Thank you for sharing all the details! You’re right about compassionate doctors willing to write you a 90-day script instead of giving you monthly refills. I’ve never understood why it mattered to them if they wrote a script for 90 or 30 days for maintenance meds — because it cost us the same amount of money to fill either one, so the value of 90 was three times greater than a 30 for us in savings — but some MDs are just hardarses about that sort of thing, I guess.

    Many of the higher end doctors in NYC are going private care only by refusing to take ANY insurance. You pay cash. No credit cards. One friend was had to start looking for a new OBGYN when she was told by her doctor — who had decided to go for-pay only — that she needed to bring $500-1000 cash to her next exam to cover any costs or tests. She did not return to that doctor.

    I miss the old days where MD offices would actually pull your blood and take your urine. Today, they push you to a private lab and you have to sit there and wait for them to act. One good thing about these lab reports, though, is that they are sent to your MD electronically for faster delivery and you can login and see the raw report yourself! That’s new. That’s appreciated. In the past, MDs would never give you lab results over the phone or let you see your own records. You “owned” them, but they controlled access.

    Love the tooth implants story! I think that’s the only way to go. Are you wearing dentures now? Will they implant posts for every individual tooth? How long do you have to wait for the post to heal before they’ll put on a tooth?

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  • ah my teeth almost desrve a post of their own ……………….. maybe when they are finished they will get one. I left after surgerywitha set of dentures – I actually walked out of the hospital with the top set in place to the applause of the whole dental department. It was the first time the brand new dental surgery department had performed the surgey at that hospital. Three weeks later I managed to get the bottom set in. Had a brand new better fitting set in for my handfasting.

    I was scheduled to have the implants just bfore Christmas but I postponed it because I wanted to enjoy Christmas away in France without problems. I have to confess I only wear my dentures on special occassions or when I need to be photographed – I have a psychological problem with them – they feel like Aliens ! My dentist and I have discussed this and we think this is because the teeth are different in shape and spacing and make up to my own. I only ever had two front teeth not four and my own teeth were shorter and squarer than the standard model .

    I have been digging out old photographs to provide the benchmark for my implants. I am have 12 mounts – 6 top and 6 bottom with two teeth on each.

    I will give you all the gory details whe I have had them done !

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    • Yes, I want a full dental report! SMILE! We have a sort of dental/dentist fetish here:

      http://bolesblogs.com/?s=dental+teeth&submit=Search

      Do you want your implants to give you back your smile at age, say 18, or do you want a more standard “Dentist Perfected” smile?

      The trend here in the USA is to implant everything and forget crowns and bridges and dentures — the hard part is that a single tooth implant costs $1,000.00USD — and they want to do one tooth at a time multiplied by 32 teeth upon completion — and you quickly learn just how fortunes are made in America.

      Dentists are desperate in the USA to bring in the cash because insurance doesn’t cover teeth. You either pay them up front or your job pulls out a “dental budget” from you paycheck every year. In a withering economy, dentists are the first luxury to go — and you definitely see that effect in dwindling waiting rooms.

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  • Whereas I have just about got over my dental phobia – I had to work really hard to get myself into the dentists door in the first place – in fact he came out onto the street to meet me the first time.

    I want them to be as natural as they can be for w woman of may age and as near as possible to the look I used to have ie shorter squarer teeth – putting a set of 18 year old looking shiny bright white teeth in my mouth are going to scream FAKE.

    I paid half up front and the balance beefore I left hospital and I got a 26 page print out of every item they had used and what it cost and a refund in the post a week later. As the operation was so new they did not know what to charge me for somethings. Every single item was listed – it is a ingle use hospital so no autoclaves for sterilization etc etc.

    The estimate for mine is about 25000 euros I paid 5000 euros for the first stage including all the magic gadgetry and diagnostic reports. Mine will come in cheaper if I can get myself to sit in the dentists chair and have them done rather than have another general.

    I can understand them being the first thing to go in austere times …………….. especially at these prices.

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    • Oooof! What you paid is about what we pay. My! What a way to really put your money where you mouth is! SMILE!

      I like the no-autoclave. It’s wonderful your doctor came out and met you on the street!

      The only thing that concerns me about implants and crowns and such is that the tooth material is about a third less durable that your real teeth, and the “teeth” tend to easily chip — but they cannot be repaired — the only way to fix a chipped fake tooth is to replace it at a thousand dollars a pop!

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      • well I am well armed with all my reports I may well shop around – having said that , the idea of doing that fills me with dread . I feel after my phobia that I am lucky to have found a dentist who I trust and who has actually become a good friend.

        he has been very good and offered me options along the way and explained the difference between them all. I do have the option of high end dentures – there is also a mix and match option available.

        I may have a trial run with a partial set to see how I feel about them – no point in spending all that money and still feeling like I have aliens in my mouth !

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        • I vote to stay with the dentist who came to you when he did not know you. He has good instincts. He did the right thing to help you cross the threshold.

          I sort of like the idea of full dentures for my own mouth when the time comes. I know the muscles in the mouth change and weaken as we age, and dentures seem like the most economic way to stay caught up with the inevitable at an affordable price.

          I think you’re right to do a trial run to make certain you have precisely what you want.

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