Perscriptions and insurance. Pharmacy problem...

[LisaR]

I still want to know what ETHICAL doctor would write an EXTRA RX for an antibiotic just in case your child gets sick again? Forget about fraud, this is incredibly irresponsible.

 

[KathyTX]

This thread has veered off-topic and into arguments about ethics. If all that's left are the arguments, we'll lock the thread.

 

[QWOT]

How is it illegal? Actually, i know it isnt.
How will it "bite him?"
I take one one Generic prilosec per day.
The rx states "take two".
My doc knows im taking one.
This IS done alot.
I get two months for the price of one.
How can this not be understood?

And, one CAN and many DO take 40 mg's (2) prilosecs per day.
PPI's are harmless drugs.

First, this is fraud. The doctor is falsifying a prescription, and improperly billing the insurance company. Period. You can try to hide behind the excuse of "everyone does it", but it is what it is: fraud.

Second, I'm frankly shocked that you would advocate this type of fraud from both a legal/ethical standpoint (I used to work medical billing), and a medical standpoint (I'm also a paramedic). Perhaps you don't do transport in your system so you wouldn't understand this; but one of the key things that hospitals want in an emergency is not only the names of the drugs but also the dosages. There is a big difference in the conditions of a person taking 20 mg of Lasix vs. 40 mg of Lasix (to give an example). Your example of prilosec may be relatively benign medically, but the concept is not; and for you as a licenced medical professional to advocate this type of behavior is repulsive.

 

[npmommie]

I still want to know what ETHICAL doctor would write an EXTRA RX for an antibiotic just in case your child gets sick again? Forget about fraud, this is incredibly irresponsible.

No ethical doctor would write an extra rx for antibiotic.

How is it illegal? Actually, i know it isnt.
How will it "bite him?"
I take one one Generic prilosec per day.
The rx states "take two".
My doc knows im taking one.
This IS done alot.
I get two months for the price of one.
How can this not be understood?

And, one CAN and many DO take 40 mg's (2) prilosecs per day.
PPI's are harmless drugs.

maybe it isn't technically illegal, but it doesn't make it right.
for one thing there are treatment protocols, for instance if I see someone newly diagnosed with hypertension, I would not immediately prescribe the highest dose of a med for them. so it would not make sense ........plus the fact that the chart doesn't match the rx just doesn't fly.

and using your Prilosec as an example, suppose your doc did this for someone and then they got confused and did start the higher dose on the bottle, prilosec does have adverse reactions, and it also has many drug interactions,( but you are a medical professional who can compete with us lowly NP's so you already know all those right??) so it would be an important piece of info if this person ended up in the hospital for whatever reason to know exactly which dose is the correct one and which the pt is actually taking.

 

[edwardsfire]

First, this is fraud. The doctor is falsifying a prescription, and improperly billing the insurance company. Period. You can try to hide behind the excuse of "everyone does it", but it is what it is: fraud.

Second, I'm frankly shocked that you would advocate this type of fraud from both a legal/ethical standpoint (I used to work medical billing), and a medical standpoint (I'm also a paramedic). Perhaps you don't do transport in your system so you wouldn't understand this; but one of the key things that hospitals want in an emergency is not only the names of the drugs but also the dosages. There is a big difference in the conditions of a person taking 20 mg of Lasix vs. 40 mg of Lasix (to give an example). Your example of prilosec may be relatively benign medically, but the concept is not; and for you as a licenced medical professional to advocate this type of behavior is repulsive.

Yawn...
Ok, YES we transport and just so ya know, not only am i a medic also, i was a combat medic.
So dont go there.
If you or anyone else do not think this is done REGULARLY, then you are naive.
Simple as that.

 

[CathrynRose]

Edward - Have you ever had to take 2 Prilosec's in a day, for your condition?

 

[edwardsfire]

No ethical doctor would write an extra rx for antibiotic.

maybe it isn't technically illegal, but it doesn't make it right.
for one thing there are treatment protocols, for instance if I see someone newly diagnosed with hypertension, I would not immediately prescribe the highest dose of a med for them. so it would not make sense ........plus the fact that the chart doesn't match the rx just doesn't fly.

and using your Prilosec as an example, suppose your doc did this for someone and then they got confused and did start the higher dose on the bottle, prilosec does have adverse reactions, and it also has many drug interactions,( but you are a medical professional who can compete with us lowly NP's so you already know all those right??) so it would be an important piece of info if this person ended up in the hospital for whatever reason to know exactly which dose is the correct one and which the pt is actually taking.

What reactions does ANY ppi have? And if you have already been taking them...Then you know you dont have any reactions.
PPI's can be taken by just about everyone with ZERO side effects, except for relief.
They are like a vitamin, you take too much, you pee it down the drain.
And, as for my daughters antibiotics, If you must know, She had had tubes in hers ears 2 times.
She gets ear infections, my ENT didnt see any reason for an additional cost to give a simple diagnosis, he saved me an office visit.
The horror of it.

 

[edwardsfire]

Edward - Have you ever had to take 2 Prilosec's in a day, for your condition?

YES. Thats my point. This is a normal thing.
I just need one 99% of the time.
I cant believe how naive some people are.
It is done so regularly, its unusual NOT to do this.,

 

[CathrynRose]

YES. Thats my point. This is a normal thing.
I just need one 99% of the time.

There we go. Case closed.

Edward has a prescription that he occasionally does not need to take all the recommended dose of.

We need a Sherlock Holmes looking smiley - but for now, with all the fraud mentions, these will have to do: ::cop:

 

[npmommie]

edward I didn't ask you about YOUR dtr and ear infections.
going back to the prescriptions, it is not something done regularly, at least not where I practice. there are other ways to save pts money on their rx's
and I think my biggest issue with this is not Prilosec itself, it is the fact that you are saying it is commonly done with patients all the time for all meds.
and yes that could present a HUGE problem and you know that.
and you know exactly what types of meds could cause problems if the dose is unclear, if a person forgets and takes too much etc etc............
that is the problem I have with this. as a provider I would be very uncomfortable with my note not matching the prescription going out the door.

 

[npmommie]

There we go. Case closed.

Edward has a prescription that he occasionally does not need to take all the recommended dose of.

We need a Sherlock Holmes looking smiley - but for now, with all the fraud mentions, these will have to do: ::cop:

no we don't . because his recommended dose is NOT 2 tablets a day.
it is one tablet a day. prilosec is not written as a prn medication.
His docs note in his chart still does not match the script unless the doc is changing his note in the chart too.

 

[edwardsfire]

edward I didn't ask you about YOUR dtr and ear infections.
going back to the prescriptions, it is not something done regularly, at least not where I practice. there are other ways to save pts money on their rx's
and I think my biggest issue with this is not Prilosec itself, it is the fact that you are saying it is commonly done with patients all the time for all meds.
and yes that could present a HUGE problem and you know that.
and you know exactly what types of meds could cause problems if the dose is unclear, if a person forgets and takes too much etc etc............
that is the problem I have with this. as a provider I would be very uncomfortable with my note not matching the prescription going out the door.

You stated "no ethical doctor" when talking about antibiotics.
So i guess my ENT is unethical for saving me a 20.00 copay.
We all know its VERY difficult to diagnose an ear infection..
There isnt much down there to confuse you, ya know.

 

[edwardsfire]

no we don't . because his recommended dose is NOT 2 tablets a day.
it is one tablet a day. prilosec is not written as a prn medication.
His docs note in his chart still does not match the script unless the doc is changing his note in the chart too.

Set yourself free.
Things are what they are, and THIS is COMMON.

 

[CathrynRose]

 

[npmommie]

here is a medscape article
http://www.medscape.com/viewarticle/456510

oh darn, you may have to log in to see it , never mind

 

[npmommie]

You stated "no ethical doctor" when talking about antibiotics.
So i guess my ENT is unethical for saving me a 20.00 copay.
We all know its VERY difficult to diagnose an ear infection..
There isnt much down there to confuse you, ya know.

ok, so do you have an otoscope at home to take a look when she has ear pain?
if you don't then yes its irresponsible, history or not.
over use of antibiotics is the main reason the bacteria that causes ear infections is so resistant

side note, i am sorry your dd has such a history of ear infections

 

[edwardsfire]

ok, so do you have an otoscope at home to take a look when she has ear pain?
if you don't then yes its irresponsible, history or not.
over use of antibiotics is the main reason the bacteria that causes ear infections is so resistant

side note, i am sorry your dd has such a history of ear infections

A per my ENT "It aint that difficult to diagnose an ear infection in a 1 year old"
If they cry and pull on their ear...they got one.
Treatment is the same, Antibiotic.
All ear infections are treated with antibiotics IF they are repeat "offenders"
I grew up with the same problem.
You like to use the word "irresponsible" alot. Careful how you throw your opinons around, they arent always..golden.
Oh, and the "over use of antibiotics" thing...
Our possible surgeon general, Dr. Gupta....has shown research that just might thwart that theroy.

 

[Tinkerbelle'sMOM]

I'm telling you, it isn't common, and I work in a really large teaching facility...if we tried to write scripts for the wrong dose, etc, we would lose our job. But I guess if he is private practice he may be getting away with it and falsifying his documents in the office.

And yes, there are side effects to PPI's....maybe you should do a little research, or at best, your doc should be talking to you about this.

And we do NOT routinely give antibiotics for all ear infections..depends on what we see when we look and a kid pulling their ear doesn't constitute an ear infection.

But then again, maybe all of us wasted our time in school to be advance practice nurses or docs....the general public always knows better.

 

[Green Tea]

1. I already acknowledged long ago it was probably legal. I still maintain it is NOT good medicine.
2. I have a lot of contact with many dr. offices and again, I don't know of ANY that do what you're saying. How many doctors have you had that do this?
3. It may be a safe dose written but it is NOT safe to have the bottle directions be different than what you (generic you) are supposed to be taking. I am thinking particularly of elderly patients who confuse easily, forget what the doctor verbally said, but read the bottle and take what's written on there. Regardless of saving money, that is a lawsuit just waiting to happen.

I suspect it not a routine thing for the doctor, but done in instances where the doctor has a relationship to his patient where they are working on managing a chronic condition or the patient is the judge of how much they need. AND where the doctor knows there is a level of intelligence with the patient to use their judgement. Think about pain medication following surgery. It might be written to take 1/2 to 1 pill every 6 hours as needed. You get the full pill dose, but you are taking half. I remember this being the case back when Claritin was by prescription. Children's syrup was 5 mg. The pills were 10 mg. For a child who swalled pills and hated syrup, we cut the pills. The medicine lasted twice as long. I didn't consider it fraud. It was working on managing with a physician. Not asking for unethical variances.

Another instance might be where it takes time to find the right dose of medication for something, say antidepressants or blood pressure meds. Maybe they want you to start on half a pill, then go up to a full. Eventually maybe reaching 1.5X the dose. The meds would likely be written for more than an actual one month supply because of the variations needed. Sometimes the patient needs to be a partner with the medical care professional to manage symptoms.

 

[barkley]

it downright scares me that any doctor today would treat "all" ear infections in repeat offenders with antibiotics.

i was one of those kids who was a "repeat offender" with ear infections in an era where this was the common practice-now as an adult i'm left with ears that never 'learned' how to address/recover from non infection based issues such that i can have hearing loss and pain for months at a time with something as minor as a little fluid behind my eardrum. over prescribed antibiotics resulted in me becoming immune to their benefits such that i can't use any but the 'super' types on the market (and doctors don't prescribe those unless it's a clear cut bacterial infection). my freaking ear drums are so scarred up from having infection after infection (i'de take antibiotics for an earache as a kid then a little fluid or wax would build up and my ears did'nt know how to deal with it without antibiotics so i'de be back on them again in a couple of weeks for months on end) that they grab onto anything and hold tight causing more problems.

i'm also surprised doctors would prescribe antibiotics for these kinds of things without doing an appointment and diagnosis of each instance-maybe my insurance company is just hypervigilant but a few years ago i had a situation where a couple months after i got a script for one of the kids filled (antibiotic for a bacterial ear infection) i got a letter from my insurer (scripts and doctor with same carrier) inquring of the circumstances surrounding the doctor prescribing it. come to find out the computer at the practice hiccuped and failed to bill my insurance company (and when they bill it shows the diagnosis) so my insurance company was investigating if the doctor was prescribing without doing a face to face with my child to evaluate and diagnose (apparantly their contract forbids it-esp. with some types of meds). since the insurance company's computer did'nt show a billing from the doctor's office within so many days prior to the script being issued it triggered an alert.


btw-anyone interested in reading about DR. SANJA GUPTA'S position on antibiotics might want to read the article he wrote for time magazine a few years ago. in it he states that ..."they have been DANGEROUSLY OVERUSED for decades creating strains of bacteria that are resistant to first-line antibiotics and forcing doctors to use stronger and stronger drugs...", "antibiotics should be prescribed only for bacterial infections...".