Can We Talk?
Does your doctor have a relationship with a drug company? Are they influenced in choice of treatments or medications recommendations?
(This appeared in the TIME) “Using the following tool, you can search for any physician in the database by last name and see any gifts, consulting fees, paid travel, or other payment he or she received between August and December of 2013.”
Sample Letter: Reframe the Prior Authorization Process
To: The Honorable Senator (Name) or The Honorable Representative (Name)
(Room #) Senate Office Building or (Room #) House Office Building
United States Senate or United States House of Representatives
Washington, D.C. 20515
RE: Reframe the Prior Authorization Process
Dear Senator (Name) or Representative (Name)
I am writing you because I am greatly concerned about the state of Health Care in America, specifically about how Health Care Insurance Companies use the Prior Authorization Process to deny patient access to prescription medication, durable medical equipment and treatment service plans. (Insert your own experience as a caregiver or patient.) Health Care Insurance Companies have absolute authority to deny requests made by doctors even if based on sound data, and to substitute alternative medications to those originally prescribed at their discretion. What they are doing is costly in terms of fees and practitioner time away from patients, adds paperwork, and disrupts patient care management. As a citizen of this country and a taxpayer, I request that you do whatever you can to create legislation which reframes this Process. As we are in the middle of a pandemic, please give this your prompt attention. Thank you.
Good Reference Article: Schroeder, Michael O., “Racial Bias in Medicine Leads to Worse Care for Minorities,” https://health.usnews.com/health-news/patient-advice/articles/2016-02-11
Good Reference Article: Ward, Victoria, “The Shocking Truth About Prior Authorization Process in Health Care,” https://getreferralmd.com/2018/04-prior-auth-problems-healthcare-2
“Every day, hospital staff at a private dialysis clinic near Salvador, Brazil ….” Great example of patient needs considered.
Things To Know About Kidney Disease/Dialysis:
Cholesterol – a waxy substance made by the body that circulates in the blood by attaching to proteins (lipoproteins)
– two forms
(LDL = Low Density = Bad)
– can lead to Heart Disease/Strokes
– (HDL = High Density = Good) Makes Vitamin D and Bile
– comes from food and from the liver and genetics
– a kind of fat
Statin Medication – lower cholesterol by stoping the liver from making lipids (a kind of fat)
Prior Authorization – a management process used by Health Insurance Companies to determine if they will pay for prescription medication, durable medical equipment or treatment procedures/ safety and cost-saving mechanism/costly/time consuming.
Nephrologist – Medical doctor specializing in diseases and physiology of the kidneys
Formulary – a list of specific medications that are approved by a health insurance company
FDA (Food & Drug Administration) – a government regulatory agency within the U.S. Department of Health & Human Services
-doesn’t regulate cost but does give approval so drug can be sold
Biopharmaceutical Company – makes pharmaceutical drugs
Pharmacy Benefit Managers (PBM’s) – drug distribution companies
Hemodialysis – process of purifying the blood of a person whose kidney’s are not working normally
-removes waste and excess water
Public Relations Companies: The Ugly Truth Behind The Pleasant Veneer
It is my belief that there is no better way for authors to give-back to the industry than by sharing lessons learned from personal experiences, especially what can happen if you encounter a scam artist. Take me, for example. Writing my first book was challenging enough. Then I decided to self-publish. Being new to the industry, I didn’t know what to look out for when approached by a master of deception masquerading under a façade of good will just waiting to make a profit at my expense.
I knew that successful authors posses many attributes or what I refer to as “heroes within.” Passion, determination and dedication are needed to produce memorable products, or at least have the courage to participate in the process. Confidence fuels the creative journey. It grows stronger with experience and nurturing. Intuition is that gut-level feeling that something is right or wrong. I didn’t know the power generated when using those attributes in concert to safely navigate unanticipated situations. Letting my “heroes within” guide me was meant to be my life-preserver, my bridge in the event that I encountered troubled waters. I lost focus, which is something that can easily happen to a novice author who is not well-grounded in the details of the dark side of the industry. I needed to learn to trust my gut-level feelings because they were trying to warn me of the danger ahead. Instead, I dismissed them because they were inconvenient.
I knew that marketing my book would be a journey. I didn’t realize how soon I would need my life preserver. My encounter with those troubled waters was about to happen. I wanted to share my creation with others. But my lack of experience navigating the mysteries of marketing was more than I thought I could handle by myself. My goal was to sell copies of my book, but I was not thrilled with the prospect of carting cases filled with copies around town trying to persuade “mom-and -pop” book stores to take a chance and put my book on their shelves or paying for booths at business expo’s and mixers with no guarantee that anyone in attendance would belong to my target population.
Then it happened. During one of many expo’s, a “false prophet” (aka scam artist) stopped by my booth. This person was a charmer with a definite gift-of-gab who pushed all of the right buttons and literally had me mesmerized. Little did I know that below this delightful veneer lurked a predator. I was simply thrilled and fell for the “pitch”, lock, stock and barrel. I sent my “heroes within” packing and put a blindfold on my critical thinking skills. To my credit, I did check-out this person’s website, which was simply beautiful! Before you could whistle Dixie, I engaged the services of a public relations person (aka scam artist), and committed to a long-term (6-month) contract at a monthly rate of several hundred dollars. That was a big mistake.
Even as a novice author, I knew about the power of the sales pitch and that I would use one while promoting my book. But, I considered myself to be an honest person and had no intention of misleading anyone about any aspect of my book. I never considered that someone else might have dishonorable motives, especially when using a pitch with me.
This public relations person seemed to be the answer to my prayers. I was bombarded with silvery words and promises to “make things happen.” The problem was that my expectation didn’t match this person’s hidden agenda. My understanding of providing “public relations and marketing services” was that this person would already have established relationships with well-known media contacts, know how to schedule broadcast appearances, and structure events attended by people who actually wanted to buy my book. None of this was written in the contract because I didn’t think that it had to be. After all, wasn’t that what a public relations person was supposed to do? But, the objective of this scam artist was to “create opportunities for new clients which could potentially lead to sales.” Doing the right thing was not a consideration.
What followed during the next four months should have alerted me as to the true nature of the person I was dealing with. But, I continued to avoid attending to the signals being sent to me by my “heroes within” and didn’t engage my critical thinking skills because I was caught-up in the “thrill of it all.” I did receive a Press Release with the assurance that it had been distributed to several media outlets. But, being poorly written I had to revise it. When I questioned why things were moving slowly I was told that success would “take time,” and to be patient. After all, I “needed to develop a platform and a tribe of followers.” Who knew how long that would take? I was saddled with the responsibility of using social media skills to “friend” masses of people and advertise events. These were additional duties for me, which I thought I paid this person to do. I was doing more than the public relations person with the exception of actually contacting and booking internet radio talk shows. I became curious, read a few articles and found that booking these events was not that hard to do. Something was very wrong. With each discovery and accomplishment on my part came the realization that I was becoming my own public relations person. I had allowed myself to be used as a cash cow that could be milked for this person’s profit.
When I finally confronted this person, I received a tongue lashing. The public relations person reminded me of all that had been done on my behalf to include positive press coverage and tried to put a guilt-trip on me. Imagine that! I was told that I had actually contracted for nothing more than “exposure,” and wasn’t paying enough money for more time and effort to be devoted for a really good promotion campaign.” The conversation spiraled downhill with the comment that my book was “terrible” (what happened to positive press coverage), which was ironic because it had already received kudos when profiled in a newsletter published by a renowned professional military organization. There was also the implied threat that opportunities for continued “exposure” would disappear in the event that I terminated the contract prior to the 6-month date. Needless to say the ugly truth had finally been revealed. The “thrill of it all” was “gone with the wind,” and with it went that public relations person (aka scam artist). I made a joyous reunion with my “heroes within”, critical thinking skills, and every other attribute I had so easily and eagerly turned my back on.
There is something to be said for lessons learned through the school of hard knocks. I have no doubt but that there are honest public relations people who actually make life easier for an author. The challenge is to detect the scam artists before they can victimize you. You also need to do a thorough background check, know exactly what they will do for you, and spell everything out in the contract. Dot every “I” and “cross every “t”. The irony of this situation is my discovery that I could actually do everything myself that I paid this person (scam artist) to do for me. I could have saved myself a lot of time, money and heartache by rolling up my sleeves, engaging my critical thinking skills and intuition, and doing what needed to be done. All that I needed to do was believe and not put my trust in a false prophet. Needless to say, I have no future plans to ever recommend or personally contract with a public relations person. My best advice to you is, beware.