Where are the doctors?

[Cassander]

Where are the doctors?

Samandkatharine;1638850 wrote: Just got off the phone with the Dr. in SF. He charges a minimum of 675$ for an initial visit. To top that off, he wants you to see a therapist in his office at the rate of 200$ an hour. This just stinks. I think it's a diservice to us working folks who just want a doctor who knows what he's doing.

sam

hi sam...

out of curiosity, what kind of doctor is he? Family doc, GP, internist, psychiatrist, addiction specialist?

what do you get for the 675$ initial visit? Will he take a comprehensive history and commit to treat co-morbidities?

how much of the 675$ would be covered by your insurance (if you chose to make a claim/s?)

what would be involved (in terms of time and cost) in follow up visits with him and the therapist, if you did decide to go forward with him?

does he prescribe high dose baclofen? up to what limit?

has he had any 'success stories' treating alcoholics?

Hope you don't mind answering these questions and/or following up with the doc. These are all important issues to us if the medical community is going to take responsibilty for the treatment of alcoholism.

FWIW (and playing a bit of devil's advocate), I can't help but think that 675$ plus subsequent visits plus the therapist plus the cost of bac and other meds might not be such a bad deal if (i) you were assured thoughtful, professional, competent treatment and (ii) there were a fairly high likelihood of eventual success. It would certainly be cheaper than rehab and might even be cheaper medical treatment than the cost of self-medication with booze, when all is said and done.

Best,

Cassander

[Samandkatharine]

Where are the doctors?

Cassander;1638872 wrote: hi sam...

out of curiosity, what kind of doctor is he? Family doc, GP, internist, psychiatrist, addiction specialist?

what do you get for the 675$ initial visit? Will he take a comprehensive history and commit to treat co-morbidities?

how much of the 675$ would be covered by your insurance (if you chose to make a claim/s?)

what would be involved (in terms of time and cost) in follow up visits with him and the therapist, if you did decide to go forward with him?

does he prescribe high dose baclofen? up to what limit?

has he had any 'success stories' treating alcoholics?

Hope you don't mind answering these questions and/or following up with the doc. These are all important issues to us if the medical community is going to take responsibilty for the treatment of alcoholism.

FWIW (and playing a bit of devil's advocate), I can't help but think that 675$ plus subsequent visits plus the therapist plus the cost of bac and other meds might not be such a bad deal if (i) you were assured thoughtful, professional, competent treatment and (ii) there were a fairly high likelihood of eventual success. It would certainly be cheaper than rehab and might even be cheaper medical treatment than the cost of self-medication with booze, when all is said and done.

Best,

Cassander

None is covered by insurance.
He's an addictions Dr. And/ or "concierge" high end Dr.
He does use baclofen , not sure up to what dose. Didn't ask his success rate.

He sounds legit, but I'm a mom, not even close to rehab(sober on Bac) and I live 60 miles away, with kids at home. I don't have that kind of $ to cough up, nor the time to drive to and from his office twice a week. I know I sound ungrateful. I do feel that this Dr. using his credentials to pad his wallet.

Sam

[Cassander]

Where are the doctors?

sam

all of your concerns are totally legitimate. I don't think you should feel ungrateful.

however, at the end of the day, if we are going to get anywhere in making medical treatment readily available to alcoholics, the questions I'm asking must be dealt with...sooner or later...one way or the other.

as to insurance, mental health coverage is now required for health insurance sold in the US. There are still reasons why coverage might be too expensive (for example, high deductible plans) and there are legitimate concerns about putting mental health treatment through insurance. But folks should know that mental health treatment IS COVERED now in the US and patients do have substantial privacy rights in protecting the nature of treatment for which insurance reimbursement is sought.

it is true, however, that so-called 'concierge' doctors in the US are offering services to the public which may not be covered by insurance. Some 'concierge' docs do accept insurance, however, in order to assist the patient in recovering some of the cost of treatment. Each concierge is different and you won't know until you ask.

The 'concierge' movement is subject to extensive debate here in the US. Many people feel, as you do, that concierge physicians are just padding their wallets, but concierge physicians feel that they offer a higher level of service which often leads to more satisfactory outcomes. When it comes to medical treatment of alcoholism, I would be very reluctant to pursue an uninsured, private pay course of treatment without some assurances of the likehood of success, including some track record of success.

I know I am asking a lot of questions, but why do you say you would have to drive to and from his office twice a week? Did he outline a likely course of treatment and likely fees? If so, I would be interested if you could share it.

If all of this is just too much in the way of questions, sam, and you would rather not follow up with me, I certainly understand. But it would be nice to get to the bottom of what this doctor is proposing and see whether it makes sense (any sense) at all. If it ends up costing a thousand dollars a week (or more) it might not be cost effective for you (if you are already 'doing fine' on bac) but it may be very cost effective to another person in Northern California who is not doing well and whose alternative is a $30,000 month long visit to rehab.

Thanks,

Cass

[Samandkatharine]

Where are the doctors?

I know I am asking a lot of questions, but why do you say you would have to drive to and from his office twice a week? Did he outline a likely course of treatment and likely fees? If so, I would be interested if you could share it.

If all of this is just too much in the way of questions, sam, and you would rather not follow up with me, I certainly understand. But it would be nice to get to the bottom of what this doctor is proposing and see whether it makes sense (any sense) at all. If it ends up costing a thousand dollars a week (or more) it might not be cost effective for you (if you are already 'doing fine' on bac) but it may be very cost effective to another person in Northern California who is not doing well and whose alternative is a $30,000 month long visit to rehab. "Quote...

Cassander, you ask very good questions. For me, it's not cost effective. I talked to a receptionist this morning and I was not made comfortable from the get go. I was in the customer service industry for 13 years before I had kids and I'm appalled at the quality of care these doctors give at the front end..meaning the person who answers the phone. For 1000 plus dollars this doctor expects you'd think the receptionist would be warm and caring. For a person in the throws of addiction, I would be put off, made to feel dirty and not know where to turn. Yes, it may be a solution for someone who lives within a 25 mile radius, has no one to tend to at home and has the money to spend, which I would do in a heart beat at the very beginning of my hell hole. BUT, for those with insurance it may be wise to sleuth around and find a GP who is willing to look into Baclofen or read the information that the senior members have so generously found. This clinic offers many services, including house calls, integrative therapies, mental health, nutritional help..all the goodies we want in helping us get sober.
I guess I'm lucky. I got hold of Baclofen before Evan died, had his help and the help of many others. My GP is willing to Rx it up to 30mg. I'm at 75mg with no cravings. I switched at 80mg and I want to go lower as a maintenance dose because I'm having trouble sleeping. Maybe I can get my GP to go higher...50mg? I still have liquid for the time being and pills are getting more bearable. I just want to be under the care of a real doctor just in case.
Ask any questions you want!! I'm an open book.

Thanks Cassander:h

Sam

[spiritwolf333]

Where are the doctors?

Small Town Doctors

Hi Cass and Others -
Any thoughts on a specific list of documents, etc to take to a local doctor?

Also, other comments:
.01. Insurance -I think that my wife and I have one of the best policies one can get (state school teacher). Insurance still only pays 60% of certain approved charges for mental health. I have used this insurance to cover most all of my rehab-recovery issues and have not experienced any negative consequences. I

t is my opinion that the insurance companies are thankful for the fact that many people won't use insurance for recovery. And in total, the insurance companies still do not treat mental health nearly as well as they do physical health. I find it quite amazing that the insurance don't realize the fact that if they placed mental health above physical health that the PHYSICAL HEALTH PROBLEMS WOULD THEN BECOME MUCH LESS.

.02. DOCTORs: I may be totally wrong in my assumption, but I have to believe that most town doctors are more than willing to precscibe baclofen for alcoholism -IF THE DOCOTRS HAVE THE INFORMATION. My doctor is a "small" town doctor. I have all the confidence in the world that he will review and educate himself regarding baclofen and will then prescibe me my current dosage (180mg). But I need to PROVIDE THE STARTING DOCUMENTATION.

I am somewhat apprehensive about telling him that I am an alcoholic and went to another doctor-recovery center. I think it's time to go ahead and approach my local doctor?

I'm just not sure we give most local gp doctors enough room or credit. Perhaps many of us are "apprehensive" about approaching them? And my insurance would cover 90% of my visits to him.

List of specific most helpful documents sure would be helpful.

[Cassander]

Where are the doctors?

It strikes me from my discussion with sam that newbies and lurkers (and many of the rest of us) may not know much about how medical treatment for alcoholism is covered by insurance in the US. The important new development is that under "Obamacare" there is far more mandatory coverage for mental health issues, including substance abuse, than there has been under pre-existing law.

Here are some excerpts and Q&A from http://www.mentalhealth.gov/get-help/health-insurance/:

The Affordable Care Act [provides] one of the largest expansions of mental health and substance use disorder coverage in a generation, by requiring that health insurance plans on the Health Insurance Marketplaces cover mental health and substance use disorder services. These new protections will build on the Mental Health Parity and Addiction Equity Act to expand mental health and substance use disorder benefits and federal parity protections for behavioral health to 62 million Americans.

Because of the law, health plans must now cover preventive services like depression screening for adults and behavioral assessments for children at no cost. And starting in 2014, most plans won?t be able to deny you coverage or charge you more due to pre-existing health conditions, including mental illnesses.

Q: Does the Affordable Care Act require insurance plans to cover mental health benefits?

Answer: Starting in 2014, health insurance plans in the individual and small group markets and Medicaid Alternative Benefit Plans must include coverage of essential health benefits, which include 10 categories of benefits as defined under the health care law. One of those categories is mental health and substance use disorder services. These plans must meet health and substance use parity, as set forth in the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), meaning coverage for mental health and substance abuse services generally cannot be more restrictive than those for medical and surgical services.

Question: How do I find out if my health insurance plan is supposed to be covering mental health or substance abuse use disorder services in parity with medical and surgical benefits? What do I do if I think my plan is not meeting parity requirements?

Answer: In general, for those in large employer plans, if mental health or substance use disorder services are offered, those services already are subject to the parity protections required under the Mental Health Parity and Addiction Equity Act (MHPAEA). And in 2014, for those in most small employer and individual plans, mental health and substance use disorder services will also become subject to the MHPAEA requirements.

If you have questions about your insurance plan, we recommend you first look at your plans? enrollment materials, or any other information you received from the plan, to see what the coverage levels are for all benefits. Because of the Affordable Care Act, health insurers are required to provide you with an easy-to-understand summary about your benefits which should make it easier to see what your coverage is. Contact your insurance provider or your employer?s benefits administrator for more information or to ask questions.

More information may also be available with your state Consumer Assistance Program (CAP). In states where no CAP exists, there is a list of specific state resources.

Q: Does Medicaid cover mental health or substance use disorder services?

Answer: All state Medicaid programs exit disclaimer icon provide some mental health services and some offer substance use disorder services to enrollees. These services often include counseling, therapy, medication management, licensed clinical social work services, peer supports, and substance abuse treatment. While states determine which of these services to cover for adults, Medicaid requires that children enrolled in Medicaid receive all medically necessary services, including mental health services.

Q: Does Medicare cover mental health or substance use disorder services?

Answer: Yes, Medicare covers a wide range of mental health services.

Medicare Part A (Hospital Insurance) exit disclaimer icon covers inpatient mental health care services you get in a hospital. Part A covers your room, meals, nursing care, and other related services and supplies.

Medicare Part B (Medical Insurance) exit disclaimer icon helps cover mental health services that you would generally get outside of a hospital, including visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor.

Medicare Part D (Prescription Drug ) exit disclaimer icon helps cover drugs you may need to treat a mental health condition. Each Part D plan has its own list of covered drugs, known as formulary. Learn more about which plans cover various drugs exit disclaimer icon .

If you get your Medicare benefits through a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, check your plan?s membership materials and call the plan for details about how to get your mental health benefits.

Cassander

[Samandkatharine]

Where are the doctors?

I have blue shield, including mental health benefits. I have great insurance with psychiatrists that suck. I know that's better than nothing. My one choice of addiction doctors is a 73yo who needs to retire. That's it. That's why I'd have to go out of network.

Sam

[Cassander]

Where are the doctors?

Sam

I would be the last person to say that we have a health care system, or a health care reimbursement system, here in the US that really works. Especially in the case of mental health benefits and doubly especially in the case of alcoholism. I have pretty much gone on record to this effect in numerous places on the forum.

However, there may be substantial advantages to you in carefully examining your choices under your blue shield health insurance policy, especially in light of the recent Affordable Care Act amendments relating to mental health and substance abuse...even if you have to go "out of network".

I do agree with you that you are better off if you can find a kind, concerned and competent physician to oversee the totality of the physical and mental health issues which can arise as you transition to a new lifestyle without alcohol.

Best,

Cassander

[skullbabyland]

Where are the doctors?

Great discussion here... Thanks, Cassander, for posting about the ACA's new coverage with mental health/addiction issues.

[spiritwolf333]

Where are the doctors?

Cassander;1638997 wrote:
However, there may be substantial advantages to you in carefully examining your choices under your blue shield health insurance policy, especially in light of the recent Affordable Care Act amendments relating to mental health and substance abuse...even if you have to go "out of network".

I do agree with you that you are better off if you can find a kind, concerned and competent physician to oversee the totality of the physical and mental health issues which can arise as you transition to a new lifestyle without alcohol.

Best,

Cassander

Cass -Your health insurance information is appreciated. Perhaps mental health care is starting to see better days?

[Cassander]

Where are the doctors?

I have been a broken record over the past few years about the disinclination of doctors (in general) to get involved in treatment for alcoholism. Some here on this board disagree and assert that GPs and other primary care docs are increasingly sensitized to issues relating to alcoholism and its treatment. I still think the situation is pretty dismal, beginning with the fact that most doctors don't even inquire about alcohol abuse in regular checkups.

In any event, here is an interesting study which discusses the current state of communications between doctors and patients regarding alcohol consumption:

http://www.medpagetoday.com/upload/2.../mm63e0107.pdf

This doesn't mean we aren't making some progress in institutionalizing the treatment of alcoholism...just that we may still have a long way to go...

Cass

[spiritwolf333]

Where are the doctors?

Hi Cass -thanks for the post and thanks for being a broken record. I personally think that it is critically important to keep the dire statistics regarding alcohol abuse and lack of doctor inquiry in front of as many people as possible

The lack of attention by doctors to the alcohol problem is incredible. Before reading this CDC article, I "assumed" at least 30% to 40% of doctors at least mentioned alcohol use as part of a standard check up protocol.

According to CDC only about 15.6% of doctors ever discuss alcohol with their patients. (15 out 100 patients)

Why is this the case in this day and age that we live? My theory is this:
-Most doctors would not know how to address a patient with an ongoing alcohol problem even if they found out their patient had a problem
-Most patients who have or are currently abusing alcohol do not want to discuss this issue with a doctor (Shame-Guilt-Fear)


Where are the doctors? Followed by: Where is the Alcoholism Education and Where are the Medications (to treat the brain disorder portion)?

Cass -We have to keep talking about these issues in order for the stigma of "alcoholism" or alcohol abuse to become accepted as "legitimate" treatable disease.
With this said, I think that it is important to remember that "Alcoholism" is an incredibly complicated challenge -even today.






Excerpt of Stats from CDC (Center for Disease Control):

?According to the Behavioral Risk Factor Surveillance System (BRFSS) survey, more than half of the adult U.S. population drank alcohol in the past 30 days. Approximately 5% of the total population drank heavily, while 17% of the population binge drank. (sw-in the past 30 days, 650,000 people in the USA)
?There were approximately 88,000 deaths annually attributable to excessive alcohol use. In fact, excessive alcohol use is the 3rd leading lifestyle-related cause of death for people in the United States each year.

Results: The prevalence of ever discussing alcohol use with a health professional was 15.7% among U.S. adults overall, 17.4% among current drinkers, and 25.4% among binge drinkers

[Xadrian]

Where are the doctors?

spiritwolf333;1644053 wrote: According to CDC only about 15.6% of doctors ever discuss alcohol with their patients[/I][/B]. (15 out 100 patients)
[/COLOR][/I][/B]

15 out of 100 doctors is that.
And I expect those doctors don't discuss that with all of their patients.

[Samandkatharine]

Where are the doctors?

Doctors may want to talk to their patients about their alcohol use, but most patients lie about it. I would give the standard 2 glasses of wine answer:H

We need to be more honest too.

Sam

[Cassander]

Where are the doctors?

yes, Sam...we need to be more honest, too. No disagreement.

But in a (more) perfect world, alcoholism would be understood as a disease (and not some kind of moral failing) and we and our physicians would have a more open and honest dialogue about our addictions and mental health.

And we would understand that more honesty and transparency with our physicians would lead to greater health and happiness.

We would not have to fear that our doctors would pass some kind of moral judgment on us if we admitted we drink too much.

Doctors would ask us how much we drink, and we would honestly answer. And if treatment were indicated, we would be treated. And healed.