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I am saving $435 by NOT going to the Endo

Discussion in 'Parents of Children with Type 1' started by cadesmom, Oct 13, 2008.

  1. cadesmom

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  2. frizzyrazzy

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    I"m not sure I understand the results. I live 1 mile away from our hospital, have 0 co pays and I don't work. So technically I spend pennies to go to the endo. What are all those other results that show up on the spreadsheet?
     
  3. caspi

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    I don't understand them myself............ I am one of those that has to REALLY travel far to see an endo - 120 miles each way - but I honestly think that doing so every 3 months to keep my child healthy is the least that I could do! I'd travel a 1,000 miles if I had to! I had the option, and tried out, an endo that was "only" 60 miles from us, but I was more comfortable and have better communication with our current endo. Sometimes convenience isn't everything!;)
     
  4. OSUMom

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    It really is difficult trying to fit the endo visits in for my son. Is this program covered by insurance?

    Never mind - it's not available in my state anyway.
     
    Last edited: Oct 13, 2008
  5. kevin@diabetech.net

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    Hey all, Kerry let me know that there were some questions. We're trying to provide a tool that let's people figure out the travel side of diabetes care. Obviously, if you drive you have to spend money for gas, wear and tear on tires, etc... so that is a very real cost. If you walk I suppose you wear down the rubber on your soles but that's a little ridiculous ;)

    Besides the car cost the calculator also asks if you stay value your time (pick a #) or more directly if you earn an hourly wage you might really miss out on wages that you otherwise would have made. Do you have to eat out due to the distance traveled and time away from home. I know when my family traveled 4 hours to Houston and back for 2 years x 4 times a year the food bill was not immaterial $. Neither was the cost of the hotel as 8 hrs round trip in one day wasn't going to happen. Co-pays are a real out of pocket cost too if you have them. If you don't then it's not counted in the calculator. When we traveled for visits we had to board the dog for 2 nights - real money.

    I happen to know several families who fly to their visits for the same reasons you mentioned - if it works for you it's priceless. Closer isn't always better but congrats to those who are happy with an endocrinologist close by.

    So the major cost driver in this is clearly distance traveled (x 4 visits per year). And I'd bet that if you value your time even the tiniest bit and you eat a couple of meals because of the travel (even without a hotel stay), you're talking a few hundred dollars a year because you have to see the endocrinologist.

    Anyone who has input to what a good calculator should take into account should comment to this thread and then anyone else is welcome to put together a better or more representative tool. This is just the one we put together based on all of our discussions with families over the years and people like Kerry as well.

    Also, we can work with any endocrinologist in any State - whereas Endocrinologists currently are not allowed to work across State lines unless they are licensed in that remote State. I think Ohio and California might be coming online soon. It all depends on a willing and competent endocrinologist and of course if people like him/her.
     
  6. KeltonsMom

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    When California comes online I will seriously consider it...
     
  7. OSUMom

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    After looking at the costs of the program, for us just based on lack of time for the endo when home from college for 2 of the 4 visits a year, it's not something we'd consider. It's a great idea if insurance would cover the costs.
     
  8. kevin@diabetech.net

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    More to it than just reimbursed or not reimbursed

    Ah, I think you've missed the point of the calculator. What this says is that if you spend a ton of money due to travel costs (last time I checked Blue Cross isn't paying for my gas, meals and hotel) you can actually pay less total out of your own pocket for tools and traditionally non-insurance reimbursed remote video consults with your endocrinologist (or CDE for that matter). ...Even if those things are not directly reimbursed. If you live around the corner and don't have a dollar value for your time then the calculator shows that you aren't spending very much out of pocket so on a pure out of pocket cost basis the remote option isn't a cost saver.

    That said, there are some people in this program who are local (most live 3hrs away or more) to the endocrinologist who started up this program and while their travel costs are small, they place more value on their time and also like the option of getting same day appointments.

    Bottom line is that the true cost of some things isn't always limited to whether not that something is "reimbursed". Hopefully, these kinds of interactions with endocrinologists and CDEs will be reimbursed in the future and the families participating in this program and others like it are creating the data necessary to get the insurance companies to change their position.
     
    Last edited: Oct 15, 2008
  9. OSUMom

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    I didn't miss the point. I understand the calculator is for people who travel far distances. I responded because I thought you might like to get feedback from people who are interested in your services for other reasons (your post on the college forum).

    There is a continuum of the value of a service and what a person is willing to pay for the service. Not every family is at the same place on that continuum especially in a struggling economy or when putting a couple of kids through college (or a young adult putting themselves through college). I thought maybe my opinion would be helpful information as you look to grow your business.
     
    Last edited: Oct 15, 2008
  10. Mody_Jess_Pony

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    People serious count the wear and tare on their tires as an expense to go to the endos?
    Sorry teh service isn't avliable in canada but I just had to pipe up isn't that a tad over the top.
     
  11. kevin@diabetech.net

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    Thanks for your feedback - of course your help is appreciated. I hear you loud and clear - that's why I made sure to let you know that we are working hard to get these visits covered by the carriers. Sorry if I offended you ;)
     
  12. Mama Belle

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    Kevin- as some feedback it would help if the bars on the graph were identified. I am never going to evaluate anything I do based upon incomplete information. I doubt others will either.
     
  13. Momof4gr8kids

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    I can also see how this service could save money, and I am glad we have innovative people trying to make life easier. But, I would be a tad bit iffy about the quality of service a person could receive without being seen in person. I highly believe that there is more than data to seeing a patient. Since this seems to be a package cost, I probably wouldn't use the service because some things might not be caught as fast as if my DD was being seen in person, and if she did require extra endo attention it could mean I loose out on part of the package, have to pay extra, or if insurance was paying, insurance might not cover the additional services because they have already paid for upcoming visits.
     
  14. cadesmom

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    Let me just start by saying this kind of service is not for everyone, some people are lucky they have a good Endo in the same town they live in, I on the other hand must travel far away to get good D-care for my son.
    I have been to 3 differant Endo's and none of them did much with my son, The visit was mostlly talking to me, The only thing they really do (or atleast the one's around here) are listen to his heart and look at the places where his sites go in, thats it, if I felt there was a problem our ped. could take care of the small things.
    We go to the office once a year, and have web cam visits 3x a year, this is the best thing we have ever done, and I feel blessed to be a part it.
     
  15. Knittingfor4

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    :eek: I must be totally stupid - I didn't understand at all. Where do you see your numbers? I see a colorful graph, but I can't tell what it means :confused: LOL
     
  16. kevin@diabetech.net

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    You should try it again. I had to go in and fix something since I think it ran out of room to show new results. Hopefully you can see the text descriptions on the charts?

    I just entered my personal experience for going to Houston from Dallas for a year. We did that because we felt our daughter and the family needed the pump and we had no chance of that happening locally. The calculator tells me that we spent $3672 that year and that seems about right considering that we did hotels and it took 2 days meaning I couldn't work for 2 days and of course that was costly, too. If we could have used Diabetes HouseCall, the calculator says that we could have saved $1705. That would have been nice but that was several years ago and not every endocrinologist is ready for this just as Kerry says not every family needs it either. But if you do, it's nice to know that healthcare is making progress.
     
    Last edited: Oct 16, 2008
  17. Momof4gr8kids

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    I'm sorry. I wasn't trying to say no one should use this. Those are my personal feelings about using the product. I'm not crazy about our endo either, so I can understand choosing another option. I just don't think for us (my family) this is any better than what we have, and this would actually cost us more than we are currently spending.

    I was actually responding to Kevin's request for feedback. I should have quoted his message in my post, or addressed my post to him.

    Kevin, what about consultations for emergencies that are not D related, but effect the D?
     
  18. kevin@diabetech.net

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    Great question. (Fyi - this protocol requires also that the family has a competent local pediatrician and the technology allows the endocrinologist and the pediatrician to share information easily). Between visit questions are handled quickly via email (and phone if necessary) for basic questions. Quarterly visits are available same day so you can just reschedule next month's visit to today if that makes sense. There are also CDE visits available if you need something in between (one CDE visit focused on carb counting is also included in the HouseCall service). Very soon we believe that the carriers will reimburse for these provider visits (there are specific caveats), too so that will open up a whole new level of interactions as well as more providers being interested in participating as a Diabetes HouseCall provider in other States. We already have one health plan in Texas paying for this inside of a controlled pilot and we have a meeting scheduled for December with one of the larger carriers where we hope they will give their approval, too.

    Also keep in mind that if there are lots of D things happening, too many for a high quality remote visit, the endocrinologist reserves the right to recommend a face to face visit with the family. All of the face to face visits bill according to the family's insurance just like a traditional visit requiring only travel and the co-pay. The details and gotchas have been learned over the past several years and we continue to make adjustments as we go and learn more about working with families within this combination model of remote plus face to face visits.
     
  19. caspi

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    I'd just like to add my two cents here -- I think that what you are doing, Kevin, is a great idea, especially for those of us that have to drive so far for our office visits. We personally don't mind the office visits and (for now at least) can afford them, but having that option out there is wonderful!

    I think what you are doing, Kevin, is admirable! You have put your heart and soul into all of this and it truly shows. Thank you for sharing your ideas and products!!! :cwds:
     
  20. twodoor2

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    I think going to the endo for us is a complete major waste of time. All they do is weigh her, take some vitals which she gets at her checkups anyways. I can see she's growing and thriving, and then they download our pump. The endo finally walks in and gives me a little shpeel on breakfast spikes, they ask me if I want any prescriptions, and we go home. The whole time Elizabeth is bored to tears, even if I bring a coloring book and a leapster.

    I have to take a day off of work and I need to save my vacation days!!

    I have to drive 30 miles

    I have to drag my child out of school.

    Complete and utter waste of time since I do all the diabetes management myself. I think I'm going to start only going every six months.

    I can always call to get prescriptions refilled, and my pediatrician will give us orders for the A1C. I get her A1C's done on the weekend, not at the endo visit.

    If her A1C's went to the moon, I doubt they could do anything to help me anyways. Her blood sugar only got controlled after I started learning from CWD, and taking over all management myself.
     

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