POZ Community Forums
Main Forums => Living With HIV => Topic started by: tednlou2 on July 26, 2010, 01:10:23 am
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Just read a question from someone in the UK to a doc here. He said his clinic is scaling back CD4 counts to people stable on HAART to just once a year--6 months for viral load, CBC. Just curious if waiting a year to check CD4 is a good idea. It kinda got me wondering whether once stable for a while on HAART, you wouldn't worry about waiting a year. Or, you'd know something is wrong when vl was checked at 6 months if it went detectable? If that happened, I'm sure they would check CD4 at 6 months. So, is this really a big deal or not good medicine?
http://www.thebody.com/Forums/AIDS/Labs/Current/Q209894.html
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I've been undetectable and stable for 7 years. I am going to get labs once a year unless I have a some symptoms of a medical condition. My doctor is okay with this.
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Just read a question from someone in the UK to a doc here. He said his clinic is scaling back CD4 counts to people stable on HAART to just once a year--6 months for viral load, CBC. Just curious if waiting a year to check CD4 is a good idea. It kinda got me wondering whether once stable for a while on HAART, you wouldn't worry about waiting a year. Or, you'd know something is wrong when vl was checked at 6 months if it went detectable? If that happened, I'm sure they would check CD4 at 6 months. So, is this really a big deal or not good medicine?
http://www.thebody.com/Forums/AIDS/Labs/Current/Q209894.html
I'm still starting this journey, but it seems like a small price to pay for the overall security of access to medications and treatment regardless of employment and income.
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If my doctor recommended this to me, I would not feel uncomfortable.
Whats wrong with saving some money in times of limited budgets.
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I've had the same ID doc for the last eleven years. In that time I've gone from every three months, to every six months, to now where I go just once a year. We are both very comfortable with that arrangement. I'm on ADAP and I feel by going just once a year I'm freeing up some money for someone else to use.
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No. but I have a reason. Having been a LTNP with a CD4 1400+ for 21 years and they crashed within 3 months of labs.
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I would not be comfortable with this. But Ive only been Ud for 6 or so months and am still going every 3 months.
-Will
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If labs showed undetect. for 3 or more consecutive draws I would be comfortable with every 6 months - but not 1 time a year. Right now I am still on the every 3 month plan.
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I wouldn't feel comfortable either. I might do once every 4 months, but for now it's not a problem every 3 months.
Ray
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for many years (10-15yrs), I was ill and my numbers stayed right on the cusp. I was in for labs every 6-8 weeks. During the last 3 years, out of 6 years that my numbers have finally been stabilizing so well, the doctors have been stretching out the time between tests. With just this last visit, the timespan went from an all-time high of 5 months to an even longer 6 month span.
At first, as these intervals were expanded, I was a little nervous after so many years of being so closely monitored. However, it just goes to show the efficacy of these current meds and it is the "reward" for finally getting a good regimen (one that works with no side effects) and remaining properly adherent.
I swear, it sure is nice to be healthy enough to only go twice a year. ;D I would imagine this is a fine way to handle patients with stable numbers, after a period of time, who seem to remain adherent to their meds and who don't have other outstanding health issues. Besides, as others have said, the less money spent tracking my stable numbers, the more money there is in the pot to assist someone who isn't as healthy or to assist me if something untoward should happen. ;)
I would be comfortable with every 6 months - but not 1 time a year.
the linked article/question actually speaks of 2 testings a year of the viral load. the cd4s were only checked once a year.
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hell let my doc tell me to visit once a year , that would save me so much money
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I've been steadily undetectable now for four years, but since previous to that it took me 13 years of treatment to get there neither my doctor nor I are comfortable going for less than four months between lab work. Actually I'd probably be fine to get it done every six months, but I don't press it plus seeing as how I can zip up to the doctor's office within 15 minutes it's not a hassle to continue this way.
Plus I'm on my next to last treatment option, or thereabouts, so I don't have much room to play around with things. This fact has tended to make me somewhat conservative with my own treatment, and I could care less about saving anyone else money in that light.
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I'm not sure how the US system works for schemes like ADAP but seeing as the OP raises the issue in relation to the UK, I feel able to respond.
There seems to be a worldwide general misunderstanding about "free" health care in the UK. Sure, some people are eligible without contributing (i.e. the unemployed, people on the lowest incomes) but ultimately, at an average 11% of your gross salary deducted every month (this is on top of income tax) and on average 13% contribution from your employer in National Insurance contributions (total: 24% of gross), health care is far from free in the UK for those who are employed (and you pay whether you use it or not).
Now, I fully support reducing costs in times of need but if I'm paying for it, however, I expect any reduction to at least follow an agreed national standard as a minimum - not for it to be determined locally to cut a few pounds/dollars. There are far greater savings to be delivered in the NHS than whether I have a blood test four times per year or three times per year or even twice a year. The relative savings to NHS budgets are proportionately negligible.
Cost is relative. If I'm in a resource limited setting, these tests are "expensive" - of course they are. However, when a proportion of 24% of my gross wage is pumped into health care they are not "expensive" in relation to the contribution I have made.
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I have private insurance through my employer and every time my doctor orders labs I pay $240.
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I have private insurance through my employer and every time my doctor orders labs I pay $240.
Interesting. I have to add that for the decade from '93 - '03 when I was on private insurance I never once paid for a lab test. In fact, as my viral load was detectable that entire time my doctor(s) were conducting cd4/vl tests either monthly or every other month.
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Interesting. I have to add that for the decade from '93 - '03 when I was on private insurance I never once paid for a lab test. In fact, as my viral load was detectable that entire time my doctor(s) were conducting cd4/vl tests either monthly or every other month.
Same here Ms. P -- I have private insurance - I pay "0" premium (all employer paid); $15 co-pay PCP, $30 co-pay Specialist (ID doc) and no co-pay for labs.... very grateful on this end....
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I think you have two main issues here. The first is whether a patient is stable enough, to be monitored with 2 6-month VLs and an annual CD4. That is an issue to be decided between the patient and doctor, period. The second issue however, is exactly why changing health care delivery systems is so frustrating. Take a look at the big picture, what if, most of all maintenance testing could be delayed, a month, a few months or even a year, with no adverse effect on the patient? All this testing is great, but only if you really need it. Using excessive testing as defensive medicine or to coddle patients has to change, if we are to ever begin controlling health care costs.
I also have a problem with the idea of I pay into the system, so whatever I need is what I should get. Rather I see it as: I pay into a system and I want my money to buy the most reasonable health care possible. The only way to wring excesses out of the medical system is to review and/or change practices that consume a large portion of expenditures. I see this suggestion as having the potential to reshape how we view the delivery of medical services. I would love to see the math, if we could reduce excessive testing, say 25% and redirect those funds where they can best be used.
I still remain puzzled on how so many people, can be so insensitive to their fellow citizens. I will never understand this "I have mine, who cares about you" mentality in regards to health care.
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I have been stable or increasing CD4 for many years... undetec for 10+ went from the 6 wks to 6 months over that time period for testing , within that time I switched back to the 3months when changed meds..... after stable period of 1 yr on new meds , went back to 6 months and the lastime (june) Dr was considering 1yr.... so I see this, as Joe pointed out, a very individual situation... unnecessary "feelgood" testing is a waste of resources. but if your situation is volatile then get it done.... Phillies case is perfect, when you have few options for treatment you need to be very cautious about testing the limits.
Having said all that, if other issues are in need of monitoring, sugar levels, fats, testosterone etc ..... then those items may need frequent testing....
Joe's comment about changing the "health care" system to control cost is right on...just because you paid in ( like any insurance policy) doesnt mean you have to "collect" the whole point is to spread the cost around such that those who need treatment get it when they need it..... it is not like retirement plans where they owe you something for your contribution
Nick
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At my last appointment, my doctor tried to persuade me to come back in six months instead of three. We compromised on four, but I'm uncomfortable with this for the reason Rodney stated in his post.
No. but I have a reason. Having been a LTNP with a CD4 1400+ for 21 years and they crashed within 3 months of labs.
I've known of other LTNPs or LTSPs who had similar experiences - when their numbers crashed, they did so very quickly. I don't want to chance not knowing about it if/when it happens to me. When I schedule my next appointment (at my next appointment, if you see what I mean) I'm going to insist on no less than three months.
If I were on meds for a few years and undetectable, I'd be happy with only going every six months. A year? Not so much.
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Interesting. I have to add that for the decade from '93 - '03 when I was on private insurance I never once paid for a lab test. In fact, as my viral load was detectable that entire time my doctor(s) were conducting cd4/vl tests either monthly or every other month.
I did not pay for labs back then either. Employers are cutting cost by adopting healthcare plans that pass more of then expense onto the employee. For example, I used to go to the doctor and only paid a $20 copayment, no fee for labs. Now I still have the $20 copayment but it is after I pay a $500 deductible, so the first time I see my PCP I pay the full $130, then I have to pay 20% of the costs of the lab work, also after the deductible is met. Did I mention I work for a hospital system with 7000 employees?
Oh, and the money I spend on medications does NOT go towards that deductible. That is a different category.
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I have private insurance through my employer and every time my doctor orders labs I pay $240.
Ouch... my CBC is $11 and a full set of labs is $178.
I'm still fine with paying $800/yr for data on my condition. I think that is cheaper then being sick or in the hospital.
I prefer more data not less. Saving some money up front and losing the "what's going on" factor is not in my mind a good move. I think it's completely possible to eliminate the office visit and simply have the labs ordered, the doc to glance at them, send a copy to me, and schedule a office visit if something actually warrants one. After a while with HIV most of us know if we have an issue with our numbers. So tying up the doctors time to say "hi" isn't efficient. He can look at labs in 30 seconds.
On the other hand, having a good relationship with your doctor is important to staying healthy. I think I'm in the best shape of my life partly because I see my doctor regularly. Nothing festers or sits. I'm comfortable telling him about things in my life.
Case in point, I went in for routine bloodwork results. We got to talking and I remembered I occassionally have been having asthma issues... once or twice a week. He scripted an inhaler for me which is all it takes to put that in it's place if I have an asthma attack. I wouldn't have done an office visit just for an inhaler. No way, no how.
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I did not pay for labs back then either. Employers are cutting cost by adopting healthcare plans that pass more of then expense onto the employee. For example, I used to go to the doctor and only paid a $20 copayment, no fee for labs. Now I still have the $20 copayment but it is after I pay a $500 deductible, so the first time I see my PCP I pay the full $130, then I have to pay 20% of the costs of the lab work, also after the deductible is met. Did I mention I work for a hospital system with 7000 employees?
Oh, and the money I spend on medications does go towards that deductible. That is a different category.
I'm still one of the 'fortunate ones' in terms of insurance. I pay $25 for a Dr. visit, nothing for labs at all, there are no yearly minimums I have to meet, etc. That and my insurance is paid for entirely by my employer.
My ID Dr. is considered one of the best in our area... if not the best. He's the one my medical friends (nurses, Dr's, etc) say they'd want to see if they were HIV+. He's switched me to labs every 4 months - 3x per year. I was kind of surprised by that, but mostly I'm fine with it. My numbers have been very stable after the initial drop in VL and rise in CD4's. Of course, that schedule can and will be modified if needed. I don't know that I'd feel comfortable with going 2x or 1x per year, but I'm sure that in time I'll be OK with 2x if it's indicated / suggested.
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I'm stretching my appointments out to every four months, on my own initiative. I don't tell the doctor, I just do it.
The reason is so I can save some money, rather than any sense of altruism toward 'the system'. Because I feel that any money saved by 'the system' will go toward executive bonuses and perks.
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I'm still one of the 'fortunate ones' in terms of insurance. I pay $25 for a Dr. visit, nothing for labs at all, there are no yearly minimums I have to meet, etc. That and my insurance is paid for entirely by my employer.
My ID Dr. is considered one of the best in our area... if not the best. He's the one my medical friends (nurses, Dr's, etc) say they'd want to see if they were HIV+. He's switched me to labs every 4 months - 3x per year. I was kind of surprised by that, but mostly I'm fine with it. My numbers have been very stable after the initial drop in VL and rise in CD4's. Of course, that schedule can and will be modified if needed. I don't know that I'd feel comfortable with going 2x or 1x per year, but I'm sure that in time I'll be OK with 2x if it's indicated / suggested.
How can one lose employer covered insurance? Is it possible to be "locked out" of employer insurance? How do we prevent this?
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How can one lose employer covered insurance? Is it possible to be "locked out" of employer insurance? How do we prevent this?
Technically, I can't lose my insurance unless we all do ('we' being all State of NC employees) as long as I'm still employed by the State. I have heard of insurance companies doing screwy things when they didn't want to cover a particular employee or particular 'class' of employees.
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I've been on 4 months for years. Many times I even cancel-pospone another month dragging it out to 5 months. I'd be fine with VL @ 6 months and CD4 @ 1 year since CD4, after a time, stabilizes anyway. CD4 might shoot up after meds the first few years, then usually drop off to a more stable history. Mine jumped from 83 to 800 over 2.5 years, then fell back to 500's and has remained stable between 550-600 time after time. So I'd say thats going to be my base figure from here on out.
So I'd be ok with 6 months on VL, and 1-year on CD4. My doc still wants a 4 month-er check but Im going to push the issue next visit. Its not I hate seeing the doc, but getting labs is a pain. Small office, huge waiting line always, no seating, and they usually screw it up anyway. Ask me of I fasted, I did, but they still neglect to include cholesterol lab. Then next time I say i did not fast, so they take blood for cholesterol anyway. I just hate getting labs.
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How can one lose employer covered insurance? Is it possible to be "locked out" of employer insurance? How do we prevent this?
For the most part it doesn't happen..... now you should realize that your employer probably sees everything. If they are over about 50 employees they are probably "self-insured".... over 300 and they are definately self-insured. This means they pay the claims as if they were the insurance company and use blue cross blue shield, etc to administer the claims, contracts, etc. They take your premiums and buy excess coverage and then simply run the program to break even or generate a profit.
As the "insurer" they are entitled to see what they are paying for and most companies keep a list of high-users..... officially they can't use this... but unofficially you don't wanna be at the doctor's every week either.
Large companies typcially are better behaved about this then small ones as the costs average out over a larger group.
I wouldn't be surprised to see companies constructively terminate expensive employees like women, diabetics, cancer patients, and yes HIV patients.
Women can get pregnant, have breast cancer, and have feminine problems.... all of which are extraordinarily expensive. Women's health insurance is almost twice as much for a middle aged woman then a man. It's sad, but true.
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If you're on meds, adherent, undetectable, and stable, then yeah I would do this. Otherwise no.
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Once my VL became undetectable, my Dr. advised me to go once a year for CD4, but my clinic seems to 've adopted a general policy against VLs in general for those appearing to stable. I am not sure I am confortable with this because I 've not been able to talk them into it for over a year now.
Maybe it is ok, maybe it isn't, hope it is okay.
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I would be comfortable with it. Over the past 11 years with HIV I've gone from every 3 months, to every 6 months, to whenever I got around to taking the morning off work to go. My last labs were in Feburary and I won't get labs done again until Janurary (due to insurance issues). That'll be 11 months and I'm totally comfortable with that.
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I would be comfortable with it. Over the past 11 years with HIV I've gone from every 3 months, to every 6 months, to whenever I got around to taking the morning off work to go. My last labs were in Feburary and I won't get labs done again until Janurary (due to insurance issues). That'll be 11 months and I'm totally comfortable with that.
You're such a trooper Etay. How's the delivery business these days?
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What's the point of checking your labs if you don't let the numbers influence your decision to medicate. I have you on ignore so don't bother responding I just happened to see Skeebo quote your post.
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I would be comfortable with it. Over the past 11 years with HIV I've gone from every 3 months, to every 6 months, to whenever I got around to taking the morning off work to go. My last labs were in Feburary and I won't get labs done again until Janurary (due to insurance issues). That'll be 11 months and I'm totally comfortable with that.
This makes no sense. Sorry.
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This makes no sense. Sorry.
well, sure it does. ;) He may say it's because of an insurance issue; but what he really means is that he is comfortable now having his doctor only lecture him once a year. Then he can go about his business without being bothered by little ol' aids for the rest of the year. :D
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This makes no sense. Sorry.
Makes sense to me! His insurance is giving him issues because they know he is going to cost them a bundle here very shortly. They've prolly got him red-flagged sorta speak... trying to find a loophole to drop him before he causes their stock to plummet.
Ehhh, wait a second.... Rev, you wasn't talking about insurance issues were you? I find solice, and hope as well, in thinking that when reality sets in for Etay that the meds will take hold quickly and bring him back to us in one piece.
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I think it's completely possible to eliminate the office visit and simply have the labs ordered, the doc to glance at them, send a copy to me, and schedule a office visit if something actually warrants one. After a while with HIV most of us know if we have an issue with our numbers. So tying up the doctors time to say "hi" isn't efficient. He can look at labs in 30 seconds.
I've been wondering this same thing. I like my ID doctor just fine, but the appointments are usually quick and don't really do much for me. I only go to hear the actual numbers and get reassurance from him that things are fine. Couldn't he do that over the phone?
Due to some difficulty in rescheduling an early July apptmt., I'm actually going to be 6 months between appointments when I finally make it in late August. It made me kind of nervous at first, but I'm over it. I'd gladly welcome the day that my doctor requested annual visits!
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I find solice, and hope as well, in thinking that when reality sets in for Etay that the meds will take hold quickly and bring him back to us in one piece.
and the choir says, "Amen!" ;)
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I would be comfortable with it. Over the past 11 years with HIV I've gone from every 3 months, to every 6 months, to whenever I got around to taking the morning off work to go. My last labs were in Feburary and I won't get labs done again until Janurary (due to insurance issues). That'll be 11 months and I'm totally comfortable with that.
comfortable, but not the wisest thing for someone with your numbers. do you qualify for ryan white services for labwork?
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Thanks, Max. I researched Ryan White and its looks like I make too much :( I spoke to my nurse about programs that would pay for labs until my insurane kicks back in. She hasn't gotten back to me. I just assumed she couldn't find any services for my income bracket. My boyfriend wants me to go to his doctor. Maybe I'll make a deal with him. I'll go if he pays! If not, then January it is.
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Thanks, Max. I researched Ryan White and its looks like I make too much :( I spoke to my nurse about programs that would pay for labs until my insurane kicks back in. She hasn't gotten back to me. I just assumed she couldn't find any services for my income bracket. My boyfriend wants me to go to his doctor. Maybe I'll make a deal with him. I'll go if he pays! If not, then January it is.
"looks like" may not actually be, until you sit down with an aso counselor and nurses aren't insurance experts. if your income bracket is too high then maybe you can set aside funds to take care of business. there's always sliding scale. however you have to do it, if it's worth it to you, you'll get it done...
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Max, it's not. That's why I haven't paid myself to get it done. I'm not using the numbers to determine when I go on meds. I have the money to pay out-of-pocket. That's no issue. I don't see the need to pay for labs now, expecially since knowing the numbers aren't motivating me to start treatment. I know they are no better than they were in February. I'll just wait until my insurance pays. If my boyfriend REALLY wants me to get labs done, he'll put his money where his mouth is and pay.
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Max, it's not. That's why I haven't paid myself to get it done. I'm not using the numbers to determine when I go on meds. I have the money to pay out-of-pocket. That's no issue. I don't see the need to pay for labs now, expecially since knowing the numbers aren't motivating me to start treatment. I know they are no better than they were in February. I'll just wait until my insurance pays. If my boyfriend REALLY wants me to get labs done, he'll put his money where his mouth is and pay.
The medical examiner usually does labs and its included in the package fee for the autopsy...
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The medical examiner usually does labs and its included in the package fee for the autopsy...
Yes they will be in the coroner's report.
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i have just been put on 6 monthly visits here in spain, pos dec 08 ,started meds in dec 09 no real problems to speak of and undetectable so feel happy with this new set up . We can also phone or just turn up if we have any concerns
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Max, it's not. That's why I haven't paid myself to get it done. I'm not using the numbers to determine when I go on meds. I have the money to pay out-of-pocket. That's no issue. I don't see the need to pay for labs now, expecially since knowing the numbers aren't motivating me to start treatment. I know they are no better than they were in February. I'll just wait until my insurance pays. If my boyfriend REALLY wants me to get labs done, he'll put his money where his mouth is and pay.
imo thats alot of risk to take for someone with your numbers, especially when the funds are there. so is not medicating. but hey, whatever floats your boat.
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For the the issue comes down to how much trust do I have in my doctor and why is he suggesting it. Mine suggested once annually after I got 5 straight non-progressive reports over the first 18 months. However, if I go in for anything medical over the course of the year, he will sometimes say, hey, you want your blood done? I also know the blood work for GD4 and VL in my area costs between $800-$900 each time they do it and I have no insurance. The area health provider I see covers it, so I figure it's not a $$$$$ thing but a matter of trust. Now if I felt like crap or not as good, it's a no brainer for me. I, however, have not been recommended for medication to date, so I would imagine it would change at that point. I guess it's a nexus of $$, trust, and overall security. Z