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    March 13, 2020
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Business Insight Would you like to hear a story? 1 like telling you stories from my professional life. Í think they show not only how much 1 enjoy doing what 1 do but also make my experiences more realistic and closer to your own stories. As you know, I see a lot of psoriasis patients. Psoriasis is a inflammatory disease, with origin in immune system but presenting with skin plaques and lesions. It is often associated with psoriatic arthritis, making patients' life even more difficult due to joint pain in addition to terrible itching. 1 also conduct many psoriasis studies. They develop novel drugs and allow patients to receive a great medical care at no charge. But studies start and end, and patients need medication after studies as well. Sometimes, we are able to get patients into promotional programs, 'letting medicine to be received at a very low price. But we still need to make sure we follow standard of care and check patients' bloodwork and physical examination. During the studies, all is done as a part of the grant and patients pay nothing. department for his annual bloodwork After the study, we return to the reality at $625 level. The second patient also of insurance and bills. Here is my story: I have two patients with psoriasis who were a part of the same study for several years. When the study ended, they both received continuing medication as a promotional voucher at no cost. The first patient has his own trucking business but no insurance. He actually amounting it to $105. The patient with had one a couple of years ago but his wife got sick, and, as a private plan, the premíum went to a very high level, over $1200 a month, which he could not pay. Both, he and his wife are uninsured and not qualified for any public assistance due to the trucking business. They pay times the price for the same service. out of their pocket for what they must pay. The second patient ended the study and out that yes, uninsured patients pay rolled the medication into his employer- more, many times more, and that is how based medical insurance. He has $1000 deductible but insurance pays 80% after that. Not bad. Both patients required medical check up after 1 year of the standard of care use of the medication. This means physical exam and the bloodwork. Both received an order to have the bloodwork done locally. Both had it done, both were in a good shape and received renewal of their medication for psoriasis. chronic About two weeks into the prescription, my office got two calls. The first patient was charged by the lab w received a bill from the lab department but the bill was for $105. Both were ordered identical tests. What happened? Well, the patient with insurance has his bill go to the insurance first, the insurance applied all the contractual fees and discounts, and applied the fees to his deductible, no insurance received no discounts and no contractual fees and ended up with the bill six times higher. He not only is penalized by the system for not being able to afford medical insurance, he is also penalized by the system paying six How does it make sense? My office called the lab department only to find it works. Let me tell you, no, it should not work this way. No, this is all wrong. It is un- human. It is unfair. It is unjust. The story is not over yet but I do not know the ending. My office is working on it. What 1 do know is that any of us can become my patient #1 one day and we need to do something about changing the system. We really do. Michael Bukhalo, MD Arlington Dermatology 5301 Keystone Court Rolling Meadows, IL 60008 Tel. 847 392 5440 | www.arlingtondermatology.net Business Insight Would you like to hear a story? 1 like telling you stories from my professional life. Í think they show not only how much 1 enjoy doing what 1 do but also make my experiences more realistic and closer to your own stories. As you know, I see a lot of psoriasis patients. Psoriasis is a inflammatory disease, with origin in immune system but presenting with skin plaques and lesions. It is often associated with psoriatic arthritis, making patients' life even more difficult due to joint pain in addition to terrible itching. 1 also conduct many psoriasis studies. They develop novel drugs and allow patients to receive a great medical care at no charge. But studies start and end, and patients need medication after studies as well. Sometimes, we are able to get patients into promotional programs, 'letting medicine to be received at a very low price. But we still need to make sure we follow standard of care and check patients' bloodwork and physical examination. During the studies, all is done as a part of the grant and patients pay nothing. department for his annual bloodwork After the study, we return to the reality at $625 level. The second patient also of insurance and bills. Here is my story: I have two patients with psoriasis who were a part of the same study for several years. When the study ended, they both received continuing medication as a promotional voucher at no cost. The first patient has his own trucking business but no insurance. He actually amounting it to $105. The patient with had one a couple of years ago but his wife got sick, and, as a private plan, the premíum went to a very high level, over $1200 a month, which he could not pay. Both, he and his wife are uninsured and not qualified for any public assistance due to the trucking business. They pay times the price for the same service. out of their pocket for what they must pay. The second patient ended the study and out that yes, uninsured patients pay rolled the medication into his employer- more, many times more, and that is how based medical insurance. He has $1000 deductible but insurance pays 80% after that. Not bad. Both patients required medical check up after 1 year of the standard of care use of the medication. This means physical exam and the bloodwork. Both received an order to have the bloodwork done locally. Both had it done, both were in a good shape and received renewal of their medication for psoriasis. chronic About two weeks into the prescription, my office got two calls. The first patient was charged by the lab w received a bill from the lab department but the bill was for $105. Both were ordered identical tests. What happened? Well, the patient with insurance has his bill go to the insurance first, the insurance applied all the contractual fees and discounts, and applied the fees to his deductible, no insurance received no discounts and no contractual fees and ended up with the bill six times higher. He not only is penalized by the system for not being able to afford medical insurance, he is also penalized by the system paying six How does it make sense? My office called the lab department only to find it works. Let me tell you, no, it should not work this way. No, this is all wrong. It is un- human. It is unfair. It is unjust. The story is not over yet but I do not know the ending. My office is working on it. What 1 do know is that any of us can become my patient #1 one day and we need to do something about changing the system. We really do. Michael Bukhalo, MD Arlington Dermatology 5301 Keystone Court Rolling Meadows, IL 60008 Tel. 847 392 5440 | www.arlingtondermatology.net