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Leanne Buchanan, Hemophilia Foundation of Greater Florida (HFGF) Outreach and Education Nurse
Resides: Winter Springs
Hometown: Sanford
Involvement with HFGF: One year

Florida native Leanne Buchanan joined the ranks of the HFGF as Outreach and Education Nurse last August and hit the ground running. New to working with the disease, but with a 30-year career behind her as a practicing nurse, Leanne is thrilled with the chance to help the bleeding disorders community.

“I am loving this opportunity and everyone has been so heart-welcoming to me,” says Leanne, who has resided in Winter Springs for the past 28 years. “In the beginning, I spent several weeks crash-coursing. I feel pretty comfortable that I can answer just about any question.”

Leanne is responsible for half of the Sunshine State, from Ocala south. Missy Zippel, a 40-year plus Foundation mainstay, is responsible for the northern section.

Using Missy as a mentor, Leanne says she has been defining her role since day one. Until the pandemic, she visited patient homes and school districts where she offered training on bleeding disorders.

“Being a nurse in the school district I can say we didn’t know much about bleeding disorders,” she notes. “Hemophilia and bleeding disorders are so specific it makes it difficult, so my mission is to visit all school districts for training. I have been very well received by schools. They are thrilled to have me visit.”

Once on campus, Leanne’s first priority to make sure the kids that need help the most are getting what they need. She trains physical education coaches, nurses and teachers what to look for and how to treat the disorders. She utilized her past knowledge and data as a school nurse to first visit the schools that she knew had the largest number of bleeding disorder students.

Leanne also visits Hemophilia Treatment Centers around the state to introduce the Foundation to people and to try and help them in any way she can.

“I was talking to a mom at Arnold Palmer Hospital who said her child was being turned down by day care because of a bleeding disorder. I told her I would talk to them. She said, ‘You will?’ I will do whatever it takes to make these kids’ lives easier.”

Spreading the word about the work and offerings of the Foundation is another project on her plate. Leanne sent postcards to hematology and oncology offices throughout Central Florida—including Tampa and Clearwater—introducing herself, asking if they had any needs the Foundation could fulfill.

“We need to make sure everybody knows who we are,” she says. “I am surprised how many do not.”

A public health nurse since 1986 spanning a variety of different capacities, Leanne came to the Foundation from the Seminole County School district.

And although she admits to having an affinity toward Italy where she has visited several times, the Sanford-born Leanne loves calling Florida home.

“I wouldn’t live anywhere else besides here.”

People in the bleeding disorders community face many challenges, not least of which is dealing with the financial burden of outrageous copays and out-of-pocket expenses. For one Severe Factor 8 patient in Orlando, dealing with this burden has not come easy. Here he shares his anonymous story:

“The medication that I take finally works for me after five years of changing products and incurring multiple bleeds, stress, crawling to the bathroom because I cannot walk, and infusing sometimes twice a day for several days in a row to get a bleed under control.

I have had to send in an infusion log to justify getting my NORMAL prophylactic medications. My insurance company requires this for a prior authorization two times per year for medication that I have taken since I was two days old.

Unless I have a bleed, my insurance company will no longer ship my as-needed doses for bleeds. They send me 3 doses for bleeding episodes; if I have not had any documented bleeds they will not send the as-needed doses for bleeding the next month. Do they not understand that, God forbid I have an emergency, I will need as much factor as I can get if I’m injured? This puts me at serious risk.

Why do my copays and prescription copays not count towards my Out-Of-Pocket (OOP) expenses?

My OOP expenses per member is $7,500 and total OOP max is $15,000. I paid $15,000 OOP in 2019 for my medical bills on top of paying $22,000 in 2019 for my insurance premiums; I am self-employed and own my business. My business partner and I paid over $44,000 in total for our health plan in 2019. This does not include the OOP for my pharmacy co-pays which topped $5,000 in 2019.

This is a financial burden for me and for my family. We had to put many of those expenses on credit cards with interest rates of 22% and higher, further exasperating the financial burden that we face. This will not change in 2020; now that I am forced to work from home, I still have to pay for health plan, copays for my medication, credit card bills and medical bills that we are on a payment plan for from last year.

On top of these expenses, I incur a gym membership for $32 per month to try to stay healthy and in shape. I eat healthy which costs more. So it’s much more than just the healthcare premiums. We take control of our health, exercise, and eat healthy which is more expensive than eating processed and canned foods.

This is a problem.”

A big part of the problem is copay accumulators. These are health insurance policies that prevent any copay assistance from counting towards any copay deductibles or out-of-pocket limits. That means that patients are left with the burden of paying copays and out-of-pocket expenses from the prescription in full.  Sometimes they don’t even realize this until it’s time for a procedure.   Meanwhile, the insurance company gets paid twice – once from the copay assistance and once from the patient. Bills have been introduced at the legislative level to try and ban copay accumulators, but they haven’t moved far.

Your voice matters in helping these issues come into the spotlight so that patients like our patient above don’t have to suffer through financial uncertainty. Contact info@bleedingdisorderscoalitionofflorida.org to learn how you can get involved in helping this issue get pushed through the 2021 legislative session.

Natalie Rubin
Resides: Tampa
Hometown: Streamwood, Illinois
Involvement with HFGF: Four years

Natalie Rubin has first-hand knowledge of step therapy, the controversial treatment plan designed to save insurance companies money. Also known as “fail first” protocols, the patient is required to “fail” on an insurer-preferred drug therapy based on a similar diagnosis before it will cover doctor-subscribed therapy. Diagnosed at age 12 with type one Von Willebrand and a patient of Ehlers Danlos syndrome, a connective tissue disorder that brings with it illness on a regular basis, Natalie is now speaking out against the therapy.

Diagnosed at age 12 with type one Von Willebrand and a patient of Ehlers Danlos syndrome, a connective tissue disorder that brings with it illness on a regular basis, Natalie is now speaking out against the therapy.

“The goal is to get rid of step therapy all together,” says the University of South Florida freshman. “Step therapy is not effective and not helping anybody.”

Advocating on behalf of the Bleeding Disorders Coalition of Florida (BDCF), Natalie says when she was in junior high school her insurance company wanted her to take an anti-depressant for her Ehlers Danlos instead of her prescribed Lyrica.

“There were side effects, and I missed a lot of time in school because it,” she explains. “I was sick, and I had an abnormal gait that made me wobbly. Not good for someone with a bleeding disorder.”

Hemophilia Foundation of Greater Florida (HFGF) Executive Director Fran Haynes says these protocols can create life threatening problems by preventing patients from gaining access to the most appropriate medication for their condition. Further, for a member of the bleeding disorders community, step therapy is always inappropriate because the consequences of a “failure” are too serious. HFGF is a partner in BDCF, along with the Florida Hemophilia Association.

“The risk of a major bleed or cumulative damage from repeated bleeding episodes are too high,” Fran says.

BDCF is currently supporting two bills in the Florida legislature that deal with step therapy. If step therapy is allowed to continue, the BDCF asks that it must be subject to reasonable constraints, including patient exceptions and covering the provider-prescribed medication. At least 26 states have enacted some form of step therapy protections.

“Doctors should have the final say on whether a non-preferred drug may be dispensed,” notes Fran.

“The doctor wants you to take one drug, but the insurers won’t cover it unless you take others first,” adds Natalie. “They claim it works. It does not. It’s not the truth.”

Natalie is pictured here at the 2020 Bleeding Disorders Coalition Legislative Days.

 

HFGF Virtual Hug

My name is Genesis Erickson and I was selected to be a member of the National Youth Leadership Institute (NYLI). This is a program at the National Hemophilia Foundation (NHF)  for 18-24 year olds in the bleeding disorders community. The program provides us leadership opportunities to encourage personal growth, learn how to effect change, and positively influence others. I am excited to learn and share experiences of living with a bleeding disorder while learning how to become a distinguished leader. 

This past January, I had the opportunity to attend the NYLI First year leadership training in New York City. At this event, I met the other 8 people in my cohort who come from all over the country. We had public speaking workshops, met with each department of NHF, and worked on self-development as well as emotional intelligence. It was a wonderful introduction to the program and I am so excited to continue and see where NYLI leads me.

The next month, I was on a plane to our nation’s capital for Washington Days! Here I got to tell my personal story of living with a bleeding disorder to our elected representatives. I was so happy to stand beside other people in the Florida bleeding disorders community as we advocated for a continuation of funding to our HTCs and for access to skilled nursing facilities for people with bleeding disorders. After the day on the hill, NYLI members learned all about intersectionality and then provided recommendations to the NHF on how we celebrate diversity in the bleeding disorders community and include people of all different backgrounds. 

In the future, I will learn how to facilitate workshops and use those skills to deliver workshops to kids and teens all over the country. We will be a part of NHF’s annual bleeding disorders conference each year. I will also work closely with HFGF throughout my time in NYLI and after. I encourage any young adults who have an interest in becoming a change maker, especially within the bleeding disorders community, to apply to this program in the future. I am excited to serve our community in the years to come!

How To Advocate For Yourself

HFGF encourages you to advocate for yourself! Click here for a brochure to print out.  HTCs – Please share with your patients!

Being your own advocate means asking for what you need in a direct, respectful manner.

To Be Your Best Advocate:

  • Believe In Yourself
  • Know Your Rights
  • Have Your Facts Straight
  • Decide What You Want
  • Plan A Strategy
  • Target Your Efforts
  • Gather Support
  • Express Yourself Clearly

You Have To Advocate Yourself:

  • With Your Medical Team
  • Through Insurance Issues
  • Legislatively

Advocating For Yourself Medically:
Knowing how to navigate the healthcare system will allow you the best treatment possible. If you and your HTC team are partners in your healthcare decisions, you’ll feel ownership of your wellness. Standing up for yourself medically is your right.

Advocating For Yourself With Your Insurance Company:
It is your right to appeal your insurance company’s decisions on claims. Communicate with your HTC team.   They can help. Be patient: This may take time.

Advocating For Yourself Legislatively:
Laws are made for you and the bleeding disorders community statewide and federally. You can have a voice in what laws are passed by understanding the process and identifying your legislators. HFGF is part of the Bleeding Disorders Coalition of Florida and is here to help you advocate for the bleeding disorders community legislatively.  Contact info@bleedingdisorderscoalitionoflorida.org if you’re interested in getting involved legislatively.

HFGF has a social worker and outreach nurses on staff to help you advocate for yourself.  Contact leannebuchanan@hemophiliaflorida.org for assistance.  Click here for a list of Florida Hemophilia Treatment Centers.

Telehealth is Now Available at the University of Miami Hemophilia Treatment Center!

The HTC hopes that all of our patients and families are staying healthy during the restrictions imposed by the pandemic. While it is definitely frustrating and stressful to not see most, if not all, of our patients in clinic, the University of Miami Health System has streamlined a telehealth option which is currently in development for pediatric patients.

Telehealth or remote visits allow health care providers and patients to interact in real time, using computer access. We can see you; you can see us. We can have conversations, and “see” a problematic joint or bruise. We can ask questions and depending on the situation, figure out if you/your child has difficulty moving a joint or an extremity, which would result in more informed management.

Labs would need to be done at Quest Diagnostics or LabCorp—orders would be placed through the UChart app as usual.

Not every issue would require a telehealth visit, just as many issues have been managed through email and phone conversations in the past. You may certainly call the main office number—(305) 243-0834, and leave a message. You may certainly email any of the providers, as per the earlier email blast. If a televisit seems necessary, then you would go on and get that set up as per the instructions.

Call the scheduling line as you would ordinarily do, and request a telehealth visit with your provider.

Families must  have access to any electronic device that has a build-in camera and microphone (laptop/desktop/tablet/iPhone) for a video visit.

In order to participate in a Telehealth visit, our families MUST have an active MyUHealthChart account to access the video visit link. You will be able to gain access to the MyUHealthChart portal at the time that you register for the televisit. At that time you will also have to “sign” a consent for a televisit, just as you have to sign a consent for treatment whenever you check-in for clinic visit. The scheduler will assist you with these preparatory tasks.     

FYI for Pediatrics:

To grant parents access to the MyUHealthChart site–Per Registration, parents must provide their full name, date of birth/DOB and an email address they want associated with the pediatric patient’s account.

Before proceeding with scheduling, please be aware that your insurance may or may not cover the visit. Insurance coverage rules for TeleHealth visits are changing daily.  If you proceed with the Telehealth visit, UM will bill your insurance accordingly.  If telehealth is not covered then, as always, you will be financially responsible for the copay assigned by your insurance company. CMS (Centers for Medicare & Medicaid Services) will cover telehealth services nationally for Medicare and Medicaid patients. Check with your insurance carrier to find out if telehealth is covered.

As per the earlier email blast, your HTC team is working, although often remotely, and are available to address your needs and concerns.

Email communication and phone message responses may be delayed but there should be a response to a non-urgent matter within the business day.

We are sure that this additional technology will be helpful for our families during this challenging time.

Information regarding the access to the telehealth option for our adult patients will be forthcoming when available.

For urgent matters outside of normal business hours (Monday-Friday from 9A-5P) and after-hours:

PEDIATRIC PATIENTS:

Call (305) 585 – 5400 and ask to speak with the Pediatric Hematologist On-Call.

ADULT PATIENTS:         

Call (305) 243 – 1000 and ask to speak with the Adult Hematologist On-Call.

For non-urgent matters, please call the main number at (305) 243 – 0834 and leave a message. Please be advised that responses may be delayed.

The HTC team appreciates any suggestions from our families, as you work within the limitations necessary to prevent the spread of the COVID-19 virus, to improve our communications with you all.

Click here for additional instructions.

CHANGE THEIR WORLD. CHANGE YOURS. THIS CHANGES EVERYTHING.