Double-billing & Paperwork

 

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After more than a year of going to this particular doctor to treat my diabetes, she has finally decided to get involved in my care.

First, she wouldn’t treat my diabetes, insisting that diet and exercise (self-control) would cure me.  Yeah, right.

Then, as my liver was found to be faulty, I asked for a simple prescription for Metformin, in the hope that it would make things better (or, prevent things from getting worse).  Ha, ha, hah, ha, hah !

After being affronted by my request (that took 3 months to work through last year), she then decided that Metformin may be reasonable.  (I guess she didn’t like me going over her head to my Pulmonologist and getting a recommendation to the Stanford Liver Clinic).

Once she saw my first set of numbers, about November 2017, she then decided to increase my Metformin to 3x per day, causing gastric issues and resulting loss of control on a daily basis.  So, now we’re in 2018, and she has lost her mind.

The first recommendation was for Glumetza, with an average cost of $6,xxx per month (not in this lifetime!, even if my insurance would cover it).  The next recommendation was for Fortamet.  Much more reasonably priced for the generic version at $293.xx per month, but still way too expensive.

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Nope.  Not gonna do it.  Certainly not considering it when the insurance coverage is now denying coverage and trying to be my secondary coverage vs. my primary coverage.  Medicare is useless, and now my doc is also double-billing me, since I paid for the services when I was in her office (and they appeared to submit the bill anyway).  Ain’t nobody got time for this drama.

I didn’t fight with the insurance companies and the doctors when I was employed and had a steady income.  I’m certainly not going to add to my stress and fight with them now that my monthly income has been reduced to a pittance.

So not doing it.

On a more positive note, it’s almost fishing season.  Time to step away from the phone during business hours, and avoid all the drama involved in debating these issues.

Daily Prompt: Inefficient

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via Daily Prompt: Inefficient

I am now covered by Medicare, after 2 years of being on disability.  Of course, they start this mid-year, after I’ve already been working to meet my deductible for 2018 ($13,000 under 3 different categories.  I call that “coverage refusal roulette” for the uninformed).

My favorite bit of inefficiency today was to receive two (2) letters on the insurance company’s coverage portal, and only be permitted to reply to one (1).  Inefficiency at its most obvious.

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My favorite part of this whole thing was having to try and educate the insurance company that my employer has over 100,000 employees and they are not allowed to make themselves secondary in terms of coverage behind Medicare.

I hate fighting over insurance issues.  What’s the point of having insurance “just in case” when they refuse to cover anything?  I guess that’s the height of inefficiency.  Believing that coverage might actually work.

Disengenuous.

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I was reading CNN this week, and found a very misleading article entitled,

What happens when a patient says, ‘Doc, help me die’”

It was an opinion piece, and I’m still furious at the life-at-all-costs doctor type deciding he knows better than me that there is nobility in suffering.

Rather than being honest with his patient that the matter went against his personal beliefs, he tries to turn the right-to-die with dignity movement into something demanding spiritual intervention.

Sigh.

According to the homily-based viewpoint of this Doc, “He who has a “why” to live can bear almost any “how”‘.

Really?!!

I have plenty of reasons to live, but if my body is not going to allow it, and I’ve been on this journey for multiple rounds during my 57 years here, what is the purpose of  denying me relief from suffering?

According to this doc, “We are sent to heal even when cure is not possible. What we should be trying to heal is often not physical disease or clinical depression, but a person’s sense of insignificance and hopelessness, which we cannot heal by eliminating the person.”

What the physician is willfully overlooking is the fact that one doesn’t need to feel insignificant, hopeless or clinically depressed to choose euthanasia.  One just has to be tired of the fight to live when they no longer have quality of life, cannot do things they used to enjoy without pain, or at all, and – last time I checked – none of us gets out of here alive under any circumstances.

Choosing to die in peace, at home in their own bed, is what my Mom wanted.  We made that possible for her.  It was humane.  It was loving.  I reject the doctor’s viewpoint that choosing an end to life is wrong.  If the doc can’t do what the patient asks – fine.

But, find the patient another doc who will honor his wishes, or set him free to find one who will, vs. trying to dress it up in pretty colors by dragging out the decline over weeks or months because you (the doctor) see some personal benefits to others suffering while under your care.

In reality, death needs help for one to die at home under hospice care, I will always go on record that I’m ready when my time comes, as fighting to live is exhausting with a chronic condition, and one has a right to avoid suffering needlessly.

That choice doesn’t make me suicial, depressed or morally bankrupt.  That just makes me a realist who plans ahead.

No choices.

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My life is like this gorgeously fudgy and sugary slice of goodness.  Perfect in the moment, even if you might regret your choice to fall off the sweets wagon later.

While I know my diabetes is signaling a ramping up of my body to get it closer to the finish line as my tired old lungs wear out, I really find it hard to take the food restrictions seriously.

Yes, I’ve upped my proteins and reduced my carbs.

Yes, I monitor all my foods in light of the glycemic index, even though it doesn’t seem to make much difference in my overall health.

But, at the end of the day, if I want a 400 calorie slice of heaven, I will have it.  In place of meals, I will have 2-3 in a day, if I’m so inclined.  After all, if I’m falling off the wagon, I’m diving head first.

Not smart choices, but certainly my choices.

Anything I do or don’t eat isn’t changing the outcome, or even delaying the inevitable, so I’m sticking with my choices vs. no choices.

$6,000 Conversation

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Had my quarterly doctor’s appointment with my pulmonologist, and he – again – wanted to know who my primary care physician was.

Yep, it’s still him.

All my problems begin and extend out from a bad set of lungs, so why oh why would I put another gating doctor between him and me?

I already see way too many docs as my body fails (him, then the endocrinologist, then the herpetologist, the eye specialist, and any one else that needs seeing).

There’s now an issue with my heart that showed up during the clinical trial pre-qualification testing at the liver clinic (with the herpetologist).

There’s always something new showing up.  It’s just parr for the course as the inflammation spreads to the other organs in my body.

But, while the doctor wanted me to have a colonoscopy because Medicare is requesting it, I pushed back.

Why?  Why go looking for trouble when there’s already plenty to choose from, and I don’t plan to go wandering down that alleyway, getting an exam “just in case”.  That “just in case” kind of thinking is for healthy people, people who have a wonderfully functional body.  It’s not for people who are just trying to keep busy and enjoy life before the inevitable end.

While the doc agreed to that rationale over the heart issue  (the problem is a known side effect from medication damage and already struggling lungs), he went to bat for the colonoscopy, which was pretty funny.

We compromised in that I will do the at-home test, which has an 88% accuracy rating.  And which compromise will get Medicare off his back over the paperwork for their care standards.  (Sorry, doc, but you ARE my primary care physician, since my primary problem is bad lungs).

That being said, though, it lead to the next challenge, which was the $6,000 a month diabetes medication recommended by the endocrinologyst (I ain’t doing it), and another conversation about euthanasia.

While he has always side stepped the conversation in the past (he is very much about saving lives) I think the death of his 95 year old mother last November convinced him that there is a time and a place for such moral dilemmas.  Finally.  Her end was long and drawn out, and both she and the family suffered with this beloved 95 year old woman for almost a year before she passed.

There are no easy answers, but it was a good conversation where I made it clear what I wanted, and he agreed to honor my choice.  Finally.

Daily Prompt: Invisible

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via Daily Prompt: Invisible

I have an invisible illness.  COPD – Chronic Obstructive Pulmonary Disease.

What COPD means to me, since I can still pass for normal as I’m not on oxygen, is that no one sees:

– sleepless nights

– pain related to strained lungs, arthritic bones, sore eyes

– the pain side effects I get from the various “treatments”

What they see is a seemingly lazy  person, who appears to be able to still live independently, who still drives, and who needs lots and lots of naps.

They see the house I’ve been trying to paint for almost two years, and which interior still needs a lot of work. A. LOT. OF. WORK.

They see all the boxes from my move in October 2016, still largely packed, and moved out of my way from place to place in the house – when I’m ready to tackle another room – and have the money to hire some day help.

Offended, they see that I’m turning down offers of help, not understanding that their help comes with a price more precious than money – my increased exhaustion from dealing with their social expectations on top of getting the one task done and calling it a day.

I have a friend who loves to board game.

I like board games, too.  But, I can no longer game for 7-8 hours at a time.  To do so risks my safety during the drive home, so I hide my exhaustion away, and then go nap in a parking lot, out of his sight, before I am then well enough to drive home.

Once home, I put off gaming again for months, as the weather or circumstances aren’t right for me to be able to push the envelope.  Again.

They don’t see all the financial issues I’m tackling, pre-paying for cremation, burial and related expenses.  Paying for the lawyer to get the Will and (negligible) estate documents done, and arguing with the lawyer about the exact words I want in my Healthcare Proxy so that I leave no wiggle room for escape should I lose my mind before my body runs down, leaving me to be an unsupervised and willful child, left to play in traffic because I have no spouse or local next of kin.

They don’t see the steps I’m taking to prepare for the inevitable, and ensure it’s documented I want euthanasia and relief vs. being hooked up to machines.

So many invisible aspects involved in being a single woman, battling birth defects, and reaching the long forseen end of my time here on earth.  Neither happy nor unhappy times.  Merely necessary and invisible

 

Queen Mimi

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I am struggling with a friend who has chosen homelessness, and keeping money in her hands for Latte’s and whatever she choses to purchase, vs. having a roof over her head and minimal standards for quality of life regarding access to showers, food, necessary medications, shelter, etc.

In particular, I’m struggling with my wish to kick her out of my life, and find a way to also remove her elderly dog from my life.

To then find that there is a homeless woman who has been featured in her own documentary, “Queen Mimi”, is just hitting a raw nerve.

I really wish we still had poor houses.

It’s pouring outside, and I worry that she’s sitting in a Jack in the Box or other fast food establishment, trying to stay dry, and trying to get through her day until she’s able to claim a bed.

Not that I want her moving in with me, even temporarily, as she is too unpredictable as her mental health declines.  And I am not a martyr, regardless of any bad choices I make trying to be a decent person vs. a dismissive person.

So, what am I doing to make it better?  Not much.  In fact, I’m adding to my own stress by buying beads to make jewelry (which I cannot do so long as my arthritis is acting up).

No answers here.  Just purging my brain of its latest, unproductive thoughts.