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.

inefficient

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.

 

Affordability – ha !

Pharmicist

Can I tell you how much hate debating Rx costs and brands with the pharmacist?  Last year, they changed my branded Xopenex inhaler to Levabuteral (generic) in virtually identical packaging, that almost killed me.

So, the whole debate over brand medicines versus generic medicines is something that only a qualified individual should determine (and I am neither a pharmacist nor a doctor, the two people who should be having the necessary conversation).

Anyway, even though I refuse to allow my pharmacist to have my phone number (because they love their robo-caller), the phone number is buried in the “notes” section of my account, and a determined pharmacist can find it if he or she wishes.

He wished.  I got a voicemail indicated that they could not fill my “Glucophage” Rx because it costs between $4,000 and $5,000 and is restricted by my insurance company, and would I allow a substitution.

Moi ? ! ? ! ?

Why aren’t you talking to my doctor vs. me?  I am not debating the merits of various medicines, but I will have a conversation with my endocrinologyst about what is and is not affordable.  So, I send a message to the doctor, and she’s telling me that she prescribed EXACTLY the right thing, “Glumetza”, and did I want her to get a pre-approval for the medicine?

Glumetza cost

Heck, no !

Glumetza for 60 tablets (and she would like me to try it for a month for 90 tablets) is outrageously priced.

So, I sent yet another email off to clarify the different names of the products being referenced (Glucophage is about $113 per month), and asking her to clarify with the pharmacist if “Glucophage” is a reasonable substitute for the “Glumetza” she originally specified.

I’m at the end of life folks, finding it tough to afford everything.  If you think I need at $6k medicine (or even a $2k medicine) each month, then you value my life a heck of a lot more than I do.

Yes, the metformin is improving my liver enzymes.

Yes, the metformin is causing explosive bowel movement issues.

I’ve already cut back on the metformin and removed all herbal supplements possible to mitigate some of the side effects.

My next choice is to do without the medication recommended if you think that switching it to a more-expensive-than-gold Rx is a reasonable solution.

As referenced in the book by Atul Gawande, “Being Mortal”, I don’t want to spend the last bits of my life worried about how I’ll afford to live, and scared of the costs of my medicines.

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People lived for millions of years without these expensive Rx’s, and I see little value to foolishly expend insurance resources that are unaffordable.  I am not Rockefeller with limitless income, and I accept that my entitlement to care comes with some reasonable caveats.

If the medicine is causing a side effect trying to resolve a problem, then one eliminates the unaffordable solution AND the medicine causing the problem.  One does not believe that they are entitled to exhaust insurance dollars which are better spent on children and young adults when we already know that we are simply delaying the inevitable biological breakdown in my particular case.

 

Dente

Diplomacy is exhausting.

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Doing well despite the rough start to the weekend. Last night, the friend whose dog I’m caring for had a meltdown over the dog’s care, demanding that I get a second opinion, etc., even though we’d previously discussed the fact that I am not wealthy, and that the dog is already under the care of a good vet.

It’s sad when people neglect themselves as they age, but it’s even sadder when there are animals involved.

At this point, I’ve gotten 12 calls and 4 voicemails today as she is working herself into a fine lather to vent her spleen. So, I’ve left her a voicemail (since she didn’t answer the phone), that the dog is fine, is already under the care of an excellent vet, and that she is not allowed to spend my money demanding anything. I am doing what I said I would to care for the dog temporarily, until her living situation is resolved (we are hoping she’s conserved and her niece appointed as guardian), but failing that, she has an action item to find a new place to live that will allow her to keep her dogs. Until she has a workable plan, the dogs are safe with other caregivers.

At 15 years old, though, this dog is at the end of it’s natural life, and I am doing everything necessary to keep it comfortable and happy despite its blindness, eye infection and underweight status. My angry friend has 2 choices at this point:

1) Stop calling me and adding to my stress, and I will continue to update her once a day, between 5 and 6 pm;

or, 2) find someone else to take over the care of the dog.

I am not willing to bring the dog for a visit (a 6 hour round trip car ride) while she is in such deep stages of grief and anger at the changes in her living situation, and not until the dog has gotten all of its vaccines and immunizations updated. So, she knows that I hope to bring the dog for a day visit in April, after I have all my appointments taken care of, and presuming that such a visit will not cause a scene.

The reason I’m writing this post, though, is not for encouragement or support. Instead, I’m asking each of you with pets to consider what will happen if you can no longer care for your pets as our shared illness progresses. My cat, Katie, already has someone waiting in the wings to care for her should she outlive me. And, the fur coated diva will be my last pet should I outlive her.

The lives of our four footed friends are a blessing, and I truly feel we need to handle our guardianship responsibilities well by having a plan for our lives and theirs as it gets closer to us all meeting at the rainbow bridge.

Whatever’s going on in your lives this weekend, I hope you’re doing well and having fun.

Boundary Management

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via Daily Prompt: Uncompromising 

Today’s writing prompt could not have come at a better time.  I am busy dealing with a mentally ill friend who is uncompromising in her belief that we are all against her.

That life has been set up to cheat her.

And that she gets to decide when others have “enough”, so they should be willing to bail her out of whatever disaster she is dealing with.  Again.

Tonight, I was having a relatively good phone call, where she asked how the 15 year old cocker spaniel was doing, and I responded, “Fine.”  She’s not enjoying the rcommended eye treatment for the infections to her blind puppy eyes, but she’s sleeping well, pooping and peeing as normal, and dealing with the realities of being a 15 year old dog as well as can be expected.

We ended the call, and then the voicemails started.  “I’d like you to give the dog a break, she’s depressed, so take her out for an ice cream and find her some kids to play with.”

”I want her to have a second opinion from Dr. Burr…” (with an extoling of that doctor’s qualifications, even though I’d told this friend a week ago that there was no budget for a second opinion, reminded her that the dog was 15 (at the far end of the normal lifespan for the breed), and that there was no more money to be spent on this dog beyond the current treatment plan).  I started a course of treatment, and would see it through with the next vet visit on the 16th.

Relentless and uncompromising, this friend left me and other friends teary voicemails this evening about running away from her care home, and demanding that I bring her depressed dog to see her, and just generally throwing a temper tantrum via the phone.  Completely uncompromising.

No thought or consideration was given to the fact that the friend is now living 2-3 hours drive away, plus the fact that she had been told that the dog was not coming for a visit until sometime in April, soonest, after its immunization shots were up to date and its medical care completed.

She wants what she wants when she wants it.  Truly, a sense of perspective is a terrible thing to lose.

So, it was my turn to be uncompromising.  If she doesn’t like the care her elderly dog is getting, and she can find someone else to take over it’s care, I’m happy to have the dog picked up.

However, she can’t have the dog where she is (and she can’t care for herself physically, emotionally, medically or financially, never mind injecting a blind dog who needs constant supervision and medical care into the situation), and I’m not taking a 5-6 hour round trip just to get her to stop blowing up my phone with her demands.  Especially since the scene she will throw when it’s time for me to return home would be yet another hysterical meltdown.

The dog is fine (or, as good as can be expected at 15 years old), so now I’m being uncompromising. I just wish I didn’t feel like such a hard hearted Hannah, doing what’s best for everyone in this sad eldercare situation.