Hormones suck and insurance companies suck more

January 25, 2013

I want to cry.  I am not sad or upset, but I want to cry.   That’s the beauty of having a prescribed hormone yanked away.

When I wrote this post a week ago, I figured the med would be approved eventually, so I’d just have one unpleasant month.  PrescriptionAs it turns out, the insurance company denied it completely.  I’ll need to appeal.  Or try another med.  Never mind that I’ve been on this one for EIGHT YEARS!  Never mind that my DOCTOR prescribed it because he felt it was the best option for me.  Nope, the insurance is deciding this one.

Memory is a funny thing, especially when you have cognitive and memory problems.  I know I’ve been off the med for brief times before, and I remember that it made me emotional, but I didn’t remember it being this particular level of hell.  For the last 24 hours, I’ve been a wreck at times and I’ve felt fine at times.  When I feel fine, I figure the other stuff was a fluke.  Then I’m a wreck again and I know that I need to find another solution.  I can’t just wait to see if my body normalizes over time.  (We tried that once.  It didn’t.)

I’ve been really anxious.  And I’ve been obsessing.  Last week, before the hormone change kicked in, I sent a text to the guy I’m sleeping with.  He didn’t answer right away.  I thought about him occasionally, had some nice sex fantasies, and assumed he was busy and would get back to me later.  Then I moved on and did other things.  Yesterday the hormone stuff started, and it was much earlier than I expected.  I sent him an email yesterday and he didn’t respond right away.  I started wondering if he didn’t like me anymore (even though we sent flirty messages earlier in the day and made a date for next week.)  Then I started thinking he was intentionally ignoring me.  He’s avoiding me.  He’s going to ditch me and that’s why he’s not answering.  He’s sick of dealing with me.

Ok, I know how ridiculous that sounds.  Even while I thought it, I knew it was ridiculous.  And yet, I couldn’t stop thinking it.  And I kept thinking about it.  Even when I tried to do other things, I kept thinking about it.  Every time I had an email or a text message, I wondered if it was him.  That’s not normal.  That’s not me.  I don’t usually obsess like this.  And I’m pretty sure that next week I won’t be obsessing and anxious and weepy.  But right now I am.  Right now I’m crying because I got a call about scheduling an appeal hearing for state medicaid, and I couldn’t thinking clearly enough to make an important decision (because of this mess with the medication,) and I started crying.  Again, that’s not me.

There are a lot of good reasons to stop taking a prescription.  I can think of many.  And they all involve choices being made by the patient and the doctor based on what’s best for the health of the patient.  None of them involve money or insurance companies, and yet that’s how my decision is being made right now.  This is just plain wrong.  I’d like to call the insurance company and tell them that, but when I called before, I started crying.  The irony.

So I’m legitimately angry, pissed off, furious.  That’s my normal response, and I’ll happily embrace it.  As for the rest, I’m hoping it goes away soon, so I can go back to feeling like myself.  I miss me.

4 Comments | Expectations, Frustration, Healthcare, Isolation, Limitations, Medication, Rants, Relationships: Family & Friends & Dating & Sex, Symptoms, Unpredictable | Permalink
Posted by chronicrants

The doctor-medication-insurance run-around

January 18, 2013

I have been trying to refill my prescription for more than 3 weeks, and now I won’t have it when I need it, by Tuesday.

I have been on this prescription for a long time, around 7 or 8 years, and it works.  It’s a hormone, and it’s not a life-saving Prescriptiondrug, but it sure does make my life better, especially for several days a month.  For various reasons, I went off of this drug twice in recent years, and each time, I had bad PMS symptoms.  The moodiness was really horrible.  Plus I didn’t get a period.  It’s obvious my body reacts better when I am on this drug.

When I started this drug, my insurance covered it with a $40 copay.  Later, it was covered with a $10 copay.  Now, it may or may not be covered.  They haven’t decided yet.

The process started a few weeks back when I called the pharmacy.  I was out of refills.  They called the doctor.  I called the doctor.  The doctor sent the refill.  Then the insurance company told the pharmacy that they needed prior authorization from the doctor.  The pharmacy then contacted the doctor’s office.  They were closed for the week of Christmas and new year’s.  It’s a small office, just the doctor and one staff member, but I was still annoyed.  Next, the administrative staff member tried to send in the authorization, but there was confusion about the insurance, so she called me.  I had forgotten to tell them about my new insurance.  Oops.  Ok, that was totally my fault.  I scanned a copy of my new insurance card and emailed it to her.  She told me she received it and would take care of everything.  More than a week went by and I didn’t hear from the pharmacy, who was supposed to call.  So I called them.  I assumed everything had gone through and they had just forgotten to send the order.  Nope.  It turns out, the paperwork from the doctor’s office didn’t go through.  They contacted the doctor’s office and the paperwork was sent.  I got a call from the pharmacy that the insurance company was processing it and that it can take up to three days.  Then today I got another call that it might not go through.  I asked how much it would cost out of pocket.  I figured I could pay $30 or $40 if I had to.  It’s $104.  Hmm, not in the budget.  I called the insurance company.  They told me to call the company that handles their prescriptions.  Those folks told me it was still being processed.  Apparently, they need the doctor to explain why he is prescribing this particular drug, instead of having me take something else.  They called his office, and were told to call back on Tuesday.

I need the new prescription by the noon dose on Tuesday.  Let’s say the doctor gets back to the insurance company on Tuesday and actually satisfies their questions.  Let’s say the insurance processes things quickly and sends approval to the pharmacy on Wednesday.  The pharmacy is quick, and could probably send it out on Thursday.  That means I could receive it by UPS on Friday.  3 days too late.  And that’s if they move quickly.  That’s if they even approve it at all.  I won’t take a different drug, not with the kinds of side affects I’ve had in the past.  But then, what choice will I have?

So it looks like 1 month wasn’t enough time to refill this prescription.  And I found the flaw in my supposedly-great health insurance.  It could be a rough month.  As the time approaches, I’ll have to warn my friends about my likely upcoming moodiness.  And that will be around the time I expect to hear about the disability insurance appeal, so I’ll be on edge anyway.

There are many, many ways that the system lets us down, that it seems to put the needs of the patients last, that it makes an already bad situation even worse.  This is just the one I’m dealing with today.  By tomorrow, I’m sure I’ll be dealing with another.

4 Comments | Educating, Expectations, Frustration, Healthcare, Medication, Rants | Permalink
Posted by chronicrants

A new low: suppositories

December 5, 2012

About a month ago I wrote about some of the varied “gross” aspects of my health issues.  These have set a whole new standard of “grossness” for me.  I don’t think twice about some things that would make other people really cringe.  And yet, this week’s prescription of suppositories really got to me.

I have had gastrointestinal problems for many, many years.  I’m not even sure when it all started, but I’d say it’s been around 18Suppositories years now.  That’s 18 years of pain, cramps, diarrhea, constipation, gas, heartburn, and nausea.  Oh, and fear.  Definitely don’t forget the fear.  There were so many nights I lay on the bathroom floor, doubled up in agony, wishing the pain to go away.  There were times I hoped I’d die.  I have spent countless hours dealing with this stuff over the years.  At times, it has felt tortuous.  Sometimes, it was worse than any of the other pain I had throughout my body.

So that’s some basic background on why GI stuff is a sensitive area for me.  I guess a lot of people would have emotional issues after 18 years of that.  Thanks for getting through that.  As a reward, here’s a more fun example of my emotional response.

I love sex.  I miss sex, but that’s a subject for another day.  Today’s point is that I love sex.  While I’m not ultra kinky, I’m definitely somewhat kinky, and I’m open to trying a lot of new things.  I’ve been tied up, spanked, and part of a threesome.  I’ve tried a lot of different positions.  I’ve had sex in public places.  I’ve taught my partners to be more kinky.  I’ve taught my partners new positions and techniques.  I’ve worn a collar, used toys, and made all sorts of sounds.  It’s not like I’ve tried everything, but I’m open-minded.  I only have three rules: (1) I’ll only have sex with consenting adults (2) I’ll only have sex with people I trust (3) I won’t let anyone do anything ass-related.  Yeah, that last one is a bit of a surprise, right?

So if I won’t let anyone put anything up my ass for sexual pleasure, do I really want to do it with a medication?  I mean sure, the affects of the med should last longer than an orgasm.  And maybe the med will help me get healthy, which will get me to the point of dating again, which means I’d start having sex again, which would be fantastic.  But that’s a lot of “ifs” and really, she wants me to stick medication up my ass!

After 18 years of pain and everything else, I just can’t stand the idea of using that out-hole as an in-hole.  I can’t do it.  I have rearranged my life for my health.  I left my job.  I started an intense diet.  I stopped dating.  I limit social time with friends.  I limit time with family.  I take a huge assortment of medications, supplements, and homeopathic remedies.  But I can not, I will not, stick anything up my ass.

I finally told my doc of my emotional discomfort with this so she gave me an alternative: it can be inserted vaginally.  Bingo!

4 Comments | Decisions, Expectations, Frustration, Limitations, Medication, Pain, Rants, Symptoms, Unpredictable | Permalink
Posted by chronicrants

So happy I could cry: I finally have great-seeming health insurance

November 9, 2012

I’ve long since given up on going out on a Friday night.  If there’s a special event, like a friend’s birthday, then I’ll make the effort when I can, but otherwise, I just stay in.  I hope that changes one day, but for now, paying bills is the same to me on  Friday as on a Wednesday.

So I was going through my bills and other paperwork tonight, and I came across my new health insurance handbook.  It arrived in the mail earlier this week and I hadn’t gotten to it.  Unlike most people, I actually read these things.  Plus, I went to my PCP’s office today to show them my new insurance card and arrange a referral for my rheumatologist and they said I didn’t need a referral, so I wanted to make sure for myself.

I started flipping through the handbook, figuring I’d do a thorough reading later, but then it really caught my attention.  You see, I’ve always had employer-provided HMO plans.  With these plans, PCPs (primary care physicians) must give referrals for all specialists, and I pay premiums and co-pays for everything.  I’ve been lucky to have plans that didn’t have deductibles or co-insurance.  It was a very restrictive system, but it was the only one I knew.

That’s why I was shocked to find out about my new plan!  Now, I haven’t used any of these services yet, so I can’t be sure if they’ll work out the way they’re supposed to.  And I don’t know how long I’ll have this plan.  For one thing, I appealed my denial of medicaid, so I could end up with that instead of this.  And of course that doesn’t compare to the uncertainty of the long term disability insurance mess.  If I get the insurance coverage when we appeal, then I’ll get my old health insurance back.  I’d rather keep this new insurance, I think, but I definitely need to win that appeal so that I have an income.

I was accepted for this new plan despite my pre-existing health problems because Massachusetts rocks, and it was given to me without having to pay premiums because I have no income and Massachusetts rocks some more.  Believe me, I know how lucky I am!  But I was still shocked to read the details of this plan.  I can see specialists WITHOUT A REFERRAL!!!!  I feel like I’m dreaming.  This means that I don’t have to worry about whether or not my PCP agrees with my decision to see a certain doctor!  My big issue now is that I need to find a new endocrinologist, since my last one dumped me for being the cause of too much paperwork and too many expensive tests.  I’ve been worried about finding someone who practices what I think is best approach based on the research I’ve done.  Then, once I find them, my PCP would have to approve…. but not anymore!  I figure if I can see someone soon, then even when/if I get my old insurance back, my PCP would be more likely to go along with it because I’d already have seen the new doc (or she’d be pissed, in which case I’d find a new PCP.)

Even more amazing, there are no co-pays for visits, and the co-pays for meds are incredibly low.  Now again, this is a plan for people who have no income, so I know this isn’t what everyone gets.  Still, it’s amazing to me that they did it right!  They are offering free coverage to people who can’t afford to pay, so that we don’t get really sick and end up costing even more money to them later.

It’s amazing, almost unheard of, but I think I’ve finally encountered a health-related, government-related system that isn’t broken!  I sure hope it turns out to be as good as it seems, because right now, it seems too good to be true.

I’m sure all of you readers in other countries are wondering what all the fuss is about.  I just can’t even tell you.  Click on the “Healthcare” category in the sidebar on the right (you might have to scroll up or down) and you’ll start to understand just a little bit.  It’s really lousy here in the U.S when it comes to health insurance.  Most of it is linked to employers, and many people choose jobs based less on their passions, the work, or the job potential than on the health insurance that’s provided.  I really hope this ray of sunshine lasts for me, and that the new Affordable Care Act helps things!

6 Comments | Educating, Expectations, Healthcare, Medication, Politics, Raves, Support, Unpredictable | Permalink
Posted by chronicrants

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