Last summer, I got a dental infection. It needed treatment with not one, but two antibiotics. That led to a gut infection, which pretty much left me as ill as I can recall being in years. But here's "The Rest of the Story."
My parents were awesome people, but they grew up poor. I remember the day my mom came home after having ALL of her teeth extracted. I don't think I was in school yet, and she was only 20 when I was born. Regular dental visits were not part of my life, growing up. Toothbrushes were also not a regular part of my life in early childhood: It took some dental hygiene classes in school and some sleepovers at friends' houses to notice that we were missing something. By the time I was a teen, brushing was a regular habit, but by then the damage had been done.
When I was 21, I got a job with REALLY good dental insurance. It took a good dentist about a year of almost weekly visits to fix what could be fixed and pull what could not. When all was said and done, I was down 2 wisdom teeth and 4 other adult teeth, and had fillings in nearly every other remaining tooth. I lost another tooth during medical residency - I just couldn't afford a root canal. So when I finally got another 'real job' I started seeing a dentist again.
To cover a gap due to these missing teeth, my dentist recommended a permanent bridge, crowning 3 teeth and adding 2 'fake' teeth. Twenty or so year later the enamal cracked, and I had to replace it. Now, these suckers are expensive: A 5-tooth bridge is $2500-$3500, and dental insurance at the time covered very little of it, but hey, I like to eat, and chewing with your gums isn't comfy, so I did what I had to do. When the replacement bridge was installed, I needed a root canal in one of the teeth, so the timing was good even if the cost was ungodly.
Fast forward to last summer. The infection I had was in the tooth, under the bridge, with the root canal. So earlier this year I went to an oral surgeon and had some procedure done that made the tooth stop getting infections. I went for routine follow up at the end of July, and he said it was healing well, despite the fact that I told him that it felt like the bridge was, "Chewing funny."
Two days before we left for the beach, I had a routine cleaning. I told the hygienist the same thing. I was due for x-rays. My regular dentist was on vacation, so another guy looked it all over, said everything looked great, see you in 6 months.
Later that same day, I was eating, and the bridge came out. At least, that's what I thought at first. But what actually happened was that it BROKE between the two 'fake' teeth, bringing the recently repaired tooth right out with it, root canal included. So, there I am with essentially three teeth in my hand and....Geeze. In retrospect, the crack is completely visible on the x-rays, not that it mattered. It would have saved me only one emergency dental visit the next day.
So.
Today, after a lot of back-and-forth between my regular dentist and the oral surgeon, the bridge has been turned into 2 crowns, and sad remains of the other tooth pulled. An implant was placed, and I'll tell you that I've never had so many stitches in my life as I have in my mouth right now.
The total anticipated cost on this baby is about $3500, but thanks be to God this guy takes our insurance, so I'm expecting to pay less than a third of that. And THEN I get to see about getting a removable bridge, because no way in HELL am I putting in a third 'permanent' bridge at those prices.
And tonight, I have to say, I am incredibly grateful for hydrocodone, and for medications that cut nausea enough to make it possible to take it.
Interestingly enough, dental implants frequently require bone grafts, and I needed grafting. So I now have donor bone in my jaw (not to be disrespectful, but jamming splinters of someone else's bone up under your gums is uncomfortable while it is happening, even with Novocaine, and QUITE painful when the Novocaine wears off). I asked the oral surgeon about the donor, thinking to write to the family and say thank you, but he said, "It came from the University of Miami, so it must have been a smart guy." By this point I was a bit dazed by all the yanking and jamming and whatnot, but I'm planning on slapping him upside the head when I go back for my recheck to remind him that perhaps some respect is due to those who donate, right?
DeeDee
Monday, September 25, 2017
Tuesday, September 12, 2017
Prescription Glitches.....
Babygirl has been managing her pill sorter for some time now. Generally, she's pretty good at it. She lets me know when she is running low on things, but yesterday for some reason I asked her to check on her supply of translplant medications. She'd asked me to call in the one that has to be filled at the local pharmacy, but I couldn't recall getting any medications from the specialty pharmacy that sends her 90 day supplies of the pricy ones.
Sure enough, one of them was pretty close to gone. She just sorted two weeks' worth, and there are a few still in the bottle, so we have time enough to get them ordered. Another one was about to start on the last bottle. The pharmacy usually can get them to us in three to four days, so no problem.
I put in the call, and the chaos began.
"That will be two medications, with $15 co-payments each, for a 30 day supply, okay?"
Um....not really! "Why just 30 days? We always get a 90 day supply. And why do we have a co-payment? We haven't had to ever pay you for these medications before! Not that $15 is so much, but what changed all of a sudden?" I know insurance companies sometimes change the rules, but to change two rules simultaneously seemed, well, just off.
I spent thirty minutes on the phone with a very patient and kind pharmacy representative who did her best to try to figure out what had changed and why. When all was said and done, she really didn't know, but mentioned something about a 'cap' on the amount of medication, and read me back from the insurance coverage that this was, indeed, what the price and amount was supposed to be.
Well, we're three weeks away from out of medication on one dose, so here's my credit card number and go ahead and ship just THAT one, okay?
We've been using this mail-order specialty pharmacy for transplant medications since right after Babygirl's Medicare ended 2 1/2 years ago. We were told, if I recall correctly, that we HAD to use it for these medications or face fairly astronomical monthly co-payments at the local pharmacy. We've been using them without a single glitch ever since, and I have nothing bad to say about them - they've been convenient, easy to contact, and unfailingly courteous. But.
There is no way to tell someone who doesn't have a chronically ill child (or a personal catestrophic illness) just exactly how gut-clenchingly terrifying the word "CAP" is. The implications are staggering, nauseating, insomnia-inducing, palpitating, adrenal-squeezing: That moment when you realize the ship is going down and there is nothing you can do to stop it.
It implies that your coverage is running out. And without that coverage, bad things - VERY bad things - will happen to your child.
It was a good thing we were having chicken soup for dinner. (Cock-a-leekie soup, actually, but no one seems to believe me when I say that, and it makes people laugh. But it's very good soup.) It's very calming.
During lunch today I called the pharmacy benefits department of our insurance. They looked over the policy, and assured me that the mail-order people have it right: We can only get a 30 day supply for a $15 co-pay. "Since when?" I ask. "Since always," they reply. They seem to believe that the pharmacy has been working in error for 2 1/2 years, gifting us with co-payment-free medications to the tune of nearly $1500 in missed revenue without noticing. Furthermore, they tell me, I should be getting these at my local pharmacy because the monthly co-payment THERE is only $10.
I was so mystified by this absolute crock of crap that I totally forgot to discuss the work 'cap', but under the ACA (while it stands, and God bless us, it still stands) there ARE no caps, so I'm going to let that sleeping dog lie and hope my adrenal glands and my gastric lining recover.
Meanwhile......Babygirl turned 18 on the first of this month. I can't help but wonder if THAT tripped some trigger somewhere.
DeeDee
Sure enough, one of them was pretty close to gone. She just sorted two weeks' worth, and there are a few still in the bottle, so we have time enough to get them ordered. Another one was about to start on the last bottle. The pharmacy usually can get them to us in three to four days, so no problem.
I put in the call, and the chaos began.
"That will be two medications, with $15 co-payments each, for a 30 day supply, okay?"
Um....not really! "Why just 30 days? We always get a 90 day supply. And why do we have a co-payment? We haven't had to ever pay you for these medications before! Not that $15 is so much, but what changed all of a sudden?" I know insurance companies sometimes change the rules, but to change two rules simultaneously seemed, well, just off.
I spent thirty minutes on the phone with a very patient and kind pharmacy representative who did her best to try to figure out what had changed and why. When all was said and done, she really didn't know, but mentioned something about a 'cap' on the amount of medication, and read me back from the insurance coverage that this was, indeed, what the price and amount was supposed to be.
Well, we're three weeks away from out of medication on one dose, so here's my credit card number and go ahead and ship just THAT one, okay?
We've been using this mail-order specialty pharmacy for transplant medications since right after Babygirl's Medicare ended 2 1/2 years ago. We were told, if I recall correctly, that we HAD to use it for these medications or face fairly astronomical monthly co-payments at the local pharmacy. We've been using them without a single glitch ever since, and I have nothing bad to say about them - they've been convenient, easy to contact, and unfailingly courteous. But.
There is no way to tell someone who doesn't have a chronically ill child (or a personal catestrophic illness) just exactly how gut-clenchingly terrifying the word "CAP" is. The implications are staggering, nauseating, insomnia-inducing, palpitating, adrenal-squeezing: That moment when you realize the ship is going down and there is nothing you can do to stop it.
It implies that your coverage is running out. And without that coverage, bad things - VERY bad things - will happen to your child.
It was a good thing we were having chicken soup for dinner. (Cock-a-leekie soup, actually, but no one seems to believe me when I say that, and it makes people laugh. But it's very good soup.) It's very calming.
During lunch today I called the pharmacy benefits department of our insurance. They looked over the policy, and assured me that the mail-order people have it right: We can only get a 30 day supply for a $15 co-pay. "Since when?" I ask. "Since always," they reply. They seem to believe that the pharmacy has been working in error for 2 1/2 years, gifting us with co-payment-free medications to the tune of nearly $1500 in missed revenue without noticing. Furthermore, they tell me, I should be getting these at my local pharmacy because the monthly co-payment THERE is only $10.
I was so mystified by this absolute crock of crap that I totally forgot to discuss the work 'cap', but under the ACA (while it stands, and God bless us, it still stands) there ARE no caps, so I'm going to let that sleeping dog lie and hope my adrenal glands and my gastric lining recover.
Meanwhile......Babygirl turned 18 on the first of this month. I can't help but wonder if THAT tripped some trigger somewhere.
DeeDee
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