When Babygirl turned 18, we applied for disability for her. Now, most people under are turned down as a matter of course on the first try, but...If you fail the vision test, and add in all the rest of her struggles, I guess you qualify. Because she is over 18, this gets her a small income of her own, and, because she is over 18, it makes her officially "poor." So, after some difficulty with the system, she qualified for Medicaid, supplementing our private insurance. The problem is, Medicaid is state-based, so it covered anything here in OUR state, but not her out-of-state care, which was, until recently, the majority of what really cost the most. Even her transplant medications, since they were written by out-of-state providers, were only covered on OUR insurance, not her Medicaid, so her co-payments and deductables remained unchanged, and high. If it had been all on her, it would have taken half or more of her disability income to pay for it.
But, after two years on disability, one becomes eligable for Medicare (we "Aid" the poor, we "Care" for the elderly and disabled). So, suddenly, she got a Medicare card (which we had, temporarily, when she was on dialysis. We apparently also "Care" for those in renal failure.) But when you qualify for both Medicare AND Medicaid, interesting things happen.
First, let me explain Medicare. Medicare has 4 parts. Part A covers 80% of your hospital stays, and everybody over 65 automatically gets this. This is, by itself, crappy insurance. It won't pay your doctor, or your medications, and, if you are in the hospital for 2 days and get a $10,000 hospital bill you will owe $2000. Multiply THAT times a few more days.
Part B covers doctor's visits, or at least part of them.
Part C covers home health care/PT/ and some other miscellaneous things.
Part D covers prescriptions, or part of them.
Parts B, C, and D have to be purchased by the consumer. Yes, YOU have to pay for them.
Now, there are some reasonable plans out there, and there are price breaks based on income. And if you qualify for Medicaid, then Medicaid will buy your B and D plans (although they may cut a deal with the cheapest, meanest most Satanic insurance company ever to make a dime off your Granny's back, but hey, poor people shouldn't complain, right?).
So, Babygirl has new insurance, and we didn't get an up-front choice as to which Satanic flavor she got. And by some clerical error, we never got a prescription card. So we just kept going to our pharmacy and using my insurance, until I our pharmacy about her new plan. Horrified faces. Apparently we've been committing some sort of fraud.....
So we finally got ahold of the new plan. And it turns out, according to the witless wonder that we spoke to, that her transplant medications are considered a hospital benefit and not a prescription benefit so we have to change pharmacies, because ours doesn't bill Medicare B, only D.
So, we have the new transplant team send new prescriptions to CVS, who have assured us that they bill Medicare B. We have 5 transplant related prescriptions. I get a call from the new pharmacy that 2 need to be ordered and they will let us know when they are in. A few days later I get a text that 2 prescriptions are ready. This repeats a couple days later. But since I'm waiting on 5 prescriptions, I just sit tight.
Then, a phone call: "Are you coming to pick up those 2 prescriptions or do you want them delivered?" I asked about the others, and the woman said, "Oh, look, there are more, but they were filed. I can get those filled in 15 minutes."
Babygirl and I put a dog on a leash and walked a mile to the pharmacy. She waited outside. And waited. And WAITED.
One prescription was ready, 90 day supply. One of the ones that needed to be ordered STILL needed to be ordered, would tomorrow be okay? The other one that needed to be ordered ALSO still needed to be ordered, but was out of stock, so they couldn't order it. They had 70 out of 90 days available, if they used 3 different manufacturers. Was that okay? The fourth had a 22 day supply in it, for no reason that anyone could determine, and they had to re-do it to make a full 90 day supply, would I mind waiting? I completely forgot at that point that there was supposed to be a 5th medication. I have to check on that when I go to pick up the remaining bottle.
What. A. Cluster. We are in the middle of the Zombie Apocolypse. Avoiding people is the name of the game here. I was the only person in the store when I got there, and FIVE sets of people came and went for prescriptions while all this was going on. If I had accepted home delivery, the whole order would have arrived a complete mess with no explanation, and ...... do I stick with these yahoos or start over somewhere else???? Oh my dear Lord.
Oh, and despite the fact that I was assured by Babygirls's Medicare D plan that they DO NOT cover her transplant meds, THEY FRICKIN paid for them. Not the B, but the D. So, does that mean I can go back to my regular pharmacy???????
And Babygirl's response to all this was classic, polite, optimistic Babygirl: "Well, they got ONE of them right!"
That's a low bar, Babygirl. A really LOW bar. LOL
DeeDee
Thursday, April 9, 2020
Thursday, April 2, 2020
The Zombie Apocalypse.....
Three Sundays ago I stood in the pulpet of my church, and told our largely elderly congregation what they needed to hear but did not yet fully understand: We need to stay away from each other to be safe. I resigned, temporarily, as choir director, and told them that I would not be back until the epidemic (then not yet officially a 'pandemic') had made it safe for me to do so.
Within days, I was also working from home. A year ago it would have been unthinkable to have a visit with a patient with no hands-on contact. Now, I have to use my ears, my intuition, my gut. I have to ask patients to tap their own sinuses and report what it feels like without being able to SEE the grimace that tells me that there is a problem under there. Video is coming. I need "Webside manner" training, and I'm supposed to wear my stethescope and a white coat. I have perfectly terrible bedside manner (which is why a certain type of people love me LOL), I don't OWN a white coat and WTH am I supposed to do with a stethescope during a VIDEO visit for crying out loutd?
Covid-19 is reshaping a lot of our world. I'm a natural introvert, living in a house full of introverts. We miss eating out. Otherwise, life is good. But there is a lot of anxiety and uncertainty in the air. Some people's hearts are simple dripping with fear.
I'm not sure what to do about that. It isn't that we, ourselves, have no reason for fear. Hubby and I are asthmatic diabetics. There's some risk there. Citygirl, Jujubee and Curlygirl all have asthma. And Babygirl. Well. Her immune system is suppressed on purpose, so, there's that.
But....
The one solid lesson I have learned, being Babygirl's mom, is that I have no control whatsoever over the future. None. What is coming, is coming. I can do what I CAN do: Make sure there is plenty of soap in the house, make masks for people to wear, keep our food sources safe, and maintain agressive social distancing. But in the end, I will have to deal with what I get, and worrying about it ahead of time will change precisely nothing.
That doesn't mean my mind doesn't go there. I had a serious kick-in-the-gut thought yesterday. Babygirl is technically an adult now. If she gets any kind of sick, I won't be allowed to be with her in the ER, or for any hospital admission. NO visitors are allowed at all anywhere right now, except for "beginning of life, and end of life." And even then, it's only one. One visitor for new moms, or for the dying. Not one at a time: ONE ONLY. THAT might just about kill me.
DeeDee
Within days, I was also working from home. A year ago it would have been unthinkable to have a visit with a patient with no hands-on contact. Now, I have to use my ears, my intuition, my gut. I have to ask patients to tap their own sinuses and report what it feels like without being able to SEE the grimace that tells me that there is a problem under there. Video is coming. I need "Webside manner" training, and I'm supposed to wear my stethescope and a white coat. I have perfectly terrible bedside manner (which is why a certain type of people love me LOL), I don't OWN a white coat and WTH am I supposed to do with a stethescope during a VIDEO visit for crying out loutd?
Covid-19 is reshaping a lot of our world. I'm a natural introvert, living in a house full of introverts. We miss eating out. Otherwise, life is good. But there is a lot of anxiety and uncertainty in the air. Some people's hearts are simple dripping with fear.
I'm not sure what to do about that. It isn't that we, ourselves, have no reason for fear. Hubby and I are asthmatic diabetics. There's some risk there. Citygirl, Jujubee and Curlygirl all have asthma. And Babygirl. Well. Her immune system is suppressed on purpose, so, there's that.
But....
The one solid lesson I have learned, being Babygirl's mom, is that I have no control whatsoever over the future. None. What is coming, is coming. I can do what I CAN do: Make sure there is plenty of soap in the house, make masks for people to wear, keep our food sources safe, and maintain agressive social distancing. But in the end, I will have to deal with what I get, and worrying about it ahead of time will change precisely nothing.
That doesn't mean my mind doesn't go there. I had a serious kick-in-the-gut thought yesterday. Babygirl is technically an adult now. If she gets any kind of sick, I won't be allowed to be with her in the ER, or for any hospital admission. NO visitors are allowed at all anywhere right now, except for "beginning of life, and end of life." And even then, it's only one. One visitor for new moms, or for the dying. Not one at a time: ONE ONLY. THAT might just about kill me.
DeeDee
Thursday, March 5, 2020
Nothing is Wrong In Rochester.....
Babygirl and I went for her routine kick-the-tires, check-the-oil, 3-month doctor visit. Except it wasn't quite....routine. For the first time in 8 years I had to turn north instead of south (and I swear if Google hadn't been scolding me the ENTIRE time I WOULD have gone south!), and we went for our first visit with the transplant team at University of Rochester, Strong Memorial Hospital.
We drove right past University Hospital in Syracuse, a closer alternative. We plan to never darken their doors again unless no option exits otherwise, since our last experience there was less than positive (Week Seventeen - The First Surgery.....), as you can read if you desire.
Google took us to the hospital, but not to parking. We bumbled through a private lot, let Google lead us into the ambulance bay (!!), and finally found our way to the 6th floor of the parking garage (parking here is more affordable than at CHOP, $6/visit at the worst with no need to validate. If you forget to validate at CHOP you can get hit with $24!). We had left early to allow for the bumbling, and got to our appointment with plenty of time for the endless paperwork that a first visit to a megaceenter entails. In the proscess, we discovered that her Medicaid is not valid. It's always something.
The appointment was the usual: Weight (but no height measurement - they were content to let her just tell them!), blood pressure, pulse. No urine test (which is interesting. One of her medications can cause severe birth defects. A pregnancy test was mandatory (if not necessary) at each and every visit at CHOP since she turned 13).
A nurse practitioner student took her history, and spent endless time getting her extesive medication list into the computer. A nurse practitioner confirmed it all. A social worker came in to see how she was handling the transition, and to give us resource information if we needed it. And then came....The Doctor.
It was a bit of a Soap Opera moment, actually. He's tall, dark, and almost as handsome as he thinks he is. "Why were her doctors seeing her every three months? When our patients have stable transplants for 8 years, we see them annually!"
He's clearly a man who knows his value and isn't used to getting questions from patients and their moms.
"Well, rejections are most common at age 14 and 18, so they are pretty rigid about compliance in their adolescent patients, most likely aimed at improving the odds that they WILL have a stable transplant at 8 years."
Ahem. But we had questions, most of which had nothing whatsoever to do with her kidney follow up. We know the kidney is doing fine.
"Her pediatric nephrologists were unable to clear her to use CGRP inhibitors to prevent her migraines. I was hoping you had enough experience with them to allow her to use them. Oh, and she needs a referral to neurology. We are still driving to Delaware to get her Botox done because we can't find a more local provider to do it."
It's kinda fun when you get to explain a new class of medications to a blank-faced Uber-Specialist because he has Never Heard Of Them. (Short explanation: They are injections of antibodies that scavenge the inflammatory by-products specific to migraine headaches to prevent recurrences. Similar medications are used to treat elevated cholesterol, allergies, and several other issues). Because they involve modifying the immune system (sort of?), he was concerned, and wanted to veto. I refused to let him unless he did some research first. He agreed.
He put in a neurology referral and instructed us to call if they refused to take her so he could speak to them (they have already refused a referral from our primary care doctor).
He did a thorough exam, told us he wanted her to do monthly blood work at home, and then announced that he would see us in a year, but that the nurse practitioner would be back in to send in our prescriptions because "she's better at that than I am." So kind of you to notice.
When she returned, she asked about follow up and was appalled to here the 1-year plan. "On a patient just transferring from pediatrics? We need to get to know you first! We usually do every 3 months for a while. Babygirl was clearly relieved by this. We scheduled follow up for June, but can adjust based on neurology, if/when we get that apppointment.
We stopped at an outlet mall on the way home, walked 2 miles and did some shopping. We discussed politics, tax distribution, the importance of elections that DON'T involve only presidents, health care, and listened to both current music and Pandora's Chicago channel.
When we pulled up in front of the house, I looked at her and said, "I just drove 7 hours. You'd think we'd have gotten farther away!"
DeeDee
We drove right past University Hospital in Syracuse, a closer alternative. We plan to never darken their doors again unless no option exits otherwise, since our last experience there was less than positive (Week Seventeen - The First Surgery.....), as you can read if you desire.
Google took us to the hospital, but not to parking. We bumbled through a private lot, let Google lead us into the ambulance bay (!!), and finally found our way to the 6th floor of the parking garage (parking here is more affordable than at CHOP, $6/visit at the worst with no need to validate. If you forget to validate at CHOP you can get hit with $24!). We had left early to allow for the bumbling, and got to our appointment with plenty of time for the endless paperwork that a first visit to a megaceenter entails. In the proscess, we discovered that her Medicaid is not valid. It's always something.
The appointment was the usual: Weight (but no height measurement - they were content to let her just tell them!), blood pressure, pulse. No urine test (which is interesting. One of her medications can cause severe birth defects. A pregnancy test was mandatory (if not necessary) at each and every visit at CHOP since she turned 13).
A nurse practitioner student took her history, and spent endless time getting her extesive medication list into the computer. A nurse practitioner confirmed it all. A social worker came in to see how she was handling the transition, and to give us resource information if we needed it. And then came....The Doctor.
It was a bit of a Soap Opera moment, actually. He's tall, dark, and almost as handsome as he thinks he is. "Why were her doctors seeing her every three months? When our patients have stable transplants for 8 years, we see them annually!"
He's clearly a man who knows his value and isn't used to getting questions from patients and their moms.
"Well, rejections are most common at age 14 and 18, so they are pretty rigid about compliance in their adolescent patients, most likely aimed at improving the odds that they WILL have a stable transplant at 8 years."
Ahem. But we had questions, most of which had nothing whatsoever to do with her kidney follow up. We know the kidney is doing fine.
"Her pediatric nephrologists were unable to clear her to use CGRP inhibitors to prevent her migraines. I was hoping you had enough experience with them to allow her to use them. Oh, and she needs a referral to neurology. We are still driving to Delaware to get her Botox done because we can't find a more local provider to do it."
It's kinda fun when you get to explain a new class of medications to a blank-faced Uber-Specialist because he has Never Heard Of Them. (Short explanation: They are injections of antibodies that scavenge the inflammatory by-products specific to migraine headaches to prevent recurrences. Similar medications are used to treat elevated cholesterol, allergies, and several other issues). Because they involve modifying the immune system (sort of?), he was concerned, and wanted to veto. I refused to let him unless he did some research first. He agreed.
He put in a neurology referral and instructed us to call if they refused to take her so he could speak to them (they have already refused a referral from our primary care doctor).
He did a thorough exam, told us he wanted her to do monthly blood work at home, and then announced that he would see us in a year, but that the nurse practitioner would be back in to send in our prescriptions because "she's better at that than I am." So kind of you to notice.
When she returned, she asked about follow up and was appalled to here the 1-year plan. "On a patient just transferring from pediatrics? We need to get to know you first! We usually do every 3 months for a while. Babygirl was clearly relieved by this. We scheduled follow up for June, but can adjust based on neurology, if/when we get that apppointment.
We stopped at an outlet mall on the way home, walked 2 miles and did some shopping. We discussed politics, tax distribution, the importance of elections that DON'T involve only presidents, health care, and listened to both current music and Pandora's Chicago channel.
When we pulled up in front of the house, I looked at her and said, "I just drove 7 hours. You'd think we'd have gotten farther away!"
DeeDee
Tuesday, February 4, 2020
Eight Years Wiser.....
"I think if I'd known how hard it was going to be I'd have toughed it out on dialysis." - Babygirl.
Eight years in. Meds twice a day. Ongoing, neverending cautions to avoid infections. Headaches triggered initially by one of the transplant medications that did not resolve when the medication was stopped.
It's hard, at this point, to guess which side of the coin would give you the better quality of life. The short-term death rate is higher with dialyis. Swimming would be harder because of the catheter, and traveling for a vacation with the machine? Not really sure how that would work. And how do we know for sure the migraines wouldn't have become an issue anyway?
There's no backpeddling on the journey: It's the road we're on. There are awesome times and bad times, and Babygirl has become an amazing young woman despite/because of the challenges she face for so many years.
She's kind, loving, funny, generous. She's a great daughter, devoted dog mama, wonderful sister, amazing Auntie. But if wishes were horses, we'd for sure own a large herd.
DeeDee
Eight years in. Meds twice a day. Ongoing, neverending cautions to avoid infections. Headaches triggered initially by one of the transplant medications that did not resolve when the medication was stopped.
It's hard, at this point, to guess which side of the coin would give you the better quality of life. The short-term death rate is higher with dialyis. Swimming would be harder because of the catheter, and traveling for a vacation with the machine? Not really sure how that would work. And how do we know for sure the migraines wouldn't have become an issue anyway?
There's no backpeddling on the journey: It's the road we're on. There are awesome times and bad times, and Babygirl has become an amazing young woman despite/because of the challenges she face for so many years.
She's kind, loving, funny, generous. She's a great daughter, devoted dog mama, wonderful sister, amazing Auntie. But if wishes were horses, we'd for sure own a large herd.
DeeDee
Monday, February 3, 2020
Eight Years Without Your Boy....
Today is the day that Jorge's Mom must dread more than any other day of the year. The anniversary of his passing cannot possibly become any less raw with the passage of time.
He'd be in his 30's now. She has to wonder if he would have had kids, what kind of Dad he would have been, what his life's work would have become.
I have a friend who's been missing her boy this long. There are two days in each month, every single month, that bring her to her knees still.: The day that corresponds to the one on which he arrived, and the day that corresponds to the one on which he went home. Every. Single. Month.
I think of Jorge's Mom on the 'thirds.' Not every month, I'm not diligent enough for that. But often. Whenever I catch a glimpse of the little J that Babygirl had tattoo'd on her arm, I say a prayer for his family.
I've thought about them all day today, remembering the chaos of that day eight years ago. (February Third - The Big Day..... Babygirl wanted, for the first time that I can recall, to go back and actually read the blog from that week (her final takeaway: "You shouldn't have let me eat so many pancakes." LOL). Remembering all the details, all of the crazy, all of the joy! And never, ever, ever forgetting what it cost someone else.
DeeDee
He'd be in his 30's now. She has to wonder if he would have had kids, what kind of Dad he would have been, what his life's work would have become.
I have a friend who's been missing her boy this long. There are two days in each month, every single month, that bring her to her knees still.: The day that corresponds to the one on which he arrived, and the day that corresponds to the one on which he went home. Every. Single. Month.
I think of Jorge's Mom on the 'thirds.' Not every month, I'm not diligent enough for that. But often. Whenever I catch a glimpse of the little J that Babygirl had tattoo'd on her arm, I say a prayer for his family.
I've thought about them all day today, remembering the chaos of that day eight years ago. (February Third - The Big Day..... Babygirl wanted, for the first time that I can recall, to go back and actually read the blog from that week (her final takeaway: "You shouldn't have let me eat so many pancakes." LOL). Remembering all the details, all of the crazy, all of the joy! And never, ever, ever forgetting what it cost someone else.
DeeDee
Monday, November 18, 2019
Fixing Things. It's What I Gotta Do.......
Let's see....
Since our last little cliffhanger, (Cancelled....) I've spent about 2 hours on phones, off and on, trying to make all of this work somehow. Each call has landed on a different day.
First, a second call to Nemours to see why, after nearly two days, they haven't called back.
Next, and longest, was the insurance company. Finding out what was holding up the Botox was...opaque, to say the least. The number on our pharmacy card reaches the mail-order pharmacy, which is a fairly useless (to us) place. We found out during the Great Transplant Medication Shortage (The Terror of Running Short....) that this is not actually considered to be OUR mail-in pharmacy (We can get 'ordinary' medications mailed to us from there if we want, but it is more expensive than using out local pharmacy. And for 'special' medicines like transplant stuff, we have to use our local pharmacy, 'cause THAT's our ACTUAL mail in pharmacy, even though we just walk in and pick them up. Don't ask me. I'm just The Fixer.). But I had to start somewhere, so....
The very nice lady who answered wasn't sure what the issue was, because Botox is in a Super Special Category that is neither "regular" nor "mail order," so it wasn't her department. "I'm going to need to talk to someone else, and it could take quite a while. If you don't want to listen to the whole thing, I can put you on hold."
Well, honestly, I'm still at work, and I have a lot of charting and dictation to do that I really don't want YOU to listen to, so sure, sounds like a plan. "Do you think I'll have time to run to the bathroom, because I probably should have done that before I called you!" She assured me that if she comes back on and I'm gone, she'll wait for me.
No need to have worried. Fortunately, the Muzak was not too grating, because a full hour after I got back to my seat, she came back on. It turns out that the Botox authorization WAS still attached to Nemours neurology. She could see a record of ONE call from the new neurologist requesting that it be released to them, but no calls from Nemours allowing it to be released.
By the time I had this information, it was too late on Thursday to call Nemours again. Friday I got ahold of the injections scheduler, and she said the reason the provider hadn't called back was because she was concerned that they wouldn't be able to get the Botox, because it had been released to the new provider. Well, damn skippy. "As a matter of fact, no, it has NOT." I filled her in on what the insurance company had said, and she was a bit miffed at them, since she herself had called them.
(So either she never called, or the insurance company made no note of the call and failed to release the medication that my kid needs, making it necessary for her to WAIT an extra three weeks. I'm placing ALL my money on it being the insurance company. I've been playing this game with them for more than a minute now.)
At this point, we are running out of options. I'm going to assume that our appointment with the new neurologist is, in fact, cancelled (something that I confess I have failed to confirm one way or the other since this all began. If I ask her to release the medication now, this will likely backfire badly; and honestly, I don't think I can be polite to the scheduler in the new doctor's office at this point.
So: "Can she be fit in when we are coming down in December? I'll clear my schedule and come a day early, stay a day longer, whatever works."
I got a call at the end of today: She has an appointment.
I admit I cried when I put the phone down. I just needed a minute. I am getting too old for this stuff.
DeeDee
Since our last little cliffhanger, (Cancelled....) I've spent about 2 hours on phones, off and on, trying to make all of this work somehow. Each call has landed on a different day.
First, a second call to Nemours to see why, after nearly two days, they haven't called back.
Next, and longest, was the insurance company. Finding out what was holding up the Botox was...opaque, to say the least. The number on our pharmacy card reaches the mail-order pharmacy, which is a fairly useless (to us) place. We found out during the Great Transplant Medication Shortage (The Terror of Running Short....) that this is not actually considered to be OUR mail-in pharmacy (We can get 'ordinary' medications mailed to us from there if we want, but it is more expensive than using out local pharmacy. And for 'special' medicines like transplant stuff, we have to use our local pharmacy, 'cause THAT's our ACTUAL mail in pharmacy, even though we just walk in and pick them up. Don't ask me. I'm just The Fixer.). But I had to start somewhere, so....
The very nice lady who answered wasn't sure what the issue was, because Botox is in a Super Special Category that is neither "regular" nor "mail order," so it wasn't her department. "I'm going to need to talk to someone else, and it could take quite a while. If you don't want to listen to the whole thing, I can put you on hold."
Well, honestly, I'm still at work, and I have a lot of charting and dictation to do that I really don't want YOU to listen to, so sure, sounds like a plan. "Do you think I'll have time to run to the bathroom, because I probably should have done that before I called you!" She assured me that if she comes back on and I'm gone, she'll wait for me.
No need to have worried. Fortunately, the Muzak was not too grating, because a full hour after I got back to my seat, she came back on. It turns out that the Botox authorization WAS still attached to Nemours neurology. She could see a record of ONE call from the new neurologist requesting that it be released to them, but no calls from Nemours allowing it to be released.
By the time I had this information, it was too late on Thursday to call Nemours again. Friday I got ahold of the injections scheduler, and she said the reason the provider hadn't called back was because she was concerned that they wouldn't be able to get the Botox, because it had been released to the new provider. Well, damn skippy. "As a matter of fact, no, it has NOT." I filled her in on what the insurance company had said, and she was a bit miffed at them, since she herself had called them.
(So either she never called, or the insurance company made no note of the call and failed to release the medication that my kid needs, making it necessary for her to WAIT an extra three weeks. I'm placing ALL my money on it being the insurance company. I've been playing this game with them for more than a minute now.)
At this point, we are running out of options. I'm going to assume that our appointment with the new neurologist is, in fact, cancelled (something that I confess I have failed to confirm one way or the other since this all began. If I ask her to release the medication now, this will likely backfire badly; and honestly, I don't think I can be polite to the scheduler in the new doctor's office at this point.
So: "Can she be fit in when we are coming down in December? I'll clear my schedule and come a day early, stay a day longer, whatever works."
I got a call at the end of today: She has an appointment.
I admit I cried when I put the phone down. I just needed a minute. I am getting too old for this stuff.
DeeDee
Tuesday, November 12, 2019
Cancelled.....
Babygirl is due for Botox injections every 12 weeks, so she should have them November 21. Due to miscellaneous scheduling issues, our new local neurologist set her up for November 25 when she first met him back in August. Shortly after that appointment, his office called me.
"I'm trying to get authorization for the Botox, but your specialty pharmacy tells me that there is already a prior authorization in place elsewhere that needs to be cancelled so we can set one up here."
No problem. I'll call them.
Nemours informs me that cancelling the PA isn't needed, the new doctor just needs to ask the insurance company to transfer it over to them.
I'll let them know.
"I've contacted your insurance and they assure me that the other hospital needs to cancel the PA before we can proceed."
Got it. I'll let them know. In person, since we happen to be going down there.
"We do this all the time, and we know they are wrong, but we'll be glad to call your insurance company and talk to them."
Somewhere in the middle of all of this, I called the insurance to see if I could get a handle on where exactly the problem was. I'm pretty sure they told me the new doctor only had to submit the appropriate paperwork.
I let them know. And that was the last I heard about it, likely about 3 weeks after we saw our Nemours neurologist for her last set of injections at the end of August.
Today I got a message on my phone while I was at work. "We're just letting you know that we don't accept your insurance for Botox. Give me a call and let me know if you want me to put in a referral to the pain management center." Hmmm....refer us to Pain Management, at the hospital where I DON'T work, when my JOB IS PAIN MANAGEMENT at my OWN hospital????
Problem is, we aren't set up for Botox at our center (yet) and the other neurology group doesn't do it at all. And our insurance barely covers the other pain management group - Hubby used to go there and our bills were outrageous.
So I call back. The lady who has been working on the PA is clearly frustrated, and tells me: A) Nemours still has not "released" the PA they have on the Botox, and she has tried NINE TIMES to get the paperwork through, and B) even if she does, our insurance is apparently famous for authorizing it and then not paying for it anyway (which, if you knew that, WHY did you not say so 3 months ago?).
Well. I can hear that she's frustrated, and I understand, but she's at least 10 levels less frustrated than I am. I have a kid whose headaches are already in pre-Botox ramp-up mode and she's been suffering pretty badly for more than a couple of weeks, and the shots as planned were already going to be half a week late. Even if she refers me to the other place, there is NO CHANCE that we will get in in less than a week for those shots.
"I can pay for the Botox. We have a Health Savings Account, it's no problem." "How can you pay for it if I can't even GET it for you?"
Frackin' crap on a cracker. I. Just. Can't. Even.
I put in a call to Nemours Neurology. We have to go to CHOP on December 12, maybe they can fit us in (but by that time we will be THREE weeks overdue). They are checking schedules and will get back to me. Tomorrow I'll call our insurance and have a WTF conversation with them. And if all else fails I'm going to have a come-to-Jesus doctor-to-doctor conversation with a specialist that I've been sending patients to for literally more that 20 years, and let him know that he owes it to ME to take care of my kid, just this once.
I've never called in my chips on a specialist before. But this may be the time.
DeeDee
"I'm trying to get authorization for the Botox, but your specialty pharmacy tells me that there is already a prior authorization in place elsewhere that needs to be cancelled so we can set one up here."
No problem. I'll call them.
Nemours informs me that cancelling the PA isn't needed, the new doctor just needs to ask the insurance company to transfer it over to them.
I'll let them know.
"I've contacted your insurance and they assure me that the other hospital needs to cancel the PA before we can proceed."
Got it. I'll let them know. In person, since we happen to be going down there.
"We do this all the time, and we know they are wrong, but we'll be glad to call your insurance company and talk to them."
Somewhere in the middle of all of this, I called the insurance to see if I could get a handle on where exactly the problem was. I'm pretty sure they told me the new doctor only had to submit the appropriate paperwork.
I let them know. And that was the last I heard about it, likely about 3 weeks after we saw our Nemours neurologist for her last set of injections at the end of August.
Today I got a message on my phone while I was at work. "We're just letting you know that we don't accept your insurance for Botox. Give me a call and let me know if you want me to put in a referral to the pain management center." Hmmm....refer us to Pain Management, at the hospital where I DON'T work, when my JOB IS PAIN MANAGEMENT at my OWN hospital????
Problem is, we aren't set up for Botox at our center (yet) and the other neurology group doesn't do it at all. And our insurance barely covers the other pain management group - Hubby used to go there and our bills were outrageous.
So I call back. The lady who has been working on the PA is clearly frustrated, and tells me: A) Nemours still has not "released" the PA they have on the Botox, and she has tried NINE TIMES to get the paperwork through, and B) even if she does, our insurance is apparently famous for authorizing it and then not paying for it anyway (which, if you knew that, WHY did you not say so 3 months ago?).
Well. I can hear that she's frustrated, and I understand, but she's at least 10 levels less frustrated than I am. I have a kid whose headaches are already in pre-Botox ramp-up mode and she's been suffering pretty badly for more than a couple of weeks, and the shots as planned were already going to be half a week late. Even if she refers me to the other place, there is NO CHANCE that we will get in in less than a week for those shots.
"I can pay for the Botox. We have a Health Savings Account, it's no problem." "How can you pay for it if I can't even GET it for you?"
Frackin' crap on a cracker. I. Just. Can't. Even.
I put in a call to Nemours Neurology. We have to go to CHOP on December 12, maybe they can fit us in (but by that time we will be THREE weeks overdue). They are checking schedules and will get back to me. Tomorrow I'll call our insurance and have a WTF conversation with them. And if all else fails I'm going to have a come-to-Jesus doctor-to-doctor conversation with a specialist that I've been sending patients to for literally more that 20 years, and let him know that he owes it to ME to take care of my kid, just this once.
I've never called in my chips on a specialist before. But this may be the time.
DeeDee
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