The Rant Continues

[gja1000]

I'm posting waaaay to much in the vent section - what does that say about me??? :confused:

This is just NOT my month for health care things. Or maybe it IS the month for health care challenges........

We FINALLY got Gary's injection for his neck scheduled for Jan. 30th. That is so far away though, I feel so sorry for him. He had a terrible night last night, but he is better today.

The story is that he went to the doctor on the 12th. They said, "yep, he needs another injection". But they had to clear it with his heart doctor to stop his blood thinner 3 days before and 2 days after the injection. So they called me on the 13th, to get the exact name of the cardiologist. I couldn't talk to anyone directly (of course :roll eyes:) so I left them a message on the 13th with the doctor's name and phone number, along with the NP that also takes care of Gary (it's a heart failure clinic and so he sees the NP actually more than the doctor). So, they had 2 contact names.

When I hadn't heard back from the neck doc's office by the 18th, I called and they were supposed to call me back - but they didn't. So then on the 19th, someone called and asked me, "DID YOU EVER GET APPROVAL FROM THE CARDIOLOGIST TO STOP THE COUMADIN" :mad: Like I was supposed to get the permission - no I don't think so. I told her that HER doc's office had called and asked for the cardiologist's contact information and I had given them that information on the 13th and now we were waaaay beyond patience for this delay (I was nice though, not mean).

So she says she will talk to the neck doc on Friday (yesterday) and call us back Friday afternoon (20th). By 4:00PM Friday, no one had called so I called AGAIN and of course, someone was supposed to call me back and yay! they did this time and we scheduled the injection. But of course by NOW, the first appointment available is the 30th - a whole 9 days away. I was pretty upset last night because Gary was in so much pain, but he is better today. The new pain meds they gave him don't work, but the muscle relaxant did work. We also have some stronger pain meds so he will try those if he gets into this shape again.

OK, that is issue #1

#2. We have been trying to get his medications transferred over to a new mail-in pharmacy (Caremark) and that has been a real saga, with many phone calls and LOOOONG periods of time on hold. Anyway, finally I was able to get his online account set up and so I thought everything was OK. I knew his insulin did not transfer over to Caremark, but I thought that was OK because we had an appointment last Thursday (the 12th) with his endocrinologist and I knew we could get a new prescription for insulin. We went to the doctor and I watched him submit the prescription for insulin via his computer. So, every day I checked to see if it showed up on Gary's list of meds on the Caremark website, but it never did. I tried calling Caremark one evening, but couldn't wait long enough on hold to actually talk to someone :roll eyes: So, yesterday (the 20th) there was a message from Caremark (on our voice mail) that Gary's doctor had submitted the prescription to Caremark Specialty pharmacy, instead of Caremark mail-in pharmacy (where he should have submitted it). They went on to say that Caremark Specialty had forward the prescription to Caremark Mail-in pharmacy but that they couldn't fill the forwarded prescription because was not submitted directly from the doctor. WTF! :confused: So I called the endocrinologist office and (of course) had to leave a message about the prescription. They called me back later in the day to say that Caremark had called THEM, and THEY had FAXED the prescription on the 13th, then someone from Caremark called them again and they FAXED the prescription on the 17th :eek: Mind you, Caremark called ME with the message above on the 18th!!! The nurse who called me from the endocrinologist office was at her wits end. She was saying what more are they supposed to do and I agree!!! :mad: She was going to fax it again and call them again. She said if it doesn't show up by Monday to call her again. Do you know how frustrating this is!!! :mad:

Oh, but i am not done! :D

Today I realized that we hadn't gotten Gary's insulin pump supplies (tubing and cartridges - they usually come about the 18th of every month). Gary gets his insulin pump supplies from Medicare since he is 100% disabled, Medicare is his primary insurance, and his BCBS is secondary. His pump supplies used to come every month, but Medicare changed some things and so when I called, they explained that he was getting 3 months worth of supplies in one shipment and his next shipment was due to be shipped Feb. 17th. OK, that was fine with me - EXCEPT - after I hung up I thought, "you know, I don't' think we have enough supplies to get to Feb. 17th". So, I went and counted tubing and cartridges and sure enough we only had enough to get to the 15th. THEN I realized we will be out of town from the 16th to the 21st and he sure as heck doesn't have enough supplies to last to the 21st.

So, I call the medical supply house that ships the supplies. Always in the past when we were going out of town, they would ship his supplies early enough to get here before we left. So, the lady on the phone says, "nope, can't ship early, Medicare won't let us". I say, "Well Gary will be out of supplies and unable to use his insulin pump for 6 days" :eek: She says, "I'm sorry, Medicare won't let us ship early" And I tell her that they always did before and she said they don't do it anymore. So, I ask to talk to her supervisor who says the same thing - but finally he says they will ship us a few sets to get us through the 6 days, AT NO CHARGE. I'm thinking they must be absorbing the cost because they can't bill Medicare, yada yada yada.

I'm very grateful for him doing that and I do understand that Medicare has really tightened up their procedures (there is SO MUCH Medicare fraud), so I understand that, but there can't just be blanket rules that can't be bent in special circumstances. Also, part of the problem is that when Gary is on Prednisone for his asthma, he uses more insulin so his pump tubing and cartridges have to be changed more often and thus, we use more supplies. The supervisor said that he would increase the number of tubings and cartridges we receive with each shipment, so hopefully this won't happen again.

WHEW! I am really tired of venting. :D I'm so tired of medical challenges!!!

[Blueyes]

*Waving my hand in the air* I KNOW, I KNOW just what you are going through!! We don't have Medicare to deal with, but we have Caremark!! They have decided that they won't send Mike's insulin injections like he usually gets, and they want him to use a different brand of blood thinner injections than Lovenox..there aren't many choices:eek:

I'm so sorry Gary has to wait so long for his injection! It's ridiculous! Having to deal with all of Gary's medical stuff is enough to make YOU sick, Gayle. Take care of yourself, please!

Mike has had lots of weird things wrong with him lately, but it was just determined that he has extremely low testosterone. Of course they can't give him testosterone because it may cause blood clots. Now just let your minds go here a moment... I live with a MAN that has big hot flashes, cold chills, can't concentrate on anything AND has estrogen filled mood swings!

I think we may just need to send them to the woods together, Gayle:p!!!!

[Tiramisu]

Now that's true love!

[Janet]

Wow Gayle....that has got to be so frustrating. There is no reason you had to go through all of that. I know we mentioned this on another thread, but how are older people suppose to be able to handle their health care. Heaven forbid that Gary didn't have you, would he be able to do all that? It just doesn't seem right.

You vent all you want girl!!! I would be bald by now....pulling my hair out!

[gja1000]

Heaven forbid that Gary didn't have you, would he be able to do all that? It just doesn't seem right.

You vent all you want girl!!! I would be bald by now....pulling my hair out!

Ha! Ha! I was telling all of this on the phone last night to my daughter. She laughed and told me to tell Gary that if anything happens to me, he better have enough money saved up to hire a full-time caregiver because there is not enough anti-anxiety medicine in the world to get her through handling all this sh!t!!! :D We were all laughing, but she is right, I don't know if she could handle all of this. She reminded me that the "Joyce, letter, mineral rights blowout" happened during this time too. She's right. I get so used to handling medical issues, it almost seems normal now.

[gja1000]

*Waving my hand in the air* I KNOW, I KNOW just what you are going through!! We don't have Medicare to deal with, but we have Caremark!! They have decided that they won't send Mike's insulin injections like he usually gets, and they want him to use a different brand of blood thinner injections than Lovenox..there aren't many choices:eek:

Mike has had lots of weird things wrong with him lately, but it was just determined that he has extremely low testosterone. Of course they can't give him testosterone because it may cause blood clots. Now just let your minds go here a moment... I live with a MAN that has big hot flashes, cold chills, can't concentrate on anything AND has estrogen filled mood swings!

I think we may just need to send them to the woods together, Gayle:p!!!!

Oh Betsi! You are dealing with this idiocracy too!!! I know there is all kinds of fraud that makes insurance companies want to be so strict. And I also know they are looking out for their bottom line (why they want to change Mike's blood thinner injections). But that just makes it harder for those of who are just trying to do everything we can to keep our loved ones healthy enough to enjoy life. I know the reason Gary's insulin doesn't show up is because they don't want to pay for the type of insulin he has been taking. Yes, we can change back to a less expensive insulin, but the one he is currently taking is better for his blood sugar. OK OK, I can compromise but all this drama of getting the damned prescription to be available to him is just NUTS!

[judy]

Give me their phone number, Gayle! I will have it out with all of these "pass the buck" rules! It does sound like you found the right supervisor though. I hope you wrote down the name. This is a life or death situation, and they are worrying about Medicare paying???? I wonder if you called the insulin manufacturer, they would send you a batch?

Betsi, I am so sorry for Mike, but I am still laughing at your post! You really should hide in the cellar when his hot flashes and mood swings get out of hand! My SIL has the same problem, but he can take testosterone as soon as he gets to the endocrinologist to begin. He really needs testosterone. He certainly has not "manned up" as far as working is concerned.

I called my dental insurance company, and FINALLY, they do not need any more paperwork!!!! They will now review it. The young woman I spoke to rold me that I will be getting a check, but I will believe it when I see it!

Now...onto Medicare and my new drug company.

[DianaB]

Oh Gayle......You need a BIG hug!!! Dealing with all of this.....AND.....Joyce!!! I'm surprised that I haven't heard screams of fustration all the way up here!!! You certainly deserve "The Wife of the Year" Award!!!!

Betsi, I don't know how you do it either!!! I'm not sure how I would handle an emotional man that's dealing with hot flashes and other stuff!!!

You two should go and just have a weekend together with lots of fun and laughter!! You both deserve it!!!

[Blueyes]

Sounds like a great idea:D

[gja1000]

Yes!! :)

[judy]

I called the drug company, my union, and some other Human Resource place involved with the Dept of Ed retirees re Medicare. I also went to my doctor, who told me that next time I come in, he will have to do a physical, and some other stuff. He told me not to worry about anything. They know what has to be done, and will do it.

WOW!!! So far, so good! I got this thick booklet about Medicare, which I definitely don't want to read. I will look through it though, just so that I am familiar with what I can expect and what I am entitled to.

Now, to wait for the dental insurance check!!!;)

[Lindsey]

Wow I can't believe all the stuff you need to go through!!! :eek:

[DianaB]

I'm dreading dealing with all of this whenever it comes my turn!! At least I'll know to turn to you guys because you'll have it ALL figured out by the time I need the info!! :sidesplit:

[judy]

You are right Diana. We can walk you right through it. Let's just hope we still have Medicare!

[Janet]

You'll have to explain it to me at the same time as Diana. I'm really dreading trying to understand all that stuff.

[gja1000]

We've had Medicare since 2005 - or I should say Gary has had Medicare since 2005. It has been fine, we've not had any problems at all with it. However, you MUST have a secondary policy that covers what Medicare doesn't because Medicare only pays 80% of most things. Gary had open heart surgery and we would have been out thousands of dollars if we'd had to pay 20% of the bill. Also you need a secondary insurance for the RX benefits. Medicare's plan D for prescriptions does not cover everything (but the new health care bill does increase the RX benefits so that is good). At least it is better than nothing though. Prior to Medicare part D, there were no prescription benefits with Medicare and as you all well know, prescriptions can cost hundreds of dollars per month if you don't have insurance.

Medicare part A is the physician coverage and Medicare part B is the hospital care. You have to pay a premium for Part B, but it is worth it. Judy, you will get that book every year. I just throw them in a drawer.

[judy]

Thanks, Gayle! I have GHI as my secondary insurance, and have part D already. I have to pay for it, from my SS check, but it seems that the teachers' union reimburses us every year for the cost. I think I will get 75% for generic prescriptions. I don't know what percentage I pay now, so I will see. I only take one name brand - Nexium. If there is a generic, I'll switch.

I am very, very fortunate to have this coverage. The teachers' union is wonderful to us. We are covered for life! I loved teaching, but having taken care of all those people's children for so many years, I think it is fair that their taxes take care of me now! All of these anti-unionists can go screw themselves as far as I am concerned! I would like to see any one of them teach a class of 30 teenagers, and do it well.

[gja1000]

I had lunch with a Nurse Practitioner friend of mine this past week. She has her own practice with a doctor in a little town near the lake where Gary is fishing. I was telling her my woeful story of trying to get Gary's neck injection scheduled, his medications ordered, and getting his insulin pump supplies increased to match his needs. She just shook her head and said that I was motivated and knew what I was doing and I persisted until I got what was needed. However, she went on to say that most of her patients can't or won't do that and they just give up. When they come in to see her days/weeks later, they have not scheduled their procedure or they are not taking their meds (even the essential ones) because they couldn't get what they needed so they just gave up. It is so scary to me that this happens, but i know it does. I remember being told that Gary's doctor wouldn't approve something and I knew that was not true - but most people would have just believed that, and thought OK, I guess I don't need that medication or whatever. It's just too sad.

[DianaB]

I'm not to that stage of life yet and it scares me to think that getting health care will be so difficult that I'll give up. I hope that Gary appreciates the fact that he's in good hands!!

[Janet]

Wow...I feel the same as Diana. It's getting scarier and scarier to grow old. Sure wish you and Gary didn't have to deal with this.

[judy]

My doctor told me that a lot of doctors up here are not accepting Medicare because they pay so slowly! We do have good clinics here though, but for a doctor not to accept at least a percentage of indigent patients is just wrong!!
They do make an awful lot of $!

The drug companies and the insurance companies need to be regulated. I do not like the idea of government control over everything, but at some point, greed outweighs rights of commerce!!

It is a slippery slope, but too many people are without health care and medicine.

My dental insurance company is a good example...I just went down to the city this week for him to fill in another form!

[DIANE W]

Goodness it must be so worrying for everyone, i understand the health provision is very different in the States to ours in England, when i hear your stories, i thank my lucky stars that we dont have that worry, we have unlimited access to free health care (well we do pay through our National Insurance and Taxes), but it is free at point of access.

Your right it is good that a person has someone looking out for them, i remember when i was at the hospital with my Aunt, some patients didnt have any visitors at all, and i was so concerned about decisions that were made, about their care, with out someone looking out for them.

Even now i am the only carer for my Uncle..... and i have to double check his medication, sometimes the pharmacists make mistakes, and what worries me is if the older person lives alone and doesnt realise it is a mistake:(

[DianaB]

Your pharmacist makes mistakes???? My daughter used to work in a pharmacy and that is a HUGE no-no. You need to change who you go to. That can be deadly.

[judy]

Brandon was in a very good hospital, but it is in Albany, a large city. They are all understaffed. She had to be there 24/7. If she had not insisted and fought for CAT scan, they would not have found what was wrong with him. The physician on the floor also sent him home without one medication, and an undated prescription for pain meds, which could not be filled legally. Luckily, the surgeon is a wonderful doctor who called to see how he was and is going to straighten everything out.

Brandon's roommate was an 8 week old baby who was so abused by her father. It was on the news, and is in all of the newspapers. Jessie wanted to take her home! The doctors were discussing giving her morphine because she was crying.
She does have a lot of damage, but one nurse carried her whenever she could get time, and she stopped crying. Babies need to be held,not given morphine!

How is your national health plan, Diana? I find the Obamacare plan very confusing, and I really do not know what is offered by it. A lot of people here are very much against it. Do gov't health plans work out well?

[gja1000]

Judy, I can tell you about the Affordable Care Act, aka Obamacare. It really is insurance reform and it is nothing like national health insurance as Diane describes. The Affordable Care Act is a start, but more needs to be done. It has some really good aspects, in my opinion. When fully enacted, insurance companies will no longer be able to deny coverage for pre-existing conditions and there will be no lifetime cap on the amount of insurance benefits (often $500,000 or $1,000,000 a which sounds like a lot but really isn't when you have lots of problems like Gary). These two things alone are a godsend for many people. it also mandates that insurance companies have to pay for health promotion because a part of the Act is to try to save money by getting people tne care they need before they get chronically ill and by providing health promotion. It also requires insurance companies to allow parents to keep unmarried children on their policies till 25 or 26 (I forget which). This is really great because so many college students are uninsured. It increases the amount that Medicare Part D pays for prescription meds and reduces the out of pocket expenses.

The controversial part is that everyone will have to buy health insurance - but heck, everyone has to buy auto insurance so why not health insurance. This will partially be accomplished by increasing the Medicaid eligible numbers. Right now, you have to be very very poor to get on Medicaid, it's currently like 200% of poverty and that will change to 144% of poverty, so tha people with low incomes will not have to buy insurance, they will be eligible for Medicaid. Many people don't like this, but I think it's OK (thats because i see what happens when people cant get health care till they are severely ill). People with incomes near the poverty do not have money to buy insurance. This is part of the Act that is being challenged by several states. The Supreme court will hear these two challenges (the individual mandate and increasing the numbers eligible for Medicaid) week after next, March 25 & 26, I think.

Others who don't have insurance through their employers will be able to buy low cost insurance though insurance exchanges (states can band together or go it alone to create an insurance exchange so that the rates are affordable). This is much the same as those who have to pay some or all of their insurance premiums through their employer. It really isn't any different than that. There are other aspects in the Act, but basically these are the aspects that affect the populace.

A really good source of information is the Kaiser Family Foundation. If you google Kaiser & Affordable Care Act, you will get lots of links that summarize the provisions in the act in plain speak. I have a couple of sets of slides that I can post that also summarize the act pretty well.

[DIANE W]

Your pharmacist makes mistakes???? My daughter used to work in a pharmacy and that is a HUGE no-no. You need to change who you go to. That can be deadly.

Actually Diana, we have changed, we moved from the one attached to his Dr's, to one 7 miles away, they still deliver his medication every month, i watch carefully, I make sure he gets all he needs. They annoy me though as he has regular medication, and yet still they leave things off, which means i then have to chase around.
I just feel sorry for older people who perhaps havent got anyone to look out for them, and do these things, it must be hard on them.

[DIANE W]

Brandon was in a very good hospital, but it is in Albany, a large city. They are all understaffed. She had to be there 24/7. If she had not insisted and fought for CAT scan, they would not have found what was wrong with him. The physician on the floor also sent him home without one medication, and an undated prescription for pain meds, which could not be filled legally. Luckily, the surgeon is a wonderful doctor who called to see how he was and is going to straighten everything out.

Brandon's roommate was an 8 week old baby who was so abused by her father. It was on the news, and is in all of the newspapers. Jessie wanted to take her home! The doctors were discussing giving her morphine because she was crying.
She does have a lot of damage, but one nurse carried her whenever she could get time, and she stopped crying. Babies need to be held,not given morphine!

How is your national health plan, Diana? I find the Obamacare plan very confusing, and I really do not know what is offered by it. A lot of people here are very much against it. Do gov't health plans work out well?

Judy..... I have never known any difference than what we have now, our national health service, covers everything at the point of need. We get free access to Dr's and hospitals, 24 hours a day, i am very proud of our health providers, they do tremendous work, under difficult circumstances sometimes. We pay for our prescriptions = 1 item is currently £7.40, unless you are on low income, or have certain medical exemption, like being diabetic for example.
We pay national health contributions through our salary, it is a percentage, not sure how it is worked out.

[JJJ]

I would love to have your medical system Diane W. I don't think the Obama is a bad plan. Those who are against them are those who own their own company. I also think they need to work on it a bit more to keep every side happy.

I have been without insurance for years now. If I get insurance from my employer that's half my pay. My boys qualify for CHIP and I pay a monthly premium so I'm happy with that. But once my boy had to had stitches and that cost me $2000 out of pocket and he didn't even get a room in the hospital. They clean him up and staple him with no anesthesia or numb med.

[judy]

That's terrible Jessica! Will you have better medical care under the Obama plan?

Thanks for the explanation Gayle! I have insurance, plus Medicare now, so I am very lucky!!!! I did start using the Part D of Medicare, and the one prescriptiom was only $1.50 co-pay instead of $5.00. CVS used to charge me $17.00 for my co-pay. I changed to our local pharmacy, which is much cheaper.

I get most of my prescriptions by mail. I don't know what the co-pay will cost this month since I began Medicare. It usually costs me about $10/3 month supply. I cannot complain!!! The only thing that is more is Nexium for $40/3 months. I tried the otc and I think the Nexium works better for me.

I would not mind contributing some so that everybody has affordable health insurance. I am of the "it takes a village to raise a child"m philosophy, and feel that we all have to take care of each other.

[JJJ]

I have not read too much on the Obama plan but hopefully it's something better than what I have. They were going to implement a law that anyone who benefits from the government should be drug tested. I was all for it but I really don't know what happen or was it just hear say.