Tuesday, September 29, 2009

Extreme Unction: Last Rites of the Insured

Here we go, Gentle Readers, setting out on our first LIVE blogging event!

The occasion? If you will direct your eyes to the upper left corner of the page, you'll see a countdown clock, ticking away the seconds until I join the ranks of The Uninsured. See it?

As I write this, it reads: 1 day, 12 hours, 51 minutes, 35 seconds. 34, 33...

And so, down to the wire, with my sour stomach in a knot, I am getting ready to submit for refill as many prescriptions as I can -- because at the moment, I am covered at 100% for medications. That'll drop to zero in 1 day, 12 hours, 48 minutes, and 51 seconds. 50, 49...

Yes, right *now*, I am fulling covered for everything from hospitalization, tests, and office visits to durable medical goods (I'm tempted to try and get a new wheelchair while I can... but don't worry, I won't).

"How wonderful for you!" you may be thinking. Good thing you're not actually here. I might have to hurt you. I might have to explain that in order to reach this level of coverage, I had to bleed many, many dollars -- an amount far beyond what I can actually afford, such that now (1 day, 12 hours, 42 minutes, 6 seconds to go! 5, 4...) I am up the creek without insurance.

The pharmacy I use for all medications except the strong painkillers I take is only a few blocks away, part of a large national grocery chain. The drugs for pain I fill, monthly, in the pharmacy housed in the same building as my pain management doctor, so that the pharmacist knows me or can easily doublecheck my legitimacy. I fully understand -- dispensing methadone and endocet is serious business. I saw the pain doctor last week -- or rather, I saw the PA, who is infinitely more on the ball than he is. She, at least, knows how to keep a small measure of hope alive. Whereas he makes a Pointed Point of telling me, whenever he sees me, that there is nothing more to try in my fight against the pain, primarily from CRPS/RSD and collapsing joints -- except for pharmaceuticals. His average time with me is under two minutes, and given that this includes that Pep Talk? Well, it really is a freaking shot in the arm to talk to that... man. His PA, though, shares information from the conferences she attends, tells me of things other CRPS patients are trying, and tries to resuscitate my flagging faith in the medical arts. Through her efforts, I believe I am taking the appropriate amount of narcotics; When he was running my show, I was overmedicated. I would rather hurt, which I surely do, than be befuddled and vacant. It is a fine line and I am happy to have her help me walk it.

I didn't tell her I was losing my insurance coverage. I sat there, chatting away and panicky inside because I knew time was running out. The way this physician operates, you must make a $195 office visit every month in order to receive pharmaceutical pain management. He is a physiatrist -- a specialty foreign to most people. In fact, most times, when I write "physiatry," I receive kind corrections from people who explain that the correct spelling is "psychiatry." I don't mind. I understand how they might make that assumption! A physiatrist is a doctor specializing in rehabilitation:

Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians have completed training in the medical specialty physical medicine and rehabilitation (PM&R).

In other words, my doctor resents like hell being asked by my s.u.p.e.r.b primary care physician to write monthly prescriptions for pain medications. He does not like to treat patients solely with drugs. It's confusing, sometimes, his attitude --which is fairly legible upon his face. He is so resolute about there not being anything else to try -- when common sense might dictate that he would be first in line in favor of alternative, and more permanent, measures.

In fact, he and one of his partners proved to be the roadblock preventing me from getting a Spinal Cord Stimulator or an Intrathecal Pain Pump -- both things that might afford me real relief. And now, of course, as it has turned out -- there is not a surgeon in the world who would agree to implant another foreign body. Until the source of this osteomyelitis is found, it is too risky. Even then, since I am now severely immunosuppressed -- well, blah. And bleck, too.

Now, of course, I have no choice but to tell him and the PA that I'll be paying out-of-pocket. I am scared he will say that he won't negotiate with me -- neither about price nor about frequency of visits. Perhaps he will seize this as an opportunity to finally dump me as a patient altogether.

Sometimes I wish I felt secure enough to tell him how I never take as much pain medication as I am "supposed" to... how I force myself to take drug holidays every few weeks... but I don't think his reaction would be positive.

1 day, 11 hours, 52 minutes, 39 seconds. 38, 37...

Well, there is no putting it off, this list of medication refills. The pharmacy I'm using allows for submission of refills via the internet, so I'm just clicking from this window to another to finally be done with this.

Since the latest Wordle Contest has been such a bust, maybe I should start a "Guess the Grand Total" Competition. The closest to the actual cost paid by BCBS gets The Castafiore for a day! It matters to me, the total, even when they pick up the final tab -- because I pay upfront, and then am reimbursed. I've never had too many problems with them refunding my money (in about 3 weeks or so) but, at the moment? I would not be surprised by anything that bleeping insurance company does...

It can be scary to put all of these things on a credit card every month, trusting that a refund will arrive in a timely fashion. For what it is worth, I pay my credit card balances in full each month. At least, that was my habit.

Here's the list, in no particular order. Last week, methadone and endocet were filled at a cost of $106.28 (remember, too, that these are the negotiated prices).

Prednisone (generic)
Hydrocortisone (generic)
Plaquenil (hydroxychloroquine, generic)
Glimepiride (generic)
Amitriptyline (elavil, generic)
Alendronate sodium (fosamax, generic)*
Lasix (furosemide, generic)
Zofran (ondansetron, generic)
Diabetic testing supplies**

PLUS -- I'll be calling my trusty pharmacist to see if I have any antibiotics with refills, just to have some on hand in case Infectious Disease Dood wants to give any another try.

*I'm filling this instead of Forteo. I mean, scope out how much that costs! I am afraid to charge it this final go 'round, because several times already, BCBS and my doctor have come close to brawling over it. I'll tell you a secret. Shhhh! We are. No, we were giving this daily injectable a shot (sorry) in the hopes that my poor disappearing, "avascular," and infected bones might be reincarnated. I do have severe osteoporosis, but it is as a function of osteomyelitis, severe AVN, and CRPS. If my s.u.p.e.r.b primary care physician had his way, I'd take both Fosamax and Forteo.

**Actually, I may pass on these. I am not technically diabetic. However, due to the combination of steroids and infection, my blood sugars have been too high. I know any doctors and diabetics out there are likely to curse me -- but I prefer not to do a lot of testing. The results don't influence what I do and I think the hemoglobin A1C is superior to my dripping blood all over the damned place. As I lose fine function in my hands? Diabetic testing is not so easy anymore.

There's been quite a lag in between the last paragraph and this one. I'm starting the daily afternoon climb of Febrile Mountain, and that, combined with pure anxiety, has left me acting much like someone hopped up on speed. I've dealt with paying the mortgage, VISA, the electric and gas bills, as well as the phone and internet.

I had a brief internal debate as to whether or not internet service should continue to be a necessity, or whether it was a luxury I cannot afford. The decision -- to keep it -- was based on its capacity to entertain and distract me, lessening the need for breakthrough pain medication. Does that sound strange to you? Hmm. It probably does! Makes perfect sense to moi. Also involved in that decision is the fact that The Fredster, La Bonne et Belle Bianca Castafiore, and
-- though she doesn't think I know -- Marmy, all rely on the internet as well.

I may start passing the hat, though! Uncle Kitty Big Balls is in charge of Feline Accounts Receivable and has hissed in my general direction that some "accomodation" might be possible.

Anyway... so I've been wasting time, trying not to deal with this Final Rite of the Insured. Did you know that "Anointing of the Sick" has replaced "Extreme Unction"?

1 day, 10 hours, 46 minutes, 58 seconds... going, going, gone.

photo credit -- f 128 Simple, Strange, Roots Photography

Geoffe Haney is a photographer that holds a BFA in with a concentration in photography. He enjoys alternative process to make his images. He utilizes digital, pinhole, Polaroid and other methods to create the perfect image to his eye...

Prints are available in limited editions. If you are interested...He can be contacted by writing to geoffe@gmail.com

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