Dear President Obama...

Mr. President:

I learn something new every day.

I'm one of your avid supporters, President Obama, and someone who has benefited enormously, albeit catastrophically, from the Affordable Care Act, most specifically the Pre-Existing Coverage that was made available for me to purchase.  (An aside -- in your campaigning, it would help people to understand PCIP better if they knew that it was not "welfare," that enrollees pay their way.  However, I confess to having blown, all by myself, the national budget for this program, and it is only September!)

I'd be even more avid in my support if you'd push for real and true reform in your next term in office.  That's right -- the public option, true universal coverage, deep, real reform.

But there is also in me a conservative streak, though I prefer to consider it basic common sense.

The medical details are irrelevant in this story of abuse of the health care payment system:  On July 10, 2012, I required emergency transportation from a doctors' building to the emergency room of the hospital across the street.  Well, to call it a "street" is a stretch, since it was more like an alley.

There was no need, as there was no time, for even the taking of basic vital signs, no i.v.s started, nothing. They just put me on the stretcher, took the elevator down to the ambulance, loaded me into it, crossed the alley, and delivered me to the emergency room.  In the interim, they managed to muck up information such as the office we had come from and the reason for the emergency transport.  (The guys said "dislocated shoulder";  In actuality, it was sepsis.)

Because I have passed the catastrophic limit for the year, most of my medical charges are being paid at 100% by PCIP -- for which you have my deepest gratitude.

I still make it a habit, however, to peruse each and every Explanation of Benefits form that comes my way, and there are some almost every day.  It's been that kind of decade.

The EOB for the ambulance ride arrived in today's mail.  PCIP payed them a whopping $963.00, exactly what they billed.

I thought about ignoring it.  Why should I care?  I'm at 100% coverage, my health is "catastrophic," and I had just spent two hours convincing a radiology practice that they would likely get paid if they would file with PCIP and not the insurance company I had four years ago.  But, still, I found myself reaching for the phone.

The first two times I dialed and explained why I was calling, my call was disconnected during the complicated transfer to the billing department.  The third time, I think the Obama-like steel in my voice made the call go through like magic.

I discovered that a nifty way to inflate an ambulance charge is to alter the address of origin for the "pick-up" or rescue, or whatever they choose to call it.  The Big Ride.

My home address was "inadvertently" listed as the originating point of the ambulance ride across the alley. My home address, of course, is in a different city -- not too far away, but still...

Call me a cynic, or nuts (though you'll not catch me conversing with an empty chair), but I suspect this inadvertent confusion of addresses happens with some frequency among the shadier members of the rescue community.  I suggest that anyone taking The Big Ride and facing a huge bill as a result obtain the paperwork designating starting and ending points.

They're going to "investigate" my claim.  I asked them to please reimburse a goodly amount of that charge to PCIP.  I'm doing what I can, President Obama!

I hope your ribs are okay -- I saw that tremendous bear hug you got at the pizzeria this morning!  Good thing you didn't need an ambulance!

Your supporter,
Profderien

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)
Lumigan
Nexium
Starlix
Glimepiride (generic)
Baclofen
Tizanidine
Amitriptyline (elavil, generic)
Alendronate sodium (fosamax, generic)*
Cymbalta
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

Medical Bills

Housekeeping, odds and ends.

Today, I received the bill from Pretty Hospital for the last go 'round of surgery: $48,092 and change.

In the same pile of mail was a personalized form letter (you know, they toss your first name into the text here and there for that *special* touch) -- from a former Chairman o'the Board to the same institution, suggesting that $420 would be an appropriate donation toward keeping Pretty Hospital more better.

The hospital bill will be paid by BCBS -- Bull Crap Bull Skeet of Tête-de-Hergé -- to whom I now pay $1300+ a month in premiums. I am exceedingly angry at the recent hike, coming as it does after another hike just 6 months ago. I *know* that I cost them lots of money. I also *know* they are trying to squeeze me out of my coverage.

I paid out all my deductible and out-of-pocket expenses by mid-February -- $5,000+.

Grrrrrr.

Also found in the pile of catalogs and grocery store ads? A bill from the Ecstatic Infectious Disease Group for $2185.11. I cannot explain exactly why, but yes, I am responsible for the full amount despite my excellent insurance coverage.

It surely is a fascinating game, the way the amounts charged receive odd payments here and there, way strange adjustments -- all to end up quivering with expectation in the balance column.

For instance, 08 January 2009 sees a charge of $1995 for VANCOMYCIN HCL 500MG, for which no payments were made, but a whopper of an adjustment is noted -- $1866.06, leaving moi with a line balance of $128.94. Now, THAT is an adjustment.

However, as I scan the dense Statement of Account, I note that, for other things, I am royally screwed: Elastomeric Infusion Devise "cost" $825 on, oh, let's pick... 15 January 2009, with a payment of $192.57 and an adjustment of $549.90, leaving this pauper with a balance of $82.53.

Hmmm -- but back on 01 January 2009, the charge for that self-same Elastomeric Infusion Device schtuff was $770, a charge toward which no payment was made, though there's an adjustment of $513.24, leaving this sucking hole of broke-ness with a balance of $256.76.

Strange and incomprehensible, these jumbled numbers. I do believe that that is the plan! Confound them with numbers and demands for payments. Ah... and there is no sign on the Statement of Account of the four payments I made while at the office, payments totalling over $1100.

Yesterday, I received a fairly chummy letter from Bull Crap Bull Skeet of Tête-de-Hergé, the verbiage of which seems to indicate that they've once again been caught with their paws in the cookie jar.

"As a result of Tête-de-Hergé Safety and Fire Commissioner Benevolent Guy's examination of reimbursement policies involving ambulance services (air and land),
Bull Crap Bull Skeet of Tête-de-Hergé has agreed to review and adjust certain ambulance claims.... " Yes, I am in the group of sickly poopheads who may be entitled to refunds of payments made to various ambulance providers (It is an odd and little known fact that in the villages around Marlinspike Hall, deep deep in the Tête-de-Hergé, 1.4 vehicles out of 3 are ambulances, or former ambulances.)

This is, of course, good news. Except that, as I read on, I am lost in the morrass of instructions about how to go about submitting a claim to get MY MONEY.

Someone somewhere has a sense of humor, though, because if I "have any questions about this letter or an Explanation of Benefits relating to an adjustment for an ambulance claim, please contact our dedicated Customer Service Unit." Ar! Ar! Ar!

Well, it is time to get hooked up to my little medicine balls of daptomycin. I've no idea how much it costs. What am I supposed to do? Decline the recommendations of one of the top Infectious Disease doctors in the region because I cannot spare the odd dollar? On the other hand, he is working in the dark -- assigning various antibiotics to a patient whose nefarious pathogens refuse to grow in the Pretty Hospital lab. I might get just as appropriate coverage by chowing down on moldy bread.

I hate money. Yes, even when I am in good straits, I hate money. It is nothing but a contractual construct, by means of which we condemn a good portion of the planet's human inhabitants to lives of drudgery and need.

Why not go click on the link for the Site Officiel du Parti Socialiste in the Tangent's List to your left? Yeah, that's right -- you've found a live one...

I will close with my favorite medical charge of the *day*: $4,344.00 for the Recovery Room. First off, they don't like it when I call it the "Recovery Room"; No, today it is known as the PACU -- post-anesthesia care unit, or something to that effect. More to the point, I was there for about an hour and a half. Unless they were doing heroic and expensive things while I was still fuzzy, they did precisely... nothing. Yes, they took vital signs and actually did hang a bag of vanco, but beyond that? Nothing. That's a whole lot of nothing.

More Rotten Pot -- That's "Pot Pourri" to You!

Hmmm. I began this hodge-podge of an entry on October 3, and promptly forgot about it. In fact, when I stumbled upon the list of my dozen or so drafts, it was quite enlightening. As in: Oh, so that's where I left that thought.

Today is October 11, 2008, and I am different than I was on October 3. Primarily, I am much, much poorer, having lost beaucoup d'argent in the market. My health care costs (insurance premiums, co-pays, out-of-pocket, and care not covered) use over 85% of my private disability income. I am responsible for keeping the household afloat, so supplementary monies from my investments are the only help I have. Rather: HAD. I pay all utilities (except water), groceries, and half the mortgage -- plus, I cover the inevitable unscheduled expenses that occur in the maintenance of your average centuries-old European manor located in the Tête de Hergé. Stuff like the costs of reparation of smoky Rembrandts when Marmy decides to do a little vertical marking. Like weaving a textile patch to match the one-of-a-kind medieval tapestries that depict the warring and artistic history of the Castafiore family. Yes, and the more mundane stuff -- a better grade of lawn mower, hedge clippers, HVAC repair, and the odd new roof. So, as my investment account was decimated, my panic grew in countertime, in immensity. I cannot show fear to the Fredster, to the Felines -- not even to La Belle Biance Castafiore. "Don't worry!" I practically crow. And my-oh-my, the afflictions that go with living with CRPS / RSD? The exacerbations due to emotional stress? I've got 'em! For once, I will spare you the laundry list. (There is one thing, though, that has me confounded -- a blistery rash that feels and looks like a bad burn. Not knowing what to do, I slathered on some betamethasone dipropionate cream. When in doubt, find the closest steroidal concoction!)

After deleting all the now irrelevant detritus from the draft, and after adding all the flaming issues of the day, this is the sad bit that remains:

• I have fallen in love with Jon & Kate plus 8 -- I sometimes watch marathon sessions of the television show and am simply in awe... Laughter comes easily: yesterday, one of the sextuplet boys ran to Daddy, full of eureka and aha, to whisper "I am your son!"; Kate keeps her toenails painted because another one of the boys has a toe fetish; The twin girls shop for each other's Christmas gifts but insist, as well, that they each *receive* the same item that is being gifted... Still, I wish Kate would ease up -- verbally -- on Jon, although I get that she is maxed out in every imaginable way. He's amazing, she is awesome -- I am slack-jawed, and those children are blessed.


• Austrian National-Socialist Joerg Haider is dead. Saves me some trouble. Why is Mugabe still alive?


• I killed Pinochet. Yes. Yes, I did. Shush! I did, too! Much in the same way that I kept the paper cutout of the life-sized head of Jesse Helms impaled on my cork bulletin board with a 5.5-inch Henckels boning knife.


• What makes hydrogen peroxide fizz?


• The mail just came -- and despite my instructions that no bills find their way to me this morning, Fred somehow allowed Plumtree Orthopaedic Dudes' bill into the pile of junk mail (a Vera Bradley catalog, a Fidelity mailer on "retirement planning," and my yearly "invoice" for our CCF-sponsored Ethiopian child). How is it that my insurance refuses to pay for the services of the PA who apparently assisted my orthopedic surgeon in my recent surgeries? Even more wondrous... how is it that said PA *dares* to charge me $7,427.12 for his services when he is as much a surgeon as I am? And... jagged deep breath... what the hell is this additional $17, 125 listed as a balance? Plumtree Orthopaedic Dudes have always engaged in crooked billing, in my experience, but after two go-rounds, years back, I gave up trying to fight it. So how screwed am I? If you have followed my saga, you know that my real and actual (i.e., not the PA) orthopod is yammering the pros and cons of gifting me with a new right shoulder prosthesis, once he is convinced the infection that decimated the success of the old one is definitively gone. Will he proceed if these charges are still in dispute? Because in dispute they are. The hospital bill was over $100,000 and was paid in full by insurance... what is the problem with resolving the surgeon's fees? Could it be that they have finally caught on to the fraudulent billing (primarily double-dipping, duplicate charges in masquerade)? I have excellent coverage and am darned lucky to have it -- but I pay over $17,000 a year for the privilege (privilege?). Where did I stash those spare millions?


• Sarah Palin, reverse-nepotism in action!


• Does crystal meth give women a high, whiny voice? Or do women with high, whiny voices have an unusual affinity for the drug?


• And, as always, I wonder, along with Bill Cosby: Why is there air?