Anxious Sunday

Went without the mirtazipine last night.  And I’m trying to forgo the ativan today.  It’s going to be tough.  I woke up stressy and anxious, and it’s just lingering.  Usually, it fades for a time in the AM after I get up (if it’s there….it had been a constant but had faded this past week) then resurges again in the late morning/early afternoon.  Today, it was there when I woke up and it’s remained and built since I’ve been up.  I’m very disappointed.  I doubt it’s a lack of mirtazipine, it’s not supposed to have psych effects this quickly.  If anything, it’s probably just a lack of general sedation that’s affecting me right now.  The mirtazipine truly is very sedating, especially this early on and at this low dose (it has a funny response curve, apparently at lower doses, the antihistamine/sedating effects are stronger…go figure).

So I’m down that this is happening today.  Today, my husband is going to pick up my good friend’s teenaged daughter from camp and we’ll have her at my house until her grandparents come at some point (this afternoon?) to pick her up on their way to Canada.  I’m stressing about my husband driving the hour up a busy highway, stressing about what I’ll do to entertain a teen, stressing about whether her grandparents will come in to visit, whether they’ll have all their pets with them (I believe they usually take the whole menagerie up to Canada with them) and where they will stay if my friend’s parents come in to visit (it’s supposed to be the hottest day of the year so far today, highs in the 90s, not ok weather to leave pets in a car).  So stress stress stress and anxious anxious anxious.

Got this song in my head….

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Dr. Dumbass

Oh, someone wins for clueless doctor in the news.  This one may top my top ten.
Mid-South Doctor Gives “Ghetto Booty” Diagnosis
From WERG, Channel 3 Memphis
Posted on: 4:04 pm, July 12, 2013, by Candace McCowan, updated on: 06:49pm, July 13, 2013

A Mid-South woman has filed a complaint with the Tennessee Department of Health after she said the doctor she went to see for back pain gave her an insulting diagnosis.

“He said ‘I know what the problem is. It’s ghetto booty,’” said 55-year-old Terry Ragland about what she was told by Dr. Timothy Sweo in April.

…. “I think I blacked out after he said ghetto booty. I think my mind was just stuck on the phrase because I couldn’t believe he said that,” said Ragland.

The doctor’s response to the complaint: “I was trying to take a technical conversation regarding your lower back and make it less technical.” and “I think I do understand why her feelings were hurt but I don’t understand what’s offensive about it,” said Sweo.

The patient’s response to the doctor:

“It says to me that he doubts what type of intellect I have, how intelligent I am to be able to understand what he conveys to me in a medical term,” said Ragland.

As Dr. Evil would say, 

authority

Waiting for an authorization to continue my pantoprazole.  You’d think this would be a pretty straightforward thing for the GI doctor’s office to process, wouldn’t you?

Apparently not.  I called Tuesday.  It’s Thursday and still nothing, not just no authorization but no communication from them about whether they need more info.  So yeah, I’m gonna be that end of the week call, a little pissy, a little demandy.  Because they can’t get their shit together?  Not sure what the reason is.  I do know that this method – where the insurance tells the pharmacy, they tell me, I tell the doctor, and they need to then tell the insurance who needs to tell the pharmacy who needs to tell me – doesn’t work so well.

Kinda feels like this, and I’m Harpo, there in the middle, unable to stand up straight on my own all through it:

Processing

Sometimes I think I need the affective equivalent of the Mac OS spinning pinwheel or the Windows hourglass to use when I am in one of those situations that taxes my resources way way way beyond their capacity.  A message that says “This person has become unresponsive.  Do you want to wait or force quit?”  Or in the case of yesterday’s dealings with the insurance company and my primary care’s office/billing coordinator, “A fatal error has occurred.  Out of patience.  Shutting down.”

It would spare me the pain of having to try to explain what I’m trying to explain while also trying to explain my processing.  Which I will do.  At length.  Because, to continue the computer analogy, I have a somewhat quirky operating system courtesy of my very dysfunctional upbringing.  I’m like the old Dell in the corner, the one with all that memory but which has an old crappy processor and is running Windows Vista.  Sure, I have some really cool programs but if you tax my resources by opening up too many browser windows running all kinds of flash, I have nothing left for the simple operations like switching tasks appropriately or, oh I don’t know, being able to handle your choice to insert some clip art into a Word document.

Yesterday was a very taxing day.  It’s been a taxing week, with a long prodrome.  This week, I had a conference way out in the Western part of Northeast State that my boss, when she was feeling pissy with me back in March, basically insisted I go to.  Then Wednesday through Friday is another conference, which I am presenting a nearly 2 hour workshop/lecture at.  And next week is another conference.  On top of all of this, I have a few fires that keep popping up at work…last minute “OMG” type stuff that has to get done or at least considerably started now now now.  Oh and all the normal stuff that I do for my job too.  I am doing all of this juggling on between 850 and 1100 calories a day – 1100 is a GOOD day and is only accomplished with significant time, effort, and on days when I’m out of the house, extra weight because wherever I am going, I have to bring my own food or run the very high risk that I will have nothing at all to eat.

This does not make for a happy, well adjusted set of responses to stressors.

So when my health insurance company called me after part one of the week’s three day conference to tell me that oh they changed their minds (again) and I  can’t see my primary care as a primary care because my doctor’s office either can’t or refuses to bill as a primary care for me, I was not in an ideal position to handle that.

I’ve been dealing with this particular issue for months.  I have several pages of typed notes.  And among all of it, the one person I have NOT been able to connect with is my doctor’s billing/office manager.  I left her a message a few weeks ago asking, as recommended by the insurance company, if she can tell me whether my primary care CAN bill as a primary care with this insurance company. She called back….oh it was a few days later I’m sure, and left a message that did not at all answer my question.  She answered a different question, the one the insurance company always starts with, and which I know from miserable experience that you have to press the largely not very with it people who you first get on the phone when you call Big Crappy insurance to get them to even understand what you are asking.

Here’s the background on the plan and the conundrum.

  • My plan has two tiers.  There’s what we can call the basic network of providers and a preferred network of providers.  All of them are in Big Crappy Big Shot insurance network, just some are also in Big Ass Teaching Hospital Preferred Network too – this distinction makes the two tiers of coverage/billing/copay.
  • If you see a specialist in Big Crappy Big Shot network who is also in Big Ass Teaching Hospital network, you pay $15 as a copay.
  • If you see a specialist who is just in Big Crappy Big Shot network but NOT at or affiliated with Big Ass Teaching Hospital, you pay $40.
  • Moreover, the plan I have does not REQUIRE a primary care, but it does allow it.  A primary care in Big Crappy Big Shot network can bill as such and can therefore charge a $15 copay for primary care visits.  And, trivially (from a logic perspective) a primary care in Big Crappy network who is also in Big Ass Teaching Hospital network can charge a $15 copay because even if they are billing as a specialist and not a primary care, it’s only going to be $15.

Ok.  Got it?

So my doctor is in the Big Crappy Big Shot network and is not in the Big Ass Teaching Hospital network.  I consider him my primary care, he considers himself as my primary care, and he is who I see for my primary care.  He does have a double specialty but in my state with the primary care shortage, the doc who you see for primary care can have a specialty that is not traditionally one of the primary care specialties.  I double checked this with Big Crappy Big Shot healthplan in one of the very early phone calls.  So, I should, theoretically, be able to see my guy as a primary care and have him bill both the insurance company and me as an in Big Crappy network primary care.  I.e. I should have a $15 copay.  And yet it keeps coming to me as a $40 copay, suggesting that he is billing as a non-preferred specialist.

A reasonable question here is does my doctor not have a primary care contract/privileges with this insurance company or is there just some mistake in how it is getting processed in the billing cycle.  What the insurance company keeps thinking I am asking and which I have to break through every single time we talk about it is “what is my copay to see a specialist who is in Big Crappy but not in Big Ass Teaching Hospital network for a specialist visit?”  Why the fat frickity frick would I be asking that?  That is easily answered.  It is very clear.  I would not spend hours trying to clear that up.

The insurance company tells me that the bills coming in from my primary care visits to this doctor are coming in from this doc’s office coded for specialist.  Hence the $40 copay.  “Ok, well, can they bill for him as a primary care in your plan?” I ask…and I have to ask it alot since I’ve been through three rounds of laying this all out, then getting to the point where I can ask that question, then told they have to research it and call me back, then called back with an answer that either isn’t an answer or, as I said, isn’t an answer to that question.  Yesterday, I spoke with someone at Big Crappy who generally gets the issue and who I have to spend far less time setting it up for.  She tells me that I should call the doc’s office and find out if they just don’t bill as a primary care.  “Does he have a primary care contract with you?” I ask.  She doesn’t know, provider services would but I can’t call them.  My doctor’s office should know this, she tells me.

So back to the doctor’s office and the billing manager.  I left this question for her a few weeks ago.  She called me back a little while after I left that initial message.  Instead of answering my question about whether my doc can bill as a primary care in Big Crappy Big Shot insurance, she says in the voicemail she left: “Your insurance doesn’t require you to have a primary care.  The reason for the $40 copay is that if you see  a specialist who is not in the preferred network, it’s $40 because you have a tiered plan.”  Ah, so she answered the dumb question.  I did not blame her for the dumbness, because I know that the folks at Big Crappy will assume that any question about copays is THAT question about copays.  I call her back that day and I get her voicemail.  I was on a short break at a conference (yes, another), and so I had to speak quickly and concisely.  I thanked her for calling them and explained that unfortunately Big Crappy didn’t answer the question I actually had, which was etc. and yadda yadda and whatnot.  I wait.  She did not call me back.  This takes us to yesterday.  Yesterday, the Big Crappy people follow up again telling me that all of my bills from the doc in question are being submitted from his office as specialist visits, not primary care and that I need to ask the primary care’s office about whether he can bill as a primary care with them.  Big Crappy tells me that the doctor or his billing manager should know this and if they don’t, they can call provider services.  Big Crappy insurance gives me the provider services number too.

So I call the office manager yesterday.  I leave another message.  I sound brittle, because I’m trying really hard not to sound as infuriated and frustrated and just plain EXHAUSTED as I am.  I realize as I am leaving this message that maybe the reason why she hasn’t replied to my clarified question that I left her a few weeks ago is that she might have been on vacation or out.  I call the main number and ask.  “Oh she’s been in and out.  I’ll tell her you called.” the secretary tells me.  “Uh, ok.” I say, realizing then that this means the billing coordinator has just been blowing me off, probably assuming she answered my question and not interested in re-answering it or explaining it.  So I add “can you let her know that I did get her message but I did have a follow up question and that’s what I’m calling about?”  Yes, says the secretary.

The office manager calls me and from the start, she’s got a chip on her shoulder.  I try very very very hard to work with her, but it is clear that she feels that she has put in more than enough time on this.  As she is explaining it though, it’s clear that she’s still answering the wrong question.  So I try to let her know, and believe me, I try gently, that I appreciate the effort but that I think the insurance company didn’t understand the question.  She says that my doctor can be a primary care with my plan, but that with my plan, I don’t NEED to have a primary care, and that she only has one provider number for my doctor.  I say that I know that I don’t have to have a primary care, but I can have one…and say “the problem is, there’s a difference between ‘need’ and ‘can’ here…” and I was going to finish that sentence with “that the insurance company seems to overlook when they are answering questions about primary care for this plan” but she cut me off (about the 5th time she interrupted) and said “Oh well I’m sorry that my understanding of the English language is so bad that I apparently don’t know the difference.”

Boy, that escalated quickly.

There is just no need for that sort of shitty attitude.  I don’t tell her this (5 years ago, I would have).  I say “It sounds like you are offended, and I think you think I was insulting you – is that accurate?  Are you offended?”  “Yes” she said sulkily.  “It really wasn’t my intention.  I don’t think that you don’t understand the difference, I think the insurance company is playing games with words here, and I just need some help breaking through that.”

I think I deserve a fucking medal for being so god damned nice about her shitty attitude.  And mind you, this is on a grand total of about 200 calories at that point for the whole day.

So I’m still processing this shit.  I just really don’t know how to proceed or where to file this away in my brain so that it doesn’t alternately piss me off and distress me greatly.  I need my primary care to be a part of my team, on my side to help me manage elements of living with an evolving, chronic illness.  It’s already tough enough that the systemic barriers between doctors’ offices and health care networks, on top of the historic culture of medicine, actively prevent collaboration between care providers.  Add to it leaving the patient out to hang on dealing with the insurance company and billing and you’ve got something that is just so unbelievably toxic.  While I process, I think I need to hang up the “fatal error” sign, spin the pinwheel, and just let people know that all of my resources are otherwise engaged so please don’t ask me to open up another tab in facebook or you’re gonna get blue screened.

reminder

A reminder not to take things too seriously.  In the words of the Indigo Girls, it’s only life, after all.

I need it this week.  Didn’t get the job I applied for, which is too bad.  I think it would have been a nice fit.  I don’t mourn the position, but I miss the little bit of hopeful feeling it gave me to have applied to it – like a $20 bill in your wallet or the muted pleasure of getting up on a Friday morning to go to work.  I had this sliver of hope until Thursday morning when I got notice that I was out of the running for the job.

Most of what’s been eating at me this week is work and housing related.

  • I’m still being fucked about on the accommodations request.  I received a call late yesterday afternoon from HR to follow up on a complaint I made about a harassing coworker (we met, god, months ago and they are finally now writing up the letter, and they wanted to check in and see how things have been going with that coworker).  At teh end of the call, HR adds a note on the latest “progress” on my health accommodation request:  We’re “slogging through” the extra information we asked you to get from your doctor, it’s still “vague on the date of onset” (of illness(es)) “and the anticipated duration, but we’re working through it”.  Holy shit, really?  I submitted that request in early January.  To me, this latest update says we’re looking for excuses to deny your accommodations and are hoping that we can make a case that your health problems don’t qualify as disabilities.  What a thing to hear.
  • I still work with morons.  It’s been hot this week, legitimately hot.  Over 80 several days.  On Thursday, I went to take my lunch break (which HR says if I take at my desk or in my office, where I have some control over the room temp, I can expect to be interrupted and no accommodation will be made to back me up on that) in the break room.  Earlier in the day, the A.C. had been on.  When I went up, it was like walking into someone’s mouth.  Warm, damp, and slightly smelly.  Clearly, one of the cold blooded bastards I work with had been too cold, but they didn’t even open a window for fresh (if warm) air.  Without thinking, I exclaimed “Oh my goodness, it’s toast y in here,” after walking in.  A woman who has harassed me at work over health stuff said “Yes, and I know how much you love  the heat so I won’t open the window for you.”  Nice.  Really really nice.    Yes, I documented it.  No, I’m not going to make ANOTHER official HR complaint against her because the last one was handled so ham handedly that it caused more problems than it solved.  I am going to mention it at the meeting HR set up for next week and I very much consider it to be contributing to a hostile workplace, so if I do need to make a complaint to the EEOC, you can bet this will be in there.  I left, left the building, as was recommended by HR in their response to my request to be allowed to take a break in my building, drove to a place to get food, checked my blood sugar in the parking lot because I was feeling ill, and yup, it was on its way down – 82 and dropping I’m sure.
  • We still need to move and don’t want to.  There’s nothing good listed – we love living in a single family house, can’t afford to buy yet, and desperately do not want to live in a multi-family again.
  • How about health and medical stuff?  Well, that was more last week but I suppose the influence of it isn’t gone.  No lab evidence of mast cell disorder, according to Endocrine.  I’m discharged from their service (and good riddance!).  The abdominal pain was nothing discernible – which I found out (two days) after spending 5 hours on Monday night at my primary care’s office and the hospital across the street.  Home at 11:00 PM after being up at 5:00 AM, what a way to start the week.

On the plus side, my primary care is still as great as ever and was not dismissive.  My most recent round of lots of medical appointments is over (the clustering is because I try to schedule appointments during slow times at work and we just had break last week), ending with seeing the genetics folks at the B.A.T.H..  The doctor was informative and kind. He’s testing to rule out EDS type 4, and although he thinks I may have it, there is no good test for EDS type 3 (hypermobility type – reading the diagnostic criteria of it is like a checklist of shit that is wrong with me). He did have some good recommendations though. And he was sincere. And kind. I think I mentioned that but it bears mentioning again.

So here I am.  Lots of crap things, one small bright spot.  My natural inclination at times like this is to vow not to get my hopes up again because the let down is so bad.  But the bad is bad enough, or enough picture of a trivia game card with names of medical specialities as categories.bad (depending on how you look at it) that I need something.  If I were going to use anything as a sort of getting me through life-saver, I find the idea of a potential job or a nice new home slightly more appealing than “hey that doctor was nice”.  Also, there is the inherent drawback of investing any hope into the possibility of a unifying diagnosis in that each step of the way comes with more appointments, more missed work, more chances of getting a not great doctor or doctor’s staff, or a scary test… I was joking with my husband that, regarding the medical stuff, I feel like I’m at that point in Trivial
Pursuit where you have all the pieces but you still have to role the exactly right number to land in the center and you still have to get the right question.

I think instead I’m going to try for the absurdist path.  Rather than getting caught in the hopeful/unhopeful mindset dichotomy, I am aiming for a more immediate one that I suppose I could call a temporally relativist take on positive existentialistm.  And toward that end, I am going to try to laugh at the laugh at-able and consider that when things are tough, I am at least young (ish) and have love, and a cat, and a comfy bed, and clothes on my back, and I’m continent, and, well you get the idea.

Here’s a fun thing I ran across this week.  Looking for more of this sort of thing as a reminder that there can be fun in the chaos, diamonds in the coal, flowers in the dirt.

theme song

Busy time at work, bad outcomes with HR, too many doctors’ appointments this month, nausea every night, applying to other jobs and wondering if I can do it, knowing we have to move and not wanting to.  But I’m getting by.

Needed a good laugh

Yesterday was not a good day.  Work/disability stuff.  Long story, leading to HR and an “official” complaint.  Possibly leading beyond that, we’ll see.  I may post more on it later.

In the meantime, I offer this gem from Parks and Recreation: “Fix me!”  So funny and I really need to find things to make me laugh.

way down now…

Last night’s hypoglycemia was a real pisser.  I finally threw in the towel at 85 and went to bed.  That’s 45 minutes after a peanut butter cup, a fruit yogurt, and a glass of cider.  No idea what tanked it, and so glad for that alarm going off in my head that got me up and checking the sugar because if that much sugar only got it up to 85, I think it was well on its way to a seriously low low.  I’m not much good for remaining conscious under 60.  Today’s been better so far, it didn’t get below 89 at least.  But my blood pressure, crimeny.  79/56.  Makes me think of this song from my younger days:  

the world is very different since the robot uprising

Affirmative!

I got a roomba!  Works great so far – perfect for a neat freak with chronic fatigue.

Flu season

If you haven’t watched the Flu Season episode of Parks and Recreation, go watch it now – ungodly funny.  I think I may show it to the students at work as part of an educational lecture series on not coming to work sick.