Adventures in Insurance

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So if you don’t want to read a long, whiney post, just keep on scrolling. I posted something earlier today that’s a whole lot more uplifting.

I officially left the workforce in November. From an insurance standpoint, this means that I was covered by employer’s policy through the end of the November. In December, I was able to continue that coverage under COBRA which simply meant that I paid 100% of the premium instead of the company paying a portion. As I had 0obstaclecoursedesign-000met 100% of deductibles, out-of-pocket, etc. and everything (including prescriptions) was being paid, it was a good deal. It took some diligence to make sure everything was in place and that coverage didn’t lapse. The Thanksgiving holiday slowed some progress, but everything worked out.

Now last year, through December, medical coverage was through Insurance Company A. My ex-employer switched insurance providers starting January 1 to Insurance Company B. In order for me to continue coverage, I had to pay my December premium to Company A. Once I paid for December, my information was to be transferred to Company B for coverage under the new policy starting in January. I then had to pay my January premium by a certain point in December. With some hand wringing and tooth gnashing on my part, all of that happened but we got down to December 28 and I had no confirmation (even though I paid the premium) that I actually had health insurance coverage starting January 1. This was important because the first two weeks of January, I have scheduled two sets of labs, one X-Ray, three doctors’ appointments, my Actemra infusion, three prescription refills, and four physical therapy sessions — all of which had to be verified with the new Insurance Company B. But finally on December 28 I was able to print out a temporary insurance card and start providing the pertinent numbers to those various people who needed it.

So I’m feeling pretty good. I start January with a sense of accomplishment that even though I had been treading some pretty treacherous waters, I had successfully transitioned from group coverage to COBRA and then to a new insurance provider.

I guess being smug is the same thing as pride because I was feeling smug and there was definitely a fall in my future.

I was on Insurance Company B’s website checking to make sure that my dentist (with whom I have an upcoming appointment) was in network. But the weird thing was that I didn’t see any dental insurance coverage listed.

I contacted my old HR department. We went around the mulberry bush a few times (metaphorically speaking) before we figured out what happened. In addition to the health insurance election I made back in December, I was to have also made elections (if I wanted) for continuation of dental and vision insurance. But guess what? Those were never transmitted to me, so I had no opportunity to make the elections. So my dental and vision coverages had actually lapsed in December and therefore had not been transferred to the new provider to begin coverage in January. I didn’t know they weren’t bundled altogether, so I didn’t raise a flag at the time. I selected the only thing that was made available, which looked like this (whatever those codes mean):

Insurance elections

The “fix” was to go back to Insurance Company A, turn on those elections and pay the December premiums. Theoretically this would then automatically flow through to Insurance Company B where I could then pay the January premiums and once again have my eyes and teeth covered. Oh, and it’s now the first week of January and I only have until January 14 to make all this happen or I lose eligibility. Previously, it took more than two weeks for each step of the process for medical coverage.

So I immediately thought to myself, “Self: It’s still open enrollment. You can just find an individual dental policy and sign up for it and skip all that trauma.” So while I had my old HR department chasing down how to “turn on” the original elections that should have been available to me two months ago, I start on a multiple-hour investigative journey into the land of dental policies to see if I can find a reasonable replacement on my own.

I’m sitting there after a few hours, my desk littered with printouts of policies, trying to sort out which are affordable, which have my dentist in-network, which are insurance companies I’ve actually heard of, and my phone rings.

It’s my physical therapy provider. They can’t verify health insurance benefits for my PT appointment the following morning. It appears that Insurance Company B has my birthdate wrong. Since my provider has the correct birthdate, it doesn’t match what the insurance company (incorrectly) has and they won’t verify that I’m covered.

So this is the first Monday of the new year, right? Insurance companies are getting slammed by people with questions. Insurance Company B’s website has crashed. It won’t even load. (They eventually put up an error message.) I call the customer service number. I am on hold for 46 minutes until I finally get a representative. (Thank you, Sprint for unlimited minutes …) She immediately asks me to verify my birthdate. You can only imagine how that conversation goes.

It doesn’t get much better after that, compounded by the fact that English is obviously not her first language. But she tries to be helpful and eventually, after about 17 security questions, decides she’s actually speaking to me and tries to fix my birthdate. She can’t do it. It’s one of those protected fields that only authorized users can change and she obviously isn’t authorized enough. She says she’s sent the request to “operations” but it may take three to five days for it to be corrected. I explain that’s not good enough and ask if there is a supervisor or someone else who might be able to help. She puts me on hold. Comes back. Puts me on hold again. She finally comes back and tells me that no one is answering — she is rolling directly to voicemail. So after more than an hour, I’m not really any closer to getting the situation fixed than when I started. She did, however, tell me the issue with my birthdate. The last four digits of my Social Security number (which actually form a valid date) got input as my birth year. (I am momentarily elated as this makes me much, much younger than I actually am …) She also told me that my old company should be able to correct this issue on their administrator screens.

So I go back to my old company’s HR department (who is still trying to work on my dental and vision elections) and explain the new problem. No, they can’t fix it on their screens. But they did send in an urgent request to their Insurance Company representative.

Deflated, but not yet defeated, I return to my quest for dental coverage. It turns out the best policy I can find will cost about 20% more than what coverage would be through my old employer. That’s actually not a lot of money as dental premiums are not that expensive for one person. The problem is, that since my dental coverage actually lapsed (through no fault of my own), I was looking at a six- to 12-month waiting period for any kind of dental procedure other than a simple clean and check. I have not one, but two crowns that need to be replaced, so that issue made my finding my own, separate dental policy a really bad idea.

I give up for the day and go drink scotch. Glenlivit bottle

The next morning there is an email for me from the company HR department. They say the birthdate issue on the health insurance is now corrected. Sure enough, when I arrive at the PT appointment, they are able to verify coverage and my pharmacy has also been able to process my prescription refills.

I call Insurance Company A and ask them what the December premiums will be for dental and vision insurance. Even though neither the elections nor the premiums are showing up yet on the website, I make a payment online. As soon as the premium notice shows up, I need to have the payment waiting for it. Because it still has to be processed then transmitted to Insurance Company B in order for me to pay the January premium.

So things aren’t perfect (yet). But the truly large issue of health insurance has, at least, been addressed for the moment. I have people helping me work the issue of the dental and the vision coverage. True these are, no doubt, the same people who caused the screw up in the first place, but who better motivated to correct the situation?

It’s now the third work day of the new year. I hope this week is not a harbinger of the rest of the year. But I do hope your 2016 is not only starting well but will be filled with both health and happiness.

Thanks for checking in.

Hurdles

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When I was a little girl, I hated getting shots. Annual vaccinations for school were bad enough but when you were sick and had to go to the doctor, it was even worse. That was because when you got a shot (as opposed to, for example, that great cherry-tasting cough syrup), that meant you were REALLY SICK. That’s what our friends said: “She was REALLY SICK. She had to get a shot and everything.”

The first time I gave myself an injection was in the hospital after my hip replacement surgery. As a precaution against blood clots, knee- and hip-replacement patients are routinely prescribed blood thinners for a period during recovery. The new oral medications hadn’t yet been introduced, so the drug of my surgeon’s choice was Lovenox® which is a daily injection, administered in the abdomen. By this time I was old enough to quit being quite so squeamish getting shots given to me by others, but never in a million years did I ever imagine actually having the courage to stick a hypodermic needle into my own skin. (I swore I’d never become a drug addict because I could never stand to give myself a shot.)

That first self-injection was fairly early after my RA diagnosis. I’ve learned since then that RA presents us with a number of hurdles.

Read the rest of this post at RheumatoidArthritis.net here: https://rheumatoidarthritis.net/living/hurdles/

Sally Fields and Me

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Sally Fields is credited (and misquoted) with the phrase, “You like me. You really like me.” (What she really said was, “You like me, right now, you like me.”) Misquote aside, I know how she felt when I heard that once again, Healthline has nominated rheumatoid-arthritis-bestthis blog as one of the best RA blogs for 2015. (This has happened each year starting in 2012.)

And although I’m also fond of quoting Groucho Marx who said, “I wouldn’t want to belong to any club that would have me as a member,” I’m thrilled once again to be part of the chosen few along with many of my favorite other RA bloggers.

This is actually a contest. If you click the link on the graphic, it will take you to the Healthline site. Rather than wasting time and energy voting for me, I would rather you explore some of the many marvelous voices out there in the community of chronic disease. I do every year and have always found both joy and inspiration.

Thank you, Healthline, for the nomination. And thanks to each of you who visit my blog and find something of value here.

Communicating with your Doctor — Be Your Own Advocate

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I posted earlier about the discussion we had at the recent Joint Decisions’ Empowerment Summit** concerning communicating with your doctor. The clever people at Joint Decisions and Tonic Life put our discussion points into a great infographic. Both the blogger and their blogs are listed so you can get further acquainted with this talented group of people (if you aren’t already). I hope this is helpful for you as you prepare for your next appointment.

Joint Decisions 2015 Empowerment Summit Infographic_Be Your Own Advocate...

**Janssen Biotech, Inc., paid for my travel expenses for the summit. All thoughts and opinions expressed here are my own.

The 12th Day of RA (2015)


My previous versions of this were focused solely on RA. Of course RA doesn’t happen in a vacuum and you have to fit everything else in your life in and around miserable RA symptoms (and treatments). The holidays make this even crazier. So this year’s rendition tries to do just that — fit in all the holiday craziness in with managing the disease. (Oh, my.) I hope that you enjoy it and that you and yours have a joyous holiday season — whatever that means to you.

The 12th Day of RA

On the twelfth day of Christmas, my RA gave to me:

Twelve cookies baking,

Eleven cards addressing,

Ten fingers flaring

Nine co-pays pending

Eight gifts to be wrapping

Seven cousins coming

Six labs a drawing

Five hours sleep!

Four aching joints

Three shopping days

Two swollen knees

And a wish for a healthy New Year!

 

Update Updates

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I guess progress is being made, although sometimes it feels more like paint drying. Thought I’d bring you up to speed with some of the updates I posted previously.

  • I had my liver biopsy last Friday. It couldn’t have been easier although while I was sedated, I certainly remember the entire procedure. The worst part was having to lay still for three hours afterward to make sure I hadn’t sprung a leak. I can’t lift more than five pounds for two weeks nor can I drink alcohol for a week afterward. Both of these can be challenging during the busy holiday season. I haven’t gotten the results yet, but I am optimistic that there won’t be anything serious showing up.
  • The biopsy results are important because my rheumatologist won’t discuss altering/increasing my RA treatment plan until they come back. This is discouraging because I feel like I’ve been in a flare for the last year. I’m just thankful that I made the decision to “retire” a few weeks ago.
  • I had my second Actemra infusion two days ago. The only issue is that they used up all my “good” veins during the liver biopsy so starting the IV for the infusion was a bit more challenging than usual. I didn’t have the headache I had last time, but I’m still not feeling that it’s making a dent in the pain and swollen joints.
  • Started physical therapy for my knee. Turns out that it might be my IT band instead of my knee. The pain has been where the IT band connects to the knee and when the therapist was working on it, it was painful all the way up to my hip. It would be great if that were the case. Even though my recent knee check up and X-rays show a close-to-perfect replacement, I’ve been worried that there really was something amiss. IT band problems can be treated successfully.
  • I don’t think I mentioned that I have been having heel pain and was referred to a foot and ankle doctor. It doesn’t appear that there is a full tear of the Achilles tendon or other “urgent” situation. The doctor injected my heel which provided some relief for a couple of days, but I think there is an MRI and further investigation in my future.
  • I am still navigating the treacherous waters of COBRA and changing health insurance companies. It is, literally, a daily battle of checking websites, emails to my previous company’s HR department, calls to insurance customer service staff etc. The issue is that I need to my physical therapy appointments next month approved along with my Actemra infusion and right now there is no evidence that I have insurance starting January 1.
  • And the disability claim process continues to drag out. This has also taken hours of my time on the phone and sending materials. Just when I think they have everything, I find out they have gone back to my doctors for even more information. I guess the good news is that at least, to this point, they haven’t denied the claim.
  • I finally get out of my back brace this week (after three months!). That’s a great holiday gift.

I am hopeful that all these things are resolved before the end of the year. In the meantime, my best wishes to you and your family for a wonderful holiday season. Thanks for checking in.

The Power of Words

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I recently read an interesting article about how humans formulate words that connect and convey internal physiological/physical situations to the outside world. A couple of early examples would be the infant crying when they are hungry or in pain morphing into the toddler who can actually say “hungry” or “hurt”. Humans also learn words that convey external situations to internal feelings, like “hot”.

It struck me that this process does not stop as we grow. In fact, this early development helps define our reaction when we hear others say those words. The word “hurt” may conjure up the pain of a skinned knee for one person compared to more traumatic pain for someone else.

In addition, I realized we continue to connect both our emotional and physiological feelings to specific words as we have new experiences. For example, since my RA diagnosis seven years ago, I’ve had conversations with or read many discussions by patients concerning the infusion experience. The words used by (and therefore both the emotional and physiological impact on) patients varied greatly depending on the infusion environment. Probably the most extreme examples are the experiences discussed by patients who undergo infusion in a highly clinical environment, often side-by-side with terminal cancer patients who are also receiving infusion treatments. Compare this experience to patients who receive infusions in a more private, comfortable setting. The people in the clinical environment use words like stressful, depressing and discouraging. Those who receive their infusions in the other setting use words like calm, easy, and reassuring. I can’t help but believe that the same word, “infusion”, conjures up a completely different response and imagery from the two groups of people. Given the demonstrated effect of both stress and positive thinking on medical outcomes, I can only wonder if the less-clinical environment also helps support a more favorable response to the medication.

Read the rest of this post here: https://rheumatoidarthritis.net/living/the-power-of-words/

Updates

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I keep thinking I’ll find time to do a post on all of my latest adventures but the Updatecalendar keeps ticking by, so I thought I’d just do some quick updates.

  • I told people that when I “retired” I was going to learn how to use Twitter, call the dishwasher repair guy and finish my second book. I haven’t done any of the above. As the great American humorist, Erma Bombeck, often said, “Life is what’s happening as you make other plans.”
  • Two weeks ago (the first Monday of my retirement), I had my first Actemra infusion. I’ve been on the self-injectable version but it wasn’t quite doing the job. I’d feel better for a couple of days, then it would wear off. My rheumatologist suggested that we switch to the infusion because she can adjust the dosage. This in lieu of changing drugs yet again. The only biologic that I haven’t been on is Rituxan. If I also “fail” on that, I am out of biologic options. So far, I haven’t had good results after the infusion. We started on the lowest dose and it hasn’t seemed to helped at all. Fortunately since I’m not working full time I can take it a bit easier.
  • I am also thinking that I will discuss with her adding back in another DMARD, perhaps going back to methotrexate which I hate because of the brain fog. Although now that I’m not working, I will be better equipped to deal with that situation.
  • Per my earlier posts, my liver enzymes have been elevated. As I expect that we will increase the Actema and that will probably cause even more issues, I went to see my gastroenterologist to see what might be done to help support my poor, overworked liver. I really love this guy and his realistic approach to medicine and after some discussion, he recommended that we do a liver biopsy. He said that the best thing we could do is rule out there is any disease causing the elevated liver enzymes. In my particular case (and I would surmise in many RA patients as well), autoimmune hepatitis can’t be discounted without the test. Once we do the biopsy and rule out liver disease, then my rheumatologist can increase the RA meds. Even though my liver enzymes might be “high”, the “safe” range is expanded. The liver biopsy (which doesn’t sound very pleasant as you are awake when they do it), is scheduled for about 10 days from now — right before my next infusion.
  • Scheduling the biopsy procedure was greatly complicated by my current insurance situation. At the end of November I changed from my company paying the group insurance to COBRA where I pay the premium, which I did right before Thanksgiving. Unfortunately due to the holiday, the premium was showing paid on the COBRA site but on the eligibility part of the system, it showed my coverage ended on November 30 and so therefore they wouldn’t verify benefits for a procedure being scheduled in December. Didn’t matter that they could check and that I paid the premium, without their computer system having that checkmark, nothing was going to happen. I spent hours on the phone on November 30 to no avail. Patience actually paid off. The very next day, on December 1, everything had percolated through the system and I was shown as having coverage through December 31. That’s the good news. The bad news is that my COBRA coverage is changing plans effective January 1 and I have to be enrolled and pay the COBRA premium on a new plan which then has to percolate through the system before I can verify coverage for January. Sheesh.
  • While I have coverage and fully paid deductibles, I had made an appointment with my ortho surgeon to order some physical therapy for my (replaced) left knee. In the meantime, I have developed severe pain in my left heel. Consulting Drs. Google, WebMD, and MayoClinic.com, the symptoms are consistent with bursitis of the Achilles tendon, but unfortunately also with a torn Achilles tendon. The bursitis is easy. The torn tendon is not. If that’s what it is, it could require surgery and will require 12 to 16 weeks in a cast. I find out tomorrow what’s going on there.
  • In the meantime, I have filed a disability claim with my former employer’s disability insurance plan (to which I had paid in more than $1,000 in premiums this year) as I retired because I am no longer able to work full time. That was almost three weeks ago and I’ve yet to get a determination. They keep asking for further information from my doctors and I can see a long, drawn-out process where they deny and I appeal. In the meantime, I have no income coming in past my final employment check. It’s very frustrating.
  • That being said, I do have retirement savings and I have a meeting next week with my tax attorney to figure out which (very small) pile of money I should start tapping first. There are trade offs between tax consequences vs. growth and I’m smart enough to know that while I could probably figure it out, I’m better off asking for help from someone who does this for a living.
  • Thanksgiving was good, quiet, fun. My husband and I went to our neighbors for Thanksgiving lunch. She made most of the meal. I made my world-famous chorizo cornbread stuffing and a vat of my sinful gravy. So much for my diet.
  • But, because of my Saxenda prescription, I’ve been eating less and have lost about 7.5 lbs in the past month. I had started back to working out in the pool, but due to the pain issues in my heel have postponed any more workouts until I see my ortho doctor. I’ll do the physical therapy for my knee (if he prescribes it) at the same hospital facility where the pool is, so I am hopeful that will keep encouraging me to work out. Assuming I’m not in a cast.
  • I am now 19 days and counting before I can quit wearing my brace which supports my recuperation from spinal fusion therapy. Being free of this encumbrance will be a terrific Christmas present.

I think that brings you up to date. Everyone has been asking me how I’m enjoying my leisure time and, frankly, I’m not sure how to answer that question because I really haven’t had any leisure time to evaluate. I have been able to take one or two afternoon naps over the last couple of weeks and just knowing that’s an option is wonderful.

I hope that whatever updates are happening in your life are blessed and reflect the wonderful holiday season we’re entering. Thanks for checking in.

Physical Evidence

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Like many RA patients, there is often a gap between how I feel and what my lab results or other tests actually show. This is compounded by the fact that I am R factor negative, meaning that a standard test for diagnosing RA comes back normal (even though I’ve lost three major joints to the disease). Therefore, whenever I get physical evidence about a condition that correlates to what I feel, it feels like a victory.

I recently made the difficult decision to leave the workforce. I’m still struggling a bit on whether to describe myself as “retired” or, as I left largely to deal with my health, as “disabled”. I’m not much of one for labels of any kind so I’m ignoring the discussion at the moment. I’ll figure it out later when it becomes important to things like disability claims.

One of the things we all know is that stress is not only an issue unto itself, it generally magnifies other issues you may have. For someone with RA, it can trigger flares and increase fatigue. I wear a Fitbit HR which, among other things, tracks my heart rate which is a pretty clear indicator of stress.

In the picture to the right, the recorded resting heart rate of 101 bpm (which is extremely high by any Heart ratestandard) was my final Friday at work when I was scrambling with my team to get a major project out the door. This high heart rate is a direct reflection of the amount of stress that I was under leading up to my “retirement”. (You can see the upward slope leading to that final day.) Since that time my resting heart rate has dropped steadily. Yes, it’s still high. However, the dramatic decline headed back to more normal levels once I eliminated the stress of work from my life is amazing. To me, this is just visual proof that I made the right decision.

My immediate focus is to get my health back into reasonable limits. I am working on my weight, my heart rate and stress levels. All these things will positively impact not only my RA, but also my blood pressure and cholesterol and triglyceride levels. Being more physically fit will increase the overall quality of my life.

I wish there were Fitbit monitors for other aspects of my life that would automatically track the pain in joints, the number of times my fingers are swollen, or other indicators that my RA is active. Someday there very well be. Until that time, I’ll use the tools I have to help track my progress and celebrate victories like this one.

Wishing you victories both large and small in your life today. Thanks for checking in.

 

Another (paid) RA research study

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I happen to already be registered with Focus Pointe Global which does medical research — everything from surveys to clinical trials. They are currently looking for participants in an upcoming study on RA. I’ve included the details below. Links are provided to register and/or ask questions.

Focus Pointe Global, a National Medical Research Company, is currently looking to speak with people living with Rheumatoid Arthritis for an upcoming research opportunity. There are no sales involved and all information collected during the research process will be kept confidential and used for research purposes to help those in the healthcare field better understand the needs and challenges of living with RA.

 By participating, you will be able to give direct feedback to professionals that can actually make a difference. Participants will be compensated for their time and efforts. This opportunity is available nationally.

If you are interested, please click this link, sign up, and fill out the short survey and you will be contacted within the next month: http://bit.ly/RAStudy

If you have any questions, please email: medconditions@focuspointeglobal.com

 

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