Limited Medical Update

Oh, wait, there isn’t much of one. I’m sick — but don’t feel bad except for the damn infernal 24/7 hacking. The doctor says I’m sick and am suffering from some unknown viral malaise. Doesn’t that sound fun. My throat is shredded to bits from the constant hacking. Talking hurts, so I haven’t been doing much of it lately despite some people’s efforts to try and make me talk.

I begin antibiotics today for a week coupled with some highly narcotic cough syrup (yay) Hydromet Syrup which my insurance has inexplicably declined to pay for even though it’s clearly covered. I asked the pharmacist why. He explained as follows: “Your doctor prescribed a 1/2 teaspoon dose once per day and gave you enough for 48 days. But the insurance company will only pay for 30 days’ worth.”

I explained to the pharmacist that I’m supposed to take 1/2 teaspoon dose at least twice (as needed) per day which means I got a 24-day supply at most. But, the prescription says one per day or as needed. So I asked him to give me less, and he said it’s a liquid in a standard size bottle and he can’t. My choice is to call the doctor back tomorrow and have him re-issue the prescription or pay for it. I’m very cranky already and decide I’ll just pay since I’m already pissed off and the talking is killing me. All that, and it’s only $15.82 — if my insurance had covered it, it would have been $20 which is my minimum drug copay. Fucking insanity, I say. I paid less not being covered.

I also went to the otolaryngologist (ENT) to discuss my results from the Endoscopy in more detail but he referred me back to the original doctor who did the procedure instead and said he should go over it with me instead. That pissed me off. I paid $30 to get sent to another doctor. So that’s two co-pays today. Although the ENT did give me a lecture and a half for taking Orange Juice for my cold (which is a no-no for Acid Reflux patients). I assumed that the cold was worse and a few days of that wouldn’t be a problem — I stand corrected. No citrus ever again for any reason. He said OJ for colds is an old-wives tale anyway, though he supports chicken soup. He then gave me the official “endoscope up the nose” procedure — which is a problem because with my cold I can’t breathe so well through my nose and we almost had an episode like before (previous blog post).

Then of course, I didn’t mention the insurance crisis. We have two plans at our office a regular plan and the same plan with the Open Access option. The OA option is quite a bit more money (nearly double the price) but I gladly pay it because I’ll be damned if I’m letting some insurance company book tell me what doctors and I can or can’t see and double-damned if I’m going to keep going to my primary care to get a referral. If I know what’s broken and I know what type of doctor can fix/treat it, then I’ll find one that’s good and go to him/her right away and shave days and dollars off the process.

So I go to the otolaryngologist and check-in like always (remember, I’ve been before) and pay my $30 co-pay for a specialist. No worries. Sit down. I get called back to the window and told “You need a referral to see the doctor, or you have to pay $290 for the visit plus any additional money for whatever the doctor does.” I ask why because I’m on the OA plan. She says I’m not and she shows me a printout which conflicts with the card I have. She gets her phone, dials the physician access line, and presses my card number into the automated system. Sure enough it says I’m on the regular HMO without the OA option. I call my office and ask the controller to get the insurance agent involved but it’s too early and we can’t get it resolved. We come to a compromise: I leave her a signed note saying she can charge my card if it isn’t resolved in 24 hours. When I get back to the office later, Aetna insists I’m on the OA plan and can’t explain the failure of the physician’s automated line to get it right. They promise they’ll call me back within an hour and also call the doctor and straighten it out. That was 10 hours ago. Not done. (My primary care doctor was nice enough to fax a referral to the doctor, so I don’t get charged. Technically not proper but nobody feels bad because the insurance company screwed it up.)

I hate insurance companies. I wish I could stop coughing.

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