Medical Update

I ran out of Lamictal because my appointment with the APN on Friday was cancelled for reasons outside my control. The receptionist said the “other doctor” would refill my prescription that day. Nada.

I called today around 11am and the same receptionist said the APN would take care of the prescription within the hour. “I’ll call you.” Four hours later, no call. I called back at 3pm and she said “by the end of the day.” I had important things to do today, so I couldn’t sit around waiting for it. But, according to the voicemail I just listened to, it’s waiting at my pharmacy.

I called my dental insurance to find out if there was any update regarding my periodontal referral for my Endangered Molar. I had received authorization for a consultation only; the periodontist (whom I saw on January 22nd) had to request authorization to actually treat me.

The dental insurance representative said they hadn’t received any such request from the periodontist! It’s been almost four weeks! And to make matters worse, she tried calling the office three times and kept getting a busy signal. She said she’d leave a note for someone to try again later.

When I’d met with the periodontist, she seemed to be on my side. They said “we’ll call you to make an appointment,” so I was a good patient and waited. They made it seem like any delay would be because of the insurance. I trusted them! I feel betrayed.

In related news, I went to get a root canal on Root Canal Molar last week. The endodontist-in-training attempted to perform the root canal, but had difficulty accessing it for several reasons – including but not limited to my inability to open wide enough for her to reach the back top of my mouth. Apparently the tooth is also rotated toward my cheek, making it even harder to access. We both put in our best effort, but all she really ended up doing was beating me up.

We’re officially at 6 months since I started having unbearable toothaches, and I still have yet to receive treatment! The bone damage near those teeth keeps getting worse; I can see it as a growing dark area in the x-rays.

I have an appointment to go back and try the root canal again… In two weeks… But I’d really rather not. We’ll need at least a couple of painfully long visits just to complete the root canal, then another 2 or more for the crown – if it’s approved – and there’s a chance I may have a problem with it later and have to come back again…

No, just no! That’s not happening! I’d rather just get the damn thing pulled and be done with it! I don’t even want to replace it with anything.

So now I have to convince the endodontist-in-training to refer me for an extraction and wait for that to be approved… I just hope I can communicate with her directly – and that she’ll follow through in a timely manner – without jumping through a million hoops. I can’t tell you how often I’m tempted to try and pull both teeth out myself!

But wait, it gets better! The sleep study that contributed to my crisis two weeks ago failed to reveal whether I have sleep apnea! The doctor had called me to discuss the study and, when I told him I’d slept much worse than usual, suggested we try an in-home study. I agreed and he said someone would contact me to set it up…

I was just thinking it was time to call them and find out what happened, when I received a letter from my insurance company saying they were terminating treatment by an out-of-network provider. The letter didn’t say what treatment; in fact, there is a sentence that doesn’t make any sense because the [insert colourful phrase in gorram Chinese here] who prepared the form letter didn’t bother adding what I consider the most important information! The only clue I had was at the very end: “cc Obnoxious Sleep Center.”

I was very worried that they would turn around and make me pay for the on-site sleep study (that had proven to be a waste of time and fucked up my head). I had trouble focusing on other things all weekend, I was so angry! I hated the insurance company for sending me an unedited form letter – instead of calling me to address the issue and offer help. I also suspected the sleep center of lying to me, billing my insurance for treatment I hadn’t received, etc. In short, it all made me feel very unsafe.

I called my insurance about the letter today. It had been intended to inform me that the in-home sleep study was denied because they don’t think I need out-of-state treatment. I explained that I wouldn’t be treated out-of-state, both the sleep center and my home are in the state that’s currently paying for my healthcare. But apparently the company (parent company?) that would ultimately receive the funds is based in another state. My results might have to be processed in another state, etc. To be honest, I understand why they wouldn’t want to pay for that. I just wish they’d told me in a more straightforward way!

The doctor who is ostensibly treating me was and may still be trying to get the decision reversed. As far as I’m concerned he’s welcome to continue (or not); I’ll follow through with whatever works best for me. I now have a list of names, addresses, and phone numbers that may or may not be accurate contact info for in-state sleep specialists.

I’d almost rather not even bother! But if I do have a sleep disorder, treating it could go a long way toward helping me function better in my daily life. I need all the help I can get – especially with two emotionally-intense graduate-level classes. I just need to consider whether trying to access treatment is worth the disruption it’s causing to my everyday life…

I’m considering the possibility that I might be better off going untreated, at least until my classes are over. Then I don’t have to play phone tag, listen to musak while on hold, reschedule my life around appointments that only add to my difficulties, and constantly feel like I’m beating my head against a wall. I estimate that more than half of my current stress would be eliminated if I weren’t trying to access healthcare (particularly dental) at this point in time. I kind of need to stay on my psych meds (I think), but perhaps the rest of it should be put on hold.

On a much more positive note, I took some steps toward finding a potentially-therapeutic group experience today. I met with the leaders of the “coming out” counseling group and told them that I’m trans*. They admitted that they’ve been having trouble finding members and expressed concern because the couple of clients they do have are cis, coming out as lesbian or gay. They would want to have at least one other trans* person in the group so there would be someone I could relate to on that level.

I appreciate that, even though it is a bit disappointing. At least they’re willing to work with me to find a group that might work, whether it’s the “coming out” one or another focused on general interpersonal issues. I expressed my interest in the latter and they said “if you don’t hear from us in two weeks, give us a call.”

They also encouraged me to join the extracurricular LGBTQ+ group I’ve been considering; that helped me overcome my reservations and actually show up for it today.

The facilitator was sitting at a table, surrounded my empty chairs. I walked over, said “my, what a lively group we have today!” and sat across from him. We talked for a bit about random things (completely unrelated to sexual orientation and gender identity) and had several awkward pauses.

Then he asked what I was hoping to get from the group. I told him I want a safe place where people will see me as I am: queer. He said that’s exactly what he intends for it to be, and what it had been in previous weeks when people actually showed up. His words were welcoming, but he seemed skeptical regarding whether he would see me again.

I think I’m actually more encouraged to return than I might have been if there had been a group. I felt like I bonded with the facilitator, and that makes me want to come back. I felt safe there; knowing it’s a safe place will make it easier to be there as part of a group. I feel less like I’m inserting myself into someone else’s party and more like I’m helping to establish the group. Next week we’ll be starting on the same page.

Back on the Healthcare (Headache) Bandwagon

Wakana has been urging me to see a psychiatrist, so I’m finally starting to move in that direction (now that I have health insurance, thanks to the Affordable Care Act). I found a local psychiatrist in my plan, but I think I need a referral from my primary care provider to go see her. I was concerned because my healthcare ID cards have my birth name on them, but I’ve updated my social security and driver’s license to reflect my married name. I don’t want to be denied healthcare because of the inconsistency.

So I called my HMO, and had to talk to a machine, and finally got to talk to a person, who gave me a number I’d already tried and gotten a busy signal, then transferred me to an automated health screening. (The person was nice and as helpful as possible, given the bureaucratic red tape.) When asked to rate my overall health, I rated it as “fair” – but the other questions led me to think perhaps it’s a bit better than that. I don’t need the equipment or assistance they specified (though help remembering to take medications might prove useful, and I’d love to have someone come in and help me declutter on some kind of regular schedule). I only answered “yes” to one of the conditions mentioned: symptoms of depression. The thing is, there were no questions about the severity of my symptoms. The only other clearly mental-health related question was “Have you been diagnosed with schizophrenia?” There was no mention of bipolar, anxiety, PTSD, dissociative disorders, or other mental health issues.

After being screened, I tried calling the bureaucracy again and selected the option to talk to a human being. I was forwarded to an answering service, which then disconnected me because the mailbox was full. I don’t know if going through the automated service would have worked better, but think I would have been transferred to a human answering service disconnected anyway.

“Oh, well,” I thought. “I’ll just have to go there in person and deal with whatever stupidity awaits me. I’ll bring water, snacks, and a good book.”

Of course I didn’t feel up to it today. I was barely able to keep myself from crying while I was on the phone, and I’m sure some degree of distress came through in my voice.

The human being I’d talked to assured me that healthcare providers would accept my insurance as long as I had the relevant ID, even though the name on it doesn’t match the name on my state-issued photo ID.

So, I tried calling my primary care provider. Might as well make that appointment, right?

“The office is closed. Please leave a message after the tone.”

I think I’d rather go eat someĀ ice cream…

Healthcare Headache

My health insurance finally paid their share of the bill for my first visit with Psychiatrist B, which occurred 7 months ago to the day.

When I learned of this, I decided to (finally) look into options so I’ll have health insurance after my current plan – which is dependent on my being a full-time student – expires. There is an option through my current company. When I called for a quote, the person I spoke to was very nice! She asked a few questions and suggested a plan that costs – wait for it … – $400 per month! This is marketed to students who are between leaving school and receiving health care coverage from their employer, mind.

I took a look at the information she sent me and became quite concerned. One of the criteria that prompted her to suggest this plan instead of a less-expensive option was my need for prescription coverage. When she told me the benefits, I thought they included prescription coverage. But when I looked at the explanation of what the plan covers, it explicitly excluded all prescription drugs – even generic! It also explicitly excludes mental/behavioral health care.

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I thought, there has got to be something better out there! I searched for “affordable health insurance” and found ehealthinsurance.com. Through that site I was able to find a plan with a different company that costs $320 per month. Their prescription coverage includes a $15 copay for generics and coverage of 50% of the cost of brand-name drugs up to a certain limit. They also cover 70% of mental/behavioral health care, up to a certain limit. Sounds pretty good.

Except that, according to their brochure, I might not be able to switch companies and I might have to wait to enroll within a specific range of dates and I might have to go several months without coverage. I have no idea whether I’ll be able to find a psychiatrist who is in-network for both companies. “Long-term care” is on the list of services they don’t cover – I have no idea whether that applies to me or not or even what it means in terms of practical considerations.

Worst, I read a customer review by someone who said coverage was denied for treatment of a “pre-existing condition,” and ze had to fight for what coverage ze did receive! WTF?! I wouldn’t care so much about health insurance if I didn’t have a “pre-existing condition” that (likely) requires inhumanely expensive medication to treat! And there’s the nagging voice in the back of my head asking, am I really saving any money if my health insurance costs over $300 per month? That’s before the copay for the doctor’s visit, the copay for (or half the cost of) the prescription medication, and 30% the cost of any additional (limited to a certain number of visits) mental/behavioral health care I receive.

But then, I’m reminded of the first time I used my school’s insurance to help pay for a prescription. Long story short, I literally saved $100 on that month’s supply of the generic drug. Add the doctor’s visit that finally got paid for ($250, minus the $25 copay) and I’ve already saved $5. Never mind if I do need to go to the hospital, etc. And preventative health care … I have yet to compare insurance coverage vs. going to a low-cost clinic (e.g. Planned Parenthood), but there’s a decent chance I’d be saving money there, too – especially since companies are increasingly required to cover preventative care at no cost to the patient.

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Oh, I just took a look on Planned Parenthood’s website, which has a link to HealthCare.gov. Starting October 1st, I’ll be able to search for low-cost insurance options there, with coverage to begin in January. Yay, Affordable Care Act!!! Why, oh why couldn’t you be fully implemented immediately?! (I’ll refrain from soapboxing about what healthcare should look like in the US – and still won’t, come 2014 – … at least for now.)

Anyways, I still haven’t decided what I’m going to do about health insurance from mid-August (when my current plan expires) to January (when coverage begins for any low-cost plan I manage to find on Healthcare.gov). But at least I have hope that paying through the nose for whatever plan I do find (or going without insurance, as millions of Americans do) will be a short-term solution.

What’s your experience with health insurance, particularly trying to find an affordable plan? Any suggestions? International readers, how does access to affordable health insurance in your country compare to what I’ve described here?