I Love My Health Insurance, But ...

Several weeks ago, my doctor told me to go to the emergency room. I did. Now the bills are arriving. I thought I had good health insurance. I do. But, my stated coverage and the bills don’t agree.

In-network. Deductibles. Out of pocket expenses. 80% here. 90% here. Medically necessary. Negotiated rates. Denied because of an incorrect number.

I try to be responsible with my and the insurance company’s money, but I don’t always understand. I’m not great at surprises. I want to know the rules. I want to play by the rules. I don’t want the rules to change.

Yesterday, I called the insurance company (Aetna). I spoke with a wonderful woman. It’s not often enough that I get the nice, helpful, intelligent, English-speaking customer service rep. She looked up each bill and explained what I really owed and why. The hospital billed incorrectly so Aetna has ask them to resubmit – don’t pay anything yet. The pathology lab billed incorrectly asking for payment of the part that Aetna and the doctor agreed to write off – pay a much smaller amount than what the bill asks for. One doctor asks for a large amount – pay it because that includes your $250 deductible and now you’ve met that deductible you won’t pay it again this year.

I appreciated the help for what is way too confusing for me. How can an average person understand and get this right? And there are more questions …

Do I pay the bills now? Do I wait for corrected bills? Do I hope that everything gets worked out through this bureaucratic system on its own? Do I pay what the insurance company says is correct? Do I pay what the doctor says is correct? Do I pull my hair out and deal with increased pain because the stress of figuring this all out is overwhelming?

WebMD’s interesting article on using the Pain Scale

I just read an interesting on-line article at WebMD (www.webmd.com) titled “Using the Pain Scale: How to Talk About Pain” by R. Morgan Griffin. Click here to read the entire article.

The article starts saying, “One of the hardest things about chronic pain is that only you know how bad the pain feels. There’s no blood test that can show how much you are suffering. There’s often no outward sign, like a bandage or a cast. There’s just the pain.”

That sounds like I could have written it – or did write it in my own memoir. Pain is personal, invisible and difficult to explain … and sometimes difficult for others to comprehend.

I’ve written before about the subjectivity of pain scales. I’m not a big advocate of using these 1 to 10 pain scales because they are not consistent and really don’t say anything about my pain. A while back, my husband was bent over in pain; yet, when the doctor asked his pain he said 2 or 3. I told the doctor based on his actions, it was a 6 or 7. Which number was accurate? Should the doctor treat a 2 and a 7 differently?

Last week, at the Pain Clinic, I was asked (as I am always asked), what my pain number was. I said 6 with 30 mg of extended release morphine in my system. That’s because I have done extensive research on the meanings of the numbers. Some pain scales actually give descriptions of the pain as opposed to you just blurting out a number between 1 and 10, so I know that 6 or 7 is accurate … for me.

Now to where the article makes complete sense. It talks about the need for context in addition to the number. How do I feel? How does the pain affect my life? The article goes on to explain that the pain scale is more helpful over time when a doctor gets to know you and your numbers. By using the same scale consistently with the same person, a doctor will get a good sense of how your pain is progressing and how well your treatments are working.

Maybe that’s another item on my list of why I am withholding final judgement on the new Pain Clinic. Saying one number one time without the additional context or information, just doesn’t make sense to me. What’s your number? What’s the basis for your number? Does it make a difference in your treatment?

Ashworth Drugs Still the One for Me

I still plan to blog about my first visit to the pain clinic, but first I have to think … really think … about what I saw, heard, learned, experienced. First I’ll start with the follow-up at the drug store.

I go to Ashworth Drugs in downtown Cary. In my book, I write about my decision to go there and it still holds true today. Their slogan says, “We fill your prescriptions promptly and with the courtesy you deserve.” Very true!

Yesterday, I stopped by to ask questions about a new Rx the pain clinic gave me for the pain I experience from arthritis. Turns out the Flector patches are brand new and pharmacists are seeing a big push on their use (hmmm, could that be what the drug reps are pushing these days when you always see them in doctor offices?). The patches are VERY expensive (about $6 each and need 2 per day) and many insurance companies are not covering them (yet) because they have not necessarily shown their effectiveness. My husband works hard and has good coverage – for $10, I can get a month supply.

Although skeptical that the patches really work (they are a topical delivery of an NSAID – wouldn’t taking a pill work the same and cost a lot less?), I am going to try them.

In addition to the pharmacist taking the time (promptly and with the utmost of courtesy) to discuss the new prescriptions, she also listened (and rolled her eyes appropriately) when I told her that this pain clinic requires a urine drug screening of everyone, all the time (more on that later) and recommended new procedures before even looking at my MRIs or taking much time to get to know me and my pain.

Maybe they are miracle workers and I should be excited ... or maybe I’m old-fashioned and like to build a trusting relationship before jumping…

Brady and Grandma Time

Last week, I spent a few days in Nashville, Tennessee. My daughter and son-in-law went on a whitewater rafting trip and I got Brady all to myself for 24 hours. It was a blast! Brady and I went shopping for a Floppy Seat for him (it goes in shopping carts and high chairs) and some herbs for the empty pots at Brady’s parents’ house. We ate … we drank … we slept … we pooped … we watched the NASCAR race (he wore his brand new “this is how I stroll with Kyle Busch” shirt) … we talked (he even talked to the cell phone when Katie called).

I had a great time (and enjoyed time with Katie and Jason too), but spent the few days after I returned recuperating from extra back pain. Sometimes it’s just worth the price I pay for the fun I have.

I went to a new Pain Clinic last Friday and now one of my step-sons is visiting. More stories soon.

Needed: Hows and Whys … Not Just DOs

I’ve been debating sharing this information because I find it kind of embarrassing. After a couple weeks and today’s doctor’s visit, I decided to share in case anyone else is going through this.

I have uterine (and other organ) prolapse. That means some internal organs are drooping in my private area. Go online and read somewhere else if you want specifics. A couple weeks ago when I called my primary care physician’s office about what I was feeling and seeing, they sent me to the emergency room. I went. Turns out, it wasn’t an emergency and a couple weeks later, I visited a gynecologist who gave me a pessary. A pessary is kind of like a diaphragm that is inserted and supports (holds up) the internal organs.

I didn’t get a warm and fuzzy feeling from the gyn on the first visit. Today, I returned for a check-up. I told her the pessary didn’t feel like it fit well. Of course, they are non-returnable (and we are glad they are), but now I’m buying a second one (and I don’t think this one fits right either).

Here’s my problem with this doctor. I believe she is totally competent. She deals with this condition numerous times a day. BUT, I don’t think she gets that it’s the FIRST and ONLY time I am dealing with it. She says, “It fits fine for your anatomy.” I ask her about surgery; she says, “It would require a complete hysterectomy.” I ask her about what the emergency room found on my ultrasound; she says, “It’s nothing.” I tell her it’s difficult and painful to remove the pessary; she says, “Use the estrogen cream.” One sentence answers and that’s all.

I need empathy. I need why I’m doing or feeling something. I need how to do it. I don’t function well with just “do this, don’t do that.” I need more. So now I’m home with 2 pessaries – neither which I’m comfortable with. I still don’t have a good feeling. But since she assured me it’s not an emergency, I think I’ll just live with what I have for now … and start looking for another GYN that provides more than just one short sentence answers and cares (or at least acts like she cares) about me, the patient.

I’m not going to worry about it anymore till next week when I return from a solo trip to Nashville to babysit my 6 month old grandson. Hooray!