Wednesday, July 16, 2014

Diabetes and the ACA, how they don't mix

One Woman's Journey Through Diabetes and Obamacare
You first question might be, “why should I care?” My answer is simply that $400.00 of YOUR tax dollars are being given to an insurance company every month for me alone. Most of the recipients of ACA policies are getting subsidies because we are the population that were not insurable before Obamacare. We are the out of work, the too old or sick to work and in the states that have refused to expand Medicare. The other reason you should care is you are probably next when your nice, high paying techie job gets shipped overseas or to a Red State where they can get a tax free card and labor at a fraction of the cost they are paying you because the standard of living is so low and everyone is getting food stamps and welfare. With the portability of technology, companies can move their manufacturing, tech and offices several times a year to take advantage of willing politicians who need money for vacations, cars, low interest mortgages, credit cards, fancy dinners, clothes, etc... MEME's on TV so uneducated people vote them back into office.
My little journey began when I got my insurance card and I called my regular Ear, Nose and Throat doctor for an appointment because he was listed on the insurance web site as taking their insurance. Because my regular doctors were listed on the web site, I had signed up of the CIGNA policy through the ACA. What I did not know was there were two grades of policies, normal corporate and ACA. CIGNA was publishing their corporate list of doctors, not their ACA providers. You didn't get to see that list until after you had a card and the Federal Government had crossed their greedy little palms with gold AND you managed to practically hack their site because there is no really easy way to discover who takes your policy and who doesn't. Each doctor of their over 500 has to be individually accessed to find out if they take the ACA policy. That takes hours. Trust me, I know. I've done it.
I was actually screamed at in the doctor's office because I had an ACA policy and had to shell out $400.00 with a maybe they will pay for the tests as I was, red faced, finally shoved out the door. They never filed a claim for the tests.
At the gynecologist, I had been told they took the ACA policy. Yes, at this point I had not managed to find out from the CIGNA web site who was who so I was asking the doctors before I made an appointment. I had found a small lump on my breast as needed a mammogram. You need a prescription for one. When I got there, still half scared to death, I was told they didn't take the ACA policy but if I paid for the exam it would be $175.00. If they filed for reimbursement as an out of network provider, CIGNA would demand I pay them $250.00 for the visit. However, they would have the lab bill CIGNA and they would get paid for the PAP smear. I would have to find my own Mammogram facility that took ACA policies. Fortunately, there was one a few blocks away and now out $575.00 that I now had on a credit card, I made certain my hematologist, took ACA policies before I showed up in that office.
Much to my shock as I had been treated pretty much like last week's bad garbage, I was treated nicely there, but it was downhill from that point and this is what you really need to know.
On Friday the 13th in June, the hematologist's office called hysterical, demanding I get to an emergency room right that moment. The lab they sent my blood to had called frantically. I had a blood sugar level of 500 and was in diabetic ketoacidosis (DKA). By the time I reached the ER, my blood sugar was 650 and I was really in diabetic ketoacidosis. The ER wanted to put me in ICU because they could not stabilize me. I continue to protest as I knew the insurance wasn't covering the ICU and finally when I was out of ketoacidosis around midnight they agreed to place me in a sparsely populated ward where the nurses could check me hourly.
I have back and hip injuries from a car accident 40+ years ago and the mattress was nothing more than a foam topper normally placed on a mattress now residing on a stainless steel table in a plastic cover and to add insult to injury, was designed with multiple little spikes that the sheet settled into when left at rest. I managed to pull three straight back chairs and a couple of pillows together to sleep on. It was either that or the floor and who knows what lurked down there. I was ready to go home the next morning on Saturday and the hospital refused to release me.
It works this way. This is from the Mayo Clinic:
Seek emergency care if:
  • Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L)
  • You have ketones in your urine and can't reach your doctor for advice
  • You have multiple signs and symptoms of diabetic ketoacidosis — excessive thirst or frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath, confusion
Remember, untreated diabetic ketoacidosis can be fatal.”

My glucose was 650, I had no doctor and I had never been treated for diabetes. The hospital was not risking a lawsuit if I dropped dead. If I signed myself out, they could not give me medication and the doctor estimated I would be dead or in a coma within 24 hours with no medication. Thus, they found an air bed, slightly better than the old bed of I have lain on a bed of nails and it is more comfortable than the first bed....13 pillows and I was set to try another night.
In came a kid, okay maybe she was 18 or 19, to give me my dietary training which consisted of a few pages copied off her text book and “there is an app for that.” Don't exceed 15 unit of carbs a day. Okay, what is a unit? Is it a gram? Oh, there's an app for that. Just type in the restaurant's name and bagel and it will tell you. I don't eat out and I'm a vegetarian. This was not going well because I knew more about nutrition than this girl and her app. After she left, in came a doctor, who left her card and told me to come and see her as soon as I was released. Highlight that sentence because it is a scam.
Sunday, I still can not get out of the hospital so I called my husband and told him to bring my laptop as I was really getting bored. By the time he got to the hospital, I was suddenly being released. It was 4:30 PM on SUNDAY and they were phoning the insulin prescription into the pharmacy by my house. The nurse ran in to show me how to inject myself and with me protesting that the pharmacy was closed, they gave me a written prescription at 5 and asked if I was feeling well enough to walk out of the hospital and scattered like rats deserting a sinking ship. George turned to me and said, “What just happened?”
I answered, “they probably just found out the insurance company isn't going to pay.” When I am right, I am right.
We had to find an all night pharmacy. Walgreens doesn't take ACA insurance so we had to go to CVS. The original CVS that had the prescriptions phoned in to, marked them filled so the second one could not use the insurance and I had to pay $277.00 to get the bottle of Lantus from them with the promise I would get the money back. Yeah, sure....I have not only paid for that bottle but $150.00+ dollars copayment for a bottle I never got. I was too sick to argue as my glucose was no where near normal or controlled.
Monday, I got to play run to pharmacies as it turns out the pharmacy that marked the prescriptions filled, didn't even have the medicine to fill them and I had to return to the all night pharmacy across town and that is where I paid for the same medication twice while getting it once. Not only that but now it was Monday and CIGNA was balking at the bill. I had to have their meter instead of the cheap one from the hospital and close to 10% of this brand's test strips and even lances are defective. At a dollar a test strip and only being able to get exactly the number ordered for exactly the number of tests for 30 days, that leaves me without tests for 2.5 days.
Tuesday my blood sugar exceeded 200, normal is below a 100, and I called the doctor on the sheet I received from the hospital and whose card I had. The only person I could reach was the physician's assistant and she told me to come in and get a sample bottle of insulin or she would phone in a prescription for short acting insulin and I could discontinue the one pill I was taking. This bottle of pills was close to $200.00 in copayment and I had taken one of the 30. Growl....but I got two bottles of insulin and a couple of packages of needles and really important badly copied piece of paper to write my 4 times a day readings on. I should call on Friday for an appointment. Waiting at home in the mailbox was the letter from CIGNA stating they were denying the whole claim as my condition was not life threatening. Please read the quoted part from the Mayo Clinic again. This is a doctor signing the denial. The hospital appealed and on Wednesday I got a letter stating they would pay for 23 hours of observation but every item of care I received in the ER would be individually reviewed and the other 2 days of care and stay were denied. Remember here that the hospital refused to release me.
I waited until Friday and called the specialist with my little piece of nice filled out paper and I was told I really wasn't a patient and they had only given me the insulin as a courtesy to the hospital, the doctor was on vacation and to call my primary care physician and get a referral. I didn't have a primary. I just got insurance. I haven't been able to afford a doctor in three years, however, my hematologist had recommended someone and I called them.
In the mean time, I am running out of syringes because the insurance only covered a couple of bags based on 28 days of one injection a day and now I am getting 4 injections a day. Back to the pharmacy, where I have had such fantastic experiences, and I get to buy 2 bags out of pocket but not worry, my prescription of syringes was going to paid for on the 5th of July. I show up on the 5th of July and they deny anyone ever said that. However, at home I find the print out from the pharmacy and clearly printed is to return on the 5th of July. By that time, I had bought another 6 bags of needles, full retail and I guess I should consider myself lucky they let me buy them.
I couldn't get a doctor's appointment until August and I frantically explained the situation to the General Practitioner's . No problem, they set me up with a physician's assistant who was very helpful the next week in showing me how to adjust the Lantus, which is a long acting form of insulin, but when it came to the pills or the short acting, they were not comfortable dealing with a new diabetic. That was easily understood. They are general practitioners, not specialists. So, I left with my referral thinking I had met all the requirements to see the specialist.
After I lost it on hold and George had to finally take over because I was almost out of insulin, he spent all afternoon finally getting the specialist's physician's assistant to phone in the substitute for Lantus CIGNA was willing to pay for and for the pills and the 2nd insulin and more needles and you can call back in 2 months and MAYBE get an appointment. I was livid.
So I wasn't surprised when I spoke with a second doctor who suggested I go to the specialist's office and refuse to leave until I saw the doctor. As he put it, you don't have your diabetes under control and you have no way of even knowing if it is under control. You have not seen a doctor since you were released on the 15th of June. It is the 16th of July. You have no real training in how to take care of yourself. This doctor is never giving you an appointment because of the ACA insurance. You have to force them to see you.
Yup, I can't think of better medical care I can get than the kind you have to stage a sit in at the doctor's office to get. Perhaps holding a gun to the doctor's head would work better. Of course, she is on permanent vacation so my options would be the receptionist or maybe physician's assistant.
It works this way. To get the government money which happens to be YOUR TAXES, the insurance company has to demonstrate that they have X number of doctors in every specialty based on the population of your area. So, they sign doctors up and put them on the web site as accepting new patients. However, since the GOP/Tea Party gutted the ACA before they voted for it, there is no way to punish the anyone if no one ever bothers to see a patient and no way to actually check. I'm sure the bought doctors get something in return like free vacations/seminars in 5 star resorts in the Bahamas or Mexico, low interest loans, free samples of medications they shouldn't have if they need a boost to get through the day (remember I worked for a psychiatrist for 10 years and saw all the addicts with MD's and wondered how they got the drugs. You can't write yourself a prescription for a narcotic) and plenty of perks. Whatever they are giving them is a drop in bucket compared to what they are getting from the Federal Government in subsidies that YOU are paying for. I'm paying good chunk of change out of my pocket to the point I am considering dropping the policy and paying the fines. It may work out cheaper.

Meanwhile, these GOP/Tea Bag doctors think they are making off like bandits with no regard for how many people's deaths they cause and as a plus think they are gutting Obamacare which they have been sold a bill of goods is going to put them in the poor house where the rest of us now live. The only people making out like bandits are the insurance CEO's who will be getting billion dollar bonuses and perks this year from all the money the ACA just dumped in their pocket and they are used to killing people so no biggie on their conscience if they actually have one. Oh, don't forget the GOP/Tea Party politicians drunk on power and/or booze who will be reaping those huge campaign contributions which are again, a drop in the bucket compared to the money the insurance CEO's are getting. The politicians never could do math, anyway.
My claims are still denied and here is the treatment protocal for my diabetes just in case you think everyone including was over reacting:

Medical Treatment

  • Fluid replacement and insulin administration intravenously (IV) are the primary and most critical initial treatments for diabetic ketoacidosis. These therapies together reverse dehydration, lower blood acid levels, and restore normal sugar and electrolyte balance. Fluids must be administered wisely - not at an excessive rate or total volume due to the risk of brain swelling (cerebral edema). Potassium is typically added to IV fluids to correct total body depletion of this important electrolyte.
  • Insulin must not be delayed and must be given promptly as a continuous infusion (not as a bolus - a large dose given rapidly) to stop further ketone formation and to stabilize tissue function by driving available potassium back inside the body's cells. Once blood glucose levels have fallen below 300mg/dL, glucose may be co-administered with ongoing insulin administration to avoid the development of hypoglycemia (low blood sugar).
  • People diagnosed with diabetic ketoacidosis are usually admitted into the hospital for treatment and may be admitted to the intensive care unit.>

Tuesday, July 1, 2014

The New Pattern of my Life: Darning the Pillow

My new mornings and days.....

I'm not complaining, just adapting. It is sort of like you would decide on a new exercise routine or new job. Adjustments have to made and old habits discharged.
Habits are not a bad thing, though they get a bad reputation. Habits can have two functions depending on the type of person you are. My professor and mentor used to say there are two types of people: watch dogs and bird dogs. Watch dogs bark at everything new and retreat to their dog houses to hide if the new thing gets too close or they attack and try to kill it. Bird dogs are always out hunting for new things. You may send them out to retrieve a bird but there is no guarantee they will return with your bird or even with a bird. They just delight in bringing something new home to examine and use. Unfortunately for society, there are a thousand watch dogs to every bird dog. The actions of both dogs are based on habit it is just how they interpret and use the habit that differs. The Watch Dog uses the habit, its house, to hide from anything new. The Bird Dog uses the habit, its owner and retrieving pattern to seek out new things to learn. It works the same way with magic. At first every little thing must be coordinated and learned painstakingly and then it becomes rote and done instantly.
That was something I learned this morning to my amazement. All night I have derided the cats for tracking litter into the bed. When I got up this morning, I had the stuff attached to my leg and it was almost impossible to remove. The situation has been getting worse all weekend until this morning I thought I was in the kitty pan. In the bathroom with strong glasses on, now that I no longer have 20/20 vision due to the diabetes, I saw the pieces were strangely uniform in size and shape and prone to static electricity. This is why I couldn't get them off my leg. Now this was strange because litter is neither. I was ready to kill a cat when I discovered a few minutes later my favorite pillow, the little heart one that is the perfect size to prop my leg up at night, was bleeding microbeads due to several cat holes.
This presents a new problem as there is no way I can see to thread a needle. Then I remembered seeing a sewing kit on my nightstand when I cleaned up with what I thought were prethreaded needles. Thank you what ever hotel (It has an H on it so I am thinking Hilton) that put these in the rooms and Neutrogena for making them. (I don't make it a habit of staying at expensive hotels as I can't afford to travel any more, but back when I was working in psychiatry, I had to travel and take classes to keep my licenses up to date.) These prethreaded needles should be available in the craft store. It came with basic colors of thread, about two feet and lovely sharp needles. I set about darning the pillow which had a total of 4 holes in it.
It has been at least fifteen years since I hand darned anything. The first knot was awkward and the first stitches. Then I fell into a familiar, rote pattern. The little pillow was darned in no time without me even thinking about what I was doing. It must be the thousandth thing I have darned in my life and now it is as easy a breathing again, even with a decade break from darning.
Hence my new life will be a little hard to learn but eventually it will be a pattern, a jumping off point for the rest of my day. I awake and instead of grabbing the cup of Joe, I have to grab the test kit and test myself. Then I weigh myself and then I inject the insulin and take the pill. Then and only then can I have my infusion of coffee, now with a powdered whitener instead of the sugar laden organic milk. My PA suggests in case of a hypoglycemic attack to drink 8 ounces of milk because the sugar hits instantly and protein will carry you and maintain the sugar level for a couple of hours. All these years, I thought orange juice was the way to go but it just provides the sugar high and then you drop like a rock. I am learning.

I guess even an old Bird Dog can learn new tricks. Actually I think I am a cat because ordered to retrieve, I am more likely to give you the finger and go do what I want to......well, not any more....