Finding What The Insurance Doesn't Cover

So. Doctors Day. Following Pharmacy Night. It's been an education.

First, the pharmacy. For some reason, the tail end of my limited prescription for blood thinner got (lost?), and I was given a whole 'nother 90 days of it. I'll actually need about 20 pills. The bottle is even marked "partial refill remaining." Nope, they won't take the excess back. I decided, since I'm off blood thinner completely on April 8, and there was no charge with the new Medicare schedule, I'd just take it as a win.

But while I was there, I was asked if I'd had/wanted the new shingles vaccine. It's 50-90% more effective than the previous one, and dead rather than live vaccine. It has to be mixed per each dose, and takes about 15 minutes to prepare. There will be two shots of this vs. one of the earlier, and $175 each vs. $600 for the one. And, no, my insurance doesn't pay for this one. It will, however, take the cost of both off my annual deductible. I'm not completely sure what that gets me, as it seems that everything is either free or not covered at all. Maybe I'm just not understanding the terms.

My decision was a simple one. Daddy lived through shingles, and for long long months, his repeated refrain was "I want to die!" My brother got the original shot and shingles. He doesn't speak about his experience with it, but I'm sure he'd rather have avoided it. The pharmacist at the window told me she'd had it three times - in her 20s!

I dug out my credit card. Of course.

I was warned that this shot would reult in a sore arm for a few days. He was ready to advise all kinds of things (heat, cold, movement, etc.) but I interrupted him to let him know I'd heard that about all shots, it was never true, and that compared to (fill in the blank: root canal, childbirth, gall bladder surgery the old fashioned way, bilateral knees 10 years overdue for replacement - due to no insurence, natch) I'm sure I could live through this.

Turns out the arm is actually sore. Oh well, still not that big a deal.

This morning was a visit with my favorite cardiologist's PA. She finds the time to actually talk to you, not barking an order on the way out the room like her boss does. We have balanced many of my medications, changing levels and monitoring reactions, discussing things all the while. She trusts me to change one if (fill in whatever effect is pertinent) happens, allowing for the procedures I went through last year for making changes. I know when something is really wrong, or expected. Nearly everything with an Rx label in my bathroom winds up affecting this specialty, and nobody else cares to monitor or advise in that detail. Again, we discussed both how things went in the past, and planning for the future.

In addition to medication issues, I found out some other things. She recommended I get a document from each of my docs summarizing my current health status, labs, etc. before we travel. When I showed her my 2-column list of medical history she was impressed, but commented I should add the manufacturer and model of my pacemaker and watchman. I was informed in better detail how my pacemaker monitoring works. It contains a memory chip and the plug-in machine on my headboard periodically downloads and records what's been happening. Since I've had it, for example, there was a series of 6 (!) heartbeats which qualified as A-fib. All else is normal. That comes well under the 1% category. But if it happens again, everybody will know. This came out of her taking me to her office where she pulled up my records, showing me a recent EKG sent to their office.

We discussed a flutter I can feel periodically. It seems to get worse in response to caffeine. I've been cutting back, except for occasions like, let's see, Girl Scout Thin Mints sales? She informed me that aging increases sensitivity to caffeine in some people. Other docs have just flat out stated I should quit. Since it had never been a problem, I had seen no reason to suppose things might change. What I had noticed was that my insomnia lessened when I started my day with coffee, and I know that good sleep is important to my heart. I can feel it after a bad couple of nights. So why stop coffee?

In order to help figure out what else might be going on, she's setting me up with another monitor to see what's happening so we can figure out out response. Figure April till it gets approved. Insurance, don'cha know. It would be my 3rd time wearing one, and what she suspects isn't recorded for in my pacemaker, but still, they might balk. I've seen those bills. 

She also sent me for a CBC to figure out whether I'm on the right dose of blood thinner. How are my platelets doing? It's seemed like this dose was too large, which is why most weeks I skip one dose. So we discussed interactions with aspirin and ibuprofin, how much of either was I taking? This time she had to figure out how to code it so insurance would pay for the test. I am, for the moment, theoretically anemic. Nobody ever bothered to let me know that some kind of ongoing monitoring or testing might be useful once I'd switched to the plavix, just that I no longer needed INR tests since I was off warfarin.

I also know that I was correct in thinking she was in pain while walking, and she informed me why. We shared ways of dealing with it, since I've been there too. I know where she plans to travel this summer (Europe) and she knows where I do. And she likes the cookies and recipe copies I dropped off on my last visit.

No, it's not a bribe. These are just great friendly people staffing that office. Well, the cardiologist is a stereotypical king of his world, but I only see him once a year. As long as the job gets done, there or by referral, I can deal with his personality deficit.

But I said "doctors" day. Plural. There was a different visit leading to another lesson in insurance and healthcare costs. I need a steroid creme. I can't apply it for a week as it will prevent the two punch biopsies from healing, but after that, 3 applications a day for perhaps 5 months, depending on its progress. The week delay turns out to be a good thing, since what she prescribed winds up costing - gulp! - $210. per tube. Insurance doesn't cover. I know this because before I was half a mile away from this doc's office my pharmacy called with details. And a question. Would I like them to call her and find out if there is a substitute that will be either covered or at least cheaper that will do the job she wants?

Again, the answer was simple, as soon as I verified the details. I'll be waiting to hear the outcome.

Oh yeah, no pool for a week in the meantime. Even without it I've been losing a couple pounds a month lately. I think it's time to find a set of stairs and start strengthening those muscles now. Soon as I remember I wanted to.