things that keep me up at night

I went to the doctor today for my Restless Leg Syndrome. For those of you who don't know what it is it's a sleep disorder/neurological condition which causes a drop in dopamine in the brain resulting in a number of symptoms.

I get a creepy feeling in my legs and an urge to move. This usually starts after dinner when I sit and increases in intensity when I go to bed. When I lay down the sensation is accompanied by an aching deep in my legs, primarily in the bottom half but sometime the entire legs. Relief comes from moving, sometimes just rubbing my feet together or stretching will help but mostly I need to walk.

Anyway,  my regular neurologist wanted me to see the sleep doctor in his practice, he's concerned that along with the RLS that I might have sleep apnea. Bill's been saying that he thinks when I sleep on my back I stop breathing for bits of time. I snore as well which makes it easy for him to hear the pauses in my breathing. At least he thinks so.

I have insurance (I've always considered it to be good insurance) so I went into this without much worry of being covered or even the least concern of the cost. His charge is $1,689. If the insurance company pays less I would be responsible for the remainder.This is for a full night in the sleep lab and the full diagnosis of the results.The lady in the office told me that my insurance company has a reputation of not paying much.  But my deductible is reasonable so I'm not all that worried.

So I said to myself, self.....  I've been to the doctor a number of times this year and surely I've built up something towards my deductable right? My deductible can't be more than $250.00-$300.00. Well I checked and I have two words holy crap! My deductible has been raised to $1,000. Damn it to hell! Don't get me wrong I'm so grateful I have insurance but $1000!

I thought Obama-care was supposed to save us money. Put one in the not true for me column.

I hope my Political Representatives, my President and my insurance company are bedding down all nice and cozy tonight (sarcasm). I know they don't lose sleep on the little guy or gal.

Jen plans to keep breathing, my legs will keep moving unfortunately, and I'll try not to dwell on my soon to be dwindling bank account, damn it!

flying my freak flag

Do you have things that just drive you crazy for no other reason than it's just a quirk of your personality? I'm not sure what it is with me but this week I'm flying my freak flag and it's flying high and waving all over the darn place.

photo attribution

It could very well be I have problems with authority figures or want my way or it could just be I'm getting bitchy in my old age.

Anyway I did all this research to find a Dermatologist that takes my insurance plan, it's not all that easy and sometimes when choosing a specialist I might have to drive as many as 60-100 miles to stay {in network}. So I find this doctor 42 miles from my house at this point I'm doing a happy dance. I looked up his credentials and so on and call his office to confirm he's on my plan and make an appointment.

I still have that rash under my arm {7weeks or more} and I want him to take a look at the area around my healed MRSA wound; the skin surrounding the scar tissue is hyper-pigmented and I wanted an opinion on if it needed treatment or if the discoloration will fade with time. Let me just say that these two issues were treated previously by two different doctors, rash by my internist, wound by my wound doctor.

I dial the phone and the receptionist answers the phone the conversation goes something like this...

"Him my name is Jen, is Dr. Blah Blah Blah taking on new patients?"

"Are you insured, what kind of insurance do you have?"
Now I'm thinking to myself I guess that means he's taking new patients but a hello would have been nice so I play along....


So mentioned the company.
She clarified a few more questions about my insurance then went on.....


"So what's the problem you'll be seeing the doctor for?"
I told her about my arm pit rash and my skin surrounding the scar, then she says to me....


"We require your doctor(s) send over a referral and we get you an appointment."

OK hold the phone.....my insurance doesn't require referrals to see a specialist.What if i have a reason that I don't want to share the fact that I'm seeing a dermatologist with either of these two doctors, that's certainly my prerogative? Then my next thought was, doctors don't do anything for free anymore or over the phone! Will i have to pay- make an appointment in order to get this referral that isn't even required?


Or what if I was a person who didn't have a regular doctor?


I spent a lot of money with my wound treatment last year....I'm still getting bills eight months later.  In addition, my former wound doctor is a hospitalist he doesn't even have an office- the hospital is his office and we all know their rates! 


Ridiculous, this whole that's what this whole thing is is becoming. All I want is a freakin appointment, I'm not a circus clown jumping thru hoops...so we continue to converse. I go on to tell her, "I've had this insurance for 30+ years and have never been required to do this before, may I ask why?"

"It's the doctor's preference and it's his personal rule" the receptionist tells me.

So I say, "I'm a 52 year old woman I believe I am capable of making the decision as to whether I need to see a dermatologist without another doctors evaluation, permission, knowledge or referral, rolling my eyes."
I'm glad she couldn't see me because I was being a tad disrespectful with my facial expressions!

She then says to me, "if you want to see Dr Blah Blah Blah the referral  is required"

Then I told her with a sigh, "With all due respect I think this rule is unnecessary and may even cause me to incur an unnecessary expense  I believe I'd rather find another doctor, thanks but no thanks."

Now I'm annoyed! This type of crap bothers me to no end.

I then hang up my phone so I can  hoist my freak flag a bit higher and started looking for another doctor!

Do you have quirky things that just really annoy you more than they should?

When was the last time you flew your freak flag?

Linking up with Shell today.
Thanks Shell....

do your job for crying out loud!

I have an intense dislike for people who give poor customer service. I have an even greater dislike when I start getting the feeling that I'm dealing with people who would rather put all their energies into harassing me the client then in doing their job. 

So now I need to vent!

When I was ill with my MRSA wound I required medical equipment in order to heal more quickly, my insurance authorized the use of this equipment with a participating provider for a period of three months at a cost of zero dollars to me-or so I thought. When my doctor determined the course of treatment was complete (after five weeks) I returned the device. 

That is when the first call came. The company who provided the equipment wanted to confirm my insurance ID # because the insurance denied the claim. Well I had an authorization in my hand so I asked the girl are you sure you're filing with the right insurance company, because I’ve had the same number for over thirty years?

I had a suspicion they weren’t doing it correctly since I live in Virginia, the company who provided the service was is in Texas and my insurance is from New York so I wanted to confirm. I even asked twice and was dismissed, they assured me they were the experts “they do this all day long they know how to file insurance claims”. 

Then a few weeks passed and a gentleman called saying that my insurance company wasn't recognizing my insurance ID # and the claim was denied. Could I confirm the number again, so I gave it to him. I asked again whether the claim was being sent to the right insurance company; again I was dismissed because they know what they’re doing! 

Then again it happened with another person calling......

Then again it happened with another person calling.....   

photo credit

The other day I received a voice mail from Ramona, the insurance collection specialist; she asked if I would please call her back. I did; every freekin day for three days and she NEVER returned my phone call. Needless to say now I'm really pissed.

But not as pissed as I was when the letter from her came on the fourth day, saying” they would encourage me to get involved in the processing of this claim”. Charges due $4,577.00 for the medical equipment; claims to date have been denied.

The denials were NOT from MY INSURANCE COMPANY! * insert screams and foul language of your choice here*

So I'm left pondering these things.

What if I was an elderly person or otherwise a vulnerable person, not familiar with my benefits? Is it possible that the letter I received could have been construed as a bill? I think it’s possible. I’m wondering how many people would have just sent the money in thinking it was due!

This company employs a staff of people to file insurance claims and secure payment. In today's economy there are tons of people who would love to have a job and would actually work- do the job they’re paid to do.  What burns my ass is that not one person including the insurance collection specialist called the insurance company listed on the authorization form; does that make sense to you?  

I called my insurance company and they didn't have a record of one single claim or call from them requesting payment or asking for assistance on how to properly file a claim. They are participating providers (duh!) and the authorization form has the name of the insurance company written on the letterhead. And the $4, 577.00, never gonna happen, they are contractually obligated to take a reduced amount.

I arranged for my insurance company to call Ramona, they left her a voice mail too, I’m not holding my breath if she'll call them back.

Yippee you cancelled my homeowners

I hate loose ends. I guess it's part of my personality. When things are unfinished or left up in the air it makes me want to scream! Well maybe that's a bit dramatic truth be told it does make me uncomfortable.

So today when I opened an envelope from my insurance agent who covers my second home in Florida only to find out at the end of the policy in Feb. 2012 he is canceling the home owners, my first thought was to find another policy right away. State Farm is getting outta dodge (Florida) or that's the rumor. So they cancelled us - reason because we don't reside in our home full time. O.K it's a second home, we can't exactly do a Solomon and split ourselves in half can we? And they've been covering us for years, it sounds like a load of shit to me that is their excuse for canceling us that is. The timing as the first hurricane bears down on the east coast doesn't go without notice to me or my husband. It's not going to hit Florida but it still makes me wonder!

So now comes to the part of me leaving things unfinished, not gonna happen so I jumped right on my laptop and did a search for insurance. So I popped in the address; twenty minutes later we got a call from the nicest guy representing an insurance company. Since we're twenty minutes from the beach and haven't ever made a claim, he wrote a policy for the house. E-mailed it for our approval and we'll finalize it on Monday.

You want to hear something funny? Turns out all things included it costs half of what we were paying with State Farm. Isn't that that our good luck? Not that I've ever had much but hey whose complaining. Insurance laws require that State Farm refund any payment they've received in advance and  I've payed for the year.  As soon as I get my new policy in my hand I will cancel theirs a.s.a.p then the refunded amount basically pays for the new policy. Not bad huh?

my leg wound, a cow and a penis?

My head is spinning, yet another week has past and my leg trauma drama read here continues with another therapy. The wound vac      (negative pressure wound therapy) is gone for now and am now being treated with what they call an unna boot. The wound vac as it happens was damaging the skin around my wound so they decided to give me a break hopefully for good.*fingers crossed*

This new thing the unna boot is a wet gauze bandage soaked in zinc ointment which will heal my wound and help treat my damaged skin surrounding it. Then on top of that they wrap this other type of dry ace type bandage- tightly. Its wrapped from the arch of my foot to just below my knee, my legs feeling a bit claustrophobic- can that happen?

Truthfully, it's rather like wearing wet underwear and putting dry pants on top YUCKY! This stays on 24/7 like the dumb vac. I have to put an knee high stocking so my leg doesn't get plastered to the sheet at night and keep my leg up for hours on end during the day so it doesn't swell. This whole affair which started as a simple bruise and a few blisters is just getting more and more bizarre every week.

If I could run out to the mailbox every day to see if my insurance pre-authorization is in the box, believe me I would. Tomorrow, I think I'm gonna pre-schedule an anointing with my parish priest- some priest will do it some won't, we'll see about my new pastor. I thinking positively that the ok for the skin graft will go thru and I'll be good to go on all fronts.  That might happen in three weeks, prayers please!

I wish to heaven I was an accomplished humor writer because I was doing a bit of research on the type of skin graft he's planning to use (Apligraf),  I read that the skin is made from the cells from infant foreskin (that would be from a penis for those of you who live in a cave and are not informed on what foreskin is) and bovine collagen; no lie. Like skin from my ass wouldn't have been funny enough! This is just to funny and will have to wait for another post.

checkin the facts

Do you check facts- look into things even though people might tell you something and sound completely certain? The girl at my doctors office made inquiries with my insurance company the other day to confirm coverage for a procedure.

She, while I was undergoing treatment checked to see if I could have three different types of grafts and all weren't covered she was clearly certain. To say the least the doctor and I were unhappy, this news easily could add weeks if not months to my treatments and healing process.

I wasn't pleased since this my first experience being denied coverage in 30 years with the same company. I even wrote a post about it no-way-not-chance-denied. I will say maybe that post might have been a bit premature. I should have checked my facts, something I usually do; I was remiss.

After stewing about it for a few days, forming my arguments pouring over all my coverage and finding no such exclusion I decided to call and inquire about two things.

1. did she receive the right information from the right place.

2. if she did receive the right information and grafts weren't allowed, was there a process to challenge my coverage and if so how?

Well guess what? I called both sections of my company; checked both the hospital and doctor coverage  thoroughly and guess what? After lengthy phone calls they have no record of an inquiry the other day    ( they keep records of all calls and inquiries) they get logged into the system by insurance ID number. *curious*

There is a process in place it takes 14-30 days to get everything pre-authorized;  since it's not an ordinary/common procedure, I've opted to do this. A few quick faxes with a bunch of info and hopefully we'll be in business. My doctor's gonna be happy Monday when I tell him!

So now instead of having to worry about all this insurance nonsense maybe now I can start worrying about whether a skin graft is as painful process; does anyone know?

no way, not a chance, denied

I have the same health insurance for the past thirty years.I go to the doctor, I pay the co- pay he treats me-the end. In the event that I go out of network I pay the 20% after I reach the deductible, no problemo. Never once has the insurance company placed itself in between the doctor and my care as a patient; that is until now.

And the things that burns my ass is that I believe their decision isn't in their best interest either; meaning in the long run their decision is going to cost them more money. Then there's the little matter of my doctor who went to medical school and has twenty year of experience being overruled by some bureaucrat who knows nothing about me. I'm infuriated that this could happen.  

My leg wound  has required considerable medical attention. Since mid April I have needed weekly doctor visits,  wound treatments and medications. Beginning in June I have needed home nursing visits three times weekly added to my Monday doctors appointment and NPWT -Negative Pressure Wound Therapy 24/7. All these thing necessary to close the wound which is pretty much a crater in my leg that was caused by an infection after my fall.

Yesterday my doctor decided three more of NPWT and then he thinks I'll be in perfect shape for a skin graft. Grafting will move my healing along considerably; this to me means less nursing, less medication, less doctors visits to the Wound Clinic (which is part of the hospital) and less bills for me to pay. So he contacted the insurance company to find out which biologic graft my insurance allows.  Guess what their response was? No. Apparently I am going to have to throw my leg on an open fire and burn the thing to qualify for a graft.

My condition does not qualify for a graft so the solution is for the insurance to keep on paying hospital bills and home health care bills and NPWT rental fee's and medications and doctor fee's for as long as it take for my leg to heal using the therapies they've been using; no rush right?

Why make heal it quicker put a $1,200 graft on it? It makes much more sense to pay a home nurse $400.00 a week for up to nine weeks that's much more sensible. And while that's going on I'll just keep those weekly visits to the hospital's Wound Center and generate some more hospital bills while I'm at it.Oh and lest we not forget the doctor's bills that the insurance company will have to pay.
They're being dumb! 
It makes no sense to me at all.

my leg trauma drama

If I could  have anticipated that my week at the beach and the fall that I took when we vacationed there read here in my post-  WE DUCKED DOWN TO THE BEACH  would have turned into such a long and drawn out nightmare then I might have stayed home. I've explored the internet and some natural and home remedies but to no avail  the legs wound is still unhealed as I wrote in my post- MY LEGS A PAIN IN THE ASS.  I have gotten the best care possible from my regular doctor; but it's clear it was time to explore new options.

So my doctor sent me off to the Wound Care Center yesterday and met my new doctor. He will be the guy who will tend to my wound for what will be roughly the next 16 weeks. Yup you read it right 16 weeks, my summer is ruined no beach no swimming...sucks right? I have to go see him every week on Monday afternoons for a debridement (he scrapes) the wound with a tool to clean off the tissue so it will heal from the inside out. Apparently the trauma from the fall was so deep that the wound formed down as deep that the muscle is exposed in places, yuck. If it doesn't heal from the course of treatment he's set forth, I'll have to have a skin graft done. Crap! 

Every day I have to put special cream on it, bandage it in a sterile bandage then wrap my leg from below the knee to my ankle in an ace bandage. For the entire day every day for the whole course of the treatment I have to wear that darn ace bandage except while sleeping of course. Four time daily I have to raise my leg for 1/2 hour above my head and lay flat on my back and rest the leg. I'm never gonna get anything done! Then he told me, actually it was more like a warning. If I saw any sign of infection, redness or if the cellulitis returned I was to go straight to the hospital period. That I have taken enough oral antibiotics that I was going on an IV in the hospital no negotiation no questions asked!

With all seriousness I don't know what I'd do if I didn't have medical insurance! I am so grateful that I am covered by a good policy (medical, hospital, drug coverage). I can't imagine what people do without it.I can only imagine that this treatment will be a costly one. Even the twenty percent that I'll end up paying will probably be a good amount. I really liked the doctor I should say and I'm so grateful for this man, the doctor who has taken on my case. He was in fact quite knowledgeable and I'm confident  in his abilities.

Let's pray all goes well.

after my fall- what's a gal to do?

A few weeks ago I wrote a post on this blog about how when we were on vacation at the beach and I fell down the stairs- read here WE DUCKED DOWN TO THE BEACH for that pleasant little story.

Little did I know how much trouble that fall would cause me at the time I considered myself lucky after all I was just bruised and I didn't break a thing. Two blisters developed on the back of my leg below the calf but above the ankle  from the pressure of my leg rubbing on the wooden step in the process of the fall. Needless to say the bruises below healed with time but those blisters got bigger and then they broke and that my friends is when the infection set in and thus my trouble began.

To my disappointment my doctor was on vacation and I had to see a substitute doctor, he didn't exactly inspire confidence in me and told me the bare minimum, I had an infected wound and he gave me a prescription for antibiotics. Further complicating things I am allergic to penicillin and that is always the medication of choice with bacterial infections. I knew I had cellulites although he didn't mention it.  I'd seen it before I was familiar with that redness, the heat, the swelling; my infected wound was surrounded by what I had come to understand as an army of white blood cells trying to fight off my infection.

I have never been a slow healer, nor am I a diabetic but these blisters are far from healed and still infected even though I've had them for almost a month. My doctor is back from vacation so I of course went right back to him concerned about all the redness and yuckiness going on-still. He was not pleased at the passive way in which the other doctor treated me- choice and quantity of antibiotics- no topical antibiotics given either . So now I have to take 2000 milligrams of antibiotics per day, plus I am to apply a stronger- prescription cream, better then the over the counter one I had taken upon myself to use.

If by Monday it hasn't clear up substantially when he calls me then I'll have to go on IV antibiotics. This should be something since I live in a rather rural area and will require some type of home nursing service for that.  I'm quite confident that my insurance policy is a good one so I'm not at all worried that it will be covered. I am however more worried about the availability of a provider to come to the house given my location .

This whole thing just seems so ridiculous don't you think? I couldn't make this stuff up if I tried; all for a couple of blisters!