Category Archives: Insurance

Snot Funny

I feel like I’ve just snorted a few lines of fire ants. My eyes won’t stop leaking. I feel like shit.

Two mornings ago, I woke up with the beginnings of what is most likely the head cold mom had three weeks ago. At least she loves me enough to share with me. Why it took my wonky body three weeks to come down with this thing, I do not know. I can’t explain anything my body does – I cannot be held responsible for my body’s actions.

It started out with just a hint of yuck and some extra sneezing. Now, I’m in full-on, flat-out My Body Hates Me Mode – fire ants, leakage of facial juices, and the ever-present nausea that comes with postnasal drip.

Won’t someone kindly rip out my sinuses, please?

On a happier note, everything is worked out with my insurance. Well, everything I actually CAN work out with my insurance is all worked out. My pain doctor’s office got my new referral, insurance approved my morphine for six more months, and I didn’t even have to have them change my primary care physician because they had the right one on file! I’m still waiting for my insurance cards to arrive in the mail, but I can get medical care and prescriptions filled by bringing the letter they sent me wherever I go to get treatment.

I get all of my meds refilled next week, and I still have to find out which ones are the least expensive so I can pay for some out-of-pocket so I can have the more expensive meds covered by insurance (they only cover five prescriptions per month, bastards!).

Everything fell into place perfectly, which is unusual for me. It’s a huge weight lifted off of my shoulders. I have several big English papers due in the next few weeks, and now with this face-explosion of a head cold, insurance issues are the last thing I need or want to be worrying about.


Leave a comment

Filed under Insurance, Medicaid, Medication, Sick, TennCare

Bye-Bye BlueCare!

This morning, I called BlueCare to check to see if the prior-authorization for my morphine had been approved, or even requested in the first place. Instead of finding out the status of the prior-authorization, I received some surprising news.

As of March 26th, I have been covered by Americhoice! TennCare approved my request to be changed from BlueCare to Americhoice! I was told that the request would take about 30 days to be processed. It took THREE days.

I no longer have to worry about whether or not my appointments with my pain management doctor will be covered (unless they dump Americhoice patients, too).

There are things I still have to take care of, phone calls I still have to make (ugh, I hate the phone!), and ducks I still have to put in a row. Because it will take time to get my new insurance cards, and I have medical needs that are time-sensitive, I have to:

– Call Americhoice and see if they can tell me what my ID number is.
– Have them change the primary care physician they have on file for me, if it isn’t already correct (because they usually just assign a primary care physician based on how close they are to where you live – mine is more than an hour away).
– Call my primary care physician’s office and tell The Referral Lady that I need a referral through Americhoice to my pain management doctor’s office.
– Call my pain management doctor’s office and let them know that I need a prior-authorization through Americhoice for my morphine.

I’m off to check the mail and get these phone calls over with (ugh – anyone want to do it for me?).

Leave a comment

Filed under Doctors, Insurance, Medicaid, Medication, TennCare

Old People Diseases

When I say I’m only 26, but my body acts like it’s 86, I’m not fucking kidding! I was diagnosed with osteoporosis when I was 23, I started menopause when I was 21 (that was surgically-induced, although that wasn’t the original plan), and I had my first joint replacement when I was 20.

Now, I have another one to add to my list: high cholesterol.

On Wednesday, I paid a visit to my doctor to check up on some bloodwork I had done way back in December. I also had to get my osteoporosis medicine refilled, and I took the opportunity to complain about the difficulty I’ve had with breathing properly.

In addition to my osteoporosis medicine and a referral to a (very generous, I’ll get to it in a minute) pulmonologist, I left my doctor’s office with a shiny new prescription for cholesterol-lowering medicine. My total cholesterol was 291, but he said that my good cholesterol was high, which is, well, good! He also said that based on my age, diet (ha! I barely eat!), and malabsorption issues, the cause of the high cholesterol is genetic.

Ah, how my genes love me.

So, on to the pulmonologist! My difficulty breathing has been going on for a very long time. Most doctors that I mention it to just blame it either on dysautonomia (which we know I do have), or psychosis (which we know I do don’t sometimes maybe almost have). It got to the point where I was more scared of living with it in silence than I was of bringing it up with the doctor. Thankfully, he was concerned enough (or just wanted to shut me up enough) to refer me to a specialist.

The doctor told me about this awesome pulmonologist. He said that this doctor was young, but cautioned me not to let myself be fooled by this doctor’s youth. He went on to say that this doctor will search and ask other doctors until he figures out what’s wrong.

Unfortunately, TennCare won’t pay for me to see this doctor. Of course! That’s because this doctor is probably good. TennCare doesn’t pay for anything good.

But wait! There’s more! As soon as this pulmonologist heard that I have Ehlers-Danlos, he decided he wanted to see me anyway, insurance be damned.

Take THAT, TennCare! You can kiss the fattest part of my ass!

I’m excited and terrified about this appointment at the same time. I’m excited that I may finally get an answer as to why I have such a hard time breathing, but I’m terrified that the only answer will be that it’s something there is no treatment for, or that it’s because I’m crazy.

I’m just thankful that my family doctor took me seriously enough to send me to a specialist. Now, let’s hope that the specialist takes me just as seriously.

Leave a comment

Filed under Breathing, Doctors, Dysautonomia, EDS, Insurance, Medicaid, Specialists, TennCare

TennCare Trauma

TennCare, my terrible, horrible, no-good, very-bad health insurance, is run by a bunch of assholes who have no understanding of how chronic illness “works.” If they had any understanding of how chronic illness works, they would happily pay for more than five prescriptions per month, cover more than three long-acting painkillers (two of which are morphine-based, so if you’re allergic to morphine, you’re fucked!) without the patient having to put up one hell of a fight, and allow you to see certain doctors, like my pain management doctor, for longer than three months, or three visits, whichever comes first, at a time.

When it comes to medical insurance, my attitude is that of, “Sit down, shut up, and cover it WITHOUT me having to fight you for it.” I need not concern myself with time limits, visit limits, Preferred Drug Lists, or Prior Authorizations. Needless to say, TennCare does not share my attitude toward medical insurance.

I’ve had to constantly fight TennCare for everything I have. Seeing my pain management doctor is no exception. Today, I started fighting the good fight once again. This time, it’s to change “managed care organizations” (and check to see if my long-acting pain medication has been approved for six more glorious months). I have to change managed care organizations so I can continue to see my pain management doctor.

There are two managed care organizations: BlueCare and Americhoice. I have BlueCare. Apparently, BlueCare is either so shitty or so hard to work with that my pain doctor’s office will no longer participate in the BlueCare program. They do, however, participate in the Americhoice program (with no three-month/three-visit restriction!).

Now, my only choices are switch to Americhoice or stop seeing my pain management doctor. The latter is not an option – my GP’s office will not manage my pain and, as far as I know, there is nobody else in this area who is not afraid to prescribe narcotics to a 26-year-old. Not taking my morphine is not an option – if I do that, I’ll turn into even more of a homicidal vegetable than I am now (go ahead, let your mind take you there).

I asked to be switched to Americhoice once before, but my request was denied. I usually try not to be negative, but I almost expect to be denied this time around. Maybe my request will be approved, but then my pain management doctor’s office will drop Americhoice patients, too. That’s just my luck when it comes to this kind of thing.

Not only am I afraid of fighting my insurance, I can’t stop thinking that my pain doctor is just trying to get rid of me. I know this is ridiculous: I was the one who wrote to him, and if he didn’t want to see me, he wouldn’t have responded. I can’t seem to stop my mind from going there, though.

This morning, I woke up and made 57 thousand excuses not to call TennCare and get the process started. I hate using the phone to begin with – autism spectrum disorders and the phone do not mix – but I bit the bullet and took care of it.

And now we play the waiting game. The next time I open my mailbox and see a letter from TennCare, my heart will stop for a second and that all-too-familiar sick feeling will rise in my chest.

Until then, I wait, and I worry.

Leave a comment

Filed under Doctors, EDS, Insurance, Medicaid, Pain, TennCare