I am gonna whine

Sunday, early afternoon, and I am cleaning up.  We are recyclers, but the city in which we live doesn’t make that easy.  We have to gather up our recycling and tote it about in order to love our planet, but we do it.  So Sunday, as I’m picking up, I put all of our recyclables in a bag, planning on taking them to a recycling center the next day.  They are sitting in the open trash bag against our front door in case I come upon a soda can or empty soap bottle whilst I go about my other cleaning business.  Bart, chubby feline, begins nomming on the bag because he loves to eat plastic.  Okay.

I figure it’s pretty full and put said bag out into the shared hall of our building while I finish my last task with every intention of getting the bag and putting it into the car in just a few minutes.  I wasn’t ready to go outside because, well, I didn’t have pants on, okay?  It is kind of hot, and why should I wear pants in the summer if I don’t have to?

Meanwhile, The Boyfriend wakes up and starts having explosive diarrhea and simultaneously begins vomiting.  My attention immediately switches to him.  Instead of doing other stuff, I'm worried about him dehydrating because this goes on for HOURS.  Thirty hours to be exact.

Cut to today, nine o'clock on a Monday night.  He's been sleeping soundly without waking up to shit every 20 minutes for the first time in a day and a half and I’m lying in bed next to him vigilantly watching because he’s hardly kept down anything.  Suddenly there is crazy knocking on the front door and doorbell ringing.

What the holy goddamn fuck?!

I jumped straight up as did The Boyfriend.  I told him to lay back down as I run out to the door.  Normally I make him answer the door because this place is SCARY, but this time I am PISSED that someone woke him up and I don’t want him out of bed, jarring his stomach around.  In probably fifteen seconds I’m at the peephole.

NO ONE IS THERE.

I am NOT going to answer the door to no one.  I wait, look about, there’s no noise.  If someone’s waiting on the other side with a gun or something, I decide I don’t want to be there, so I go back to The Boyfriend, tell him to get back in bed (he’s out at this point) and follow, telling him no one’s there in a hushed voice.

Then the banging and ringing begins again!

Only this time with the drunken slurs of our landlady/super/whateverthefucksheis, “It’s Drunken Landlady!  You need to clean up this trash out here!  Blah blah, *hic* blah!”

So I immediately open the door to get her to shut up.  I realize I am in the wrong, but am also really pissed at the way she’s handling this.  Before I can even say hello, she goes off about this trash and how we can’t be doing this because if we do than everyone else will and “That’s trash—it doesn’t belong in the hall it belongs in the dumpster!”

I was really taken aback, and I wanted to apologize initially, so that’s what came out.  I started telling her I didn’t mean for it to happen, but she just went on and on, so I interrupted her and tried to explain what happened, that I had completely forgotten it was out there, and then The Boyfriend was behind me and he was so pissed and starts telling her she doesn’t need to come over banging on the door and screaming.  So I try and explain about how he was really sick and I forgot about the bag, and she just yells over me the whole time, really inappropriately—that’s not how adults deal with a problem.

So I put my hand up and say, “WAIT!”  She finally takes a breath.  I’m like, “Before you started screaming I had every intention of apologizing.  I had forgotten this was out here, so I’m sorry.”  I was saying it with a hard tone, but I wasn’t screaming by any means.

She kind of settles down, then goes on to say, “Well we’re talked about this before.”

Excuse me?  My mind went completely dumb.  We had?  Then I remembered.

Last fall I had these bites all over me.  My whole body swelled up.  TURNS OUT IT WAS BEDBUGS.

Anyway, the fuckers were coming from the apartment above us, so we had to truck all of our clothing out in big plastic bags and wash it at a laundry mat, AND TAKE THE CATS WITH US, while some strangers roamed around our apartment and sprayed it.  Anyway, in that process, we had like eight bags of clothing lined up in the hallway to take to the laundry mat.  She happened to come by at the same time—WHILE WE WERE CARRYING THEM TO THE CAR—and tells us we can’t leave trash in the hall.  How fucking stupid can a person be?  We tell her, WHILE CARRYING THESE BAGS, that we are moving them RIGHT NOW and they’re not trash—they’re our clothing because HER BUILDING gave us bedbugs (she didn’t know because the building is owned by a different company, I don’t really know her exact role).  We then had a conversation about the whole thing.  She settled down after we explained it.

So back to the present, I remember the bedbug situation, and I go off, “Seriously?  You mean when we had eight bags of NOT TRASH out here and were moving it when you came along?  That was NOT us leaving trash out!”

She basically says whatever and tells us it’s her job to check on these things.

Ah.  Finally I know what her job is.

Then she kind of goes to leave and I decide I’m not done.  “You know, you can’t just disappear after you knock because I am NOT going to answer the door to no one.”

She get all offended then and says, “Well, I guess I just have to announce myself from now on!”  Rolls her eyes, throws her hands up, that sort of thing.

I was downright PISSED.  I point to the shared door and tell her when other people are leaving that open constantly, I am not inclined to just answer the door when someone comes literally pounding on it at nine at night.  She seemed to get it then, she even told me she got it.  The Boyfriend warns us the cats are going to run out, so I basically shut the door on her, but she was already walking away.

What pisses me off so much is that she chooses to pick on us when the other people in this building are utterly disgusting and the general upkeep of the whole place is pretty much nonexistent.  The other tenants are loud as all fuck and are all perpetual smokers (but so is she so of course she sees no problem with a little extra cancer floating our way).  I can’t use my bathroom in the morning without feeling like I’m showering in an ashtray.  The people who have balconies have shit strewn all over them (I think someone is even growing pot), the dumpster is always overflowing and smells terrible, and the parking lot is filled with an assortment of cars that don’t have parking tags in them.  Half the screens in these windows are falling out, the doors have one inch gaps underneath them, the tile in the walkways are all ripped up, the cement stairs are crumbling, the washers both leak, the dryers smell like burning, and I could go on and on, but that’s really enough to prove my point.  How does one bag of trash warrant her tirade when all this other shit is going on?

And what made talking to us like that, like we are children, seem appropriate?

Total lack of sense.

Sorry, I just…ugh…I couldn’t.  FUCK LANDPEOPLE!

My Apologies

Yesterday was a good day.  I found out that I am, pretty much, finished dealing with medical bills.  Bills I incurred SIX MONTHS AGO.  I should consider myself incredibly lucky because most places would have sent me to a collections agency for not paying them after 30 days (except, oh yeah, that happened too), but that didn't relieve the stress of having to call four separate billing agencies weekly (more often than not a few times a week) to keep them from turning me over to debt collectors and ruining my non-existent credit.

So this blog is supposed to be an explanation for my inability to be myself for the past half a year.  Besides the fact that I very literally almost died, lost my car, missed a lot of my paid-by-the-hour-no-vacation-or-sick-time job, was in extreme amounts of pain, had to buy another car, got dropped from my car insurance, and am now suffering post-traumatic stress disorder every time I'm in the passenger's seat (and am not even considering the driver's seat still), I have been totally stressing out about these bills.  I do have insurance, but they denied covering anything for months.  Thankfully I am also so far below the poverty line that the leftover bills from the hospital were covered by hospital charity, but I had no idea I was going to be awarded that until just yesterday.  Hurray!

I also thought this might be a good time to share with you all the cost of medical care in America.  Working in a doctor's office I understand why some things are charged the way they are, there's liability and massive overhead for healthcare, but HOLY FUCKING SHIT CHECK THIS OUT:

That is just page one.  Let me break this down for you.  Just to stay in the room for one night it was $1,605.  That's like 8 days in the Waldorf Astoria Orlando Hotel via Expedia.com.  Believe me, it wasn't that nice.  THERE WASN'T EVEN A MINI FRIDGE.  Not that I would have broke into that shit.  Can you imagine what peanuts would be?

Then they drew blood of course and ran all these tests.  But like, I don't exactly see the point.  ALL my scores were totally out of whack (I have access to the OhioHealth database at work so I looked my own results up) which you would have had to guess they were going to be all fucked up because I'd just been hit by a car.  And of course it had to be taken twice to make sure everything went back to normal.  Or something.  Because they obviously had no idea what normal was for me...

Page two is interesting because of the radiological stuff.  Here you can see the hospital getting its machines paid for tenfold!  Also, be sure to note that these fees are for the pictures alone--they do NOT cover the radiologist's charge for reading anything.  That bill will come later.  Or in my case not at all until some rando calls me and asks for my credit card info.  More on that later.

To this day I don't know the actual difference between physical and occupational therapy and I have apparently had both!  I guess two girls showing me how to use my crutches for about 10 minutes and having me go up a few stairs was the physical part and ultimately making me puke was occupational?  I did continue to vomit the rest of the day, and I was really good at it.  I mean, I would have hired me.

Now this page...this page burns my biscuits.  I don't know what all those charges are under the catheter, but oh my fuck it better not be for inserting it the THREE SEPARATE TIMES.  Those bitches should have paid me for that--no one should have three strangers fucking with their vagina for that long and not make some profit.  Also, "ER Level V."  Remember that.

$49.20 FOR A SODIUM CHLORIDE INJECTION?  FOR FUCKING SALT WATER?  FOR SHIT THEY GET IN BULK FOR LIKELY LESS THAN A DOLLAR A BAG?  SHIT THEY GET FOR FUCKING FREE WITH INFUSIBLE DRUGS?

Enoxaparin is the generic name for Lovenox which is essentially a blood thinner.  I had to self inject that stuff everyday for a month afterward so I wouldn't clot and DIE.  A month's supply of that stuff costs $500.00 at the pharmacy.  Yup.  That's a lot, but it's also only like $17.00 a shot.  As hefty as that is, it is significantly less than the $96.60 I was charged for them while I was at the hospital.  Also, rat poison is like $5 a box and it is PRETTY MUCH THE SAME THING.

AND IN WHAT FUCKING WORLD IS HYDROCODONE $3.75 PER PILL?

Remember ER Level V?  I knew you would.  Well what the hell is this almost $6000 trauma activation fee?

I'd also like to point out that I spoke with Dr. McGann once, he was a total asshole, and I was sent a separate $900 and something bill for his services separately.  My orthopedist who I followed up with was about another $1000 for two separate visits and some x-rays, a chunk of which I paid for out of pocket because, lucky me, my accident happened in December and my insurance rolled over in January so meeting my $5000 deductible (yeah, you read right--three zeros) stopped mattering when I had to go for a follow up in the new year.  Then I had a $1100 ambulance service fee.  Ambulances are run by separate companies, just so you know.  And the people who work in their billing departments will call you a liar when you're telling them the truth.  It's a fact.

And remember the radiologist's fees?  Well, I got a call from a collection agency asking me how I was going to pay this $43 bill.  I had no idea what he was talking about, and could barely understand him to boot, and had to practically beg him to find out where the bill was from.  Then I had to google the name and get a phone number, call it, be asked for my account number, explain that I don't know what it is because I never received a bill, be told they need an account number, tell them again I don't have access to it, but I did get a call from a collection agency, and finally give her my name which she used to pull me up just as easily as with an account number.  She tells me they billed the insurance company five times, denied all five times, then billed me, THE LETTER WAS RETURNED TO THEM BY THE POSTAL SERVICE AS UNDELIVERABLE (the USPS is pretty fucking sucky here at our apartment), and so they sent me to a collection's agency EVEN THOUGH THEY CLEARLY HAD MY PHONE NUMBER TO GIVE TO THE AGENCY AND COULD HAVE JUST CALLED ME.  When she told me the bill was for $39 I almost shit myself.  I told her if I had gotten a bill for that little bit I would have paid it with a smile on my face.  Eventually they straightened everything out and I paid it out of pocket even though insurance should have covered it, but that scared the shit out of me.

So hopefully this kind of explains why I have been in not the best mood for the last half a year.  Well, no, probably not, but maybe something got knocked funny in my head.  They never did a brain scan, after all, so we may never know.

I also want to be clear that a big part of showing you this was to make you all appalled at healthcare costs, not to be me just bitching about it because, while it sucked, I am not in debt now and I'm not having to pay off thousands of dollars like I know a lot of people get stuck with, so I am very thankful.  I also understand, like I said, the overhead at a hospital.  I understand doctors need to make $500 to look you over and do nothing for you.  I GET THAT.

I am most thankful, however, to be done with it.  And maybe now my chronic diarrhea will go away.  We'll see.  And if it doesn't you'll be sure to know!

The Real Evil

If you're unhappy with healthcare in America, well, first of all just be happy to be healthy.  Second of all, direct your anger at the right places.  I'm not saying I know exactly what goes on everywhere, but holy shit there is stuff going down that is regoddamndiculous.

This will be a meander away from me trying to be funny and just be me being really upset.  But do carry on, I beg you.

Among many other duties at my job, I get medications approved for patients.  That process alone, beyond just being frustrating and near impossible, is mind boggling when you really sit down and think about it.  So, here's how that "works."  You have insurance.  You pay for that in some form or another.  That insurance only covers so much of whatever you get.  That insurance will also probably have some kind of prescription coverage with it.  The insurance company then sets up a formulary--the drugs it deems appropriate for you, because, you know, they know you, your medical history, and are your doctor or at least think they are.  If you need one of those prescriptions, you get it discounted.

But if your doctor, God forbid, prescribes something off formulary you have two choices: pay full price or your doctor has to attempt to get an authorization for that medication.  That is where I come in.  The pharmacy notifies us that the med isn't covered, and I have to call about 17 different numbers until I can get someone to fax me a form where I put down your information and answer their questions like what your diagnosis is and what you have tried and failed.  If you haven't tried enough random medications that were cheap and just might have worked to save them money on this pricier one that your doctor who went to medical school has prescribed for you, the insurance company will refuse to cover the medication.

Isn't that fucking insane?

Despite that your doctor says, "I think you need Whatevercillin," since it costs $20 more than Whachamacallitumab which is sometimes used before stepping up to Whatevercillin, the insurance company INSISTS you try it.  Possible reactions or the pain/sickness you'll deal with until you get to something that works be damned!

One of my favorite ones is when the insurance company asks if patients with like crippling arthritis who need an immune blocker have tried aspirin.  OF FUCKING COURSE THEY'VE TRIED ASPIRIN!  IT IS NOT FUCKING HELPING, OBVIOUSLY!

But it's a normal process, so my outrage at the whole process is kind of dulled.

It does, however, get really terrible when you look at specific cases and you see how some people are suffering.

We had this one lady with rheumatoid arthritis who had it for years.  She'd tried a few things without improvement, so was going onto another med called Enbrel.  In her history she had tried a drug called methotrexate.  (By the way, methotrexate can give you cancer, but don't worry about that.)  When this lady was on it she had an allergic reaction to it which caused her mouth to fill up with sores (like a lot of drugs in rheumatology, methotrexate kind of compromises your immune system).  Uncomfortable to say the least.  So over the course of her therapy after that, methotrexate was never used.  Now, with a lot of the meds this office prescribes, methotrexate is prescribed along with them because it makes them more affective.  Understandable.  So the insurance company, in the prior authorization, wants to know if she'll be taking methotrexate along with Enbrel.  No, we tell them, she is allergic to it, as documented.  Problem is, that documentation is from years ago.  Insurance company says they won't pay for Enbrel (literally THOUSANDS of dollars, but the evil of pharmaceutical companies is another story) unless she's tried and failed methotrexate again.  So the doctor is forced to put her on it again.  Her mouth swells up.  The pain she's in from her disease (which isn't getting taken care of because she can't go on the Enbrel) is only intensified because of these crazy mouth sores.  Thanks a lot, insurance.

The thing I am currently dealing with that sparked this whole rant, though, brought me to tears this week.  We have this man with ankylosing spondylitis, one of the most unfair medical conditions I have ever heard of.  The disease basically causes your spine and pelvis to fuse so you can't move and often causes a curve in the spine.  This patient just came to us a month ago, referred by his primary care doctor, after they found that in one short year the man had LOST SIX INCHES OF HEIGHT.

So the doctor says he needs to be on Remicade, an infusible medication.  We start the prior authorization process (because Remicade is like a bagillion dollars) and they take FOREVER to get back to me, so I call them.  Turns out they "never got it."

This is a clever trick that is all too often played by insurance companies.  If there is any way for them to hold onto their money a little longer, they will.  A patient who used to work for one of the bigger companies in Ohio said they were instructed to literally throw every third claim on the floor.  That sounds like crazy exaggeration, but with the number of things that I get fax confirmations on that were "never received," I believe it one hundred percent.

Anyway, I send things again (it is possible, I guess, that it got lost or whatever) and call for confirmation.  A week or so later it comes back denied saying that the patient hasn't tried and failed and disease modifying anti-rheumatic drugs (DMARDs).  Another thing the insurance companies LOVE to do is waste paper.  They fax us the denial and then also mail it to us.  So I get the fax which is just like "DENIED, MOTHER FUCKER!  TAKE THAT!!!" but then the mail comes and it says that they are denying our prior authorization for use of Remicade for his RHEUMATOID ARTHRITIS.  WHAT THE FUCK, ASSHOLES, THAT IS NOT HIS DIAGNOSIS!!!

Yet another trick those fucks use is screwing stuff up like that on "accident."  And, of course, only putting that information in the mailed letter, so if we were a bigger office it might get skimmed over that the denial was based ON THE WRONG DIAGNOSIS because the info was already received in another form.

(Side note: If you think I'm over reacting based on this single case, consider the prior auth I did two weeks ago for a patient to up his Humira from once every two weeks to once a week.  I sent everything off and then a few days later I got both a denial and another request to do another prior auth, so, confused, I called the medical review at the insurance company who said the second request was sent on accident (so if I had just done it, I would have been wasting more time and would have never gotten a response) and that the denial was because, quote, "Well, all the requirements are here, but whoever at your office filled out the form checked that the patient would not be taking Humira as a weekly dose, so you'll have to do an appeal."  An appeal for a clerical error.  As the woman went on to tell me that the appeal process would take fifteen to thirty days from the time received, I skimmed the form that "whoever at my office" (me) filled out and found the question CLEARLY marked with a yes.  I interrupted her, "Um, I filled this out and I'm looking at it right now, and it's marked yes."  She goes on to tell me that I still have to appeal because they have a no on file.  I say, "Really?  So the patient gets penalized because someone THERE messed up?  I don't understand how the fax of the form that I filled out is somehow different than the one in front of me."  And she says she has a photo copy of it right there and...oh...wait...someone must have read this wrong...yeah, I see it...that does say yes.  So she's all, "I'll fix this and call you back this afternoon."  So, if I hadn't pushed it and forced her to look at that form, it would have been maybe another month.  Tell me that wasn't on purpose.)

But back to my dude with the AS and the denial based on the WRONG DIAGNOSIS.

I call and tell them that he's been denied based on a diagnosis that was not written anywhere on the original form I sent them and has never been in his medical history.  They say I have to appeal anyway.  I'm not all that surprised because infusibles usually require appeals.  So I write up this letter saying that the guy HAS ANKYLOSING SPONDYLITIS in big fucking bold, underlined, non-comic-sans font and go on to explain that Remicade is considered first line therapy for the disease according to the FDA (who, by the way, might be the biggest fuckers of all, but they can be handy to quote in a jam like this) and that DMARDs are not an accepted treatment for this guy's disease as they have not shown to affect the spine.  I also mention that this guy is SIX INCHES SHORTER THAN HE WAS A YEAR AGO and that this kind of disease progression warrants treatment with an infusible.  I mean, the guy is stooped over so much he's rocking back on his heals to look forward and can't move his head 

independent of his body.

And what do they do?

Nothing.

I wait and wait and I hear nothing.

So I call and the woman tells me it's been denied (but apparently no one thought to tell us.  Really, we should have been expecting it, though, right?).  I say, "Even though the medications you are requiring him to be on are not FDA approved for his condition?"  She tells me that the insurance company has its own policies about drug approval.  "And those policies are based on what?" I ask, "Could you require him to have failed birth control for his condition too?"  This might not have been fair; SHE didn't deny him, the company did, but frankly I was mad, not to mention that I was so deeply seeded into this fucked up world that reason didn't really have a place in my brain anymore.  And she took it in stride anyway by ignoring me and repeating about the policy thing.

So now the doctor is trying to do a peer to peer evaluation of the thing even though they told us we couldn't because she is a badass and no one tells he what to do!  Peer to peers by insurance companies are equally stupid, by the way, because you call them to set it up and they call back like three times to confirm different call back dates and eventually end with, "We will call on Thursday or Friday between the hours of 8am and 6pm.  If the doctor is not available we will set up another time."  Then the doctor has to talk to someone at the insurance company who is considered a "peer" but is usually someone who is not allowed to practice anymore (for whatever reason like fondling his patients or killing too many of them) and who works for the insurance company so is not inclined to be impartial.

Anyway, that's where that is at.  And I am really upset.

I don't know how involved the government should be in healthcare considering the FDA is run by the government and they are LITERALLY ON THE TAKE (I'll tell you about that later), but someone needs to be monitoring the insurance companies.  I think this case may warrant being brought up to the insurance board.

The Worst Thing About Going To The Gynecologist

I totally deprived you guys of this wonderfulness.  I started it and never finished.  Here's what I had.


The worst thing about going to the gynecologist is that, after the whole thing, you technically end up buying her dinner.

Also The Boyfriend calling her the vaginologist isn’t that great either.  A nice thing about this trip, though, was that she surprised me by telling me they only do pap smears every other year now so this year I drove an hour to Newark to wait thirty minutes in the waiting room and another thirty minutes naked save for a paper gown and socks on a table in a cold-ass exam room, fanning my vagina which had conversely broken out into nervous sweats just to have a midwife come in and stick a finger inside me for about half a minute.  I feel so used.

The best thing about the whole experience was that she told me, “You’re funny” about seventeen times.  AND I didn’t even have to use any of my utterly hilarious gynecological humor on her that I’d spent the earlier week coming up with.  I felt only a little cheated not getting to ask her any of the questions I’d been mulling over while she cranked open my nanner so as to distract myself like, “How do my labia compare to other labia?  You know, aesthetically speaking?”

There is an unexplained beeping coming from somewhere

and I can't even find the fucking thing because, of yeah, I can't fucking walk. I can't go Christmas shopping. I can't go see my best friend graduate. One of these cats is driving me fucking insane because he can now get on the kitchen counter because our kitchen table was moved too close to the counter and I can't move it away because, of yeah, I CAN'T FUCKING WALK! Also, I can't stop the cat because I can't go knock him off. I have a squirt bottle, but that does little good when he hides behind the fridge. He also gets up on the dresser and scratches at the plastic on our fucking shitty windows and lets the cold in while I'm trying to sleep and I have to spray him to stop again and wake up very three fucking seconds and then I have to get out of bed and shut the door which takes like twenty minutes and I have to get Bart out of the room too who hasn't done a single thing wrong because he's just fat and stupid, but not bad, but he doesn't move when I tell him to so I have to yell at him and smack him with a shirt and I feel horrible but I'm just so goddamned tired and I hurt so fucking much that I can't sleep anyway and I'm alone at night all the time because The Boyfriend has to work so much and I'm awake all by myself during the day and I CAN'T FUCKING WALK so I can barely cook anything to eat and I've been constipated for the last two weeks and finally took a laxative and shit my guts out all day today, over five times today, and I got my period because I had to stop taking my birth control and of course it's like two weeks early so it's going to last now for two weeks and now I'm going to have menstrual cramps on top of everything else which is great timing because I have like 3 painkillers left and I'm off the birth control because of this stupid blood thinner that I have to inject in my stomach every fucking day and it hurts so much it's almost worse than my hip and I can't even laugh because it feels like my insides are trying to explode out of me when I do, so nothing can be funny and sometimes I sneeze on accident and sneezing is the worst thing ever, except it's not worse than just feeling like a useless piece of shit who can't even shower herself which I couldn't do today because The Boyfriend got called into work early and of course it's the day that I shit 5 times and got my period and my vagina is all mucus-y and I am just angry all the time and feel like poop and want to pass out after washing three dishes and don't think I'm ever going to get better.

And ya know what? I'm sick of people telling me I'm lucky. I FUCKING KNOW. I SAW THE GODDAMNED SUV SLAM INTO ME!!!

Also, THIS WASN'T MY FAULT. FUCK THE POLICE!!! SERIOUS-FUCKING-LY! They fucking charged me because I was the easy one to pin it on, because they knew very fucking well I would be too hurt and too inexperienced to go to court.

Sigh...

And if any of you don't agree you can go fuck yourselves because if I can't rant on my blog then where the hell else am I supposed to do it?

u

g

h

I cried today for the first time since this happened.

Today was just a bad day.

Thanks for sticking around til the end. This won't happen again.

Promise.