ERMEHGERD SCHNERZZLES

Stolen from CuteOverload. CRANK UP THE VOLUME, PEEPS.

I have the letter!

Yes, my friends, the letter from the OEB that tells me that I am getting Moneys from the insurance people is here in my hot little paw. As I said to La Belle Dame, though, I ain't chillaxin' until that check's cleared.

With my luck, BCBS will skim 90% of it off for processing costs. Which will, of course, lead to the recently-repaired Hell Bolts being sheared again.

*** *** *** *** ***

I have made a new friend.

A few days ago we got one of those patients in: you know the sort, that come without CDs of scans and with minimal information from the transferring hospital. Luckily, this nice little old lady had no medical history, and not because she'd never been to the doctor. She was, at eighty-something, simply that healthy. A lifelong non-drinking, non-smoking vegetarian, she'd had a TIA as a result of a brief dip in her already-low blood pressure.

So, upon her arrival to the NCCU, I paged the dude on call. And paged and paged. Finally, I sent a text page reading "Are you alive? If so, call Jo at XXXX. Minimum three minute rates apply."

The dude on call called me back immediately and apologized. Turns out that between consults and admits at Holy Kamole, he had more than fifteen patients to see. I said I just wanted him to know that I'd gone ahead and entered orders under his name, using the NCCU order protocol, to which he said, "Oh, are *you* the one who entered all those brilliant orders? You clever little thing, you."

"Yes, darling," I said, "I did enter those orders. Now, you'll have to swing by and work your magic on our sweet LOL, but the rest is taken care of for now. Just decide whether you want heparin and let me know, okay?"

"Brilliant!" he replied. "I'll be there as soon as she gets to sleep and the nurses have relaxed for the evening."

He greeted me the next morning, after no sleep, with a muffin. He thanked me for saving him a half-hour's work and making his life easier.

I may have to reassess my attitude toward new fellows.

*** *** *** *** ***

It dawned on me yesterday that when my boss is not around, stupid shit happens much less often.

*** *** *** *** ***

The Apocalypse is nigh: it is August in Central Texas, and I have all the windows open. We've gotten some rain in the last couple of days, and it's now a balmy 70* at just past 0800. All the fans are on, the a/c fan is whirring away, and the cats are napping on the north-facing windowsills.

After two years of really weird weather, this is a relief. This is how it's supposed to be here: daytime highs in the 90's, occasional rains that flood the highways, and brisk mornings. Ever since everydamnthing burned down last year, I've been watching the skies and the winds. Normal is a little disturbing, but I'll take it.

*** *** *** *** ***

Three big things are going to be happening here in the next few months:

1. A template and step-by-step instructions on how to fight insurance companies. Once the template and instructions are up, I'll put permalinks in the sidebar for anybody who wants to use them. Not everybody has the resources and time I do; it's a no-brainer to distill everything I've learned in the last two years, and all the expert help I've had, into something you can fill in, print out, and send off in order to get your money back.

2. HN might be migrating to a new platform. I haven't decided yet. If HN does move, it'll have the same look & feel and the same layout as before, or as nearly as possible.

3. I am dog-hunting. More to come on that as things develop.

Well, well, well.

That appeal? The one that got lost, then found, then didn't have enough paperwork attached?

JUST GOT APPROVED FOR EIGHTY PERCENT REIMBURSEMENT.

They just called.

You may commence celebrating.

Hi. My name is Jo, and I am totally demoralized.

Or not. It's been a rough week.

I talked to the friendly folks at the employee benefits office on Tuesday about the Ongoing Drama Of The Obturator. (For those of you coming in late, the prosthetic I wear to replace my palate/protect my airway/allow me to eat, drink and talk was not paid for by insurance. Given that the whole process cost as much as a new car [Hyundai, not Mercedes], I was a little peeved by that, especially given that the insurance company [Blue Cross/Blue Shield of Texas] first denied that it was medically necessary, then failed to follow their own rules on covering prosthetics.)

So I appealed, all the way to the Office of Employee Benefits. Beloved Sister and I worked up and sent a multi-page appeal letter complete with charts, diagrams, copies of reciepts, photographs of my mouth post-Harrowing, and ninety other things. The nice folks from the OEB asked me to send them a couple of additional pieces of paperwork, which I did. . .and I waited. They told me the whole kit and kaboodle had gone to some doctor who reviews things like this for them, so I waited.

And waited. I had no idea how long it would take for said doctor, who probably has a desk full of appeals, to get his head around mine.

So, when I called on Tuesday, I was expecting that things might not be fresh in the OEB's hivemind, given that the submission date for my appeal was back in March. I was not expecting them to tell me that the case had been closed for lack of documentation.

Well, to be more exact, first they told me that there wasn't anything there. Then they told me that yes, they'd found the file, but it'd been closed for lack of documentation.

Now: given the eight-page letter (with charts, diagrams, and circles and Xes on the back) and the two times I faxed the same information to my contact at the OEB, this was not what I was expecting. The nice contact at the OEB told me it would take her a couple of days to get everything together (right after she told me that everything was printed out and gathered up) for her boss to look at, so he could decide what was going on. So I told her I'd be calling her first thing Friday morning.

I am, to be nice about it, gob-fucking-smacked at this whole thing. I mean, I understand if they deny the appeal. Even though BCBSTX claims to reimburse non-network providers of prosthetics at 60% of cost, and even though they claim to reimburse at standard market rates (manifestly untrue; they actually reimburse less than Medicare or any other provider), I can see that they could finagle a way to deny my claim. That is, after all, their business.

Let me be a little more clear for you: The purpose of an insurance company is not to leverage your premiums into providing efficient, quality care for you. The purpose of an insurance company is to make money for their shareholders.

However, going back to the OEB: the University of Texas is a huge system, with many, many employees. The Office of Employee Benefits is, by necessity, the sort of bureaucracy that can handle that volume of employees. You would think that they could, at some point, have sent me a letter--not a certified letter or a wax-sealed scroll via elephant, just a letter--to tell me that they'd closed my file because I hadn't submitted some document or another.

Or, alternatively, they could've contacted me at the address, two telephone numbers, or email address that they had to let me know they needed more paperwork.

But they didn't.

Somewhere, somebody fucked up. I intend to find out who it was, and make them figure out how to fix it.

At first I was coldly enraged. I told Beloved Sis that the noise she was hearing was the sound of the bolts that hold Hell down shearing loose. Then I spent two days feeling horribly sick and depressed and stressed out. It's amazing how canalized anxiety becomes in the body.

Now I'm just peevish and determined.

Peevish. And determined. Very determined.

Odds, Ends, Updates

OEU the first:

I saw Dr. Crane today and had my tongue yanked around and both of his hands in my mouth at the same time. The exam was clean, the MRI looked "great" (his words; he's not given to superlatives) and I don't have to see him again until February. I won't have any scans then, either.

I said, "No scans?" He told me that at two years, in his experience, it's safe to begin backing off the surveillance scans and just go with eyes-on exams. It's simultaneously exciting and weird to know that my interior doesn't have to be irradiated for everybody's psychological comfort. I worried before every scan; now I'll worry that I'm not *having* scans.

"Nearly cured" is a strange place to be.

OEU the second:

Now that I've told Mom, it's time to tell you guys: I'm dating somebody. Seriously. As in, Talking Marriage Serious. He's marvelous beyond description, with just enough of the annoying human things that everybody has to keep him normal, and I've known him since we were both teenagers. His name is Brother In Beer (yes, the one who sent the lovely flowers after surgery). He's intelligent and funny and sweet and writes beautifully and routinely throws himself down rocky hillsides while perched on a bike. (Yes, he wears a helmet.)

I'm pretty stoked.

OEU the third:

Work sucks. We're staffed for twelve in the surgical CCU and have eighteen to twenty patients every day--even our code bed is full--which means that the staffing in the neuro CCU has been short. If everybody in the SCCU is tripled, they can't exactly send two people to help us out in the NCCU with our six or seven patients.

Plus, we've been having a rash of codes lately.

OEU the fourth: 

Aside from the staffing thing at work, things are going really well around here. I've not been *here* as much as I'd like; there's a lot of writing I've been doing for money that cuts into my blog time. As soon as I get this month's stack of articles sent off, though, I'll tell you funny stories about the Guy With No Memory At All and touching stories about bunnies.

Basically, this summer can be summed up in one well-known phrase: Two out of three ain't bad.

Semi-demi-hemi-annual MRI today!

And no, I don't have the results yet. I won't for several more days.

This was how it went:

http://www.marriedtothesea.com/072412/