OK, maybe I was a little quick on the throttle there.  The cuerpo spent about 30 days going in the right direction before deciding to make a u turn and go back in the wrong direction.  So here is another entry in this account of my health.  As promised before, there are no opinions offered only experiences shared. 

Sweat.  Sweaty.  Sweatier.  That describes me.  I thought it was just my body reacting to all the hormones and other things I was putting into it as a form of tumor control.  To bring us all up to speed, 8 injections a week and 12 pills a day are my life.  And the church I am blessed enough to work with.  They are my life.  The first I noticed that all wasn't just peachy was preaching for said church and putting on a powerful sweat.  I mean the kind of sweat where people who sit near the front are bringing me water and handing me Halls drops.  At the end of the lesson, which I did cut short, I went outside to dry off, which is saying something for Houston in May.  A lady from the church told me that if I wasn't careful I would catch pneumonia.  And I'll be danged if she wasn't right.  I was getting ready to go see my son at a family reunion and went to the doctor because I couldn't seem to shake a cold.  It was then that the doctor, the well known and respected ENT Dr Clement Chinkoff asked me to spit into a tissue he was holding.  He meant stuff from the lungs, not garden variety spit.  I obliged him and he looked at it, swore (either that or he was planning a vacation and already thinking of some exotic island, said "sunny beaches") tossed the tissue in the trash can, put on gloves and a mask and said, "let's look a little further."  Dr. Chinkoff is an Oriental man who doesn't speak like most Oriental doctors.  It's because he was raised in Bryan, Texas.  Or as he says it "Brine, Texas."  He did some sample taking, asked me if I had any fairly recent MRI's of my head (which I did, don't ask me why.  No go ahead and ask me why.  It's because I've been to too many doctors who asked me "do you have your latest test results with you?" that I always carry them with me, or at least in the truck.)  I duly went out and fetched my MRI and he looked at it and said, "Here we go, look at this."  I said, "and a handsome brain that is, and look, what an exquisite tumor!"  He said, "no, I couldn't care less about the tumor, I'm looking at the sinuses.  Look at those, they are jam packed!  He said this with gusto.  A gusto I used to associate with "we've got something" and now associate with "a follow up visit is in order sooner rather than later, pay the lady at the front."  He looked at me with gravity and said, "You aren't going anywhere.  You've got pneumonia and a mother of a sinus infection."  You are going to go on 8 weeks worth of antibiotics, nasal spray that is so addictive that they are willing to give you the first month free just to get you hooked, and ear drops that you will have to put in several times a day and pack with cotton.  You are going to puke from the steroids and antibiotics but you look like a few weeks of puke won't hurt you.  And puke I did.  I should be no stranger to puking.  In fact, I've done it so much for so long that if there was a way to gain pleasure from puking, I would have figured it out.  Nope.  As I've chronicled before, if you're puking your own mother will go out the back door to keep from having to check on you.  I had my own respiratory therapist come by the house two times a day to give me breathing treatments and what he called a sinus wash.  I called it waterboarding.  And for the record, I agree with the democrats on this one.  It's torture.  After the second wash I was telling secrets that I was making up, just to get him to stop. 

So I am back.  I didn't get to make the reunion and I am very disappointed.  I haven't seen my son since November and was looking forward to seeing him.  On the other hand, he and his lovely wife, Peach, were moving into a new place and had I been there, I would have been part of the moving brigade.  The difference is puking because you are taking drugs that have the last name "sone" and puking because you've helped carry a couch up three flights of stairs. 

There have been some other changes as well that I'll write about in this, the latest installment of General Hospital, which I have a far amount in common with. 

Take care and it's good to be back with you. 

Dave

Hi there,

OK, so it isn't a roller coaster of love but it's a roller coaster nonetheless.  Let me catch you up.  Trust me, this is worth your while.  A couple of weeks ago I was reclining at Chez Yasko when the telephone rang.  I checked the caller i.d. because if it was Dell I didn't want to talk to them and besides, its a crappy computer.  No, I'm just kidding.  Dell and me are cool.  It was Dr. Torres, my endocrinologist.  My New Endocrinologist, who between you and me is shaping up to be a lot like my old endocrinologist only younger.  He was telling me that my latest round of blood tests, the ones that had the high blood counts, also showed where my IGF 1 (that's insulin like growth factor) had zeroed out and I would need to go on daily injections of something called recombinant igf.  I said I would get with my insurance company and see what it would take to begin daily injections of said hormone/gene.  I did some research and found out that the recombinant means it contains bacteria, in this case, e. coli.  It's also a thousand bucks a pop.  Only in America does it cost a thousand bucks for a shot of e.coli which, if memory serves me correctly, you can get for 99 cents at your local Jack In The Box.  You don't get the nifty antenna ornament at the endocrinologist, either.

Enter the insurance company.  I've discovered the difference between low dollar Blue Cross/Blue Shield and High Dollar United Health Care is lubricant.  Blue Cross doesn't lube you up before they screw you over.  United Health Care does use the grease.  However, the end result is pretty much the same.  I called United Health Care and told them of my conversation with the endocrinologist.  The customer service representative, a very nice young man named Derek from San Antonio, told me that it did look like the treatment was covered but that he would need to have the doctor give him the diagnosis code and the treatment code.  He put me on hold and called the doctor and came back on the line a few minutes later to tell me that he had the right codes and he was sending the claim through and would get back with me as to its progress.  I thanked him and waited to hear from him.  He did give me his direct line and the green light to call him anytime I needed.  I was thinking "why not give him a call about midnight just to see if he wants to bust a rap or do some sharing."  But I didn't. 

The next day in the afternoon I hadn't heard from him so I called him back.  Hey, this ain't the rules of dating here so I don't have to wait a certain amount of days.  It took me a while to get to him because he told me he didn't recognize the number coming up on his caller i.d.  I said, "so you hate Dell too?"  I didn't but I'm sure he does.  Here is what he told me.  "The medication is covered but only through a direct bill pharmacy.  I said, "what is that?"  He said, "a direct bill pharmacy is one that bills the medical side of your insurance as opposed to the pharmacy benefit side.  Your medicine isn't covered under the pharmacy benefit side because it's an injectable.  It is covered under the medical benefit side providing you use a direct bill pharmacy." 

So I thanked him and called my local drug store.  The one that sends me a Christmas card every year.  The young man at the pharmacy, Tim, is an excellent person.  In fact, the pharmacy at CVS on Cartwright Road in Missouri City Texas is staffed with exceptionally gifted and compassionate people.  Tim, Aleah, Kathy, Sarah, Blessy and Janet are truly wonderful folks who go above and beyond the call of duty when it comes to me.  Tim told me that CVS doesn't direct bill the medical side and that he'd never heard of that.  I asked him what the medicine would cost if I bought it and he looked it up and said, "just at a thousand."  I said, "how about if I buy it and submit a claim to the medical insurance."  He said, "I've heard they'll disallow it if you do that."  So I made a note to give Derek a call to get some clarification.

The next day I found the note to call Derek and called him.  He didn't pick up.  Instead I spoke to a young lady named April who told me the same thing Derek had.  That I had to use a direct bill pharmacy.  So I asked her to give me a list of direct bill pharmacies they did business with.  She said, "let me put you on hold and find it."  Forty five minutes later she came back on and said, "we don't have a list of direct bill pharmacies we do business with.  It's up to the customer to find a direct bill pharmacy."  Then she said, "that doesn't make sense, does it?"  (In hindsight, we will refer to that particular line as "the application of lubricant.")  She said, "you would think if we were going to force you to use a direct bill pharmacy we would have one for you to use but we don't."  So I said, "how about if I go to CVS, give them the prescription, have them fill it, pay for it and submit the receipt to the medical side of my health insurance.  You guys could reimburse me."  She said, "we can't do that.  It's got to come from a direct bill pharmacy or we will disallow the claim."  I should have said, "do you have any more lubricant?" 

I do have a friend who runs a pharmacy in the Hill Country.  So I called him and said, "Say friend, here is the medicine I need and here is what the insurance company is telling me.  Can you give me any help as to where to find one of these direct bill drug stores?"  He said, "I've only gotten involved in direct billing the medical side once or twice and it wasn't a very good experience for any of us so I don't do it and I don't know where you'd go and have it done."  I said, "so do you want to roll the dice with me?"  He said, "not really, but I do enjoy reading your blog."  This man and his entire family are the kindest, most compassionate folks I know.  If he isn't interested in rolling the dice it's because there is no way on God's green earth those dice are going to come up anything but losers, plus I'm honored you read.  Thank you.

So I called April back and she said, "let me get Derek on the line."  Derek popped up and I said, "so let me get this medicine stuff straight.  The only way for me to get it is to use a direct bill pharmacy, which doesn't exist.  I can't go and purchase it and get reimbursed because you would disallow it.  So basically I'm covered for a medicine you guys have made it impossible to get."  He said, "I feel your pain.  Maybe we can get the doctor to order it and charge your insurance and he'll give it to you and you and him can get together on what the insurance pays and what it doesn't pay after it's gone through the process.

So it was off to see the endocrinologist.  He told me I would need to talk to his office manager, who happens to be Mrs. Dr. Endocrinologist.  A handsome yet severe looking woman who looks like she runs a tight ship.  They told me to come at 2 and so I did.  I ran into somebody from my church in the waiting room and we chatted for an hour or so.  Finally at 5:30 she walked over and said, "you need to see me?"  I said, "why yes I do."  So off we went into her office.  I told her all the insurance folks had said and that I was coming to see if they would order the medicine and bill my insurance.  I told her I would pay them the retail price and whatever my insurance paid, they could reimburse me.  So if they wanted a thousand dollars, I would give that to them.  If my insurance company paid 500, then she could give me 500 back or keep it for the next time.  English is not her first language.  She said to me, "are you asking me to risk my husbands license so you can get this (she said it "thees") medicine?  I said, "I'm not willing to risk your husband's license.  I need your husband to help keep me alive.  He's prescribed a medicine to me that my health insurance has made it impossible for me to get without your help.  She said, "I am not willing (weeling) to make the insurance company mad at us."  I said, "the insurance company told me to come up here and talk to you.  I'm not weeling myself to make the insurance company mad at either one of us."  She said, "I will call them and only do whatever they tell me I can do." 

On the way home I stopped in at a couple of pharmacies who specialize in custom prescriptions.  No direct bill.  I also stopped in, during the day, at my Primary Care Physician because they offer bio identical hormone therapy through their newest service "The Bionique Institute."  I wondered if we could come to an arrangement.  The lady who runs it is in her mid 50's and if she was a 1 wood I'd describe her as a persimmon shaft with dried out leather covers.  She informed me that they didn't do real treatments.  Only what she called "vanity appointments" that had all to do with botox and the odd bit of hormone cream to reduce liver spots and skin aging. 

While I was at the endocrinologist I got a call from my father.  He said, "I need you to get in the car and drive up here tonight so I can watch my new television.  I need help setting it up and if I have to wait on you to get well then I'm never going to see my new TV."   Don't lean on me Bill.  Not today.  I ain't in the mood.  Tell you what, I'm good and lubed so let me tell you where to put that TV.

Which leads us to Friday.  I started by getting up early and heading up to my folks to help set up the television.  I had no problem with going because I love my folks and I love going up to the woods where they live.  I just wasn't in the mood to go the night before.  While on the road I thought I'd call and speak to Derek or April and see where we stood.  I couldn't find either one of them.  The person I did speak to told me that after further review, the medication the doctor told me I needed was not covered by my medical insurance.  I said, "oh my. Well, thank you for trying."  Wait, no I didn't.  I threw a hissy.  After I had gone on for a while and used words like "disembowel" she said, "would you like to talk to the supervisor who made the decision?"  I said, "why yes."  OK, I didn't.  I'm sure it came out "sansabelt fockeydoodle santa barbara blister somebody's butt raw."  She connected me.  It went straight to her voice mail.  The message was terse.  That's a good way to put it.  Terse.  Have me run through hoops telling me I'm covered but only from a pharmacy that doesn't exist and go spend an afternoon trying to talk compassion out of Eva Braun and after all that tell me I'm not covered.  "Lady, we are going to talk."

Then I called the person who handles employee benefits and I told on the insurance company.  She was very kind and said, "it's time to bring in the big guns."  And that was the start of a beautiful few hours.  All the folks who wouldn't talk to me from United Healthcare couldn't wait to talk to me now.  There are still some complications.  One being that the insurance folks are saying that the diagnosis and the treatment don't match up.  But you know something?  That's not my issue.  That's the doctor and the insurance's issue.  Plus they told me they had talked to him and were going to follow up more on Monday.  As one who holds credentials with the State of Texas in the field of diagnostic psychology (that just means the court will accept my opinion as an expert opinion in the realm of diagnosing mental illness) there are times when you make a diagnosis and somebody is going to disagree with it and you've got to stick to your guns.  If the new endocrinologist isn't going to stick to his guns on his diagnosis, then I don't know if I would want him to even touch me, never mind treat me.  So tomorrow should be gut up or shut up time from the doctor.  Either way, I'll know and I'll deal with it whichever it is. 

And that is my story and I'm sticking to it.

Good Night and God Bless

Love
David

www.bpdfamily.com