Flaming (o) Queen

Wow. I’ll admit to being really shocked that I could finally get OD to work for me just now. Granted, I gave up trying a while ago; but I thought to myself this morning, “Let’s just see…” and I was pleasantly surprised! Hooray to whoever got it up and running more quickly and smoothly again!!!

There’s been so, so much that has happened over the past couple of months that I fear making this entry too long. So I’ll try to condense things as much as possible. Just hold on, because you know how long-winded my fingers can be!

Firstly, that damned tooth problem I was having. You know, the tooth needing a root canal that abscessed (again), caused me to spend hours at the emergency room with nothing done other than give me an antibiotic that I couldn’t get filled that day? Yeah, well… after that course of antibiotics and even another, the root canal day was finally fast approaching. Two days before the scheduled appointment, the freakin’ tooth broke off. Just broke off, and below the gum line, with not enough to save it! So, at the day of the appointment I showed the dentist. And she told me that, of course, it’d have to be extracted. But since there was still a lot of infection she wanted me to do yet another (!) seven day run of penicillin and THEN go back in for the extraction. It’s been the only time they’ve been able to get me in in just a couple of weeks, and that was only because she (dentist) authorized them to triple book her!

A couple of weeks later, the tooth was pulled. I hated it because it’s right lower front and shows the gap when I smile big or laugh, both of which I do a lot, believe it or not! Oh, and get this: the extraction was on a Friday. The dentist didn’t give me another prescription because she figured the antibiotics had killed everything since I’d done a total of twenty-seven days, taking it four times a day. So, you guess it: by Saturday afternoon I was in excruciating pain, but had to wait until Tuesday (the Monday being a holiday) to get onto the fourth run of penicillin! Sheesh! And you know what’s frustrating me more than anything? Even though it appears to be healed and all, when I press from the outside against the gum in that area (or when I brush it too hard), there is a good deal of pain still, that may or may not be the ongoing infection. Oh, and it seems as if my lower lip and partial right jaw/cheek have been damaged by the infection to the point that they’re still numb, probably permanently. Fuck. Fuck a flamingo.

So, that finally over (for now), I was informed by my counselor that both she and my psych doc are leaving the clinic as of the end of January. I knew it was coming with my counselor… has been for a long time since the clinic made all kinds of changes that have primarily shown financially bad for me and many others. It’s non-profit, yet everything has become cost-based and income-generated since opening the other clinic and merging/taking over the women’s health group.

My counselor wanted my insurance stuff so she could call to see what my coverage is. She takes Medicare (my psych doc doesn’t), so that part is okay. It’s the Medicare supplement coverage that would cover my co-pays that my counselor looked into to find out what the insurance company pays, etc. They are working with the clinic, provided one has the right insurance coverage, so the clinic can be billed for one’s copays while continuing their care with my counselor and psych doc. (They’re the only two currently left at the clinic, the clinic doing away with the psych care because “we’re not making enough money off of it.”

What my counselor found out while looking into my secondary coverage is that — guess what! — my medical supplement insurance is messed up again. Wow, no big surprise there. If you’ve followed me for any amount of time you know that my insurance coverage through the bank gets screwed up a couple of times each year. I thought I’d made it rather unscathed this year — only a little bit of a bump in the early part of the year. But noooooo!!! You see, I’ve gotten statements throughout the year from, say, the hospital (for my shoulder surgery and subsequent physical therapy); the company that provides my oxygen supplies and CPAP equipment replacement needs; and other, one-off things like an MRI; a couple of chest x-rays; and a couple of other specialists.

The rub? It turns out that, even though the premium for the medical portion of my secondary insurance has been faithfully paid every month, never late, etc., to the bank, there has been a lack of communication between the bank and the insurance provider. The insurance provider shows that I do not have medical coverage! Well, then, what about the card that was sent to me? Not to mention, what about the few times I called, wondering why (on the EOB’s I received as well as statements from the various providers) there had been no payment from Aetna? I was told over and over again that they are way behind in claim processing, etc., and to “ride it out.” I can’t “ride” anymore, because a couple of months ago I started receiving phone calls and statements of overdue balances, and, of course, collection notices up the wazoo. Why I haven’t gotten these earlier in the year, I don’t know. So basically my only medical coverage for this entire 2013 has been Medicare, even though hundreds of dollars each month have been paid so that I would have secondary coverage.

So I have all kinds of phone calls I have to make (possibly including one to an attorney if I can find one willing to pro bono me) to try to get this figured out. It’s daunting. I have to get all of my statements matched with the EOBs for entire year since January 1. I have to attempt to get each provider to re-submit all of those bills (provided I can get the insurance corrected). That means contacting each place and trying to explain all of this. If they won’t re-submit, I can’t submit claims myself for most of all of what I’ve had done medically over the last eleven months because most of it is past some two-month arbitrary cutoff. (Did I use “arbitrary” correctly? For some reason I don’t think so!) And if the supplement isn’t rebilled, meaning they won’t be paying, I’ve got to fight with both them and the bank to get a year’s worth of premiums refunded. (Those would go to the clinic, who covers the medical portion of my supplement premiums to help me out.)

What it could all boil down to is that I could find myself responsible for thousands of dollars worth of various medical care that should have been paid all along the way. I guess I shouldn’t have taken it on face value when I was told that the claim processing was just way behind, because now I’m not just on the chopping block, but I’ve apparently also been sharpening the axe all along.

There’s some other things going on, too, that are causing me much distress. But this entry has been long enough (too long, as usual), and I’ve now worked up myself again too early in the day for me to fix anything. I have to wait a little bit to call Aetna to see if the person with whom I need to speak is in the office and can offer me some assistance. Apparently I can only deal with her because she handles the bank’s employees/retirees stuff for those of us whose last names begin with “F.” Ye

ah, well I’ve got something that starts with “F,” too, dammit. I tried to get in touch with her last week but she was off all week for the holiday. So I called first thing when they opened early yesterday morning, only to be told that she was out sick. And it seems I can’t really get anyone else to help me unless she’s been out for a certain number of days. What the hell?

I’m also trying to get the bank to intervene and help me get Aetna sorted out. I mean, after all, it’s the bank who’s been getting the payments, and who authorized/enrolled me from the very first of the year.

Shit, but I could go on and on. Just, please, if you prayer or light candles or think good thoughts… whatever you might do… I could really use the positivity going out into the universe on my behalf. This is the biggest fuck-up in probably twenty years of having to deal with not only the health issues but the insurance/financial stuff. I appreciate the mental help with this!!! Thanks!