Sawaboof

I love books, beer, coffee, tea, SciFi, espresso, music, baking, cooking, eating, food, laughing, riding my bike, going for walks, and living in Milwaukee.

My Twitter!
Some worthwhile posts
Ask me anything!

tumblinks

search

powered by tumblr
seattle theme by parker ehret

  1. Why is this hard?

    1. Guy on phone: I'm calling from Connect for Health Colorado. Our records show you have started the enrollment process but haven't purchased a plan yet.
    2. Me: Yup. I have coverage through my previous employer through 4/30.
    3. Phone guy: Ok, but you only have until 4/15 to enroll in one of our plans.
    4. Me: Actually, 4/30 counts as a COBRA-Qualifying event, because the plan I was on doesn't renew until 7/1, and I start a new job on 4/21 so, I was going to wait until then, since both of those situations are qualifying life event and the deadlines don't apply to them.
    5. Phone guy: No, you really need to enroll in one of our plans before the 15th.
    6. Me: Ok, but I don't want to do that right this second so can I have the number to call you back?
    7. I'm not calling him back.
     
     
  2. Here’s a tip for all you doctors out there.

    When your patient comes to you and asks a genuine question about her medications, the correct response is not “you have ADHD or you don’t”. That’s actually incredibly insulting.

    And suggesting that she get testing done for ADHD, after she talked to you, in depth, over a year ago, asking about filling her scripts because her nurse practitioner was leaving, and the therapy she’d been using for over a year for managing an incredibly late ADHD diagnosis and other things was coming to an end, well that’s just a slap in the face.  

    1. That medication I’m asking about, it’s a fast acting medication with an incredibly short half life. It doesn’t build up in my system over time and change my brain chemistry in such a way that I need to be weaned off of it if I need to discontinue it. When I ask about using it as a PRN because I’ve put a lot of work into managing issues without medications and continue that work every day, but sometimes it’s really helpful to be able to not space out during long meetings or losing whole minutes of time while I’m driving to Minnesota, I’m looking for a helpful answer. Not an accusation that makes me feel like a drug-seeking hypochondriac.

    2. There’s no magical test for ADHD. I spent a year in therapy with someone who specializes in ADHD. I had to get records from elementary school to see my teacher comments about my classroom behavior. I read books and talked about them with both the therapist and the nurse practitioner and how I related to them. I had to have a fucking meltdown at work to even consider seeking treatment in the first place. It was long and time-consuming and expensive. It’s insulting to me, my therapist, and the nurse practitioner who used her own professional judgement when prescribing the medication in the first place to suggest that, maybe you don’t actually have this thing you’re getting treated for.

    3. Also, I know you were available and weren’t with a patient that time I came to urgent care and I had to see some stranger because you didn’t want to come out of your office. I ended up having shingles. So, thanks for caring. I used to like you. A lot. I liked that you went to the office early the day after I came in with a 104F fever and personally called me to let me know that you couldn’t wait until office hours to look at my x-rays and see that I had pneumonia. I liked that you joked around and used to make it a positive thing that I had ideas about how to manage my health care. I liked that you respected me and my nursing background. I don’t know what happened or what’s going on in your life that made you lose that doctor-patient connection I liked so much, but I hope you figure that shit out. 

     
     
  3. October 10th is World Mental Health Day.

    For one day, let go of your assumptions that someone should just

    • Smile more
    • Try harder
    • Stop attention seeking
    • Stop drug seeking
    • Take more pills
    • Appreciate life more

    • Stop faking it
    • Think about all the good things in their life
    • Lighten up
    • Talk more
    • Talk less
    • Snap out of it

    For one day, instead of promoting stigmas, stereotypes, and ignorance—instead of making the problem worse—take a few minutes to educate yourself.
     
     
  4. Cost of Mirena: $685.47.
Cost Aurora Health Care bills for it: $1195 plus $465 insertion fee.
Edited to Update:
This bill has been run through my insurance provider.

Amount my insurance paid: $0
Amount excluded because of negotiated rates with my insurance provider: $907.73 
My balance: $752.27
Cue call to Patient Care (866-253-2273; http://www.patientcare4u.com/), an advocacy agency that I’m assuming my employer pays for, I have no idea, that will help you through any questions or issues with your insurance provider, claims, benefits, etc. My advocate, Jessica, came to the same conclusion I did. Humana is incredibly vague about their Women’s Health coverage, with the exception of mammograms and childbirth, neither of which I’m interested in right now or ever, respectively. So Jessica will be calling Humana tomorrow to discuss what exactly my coverage is and why my IUD through a preferred provider wasn’t covered. She will then call me back. I’ll be waiting until then to make any payments to Aurora because $752.27 is not a small sum of cash.
Anyway, this is fucking ridiculous.

    Cost of Mirena: $685.47.

    Cost Aurora Health Care bills for it: $1195 plus $465 insertion fee.

    Edited to Update:

    This bill has been run through my insurance provider.

    Amount my insurance paid: $0

    Amount excluded because of negotiated rates with my insurance provider: $907.73 

    My balance: $752.27

    Cue call to Patient Care (866-253-2273; http://www.patientcare4u.com/), an advocacy agency that I’m assuming my employer pays for, I have no idea, that will help you through any questions or issues with your insurance provider, claims, benefits, etc. My advocate, Jessica, came to the same conclusion I did. Humana is incredibly vague about their Women’s Health coverage, with the exception of mammograms and childbirth, neither of which I’m interested in right now or ever, respectively. So Jessica will be calling Humana tomorrow to discuss what exactly my coverage is and why my IUD through a preferred provider wasn’t covered. She will then call me back. I’ll be waiting until then to make any payments to Aurora because $752.27 is not a small sum of cash.

    Anyway, this is fucking ridiculous.

     
     
  5. Update on last week’s Medicare fiasco. My member is still in the hospital because:

    1. Under Wisconsin law, someone with a developmental disability cannot be admitted to a nursing home without a need for skilled nursing care, which he has so

    2. He needs a pre-admission screening to prove he needs the nursing home level of care but

    3. Since he won’t need to be at a nursing home for 30 days or longer and he would be discharged to the nursing home from the hospital he’s exempt from this screening, however

    4. Now the nursing homes we were looking at are refusing to admit him under this exemption because, let’s be honest, a lot of group homes have a tendency to give a 30-day notice to residents once they go to a nursing home, and the nursing home, rightly, doesn’t want to be stuck with a new resident, so

    5. His group home manager is calling the intake coordinator at the nursing home to assure them that my member will be returning home once his IV Antibiotics are finished.

    Meanwhile he’s still in the hospital. By the time this is all sorted out, he can probably just go home.

    This could have all been avoided if Medicare would just cover the goddamn outpatient IV Antibiotics.

     
     
  6. It’s not even 9am yet…

    After several back and forth phone calls on Friday with the Aurora St. Luke’s Medical Center’s Social Worker and Nurse regarding discharge plans, I was kind of expecting at least a voice mail letting me know when my client was discharged.

    Especially since we hadn’t actually established which services he’d be needing in the community. The only voice mail I have today was left by a provider needing authorization for services they started providing on Saturday.

    Because I didn’t specifically tell the Social Worker we need to know exactly what my client would need upon discharge and we would need to authorize it prior to him being discharged and, because he is consistently non-compliant with medical advice, I would need to be directly involved in discharge planning to help make sure he is getting the best services for him to ensure recovery in the community, and prevent readmission.

    Apparently the needs of the hospital to get the patient out of the hospital before the weekend trumps the actual needs of the patient.

     
     
  7. Today in the World of RN Case Management

    I spent the past few days arranging the discharge of a client from the hospital. He needs to have IV Antibiotics for 2 weeks, and would need a home health agency to do some cares for him outside of a hospital. No problem. He was all set to go back to his group home, which made special arrangements with the staffing schedule so he would be able to stay home during the day (the home generally isn’t staffed from 8am-3pm because all the residents go to a day program). The social worker at the hospital was going to make arrangements with a home health agency to go to the group home every day for skilled nursing cares. Everything was going to be just fine.

    Until today. I get a call from the home owner saying the hospital can’t find a provider for home health care. Ok. There are like 6 gazillion companies that do this. That makes no sense. I called the social worker at the hospital, who redirected me to the intake coordinator for one of the providers where I found out…

    Medicare won’t cover outpatient IV antibiotics so, instead of going home with a home care agency in place to manage the PICC line, my client has to go to a nursing home for 2 weeks for absolutely no reason. Thousands of dollars difference in cost for care, in addition to an increased risk of infection, wounds, communicable diseases, and readmission to the hospital. Nursing homes are just lovely. You’re welcome, taxpayers.

    If you want to know why health care isn’t affordable, it’s because shit like this, and completely not like this but just as stupid, happens every day. More than once. One bill isn’t going to fix that. It’s not even going to scratch the surface. But, hey. At least everyone can at least be financially covered while some politicians pretend they’re going to do something to fix things. Don’t get me wrong. I think it’s great that everyone gets health insurance. I’m just not going to sit here and pretend that makes health care more affordable or fixes anything wrong with the quality of care. Or the lack of emphasis on prevention, education, and community health. Or the way things are billed. Or the way records are kept. Or the lobbyists that influence every single decision made by politicians. Or even the overall uneducated and/or non-compliant American population. Seriously. Do you know how much Type 2 Diabetes and its complications cost to manage and treat every year? A lot. Type 2 Diabetes and its complications are almost 100% preventable. Twenty per cent of antibiotics prescribed every year are completely useless.

    America’s got work to do and no one willing to do it.

    So, I guess we took a tiny step in the right direction. Great. That’s enough. The bigger issues are all the way over there. But at least we made a little progress. 

     
     
  8. On Antibiotics

    One out of 5 prescriptions for antibiotics is written to treat sinusitis. Sinusitis, when caused by a virus, does not respond to antibiotics, and research shows when it is caused by a bacteria, antibiotics don’t treat it any quicker than a placebo.

    This means that *at least* 20% of antibiotics prescribed are completely medically unnecessary. If you want to know why we have so many drug-resistant bacteria, this is why.

    Stop demanding unnecessary medications from your doctor. You are what’s wrong with America.