Thursday, December 23, 2010

Lessons in Frustration

You would think that Medicare Part D would become easier to navigate after six years... NOT!  I thought we had everything set.  We got the formularies from our 2010 provider - Arkansas Blue Cross/Blue Shield - in the fall... and of course, not all of Mam-ma's medications were going to be covered for 2011.  So I began a search for another provider.  We have changed every single year so far.  The "winner" was Health Spring, headquartered in Nashville, Tennessee.

I have to say, from the time I enrolled with Health Spring, the customer service has been superb.  I have gotten right through to a representative, my questions have been answered quickly and thoroughly, and I have even been wished a Merry Christmas!  I got the new membership card in the mail and tucked it into my wallet to show to the pharmacy staff, so that they could record the new numbers when I picked up Mam-ma's medications last Friday for the month of December.

When I arrived at the pharmacy, the clerk said, "I hope you brought Ms. Polly's new card."  I proudly said, "I surely did!" and she added... "That's good, because we need to try to run it - her other insurance provider has refused payment."  "What?"  It seems that Arkansas Blue Cross/Blue Shield went ahead and stopped providing coverage for my grandmother a month early - even though she was supposed to have coverage with them through December 31, 2010.  "Will Health Spring go ahead and pay?" I asked, adding that their information indicated coverage began on January 1, 2011.  "We don't know - we're going to try," the clerks told me.

I was astounded... and frustrated.  The clerks told me this happens all the time, although it's never happened to us before.  And, since there was no insurance coverage, the refills I had called in to the pharmacy the day before had not been filled, so there would be a time issue.  To further complicate things, one of the prescriptions had expired.   We had just seen the cardiologist a week earlier, and he said, "Tie a knot in this rope and hang on," so I knew he wanted to continue this medication.  Luckily, his name was on speed dial in my phone, so I made a quick call, and almost before I could hang up, the nurse had faxed over a new prescription.

I decided to go ahead and do a few other errands... get Mam-ma to the beauty shop... and return for the medications.  When I got back, the new provider was agreeing to cover all of the drugs... except for a name brand on a thyroid medication.  "It was on the formulary," I told the pharmacist.  "Yes, but the insurance provider wants you to use a generic."  We've never used a generic, and it might be fine... but at 98 with all going well, I would rather not rock this boat. 

So, I called the family physician's nurse to see if the doctor could authorize use of the name brand drug.  She was unavailable and would return my call.  She did... about an hour later as I shopped for Mam-ma's groceries.  I explained the problem, and she said, "Well...why can't she just take the generic?"  I explained further that she is 98 and doing well, and we want to keep things the same.  She said, "You'll have to fill out a form."  I told her no... the pharmacy said all it took was a verbal authorization from the doctor, with a notation in my grandmother's file on HIS end, in case the auditors ever checked.  She said, "I'll have to talk to the doctor about that and call you back." 

Thank heavens for small towns!  It was late on a Friday afternoon, and the nurse did not return my call, so the pharmacist "spotted" me a week of the name brand medication.  He said I could get the rest the next week if the authorization came through... or he would fill the generic at that time and I could pay for the seven pills.

On Monday morning, the nurse did call back, and all was well... the name brand was authorized.  She added... "And we need to see Ms. Polly for a 6-month checkup."  I told her we had not been for a "6-month checkup" in years.  She said, "I know... it's been July of LAST year... and we really need to see her.  We're supposed to see her every six months for insurance purposes."  I explained that I do not like to expose Mam-ma to the potential illnesses in the clinic... she is 98 and frail, and it's not worth it.  She said she understood and offered us a late-January appointment - first thing after lunch with the promise of getting her directly into an exam room and a short wait time.  So I agreed.  At this point, I'm picking and choosing battles.

On the way home from the beauty shop, Mam-ma told me that her teeth were really bothering her.  She said that the new liner the dentist put in when he put them back together was "not right."  She added, "They're too full."  I didn't say much... sometimes she has to wear them a few days before they feel right to her.  She did not mention it to my mother, who was out of town celebrating Christmas with her husband's family.

But over the weekend, Mam-ma continued to tell me that she needed to go back to the dentist... and she planned to call Monday morning.  I had a full week of activities and preparations for the Christmas holidays, so Monday morning, I called Mam-ma and asked her if she had contacted her dentist.  She had not, but she wanted to.  I decided to cut to the chase and call the dentist myself.  We secured an appointment for the following afternoon at 2:00.  Later that morning, someone from the dentist's office phoned and said, "I'm confirming your appointment for tomorrow morning at 11:00."  I told her no... it was at 2:00 p.m.  She said, "That's Ms. Polly's appointment... your annual cleaning and checkup is tomorrow morning at 11:00."  I had totally failed to write it on the calendar and had no clue.

The gracious receptionist offered me a 1:00 p.m. appointment... with Mam-ma's appointment to follow at 2:00.  That was great!  So Tuesday, I picked Mam-ma up shortly before 1:00 and we drove to the dentist's clinic.  I got right in, and Mam-ma was put in a room next door soon afterward.  The hygienist and I overheard Mam-ma tell another assistant that she was not ready for Christmas, because "they won't let me cook any more."  Now, for the record, last week Mom called one afternoon to see if Mam-ma took her noontime medication, and her friend Ruby answered the phone.  She said, "I don't think Polly took her medicine - we're making peanut brittle."  Mom was so flabbergasted and upset that she just quickly said "Goodbye" and hung up!

Monday morning when Mom called, Mam-ma said, "I'm in the middle of something."  Mom asked, "Are you getting your bath?"  Mam-ma replied, "No, I'm making sugar cookies.  Mary (the housekeeper) is here."  Mom said she felt sure that Mary was not helping with the cookies!  Every time I go to my grandmother's, there is no evidence of any of this baking.  I've not seen as much as a peanut.  I did see a jar of sugar cookies tucked away on a lower shelf of the telephone table today, and I pretended they weren't there.  Mam-ma took peanut brittle to her hairdresser last week and tried to brag to me about making it.  I would not acknowledge her comments... and I could tell that really made her mad!

Meanwhile, the teeth are still not right.  I asked Mam-ma if she was eating better, and she said, "No, not really.  These teeth are still not right."  Now, in the dentist's chair, she said they were fine.  I asked her why we left the clinic with teeth that don't fit right, and she said, "Well, he was busy."  I told her... "He's been busy every time you are there, and he would prefer you get this right and not have to keep returning."  She said, "Well he said, 'Now, if these give you any trouble, you know what to do.'"  I asked what that meant, and she said, "Well, he means for me to come back!"  She added (as always), "You just don't understand, because you've never had dentures!"  I told her, "I understand you don't leave the clinic until they fit right!"  So now the holiday weekend is upon us, and her teeth are not fitting right, and there is nothing to do except muddle through the next few days.

Honestly, we're not sure there is anything to do.  The dentist has worked and worked on these dentures... and Mam-ma absolutely has no jaw bone left to anchor them.  The dentist says it is eroding faster than he can adjust the liner.  If it gets to the point where nothing can be done, I believe it will take a toll on Mam-ma's overall health and speed along her general decline.  I'm hoping when her mouth heals a little and settles down, the teeth will settle into place again, as has happened before.

Meanwhile, we still have not heard anything about the room at the assisted living facility.  I visited friends who live there last weekend, and I reported to Mam-ma about how nice the facility was and how happy these folks were living there.  She had very little comment.  However, an older cousin told me tonight that he had a long phone conversation with Mam-ma last night, and she is ready to move.  He said, "I honestly believe that if I told her right now there was a room ready, she'd start packing."  He added, "She told me she can't wait to move there."  Of course, that is news to me... so we shall see.

So another Christmas is upon us. Mam-ma has made new baby quilts for my great-nephew, Timothy, and his sibling who will arrive next May.  She asked me to buy her white glue last week at the store, and Tuesday, she sent home two large white shopping bags that contained the quilts.  She had glued Christmas cards to the sacks for decoration... a clever idea... and a much safer use of her time and energy than baking or making candy!  My mom and her husband will pick up Mam-ma and bring her to our house for the day.  She will be exhausted when she returns home... and she won't hear half of what is said while she is here.  She told me today that she plans to wear her long underwear under her clothing so she won't be cold.  There is no way we could keep our house warm enough for her and stay in it ourselves!

Our family opted not to exchange Christmas gifts this year... for a variety of reasons.  Santa Claus has left filled stockings for everyone, and we will enjoy sorting through those goodies.  But our day will be about eating a good meal and enjoying each other's company - and watching Timothy play with his gifts. 

If anyone asked me what I want for Christmas this year, it would be for us to enjoy a good day together with no crises or catastrophes... and for a room to become available at the assisted living facility for my grandmother.  Whether she takes it is still up to her... but I'm praying that the timing will be right and everything will come together for her to find some semblance of happiness there.  At least I will know that she really is taking her medications when she says she is, and she is relatively safe and her basic needs are met each day. 

I'm realizing that I whine and complain a lot about things that I cannot change, and I'm earnestly seeking a deeper faith and trust in God to handle what I already know I cannot.  I'm trying to learn to let many things go in one ear and out the other... and to fully understand that we are now at a point where Mam-ma may not even be able to remember she isn't supposed to do certain things, like bake cookies.  This is a transitional stage, and for the most part, my grandmother is still functioning better than many who are a decade younger.  Still, she grows a little more tired and frail with each week.

I plan to treasure the time we share this Christmas... to collect as many memories, take as many pictures, and enjoy as many laughs as possible.  I hope that your holidays are filled with the same.

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