Went To The Doctor This Morning

Finally. I had, after three and a half years, half a dozen doctors, and a full compliment of attorneys, been awarded disability by a judge last January. Not one person involved disagreed with the diagnosis, prognosis, or lack of hope for recovery.

Except the insurance adjuster, I mean. But I was talking about people, not insurance adjusters, wasn’t I?

I’d been seen by some of the biggest names in the field in the Philly area including the chief of orthopedic surgery at Hahnemann University Hospital and the head of Orthopedics at Temple University, and none of them could do much of anything. My pain management doctor, Dr. Lam, had finally just stopped beating around the bush and told me flat out that I would be using a walker in a year or two, and in a wheel chair within five. Sometimes, it’s just that way. Nothing they can do.

While I had been pushing for her to lay it out bluntly, I have to say the shock was more than I was ready for. I cried right there in front of her and my wife like a five year old girl who’d just broken her favorite porcelain doll.

It was mid April I think, when I finally got my Social Security Medicare card. I immediately began seeing our family doctor, to see what he might be able to do that the other doctors hadn’t done. I wasn’t very hopeful.

I also started immediately looking into the whole prescription drug plan thing. What a mess and a maze! I only had until the end of May to figure out what the hell was going on, and which plan from which company I should go with.

Um.. no.

Apparently I had misread something, and I actually only had until May 15th. I didn’t realize that until May 23rd.

That meant I couldn’t sign up until November. Well, I’d just have to pay for meds until then.

Dr. Pace tried a couple of things, after studying every little thing that every other doctor had done.

Then he prescribed Cymbalta.

Cymbalta? That’s for depression. I admit my situation can be depressing, but I wouldn’t say I’m by any means clinically depressed.

Turns out that this drug from Lilly is also used to treat chronic pain. Somehow whatever it does for depression involves nerves and neurons, and has the effect of mitigating chronic pain in patients with nerve damage. It sort of tells the nerves to stop telling the brain “Hey Shithead! I’m hurting down here!” So you take this anti-depressant, and the nerves shut up (well quiet down, anyway).

Hey, I’m desperate, I’ll try voodoo if it might work! (Ok, not really, because I know it doesn’t, but you get the point of hyperbole, right?)

Sunovabitch. I started having more “good” days, where I could function somewhat, and fewer days where I couldn’t. And it didn’t dope me up so bad as the drugs I’d been on before. I’d already spent a few years walking around like a zombie, and quite frankly I’d rather deal with the pain. At least my brain works when I’m not on pain meds.

But then Doc Pace ran out of the free samples he gets from the distributors. So my wife went to the pharmacy to fill a prescription for the Cymbalta.

$300.

For two weeks worth.

No friggin’ way I can afford that. None.

So I’ve done without for almost six months now. When November came, I immediately went and signed up for supplemental insurance as soon as the registration for 2007 opened, and my wife made an appointment for the first of the year for me, so I could get the Cymbalta back.

So today I went back to see Doc Pace, and he not only put me back on the Cymbalta, but he had more samples, which at first sounded ironic, but turns out to be very helpful anyway.

Yeah, now I’m getting around to the point of this post, just hold yer damned horses.

Have you actually looked at the Prescription Drug Plan thing the politicians have been touting as so freakin’ cool? I just did, and let me just say it’s a Goddamned waste, just about.

Here’s how it goes:

$30 for a month’s supply of Cymbalta – MUCH BETTER THAN $600

but it only covers until the total cost of prescription drugs reaches $2400. Not my out-of-pocket expense, but total cost.
So it covers me for four months. One third of the year. Less, actually, because there are other meds that go with the Cymbalta, but they’re rather cheap, so let’s not even consider them for a second.

After those four months, I have to cover 100% of the drugs until my out of pocket expense reaches $3850. Now, subtracting the $120 that I already had to ante up for the Cymbalta for the first four months, that leaves me with a bill for the meds of $3730, before it kicks back in.

This is the infamous “donut hole” that the fucking jerk off in the White House keeps talking about.

So, at $600 per month, I’ll be footing the bill entirely for over six months. That will take us to November.

In November, the plan will pick back up, and I’ll have to pay 5% from there out, or $30 for November and December.

Now, adding in the monthly cost of $89/month for the coverage (as mandated by the law), that means I’ll be putting out $4978 ($1068 in monthly premiums + $120 for January through April + $3730 during the donut hole + $60 for November and December). Without the insurance, I would have put out $7200 ($600/month).

This oh so wonderful thing that the President and the Republicans have graced me with does indeed save me money. A grand total of $2222.

This is why I paid disability insurance for all those years while I was working?

Thanks.

10 Responses to “Went To The Doctor This Morning”

  1. Robyn Says:

    Wow. What to say. “I’m sorry” seems trite, so I’ll skip that and just sit and read your post with emphathy.

    Insurance is such a screwy concept and an almost impossible program to maintain. I like the Amish idea–they don’t buy insurance, but when one of their community gets sick, the others pitch in to cover all the costs.

  2. Lou FCD Says:

    Well I appreciate your sentiments, Robyn.

    Sometimes the old ways really are better. In Eastern KY where my in-laws live, there are still one or two doctors that will accept some of a farmer’s harvest or livestock yield as payment from someone who can’t afford to pay money.

    There used to be a little market that did too, but it closed a few years ago.

    It really bothers me that ours has become a society where most folks don’t even know their neighbors’ names, much less help them when they need it.

    I really wish ideas like Habitat for Humanity would catch on more in all sorts of areas of life, too. The days seem long since gone when the entire town showed up to rebuild someone’s barn after a fire and such.

    I think if it came down to it, Doc Pace would be that kind of Doc, if he could.

    Odd that he’s from Philly too, and interned under the physician that saw my late grandmother for 40 or 50 years.

    Small world.

  3. Kristine Says:

    How awful.

    Our culture has become so alienated from everything that we like to claim that we stand for. I wish there was something I could do for you.

    We are fortunate to have found a neighborhood where we do know our neighbors, and run into each other on the sidewalks, and do things for each other (my neighbor even offered everyone food to help her with repairs to get her triplex up to code, just like the old barn raisin’.) I think if enough people get disgusted with the status quo we can do something about health care, if not single-payer then maybe “health care co-ops” or something.

    All my best wishes (and of course, my shimmies) to you.

  4. Robyn Says:

    Habitat for Humanity in other areas is an incredible idea. These things come about when someone with foresight recognizes a need and takes off with it. Have you thought about that in more detail?

    It seems to be time for a healthy crop of John Doe Societies to take over–I’m not slamming government here because I have always thought we rely on Washington too much anyway and should take more responsibility for our communites and neighbors. So, Lou, get to it. Create a John Doe Society that focuses on health care costs.

  5. Robyn Says:

    Interesting timing, I just read this little story in my local newspaper:

    http://www.timesreporter.com/index.php?&Category=6

  6. Lou FCD Says:

    Thanks for the shimmies, Kristine! I’d return them, but it’d put me in traction, and with the extra thirty pounds I’ve put back on, it’d be pretty ugly.

    How cool is the timing of that Robyn?

    Just when ya almost lose faith in humanity….

    🙂

    I hadn’t heard of the John Doe Society before. I’ll definitely be looking into that!

  7. Alan Fox Says:

    Hi Lou

    I am shocked and saddened to learn of your health problem. It must be an indication of your fortitude that you have not (AFAIAA) mentioned it before in the blogosphere.

    Having two collapsed vertebrae myself, which regularly render me incapacitated for a few days or a week, I possibly have an inkling on what you are going through, and I am very sorry to hear the bleak prognosis.

    On the other hand you appear to have the warmth and comfort of three fine women (or should that be four including Kaylaface). My very best wishes.

  8. Lou FCD Says:

    Hi Alan. Good to see you here.

    It’s not something I mention much, I guess. I’m usually running my trap about other stuff, I suppose.

    🙂

    Sorry to hear you’ve got similar issues. If ever there were a case for any “Intelligent Designer” to be a completely incompetent moron, the human spinal column is it. It just isn’t built for what we do with it (starting with walking upright, for instance).

    My wife and children do indeed take good care of me, and the girls certainly keep me entertained!

    They’re the most interesting thing to happen to me since I finished reading teh whole interwebs out of boredom! 🙂

    Do be kind enough to drop by on occasion. I really enjoy your blog and I’d like to be able to return the favor once in a while.

  9. Robyn Says:

    The John Doe Society is from Meet John Doe, the classic Gary Cooper film. His character started a grass-roots love-thy-neighbor movement in the midst of the Great Depression. Sorry introduce a movie into your otherwise serious and very real situation, but it a great film with very real ideas.

  10. Lou FCD Says:

    Well it’s a good idea, nonetheless.

    “Pay it forward” similarly posits an idea worth pursuing.

    And don’t worry about it, Robyn. It’s never good to take anything at all too seriously.

    🙂


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