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.
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.
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?