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Caregiving headaches



My daughter came in last Saturday for one of her short visits. Larry and I always look forward to seeing her. We decided to go to one of the new outlet malls in our area. Big mistake! Since it was the holiday weekend, thousands of people were there plus it was so hot. I may take Larry back as it would be a good place to wheel him around when it gets cooler. The rest of the weekend we did laid back things like cooking out, walking or just sitting out. We celebrated my son's birthday with a cookout.


Yesterday I went to get Larry's prescription for his medicine renewed. He takes 6 of these pills 3 X a day. They would not give the prescription with the same rate as before, and said I would have to pay $85 to get it filled. If I wanted to get it for the discount price, I had to have his urologist call an 800 number. This was a big surprise. The reason was they have a limit now on the pills Larry takes per day or whatever. (Express Scripts has taken over from Medco which is our Part D plan we pay premiums on every month). Do you know how hard it is to get a doctor to call in an authorization? His nurse called me back today saying she would try to get it in tomorrow or day after as she was covering for another Dr., had to get in at 7 a.m., etc. and it is hard to get through the 800 line! I said "this just happened, plus we are out as of today, plus I had a speech therapy for Larry today, plus I had skin cancer surgery!!" She said she would try, and if she gets through,it will be another 24 hrs to get it. In the meantime, I asked Walmart to give us a 3 day supply which is $8. I normally pay about $12 for 180 pills.


The second headache was today at the speech therapy evaluation. It was scheduled for 11:00. I was hopeful, as we went back to our old facility and the therapist had a connection with the previous one that left. We waited for 15 min. and then another therapist came out. They were trying to find Kathy as we had the appointment with her. I told the other therapist Larry's history and then Kathy finally showed up. I had to retell her as she kept asking me questions and writing notes down. Couldn't she look at the computer for his history?? Another student was there in training. She probably thought "what am I getting into"? Kathy then did some testing on Larry and gave him some more swallowing exercises. A page of 7 swallowing ones to do, 10 reps each 2 X a day. One includes singing the Do Re Me.... She tested him on that. Funny, first she asked if he could sing a song. You should have seen his face. lol I then suggested the Do, Re, Me thing. She pushed off seeing him for 2 weeks and asked him to promise to do the exercises. He said "yes" like a good little boy waiting to get out of there.


In the meantime, I am getting notices from Medicare saying they denied several of the Experia E-Stim therapies from the other facility. I will have to fight that too I guess. The therapist assured me we were covered there.


The good news is the weather has been great the last few days except we are bone dry. Hopefully, it will rain soon!




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Oh my, I do dread what will happen when we roll over to medicare & back up insurance. It's worth more to me if we could just pay the high priced insurance each month. I know we use mail in express scripts and they will not pay the same at the pharmacy window then if you get a year prescription and they refill it for a 3month period at a time. Like that, our co-pay on non-generic drugs is $50, $20 for generic. But mostly all I can get at the store is temp meds like when you are sick, or first time fills, or ones that are on that $4/$10 for 3 months chart. But seems you have to only take one a day or the price goes up.


I know this is so maddening, try to not go crazy, the only thing that helped me was binge eating. I know that isn't good for me, but it was that or go crazy.

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As Afforable Medical Coverage (Obamacare) approaches, I too am seeing a lot of dead ends and questions. No one knows what is going on, us or them. Hope it is all worked out by next year.

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Julie,I cannot make paragraphs. But, I do know how to take care of your express script problem. You can initiate the quantity limit exception. Call up the insurance company, they will need authorization from Larry for you to talk to them on his behalf. You should get that on file. Otherwise they will bother you everytime you call. Once you get past that hurdle. Ask them to initiate the request. This means that they will call and fax your MD to get the authorization done. Quantity limits are the easiest ones to get done. You need to tell them that this is continuation of therapy and that Larry has been titrated to this dose (he was started at a lower dose and the MD worked up to this higher dose). Give the insurance you MD's fax # and phone #. They will call and fax. your MD. IT is easy for you MD to fill out the form and fax it back. When you talk to the insurance tell them that you want the request expedited. You want this done ASAP. Ask them what time this would be. For the place that I work it means that this will get done in 24 hrs. The authorizations are usually back dated for 3 months. Ask Express script. If this is true..then if you had paid cash then you could always go back and get reimbursed by the pharmacy. THe pharmacy would just have to reprocess the claim on the day that you bought it. Even now. You paid for a 3 day supply. Just get them to reprocess the entire claim for that date. They can just subtract the 3 day supply that was given to you. This is what I do with my new job. message me if you have any questions. Ruth

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Julie: Blessings for our Ruth.


Now that you know, never allow a Student sit in on a first visit of anything. For the actual therapies, that is fine. But the initial evaluation counts as part of the therapy that is allowed and you want 100% regardless of whether you know the therapist or not. Like Bruce at our Outpatient Clinic.


You'll have to challenge the Estim. Always a bummer, but he needed it and it will be worth the fight.


See you have to get three issues at a time to keep you on your toes because you don't have enough to do. LOL Go easy, one thing at a time. So glad you enjoyed your visit with Tina and Louis. And I do hope you get some rain soonest. Debbie

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Ruth, thanks so much for your help. The nurse from the urologist office called this morning and said the order was put through. Thanks for your help with these big drug companies too. This was a prostate med that Larry always takes and we still had to jump through the hoops to get it approved. I will go back tomorrow and get the rest. Hopefully, I will not have to go down this road next time he needs a refill.


I wish I could help you with the paragraphing.





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The paragraphing is the first icon on top of this box on the left, when you're writing a reply. It looks like a key hole. The prompter (arrow) lands there by itself and "toggles" you to no paragraphs, without you clicking on it. Likewise it will underline on it's own will, or make the print bold as it's doing here, because the prompter touched it. I get tired of doing it, but just put the arrow back to the correct icon and click and it will toggle back to normal.

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