Me

Earlier this month, my employer royally screwed me when they told me that I could no longer see my doctor and instead had to see a company doctor. This was a bid to force me on to a cheaper medication regimen.

So I grabbed a large tube of KY and unscrewed myself. The first thing that I did was contact my wife’s employer and asked how we could add me to her insurance even though we were outside of the annual open enrollment period. The answer was we needed to show that I had lost my current coverage through no fault of my own, so I got a letter from my doctor’s office that said “Due to changes in my insurance plan, my doctor was no longer covered by that plan.”

Once I was added to the wife’s plan, I waited for the new insurance card to come in the mail, took it to the doctor’s office, got added back to the practice, and made an appointment. He wrote me a new prescription, and now we are waiting for the medications to be approved by the new insurance company.

I am also looking for a new job. I interviewed for one yesterday and they were excited to see me. It looked like a good place to work. However, the job offer was not at a good pay scale. I was willing to take a cut in pay, but the offer they made was a full 25% less than I make now. That was just too low, and was an even lower offer than one I turned down last month.

The search continues.

I continue to work on my issue. I have until the end of April, which is when the medications run out. I have received no fewer than 50 emails on the subject, and they are therefore too numerous to answer individually because of my work schedule. I thank each and every one of you who have emailed, messaged, and posted comments.

There has been a major breakthrough, and it appears as though I have solved the problem by getting rid of the insurance company that caused the problem in the first place. I will know more in the next few days. More to follow.

I’m not defeated, and my last posts weren’t intended to convey that impression. Just because you are getting screwed doesn’t mean that you have to keep allowing it. I’m going to lose access to at least one doctor. My PCP has fired me from the practice, so I will have to get a new one. I am not sure yet about my endocrinologist.

I have been talking to some doctor friends, ones who work for my employer, and ones who do not. The doctors who DO work for my employer aren’t going to be able to write me a prescription for the more expensive drugs, and the insurance company says that I *have* to use the company’s pharmacy.

Usually, a provider or pharmacy that is not on the preferred list can still be used, albeit at a higher rate. They aren’t doing that here, and it’s being done that way to force patients onto the cheapest plan possible.

There are several loopholes in the system, and I plan on exploiting those. I will know within a month if I can make that work or not. All I know is that I am NOT going on insulin.

In my case, I need to get a doctor that will work with me, PLUS I need to get at least one refill on my medication under the current insurance, so that I have enough to last me until the open enrollment period for my wife’s insurance in July. I know plenty of doctors, but it’s the double hit of doctor PLUS pharmacy that is making it tough.

The rules and laws here are complex, but in complexity, there are loopholes. The more rules there are, the more holes there are to drive through. I have time to explore those, and even though I am screwed, I won’t be screwed forever. I don’t plan on staying that way.

Insurance companies hate diabetics even more than they hate smokers. The reason for this is that diabetics are famous for not complying with doctor instructions, and the disease is a progressive one. You don’t ever become cured of diabetes, the best you can do is manage or delay it. What manages it today will likely not manage it a year or two from now. It requires constant vigilance on the part of the patient and the providers. It’s a lot of work, and most of those who have it do not manage it well and wind up with complications like kidney, eye, heart, and brain problems. They wind up with nervous system problems, bone problems, and GI problems like gastroparesis. Treating all of this is expensive. The faster the patient dies, the cheaper all of that is from an insurance standpoint.

It isn’t that the insurance company is TRYING to kill you. No, they look at costs, and say “Gee, when we give drug X, diabetics cost us $y over their lifetime. When we give drug Z, they cost us $2y over their lifetime. Let’s only allow drug x.” They just don’t bother looking at anything else, it’s a pure monetary decision.

For those reasons, insurance companies WANT you to keep eating like shit and taking insulin, knowing that this will save them money over the long run. That’s why insurance companies want you to eat a regular diet and take cheap medicines like metformin. It’s up to each diabetic to carefully monitor their A1C, find trustworthy doctors who care about their patients, and keep on your insurance company’s ass. No one cares as much about you as you do.

Normal blogging to resume soon.

Shady stuff with my health insurance. The way that health insurance works with large employers is that the employer pays the bills, and the actual insurance company administers the entire thing. It’s cheaper for the employer that way.

I tried to get added to my wife’s insurance. It is outside of her open enrollment period, so I need a letter saying that I am no longer able to see my chosen doctor under my current insurance. No one will put it in writing- not the insurance company, nor my employer’s benefits team.

The insurance company says that the decision to force me to use certain doctors came from my employer’s benefits team. The benefits team says that it came from the insurance company. They both suggested that I go to the insurance benefits webpage and look up my doctor to see that he isn’t on the list. That isn’t good enough- to get coverage, I have to prove that my coverage changed. No one will give me that.

Even worse, even if I wanted to change doctors, it’s snowbird season. Few of the doctors in the area are accepting new patients. Of the ones who are, the next appointment is in June. I pointed out that I only have medications until mid April. I was told “well, you can always go to the emergency room. They can refill your medicine.” I can’t believe that it’s illegal to pay cash for a doctor visit if you have insurance and your insurance won’t pay for it, so your only choice is to start patronizing the emergency room.

No. The emergency room will only give insulin. That’s the point of this. I don’t want to be an insulin dependent diabetic. That is a death sentence, it’s only a matter of time at that point. I have done this for more than 30 years, and I know where that road ends.

I will have to deal with this on my next weekday off. It’s daunting.

I am a diabetic, and have been for two decades. I always knew that I would be, mostly because of my family medical history. My Father, his mother, and his father all had diabetes. It killed every one of them before they were 64 years old. I often joke that I lost the genetic lottery. My grandfather died when he was 47 years old. My grandmother, when she was 63- after having to live without legs for two years. My father died at 62. When I was diagnosed with diabetes, I lived in fear that I too would be dead before I could collect Social Security.

About 4 years ago, the diabetic medicines that I was on stopped being effective, and my A1C climbed to 10.0. This is a part of the disease- diabetes is a progressive disease. My doctor wanted to put me on Insulin, but knowing just how fragile diabetics become when they go on Insulin, I wanted other options. I see the story every day- insulin dependent diabetics inevitably go down the same road, ending in amputations, kidney failure, and death. Having to be on Insulin is a death sentence. I wasn’t going to do it.

That’s when the new class of diabetic medicines came along, and they were a miracle drug. Once I began taking Mounjaro, my A1C dropped to the mid 6’s, and my blood sugar is now well controlled. For the first time, I began thinking that I might actually make it to my 70’s. My last A1C was 6.2.

Since I could prove that I had been on Metformin and Actos for more than a decade, my insurance was willing to cover the $3,000 per month charge for the medicine. Insurance companies hate these new drugs- that’s why they got the Biden administration to go on a rampage to lower the cost of Insulin- they needed a cheaper alternative to the new medications.

Then two years ago, I got a new job. A new job means new insurance. The hospital that I work for, who is also my insurance company, requires you to get all of your medicine from the company’s pharmacy. That pharmacy has done everything that they can to force me to switch from the more expensive drug and take insulin. They delay filling my prescriptions, and say that they don’t have any, but if I would only switch to insulin, they have plenty of that available. I refused, and kept forcing them to pay for the drugs. As long as my doctor says that this drug is medically necessary, the insurance has to pay for it.

So this month, two months after the open enrollment period ended, my insurance company informed me that they will no longer pay for me to see any doctor who isn’t employed by the company that owns the hospital, and not coincidentally, the pharmacy. Not only that, but they are prohibiting me from paying out of pocket to see my current doctor. That was confirmed by my doctor this morning. They were threatened with legal action if they continued to see me for cash while I have active insurance. All of my future doctor’s appointments were cancelled. I offered to pay cash, and my doctor’s office told me that they can’t let me do that as long as I have active insurance. Now I am forced to see a company doctor, who will immediately place me on insulin.

I have a three month supply of medication left, and will be out of it by April 28. I can be added to my wife’s insurance during her open enrollment period, but that isn’t until July 1. It looks like they are going to force me to become Insulin dependent. I am sitting here thinking that my employer would rather kill me than pay for my medicine.

The only way to be added to my wife’s insurance earlier is to get a new job, and it has to be involuntary. I have to find a new job, then find a way to get fired, and I have to do it within the next three months. Maybe I can ask my boss to do me a favor and fire me.

My only other option is to try to convince a compounding pharmacy to sell me some generic, but you have to be obese for that to be legal, and I am not fat enough for that.

I am screwed.

No post yesterday because I was arguing with a bank. We decided to eliminate some debts. One of them was a loan with a small regional bank, let’s call them creditor bank, who we had requested a payoff quote from. The quote was for $41,800. We signed an authorization for them to perform an ACH from our checking account for that amount. That transfer cleared on Friday.

This morning, I get a notice from my bank that my checking account is overdrawn by more than $30,000. Of course, I call immediately to see what the problem is. It turns out that the creditor bank performed a second transfer in the amount of $41,300. The transfer was pending, so it hadn’t officially cleared yet. I paid $35 to put an immediate stop payment on that transfer.

Multiple calls to Creditor bank eventually wound up in an account representative, myself, and the manager on a three way call. The story they gave me was too crazy to make up. According to them, the amount of the payoff that I was quoted was incorrect. The payoff was actually $41,300, which was $500 less than what they had originally quoted me. Instead of simply mailing me a check for the overpayment, the bank thought that it would be a good idea to go ahead and take the correct amount out of my bank as a second ACH transfer, then the plan was that they would refund the original ACH payment back to me in 10 business days.

My response was: “And you think that is a good idea?” They thought that it was.

Ok, dummies. Wouldn’t it be easier to simply refund the $500 overpayment, rather than perform an ACH transfer that you weren’t authorized to withdraw, and then have to go back and refund more than $40,000? You do know that what you did was called stealing? Did you think that I wouldn’t miss the money?

No, they responded, because we were not intending to keep the money, we intended to refund the incorrect amount all along.

My answer to that was, “Well, I had to sign an authorization for you to perform the original transfer. Where is the signed authorization for the second transfer?” Crickets.

How can a bank, people whose job it is to handle money be so monumentally obtuse? I am not intimately familiar with banking regulations, but I am betting that what they did was not legal, and if it is, then one has to wonder why.

It took me most of the day playing phone tag to get it straightened out.

Holiday weekends are always outliers in the emergency department, and coupled with the cooler temperatures and rain that we had, Thanksgiving was even more so. We weren’t busy, with our census hovering at around 60%. We didn’t get a lot of patients, but the ones we got were sick. In other words, we were a true emergency department and not just a free clinic for welfare queens, homeless bums, drug addicts, and illegal immigrants.

My shift was cancelled on Thanksgiving day because there were only 40 patients in a unit with the capacity of over 100. My wife and I had not made dinner plans because I was supposed to be working. We discussed having a freezer pizza, then decided to go out. All of the restaurants in the area were either closed or full, so we wound up driving to Orlando and eating at Maggiano’s. It was amazing.

I actually worked on Friday. A man came in complaining of flank pain. He had a history of kidney stones, so that’s what I worked him up for. It turns out that it wasn’t stones- when his CT scan came back, he was riddled with cancer.

Another man came in came in complaining of shortness of breath that we diagnosed with lung cancer.

At one point, we had a brief rush of patients during the 90 minutes that we were briefly understaffed. The morning nurses had gone home, and the ones scheduled for the afternoon hadn’t come in yet. I was covering 5 rooms for that period, and I was OK with that because three of them were empty. Then a line of ambulances came in to give me an asthmatic, a hip fracture, and a woman with a blood sugar of over 500. While that was going on, a woman flagged me down to unhook her father from telemetry so he could use the bathroom. He wasn’t my patient and I was quite busy, but it only takes a minute. I unhooked him and started to leave, and she stopped me to say, “He doesn’t walk well. I need you to walk him over there.”

I replied that I was too busy to do so and left to go see my patients, so she began yelling at me while following me across the department. I told her that she could walk him to the bathroom if she wanted to. It was at that point that she began yelling even louder and started telling me that I am a dick. She then said, “I am going to go get the doctor and tell him what an ass you are. I hope you get fired.”

My response was to call security. I told security to remove her to the lobby until she learns to control herself and act like an adult. Her husband chimed in at this point, saying “That’s my wife. She’s just worried about her father.” Security asked me if I wanted the husband removed as well, and I replied with: “No, he isn’t interfering with my patient care, just her.”

She ran over to one of the ED doctors and began complaining. The joke is on her. Doctors don’t run the hospital, nurses do. People think that because doctors write prescriptions and orders for patient care, that doctors are in charge, but that isn’t how hospitals work.

Anyhow, my charge nurse had to get involved at this point. He pulled me into the medication room and asked me what happened, then agreed with me that her following me around the ED was interfering with my care of my patients. They decided to teach me a lesson by having the father sign out of the hospital against medical advice. All because I was too busy taking care of sick people to be her personal butler. I guess she showed me.

On top of that, I had a patient with COVID, two with RSV, and the funniest one of all. A woman had gotten in a physical altercation with her roommate, and it was so funny I had to leave the room to keep from laughing. It went like this:

• Doctor: “So why are you here today?”
• Patient: “I got in a fight.”
• Dr: “How did that happen?”
• Pt: “My roommate locked me out of my room and said I wasn’t allowed back in because my pussy is too hairy, so I punched her in the face. She hit me in the face with the remote control, said ‘Merry fucking Christmas,’ then hit me in the face with a fruit basket. I fell and bit her on the toes, and that is how two of my teeth came out.”

It was at that point that I had to leave the room to keep from laughing.

That was my holiday weekend. Now to resume normal blogging…

We finally sold our old house and the closing is next week. I called the insurance company to cancel our homeowner’s policy, effective on the date of closing. They refused to do so, telling me that they can’t leave me without insurance unless I can prove that the house is insured elsewhere. Uh, it isn’t going to be my house any longer, so why would I continue to insure it? And, since the house is paid off and there is no mortgage holder, why is it any of their business if I choose to be uninsured and assume the risk myself? I am betting you that they won’t be so concerned about leaving me without insurance if I don’t pay the premium.

Doing the math, we have owned that house for a total of 15 years and we never filed a single claim against our insurance. It was paid off and mortgage free as of six years ago. My insurance is about $2000 per year. If I had chosen to assume the risk myself as soon as we paid it off, I would have (counting my normal investment returns of about 8 percent) an additional $15,000 in my bank account with which to take care of any problems.

Speaking of homeowner’s insurance scams- I wanted to insure my solar installation. I was kindly informed by my insurance company that it would cost $2500 per year just to insure my solar panels against hurricanes, but there would be a deductible of $10,000 for hurricane damage. They are otherwise covered under the rest of my homeowner’s policy with a deductible of $1,000. Uh, the solar panels themselves cost $20,000. So in the event of a hurricane (remember my panels are engineered for winds up to 140 mph) I would actually be losing money to insure them if they can make it at least 3 years without being damaged (The cost to insure them for 4 years is $10,000, plus the $10,000 deductible). Needless to say, I elected not to cover them. I think my risk of a 140 mph hurricane in the next 4 years is pretty low.

I also recently bought a new truck and traded in my old one. I tried to log into my insurance company to take care of things, and the system wants to send a 2FA text to my wife’s phone. She isn’t home. There is no option to select my phone number to log in. So now I have to call them and get stuck in phone tree hell.