A Song of Pain and Rage
I am raging so hard right now.
For the last week, I’ve been dealing with mountains of ineptitude from the medical establishment. Namely, my doctor wrote a prescription on Friday. At the pharmacy, it was “rejected for prior authorization.” According to the pharmacy, the insurance company rejected payment, and I would have to take it up with them. I was, of course, welcome to pay $235 in cash and leave with my prescription immediately. HA!
Of course, I did not have this information until after the close of business hours, as my appointment had been in the late afternoon. Which meant that the doctor’s office AND insurance company were both closed for the weekend. (FYI, in Texas, the Medicaid program just pays for people to have private insurance instead of covering medical bills directly. Because this is Texas, friend of both corporations and ineptitude.)
So I settled myself in for a really fucking uncomfortable weekend, sure that it would be taken care of on Monday. The medication in question was one of two pain medications that I have been taking for quite a long time. It was the significantly “heavier” of the two, and I was somewhat worried about going into opiate withdrawals in addition to suffering immense physical pain… But it would all be taken care of on Monday. Right? So I leaned much more heavily on the other pain medication, prescribed in limited quantity for “breakthrough pain,” which is supposed to be used sparingly throughout the month.
Monday came and went. I logged several calls each with the pharmacy, the doctor’s office, and the insurance company. No results.
Tuesday came and went. I made the same round of calls several times, without either results or even so much as a return phone call from the doctor’s office. I was pissed on Tuesday because this whole problem could be alleviated by ONE individual clicking a button on their computer screen that said “authorize,” and also because I’ve been on this medication for a good amount of months and have never had such problems before. ”Prior authorization” had never been required, and it SHOULDN’T, because the medication, while expensive, was still a generic. The insurance company’s customer service representative explained that they had “changed the matrix” to require prior authorization on that specific dosage and quantity of the medication in question. I started out pissed at them, but the longer the bullshit stretched out, the more angry I became with the doctor’s office.
Why? Because sure, the insurance company “changed the matrix” and added a new layer of difficulty to my life. But it was the doctor’s office who simply had to make a phone call in order to get the individual at the insurance company to click the stupid “authorize” button. And they hadn’t done it. Every time I called, there was some new excuse. Having done clerical work and even WORKED IN A RESIDENCY PROGRAM (my doctor is the head of a residency program), I am fully aware that they can do things really fast or let them linger for weeks.
So when Wednesday rolled around and nothing had been changed, and the doctor’s office continued to give me the run-around (“oh, we haven’t received a request from the pharmacy” — bullshit), I arranged to get a ride and took my crippled ass to the doctor’s office. To say they weren’t pleased to see me was an understatement. I reached the receptionist at 3:48 pm. I was called back to talk to the nurse at 4:10 pm. The charge nurse assured me that they had “sent the fax.” In fact, they had done it “today” because “we didn’t receive the request until today.” O RLY?
So I called the insurance company from within the doctor’s office. They said they had not received anything from the doctor’s office, but that if I could just let the customer service rep talk to a member of the doctor’s office staff, she could override the system, as I had already been waiting for so long.
The charge nurse refused. First it was that she couldn’t talk to the insurance company on my phone. Fine. I guess I can understand that from a “chain of responsibility” standpoint — she could be talking to anyone, right? So I got the rep’s extension and asked her to please call from the office phone. The goal was to get it taken care of while I was there in the doctor’s office, so we could stop at the pharmacy on the way home and be done with this miserable fucking nightmare. I was quite a bit more polite than that, though in retrospect, maybe I shouldn’t have been. Why? Because she also refused to call them from the office phone. She said that she had done her part by sending them a fax and that if the fax hadn’t been received within 72 hours, she could send another fax.
Somewhere in the middle of all this, while I was on the phone, the charge nurse asked the (snotty) receptionist what medication I was “trying to get.” The receptionist told her, and they exchanged a glance before the nurse said “ohhh… I understand.” And not in a nice way. In a… judgmental way. Because clearly a young woman who can walk and work and live a normal life has any fucking business judging a woman in a fucking wheelchair who is only trying to get someone to authorize a medication that the nurse’s fucking employer — a well-seasoned, no-bullshit physician — prescribed.
So, at that point, I pursed my lips and sat quietly for a moment. To hear her tell it, the charge nurse is in “charge” of the whole office and there was no one to appeal the decision to. Experience tells me there’s always a higher authority, especially in a residency program, but getting access to that authority is not easy. My doctor was out of the office. The charge nurse was being, for lack of a better word, a bitch.
The only thing left to do, for the moment, was find out when or if “the fax” had been sent. So I requested a copy of it. In Biblical times, the response would have been classified as “much wailing and gnashing of teeth,” but she finally gave me a copy of the fax (cover sheet only), which showed that the fax had indeed been sent… On Wednesday at 16:00, or 4:00 pm. In other words, after I arrived but before the nurse called me back. So I had spent days getting the run-around only to find out that it had, in fact, been nothing but run-around.
I suffered a pretty miserable night, as the “break-through” medication was dwindling. This morning I called the pharmacy, who is familiar with me on a first-named basis, and they verified that the prescription was still “rejected for prior authorization.”
So I called the insurance company. They were not familiar with me on a first name basis, but were able to see the sheer amount of times I’d called in the past week. They said they hadn’t received any fax from the doctor’s office, but that sometimes it took 24-48 hours to “process.” Interesting (and not the 72 hours that the charge nurse had told me).
Then I called the doctor’s office. I asked that they please call the authorization in, as the insurance company couldn’t verify receipt of the fax. This was met with several impassioned iterations that “we sent it yesterday!” And… at this point, I don’t disbelieve them, due to the fax cover sheet with confirmation showing it was transmitted successfully.
It’s just that it doesn’t really matter anymore. I am OUT of “breakthrough” medication now. I tapered as well as I could, but I never expected to still be high and dry 6 days after first presenting the damned prescription. Opiate withdrawals are a real fucking bitch. I do not care that they already faxed it, since “already” is defined as “not until I showed up in person at the damned doctor’s office” which, by the way, is on the other damned side of the damned city.
And so, here I am. The breakthrough medication was at no point enough to actually relieve the pain. If it was, it would be my “only” pain medication instead of my “breakthrough” pain medication. It did keep me out of withdrawals when I was able to take a reasonable amount of it, but it’s been days since then. My arms and legs ache, I’m sick to my stomach, I’m hot and cold at the same time, I have diarrhea… And the pain. It’s incredible. It has a life of its own.
I used to think that I was pretty tough. That I could handle anything. That nothing could hold me back, not even pain. This is because I was arrogant and also had NO IDEA what pain was, what it really meant to hurt. I just… I had no idea.
This is… not the same as someone whose “back hurts” or has a sprained ankle or even half a dozen broken bones. This is major joints just… demolished.
There’s a hip replacement in my future. And an ankle fusion. Possible knee replacement. Even those are unlikely to solve my problems. Medication has never completely relieved my pain; I’m well aware that all I can ever hope to do is manage it (make life more tolerable), and even that is not possible 100% of the time. I would say that, fully medicated, I can stand to be alive about 70% of the time. (This is not the same as being suicidal, though I have heard of untreated orthopedic pain doing that to people.)
I wake up crying in the night. Fully medicated, that happens maybe a couple of times per month. The last several nights, it’s been 3 or more times per night. My dreams have been filled with graphic imagery of torture. I can see how someone could go completely crazy.
Here’s a little science on the subject of pain for the nerds. One quote hit me pretty hard: “Chronic pain is like water damage to a house — if it goes on long enough, the house collapses.”