Praise then darkness, and creation unfinished

Today's visit was longer than I expected, but hardly unpleasant at all.

I was there for them to take impressions of my teeth, so they can make the dental implants and bridge. I expected it to be very unpleasant, because at last spring's visit to make the temporary "flapper" (which never did get comfortable), it took three tries before they got a usable impression.

I mentioned this up front, and they did the first two (out of three) impressions with a smaller tray for the modeling material. It also helped that this modeling stuff hardens faster than the one from last time, so I didn't have to carefully hold still for as long after biting into it.

It will probably take the lab six to eight weeks to make the implants and bridge, and they'll call me to make an appointment once they know.

This is going to be expensive. The paperwork they had me sign for this, after warnings about possible complications, said that I'd been given the chance to discuss what it would cost. So I asked the dental assistant, who said she'd have to go get the dentist; he in turn had the receptionist call my insurance company. The answer is that it will probably be between six and eight thousand dollars, which Vitaly said is a major discount from $12,000-$16,000. They had me pay $4,000 today, and will contact me when they hear back from the insurance company. I called Aetna a few weeks ago, on Adrian's behalf, to ask about coverage for implants, and the agent told me they're not covered at all. (She and I happen to have the same health and dental insurance, so I could call and give them my own membership number rather than saying I was calling on her behalf.)

ETA: There is of course no way to do this masked, but there were very few other people at the dentist's office, and the dentist and his assistant were both masked. I put on a fresh N95 mask, and used the Betadine iota carrageenan nasal spray, before leaving the house today, and am hoping those protect me from covid, flu, and whatever else might be going around.

I am not happy with cvs caremark: after asking for, and getting, my explicit permission to look for help paying for my expensive MS drug, they somehow decided that wasn't sufficient permission. And they were waiting until I got around to asking for an update to tell me this, after having told me that I shouldn't expect to hear from them for at least a week.

That's a week of wasted time, and maybe they'll call me within 24 hours as the chat agent said, and if so, maybe they'll be able to get me help, but I don't know how soon, if at all.

I have a call in to the nurse at the MS clinic, asking how long I can reasonably wait between doses of Kesimpta. I knew from a while ago that six weeks between doses would be fine, so I figured a week ago that I could spare a week or so for them for possible payment help, but they just used up that week.

I am additionally annoyed at the chat agent's generic apology for the "inconvenience," from someone who already knew that I had contacted them because I was waiting for my medication. She also, when I asked what days they ship, said Tuesday-Friday, and when I asked a clarifying question it turned out those are the delivery dates, and they ship Monday-Thursday. I'm hoping the nurse tells me that eight weeks would be OK. If the answer is seven weeks, that would mean placing the order by next Tuesday.

1) I finished the Dificid (antibiotic) Friday morning, but am still having occasional bouts of diarrhea. ( numbers )

So I called the dentist to reschedule, since I can't count on being able to sit still in the dental chair for long enough, and then called my doctor's office.

Carmen just called me back, and I told her what's going on. She took notes and said she is going to send a message to someone who knows more about C. diff. We were talking at 6 p.m., so Carmen didn't expect an answer today, and said she will call tomorrow if they don't respond, and that she'll call me back tomorrow or Wednesday. In the meantime, I am continuing the probiotics.

2) I got email from CVS Caremark at about 3:00, saying they had my prescription and would "begin processing it shortly. If we run into any issues while filling your prescriptions, we will contact you or your prescriber." Having heard nothing for a couple of hours, I used the chat on their website to ask for status. In reply, the agent told me what the copay would be. I asked how to pay that, but when I tried to follow those instructions, it showed a zero balance. Back to chat, where the agent told me that the way to add a payment method was via "set up automatic payment." I have done this, but that took long enough that it now says I will get the Kesimpta on Wednesday.

Given how healthcare works in the US, I didn't expect it to be that hard to find out how to pay them.

Adrian went to the pharmacy and picked up my prescriptions. One of them was run last year, and they charged a copay of fifteen cents, which I think is the lowest I've ever been charged. Yes, mirtazapine is an inexpensive generic, but that still surprised me. This year's insurance has zero copay for "tier 1" drugs, but they ran this prescription last month, on the old insurance. The pharmacist said they'd run my other prescription on that insurance yesterday, which seems odd but I'm not going to worry about.

Adrian then waited in another line to give them her and my new insurance cards and numbers, and they told her that the insurance company had taken care of it for us, which surprised me. The pharmacy returned my second phone call about this a couple of minutes after Adrian told me it was taken care of, which I told them when they started to run through the questions to confirm my identity.

ETA: I just checked whether the dental insurance part of my new health insurance covers out-of-network dentists. The answer is yes, which I learned during a slightly frustrating conversation with someone at their call center. Quite a few plans don't, including both my and Adrian's old plans.

Even straightforward calls to health insurance companies can be draining, and I had to repeat myself a bit on this one, but now I have the basic information.

I have now received from Aetna, in order, a SilverScripts card (prescription drug coverage only), followed by a letter saying that they couldn't process my request for enrollment in a Medicare Advantage plan for 2025, and now a Medicare Advantage card that was printed on Nov. 1, 2024.

I called Aetna two days ago, after receiving the letter saying there was a problem with the enrollment. I think the 2025 plan application is now sorted out, but I should call Medicare and ask what they know about my 2024 and 2025 coverage.

I decided on a plan, and called Medicare for help with signing up, rather than going through the insurance company website. This turned out to be a good idea, because I am signed up for the "Aetna Medicare Discover PPO" 2025, but the agent couldn't set that up for 2024 because, on paper, I've been enrolled in Medicare (part A) since April, which is more than three months ago. (Never mind that I only found out about it a month ago.)

I asked the agent about buying a prescription-drug-only plan, and he found me one for $15.70/month that covers most of my prescriptions (excluding the Kesimpta). I bought the plan mostly just in case I get sick in November or December and need something more expensive than doxycycline. The interesting question now is, will I be covered by my previous health insurance for the next week, or does it go "poof" sooner? I think Cattitude needs to be the one to call the Massachusetts insurance marketplace and confirm that I'm now on Medicare, but he still wants to buy insurance through the marketplace, because his name is first on that account.

ETA: I think the Silver Script formulary does include both gabapentin and bupropion, and that the agent missed that because I gave him the brand names.

tl;dr: Train ticket and appointments sorted, and I think the prescription is too.

( prescription and insurance nonsense, phone calls, train tickets )

I spent what felt like a lot of time over the last few days talking to the pharmacy, and my doctor's office, trying to figure out what the insurance company was doing with the Ritalin prescription this time, before finally managing to get it sorted out and picking it up on my way back from visiting my doctor for the wart treatment. I'm not going to try to explain what the insurance company was doing, or why, because that would require me understanding it; in the end my copay was less than I expected.

I spent a couple of hours in Davis Square, eating lunch and talking to my friend Elizabeth. Mr. Crepe no longer has any outdoor tables, but they're basically across the street from Davis Square, which does. That was fun, and we hit the sweet spot between too cold for people to enjoy sitting outside, and too hot for me to function well.

The doctor decided that the skin on my left index finger is sufficiently recovered that it was reasonable both to try freezing the wart, and that I can go back to using the salicylic acid pads. I was only able to tolerate about 15 seconds of zapping this time (instead of two 30-second zaps), which I hope means we're actually getting the cold on the wart. If the next round doesn't do it, they'll send me to a dermatologist.

Also, when I got to the doctor's office, I saw that the staff were all masked, as were about half the people in the (small) waiting room. After a couple of minutes, someone came around with disposable medical masks and told the unmasked patients to put them on. One person argued that that's no longer required, and was told "this is a private practice, we have different rules."

I thanked the person who was handing out the masks, and also mentioned this to Andrea, once I was in the exam room. She said they haven't decided what their policy will be in the future-, but assured me that not only can I keep masking regardless, but I can ask whoever is treating me to mask even if they decide not to require masks from either patients or staff. That's about as good as I think I'm going to get anywhere, and better than a lot of places.

I just went over to CVS, waited for the pharmacy to open so I could get some insurance-paid covid tests, and discovered that my insurance company has stopped doing that. The pharmacy clerk did say my insurance would cover the tests up-front if I could get a doctor to write a prescription, but sounded like she didn't think that was likely.

We have few enough tests left that I paid for one box, and will figure out how to put in for reimbursement. When I see the doctor on Friday (for something unrelated) I am going to ask her about prescribing some of those tests.

I am also not happy that Massachusetts charges sales tax on those covid tests.

I saw the occupational therapist this afternoon. She therapist did ultrasound and massage, because there's still some muscle tightness. The therapist was very pleased that I'm not wearing the brace much, because I'm not finding it necessary, and that I've been doing the exercises I already have with the two-pound weight for all three exercises, 20-25 reps twice a day.

She did ultrasound and massage, because there's still some muscle tightness. She also measured my grip strength and how wide I can stretch, and those were better than the last time she measured them. So, I will continue to do the same exercises and stretches at home, and see her again next week.

I have appointments for next week, and then for November 2, 16, and 30th, which may be more appointments than I will need, and is one more than the insurance will cover this calendar year. However, it turns out that my copay is half of what they'd charge me privately/without insurance, and we can afford the difference.

Also, something weird, but not bad, about my insurance coverage for this: the receptionist told me today that they had been overcharging me by $5 visit, because that's the copay the insurance company's website told them to charge me, three months ago.

ETA: I hadn't done the three wrist exercises with weights before heading out this morning, so I did one set of each around 5:00, which was fine. I just tried another set of each, and the first was OK, but the second hurt when I did them with the two-pound weight, so I tried the one-pound, and that wasn't any better, so I'm stopping for tonight.