Inside the Little Plastic Castle

On 8 July, I got a cortisone shot in my middle finger, in hopes of warding off surgery for yet another trigger finger. The PT handed me an oval-8 splint to wear that would help the synovial sheath swelling to calm down.

In the mail today, I got a notice from my pharmacy benefit manager (PBM) one of four profit-making entities that I buy health care from. This EOB notice comprised six sheets of office paper, mailed flat in a 9"x12" catalog envelope with a custom window. On top was the single-sided cover sheet with my and their addresses (to fit the window) as well as a boxed definition of "explanation of benefits" (EOB).[note 1] Next was another single-sided sheet with that actual explanation (details below). Then there are four more pages printed both sides explaining how to appeal (in type too small for me to read). These six sheets were mailed unfolded in a catalog envelope from Connecticut (although Navitus is headquartered here in Madison). For personal mailings, six sheets folded in an envelope costs $0.74 — sending flat sheets increases the cost 230%. Commercial postage is less but too confusing for me to calculate.

In the end, the EOB informed me that I might need to pay $1.20 for the oval-8 splint — more than it cost to send me the notice.

I know that many, perhaps most EOBs document important (nay, oppressive) amounts of money. Yet and still, this system is borked.

Players in my health care team, or, places to duplicate info and mishandle data:

1. Health plan (we pay $890/month private insurance) https://www.deancare.com [note 2]
2. Clinic — almost all my care and equipment comes from staff who work for https://SSMHealth.com They get paid by 1, 5, and 6
3. Small mental health group, home to the "in-network" APNP who deals with my psych meds. https://madisonpsychiatricassociates.com Paid by 1, 5, and 6
4. Family-owned and -run pharmacy, which gets money from 1, 5, and 6 https://www.ipcrx.com/pharmacy-profiles/2018/neuhauser-pharmacy-madison-wi
5. Navitus the pharmacy benefits manager, https://medicarerx.navitus.com co-owned by SSMHealth and Costco. 1 pays them administrative fees to pay 2, 3, and 4
6. Medicare (US government insurance, $170 monthly deducted from our retirement checks) and the only non-profit. Pays most of the bills for 2, 3, 4, and 5.

Note 1: (I’m not going to attempt to spell out what an EOB is. A handful of places try to explain in plain language: https://www.carepartnersct.com/wellness/how-read-your-explanation-benefits-eob

Note 2: I’m super lucky that MyGuy spent 20 years working for #1; he does a great job analyzing the EOBs, among many other skills.

The good news is the surgery went well. Previous trigger finger release was traumatic. That's why I delayed this for around 18 months. Now I know it can be a well-orchestrated procedure with minimal terror and pain. Since this is the sixth time I've had trigger finger I'm sure there will be a next time for me not to put it off to.

The bad news is it's the middle and ring fingers on my dominant (right) hand and wow do I feel clumsy. To ensure that I don't reach for things by mistake, I've installed a very large fluffy mitten.

( photographic proof as well as some of my hats )

I'm switching between macOS/iOS forms of dictation, voice control, sticky keys, and bashing my head gently against a pillow—it's very weird to go from typing 80 words a minute to whatever I don't even want to count.

In summary: medical procedures don't have to be traumatic!

You really don’t know what you’ve got til it’s gone. Last week I was starved for content. Now I’ve got six posts I could draft if I could only type. Not to mention eight pieces of beadwork I would craft if I could only use my right hand.

MyGuy is being exquisitely helpful, and still my major mood is Whine.

Thank you so much for your kind thoughts!

Bella’s eating dinner

as well as the eighteen pills daily they sent her home with. Luckily, she loves almond butter and needs to regain weight lost over 7 days not eating. Plop a pill in a gob of almond butter and she simply thwips it down. The immunosuppressive Cyclosporin is sufficiently toxic that we have to don gloves to stuff it down her throat, and the pills themselves are huge. For these we have to pry open her jaws, jam the pill on the very back of her tongue, then stroke her throat until she swallows.

No physical damage from the crash

I was too ashamed to check in with my primary doc after the crash, even though my pain levels have stayed elevated. MyGuy finally convinced me, and I saw my doc today. He confirmed that my pain was consonant with a terrifying incident. We agreed that I got away lucky.

In convo with my therapist, I realized

• while the driver and witnesses did shit to be helpful
• I was capable of taking care of my own needs and therefore
• Prevented further damage
• Reached out for support to helpful people, like you

All good things. The final realization is one I’ve packed away in my lock box for further examination next session: the driver was in many ways acting just like my father.

Found three nifty resources as I was preparing for my WisCon panel (NEXT WEEK!)

Beyond the Fix or How Do I Live this F*ing Life?
10am Saturday in C5 second floor
virtually #BeyondTheFix on Twitter

I’m thrilled about these rockstar panelists:
Elena Tabachnick (M), Kate Carey, Shayla Dunn, and Lenore Jean Jones¹

Full WisCon Schedule: https://account.wiscon.net/grid?search=&view=list

( check out Jess Jacobs, Insickness Podcast, and Fully Sick )

Barbara Dawson is dead. Her life was deemed not that important, because she was sick, black, female, and fat. (CW: lots of anti-fat crap crawls into this story's discussion, including "blood clot caused by obesity.")

( click for horrible details )