Wednesday, August 31, 2011

Kids Say...

"I want Chuck E Cheese to come over and see my helmet."

Yep, thats what baby #2 just had to say at the breakfast table. I was so ready to write a post on how medco shorted both of my prescriptions with our new United Health Care insurance and then little miss Audrey put life in perspective for me once again!

Thankful for sweet babies and their tiny worries and desires this morning! :) Hope you have a great day too, maybe even one that involves Chuck E Cheese!

Monday, August 29, 2011

Father Damien of Molokai

Last night, my husband and I watched a wonderful movie about Saint Damien of Molokai. Once again, as in my post about Saint Gianna Beretta Molla, the saints are making me look bad.

Father Damien had a lot to complain about. In 1873, he volunteered to establish a parish on the island of Molokai for the lepers of Kalaupapa, a leper colony established there to quarantine infected people. After a short time, he began writing to his bishop and the government, petitioning them for timber to build shelters, food for the patients, medicine, and nuns and priests to assist him in his work. His petitions continued for 16 years, and fell mostly on deaf ears.

In the scene that accused me so deeply, Father Damien has returned to Honolulu for the last time to ask for help. He has contracted leprosy and this will be his last visit to the mainland, to make confession and plead for help for the lepers at Molokai. He speaks to a nun that came to Honolulu five years prior with the intention of assisting him. She was prevented from doing so by the bishop. She has adopted as her own the lie that she has been told by her superiors: the sisters are so busy here in the mainland hospital, we can't possibly be spared for Molokai. Here is Father Damien's response:

"Sister Mary Anne, here, you have 4 doctors, 7 sisters, and 100 patients, none of whom are dying. On Molokai, we have no doctors, no sisters, soon we will have no priest, and 1,000 patients, all of whom are dying."

Father Damien is then interrupted by Father Leonore, an assistant to the bishop, who calls his pleas for help an "embarrassment." Fortunately, however, the meeting made an impression on Sister Mary Anne and she and several of her companions joined Father Damien on the island shortly before his death in 1889.

The reason Father Damien makes me look bad is because he slept on the ground, re-built a church, bandaged sores for people he was not supposed to touch, insisted on clothing, food, medicine, and shelter for a wretched and forgotten people, and eventually contracted leprosy and died because he refused to leave the lepers without help. He freely chose the death he knew he would almost certainly obtain (apart from a miracle) but still refused treatment beyond what the other lepers received. Those of you who read about my insurance crisis (which should probably be re-titled "The Post in Which Beth Makes a Mountain Out of a Molehill") will understand how bad this really makes me look. In the final analysis, I am sitting on the mainland, complaining about my bandaged sores and my Japanese baths (insulin pump, anyone?) and my four doctors and seven nurses while people whose suffering exceeds mine by a factor of 10,000 languish in agony.

Saint Damien of Molokai, please keep making us look bad - and pray for us.

Wednesday, August 10, 2011

Contemplating...

Hi from the long-lost me, Jenn. Sorry it's been so long, I think I've been in one of those, life-isn't-going-the-way-I-want-it-to-so-I'm-not-going-to-blog-about-it moods. :) I'm sure that I've mentioned before the hub's and my desire for more children, and because of the female quality of my person that desire has been a bit stronger for the last months than my male typified (reasoning) dearest husband. He's had a lot on his plate at work and just wasn't ready to have the discussion about adding on to the family when I was, which is reasonable for sure. He is after all the one who provides for our family and needs to feel like he is in a place where he can feed and parent another child.

Although, I must say that I am quite astonished that we have not welcomed a pregnancy in the last 2.5 years since Audrey's birth, we do not use hormonal birth control and wow, are we really that responsible? I guess we are. ;) All that is to say, we are contemplating growing our family these days. I'm extraordinarily excited about this and wondering since we haven't done this in 3 years or ever in this town what to do next!

We just got new insurance, which I felt very silly complaining to Beth about when she lost her's the next day. :( Our new insurance does not cover my beloved endo and I had to cancel my appointment with him just this past Monday. Only to find out that the only endo our new insurance does cover in town has a 3 month waiting list.

Well, with the possibility of pregnancy, I want to know where I'm at with the "dia-beets" and I'm not so keen on the idea of waiting 3 months to find out. I did interview the midwives in town a few months ago and still am hoping to have them work with me for the birth if we do get pregnant, however, I want to also find a perinatologist to manage the diabetes during pregnancy. So I'm thinking, I'm going to try and get in for my first ever "pre-pregnancy" diabetes meeting with a maternal-fetal specialist. The midwives work closely with one doc in particular here, so I'm thinking she must be decent as far as interventions go or they would have chosen someone else. Thankfully, our new insurance covers her and I'm hopeful that she will not have a 3 month wait when I call tomorrow :)

I feel a bit hypocritical going for such an appointment after this comment, and must admit my fault and regret over this passionate statement. I still believe that specialists make decisions based on fear of what might happen rather than the reality of what-is with diabetic women and know that I will have to hold my ground through another pregnancy, Lord willing to grant me this gift. However, I've also learned that the doctors are good at managing my diabetes and holding me accountable. A good thing for baby and something I want. I remember that feeling of I have to do everything I can to make this pregnancy as normal as possible by perfecting my blood sugar control to avoid complications and to ensure the best chance at a normal delivery.

I'm scared, though. I have two beautiful and currently healthy children. Am I crazy to do this again, what are the chances I could be successful? How much harder will it be to take care of myself with two toddlers running around? Do women get births as wonderful as Audrey's twice or am I pushing my luck? What if I can't get pregnant this time? (although that wasn't an issue AT ALL the first two times, what if I've changed?) What if I do have a miscarriage, even if it has nothing to do with my diabetes, will I ever really believe that? I'm older now, and certainly much wiser, than the 23 year old who had a surprise pregnancy and willed her way through it. I've lived through friends pain and loss over pregnancy and children now. I've lived through the lives of my own two kids and realized how much of a responsibility it is to care for and train up another human being. Am I really ready for this?

As I typed that last question an involuntary smile spread over my face because I know the answer to that question. Yes, yes, I am ready. And to the others, thankfully, like Beth, I trust in the grace and plan of the Lord for the rest. Knowing His sovereignty means I can live through the rest of those questions even if the answer isn't what I was expecting. The desire for a child is a GOOD thing. Even for me, even though I have diabetes. It means I have to put on my big girl panties and man up to the huge responsibility of my diabetes while it is affecting the miraculous formation of another human being, but this is a responsibility the Lord knew I could manage. I do covet your prayers as my husband and I contemplate this decision which is why I am writing today. Lord willing, I will have more to write about in the coming months, Jenn.

Friday, August 5, 2011

The Customer is Always Right?

We don't often talk about our insulin pumps, but every now and then something brilliant or frustrating happens and it shows up on the blog. Jenn has written about her experience with the Dexcom pump. I have written about what I wish Minimed would do with their Carelink software. Jenn began a draft post that has been waiting to be finished for about 2 months now, titled "3 more reasons I'm in LOVE with the Dexcom." (Yes, Jenn, that was me trying to provoke you to finish your posts.)

At the risk of starting a Minimed v. Dexcom war, I thought I would devote this post to what I like about Minimed. For starters, it seems like they really understand what it's like from my perspective. They really get it: not just diabetes the disease and diabetes supplies, but what it's like to be a diabetic.

When I first explored pumps in the fall of 2008, I signed up for a Minimed pump at the recommendation of my doctor. The Minimed representative was crucial to getting my insurance company on board to pay for it. When he called, he made sure we spoke on the phone (no voicemail left at 10:04 am on my home phone - he called me at work like I asked him to). He did all the legwork with my doctor's office. I even got the sense that when I faxed him the paperwork with my signatures, he was waiting at the other end of the fax machine for it to come out. He was courteous, professional, effective, and decidedly non-bureacratic.

I rejected Minimed's CGM system because I was never able to get my blood sugar to be stable enough for long enough to calibrate the darn thing, and I had a whole lot of trouble inserting the sensor. I think I only ever got it right twice before I gave up the project all together. Even still, I called Minimed at least two times, pretty frustrated, and the representative talked me off the ledge. I actually hung up the phone happy and hopeful, in spite of the persistent failure I encountered in using it. Anyone who has worked in customer service knows that takes talent.

I was pleased by Minimed's service again last summer when I was pregnant. My pump started malfunctioning, and eventually got to the point where it was not delivering boluses at all. I freaked out, called Minimed at 3:30 in the afternoon, and by 10:00 the next morning, I had a new pump in my hands. They completely replaced it for free, and I didn't hear another word about it.(In case you are curious, the problem was moisture. Since maternity pants don't often have pockets or a real waistband to clip to, I was wearing it in my bra a lot. Since it was summer and I was seven months pregnant, I was sweating a lot. The moisture got in and wreaked havoc.)

My most recent success with Minimed has a rather lengthy back-story that involves all the intrigue of a mid-year letter from my insurance company, new prescription restrictions and policy limits, and "prior approval from your doctor." Or, maybe that's only a source of intrigue if a larger-than-average percentage of your time is devoted to these things...

In January or February, I received a letter from our health insurance company indicating that they would no longer cover strips in an amount higher than 204 strips. The letter did not specify the period (one month or three months), but let's take the worst case scenario. For three months, 204 strips works out to checking my blood sugar between 2 and 3 times per day.

Since I recently calculated that it costs $3,000 for One-Touch Ultra test strips for me for one year (testing 8 times per day), I can understand my insurance company's incentive to avoid covering them. On the other hand, I love to check my blood sugar every two hours. I learned how useful it was when I became pregnant. At first it was a drag, but after 9 months, I was hooked. I would prefer that my insurance company support my habit (it's not, after all, like smoking a pack a day). I would also prefer that they not change policy limits in the middle of the policy term.

I was well-stocked on strips at the time when I received the letter, so I inwardly grumbled a little but basically resolved to do nothing. When it came time for me to order strips again, I remembered the letter with some fear and trembling. I pulled it out to read again, and noticed that it said something about the possibility of having additional test strips covered with my doctor's approval. I have always hated calling either my doctor's office or my insurance company to beg for special favors, so that's when I had a brilliant idea (Enter Minimed, stage right).

I logged onto Minimed's internet store, entered the number of boxes of strips that I wanted, and penned a small note in the comment box: "My insurance company has some policy limits on the number of strips that will are covered under my plan, but I check 8 times per day and they said I could get more with approval from my doctor...," and clicked Submit. Let's see if they can figure it out, I thought to myself. I am almost always proactive in working with my insurance policy and my providers because I don't like surprise medical bills showing up in the mail, but I can't tell you how many times I've been told that they cannot guarantee coverage until the claim is submitted. So I submitted it and hoped Minimed would come through for me again.

The next thing I saw, two weeks later, was an Explanation of Benefits from United Healthcare. Of course, only one box of strips was covered. Great, I thought. This is going to be a nightmare. Still, I had hope that Minimed would call my doctor to arrange for the approval, ask United Healthcare to pretty please re-consider the claim, and send me a bill for no more than my co-pay.

We've been getting ready to go on vacation, and since the order was placed about 2 months ago, I knew we were getting close to the time when the Medtronic bill would be sent my way. I was afraid that it would show up in the mail the day we left, we'd be gone for two weeks, and I'd be on the hook for $600 with precious little time to spare to call and harass - er, request more information from - the relevant parties.

On Monday, two days ago, I received the tell-tale envelope. Gulp. I opened it slowly, and began pondering my options. Who should I call first? Should I follow up while I'm on vacation? What if I have to fax something? As you can probably guess, my bill was nothing more than my $60 co-pay. WHAT A RELIEF! Yet again, Minimed saved me the hassle and not a few gray hairs. Maybe it was not as difficult as I feared it would be, or maybe it cost one of their billing representatives an entire 8-hour work day to figure out. In any case, it's exactly what a company should do as far as I'm concerned. And the customer is always right...or something like that.

I'll be signing off for a few weeks while we're on vacation. By the time you read this, we will have been on the road for 3 hours and hopefully not ripping one another's hair out. I hope you enjoy the rest of your summer, and two things I won't be worrying about while I'm gone are 1) finishing my blog posts (ahem, Jenn) and 2) my Medtronic bill.

Thursday, August 4, 2011

Partial Resolution to Insurance Crisis

A couple weeks ago, I wrote about our insurance crisis. I guess I should say "crisis" with my tongue in my cheek, since compared to what these brothers and sisters deal with on a regular basis, it's a luxury.

After a few meetings with deans and other administrative personnel at the university where my husband is pursuing his PhD, the school has graciously extended student coverage to dependents for another 6 months. That means I will have group coverage until about February.

As things currently stand, it only pushes the problem back for a few more months, but it does give us some room to breathe. It's a resolution, if only partial. The good news is that the university was very sensitive to our situation, and giving us coverage for another 6 months gives my husband and I time to figure out where we'll collect the extra $10,000 for the year.

Wednesday, August 3, 2011

Catholicism With a Side of Natural Childbirth

I have always been struck by the alliance between natural childbirth advocates of a liberal persuasion and Christian homebirthers. And while I do probably agree with most everything in it, I don't share this article here with any other purpose than to highlight the following quote from the end of the article:

"HHS says the intent of its 'preventive services' mandate is to help 'stop health problems before they start,'" the cardinal said. "But pregnancy is not a disease, and children are not a 'health problem' -- they are the next generation of Americans."

Right on.

Vitamin D Follow-Up

I wrote about vitamin D a few weeks ago, and I recently read an article that helped me pin down some safe dosages.
In an article in the Washington Examiner, Dr. Oz rejects mega-doses (40,000 IU/day), indicating that women who took them were actually more likely to have bone fractures. He says that 1,000 - 2,000 IU/day is probably OK to take without prior approval from your doctor. He says 4,000 IU/day is probably the upper limit, and that you should talk to your doctor about it first. Since my levels are clinically normal but on the low end of the spectrum, I'm not terribly worried but I do plan to ask my doctor what he thinks at my appointment in a month and a half.