January activities, health update, puzzle of home, Cuban Artist Alex Fuster, insurance company steps to resolution

I have been wanting to write some stories for my website for over a month and just haven’t felt up to doing it. Some days I have good intentions to write, then I go to the store, do some chores or errands, then the window of pain free or relatively free time passes and I take my medicine. Then when it begins to work I get tired and I don’t feel like getting my computer out of it’s bag and setting it up and turning it on. So, I decided since today is a good day and my energy level is pretty good to finish the previous story and write this one. I am going to leave my laptop set up on a small table so when I want to write a story all I have to do is turn on the computer and type, maybe this will motivate me to write the stories for my adventures from the beginning of October through November. For those two months I posted my pictures and wrote quick posts, but I didn’t include details and what I did at the events like I usually do. I will work on those stories soon so feel free to check them in a couple of weeks. Until then, I wanted to write an update of my January activities.

Belated Happy New Year everyone. I hope it’s been an interesting one for you. I have not been very active most days, I get out to the store and do errands,I enjoy having meals out with friends, and a few times a week I’m baking and cooking. I have even gained about 6 or 7 pounds. I lost about 12 pounds on my trip last year. Experimenting with new recipes for dinners has provided me with some delicious meals. For the first time made sorghum pecan brittle, this was an interesting experience. It probably would have been easier making it with another person. Thankfully, I had all of the ingredients measured out so I could add them quickly when needed. I had to add a few ingredients and then wait until it reached a specified temperature, then add more and let it reach another temperature, and then one last time add a few more and bring to temperature. I thought I stirred it enough as it cooked, but it seems I didn’t stir it very well where thermometer was near the bottom of the pan and I knew it when I smelled something burning. Making candy is a bit tricky. Other than a slight burn taste, my sorghum pecan brittle came out good. It cracked like it was supposed to and it still tasted good. I might try making it again sometime. I looked online and found a way to remove the burned syrup from the bottom of the pan. It worked after a few tries.

I decided to make lasagna, I haven’t had it in quite a while and for some reason this came out better than other times I made it. I froze a few portions so I could have it when I don’t feel like cooking. I usually make it in a glass loaf pan which works out really well and the slices make a nice presentation. I have been freezing some of the food I’ve cooked, this way it’s an easy dinner. Some days I don’t get very hungry and then when I do I don’t always want to cook.  I also keep some frozen stuffed chicken breasts in the freezer, they are another easy meal. Cook half hour in the toaster oven and they are ready to eat. I’ve taken these on my camping trips too since it doesn’t take up much room in my tiny freezer.

A friend of mine from Seattle named Patt came to visit for a few days, both before and after her trip to Cuba. It was interesting seeing the pictures she took and hearing the stories about what she saw and the people she met. She showed me artwork she bought by a Cuban Artist Alex Fuster which included pictures of his house, swimming pool, and the street he lives on where all the neighbors wanted him to create his beautiful artwork on their houses and fences. He does beautiful paintings and also incredibly creative mosaic tile work. He also has a treadmill in the middle of his swimming pool. Here are some of the pictures she sent me of his home and artwork.

Artist Alex Fuster IMG_1233 IMG_1236 neighbors houseIMG_1237 

A month or so ago, Patt told me she saw something she thought I would like and I should be receiving it in the mail. Well, a surprise package arrived and what was it??? A jigsaw puzzle of where I live. The puzzle piece with the exact location of my residence is shaped like a house, all other puzzle pieces are regular shaped pieces. Patt knows I frequently work on jigsaw puzzles. I have several sitting waiting to be done and two that I started before I left on my trip last July. I have not been working on them much since I got home. Anyway, this 400 piece 12″ by 18″ puzzle is extremely difficult!!! When Patt stayed with me I showed her the puzzle and she said she had no idea it would be this difficult. Other than a divided highway, a few ball fields, and the roofs of a few condo buildings, the rest of the puzzle will be almost impossible to do.

I will eventually get it done, however, it will be extremely time consuming. In order to find where a puzzle piece goes, I have to look at the map that comes with the puzzle, find what rooftop shapes or colors look like the piece and put it inside the puzzle frame and eventually pieces will be joining together. The map that came with the puzzle was a little less than half the size of the puzzle and it was almost impossible to distinguish the rooftops. A majority of the picture of the puzzle is roof tops of buildings and houses. I called the company and asked for a larger size map and they sent me a true to size map which will help my eyes a lot, but I don’t think it will make the puzzle much easier to do. Basically, this puzzle is Google Map view of a half mile radius of where I live. The thought was very nice and greatly appreciated. This is a great unique gift. Puzzles can be ordered of favorite places to visit, or anywhere else. It’s a great quality puzzle and it was boxed nicely.

2016-01-02 16.43.15 puzzle LHP2016-01-02 16.58.26

I am getting back into the groove of reading books again, I have about 150 or so books on my bookshelf. Many are books by authors I enjoy reading and others are by authors I am not familiar with. Also, some of the books are part of a series and I don’t have all of the books in the series. When I am reading a series and if there are books I am missing which is frequently the case, I go to the county library website and see if they have the book I need. It turns out many times they do, sometimes I have to be on a waiting list. One of my friends is in an assisted living facility and she doesn’t get out so I send her a box of books about once a month. I know she appreciates it and it gives her something to do.

Healthwise, I am very grateful that for the past three days my pain has been minimal from mid morning until mid afternoon, sometimes a little longer. I am so very thankful. I have no idea why but I hope it continues. It could be because my sleep pattern is off and I am awake until two or three in the morning, sometimes four a.m. and if I am I take my pain medicine during that time. I also take some about 7 a.m. and go back to sleep for a couple of hours while it works. I am truly grateful for this reduced level of pain… I hope it continues to not be intense pain for quite a while longer. It’s been several years since I have not had severe pain daily.

I have to be honest, some days I don’t want to get out of bed or even move. Some days I have to make myself get up and moving, especially if I am in pain. I don’t think it’s depression. It could be a little bit I guess. Once I’m up and moving around all is well. Other days the pain is pretty intense, my leg and foot are more numb from the tumor pressing on nerves, and my upper abdomen under my rib cage feels like it’s really bruised from organs pressing against my ribcage. Like other times, after several days or a week the tenderness is gone and I feel almost normal. Looking at me from the outside no one could tell what’s going on inside my body. This is a good thing because this way no one looks at me and feels sorry for me or is conscience of my health condition.

Last January I tore the tendon in my right index finger and after splinting it two separate times last year it still did not heal. The tendon did not reattach to the bone like it was supposed to. I had hoped it would the second time. Because my finger was constantly in a bent position due to the torn tendon my finger hurt and so did my palm, so I decided in the beginning of January 2016 to split my finger again and see if the tendon does reattach this time. Today I took the splint off for about an hour and it seems that perhaps it did reattach this time. I didn’t try to bend my finger very much because it hurts from being splinted for a month, and also I want to see if my finger stays straight on it’s own. Before this last time splinting my finger, the top part with my finger nail would bend backwards towards my palm and be horizontal to the rest of my finger. So far today, it’s standing straight up. I will wean off the splint and keep it on when I sleep for a few weeks to let my finger get used to being how it is supposed to be. It will be great to not have a splint on my finger. It’s not easy to cook, bathe, clean, write, etc. when having to keep my right index finger straight, dry, and clean. I’m glad that I thought to splint my finger this last time because it seems to be working finally.

When I had the prescriptions for my pain medicine filled in early January I found out that the new co-pay for each of my three prescriptions went from $20 each last year to $40 each this year which is a big increase. Last October and November I fell into what I found out is called a Donut Hole and I paid $128 for three refills without knowing it until I got home and saw my credit card statements. I had my prescriptions on auto pay since I was traveling and didn’t want to hold up my deliveries if they could not reach me. Big mistake, I never thought to ask the cost when checking they received my prescriptions because for the year, until October, it was always the same. So, I changed the setting to say that they have to contact me before filling my prescriptions so I could avoid these excessive charges. So now, the co-pay is double, I asked if there is any way to have this reviewed and I was told about something called a tier exception.

I am writing about this in order to inform others. I didn’t know there was something called a tier exception until a few weeks ago. If I had known, I would have applied for it last year and would have saved myself a lot of money for medicine co-pays. You may have to check with your insurance company to see if it’s an option or what process you need to follow. I had to get my doctor to send a request to the insurance company asking for the tier exception and the reason why. Of course, on first try it got denied. So I called the insurance company and asked to appeal the decision. I filed the appeal and told the reason why. My doctor had to write an additional explanation of why I cannot take a drug in the lower tier that would do the same thing.

It took me numerous phone calls and many hours on the phone, and I had to resubmit one of the three medicines for a tier exception again because an insurance company rep wrote the wrong strength medicine on a form they sent the doctor. To make a long story short, the tier exceptions were approved for all three of my medicines which significantly reduced the cost for the prescriptions. However, even though it was on my file not to send any medicine or charge to it my credit card without my approval the mail order pharmacy did, to a cost of $120 when the cost should have been significantly lower. Now, after many phone calls and hours on the phone I am trying to get a refund placed on my credit card for the difference. This is not an easy process. A couple of insurance people I spoke with said I could return the medicine. I said that is not an option because I need it and if I send it back it will take a couple of weeks to return it and have it filled again.

I have learned over the years to write down a date that I spoke to someone, what the company representative’s name is and where they are located. Now, I added their employee number. I began doing this even when I was working and had to contact companies for various reasons. I carried it over to my personal life. It’s been helpful over the years. It seems that when calling customer service, insurance companies, etc. it’s almost impossible to speak with the person who helped me during a previous call. By having dates, names, etc. it documents the process and reminds me when I called or what the outcome was. I have learned that when someone says they will call me back or send me a form does not mean they will. A rep tells me that they are making a note in my file about our conversation or what process they are doing to resolve my issue. They often are not telling the truth or do not follow up like they say.

One time I received a call saying that two of my tier exception requests were granted through the end of December 2016 and that it’s in the pharmacy computer system notes. When I called the mail order pharmacy they said their system is showing it’s not been approved. I called again the next day to see if the system was updated. Still the same response. Finally, after discussing this for a while and saying it’s in their system I told the person to enter a dummy prescription to see the cost, guess what… it came up with the adjusted cost. My comment to that person was see… the tier exception was approved or the cost would be the higher cost. She had no response. I had to file a second tier request for the third medicine since the insurance company wrote the wrong strength on the form they sent my doctor. Even though it was a typo on their part, I was told I have to start the process over for the last medicine.

Of course every time I call to see if something has been done yet to resolve my problems or to see if my tier exceptions have been approved, I get someone different, they tell me that the note that I tell them was written by the person I spoke with a few days ago was not written, or it said something different then what I was told was written. One person gave me her ID number, said she promises she will call me back she knows how it feels not to get a follow up call with the outcome… No call, not even now a week later, and when I called on Friday the person I spoke with said they saw her note, and will write a note about him following up he saw her note. Today I called and the person I spoke with said they did not see her note from a week before only the note from Friday and the person I spoke with on Friday. It’s extremely frustrating. What happened that one person sees a note and another doesn’t???

This morning after several frustrating phone calls and over an hour on the phone with no results or anyone being helpful, I called the mail order pharmacy who filled my prescriptions and asked to speak with a pharmacist. The customer service rep asked why and I said to resolve a problem I’m having. God and the angels definitely were helping me during that phone call and directed me to someone that was able to resolve the issue promptly. I was connected to a pharmacist named Greg. I explained my problem and what needs to be done to resolve the issue and I informed him that people in his company have not done what they said or followed through. I apologized for bothering him, a pharmacist because I know he is busy and has more important things to deal with. I also said that I am frustrated because despite the numerous calls and hours on the phone I could not get any assistance to resolve the issue.

Pharmacist Greg was very kind, he told me what options are available and what he can do to try and get the cost corrected. He said he will call me back when he finds out if the adjustment can be done. I asked if my refill date will be affected and he said he will check and let me know. I asked if it will take several days or a week so I will know when to expect his call. Greg said it should be a few hours or a day at the most. He understood and said he knows other cases when prescriptions were filled, shipped, and charged to the customers credit card without customer approval when approval was needed. As I was typing this post and this part of it specifically, the phone rang and it was Greg. He told me that he was able to have the prescriptions billed again and that the adjusted rate was applied and my credit card will be credited with the difference. Also, he said they were able to use the date the original prescription was filled so future prescriptions will not be delayed. I thanked him and said how grateful I was for his help. If someone early in the process would have been this helpful it would have saved me hours and hours of time and frustration and loss of trust in the insurance company representatives. I know that I wrote probably more than was needed. I’m hoping this info will help someone dealing with issues needing to be resolved.

My goal is to complete the stories about the Balloon Fiesta, Texas, and the Native American Flute Festival soon. After I write a story I wait a few days and read it to see if there are any typos or changes needed. Because I edit as I write and change sentences, sometimes words are not changed that need to be. Or perhaps I think of something else to add to the post.

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1 Response to January activities, health update, puzzle of home, Cuban Artist Alex Fuster, insurance company steps to resolution

  1. maggie bossett says:

    It is indeed a nightmare to talk with insurance companies and/or Medicare. I always get the name of the person, write down the time and get the reference number for the call.
    So often it seems they are just giving you lip service to get off the phone. I hope it’;s all worked out now. Our pharmacy gave us a little seminar about the “tier effect.” I’m still not sure I understand it!!!Health insurance and medicare is a constant never-ending learning process!

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