Monday, December 12, 2016

Week 173: Common denominator

Lemon finished his most recent course of oral antibiotics on Friday and...so far, so good. Still at baseline. Now, we just have to wait and see if he can sustain it. In the mean time, we continue to pursue our plans to get a second opinion at a hospital in Milwaukee, and to get Lemon access to an inhaled antibiotic to try the next time he's sick. You may feel like you have been reading about these back-up plans for several consecutive weeks without any real substantive updates. You, dear reader, are highly observant.

Here is where we are. In order to be seen in Milwaukee, we have to get prior authorization from our clinic here in Madison. That requires the clinic to fill out a form and send it to our insurance company, which they said they would do. The insurance company then gets 15 business days to consider the matter. Today, under the assumption that the form had been sent as promised, I decided to give the insurance company a call and see where we were in terms of those 15 business days. The answer to that question: zero. Zero business days into the process, because our clinic has not yet managed to send in the prior authorization form. I don't know why I should be surprised, given that when Lemon had his G-tube placed we were on the phone with the clinic the day of the surgery to get the paperwork finalized, but there you are. Zero.

Next, the inhaled antibiotic. At the moment, Lemon is being seen by a nurse practitioner, so she sent the prescription for Cayston over to the specialty care pharmacy. Because Cayston is a specialty medication, our pharmacy benefits provider won't cover it unless a pulmonologist prescribes it (nurse practitioner does not equal pulmonologist). I contacted the clinic and let them know that they either had to 1) have a pulmonologist prescribe the medication, or 2) fill out a form (delivered via fax) from our pharmacy benefits provider to be signed by the pulmonologist saying he approved of the prescription that the nurse practitioner had put in. I don't want to discuss the number of phone calls that Papa Bear and I have made to the pharmacy, the clinic, and the pharmacy benefit people to try to sort this out, or the number of times the clinic claimed to have not received a fax that the pharmacy benefit people claim to have sent. I will just provide the following update: as of this
afternoon, the pharmacy benefit people have neither their form nor a new prescription issued by the pulmonologist. On the plus side, it does sound like they will cover the medication if we could just manage to get our clinic to deliver on either option 1 or option 2.


We have a clinic visit coming up on Wednesday, and I'm sad to say that we will have to use at least some of the time to get these logistical issues taken care of. We were supposed to use the visit for something productive, like getting trained on how to use the new inhaled antibiotic, but that isn't going to be possible. I suppose I should just be grateful that things are stable enough right now that we can take the time to talk about paperwork while we're at the clinic.

Other than that, winter is in full swing here, lots of fresh snow and it's not supposed to get warmer than 10F until at least Thursday, and then more snow on Friday. Both kids are really enjoying the winter, thanks to their snow suits and some clever new mittens we got for them--the mittens have a cuff that goes right up to the elbow, so once they're on under the snowsuit they're basically impossible for even a dedicated 3-year-old to get off. Once they accept the mittens, they can actually get on with the business of riding in the sleigh, making snow angels, and (in the case of Lime) tipping over and being unable to stand back up due to the shear volume of outerwear. Next up for us is a stream of visitors and travels--Uncle Jared, then Grandma Carol and Grandpa Dudley, and then our annual trip to Boston. Fingers crossed that it all goes according to plan!


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