Monday, June 18, 2018

Week 252: If you would like

For those of you who lost track, two weeks ago, Papa Bear came down with summer pneumonia, which Lemon and I also subsequently contracted. I got on doxycycline and started feeling much better pretty quickly, and we started Lemon on Cayston at the same time. Both Papa Bear and I noticed after a day or two that the Cayston didn't seem to be kicking in as quickly as usual, and Lemon was still pretty sick even after 2 or 3 days, when usually Cayston has him feeling well by then. Then, on Tuesday, we got the results of his throat culture from his clinic visit back. There amongst the "endogenous flora" and Staphylococcus aureus (which he has cultured since he was an infant), was a new name: Haemophilus influenzae.
Culturing a new bacteria is never good news, so I did what any responsible person would do. I dropped the name of this new arrival into Google. Aha. A well-known respiratory pathogen that causes (you guessed it) pneumonia. So, it seems pretty clear that this is what made us all sick (risk factors: attending preschool). Given that there was a new bug, and that Lemon was still sick, I sent a message to our nurse practitioner asking whether we should do anything else. She said that their general philosophy is that they don't treat H. flu, but that we could add an oral antibiotic "if I would like." Am I missing something here? If I would like? Yes. I insist on it. My kid with a genetic predisposition to lung infections has a documented new bug that isn't responding to our usual intervention plan. I must have new alternatives immediately. No putzing around. Why on earth aren't _you_ insisting on it? 

I managed to write back something a little more diplomatic, like "Oh yes, I think it would be good to try something additional," and we started Lemon on azithromycin that day. It was definitely the right decision, he started feeling better almost immediately, and his cough is slowly drying up. We're continuing with Cayston as well, so hopefully by the time two weeks of Cayston are done, we'll be back to baseline. But seriously. If I would like.

In other healthcare annoyances, let's talk about health savings accounts. We have one. We are fortunate enough to have enough financial resources to be able to set some aside in there and reap the benefit of spending pre-tax dollars on our various healthcare things. But man they do not make it easy to spend those dollars. Take our home pharmacy for example--that's where we get all the supplies for Lemon's tube feeds. Every month, I get a bill for a random number of dollars, usually between $10 and $200, which in some way corresponds to a number of dollars that we might owe for receiving the exact same set of supplies every month. 

Let's say I want to pay that bill with our HSA. I have to call a phone number, spell my name about eight times, explain that yes I have a different last name than the patient, and then have the person there read me a number of dollars that she thinks I owe. This number bears at best a limited relationship with the number I have on the printed bill in front of me. If I ask to pay the actual number on the actual bill that I have, I am informed that my choices are to pay my balance in full, or not. I opt for in full, and then agree to have the receipt emailed, which results in my having to spell my first and last name again several times, while trying to indicate that my middle initial comes between them in my email address. Eventually, we come to an understanding of how my name is spelled, and I hang up the phone. Moments later, the receipt arrives. Hooray!
Just kidding. The HSA people then inform us that the receipt from the provider is insufficient documentation of the expenditure. Papa Bear then has to call and get an itemized statement from the pharmacy (the statement that I have at home is of course useless because its number of dollars is not the same number of dollars that I had to pay in order to have the privilege of paying with my HSA card). The new statement arrives, but is tragically destroyed when our basement flooded this weekend (no joke). Papa Bear figures out that he can download some corresponding "explanation of benefits" forms from our MyChart account, which are convenient PDFs that he can then upload to the HSA people's website. Jinx! The EOB forms that you download are 2.1MB each, whereas the maximum file size allowed by the HSA website is 2.0MB. So, each one has to be individually saved as a lower-resolution PDF before being re-uploaded to the HSA website. 
And that is what it takes to spend $102 worth of our HSA. Just a little something to keep in mind if you hear anyone touting HSAs as the solution to all that ails the healthcare system.











Anyhow, enough of that. The kids started swimming lessons and summer camp, and love both so far. I'm hoping we got our summer health crisis out of the way early, so we can just enjoy the next few months!