Health Insurance and Other Stuff Update

I wasn't planning on updating this anymore, but @planetmoney retweeted a post from a couple of years ago that touched on my dealings with insurance and the health care system in general. I've gotten a couple of questions as to where I am now, so here's the update:

I'm still sick. Rheumatoid arthritis is a chronic condition; there is no cure--you just manage the symptoms. So I still have routine visits to the doctor and lots of blood-drawing.

But, I'm doing better. Some time towards the end of 2008, some of the medication I'd been taken for years (methotrexate) suddenly started working; it wasn't as if I suddenly could hop up and down stairs, but it helped, and it was an opportunity to start moving a little again. Luckily, methotrexate isn't one of the thousand-plus-per-dose medications that I'd tried; I just take ten pills once a week, and no trips to the hospital (and the costs that come with them) are required.

A little bit before this happened, my mobility and balance had deteriorated to the point where I was barely moving much at all, even when the arthritis wasn't flaring up more than usual. This, combined with some terrible stress at work, spurred me to drag my sorry ass to the gym to try to get a little activity. Exercise was difficult in and of itself, and it's a long story--maybe for another post, if I start posting irregularly again--but the combination of methotrexate kicking in, and being able to move again did wonders. I got on antidepressants again. I lost 80 pounds in a year. I still have terrible days, but it's not the norm. I'm still in pain, but it's much less distracting.

The insurance situation is about the same. A little better, as my current set of medications are cheaper than the alternatives. A little worse, as my workplace decided to axe the plan I was on, and the only remaining plan available to us is a "consumer-driven" high-deductible plan which tripled our copays/deductible and reduced the percentage of services covered. And since my husband and I work for the same employer, we're not allowed to cover each other as dependents, as spouses often do.

Thanks for asking.

The foreign policy issue

Since the McCain campaign has not yet heeded my call for a McCain/Cake ticket for 2008, I thought I would propose yet another alternative: McCain/Me. After seeing the Facebook group "I have more Foreign Policy Experience than Sarah Palin" grow to thirty-five thousand strong, I find that I can no longer stand on the sidelines while the GOP's choice is smeared. It is time for me to throw my hat in the ring.

Following the stringent standards used the Republican Party and Sarah Palin's own spokeswoman in this Washington Post piece, I give you the Sporks Foreign Policy Resume Highlights:

• Lived in over ten cities in three (3) different countries
• Have visited five (5) additional countries, and many other states within the US
• Have eaten food from over THIRTY (30) different countries, as well as fusion cuisine, exemplifying my willingness to reach across the aisle
• Have met people from at least eleven (11) different countries

Since a picture is worth a thousand words, I have included below a map of my foreign policy experience which details how I'm uniquely qualified to deal and reach out to each of these countries. Click on each marker for more details.


View Larger Map

Now, I realize that, technically, I'm not legally allowed to run for Vice President, since I'm not from the US. But, if Mitt Romney can claim that we need "change from a liberal Washington [...] throw out the big government liberals!", I'm sure the party can come up with something for me. After all, reality has never been an obstacle for the GOP.

Vote McCain/Sporks in 2008!

An alternative Republican ticket for 2008

all links safe for work except on first paragraph.



Since Mr. McCain appears to think that all it will take to sway female voters is a vagina on the ticket, may I suggest an alternative pick for the VP spot: this delicious vagina cake [NSFW] from The Erotic Bakery [NSFW] in Seattle.


The McCain/Cake ticket would offer voters:

• A chance to steal the Democrat's new focus on Western issues, since Ms. Cake is from Washington state
• An in with the traditionally liberal-leaning Pacific Northwest
• An opportunity to reach out to gamers, with whom Cake is already extremely popular
• A chance to tap into the power of internet users, with whom Vagina is even more popular
• Since Ms. Cake has no past to speak of, this allows the McCain campaign to keep its current vetting process in place, giving them the freedom to focus on more important issues, like reminding everyone all the time that McCain was a POW.

Additionally, Ms. Cake offers the following advantages over the current pick:

• No offspring born under bizarre circumstances
• No unwed pregnant Cakelets necessitating shotgun weddings in the national spotlight
• No other familial skeletons in the closet
• No former association with any parties advocating secession
• No past abuses of power or ethics issues
• No prior relationship with lobbyists or disgraced politicians
• No history of courting earmarks
• More domestic and foreign policy experience than Sarah Palin

Sure, Ms. Cake may not know how to field-dress a moose, but I believe the American public would be willing to overlook this shortcoming, even though it's a crucial part of the Vice Presidential duties, because, as Joe Lieberman reminds us, these are no ordinary times. And Vagina Cake is no ordinary VP pick.

Sunday morning, part two

This is the more pleasant side of my Sunday mornings. We use this recipe from the Seattle Times (though our cooking time is a lot shorter); here he's already drizzled the pancake with clarified butter. He usually eats his portion with maple syrup; I put fruit or jam on mine.

Brave new...something

I got a phone call from a collections agency today; they were demanding (because collections agencies are not huge on the nice) that I pay them right-now-exclamation-mark for a medical bill I'd either already paid about half a year ago, or was new enough that the hospital hadn't even billed me yet (both transactions had similar balances, and figuring out which it was was part of the problem).

That's not very interesting. What's interesting, at least to me, is how much of my life is online.

Because this phone call was a complete out-of-the-blue surprise, I didn't have any documentation of dates of service or previous bills or any other paperwork with me. But I was able to gather all these things by just looking at a few places online.

I was able to get dates and amounts already paid from Mint, and further details on specific transactions through my banks' online sites. I got dates of doctor's appointments from Google Calendar, and further details on the timing of my MRI from Twitter. I was able to narrow down the end of my Orencia treatments and rheumatologist visits from this blog.

What's ironic, though, is that the hospital's online billing site, the insurance carrier's site, and the collection agency's payment site were all completely useless. They are annoying to use, their data is outdated, and they have no useful searching to speak of. They frequently error or time out, and the interfaces look dated; you're generally better off calling these companies, even considering how terrible most over-the-phone customer service (both in terms of competency, and, you know, service) is. These companies would do well to learn a thing or two from these flexible (and free) services.

In the end, we figured out where exactly the bill was coming from, and everything ended well. But that's not very interesting, either.

Buying an iPhone, rheumatoid arthritis edition

The point of this post is not to complain about stuff hurting, but just to give people an idea of how my rheumatoid arthritis affects all kinds of little things.

I got an iPhone a bit over a week ago. I figured I'd held off long enough (over a month), so it wouldn't be too bad of a crowd. There was still something of a wait--45 minutes to maybe an hour, which wasn't too horrible, except that it was warm, which makes my hands and feet swell up until they feel like inflated baseball mitts.

So, I sat outside and waited until it felt like I had balloons for hands and feet; eventually, a young employee in a brightly colored t-shirt called out my name. My husband, who had wandered off to the bookstore while I waited (I can't walk around the bookstore--well, I can't walk around the anything for more than 15 minutes), had returned by then, so he walked with me into the store to get the phone and get it activated.

The Apple Store, unlike most retail places, actually has some seating--there are some tall stools around the counters that someone might use while test-driving a computer. Unfortunately the stools were too tall for me--they would require me to stand on my tiptoes and l wiggle my butt onto them, and you try doing that on balloon feet. But, I am a nerd and the power of shiny new gadgets compelled me, so I persevered. The counters were high enough that I could lean on them somewhat comfortably.

Getting set up with AT&T took a bit longer than for most people--I have an unusual name, so the credit check involves more back-and-forth than normal. After that was all done, the employee handed me the box, cut the plastic shrink wrap on one side, and told me to get it out--I guess so I could bond with it.

I can't get the box to come open. I struggle with it for a while, but instead of offering help, the employee runs off to get a car charger. I give up and my husband opens the box for me. A similar struggle ensues when I try to get the damn thing out of the box. I know people wax poetic about Apple's packaging (seriously, this is why people hate Mac fanboys), but for someone with hand problems, it's just frustrating. The sales guy returns, and we walk a few tortuous steps to the counter across the way to plug it into a laptop and turn it on for the first time and activate it. There, sales guy asks me to plug it into the USB adapter, where another hilarious episode of "Sausage Hands Vs Things That Require Dexterity" takes place. I fumble for a while and apologetically try to explain to him that I have "bad hands" (because "I have an autoimmune condition and this goddamn weather is making my hands feel like water wings," just takes too long), and he just sits there; hubby to the rescue again. We pay and I waddle back to the car, where I am free to play with my shiny new toy, and bitch about Apple for not having copy and paste on their phone.

Because really, who does that.

Sunday morning

I start my Sundays with fourteen pills.

But it's not all bad. Husband usually makes a giant pancake, too.

[Found it]

I found Mafalda (my cat) on the 21st. I was taking my dog Jack outside--I had taken the day off from work--and called Mafalda more out of reflex than anything; by then I was pretty sure he wasn't coming back--he'd been gone for almost four weeks. But he started meowing back at me when I called his name.

At first, I thought I was hallucinating; but I kept hearing him, so I rushed inside with the dog, hobbled up the stairs, shoved my shoes on as best as I could, and hobbled back down, almost falling on my face. I started making my way down the shared strip of grass, still calling, and he meowing back, until I came to the unit that had reported fat cat sightings, and there he was, hiding in the bushes. I dragged him out and took him out, cursing him all the way back.

He's lost some weight; his butt is pretty bony, but he still has a big floppy belly.

My fat cat has gone missing =(

Monday night, he didn't come to bed. I figured he was downstairs getting something to eat. I woke up Tuesday morning and realized he hadn't been to the bedroom all night. We've posted some flyers and Mr. Sporks is checking out shelters right now. I have no idea how he got out of the house.

Spleen: we should make a presentation before the UN assembly
Spleen: and present a plan for betterment of the world via a more liberal application of face-punching

Killing time

Well, it's been a while, but I'm one of those "don't feel like sharing" kicks. So instead of actually updating anything about my personal life, I will tell you about other things to kill time:

First, on the "holy crap I'm bored to death" front, signed up on Twitter. Add me to share in my boredom.

Second, and most importantly, I got a Nabaztag for Christmas. Its name is Spipi (you can send a message from the site). It's a fun toy, but it has its share of problems. It's quite easy to get it working if you have an open wireless network, but who does that? Getting it on a secured network took some doing; the bunny's instructions themselves weren't complicated, but it didn't want to play nice with our network. I did notice that there is a mistake in the instructions (the advanced settings tell you to only enter an IP address if you're using DHCP, when clearly it should be the opposite). What's been most annoying, though, is the lack of documentation: you'd imagine that, since these have existed for a while and they're such a nerd thing, there'd be lot of documentation out there; but most of what you find is half-assed reviews where people say "wow, looks cool, kind of pricy, though," and very little actual facts (like the fact that the RFID "sense of smell" isn't implemented at all, or that Violet's services can be somewhat unstable). You can subscribe to most features for free; Violet used to have some subscription plans, but by the time I got my bunny, all mention of them had been removed from their site. There's no really good communication from Violet to their users (their blogs are infrequently and poorly updated--much like this one, but then I'm not selling anything); quirky things happen--my bunny, for example, reads the title of all my RSS feeds with a French accent, but the headlines themselves, with an American accent--and there's no good explanation for it. But, for all the annoyances, it is a really cool toy; it's nice to just have it read stuff to me, and if it's interesting, I go check it out. Plus, the weather forecast makes me giggle.

Where I've been...

I haven't written anything for a while. Partly because I'm lazy, partly because I'm busy, and so on.

On the health front, I never heard from my doctor's office about the Rituxan. Hopefully the drug company didn't send me something by snail mail, because it probably looked like junk mail and if so, it went straight into the recycle bin. I'm seeing my doc on Tuesday, so I guess we'll see what happens then.

On the money front, I actually had some good stuff happen that allowed me to pay most of my surprise medical bill. Oddly enough this is what I'm most uncomfortable talking about, so I won't go into detail right now; I still have some pretty hefty bills, but they seem more doable.

I did go through with the server transfer, found a nice guild, and I'm raiding again, though the schedule is tighter than I'd anticipated--I get home like 10 minutes before invites go out, and by the time we're done, I have to go straight to bed (it's not that late, but I have to go to sleep relatively early if I want to not be worthless in the morning). It's been both weird and relaxing not knowing anyone on the new server--in my old guild, a lot of people had my phone number, or knew about the arthritis, or whatever; here, I show up, stab the hell out of stuff, and that's that. No dealing with the annoyingly needy people that I inevitably surround myself with, no fielding well-wishing or trying to gently turn down suggestions for quack RA cures. It's nice. On the other hand, well, I don't know anyone, really. I'm sure I'll eventually overshare and end up the same as always, but for now, it's kind of refreshing. One guildie did go and find this (hi), which threw me for a loop, but, oh well.

"In Iran, we don't have homosexuals"

Ahmadinejad: In Iran, we don't have homosexuals like in your country
America: LOL

Empanadas de Alcayota!

Somewhere along the way my weekends turned into Insane Cooking Days. I spend almost all Saturday and Sunday cooking. Now, this doesn't mean I come out of it with enough lasagnas to build a fort, or with piles upon piles of delicate pastries, or anything of the sort. Because it's so difficult to stand up and do things with my hands, it takes me a while to make anything.

This week we made humitas and spaghetti squash preserve (dulce de alcayota). Thing is, I couldn't remember what all the spaghetti squash stuff was used on. I mean, you can use it as you would jam, but with just the two of us--and really, probably it's just going to be me eating it, because MrSporks makes confused dog-tilty faces at it when he walks by--I needed ideas.

I found this recipe for empanadas de alcayota--empanadas with spaghetti squash filling. I remember these being very tasty but also pretty rich, so they were small. I'll try to make it this upcoming weekend, and see how they turn out.

NPR : Get Out Your Handkerchiefs for Chile's 'Cueca'

NPR : Get Out Your Handkerchiefs for Chile's 'Cueca'

Bafochi
Originally uploaded by Alejandro - Pérez

If there is one thing I might call a regret from my wedding, is that I didn't get to dance a cueca. Maybe I'm getting to be a sentimental as I get older, and maybe it's inevitable for the patiperro to get nostalgic, but this year's Dieciocho had me longing for empanadas, pan amasado with chancho en piedra, some manjar, and a good cueca round. Not that I could dance in my current state, but irrational longings don't seem to care about these things.

As it turns out, "cueca" apparently also means something to do with being in your underwear (in Portuguese maybe?) so in my trolling for dance pictures, I got a number of not-quite-safe-for-work pictures of people in their undies, and a lot of pictures of kids with underpants on their head.

Once I made my way through that, I found a lot of pictures on Flickr, and a decent number of videos on YouTube, too.

Bailando cueca en el desfile militar
Originally uploaded by Gabriel Ortega Berger

Cueca is the national dance of Chile. What's cool about it, is that everyone dances it. Looking through YouTube or Flickr you'll find lots of pictures of people in traditional costume, but also just people in everyday jeans. And, it's a fairly complex dance: there's a set order of moves--figure eights, turns, and demilunes, plus you're supposed to hold your handkerchief a certain way, etc. Of course, it's not rocket science, either, and not everyone does it just so, but still, September arrives, and the whole country must dance.

Bafochi
Originally uploaded by Alejandro - Pérez

There's several styles of different traditional costumes you might wear for this--varying by region, wealth, and so on, but the most common is a huaso (cowboy) with manta (poncho), chupalla (straw hat), and spurs, and the woman in china garb--a simple flowered dress (pictured right). I never much cared for the flowered dress style; partly because it'd make my butt look like a giant cabbage, and partly because people keep starching their skirts and adding layers upon layers of cloth, which doesn't look right to me. A traditional china dress is simply a humble flowered dress (like the one in this video). I preferred the solid-colored, straight skirt and boots (with spurs--no idea if that's traditional or not, but dammit, if I'm gonna put on boots for dancing, I'm putting on spurs) style (pictured left) all black, or black skirt and red jacket.

This afternoon, NPR ran a piece on the dance. MrSporks and I were in the car, and every time a Chilean spoke, he giggled.

"Your people can't pronounce the letter S," he told me when I poked him.

"S is for Commies. La ese es para comunistas," I repeated. Of course, in a Chilean accent, this comes out "la ese eh pa' comunihtah." He wasn't just picking on Chilean speech for no reason: we're notorious for dropping letters, speaking machine-gun fast, and aspirating our S sounds.

At any rate, the piece mentions the breadth of subject (protest, raunchy, traditional), cueca brava (a style influenced by brothels and the criminal underworld), and La Yein Fonda (a play on "Jane Fonda"). Unfortunately they don't touch on the cueca revival of recent years, and there are no web extras (video, sound, or pictures), but being that more often than not the country is altogether forgotten (current issue of Gourmet, which is dedicated to all things Latin American, mentions it in passing once, I think), it was a pleasant surprise.

Edit: blergh, for some reason, Blogger is eating the captions on the pictures crediting the photographers on Flickr. Click on the picture to visit the original.

kindergarten 1, calculus 0

12:57 <Syd> doing the best stuff here
12:57 <Syd> we print out 24x36 hard copies for county records
12:57 <Syd> and I am folding them
12:58 <Syd> kindergarten: still proving more useful than calculus

"Have you got anything without Spam?"

So, reading a bit about Rituxan, the new drug my rheumatologist wants me to start on, makes me feel like I'm in the Monty Python Spam skit. Except replace "Spam" with "death". Which is less funny.

As I make my way through various arthritis drugs, the side effects get nastier and nastier. I'm sort of scraping the bottom of the barrel, here; I've had this goddamned disease for what, eight or nine years now, and we're still trying to find something that helps. And so, we come to Rituxan.

"Some people who received rituximab experienced severe reactions to the medication. Some of these people died within 24 hours after they received a dose of rituximab. Most of these deaths happened after the first dose of rituximab," is the cheerful opener of the NIH page on this drug.

"Rituximab has caused severe skin reactions. These reactions have caused death," it adds (there's also dire warnings for people being treated for non-Hodgkins lymphoma, which luckily doesn't apply to me).

"Some people who received rituximab developed progressive multifocal leukoencephalopathy (PML; a rare infection of the brain that cannot be treated, prevented, or cured and that usually causes death or severe disability) during or after their treatment."

The page leaves me with this final admonishment:

"Talk to your doctor about the risks of using rituximab."

Ya think?

Except, of course, that there was no talking. I didn't read about it until after speaking to the doctor, or I would have certainly had some more questions.

"There's been more reactions to this medication than some others," the doctor told me. "So we're going to keep you at the OIC a while longer so we can keep an eye on you."

Which is great, except the people at the OIC are jackasses. Seriously. Every time I call to schedule an appointment, the idiot scheduler girl makes me repeat my history to her; what disease do I have? Who referred me? And this doctor, she is located where? And so on, despite the fact that they have these newfangled "computers" now, that show you patient information when you book them, and I've been dealing with the OIC for months. After I have negotiated the pit of stupidity which is the scheduler girl, I show up, on time, every time, only to have to wait an hour or more because they're always double-booked. Last time I was there, I spent the entire afternoon in a room they use for drawing blood and administering injections; all the actual treatment rooms (you know, the ones where they keep the oxygen, and trained nurses patrol in case you're having a tiny death-inducing reaction) were booked.

"You might consider scheduling your infusion on another day of the week," the random nurse who put the IV in suggested.

You might consider not double-booking your motherfucking facility, I thought. But I just smiled.

It's like flying Southwest. They should just give us plastic numbers and have us trample each other as we race to the available rooms.

Then, there's the lecturing. Because I've already had a reaction to a similar arthritis treatment, my doctor has ordered that they keep me a bit longer--a couple of hours, as opposed to the usual fifteen minutes. This makes the nurses at the OIC cranky. Which is perfectly understandable. After all, no one seems to actually read the doctor's orders before getting started and it comes to them as a complete surprise every single time I'm there (this makes me somewhat uneasy about the mystery solution they pump into my veins, but so far so good). Also, because of the aforementioned double-booking and scheduling-girl idiocy, they have more patients than they can handle. So I get lectured.

"You know, we don't normally keep people this long," nurse du jour will start out (apparently chemotherapy and other IV treatment is a very drive-through-y affair these days). And it goes from there.

"We never agreed to observe you this long," the last nurse groused at me. "That's just something your doctor decided."

Yes, well. Doctors and their crazy "deciding" and giving doctors' "orders". Truly a tool of The Man, always telling nurses what to do.

(Also? Ask me or any of the other patients here how much we care about inter-hospital politics or power struggles between your departments. Come on, I dare you.)

At any rate, this means that my observation period isn't really all it's cracked up to be. The first time I was there, a nurse with a chip on his shoulder the size of Texas simply evicted me from my room (ah, fancy room with oxygen tanks, how I miss you) and had me sit in the waiting room for several hours, with the IV line flopping off my arm (the actual IV drip got to stay in the treatment area). Lately, they've just been keeping me for a bit and then deciding I'm done. So at least I get to go home, where I can be not-observed while playing WoW instead of being not-observed in the hospital waiting room.

Anyway, this whole "Spam, Spam, Spam, death, Spam" thing is distressing. I know I spend a lot of time wishing I was dead, but still, I don't always wish I was dead. And if nothing else, I'm just a contrary person; I might want to die, sure, but I'll be damned if some lame-ass medication is going to be what does me in--when I die it's going to be on my terms, or by hilarious accident; not as a side effect. I'm also worried about the "severe disability" part; maybe it's my personal vanity (because I cherish my brain above most else) but the idea of not dying but having my brain turn to mush instead is terrifying.

Nerd alert

It really shouldn't be news to anyone that I'm a big nerd, but it's kind of embarrassing even for me to admit that I'm all aflutter over being able to add items to Todoist via Launchy. Yay!

Bizarre Bedtime Bookends

Last night, for about an hour, we had helicopters circling our area. They were flying relatively low, and I started out by making jokes to myself about them making a wrong turn on their way to Nevada; as the time went by, I went from bad jokes to wigged out to just annoyed all to hell.

Then, this morning I woke up to Steve Inskeep and Joe Palca singing about Moray eels on Morning Edition.

Orencia, we hardly knew ye

I went to the rheumatologist yesterday. I love my rheumatologist, but I hate going to see her. There are three reasons for this: I always cry, I have to get a battery of labs, and the bills. I have insurance, but of course they refuse to pay things left and right, so I spend the whole visit in a state of anticipatory distress. The aforementioned lab extravaganza seems to be one of the insurance's favorite things to not pay, so there's the added pre-bill stress on top of the regular I'm-going-to-get-yet-another-incompetent-phlebotomist stress.

Then there's the crying. I don't really cry a lot these days. But whenever I go to the rheumatologist I end up tearing up. First of all, my doctor seems to care, which makes me horribly uncomfortable. I want to have a business relationship with this person; the insurance (or more likely, a little bit the insurance and the rest, me) pays her, and she provides a service. But she seems to feel bad for me. It's not terrible, but this, along with the next thing, is a deadly combination.

The second thing is simply the fact that, stepping out of my protective self-involvement bubble and going to see her brings into sharp relief just how awful this is. It's putting salt in the wound. Hell, it's rubbing, salt, lemon, and vinegar in the wound and then leaving it to marinate for a few hours. Even when I do think I'm having a good day, I'm forced to admit that, yes, all my joints are swollen and yes, they are all tender, and yes, they all hurt, and I can't stand for any length of time, and I can barely walk (she was astounded a visit or two ago that I was able to walk a few yards from the elevator to my desk at work), and I haven't been able to put my own shoes on for months,--something so intimate and humiliating that I somehow manage to ignore each morning when my husband does it for me, but at the doctor's office there is no ignoring.

Here, I'm forced to discuss the fact the Orencia is not really working. Yes, it helps a little, and I can definitely feel it when it's time for another dose--like right now. A dose which I have not scheduled in light of the "Surprise! You owe us four thousand dollars!" missive I received not long ago. I'm not the kind of person who just has four thousand dollars laying about to send to the good people at the hospital (for whom, of course, everything is DUE NOW), both because I'm big fat failure and can't manage my finances properly, and because I simply don't make enough to both pay these gigantic bills and my other luxury bills like electricity and mortgage. So here, I am forced to confront the fact the Orencia isn't cutting it, and to talk about my massive bill (because of course, she's curious as to why I haven't scheduled my next dose).

Here, I am also forced to discuss the fact that the fibromyalgia is back. In short, my body has gotten so screwed up once again from being in constant pain from my joints, that my pain threshold is out of whack and my body, in its infinite wisdom, has decided that the best way to deal with this is with constant pain from soft tissues, more fatigue, and even less sleep. This means that I am in terrible pain in every single joint of my body, and in agonizing pain everywhere that's not a joint. Brushing against anything hurts. I yelp when my husband accidentally touches my shins when he's putting my shoes on. Sitting up hurts, but of course so does laying down. Wearing clothes hurts.

Here--last but not least--, I am forced to admit that I'm (no big surprise) deeply depressed and that I wish nothing more than to die. She tries, unsuccessfully, to convince me to try to get treatment again, which seems pointless to me.

She suggests that we stop the Orencia and switch to Rituxan, which works, she reminds me, by destroying my B-cells.

(I have, once again, the brief "Don't I need those?!" panic moment).

She assures me people at her office will work with the insurance to make sure it's covered. But people from her office already worked with the insurance to make sure the Orencia was covered.

She suggests I talk to patient financial services. I have already dealt with these people (in a previous "Surprise! You owe us two thousand dollars!" episode, when another insurance company decided I had not been diagnosed enough, in spite of having been diagnosed with RA by three or four doctors over the course of several years, and thus, my treatment was an optional luxury item, a pair of medical Manolos, if you will). Their help consisted of dutifully reminding me that the full sum is DUE NOW and sounding intimidating.

In an effort to not make the Giant Bill situation worse, she sends me off to the lab with the fewest labs she can get away with. This means it's two or three vials of blood instead of the usual two-gallon milk jug plus urinalysis.

And then, because this is how I repay kind professionals who show compassion towards me, I wonder how many of the labs she normally orders are actually needed.