Such a Sweetie

Dennis visited with Jean, the nurse practitioner who works with Dr. Nance, today. He hasn't told me much about the visit, but he brought home a copy of a letter she wrote to his insurance company on his behalf.

She, like everyone else he encounters, noted his upbeat attitude and contagious smile. I love his goofy laugh and very peculiar sense of humor even more. Most of all, I love that he can still make me laugh.

Dennis has so many wonderful attributes that are getting lost in the mire of this awful disease. At least his humor, his enjoyment of life, has not disappeared. For that, I feel very lucky.

New Changes

Raquel is off for three days on personal business. Our back-ups were unavailable, so I am home to be full time care-giver. Unfortunately, he does not see me as his PCA during this time, so I don't get paid. But I do get all of his undying attention.

Today we went to the urologist. Dennis has decided that he wants a different catheter; an upper pelvic cath. Instead of going through the penis to the bladder, this one goes directly to the bladder from below the belly button. It sounds strange, but not much stranger than anything else we have encountered over the past few years.

It was only a couple of years ago that Dennis began to collect canes. Just when his collection started getting interesting, more changes came along. It was diapers, layered, to prevent urine leaks. Next it was a walker, then a catheter, and now a wheel chair full time. He tucks his chin to drink, and mushes and chops his food to a "mechanical soft."

Ah, you have heard all of this before. It's just one more change, just one new and different experience. But we aren't living in his body, are we?

I am so sorry, Dennis, that your body has decided to fail you. Just know that you are still loved, and I am lucky to have you in my life.

Shiva Gets a Bath

I noticed cat hair flying all over this morning, and decided to give Shiva a bath.

I've always believed that cat bathing was not an easy project. I have bathed many a dog in the past, and while most do not like the whole ordeal, for the most part they put up with the process. They also still love you when all is said and done.

I did research on the web, first, and was prepared for the worst. Screaming, screeching, perhaps growling and baring teeth were likely to take place. I also expected that I would not see hide nor hair of the girl for a while.

It turned out not to be any worse than bathing a dog. She did cry during most of the process, and tried to escape once or twice. But she never completely put her ears back and never growled at me. When I wrapped her up in a towel and hugged her up, she ever purred a bit. I rubbed her and she snuggled back.

I still expected her to run and hide after I put her down, but she stayed close by me for the rest of the morning. She didn't seem the least bit mad at me.

Ya learn something new everyday, with every experience.

Until later,
Ann and Dennis

Tired

Dennis gets tired too easily. Well, maybe it's just too often.

Last night I came home from work, and he had just finished a session with the in-home PT, Phoebe. He was sitting in front of our new, big screen, LCD TV and practicing tennis on the Wii. He was feeling feisty and challenged me to a game of bowling. Neither one of us played a good game, but he challenged me to a second game. After the second frame, he was done.

I had picked up stuffed chops for dinner, and cooked them while we played. I chopped one up nicely for him, and halfway through dinner, Dennis wanted to go to bed.

Tonight he was in his office when I came home. The phone was ringing as I was walking up the steps, but he wasn't able to pick up the call.

We didn't spend any time together today. He was just too tired. Too tired to talk, too tired to eat, to tired to do much of anything.

Vacations are our real measure of how we are doing. Last summer, while in Paris, we took off about 2 days a week, due to tiredness. This fall, in London, it was closer to 3 days a week. But, giving that I was sick for half of the trip, it seemed a bit skewed to be considered real data. During this years spring break, we were at an every other day rhythm of fun and rest. But we were at home, and it was more about relaxing than anything else. We have slowed down, but both of us rally for real vacations.

We have been considering how long to take off for vacation this summer. How long can we rally? How many days will be down days? How much do we really want to see?

It's a question that we need to answer soon.

A Good Sunday

Happy Easter. In Minneapolis, it is a beautiful spring day. The temp is running in the upper 50's and the sun is shinning. I have two lamb shanks in the oven filling the condo with great smells. Perfection.

This is the last day of my spring break. I accomplished almost everything on my list. My taxes are done, and I get a small rebate. The insurance problems might actually be fixed, finally (keeping my fingers crossed) and there are only 8 or 9 weeks left of this school year.

Dennis has his nurse and PT visits set up for the upcoming week, and he is scheduled for another class at Pathways. He has recovered from his last hospital stay and is in pretty good spirits.

This is going to be a wonderful spring.

Ann and Dennis

Taking A Turn?

I talked with Cigna, sigh, once again, today. The lady was nice, and tried to clear up several of the unpaid bills Dennis has accrued over the past year. She was trying to figure out why he needed a primary physician while receiving care at an HMO in Wisconsin. I didn't have the energy to confuse the poor gal. Just get the bills paid and move on, is my latest thinking.

I know the people who help me the most are not paid very well. I know the people that stand in the way of happiness are overpaid, and bonused to boot. I don't understand history well enough to know if this is precisely what our founding fathers wanted for our country. I hope not.

Dennis' PT was here, again, today. She helped us understand getting in and out of bed, and it seems we have been doing the right thing. She worked him for 60 minutes, weights, exercises and walking the halls. I like what I am seeing, and Dennis seems happy with what he is receiving from the RN and PT.

Maybe life is slowing down right now. Maybe solutions are in abundance and problems are in reduction.

Getting Attention

Last night, after cleaning up the latest insurance fiasco, I went online to see what blogs were out there regarding ADP (Automated Data Processing). There were quite a few blogs relating to the stock market and ADP. I took the opportunity to leave a comment on several, regarding the inefficiency of the company.

I also found a site where ADP was recruiting new clients. I filled out a form, with the company name, Ann Is Not Happy, asking for help. I was hoping to capture some one's attention.

Voila! This morning a woman from ADP called me, letting me know she would be my personal contact at ADP. She took all of the latest information, and did one tiny thing that showed me promise. She did NOT point a finger at anyone but ADP.

Tonight, I shall do the same for Cigna.

No Wonder I Am a Cynic

Yesterday, Dennis went to visit his family doctor. Dr. Keifer is the one who Cigna denied as a family practitioner, and held up a few of the insurance claims. I asked him about his credentials, and he told me he has been, always and only, a general practitioner. He has no ENT interest, let alone specialty. Should I call Cigna and let them know?

No.

Today, I went to the pharmacy to pick up one of Dennis' meds. His insurance refused to pay, because his coverage had been terminated.

I wish I could say nice words, but none come to mind.

So I came home, called Cigna, who told me I had to call Medco (his drug coverage), who told me I had to call ADP (where he sends his Cobra payments). I spent the next hour and a half on the phone, once more, talking pleasantly to people who try hard, but aren't able to accomplish much of anything.

I asked the guy, who happened to answer the phone at Cigna, how many calls had been placed on Dennis' behalf since January 1, 2009. Over 75 calls, most of them from one of us, have been generated to fix Dennis' insurance problems. This does not take into consideration the calls to ADP or his drug provider.

No wonder we have been sleeping so much during my spring break.

Positive Signs

There are signs that Dennis' insurance issues may be getting easier. Last fall he ordered a piece of durable equipment, that was covered by the insurance company, and the bill has never been paid. For some reason, the company never pursued us, instead, they keep resubmitting the bill to Cigna.

Today we received a notice from Cigna, that the bill has been paid.

One down, 15 to go!

More later,
Ann and Dennis

An Insurance Related Phone Call

You are so lucky if you have never had to make one of these phone calls. Being put on hold is the least of the worries. Here is what I have learned, and maybe someday this information will help you. I hope you never need to do this.

• Dial the number and pray that automated questioning and answering is not the beginning of the sequence.
  
• Skip the above sentence, because you will never again hear an actual person answer a telephone when you call an insurance related company. Sorry to have even put the thought out there.
• As soon as you get a message, push zero. You probably will hear that this is not an appropriate response, but do it anyway. At some point, pushing zero, will get you set up with an actual person. Whether, or not, that person speaks your native language, or not, is a crap shoot.
• When you are required to talk to a phone system, talk slowly and clearly, enunciating every single letter and syllable. Do not, under any circumstances, get cocky and start answering the question before, or while it is being asked. You will only be sent back to Go. Trust me, oh smart alack Ann, I know.
• Push zero once again. At the very least, it may give you a sense of power over technology.
  
• When you do finally get transferred to a holding tank, find something else to occupy your mind for a while, but do not put down the telephone or remove the blue tooth. If you miss the pick-up on the other end, you will be cut off. You will need to start over one more time. By the way, by now they have taken up at least 30 minutes of your life.
• Someone will answer, most likely with a slight Indian accent. This is fine if all you need is the information that shows up on a computer screen. It is not okay if you have an actual question. If you need further assistance, ask to talk to a supervisor in the US. This is the last time that you will talk to someone friendly, by the way. So if it is at all possible to get your problem solved in India, go for it.
• Once you are speaking to someone in the US, always get the full name, the city and state and a call back number before you begin any business.
  
• Write down the following information and read it to the person who answers. I encourage you to to follow this step closely. After you have been asked to repeat these details for the 3rd or 4th time, you will either become frustrated and get snappy (my style) or get flabbergasted and get sloppy.

1. name
2. social security number
3. account number and group number
   
4. birth date
5. address, complete with zip

• If you are calling on someone else's behalf, be prepared to hand the phone to that person to repeat all of the "security measure" questions. Evidently, these phone call bank people can tell one person from another by simply answering these questions. Often I simply disguise my voice and repeat the above information. Sometimes they don't believe me, but usually, if I am being nice, they will let it go. If I am snippy, even one tiny iota, they will however refuse to talk with me.
  

That's enough for today. I have so much more, however, and am willing, able and ready to share it all with you, oh lucky readers.

Ann and Dennis

The Silver Lining

No matter how crappy life gets, if you look, something good shows up.

Because of the latest incident of pneumonia, Dennis will now have the services (covered by insurance - HA!), of an RN coming two to three times a week. We met with her today. On Monday or Tuesday, we should hear from a physical therapist to arrange for home visits on a weekly basis.

A year ago, Dennis would have outright rejected the help. Now, although he downplays the necessity, he accepted the offers.

Right now we need this. Dennis is vulnerable, under the care of highly unqualified people. I have absolutely no qualifications, other that a fairly good intuitive sense, to take care of a disabled person. His PCAs, both nursing assistants, have more experience than me, but aren't qualified to do much, medically, either. Even if it's only 60 minutes a week, having a trained and licensed nurse in to take his temp, check his heart, lungs and oxygen, it is more than what we have going for us right now.

Even though today started out rough - with a blood pressure rating of 65/40, it improved all day and ended up with some good news.

Ann and Dennis

Pointing the Finger

Finger pointing, or blaming the other guy, has been a way of life in this country for quite some time. I believe it has gotten way out of hand.

Kids at school blame peers and teachers for their misbehavior. Their parents blame kids, teachers and administrators for their child's problem. Grandparents, raising grandchildren, partially or fully, blame their own children for their child's misbehavior. Last week, a parent blamed her own mother for spoiling her child, even thought the child lived with the mother.

I believe we all know some aspect of society that excuses their own misbehavior by laying blame on someone else. Until recently, school was my closest experience with the blame game. Now, health insurance and all of it's affiliates has gracefully taken over.

Actually, not too gracefully.

I don't want to regurgitate everything we have gone through in the past few months in detail, but a summary, before talking about our latest fiasco, seems appropriate right now.

• Last fall Dennis was rejected for speech therapy payments that had taken place in the winter of 2008. We simply wrote appeal, as we have become accustomed to doing these days, and waited for the next letter. The next letter arrived in 10 to12 weeks, and said nay, and as usual, we went through the second appeal step.
• Other denials began to come in saying that this, that or the other visit was out of network. We did the appeal process with these, as we were told to do. These included necessary cath changes, physical therapy appointments, regular doctor visits, a flu shot, and the Courage Center, which has been a godsend for Dennis.
• In January, for one reason or another I decided to start calling. I figured a call or two and we would have this all straightened out. Instead, his insurance company told me to call his Cobra money collecting agency, ADP, because they had made a mistake.
• Cobra/ADP told me Cigna, his insurance company, had made a mistake, but they would take and and all action to see that everything would be taken care of.
• A bit later, after 3 or 4 calls to Cobra/ADP (laugh loudly whenever a company that deals with money or insurance tells you they will call you back) they then told me IKEA, his former employer was to blame.

Okay, you get the gist. Blame is everywhere, but that darn pointer finger is never pointed at the person that I am trying to talk to at the time.

Today, after yet another call to Cigna, the gal that answered the phone told me that the whole problem was that Dennis had never appointed a primary doctor (he had). If only we would do this, all would be well. I gave her the doctors name, phone number and address. I was put on hold.

It seems, his general practitioner is labeled, in their system, as an ENT (ear, nose and throat specialist) and does not qualify as a general practitioner. Therefore, nothing could be done to help us. Dennis must have a primary doctor who practices internal or general medicine.

Now Dennis has been seeing Dr. Kiefer for many, many years. He is a family doctor and not a specialist. But no, Cigna says, this is not possible, because their records state differently. It was not Cigna's fault, but Dennis fault, for seeing a specialist in ENT for his primary doctor. Therefore, Dennis was to blame.

More later, so much more.

Ann and Dennis

He's Home

I have not developed a habit of reading my daily horoscope and I have very few feelings about their value one way or the other. But I do find them at times amusing while at other times eerily accurate. They also seem to appear in almost any type of written material that one finds at a hospital. And where have I been biding my time lately?

Today, one of the horoscopes I ran across seemed to be talking to me about the struggle with insurance that we ran into, once again, today. Let's see what you think:

Your ability to be clever under pressure might just save the day for you, but you'll need to carefully watch every step you take today so you don't make a critical mistake. Taskmaster Saturn forms an irritating quincunx to your key planet Mercury now, indicating your inability to solve a problem once and for all. Instead, you'll need to keep coming back at it from a different angle, again and again. It's not that your strategy is ineffectual; it's just that things are more complex than they seem.

I don't understand the planet stuff, but the rest fits perfectly.

Here is a synopsis of today's insurance woes.

In order for Dennis to go home today, the hospital staff wanted one of three things to happen. One, a short term nursing home stay, which neither of us want to have happen again. Two, a short term stay at the hospital, with 3 hours a day of therapy, which the doctor seemed to think would not be a good fit for Dennis. Or three, a PT, OT and nurse to visit Dennis at the house for 30 minutes a day. We needed to agree to one option yesterday.

We were both open to the second and third option, with our preference being the home visits. The hospital social worker told us she would check the insurance and arrange for home visits for Dennis. Since the issue of being covered by an HMO in one state over had been fixed after two months of frustration, we did not anticipate a problem.

Today, she came to us and told us the insurance did indeed cover this option, and she had set us up with the in-house service, but that we had not made his monthly premium payment.

If you know Dennis at all, you know this is the last thing that he would let happen. He not only makes these payment on time, he pays them two months ahead of time.

So I get on the phone, all fired up and more than a bit ticked off. I called Medco, his insurance company, who told me that he was still considered an active member. But, since the did not take the payments, they could not guarantee that they had been made. This took two separate calls, by the way.***

Next, I call the payment collection company, ADP, and talk to a very nice lady in India, who of course cannot help me. I ask to speak to JoAnn, who has helped me, inefficiently, but finally effectively, in the past. She does not answer. I ask for her voice mail. India does not know that. So I ask for a different supervisor.

On hold. Bad music. On hold. Music gets worse. On hold.....

Finally, Harry from Detroit, answers. I go through my story again. We get disconnected.

I call again. Yes, we have made the payment and are up to date. They haven't let Medco know, yet, for some reason. It's only the 3rd of the month, he says. He says he will help me, but from past experience, I know that he is simply placating me, and has no intention of following through with promises give.

I call Medco again and explain the story, only to get disconnected once again.

I call again, and am now beginning my second hour of trying to straighten out something that should not need fixing in the first place.

To make a incredibly long, boring, and stressful story short, Dennis will receive the care he is entitled to, and ADP finally let Medco know that he is paid up in full.

But, unfortunately, as my horoscope suggests, this battle is not finished. But as Dennis' job is to fight Parkinson's, my job must be to fight for his rights.

Why does anyone have to fight so hard?

Ann and Dennis

***I will explain the process of each phone call at a later date.



I

Another Hospitilization

Happy April First!

No this is not an April Fool's joke. Tuesday morning, around 1:00 AM, Dennis woke me with his loud breathing. He was breathing in and out in shallow, quick, and laborious breaths.

I assumed he was having a panic attack, and I tried to get him to take deeper breaths. I was coaching him as I was drifting in and out of my own sleep. I wasn't having much success, so I told him I would call 911 if he couldn't slow it down. He tried, bless him, but we ended up going to the hospital via an ambulance.

The emergency room was crowded, and it seemed understaffed. He was immediately given oxygen and a nebulizer treatment, but then we were left in a room for quite some time. After an hour or two (we were not sure, as we drifted in and out of sleep), a doctor stepped in and wondered why his chest X-ray had not been completed. Things began to roll after that, he was told he had pnueomonia and a bed in the hospital was ordered for him around 5 AM.

Dennis' hospital episodes always begin on an eventful day. Last time, it was the day after we moved from our house to our condo. This time, I had to be at school early to set up a huge event for the students; a Hawaiian Festival.

So, I called for a sub for 3 days and went into work to set up the party. Thankfully, many people joined me, and worked to get it all ready in time for the kids.

I returned to the hospital to find that his bed was in one of the ICU areas of the hospital. Thankfully, the only reason he had been placed there was because there was no other room at the inn.

He's better and may come home late tomorow. So stay tuned for the hospital adventures of Dennis Cote.

Ann and Dennis