Unexpected

Oh, what a day this turned out to be. I’m looking at the time and wondering why it’s not several hours later, because this day has felt much longer than normal!

But first, I share the pleasantly unexpected thing.

As I finished up my outdoor morning routine and headed for the house, I noticed something white in the window of the cat house.

Plus, something moving in the shadows behind!

Unfortunately, my coming closer startled the cats. You can just see a hind leg of mystery kitten, who dashed out as I got closer. Little Braveheart was still in the window, and I was pretty sure it was Tabby that I saw in the shadows.

Then, the Creamsicle emerged!

Creamsicle was the first cat I saw checking out the new shelter, and I’ve seen Tabby lounging in the window. I’ve seen other kittens coming out from under it, but this is the first time I’ve seen Mystery or Braveheart inside, and the first time I’ve seen more than one cat in there. This is very encouraging. I know, in past winters, even cats that didn’t get along would still join the pile on the swing bench to keep warm, but it’s still great to see some confirmation that they can use the new space peacefully together.

What I am really hoping to see if Butterscotch’s babies going in there! They are so much smaller and younger, they are the most as risk from the coming cold. Weather Canada is forecasting a long fall and late starting winter, though. I hope they are right, because I’ve also seen forecasts for an early, long and bitterly cold winter coming up.

Meanwhile, the predicted rains last night turned out to be a brief but wicked thunderstorm, complete with driving rain, thunder, lightning, high winds and – no surprise – losing our internet. Thankfully, we did not lose power. As I write this, in the early evening, we’re still at a very warm 25C/77F!

Among the things I needed to do today was head into town and pick up my husband’s prescription refills. Even with a box of insulin, thanks to his excellent private insurance plan, the grand total is rarely more than $100. Last month, his refills happened to include both his injections and needles, and for the first time since things got messed up with his restricted painkillers, his bubble packs had all of his medications in them. So it was quite a shock, but not too unexpected, for the cost to be closer to $300. This time, it should have been less.

It was more. The total was almost $400.

At this time of the month, I simply didn’t have that. The cashier started checking the slips for me and noted that not all of them had the 3rd party payment (what the insurance company pays) on them. With 16 medications, it added up fast.

So I got her to suspend the sale while I stepped aside to look through the slips and then, if necessary, transfer funds from our emergency account. I was perplexed, though. What changed?

I went back to the pharmacists and asked if anything new had been added. The pain clinic doctor was supposed to call our regular doctor and talk medications. Our doctor said that he would fax any new prescriptions directly to the pharmacy. Could that be what happened?

Nope. Nothing was changed. However, according to what was showing up on the computer, we had reached our limit with the insurance company for medications.

Our what???

This has never happened before.

In the end, the pharmacist took back the printed out slips and told me to just take the medications, and come back after we cleared it up with the insurance company. They would rebill the amount then.

Yes. The pharmacy let me walk away with hundreds of dollars of medications without paying for them! Her comment was “we know you’ll come back.” Which is true. There’s no risk to them, since we are regulars, but still… that’s a lot of money walking out the door!

The next several hours was spent alternating between my husband and myself on the phone, with him calling the insurance company first.

In a nutshell, because we now live in a province that has Pharmacare – a provincially run government insurance program – the insurance company covers the cost of the deductible, then stops paying out because the system then covers the rest – but the system didn’t kick in.

As far as I knew, when we sent in an application for Pharmacare, shortly after moving here, we didn’t get accepted. I remember getting a letter asking for my tax information from 2015, when no such information was asked for on the form (my husband and I were both on the one form). I remember getting another letter since then that was basically a giant word salad and, as far as I could make out, we didn’t qualify. So I assumed we did not have it.

The insurance company’s limit on the deductible was only $1500. I called the pharmacy and talked to someone there who looked up my husband’s file, and they’d actually paid out almost $2000, so we were well past the limit. Most confusing of all, according to what she was seeing, is that we were approved for Pharmacare. We had it. But it didn’t kick in when it should have.

She gave me the number to call and find out why.

It turned out our Pharmacare deductible was actually over $3000. Which meant we were on the hook for the rest. The guy I spoke to said we should have gotten a letter back in the spring with the deductible amount. That would have been the letter that I understood as telling us we didn’t actually qualify. He said he would mail us a new one, which our insurance company would probably want to see.

Also, two of my husband’s medications (one of which is the pain killer that comes in slow and quick release forms) are not covered by Pharmacare at all.

My husband then called the insurance company back. Sure enough, once they have the proof in hand, they will adjust the limit to match what our deductible.

I called the pharmacy back and explained it to them, and they are fine with our coming back after all this was done, so they could re-bill the insurance company, and we would be paying only whatever was left. How long that takes depends on how quickly the letter gets to us in the mail (after that, my husband can just email a copy to the insurance company), which could take more than a week.

Our pharmacy is awesome!

If we were living in a province without Pharamacare, this would never have happened. What I don’t understand is why this didn’t happen last year! I guess the new medications my husband was put on after his stay in the hospital was enough to kick it over this year, but he was put on them late enough in the year last year, that it wasn’t an issue.

By the time this was all figured out, my husband and I were both completely drained.

The rest of the day’s plans went out the window.

It’s time to de-stress!

The Re-Farmer

2 thoughts on “Unexpected

  1. I suspect the cold will have several of them scampering for the house eventually, but it is good to see them getting used to it.

    As for the health care… I’ve said it before; train wreck. And ours isn’t any better. Almost a year and a half after I I got married and we’re on our fourth major attempt to get mine straightened out and active.

    Liked by 1 person

    • Yeah, we’ve had a few problems with the insurance since moving here that have had to be straightened out, but at no point were we ever told there was any kind of a limit, after moving to a province with a limit. !! I’m just glad we were able to get to the bottom of it and find a solution so relatively quickly, this time.

      I was just telling my brother about it and he was shocked by how high our Pharmacare deductible is. It is very unusual, but it’s also based on income, and being on private insurance for disability payments, my husband makes “too much” money for a lot of things. Talk about being caught between a rock and a hard place!

      Liked by 1 person

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