medical insurance

Unexpected

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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

The reality of things

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I’ve been told I should make sure to add warnings before I post certain things, so I’ll start with that. Towards the end of this post, there are pictures of a dead bird.

Aside from that, during my morning rounds, I did get photos of Two Face. Her wound is healing quite nicely. You can hardly tell where it is, if you’re not looking for it!

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Settling in, little by little

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I did my rounds around the yard this evening, and it’s really something to see how everything is settling in for the winter.

While I have been fighting those invasive vines all over the place all summer, there is one area where I am keeping them.  They are, after all, quite pretty, when under control!  They have gone to seed, now, and are all covered with lovely little puffs.

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I spent some time going around the yard, picking up the fallen branches, and going through where I cleaned things up in the maple grove.

When talking to my family about what I was finding, I mentioned the rows of trees that were planted too close together, with many dying because of it, and how I wanted to eventually transplant the three poor little tamarack trees.  One family member told me to just cut them down to give the other trees space.

Nope!  Not going to do that.  I really want to save these trees.

This is one of the reasons why.

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They turn a most glorious golden yellow in the fall!

In the future, I would really love to plant more of them!

It’s not unusual, when I make my way through the yard, for me to have a cat follow me.  That’s typically when Rolando Moon makes an appearance.  Otherwise, it’s Beep Beep or Butterscotch.

Today, I had two cats following me!

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Beep Beep and her boy!

Later, my younger daughter helped me move some leaf piles onto the flower garden by the Old Kitchen.  The girls have been raking the grass, but with the latest drop of leaves, it’s rather yard to tell in some places! 😀  We are starting to use the leaves as mulch in different areas as well as adding more to the garden – and that’s without doing any raking at all in between the trees!  Those will be left to decompose where they are.  We’ll just stay on top of picking up fallen branches in those areas.

Earlier today, we made a trip into town to get some prescription refills.  When they were ready, the pharmacist went through the three bottles with me.  There was supposed to be four, however.  So she went back to check what happened.  It turned out that, for some reason, the insurance wasn’t coming up to cover that one at all.  They figured it was a glitch in the system.

They ended up giving me the refill, without charging us for it now.  When I come back in about a week, for some other refills, they will charge us for it then.

Which kinda blows me away.

When we had issues with insurance, shortly after moving here, the Costco pharmacy my husband had set up with wanted to charge him full price. We didn’t even know there was a problem until they wanted some $400, when we should only have been paying $40 or so.  It was a most frustrating experience, and my husband went without some of his medications for a long time before the mess was fixed – and then even longer, because the fix put him at the wrong rate, which meant we still couldn’t afford it.

I’m rather glad we are with this pharmacy, now!

One of the benefits of going with a small town pharmacy, instead of one in the city!

Something to be thankful for, for sure!

The Re-Farmer

Sky on fire

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While tending the fire pit, burning away the rhizomes I’d pulled up earlier, I got to watch a lovely sunset.

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The photo does not do it justice.  It was as if the sky on the horizon was on fire!

I went over to the outer fence line (the cow fence. 😉 ) to get this shot, so there would be fewer trees blocking the sunset.

We had another hot and muggy day today, so I didn’t plan on doing any manual labour in the trees today.  Which worked to be a good thing, since my husband was able to reschedule a medical appointment from next week to today, so he could get updated prescriptions, and then fill them.  He was able to get an updated prescription for a CPAP as well.  He’s been without for almost a week, now.  Interestingly, after that first night without, he’s actually been breathing quite a bit in his sleep.  Granted, the incline of the hospital bed helps, but it’s no where near as bad as it was before he finally got the sleep apnea diagnosis.  Back then, he spent more time not breathing, than breathing, and had 0 REM sleep.  His case was so extreme, the sleep researcher that had his file, who was also a university professor, asked permission to use the test results and video for his classes, and his data for future text books.  In all his years as a sleep researcher, he’d never encountered a case as severe before!  So any improvement is a good thing.

This province does things differently when it comes to CPAPs, which is covered by the medicare system with a deductible.  We had to explain to the doctor that we were intending to just get a new one from cpap.com  In the end, it’s cheaper that way.  Even with the dollar difference and before insurance coverage (we have to pay in full ourselves, first, then submit the receipt).  It’s amazing how incredibly more expensive the machines and supplies are, when purchasing them from Canadian suppliers!  It makes no sense!  So by doing it this way, we are not only saving money for ourselves, but for our insurance company, too.  Also, since the machine we plan to get is an adjustable type, he doesn’t have to go through new testing to work out the settings, so it’ll probably be faster, too.  In the long term, though, it would be good to get him tested again, and see if he would be eligible for a VPAP (variable pressure, rather than continuous pressure) instead.  That is still covered by the system 100% here, too.  That will be discussed with the doctor another time.  The most important thing is getting a new machine quickly.  Sleep apnea is not something to take lightly!

The Re-Farmer

A Day Away

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An unusual day, today – I didn’t take a single photograph!  I was away most of the day, and don’t even know if the deer visited.

I had an appointment in another city; it’s still an hour’s drive away, but a much smaller city, so once there, it’s quicker to get places.  I left early, so that I could go to where I could print out photos for my mother, along with some 8x10s for ourselves to frame.  I chose a lot of images to show her when I visit – my daughter will be coming along with her laptop – but printed out “only” 14 of them for my mother.  Along with the deer she asked for, I included some birds and cats, and even one of my daughters with their completed snowman.

The staff member that helped me commented on the photos, so I told her a bit about our set up, and that they were all taken through our living room window.  I picked the 1 hour pick up option when I was done, thinking I would pay for them, go for lunch, then come back – glad that I’d left as early as I did.

Turns out that the 8x10s were done before I even finished paying for them, and the 4x6s for my mother were in process.  The other staff member at the counter that processed my payment brought over the 8x10s and commented on them – two deer close ups, and a redpoll on a twig.  There was another customer using one of their machines that heard me talking about the deer, and very excitedly asked if she could see my photos! 😀  Turns out she gets deer in her yard, too, but isn’t able to get photos of them.  So she was really excited to see them.

That done, I had lunch and hung out until it was time to find where my appointment was.  It was my first ever counseling session, to talk with someone about the stress issues I’ve been having, even after leaving the toxic environment that was causing it.  Thankfully, I’ve been able to consult with my lawyer and another expert, so I’ve got a plan of action, should things come to a head.  I told the counselor that I seriously considered cancelling the appointment because that, alone, made a huge difference in reducing the stress levels.  However, I told her I’ve also seen many people over the years dealing with stress and not going to someone for help with it and, over time, it ended up causing them more problems, whether it was not getting grief counseling after a tragic loss, or domestic situations, or for any number of things.  I didn’t want to be “that person”.   Despite the push in recent years to encourage people to view their mental health the same way as their physical health, there is still a huge resistance to actually seeing a professional about it, largely due to stigma.  Me, I’ve reached that stage in my life where I really don’t care what anyone thinks of me, and if they give me grief (or bully me in any other way), I am no longer the shrinking violet that backs off and slinks away, like I used to.  Now, I stand up and challenge people who do that, no matter who they are or what status or titles they might have.

Bullies really don’t like it when people stand up to them.  Unfortunately, it happens so rarely, they usually get away with it, and just move on to the next “victim.”

Or in other instances, try to exact their revenge though other means.  Which is basically the problem I’m having now.

I think it was a good session.  There really isn’t a lot she could do for me, but she was able to give me some resources, ask questions and listen to why I was there, and I am welcome to book another appointment any time I feel I need to.

I was done early enough that I could go and visit my sister at her farm.  I haven’t been there in years.  It was good to see her, and the changes they’ve made in their house since I was last there.

Female Redpoll

I showed my sister the photos I’d printed out and, since I had the USB stick, I brought that out for her to look at the rest on her computer.

She was surprised by a photo of a redpoll like the one pictured her.e

The surprise being the yellow/copper cap, rather than a red cap.

For some reason, my thought was that this was the difference between the males and females; the males have the red cap, the females being less bright, so they had the yellow cap.  I’d forgotten that the males have a red chest as well as the red cap, while the females have just the red cap.

So what is the one with the yellow cap?  It’s clearly the same bird.  There’s no other real difference.  I had a photo of one with a red cap, too, so we compared back and forth, and they’re the same, except for the colour of the cap.  We were seeing a lot of the ones with the yellow cap; it’s partly why I originally misidentified them as chipping sparrows, because in my own bird book, which doesn’t have redpolls at all, this was the one that looked the most like it.

She dug out her bird book, but it has illustrations only.  Male, female, juvenile.  The juvenile has no bright colours at all.

After talking about it, her conclusion was that they might be juveniles that are in a transition stage from having no bright cap at all, to their adult colours.  She is probably right.

If any birders are reading this and can fill me in, I’d love to hear from you!

I wasn’t able to stay at my sister’s for long, unfortunately.  My husband had called in some prescriptions. I wasn’t sure when the pharmacy closed, and it was nearly an hour’s drive away.  I wanted to get my own medical insurance coverage set up, too, now that we’ve been assured my coverage is all set.

It’s a good thing I left when I did.  I got there 15 minutes before they closed.

I still don’t have insurance coverage.

The first person tried to set it up on my file, but couldn’t get it to work.  So someone else came over to the computer to try other things.  She couldn’t get it to work, either.

So, it’s back to talking to my husband’s employer and their insurance carrier.

At least I was able to get his meds, though when it was rung in, the pharmacy was officially closed.

By the time I got home, I’d driven about 200 km in total, and had been gone for more than 7 hours.  About 2 1/2 hours of that was just driving.

Yeah, that’s a bit of a down side to living in the boonies. 😀

The Re-Farmer

 

The Deer Came Back – plus insurance update

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First, an update on my medical insurance situation.

I got a call back from the insurance company “about my rejected claim.”  So that’s how the failure to get coverage on my prescriptions showed up at their end.

When I spoke to them before, they were confused to find that, while everything looked as it should in one area, in another, it showed that my file was closed.  They were going to contact the employer’s carrier company to find out what happened, which is what she was calling me back about.

They were told that I had opted out of the plan.

Huh?

Nope.  I have never done anything of the sort.  In fact, the only thing I’ve ever done has been to use my prescription coverage.  My husband has been the one to deal with them, since he’s the employee.

My guess is that when there was a screw up that affected his coverage, mine got messed up, too.

The insurance company told me I’d have to contact the employer to get it fixed.  Well, I can’t, but my husband can, so he has sent an email off to them.

Hopefully, I will have coverage again, soon!

My thoughts yesterday, of putting deer feed out in a trail past Scary Eunice the Snowman, was foiled when my younger daughter went out to feed the cats ahead of me.  As the deer hadn’t made it to the feed yesterday, she didn’t add more.  So I was going to go out later and do it.

I never got a chance to.

Hungry Girl and Barbecue were already out!

They were still nervous around Eunice, and were giving her a wide berth, which also meant they were coming closer to the house.

Interesting.  The deer were less nervous about us moving around on the other side of the window than a snowman!

I imagine they’ll get used to it soon.  Or the warm weather will melt it down.  Whichever comes first. 😀

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Hungry Girl was pretty enthusiastic about burrowing and digging into the snow to get at the feed.

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And making faces at us in the window.  Not so much in this photo.

Gosh, she’s so cute.

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Barbecue was certainly enjoying himself.

What a difference between those two.  Hungry Girl is all scruffy looking, while Barbecue is so sleek and fat, his haunches jiggle when he moves quickly.

In the next while, we’ll find out if he really is a he.  March is usually when the antlers start to grow in.

Later on, Mama and the twins came by.  They, too, kept well away from Scary Eunice!

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This is one of the twins, coming back after being chased off by its sibling, using the boot trail near the house left by my daughters.  I don’t think I’ve ever seen them go this close to the house before!

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There was a fair bit of digging into the snow in some of the spots.

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And burrowing of faces.

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A bit of aggressiveness, too.  I wasn’t able to get a photo of one of the twins actually kicking at its sibling, enough that his leg even got hung up over the other one’s body.

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But that didn’t keep either of the twins from coming back.

Look how deep that snow is!  This area doesn’t get as deep as other areas, such as the open garden. It’s definitely making it harder for them to move around.

And now a bonus photo…

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One, adorable, fluffy little chickadee!

The Re-Farmer

Hello, March!

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Ah, what a lovely spring day we are having today!  As I write this, our temperature is at +2C.  That’s right, I’ve had to add a + to the temperature!  We are above freezing temperatures right now, and it’s already evening.

Awesome.

Of course, we’re also getting storm warnings for Sunday – when we’re also supposed to be above freezing for temperatures, so it’s a heavy snowfall that would happen, if it does happen.  From talking to my dad over the years, these snowfalls tend to miss the farm, and hit farther south.  So we’ll see.

The melting snow has left the deer feeding area looking much bigger!  All the detritus of past feedings is being revealed, so the spots where I’ve been leaving little piles of seeds are now looking much bigger.  And blacker.

This morning, Hungry Girl and Barbecue came over before I’d gone out to freshen up the feed.  I tried to take photos, but the camera wouldn’t work.  Checking the display, I saw what looked like CHR.  Or maybe CHA.  Anyhow, I figured the battery needed to be charged.  So I took the one from the camera to charge and popped on the extra.

Which was also almost dead, even though I had fully charged it not long ago.  I still thought there was enough charge to take some photos, but not; I still got the same display.

So I missed getting photos of them while the batteries charged.

It turned out not to be the batteries.

Somehow, the memory card got locked.  The photos I took yesterday are still there.  I copied them, but I can’t remove them, nor can I take more photos on the card.

I have no idea how this happened, or even where.  It could have happened on the camera itself, or on the desktop.

I will have to investigate further.

I did, however, get a nice photo of a blue jay, at least.

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I got a call from my husband’s doctor this morning about a change in his medication.  (I appreciate that they will talk directly to me about it, so I don’t have to interrupt his lie-downs.)  The new medication is covered by insurance, so he gave me information and instructions about it, then sent the prescription to the pharmacy so I could pick it up today.  Rather nice having a prescription that we don’t have to physically pick up at the clinic and take to the pharmacy within a limited time period!

So my younger daughter and I headed into town to pick it up (and get some Pokemon Go in).

While there, I checked to see if my own file was successfully transferred from our previous pharmacy (it was) and if it had been filled (it was).  So I got both at the same time.

One of the pharmacists and a trainee spent some time with me, making sure I had the needed information about the updated medication, the dose, when to take it, etc.  They even opened the package to look at the paperwork to make sure the dose measurements on the injector pen matched the previous version of the medication.  It did, but the dose my husband is supposed to be on is quite high, so the box will only last a few days.  It was decided to leave it as is, for starters, then in the future we can get multiples of boxes, so I’ll have fewer trips into town.

Meanwhile I glanced at my own prescriptions and choked at the price tag.

The insurance coverage wasn’t used.

So I let them know and gave them my insurance card.  Once done with my husband’s prescription, they started fixing my file.

It’s a good thing I brought an insulated bag and asked for ice packs.

I think I spent at least half an hour waiting, as they first tried to get my insurance set up on my file in their system, which failed, and the pharmacist then called the insurance company directly.

Long story short.

They couldn’t get it to work.

At the insurance company’s end, the person was going to talk to someone else, but that someone else was on lunch, so she would call the pharmacy back later.

The pharmacist, meanwhile, felt that the problem was at their end, not the insurance company.  I could pay the full price and get reimbursed (nope; we may have just got paid, but reimbursement wouldn’t happen until it got fixed, and who knows how long that would take), or she was willing to transfer the prescription to the competing pharmacy across the street to be filled.

Yeah!  Really!

I decided to not get them for now (it’s a good thing they’re not a vital prescription!!).  She said she would call me if she got a call back from the insurance company.  I mentioned coming back tomorrow, but she suggested I call, first.

So what should have been a quick trip into town, with some leisurely Pokemon-ing ended up being much longer.  At least there is a Pokestop right next to the pharmacy, so my daughter was able to throw on a lure and played on both our phones while she waited for me.

Meanwhile, my phone let me know I had a voice mail.  Which was weird, because I got no phone call.  Turns out I did, but it just never rang.  It was my previous doctor’s office, wanting to talk to me about my file transfer.

So, once I got home, I had lots of phone calls to make.

I called the insurance company and explained what happened.  He could see nothing wrong with my file on the system, so he put me on hold to talk to someone else.

When he came back, I could hear the perplexity in his voice.  It turns out that in one area, my account was active, but in another, I was no longer active.  They don’t know why.  So he was going to contact the carrier my husband’s work is hooked up with to figure things out and get my file fully active again.

Hopefully, it will not take as long as it did to fix up the mess with my husband’s file.

Then I talked to my old clinic.  Turns out there is a $35 fee to transfer a file, and how did I want to pay that?  I don’t have a credit card, but I do have debit Visa, which they take, so we did that.

I also updated my address and phone number, so she wouldn’t call my cell phone, though my cell phone number is still there as a back up.

Then I worked on something else when I got a notification from my phone.

Another voice mail.

Yeah.  She called my cell phone.  And since I had zero signal at the time, it went straight to voice mail.

I called back and found out my card was declined.  Which made no sense.

So I called the bank’s 866 number on my card.

Which got answered with a cheerful recording saying I could help them out by taking a short survey.  As a reward, select customers could win a Caribbean cruise.

Uh huh.

So I went through the three question survey (there was no option not to take it), and at the end, the cheerful recording congratulated me, because I just won the cruise; it would only cost a $65 processing fee.  Did I want to accept the prize?

Uh huh.

So I selected yes.  A live person answered the phone, greeting me with an “are you excited about winning this cruise?”  To which I responded, “Actually, I’m trying to figure out how I got you guys, because I was trying to phone … ”

*click*beepbeepbeep*

She hung up on me.

I called the bank’s number again and got through to where I was supposed to.  After being on hold a while, I made sure to first tell the person who answered what happened.  She took notes to pass on to the back office to see if there was a security breach on their system.

Then I talked to her about my debit Visa being declined.  She checked, but there was nothing wrong with my card.  After getting more details, she put me on hold and went to talk to someone in the back office about it.  When she got back, she informed me that no transaction on my card was attempted, according to their system.

Which means that, somewhere between the clinic and the bank, something went wrong.

So, back on the phone with the clinic I went.  I told her what the bank told me, and she was surprised, because she had tried twice.  I told her the bank confirmed there is nothing wrong with my card, so she said she would try again later, then call me back if it was still a problem.

So far, no call back, but then if she tries to call my cell phone again, it might be a while before I find out.  I forgot to mention that she’d called the wrong number.

Ah, well.

So, more move related hassles to sort out.

Later on, I went and got the memory card from the camera, as well as the one that got locked.  I uploaded the photos I took…

And found pictures of Mama and the Twins.

I didn’t remember taking those.

I uploaded them all, then started trying to figure out what happened with the locked card, and if there was something I could find to unlock it on the desktop.

While I was doing that, my older daughter came by to let me know she’d taken some pictures of deer while we were gone.

I suddenly felt sane again. LOL

Here is one of the photos she took for me.

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With the melt, it looks like there is so much more feed out there than there really is!  I’d emptied the bag this morning, and picked up 3 more on the way home, so we should be good for the Month.

Now, I am looking forward to a quiet evening.  I’m not used to talking so much.  My throat is sore.  I have a friend I’m hoping to talk to soon, and I don’t want to have to cut conversation short because I’ve spent so much time talking on the phone!

The Re-Farmer