Final decisions on prescriptions dilemma…

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In my post of June 12, 2012 (please see archives), I discussed our concerns for bringing our medications with us while we live about the world, often in remote areas, far from a post office.

We’ve discovered that in certain areas, the receipt of packages is not only risky due to potential theft, but also inordinate delays. The thought of worrying every few months about receiving our refills will be an infringement upon our level of enjoyment.  What me, worry?

In the June post I explained that we had sent our prescription plan a comprehensive package of personal information, our itinerary, lists and reasons for medications, doctor’s information and a completed litany of forms, along with a detailed letter explaining why we wanted to take no less than 12 months of prescriptions with us.  

Thus, we began the wait for approval for our “vacation request.” Three to perhaps 10 years is hardly a vacation, as Tom often reminds me saying, “We will be living, not vacationing.”

In speaking with our doctor, we discussed an annual Skype appointment with him whereby he could “see” us in order to meet his ethical criteria of an annual appointment in order to write refills for yet another year. This was satisfactory to us.

I weighed the package, loading it with postage and left it for the mailman almost six weeks ago.  With no response, it was hovering in my mind to call and check on the status of the request.  Friday, I called.

An hour later, after explaining the story to five different employees, none of whom could find a record of my filing for the request, my temper began to flare. It is seldom that my feathers get ruffled.  But, I knew remaining calm would get better results than to expose my ire.

In a firm, yet pleasant voice, I explained to rep #5 that I needed to be sent to someone who would be able to find the file.  I was sent to the supervisor of the “vacation request” department, explaining a very shortened version of what we needed and focused more on the location of our file.  I looked at my cell phone. I had been on this call for one hour and five minutes.

The supervisor left me on hold, returning a full four minutes later to explain that she had found the file and our request was denied! “Where’s my denial letter?” I inquired.  No response. Finally, she stated, “Your insurance plan doesn’t allow for vacation requests.”  

“Why, may I ask,” again in a calm voice, “didn’t the agent tell me this was the case after I spent an hour on the phone in June asking them how to handle a vacation request and if we were potentially qualified?”

Why did he send me a packet of no less than 10 pages, explaining the process requiring me to include information they already had in their system, asking me to hand write in the forms on the few lines provided?” 

(No, I didn’t hand write in the forms!  I printed the 12 pages of information using our printer and paper, directly from their system!)  She apologized for my inconvenience. I hung up trying to mumble some sort of a thank you. (Can’t escape my ongoing effort to have good manners, I guess.)

Inconvenience? Ha! Doesn’t incompetence sound more like it? Usually, I am a very calm person. My heart was racing. I paced around the room, adrenaline thumping through my body, heading directly to my brain for a solution. I paced. I ruminated. I paced some more. I poured a fresh glass of iced tea. 

I had an idea! Why didn’t I think of this to begin with?

My simple idea was to pay for our own prescriptions out of our pocket! Forget the prescription plan!  Forget the co-pays! Find the best possible prices for a one year’s supply (the maximum time for which the doctor can ethically write)!

The comfy chair was calling me. Sitting down, with the frosted glass of iced tea in hand, I grabbed my laptop quickly bringing up our prescription plan records to determine the co-pays we had paid in the last 12 months. The total was $1542, the new number to match!

Now, the challenge was to find a way to buy all of our prescriptions for one year for as close as possible to this number, thus justifying buying outside of the plan.

My phone in hand, I looked up the phone number of the local Cub Foods Pharmacy and had the honor of speaking to Pharmacist Renee, a breath of fresh air after that grumpy “supervisor.” She confirmed that “yes” we could buy any amount of medications for which we had a prescription. She priced 365 days of each of our combined seven prescriptions. (Numbers coming here in a minute).

Next, I called Walmart Pharmacy. What about their $4 per month prescription? Wait a minute! The $4 theory went out the window when I received the pricing from their pharmacist for the seven drugs. Our drugs were not in the $4 plan.

Here are the cost comparisons for the two locations:

Cub Foods Pharmacy $2445.80

Walmart Pharmacy:   $3022.48

Hum, not good enough. However, Cub agreed to match the Walmart’s best price on any single medication, only a slight improvement in the total, bringing it down to $2390.45, still $848.45 short of our goal.
Gulp. Gulp. Gulp. More iced tea. Wheels turning. Here we go! 

What’s the commotion among senior citizens, without access to a good drug plan, buying prescription drugs from Canada?  I tried to picture myself bobbing up and down on a bus traveling to Canada with a bunch of seniors. 

Fingers flying across the keyboard, 1/2 hour later, web sites searched, reviews read, to discover that CanadaDrugs.com may be a partial solution.

(Please understand, we are not involved in this or any other companies in
any manner, and kindly ask you to do your own research as to what pharmacies/plans may work for you).

While considering the best prices at Cub, based on best prices at Walmart, matching the best prices at CanadaDrugs.com, I came to this conclusion:

We will buy some of the drugs from Cub Pharmacy and the better priced drugs from Canada which Cub can’t match. Considering these two combined costs, we are at $1749, only $207 more than we’ve been paying for co-pays on our current plan, now to pay in full for each drug out of our own pocket, no insurance plan involved.  (I won’t get into politics in this blog, but who’s making money here? Are our own seniors being robbed?)

Before leaving Minnesota, we will purchase our last three months of prescriptions, using the plan and then use the 12 months prescriptions between Cub and CanadaDrugs.com.

We won’t have to worry about prescriptions for 15 months out. Our doctor will write us new prescriptions in a year, while we still have three months on hand, plenty of time to repeat the entire process, while awaiting for the drugs to arrive. Both Cub and CanadaDrugs.com will mail to any address.

Moments later I was back at my laptop, sitting in my comfy chair, smiling from ear to ear, freshened glass of iced tea in hand, realizing that the New with Tags, 100% silk designer tie I was bidding on at eBay for Tom’s dressy cruise outfits, was now up to $2.10 with free shipping and, ending in three minutes.

I won.

Medical woes abroad?…

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The uncertainty of the quality of medical care in the many countries we will visit, undoubtedly presents us with cause for concern.  Overall, we are both in relatively good health after working so hard to improve it these past few years.

With our healthful, low carb diet of organic, grass fed meats and produce, exercise (mostly me), reduction in exposure to toxic chemicals in our home, low stress and a happy relationship, we feel we can manage our few complaints easily from afar.

Our doctor will be available via the Internet should we have questions and we’ll be well armed with a wide array of preventive and emergency medications should an illness arise.  In the past almost year, neither of us has had a cold, a virus or illness requiring a trip to the doctor.  

Our recent medical appointments have been for the sole purpose of reviewing our travel medications, receiving our vaccinations and having blood tests with an annual exam thrown in for good measure, all of which showed tremendous improvement from a few years ago.  We are hopeful.

Assuming we don’t get bitten by a snake or warthog, break a leg or have a sudden gall bladder or appendicitis attack, we should be fine. But, of course, we must plan for the possibility of illness in the following manner:

  • Emergency evacuation insurance
  • Supplemental insurance for Jess (Medicare won’t pay for any care out of the US). Only 60 at retirement, Tom will be covered by his regular insurance.  Proof of insurance documents.
  • Prescription processing from afar (as mentioned in prior posts, we’re awaiting a response from our prescription plan as to whether they will provide us with 12 months of prescriptions at a time).
  • Emergency medication for infections, bee stings and/or allergic reactions (EpiPen) and gastrointestinal distress.
  • Copies of all of our immunizations (proof of yellow fever vaccine required with passport upon entry into Kenya).
  • Copies of all of our prescriptions (in the event we are asked during customs inspections or going through security).
  • First aid supplies: Bandages, antibacterial and cortisone creams, alcohol, hydrogen peroxide (small bottles).
  • Over the counter medications.
  • Vitamins/Supplements we currently use.
  • Medical records for both of us (scanning these).
  • Optical needs: extra sets of glasses/prescription sunglasses for Tom,  three years of contact lenses for me. Both of us are yet to have our final optical appointments.
  • Final dental appointments and supplies: Our teeth will be cleaned two weeks prior to leaving the US, while visiting Las Vegas over Christmas. The past few years, we both had all the crowns done that we’d needed.  
  • Copies of our living wills and legal designation for medical advocacy in the event of an emergency.
A neat stack of medical forms and documents sits on our kitchen table with Post-it notes reminding me to complete the above tasks on the appropriate dates.  
This Saturday is the free shredding event.  After going through every file  folder, cabinet, drawer and piece of paper in our entire home, we are ready for the event.  No words can describe the freedom we feel from unburdening our lives with paper.  
Other than the required medical documents, passports and  travel documents we’ll need to have on hand, we’ll leave a “paperful” life behind us, instead relying on the latest technology to provide us access as needed.  Yeah for technology!  Without it, planning for this adventure would be more of a headache than it already is!   

The continuing prescriptions saga…

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On May 17, 2012, I posted concerns about our prescription refills when we are out of the US. As is the case with most insurance plans, the servicing mail-order pharmacy will not send more than three month’s of medications at any time.

Writing that post prompted me to contact the mail order pharmacy to request an exception, due to our unusual circumstances of our being out of the country for years as opposed to months.

Here was the conversation with them: 

“We’d like to request that we receive 12 months of prescriptions in October 2012 before we depart for our journey. A year later, we will ensure we are at a location with an address and have you mail them to us for another year. Our doctor has approved this.”

“Oh, we don’t send the prescriptions outside of the US,” he said with authority in his voice.

Hum…I mused to myself. My choice was either to alienate him by complaining about their policy which was surely futile or, give him a proposal. Here’s what I proposed:

“Sir, we will be getting a new address in the US when we establish residency in another state in December 2012.  Also, we will be obtaining the services of mail handling company in the same state.  Could you send the prescriptions, 12 months at a time, directly to that address?”

“Gee, I don’t know,” he quips, question marks flying around his head.

“Can you find out?”  I asked.  This was like pulling teeth!

“Uh, yea. Can you hold?”  The authority was gone from his voice.

On hold for 15 minutes, he returns with his answers. “Thank you for holding. We’ll be sending you forms in the (snail) mail with instructions.” 

“Oh, I have poor handwriting (true).  Can you email them to me or are they available online?”  I asked with the utmost of sincerity.

“No, they have to be snail mailed and completed by hand,” he says, sounding annoyed with me.

Good grief! Where’s my old typewriter?

Within days of my inquiry, we received a packet of complicated forms, stating not only our standard identification information (OK, I get this) including every word on our ID cards (they have this). We were asked to list one prescription per page, reasons for the prescriptions, how long we’d had the illness, the diagnosis and the prescribing physician’s information.  

With our regular daily prescriptions plus an additional prescriptions for preventive and emergency travel conditions, this would result in completing 20 pages!  It would take days.  

Yes, I could manually enter the repeated information, for example; ID information, addresses and prescribing physician information, etc. and then proceed to copy and print the 20 pages, subsequently, manually entering the requested lengthy medical information.  This still would take days!

Yesterday, I called asking to speak to a supervisor, asking that our conversation be recorded (it was) and documented (hopefully, it was) and here was my proposal:
1. Complete one page with the pertinent basic information.
2. Print all of our prescriptions directly out of their system. (They could have done this!)
3. Write a letter, signed by both Tom and I, explaining our circumstances, reasons for the request, including our itinerary for the next 949 days thus far.
4.  Staple this together.
5.  Snail mail.

The supervisor agreed to my proposal.  I reminded him to post it in the system as to his agreement with my proposal.  Otherwise, they will receive the packet, send it back to me, complaining I didn’t fill it out correctly and this entire process would begin again.  Of course, I made copies of everything.

Does this scenario sound familiar?   I’ll keep you posted on the end result.

Medicine from afar? Refill our prescriptions? Annual checkup?

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As a health and fitness buff most of my adult life, I have made every effort to stay healthy by eating good homemade food, exercising regularly and avoiding toxins in every way possible.  

Many of my efforts have failed me and I have been forced to succumb to traditional medicine and take a few prescriptions each day, as does Tom for a variety of conditions.  

Yes, I have tried over these past years to gradually reduce these few medications with the hope of stopping them entirely. For example; days later, my blood pressure sneaks up to a dangerous level, prompting me to begin the tiny dose once again, fearful of the consequences. 

For me, it appears my genetics is the culprit. Otherwise, there is nothing in my lifestyle, that I could discover from my years of research as to why I would be plagued with these few ailments. Its frustrating. 

Don’t drink, don’t smoke, don’t drink soda. I consume only organic produce and grass fed beef, avoiding all grains, wheat (inspired by Dr. William Davis’ book, Wheat Belly) starches and sugary food.  I haven’t had a sweet treat of any type in almost a year.  
Each day and night I wear a BodyMedia armband to ensure I get in 10,000 steps a day.  It tracks thousands of measurements including how much time I spend sleeping each night which s usualiy about 7.5 hours.  
I have exercised most of my life, regularly, faithfully and with vigor while currently obsessed with HIIT training as recommended by Jonathan Bailor, backed by 1100 medical studies, 10,000 pages of scientific research, endorsed by some of the top medical professionals in the world, many from Harvard Medical School and the Mayo Clinic.  A great read!

We miss doughnuts.  Years ago, on occasion,Tom and I experienced what we called “MD days,” meaning “multiple doughnut days” whereby we’d eat many doughnuts, watch movies and lounge all day. No more.  We haven’t done this in fifteen years.  I can no more imagine, lying in bed all day and eating doughnuts than going to the moon. (Actually, space travel is on my wish list).

A fast food item hasn’t crossed my lips in 25 years!  And what has it got me:
hypertension, thyroid disease, joint and bone problems and borderline diabetes, the bane of my ancestors, most of them inflicted with these conditions, many of whom suffered and died from these conditions!  
Am I sick? No!  But…I am a slave to these few prescriptions.  Am I slim, physically fit, strong and without any memory issues at my age?  Yes. So, I faithfully take those few little pills each morning, hoping for the best, hoping in time that I will discover a way to toss them all away.

Today, I called our prescription medication plan explaining that when we’ll be traveling for no less than 949 days (so far) asking if they can provide us with at least one year’s worth of the prescriptions to take with us when we leave in 5 months and 19 days.  (We’ll figure out something for the remaining period).  The answer was “no.”They will only do what they’ve always done: if the doctor writes a three month prescription, we only get three months of pills at a time!  I asked, “Are you willing to mail our prescriptions to: Kenya, Africa or maybe Marloth Park, Kruger National Park, South Africa?” There again, the answer was “no.” No mailing outside the US.
Will our prescriptions be mailed to Africa? No.

Tomorrow, I have an appointment with the family doctor, a great guy, who will most likely try to help us figure out a solution.  Yes, we will have a mailing a mailing service with our own address where any important mail will arrive and can be scanned and sent to us by email.  

The service will forward packages to us wherever we may be. However, some countries do not welcome prescription drugs entering the country.  We shall see what transpires and post the solution to yet another dilemma.