Right on
Thursday July 30th 2009, 6:00 pm
Filed under: Crohn's flare,Knit

A quick knitting note: I worked out a pattern and started a shawl a few days ago in a 65/35 cashmere/superfine merino blend…and then had the same hesitation I’ve always had in the half dozen years I’ve owned that yarn.

It is lovely, lovely, soft stuff. But…  I finally handed Michelle two strands of it and asked her to pull them apart.  Zero effort–foof, done.

I asked her advice, and her reaction was she would never wear something where she would be afraid a wedding ring would catch on it the first time she wore it and then that would be the end of all that work.

I took the needles out, sealed it back in its bag, and put it back in its corner. Maybe someday I’ll ply it with something stronger.  To be sure, then, I tug-tested my Fino baby alpaca/silk I’d bought at Purlescence.  No breaking. Guess which one I’m knitting?

A bit of medical stuff:

After all the grief in January, I must give them credit.

Caremark sent me a letter recently, as I’ve mentioned, and then a second to reiterate the point, denying me not only my anti-nausea med because I didn’t have one of two specific types of cancer, but denying my doctor the right to prescribe an IV dose of it above a certain level.

This is stupid. This is a med that can help keep me out of the hospital, given my low blood pressure’s inability to tolerate barfing.

They told me I could appeal.

It took me awhile to do. A friend showed me a sample letter for a formal, matter-of-fact medical appeal to follow.

I couldn’t write it. I tried. I just couldn’t.

I finally sat down about a week ago and wrote the letter *I* needed to write, spelling out exactly what they had done in January and why their stance was again medically unreasonable.  That I might have been able to keep my colon had they responded in a timely manner earlier.  Telling them in no uncertain terms what I expected them to do and to do it right.  NOW. I snailmailed it to them and a copy to Blue Cross. A lawyer was mentioned as a possibility.

I got a call today from a nurse working for Blue Cross. She made no direct mention of that letter.  But she was appalled when she heard the details from back then and told me exactly what she was going to do to follow up on that. Meantime, she gave me her name, her phone number, her fax number, her colleague’s name as a backup, and told me if I had any problem authorizing anything, contact her immediately, and if I had a problem at an after-hours time, call this other number.  She told me Caremark had no business whatsoever with in-hospital dosages, not even at Urgent Care, they only had any possible say in home health care after the hospitalization.  Any problem, call her. And fax this form from their site so that Richard could call on my behalf if need be.

I was gobsmacked. They actually did the right thing. Someone at my insurance is actually on my side now.  Wow. Cool.

35 Comments so far
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Praise God! That is indeed an answer to prayer. Now, if this upcoming surgery can be that successful, please.

Comment by Barbara-Kay 07.30.09 @ 6:31 pm

And then, every now and again, your faith in people is restored. Awesome.

Comment by Lene 07.30.09 @ 7:15 pm

Praise the Lord! Unheard of! The insurance company on YOUR side! By Heavens, a heart does beat there.



Clean your house in 7 easy steps using your computer:

1. Open a new file in your computer.

2. Name it “Housework”.

3. Send it to the TRASH.

4. Empty the TRASH.

5. Your computer will ask you, “Are you sure you want to delete housework permanently?”

6. Answer calmly, “Yes”, and press the mouse button firmly… 

7. All done.  Feel better?

Comment by Don Meyer 07.30.09 @ 7:22 pm

Hurray! It’s always good to hear of a success, however large or small. 🙂
My success today? I managed to get book shelves cut to fit our living room’s “built-in” book shelves. (they lacked enough shelves.) Yes, it’s pine and we’ll have to stain it all. No, it doesn’t matter right now. I unpacked several more boxes. Ahh. Now that’s a (small) success!

Comment by Joanne 07.30.09 @ 8:20 pm

It just goes to show that prayer works! I’m sorry for all that you have been dealing with lately. At least you now hopefully have one less worry.

Comment by TripletMom 07.30.09 @ 11:42 pm

I am so glad. It must make you feel a bit better going into next week with her on your side :-}

Comment by Diana Troldahl 07.31.09 @ 1:09 am

Praise be. Amazing. Yes, praise the Lord! 🙂

Comment by Toni Smoky-Mountains 07.31.09 @ 3:51 am

I imagine there’s a nice nurse working for Blue Cross who doesn’t even know there’s some handknit lace in her future!

Comment by LynnM 07.31.09 @ 4:55 am

So glad you’ve found an advocate at BC.

Now, if only ‘they’ would do the right thing without having to be hawked and threatened and called onto the carpet for it. Perfect!

We have basically no health issues (certainly none compared with yours). We have more the usual “Oh, pay this bill would you? Yes, we know the procedure is 100% covered, but…y’know…just pay this bill.” DH has had to call twice. The last time, the person on the other end agreed (again) that yes, we were covered. But wait! There’s more! Would you believe that the authorization for payment had come ‘down’ that very morning!? WHAT a coincidence! /snort/

It’s. Not. Supposed. To. Be. This. Hard.

Comment by Liz in IN 07.31.09 @ 5:06 am

If it were a letter stating this, I’ld ask you to frame it!!!! Good Lord! Talk about seeing the light, at long last!

I can’t guess what you’ll knit next… Or can I? A scarf? lol

I’ll read your post for the answer. 😉

In the meantime, please take great care of yourself!

Comment by Suzanne in Mtl 07.31.09 @ 5:41 am

That’s wonderful! Blessings be upon that nurse.

Comment by Genny 07.31.09 @ 7:08 am

And the answer to our prayers is rcvd. Hooray! I’ll let Lucy know tonight. We’ve mentioned you in our prayers so often now that whenever I say “Alison” — even if talking about another friend — she starts doing the sign for thank you, like she does during evening prayers.

Of course, she also told her sitter to kiss her butt yesterday. She fell down, landed on her butt, asked for a kiss, when asked where, thought for a moment, then declared “Elmo-butt!” (which is her diaper).

I am too entertained.

Comment by Kristine 07.31.09 @ 7:23 am

Thank the Lord for answering prayers. It is so good when something does FINALLY go right.

Comment by sherry in idaho 07.31.09 @ 7:42 am

Thank goodness someone up there remembers the ‘care’ part of health care!

And the yarn? If it pulls apart that easy, it is not for knitting. Petting maybe? Felting?

Comment by Carol 07.31.09 @ 8:03 am

As it should be, but I’m so glad it worked out.

I just can’t gift such delicate yarns (including items knitted with such) unless I’m certain the recipient’s lifestyle makes it a good and functional gift. I hope it does find a purpose one day!

Comment by Channon 07.31.09 @ 8:09 am

what a wonderful thing!

I truly believe that as much as we are all fighting with the impossible inhumanity of the companies themselves, there are good people working in those insurance companies that really do care about doing a good job and actually {gasp!} helping people!!

Nothing like an additional “safety net” to help you feel supported next week

God bless — we’ll keep praying!

Comment by bev 07.31.09 @ 8:19 am

::cheers:: YAY!

Comment by Alicia 07.31.09 @ 9:12 am

About darn time!

Comment by Jasmin 07.31.09 @ 9:46 am

I still think you should talk to an attorney about suing the boots off (don’t)Caremark.

Comment by Leslie 07.31.09 @ 11:10 am

So glad you got this off your chest, so to speak! It’s been fermenting too, too long and the details needed to be written out and documented. Now you have more people on your side! Go Girl!!!!

Comment by Nancy 07.31.09 @ 11:17 am


Comment by RobinM 07.31.09 @ 2:14 pm

“Someone at my insurance is actually on my side now.”

Truly on your side or just protecting their own backside? Well, whatever the motivation, at least it looks like you have someone you can turn to now.

Comment by Marlene 07.31.09 @ 2:33 pm

Good luck honey!

Comment by Tiny Tyrant 07.31.09 @ 2:51 pm

Holy Cats!!!!!

Any way to fax her a scarf?

Comment by Margo Lynn 07.31.09 @ 3:09 pm

I’m so sorry the yarn didn’t work out, I bet it is heaven to knit with. Maybe you could ply it with some silk to add strength?

You go girl!! I love your spunk and am glad you sent both letters out and let them know in no uncertain terms that your surgery was because they wouldn’t do the right thing. Put some fear in them :P.

Comment by ldsvenus 07.31.09 @ 3:31 pm

I agree with Leslie, find a lawyer and sue Caremark. They’ve got to be made accountable for what they’ve done.

Comment by Eileen 07.31.09 @ 5:19 pm

I once had an insurance person totally confuse me with a discussion of whether or not something was a “procedure” or something else. So I asked my brother-in-law, who is a doctor to explain it to me. Instead I got a lengthy theological treatise on the exact part of hell reserved for insurance company employees. (One of the inner circles, I believe.) So I still don’t know what a procedure is.

Comment by LauraN 07.31.09 @ 6:18 pm

Yay you!


Comment by (formerly) no-blog-rachel 07.31.09 @ 6:21 pm

Once again, thank you Alison!
The lesson for the rest of us is to always buck it up to real persons at the insurance company, and not take NO as an answer from the prescription provider!
I try not to think that it’s intentional — that the drug providers give you grief at the time you’re least equipped to deal with it. I’m so sorry you went through all of this, including the energy spent in reliving the experience as you wrote us, but you may well have saved lives by doing so!

With gentle hugs and my heartfelt wishes for a good recovery from your upcoming surgery,

Carol in MA

Comment by Carol Telsey 07.31.09 @ 7:08 pm

Where was this lady in January?!? But a thank you prayer is still in order because it sounds like she knows what to do and will save you more grief in the future. Good luck!

Comment by shadylady 07.31.09 @ 8:25 pm

Well, it’s about time! This is the kind of thing that gets me fuming mad. The insurance companies make such DUMB decisions sometimes! It boggles my mind.

Comment by Momo Fali 08.01.09 @ 5:01 am

I concur with the ‘hope this is a trend’ idea. Finally. I’ll be praying for success in this next surgery and peace and healing after.

Comment by AlisonF 08.01.09 @ 5:39 am

YOU did the right thing by telling it like it is, speaking from your heart. I am glad you got her on your side now.

Comment by karin maag-tanchak 08.01.09 @ 4:44 pm

Well placed, well spoken words can work miracles when received by the correct eyes/ears that hear and feel and understand. Thank God that they landed on ears that hear and spoke to the right heart.

Good to have someone in your corner right now (other than all your readers and, of course, God). 🙂

Comment by Karen Lewis 08.04.09 @ 8:00 pm

Well, it’s about time! Hallelujah!!

Comment by Shirley 08.22.09 @ 1:54 pm

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