Round three

[juthwara]

We spent yesterday mired in the bowels of modern medicine. I started the day by going to my six-week post-partum checkup. The doctor confirmed that my scar is healing, my uterus has shrunk back to normal and all of my bits are in working order. I got a prescription for birth control, about which the doctor said, "Well, you probably won't get pregnant since you're breastfeeding, but probably isn't really good enough." He's right, of course, but I view it with a certain amount of cynicism since a), I'm not exactly the poster child for fertility given that it took Clomid just to get this baby and b), while I would probably prefer having sex to getting poked in the eye with a sharp stick, there are days I might have to think about it for a while. For some reason, seven weeks of interrupted, insufficient sleep, constant infant care, wildly changing hormone levels and a fungal infection have put the damper on my libido. It will eventually come back, of course, but at the moment, all of my hormones are geared towards saying, "You don't want another baby! You want to take care of this one!" and they're kind of hard to ignore.

I also got a prescription to go back on metformin. I had debated a bit over whether I wanted to go back on it while I was breastfeeding since the research on taking it while breastfeeding is pretty meager. But ultimately, it came down to the fact that I can't afford to let the PCOS symptoms come back. It's not a matter of things like extra hair or acne or even ovulating for me. My worst PCOS symptom is extreme fatigue, to the point that I was pretty much disabled for a couple years before I finally got medication. More than anything, K needs a mother who has the energy to take care of her and I need the medication to do that.

And then I went home, only to go back out again an hour later to take K to the pediatrician, as her thrush hadn't gotten any better after two weeks of Nystatin. So the doctor put her on Diflucan and suggested I call my doctor for Diflucan as well, since I've been using a Nystatin cream and clearly Nystatin isn't cutting it for this particular strain of yeast. So I went home and called my doctor, feeling a little stupid since I had just been in there three hours before. And here's where the complications started.

According to the nurse I talked to, they never put nursing mothers on Diflucan. She even put me on hold to look it up in a drug reference and came back to say that it said to use with caution in nursing mothers.

"But the baby is on Diflucan," I said plaintively. Surely they can't be worried about her getting a small amount in my breastmilk if she's taking the stuff straight up? And frankly, I would happily pump and dump my milk for a day if it meant I could finally get rid of this damn fungus. It may not be terribly harmful, but oh goodness, it's a pain all around. It makes me cranky, it makes K cranky, and when K is cranky, we all suffer. And we've been dealing with it for five weeks now.

So then I pointed out that a two week course of Nystatin for K and three weeks for me had completely failed to kill the thrush and the nurse agreed to talk to the doctor and phone in a prescription. So I took myself down to the pharmacy later that afternoon, where I experienced the morning's problem in reverse: I had no problem at all getting my Diflucan, it was suddenly impossible to get it for K. As it turns out, we needed prior authorization from our insurance to get it. The pharmacist had called to try and get the authorization, but it looked like it wasn't going to come through before they closed. So she suggested we go to a 24-hour pharmacy that night to see if the authorization had come through and if not, have them keep trying over the next day.

longstrider took the prescription to Walgreen's that evening and the authorization hadn't come through. And it hadn't come through this morning either. When he called the insurance to find out what was going on, he was told that it would take 24 to 48 hours. At that point, we quite naturally both hit the roof. Our child has a condition that requires medication, and we have to delay treatment for up to two days just so a pencil-pushing bureaucrat can say yes? Yes to a freaking generic medication that costs thirty-nine dollars?

It's the fact that they felt the need to quibble over $35 (we had a $4 co-pay) that really gets me. I became painfully familiar with the games insurance companies play to avoid paying out when my mother was in the hospital, but at least in her case, they were paying hundreds of thousands of dollars. They probably spent as much in employee time on the authorization as they did on the medication. How is this possibly financially advantageous to them? Except that of course by delaying, frustrated patients like us will give up and pay the money ourselves just to avoid this nonsense.

But we finally got the authorization and the meds this afternoon and K took her first dose with minimal dribbling, so hopefully we will finally win the War on Yeast in this house.

Comments

[archangelbeth]

Eugh, nasty nasty insurance games...

(I'm paying straight for my Unithroid 'cause they won't cover it -- when they would have to cover all the blood tests that you're supposed to get when you switch to another brand. Eeeeeediots, methinks. At least Unithroid is cheap.)