Carol Archives - Page 3 of 18 - Ramblin' with Roger

Insurance stress: CDPHP, St. Peter’s

health insurance

I am experiencing some insurance stress based on two pieces of mail my wife and daughter received the same day last week. If you want to write a blues song after reading this, feel free.

The letter was from St. Peter’s Health Partners. It runs most of the city’s hospitals, clinics, and doctors’ offices that aren’t part of the Albany Medical Center. All of our primary care physicians are part of SPHP.

“Our records show that at the time of your last visit…, you… receive your health through a CDPHP commercial health plan.” CDPHP is the Capital District Community Health Plan. “Please be aware that [SPHP] has engaged in negotiations with CDPHP for a more equitable agreement to ensure we can continue to deliver high-quality, community-based care.”

Didn’t we do this dance a few years ago, which got resolved at the 11th hour?

In bold: “Our current agreement is set to expire effective January 1, 2023; meaning some patients may have increased financial responsibility when seeking care from [SPHP] in 2023 because CDPHP no longer includes the following facilities in its network.” Over a dozen facilities, including St. Peter’s Hospital, Samaritan Hospital, and five Eddy facilities, are on the list. Interestingly, no related mail from CDPHP has arrived.

On the coverage

Meanwhile, my wife and my daughter also received a Benefits Bulletin from my former employer, the Research Foundation for The State University of New York, or SUNY RF. “If you are a retiree or an eligible dependent of a retiree and you are not eligible for Medicare, your current RF benefits will continue for 2023 unless you make changes during open enrollment.” That window is November 1-30.

Just in case we need to make a change, I went to the SUNY RF portal to see if I could find the forms to change their coverage, but none of them seemed appropriate. Some were for the retiree (me), while some were for the retiree and dependents. I am on a different plan for administrative reasons.

So I called the SUNY RF number on Monday and then a different one on Wednesday. I was offered the same form to make changes, even though it didn’t make sense to me. If I change my wife and daughter to a Blue Cross program, I hope SUNY RF does not muck it up.

CVS

Meanwhile, a good friend of mine writes on Facebook: “We’ve…just been notified by [CDPHP] that CVS will no longer take our prescription insurance effective 1/1/2023… This is very upsetting because CVS is very convenient to where we live, has a drive-through, and the closest to our house is one of the only 24-hour pharmacies in the Capital District.” We got no such letter from CDPHP.

I called my local CVS pharmacist. They said that CVS has declined to take the CDPHP price schedule, so it may very well cost more to fill prescriptions there, but they won’t really know until they start filling them next year.

This issue will be a primary concern of mine this month because I can’t wait until the CDPHP/SPHP issue gets resolved in December if, in fact, it does.

To travel, or not to travel

Coming from California

I’m writing this more than two weeks after the fact, which is suboptimal. This continuation: To travel, or not to travel.

Tuesday, October 4: My usual Bible guys meeting at 9 a.m. I believe I’m the youngest member of the group, which used to meet in person before COVID. But once we started on ZOOM, we stayed on ZOOM. Unlike most meetings, a Bible study with four to seven guys is manageable.

Conversely, the weekly book review at the Washington Avenue branch always wants to be in person. There were some furtive attempts at offering it online, but it’s just better face-to-face.

I went home, and my wife and I started a largely futile attempt to clean the house.

Wednesday, October 5: My wife and I drove to the Albany International Airport. It’s “international” because it services trips to and from a few Canadian cities. I went to the luggage area and met my sister Leslie, who had flown in from SoCal. She was going to go to her high school reunion that weekend. I had agreed to be her Plus One.

My wife suggested going to the Iron Gate Cafe, where we had eaten only a few weeks earlier. But her ankle was now extremely sore, and she begged off but dropped us off there. My sister loved it, as my wife knew she would.

My wife drove Leslie to the Avis/Budget car rental in Colonie Center, near the former Sears; I had no idea it was there. We all went home, with me navigating for my sister; she could have used her phone, but why when she had me?

Medical

My wife was on the phone with her doctor’s office, but from my end of the conversation, it didn’t sound as though her pain or possible infection was being taken seriously. Moreover, the redness of her ankle and above was very concerning to me.

This was because, in 1979, two days before I started my first attempt at grad school, I got a little cut on my baby toe. Increasingly, it hurt tremendously. I hobbled through registration, then limped to the infirmary. The doctor immediately put me on bed rest AT THE INFIRMARY for six days. He feared that the infection, traveling up a blood vessel in my leg, would head for my heart and kill me. I started classes late and never did catch up.

My wife and I put Leslie up in a hotel so she wouldn’t have to put up with our demented cat.

Thursday, October 5: I called my wife’s doctor’s office at 6:10 a.m. Of course, I got the service, but I gave the person great detail about the swelling and what appeared to be spreading infection. To my amazement, her doctor called back at 6:30 and promised a slot as soon as the scheduler came in. At 7:40, the office called, and my wife had a 10:30 appointment, which my sister drove her to. My wife got doses of antibiotics. After lunch, Leslie drove us so my wife could get an ultrasound. The good news: no blood clots.

The reserves

Leslie and I were going to Binghamton that afternoon in her rental vehicle. To travel, or not to travel, that was the question. I would have felt uncomfortable leaving my wife but for one thing. Unrelated to the medical issues, my daughter had decided to come home from college for the long weekend. SHE would take care of her mother! This was a bit of serendipity

And from the reporting of the patient, when Leslie and I came back on Monday, she had done a fabulous job. This is not a surprise, based on a story my daughter told my wife. Someone at college had accidentally cut themselves, and another student tried to patch them up, but they didn’t do it correctly. Clean the wound, pat it dry, and then put the ointment on the bandage, not the wound. My wife had shown this method to my daughter, and the message took. Can you hear the maternal beam of joy?

The family that COVIDs together…

Also, four hours in the hospital

What IS that old saying? “The family that COVIDS together…” I’m not remembering the rest of it.

As noted, my daughter developed COVID c. Wednesday, August 24, just as we were about to head off to college.

Friday, August 26, we were all going to get more substantial COVID tests at the urgent care place. But my wife opted out, deciding she had no symptoms. I chose to get one because I had a bit of a sore throat. Truth is, I often have a bit of irritation from allergies or whatever. My daughter was still positive, but I was negative.

My doc asked a bunch of questions, such as if I had chest pain. I had more pain in my right shoulder than in my chest, but she ordered an EKG. She discovered a variation from what she was expecting. Now, I was born with heart arrhythmia. My primary care physician calls it a regular irregularity.

A change in plans

The urgent care doc suggested that I go to an emergency room to get further tests. I called my wife to pick me up – taking the bus after I’d taken a COVID test didn’t seem sage – and got some lunch. Then she drove me to Memorial Hospital because it would likely be less crowded than Albany Med or St. Peter’s.

Everyone was very nice, a couple of doctors, a physician’s assistant, and the nurse. The nurse was great, actually, and I was distressed to discover that one of her other patients had tried to assault her while I was there. The hospital ran a bunch of tests and found me A-OK. My calcium was low, and some other minor things were discovered.

By Monday, August 29, I was feeling achy, and I was coughing, sometimes uncontrollably. More rapid tests. I was positive for COVID, and my wife was likewise, even though we were fully vaxxed and doubly boosted.

I can say that I have felt worse, such as when I had the flu a dozen or more years ago. But it is difficult to focus on much of anything. (This blog post of 420 words I had to do in two shifts.) I feel addled. I bollocked my Wordle on Tuesday – I got it in six – because I couldn’t focus. The word, coincidentally, was ONSET, some cosmic joke. My wife, from her activity level, seems to be feeling better than I am.

My daughter won’t get to college until Sunday, three days after classes begin. Whatcha gonna do?

My wife: adjusting to retirement

theater

Carol My wife has started adjusting to retirement. She said that on her first day off, she would turn off the alarm clock; she did, and I was pleased. And she would do her Wordle earlier in the day, which usually happens.

There’s a bit of an adjustment for both of us, especially in the morning. When she went to work or church, she’d take a shower early, and I would go downstairs to do the attestation of my blood pressure and pulse. But she tends to watch a morning news show, which is contrary to the calm I seek when taking the readings. As a compromise, we’ve recorded programs to watch 15 minutes later, which allows zapping through the commercials.

She has a different process for her day. I like to read my emails, post that day’s blog on Facebook, et al. She likes to do chores early. Left to my own devices, I’d write a blog post, or at least a draft, then have breakfast, exercise, and write some more. Emptying the dishwasher I could do after lunch. So when SHE empties the dishwasher, I feel an imbalance in The Force. This is an example of how we will eventually Figure Stuff Out.

Busy, busy!

Since our daughter graduated from high school, we’ve been busy. We’ve gone to the theater thrice on successive Wednesdays, and are scheduled for at least twice more this summer.

The first show was A Chorus Line, a show I’ve watched the commercials for since the mid-1970s but haven’t seen since the actual production until now. A great review in Nippertown hits on the expanded physical stage at the Mac-Hadyn Theater in Chatham, NY since we were last there in 2019. The next show was Ain’t Misbehavin’ at the Barrington Stage in Pittsfield, MA. It was reviewed here. Then Urinetown at Mac-Haydn noted here.

My wife and I have attended two family reunions, both sides of her family. Getting our daughter ready for college is important and occasionally tedious. Plus the usual stuff.

I said at the point I retired three years ago, I was too busy to work. My wife seems to figure this out early on in the process. I just hope she doesn’t think she has to complete all of her ever-expanding to Do list by the end of August because it just won’t happen.

Oh, it’s my wife’s birthday today!

Running hot and cold

avoiding the sun

Kelly wrote about hot and cold. Specifically: “Every couple I’ve ever known, of every combination of people, has a hot one and a cold one.

“This isn’t about looks, but about reactions to temperature. Every couple has one person who always thinks it’s on the cool side, while the other always thinks it’s on the warm side.” And for the most part, I think he’s correct. But he’s NOT right about my wife and me.

It’s because my wife has a far greater tolerance for the extremes than I do. I’m the temperate one. In the house, I need it warmer in the winter AND cooler in the summer than she does, by about three degrees Fahrenheit. So I HATE it when she bakes in the summer, but LOVE when she does so in the winter.

The first floor has, thank Allah, air conditioning. When I climb the stairs, it feels like another climate. Why doesn’t she have the fan on in our bedroom? The fact that we aren’t currently IN our bedroom is not a reason.

The GREAT outdoors?

It is even more true outdoors. She is NOT a sun worshipper, but I actively avoid direct sunlight if possible. Partially, it’s the vitiligo, but I also fear heat stroke. I almost ALWAYS have a cap on, preferably white or a light color. Long sleeve shirts may seem counterintuitive, but I can’t afford to burn. And, if I can find them, sunglasses.

I LOVE sunglasses. And that applies to the winter as well, with the glare of the snow. Because I got frostbite when I was about 15, my feet are particularly susceptible to the cold. If my head, ears, hands, or feet are cold – and this is true, indoors or out – I’m pretty miserable.

My wife can tolerate about 20 to 85 F, but I’m more of a 25 to 80 F guy. Or maybe 28 to 77. My tolerance for the cold outdoors has definitely lessened. I remember riding my bicycle when it was 20F; now it has to be 35F.