A Bit of Irony

I began work this morning at 6am.  Every Monday morning, there is catch-up work to be done since we are closed on weekends but we continue to receive handfuls of Prior Auth requests from a few offices, Urgent Care, and ER departments.  Of course this week, we were closed Memorial Day, so there was 3 days of work to do when I came in this morning.  I was working away on Saturday's requests when I came across an URGENT antibiotic request with no patient information, the rest of the form filled out in detail, and a lab report with just the patient's name which upon searching I discovered about 30 patient records, but without a DOB-sorry, I cannot begin to assume who this was for!  If it was sooooo URGENT, why not give me all the patient's information!!!!??????  Just asking.

Birthday Wishlist

Just in case anyone is wondering, the following list has been compiled to answer the question I hear yearly (I hope): What would you like for your birthday?

1. An amazingly indulgent, rich, joy-inducing cake or cupcakes
2. A gift certificate for a pedicure-really!
3. YARN!!!!!!!! To continue my knitting education by trying my hand at hats next
4. Time to finish SoftballGirl's pajamas before summer gets here
5. Bookshelves to house our growing collection of books and college textbooks
6. A magic cancer-curing pill for all affected by the disease in its many forms

On a less than serious note, here is my "Fantasy Wishlist" for my less than realistic wishes

1. A vacation house in Monterey
2. An Audi A6 3.0
3. The winning Lottery ticket for the next Mega Million jackpot
4. My very own beautiful Friesian-I have always wanted one (it's a horse)
5. An Electra Bike; Please see my previous post for my faves
6. Anonymous benefactor who funds my sewing, knitting, home decorating/outfitting, and horse interests. . . . .or see #3
7. Mediterranean Vacation on a cruiseship

New Obsession

We had a yard sale three weeks ago, and one of my neighbors cruised by on her Rat Pink cruiser bike (Remember Rat Fink? this was the girl version).  I am not a pink person, but it was a really cool looking bike.  I also observed a few other women on their cruiser bikes that day as they checked out my stuff.  Seeing the different cruiser bikes planted a seed in my mind and now, I really, really, really, want one of my very own.  I have a bike, it's a nice Trek mountain bike that I got for my 15th birthday, but it has some things that need to be done to it and I cannot ride it until it is fixed.  So I'm thinking we spiff it up, sell it, and I can get my cruiser bike!!!!! maybe?

I have done some research to determine what I would want in a bike when (if) I get one.  As is Murphy's Law, of course the brand of bicycle I want is on the more expensive end of the price range.  I think I am completely, utterly, unabashedly in love with Electra cruiser bicycles!!!!!  I cannot however narrow down which one I want.  They are all so beautiful and if/when the opportunity arises, I know I'm going to agonize over which one is perfect for me. 
Take a look for yourself: http://www.electrabike.com/
Some of my faves:


Electra Butterfly in Yellow

Electra Blanc et Noir

Electra Orbit in Buttermilk

Electra Peacock

Electra Cherie

FDA, what do they know?

FunnyMan just had a conversation with an MD regarding Zyprexa, (an atypical antipsychotic) denial.  He brought the interesting nature of his conversation to my attention. 

Here are his edited notes:
MD does not care what FDA says (in regards to being told of the FDA indicated age).  Told her to appeal (Expedited, as she deemed the situation urgent).  No changes at this time. 
Of Note: The abundant use of the word "bull****" was present and phrases such as "I couldn't care what the FDA says", "I know what works", "I am tired of spending 4 hours everyday on Prior Authorization bull****" (to which I apologized for her frustration and again reinforced the Appeals avenue) and other expressive statements were issued from the provider during the conversation.  The provider also issued the usual statement that the member will be hospitalized if Zyprexa was not approved.

Waxing Mishap = Lesson Learned

Two weeks ago, I thought it would be a great idea to start waxing my underarms myself  instead of shaving them (which I hate!)  I went to Target on my lunch hour, picked out some wax strips, then patiently waited while the hair grew to the right length to wax. (gross I know)  Saturday, I got out of the shower and decided it was *time* so I followed the directions, applied the strip to my underarm, and yanked.  Let me just say, "OOOOOOWWWWWWWWWWWW" and not all the hair came off.  I did however get some hair, skin, and drew blood.  Great....and OUCH!  Determined person that I am, I kept reapplying the strip to the unwaxed areas in an attempt to be successful. 

I even enlisted the help of Mr.CooksALot who took one look at me, winced, agreed to pull it off me, and counted to three before he yanked.  This only worked partially.  He then declared I needed to forget the wax, get my razor, and do it the painless way.  I stood there with one slightly fuzzy/waxed/bleeding armpit and contemplated having to shave off what was left of that one and do the other unscathed one fully.  I shaved off what was left and decided my lesson has been learned.  I WILL NEVER DO THIS AGAIN!  I may however try to see how the results are and get it done professionally.  Hopefully, my esthetician fares much better than I did.  If not, I guess I'm stuck shaving.  Crap.

5 Dangers of Excess Sugar By Catherine Guthrie, Experience Life

This is a reminder to myself as well as to others (if you're out there) that sugar is delicious but comsumption comes with a cost.  In light of my recent loss of control, I need to be more mindful of this information.

As kids, we were taught that too much sugar would rot our teeth, but today we know that the ramifications of a lifelong sugar splurge are scarier than a finger-wagging dentist. Yes, sugar can cause cavities, but of much greater concern is the sweet stuff’s link to bodywide inflammation.
Sugar can contribute to cellular inflammation, which is like a continuing series of paper cuts that compromise cell function. Deep inside the body, these microscopic wounds fester below the pain threshold. Because many of us don’t see or feel the damage, there is little incentive to cut back on the inflammatory diet that is causing this constant cellular damage, so the party continues.
That is, until the body blows a gasket. Left unchecked, inflammation can unleash dozens of different diseases.
Here are just a few of the malfunctions related to a lifetime of sweet indulgence.
Heart Disease
Results of a 2010 study published in the Journal of the American Medical Association showed that people who got at least 25 percent of their daily calories from added sugars were 3.1 times more likely to have low levels of HDL (good) cholesterol than people who got less than 5 percent of their calories from sweets. People on the high end of the sugar spectrum were also more likely to have dangerously high levels of blood fats called triglycerides.
Cancer
Scientists have long known that cancer cells love glucose. A common scan used to detect cancer in the body, called a PET, starts with a person downing a sugary solution. After the sugar is absorbed into the bloodstream, the scan identifies possible malignancies by highlighting areas that gobble up the most sugar. “Data supports the general hypothesis that cancer cells are addicted to glucose and that, by restricting glucose metabolism, one can stop their growth,” says Don Ayer, PhD, a cancer researcher at the University of Utah and the Huntsman Cancer Institute in Salt Lake City.
Diabetes
Type 2 diabetes, a deadly disease that can cause blindness and nerve damage, and can lead to amputations of digits and limbs, is perhaps the most direct and serious repercussion of excess sugar in the diet. In the United States, nearly 24 million people have been diagnosed with diabetes and another 57 million suffer from insulin resistance or prediabetes. Some experts estimate that by 2050 one in three Americans will have the disease.
In the early stages of type 2 diabetes, cells stop responding to insulin. Unable to enter the cells, glucose builds up in the blood, triggering inflammatory health conditions. Left untreated, insulin resistance often escalates into type 2 diabetes. But long before that diagnosis, the inflammation associated with prediabetes (sometimes called metabolic syndrome) wreaks havoc on the body, setting the stage for heart disease and cancer, among other serious problems.
Candida
Yeast is a natural inhabitant of the gut. Healthy bacteria help keep yeast levels in check. But when antibiotics, illness or chronic stress kill off healthy bacteria, yeast can run amok. Sugar compounds the problem by feeding yeast growth. “Sugar enables yeast to go from a budding stage to a tissue invasion stage,” says Carolyn Dean, MD. Yeast overgrowth can cause problems ranging from yeast and fungal infections to rashes, thrush and leaky gut syndrome.
Immune System Snafus
Because a diet laden with sugar creates body-wide biochemical stress and inflammation, it can overstress and thereby weaken the immune system in a variety of ways. One way, as noted before, is by triggering leaky gut syndrome, which leads to undigested food molecules getting into the bloodstream. When that happens, the immune system has to finish the digestive process, an overwhelming and distracting effort. “In short, our defense forces get exhausted by the sugar,” says Teitelbaum, “so that when real trouble comes down the pike, the immune system can’t respond.” A leaky gut can also underlie disorders characterized by an overactive immune system, such as rheumatoid arthritis, lupus and psoriasis.


Read more: http://www.care2.com/greenliving/5-dangers-of-excess-sugar.html#ixzz1MujOcvt7

Flour & Sugar Overload

Yesterday was not a good day for me, I went a little crazy and gave myself flour & sugar overload.  What is this exactly you ask?  It is the overindulgence in flour based food.  For the record, I LOVE bread, cake, pastries, cookies, and almost anything made with flour. 

I had two doughnuts to start off my morning courtesy of a post-meeting offering (they were screaming my name).  About 15 minutes later, GreenGirl came in with pan dulce (YUM!!!!!) so eventually, I had an empanada which turned out to be pineapple instead of the pumpkin I was searching for.  Lunch was a slice of BBQ chicken pizza, and then later on, I found the pumpkin empanada, so was compelled to take half leaving the other half for Snort. 

Needless to say, I felt yucky!  I vowed yesterday to keep my intake to a minimum from now on.  Oddly, I had 2 pieces of toast with Nutella this morning.  Mid-bite, I realized the stupidity but decided the breakfast bliss was good enough to hold me today.  Therefore, the rest of my day will be void of flour and sugar.  I hope.  I will try.  Really hard.

Paraprosdokian

A paraprosdokian is a figure of speech in which the latter part of a sentence or phrase is surprising or unexpected in a way that causes the reader or listener to reframe or reinterpret the first part. It is frequently used for humorous or dramatic effect, sometimes producing an anticlimax. For this reason, it is extremely popular among comedians and satirists.

I asked God for a bike, but I know God doesn't work that way, so I stole a bike and asked for forgiveness.

You do not need a parachute to skydive. You only need a parachute to skydive twice.

The voices in my head may not be real, but they have some good ideas!
Always borrow money from a pessimist. He won't expect it back.
A diplomat is someone who can tell you to go to hell in such a way that you will look forward to the trip.

Money can't buy happiness, but it sure makes misery easier to live with.

I discovered I scream the same way whether I'm about to be devoured by a great white shark or if a piece of seaweed touches my foot.

The last thing I want to do is hurt you, but it's still on the list.

If I agreed with you, we'd both be wrong. (I have used this one!)

We never really grow up, we only learn how to act in public.

War does not determine who is right - only who is left.

Knowledge is knowing a tomato is a fruit. Wisdom is not putting it in a fruit salad.

Evening news is where they begin with 'Good evening', and then proceed to tell you why it isn't.  

To steal ideas from one person is plagiarism. To steal from many is research.  I love this one!

A bus station is where a bus stops. A train station is where a train stops. On my desk, I have a work station. 

Dolphins are so smart that within a few weeks of captivity, they can train people to stand on the very edge of the pool and throw them fish.

I thought I wanted a career, turns out I just wanted pay checks.

A bank is a place that will lend you money, if you can prove that you don't need it.

Whenever I fill out an application, in the part that says "In an emergency, notify:" I put "DOCTOR".

I didn't say it was your fault, I said I was blaming you.

Why does someone believe you when you say there are four billion stars, but check when you say the paint is wet?

Why do Americans choose from just two people to run for president and 50 for Miss America ?  This one is a REALLY good question!

A clear conscience is usually the sign of a bad memory.

I used to be indecisive.  Now I'm not sure. 

I always take life with a grain of salt, plus a slice of lemon, and a shot of tequila.
You're never too old to learn something stupid.  So True!

To be sure of hitting the target, shoot first and call whatever you hit the target. 

Nostalgia isn't what it used to be. 

A bus is a vehicle that runs twice as fast when you are after it as when you are in it.

Change is inevitable, except from a vending machine.

AND my favorite is -

Going to church doesn't make you a Christian any more than standing in a garage makes you a car.

To Err is Human, however it will not be tolerated!

Some people are not always sure how to spell or word things.  I personally always check (if possible) before I write/type a word I question the spelling of.  My assumption is that some MD office or pharmacy staffers don't have that luxury, they need to get their PA forms to me ASAP so they can move on to something else.  These mistakes are my favorites.  I keep a running notation when I come across these gems.  Here we go.

Perineal allergies: this was written on an Allegra (allergy med) request.  I don't think this will help the patient, who is female, as I doubt her perineum is causing her allergies.  Note to office: it's Perennial

"She did not get no relife from that drug": so the drug did not grant extra life (?), and 'did not get no', HELLO, that isn't proper grammar!!!!!!!-Mr.CooksALot uses me as his spelling/grammar verification and thinks I should have been an English teacher.

Quote from an RN (that's what she told me she was) I was speaking to on the phone: "Well algia is pain, what's the difference between post herpetic neuralgia and myalgia?"  (really?)I told her we could only approve a Lidoderm patch for diabetic neuropathy (nerve damage) or post herpetic neuralgia (nerve pain resulting from shingles or herpes) prior to this question. 
We went back and forth on this one until she yelled at me that the patient just had surgery where they had to crack his chest and he was in pain!  I transferred her call to RedBull because I was getting nowhere. So, RedBull asked her what the application site would be, if they were going to put the patches over the incision site.  She had no idea but argued again that he was having algia-which is pain. I think she told me this about 15 times!

I got a request for a birth control pill called FemCon Fe which is chewable.  The office had written on the form that NuvaRing was tried and eventually discontinued because it wasn't chewable.  This made me wonder if the patient tried to chew it.  I certainly hope not, but would not be surprised if she did.

Just the other day, we got a request for Chantix which is a smoking cessation medication and the office wrote that it was to treat the patient's ADHD.  Hmmm.....not so sure that is gonna work.

Antibiotics treat infections, I think most people in general know this.  Singulair, Clarinex, Xyzal, Allegra, Allegra-D, and Claritin-D are all antihistamines, they do not treat upper respiratory infections!  Never have I heard of an antihistamine clearing up an infection on its own, yet we get these requests and the patient isn't on an antibiotic.  I see this weekly at the very least.

FYI to certain MD offices-crying at school doesn't require an Adderall prescription, this can usually be treated with a hug, reassuring words, and a tissue from a teacher or the parent.  I don't know how this constitutes medical rationale in your book, but in ours, that doesn't fly. Thank you.

Oh, how do I loathe thee?

To the large nation-wide chain drug stores across U.S., I just wanna say, "WHY!?"  Why do you make the patient's life, the MD office's life, and my life so flippin' miserable?  I spoke with a poor RN today three times in 30 minutes on one patient due to your mistakes because you cannot read prescriptions!  I know some stores here and there across the U.S. are decent, and your patients like you, but almost every time I deal with an issue, it involves you.  All of us here in the Prior Auth Department implore you:  Please, for the sake of patient care, GET IT TOGETHER!!!!!!!!
Thank you.

How Convincing!

I have a "collection" of sorts at my desk.  Various notations, sometimes copies with info whited out, of interesting Prior Authorization form submissions.  My favorite is the request I received for the ADD/ADHD drug Adderall XR 15mg.  A Pediatric MD wrote in the rationale section: "Just like Goldilocks, Adderall XR 15mg is 'just right'", patient has no side effects and is getting good grades.  I laughed so hard and told my whole department about it.  Amazing, simply amazing.  That PA request made my day.

Introduction

So, I have been meaning to create a blog about the "other side" of healthcare, Prior Authorization.  As a dedicated fan of Dr. Grumpy, The Angry Pharmacist, Fast Food Pharmacy, and many others, I thought I'd better contribute the gems I deal with or forms I come across on a daily basis to provide balance (or some semblance of it) in the blog world.  I work for a Pharmacy Benefits Management company that administers Prior Authorization services for many health plans across the US. 

As much as I know how frustrating it is to submit a Prior Authorizations, (I've been on the pharmacy side prior to obtaining this position) it is frustrating on our end as well with offices that submit a blank form with only a drug listed, phone calls from adamant MDs/RNs/MAs/MAs or CNAs trying to be RNs/receptionists and the like.  Like you, we are not miracle workers/mind readers/magicians/swamis!  Therefore, I make my contribution.  My stories are true. The names and places of occurrence (if applicable) have been changed to protect the innocent/stupid/funny-you get the idea. If I entertain you, I’m glad. If I offend you, I’m sorry.  Welcome!