I got a call from an office today that ended in a disgruntling conversation. The Medical Assistant calls me stating the doctor wants to discuss a denial we issued on a patient. I look up the information and lo and behold, they want a narcolepsy drug that doesn't treat ADHD for a patient with ADHD. I don't have any idea why on earth the MD would want this drug, it doesn't make sense, and is not FDA approved for this indication. We of course, denied it for off-label use. If the FDA doesn't approve it, we don't either.
The MD calls back ticked off and they want to speak with the reivewer, who is (hands flying to both cheeks in shock) NOT A Medical Doctor but a Doctor of Pharmacy!!!!!! What is the world coming to???? Apparently FunnyMan's doctorate is not good enough for Mr. MD. Oh, well! His pharmacological knowledge eclipses yours jackass, deal with it!
I asked FunnyMan if he queried the doctor as to why a PharmD isn't as good as an MD. His reply: Delusions of grandeur...why bother.
My impression: good call, good call.
Jul 28, 2011
Feeling Naked
Yes, it is true, I am feeling naked today. I don't know what to do. There is nothing for me to do until I go home at the end of my day. How am I naked at work? I'm not entirely naked, I am dressed properly, wearing heels, and in looking at me, one would not be able to tell unless they focused on my hands.
I removed my wedding ring and my favorite sapphire ring that I wear daily, before I got in the shower last night. I looked at my rings on the counter this morning while I was getting ready, but they did not end up on my fingers. Therefore, I am naked. I don't like being naked, it actually makes me acutely aware of their absence. I am also aware of how obsessively I touch the bottom of my wedding ring throughout the day.
Today, I feel my finger, not my ring. I feel guilty. I know I didn't do anything wrong, it was 5:00 this morning, my brain was still in a patchy fog at that time, and I didn't put them back on. Oddly I feel like I'm misrepresenting my marital status today as the result of a mistake.
Weird, I know.
I removed my wedding ring and my favorite sapphire ring that I wear daily, before I got in the shower last night. I looked at my rings on the counter this morning while I was getting ready, but they did not end up on my fingers. Therefore, I am naked. I don't like being naked, it actually makes me acutely aware of their absence. I am also aware of how obsessively I touch the bottom of my wedding ring throughout the day.
Today, I feel my finger, not my ring. I feel guilty. I know I didn't do anything wrong, it was 5:00 this morning, my brain was still in a patchy fog at that time, and I didn't put them back on. Oddly I feel like I'm misrepresenting my marital status today as the result of a mistake.
Weird, I know.
Jul 22, 2011
Love/Hate fabric stores
When it comes to sewing, I am pretty new to it. Still learning the difference between certain fabrics so need some guidance as I go along. Of late, I have a particular urgency when it comes to obtaining fabric that I want. We're taking a trip to GamblingVille and I want to make a few dresses for my trip. I got impulsive, and here's what happened:
I went to a nearby fabric store and asked an employee where to find the various types of jersey fabric (there are several so wasn't sure where to look) I was directed to matte jersey only and was told that was the only one she was aware of. There was only solid colors and it was too see-through for my taste. I asked another person, who it turns out was brand-spankin' new, and knew less than I did about different fabrics. So she asks the same lady I already talked to who of course, gave her the same answer. Being that my trip is looming, I want fabric, I have dresses on my agenda. So, since I wasted my whole lunch hour, I came back to work and promptly browsed fabric.com, ordered my fabric, and discovered it takes up to 48 hours to ship, and 4-5 days to arrive. Crap. I could have driven a bit further to another fabric store the next day, gotten what I wanted, and I could've been able to begin my dresses this week. But, I got good deals so crossed my fingers that my fabric would come fairly quickly. Had I just gone to that store, I wouldn't be griping right now. Grrrrrrrr.....
Yesterday, as I anxiously checked my email for a shipping confirmation, I discovered that one of my fabrics was out of stock and I had 24 hours to let them know if I wanted to substitute another or leave it off. I called STAT, waited on hold for a good 15 minutes to have a 3 minute conversation which ended with the rep telling me my fabric would ship out Friday (today). I told her that I was really needing it ASAP but that did me no good, she wasn't handling it personally.
So, here I am anxiously awaiting my package that likely won't get here until next Thursday, which leaves me 3 days (during/after work only) to make 3 dresses, and pack for 3 people. Maybe I will dial-down my ambition and just do what I can. Imagine that! We'll see what happens.
I went to a nearby fabric store and asked an employee where to find the various types of jersey fabric (there are several so wasn't sure where to look) I was directed to matte jersey only and was told that was the only one she was aware of. There was only solid colors and it was too see-through for my taste. I asked another person, who it turns out was brand-spankin' new, and knew less than I did about different fabrics. So she asks the same lady I already talked to who of course, gave her the same answer. Being that my trip is looming, I want fabric, I have dresses on my agenda. So, since I wasted my whole lunch hour, I came back to work and promptly browsed fabric.com, ordered my fabric, and discovered it takes up to 48 hours to ship, and 4-5 days to arrive. Crap. I could have driven a bit further to another fabric store the next day, gotten what I wanted, and I could've been able to begin my dresses this week. But, I got good deals so crossed my fingers that my fabric would come fairly quickly. Had I just gone to that store, I wouldn't be griping right now. Grrrrrrrr.....
Yesterday, as I anxiously checked my email for a shipping confirmation, I discovered that one of my fabrics was out of stock and I had 24 hours to let them know if I wanted to substitute another or leave it off. I called STAT, waited on hold for a good 15 minutes to have a 3 minute conversation which ended with the rep telling me my fabric would ship out Friday (today). I told her that I was really needing it ASAP but that did me no good, she wasn't handling it personally.
So, here I am anxiously awaiting my package that likely won't get here until next Thursday, which leaves me 3 days (during/after work only) to make 3 dresses, and pack for 3 people. Maybe I will dial-down my ambition and just do what I can. Imagine that! We'll see what happens.
Jul 18, 2011
Weekend Whining/Grumbling
We hosted a birthday party this weekend for one of our girls and inevitably some drama took place. I have one sibling-in-law that cannot mind their manners and makes scenes over stupid crap. True to form, a mini-scene was performed in the dining room for everyone to see, and the climax occurred in the middle of the street for all the neighbors to see.
(sigh, shaking head)
It's a child's birthday party, can't you just mind your manners you insensitive yet overly sensitive, self-absorbed, negativity driven, overly critical, big-mouth person? A simple request made of every parent who was there is not a stab at you or your children. We love your kids, we always have and will. It wasn't specific to you, but your world doesn't work like that I guess. All I can say is thank God you left and decided not to return, you spared us and the rest of the guests your needless, childish, reactionary bullshit.
Stupid ass. (a quote from my mother-in-law)
(sigh, shaking head)
It's a child's birthday party, can't you just mind your manners you insensitive yet overly sensitive, self-absorbed, negativity driven, overly critical, big-mouth person? A simple request made of every parent who was there is not a stab at you or your children. We love your kids, we always have and will. It wasn't specific to you, but your world doesn't work like that I guess. All I can say is thank God you left and decided not to return, you spared us and the rest of the guests your needless, childish, reactionary bullshit.
Stupid ass. (a quote from my mother-in-law)
Jul 13, 2011
Can I inflict bodily injury?
Snort is making me crazy! I am "rescuing" him by fixing errors, making things right, and I'm done. I snapped at him earlier because he intercepted a request I was personally handling, didn't do it right, and I could not find what I was looking for. This request had a special process I needed to follow and when I asked if anyone had seen it, nobody knew about one but he said he saw something like that earlier. I brought it up on my screen and asked if that was the one and he said yes.
Two Words: So Done/Choke Him/Don't Touch!!!!!!!
(sigh of relief now that I've vented)
Two Words: So Done/Choke Him/Don't Touch!!!!!!!
(sigh of relief now that I've vented)
Jul 8, 2011
Don't you dare call me. . . . . . . .. . .
Any of the following names when we are on the phone discussing a patient or if you are the patient and I'm answering your questions.
Hon-Sorry, not your hon.
Honey-unless you are my mom, but she works in finance so doesn't fit the above description
Sweetie-unless you're one of my parents, neither of whom work in health care
Sugar-don't even dare
Babe or Baby-unless you're Mr.CooksALot
Love(y)-prepare to forfeit your ear, I will rip it off over the phone if you call me this!
Missy-I will inflict bodily injury over the phone if you use this
Child-I don't know you, I am not your child!
I recently was speaking with a patient about her prior authorization and I almost completely lost it as she repeatedly called me Honey and Hon. I let it slide when the voice (or DOB if a patient) indicates someone who is much older than I am. This was a 23 year-old calling me this. I about told her off, but didn't as I need my paycheck. It is actually exponentially worse when these terms of endearment come from a man, unless as previously stated, he is of advanced age and doesn't sound creepy or shady. I will ask them to stop calling me by those terms and cross my fingers they don't get off subject in our conversation. This happens rarely, as I can be a chicken and try to keep my professionalism to a maximum at all times. It has however, happened.
For the record, to the creepy, sleazy sounding pharmacy owner in New Jersey: NO, I WILL NOT take a trip to your state soon, you will not, I repeat will not call me babydoll, and I WILL NOT be calling you to show me around. EVER. The fact that you told me I sound very beautiful and like an amazingly interesting woman didn't help either. You really freaked me out and I am now thoroughly weirded out. Thanks a lot.
Hon-Sorry, not your hon.
Honey-unless you are my mom, but she works in finance so doesn't fit the above description
Sweetie-unless you're one of my parents, neither of whom work in health care
Sugar-don't even dare
Babe or Baby-unless you're Mr.CooksALot
Love(y)-prepare to forfeit your ear, I will rip it off over the phone if you call me this!
Missy-I will inflict bodily injury over the phone if you use this
Child-I don't know you, I am not your child!
I recently was speaking with a patient about her prior authorization and I almost completely lost it as she repeatedly called me Honey and Hon. I let it slide when the voice (or DOB if a patient) indicates someone who is much older than I am. This was a 23 year-old calling me this. I about told her off, but didn't as I need my paycheck. It is actually exponentially worse when these terms of endearment come from a man, unless as previously stated, he is of advanced age and doesn't sound creepy or shady. I will ask them to stop calling me by those terms and cross my fingers they don't get off subject in our conversation. This happens rarely, as I can be a chicken and try to keep my professionalism to a maximum at all times. It has however, happened.
For the record, to the creepy, sleazy sounding pharmacy owner in New Jersey: NO, I WILL NOT take a trip to your state soon, you will not, I repeat will not call me babydoll, and I WILL NOT be calling you to show me around. EVER. The fact that you told me I sound very beautiful and like an amazingly interesting woman didn't help either. You really freaked me out and I am now thoroughly weirded out. Thanks a lot.
Jul 5, 2011
Chewing while on the phone
Happy belated 4th of July! I hope all enjoyed the 3-day weekend. I did, but it went entirely too fast! Late nights watching fireworks don't make for wonderful (let alone easy) early mornings where one must wake up to be at work by 6am or earlier.
On to business: my first call of the day was a doctor who wanted to speak with one of the reviewers on an acne medication denial. I answered the phone and while I'm stating my name, department, then ask how I can help, all I can hear is chewing and smacking loud and clear in my ear. Dr. then states his name and doesn't seem to be able to get through a sentence without punctuating pauses with smacking and/or chewing followed by the occasional gulping of a mystery drink. Now, I know a lot of us can be pressed for time and need to try to get a bite in when we can, but does it have to happen while you're talking to me?
As I have stated in previous posts, I have a very vivid imagination. While I hear these gross sounds coming from his mouth, my imagination is kicked into gear with all sorts of unsavory images. This morning, I imagined pints of spit flowing from his chomping jaws as he chewed and smacked away on what I imagine to be either peanut butter right of a spoon or a giant sandwich oozing condiments. Bluto from the Popeye cartoons came to mind as well although this MD didn't sound like him at all. I also imagined the gulping was not of water, but a giant mug of soda or beer. Why? I don't know, but the sounds fueled my imagination and that's what I came up with. Supremely disgusting, I know. I did do a couple impressions as I told co-workers about the experience...and then I got grossed out all over again. Blech.
(tongue sticking out of mouth in disgust)
This leads me to the general question: Why would someone do this while on the phone? How does it not occur to someone that this is supremely rude and could render someone nauseated? I must admit later on this morning, I got caught with a bite of granola bar in my mouth and had to answer my phone. I have the decency to at least do my very best to hide the fact I'm talking with food in my mouth and sound like my normal PA Honeybee self. (Patting myself of the back) Ha! Ha!
On to business: my first call of the day was a doctor who wanted to speak with one of the reviewers on an acne medication denial. I answered the phone and while I'm stating my name, department, then ask how I can help, all I can hear is chewing and smacking loud and clear in my ear. Dr. then states his name and doesn't seem to be able to get through a sentence without punctuating pauses with smacking and/or chewing followed by the occasional gulping of a mystery drink. Now, I know a lot of us can be pressed for time and need to try to get a bite in when we can, but does it have to happen while you're talking to me?
As I have stated in previous posts, I have a very vivid imagination. While I hear these gross sounds coming from his mouth, my imagination is kicked into gear with all sorts of unsavory images. This morning, I imagined pints of spit flowing from his chomping jaws as he chewed and smacked away on what I imagine to be either peanut butter right of a spoon or a giant sandwich oozing condiments. Bluto from the Popeye cartoons came to mind as well although this MD didn't sound like him at all. I also imagined the gulping was not of water, but a giant mug of soda or beer. Why? I don't know, but the sounds fueled my imagination and that's what I came up with. Supremely disgusting, I know. I did do a couple impressions as I told co-workers about the experience...and then I got grossed out all over again. Blech.
(tongue sticking out of mouth in disgust)
This leads me to the general question: Why would someone do this while on the phone? How does it not occur to someone that this is supremely rude and could render someone nauseated? I must admit later on this morning, I got caught with a bite of granola bar in my mouth and had to answer my phone. I have the decency to at least do my very best to hide the fact I'm talking with food in my mouth and sound like my normal PA Honeybee self. (Patting myself of the back) Ha! Ha!
Jul 1, 2011
You want what? Ummmmm......NO
I got a call today from Customer Service on the other side of the wall from me, and they had a patient on the line asking if we could issue an emergency supply of Expensiva, a costly injectible medication for arthritis, psoriasis, Crohn's Disease. I asked if we had received a Prior Authorization request and she stated that the MD office is closed for the holiday and won't be in until Tuesday so has not submitted it yet. The patient is pleading that we give them an emergency supply, there is a major flare occurring, they are bleeding, and in much pain. Based on the diagnosis I knew this was a lost cause, but, being the thorough person I am, I asked RedBull if we could accommodate the patient.
Here's how that went:
RedBull: have they had it before?
Honeybee: According to our records, nope.
RedBull: Was there previously a grandfathered PA even?
Honeybee: nope
RedBull: So, they want us to issue an emergency supply for a new start of Expensiva which costs thousands of dollars, you cannot break the box, and must fill the whole kit for a non-life-threatening diagnosis?
Honeybee: That's what it sounds like to me unless they got it under another insurance coverage which explains why we don't have claims history.
RedBull: That's a possibility. The emergency supply is not gonna happen.
Honeybee: that's what I thought but I just had to make it "official" by checking with you. My inclination is to recommend some Polysporin and bandages for the bleeding & to have them call the MD on call to see if they could do some oral steroids to help get the inflammation down & stop the bleeding, but that's just me. Steroids will kick in fast, Expensiva needs to build up in your system, it isn't going to provide instant relief for anyone.
RedBull: good call, you need a significant raise
Callous and heartless as our exchange seems, this is reality in PA Land. If you haven't begun therapy on a drug in the recent past, we're not going to issue an emergency supply (unless we're talking a drug for a life-threatening condition) without a Prior Authorization request. Sorry!
Here's how that went:
RedBull: have they had it before?
Honeybee: According to our records, nope.
RedBull: Was there previously a grandfathered PA even?
Honeybee: nope
RedBull: So, they want us to issue an emergency supply for a new start of Expensiva which costs thousands of dollars, you cannot break the box, and must fill the whole kit for a non-life-threatening diagnosis?
Honeybee: That's what it sounds like to me unless they got it under another insurance coverage which explains why we don't have claims history.
RedBull: That's a possibility. The emergency supply is not gonna happen.
Honeybee: that's what I thought but I just had to make it "official" by checking with you. My inclination is to recommend some Polysporin and bandages for the bleeding & to have them call the MD on call to see if they could do some oral steroids to help get the inflammation down & stop the bleeding, but that's just me. Steroids will kick in fast, Expensiva needs to build up in your system, it isn't going to provide instant relief for anyone.
RedBull: good call, you need a significant raise
Callous and heartless as our exchange seems, this is reality in PA Land. If you haven't begun therapy on a drug in the recent past, we're not going to issue an emergency supply (unless we're talking a drug for a life-threatening condition) without a Prior Authorization request. Sorry!
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