Round and Round We Go

The latest theory, supported by anecdotal evidence from a couple of other breast cancer veterans, is that perhaps my joint pain is the result of an abrupt drop in estrogen—in my case, the kind that accompanies acute-onset menopause, which is what you get as a parting gift along with your oophorectomy. (Try finding that in an Oscar-nominee basket!)

It definitely makes more sense time-wise: the pain hit exactly a month after the oophorectomy, compared with five and a half months after I started on Herceptin.

I ran the theory by my physical therapist yesterday. It was new to her, but she said she'd ask around. MOSWO is out of the country, so I'll talk to him about it when he gets back. And I'll see what the rheumatologist has to say when I meet him on Thursday.

Meanwhile, the nurse-practitioner who works with MOSWO suggested that I move on from Motrin to Naproxen, a prescription-strength anti-inflammatory that may be more effective. She called in the Rx on Thursday, and Zach and I headed to the pharmacy on Friday morning to pick it up.

Not so fast.

According to the pharmacist, both of my insurance companies denied coverage.

Not for the Naproxen.

For me.

<sigh>

See, a few months back, during the whole Emend fiasco, I used up the annual prescription-drug benefit provided by my primary insurance, the one I have through Columbia. Fortunately, I also have secondary insurance through Zach and one of his unions (thank you, SAG!), and that, too, has a prescription-drug benefit. So when I maxed out the first prescription-drug benefit, the second one automatically kicked in.

The two insurance plans are on different "plan years." The Columbia insurance runs according the academic year, and the SAG insurance runs according to the calendar year. And it's actually a little more complicated than that. Most Columbia students start classes after Labor Day, so their insurance plan runs from September 1-August 31. At the J-school, however, classes start in August, so J-school students have a separate plan that runs from August 1-July 31.

This all matters because even though I'm currently on medical leave, I was able (through a COBRA-like process) to extend my Columbia insurance so that I'll have it, uninterrupted, during my time away from school and then again when I return for the spring semester. It will finally end next July 31.

See, the word "uninterrupted" is key.

When the pharmacist told me that the Columbia's prescription-drug folks said I wouldn't be covered until September 1, I knew exactly what the problem was: they didn't see the asterisk next to my name, or the footnote below that said "Alert! Alert! This is a J-school student. Her coverage starts on August 1!! DO NOT MESS THIS UP!!"

But I couldn't figure out why the SAG insurance refused to cover the prescription, especially because, according to them, my coverage ended the very day before. It made no sense whatsoever.

Until Zach called and discovered that the SAG insurance folks had just—the very day before—received a form from us, telling them that my Columbia coverage had (so we thought) kicked back in. That meant that they didn't have to cover my prescriptions, since my primary insurance was supposed to be doing that.

Meanwhile, I called Columbia and left a message for the very top university official in charge of student health insurance—the one who handled my extension. Had I been a student at any one of the university's other schools, the extension would have been a very simple transaction—fill out a form, write a check, go on my merry way.

But, because the J-school has its own separate plan, things were not so easy. Turns out I'm the first J-school student to want to extend her coverage while on medical leave. Ever. This meant that the very top university official had to negotiate a whole separate contract with the insurance company, and that took time. A couple of months, in fact. And those couple of months ended—surprise!—right before the July 31 cut-off date for my regular coverage.

So even though a new form was created, and I filled it out immediately and hand-delivered it to the university—along with not one, but two separate checks—and even though things seemed fine for the first three weeks (during which I had several sessions of PT plus another round of Herceptin), there was the inevitable snag along my merry way.

The very top university official checked with the folks at my primary insurance company, and they confirmed that my coverage was indeed uninterrupted.

But, um, the folks at their pharmacy management division must have missed the memo.

In theory, all of that is being straightened out. And I did get a "sorry for the mix-up" message from the very top university official. But I still don't have the prescription, because by the time I got the message, the pharmacy was closed. And then we headed upstate before it reopened the following morning.

So I'm still taking the Motrin. And still hobbling down stairs and across rooms.