Friday, April 17, 2009

Sinus Mess

A week ago I went to radiology to have a CT of my sinus. I kinda just went for fun, you know, since it had been over a year since I had a CT of my sinuses. Well I was shocked to get a phone call the very next day from my doctor explaining I had such a bad infection and inflammation that they actually want to treat it with nasally inhaled antibiotics and steroids. Seriously??? I knew i had a sinus infection when I got back from Mexico, 3 months ago! But I thought I took care of it by flushing the sinuses with salt water and antibiotics. Apparently not!

So by Tuesday this week I still had not heard from my pharmacy that they had any new prescriptions for me, so I gave them a call. Come to find out they did fax the request to a compounding pharmacy in Los Angeles. Yeah, like FOUR HUNDRED miles away. This must be one special place! I looked up compounding pharmacies in my area and though they are few and far between, there are some within 30 miles.

It doesn't really matter because I'd rather have my meds shipped to my door overnight anyway, rather than driving an hour to pick up some meds and then an hour back. Surely my time spent in the car is worth more than the $10 shipping fee. Not only that, but since these meds are in the top tier of my prescription copays (non-formulary) I get to pay the highest copay price. Yippeee~! So $80 later I should have my months worth of meds at my door..... SHOULD HAVE is the key word.

Along with the meds I'm going to need ANOTHER compressor in this house. I have 3 that I already use on a daily basis. First we have the oxygen concentrator. It's about the size of a small refrigerator. I keep this one in the den and run the oxygen tubing to my room when I sleep.

Then we have the HFCWO device. (High Frequency Chest Wall Oscillation) This thing weighs about a ton and is loads of fun to travel with. It ties me down 3 times a day, for 30 minutes each day.

Then there is the small, but important nebulizer compressor. I use 4 different medications in this thing 3 different times a day, totaling close to 2 hours of therapy.

And now they want me to get a second nebulizer, specially made for the sinuses. What's the difference between the other nebulizer and this new one? Apparently about 2 PSI. The one I use for my lower airway (lungs) outputs about 18 PSI and the new one outputs about 20 PSI. The cost difference about $200! The higher PSI apparently creates smaller medication droplets that are then absorbed by the sinuses. The lower PSI would create larger droplets too big for the sinuses to use.

I spent about 5 hours on the phone Wednesday trying to find ONE durable medical equipment company contracted with my insurance that stocks this thing. I finally found ONE! However, they said they probably won't give it to me, even if I have a prior authorization... which is a whole other story. I don't even have one of those yet! The reason the company won't supply this to me is because my insurance will pay them for the SinuStar, but they will pay the going contracted rate for it. And I don't know how much that is, but the DME said it's not enough. So she won't rent it to me through my insurance. I can understand if the insurance is only going to fork out $50 for this thing, and the company paid $250 for it from PARI, then they do get screwed. But who's getting screwed the most here??? Me perhaps? Because my sinuses are apparently destroying themselves and nobody wants to help me. And you know what's going to happen if they don't control the infection soon? Yeah, you guessed it, I'll need another multi-thousand dollar sinus surgery. And guess what, my insurance covers that.

Can you tell how much I love HMO's?


Liza said...

Could you afford to pay for it out of pocket? I just googled it, like I did for my son's spare pari proneb ultra and looks like there are several places that sell them for $50. Our original DME charged our HMO $365 dollars for a pari proneb ultra. Amazing, huh.

Good luck. Liza aka ratatosk from cf2chat.

The Mantha Family said...

That sounds so ridiculous - were you able to get the new nebulizer? I hope you are feeling better now.