Diffusing Stress with a Laugh

Every week in the middle of DBT group we take a break and then come back and do a Mindfulness exercise.  Today Sierra handed out sheets of paper and told us we were going to do the one where we make smaller words out of a big phrase.  I clapped excitedly.  She warned the group that this was my favorite and not to be upset when I get way more words than they do.  She gave us the phrase and said it should be easy to find words.  I said, “But there are no As or Os!”

The phrase was INTERPERSONAL EFFECTIVENESS.  Notice both an A and an O in there?  Notice how there isn’t a U?  After we all got done laughing at me, I wrote down the phrase at the top of my paper.  I started making words.  I was nearly down the first column when Rochelle said, “Have we started yet?”  Oops.  I got a little eager.  I said I’d sit out the first minute but Sierra told me to keep going.

As usual, everyone freaked out when they saw my page.  I counted it up and had 76 words, which is my new record.  Other people counted theirs and said they got distracted by the sound of my frantic pencil scratches.  I did have to volunteer to scratch out all the dirty words I used, in case they didn’t count.  (Come on, don’t tell me you didn’t immediately see “PENIS” in there.)

The best news about this is that I laughed when I said something completely idiotic.  Absolutely no flush of shame and no urge to go hurt myself for looking foolish.  The same has been happening for about a week in other situations.  I went from one scheduled shift to three in one week, then a coworker called in sick the last day and I worked 8 hours alone.  I took it in stride.

I got letters from my car insurance about paying (or not paying) for medical bills that had nothing to do with my car accident anyway – an ultrasound I had for complications of surgery.  Blood tests to follow up on the ultrasound.  An ER visit to get admitted to inpatient.  I laughed at the ridiculousness of the situation and calmly went to the hospital billing department to sort it out, only to find that the car insurance had actually requested all my bills that had already been paid by my health insurance.

Then yesterday I stayed calm when my dentist was being snarky to me, and again when I was driving down a country road and the cop behind me suddenly turned on his lights.  I’d never been pulled over before but apparently did what I was supposed to do.  He told me my brake lights weren’t working and when he found out where I was headed (not far) he told me to drive carefully and get it fixed right away, then walked back to his car.  I didn’t panic at all, and drove just far enough to be parked in a lot where mom could come meet me with replacement bulbs.

As it turned out, only the left one worked, so we drove back to the auto parts store and followed the manager’s advice.  It still didn’t work so he tested the bulb, found that it was defective, and gave us a new one.  I feel super loyal to this store, as he also helped out when I needed to replace a headlight bulb and couldn’t wriggle my hands into the tight space.

I made a comment to Sadie about how well I’ve been handling things lately.  She asked what changed, and was probably perturbed when I said, “Medication.”  Well, I’ve been using the coping skills she has taught me for a long time, but they are only so helpful when the medication isn’t quite right.

Insurance Drama

Last year in January, I received a full-time position at the company where I was working as a temp. I was due to have insurance coverage starting April 1st. Between those two dates, I managed to accumulate two ER visits and a 4-night stay in the psych ward. The ER visits were written off by the hospital under their charity program, and I received a 50% discount on the psych ward due to my position on their sliding fee scale.

Over the course of the year, I paid over $4,000 in medical expenses on top of what was covered by my excellent new insurance, and on top of the several thousand dollars I still owe to Community Mental Health Center (they have a policy of providing treatment whether you can pay or not). Eventually, I paid enough that my insurance started covering everything 100%.

Then I quit my job. I was very worried about how I’d manage my health care after that point, but my therapist assured me it would work out. I was paying the minimum amount that they charge anyone based on the sliding fee scale, with the expectation that any additional charges might end up being waived due to what they call a “fee reduction”. And if they aren’t, no big deal. It’s all tacked onto that giant bill that I continue to pay off at a rate of $50 per month.

After multiple rounds of paperwork, I was finally approved for a state-sponsored health care plan. I pay the minimum premium of $1 per month and have no co-pays for appointments or prescriptions. I was able to print a temporary ID card from the website on March 16th and struggled to use it at the pharmacy. After multiple calls from the pharmacy tech to the insurance company (and multiple days of me coming and sitting at the pharmacy waiting), they finally got my insurance to work and I picked up the prescription.

A week later, I went back for two more prescriptions and once again the insurance wouldn’t work. After returning a few days later with the same result, I decided to use my Effectively skill and go ahead and pay for the prescriptions, knowing I could come back for a refund once the insurance was sorted out. So I picked up those pills and went home to continue waiting for my official insurance card.

The card finally arrived in the mail today. I am required to choose a Primary Medical Provider and get referrals from that person for all specialists. This required a few phone calls. First to the insurance company to give them my doctor’s name and ask a few questions. Then to the doctor’s office to give them my new insurance information and ask for referrals to my individual and group therapists and my psych APRN. The first call went fine, but when I called the doctor’s office, the receptionist told me my new insurance wasn’t accepted, despite the doctor being listed in the provider directory. She put me on hold for a long while, and finally came back and said she would need to call me back later.

Cue panic. I had just gotten comfortable with that doctor (or rather, her nurse practitioner) and didn’t want to look for a new one. And obviously if she doesn’t accept my insurance she can’t refer me to the specialists whom I’m already seeing. I did eventually receive a call back though, and the receptionist informed me that she’d been confused, and they do accept that insurance for existing patients, they just won’t take new patients who have it. *sigh of relief*

The Cost of an Overdose

As it turns out, overdosing is mighty expensive. It has been 28 days since I overdosed, and the bills have poured in to my insurance company. Here is a breakdown of all the charges, with original cost and insurance-approved cost in parentheses:

AMBULANCE
* ALS1-EMERGENCY ($1,100 -> $400.06)
* GROUND MILEAGE ($112 -> $50.12)
* AMBULANCE O2 LIFE SUSTAINING ($35 -> $0)

EMERGENCY ROOM DOCTOR
* EMERGENCY SERVICES ($506 -> $332.16)
* ELECTROCARDIOGRAM REPORT ($25 -> $17.78)

ICU DOCTOR
* INPATIENT PHYSICIAN SERVICE ($501 -> $233.99)

COUNTY HOSPITAL
* MISCELLANEOUS SERVICES ($42.15 -> $34.14)
* MISCELLANEOUS SERVICES ($58.72 -> $47.56)
* MISCELLANEOUS SERVICES ($8.60 -> $6.97)
* MISCELLANEOUS SERVICES ($47.10 -> $38.15)
* MISCELLANEOUS SERVICES ($67.40 -> $54.59)
* COMPREHEN METABOLIC PANEL ($322.40 -> $261.14)
* ASSAY BLOOD ETHANOL ($105.00 -> $85.05)
* ASSAY URINE ACETAMINOPHEN ($159.60 -> $129.28)
* THERAPEUTIC DRUG ASSAY ($97 -> $78.57)
* DRUG SCRN 1+ CLASS NONCHROMO ($250 -> $202.50)
* AUTOMAT HEMOGRAM-COMPLET DIF ($77.50 -> $62.78)
* AUTOMATED, WITHOUT MICRO ($48.60 -> $39.37)
* CRITICAL CARE FIRST 30-74 MN ($693.20 -> $561.49)
* NONINVAS EAR/PULSE OXIM;SING ($88 -> $71.28)
* ELECTROCARDIOGRAM, TRACING ($207.90 -> $168.40)
* INPATIENT PHYSICIAN SERVICE ($584.70 -> $473.61)
* MEDICAL SERVICES ($75.40 -> $61.07)
* ELECTROCARDIOGRAM REPORT ($26.70 -> $21.63)

ON-CALL THERAPIST
* MEDICAL SERVICES ($82.50 -> $58)

MENTAL HEALTH CENTER INPATIENT UNIT
* MISCELLANEOUS SERVICES ($2,000 -> $1,050)
* MISCELLANEOUS SERVICES ($56.33 -> $0)

PSYCHIATRIC APRN
* INPATIENT PHYSICIAN SERVICE ($85 -> $85)
* INPATIENT PHYSICIAN SERVICE ($75 -> $65)

The grand total was $7,537.80, of which my insurance approved $4,689.69. Fortunately for me, I had already reached my maximum coinsurance for the year and did not have to pay a cent of this. Unfortunately for the purposes of this post, I cannot give an idea of what the out-of-pocket cost would have been.

niagara-river

The real cost of an overdose isn’t monetary though. It’s the risk of having permanently damaged internal organs. It’s the awkward silence when you try to explain what you were thinking, or possibly not thinking. It’s the knowledge that everyone is looking at you distrustfully, wondering how long until you try it again. It’s the awful realization that you could very well be dead, and after coming that close you understand that you never wanted that to happen. It’s the fact that once you’ve overdosed, it continues sounding like a legitimate solution, no matter how mild your depression may be.