State of confusion

Filed under the conundrum that is the healthcare system in America:

A couple of weeks ago, CenterWell, which is the mail order prescription subsidiary of Humana’s pharmacy benefit management (PBM) operation, emailed me that they were processing autorefills of three prescriptions. Fine.

A few days later, I got a message from my PCP indicating that she’d received the request for refill, but that it’s good practice to check in periodically with patients on maintenance meds, so would I make an appointment? Only—she’s not the prescriber for these particular drugs. I replied asking if she wanted me to transfer the management from my other provider to her; she declined for [reasons]. Fine.

(Well, actually, not entirely fine. Seems to me that she could have looked at my history and realized that she is not, in fact, the prescriber, and maybe reached out to me for clarification. I mean—the meds are listed in my portal records; you knew there was a portal, right?—but there’s clearly no record that she or any other provider in the practice prescribed them. I know things get muddled when Amazon takes over, but still.)

So I called CenterWell to find out why this practice and not my actual prescriber got the refill request and got through to a representative who identified herself thus: “This is Betty [I’ll say], your pharmacy advocate.”

I explained the situation—for some reason CenterWell contacted my PCP and not the (sole-practitioner) specialist for the refill; what gives? Well, Betty, my pharmacy advocate, put me on hold for a while and then came back to say, no, they’d sent the fax request (they only do fax) to [specialist’s] fax, so everything was as it should be. I asked why, then, did it show up at PCP and not [specialist]. Well, she couldn’t say, because that’s the fax number they have, so…

I replied that whatever number they have is clearly not his, because it ended up at PCP. Betty, my pharmacy advocate, asked if [specialist] isn’t part of that practice. No—he’s a sole practitioner and in fact operates in a different state.

To give her credit, Betty, my pharmacy advocate, did try calling him to find out what gives, but she got no response, as I knew she would. He’s a sole practitioner and has appointments and no receptionist. She returned to the line and reported her lack of success, and I explained why that would be. I said that if she left a voicemail, he’d get back with her, but she’s not allowed to get callbacks.

Again, she asked if I was sure that [specialist] isn’t part of the (admittedly huge, found in many states) practice. I said no—the specific PCP is in Virginia; [specialist] is in DC. Betty, my pharmacy advocate, didn’t quite get that—what state? The District of Columbia.

“He’s in the state of Columbia?”

“No—he’s in the District of Columbia; our nation’s capital.”

Well—in the end, I could see that I was not going to get anywhere with Betty, my pharmacy advocate, so I said I’d just contact [specialist] and have him submit new prescriptions every three months, instead of one 90-day script with a refill; would that work? Yes, she said (probably relieved); that will work.

So I thanked Betty, my pharmacy advocate for her time and emailed [specialist]. He called me back and we had a good laugh about it. I knew he had, in fact, once worked for the gigantic PCP—like 10-12 years ago; evidently that fax number (which is in the 617 area code, not 202 for DC or 703 for this part of Virginia) still appears in databases and the effort to correct it is more than your life is worth. We agreed on the every-three-months plan and there it is.

The thing about this encounter is that these gigantic companies give their frontline customer service/pharmacy advocate people a script and no agency so that they are not really able to provide service or advocate. Betty, my pharmacy advocate, and her colleagues have no ability to do anything that can’t be realized in real time—no voice mails, no emails, no call backs; only what they can do while the customer is actually on the line with them. She tried, within the strictures Humana/CenterWell placed on her, to help, but she had no ability to move outside a very small box. It took two individuals—me and [specialist] to work out a solution, which places the burden on getting the products/services for which I pay Humana (market cap: $36.7B) delivered. Me, a retired person, and [specialist], a sole practitioner.

Seems to me that this is kind of backwards, but they make it so exhausting to even get what you’re paying for that trying to get them to fix their system is just beyond the beyond.

You know—a conundrum.

 

©2026 Bas Bleu

 

Staying healthy

As we head into the Covid and flu season, people in normie countries can be glad that they’re not facing the chaos that this administration has set loose on the United States. Under the direction of Health and Human Services Secretary Robert F. Kennedy, Jr.—a recovering (maybe) heroin addict with a medical history of a worm literally eating part of his brain and insane views on a vast array of medical issues—it’s every state for itself when it comes to distributing the annual booster for a virus that, five years ago, literally stopped the world in its tracks and killed more than a million Americans.

Yeah—vaccines are worse than the disease, according to RFK, Jr., so he’s issued directives severely restricting who can “legitimately” (people over the age of 65, okay (begrudgingly), small children, folks with some medical conditions) receive it and who just has to roll the life-or-death dice (the rest of you suckers). Red states immediately jumped on the no-you-don’t bandwagon—prepare for mass graves in Florida, y’all—and California, Oregon and Washington have banded together in a fuck-you-CDC alliance to ensure that all residents on the West Coast get access.

In the Old Dominion, Republican Governor Glenn Youngkin has fallen in line with his masters and made it as difficult as he can with the powers he has. So here’s my tale:

I had a video call with my PCP on Monday; the primary purpose for me was to get clarification about the Covid vaccine. As in years past, Medicare will only pay for it if you get it in a pharmacy (no idea why). Being over 65 is an absolute justification for the shot, but my doctor issued me a letter authorizing it for me anyway.

(Now—I had been on the CVS site the previous week; their vaccinations app showed that I could get the shot in a couple of stores not particularly near to me, and only for a couple of days ahead. It wouldn’t let me expand the timeframe. There was a statement that this was predicated on availability, and that they would also welcome walk-ins. I didn’t feel comfortable with the walk-in crapshoot, ergo the convo with my doctor. Interestingly, the app showed availability in Maryland, where the vaccine offered was Moderna; all of Virginia is Pfizer. Also—many Redditors said they drove from Virginia to CVS stores in Maryland, walked in and got the shot without issue.)

Later that day I happened to be near the CVS closest to me (which hadn’t shown up on their app), so I walked in to ask. The pharmacist said 1) they had the vaccine, but 2) I couldn’t get it without a doctor’s prescription. Age didn’t matter—have to have the prescription.

“Everywhere in Virginia, you have to have a prescription.”

Okay—I messaged my doctor, asked her to send the letter she’d issued to me over to the CVS so I could make an appointment. Later that day I received an email from CVS announcing an appointment for 1630 Tuesday.

Well, okay—a little NHS-y in terms of “this is what you get”, although much faster than their usual four to 400 weeks; I debated whether to try to reschedule or just get it done.

Then Tuesday morning, this appeared in my queue:

The link took me to a page that announced no availability anywhere.

So I called the pharmacy—had to leave a message for a callback, because of course you can’t talk with anyone. Someone did call back, however, and said that I could come in at the scheduled time.

Okay—by this point, my anxiety level was almost right up there with autumn of 2020, when they first came out with the vaccine and the process of getting into the queue for something that might save you from a debilitating and deadly virus seemed obscure and arbitrary. (In hindsight, it was a miracle of organization, given the circumstances, and much better communicated than what’s happening now.)

So, I showed up at 1620, checked in, waited about three days and was out by 1640. No worse than last year, really. Muscles at point of injection are a bit sore; otherwise fine.

But I have a couple of words for the Kleptocrat, RFK, Jr., Mehmet Oz (bobble head of Centers for Medicaid & Medicare), Glen Youngkin and all you Republican Rapture-seeking flat-earthers: fuck you.

(Still have the flu shot to go, but I can get that at CVS. Without a prescription.)

 

©2025 Bas Bleu

 

 

Give me the rep who's seen some things

My prescription insurer is Humana, the fourth largest healthcare insurer in the country. (Considering the business model of healthcare insurance companies, that means it’s a fucking big outfit.) The division that handles Humana’s mail order pharmacy is called CenterWell. Not an everyday brand, but as part of Humana, you’d kind of think it’s got some legitimacy in the field.

My primary care practice is OneMedical—as in Amazon OneMedical. (Don’t @ me; the preponderance of providers I’ve had there have been excellent, and you can always get an appointment when you need one. They also spend 20 minutes with you, instead of the industry-standard 15, or the 10 minutes I get at my orthopedic practice. And I’ve been with them since before the Amazon takeover.) Again—not hard to find or contact.

So it has been an absolute clusterfuck of an experience to get two medications my doctor prescribed for me into the CenterWell system…for more than two weeks.

I got the prescriptions filled for two one-month runs at CVS; after lab work confirmed that they were working, I used the CenterWell website to request a transfer. (During the second month, I received both emails and snailmail urging me to make the shift to save money.) I did everything as instructed and got online confirmation.

So when a week went by and I hadn’t received anything, I went back to the website. Seeing so signs of an order in process, I used their chat, where I allegedly got a human identifying itself as Sally. She informed me that “the fax we sent to your doctor was not a correct number.” She kept repeating, “The number we had was incorrect.” With some probing, I discovered that it took them six days to follow up the failure to connect, “[b]ut now we have the correct number and the new request was sent and we are waiting for your doctor to respond.”

Well, I terminated the chat and called their “customer care” line, where I spoke with Terri. She gave me the same improbable story: they only do this stuff by fax, and (implication) waiting six days to follow up is SOP. I still couldn’t get any sense out of my query as to why they didn’t have OneMedical contact details.

But, since I’m a girl who believes in redundant systems, I went to the OneMed portal and requested that they send the 90-day Rx to CenterWell. A little non-plussed to have one of the OneMedical staff ask for CenterWell’s name/address, as it wasn’t in their system, but I tracked it down and gave it to her. She said she’d sent them the prescriptions.

That was Friday.

Over the weekend I got two of these emails:

Which did not fill me with warm and fuzzy confidence. So I went online yesterday to find that CenterWell had no sign of having anything they were processing. (There was also no information relative to the email—I clicked on the link and got nothing that would tell me what provider or medication their email referred to.)

In chat, “Julia” kept repeating such vapid, banal phrases—wrapped around the reality that she’s “mute” and therefore cannot do anything that would help break the logjam—that I asked her if she’s a bot. She says no, but…

Anyway—a call to customer care, where I get Belinda. Belinda has clearly seen some things. Belinda listens, checks up my history (seeing that I’ve been getting the meds filled at CVS) and says, “I’m going to call your doctor while you stay on the line. We’ll get 30 days at CVS, and when 15 days have passed, it will automatically trigger the 90-day request for mail order.” And she did it. While I was waiting, a notification came in from OneMed that they were reviewing the prescription request, and 15 minutes later, I had the confirmation.

But here’s the thing: two bloody multi-billion dollar companies with systems out the wazoo couldn’t get shit done for two fucking weeks until one woman called another. It shouldn’t have required that.

 

©2025 Bas Bleu

 

Medical wonder

Yesterday I had occasion to have a CT abdominal scan. The prep for that required that I ingest 1.5 bottles of what is pleased to call itself a barium smoothie.

Let me just say that it’s not so much a “smoothie” as a “slimy”.

The scan itself lasted less that 15 minutes, from being called to the waiting room to exit. That was a breeze.

 

 

©2025 Bas Bleu

Gratitude Monday: Vaxed to the max

Last week I decided I could no longer put off getting my seasonal vaccinations—for flu and COVID. So I made an appointment for them both on Wednesday. I generally do not react badly to flu shots and the only COVID inoculation that bothered me was the third one in the first series, so I figured I’d be fine.

Well. It’s been interesting.

(BACKGROUND: When I moved back to the District They Call Columbia, I could not believe how difficult it was to find a primary care practice. For a city that boasts three medical schools, you’d have thought there’d be a surfeit of them, but it took me months (and a couple of false starts) before I landed on OneMedical. A quasi-concierge concept headquartered in San Francisco, the attraction for me was that, for a $200 annual fee, I could be seen at any OneMed office by any OneMed provider, get same-day appointments, spend 20 minutes with the doctor per appointment (as opposed to the 15 minutes most insurance-driven practices) and develop an actual relationship. The bonus was that there was an office two blocks from my job at Metro Center. Eventually they opened offices closer to me in the People’s Republic, so I was happy.)

I showed up for my appointment to be told by the lab tech that “they” had put an order for the regular flu dose. I need the high-dose vaccine and I’d specified that when I made the appointment online.

In fact, their portal prompted me for the high-dose version, which makes sense—I’ve been getting this since I started with OneMedical. And it’s not rocket science—even pharmacies twig that I get high-dose.

CVS: You’ll want the high-dose shot.

Me: Yes.

CVS: Yeah—we don’t have any.

Well, it got worse. The lab tech couldn’t put in an order herself to change the dosage; the two people associated with my care (neither of whom I’ve seen, as the person I was seeing left the practice six months ago) were out of office—one until 8 November, the other till 1 November. The tech messaged others on the medical team, but got no response. So she gave me the COVID booster and said she’d contact me when they got the flu thing sorted.

It was clearly some kind of system thing—to do with the protocols set up for dispensing vaccines. Amazon bought OneMedical about a year ago and it occurred to me that they might have had some of their geniuses messing with the software. But this is just speculation.

Still, it was annoying. Thursday morning I was just sitting down to write a nastygram asking why it is that I could see anyone in the practice on a couple of hours’ notice, but they couldn’t find someone to authorize the correct dose—especially since I’d specified that when I made the appointment using their own systems—when I saw an email in my queue saying they’d got it sorted and I could drop in at any time to get the shot.

So I got it on Thursday. And Friday when they sent me the “how did we do” survey email, they did not get a good Net Promoter Score. (They also emailed to invite me to leave a Google review. I replied, “You seriously do not want me leaving a public review.”)

The other interesting thing is how I reacted to the COVID vaccine. (This one was Moderna; all the others I’ve got have been Pfizer. Dunno if this is salient.)

This was Thursday morning. You can see how inflamed the area around the injection is. That was tender, the shoulder joint was sore and I was achy. It was hard to raise my arm and I couldn’t clasp hands behind my back. Also—I got completely exhausted. Both Thursday and Friday I had to lie down in the afternoon to rest. And it’s not like I was running marathons or anything.

The injection area was still inflamed on Sunday, and it also itched like crazy. (The flu site is tender, but not inflamed.)

However—in the global scheme of things, this is small potatoes. Despite the corporate glitching and the physiological hiccups, I am now set for flu and COVID season, and I am grateful for that. Even ifall it took two trips to get it done.

 

©2024 Bas Bleu

 

I can do this

For about three weeks, I’ve had first muscular discomfort and then muscle/joint pain in my left hip. It started with something behind the pelvic blade, then moved deep into the glute and finally attacked the ball and socket. Having had way too many interactions with orthopods in the previous two years, I tried toughing it out for much longer than I should, but eventually caved.

Saw the doctor yesterday and the diagnosis is bearable: trochanteric bursitis, caused by chronic tendonitis. Treatment: a cortisone shot to reduce the inflammation and physical therapy to, you know, do the usual. Prescription-strength NSAID as backup.

I can’t tell you how relieved I am about this. I’d nearly convinced myself that this pain, which greatly limited my mobility and flexibility, would be my future, and now it’s just an episode.

 

 

©2024 Bas Bleu

Gratitude Monday: recovery

Okay, at the nearly two-week mark, I believe the tide has turned on this bout of plague. For the first time since it started, my signal for waking up was not 37 seconds of coughing. I don’t have coughing-induced headaches. I can draw in breath without hawking up a good chunk of my pulmonary system. Like Twitter advertisers, I have paused the production of snot.

And this is my gratitude today.

 

 

 

Streptococci lurk

As I’ve mentioned, my flight back from Paris last week was a damned plague ship. So of course I’ve been sick ever since. My capacity for manufacturing snot is really impressive, but it’s the cough that’s killing me. I have a history with coughs, so I’ve been trying to tame this sucker for days.

I made an appointment yesterday with my primary care doc for a telehealth visit, because all I wanted was a prescription for cough medicine with codeine, which is the only thing that’s ever killed my coughs. Well, according to her, codeine is out of fashion and pharmacies don’t even stock it. But she wanted me to come in anyhow so she could listen to my lungs; she was concerned about the prospect of pneumonia. So I went in.

Got tested for flu and COVID (both negative); lungs are fine, although it’s hard to “breathe deep” when doing so triggers a coughing fit. She gave me prescriptions for benzonatate and albuterol and advised otherwise to rest and drink plenty of fluids.

(For the record, I’ve already gone through a gallon of various juices since Monday.)

Anyway—all this is by way of explaining today’s earworm: Vivian Blaine singing “Adelaide’s Lament” from Guys & Dolls.

Obviously, a poisen has developed a cold.

 

Prepping

Got my annual flu shot yesterday. Last week it was the COVID booster, which clearly will also become an annual affair.

And on Monday the heating guy came to check out the furnace.

I am ready for Winter.

 

 

 

In hand

I saw the hand surgeon yesterday. He—not being the person actually affected—is happy with my progress. And I’m doing okay. Not full functionality; probably around 80%.

Which is to say, I can open lidded jars and most screwtop wine bottles. But I can’t get the tips of my fingers against my palm.

Surgeon says that could take a year. But the bones have actually healed, so he’s happy.

As with my knees, I continue the exercises and carry on.

 

 

Gratitude Monday: bones, muscles, nerves & ligaments

Last week I came across this video on Twitter.

There is always a reason to enjoy life ❤️
Glory to the heroes 🇺🇦 pic.twitter.com/9mV6INhpTN

— Oriannalyla 🇺🇦 (@Lyla_lilas) August 9, 2023

Given my recent surgical history, I have to confess that as I watched it, my initial thought was, “These guys for sure are doing their PT exercises and their physical therapists are completely badass.”

Because I understand all too well how much a difference it makes that you do your damned exercises every single day, to keep the muscles and ligaments strong and in alignment to support whatever bone or joint issue you have. (I've come to the realization that I'll have to do my damned exercises every day. Forever.)

And these guys have some issues.

(TBH, the first time I watched, I was so focused on their legs I didn’t even notice the guy on the left has also lost both arms.)

Yet they dance with absolute joy, with whatever limbs, bones, muscles, nerves and ligaments they have left. What an inspiration.

Last week I also had a convo with my yoga instructor about mountain pose: the one with both feet strong on the ground (parallel on the outside edges) and all joints stacked all the way up to the head. Here’s what populates my mind whenever I prepare for mountain pose:

Christopher David, a Navy veteran, doing nothing to provoke federal “law enforcement” thugs at a Black Lives Matter protest in August of 2020. Look at the way he stands as they pummel him with their nightsticks and spray pepper gas on him. (The beating broke bones in his hand, somewhat similar to the fractures I sustained back in April.) That is mountain pose. He held it through the pounding, only turning away when he got the pepper spray blast. The videographer blurred out his hands when he flipped them the bird(s).

When I saw the video of David, I’d only been practicing yoga for less then two months. Perhaps that’s why the image imprinted on my cortex. Certainly, yoga is not meant to incorporate violence or pain, so possibly my bad.

But—as with the Ukrainian amputees—I look to him as inspiration for what a person can endure and restore within the confines of bones, muscles, nerves and ligaments. And I consider these reminders as graces; unasked and unlooked for (in the words of the daily prayer of the Novena to Saint Bartholomew).

And I am grateful.

 

 

Auto da fé

I had to buy this grip strengthener device for my hand exercises.

I can't get over how much it makes me think it's something the Grand Inquisitor would use when questioning suspected heretics.

Gratitude Monday: up, down and over

Week 10 and my gratitude is that in the past few days I’ve been able to go up and down stairs mostly without thinking about it. That means: I’m not hesitating every time I raise my left leg to check that it’s not going to scream at me.

Also, last Thursday I was at a town hall held by the People’s Republic’s rep on the Fairfax County board of supervisors and I realized I’d crossed my left leg over my right and it wasn’t painful.

It’s taken me weeks longer to achieve the stairs (evidently my right IT band is not as evil as my left), but I don’t think I was able to cross my legs at the knee for well over two months last time. So I guess it works out.

Anyway—still cause for celebration.

 

 

 

The hand I'm dealt

Saw an occupational therapist yesterday for my hand. This is because the orthopod finally suggested that physical therapy might be the next step (the fractures have healed).

This is a good thing because—three months out—I still can’t make a fist and I have to shift to my right hand to open anything that unscrews.

The OT kept asking me why I didn’t seek immediate treatment after the geese-induced fall. I kept telling her that it didn’t hurt all that much.

Then she asked why I didn’t get OT earlier in the process. Because the surgeon didn’t suggest it until last week. (He said the bones had healed, but the soft tissues need help.)

The upshot apparently is that I may not now recover all range of motion, because tendons require help within a couple/three months. But I can increase strength.

And maybe unscrew some wine bottle caps.

 

 

It's a thing

Following up on yesterday’s post about cautious recovery optimism, I saw the surgeon for my two-month checkup. He concurs with my physical therapist that the IT band is the culprit. Evidently, when they replace your knee, they may or may not also realign things that were out of whack because your leg components weren’t working properly as your cartilage disappeared. So IT band revenge is a thing.

I’m to keep up with the exercises, add anti-inflammatories to the acetaminophen I’m taking and check in with him again in a couple of months.

Yay?

 

 

Gratitude Monday: stepping forward

After nearly a week of what I considered a setback in my recovery, I’m grateful today that I appear to be back on the rails, knee-wise. The worst thing for me was that I could not go up more than three steps in a staircase without the knee pain telling me, “Cut that out!”

On Wednesday, my physical therapist diagnosed the problem as probably my IT band, compounded by glutes not doing their job. (I hate my IT band & it hates me.) She did a lot of work on the point where it connects to the knee and gave me some exercises to make the glutes step up to the plate.

By Friday, I could go up the stairs fairly fluidly (although I’m still tentative, anticipating protest) and I was able to have a yoga lesson that did a lot of work on the glutes. (I know that was successful, because I was feeling the muscles on Saturday.)

So I’m cautiously optimistic that—as I turn the corner on the eight-week milestone—I’m going to be okay. For a while, I wasn’t sure.

 

 

 

Gratitude Monday: time

Three weeks out from knee replacement surgery and I’m making progress. But I didn’t really realize it until talking with a friend yesterday, who asked what’s different between now and February.

When I started ticking off points, I saw that I may be one week behind the last time, not the amorphous stretch of time that it feels like. In February I was driving at week two; this time it’s week three. Not so bad.

I haven’t made it to the floor yet (just consider what getting on the floor when you can’t fully bend a knee is like; then consider what getting back upright is like), so no yoga. Last time I had a lesson at week two, I think. But I’m aiming for it sometime this week.

I feel like I’m more tired, but it may be just that I’m not forcing myself to join work meetings and just letting my body take what it needs from each day.

So today I’m grateful for having the time to heal, and for being able to take the time to do it.

 

 

Getting out

Okay, I drove the two miles to PT and back yesterday. The worst part was getting in and out of the car; depressing the clutch was merely uncomfortable.

I confess that when I got out of PT I decided against going to the grocery store because I was well and truly knackered. Wrapped an ice pack around the knee and napped. But that’s okay—the only thing I have to do at the moment is heal.

Maybe try for the grocery store and the library tomorrow.

 

 

SITREP 21: vroom vroom

Major milestone in recovery achieved: I can drive.

Last time round, I hit the mark at the one-week point, so it’s been frustrating to me that it’s taken three weeks this time. Of course—this time it’s the clutch leg affected, so there is that.

It’s not entirely comfortable, but I can do it. I confess that getting into and out of the car is as problematic as it was last time. The door has to be at its widest open point for me to pull off the bending and twisting. Since I drive a coupé, that means I have to park carefully away from everyone else so I can get the door all the way open.

But I am so relieved to be able to do this again; you have no idea.

 

 

 

SITREP: 15

It’s been 15 days since my total knee replacement surgery, so time for a sitrep.

I went in to the surgeon’s office for the first post-op checkup yesterday. Since I’ve been through this before, I have a point for comparison, and I’m not really happy about where I am. When I went in for my two-week check in February, I drove to the appointment and walked without a cane. I can’t do the folding necessary to get into my car, much less drive the stick shift. And I’m using a cane for balance (although once I warm up, I can walk around the house without it.)

I did bend to 96 degrees at my PT session on Monday, but the session wore me out. That may have been the case last time around, but I don’t recall.

The PA pulled off the bandage and pronounced herself satisfied with the condition of the incision. I thought it looked gory, but now that I see the photo from February, I guess it’s about the same.

Interestingly, no real bruising on the shin as with my right leg (although some right on the knee, to the left of the incision), but whole bunch of color in the calf.

And I got basically no ankle. But I know the swelling will subside, so it’s just kind of a point of interest.

I told the PA that I’d really like to have been forwarder at this point; she thought I’m doing really well. Keep moving, keep doing the PT exercises, keep taking the meds. (She was unsurprised that I needed the heavy-duty stuff after my PT session Monday.) As she put it, “We say, ‘It’s only been two weeks.’ You think, ‘It’s been two weeks!’” So I need to reframe my thinking.

My friend took me to Trader Joe’s after the appointment, which was quite the treat. But I needed a nap after the outing. A three-hour nap.

It’s only been two weeks.