Dithering Along

Like usual, no deeply profound thoughts roiled my head this past week.

Like usual, the challenges around here were pretty close to that which we could handle.  The weather has been one challenge.  I live in an older rental townhome.  Last summer the air conditioner completely gave up the ghost, and the landlord had to replace it.  Which means that we're rather sufficiently cool on the upper floors, but in the basement, well, most days the indoor/outdoor thermometer on my work desk reports indoor temperatures in the low 60s.  Which is what it takes to keep the upper floors in the low 70s.  

Yes, we've tried a variety of fans in various locations.  I put fans in front of cold air vents upstairs to suck some of the air out of the basement.  I also put fans at the bottom of the stairs, blowing up.  Not much different than the usual state.

The new challenge this week was something that I've been dreading for about five years now.  Leo, or properly, Leonidas, our 13 1/2 year old Belgian Tervueren dog, started having some bedtime issues.  He would come to the edge of the bed, whimper a little bit which has been his traditional "hey, I need to go outside and do my business, I know I'm not supposed to do it indoors" for the late night version.  I typically have them out every morning around 7 am, they get a mid-day jaunt around the yard when my wife takes her lunch, they get out after we're done, before dinner, then a walk around the parking lot across the street.

When this whole thing started, my wife was concerned she wasn't moving as much, so she started taking longer walks over lunch, and taking the dogs with her.  She'd try to do a mile or more at lunch time, and the dogs enjoyed it when the weather cooperated.  Lately, though, Leo just hasn't been up to it.  Where, for many years, he was out front, pulling us, he has now become the tail-end charlie.  His vet (or as my wife call her, his girlfriend, because they're both excited to see one another) has seen him and has diagnosed him with arthritis, which is slowing him down.  We can hear it occasionally as when we walk around the school parking lot, when the almost-always-present traffic noise quiets down, and his rear foot toenails drag on the sidewalk.  

He's usually walking in the grass most of the time, which is one of the reasons I walk him over there.  Much easier on puppy feet than asphalt that's been in the pounding sunlight all day.  But Leo has been slowing down, and Wednesday and Thursday nights, he was panting heavily, whimpering, and really not able to get comfortable, even being up on our bed.

So his girlfriend the vet recommended an anti-anxiety medication to help calm him down.  It didn't kick in fast enough on the first dose we gave him Thursday evening, so Ann ordered a Leo-sized "Thundershirt" at 3 am, and thanks to Amazon Prime, it showed up in plenty of time for bedtime Friday night.  It also seemed that his anti-anxiety meds kicked in with his arthritis medication and his anti-"gulp" drugs, and all of them combined to make him feel pretty tuckered out. 

Yes, he's on the high side of the curve for the age of his size of dog, so we know we're on short time.  I do wish he would manage to make it a few more years, but I know that's a real false hope.  If he makes it to Jack's wedding next spring, I will be thrilled and love those pictures.  But the bottom line is that no matter when it happens, we'll all be devastated to lose what we all agree is the sweetest dog we'll ever have.  He's just the sort of walking Teddy Bear I wanted when I was a kid.  He's not an imposing size, but he is big enough to have that deep chest bark, when he uses it, that announces to anyone that he's here, and he's ready for whatever they're doing.  

But what he is most likely to do to the people he loves is walk right up to them, and try to sniff their breath.  He has such bright eyes and such a soft coat that it's a pleasure to tangle your hands in it.  If he first meets you with us around, he will be somewhat aloof, because, well, he doesn't know you yet.  I have seen him take to some folks, but mostly, he'll bark a bit, then stay away from you to make sure you can be observed from a distance.  But he can also decide he likes you and come over and sit next to you.

And then there's the work front.  I am moving on from the interview I had two and a half weeks ago.  The company is another one of those "best in town" outfits that I guess I'm just not special enough to join.  It's been a few years now, and I guess I am finally coming to the realization that I'm not a very good interviewee, no matter the amount of preparation I do.  I expect due to nerves and my desire to give them all the information I can, I may prattle along with a lot more answer than they would prefer, and I have been working on that.  But I do go over in my head so many details and potentially difficult interview questions I'm probably over-prepared.

As to the current day job, some of my co-workers are exiting the ... well, the no-longer-existent office in advance of their final date.  I was informed yesterday that the day I had circled on my calendar as the date of doom, my last paid day, is not what I had thought.  Due to a shift in my daily role to the "transition team" which is responsible for insuring existing patients who require long-term services continue to get them from another provider without a gap in service has apparently shifted my end date to early September.  Coincidentally, the last day is my fourth anniversary of joining the organization.  I had hoped to get a good fifteen years or so in, but that's not going to happen with this organization.

Again, for the folks who just stumbled in here, I had a 20 year career in IT, but after the Great Recession and the rather sharp shock of my employer ceasing to exist after the company owner committed suicide, I took the job I could find - and worked for Target - for six years before a good family friend was able to get me in for a second interview at her employer (the first interview with a couple of contractors saw me eliminated for unknown reasons, as the contractors left a few weeks after my interview), and I am working in health care for a provider.  I am non-technical, but what I did do before this current shift was ask insurance companies if they would be willing to consider paying us for services that the person who pays their premiums needs to stay alive.  Or in some cases, it's a quality of life thing like getting rid of the painful infection outside of an extended, six-week hospital stay. 

These days there are a lot of medical conditions which require long-term treatment - those range from basic infections to cancer, heart failure, and gastrointestinal problems that prevent people from taking their nourishment like most of us - through their mouths.  My employer has managed to grow into one of the bigger companies in the world while taking care of people in a lot of ways, this was one of the ones that allowed people to go home, or to a nursing home or other sort of managed care location so they could be with their loved ones, not in a hospital bed, while a longer course of treatment, some lasting for "the rest of their life" and give them a better quality of that life and those precious remaining days.

I'd have to take documentation prepared by professionals, and the prescription written by the doctor, and do a whole lot of math.  I'd have to find the medications on a list, figure out how much it would take for however long the doctor said they needed, and then ask the insurance company using everything from a plain old phone call to high-tech secure web sites, if they'd be willing to consider, possible, paying us for the services we were about to, or in some cases, already rendering.  While what we did was called "Prior Authorization" what it very often was was asking an insurance company "hey, Fred was sent home from the hospital last Friday with a prescription for this medication, which we filled starting last Friday - will you consider paying us for it?"  In a lot of cases, we had contracts with these insurance companies to provide the medication and the supplies it required to get it from whatever it looked like in the pharmacy into the patient. 

Typically, this involved getting it into the patient's existing IV line that was still in their arm, chest, or where ever, when they left the hospital.  Now, in my day job, I'm restricted by HIPAA, which is the stack of federal laws which prevent me from disclosing things that most of us wouldn't want everyone world wide to know about - like address, phone number, next of kin, social security number, insurance provider and their policy number, their medications, their conditions, and a lot of other details - right down to "is there working refrigeration where the patient lives to insure that the medication is properly stored until it's needed?"  

Thing is, before working in health care, in IT, I sort of followed the same sort of code.  There are many things I know about the people and companies I worked for regarding their IT environments.  I knew vulnerabilities, I knew back doors, I knew operational information, including some of their most secret passwords, because, well, I had to set them, use them, or get them for other folks.  And I regarded it as a part of the employment relationship I had with that organization that the confidentiality they required from me while I was doing the job remained a part of my existence after that job went away.  The typical disclaimer/lecture I used to give folks when I'd begin training them for various things like email use was "As your employer pays you for your time, and has purchased the computers, the software, and all of the bits that allow you to make that email work, you have absolutely no right to privacy on this network, so please do not put your banking information or any other personal information in this system.  If you don't want me and your boss to know about it, don't put it in here."  

It's not that I had countless hours of free time to monitor every email or other exchange on the network.  The real case, however, is that there was times where unusual problems caused me to have to take a look at things, and some times, that didn't end well for some folks.  Back in the day, as it were, I had some complaints that people weren't getting timely responses from our new email system.  I went and took a look.  It was running fine.  No problems with the server.  But they were telling me that so-and-so was sending them email, they weren't getting it. 

Ah, I remember thinking, that's probably the issue.  We had an artist who was responsible for doing artwork and sending it out to a printer to make sure it was printed for advertising.  Those documents and images were often huge, because we liked high-quality work.  So I tucked into the system and took a look at the ... well, rather than get all messy with details from 20 years ago, I basically reviewed a file that tracked the outgoing and incoming email.  There I'd see the name of the person sending the message, I'd see the message, and where it was going.  And I'd read the entire message.  In the case where it was a piece of artwork, I was not able to see the image, but I could tell pretty quickly it was an image because most of them included the name of the file, and the rest.

Which was one of the times where I ended up feeling pretty angry, sad, and upset.  A person whom I considered a friend - not close, but we were friendly to one another, joked around a lot, and I liked the person - was sending out confidential information.  Things like when my employer was going to do certain transactions.  The sort of information that a competitor, like the one who was going to get the message, would like to know because they could then do it before we did, which would raise our costs and reduce our effectiveness.  So I had to pull messages from that person from the out-going queue, and I had to print the information, and first take it to my supervisor and tell him that this is what is happening and it's why I'm going to be in the head of Legal's office for a chunk of time before we end up in front of the big boss, then another executive, and then HR, before I can get anything else useful done that day.

And to their credit, my boss came along for the ride, all the way up the food chain, and all the way back down.  I got a letter placed in my file signed by a number of the executives, thanking me for catching this and my discrete, speedy action in stopping the leak and assisting in insuring it did not happen again.  

It wasn't one of my best moments - not from that standpoint, but because it highlighted how really vulnerable our information was.  It did make it clear, however, that we were on solid legal ground before we did anything because I had taken to giving that little lecture every time I held any training, so it was rolled into standard policy, and it was added to a couple of other items, including the paperwork all new-hires had to sign.  

What was the most depressing moment for me in all of it was that there were people who really didn't seem to understand that trust and loyalty were requirements in their day job.  And that was long before I started seeing pictures of people at their worst possible moments - which was what a recent - well, last year - upgrade did to our internal systems.  With more room, more storage space, as it were, and a better way to organize all of it, we started archiving medical documents that included pictures.

Now, I'm sure you're asking yourself "if he isn't clinical at all, why can he see medical images?"  Well, here's the deal.  When I go to the insurance company and ask if they're willing to pay my employer for a particular medication, they want to know why.  There's very little trust left in the world, and while I trust my doctor, among many other people, to do the right thing, it is pretty well known that there have been some folks who have sought to find a crack in the system and use it to get rich.  People like doctors who prescribe specific medications that the drug companies will pay them a little bit extra for as a thank you.  Or people like doctors who have a financial interest in a particular sort of medical service provider who then allows them to make a profit from the service they prescribed.  Or people who, for whatever reason, are convinced that they need that opioid, desperately, and so desperately, in fact, that they may be willing to threaten, or even kill, people.

That's right.  So in order to convince the medical professionals employed by your insurance company who evaluate these things, I have to send certain documentation along that explains what the doctor saw, reviewed, and decided was important about the condition you have to decide to give you this particular treatment.  As I am non-clinical, what I typically do with these rather long documents is look for the most recent date where the doctor entered their notes that they reviewed test results, spoke with you, decided to use this particular drug to treat this particular problem, and then signed their name - usually electronically.  I know.  Most people assume that the doctor's word is about enough.  Due to medical science, these days, these sorts of decisions aren't left to just your doctor, but usually involve a couple of them.

Most of the insurance companies I work with have people like me on-staff who take the documentation I send, and verify that the information I've sent is adequate.  Then they pass it on to a medical professional - sometimes this is a Nurse, sometimes it goes way up the food chain to a proper doctor, and in some cases, some of the patients I see, it goes in front of several doctors.  

And to the credit of the folks who took the notes and were as complete and thorough as possible, I very often was able to get the service approved for authorization, which in my world is qualified by a half-dozen disclaimers which assure me that while this service may be authorized, it will be reviewed again when we send in the bill, and the insurance company might decide then not to pay for the service they approved earlier, but the authorization is the best way to insure, going forward, we stand a better chance at getting paid for the service, than we would if we didn't get an authorization.

That does not mean that we never get paid, because by now you have to realize that just about every single decision a person makes in a day can be appealed, taken to court, or in many other ways be re-re-re-re-reviewed to possibly get people to change their minds.  This is where things like reputation, responsibility, honesty, and a lot of other factors fall into the basket.  Does the doctor have a habit of over-prescribing?  Does the doctor have a vague reason?  Does this make sense to others?

That's why when I send a request for an authorization, clinical documentation, including, sometimes, full color pictures of an injury or an infected site, along with a whole lot of notes.  And the message I send is secured all along the way.  I have a login to many insurance portals where we upload the documentation, or if they prefer, we may fax it in.  Yes, I have a tool in my email which allows me to send a message to a particular server, which turns around and faxes it to their secure fax number - which in most cases is another server just like the one we have, except theirs accepts the incoming fax, and emails it to their internal resource who needs to review and make sure the attached documentation is readable.  After that, the medical staff gets involved.  If need be.  And if not, they look at a list of things that are standard approvals, and in some cases, they may just let me know I don't need an authorization for that.  In others, they tell me it's approved for X days, or whatever.

In most cases of longer-term therapies, the doctor prescribes a particular medication, and those orders are good for a year.  Some places will tell us "yah, sure, go ahead, you're good."  Others will tell me "fine, OK, we'll approve this for six weeks, but in six weeks, we need an updated document that tells us how the therapy is going, if it needs to continue."  So yeah.

Enough about my former day job.  The bottom line there is that yes, I have access to a lot of information.  No, I do not laugh at the pictures.  I've been in the hospital bed.  I've been the fool who didn't know what was going on, I thought it was minor, I thought I had it under control.  Turns out my opinion is very, very useless when it comes to diagnosing my own medical conditions.  Fortunately, I've come to learn that the professionals are usually right. 

So that was my week.  Still digging along, trying to get through from Monday to Friday, and find a new employer.  I've really come to like working from a seated position, but I can work on my feet if need be.  I just need to find someone willing to pay me to do whatever it is they need me to do.  Yeah, I'm not very specific, because I'm open.  This experience has taught me I can still learn, be flexible, and get the job done.  I have a good attention to detail, I have good work habits, and I work hard and smart.  Hopefully, I'll find someone willing to give me a shot.