Jailhouse Lawyer, Esq.

Jail•house law•yer (noun): a prisoner who has taught herself  law while serving time, is knowledgeable about technical legal matters, and gives legal advice, especially to fellow prisoners.

I am a do-er. When no one else will do something, I will. A confrontation? I guess I'll do it. A legal battle that a lot of people would take on if they could? I guess that's mine, too. I have so many whines, things I kept thinking I should write about here and now they're all jumbled up. Imma take on one at a time. Forgive my typos. I'm on my phone, in bed, because i can't sleep.

My medical insurance. 

I have taken a medication called Provigil since 1999 for idiopathic hypersomnia (aka primary hypersomnia). It is a non-amphetamine stimulant, not exciting to abuse like Adderall but sometimes abused by college students or professionals seeking to maximize their attention and wakefulness. Not me. I take it so that I won't fall asleep while driving. It is also secondarily used as an adjunct for the depression side of my bipolar disorder. Provigil is only labeled for narcolepsy, sleep apnea, shift work sleep disorder (and maybe MS related fatigue). However it is very commonly used off label for idiopathic hypersomnia (IH). CVS Caremark (CVS) requires prior authorization (PA) for any Provigil prescription. 

Two years ago, it took 2 months of fighting. The meds would cost me approximately $3,000 a month to pay out of pocket. In the ridiculous battle that had my arguably expert physicians (one of whom literally wrote the book on this stuff) having to defend their clinical actions to rural psychiatrists who admittedly never have seen a single sleep disorder, I was left without meds for a month, saving CVS tons (not the full $3K I'm sure, but it was a nice chunk of change, I'm sure). I finally won when it got to the external level with the reviewer saying that it was OF COURSE medically necessary and consistent with the standard of treatment. 

Last year when they told me I needed to get PA again, I called in a hysterical suicidal rage and told them that they were fucking with people's lives, that this is a psychiatric med and they know I have a history of psych hospitalizations. I told them that it was clear CVS chooses money over patient welfare and that they had blood on their hands. I asked them if I needed to come down there and show them my blood on my hands for them to see what they were doing to people.  This was at 4:15 pm. The next morning I got an automated call telling me that my request had been approved. What took 2 months 2 years ago took 1 day last year. 

This year it starts up and I find a law that says if my doctor is prescribing led for an off-label use and it is something that has been covered in the past, I simply need to provide 2 research articles that demonstrate the safety and efficacy (effectiveness) of the med for my condition. I researched laws like crazy and I researched drug studies line crazy.  I know all about the laws regarding coverage of medications and I know aaaaallllll about the Provigil research. Then I called to get a copy of my records so I could see how and why I was approved last year. I was told that they would "never" give me my records. 

HOLD UP. 

This is in complete violation of my civil rights as protected by HIPAA. Just as fiercely as HIPAA a protects me from having my healthcare information shared without my consent, it protects my right to have access to my healthcare records. So I started a battle with them over that, filing a complaint with the Office for Civil Rights. I researched the privacy laws, access to records laws, federal laws, state laws, penalties for violations, etc. Over the course of a month, I had numerous reps first tell me that my records were on the way and then ultimately that they were never coming because it was CVS's policy to not release records. Not only that but they knew I was waiting for those records to file my appeal this year and it's not crazy talk to say that it appears they may have been trying to stalk that so theat I am eventually left without meds for a bit again this year. Cases like mine almost without exception prevail once they get to the external review level but they count on people giving up before they reach that point. 

But back to the PA part of this. So I gatheted 9 articles. I wrote a 13 page cover letter that cited the laws that order them to give me my motherfucking medication simply because my doctor has ordered it (as long as I can find 2 articles to support the safety/efficacy). I attached approximately 50 pages of the actual journal articles. 

1) I also have OCD

2) I'm Italian-American

3) I'm a Scorpio

4) I'm smart

5) I'm resourceful 

6) I know how to research (thank you, dissertation)

A few days later I got the automated call that my request had been approved. I called to ask how long it was good for since it has always only been for 1 year at a time. The girl said, "It says here 'lifetime.'"

SUCCESS!!! SCREW YOU, BIG INSURANCE COMPANY!!

After a month of harassing them and making complaints to the Office for Civil Rights, I finally got as much of my records as I think they will ever admit as existing. I'm pretty certain there has to be more to my record but I can't prove it so this will have to do. 

This is really only part one of my jailhouse law education but it's 1:50 am, I suck at typing on my phone, and I'm hoping that im actually sleepy now.  I swear I'll fill in more soon. 

Jumping in with both fucking feet. *gulp*

Okay.

I'm doing it.

I'm writing a blog.

I have literally six other blog titles reserved, keeping my options open but I've yet to write anything.  For years people have been telling me that I should be writing something, anything.  So here I am.  I don't even understand what people write about in blogs but I suppose the title of this blog might give you an idea of where I'm going with this.  I write too much for facebook.  I've had some (*ahem* rude) people comment that I am too long-winded on facebook.  I have had many, many more people tell me that they appreciate and enjoy my ramblings.  So I'm bringing it here.  I am a woman, a feminist, a  social liberal (I have no interest in official politics, though I'm liberal in thinking there, too - so sue me), a wife, a mother, a daughter, a sister, a friend, a neighbor, a psychologist, a university professor, and a person diagnosed with bipolar disorder (and OCD, depending on who you ask).  I am also intensely passionate, driven, and stubborn.  If you get on my wrong side, so help you Universe.  I am smart and I am persistent and I will win.  I have opinions and while I try to bite my tongue because one of my worst fears is offending/alienating others, if you get me going, you will not hear the end of it.  And I will never, EVER argue my case without citing research.  This this what you can expect to hear about:

1. My kids being funny.
2. My kids being jerks.*
3. Maybe my husband being a regular human but I get annoyed with regular humans because I have crazy ideas of how things should be (like knives should not be left hanging over the sink even if you think you might be making another sandwich).   He is the very, very best husband and father in the world.  But he is not perfect.  And he's a fucking saint for putting up with me and our aforementioned children.
4. My struggles with bipolar disorder.
5. My struggles with motherhood.*
6. My struggles with everything.*

Some of these struggles end up reading as being very very funny and sometimes they are not unlike a horrific train wreck from which you cannot look away. See that?  Perfect grammar.  Total Grammar snob.  However, unlike many grammar snobs who say that bad grammar or spelling annoys them, it cracks me the hell up.  I especially "love" the inappropriate use of quotation marks.  That, and the misuse of the word "literal." (I also realize that I use sentence fragments, I start sentences with the word "and" too frequently, and I am very uncomfortable with how many commas I use but I have just decided to let that stuff go).  I also still use two spaces at the end of sentences and I don't care.  I'm keeping it that way.  I don't care if it makes me look old.  I am old.  Speaking of grammar and age... Book nerd here.  I read young adult, new adult, and erotica, sometimes verging on outright smutty porn.  My kindle looks like it belongs to a teenager leading a double life.  I am downright obsessed with a certain YA trilogy but since I have no tattoos, I'm very hesitant to lose that virginity at all, let alone with a text tattoo on my foot that says "she has no idea.  the effect she can have."   My husband has an adorable two-inch dolphin tattoo on his shoulder, you know, where an anchor or a set of pistols or something should go?  It's blue.  It's the cutest.  He got it at 18 and he thinks my getting this tattoo would be the worst idea ever, second only to getting a cute dolphin on my shoulder.  Oh, wait.  That might actually work on someone like me.

*I am honest to a fault.  Not in an insulting way but in such a way that it sometimes makes others uncomfortable mostly because I think it makes it harder for them to ignore the part of themselves that feels the same way.  It leaves me vulnerable and open to attack but I will not/ cannot change.  I am that person that says what others are thinking.  Yes, my kids can be total jerks.  I said it.  TOTAL jerks.  And I think about running away at times because of it (that combined with that pesky mood instability thing I have going on).  The thing is this; I think quite a few people feel this way and they feel like assholes because they think no one else does.  So I say it.  I get private messages on fb from people telling me that they appreciate hearing that they are not the only ones.  So I keep saying it.

That said, I hope this is anonymous.  I don't want my kids' classmates' parents to see this and hold it against my kids.  I don't want my parents to read it.  As much as I strongly believe in speaking out in order to decrease the stigma of mental illness, that stigma is still strong.  Frankly, I worry about losing my faculty position in the psychology department, of all places, because people are afraid of bipolar disorder.  So I hide.  I do share but in dribs and drabs, doling it out based on the reactions I get to the information I'm dropping.  My real friends know all about this.  But school acquaintances do not.  I, unfortunately, need to keep it that way for my kids' sake.  It kills me that I am part of the problem because that violates one of my cardinal rules. 

But I digress, I want to keep this as anonymous as possible which is such a shame because it is my friends who have been hounding me to do this for at least 10 years.  Maybe they'll stumble on it.  Maybe they'll see through it.  Whatevs.  IDGAF.

That brings me to my last two points.  I love internet abbreviations.  They crack me up.  And I cuss like a motherfucking sailor.  Deal.  :-)

P.S. Another point (I often like about last points, like dance teachers with their "last time" bullshit), I hate proofreading.  Sorry.  I used to be able to get away with it but since facebook I've noticed that I can't write two sentences without some really stupid typos.  I think it's because I type faster than I think and my fingers type what they think I'm going to say instead of waiting to find out what I really want to say.  There's your warning and I can rest easier knowing you know that I know I probably have lots of typos.  Phew.

P.P.S.  See, I told you.  Never done.  I've rambled horribly.  I just have so much to say and don't know how to direct it yet.  I'll get better, I promise.  Stick with me.  I know I'm all over the place just like I know I use too many commas and start too many sentences with "and."