“Winter Blues.” That’s what people call it, when you don’t want to leave your house, and it just so happens to be winter. You hibernate and wear the same clothes on Sunday that you did on Friday, and you do so pretty matter-of-factly. The thought of showering means getting wet, which means getting naked, which means 1) passing a mirror, in winter, when you look like glue that’s been left to dry on a toddler’s collage; 2) facing up to just how many hair bits shouldn’t be hairy, and then determining how much longer you can get on with them being hairy (what? You can’t help but wonder if they’re keeping you warmer, though shaving your toes is perhaps a good idea); 3) getting cold at some point. Quite frankly, I’m to the point where even reaching for a makeup wipe—which to be clear, is the laziest possible way one can clean her face of makeup and debris—is reminiscent of the anticipatory terror I’d feel as I braced myself to breastfeed. Winter Blues, though, in my case, might want to be renamed Winter Reds.
Man have I been pissed lately, and I don’t really get mad. I really don’t. I get annoyed. I’m awesome in the complaints department, but I don’t have the anger gene. Except when you fcuk with my kids (I’m willing to bet, it hasn’t happened yet) or with my health insurance. Because when health insurance tries to arm-bar me, that means they’re screwing with my meds, which means they’re diddling with my hormones, which means, I’m a pscyho mama from hell, and you want no part of this. Let me explain for a quick second.
I’m in full blown menopause since before age 36. At age 36 I was officially diagnosed, but I remember specifically having hot flashes in 2009, at age 34—of course, never thinking it could be menopause, so I never considered having myself tested. I thought my lack of period was just due to diet, stress of twins, moves, Phil’s health. Nope. Premature, Full On, Menopause. Joy to the fishes in the deep blue sea. No one knows why. My mother didn’t hopscotch her way into menopause until age 52. Some people think, SCORE, no more periods! Awesome for you. Mmm hmm, a new paunch, an attractive new hairstyle to try for thinning hair, a total gain (all of it weight), oh, except for the loss of your sex drive, and energy, but at least there’s these inspiring words: vaginal atrophy. SCORE. Ooh, and you know what else? You begin to piss out your bones. Not to mention, the delivery of the news, “you’re out of eggs. You can no longer have children.” Thankfully, I was already good there and hadn’t intended to have anymore children. It also felt like a validation of my intuitive skills—years before I knew any of this about my health, I went off the pill and told Phil I was ready to start to making babies married or not, pronto! People thought I was rushing into things, but clearly my body and intuition knew it was time to step on it. Boy/Girl twins, the labor jackpot—they were in a rush too, arriving the first week of December, when the weren’t due until Valentine’s Day.
We switched healthcare providers sometime last year. I’m on Estrogen, Progesterone, Testosterone, and Estring (local estrogen for the vag, which keeps the tissue young and healthy, which is my doctor’s way of “puttin’ a ring on it”). The ring is replaced every 3 months. Life before the ring was agony. Sex was very painful. Phil was afraid to have it because I was in tears. It was a bad scene. One of the joys of menopause is that the walls of vag can thin and harden and sex can be very painful. Bone dry. My doctor had provided me with a sample of the Estring, and I had filled a prescription before we switched healthcare providers, so it hadn’t been an issue. I went to the pharmacy to refill my prescription, and my new healthcare, CVS CareMark had denied coverage. Joy. That will be $300 each and every time you fill just this one single prescription, for next 15 years. CVS CareMark has been dishonorable, doped up on incompetence, tripped out on true negligence.
I went through the whole song and dance, having my doctor’s office fax in the necessary forms showing medical necessity for the Estring, right down to the clinical measurements of my vagina! Denied. I phoned customer service, asking what was needed. There’s “outstanding information from your doctor.”
“Why, thank you. My vagina is pretty outstanding.”
“Pardon me, ma’am?”
“What information is still needed from my doctor exactly?”
“Well, that was faxed to your doctor, ma’am.”
“Yes, I’m sure. But, I’m asking you now.”
She can’t tell me. She puts me on hold. For twenty minutes. I am transferred to three different people. Someone explains that since my doctor has already submitted an appeal once before, and this is the second appeal? My doctor needs to explain in writing why the formulary alternatives for the Estring cannot be used, showing documents where I have used these alternative drugs, giving dates, or giving reasons why it would be harmful for me to use them. It then lists these formulary alternatives. Okay, I explain. But my doctor already phoned the Urgent Medical Necessity Appeal hotline, since I’m in pain, and was standing in the pharmacy, waiting for my medicine. It was absurd for it not to be covered. I’ve been on it for three years. There is no other “ring” on the market, no “generic” ring. There’s Estring. The formulary alternative is a cream, Estrace, that is applied DAILY for the first two weeks, then applied twice weekly.
A history lesson in me: I am SHIT with creams. Do you know why? They leave room for HUMAN ERROR. They are not exact. They drip. They remain on your hands and clothes. And what’s worse, I don’t care what people say, they TRANSFER TO YOUR KIDS. You wash your hands, but these hormones transfer. I am totally paranoid about it. I am very sensitive about it. As it is, having to take testosterone in a gel format, I am NOT THERAPEUTIC and I do not take it as often or as prescribed because of the dosing, because of the method, because of the measuring and because of the fear factor with my kids!!! NOW you want me to add ANOTHER FCUKING CREAM?!
I HATE YOU. I seriously hate you. You cannot do this to me. I won’t do it. No. I am not adding another cream, another hormone that can harm my kids. It freaks me out. Twice weekly, for the next 15 years? No fcuking way. No. Just no. No. No. No. No. No. No. No.
“Sorry, ma’am. But, that’s our final decision.”
“My doctor says she sent you all the necessary documentation on January 15, via fax. She can’t imagine what else you could possibly need from her.”
“It seems your doctor sent us a 25 page fax on January 15, but we sent it back, because we closed this appeal on January 14. So, we don’t need to read it. Anything you want us to read going forward needs to be handled externally, through the State of New York. Good luck.”
“Did you seriously just say, ‘Good luck’?”
“Yes, ma’am. Is there anything else I can do for you?”
“So, no one read it?!”
“Is there anything else I can do for you?”
Oh is there. I’m still thinking of an answer. Seething.
My other issue with the cream, aside from the inconvenience of application, and fear of transfer, and worry about being non-therapeutic because of both, is that the absorption rate into the overall body is different than that of the ring. Studies found that the estrogen creams, like Estrace, appear to have a higher absorption than the Estring, so even though it’s applied locally, and there to support local estrogen therapy, it’s absorbed into the rest of the body, which may increase your risk for breast and other forms of cancer. And it’s all being denied because of how a form is being filled out?!
There is obviously medical necessity here. I have been in tears over this for the past five days. My gynecologist doesn’t accept insurance, and perhaps her office manager doesn’t know how to properly fill out a form. Perhaps she could have clearly stated that the formulary cream that’s covered by insurance, Estrace, would be a health risk for me because of the absorption rate. My doctor has since sent me a ring, so I’m good for 3 months, as I fight this battle.
Perhaps it means fighting it through New York State. Perhaps it means making an appointment with a new doctor, who’ll write the same prescription, and who’ll know exactly how to fight it before it becomes a war. I feel like I need a new game plan, preferably something that involves nothing to measure, and nothing that can transfer onto my kids.
And now, I must prepare this house for the 24 inches of snow that are to come with this blizzard tonight. Please, do not let us lose our power, because for us, that means our heat, our stove, our oven, and perhaps my vagina.