Monday, June 25, 2007

To pay: 1779 kr

Last week I came home to find a couple of letters from Germany in my mail.

One was from the German insurance company that I had to pair up with to get a German health insurance. I thought that maybe they had finally gotten around to send me the insurance card that they promised me almost 2 months ago. However, it was just a second reminder of a questionary that I had to fill in and return (that I had actually done more than a week before, even though I have never seen the first questionary – only the reminder of it!).

The second letter contained some words on the envelope that immediately got me a bit worried – I smelled some kind of bill. I opened the letter and just as anticipated it was a bill – from a company representing the German ambulance service, Deutsches Rotes Kreuz. If you read my last entry you may guess what this bill was all about.

Being born and bred in Denmark, I have never been accustomed to much self-payment when it comes to health care. Every Dane has a civil registration number and a health insurance certificate issued by the municipality where he/she lives. This card entitles the holder to get free medical attention - except if you need medical statement or the like - by your PCP, treatment and admission on any public hospital and/or ER, and urgent paramedic assistance when needed. It is also possible to underwrite additional insurances to cover some or all of the expenses to dental care, physiotherapy, chiropractor treatment and the like.

I know that the abovementioned benefits are costly, and that is why we pay rather high taxes (40-60 % of our income), but it makes sure that no matter your income and insurance status you are able to get basal treatment at any time needed.

The Danish health insurance certificate also serves as a travel health insurance to some degree in some parts of the world. Therefore, I had this certificate along with me, when I went to Germany, as I hadn’t received any card to show my relation to the German health insurance company. On the night of June 12th when my parents, through the receptionist at the institute where I was living, required medical assistance to overcome the severe hypoglycaemic reaction I was caught in, the only “insurance card” that the paramedics could relate to was my Danish one.

The reason why I needed to establish a German health insurance when initiating my work in Germany was that my Danish insurance could not cover me when I was working abroad, being paid by a non-Danish employer – and it didn’t matter whether I would have the general yellow Danish health insurance certificate or the blue European one. Some of you may remember the difficulty I had finding out what insurance what needed and getting it settled. Therefore, there was no doubt in my mind that the bill from the German ambulance service sitting in my hands would not be covered by my Danish health insurance. I did have other Danish insurance alternatives, but I figured that the chances of getting them to cover this were equally small, given the fact that I was working abroad, not being on vacation. Left was the German health insurance. I had a letter from them, dated May 4th, that I had been accepted by their plan, stating an insurance number and a promise that I would receive an insurance card to show my membership within a few days. As mentioned, this had never happened.

I logged on to the Internet to investigate the actual terms of this German insurance (i.e. what is the actual coverage, and is it managed by reimbursement or directly, etc.). I didn’t get much wiser by searching their web-page, though – not only because it was in German ;-)

I decided to call them the next day in stead, in order to ask about the second reminder of the questionary that I had already handed in, the missing insurance card, and then whether they would cover the cost of the ambulance service and how.

I was lucky enough that the insurance worker answering my call was willing to try to get through the conversation in English. Essentially, I do understand quite a lot of German, but I have difficulty expressing myself (I haven’t used this language since public school 13 years ago), and in this situation I wanted to make sure that I understood everything right just as much as I wanted to be sure that got my message through. Still, I am a little worried about the latter :-/

I was told that the insurance company would reinitiate the process of issuing an insurance card to me, that I should just ignore the second reminder of the questionary given that I had obviously already filled it in, and that of course they would cover the ambulance service since it happened on June 12th and I was officially included in their member crowd as of June 1st. I was instructed not to pay the bill, but send it to the insurance company for them to take care of it. I did that immediately, including a letter of information about my conversation with the employee and the fact that I had never received an insurance card. Additionally, I included copies of the letters from the insurance company about my acceptance – for them to see the dates – as well as a copy of my Danish health insurance certificate to point out that even though this was what the paramedics had used to note information about me on their chart, they had managed to get my date of birth all wrong (my date of birth is 14.08.1977, but this somehow turned into 17.08.1977 on the paramedics’ chart and therefore also on the bill). In my letter of information I requested to be notified when the bill have been paid/if they for some reason are not able to pay it before July 2nd when it is due, so that I will not receive reminder fees. I hope that I do not have to worry about that, but I can’t help it. It is just something about foreign business partners, not least on the insurance side, that makes me very careful trusting them.

By the way, the bill amounted to 235.19 Euros (1779 Dkr or 315.3 $) for 30 min of work. Hypoglycaemia sure can be expensive!

Tuesday, June 19, 2007

Yet another comeback :-)

Once again I have been away for a while, not because I haven’t had anything to post about – on the contrary actually – I’ve just been to busy to do so. Therefore, this post will be a lengthy one, containing a little on many different issues, some of which I will – hopefully – find the time to elaborate on in subsequent posts :-)

The past months have been crazy work-wise. I finished my research assistant-contract by May 14th, without actually being done with all the different projects I had been involved in the past year, partly because the instruments needed for sample analyses had been out of order most of the spring. I had also received some samples from the German group that I have now joined for my PhD-study, and I had hoped for the analyses of these to be done before I went to Germany, so that I could bring along the results and explain them to my new colleagues. Unfortunately that wasn’t possible. When I returned to the Danish lab this week, I learned that only a few of the samples had been run and moreover the runs were unsuccessful :-/

After I finished my contract I had a few days to prepare for the holiday that Jimmi and I had planned. We went to Rhodes for a week, and just by chance one of my father’s colleagues, who is married to a native Rhodean (is that what people from Rhodes are called?) were also at Rhodes at that time, so we arranged for some meetings down there, experiencing some alternative sight-seeing as well. There is so much to tell about this vacation that I think I need to reserve a post for that – I just don’t know when I will get to that so I will just give you a few pictures :-)

Our return from Rhodes turned out to be quite an experience as well. Our flight was to depart 9:50 PM local time, meaning that we should land in Denmark at 00:30 AM (there is a time difference of +1 h from Denmark to Greece). The boarding began on schedule, but because passengers are to be transported to the plane by busses, this already caused a delay – maybe because 2 flights were scheduled to depart for 2 different Danish airports within 5 minutes. Anyway, once all the passengers had finally boarded the plane, approximately 30 min late, we were told that they had a problem with the plane: It wouldn’t take in fuel! We were told that the crew was trouble-shooting, and that they would provide further information when available. Another 45 min or so past before the captain provided further information: They had been through the whole repertoire of possible sources of this error, without seeing any improvement, so now they would turn to the last possibility, which according to the captain usually cured even the most severe of these types of errors. They would shot the plane down completely and then restart it just like rebooting your computer when nothing else works. So the plane went dark, only for a minute or so, though, and another half hour passed until we were finally told that now the problem seemed to be fixed and we would depart shortly. We landed safely in DK at 02:20 AM, feeling very sorry for one of Jimmi’s theatre colleagues who had agreed to pick us up from the airport – it is a 75 min ride from Odense. Thus, we were back home and in bed by 4 o’clock in the morning – and for those of you not familiar with the Danish summer, I can tell you that by that time the birds have started their morning singing ritual, and the sun is beginning to rise!

Due to the late arrival at home after our trip to Rhodes of course the better part of that day was used for sleeping and taking care of a lot of laundry, because I was to leave for Hamburg just a couple of days later.

Just before leaving for Hamburg, actually on the morning of the day I left, I had an appointment with my endo. He had a lot of questions about my going to Hamburg, the PhD-project I was starting, and the article that he wanted me to write (my doc was also co-supervising my Master’s thesis, and after my graduation he wanted for us to publish the results, even though the most important of these actually derived from one single experiment, because the back-up samples were lost due to instrument-related issues) – but there were also time for to discuss diabetes issues. He gave me the results of the blood samples, my A1c being 5.0 this time, all the other values being okay, except for the thyroid levels which are still a bit off, but not yet at levels were they usually start treatment. Although I do appreciate the low A1c I made it clear to my endo that while in general I think things have been good/improving the past 6 months, I still think that there are too many readings below 2.0 (36) which I do not like, but he told me to discuss this in detail with my D-nurse, because he is not much into the pump managing himself. It is fair to admit one’s lack of experience, but in this case it seems like it is making my endo-visits rather useless….

The readings below 2.0 (36) are not only a worry to me but just as much to Jimmi, who of course has been deeply concerned about me going to Germany by myself. I do understand his concern, however, I have lived by myself before, and I have been confident that I would be able to do so again and after all it was only for little more than 2 weeks. I thought of it as a chance to prove to him that it could be managed before having to leave for Glasgow sometime in August, probably having to stay there for a bit longer (i.e. months).

Unfortunately, my stay in Hamburg wasn’t all that successful as I had hoped for diabetes-wise. At home I am fairly active, riding my bike close to 20 km (32 miles) a day if not more, playing soccer 2-3 times a week, and swimming – whenever possible – once a week (the swimming facilities at the university are closed during the summer due to maintenance work, though). In Hamburg, my accommodation was at the very same building as the lab, meaning that I only had some hundred meters of hallway and some stairs to force to back and forth to work. Shopping was close by as well, and as the working hours in the lab was typically long, I didn’t have the time for long walks/runs if I was also to chat with Jimmi, and sometimes my parents as well, before going to bed. Therefore, my exercise regimen was deeply impaired, something that – as anticipated – greatly affected my BG-readings. I struggled a lot during the first 1½ week to adjust the basal rates, trying out many different combinations. Approaching the second week, very warm summer weather hit us. Outside temperatures hovered around 30 °C (86 degrees Fahrenheit) and as the lab didn’t have air conditioning, but did have large windows turning south, especially the afternoons were almost unbearable hot – especially when you have to wear a lab coat and cloves to protect yourself! Very warm weather has always seemed to cause me problems, usually with increased chances of lows, and this time was no different.

Tuesday was a real rollercoaster-day, where high readings caused corrections that would then send me low. In the evening I went out for a walk, but didn’t get far before I could feel my legs not willing to support me anymore. I had to stop in the middle of a square along Reeperbahn, sit down and wait for half a package of glucose tabs to do their job. After that I completed my errands, and returned to my room around 8:20 PM. My intension was to test right away, and I had actually prepared both meter and lancer for this, I just never got around doing so, apparently already being low enough for my brain not to function properly.

I barely remember talking to Jimmi on my mobile phone, because I had problems logging on to my computer (we usually would use Skype to talk to each other in the evenings, in stead of spending a lot of money by using our mobile phones). I do remember glancing at my wrist watch at 9:30 and 9:45 PM, but after that and until about an hour later I only have flashes of memory – which I don’t even know if to trust – about what I was doing or what happened around me. What I do remember, though, when slowly coming out of this nasty low, is my room being crowded with people I did not know, the only familiar face being my neighbour, who also happened to be a diploma student in the lab. He was generously handing me cola (the sugared variant), and assured the paramedics – and whoever else was in the room – that they didn’t have to do more, when they had gotten a reading of 53 (in my foggy brain it took some time to realize that the result was not 5.3, when they showed me the meter, and subsequently do the math to convert this value into one that I could relate to, i.e. 2.9 mmol/l). He would stay with me until I had safely recovered. So he sat with me and told me what had happened, and that I should probably call my boyfriend because he was worried. Before I had a chance to do so, however, my dad called as it was apparently my parents who had alarmed the institute that I needed help. Jimmi had called them because I failed to answer his calls 10-20 min after he had called the first time and noticed that I was low (he told me afterwards that he called back several times before he proceeded to alarm my parents because I had told him that I had eaten some glucose tabs and so he wanted to give these a chance to take effect). Talking to my parents afterwards they also encouraged me to contact Jimmi as soon as possible, because when he called my parents he was apparently already in the process of arranging some transportation to get him to Hamburg ASAP.

I spent 30-45 min talking to Jimmi trying to make him reconsider his decision about coming to Hamburg. It was difficult – and I am sure that I would have been just as difficult to turn around if it had been the other way around – but I finally managed to make him turn around (fortunately he was just outside Odense, so he hadn’t gotten too far away). He wasn’t happy about it, and didn’t at all feel comfortable with the fact that I was alone in my room with no one to notice if I got low, but at least he agreed to give it a night’s sleep and thoughts before continuing.

I hate the fact that it happens, especially because it had actually been a long time since paramedics was needed, and I felt confident that I could handle it. That it did happen, however, makes me think that maybe I ought to pursue the Paradigm real-time system more, even though I don’t know if it is available in DK yet. Though this system is certainly not perfect yet – as can be seen from all the comment and suggestions that Will received after posting about Medtronics wish to gain input from the (potential) users of their system – it could perhaps provide me, and not least Jimmi, with a little more trust in the ability to prevent severe lows. I don’t know. I will discuss it with my D-nurse, and find out what else can be done during the coming 2 months before I am likely to be off for Glasgow. Test more often, many may say, but during my stay in Hamburg, I actually tested 10-18 time a day, so I don’t think that there is much more to win there. Other types of actions need to be taken, because I will not allow, least of all accept, the D to prevent me from following my dreams!