On Kaiser, Defeatedly

Updated February 24, 2016 — this post was written a long time ago. Since then, I’ve changed my viewpoint on Kaiser as a whole, and am actually a huge fan of their services. I ask that you read this post, of course, but also read my updated post — it’s after being a Kaiser member for 4 years, so it’s got a lot more wisdom in it, hopefully.

TL; DR: Adderall rant, Kaiser Permanente, ADHD.

You may know that I’m lucky enough to be on my mom’s health insurance (since I’m not yet 26). You may not know that we recently switched from a PPO to an HMO. We were hesitant to make the change, but we reviewed all of the coverage and pricing plans and realized that we would save several thousands of dollars over the course of the year by going with an HMO…Right now, I’m thinking that perhaps I’d be willing to sacrifice any amount of savings in favor of a PPO.

After getting a work review that involved a negative look at my lack of focus in mid-2011, I realized that it was finally time to address something I’d known about forever but had never really acknowledged. I went and spoke to my primary care provider about the possibility of having ADHD.

She was initially dismissive, as I expected her to be, and insisted that I get an official evaluation. Several hundreds of dollars later, I was fully evaluated for all learning disabilities and ADHD. The results were exactly as expected: zero learning disabilities (even the things I’m terrible at are well within the “average” to “above average” range, which soothes any fears of inadequacy but makes me wonder how bad everyone else could possibly be at math) coupled with hardcore ADHD. It’s surprising that I was able to get this far without serious complications – apparently, I’ve just developed a really functional network of coping mechanisms.

Post-diagnosis, we began to medicate. The first round was Ritalin, to which I reacted horribly. I still shudder to think about it. The next round was a more common medicine, to which I have adapted quite well, other than a few side effects such as forgetting to eat. My insurance company was hesitant to cover the drugs, and so for a few months, we paid out-of-pocket while working with the doctors and pharmacy and insurance company to get it all worked out. Ugh. After rejection after rejection, I was worn out, but we won a series of logistical battles and got my meds covered. (I left the most awkwardly grateful voice mail for my doctor’s assistant and her nurses – I was so happy.)

Finally, life was beautiful. I had my meds covered by insurance, I had a supportive team behind me that understood the situation, was monitoring my weight and vital signs, and was generally kicking ass at work as a direct result of my medication and other approaches to treatment. However, my room and car did not magically become cleaner. (In my mind, I thought I would turn into Monica from Friends and have to have everything neat and orderly. Obviously that’s not how it works.)

But the bottom line reared its ugly head and now I’m beginning yet another difficult round of obstacle hurdling, in the form of the looming giant Kaiser.

This morning, I met with one of their mental health drones, where I immediately handed her a full copy of my initial diagnosis and report, hoping to avoid having to go through the next hour and fifteen minutes. But alas, I was not so lucky, and instead, was subject to an interrogation of sorts.

This sounds silly, and is totally immature and the wrong way to approach these things, but I always panic. I know there’s an answer that they’re looking for, and I know that I need to display symptoms of ADHD without looking manic or insane. The psychologist who did  my initial evaluation made me feel so at ease about the whole process, so that it felt less accusatory and more geared toward me.

Instead, I found myself second-guessing each question, and trying to remember how I answered questions like “how many drinks do you have per week?” with their pharmacist during the initial call to establish health history and transfer of medications. (Oh yeah – there’s an initial call where they lecture you about deciding to have children. I think I got an over-eager pharmacist – his three-minute lecture on what to do if I decide to get pregnant was not only above the call of duty, it bordered on completely inappropriate. He’s lucky I was at work, or I would have torn into him about how offended I was. Instead, repeating “I am well aware” in an increasingly-icier tone had to suffice.)

The problem with this process is that I know it’s very necessary. I am well aware that ADHD medications are wildly abused and heavily regulated by the government. I get that doctors can get into trouble for over-prescribing and for lack of attention to detail.

However, I’m shocked because while I have such a hard time getting the medications that I have a demonstrated need for, I know personally or know of people who are prescribed any number of medications and who abuse them, distribute them, and otherwise misuse them. And the minute I go in with another issue, it’s medication, medication, medication. I don’t want to have to have a 7-day pill-box full of stuff. I don’t want a collection of uppers and downers and middlers. (Middlers aren’t a thing…yet.)

I really hate the fact that I immediately feel suspected of some wrongdoing. I hate that they assume that I’m going to use the medicine for an illegitimate purpose. No, I’m not going to snort it or sell it. Instead, I’m going to go to work every day, take my pills, and maintain a professional demeanor. Is that seriously so hard to imagine? Just because I’m young doesn’t mean that I’m trying to take advantage of the system. I’m sick and tired of feeling like a criminal just because I’m trying to get a prescription.

Ready for the cherry on top of the “Fuck you, HMO” sundae? I had to take a drug test to get a prescription for Adderall. I had to drive across town to pick up medicine that I was told wasn’t there when I went to pick up my other medicine two weeks ago – it was. And while I was there, I had to pee in a cup. A drug test? Are you kidding me?

I get that they want to make sure that I’m not abusing other drugs – I’m not – but at the same time, I’m a patient. I’m in their care. This is supposed to be a team effort to ensure my health and well-being. Instead, it seems like I’m being observed, held for the full 48 hours waiting for the indictment I know won’t come. I’ve never been drug tested before in my life. Not for any job. Not for any activity. Not for anything. And yet, to get a prescription for something that I’ve already been taking for 8 months, I have to go put my card in a box, push a doorbell, and wait to be handed a plastic cup,

In order to get the new prescription, not only do I have to pass the drug test, I also have to get an EKG at some point in the next few weeks. Do they think I have endless amounts of time to spend not working and getting tests run? Ridiculous. God, it’d probably be easier to buy my meds off some kid on the street.

The mental health drone was quick to assure me that segmented health care is great, once you get used to it, and that she’ll contact me via email but we most likely won’t meet for another year. I’m fine with that, but I guess there’s a disconnect for me between “be well” and the fact that I’m just a member number and a urine sample to them now. I’ll wait in their lines. I’ll wait for my name to flash on the board so I can go stand in another line. I’ll never see the same Kaiser employee twice. I’ll be stickers on a piece of paper. I’ll be copays. But I won’t be Katie Barry, the person. I won’t be Katie Barry, who has individual needs.  I’ll be that damn member number and nothing more.

I realize that this will pass and that my level of indignation is probably a little over-dramatic. But I don’t care. I feel like a head of cattle and I hate it. I’ve always been a little bit on the sensitive side, afraid to get into trouble, and feeling so scrutinized, like I’ve just been called into the principal’s office, for something I can’t help is more than just a bit disconcerting to me. I imagine that as we continue with this journey, I’ll get more comfortable with the system, but for now, I’m annoyed, overwhelmed, and seriously not happy with my providers or the level of care I’m receiving.

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9 thoughts on “On Kaiser, Defeatedly

  1. I know this is an old post, but… damn, I’m sick of Kaiser. I had them as a kid, and they’re great if you don’t have any major health issues or if your health issues are textbook and common. But when I just STOPPED SLEEPING four years ago, I got “it’s a mystery, take a sleeping pill”, and even THAT was a struggle to get and maintain, with my doctor wanting to send me to a shrink for my sleep issues about twice a year despite the first shrink stating that it was not a mental problem.

    When my husband lost his job this last winter, it was a blessing in disguise. I ended up on Medi-Cal and seeing a local doctor, and for the first time I was treated by someone who wasn’t just trying to check her boxes in the system and get me out the door. She has been working with me on a diagnosis and is actually treating me for my symptoms in the meantime. What a novelty!

    And now I’m on Adderall and functioning almost normally for the first time in a year… and my husband’s new job ONLY offers Kaiser insurance. I’m terrified that they will throw me right back to “you don’t need to be medicated until we know exactly what’s wrong with you… but your case is unusual and you’re confusing. Maybe you should see our shrink.”

    • It’s funny because now that I’ve been with kaiser for a while, I really enjoy how streamlined the system is. Yes, the adderall does take some extra effort but I’ve gotten used to it. I brought in the original report with my diagnosis of ADHD and saw one of their mental health professionals, who agreed with the report and worked with me on the adderall. My prescription is down to $20 a month. It’s been great. I urge you to find a kaiser physician who understands and to be flexible in the beginning. It will get smoother, I promise!

      • I had the same exact experience with Kaiser and Dexedrine. After 3+ months, I was finally meeting with a shrink whose only function was to prescribe medications and ask short questions using an IPad. It’s better than it used to be, but there’s still a huge disconnect and I really wish there was a way to find a specialist or someone well-acquainted with ADD so I can find the right balance of meds and maybe even ADD-specific counseling. My relationship has been non-existent for a while now, and it’s all related to changes since being prescribed the last medication. Any luck in finding someone knowledgeable in adult ADD?

  2. Hi, I stumbled across your blog after searching about Kaiser and ADD. I am also in the Denver area and am about to go through an ADD screening with my Kaiser HMO. I was wondering if there is a doctor your recommend with them who is familiar with the issues. Any info would be helpful!

    • Dr James Bachmann is fantastic. He’s down at skyline, if that’s nearby. I’ve found him to be knowledgable, professional, and personable.

      • The doctor in their mental health department that I first saw us no longer there, so unfortunately, I can’t make any recommendations there. But best of luck!!

  3. I’m about to take my Adderall pee test for Kaiser Gustaponente and I am worried because I do enjoy to chief the leaf. I googled “Pee test for Adderall at Kaiser” and this article came up. Since I’m ADHD, I always glance at how much I have to read before to determine if I’m moving in or not. I took a look and thought I’d get through a paragraph or two, but your writing was so good I breezed through the whole thing. Just thought I’d drop a comment and let you know.
    Cheers,
    Steve

    • Thanks so much, Steve! I hope that your test went well — I think they’re mostly checking to ensure that you’re taking the proper dose of Adderall rather than looking for other substances, so hopefully it all went smoothly! I really appreciate your kind words!

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