Pharmacie (Tuesday, 2012 August 21)

August 21, 2012

America is wonderful. I can eat salad every day and root beer every night. My Internet connection is ten times (!) faster than what I had in village. Last night I had some sake. It wasn’t as good as I remembered it. (Maybe it was just a shitty sake.)

But perhaps not all is roses in the Land of the Free. Lately I’ve been trying to sort out my last Peace-Corps-related medical crap, which is as usual complicated and tedious. Here’s the essential backstory, from a Moroccan volunteer’s blog: we are fully covered during service, and after service Peace Corps gives us a month of After Corps insurance, and on our last week of service we go through medical exams to tell the difference. Only, you’re doing these exams on your way out of the country, so how can Peace Corps continue to treat you? For that we have the notorious Form 127C, yet-another Peace Corps-specific thing. Form 127C is officially the "Authorization for Payment of Medical/Dental Services". You can think of it as a purchase order, granting the holder the ability to seek pre-authorized treatment which Peace Corps will pick up the bill for, sort of like a medical blank check. I received two such 127Cs, one for my "terminal malaria prophylaxis", which is the last prophylaxis I will have to take in order to hopefully flush the last of the malaria from my system, and one for my positive tuberculosis test.

The official party line regarding form 127C is that 127C is only to be used for evaluation, not treatment. If you became ill as a result of service, 127C lets you get a diagnosis and a treatment plan, but to actually follow the treatment you get to file a Federal Employee Compensation Act (FECA) claim. However, both of my 127Cs are written "to include the cost of medication".

Even using the 127C is kind of a mess too. Which doctors take it? How do they use it? Remember that we’re talking about the cooperation of three different agencies here.

  • Peace Corps, i.e. the United States Federal Government.
  • This weird AfterCorps insurance thing.
  • The medical providers themselves.

The AfterCorps web site says that in order to use the 127C you have to find a doctor in their network, or more precisely networks, because they’re affiliated with ChoiceCare in most of the U.S. but they’re PHCS which is now called Multiplan in New York and New Jersey. Those doctors still won’t know what to do with the 127C, but maybe they’ll accept your AfterCorps insurance "card", which is really a folded-over sheet of paper, and maybe they’ll try to bill Peace Corps for your co-pay, or however it’s supposed to work. Honestly, I’m still not sure that’s right.

But then you have these prescriptions for these medications. I went to two different pharmacies looking for Primaquine 15 mg (the "terminal prophylaxis" thing) and neither one could find it in that dosage. But I lucked out with the nice gentleman at the Rite Aid at the Junction, who was nice enough to look it up online and apparently the 26.3 mg tablet that all the pharmacies have available only contain the 15 mg of Primaquine that I needed, plus phosphate salts or something. Look, I’m not a scientist. But I got stuck because my "insurance" didn’t go through, and indeed, the AfterCorps affiliate BeneScript that fills prescriptions didn’t even have me on file. And the pharmacist was not taking a 127C form.

So today I called AfterCorps/Peace Corps and got a friendly lady to explain all this to me. The 127C thing is not affiliated with insurance. The 127C works for prescriptions on a "pay and claim" basis, meaning I don’t try to get it covered under any insurance; I just buy the medicine and get it reimbursed later. This will be all kinds of fun with the 6-month course of medicine for TB. The doctor’s visit is also not affiliated with insurance, but we give them insurance information with the hope that they try to bill Multiplan, who will then pass the buck onto Peace Corps. It’s all very complicated. The question of why BeneScript doesn’t know who I am at all is concerning but it is a question for a later time.

This is a fire hydrant in Prague.

This is a church at a square in Prague called NámÄ›stí míru. The Use-It map promised us hot dogs at this square, but we couldn’t find them.

Swiss money is pretty! [Edit: it’s actually Czech money.]

Aggressive dog in Geneva wants a piece of your goose.

Not depicted: there’s no "open container" law in Europe.

New universal condiment.

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