Dear reader,

This post is about my experience this week of navigating getting a prescription from my South Korean doctor and everything else that happened around it. If you interested in medical stuff, please read on.

Let's start from the beginning: I had the day off, plans were to take the 2:10 bus into Daegu by myself, as Eric was working, but Wednesday's are a short day so Eric was able to scoot away and join me - which was a relief - as it ended up being a pretty long day. This trip we had a bit more time for commuting to the hospital so we were not rushed in running to get to the hospital. We checked in at the Fatima International Hospital secretaries office and then were told to go upstairs again to 301 the Digestive center, we found ourselves with a longer wait, 8 patients, ahead of us. I didn't figure out whether this was an appointment system or whether they booked so many appointments and just hoped to get through them as fast as they could. The hospital closes around 5pm-ish, "my appointment" was supposedly at 3:50pm, we got into the office at 4:30pm. Certain hospitals in America can be this way too* I just didn't have a robust way of asking and learning about the waiting process.

I left you last week with my first appointment with my Korean doctor requesting to receive a prescription for Stelara for my Crohn's diagnosis. This week was a follow-up to that, I had sent over my full medical records which ended up being a +200 document. I had hoped that my doctor had had time to look the document over, as we went into his office we soon realized he never even received it or looked it over. I had to communicate that the secretary, Sunny, had received it via email and said they uploaded it into their medical system. The doctor finds the document and starts to look it over, frustrating, but okay. He takes his time and he's trying to figure out my whole medical timeline, he then writes down a simple timeline himself, he got most of it right. 

He explained that in Korea when diagnosing Crohn's disease and starting treatment they always start out with an oral pill treatment, this is called Azathioprine. My doctor back in the states went over this medicine and option, this has an increased risk of Lymphoma and skin cancer associated with it if you take it for a long period of time. Once you see any negative results on this medication can you then move to something else, switch to something stronger or more effective and targeted towards your disease. This is the ladder in which he explained Korean doctors deal with Crohn's, along with how the Korean insurance will provide and approve of medicines. Obviously, my American experience did not follow this process, we were approved for Humira but then my insurance (at the time) actually approved and preferred Stelara, which was fantastic as it is - to me - a better drug: newer, fewer injections, and more targeted towards Crohn's disease. Humira treats many auto-immune diseases and is a 2-week injection, Stelara is an 8-week injection. 

So here I am in Korea, an American that did not follow any procedure that Korean Insurance wants/likes, requesting a prescription. Oh and most importantly: Korea Insurance only approves of a 12-week injection for Stelara, America approves of an 8-week injection cycle and the medicine is VERY expensive. How expensive you might ask?

Well, I was sent a bill this week for this year from my old US insurance Regence Blue Cross / Blue Shield stating that my insurance somehow ended early - it did not, I did quit my job, but my insurance didn't end early. It states that some prescriptions were filled after the last date of coverage, and they are requesting a payment for: $23,440.05 in reimbursement for the prescription drug benefits they provided after your coverage was ended. That is Stelara. I think for a full year? I, obviously, need to call them and am working out how to do so as I don't have a US phone number nor am I in the same time zone. (A call will be made around 4:30am Tuesday morning to get in on the east coast time to haggle with my pharmacy.) All Americans that have ever had a bill for any medical issue know our healthcare system is Fucked up, that's with a capital F, but it's important that other healthy people keep hearing about it as well. Paying for medical bills through Go-Fund-Me is the best sort of help for any American in paying off your medical expenses and that should say everything. 

I got that letter the morning before going off to the Korean doctor so my mind was running with medical issues. I was very happy to have Eric along for the ride so I had support. 

I hope to dispute and appeal the $23,440 bill and have hopes that it will get resolved. But it doesn't make it less stressful, I came to Korea to save up money (my main goal) and that bill or having to pay whatever in Korea would really take away from that. Having a disease is already hard to navigate emotionally but then to have it take away from your own personal goals really takes a hit.

Continuing: in the doctor's office, we are getting knocks and calls from the nurse to move along as other patients are waiting outside. We discuss how the doctor will send in a request for coverage for my medicine for the 8-week injection, he states that this might be denied, this might be reduced to 12-week injections, or lastly asked to jump on the Korean treatment plan which would mean being taken off of Stelara put on Azathioprine, see how I react to that, and possibly get put back on Stelara?

Second blow of the day: was ending the appointment, heading downstairs and paying for the appointment to find out that I was paying for my one shot Stelara injection right there out of pocket it is: $1,200 - which is actually cheaper than the USA! - that's the silver lining? In the states my shot is $4,000. I was very shocked and asked her why the appointment was so much and she said the injection was expensive and I realized I was paying for Stelara today not when I pick it up. Thank god we have enough money for that. 

We paid and walked out of the hospital, picked up kimbap and sandwiches at the EMart, and ate dinner on a park bench and discussed the day we just had. Seems we came to four options:

1. Korea Insurance covers my medicine

2. Korea Insurance covers only 12 week injections (can I get the other in between shots prescribed from my doc and pay out of pocket for those?

3. Korea doesn't cover my medicine and I walk the Korean process of meds they prescribe.

4. I pay out of pocket every 8 weeks for my drug so nothing changes. 

Eric says the most important thing is to stay on medication, that we are making plenty of money here that we could actually take the the hit paying $1,200 every 8 weeks and still save and do what we need. It was reasurring to hear, if all else fails - we can pay - as we have housing and food all taken care of here, seeming to be still the best benefit of this job. 

I'm hopful I can get either a combination of coverage or my fingers are firmly crossed for full coverage. My doctor sent over a medical summary and stated that changing in medication could induce a flare and lose much progress and stability I've gained on this medication - so here's to hoping they hear and understand the importance of not messing with a sick persons path to stability! 

For photos this week: another STEAM in Andong and robots. We are constantly being surprised with our classes and the students, it’s really a blast.

We really do love it here so far, even with this bump in the road, I'm grateful for the experience of it all. I’ve got positive eyes for the future, I think it will all work out as it needs to. It feels a little like a rollercoaster right now, but will get off and see it was all worth it 🤞🏻