Well, I do have some good news. I asked my pdoc about clozaril and abilify and on her interaction tracker it is moderate. The risk is if you process abilify slowly then you will have increased abilify levels in your blood. But she has a patient on clozaril and abilify and he's been on it for a while (started the add-on abilify in the hospital) and has been fine.

She said typically they do go up very slowly and the highest they usually start is 25 mg. Then she made sure I understood I'll be starting low and going up slowly. In fact I'll be leaving the hospital before I'm on enough to be feeling very good probably. (Hopefully the hail Mary lithium will prevent this but so far nothing has changed and I know that 225 mg of lithium is being asked to do a whole lot).

I know diagnosis can vary over time and I think some clinicians don't like to be nailed down so they use NOS but mostly I think it is avoid having to keep up with the bipolar state as it changes. My pdoc changes mine based on where I am and that is how the coding is supposed to work. Like typically my diagnosis is bipolar I, mixed, severe. Right now it is bipolar I, depressed, severe which I've never seen on my paperwork before. It should also have with psychotic features but I haven't shared that lately; I'm paranoid about my paranoia . The specifiers like psychosis, depression, mixed, manic are supposed to be changed depending on where you are the day you are being assessed. Using the BP, NOS code is probably a lazy way to not have to re-code every time. If you had private insurance they'd get on his case about that but Medicaid doesn't bother much. I've seen drs. use things like Mental Illness, not otherwise specified on Medicaid patients. I don't even know what that means and it certainly didn't help me treat them. (That was the dr I mentioned the other day that I left the job partly b/c he was letting people die thinking he could diagnose without testing). I can't remember his other ridiculous diagnoses but he had a number of them, things that were either so obvious like "elderly" or things that made no sense. "Wound, not otherwise specified" was another. Um, at least tell me where the wound is so I don't grab it? And what kind of wound, how bad is it, etc? Oh and "breathing difficulties". So occasional asthma or is the person on a vent? Etc. through all kinds of illnesses.

Instead of leaving a voicemail with the specific questions about sliding scale could you just leave a message asking for someone who handles billing to call you when they have time? I know for me it gets harder and I'm less motivated to call if I have to try over and over when I dread it already. I know that would work at my therapist's office and at dr's offices I"ve been to and had to fight with over Medicare billing so I think it's fairly commonly the set-up. That also saves you from having to ask the receptionist and then being passed on and you'll probably never see the billing person ever which is helpful.