Coffee heat rising

Health Insurance: Is your employer paying its part?

One of M’hijito’s good friends, a young newlywed who had just purchased a house, was sideswiped by a fifth-wheel while he was on his motorcycle. Because he was wearing a helmet, the young man survived. However, he’s lost a kidney and his spleen, and he broke three vertebrae. He’s still in the hospital, a very sick puppy indeed.

As you might surmise from the fact that he and his bride qualified for a mortgage in these tough times, he had a good job with good benefits. Or so he thought.

Well, come to find out: his employer was not paying the employer’s half of his health insurance premiums. That means he’s not covered. He’s now relying on the state’s half-baked indigent health-care system to keep him in the hospital until he recovers enough to roll home in a wheelchair. The bills the kid has racked up will ruin him and his wife financially just as they are beginning their life together.

Lawyers say the employer is apparently broke—this is why he was welching on the health insurance policy—and they hold out little hope of getting any blood out of that turnip. The kids probably will have to declare bankruptcy, and that won’t get them out from under a mortgage that likely requires two paychecks.

I have no idea how a young person in good health who generally stays away from doctors would find out whether an employer really is paying its part of the health-care premiums, especially if it’s a small business with no HR department. Probably you could call the insurance company and confirm that you’re still on its rolls. Given the nature of our deprecession, if you have no recent confirmation that you’re enrolled in your health plan, it might be a good idea to check.

And please. Stay off motorcycles!

Suzuki photo byRich Niewiroski Jr.

Awww, C’mon! Am I really that dumb?

Seriously. How dumb DO they think we are? And more seriously: could they be right??

Late in October I dropped by my doc’s office to get a flu shot. I was there for all of 10 minutes, 8 of them spent in the waiting room.

Friday, comes a statement from my insurance company: the doctor has charged my insurer $86. The insurer is disallowing it, claiming the Her Doctorness is not in the RAN+AMN network. So now I’m expected to pay this bill.

Yup. You read that right. EIGHTY-SIX BUCKS for a $10 flu shot.

So I shot off an e-mail to her, she also being one of my coreligionists who sang in the choir with me ($86 for a flu shot: ain’t that Christian?). She replied that she was shocked and would get after the office manager. And so she did. Yesterday morning, comes this missive from that worthy:

I am very sorry for the inconvenience. We deal with hundreds of insurance plans and our front office MA should have known that we are out of network for Ran+Amn. You must understand however that your card also has BENEFITOPTIONS and BEECH STREET in large letters. We do participate in these plans and it is the ultimate responsibility of the patient to make sure hisor her primary care physician is on the plan.

Grocery store flu shots are less expensive because they are purchased in extreme bulk for the masses. They also have a greater incidence of sideeffects, Dr. Wallbanger [my doc friend’s senior partner in the practice] tells me.

In our practice, we normally do a nurse visit taking the vitals of thepatient receiving the flu shot. Insurance billing requires that we bill $40 for this procedure and insurance pays whatever they like.

Billing code 90471 is administration of the flu vaccine and the going ratefor insurance billing is $26. The rate for the vaccine itself is $20.

We administer flu shots in our practice as a service to our patients, andwhen billing insurance there are set amounts for each service provided.

As our front desk did make the error, we will write off all but $20 of the remaining balance for your flu shot.

Total price for a cash pay flu shot is $30, you already paid $10, so
remaining balance is $20.

Again I am very sorry for the inconvenience.

Okay. Are you following this?

Item 1: The head partner in this practice is actually suggesting, with a straight face, that the vaccine he’s getting is BETTER than the second-rate vaccine dispensed at Walgreen’s or Safeway, where, if I’d had the time and patience to track down a flu shot clinic event, I could have had the shot for a $10 copay.

Oh, dear Dr. Wallbanger: can you spell S-P-E-C-I-O-U-S?

You understand: he and his office manager assume I’m so stupid I will buy this story.

Item 2: We’re told the insurance company requires that the practice overbill, in the amount of $40, for a grand total of 2 minutes of a junior college graduate’s time.

And Item 3: We learn that really, we shouldn’t believe anything we’re told by the front office staff. Just because the staff says the practice is in-network doesn’t mean it is in-network. In other words: it’s the patient’s responsibility to read our minds. And BTW, try to read RAN+AMN’s corporate mind, too, since that worthy organization does not publish a list of participating providers online, at least not that three Google searches will bring up.

What’s being said here is either “we try to gouge your insurance company and if we can’t get away with it we still overcharge you but only by about half of the overcharge we try to extract from your insurer” or “we think you’re dumb as a post.” Or maybe some combination of those.

Okay, okay, I admit it: They could be right!

This afternoon I donned some garden gloves and rolled the compost bin into the alley by way of trying to salvage it after the Great Bee Fiasco. By the time I got it where I wanted to dump the contaminated compost, wisps of white vapory stuff that looked like smoke were leaking out around the lid. It kept on leaking. “Is it on fire?” I wondered. Felt the side to see if it was hot: no, not especially. So I waited a while till this phenomenon settled down.

Finally opened the lid. White airborne powdery stuff was still floating around inside.

Waited a while longer. Then rolled the thing upside down and tried to dump out the compost.

No luck. It really needed to be pulled out a fistful at a time, not a practical option with weird (stinky!!!!) white powdery stuff drifting in the air.

Went into the garage to drag out a little hand-sized pitchfork-like thing. Held my breath and tried to fork out the bin’s contents without inhaling any powdery vapor.

This did not work well, and soon I was fairly certain that if I breathed much more of the “beekeeper’s” crud, it was gunna make me good and sick. Rolled the composter over to the bulk trash pick-up place, where it will sit for the next two and a half months, providing the Trash Cop doesn’t wander up the alley before the next pick-up is scheduled. He hates that.

By the time I finished, my throat was burning and I felt dizzy. Luckily, I’m going to dinner at the home of friends, one of whom is a nurse-practitioner. A psychiatric nurse-practitioner (where was she when I was busy hiring the bee dude?), but a nurse nonetheless. Matter of fact, this is the very friend who gave me the composter as a lovely and much-valued gift, some years ago. She should be able to recognize if I start to croak over during the salad course.

The bee dude’s bill is in hand: Contrary to his listing online as such, this guy is no “beekeeper.” He works for an outfit called “Atomic Exterminating Company.” Atomic, indeed: young Dr. Strangelove nuked my bees, nuked my composter, and damn near nuked me.

Well: Dumb tax, eh?

I’m still left with the question of how we’re supposed to know when service people are lying to us! I guess that requires you to be smarter than this Ph.D. is.

Lose some pounds, keep some bucks

Cassie the Corgi is getting a bit on the chunky side.Bad. The corgi is built like a dachshund: short legs under a long spine. This mutation puts a lot of stress on the spinal column, making the dog susceptible to back injuries and debilitating arthritis. Apparently overweight is the most common cause of crippling back pain in these dogs, and the most common cause of premature death.

So it’s time to put the pooch on a diet.

I’ve been feeding her about 8 ounces per twice-daily feeding: 2 ounces of starch, 2 ounces of veggies, and 4 ounces of meat with each meal. Pretty clearly that’s too much: she’s gained three pounds since she moved in with me. That’s a lot, when you’re supposed to weigh about 21 to 23 pounds: 13 percent of her desired body weight!

The rule of thumb for feeding DIY doggie cuisine is 2 percent of of the ideal body weight. Assuming Cassie should weigh 23 pounds, that would be 7.46 ounces a day, or 3.68 ounces a meal. That is not much food! In fact, it seemed way too little to sustain such a lively little dog, and so I just started feeding her by guesswork.

Evidently I guessed wrong. I’ve been feeding her 8 ounces per meal.

Interestingly, not only was she beginning to look like a tiny barrel with legs sticking out, she also had lost her enthusiasm for the beloved doggy dish. She had to be coaxed to eat. No wonder: the poor little thing must have felt like she had a cannonball in her belly.

Yesterday I cut her ration to 5 ounces. This morning she was dee-lighted to scarf breakfast, and she greeted the day by rocketing around the house like a Roman candle run amok. Clearly she feels better on a lighter diet.

This is going to save some cash: half as much frozen vegetables, rice, and chicken represents a significant savings on dog food. I think I’ll ease her down to 4 ounces per feeding and see how she does.

Monkey See, Monkey Do

It occurs to me that what’s sauce for the pooch could be sauce for the human: What if I restricted my feed to 2% of my desired body weight?

That would come to 2.6 pounds of fine cuisine per day.

Seems like a lot. A typical meat portion for me is about 4 ounces. Because there’s nothing to eat on the campus that isn’t junk food, I don’t eat lunch. Somehow I doubt that 2 pieces of bacon, a piece of toast, orange juice, and strawberries in the morning plus 4 ounces of grilled meat and a salad at night come to something over 2 1/2 pounds of food. However, this morning I ate enough oatmeal to create the lead-ball-in-the-belly sensation. And I do eat a fair amount of watermelon and fruit during the day.

The difference is that Cassie eats better than I do. My diet is not a carefully calibrated fusion of mixed vegetables, starch, and meat. I eat whatever comes to hand, which tends to be high on cheese, meat and fish, crackers, and fruits and low on vegetables.

What if I weighed my food and tried to keep the daily volume to 2 percent of the body weight I’d like to have? Or less? What if I made an effort to balance veggies and starches 50-50 with animal proteins? This could be an interesting experiment.

Might save some money at the grocery store, too!

Health insurance flap settles down

Our Beloved Employer’s announcement that its only health insurance plan to cover the Mayo has been discontinued caused some annoyance among a number of employees. As it developed, I was not alone.

The HR website gave no clue as to what plans we will have for the open enrollment that starts today. One page says something about Aetna, but another page — dated 2007 — makes no mention of an Aetna plan. If you call on the phone or e-mail, they won’t tell you anything. Instead, they instruct you to attend one of the “benefits fairs” slated for this month.

So I trudged across campus to today’s “fair,” hoping to pick up some paperwork that will compare plans and maybe even say what hospitals are covered. No such luck: the two-hour “fair” amounted to an endless PowerPoint presentation! Attendance was standing-room only.

Oh, lord. So I sat on the floor, having run a little late because my car’s battery went dead and it took an hour or two for my mechanic to come up to my house, jump-start the chariot, and then follow me to his shop and change the battery and fix the fuses that blew in the process. Mercifully, the HR “presenter” paused as she cast up a slide listing the prices of the various plans, just long enough for me to raise my (literally) sweaty little paw and ask if any of them covered the Mayo. Yes, she said: RAN-AMN, an EPO with a monthly premium of $30.

Hot dang! I couldn’t believe it. The plan that worked was a sister EPO — our 2007-08 premiums have been about $25. I picked the now-defunct Schaller-Anderson plan because HR told me it was the only plan that covered the Mayo. So this means either they misinformed me last year or RAN-AMN has picked up the Mayo as a network member.

I’d figured I was going to have to go with the PPO, whose rates are around $200 a month for a single person, or try to get a bare-bones high-deductible plan and go with a doctor in a boutique practice, by way of getting access to medical care…something that’s in short supply around here. Having learned to take what HR says with a crystal of sea salt, I called the Mayo’s billing department and learned that yea verily, they are part of RAN-AMN’s network.

So that’s a relief. If I’d had to go back to the PPO, it would have meant the end of my plan to save enough to pay off the Renovation Loan, since the monthly setaside for that is almost exactly the same as the PPO’s premium.

Interestingly, deep in RAN-AMN’s fine-print paperwork, I found a proviso saying that if you are eligible for Medicare (not if you have it, but if you’re eligible), then the insurance you’re buying through GDU becomes “secondary.” This implies that you can NOT opt out of Medicare just because you have a job that offers comparable but cheaper coverage.

It looks to me like Medicare is going to be an expensive proposition. Everyone gets Medicare Part A, “free” for 40 years of payroll deductions. But it doesn’t cover much and leaves you open to bankruptcy should you develop an expensive ailment. So you have to take Medicare Part B, which costs almost $100 a month. Then you also have to take Medicare Part D — if you decline it and then later pick it up, you have to pay an extra premium (a de facto fine), for the rest of your life. Medicare D costs around $30 a month, and rising. But Medicare A, B, and D still don’t cover you well adequately, because Medicare has become so chintzy that more and more doctors won’t accept “assignment” — that is, they won’t work for what Medicare pays. So, to guarantee you can see the doctor of your choice or a competent specialist, you also must buy “supplemental” or “Medigap” insurance, which apparently costs upwards of $145.

So you have to cobble together four different plans to get full coverage, and by the time you’ve done that, the cost of health insurance for a retiree will exceed $250 a month. I would find that a strain on the decent salary I’m earning. To have to pay eight or nine times my present healthcare premiums for Medicare when I’m living on a reduced, fixed income will pose an interesting challenge.

As you can imagine, any Pushmi-Pullu as jury-rigged is this is complicated and confusing. The government’s official Medigap document linked above is 52 pages long, and following it requires your full, undivided attention. Then we have this overview of Medicare, 113 pages full of details whose complexity rivals the U.S. tax code!

Look, I’m grateful not to have to pay the exorbitant rates with which insurance companies gouge older Americans — $400, $500, $600 a month. But still…I’m brought back to the same thought that always occurs to me every time I have to look into our health-care system:
There’s no excuse for this.