Things I don’t like: health insurance

Last month I wrote my first Things I don’t like post. It’s time for a follow up, and this time I’m going to pick on insurance companies, specifically, health insurance: both medical and dental.

Reading a Grumpy Rumblings post this morning that pointed to a New York Times Opinion article reminded me of my gripe. This NYT article is excellent and really must be read. Go ahead, do that now and then come back here.

The points of the article that really resonate with me are that it can be very hard to purchase insurance in the open market, and that without insurance medical necessities such as tests and medications cost so much more. What a truly screwed up system we have! It charges people paying cash up front more than people who require the medical provider to bill an insurance company. Doesn’t the medical provider then have to wait to get their money? And they have to pay for people to do the billing and monitor the status of the billing, too? Aren’t these more expensive to the medical provider? I just don’t get it.

I have insurance available to me through my job. I do pay for some of it, but it is heavily subsidized by my employer. I also have a choice of medical plans, so I can pick one that fits my needs. I use a PPO plan (which stands for preferred provider…something or other) because it allows me more flexibility when choosing medical professionals for my care.

Last fall during open enrollment I actually considered not enrolling in the PPO plan this year and instead going with a high deductible plan. With my current PPO plan, I can also take advantage of the medical flexible spending plan (FSA) that allows me to withhold money pre-tax for expenses not covered by insurance, such as deductibles and co-payments. However, with a high deductible plan I could have started a health care spending account, which allows more pre-tax withholding of money that can be rolled over every year, unlike the medical FSA which must be used within a single tax year.

It wasn’t the tax sheltering that made me think of a high deductible account, though. It was the fact that I do so much medical care out of network anyway that I feel it may be a better value for me. Plus I knew this was going to be an expensive year and I thought it may be better to look at 2011 as the year I actually have enough medical expenses that I would qualify for a tax deduction. But only if I didn’t participate in the medical FSA.

The reason this was going to be an expensive year for me is that I am getting a lot of dental work done. And here’s where the extreme dislike comes in: my dental insurance is screwing me over. It’s nothing personal, I know. This is just their standard operating procedure. One of the ways insurance companies scrape out profits is by delaying payment by denying claims. The claimant must then contest the denial, and the insurance company has extra time to “examine” the merits of the claim. This is exactly what is happening to me and I hate it.

This all started last fall for me. I finally decided to give in to my dentist’s recommendation that I visit an orthodontist about getting my bottom teeth fixed. They’re crowded and overlapping which makes cleaning and maintenance a real challenge, and since I want to keep my teeth for as long as possible it was time to address the problem. So I saw an orthodontist and he recommended I consult with a periodontist before starting any orthodontia because there was a bit of gum loss in some areas. I consulted the periodontist last year, too, and scheduled my first procedure with her for January since I had already tapped out the medical FSA for 2010.

In mid-January I had a gum graft done. It was an intense experience for me since I had never had a dental procedure that required Novocaine or consciously laying there while someone performed delicate surgery in my mouth. (I did have my wisdom teeth removed when I was 19, but it was done under general anesthetic so I was completely unconscious.) After it was over, I got even more shocking news: I would have stitches in my mouth for about six weeks and I needed to pay the the full $3,000 bill right then and there and wait for my dental insurance company to reimburse me later. Gulp. Thank goodness they took Discovercard.

The periodontist submitted the claim for me the same day and a week later I got the Explanation of Benefits (EOB): denied. The insurance company needed more information to process the claim, and the code on the EOB pointed to something about…x-rays?! I called the insurance company and asked for clarification. Yes, they said, they needed x-rays. I told the agent I was confused. Did they not understand I had a periodontal procedure that involved simply soft tissue work? How could they assess the need for soft tissue work from an x-ray, which only shows bone? She insisted they needed x-rays and that was that.

I happened to be seeing the periodontist that day for a check up, so I talked to her about this issue. She said she would file a complaint form showing that her professional association did not recommend x-rays for soft tissue work like gum grafts. For anyone with a modicum of understanding of human anatomy, this makes sense. And for someone like me who is being treated for hypothyroidism, getting irradiated unnecessarily in the head and neck area is really not a good idea.

The periodontist also commented that this is not an unexpected outcome when dealing with insurance companies. They typically deny claims once or even twice before finally paying. Each time they have 30 days to evaluate the contested claim. That means that a person like me has to front the big insurance company thousands of dollars for up to two months. Until I get the final EOB I can’t file for reimbursement through my medical FSA either. So I’m just out the money until I can get the insurance company to cough it up.

As I said to another agent of this insurance company during one of my follow up calls, it’s despicable how hard they are making me work for my money; money I’ve paid them diligently over many years. I’ve had dental insurance for nearly 13 years now and paid premiums to them every month. During that time I’ve only had the basic services done: biannual exams and cleaning. That’s it. The one time I make a claim, they screw me and make me jump through hoops.

There is another important lesson buried in here: emergency funds are essential for things like this. Yes, I charged the procedure to my Discovercard, but when the bill came due I didn’t want to ask Discover to finance my procedure. That would have made a bad deal for me even worse. So I transferred a bit from my emergency fund to cover the unplanned bill, and when I get reimbursed (some day) I will transfer the money back to the emergency fund.

Thank goodness for emergency funds! Thank goodness for planning ahead! And shame on Metlife Dental.

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Experiments and randomness

I’ve been doing many things lately, but unfortunately none of them have involved writing on my blog. Now I have the pleasure of trying to sum up all of the interesting (to me, at least) things that have kept me so busy.

Personal Grooming

I haven’t used shampoo or conditioner on my hair for just over two weeks now and it’s looking and feeling great. Instead, I’ve been washing my hair with a baking soda slurry and rinsing with diluted vinegar.

I first read about this approach about two years ago, I think. I tried it back then and didn’t like the results. It was the middle of summer, I was working out a lot at that time, and I felt that without shampoo my hair was sort of greasy looking and feeling. Now that it’s winter and I’m not working out very much (which leads to other problems besides greasy-feeling hair) I thought it was a great time to give it another try.

At first I just tried using baking soda alone. I’d mix it with a bit of water in the shower then sort of pour it on my head and rub it into my scalp. After rinsing thoroughly my hair felt OK, but also sort of dry. But my scalp didn’t feel dry at all. In fact, that was something I had to get used to. I guess after all those years of washing with shampoo I had come to associate clean hair with a scalp that felt pretty tight and dry. But the baking soda and water treatment simply left it feeling…well…just clean, but not tight and dry.

The real magic came when I started adding a vinegar/water rinse. Wow did my hair feel soft and silky afterward! It took me about a week to get used to a hair wash not resulting in a dry scalp, but now that I’ve adjusted I think I’m hooked for good.

There are all sorts of “recipes” one can find with a simple search, but I just sort of wing it. I put some baking soda in a re-purposed cream cheese tub then put it in the shower. I add water once I’m in there, then stir it up with my fingers and start applying it. The vinegar/water rinse I pre-mixed in an old plastic Coke bottle that I leave in the shower.

Techie tinkering

I bought a NookColor eReader from Barnes & Noble the day after Christmas. I love reading and books, but I’ve also been trying to cut down on the amount of stuff I have in the house. That means I’ve been boxing up and selling off books, so I really didn’t want to keep bringing new ones in the house.

For the past couple years I’ve been using the library a lot to trim my book budget and minimize book clutter, but even then I’m left with the awkwardness of toting a big book with me wherever I want to read. My work bag is already full enough without adding a large hardcover to my daily load.

I knew I was ready for an eReader and I was tempted to get the Kindle, but I was seduced by the promise of greater flexibility offered by the NookColor. What do I mean by that? Well, for one NookColor reads ePub files, which are a non-proprietary format used by many different eReaders, unlike the Kindle. Libraries also lend ePub files, so I can (theoretically) borrow books from the library with my NookColor. (Licensing issues pretty much make that a once a year possibility, but at least it’s a possibility!)

NookColor had a pretty decent web browser and WiFi capability, so I could check websites as needed/wanted. It also came with Pandora and a few games loaded on it. And it could be easily “rooted,” which means it could be configured to operate as the Android tablet that it truly was. Barnes & Noble is supposed to open this device up to at least some of the apps in the Android market some day…and I was patiently waiting for that day.

I went two months with my NookColor running as Barnes & Noble intended it to. Then I decided to take matters into my own hands and “root” it the weekend before Valentine’s Day. Now I love it more fiercely than ever before. Still a fabulous eReader, but also a small WiFi tablet for at least half the price of an iPad or any other Android tablet out there. 🙂

I’ll have to write a special post about just what was involved with the process. For now, just know that I’ve spent many evenings trying out new apps from Android market and continuing to devour ebooks in the dark in bed. (One of the reasons I really like a backlit screen!)

Wandering

After much deliberating and research, I took the plunge and bought round trip tickets to Madrid, Spain a few weeks ago. I leave next week, so I’ve been sort of in a whirlwind of travel preparation, including getting tickets for transportation once I get to Spain on the bus and high-speed AVE train. (I’m really looking forward to experiencing high-speed train travel!) I also have to get all my work projects in order, too, which means my free time to do things like write and read blogs has been really scaled back.

Now that I have a nifty little WiFi tablet to take on my trip, I hope to get a few simple blog entries composed while I’m traveling. The WordPress Android app seems OK, so my main issue will be trying to write with only an on-screen keyboard. In my experience, people who are hunt and peck typists aren’t bothered by on-screen keyboards, but people like me who learned to use a keyboard in the old touch-type style find it a bit difficult.

This trip will be exciting and scary at the same time. After all, I’m traveling solo and independently, and I’m not completely fluent in the language. There will be no tour operator to help me negotiate tricky situations, but I think I can manage. I’m trying to find a really good travel phrasebook/translator for my iPhone (which I will have with me, but will *not* be using data roaming), which is proving to be trickier than I thought.

One way or another, things will work out. They usually do. Besides, if I didn’t open myself up to a few challenges here and there, life would be much less fun.

Fun with spam

I’m going through a tough time with work right now and need a little pick me up. I know it’s considered bad form to complain these days when one isn’t unemployed or underemployed, but I’m just not feeling the love for my work lately. (And by lately, I mean for the past year or two.)

So as I struggle to figure out what to do next to bring some more “rah rah” to my work day, I’m looking for a bit of humor wherever I can find it. The spam comments in WordPress are fitting the bill right now. Here are some of the more memorable bits that I’ve found.

I was even-handed wondering if anyone has buy Wow gold us fitting stratagies after getting gold… im dead tired of walking there ill-starred ;_;
Thanks seeking the pinch

Umm…what is even-handed wondering??? And just what is “the pinch” you’re seeking? (Probably best that I didn’t ask that, actually.)

I’d have to verify with you here. Which isn’t one thing I often do! I take pleasure in studying a post that will make folks think. Also, thanks for allowing me to remark!

Well, thanks! I think…I’d have to verify with you here. You know, just to be sure.

….Your understanding and kindness in playing with a lot of stuff was very helpful…

Whoa, there! I can’t recall posting anything about playing with a lot of stuff! That’s not usually my style on a public blog, after all. I’m much too demure for that.

————————-

It’s the terrible syntax that makes these comments really stand out as spam. (Well, and the return addresses for things like male sexual enhancements.) I work with people outside the U.S. all the time and find the little turns of a phrase or unique term used in place of common U.S. vernacular to be intriguing. Why do my colleagues in India “have doubts” when my colleagues in the U.S. “have questions?”

(Whatever issues I’m having with work these days isn’t a reflection on the people I work with, by the way. I love working with people all across the world, even if crossing the time zones makes for some nontraditional work hours.)

So, I’m going to giggle all I want when I check the comments on my dashboard and see these kooky statements. Everyone needs a little pick me up.

The blizzard post

Unless you’ve been out of the country over the past few days, you know that most of the U.S. experienced pretty severe weather recently. In Chicago we had the third worst blizzard ever (well, since weather records have been kept, at least).

View of blizzard in the morning

Morning of February 2, 2011

We get one of these big blizzards about every 10-15 years, so long time Chicagoans are prone to compare the blizzards and discuss how horrible they were. In Chicago, blizzards have had a huge impact on politics and elections so they are serious business. I’ve lived here most of my life so I have personal recollections of the blizzards of 1979 and 1999. (I was still in utero for the 1967 blizzard, the biggest of them all.)

What I remember most about 1979 was that the snow was up to my waist (of course, the height of my waist was a bit lower then it is now) and that we had a day or two off from school. There was some shoveling involved, but I don’t recall it being onerous. My dad was doing most of it, I’m sure. After that blizzard we bought a snowblower.

In 1999, I was scheduled to move from my apartment of the previous six years to a condo purchased by my husband and I. We had canceled our telephone service (and also our Internet service, since back then we had dial-up like most people…and were probably pretty lucky for having it in the first place), and had all of our possessions in boxes. We also had no fresh food in the fridge and minimal food provisions, in general. I think it’s obvious that our move was delayed. Luckily, I had some good neighbors in the apartment building who fed us and let us hang out with them in their much more hospitable apartment until the movers could get down our street.

For this blizzard, I was well prepared. I had plenty of provisions (even under normal circumstances, I have about a one month food supply on hand, it seems), two shovels, a new bag of ice melting compound, and a high speed Internet connection. My office closed early on Tuesday, but I had slipped out about an hour after the snow started and missed the big crush of commuters at the rail stations.

I actually worked through the beginning of the storm. I had to finish up something and deliver it to my boss, so I worked until about 8:30 pm. Then I sat back with some wine and enjoyed the social media blitz, monitoring the #snomg trend on Twitter. I experienced thundersnow for the first time. It was pretty fun, actually.

Shovel in the deep snow

The digging out begins

The next day when the snow stopped falling and the winds had died down (gusts were clocked at up to 70 mph in some areas) the clean up began. This is where neighbors helping each other becomes important. (Yes, its another instance where community has perks!) From my household, there were two folks with shovels: me and my roommate/tenant, Dave. We had to clear the following places of at least 20 inches of snow (more in some places because of drifting): front sidewalk, front steps, back steps, path to rear of yard (for trash removal), and driveway (so we could get the car out…not that it’s used every day, but it will be needed eventually).

It took us about 1.5 hours to do this. I had to go back inside to attend a conference call meeting (the office was still closed, but I still had to work *sigh*). About two hours later we got back out again because we realized we’d need to clear out a portion of the alley in order to get to the street with the car. At this time there are many others out clearing the sidewalks and digging out their cars before the sun sets.

People with shovels, snowblowers, and a frontend loader

The many ways to clean up after a blizzard

Another hour of shoveling goes by. Then a guy with a small front-end loader just shows up. Really. No one knows exactly why he was out there, but people started approaching him and offering cash for him to clear some the snow. A portion of our street was cleared, the parking lot of the neighboring condo building gets cleared, and part of the alley gets cleared, too. By the time he was done (at least $250 richer) those of us living on the east half of the block were able to access the main arterial street (which the city was keeping clear of snow as a priority).

I headed back into the house, shared with my roommate some of the beef stew I had started earlier, and had a bit more wine. Then I took a hot bath with lots of Epsom salts and went to bed.

Things could have been much worse. And the city really did a great job warning people and keeping the main streets clear, overall. We had power (and Internet!) throughout the entire storm and helped each other out. I got lots of exercise shoveling, and am only a bit sore. Not a bad experience, over all.

Car buried under lots of snow

Really, really buried

(If you’d like to view more photos, go to my Flickr album!)