Tag Archives: insurance

The post in which I don’t bitch about health insurance…

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I know the hip thing to do is bitch about health insurance and the American medical system on social media. There seems to be an entire cottage industry dedicated to telling us how awful everything this. My experience over the last year has been the polar opposite of the narrative I’ve seen being pushed across the internet. 

About a month ago, I got a notice that BlueCross didn’t want to pay for my 30-day heart monitor. Frankly, with the $10,000 bill associated with it, I didn’t exactly want to pay it either. But, as it was “not medically necessary,” according to their note, they weren’t going to pay. That’s despite two cardiologists deciding that that level of monitoring was, in fact, medically necessary. 

After several long conversation with me – and presumably even longer discussions with people representing the hospital system and the test provider, it looks like BlueCross ended up paying out about $3,000 as the “insurance rate.” I just paid $36 as my portion, and everyone now appears to be satisfied that they’ve done their due diligence and has gotten a fair shake. 

I honestly was expecting more of a fist fight on that. Who really knows? It may yet come back to rear its ugly head, but for now I’m considering it a win.

Look, I’ve learned a lot about health insurance in the last year. It’s not an ideal system. It requires you to keep a very close eye on your treatment plan and everyone involved in it. Even more so, it means staying on top of your insurance provider, knowing their terms of service and the ins and outs of your policy, and questioning everything that doesn’t pass the common sense test. That’s just the baseline starting point to participate in the system. I don’t know that it would be any less complex under single payer. Under any universe of care, I expect that I would want to be very aware of what was happening and the services that were being provided on my behalf. 

What Annoys Jeff this Week?

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1. The good idea fairy. The GIF is a pernicious feature of life in the bureaucracy. Its mission is to take projects or programs that are perfectly fine, even serviceable, and sprinkle them at the last possible minute with pixie dust and render them stupid, painful to execute, or optimally both. Having great ideas is fine, but when your idea of the week generates a minimum 80-hour per year manpower requirement when you’ve just lost one of three employees, it might not be a particularly good time to launch this new crusade. But hey, if the powers that be want me to spend my time following grown ass adults making sure they’ve cleaned up after themselves, I’ll do it all day long… but they shouldn’t be surprised when a whole laundry list of other “very important activities” just doesn’t get touched.

2. Data mining. My insurance company partnered with a company doing “free” A1C testing at home. Fine. I’ll share a bit of medical privacy for a free test. But dudes you’ve got to make it easy. I walk into the doctor’s office every six months (or more often lately), they jab my finger and my A1C number appears in my online patient portal before the doctor has even walked into the exam room. By contrast you gave me two columns of instructions that included “let the sample air dry for 3 hours before packaging” and then “it must be shipped the same day.” Either make it easy to go along with your data gathering scheme or bugger directly off.

3. Breakfast on office days. On days I’m stuck going into the office, I used to just swing through McDonald’s and grab an egg McMuffin. It was the definition of quick, easy, and simple. Now I’m making breakfast at home. It’s not that I don’t make a tasty breakfast so much as the process is a massive time suck. Instead of scarfing down my egg sandwich at my desk or in the car, I’ve got a full meal to prep and clean up before I’ve even left the house for the day. It’s reduced my morning reading time on office days to practically nothing. That makes it a pain in the ass with very little ROI besides a vague “healthiness” that doesn’t do much to improve my general mood in the mornings.

Diagnostic tests, doctor shopping, and medical snobbery…

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Since my original diagnosis of “probable SVT” way back in July took place under the umbrella of the ChristianaCare hospital system over in Delaware, my first appointment with cardiology was also made within their system. That was fine. Their main campus is reasonably well reviewed and I could get seen by a cardiology nurse practitioner in August, which I’ve found out through this process is a fast turnaround for a new cardiology patient who isn’t inactively laying in a hospital bed. 

In the intervening days and weeks, though, I had a follow up with my primary care doctor, who operates as part of the Johns Hopkins system. He was less enthused about my decision to use Christiana for my cardiology needs – explaining that their cardiology department, while fine, is “not ranked” whereas Hopkins cardiology is currently ranked 13th in the nation with the hospital consistently ranking very near the top of any list of “America’s best hospitals” that’s ever put together.

Yes, my primary care doctor is a medical snob.

Despite his cajoling, I kept my original appointment, which led through a series of tests and reports that I was going to need anyway. I also reached out to Hopkins Cardiology to get myself on their waiting list for new patients and ended up with an appointment scheduled deep into October. It wasn’t ideal, but since I was going through all the preliminary tests and could then hand over a pretty good sized file, the timing wasn’t a major issue for me. I was able to take advantage of their wait list option to get my first appointment in the books last week – with a guy who has been practicing for 40+ years and has the look and feel of someone who has seen just about everything. In other words, he’s exactly the guy I want even if all we’re doing at the moment is preventative and exploratory. 

With all other things being equal, if being able to access some of the best cardiologists in the country means driving 45 minutes west instead of 25 minutes east, ultimately it feels like not much of a decision at all. 

It turns out, like my primary care doctor, I too am a medical snob.

So, I’m going all in. My optometrist recently retired. Instead of going over to the doctor that took over his practice, I’ll let Hopkins run the show for my eyes too. I’ve got my first appointment set up with the closest branch of the Wilmer Eye Institute later this year. That puts all but one doc under a single banner… and when the time comes sometime in 2024, I’ll bring that one into the fold too.

All of these new faces on my medical team are a little further away than I’d like, but I feel like what I’ll lose in adding a few minutes of extra travel time, will pay me back in the convenience of having them all working under the same organization. I was woefully unprepared for the level of coordination I’d need to do myself when my primary care doc and everyone else had electronic records systems that refused to communicate with each other. 

I’m in no way fool enough to believe that being “nationally ranked” is any guarantee of better outcomes. For now, it appears that most of my problems are fairly benign, but should something become more involved or I develop a novel condition over time, I’m going to put my faith in the big name going forward. Hopefully they’re not just riding their 135-year-old reputation. 

Some people would take this opportunity to rail against the American healthcare system. Undoubtedly, it has challenges – but I’ve been absolutely amazed by the level of services and the array of options that have been presented to me over the last three months. Don’t think for a moment I’ve failed to realize my great good fortune to have both the geographic proximity to one of America’s great medical centers and an insurance plan that makes walking through their doors possible. There hasn’t been a day go past recently when it hasn’t been at the forefront of my thoughts.

I’m shocked that reporters try to sell panic…

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A certain segment of the media is busily peddling fear and angst about the banking sector. One headline asks, “Fed says don’t worry about banks, but why should anyone believe them?”

Well, mostly because the Fed is doing precisely what it’s supposed to do when a bank finds itself teetering on the edge of collapse. Most recently, with First Republic Bank being seized by regulators and mostly sold off to JPMorgan. Depositors – the mom and pop Mr. and Mrs. Mainstreet that reporters are so fond of citing – were protected up to their federally insured limit and FRB’s investors were left with their dicks in their hands. This morning, FRB’s branches opened as scheduled and depositors had full access to their funds. That the system is working as advertised is precisely why the vast majority of depositors shouldn’t be worried about their chosen bank.

I’m not entirely sure what else we should reasonably expect the Federal Reserve and the whole laundry list of financial regulators to do under the circumstances. Protecting depositors while allowing the market to punish corporate officers and investors feels like the right approach. That’s the “risk” part of the risk and reward dynamic of the market at work. 

By all means, improve the financial stress tests imposed on banks and change the rules to discourage managerial incompetence in the executive suite. Beyond that. I’m not sure what financial reporters are up to beyond trying to gin up panic and worry where none appears to be justified.

Slice and dice…

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Over the last three months or so, I’ve been spending time with a local dermatologist. Fortunately, he’s not treating me for anything traumatic or catching, but we’re working through a pretty large number of skin tags that have annoyed me for years, but that I’ve never had the time, inclination, or, frankly, the ready cash to do much about. BlueCross is very clear that it’s the kind of thing they consider cosmetic, so anything done along these lines has to be fully out of pocket.

I would tell you that I’m not vain, but that’s obviously not entirely true. I have plenty of vanities, they’re just generally not the physical kind. Whatever else it may be, I’ve long considered my body just the meat suit responsible for hauling my brain around from Point A to Point B. As long as it’s managing to get that job done, it’s good enough. These little tags we’re working on now were starting to be an issue even in my general disinterest. 

So, for the last three appointments, we’ve been trying to kill them with blistering cold. That has met with some limited success. Looking at the progress to date, the doc wasn’t happy – and in honesty nether was I. So, today was the last round of that approach. In three or four weeks, instead of the fancy cryo gun, we’ll be going with the more old-fashioned lidocaine and razor blade approach. As I understand it, where freezing is more akin to using a smart bomb, the razor is more like stepping up to wholesale carpet bombing.

Just now, well into this process, I’m willing increase the pain threshold in exchange for a shorter duration of effort. Sometime towards the end of June, I guess I’ll subject myself to a bit of slice and dice for purely cosmetic purposes. It turns out, my vanity isn’t as well controlled as I liked to imagine. 

What Annoys Jeff this Week?

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1. Rabbit holes. I’ve lived these last 43 years without ever needing much more than my regular checkups and copays. Despite that, I recently went down an internet rabbit hole reading about my insurance plan’s catastrophic health coverage and how to avoid out-of-network charges. I mean it’s nice to know and surely will come in useful someday, but there’s an hour or two of my week I’ll never get back.

2. Normal. Turn to any news provider and you’re bound to hear stories about “getting back to normal” or “the new normal” or “life after COIVD” or “life with COVID.” Most of those stories turn on the same general theme of wanting something analogous to pre-pandemic life to return as close to immediately as possible. Personally, I’m in no rush… although that could be because most of what I’ve enjoyed during the Great Plague are the same things I enjoyed doing back in the Before Times. The only significant change I’ll notice in getting to whatever “normal” looks like in the future will be inevitably spending more time commuting and sitting in a cubicle. If you’re waiting on me to do handsprings about that kind of normal, it’s like you don’t even know me.

3. Mud. I plant grass seed in the back yard every spring and fall. Jorah, on the other hand, spends all four seasons doing his best to turn everything inside the fence line into a sodden morass. It’s not entirely his fault. The soil is thin and surprisingly bad – mostly clay and rocky – so what grows there doesn’t grow thick. Being a deeply shaded area, at least a third of the green is moss rather than grass. The minute it’s disturbed, it opens a gash and mud ensues. I only bring it up because his favorite thing to do on rainy days is go every outside at full speed kicking up mud like some kind of teenaged bubba with a lifted F-150. That’s fine outside, I suppose, but it’s current on him, the floors, a couple of walls, and a bit of the ceiling from when he had a good shake. 

What Annoys Jeff this Week?

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1. Firewalls. I’m perfectly well aware of the need for network security. Keeping China out of our computer system is a worthy goal. That being said, it feels like there should be some kind of reasonable middle ground that would not also block me from accessing large swaths of the interwebs that I need to do my actual job. For the country that put a man on the moon using a ship with less computing horsepower than a TI graphing calculator, it really doesn’t feel like it should be that much of a stretch.

2. Risk mitigation. Hawaii is a beautiful part of the world. I was lucky early in my career to have everyone pay for me to spend a fair amount of time out there. After reading all the news reports of homes being destroyed and residents being left penniless because their property wasn’t insured, all I can do is shake my head and wonder what the fuck they were thinking. It’s very clear from the first time you fly into the airport on the Big Island that you are treading on the upper reaches of a volcano – one that you know is active because it’s been spewing lava into the ocean for a couple of decades now. Building or buying a house sitting on top of an active volcano and then opting not to hedge your bet, feels awfully foolish. When I lived deep in the heart of the New Madrid Seismic Zone the likelihood of the house falling down on my head was small, but the severity if it did happen was catastrophic. You can bet your last puka bead that I threw down the extra scratch to tack on an earthquake rider to my policy. I’m not saying I don’t feel bad for the people who gabled and lost, but living in paradise doesn’t negate the need cover your own ass.

3. Death to America. I don’t agree with every policy position set out by the Trump Administration. Not by a long shot. However, when the religio-extremists governing Iran are sending their people into the streets to chant “death to America,” I’ve always thought there’s a good chance we’re doing something right.

New drugs…

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One of the many exciting parts of my recent run of days off was a visit with my frighteningly Teutonic primary care doctor. I actually like the guy – Not just because he’s instrumental in keeping me alive despite my best efforts to the contrary, but also because he’s not a pushover. I’ve had docs in the past who were probably a bit too willing to give way in the face of a strong personality. This guy, well, he’s not a pushover. Even when I’m blatantly ignoring his advice, I appreciate his frank and direct approach.

This most recent visit resulted in a few tweaks to the daily chemical cocktail that’s doing its best to keep me from dropping dead. Although I’m feeling fine, we added a fairly new drug to the mix because some of the underlying numbers were starting to creep off target. Yeah, it’s another hundred bucks a month out of pocket, but when weighed against the previously mentioned dropping dead option, I suppose it’s really a bargain.

As a responsible drug user, I try to be at least minimally informed about what I’m swallowing down with my morning coffee. Reading the list of potential side effects checked off most of the usual unpleasant check boxes: May cause runny or stuffy nose, sore throat, headache, irritability, back pain, joint or muscle pain, nausea, stomach pain, or diarrhea. Basically what the helpful information packet told me is that the side effects are a subset of conditions I already expect to experience on a regular basis. Super.

Better living through chemistry, indeed.

Magnetic…

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From the time I got my license in June 1994 until October 2011, the only accidental damage I ever had to a vehicle was the occasional cracked windshield. Admittedly, the Jeep’s flat glass seemed to have an unnatural attraction to rocks kicked up at highway speed, but still that was just the cost of doing business. Since October 2011, the tide has turned. I can’t unnamedseem to go six months without the telltale screech of rending sheet metal. A parking meter jumped out and tagged my left turn signal, a crease appeared in my rear bumper shortly thereafter for reason or reasons unknown, an old man in an F-150 faked me out with his turn signal and cost me a new front end, and today I’ve got a softball sized dent on the left bedside from an unfortunate run in with the grill and hood of a Chevy.

Big Red is a trooper, though. Dents, dings, a new front end and she just keeps doing her thing. Now we’re off tomorrow morning to the body shop for the latest repair estimate. Given the relatively recent completion of my new front end, I’m trying to keep this one off the books at the insurance company. Unfortunately I can already hear my credit card screaming in protest. 2013 was basically punctuated by one headache after another. It’s becoming more obvious by the day that 2014 isn’t going to offer much in the way of relief, but just more of the same.

I love my Tundra, but she’s a rolling accident magnet… and if she wasn’t so damned close to being paid off, I’d think hard about trading her in on something that might not have so much bad mojo attached.

What Annoys Jeff this Week? (The Centennial Edition)

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Good evening ladies and gentlemen and welcome to the 100th installment of What Annoys Jeff this Week. With nearly two years of weekly annoyances under my belt, the only thing I can say from the writer’s perspective is that despite living in a universe that seems personally intent on agitating the shit out of me, I always look forward to Thursdays. They’re the day I get to compact many of the small issues into one great big ball of pissed off and launch it out into the world. It may not be classy, but it’s cathartic.

I thought about working up something special for this auspicious occasion, but decided quickly that the best tribute would be letting it out the same way I do every Thursday – a simple list and brief description of the week’s three most pressing annoyances.

1. Technology. Honestly, I don’t know who I would be if I weren’t wrapped in the warm electromagnetic cocoon of modern technology. That’s also the problem. In a week that’s been a near constant battle with my laptop, with my wireless router, and my internet provider just to stay connected, I wonder if perhaps I’ve put a bit too much reliance on the network. Yeah, that’s really not so much a question as a statement of fact. Still, I’m pretty sure what I’m really looking for is a system that works flawlessly all the time and not a way to disengage myself from it… because the only thing more annoying than having every bite of universal data at your fingertips is not having it when you want it. Stupid double edged sword.

2. Insurance. I got a notice this week that my prescription drug plan cost is going up about $40 a month. The cost of my general insurance plan is jumping this year too, but that’s not what annoys me, really. After all, the insurance premiums and out of pocket costs are basically just the price I pay to avoid being dead. As far as I’m concerned, not being dead is basically worth every penny I need to pay. Quite frankly, I don’t want healthcare in the country to be “average”. I want to nation’s best hospitals and corporations to dump money hand over fist into developing innovative treatments and medical equipment. Like it or not, 300+ million people can’t all get the best care on the planet, but over time the ideas they pioneer at the best hospitals can develop into common practice across the country. That’s good for everyone. Until then, if I want to drive myself eyeball deep into debt to get treatment at Hopkins, Sloan-Kettering, or the Mayo Clinic, that’s my decision because at least for now I’m the one paying the bill. When someone else foots the bill and tries to be all things to all people, we inevitably end up with a mediocre “standard level of service,” and I like being alive entirely too much to let any government entity of company decide what treatment checks off the box that says “good enough.”

3. Chicks. Don’t get me wrong, I have nothing but love for you ladies out there. You’re soft and curvy and smell nice. I love the way you walk and the way you talk… but after 35 years I still have no ability to understand the way you think. Although I am an accomplished man with many skills and talents, the ability to read minds is one that, thus far, I haven’t mastered. I’ll keep working on it, but in the meantime I’d consider it a personal favor if you could just go ahead and tell me what’s on your mind rather than letting me speculate wildly on my own. Trust me, left to my own devices my mind can conjure notions that are generously described as “bleak.” And that tends to be a situation other than good for everyone involved.