Tag: insurance

The Modern Diagnosis

Steffie had a pretty bad allergic reaction this weekend. It wasn’t fun for her, or for us. Your child can grow up – but she’s still your child.

As the week went on, the allergic reaction went away. That’s good.

Our family physician said Steffie should see an allergist. I called the to make an appointment with the allergist I see… or anyone in his practice. June – the earliest available appointment is June!

Popular folks these allergists.

I wasn’t sure what to do, so I sent my allergist an email, with a photo of Steffie taken while she was in the midst of the reaction. He took a look and wrote back.

His response suggested what we were already doing was right, and it wouldn’t be necessary to see him until or unless there were more problems.

I’m glad he wrote back, but this is a hell of an imposition on my part, isn’t it? Maybe it’s time to acknowledge the new era and have our insurance companies (or, shudder, me the patient) pay for this service.

As far as I can tell, when my internist or allergist gives me advice from his keyboard, he’s doing this out of the goodness of his heart – literally giving away the work he usually charges for.

My guess is, in some cases, Internet consultation is a good thing. From an insurance standpoint, isn’t this a chance to purchase a more cost effective service for their customers? Shouldn’t the physician be compensated to encourage this?

I am not a doctor (nor do I play one on television&#185). I’m sure those I know will tell me if I’m off base here.

&#185 – That line, “I’m not a doctor, but I play one on television,” was actually used in a TV commercial about 40 years ago.

Blogger’s addendum: And, my primary physician did respond:

If there were something that were more than 100%, I’d agree with you that much. Does the accountant or lawyer or guy at the gas pump EVER give it away for free? I think that our ethic and culture is different, though. Medicine is rightly called a “caring profession.” and when we care, we really do care. So we do it, without listening for the sound of the cash register ringing.

And don’t hold your breath waiting to hear that Aetna or Anthem or, God forbid, Medicare will ever pay me or your allergist for giving you email or even telephone advice. Not in my lifetime, and I plan to torture all of you for many years to come.

Akron’s Fine For Speeding

It looks like Akron, Ohio has put in automated speed enforcement equipment. Hey, this stuff works like crazy!

Here’s part of what Akron and the vendor said as the program began:

William B. Danzell, Chairman of Nestor traffic systems, stated, “We are excited to partner with the City of Akron on such an important safety initiative. We believe that the unique ability of PoliscanSpeed to capture violations on limited sight roads makes it the most effective system for Akron’s automated enforcement program. This technology, coupled with our turnkey processing services will allow the City to provide consistent enforcement without burdening City resources.”

Strongly supporting Akron’s implementation of the Automated Mobile Speed Enforcement System, Mayor Donald Plusquellic quoted, “Nestor’s PoliscanSpeed System is another tool that we can use to let our community know that speed limits will be enforced and that we are serious about ensuring safety in our neighborhoods.”

And here’s the proof in the numbers from the Akron Beacon Journal:

Here’s a look at the first 19 days of work, all weekdays, for the automated speeding ticket machines:

Total drivers fined: 2,676

Amount of fines: $451,500

Amount vendor to receive ($19 each): $50,844

Remainder to city: $400,656

The worst offender was going 29 mph over the limit (54 in a 25 mph zone).

Forty percent of those fined $150 were going 10 mph or less over the posted limit.

More than half of the violations were in 25 mph zones, with the average violator going 37 mph.

The Copley Road area near Erie Island Elementary School yielded the most fines, followed by the 400 block of Darrow Road near Betty Jane Elementary School.

In many cases, the cameras wrote more than a ticket a minute. On Nov. 7 at Copley Road, a camera ticketed five people at 3:16 p.m., then caught seven more at 3:51 p.m.

It’s no secret, if you scrupulously enforce traffic laws, you will find violators. There’s one highway I take home from work every night where I’ve exceeded the speed limit by a factor or two or more! I’m sure I’m above the limit more than I’m below it. Who isn’t?

Maybe I’m going too fast, by a little. Definitely, the posted limits are too low by a lot.

I’ve never quite understood how speed limits are derived, but they’ve never made sense. As I exit a two lane divided highway with broad shoulders, its speed limit is lower than the city street with no shoulders I’m entering.

Is speed enforcement a matter of safety or income? I would hope it’s the former. It’s extremely tempting to make it the latter. Look at the incentive for Akron. Look at the incentive for the vendor.

Of course a speeding ticket (or any moving violation) has secondary implications. Your insurance company knows and you’re likely to see them extract an additional premium on your policy.

If we’re going to have this more stringent enforcement policy, isn’t it time to revisit the speed limits themselves? If they are too low or unrealistic, do they become a form of entrapment – enticing me to break the law?

The Meisels Go Home To New Orleans

Back when Hurricane Katrina was threatening the Gulf Coast, I did my best to get Ruth Meisel out. The day she drove to safety up north was the last time she saw her home, until yesterday.

With her two adult children in tow, Ruth Meisel returned to New Orleans to see what could be salvaged and tie up loose ends. She will be among the tens, maybe hundreds of thousands, who will leave their homes and move elsewhere.

New Orleans is being abandoned, wholesale.

I asked her son, my friend, Farrell to type some of his thoughts so I could put them here in the blog. I’ll sprinkle a few of his photos here, though the best way to see them is in this slideshow.

Clean up goes on. 80% of the city was affected. Some parts of the city have begun to function, albeit at half speed. This area is still without electricity and is deemed unsafe. It’s expected that electricity won’t be restored in New Orleans East for six to nine months. My mother returned for the first time since the hurricane and subsequent floods, to survey the damage and see if anything could be saved. She’s suited up and ready to go inside. In the background, my sister, Cheri, ready to suit up, as well.

It’s nice… no, it’s amazing to see Ruth smiling.

Here’s my read. She could be distressed with what she’s about to see, or she could be happy to see she raised her children right, and they are accompanying and supporting her. She chose the latter.

My mother knew from earlier reports and a prior visit by my sister, that things didn’t look so good. She’s been very optimistic and hopeful, looking forward and giving us much encouragement. My mother’s house survived the storm on the outside, but the inside looked and smelled awful and was a total disaster. Entering the front door we were greeted by a living room chair that wasn’t there when my mother left in August. That gives you an idea of how we were greeted.

From the marks on the wall it looks like 4-5 feet of water made it into the house. From the ‘bunny suits’ the Meisel’s wore, you can assume it wasn’t spring water.

Nearly everything was ruined.

One of the things that struck Farrell when we spoke on the phone was the proliferation of signs advertising Katrina related services. There are also markings, scrawled on homes with spray paint.

This house has been FEMA’d. FEMA is not an acronym here. It’s a four-letter word. BTW, so is Bush.
One of the city’s synagogues, Beth Israel, an Orthodox house of worship…Also one of the city’s oldest, which used to be in the historic uptown area until the late 1960s. Also on Canal Blvd, note the watermarks. Reportedly, the head Rabbi fled town, leaving the Torah scrolls to flood and be rescued from religious volunteers. The Rabbi has since been fired. My sister spotted prayer books and prayer shawls on the ground in front of the now-deserted synagogue….a sin in the Jewish religion.

Here’s how Farrell ended his note, and I’ll leave it pretty much intact:

As I visit here, for the first time in several years, 3 months after the devastation that has been chronicled worldwide, I have now discovered: A Missing City. Parts of the city and neighboring parish (Jefferson) we have seen are beginning to function, but it’s slow and without spirit.

In our many conversations with New Orleanians and Jeffersonians, one hears a great deal of anger leveled at Government. I could only find one person with a nice thing to say about President Bush. I asked why? The waitress at the seafood restaurant said it was the Louisiana Governor’s fault for not letting Bush send FEMA and the troops in. I then asked, out of curiosity, did she know that Bush was on a fundraising trip in California for three days before he did a “fly-over”, VP Cheney was buying a vacation house and the Secretary of State was shopping in Manhattan, while her home state, Alabama, was flooded. The waitress hadn’t heard that.

A newspaper stand owner or manager clearly vented his anger towards Bush, but didn’t spare either the local, regional and state governments, but felt, the US Government let Louisiana down.

Most of the Greater New Orleans area, (Orleans and neighboring parishes), as it’s known, with some 1 million people once living there, don’t have electricity, a home, assistance from FEMA, insurance companies, and they feel forgotten just three months after the hurricane and floods.. As is the case with crises the world over, once the cameras leave, the sense of urgency goes with the camera crews.

The stores and shops that are open are operating for limited hours due to two factors: limited shoppers and limited staff.

It’s quite unusual to be driving in one part of the area, say neighboring Metairie, where the shops and malls have reopened, only to continue on Interstate 10 to downtown New Orleans, and pass through darkness because whole areas have no power.

There were some signs of life downtown and in the French Quarter. The beautiful St. Charles Avenue historic areas seemed to be untouched and lit, yet, just a few blocks away, one would have thought we could have been in a war zone.

Rumors of price gouging exist. Household stores are reportedly charging double for goods consumers can buy in the middle of the state or in Mississippi for less. Gasoline is 30 cents a gallon more expensive than in the center of Mississippi or Louisiana reportedly.

Residents feel abandoned now. From the newspaper shop owner to restaurateur, residents don’t feel the city of N.O. census will approach even half of it’s close to 461,000 registered residents.

Employers are looking for employees. Potential employees are looking for housing, assistance from FEMA and the insurance companies, and those are the few, who have returned.

The Times-Picayune reported today that the New Orleans Mayor, Ray Nagin, rumored to be in Washington on business, actually wasn’t there on business, but took his family on vacation to Jamaica. While I’m sure he’s deserving of a break, there are several hundred thousand to one million people, who’d love to take that break, if only they could get some help from the various government agencies so they could get on with their lives and rebuild. And I haven’t even begun to discuss the levee system.

As I write this at 2am Central Standard Time, I was trying to think, after only two days here, how could I best describe what I have seen and heard? The word that comes to mind is “abyss.”

New Orleans, which had once been described as the “city that care forgot,” from an old Mardi Gras tale, has become the bottomless gulf or pit. There are only a handful of truly unique cities in the U.S. with some history and character. When tourists think of those cities, New Orleans had always been in the same company with San Francisco, Boston, New York, Savannah, and perhaps one or two other cities or towns.

It would not be an exaggeration to suggest, if there is no sense of urgency, New Orleans could drop off that list in my lifetime.

Please, look at the pictures. It is so sad… so tragic.

I’m More Pessimistic About Hurricanes

Recently I was interviewed for an article in Business New Haven concerning hurricanes. I’ve linked to the text.

Over time I’ve become more pessimistic of what might happen in a repeat of the hurricane of ’38 scenario for Connecticut. There would be little time for warning and difficulty explaining where the damage might occur.

Even in 2005, a tragedy seems unavoidable. That’s not what I want to say, but it is a realistic expectation.

I’m glad to see, though Dr. Mel Goldstein and I were interviewed separately (I didn’t even know he had been interviewed), we are in agreement with our concern.

Unlike Katrina where good advice was ignored, I’m not sure what we could do today to help prepare us for a hurricane approaching us at 60 mph. The entire East Coast would need warning. What good would that do?

Continue reading “I’m More Pessimistic About Hurricanes”

Managed Care Hell

I take Lipitor for my cholesterol. Since I have been taking it (and before Lipitor, Baycol) I have had to have a blood test every six months or so. It seems these good drugs can also ruin your liver.

For the longest time I have gone to a small lab which is on my way to work. The people there are nice. They know I am petrified. They try to be gentle.

You would think after years of being stabbed and having a small vial or two of blood drawn, I’d be used to it. I am not.

Within the past year or so, our insurance coverage vis-a-vis the labs has changed. Now I have to go elsewhere if I want any coverage – and even the coverage I have doesn’t kick in until I’ve spent $250 in a year.

But where to go?

I couldn’t find the providers on the insurance company’s website, so I called and was walked through by their customer service person. Voil

Glasses – Can’t Live Without Them

Good grief. My recent experience with eyeglasses hasn’t gotten any better!

Earlier I had written about how a high price from our insurance company’s preferred provider sent me packing, across the street. Today, I got the lenses they made.

They’re awful! Worse than the glasses I wanted to replace.

I believe the probem is not in this second shop – these people have been great, and I might as well mention their name because I have nothing bad to say about them: OptiCare.

When the optician took a look at my old lenses, then the prescription, and then the new lenses, he realized the optometrist at the first place had prescribed reading glasses weaker than what I was replacing! As much as I’d like it to be true, at age 53 my eyes are getting worse, not better.

I drove to work, sat at my computer and knew it was going to be very difficult to read the screen. A quick call to OptiCare has gotten me an appointment for tomorrow morning with their optometrist and the promise of my old, pitted, scratched lenses back in this frame for another week or so. Then, hopefully, a better prescription so I can see clearly.

It’s always something.

The Quandary of Eyewear

As a kid, waiting at the bus stop on Horace Harding Boulevard for the Q-17 to Downtown Flushing, I could read the destination sign and know which bus it actually was, while it was blocks away. My eyes were good.

I got my first reading glasses about 10 years ago, and have now moved to bifocals (progressive, for vanity’s sake). As time has gone by, the reading prescription has gotten a little stronger. It’s a vicious cycle.

Those few times when I can’t wear glasses – trying to see whether it’s conditioner or shampoo in the shower – I am helpless. Words which were once clear are now smudges.

Two years ago, again for vanity’s sake, I tried bifocal contact lenses. Despite what is advertised, there is no such thing. Or, maybe there are contact bifocals. They just don’t work!

I went through four or five different pairs. Sometimes my sight was sharp up close and fuzzy far. At other times it was the complete opposite. At no time could I see anywhere near as well as I see with glasses. It was a compromise beyond what I was willing to make.

The whole idea of contact lens bifocals seems like science fiction. With glasses, your eyes move, the glasses sit still, and so you look through a different area with a different prescription. With contacts, as your eye moves, so do the lenses. How could you be looking through different prescriptions?

The last time I had a new prescription for my eyes was when I tried the contacts two years ago. Over the past few months, the glare and/or scratch resistant coating on my glasses had started to discolor and spot. And, my eyes have continued to weaken. Time for new glasses.

We have eye care insurance at work, and so I made an appointment with the national chain our plan suggests and headed over. The exam was fine.

Well, it was fine for an eye exam. Is there anyone who really knows if they’re giving the right answer when the optometrist says, “Which is sharper, this… or this?”

And then there’s the point when a puff of air is blown into your eyes!

After the exam, I headed over to the table where you actually buy your glasses. How can eyeglass frames cost more than a computer motherboard… or DVD-RW? This must be the highest markup business known to man. And the screws still come out from time-to-time.

With two years of good wear, and a look I like, I decided to keep these old frames and just replace the lenses. That’s progressive bifocals with scratch resistant and anti-glare coating – no frames. Want to take a guess?

It was around $400! And, I have insurance. This was after the insurance. I was incensed, stood up, and walked out.

At the time, I didn’t know if that was the right or wrong move, but, I felt it was ridiculous to pay that much for something that is, after all, a commodity. The glasses at any two shops should be exactly the same if they’re made to fill a prescription.

Directly across the street was another chain eyeglass place. I walked in. Another guess?

Same job, $277. And, my insurance doesn’t even come into play. Even the $277 seems high, but considering the first number I ordered them on the spot.

With all this behind me, I sent an email to the benefits director at our company. He handles insurance for the hundreds of employees at our many stations. My point to him was, what’s the use of the company paying if no one is getting a benefit we couldn’t get without the insurance? It’s not the company’s fault. They think they’re giving a benefit to their employees. And he agreed.

He called his contact from our insurance company, who said something didn’t seem quite right. And that’s where I left it.

This story’s not over yet.

Drugs

A year or so ago, one day without warning, my upper lip swelled to about the size of my thumb. It wasn’t pretty. Though I wasn’t in pain, I couldn’t work because I was scary looking (I thought about posting a photo I took at the time, but it really is gross).

From that time on, I started having episodes where my toes or fingers or lips would swell. If things weren’t swelling, they were itching, like my palms or the soles of my feet.

It wasn’t hurting me, but the swelling would come on without warning and be a distraction. And, of course, I was worried about the unknown. What was in me causing this?

I saw my family physician (I do tech support on his computers, he does tech support on me) who had me take a small battery of tests (probably an AAA battery) only to find nothing.

Then I went to visit the chief allergy guy at Yale/New Haven Hospital. He too could find nothing. But, he was confident, without even knowing what was wrong, that I could be treated. Not only that, he didn’t think we’d ever know what was wrong! But, it made no difference because we’d control it.

There is a great leap of faith necessary to accept a diagnosis like this… and I leapt.

He was right. I started a daily Zyrtec pill and the problems went away. Zyrtec isn’t the most expensive drug you can buy, but it’s not cheap either. My insurance company was paying a large part of the bill and my cost was $60 for 3 months.

Then Claritin left the world of prescription drugs and insurance companies started licking their lips.

With Claritin available over-the-counter, my insurance company decided to remove all the drugs like it from their formulary. Not only wasn’t Zyrtec covered anymore, neither was any generic or proprietary drug in its family. My costs were about to skyrocket.

When I last saw the allergist, I asked if there was anything cheaper to take. There was, and tonight, I got the $7 antihistimine. The pharmacist gave me a stern look and said this was an “old” drug. Though I was taking a small dose, it was powerful. Maybe I should take it at bed instead of with dinner. I might get sleepy.

Now I’m scared.

I told Helaine and she said I was crazy. Why would I let money stop me from taking something that has been incredibly effective? And, as always, she’s right.

If they don’t work, or if they knock me for a loop, I’m only a day away from changing prescriptions again. And now, my insurance company gets added to the ‘do not like’ list.