On Buying Health Insurance

There are more choices than there are distinctions. It’s impossible to see what’s different between various policies without being a statistician and actuary. I’m pretty math savvy and my head is swimming!

In the past we depended on insurance to help beginning with dollar one. Now, I’m wondering how important ‘dollar one’ really is.

obamacareSince I left FoxCT I have been insured through COBRA, the Consolidated Omnibus Budget Reconciliation Act. All that means is no employer subsidy. I’m paying 100%.

Insurance is expensive. You probably already knew that.

Eighteen months have passed. I’m forced to get coverage on my own. This is among the most confusing things I’ve ever done!

First the good news. Under the Affordable Care Act, aka Obamacare, I can buy insurance! How that would have worked out before, considering my back surgery two summers ago and my age? All I know is, I’m insurable.

My beef with Obamacare is it doesn’t go far enough. Why do we bother with private insurance? Why must we confuse everyone? The rest of the world seems to prefer a single payer system. Seniors seem happy with Medicare.

There are too many choices.

Let me refine that. There are more choices than there are distinctions. It’s impossible to see what’s different between various policies without being a statistician or actuary. I’m pretty math savvy and my head is swimming!

In the past we depended on insurance to help beginning with dollar one. Now, I’m wondering how important ‘dollar one’ really is. Are we better off ‘self insuring’ for common medical problems and letting insurance kick in at big dollar amounts? How much out-of-pocket can I take?

Within the next day or two we will reach a decision. I wish it was a more educated decision.

How To Get Connecticut Snowfall Totals

Doppler Versus Snow

This time of year there’s a steady barrage of incoming messages looking for Connecticut snowfall totals. Some folks are curious. Others want to make sure their plow contractor isn’t overcharging, or they’re plow contractors who’d like to charge more!

The info isn’t easily obtained, especially for smaller towns. If you’re looking for Connecticut snowfall totals, here’s where I go.

The most complete source is the Connecticut Department of Transportation Weather Roundup. These are collected every two hours at DOT yards across Connecticut. Because of the methodology used the cumulative snowfall total is always more than what’s actually settled on the ground.

The National Weather Service splits Connecticut between three Weather Service Forecast Offices. That makes things more difficult. You’ll have to look at all three Public Information Statements to put the info together.

Shoreline counties: National Weather Service Forecast Office, Upton, NY.

Hartford, Tolland and Windham Counties: National Weather Service Forecast Office, Taunton, MA.

Litchfield County: National Weather Service Forecast Office, Albany, NY.

Snowfall and other weather data is often critical in accidents and contract disputes. For those more exacting cases when just numbers on paper (or a screen) aren’t enough I provide forensic meteorological services for attorneys and insurance companies.

Back To Work

I’ve had two epidurals, an MRI, countless x-rays, blood tests, EKGs a few days in the hospital and full fledged back surgery. My insurance policy has a maximum yearly out-of-pocket which I’ll surely reach.

Since August 16 I haven’t worn real shoes. Until this past Friday I hadn’t even driven a car.

I return to work Monday. It’s my first time on-the-job since Thursday, August 16. That’s 53 days spent mostly on my side and definitely off my feet!

I’ve had two epidurals, an MRI, countless x-rays, blood tests, EKGs a few days in the hospital and full fledged back surgery.

My insurance policy has a maximum yearly out-of-pocket which I’ll surely reach.

Since August 16 I haven’t worn real shoes. Until this past Friday I hadn’t even driven a car.

Helaine and I began walking Friday. There’s very little discomfort, but also diminished stamina. That’s to be expected. Walking will begin my physical comeback.

My sleeping schedule has been wildly erratic. I went to bed early (for me) last night–around 4:00 AM. Even though I slept nearly nine hours I still took a nap before dinner. In that regard I’m spoiled.

Is there a way to do that at work? Probably not.

I’ve already written and recorded the audio track for tomorrow’s science story on MRIs! Report what you know, right?

My plan is to get to work a little early tomorrow. There are people to see and forms to deliver. I have learned extended time away is loaded with paperwork!

I also understand Short Term Disability. I’ve seen it on my check for decades. Until now I had no clue exactly what it was.

Helaine has baked! Just like my first day at FoxCT/Hartford Courant, my first day back brings chocolate chip cookies for my co-workers.

I’m not supposed to lift. Hopefully I can find someone who will help me carry my load from the car. Extra cookies for whoever does!

Today’s Word: Subrogation

If you’re insured it’s a cost without a benefit.

For those wondering, I’m not cured yet. I am still hobbled by pain in my leg caused by a pinched nerve. It is being pinched by a herniated disk.

Sounds (and is) complex!

The busted parts are in my back. The pain is in my leg. I’m still having difficulty coming to grips with that.

I’ve seen three doctors, had an X-ray and an MRI. I’ve also had two epidurals–all the fun getting an injection in your spine should be!

My journey has not ended.

The medical bills have started to dribble in. I will have a significant responsibility just with my co-pays and deductibles.

Without insurance… well I just can’t imagine.

I am appreciative of my employer’s insurance plan, but this is just one more reason we need a national single payer insurance system&#185.

Costs from an illness like mine can easily grow beyond anyone’s ability to pay. How many thousands of dollars have you put away for a random rainy day? I am thankful this will not be my problem, but I get it.

My main concern is getting better. As I’ve discovered, pain is no fun.

I am hoping my insurance company wants me well too, but I know that’s not their only concern. For instance it would be great for them if they didn’t have to pay my claim. That’s the reason for the letter I got today.

The letter has my insurance company’s name and logo on the top. They didn’t send it. It comes from “a leading independent provider of outsourced insurance subrogation, claims recovery and cost containment solutions for the healthcare payor and property and casualty industries.”

“Subrogation,” that’s the operative word. Subrogation means my insurance company would like to find someone else responsible for paying my bill. If my pain was caused by an auto injury or some on-the-job accident the cost wouldn’t be their responsibility.

I cannot blame insurance companies for exploring this option. No one… no company wants to pay a cent more than they owe! Mitt Romney’s, “I pay all the taxes owed. And not a penny more,” works here too.

Here’s the problem, subrogation isn’t free. Sure individual insurance companies will save money on individual claims, but subrogation itself costs. Subrogation doesn’t reduce how much money is paid, only who pays it. It could save my insurance companies money.

Oh, cmon, who’s kidding whom? My boss and I pay for subrogation. It’s part of my insurance bill and it provides no coverage or care.

If you’re insured it’s a cost without a benefit.

I called the subrogation company tonight. “Unusually high call volume,” so I tried their website. I went back to the phone after I realized all the options on their webform were aimed at finding my pain was caused by an accident or injury someone else could pay for. The questions were written in a way that made it difficult for me to answer honestly.

My phone call lasted under five minutes. Case for subrogation closed.

I wish the woman on the other side would have said, “I hope you feel better,” as we parted. It isn’t part of her concern.

I’ve come to the conclusion most people opposing single payer healthcare have had little interaction with today’s for profit system. If we had national healthcare this defensive cost would disappear and the money could be spent on getting people well… or lower premiums.

&#185 – Go ahead, call it socialized medicine. That’s fine with me.

My Thoughts While Filling Out Insurance Forms

As I considered my future and the thought of taking a chance and starting a business my thoughts kept coming back to insurance.

My unemployment didn’t last that long. Though I didn’t work for three months I was still paid for two. Not too awful. I spent a lot of time on my butt on the sofa thinking about my future and what I wanted to do.

One suspicion I had before unemployment was reinforced during it. It concerns insurance.

I was thinking about this because I spent a great part of last night and this morning filling out insurance forms online. As a new employee I qualify as of May 1.

I know this is a controversial subject. People are worried about “Death Panels” and government mandated care. Can we divorce this post from that for a moment?

As I considered my future and the thought of taking a chance and starting a business my thoughts kept coming back to insurance. Without it everything I own would be at stake. I’m not talking about luxuries. Everything is at stake! Get sick, get wiped out.

Doesn’t that make starting a business too much of a risk for anyone with a family?

Without insurance starting a business is daunting! Not just for a start-up either. A close relative once told me she feared moving her small business out-of-state because she might not be able to obtain insurance after the move.

If we’re a nation that values entrepreneurs and small businesses doesn’t universal healthcare insurance encourage that?

Phone Heaven/Phone Hell

I knew I was in trouble when the voice prompt asked if I wanted more information about my prescription. “No, said I. The disembodied computer voice told me anyway!

A few weeks ago I wrote about my trouble getting Stef’s Connecticut registration properly off-the-books. After a little phone tree hell I spoke with Jackie–my guardian angel at the DMV. Today I met her equally angelic co-worker Ann.

As it turns out there was still paperwork to be processed and a few hoops to jump before we could be straightened out.

“Don’t worry,” said Ann.

You know what? I won’t!

For my end of the deal I cajoled Stef to take a photo of her current insurance card and email it to me. I then forwarded the photo to Ann.

I so want this journey to be over, but this is the DMV. Its evil might be more powerful than the combined goodness of Jackie and Ann.

As long as I was trying my luck on the phone I rang up my insurance company to renew a prescription. They make it cheaper to get the drugs by mail but then make you jump through hoops!

Insurance companies and other users of voice driven systems try their best to reduce their employees time on the phone. Unfortunately, they are free and easy with mine. It’s almost as though they don’t care.

OK–not almost. They really don’t care about my time. Do they?

I knew I was in trouble when the voice prompt asked if I wanted more information about my prescription. “No,” said I. The disembodied computer voice told me anyway!

After any yes/no question was answered by me the automated voice waited three or four seconds before giving an acknowledgment. It was a demeaning experience. Truth is we’ve democratized this type of experience to the point where everyone is uniformly treated like crap!

The low point came when my order had been entered. I was told my cost would be $70. The voice then asked if I still wanted to get the prescription filled!

If you want to know what’s wrong with our insurance system there’s a perfect example. No one should ever have to answer that question. No one should deprive themselves of needed medication because it’s expensive. I can afford the drugs, but I’m sure people hear that $70 prompt every day and are forced to say “No.”

In the end every part of my prescription experience was cold, uninviting and devoid of human compassion. Maybe the idea of the insurance company is to discourage me from spending their money. Ya’ think?

If Ann and Jackie could handle all my calls for help the world would be a much better place!

Dental Denial

Forget political policies and promises for a moment. Forget who you supported on the issues. The Swift Boaters managed to convince a significant percentage of Americans John Kerry, a certified war hero, was a coward and George Bush who flew a totally undistinguished and suspect career in the Texas Air National Guard was Rambo!

I’ve been thinking about insurance a lot recently–especially since I got a denial this morning for some dental coverage.

Routine dental exams are covered. Going in an emergency is not… at least it’s not covered when coded as it was for me.

I tried to ask the insurance company’s CSR how it could have been coded to be covered? Seriously, what was I thinking? They are not giving out maps on how to collect. Their job is to pay less, not more.

I’ve asked someone from my company to help and they’re usually very good about this. I suspect at some point the bill will be paid as a covered claim, though there is no guarantee.

Of course this has me thinking more-and-more about the whole national healthcare tumult going on in Washington and at town halls everywhere. There is a huge amount of vitriol and disinformation being spewed.

Here’s why: It works!

As it is in election politics, Swift Boating is an effective method of turning public opinion and convincing people to support policies which are totally against their best interest! Look how effective Swift Boating was against John Kerry.

Forget political policies and promises for a moment. Forget who you supported on the issues. The Swift Boaters managed to convince a significant percentage of Americans John Kerry, a certified war hero, was a coward and George Bush who flew a totally undistinguished and suspect career in the Texas Air National Guard was Rambo!

The healthcare debate is being Swift Boated quite effectively. People are being convinced good is bad, right is wrong. As long as this tactic works (it is totally dependent on convincing the naive whose votes count one-for-one with the informed) it will be used again-and-again.

You may ask, have the perpetrators of Swift Boating no shame? No, they do not. Individual facts are fungible commodities when you’re looking to a achieve a broader goal. That’s why people are screaming against policies they previously supported.

In many ways the healthcare debate is like a parent fighting with a child. The parent takes a long term look at what he’s about to say. The child, however, is willing to slash and burn to get what they want now.

But the bottom line is, as long as this strategy works it will continue to be used.

An Insurance Claim–Like Pulling Teeth

UHC–any time anyone says anything against a single payer government run health insurance system I will fondly remember this 20 minutes I’ll never get back.

I’d like to thank United Health Care for today’s blog entry. Who knew calling an insurance company could be such a monumental event.

It all started with the automated voice prompt system. Call me crazy, but the automated voice tried to sound too friendly and it upset me. I know why it’s there. When the decision was made to put it in my convenience was down at the bottom of the list–if it was in the list at all.

Finally, after making a mistake in a date and not knowing how to undo it I asked for a representative. I answered a few questions and was transferred to another agent. She was in the “rapid resolution” department. Please. Spare me.

We went through her list of questions and when everything was done she rattled off a sentence that had lots of words but no practical meaning.

“Is my claim approved,” I asked? That seemed like a good question.

She rephrased my question to remove what I wanted to know and then answered again. It was an answer without the information I wanted. I asked again and again. Each time she rephrased what I was saying so she could answer a different, easier question. That’s a hell of a skill. Are they trained to do that?

After three or four of these little episodes I tightly rephrased my question and she fessed up… I think. It looks like I’m approved.

Why is this like pulling teeth? UHC–any time anyone says anything against a single payer government run health insurance system I will fondly remember this 20 minutes with you I’ll never get back. I know the whole idea is to make it inconvenient enough some people will give up and go away and the money will stay in your pocket.

How could a government plan be worse than yours?

Getting My Car Repaired

The body shop in North Haven reminded me of an airline ticket counter at the airport. There were young non-mechanic looking people sitting behind Dell LCD screens

My car has been dropped off to have the banged door repaired. It’s between the insurance company and body shop now. My 10 year old Mercedes SLK&#185 has been temporarily replaced by a rental Kia SUV&#178.

I decided to accept the insurance company’s offer to take care of all the details. I understand I might not be getting genuine Mercedes parts. I suspect there won’t be any parts replaced anyway. This seems like one of the few remaining injuries that can be pulled or banged out.

The body shop in North Haven reminded me of an airline ticket counter at the airport. There were young non-mechanic looking people sitting behind Dell LCD screens. A few insurance companies have offices on premises. Others are there on a regular basis. It was too business like–too neat– to be an auto repair place!

I ran into the owner. He told me it’s changed a lot since he bought the place 12 years ago. I’m sure! He has adapted his business to take advantage of technology and the changing face of insurance. It’s twice the size it was when he bought it.

He said there was a time when they spent 50 hours a week moving cars. The whole process would come to a halt as things were juggled into the right place. Time really is money. You don’t want a trained mechanic acting as a valet parking attendant.

The phone just rang. It was Robert from the insurance company. It will take until Friday for my car to be finished. They’ll have to paint the entire driver’s side. The insurance company will pay the body shop over $1,200

I can wait.

&#185 – If you hold onto a Mercedes for 10 years, it really doesn’t cost more than a ‘regular’ car you keep for half the time–or so I’ve convinced myself.

&#178 – I turned down the rental company’s insurance offering. At the bottom of the sheet it is enumerated on an annual basis. Their insurance works out to approximately $15,000 a year. Wow!

A Scrape, A Scratch, A Grand

I brought the estimate to the co-worker who bruised my door and said she’d better call her insurance company. This wasn’t going to be an out-of-pocket repair.

I guess I should have known this, but the price for a little dent and scrape on my car’s door is nearly $1,000!

I brought the estimate to the co-worker who bruised my door and said she’d better call her insurance company. This wasn’t going to be an out-of-pocket repair. She was crestfallen–which I totally understand.

For ten years I’ve been tooling around in my little roller skate with nary a scratch. It’s a shame this had to happen. I told her “life goes on.”

Crime Pays–That’s Upsetting

We have now shown that for years consumers were consistently low-balled to the tune of hundreds of millions of dollars.

I’ve just read a story in the Times about a database run by United Health Care. IT was used by UHC and other insurance companies to come up with the “reasonable and customary” numbers used to decide out-of-network reimbursement.

UHC’s subsidiary that ran the database estimated low to the tune of 28%. New York Attorney General Andrew Cuomo said:

“For years this database was treated as credible and authoritative, and consumers were left to accept its rates without question. This is like pulling back the curtain on the wizard of Oz. We have now shown that for years consumers were consistently low-balled to the tune of hundreds of millions of dollars.”

New York reached an agreement with UHC. It’s not cirminal and it takes United Health off the hook. Cost to United Health Care–$50 million.

Hold on. Didn’t Cuomo say, “consumers were consistently low-balled to the tune of hundreds of millions of dollars.” Taking Attorney General Cuomo at his word the least UHC could have made was $200,000,000. So, at the worst they had a 4:1 return on this investment.

Where is the disincentive to be evil?

Credit Card Calamity

“Is this your first time,” today’s fraud lady asked?

Last Thursday evening Helaine picked up the phone. It was the credit card company. You know it’s problematic when they call you and the person on the other end is in the states and speaks well. Someone from area code 267 (Philadelphia’s 215 wannabe overlay) had spent some time on the phone querying their system for our account balance and limit info.

“We have to close your account,” the disembodied voice said.

I assume we’re the mother lode for a scammer. We have impeccable credit (thank you Helaine) and a card limit large enough to charge Stef’s tuition. But I only carry one credit card in my wallet. How quaint. How last century. Cut that single card and I’m screwed.

The fraud agent at the credit card company began to read charges to Helaine. They were fine. It didn’t make any difference. The bank was familiar with the number the call came from. There was crime waiting to happen!

Later I spoke to someone else at the card company. Again, she read charges and everything was fine. The weekend was coming, I pleaded. Don’t cut off the card now–and she didn’t!

As requested, I called today to get the new card wheels in motion. Once again the woman on the other end read charges, but this time there were purchases I didn’t recognize. One, from a Dr. Kim in Idaho, was for a few dollars. Someone was probing,–making sure the card was OK. The biggest of the three questionable charges was from Amazon.com for over $150.

Changing credit card numbers isn’t simple. There are accounts that automatically draw from our card on a monthly basis. Have we remembered them all? The bank says incoming payments or credits and our Southwest mileage will make the transition without problem. I suppose they have experience.

Both Helaine and I have our credit card number memorized–the 16-digits, the 3-numbers on the back and the expiration date. We will have to be retrained.

Next month I’ll request my free credit report (NO–not from freecreditreport.com) and make sure things are OK;.

“Is this your first time,” today’s fraud lady asked?

American cities got fire departments because insurance companies demanded them. We’ll get rid of credit card fraud the same way–as soon as the credit card companies are ready to put their collective feet down and demand them.

Financial Talk From Geoff

It’s not just me, is it? Finances are confusing to everyone… right?

Oh please agree! I don’t want to be the Bozo on this bus&#185.

Helaine and I went through some financial papers today. Nothing dreadful, but each was more confusing than the last.

My insurance company sent me a notice saying they weren’t paying as much for recent dental work as the policy allows. My dentist is off network and out-of-state.

Uh, yeah. It’s Blue Cross/Blue Shield of Rhode Island. I live in Connecticut. Of course it’s out-of state!

Here’s the funny part. They only said they weren’t paying me full reimbursement. In reality, they were. So, based on their paperwork, some clerk in Rhode Island and I got to spend quality time together that we’ll never get back.

Then Helaine showed me a statement from my 401-K at work. We’ve been participating over 20 years. There’s a significant amount of money in it now. It said one of the mutual funds we’re in went down over the past few months.

It was a time when the market in general was tanking. I saw that with a quick look at the Dow Jones Industrials Average (which I understand is a mainly worthless barometer).

Are we in the right funds? Not only don’t I know, no one knows!

The experts often make bad calls predicting the markets (and, hey, I know a little bit about predicting). You can get lucky, or just have time on your side. We used the latter.

Unfortunately, the difference between being right and being wrong, when stretched over 20+ years, can make a huge difference. Could I have clicked a different box two decades ago and now be set for life? I will never know if my decisions were the right ones.

We’re trying to get Stef on the right track with her finances. I’ve just applied for a credit card for her. She’ll be responsible, though Helaine and I have to guarantee that by co-signing.

I called my local bank office, spoke to the manager and was on my way… or so I thought. I had to return a call from the bank Monday. They needed to verify it was really me on the phone.

I wasn’t asked my birthdate or SSN. The bank’s operator said, “In the past you’ve owned property. I’ll give you a list, you tell me which one is right.” Then she did basically the same thing with cars I’d owned.

The answer to the car question was a 1992 Camry. “That’s 15 years old,” I said. “I’m not sure the year’s right.”

But it was Helaine who made the more cogent observation. “They know everything about us.”

Alas, they do. Neither the car nor any piece of property was financed through the bank.

Finally, Helaine showed me a mortgage statement on our house. We’ve been there 17 years and have refinanced twice. Each time, we tried to shorten the term and lower the interest rate.

We can actually see a day in the next few years when the house will really be ours.

Does anyone really think, when they buy a house, some day they’ll own it? I sure didn’t.

&#185 – Firesign Theater reference. Thanks for noticing.

Your Call Is Important To Us

I had to make two calls to insurance companies this morning. There were two problems that needed attention.

Let me establish two points:

  • My call is important to them
  • My blood pressure is currently high enough to power the hydraulic system in a 737

In my first call, to my dental insurance provider, I waited on hold 10 minutes before a human picked up the phone. While waiting, Helaine and I discussed whether the on hold music was specifically chosen to encourage people to hang up. It is.

The agent who answered couldn’t find my claim because he was health, not dental. He gave me the dental number.

STOP!

That’s the number I called! Had I not looked, I would have gotten back in the same queue.

It was about this point I realized, I must dot every “i” and cross every “t,” but they don’t have to do anything. Sure there’s an obligation to get it right at some point, but no incentive to get it right the first time… and, if I get frustrated and give up, that’s a disincentive to get it right the first time.

I was calling because they sent me a notice saying they paid $.00 of $149 in dental bills.

It turns out, they had paid the bill. I am told the dentist already cashed the check.

Why did they send me this? Who knows? The person I spoke with certainly didn’t. No explanation.

If I got the paperwork wrong… well, you know.

The second call was to our drug plan about a prescription. It’s for a daily medication. It was for 12 months worth. They should have filled the prescription for 90 days – but only filled it for 30. That’s because the doctor wrote it up as twelve one month supplies.

What difference does it make? Well, the 30 day supply is $10. So is the 90 day supply!

I need to get another prescription to get this dispensed in 90 day chunks. So, now my pain also becomes the doctor’s pain.

Here’s the frustrating part. The prescription will be for the exact same number of tablets! It will still be for a year. It will still be for the same number of pills every month. There is no practical difference – none.

There is no reason for me to submit a new prescription, except to cut my cost. This resubmission has nothing to do with medicine.

I am really upset. This wouldn’t be a good day to piss me off.

Off To Vegas

We ended our big October Southwest trip in Las Vegas, where I promptly got good and sick! I’ll spare you the details, except to say I never saw the face of the doctor who came to our hotel room to administer an injection in my butt&#185!

We’ve always enjoyed Las Vegas, but this trip left Helaine a little shaken. She was reticent to go again.

Long story short, the opportunity arose, we’ve got free Southwest tickets, and we leave tomorrow. We’re going to undo the jinx of October.

We’re staying at the MGM instead of our ‘usual’ Mirage.

Of course I want to play poker, but we’re also going to a few shows: Barry Manilow (who we saw on our first date!), Gordie Brown and Roseanne Barr.

I know Manilow has supporters and detractors with no middle ground. It will be interesting to see what he does as a ‘house act’ at the Hilton.

Gordie Brown is also a house act. He’s an impressionist who plays the Venetian. In fact, I first saw him during “Impressionist Week” on Letterman and was favorably impressed. Helaine, who scours the Vegas trip report boards when a vacation approaches, has read lots of good things.

Our last choice is much more chancy. Roseanne Barr has become another house act. She’s just opened at New York New York. Both Helaine and I watched her first appearance on the Tonight Show, blown away by how funny she was. Then her career skyrocketed and crashed.

Is she still funny? Has she seen the error of her ways? I’ll let you know.

Keep your fingers crossed for good weather at Midway in Chicago. We’re on a one-stop.

&#185 – The doctor’s bill was declared ‘off network’ and originally rejected by my insurance carrier. If you’re really sick, you’re entitled to get a doctor without shopping for one who has signed the right papers. After lots of grousing, and two internal reviews, they paid it all, save the co-pay.

The insurance company, in Rhode Island, neither knew nor cared who I was.

Bottom line – If you’re in the right, don’t give up. That’s $435 in my pocket, not theirs.