Bye-Bye, Blogger, Hello Wordpress

I have decided to take a tiny step toward independence and move from Blogger to Wordpress, hosted on my own domain. Fortunately, I'm just geeky enough to be able to make it work.

So this is my last post on this blog site.

If you are currently following me here, I invite you to follow on over to my new site, http://silvergrrl.com. It is still VERY much in the formative stages, as I explore how to get Wordpress to make my pages look the way I want. I've pulled over my favorite blog posts from here to there and am exploring the world of widgets.

Keeping Busy

I have been very busy this summer. Between work & fitness instructor stuff, I'm very much a a human DOING rather than a human BEING right now.

This seems like it should be good thing, doesn't it? After all "idle hands are the devil's playthings." BUT what it really feels like is a distraction. Or like if I didn't give myself these external goals, I wouldn't accomplish anything at all. And I have to ask myself who would I be without them?

I've been here before. When we moved to Maui in 1995, almost everything I defined myself by got stripped away. It was the most terrifying thing I have ever done. But it gave me the space to figure out who I am once all that other stuff was gone. When I came back to the mainland and corporate world, it was much more on my terms instead of theirs. Now I'm a little afraid that the pendulum has swung back the other way. My husband is an excellent balance for me, as he works for himself. He keeps me from going off the deep end. However, only I can be me.

I am feeling a strong urge to reclaim my life. I have one more exam coming up in two weeks (STOTT Pilates Matwork) and then I can take a breath.

I have always been a loner

I am totally amazed that I have been happily married for nearly 18 years. How on earth does he put up with me?

Here's the thing: I am totally retarded at relationships once they get past a certain level of closeness. I just don't get how emotional intimacy works except with a very few people. Plus I seem to have an instinct for choosing friends with psycho streaks that end up dooming the friendship. When their crazy point hits mine, cablooey! Hmmm. That might all be related, yes?

Perhaps there's nothing wrong with having only a few close friends, but it feels very lonely sometimes. All I can say is that fundamentally, it's how I am. I am recharged by solitude. I like it.

I think it's why I like Twitter better than Facebook. It's more interesting and less connected, if you will, at least for me, and I like it that way.

And yet, still, I want more companionship than I have. I need to get involved with --- something. That fits my schedule and is fun, no responsibilities. God knows I have enough of those already. I think maybe I'll check out the local drum circle that meets on Friday evenings. I know some of the people who do that. Get my husband to go with me, he knows some of that crowd too.

I will keep you posted.

What Makes a Home? or, can I really learn Spanish in my 50s?

My husband and I just took a trip to Costa Rica. Aside from being a VERY much-needed vacation, we were traveling with an eye to potential retirement a few more years down the road.

There is nothing like getting your feet on the ground somewhere to feed thought processes.We lived in Hawaii for several years, so I know what it's like, at least on some level, to live in the tropics. But Hawaii is part of America, and everyone speaks English. I'm daunted by the thought of moving somewhere that requires a new language.

Now, many Americans live in Costa Rica and don't learn Spanish. They live in "gringo neighborhoods", or hang out mostly with other ex-pats. Personally, I can't imagine that. It would be way too isolating. Many Costa Ricans speak some English, but not that much. How could you enjoy people you can't talk to, or participate fully in the culture?

So while I ponder uprooting myself yet again, I signed up for LoMasTv.com and I am enjoying the little beginner videos. And I am following some Costa Rican Twitter accts, and painstakingly translating their tweets as best I can.

So adios for now, I have to go tend the black beans I am making for Gallo Pinto. That would be Costa Rican black beans & rice - too yummy!!

My trip to the Vet - by Grrrkitty

I am stealing Mom's blog again to talk about my trip to the vet today. It's way too much for tweeting!!

I went because I hurt my left rear leg back in April, and I have been limping ever since. The X-rays did not show a break, but did show that there is a problem with my knee. The diagnosis was ruptured anterior cruciate ligament (ACL) and meniscal tear. This kind of injury doesn't really heal itself without surgery.

So today I went to the vet that would do the surgery, if I have it. He checked my general health to make sure I am healthy enough for the surgery (I am!), then he had to check the joint. Ouch! So Kyle the nice veterinary assistant held me while the vet moved the joint around - we were afraid it would REALLY hurt! But you know what? All I did was fwip my tail and meow a couple of times. So now Mom & Dad know that I am not in very much pain, which made them feel better. The vet said I'm limping mostly because the joint is unstable, and I know not to put too much weight on it.

So what to do? The surgery would help stabilize the joint, but might not fix the limp. I'm actually getting around pretty well, I can even run through the house and play with my catnip mouse. The vet also said that in cases like mine, sometimes after a few months enough scar tissue forms around the injury to stabilize on its own WITHOUT surgery.

But another thing we saw in the X-ray are some arthritic changes in the OTHER knee, which so far is OK. But if it also gets a problem, then I would have problems in both legs which would not be good. Or if I blimp up and get obese (I am a svelte 7.5 lbs) then I would also have more problems.

So Mom & Dad are thinking over what the vet said so they can make the best decision.Fortunately there is no hurry.

Have you read STiLL ALiCE ??

I just finished reading - devouring, actually - the novel STiLL ALiCE by Lisa Genova. It is the story, told from Alice's point of view, of her descent into Early Onset Alzheimer's Disease.

I don't remember being this affected by a book in a very long time. I fear few things as much as I fear losing myself. This particular disease is a very scary bogeyman in my closet. Thankfully, no one in my family has it, so I am spared the genetic haunts.

SPOILER ALERT

But here's the thing that has me in its grip right now. In the story, before she is too far gone, Alice sets up an "out" for herself and a way to remember to use it. Her reminding method ultimately fails, but she stumbles across the letter she wrote to herself and goes to carry out the plan. What's clear to the reader is that her husband John found the "out" and disposed of it at some prior point in time. Alice is too far gone to care or even remember that she found the letter or tried to carry out the plan.

And that's not even the bitter part for me. The bitter part is that after he eliminates her escape plan, he ultimately can't bear to stick around and watch the end. I am struggling to find sympathy in me for his character when I feel he has betrayed her - that he exposed himself as a coward and hypocrite. Not to mention being unwilling to honor her wishes, expressed when she was still of sound mind. He makes some comments to their children about Alice's "unilateral decision" that didn't get carried out, but he made one of his own without talking to the rest of the family.

What's right? How do we come to grips with these most painful of decisions? Is it possible to make good decisions about when suicide will be the good option? Is loss of self sufficient grounds? Was John right to do what he did? How can we care for our loved ones in the face of this kind of pain? As an aside, I have NOT had to deal with any sort of dementia in my immediate family. At least not yet.After reading this book, I sort of think watching a loved one go into that dark night would be worse than going there myself.

If you have read this book, I welcome your comments about these and any other issues raised in it.

The B**ch is Back - Growly Girl Earns Her Name

Hi there! I am hijacking Mom's blog to give all my friends this update cuz there are just too many lovely twitter pals that I want to share with.

I am feeling much better today. When mom came home tonight and gave me my meds, I GROWLED and GROWLED at her! Yucky meds! (Just so you know, I never bite or scratch but I do growl - a lot - when I am cranky). My leg is still swollen some but I can put some weight on it now and I am moving around the house a lot more.

Mom and I are very grateful for all the healing paws and purrs, and pawcircles, and prayers and good wishes from you, my Twitter friends. You are the bestest friends a little cat could have!

Hopefully the swelling will go down soon, but I still have EIGHT more days of antibiotics to go. I will keep you posted on my progress.

Love,
@grrrkitty

Summing up: Don't let them cheat you!

I recently posted a series of articles about health insurance and how to tell if your doctor's office is committing fraud. I thought that was the end, but it wasn't. I feel compelled to sum up.

Part 1 is a description of fee-for-service health insurance in the US, including lots of boring terminology.
Part 2 is a description of how health insurance claims work, and how to tell what you should pay the doctor.
Part 3 describes my personal experience of how a medical practice tried to cheat ME.

So what can you do? Here are the steps to take:

1. Understand your insurance policy. Read and keep your benefit booklet. If you don't understand it, call your insurance company and ask questions.
2. Don't agree to be cheated. At the doctor's office, refuse to sign any document that says you agree to pay the difference between what the insurance company allows and the doctor charges for covered services. (Yes, this happened to a friend of mine. They tried twice to get him to sign something like that, and the second time they slipped it in with a bunch of other papers.)
3. Stand up for yourself. If you have a plan where you have to pay for things yourself to satisfy a deductible, refuse to pay until the claim settles. If they are trying to insist, get IN WRITING what their refund policy is should they happen to charge you too much. If they won't do this, or you are not satisfied by what they tell you, walk out without paying a dime. They can't physically restrain you! You can pay them after you get the EOB and know what you actually owe.
4. READ YOUR EOB. And keep it, just in case. If you don't understand it, call your insurance company. They can and will answer any questions you have.

You as the consumer have to look out for yourself. Be educated, be smart, be brave.

Is Your Doctor's Office Trying to Cheat You? Part 3

My EOB for my last doctor visit has an interesting statement on it:

"This document outlines your share of the charges for services. You should use this to determine how much you need to pay. If there is a discrepancy, use this summary to to discuss the charges with your provider."

This is a new message, and it's a perfect lead in to this last part of my little mini-series. Is your doctor's office trying to cheat you? If they are trying to bill you for more than the insurance company says you owe, then YES they are.

Parts 1 and 2 of this series outlined how all the pieces (networks, claims, and money) fit together. Here's my personal story about the weasel tactics one office tried to pull.

Two years ago, in 2009, I chose a high-deductible health plan from my options at work because it seemed like made financial sense. During that year, I needed to have a suspicious lesion removed from my leg. The nature of my coverage meant that I would be paying for the whole procedure myself, and it counted against my deductible. It wasn't that much, as medical procedures go, only about $150. On the way out of course is where you stop at the billing window. I argued with them there at the billing window for half an hour about what I should pay that day. They insisted that I needed to pay the whole amount they wanted to charge, and I insisted that we didn't actually know how their charges lined up to the insurance company agreed-on amounts.

They were impervious to that argument, and swore to me that their charges were the same as the allowed amounts.So fine, I finally gave in and paid them what they asked. About a week later, they sent me a bill for one more charge that they had missed that day, for another $6 or so.At that point, however, I wasn't paying another penny until I saw how the claim settled.

Sure enough, a few days after that the EOB arrived and showed that I had, in fact paid too much already. I really had only owed them $145. The charges that had been filed to the insurance included the extra $6 so I knew they owed me money at that point.I just figured I would get a refund the next time I went in.

I'm sure you can imagine my surprise at that next visit, when I stopped at the billing window to pay my copay for that visit and they tried to make me PAY THEM the $6 they said I still owed!! I had to make them call the central billing office. The person there not only erased (I thought) the $6 but backed off the extra $5 from what I paid that day. At that point we were even.

Six months later (Nov 2010), what do you think I got in the mail? You guessed it - a bill for the $11 plus interest. I called them and accused them of balance billing and told them I didn't owe them a penny. After more than one lengthy time on hold and a recap of the whole history, they said basically that because it was only $12 they were going to write it off. I'm thinking, damn right you are! But they did NOT admit that they were doing anything wrong.

So, fine. That was that, or so I thought. However, at the end of February 2011, once again! I received a bill for the same $11 plus interest. The bill was identical to the one I'd received last November, and basically called me a deadbeat for not paying these charges that were not covered by my insurance. So much for them writing it off.

At this point, I was seriously pissed off. But this time I was smarter. I called my insurance company and asked if they could help.Once the CSR (customer service rep) determined what was going on, he offered to conference in the billing office right on the spot and get it taken care of once and for all.And he proceeded to do just that. It's amazing how the 500-lb gorilla can whip things into shape! It was not pretty. They jerked us around, passed us to several different people, put us on hold more than once, and even disconnected the call at one point. Undeterred, my CSR in shining armor got them to finally agree, once more, to write off the bill. Interestingly, they used pretty much the exact same wording they had used in November. Without admitting that they were balance-billing, they said it had been so long and was such a small amount that they were going to just write it off. Beyond that, he extracted a commitment that they would send me a letter saying I owed them nothing. Which I received a few days later. Trust me when I tell you I have it filed away with all the other paperwork around this!

So I am quite sure that this office does this whenever they can. If I didn't know how this all worked, or didn't bother to read my EOB, or wasn't willing to fight for $11, they would have been a little bit richer. Multiply that by hundreds of patients and thousands of doctor visits, and they are raking a tidy sum via this kind of fraud.

Needless to say, I no longer go there. And I'm kind of sad about that, because I liked my doctor. But I won't do business with criminals. And I'm thinking that there's a lot of this happening these days, hence the new message on my latest EOB. In this particular instance, the insurance company is on my side, and I like that.

As a final side note, I found out who my CSR was that day and his boss's name. I sent the boss an email telling her how wonderful my CSR was, and copied him on it.

This Series:
Part 1 is a description of fee-for-service health insurance in the US, including lots of boring terminology.
Part 2 is a description of how health insurance claims work, and how to tell what you should pay the doctor.
Next: Summing Up: Don't Let them cheat you

Is your Doctor's Office Trying to Cheat You? Part 2

This article is about insurance claims and how they work. See Part 1 of this series for any insurance terms and background information.

After you visit the doctor, if it's an in-network doctor, a claim will get filed for you to your insurance company. This filing is done by the doctor's billing office, and is almost always done electronically. Electronic claims are subject to federal law regarding the information that is required and how it's formatted. This is a good thing for you, because it means there's little possibility of it getting screwed up. On the claim there's information about you, the doctor, where the service was rendered, who the insurance company is, what services were rendered, what the doctor's official charges are, and so on.


The insurance company takes the information from the claim to find you and the policy you are insured under so it can pull the correct benefits for paying your claim. It also uses the information about the doctor to identify the network so all the information related to the network agreement can be brought in as well.

At the end of all this, here's what the insurance company determines:
1) Which services are covered and which, if any, are not covered.
2) The negotiated allowed amounts for all the covered services.
3) What copay, if any should be applied for the services
4) What deductible amount, if any, applies for the services
5) What coinsurance, if any, applies for the services
6) If there are any of a variety of other things that need to be considered: max payments, out-of-pocket limits, etc.

Which is a fancy way of saying that the money, the charges submitted by the doctor, get divided into three basic chunks:

Provider Write-off: This is the non-covered amount, the amount the doctor agreed to forgo in return for being a member of the network.
Subscriber Liability: This is the amount you have to pay the doctor due to non-covered services, copays, deductible, coinsurance, etc. See below for some definitions of these terms.
Payer Liability: This is the amount that the insurance will pay the doctor as part of your benefits.


The insurance company then sends out the results of the claim processing. You will receive an EOB, or Explanation of Benefits. It lays out the specifics of how they decided the claim should be handled, and you will see information that matches the items described above. This document will also state how much money the doctor can bill you within the terms of the network agreement. This is important. You should ALWAYS review your EOBs and compare them to the bills you get from the doctor. Or how much you paid them when you were in the office.

The insurance company also sends this information to the doctor's billing office. This document is called a remittance, and describes again how the charges got divided up. Some offices get paper remittances mailed to them, others get an electronic version: but the information is the same. How much goes to write-off, how much you the member can be billed for, and how much the insurance company will pay. It's very common for remittance information to be bundled together - in other words, the doctor may get a combined remittance that has information about all the claims that were submitted and processed within some period of time, like a week.


So now, you and the doctor know what's what. What could possibly go wrong? Stay tuned for Part 3 and find out!


A few more terms:


Copay: a flat fee that accompanies specific services. For example, you may have a $25 copay for any visit to your primary physician, and a $60 copay for a specialist visit. You have to pay this every time, and they don't add up towards any kind of limit. However, it comes out of the allowed amount for your visit.


Deductible: This is a dollar amount which must be satisfied by you before the insurance company will start to pay, depending on the service. Insurance policies vary widely as to which services are subject to deductible and which are not. Really, this is all over the map and you have to read your benefit booklet to know how your plan is set up. Again, though, the deductible only applies to allowed amounts.


Coinsurance: A percentage that usually kicks in after the deductible has been met. For example, it's pretty common that a covered service is subject to deductible, then after that the insurance company will pay 80% of the allowed amount. This would be described as "Deductible, then 20%".

This Series:
Part 1 is a description of fee-for-service health insurance in the US, including lots of boring terminology.
Part 3 describes my personal experience of how a medical practice tried to cheat ME.
Summing Up: Don't Let them cheat you

Is Your Doctor's Office Trying to Cheat You? Part 1

I don't believe most doctors are trying to cheat their patients. However, I have way less faith in medical group practices, which are businesses that have little direct relationship with patients. Very few doctors can afford to have stand-alone practices, so they join groups. These docs are disconnected from the business side of things and probably have no idea when fraud is being perpetrated. 

Knowledge is power, and in this case, knowledge can save you money. Those who are trying to cheat you are counting on your ignorance. I'm going to give you just a few basic definitions so you will understand the things I'll explain later.

First, let me clarify: I'm talking specifically about fee-for-service coverage for doctor visits in the United States. If you live in some other country, chances are good that you don't have to care about any of this because it will never apply to you. Ditto if you are in the US but have insurance like Kaiser, Group Health, or some other self-contained HMO like that. Lucky you! I had Kaiser when I lived in Hawaii and I loved it.
 
So, on with the definitions. Some of these are industry-standard, some of them may vary according to who you are talking to. BUT the concepts are the same regardless.

Service: something that can be billed for by your doctor or other medical provider. These include things like office visits, lab tests, X-rays, out-patient surgical procedures, supplies used during your visit, etc.

Covered service: A service that is included in your insurance policy. Even if you have to pay for a covered service yourself, it "counts" in the insurance company's eyes. I'll explain more about this later. 

Non-covered service: You are on your own with one of these - it is not covered by your policy, the insurance company will flat out reject any claim for it, and your payment will not count towards any deductible or out-of-pocket limit you may have to accrue.

Provider Networks: Doctors and health insurance companies enter into mutually beneficial relationships. The doctor agrees to take reduced payments in return for the insurance company steering business their way. The insurance company refers to these relationships as "networks", and each network has terms and conditions that are specified in the network agreement. These are contracts that both parties must abide by.

Non-covered Charges: the charges for non-covered services. You the member are always going to have to pay these in full.

Covered Charges: the charges for covered services. These amounts generally get divided up into different chunks, described below.

Allowed Amount::This is also known as the approved amount. These are the amounts that the in-network doctor has agreed to accept as payment for covered services rendered to members of the insurance company. Any money that comes out of your pocket is based on this amount, and applies to it.

Non-covered Amount: This is known under HIPAA as Provider Write-off under Contractual Obligation. It's the amount between the doctor's normal charges and the agreed-on network allowed amount. Under most network agreements the doctor is not allowed to make you pay this difference.

Balance Billing: What it's called when the doctor bills you for the non-covered amount described above.

OK, that's enough for now. Coming in Part 2 - How Insurance Claims and Payments Work.

This Series:
Part 2 is a description of how health insurance claims work, and how to tell what you should pay the doctor.
Part 3 describes my personal experience of how a medical practice tried to cheat ME.
Summing Up: Don't Let them cheat you

My Heart is Heavy and Sad

I hope your month is going better than mine.
 
I don't know how much more I can take right now. All I see around me are greed and corruption and fear and hate. Power gone mad. The tragedy in Japan, compounded by the potentially worse tragedy if things go wrong-er at the nuclear plants. Cheating and lies and cronyism and intimidation and willful disregard for others' well-being.

An acquaintance of my husband's was murdered - shot - yesterday, along with her two children, by her drunken ex-fiance, who then committed suicide.

My own doctor's office tried to cheat me out of money that they are not legally allowed to collect. And because of the way it happened, I'm certain that they are doing the same thing to other people, who are probably paying because they don't know any better. I actually had to get my insurance company to step in to fix it for me.

So my next couple of blog posts will be about health insurance as it works in the US and how to make sure that YOU are not getting ripped off by unscrupulous billing.

The sweet feel of success

My clothes fit comfortably again, the way I like them to.

I've written earlier about the weight I gained last summer, and how I was afraid 4 lbs would turn to 8. To make a long story short, that's exactly what happened. That's almost a clothing size, and I HATE when my clothes are tight!

It's such a cliché, but I used January 1 to get serious about getting back where I want to be. For me, body size really is about calories in vs. calories out. I use the VidaOne MyPersonalDiet program to track it all [shameless plug for a great product]. It has a desktop version and a mobile version, so it's easy. Like so many other areas of life, attention is ¾ of the effort. Knowing that a workout is the difference between meeting my goal for the day and NOT meeting my goal for the day is a great extra motivator to get me to the gym. At which point I get all the other benefits of exercise as well.

Importantly, I have been able to keep the correct food balance so I don't ever really feel hungry or out of whack mentally. I also have enough energy for my workouts.

The best part is, I'm on a roll now (the 8 lbs are GONE) and I am focusing on the additional 3 lbs that just never want to go. It's always a good idea to take advantage of momentum!

Death Storm 2011

The snow is lovely. Unfortunately, the temperature was just warm enough today to make it slushy on the roads, and the "wintry mix" - I love that phrase - keeps falling. Pretty much guarantees that you would have to be insane to go out in the morning. Ice sheets on top of ice sheets.

I'm just hoping that the "wintry mix" is light enough tonight that it doesn't bring down the power lines and leave us in the dark. Bad ice storms have done that to us more than once. Thank God for the gas fireplace, water heater & stove, so even when the power's out for a couple of days we can cook & shower. And huddle for warmth by the fire.

So I am not setting the alarm for in the morning, and assuming the power stays on at worst I'll be able to work from home. They make us take vacation days if we just slack off & don't do anything at all.

Hopping into the New Year

I'm all set for the New Year: I've had my Hopping John today. I like this year's recipe better than last year's, and it was easier too. It's at the end of this post, for those who are interested.

I'm fascinated by the fact that the one ritual in my life is this annual meal, and recently acquired. I did not grow up eating Hopping John EVER, and the idea of eating it for luck on New Year's Day was new to me when I moved here to SC 12 years ago. This is maybe the third year in a row that I've fixed it myself.

Do I really believe it will bring me luck? Probably not, but preparing it makes me think about the New Year, and what's to come, and what exactly do I really want anyway? Which seems appropriate today.

And I was amused to see that a friend of mine just posted some information about the Year of the Rabbit. I quote:

"A placid year, very much welcomed and needed after the ferocious year of the Tiger. We should go off to some quiet spot to lick our wounds and get some rest after all the battles of the previous year."

Sounds like just what the doctor ordered AND it fits with the lucky New Year meal.

Here's how I made my Hopping John. Note that I rarely measure ingredients unless it really matters, like in baking.

1 lb bacon (I used uncured turkey bacon from Earthfare)
1 onion
1 red bell pepper
olive oil

2 cans black-eyed peas
1 C chicken broth
3 bay leaves
thyme

Chop the bacon, onion, and bell pepper, put them in a heavy-bottom stock pot and cook over medium heat until the onion is transparent. Add the broth, black-eyed peas, and seasoning. Bring to a boil, then turn down the heat, cover, and simmer for at least half an hour. Stir occasionally. I let mine simmer while I cooked rice to serve it over. Yum!