Category Archives: money

Blogging about Insurance

You hear it all the time. So-and-so needs an operation and the insurance company decides not to pay for it. The insurance companies are painted pretty black and with a pretty broad brush. However, our experience with our insurance company has been just incredibly good. When Kepler was in the NICU, his hospital bill was $42,000 and insurance covered all but $200. We have excellent customer service, excellent benefits, and clear paperwork.

The only tricky part is when I decide to utilize a provider who is the dreaded “OUT-OF-NETWORK.” Out-of-network claims always seem to take two or three tries, and I do get different answers from different customer service reps about these claims. But, still, overall our insurance company does a great job.

I’ve mentioned my fine therapy group I attend. The cost is $40 per session. Our insurance covers this service 70-30. That is, they pay 70% and I pay 30%. I went into this group planning to pay $12 per session, once I received my reimbursement.

Oh, how easy it is to adopt a sense of entitlement. For some reason, in 2007, the sessions’ “allowed amount” was $40. Once January rolled around, apparently, the “allowed amount” became $25.89. So, finally in June, I am having time to get this figured out. My very helpful CSR told me today that it looks like the pricing changed at the first of the year. She assured me that the coverage is still 70-30, but the company decided to pay 70-30 of a lower amount. To confound matters and compound the problem, my provider used a different (wrong) code for my February charges, so they still went through as $40 amount allowed.

I started getting a little frustrated on the phone (28 minutes) because I can’t get an answer as to WHY the allowed amount would change. If this procedure is worth $40 in 2007 surely it’s not worth less in 2008. The only explanation she gave me is that the company is reining in out-of-network providers to more closely match in-network providers. This seems arbitrary to me, although I can understand that there have to be some limits. After all, you could go to an out-of-network provider who decided to charge 2x or 3x the going rate in your area, and then that probably would be a problem for the provider.

So, the bottom line is this. I am so thankful for our health insurance. And having 70% of $26 paid is better than having 0% paid, which is the case for a lot of people. So, I will adjust. I would just like to understand how such changes come about. Did the fact that I had several claims of this sort in 2007 put up a red flag? Are there people who work for insurance companies who do nothing but figure out how to pay less benefits? As it is, our health insurance costs already went up at the beginning of the year, so it’s a double whammy to also have the benefits reduced.

I will adjust. But I don’t like the fact that I have absolutely no input nor recourse about my health insurance costs and benefits and coverage. Ultimately, the fact is, we have better health insurance than the majority of people, so I need to remember that. But it was just a shock to find out that things had changed so drastically. My payment will go from $12 to $22, which will add up over a number of weeks ($500 for the year).

A supervisor is supposed to call me early next week to give me more information about how this process happens, so I hope to take some time to think about some clear, concise questions to ask if and when the super calls.

Upon further consideration, I have NOTHING to complain about.

Go Anthem!!

Oh, Pshaw, Part II

Well, one must be on one’s toes in these days of apostasy.

At my FINE bank, when one makes a deposit, one is entitled to $100 of that deposit right now, but the rest of it only becomes available when thine deposited checks clear their bank of origin.

One would think that one would know this since one has banked at this bank for nigh only nine years. But one is not in the habit of double-crossing oneself and overdrawing one’s account, now is one?

My FINE bank tellers did confirm in fact this morning that had I been a sly enough banking customer to have deposited ONE check yesterday and ONE check today, I would have indeed had $100 available yesterday and $100 available today, which adds up to $200, which is twice as much as the $100 that is available to me today since I alertly deposited all of the checks together.

So, NOW I know. In the meantime, Kepler better not need too many diaper changes today! And I guess it’s beet pancakes for lunch too!

Never a dull moment.

State of the Union

Well, pshaw.

Greg took the [one phone charger we can find] off on his business trip (at my suggestion and with my blessing) and my phone is doing that desperate gulping thing it does as it slowly fades into oblivion.

We have cinched the belt really tight over the past week cause we sort of overspent and there was no room for foolishness since the mortgage was to be deducted yesterday. So we are down to a can of beets in the pantry, some really old leftovers in the fridge, and not a crumb in the snack cabinet. Imagine my SURPRISE!! when I discovered this morning in my daily online banking session that I had alertly and secretly arranged for the rest of Valerie’s camp fee to be deducted yesterday! So all our hard work to avoid being overdrawn by the mortgage was all for naught. And to that, I utilize a swear word I learned from my father — Fat!!

And this silly yearbook that I foolishly agreed to single-handedly create on a program I do not know how to use? Foolish, foolish. Why? Why did I agree to this? Just because there is one senior who wishes to have a yearbook. Good reason? I think not. But nevertheless I have alertly committed myself to the “little” project.

The good news is I know there is another phone charger if I can just unearth it; I have two checks to deposit and being overdrawn in the morning but not in the evening is just like not being overdrawn at all, so I will be waiting at the drive-through at 9:00 sharp; and somehow this yearbook will get done even if I have to use Microsoft Word. So, don’t cry for me, Argentina! I still have the best deal around when it comes to an outstanding hubby, and fine children who are strong and brave. I just hope they don’t mind beet pancakes for breakfast.

Budgeting: Good for What Ails Ya

Friday morning, Greg and I had a meeting with some financial planners. We found out about these guys because they specialize in helping families with a special needs family member. I was so inspired after this meeting because these guys were just so personable.

One thing I was inspired to do was print out our check register from June 1 last year to May 31 this year and start looking at the actual numbers. Budgeting has eluded me, year after year, as I have started out with good intentions, but never been able to make all the numbers add up to satisfactory numbers. So, I’m nearing the point where I will be able to put a budget on paper that I believe will work.

The other thing I was inspired to do was to ask these two guys how one gets started in the business they are in. I would love to work with people in financial planning, and although I am a bit tied up at the moment, I can see this as being something I would like to work into in the future.

I highly recommend these guys to anyone, special needs or not. They clearly know what they are doing and I came away from the meeting with a REALLY good feeling about what we were doing.

Planning for Next Year

Yes, we will still be homeschooling next year, and I am hoping to have a more active role in teaching the older kids. They have been going to an extension program for all of their classes this year, so I have had little ability or opportunity to be involved with what they have been learning. Next year, they will go to the same program, but for far fewer classes.

I have been enjoying surfing the internet looking at math programs and trying to figure out which one would work best for Val and which would work best for Joel. I don’t think the same program will fill the bill, even though they will both be learning Algebra II next year.

Think I know where that economic stimulus check is going to go — buying curriculum for next year!