SEXIEST PERSONS ALIVE

Thursday, June 28, 2012

vacation ends but celebrating begins


Woke up this morning feeling a little deflated.  The day we leave our beach vacation.  But then, by 9am, cheers of celebration.   Obamacare stands!   With a nod of approval from the Chief Justice, at that.  
 
Was funny - and telling - to see Faux News incorrectly report, ahead of the other stations, that the Supreme Court had overturned the health care law (with a loud, off-camera sigh of relief by T. Blossom, at least that's who I think it was).  And then have to back track and report that the health care law was actually upheld (with some tweaking).  

I hadn't known this until today:  The Supreme Court is there not to merely give an up or down on the constitutionality of the law in question but to find a way to uphold the law by revising.  And that's just what Chief Justice Roberts did.  

What a relief.  When you're both self-employed like my husband and me, and not one, but three family members have pre-existing conditions, maintaining health care insurance is a major expense and an even bigger source of anxiety. Obama's health care law has been a very good provision as far as we are concerned.  No pre-existing exclusions?  Check.  Coverage for dependents until the age of 26?  Check.  

And to all those follyticians (Bush, Perry) spouting off that the answer to affordable health care is medical tort reform? Wrong.  Recent study found that Texas 2007 tort reforms did not reduce health care costs nor did they lead to the influx of doctors to practice medicine here.  A previous study found the same.    

So to my way of thinking, the failure of the promises of tort reform is just another compelling reason to give Obamacare the try it deserves.  

How about you, reader?  How did this morning's decision affect you?  

Saturday, June 23, 2012

making progress

Went to bed last night with this TV news story on my mind:
And woke up to this story in my paper:


Breaking News: Archbishop's Aide Guilty of Endangerment in Abuse Case


I've worked with victims of child sexual assault most all of my career.  And I've worked on the other side so I could learn the ropes about sex offender therapy, mostly so that I would know their rules when treating a family member.  What I didn't count on but has proved invaluable was learning how the perpetrator mind works, what grooming looks like.  Helps to identify perpetrators before there's an actual outcry.  


When I read the Sandusky victim statements?  Had guilty written all over it.  A prolific groomer of the most dangerous kind, surrounded as he was by trust and awe.   


In any case, these news stories indicate we are making progress, lessening the stigma, laying groundwork for more victims to come forward.   To the eight survivors who stepped up to testify (and to his adopted son who admitted to his own abuse after he heard the victim testimonies), a big thank you on behalf of all of us in the treatment community and every survivor silently cheering.  

do do do do do-do-do-do-do...do the shuffle.


The insurance shuffle.





Warning: Pushing play button is a must. Background music a necessity. Post too painfully tedious for unaccompanied reading.

Ready? Begin.

I just spent two freaking hours tracking down mental health benefits for two patients and following up on a claim payment rejection for another patient. (The third time I've had to call for the same claim. They just can't see to get it right.)


Best medical system in the world, who?

Oh wait, and I also spent an hour the day before in the same pursuit. These several unpaid hours included, but are not limited to, the following:

YESTERDAY

1. calling toll free numbers on the back of the members' cards

2. using automated system to punch in the following information

member ID number (8 digits)
member date of birth (8 digits)
provider tax ID number (9 digits)

3. being placed on hold (can last anywhere from 3 to 15 minutes)

4. speaking to customer service rep, asking her to repeat her name due to inaudibility or unusual pronunciation of common American name. hearing CSR sound annoyed with me for asking her to repeat. and then more annoyed when I ask her to spell. general rule: the more unusual the name the greater the annoyance

5. giving CSR no less than the following information:

member name whose plan I am calling about
repeat member ID number (8 digits)
repeat member date of birth
member home address
member home phone number

provider name (that's me)
repeat provider tax ID number (9 digits)
provider address
provider telephone number "in case we get cut off"

6. having call re-routed after the customer service rep realizes I am calling about mental health benefits, not medical while writing down the new number lest the call fails to go through

7. being placed on hold

8. repeating the same 9 pieces of information once the re-routed call goes through (see #3 above)

9. being given a new number to call after the CSR realizes her company is not the vendor for the particular type of mental health plan opted by this particular patient

7. calling the new number

8. repeating steps 2-3

9. having my mobile phone cut off, apparently due to battery run down (not the fault of the insurance company, granted, but a modern hazard nonetheless)

10. repeating steps 2-3

11. being told there are no CSR available as the office has now closed (it is one hour later on the east coast where, I have now learned, too late, the company is located)

TODAY:

1. Repeat steps 2-8

2. Repeat steps 2-8 again for next patient

3. Learn I am not on a particular plan's provider network that covers three sessions.

4. Call network manager to inquire about becoming a network provider in order to get paid for these three sessions.

5. Being told this particular plan's pay scale does not differentiate between various provider levels (masters level license versus phd level - that's me) and would I be willing to accept half my usual rate (which is already half my preferred rate).

6. Telling the network provider manager I will not accept this insultingly low fee (I mean, I do have my standards, I didn't go to college 13 years in order to earn less than a carpenter's hourly rate and I am not going to step up and reward these greedy insurance bastards who pay their CEOs millions whilst stiffing those of us in the trenches actually doing the difficult, expert, and sometimes emotionally harrowing work)

7. Calling the patient to inform, sorry, I will not be able to accept her particular insurance plan. And I really am sorry. I understand financial barriers.

8. Five minutes with head on desk resisting the urge to bang furiously.







Ok, this is all in a day's work, folks, when new patients come through the door. Do we wonder why the lists of mental health providers, psychiatrists most especially, on our networks is shrinking? This is why. Or one of the reasons why. The increasing cost of tracking down benefits and unpaid claims through the labyrinth maze of automation and bored-to-the-point-of-frazzled reps.

Obtaining some patient benefits are more straight forward than this but there are far too many of these scenarios.

When I do go through this I want to scream, pull out my hair, throw my phone across the room, hunt for the battery that has flung from the phone, crawl, ball up into fetal position, cry, moan, whimper, and finally, surrender, decide it is time for me to be the patient and let some other psycho-schmoe go through this benefit assessment process in order to file MY claims.

Oh wait. That's right. I don't have mental health coverage because I am self employed. I cannot afford to see me.

So I blog. Instead. The shrink is on the couch. As I recently read on a blog header, "It's cheaper than therapy." (I would love to give a proper shout out here but I cannot remember whose blog. Can anyone help me out?)

Update:  Shout out goes to Jen on the Edge.  And a shout out of thanks to smalltownme and Jenn at Juggling Life for identifying Jenn as the author of "It's cheaper than therapy."  

Saturday, June 09, 2012

top ten things to do when mom is home alone

roadrunner on our birdbath, taken last spring, see old post, here

Top ten mom things to do on the evening of my bi-annual mom-home-alone experience:

1.  clean and refill birdbath

2.  feed chickens fruit and veggie scraps; find one brown egg

3.  sneak over to the neighbor's back yard where Daring Daughter is babysitting (ok, so i'm not entirely home alone); throw tiny pebbles at her as she swings on the hammock (listening in as she gives voice commands to her iPod);  all the while the babysittees swing on their swing set, plainly looking in my direction, laughing really loud, thereby giving me away, unheeding my pleas to:


4. watch the parade of tricked out vintage cars at the car show in Vineland, NJ, courtesy of my sister texting me pictures (don't you love modern technology?), and not really minding the longhorn orange Chevy

5. pause by the kitchen window to watch the hummingbird lap sugar water from the feeder (my mother's day gift)

6. slice up a big plate of fresh, homegrown, good-as-Jersey tomatoes (thank you, dear husband), generously sea salted and black peppered, and savor each and every bite as I sit on my back porch, under the ceiling fan, rocking in my trusty, beaten up, barely woven together wicker chair, alternating between watching the sun set and reading Austin Woman Magazine

7. share bits of tomato slices with my tail-wagging-pooch (who knew dogs love homegrown tomatoes?)


8. text my out-of-town, boys-only-weekend, golf-playing-husband,
I deposited $ into our checking account.  
In case you need extra tipping cash for the lap dancers.

9. stream foreign films on Netflix (currently playing, sidewalls)

10. repeat to myself, life is good ... life is good ...