Thursday, February 9, 2017

Why Our FREE Wellness Check-ups Cost $199.15 (More Adventures In Healthcare!)

Perhaps I was naive to be shocked when we received bills for our "free" preventative care check-ups: a total of $199.15!

For the past five years, our family used Samaritan Ministries, a healthcare sharing ministry (HSM), which provides generous, affordable coverage for healthcare needs. I've shared several stories about how an HSM provided for ER trips, surgeries, and childbirth. Due to national increasing health costs, our monthly HSM contribution increased 40% over five years, similar to many families' experiences with health insurance premiums.*

We decided to transition from an HSM to an employer-sponsored plan, based on the financial impact of three possible health outcomes: 1. No problems, 2. Maternity, and 3. Catastrophic event. With Wally's employer's contribution, traditional health insurance was slightly less expensive for each of these scenarios.

One feature of the Affordable Care Act that most appealed to me was free preventative care. I happily called doctors at the end of December to schedule 2017 wellness check-ups for both Wally and me.

When Wally visited his doctor, the receptionist told him it would be charged as a "new patient" appointment, instead of a "wellness" check-up.

The office charged us $136 up front. 

Wally's doctor did a physical, said he looked good, and drew blood for basic lab work.

We received a bill from the lab for $54.49.

When I visited my doctor, there was no fee for the appointment; I received a physical, and the nurse did some lab work.

I received a bill from the lab for $8.66.

When I called the insurance company to ask about how preventive care billing works, they pulled up each of the claims for review.

For Wally's appointment, the doctor's office had billed insurance $250 for a "wellness" check-up, despite charging us $136 for a "new patient" appointment. By double-billing, the doctor's office collected full payment from both parties.

There was no record of our $136 payment in any part of the claim, and it hadn't been applied toward our annual deductible. Once the insurance company realized what happened, they reached out to the doctor's office on our behalf to secure a refund. Insurance has called the office several times and sent a letter, yet no refund has been issued. (I'll update this post if/when the refund occurs.)


Nowhere is the "new patient" appointment fee of $136 recorded.

When I asked about Wally's lab work, done as part of the wellness check-up, the insurance rep said none of it was covered as preventive care.


She also mentioned that many of the tests -- from cholesterol to Vitamin D screening to everything in between -- were categorized as "preventive" care prior to the Affordable Care Act. However, once the ACA made preventive care no cost to patients, these basic tests were re-coded as "diagnostic" care.

So we are responsible for $54.49 in lab tests from Wally's wellness appointment. Still, I'm grateful for the 90% insurance discount. As a previous self-pay patient, I can verify that no amount of negotiation will convince labs to discount uninsured bills more than 30%. Most labs would only offer a 20% discount, if paid in full.



Given that insurance paid $0 toward Wally's lab work, I didn't expect them to cover my lab bill for $8.66. But I'm glad I asked about it, because somehow, in the convoluted world of health insurance (which sometimes, possibly might lead to healthcare), the same customer service rep who denied Wally's lab work as "diagnostic" confirmed my lab work as covered 100%. 




Interestingly, when the lab that processed my test wasn't satisfied with the payment given by insurance, they just sent a balance of the bill directly to me -- instead of negotiating with insurance. I have no doubt that many patients shrug and pay the difference, probably because they value their time and sanity more highly than repetitive phone calls and emails with customer service departments. (I do not.)

So insurance cut a check to the lab for $8.66 and zero'd out my balance due on the claim.

Takeaways: 

1. If you're expecting free preventive care, keep a side fund to pay unanticipated costs. 

2. If you get bills from your medical providers, always double-check with insurance, because they might not be accurate. Our "wellness" medical costs were cut by 73%, just from a couple of phone calls and emails.

3. If you don't already use your health insurance company's website to track claims, it's worth settin up an online account. It's a great way to track spending toward your deductible, double-check claims, and grow increasingly despondent over the "charged," "negotiated," and "paid" rates that run the insider's club of healthcare in America.

*While our family's increased healthcare premiums and costs are indisputably linked to the increases in regulations, provisions, and coverage mandated by the Affordable Care Act, I remain in favor of comprehensive national healthcare reform. Whether that means fixing "Obamacare," or replacing it, I DO NOT in any way favor repealing the ACA without a viable replacement that continues affordable coverage for the many hardworking Americans with pre-existing health conditions or employers who do not offer health insurance. It is unconscionable that our first world nation has inaccessible healthcare for so many. 

Saturday, January 21, 2017

A Better Way: Policies That Might Actually End Abortion In America

Just as we blame an abusive partner for pressuring women into abortion, I wonder if our country's family-related policies (or lack thereof) inadvertently pressure women into abortion. 

I wonder if, in some way, we will be held complicit, if not for participation in the killing of a child in utero, then for ignoring the poor as they feel cornered by this choice.


If you're serious about ending abortion in America, please consider these policy adjustments to our country's approach to family:

1. Pregnancy and childbirth will be re-categorized as reproductive wellness care. As with all wellness care, it will be covered for free by insurance. No longer will it be cheaper to get an abortion than to have a baby. 

2. Medicaid and CHIP will be expanded to cover all children, regardless of income, because no parent should have to care for a sick child while unable to afford a doctor’s visit or prescription. 

3. Maternity, Paternity, and Adoption leave will be paid. Any worker is eligible, regardless of whether they are full-time, part-time, or contract.

4. Minimum wage will be established at a livable wage and linked to the inflation index to secure future increases, so parents can support their families.

5. Childcare will be subsidized for families up to 300% of the poverty level, and any family over this threshold can receive a tax credit – not a tax deduction, a refundable tax credit – for all childcare expenses. 

6. All adoption expenses will also be eligible for refundable tax credits. No family should lose money for opening their hearts to children who need a home. 

7. Children with disabilities will receive the best healthcare, the most advanced therapy, and specialized quality childcare, so their parents know they are embraced by our country, and their children have a promising future. It is a tragedy that parents feel it's better for their children to die in utero than to live with a disability in the United States of America. Some of the most brilliant, most creative, most loving, most influential, strongest individuals are on the spectrum of physical and mental disabilities. We will set the international standard for special education and services for those who are differently-abled.

Some in our nation will say these policies are too much. Even some who profess to be pro-life have already said to me, ‘These expenses are untenable. We cannot afford as a nation to support children in this way!’ 

Then now, perhaps, as you contemplate these overwhelming expenses for the national budget, you can understand how the cost of parenting might be overwhelming for many in our country.

If we want parents to choose life, let's talk about how to lighten their load, so they can.  


Endnote on Pregnancy Resource Centers: 

Volunteers with pregnancy resource centers ("crisis pregnancy centers") have known for years that the best way to help a mom choose to keep her baby is to address the needs that make her abortion-vulnerable.
When a pregnant women enters a pregnancy resource center, she's not judged for being in her situation. She's not lectured about how abortion is murder. She's asked, "What do you need?"
Then volunteers mobilize their community to provide transportation, job opportunities, childcare, housing, baby clothes and equipment, good prenatal care, and the feeling that this child is welcomed in our world.
YES. This is an invaluable, compassionate, effective approach to ending abortion!
Realistically, the "crisis pregnancy center" model is too small to reach every woman, even with private donations into the millions. These volunteer resources aren't universally available on large scale across the country, particularly in large cities where demand is high or rural areas where resources are scarce (ie - a pro-life local obgyn to offer discounted care, a retired grandma to babysit kids for free, extensive affordable special needs therapy, etc.).
By supporting family-friendly policies, such as Medicaid for pregnant women, CHIP for low-income children, WIC nutrition for preschoolers, ECI for early in-home therapy, paid maternity leave, a livable wage, accessible and affordable healthcare for all, and a special education program that sets the international standard for supporting those who are differently-abled, by supporting these initiatives, we are taking the pregnancy resource center approach to the national level, empowering parents to choose life for their unborn children.

Sunday, December 4, 2016

Life Hacks For Large Families On A Budget

For anyone who's curious about how we live our lives with five kids six and younger... 

KIDS' ARTWORK

I'm a compulsive trasher. When there's clutter on the countertop, it's really satisfying to just sweep it all into the trash can. Our younger kids' artwork pretty much goes straight to the recycling bin, except for some handprints on the fridge. Our older kids each have a folder in which they can save papers. They know Mom trashes anything that's left around. 

SHOES

Each kid has three pairs of shoes at any given time: sandals, tennis shoes, and church shoes. I keep a box of extra shoes in the closet to save for hand-me-downs.

SHOES WHILE TRAVELING

Each child travels with one pair of shoes. For summer travel, their sandals are their church shoes. For winter travel, their tennis shoes are their church shoes. 

SOCKS

We buy one type of sock. It's black, so it's good with tennis shoes and church shoes. This is our sock pile after sorting the rest of the laundry: 



GATES

Our house looks like children live in it. But we can comfortably let kids play unsupervised in a room, knowing they won't break anything [valuable] or hurt themselves. Still, it's amazing what they find to break, and how any wall can cause a concussion.


Living Room (toddler play room) looking into Dining Room (kinder play room)

PRAY FOR IT

We pray for stuff, and God has provided in some pretty awesome ways. I can't tell you the things I've mentioned to the Lord in prayer that have shown up timely via a friend's hand-me-downs or a neighbor's trash pile -- a kickstand for my son's bike, a desk, an umbrella stroller, a pair of size 8 toddler tennis shoes, a play gate, a rain coat... And we join the circle of sharing too, passing on extras and anything that's still in good condition. (These prayers for stuff aren't fancy: "Lord, a desk would be nice, instead of this tray table and stack of boxes. But You know, whatever.")

NAP TIME / QUIET TIME

I insist on quiet time, if not nap time. As an introvert mom, I need a solid two hours without kids after lunch. Everyone is in their beds from 12-2 pm. Sometimes I let the older kids read instead of rest -- but still in their beds. 

Each bedroom has blackout curtains (or basic curtains doubled with a repurposed bed sheet). 

We're currently at two kids per bedroom, with the baby in the master with us. 

HAIRCUTS

We cut our own hair. You can buy clippers on Amazon for under $10. We spent a little more on some similar to this, because there's not time to change guides when cutting kids' hair. I'm sure there are YouTube videos to help, but we just kind of figure it out as we go along. 


And if all else fails, just put a hat on.
STUFF

We have a "To Repair" box in the laundry room and a "To Donate" box in a closet.

OUTERWEAR 

Each child has one sweatshirt, one light jacket, and one heavy coat. We live in Houston, so this is sufficient. No doubt colder climates would need more. 

CLOTHES

My ideal child's closet: 4 pairs of shorts, 4 pairs of pants, 4 short-sleeve shirts, 4 long-sleeve shirts, 4 pairs of pajamas, 4 pairs of socks, 4 pairs of underwear. 

I store extra clothes in labeled boxes. Anything that doesn't fit in the box is given away. 



PAJAMAS

We fold pajama shirts into their matching pajama pants, so the kids can easily find a matched set. This is kind of silly. Really, kids could just wear whatever they want to bed.


A stack of PJs. We store kids' clothes on shelves, just because we have more shelving than dressers. It's also easier to keep a pulse on clothing issues with open shelving.

BABY PAJAMAS

This is not a thing. The baby wears any combination of cotton shirts, onesies, and pants, and only gets an outfit change when he spits up or leaks a diaper (approx. every 12-18 hours). 

TOYS

We rotate toys and play stations. Whatever is in a room will end up all over the floor, so I try to limit the chaos. Current toys are...

Toddler Play Room (living room): Duplo Blocks, Kitchen + Kitchen Food, a Plastic Nativity Set, and a couple of cars.

Kinder Play Room (dining room): Wooden Train Tracks, Matchbox Cars, and a Train Table 

Patio: 2 Bounce Balls, 2 Tennis Balls, 2 Ride-Along Cars, 2 Lacrosse Sticks, 2 Baseball Bats, Plastic Slide

Craft Cabinet: Play-Do, Paper, Crayons, Markers, Pencils, Paint, Scissors, Glue, Stickers, Puzzles. (If it doesn't fit neatly in the craft cabinet, I give it away. Once kids are done with a craft at the table, all the pieces go back in the box, and the box goes back in the cabinet.)




Toy Closet (front entry coat closet): Lego, Nerf guns, Marble Runway, Stuffed Animals, Baby Toys. I'm the only one allowed in the Toy Closet.




BEDDING

Each bed has a fitted sheet, one blanket, one pillow, and one stuffed animal. The kids can trade for a different stuffed animal from the Stuffed Animal Box, but they only get one at a time. (I don't even like one stuffed animal on the bed, because all I can imagine is the dust, allergens, snot, and germs that they absorb and leech all over the house. I also like to keep laundry to a minimum when kids pee or throw up all over whatever is in their bed.) 

POTTY TRAINING

Potty training kids have this set-up next to their bed, because going to the actual bathroom is too scary at night:



MUD ROOM

We don't have a dedicated mud room, but there's a shelf in our laundry room, en route to the garage that holds all the kids' shoes and socks. This prevents that 20-minute scattering throughout the house that happens when everyone needs to put their shoes on five minutes before we leave. 



TUPPERWARE

I have two types of Tupperware. When I run out of Tupperware, we have an empty-the-fridge dinner.



BOOKS

We cycle kids' books like we cycle toys. There's a large box in the toy closet for books we're not currently reading. We also regularly pull out books to donate to their teachers and school. 



GROCERY SHOPPING

We mostly shop at Aldi, because the prices are really unbeatable. And there's an Aldi a mile down the sidewalk from us, and the walk wears out the kids for nap time. 

I only buy boneless meat at $2 or less per pound, because I can't handle the time or energy of removing bones. (But I tell myself it's because bones could be dangerous to the babies.) When someone's selling ground turkey for $1 a pound, I fill our freezer. Turkey's like tofu. You can pretty much flavor it to taste like anything.

Sometimes I'll go to Kroger if I'm shopping with *just* one or two kids and feeling classy. The fuel rewards are a good deal.

COOKING

We rotate through several basic meals, cooking with whatever meat is on sale or stocked in the freezer -- tacos, pasta, grilled sandwiches, enchiladas, taco salad, sliders -- and always willing to sub PB&J, cheese & crackers, or eggs & toast. I'll make a large cut of meat in the crock pot at the beginning of the week, and then use it for different meals throughout the week. For me, cooking is more a chore than a hobby, so I'm okay cutting corners here. 

KITCHEN TABLE 

The 3 kids who are 2 and younger sit in a row of booster seats with trays, next to the 4-person table. It's easy to serve baby-friendly food in one area of the kitchen and limit the mess. For me, it's easier to wash a tray in the sink with soapy water than to scrub a table where the baby sat and mashed beans into the woodgrain. 



PIT STOPS

We ride with our own potty chair. We use disposable diaper doublers (cheaper than diapers) to keep pee from splashing out en route to the next trash/gas stop. The potty chair doubles as a step stool for the back row carseats.



I hesitate to share any kind of "Best Practices," because when it comes to home and families, everyone's different, and everyone's homes will reflect whatever style of life and love they live. But if any of our systems can help others, then we're happy to share!