Sunday, July 28, 2013

7 Quick Takes: In Which A DIY Lifestyle Moves Slowly

(vol. 8)

It's not that I find the work of a DIY lifestyle enjoyable. To be honest, I would happily pay someone else to do all of our work, if I didn't have that nagging sense of budget and fear of debt.

Happily, Google interprets my nonsensical home maintenance questions (what to do if my toilet is overflowing -- #1: don't wait until you've flushed it twice more to look this up). And between Youtube, home improvement store seminars, and "This Old House" reruns, we have free access to every how-to video ever, occasionally accompanied by the patience to actually watch them.

Unfortunately, the previous owners of our home also had strong DIY tendencies, albeit expressed more superficially. Someone drilled the gutters, sans brackets, unevenly into the side of the house; so they're more of a leaky trench than a water-draining system. Someone painted over rotten eaves fascia and structural cracks. Someone didn't paint walls behind overgrowth or trees. It seems all of our home projects begin with undoing whatever the previous owners "fixed."

1. The Unfinished Refinished Kitchen Cabinets

My mistake here was a failure to realize just how many layers of paint a kitchen cabinet can hold. And how many layers of paint the hardware and hinges of a kitchen cabinet can hold. Just getting the doors off the frame took hours. Now my system is a messy time-consuming combination of chemical paint stripper and sanding, and chances are, there will be an indefinite hold on the project after the butler's pantry is complete.

I also plan to experiment with cutting plywood to fit our custom cabinet door sizes (which are about 45 years old and don't fit any standard replacement cabinet doors, which means replacing the entire cabinets, if we want to replace the doors, which is super expensive, super labor intensive, and super out-of-budget). It sounds a little ghetto, but I'm holding high hopes for what a little sanding, staining, and polyurethane can do for plywood.

Stalled-out butler's pantry, because I can't bring myself to finish sanding the doors.

2. The Toilet Replacement

We have a tiny bathroom with a giant water-guzzling toilet. The Habitat for Humanity Re-Store (if you haven't been -- go visit!) has toilets for $40 each, and we found this little jewel that will slide nicely into our bathroom, once we replace the laminate floor with tile, and pull out the oversized sink and vanity.


Old Giant Toilet (left); New Sleek, Yet-To-Be-Installed Toilet (right)

3. The Gutter Install

We're about to find out just how far we can stretch the Home Depot customer satisfaction guarantee. We meant to replace the gutters last April, which is when we bought all the supplies. But a combination of working on Saturdays, weddings, and rain delays have brought us to a project workday that is 10 days past the returns date on our receipt. Here's to hoping...*

4. The Vanity Replacement

For a 25-square-foot bathroom, there's no reason for the vanity to take up 10 square feet. However, I recently found out that Ikea sells a 10-inch sink. I've marked out in blue painter's tape where the new sink and side cabinets will go, and cannot wait to attempt bath time with toddlers with the extra 14 inches of space!


[Soon?] to come! Space in the bathroom!

5. The Deck Replacement (a.k.a. "Please let us give you our money!")

We've spent a year planning the replacement of a rotting, splitting deck across the back of our house. It's a feature our kids love and is an ideal place for toddlers to toddle. In the interest of longevity and low-maintenance, we've decided to replace it with composite decking, which is significantly more expensive than pressure-treated decking. You'd think we were trying to replace it with moon dust.

Composite decking isn't popular enough for home improvement stores to carry it in bulk, but their customer service desks and websites and promotional flyers are full of DIY-friendly promises about deck planning and special orders.

We called Home Depot to see how to place a special order. "Just come in and talk to Javier!" they said. We scheduled babysitting for the kids, and went in to talk to Javier. He dismissively said they don't special order composite decking; it's just not something they do. So we went to lunch instead.

We called Lowes to see how to place a special order. "Just schedule an appointment with John!" We scheduled an appointment with John, scheduled babysitting for the kids, and then John no-showed at Lowe's. He didn't really sound interested in follow-up when we called back. Actually, he didn't really sound that interested in decking either.

6. The Vegetable Garden


We stocked up on lawn timbers when they were 99 cents each at Home Depot's 2012 Memorial Day sale.

I suppose the picture below simply indicates where vegetables fall on our life priorities list.


Future vegetable garden.

7. The Completed Projects

Just for some encouragement -- lest I communicate that we're stalled and not just slow -- here's a list of our completed DIY projects (supported by much Googling and Youtube how-to videos), since April 2012:

- Replaced carpet with wood laminate in living room (after removing carpet and tiles that we're pretty sure were full of asbestos, but we just held our breath as long as we could while scraping)
- Insulated the garage door
- Insulated the large sliding glass door
- Replaced the kitchen shade with blinds (my favorite upgrade -- sunlight!)
- Built an inset desk in place of a vanity (with open shelving for stowing laptops)
- Replaced the rotting wood in the eaves fascia
- Removed overgrowth and 5 trees (and some beautiful oleander, because we didn't want to kill our kids or pets)
- Removed wallpaper from entryway and re-painted
- Sanded and painted wood paneling in living room (so much wood paneling...)
- Installed new kitchen faucet (a retractable spray faucet with one lever for hot/cold water -- a huge upgrade for us, and purchased for $45 from the Habitat for Humanity Re-Store)
- Built an insulated box for the attic door
- Insulated the attic fan
- Installed new ceiling fan in kitchen
- Moved kitchen ceiling fan to master bedroom
- Removed brick privacy walls from front entry (rented a concrete saw)
- Cleaned the main sewage pipes under the house, removed a major blockage
- Installed lots of shelving and organizational aids throughout the house and garage to try to give everything a place
- Repainted and replaced hardware of bathroom vanity
- Repainted entryway light fixture
- Repainted bathroom light fixture
- Repainted bathroom towel rack
- Replaced entry door
- Replaced locks with keyed deadbolts on every exterior door
- Built garden and planted bushes across front of house (twice, because we let the first ones die)

Visit Jen for more Quick Takes! No doubt more interesting than incomplete DIY!

*Home Depot accepted our returns, 10-days past the deadline, no complaints, no questions asked.

Friday, July 12, 2013

7 Quick Takes Friday: The Social Justice Series

(volume 7)

1. Please don't forget the women.

The Texas Senate votes today on HB 2, which would require clinics that perform abortions to meet ambulatory surgical center standards, require abortionists to have admitting privileges at a hospital within 30 miles, and make abortion illegal after 20 weeks gestation.

According to current projections, the bill will pass easily, and is considered a "win" for the pro-life movement.

Sadly, Amendment 23 to HB 2 was tabled: to make more public the undeniable causal link between abortion/miscarriage and breast cancer.

Amendment 24 was also tabled: to provide prenatal, delivery, and postnatal care to women who seek and are denied abortion.

Yes, children's lives will be saved through this legislation, and I am encouraged these children will not be written off, because they dared to be conceived in less-than-ideal circumstances.

But may we not forget that children are not the only victims in abortion. Let us multiply our efforts to support the women who feel their situations are dire enough to need abortion.

2. Life without health insurance.

Ever wonder what the medical bills would look like for a person without health insurance who needs to go to the Emergency Room? Here's my experience: the kidney stone revelation.

3. Life. is life is life is life.

Do you see the irony that the same legislators who are meeting in a special session to passionately push through pro-life legislation, these same legislators work in the state with the most executions, in the country with the fifth most executions in the world?

Many claim those on death row are career criminals who just plain "deserve to die." Or, who cares about the details of their particular situations, "it doesn't change the fact that the world is just better off without them." 

Do we not realize, these are the same dehumanizing arguments used to justify abortion and euthanasia, especially of those who veer from the norm of our mental or physical expectations, those who are weak, disabled, or sick? In every person, always, regardless of past or present situations, is hope, is potential, is the opportunity to love and be loved. To write off just one person begins the process of writing off any one person.


More rant on the needlessness and uselessness of the death penalty here: is killing okay if it's only done by the government?

4. Health Insurance Alternatives

Sorry, back to the disenchantment with healthcare in America topic.

Lots of people ask me how our healthcare co-op works, so I put together some of our thoughts on the good and the bad we've experienced here: health care sharing ministries as an alternative to traditional health insurance.

Samaritan Ministries is a national program that currently has 24,000 households participating. Membership legally fulfills the requirement to carry health insurance, a part of the Affordable Care Act that is scheduled to take effect in January 2014.

5. Students, Loans, Debt, and Advising

I do think it's a step backward that student loan interest rates are going up. But I think the current advising system in most public colleges and universities is a bigger travesty.

Perhaps if 18-year-olds could be made to understand what $1000 means in tuition, work, and debt, they could better prepare for the future. I don't even know if this is possible.

But I sure wish in my 30,000+ student college experience, the advisors hadn't just been grad students pushing us through a course list and then out the door with a diploma.

Some real mentoring is needed. What are your talents and interests? What kinds of jobs could that lead to? What kind of lifestyle do you want to live? Do you know how much the bill will be each month after graduation to repay the loans you're taking out today?

6. Back to healthcare.

Never thought I'd say this, but Oregon seems to have a good system in place.

7. Geez, we've got a saint for everything.

I go to my mom when I need prayer for my kids.

I go to my friend when I need prayer for my job.

I go to my mentor when I need prayer for spiritual direction.

I wonder if St. Anthony rolls his eyes and sighs when we go to him looking for our key fobs.

Something's lost that can't be found; please, St. Anthony, look around.
Lots of people post Quick Takes over at Jen's!

Thursday, July 11, 2013

What An Uninsured Emergency Room Visit Looks Like

I panicked and called 911, because it was 5 o'clock in the morning, and my husband had run to Walgreens for something to help alleviate this intense pain. Massage, heat, cold, baths, Pepto, Motrin, and Phillips had done nothing. I imagined an exploding appendix.
Our family joined a healthcare co-op of sorts that shares medical bills among members. It's a novel and appealing idea, though the claims process can be gritty. 

Here's a picture of our medical bills for a 4-hour early-morning stint to the Emergency Room, followed by our co-op experience:

Ambulance: $725.00
Discount: 0%
Total Paid: $725.00

The City of Carrollton does not contract with any health insurance companies, so their ambulatory services are out-of-network for everyone, nor do they offer financial assistance based on ability to pay.

For us, this means we can't negotiate a discount based on the discounts they offer insurance companies. It also means our middle-class household of four doesn't qualify for a break on the total.

For most residents of Carrollton, who carry traditional health insurance, this billing structure means paying toward an out-of-network deductible, which is usually significantly higher than the deductible for in-network providers. (A deductible is the amount of money a person pays out of pocket before insurance covers anything.) Once a person's out-of-network annual deductible has been met, the out-of-network coinsurance is also significantly higher, with the patient usually being responsible for 30-50% of the total bill.

Hebron Emergency Physicians: $1,403.00
Discount: 50%
Total Paid: $701.50

I was thrilled when we received this bill. I'd heard so many stories about hospitals offering great self-pay discounts to patients without health insurance that I thought this was the all-inclusive medical bill from Baylor Carrollton.

There was a 50% discount offered, if paid in full online, so I logged in, paid up, and thought everything was covered.

As it turns out, this was a bill for the doctor who poked his head in the door to say, "Hey, you're scheduled for a CT scan."

And then 90 minutes later: "Yep, it's a kidney stone. Call this other guy for follow-up."

Our three-sentence-seven-hundred-dollar relationship ended there.

Baylor Medical Center at Carrollton: $6,522.09
Discount: 78%
Total Paid: $1,400.42

So this was the actual bill for a private closet in the ER for four hours. Granted, it included two doses of morphine, and at the time, I would have happily paid much, much more.

I did the compulsory call to their billing department, requesting the same discount that they negotiate with health insurance companies. But they said discounts were only provided if I submitted a financial aid application.

Now, I don't consider our family impoverished by any stretch of the imagination. We have spending limits, naturally. But we also have food, shelter, clothing, and plenty more. Somehow, after filling out the financial aid application with our income information, Baylor Medical determined we are 80% indigent. 80 percent! If our family falls in the bottom 20% of wage-earners, then we are a blessed nation indeed.

Medical Imaging of Dallas: $917.00
Discount: 49.6%
Total Paid: $462.00

I called Medical Imaging when I received this bill, because I thought there was a mistake. In the line items of my Baylor Medical bill ($6,552.09), I'd seen a $4,000 charge for a CT scan. I knew I had already paid $701 to the doctor who told me the results, so surely this extra thousand-dollar bill was some kind of duplicate.

The billing representative who took my call was so helpful, tired, patronizing. "Yes, the hospital charges a technical fee for use of their equipment, the doctor charges a general fee, which includes telling you the results, but we charge a professional fee, which actually interprets the results."

I offered to join the assembly line of payees with an interpretation fee to communicate to the patient the ridiculous billing process to follow, but she just laughed awkwardly and asked for my credit card info.

I sent them an email asking about discounts for self-pay patients, and the responding representative said they could bring the total down to $641.

When I called in to pay the bill, the rep who answered said there was no record of the email I received and no note on my account. Luckily, my appalled disbelief at their traceless recordkeeping resulted in silence instead of profanity, because she then said, "But I can settle your account for $462."

Go figure.

Texas Urology Carrollton: $205.00
Discount: 37.1%
Total Paid: $128.80

After being discharged, with lots of hydrocodone, but sadly, no morphine, I received a referral to a urologist for follow-up. The doctor wasn't available on short notice, but I got an appointment with the physician's assistant.

As a self-pay patient, they offered a 20% discount, so I actually paid $128.80 for this appointment. (Two months after this appointment, I received a bill for an additional $82.20, and it's good I called for clarification, instead of blindly mailing my check in their self-addressed envelope. As it turns out, the balance due was a mistake, and our account was already paid-in-full.)

After looking at my CT scan, the PA found the doctor to see about scheduling some intervention. He had the urgent, technical speech of a man with a medical degree, but I was able to piece together the following about my situation:

They preferred to do a procedure with sound waves to break up the 6-mm kidney stone, but their outpatient clinic refuses patients without traditional health insurance. So they decided to schedule an operating room, anesthesiologist, and x-ray at the hospital to do an invasive procedure with a scope instead.

Luckily, the hospital also refused to schedule me until a payment plan was set, by which time, I sourced people who had the operation and strongly advised against it, and so had changed my mind about any intervention.

Unfortunately, this all happened after the pre-op lab work was ordered and completed.

Clinical Pathology Labs: $171.00
Discount: 20%
Total Paid: $136.80

Basic Metabolic Panel: $64.50
Pregnancy Test, Serum: $65.00
Complete Blood Count: $41.50

There's actually a note on the bill that says, "Perhaps your doctor did not tell you that a specimen was sent to us... and that you would receive a separate charge. Should you have questions concerning results of the test, please call your doctor."

It made me feel better that apparently it's a thing for doctors to order tests and not call their patients with the results.

In Closing:

As the kidney stone shifted, the pain lessened significantly, and the side effects of a low-functioning kidney set in. Five weeks, gallons of water, and countless home remedies later, the kidney stone passed!

Our healthcare co-op, Samaritan Ministries, will actually cover all of these bills. (You can follow this link to a post about how Samaritan Ministries actually works. Our family pays $405 a month, and our deductible is $300 per claim, which was waived in my kidney stone issues, because we negotiated discounts of at least $300 from the medical providers.)

So all of my complaining isn't so much about the cost of my inaugural kidney stone experience. I'm just frustrated and concerned for the millions without access to health insurance, who are then also without access to healthcare.

Since health insurance in the United States is provided by employers for full-time employees, my family doesn't qualify for any of the comprehensive plans. I work part-time, and my husband is listed as a "contract" employee with the company for whom he's worked six years. He used to regularly work full-time hours, but with the sweeping overhaul of the Affordable Care Act, intended to provide healthcare (re: health insurance) to all, his hours were cut to just below the minimum requirement for employer-sponsored health insurance.

Our only option for traditional health insurance is to purchase directly from the insurance companies in the private market. Needless to say, without the clout of a large pool of participants or appeal of a significant corporate account, the private health insurance companies hold all the cards. There's no such thing as negotiation or patient advocacy in this market, and in consequence, not a single private health insurance in Texas covers the basic family healthcare need of maternity. For real. (This changed after the Affordable Care Act took effect. Now every health insurance plan covers maternity.)

On a final note, the premium/deductible ratios are such that one might be culpable to the sin of gambling just for playing the health insurance game. It would at least seem wiser to buy a Texas Powerball Lottery ticket.

Healthcare Sharing Ministries as an Alternative to Health Insurance

We've opted to use Samaritan Ministries, a health insurance alternative, to cover our family's medical needs.

We chose this non-profit organization for several reasons, but in short:

   1.) We don't qualify for employer-sponsored health insurance,
   2.) Private health insurance in Texas does not cover the basic family healthcare of maternity,
   3.) The premium/deductible ratio for private health insurance in Texas is ridiculous.

Here's an overview of the Samaritan Ministries system, and how it's worked for us:

1. We pay $370 a month for our family of four.

If we have another kid, it's still $370 a month. If we have quadruplets, it's still $370 a month. If we adopt more kids, they're covered, and it's still $370 a month. Samaritan Ministries likes kids and understands that families with lots of them don't have spare cash for playing the odds with ER visits.

2. If we have a health issue that costs over $300, Samaritan Ministries covers everything over that $300 out of pocket, up to $250,000.

We could add a plan that covers us higher than $250,000 per claim, but we are playing the risk that we won’t need more than this. When Joshua had his skull/brain surgery, it was about $80,000, so we’re thinking that’s on the higher end of normal claims families might incur.

Once Samaritan Ministries receives our bills, they negotiate with the providers for a self-pay discount. If the total discount received is more than $300, that means we don’t even have to pay the $300 out-of-pocket!
3. Samaritan Ministries doesn’t cover preventative care.

This part sucks. Except there’s a Dallas County pediatric health clinic less than 5 miles from our house, and I can schedule $5 wellness check-ups for the boys with a nurse practitioner. I can also keep all of their vaccinations up-to-date for only $5 each visit.

With our previous pediatrician, we always waited at least 30 – 45 minutes, and then the doctor spent about 5 minutes with us. The nurse practitioners at the Dallas County health clinic are very interactive and have the boys go through play and communication activities to make sure they’re developing at a healthy level.

Wally and I haven’t had any wellness check-ups since being with Samaritan Ministries, but there’s a low-cost clinic in Lewisville that does a women’s wellness exam (including lab/pap smear) for $80. I haven’t tried it out.

4. Samaritan Ministries doesn’t cover sick visits under $300.

This also sucks. So we play a lot of wait-it-out games. For adults and kids over 2, the CVS Minute Clinic works GREAT. For $65, you get a check-up and prescription for all kinds of basic sickness.
5. The paperwork is annoying.

We are collecting all of the bills from my recent ER trip – ambulance (because I thought I was dying), ER, labs, and specialist follow-up – and recording them on the claim page from Samaritan Ministries, which has to be signed by our pastor, before we submit it to Samaritan Ministries.

Our pastor is really supportive, and curious to see how this plays out. He has many parishioners who are struggling with healthcare needs, and we’re the first to try out a Christian healthcare co-op.

6. Samaritan Ministries doesn’t cover eye care or dental care.

We’re looking into a dental discount plan, because those are really cheap. But there are also low-cost clinics for that stuff. And Baylor College of Dentistry in Dallas offers discounted rates.

7. There are over 24,000 households who are members of Samaritan Ministries.

8. Membership in Samaritan Ministries fulfills the individual health insurance mandate included in the Affordable Care Act.

This means we won't have to buy private health insurance through the state exchange, starting in January 2014.
.