Lazy Man and Money

Healthcare (Sigh…)

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Short of clearly negative terms such as homelessness and domestic violence, I can’t think of a more depressing topic than healthcare. The topic is so immense that I’m not even going to attempt to cover it in any kind of detail. I’m only going to address healthcare billing.

You’d think billing for something would be easy. We’ve been billing for things for hundreds of years without issue. It can’t be difficult, right?

Let me tell you how I spent Tuesday morning this week.

In March, the wife and I went on a vacation in Silicon Valley to visit with some old friends. As luck would have it, I got pink eye. I’m going to blame the Extended Stay America in San Mateo, which was one of the worst motels/hotels I’ve ever been at… and I like Motel 6.

What idiot gets pink eye when they are away from their kids for a few days? This idiot, I guess.

My wife, being a pharmacist, knew that we just needed a cheap, generic antibiotic. However, to get that antibiotic, you need prescription. That’s when everything went to hell in a hand basket.

My understanding is that some 99.9999% of the insured US population can go to some kind of non-urgent clinic for something simple like this and have it covered. I even hear that it is relatively quick. Our military insurance is great, but the compromise is that you have to go through emergency rooms for something that should be quick. It means that I often wait six hours for a visit that can be as quick as 5 minutes. (I think emergency room triages could learn from grocery store check-out lines of 12 items or less. Oops, broke my promise to stick to billing.)

In any case, such visits are always covered 100% from by my understanding. This is the way the health care plan wants it to work.

Since we lived in the area for years, we knew just the hospital to go to. It was the one my first son was born at a few years back. As far as vacation illnesses go, this is going to be easy, right?

The visit itself was uneventful. I didn’t even have to wait the usual 6 hours. In fact, I was almost unhappy to have to leave the waiting room that had a new episode of Undateable on.

A couple of months later, the bill came in the mail. We owed $400. Hmm, that doesn’t seem right. I gave them my insurance card. Turns out they ignored what I gave them and used what they had in their computer system. That was no longer an active insurance due to our move. So it churned out a bill of $400 to be sent to my house.

Fortunately my wife works in this area every day and as the sponsor of the plan called up to fix things. I’m never sure who you are supposed to call in this scenario, the hospital or your insurance. In any case, she got the problem solved…

… until Monday when I get a new bill from the hospital for $330, the balance of the portion that my insurance didn’t cover.

This is called “balance billing” and in some states and for some forms of health insurance (such as Medicare) it is illegal.

I had never heard of balance billing before. In my quick research it seems very controversial. For example, I think my bill would have been a lot cheaper if I hadn’t gone to the emergency room. It can’t be $400 for 5 minutes of someone to look at my eye and tell me what I already know, right? However, my insurance requires that I go to the emergency room. On the other hand, is it fair to the emergency room to take only $60 for what they deem is a $400 service? In this case, I think $12 a minute is still very good money, but I bet there are other cases where the insurance doesn’t cover the hospital’s expenses well.

If you really want to have your mind blown, you should read this Forbes article on balance billing. The patient planned a $2000 procedure with an out of network provider which is listed as being covered 50% by her insurance. She saved up $1000 for the procedure. However, she got a bill for $1600.

What happened?

The insurance decided that the procedure should only cost $800 (their negotiated in-network rate) and decided to reimburse her 50% of that (or $400). That left a balance of more than $1600. It’s a double whammy as she was penalized with a higher rate for going out of network and also only reimbursed 50%.

The Forbes article cites research that says only 16% of people were able to accurately estimate their bill in one study.

I can’t imagine that anywhere else in life. The closest I can think of is my mechanic, but even then I get a fairly estimate before work is done. I can understand not having billing details when you are bleeding from multiple knife wounds (or some other urgent situation). However, that wasn’t my case with pink eye and certainly not the case with the person in the Forbes article that saved up for her procedure.

Getting back to my case… I was in California and the Forbes article specifically points out that emergency rooms there can’t balance bill. So I’m not sure how their computers even allows for the scenario. As an extra layer or protection, my insurance seems to say that I can’t be balance billed. So it seems that the hospital is break the state laws and their agreement to take my insurance.

How can we fix this

From a technology standpoint, it should have taken all of 15 seconds for me to swipe my insurance card and have their computers tell me what it is going to cost for a pink eye emergency room visit. Maybe it’s 30 seconds. I’m even happy to run it myself during the hours that I’m usually waiting in the emergency room. The could even take this to the next level and make a mobile application where it saves my insurance in the app. Then I’d only need to enter my condition and GPS could tell me nearest providers and final costs (with my insurance) in the area.

This technology is thousands of times easier than programming to Siri to understand what I’m saying and respond relevantly back to it.

Is this anything new?

Not for me. Twice before, I’ve gotten in conversations that went back-and-forth between the two a few dozen times over a span of several months.

One was for an ambulance ride when I almost died choking on pizza crust. The ambulance company couldn’t figure out how to take my insurance. They couldn’t work it out with my insurance company who had conversations with them. While they went back and forth to resolve the technical issue, my bill went into collections where it started to damage my credit. I was financially held hostage by two organizations who weren’t even disagreeing with each other.

Another time, there was a disagreement between the hospital and the insurance for how the procedure should be coded. Under one coding it would be covered. Under another one it would not be. It was another case where it wasn’t an urgent condition… yet they couldn’t have told me beforehand whether my insurance would cover it.

So now, whenever I have something come up, it’s a game of medical bill roulette. I’ve been fortunate enough to win the disagreements, but I think the process to resolve the financial aspect is far worse than the medical condition itself.

Healthcare… (sigh…)

The Hidden Costs of Smoking

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Although many people realize that smoking is bad for your health, few realize just how big of an impact it can have on your wallet. If you are finding it difficult to quit smoking the following information may just change your mind. This may also be the reason why people are making the switch to vaping (Go to www.davincivaporizer.com to check it out) with those handheld vaporizers because of the savings you can get. Let’s take a look at just how expensive smoking can be:

  • The actual cost of cigarettes – Thanks to cigarette taxes and the higher prices of tobacco, cigarettes are more expensive than ever. If you are on a budget this can easily eat away at your monthly expenses. Even if you are purchasing budget cigarettes, the price is still quite high. When you figure that the average pack costs at least three dollars you can easily spend more than $90 a month if you smoke a pack a day.
  • The cost of smoking has on your health insurance – Whether or not you are currently covered by a health insurance policy you may not realize you are actually paying more for the privilege of being a smoker. Health insurance companies charge an additional percentage for smokers and depending on how high your premium is this can add up very quickly. In fact you can end up spending an extra $200 a month just because you smoke.
  • The toll smoking takes on your daily life – If you’ve been smoking for several years, chances are, you may find it difficult to take part in many daily activities. Whether it’s chasing your kids around, or a long trek to the parking lot, after time the damage the smoking does to your lungs can make these activities nearly impossible. You may find yourself avoiding these activities and as such avoiding much of life.
  • The cost of smoking related health problems – Perhaps the most obvious cost of smoking is the money that you will pay to repair the damage you’ve inflicted on yourself. Whether it’s continuous respiratory infections caused by irritated lung passages, or even cancer, the costs for these health procedures are immense. When you add this to the amount of money you’re already paying in increased health insurance premiums it is clear that smoking can be incredibly expensive.
  • The cost to quit smoking – The smoking cessation industry brings in millions of dollars every year. It is big business to try to help people kick this habit that can be very difficult to break. Whether you are paying for prescription medication to help you stop smoking, or you are trying natural methods such as hypnotism, these all can be expensive.

These are just a few examples of how smoking can impact not only your health but also your wallet. Even know many of us do understand that smoking is harmful, it can be difficult to put that pack away. While quitting smoking can be costly as illustrated above, when you compare it to the other expenses you may be facing in the future, it can be considered a very solid investment. Quitting smoking is not easy but perhaps this information about just how much it can cost you will help you find the motivation to kick the habit.

For more health tips that may save your life as well as your wallet, visit Lazy Man and Health.

Ways Not Having a Job Impacts Our Personal Finances

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I read a post that made me think quite a bit this week. Madison from My Dollar Plan has a list of 15 tips for saving money while you still have a job. I looked down the list and saw things like 401k Matches, Tuition Reimbursements, Insurance – a pile of perks that people get with their jobs. Since I’ve been without a typical full-time job for a year now, I thought I’d go through the list and really see what I have given up.

  • 401k Match – I didn’t get matched funds in either of my two jobs dating back to 2004. So I didn’t lose this when I left.
  • Flexible Spending Accounts – None of my companies have offered this benefit as well.
  • Tuition Reimbursement – Two previous companies offered this. For the first one, I applied for a class on client-server technologies (I was a computer programmer). I was told that this wasn’t relevant enough to my job. I followed up by asking what class teaches FoxPro for DOS in 1999 (answer: none). At the next company the hours prohibited me from taking the class and I had to get a B+ to qualify for reimbursement. That was too much pressure for me. I didn’t want my job performance to suffer because I had to stay up doing homework to qualify for reimbursement.
  • Wellness Programs – My last two companies didn’t offer these either. Previous companies offered a gym membership which was really nice. However, I use the gym in my own apartment complex than I ever used my gym membership back then.
  • Frequent Flier Miles – Much of the time, travel isn’t big for a software engineer. I didn’t give up much of this benefit.
  • Health Insurance – This is the biggie for most people. I have been using my wife’s policy so this was no loss.
  • Employee Discounts – I didn’t get these with my most recent jobs, but when I worked for Papa Gino’s (a New England pizza chain), the discounts of 50% off your food were great. It wasn’t unusual for the manager to send you home with a pizza for the family if you worked a solid shift.
  • Investment Services – I’m in the minority here, but I found that much of the time, I could prepare myself as well as the people who were brought in to talk about 401Ks. Though I will miss grilling them whenever they say something slightly misleading.
  • Industry Subscriptions – I used to love getting PC Magazine and eWeek back in the day. I have found those publications of less interest. I would rather have Business 2.0 if it was still around.
  • Company Car – That would be sweet, but I never had a reason for one.
  • Free Events – Companies I’ve been with have had one or two yearly bonding days. These were great and acted as mini-vacations.
  • Free Meals – My last company was big on this. I never had to pay for lunch or dinner. I miss it greatly. However, since I’ve been on my own, I’ve been eating healthier and still fairly cheaply.
  • Employee Assistance Programs – I’ve never used one of these before and I haven’t had a need of one since. For some, they provide value, but not me.
  • Friends – This is another big one. I didn’t go out for beers on the weekends with any of my co-workers, but I felt like I got along with them well.

As I look through this list, I probably gave up less than most people. The biggest thing I can think of is about $60,000 a year in income. Wait, that’s pretty big. Let’s see what I’ve gained…

  • Freedom/Time – I’ve had the freedom to do a lot of the things that I’ve always wanted to do. I have time to fit in other things.
  • Health – With that free time, I’ve found more time for the gym. I’ve had more time study healthy habits. I’ve had more time to go grocery shopping and cook dinner. In short, I feel healthier than I have in some time.
  • Fun – The extra time has allowed me to catch up with some of the household chores: laundry, cooking, cleaning, etc. This means that my wife and I aren’t always catching up on the weekends. Instead we look to go to fun things like garlic festivals.
  • Extended Vacations – Before I took this time off, I’ve never had an employer act positively to the conversation of “I want to take a month off.” Now I don’t have to ask, the question becomes one of “Can we afford to go to Phuket?”
  • Save Money – I mentioned saving money by cooking and shopping, but I also save money by not driving to work. My transportation costs have gone way down.
  • Tax Breaks – I never would claim the home office deduction when I had a full-time job. Even though I use it for my alternative income, it was too much of a risk of audit. Now that I work out of home full-time, I’m sure the IRS looks at my home office as a more legit expense. There are other tax savings as well when you run a business.

My hope is that within the next two years, my income will be up to where it was before I left. At that point, I’ll have the best of both worlds, time and money. It’s a long road and it won’t be easy. As a friend said the other day, I’m still far away from where I need to be.