I recently started receiving acupuncture. I knew that my insurance covered 12 visits a year. I checked the coverage and learned that my portion is a $15 co-pay for the office visit, and then 10% of the treatment. But that’s not how it worked out, and it’s taken several calls to get it sorted out.
Reading the Benefits Website
I started at the website. That’s where it said that the office visit co-pay was $15 (standard medical co-pay) and the treatment was 10% of the cost (standard co-insurance.) It didn’t mention anything about a deductible.
I next looked at their provider list and located acupuncturists in my area. Then I looked at their websites and an acupuncture provider website to find out who treated my condition. I called and made an appointment.
My provider called my insurance before my first visit to confirm coverage and let me know my co-pay would be $22.50. Great. I went for my first visit, paid my co-pay, and then went on my way.
The Explanation of Benefits Arrive
You would think that between me reading the website, and my provider calling them, and my provider reading their website, we would have figured it out. You would be wrong. When my first explanation of benefits arrived, it said I owed $105.00. It also said that the second “treatment” on the same day was not covered. Apparently the provider used the proper billing codes, but the insurance misread them. They’re now reprocessing those initial claims.
I also called to find out what was going on, and was told that they were billing wrong and that I had a $250 deductible. It doesn’t say that anywhere in the acupuncture portion! The deductible for the plan is never mentioned anywhere except at the top of the benefits section.
My Provider Confirms Again
I showed the EOB to my provider, who called the insurance again. Finally they explained that there’s no deductible for office visits, as they said the first time, but there is for treatments. And that they don’t start counting my visits toward the 12 until my deductible is reached. Based on what they’ve said I owe, that started on my fourth visit, so in total I’ll have 16 visits under my plan.
I’ve learned from this to always call first to confirm your coverage. The website has the correct information, but it isn’t always organized in a way that makes sense to the average user, or even to providers. Even if your provider calls to confirm coverage, if it’s an unusual situation, call to verify yourself anyway. As I learned, it can take three or four calls to get it all straightened out!
And then sometimes, as happened with my husband’s surgery, they’re still wrong. Of the $4000 surgery co-insurance they said we would owe, we paid $60. No amount of calling could have figured that one out!
It’s been another six weeks or so since my last tomato update. No picture this time because my plants are looking pretty crappy right now! The leftmost one is nearly dead. The center one is dying, with just three small tomatoes left growing. The rightmost plant is dying on the bottom and thriving on the top. I’ve completely abandoned pruning so that they stopped growing out of reach. Pretty soon I’ll have to pull the plants out. Two are destined for my compost bin. One is destined for the green bin.
End of Summer Means End of Tomatoes?
In some areas, the end of summer usually means the end of tomatoes. I thought it would, too, but I just checked and the rightmost plant has seven or eight flowers showing. Only time will tell if they get fertilized and start producing. However, the days are getting shorter, so the plants will have less sunlight to do their magic. I got my largest tomatoes in the middle of summer when the days are nice and long.
Bad Soil Means Mixed Tomato Results
My soil is the epitome of sandy soil. That’s not good for plants. I’ve fertilized and fertilized, and even replaced the soil initially with a mix of compost and garden soil. Next year when I have my garden box, the whole box will be filled with good soil, but I might dig down a bit further to deposit some fertilizer and good soil, too. Most of my Stripe Romans have had some form of blossom end rot. Of course, it’s always been a weirdly cool summer. The rot could indicate a lack of calcium, or a lack of heat. Next summer should be normal, so I should know better then.
And now for the question of the day: how many tomatoes did I get?
As of right now, I have 83 tomatoes. If the third plant hadn’t died, I’d probably be over 120. Not bad for three months! If those other buds become tomatoes, that will bring my total to 90. I’ll take it!
If you want to grow tomatoes, it’s easy. You don’t need a backyard as long as you have a sunny balcony. If you plan to start from seeds, order now. If you plan to start from seedlings, watch for seedling sales in your area. It’s usually early spring.
A few healthcare laws changed immediately with the passage of the Healthcare Reform bill, but most will take some time to take effect. Several important measures that don’t affect your taxes go into effect on September 23, 2010. You may have already received a notice about them from your health insurance company. If not, here’s what you need to know:
Health Insurance for Adult Children
Under the old law, children were no longer eligible for their parents’ insurance once they graduated from college or reached age 24, whichever came first. Under the new law, the coverage is extended to age 26, unless the child’s employer offers insurance. If you have an adult child who hasn’t yet found employment, or became unemployed, contact your insurer to re-enroll your child in your policy. Some insurers chose to keep adult children on the policies in the gap between graduation and September, but some didn’t.
Free Preventative Care
Starting now, your insurance company may no longer apply a deductible, co-insurance, or co-pay to preventative screenings like mammograms and colonoscopies. Well-baby and well-child visits are also included in this category.
No Rescinded Coverage for Technical Errors on Applications
Part of what prompted this particular reform were the horror stories about women with breast cancer having their coverage canceled because they forgot to mention a mole they had removed fifteen years earlier or other such ridiculous claims. Health insurance companies may no longer do this. I assume that they can still rescind if you intentionally lie about big things, such as not mentioning that you’ve had cancer before.
Appealing Insurance Company Decisions
It’s happened to everyone – a bureaucrat decided to deny coverage for something the patient needs because the bureaucrat thinks it’s unnecessary. While you’ve always had the option to appeal, most people didn’t know that. The new law creates a formal external review process and a formal appeals process.
Eliminating Lifetime Limits on Coverage
A person with an expensive condition or illness will no longer be able to exceed their coverage. This often happened with cancer patients, but could also happen to patients taking expensive medications. Once they reached the cap, they either no longer had coverage or had to find a new job with a new plan. Experimental procedures may still be excluded, but necessary treatments must be covered regardless of the total dollar amount the patient has used. If you require expensive care and had previously exceeded the cap, contact your insurance company to see if you’re now eligible for treatment coverage under the new rules.
Restrictions on Annual Limits
In addition to lifetime limits, some insurance companies include annual limits on coverage. Those limits are now strictly curtailed and will be banned in 2014.
No Exclusions for Pre-Existing Conditions in Children
This is another big one. Prior to today, children with conditions such as asthma, leukemia, or birth defects could be denied coverage for a pre-existing condition if their parents had to change plants. Now, children under 19 can’t be denied coverage if they have a pre-existing condition for new plans and existing group plans. If you have a plan that excludes your child, you can now apply for new coverage for him or her.
As you can see, most of these new rules targeted the most egregious insurance company abuses or are items that most people can agree needed to be changed. The controversial stuff doesn’t take effect for quite some time.
This morning, several news sources reported that economists have final declared the end date of the recession – June, 2009. You may be thinking – huh? It’s simple – the formal definition of recession is defined as a certain period of negative growth. When that ends, the recession ends, even if your personal situation doesn’t greatly improve.
This was the longest recession since WWII, lasting from December, 2007 to June, 2009. So, we can safely say that it did start during George Bush’s presidency, and Obama’s economic stimulus really didn’t do much to end it, because his economic stimulus plan wasn’t fully rolling before it ended.
Now that we’ve gotten the politics out of the way, let’s dive into what it means for you.
You Can Feel a Difference
For many people, the end is starting to feel more real, but only now, not a year ago. As late as last Christmas, I had a friend who asked her parents for grocery store gift cards and borrowed money from them to buy her children a couple of gifts. Now she has a job. As she said, they’ve gone from “we can’t pay the bills” to “we can’t pay the bills right now, but we can soon.”
Not much has changed for my husband and I, but my company did finally give raises earlier this year, so at least there’s been some progress.
Unemployment Is Still High
Many people wonder why unemployment is still high when the recession is over. Remember, unemployment is a lagging indicator. In the last recession, employment didn’t recover until 19 months after the end. So, we have at least another four months until we expect to see recovery. However, this recession was longer and deeper, so I think it will be longer. There are a couple of reasons why high unemployment lasts so much longer:
1. Unemployment only counts people looking for jobs. If you give up, you stop being counted. Many people gave up last year, and then returned to the job market this year, which caused the rate to actually go up despite an improving job market.
2. Employers don’t instantly start hiring when demand for their product increases. Instead they push their current employees harder and only hire when they’ve maxed our productivity. That can take a while.
Spending Won’t Reach Its Former Heights – For Now
Families won’t be able to use their homes like ATMs for a long time. I’m sure we’ll get there, but it will be at least ten years before banks become that reckless again. I also think that this recession has shaken the American consumer deeply. The current generation will remember the pain and be more careful with their spending. I’m not saying we won’t buy fancy phones, cars, and TVs. We will. But we may also be more careful with those purchases and save more money toward them. We may also decide to forgo other purchases.
Here’s an example: I’ve been thinking of buying an artificial Christmas tree. I wanted to buy it this year, but we’re buying a new TV/TV stand this year. A tree will cost around $600-$700, so I may put that off until next year. We can go another year without one. We’ve already done it for six years.
The Housing Market Will Still Suffer
The housing market is going to continue to suffer for a while. Although prices have stabilized or improved in some places, the end of the home buyer tax credit deflated demand. Most people who could afford to get into a home already did. Those that are left are biding their time or bidding lower. On top of that, there are still many more homes that have already been foreclosed, but not yet marketed, or that are waiting to be foreclosed. So, I don’t expect to see the housing market fully recover for at least seven years. If you don’t have to sell right now, don’t.
Even though economists say the recession is officially over, in fact they say a double-dip is unlikely, only you can decide if your personal recession is over. That’s what really matters.
Oh, what a difference a fat emergency fund makes. When I first started this blog, my husband wasn’t much into saving. He didn’t spend wildly, but he was definitely feeling like we’d never get out from under our debt and wasn’t as committed to paying it off quickly.
Then I created the Plan. Then the Plan started to work and he started to see the light. Then the Plan was complete and the prospect of buying a house became very real. Then we bought a house, and still had money left over. Now, the fat emergency fund has become a sacred cow.
Baby Stepping to Savings
I always had faith in my plan, so at first it was hard for me when why my husband didn’t see the plan. But each month, he stuck to it and started to believe, too. The first key was that I never stopped believing we could get out of our debt. As long as one of you believes and is willing to convince the other, then you can do it.
The second key was that my plan was doable and methodical. I ran calculations and determined we could pay off $40,000 by December. I knew approximately when our windfalls would arrive, so that helped. As it happened, they arrived sooner than anticipated and we paid off our debt faster.
The third key was that I built in initial successes. We were fortunate that the highest interest rates also correlated to the lowest debt, so we targeted that first. Once that was paid off, our snowball really picked up.
The fourth key was that we had a clear goal – pay off the debt so we could start saving up to buy a house. We also had a debt payoff deadline – our interest-free credit card would expire in August of that year and we wanted to pay as little interest as possible. We ended up only paying two months’ worth of interest, or about $200 on an initial debt of $17,000. Not bad!
Once that debt was paid off and our goal started to become real, his enthusiasm for saving really took off.
Where We Are Now
Fast forward 18 months. One day in April, 2009, my husband announced that “saving money is fun”. This was a breakthrough, people!
Now it’s 18 months after that and we’ve been in our house for a year. My husband has started to say things like “we can afford that,” when I say that I want to make drapes for a $400 cost instead of buying drapes for a $2000 cost.
But, we had another breakthrough when it came time to buy me a new car. Losing 30% of our income this year due to my husband’s surgery and a couple major home repair expenses means our emergency fund isn’t as fat as it once was, but it’s still going pretty strong. We didn’t have to dip into the fund at all during his disability leave.
Last month, my husband looked at the fund and realized we could almost afford to pay cash for my new car. We opted not to, because we didn’t want to drain the fund, but that realization was a big step. He now sees that we still need to be saving precisely so that we have these options, and other options, in the future.
In addition to the cushion in an emergency, that’s what the fund does: it gives you the freedom to make choices about what you want to do with your money. Need new drapes? You can decide between making them or buying them. Personally, I decided that the time investment was less important to me than the financial investment, so making them was the clear choice. But you may be able to make a different choice if you have a savings cushion and a commitment to saving.
My cousin recently went on her college tour and she looked at my old school. When I learned what they now charge for tuition, I was shocked and angry. In fact, I was stabby, for the first time in almost three months! I went to a good school, and enjoyed my time there, but it is simply not worth what they’re charging anymore. The education was good, but not amazing. In fact, some of the classes were downright awful.
The Rapid Rise in Tuition
It seems that colleges these days, even the non-profit ones, are more interested in bringing in money and earning acclaim than they are in educating their students. I graduated 15 years ago. At that time, tuition plus room and board was around $18,000. Steep, but not ridiculous. Now, that same school is asking an astounding $47,500 for tuition plus room and board. The cost of room and board has doubled in fifteen years. Meanwhile, the tuition has tripled. The total is 379% more than it was fifteen years ago.
If the cost had risen with inflation, it would be $25,000. That’s a pretty sharp difference. Almost a whole year of tuition different!
Where Is the Money Going?
According to an article in this weekend’s Los Angeles Times, the money usually isn’t going to academics. At the major schools like Yale and Duke, it’s going to sports, higher salaries for non-teaching professors, additional administrators, and infrastructure.
I don’t take issue with infrastructure improvements – certain things are necessary in today’s schools that simply didn’t exist in 1995. However, my old college does not have a single world-class athletics team, although they did rebuild the gym, maybe in hopes of getting one? The professors there actually do teach. They’ve remodeling several of the buildings and expanding the campus rapidly. However, I’ve also learned that their endowment has ballooned to over $400 million and they’re not giving as many tuition grants as similarly endowed schools. So what’s with the money grab?
Honestly, if it were my child, I would not send him or her to that school. It’s not worth it. Instead, he or she could go to a UC, which offers a similar, in some cases better, education for less cost. Yes, the rates at UCs have also gone up over 300%, but they started out pretty low so the total isn’t as steep.
Is This Fair to Our Children?
Sure, student loans make it easy to afford the education while the student is in school, but what happens once they graduate? An engineering grad may earn enough to pay back $188,000 in loans (total before interest), but what about an English major? They will spend the next thirty years paying off those loans. What happens if they want to buy a car or a house? What happens when they want to send their children to college and are still paying off their own loans?
The current system isn’t sustainable. We have to do something to contain these costs before they spiral any further out of control. The very idea of my old school charging a freshman living on campus $47,000 a year makes me irate. Harvard costs $50,000. Believe me, my college is not in Harvard’s league. In fact, I told my cousin it wasn’t worth it.
If we keep going this way, only rich students or students who plan to be engineers will have any hope of paying back the cost of their education and then eventually being able to retire. Is that fair? I don’t think so.
I read an interesting article on Marketplace.org about several bloggers who went a year without buying any new clothes. No used clothes, either, although they could buy all the underwear, shoes, and accessories they wanted. So, that got me to thinking, could I go a year without buying new clothes? The answer for me is probably no. And I don’t really buy that much, but there are some times when I do need to buy new clothes.
When I Buy New Clothes
I do tend to keep my clothes for a long time. I have t-shirts and jeans that I’ve been wearing for four or five years. Some items are probably six or seven years old. However, clothes do wear out. If I had committed myself to not buying new clothes for a year, I could do it, but I’d probably be at the store buying a few new things on day 366!
I buy a couple new shirts and maybe a new dress or skirt at the start of each summer to freshen up my wardrobe. I also buy a couple new shirts and pair of pants at the start of each winter. I buy new pajamas once a year, once I’ve worn holes in the old pair.
I buy new gym shoes every six months, but otherwise I tend not to buy shoes often. Accessories are pretty minimal, too. Usually I buy them at the same time as the new clothes.
I already know that next summer I will need to buy new crop pants. I have been looking for three years already for the perfect pairs, but I’ll finally have to get serious next summer because the pairs I have simply won’t make it another year.
What would the bloggers have done if they were asked to be in a wedding? Sure, you can avoid buying a new formal dress for most events if you already have one, but most bridesmaids are expected to wear a specific dress. Maybe that shouldn’t count for this purpose, since bridesmaid’s usually have no say in the matter!
Weight Loss or Gain
If you lose or gain more than ten pounds, you’ll either need to buy some new clothes or get your old ones tailored. Even at a ten pound gain, you’ll need new pants or you’ll look terrible. Losing ten pounds shouldn’t make your clothes look terrible, but more than that calls for some interim upgrades if you plan to keep losing.
The Changing Body
I technically still wear the same size I did in high school, but there’s absolutely no way I could wear those clothes. And not just because they were horrible 80s pegged jeans and cropped shirts. This may be more true for women than for men, but the body changes over the years. Even if you weigh the same at 40 as you did at 18, the way you carry the weight has changed. Clothes, especially jeans, start to conform to the body, and you may find that your really old clothing puckers in odd places.
I think if I made a pledge, I might be able to avoid new clothes for a year, but it would be tough. How about you? Could you go a year without buying new clothes?
About a month ago, my husband and I realized that we seem to watch more TV during the summer when there’s supposedly “nothing on.” In fact, it got so bad that I was eager for the fall season to start so I’d have less to watch (which actually isn’t true, it’s just spaced better.) When I realized that I was resenting the shows I watched, or not paying attention, I decided to take action and reclaim some of my time.
The first thing I did was set priorities. Is this episode of Weeds more important to me than an hour of writing time? No, so I taped Weeds and can watch when I’m doing other stuff.
Here are my priorities:
Clean the house for company – did that while “watching” Top Chef. I really only care about the end of each episode anyway at this point.
Write – I’m trying to finish a personal project by September 6, but I can only write from 9-10 p.m., so that’s my sacred writing time. I don’t surf the internet, read email, or watch TV during that time. I save the TV for later and avoid doing the former as much as possible. It works.
Hem the drapes – I pinned them while “watching” Psych last night. I’ll start sewing the others a little at a time while I watch TV from 10-11 each night or while catching up on movies this weekend. I love holiday weekends!
Paint the bathroom – obviously, this can’t be done while watching TV, so I’m just going to dive in.
I have lots of other projects, but these are my priorities. Once I realized that I wasn’t really invested in all those TV shows anymore, it was easy to watch them while doing other things. At this point, some of them merely serve as background noise while working on various projects. When I made my slipcovers, I watched several seasons of Deadliest Catch and quite a few movies, just to have the noise. It worked perfectly.
Do You Watch to Watch or Because You’re Bored?
And other shows, well, I’ve just cut them. Wipeout is my guilty pleasure at the start of each summer, but by about eight episodes, it gets redundant. I’ll catch a few minutes here and there, but I feel no guilt for deleting them from the DVR unwatched now. Other shows, like Burn Notice and Eureka, I watch to watch. Those I set time aside for.
I tend to be more involved with the shows I watch in the winter and fall, but I’m actually more selective with those. For example, I’ve decided not to add any new programs this year. Last year I added Modern Family, V, and Caprica, but I’m rather relieved that the latter two aren’t coming back until spring and may not end up watching them anyway. I’m realizing that my time is worth more to me than those shows. When I’m bored, I’ll watch something off the DVR, but I don’t turn on the TV in primetime and watch whatever’s on anymore. Sorry, TV, you’re just not that interesting anymore.
TV is a time-suck for me. You might have other time sucks. If you feel like you’re wasting time, think hard about your priorities. Are there are other things that are more important? If yes, then start by reducing the amount of time you spend on the activity. Then skip it a week. If you don’t miss it, keep skipping it. There, you just got your time back. If you do miss it, then you might have to reconsider your priorities.
What About What Other People Think?
For some reason, people in my office don’t talk about TV. Either they rent them all on DVD after the season is over, or we have other things to talk about. My husband’s office does talk about TV, but usually it’s not an issue. You just have to find other things to talk about. Some people may even be impressed that you watch so little TV!