Let's Face It: I'm Too Cool For You

I can’t quite put my finger on it, but this feels vaguely relevant…

a black woman named zoe amira posted a video on youtube. this video is an hour long and filled with art and music from black creators. it has a ton of ads, and in result will rack up a ton of revenue. 100% of the ad revenue from the video will be dispersed between various blm organizations, including bail-out funds for protesters. it will be split between the following, dependent on necessity

brooklyn bail fund

minnesota freedom fund

atlanta action network

columbus freedom fund

louisville community bail fund

chicago bond

black visions collective

richmond community bail fund

the bail project inc

nw com bail fund

philadelphia bail fund

the korchhinski-parquet family gofundme

george floyd’s family gofundme

blacklivesmatter.com

reclaim the block

aclu

turn off your adblocker and put the video on repeat. do not skip ads. let it play on loop whether you’re listening or not. mute the tab if you need to focus elsewhere. but let. it. play.

youtube will donate to blm for you.

2. DONT watch it in a playlist. 

3. DONT fast forward or skip. 

4. DONT skip the advertisements. 

5. Watch with atleast 480p and HALF the volume. 

6. After watching this, watch 3 to 5 any other videos then search this video (don't click it from your watch history) and watch it again. 

7. DONT clear watch history and search history. 

so it’s open enrollment time, which means you need to pick a health insurance plan from the exchanges!  it can be daunting as shit, for sure, especially if you don’t live in the filthy weeds that are the business side of our garbage health care industry like yours truly does.  

so!  here’s a quick rundown of some of the vocabulary:

premiums: this is what you pay per month for the glorious honor of having insurance coverage.  it does not count towards your deductible or out of pocket maximum.  depending on your income, you may be eligible for a subsidy or other financial assistance to make your premiums more affordable.  

deductible: this is how much in health care costs you have to pay before your insurance starts really kicking in.  for example, my insurance through work had a $1,500 deductible, so the copays and coinsurances and lab costs that i had to pay early in the year, before i had another surgery, were fully my responsibility until i’d paid out $1,500; after that, my insurance started covering a flat 80% of everything, including copays.  basically, the deductible is how many actual dollars you have to pay out for medical costs before your insurance takes over.  

if you’re someone who goes to the doctor a lot, like me, you’re probably going to want a plan with a lower deductible, which will have a higher premium; however, in the long run, you’ll come out more ahead with a high premium/lower deductible.

on the flip side, if you’re generally healthy and just need an annual checkup, flu shot, ob-gyn annual, etc., then you probably want a lower premium/higher deductible plan.

out of pocket maximum: this is the cap on how much– aside from premiums– you should have to pay in health care costs in a year.  most plans on the exchanges right now have a high deductible and higher OOP max.  

network: this is the collection of providers (doctors, surgeons, urgent care facilities, imaging facilities, etc.– any clinical medical care or medical service provider) that are contracted with the insurance plan.  this means that they have an agreement with the plan to accept payment from that plan for services.  you can still see out of network providers, but your plan may have a separate out of network deductible that is higher and that you pay separately from your main deductible (for example, if your plan deductible if $5,000, you might have a separate out of network deductible of $5,500; even if you’ve already paid of $4,950 of your regular deductible, if you see an out of network doctor, you’re going to have to hit the $5,500 deductible in copays and whatnot before the insurance covers them fully).  

most insurers have their own website that identifies what doctors are in network.  sometimes you can access this without being on the plan already, sometimes you can’t.  a decent, though inconsistent, workaround is to use zocdoc, where you can put in the plan type you’re thinking about switching to and see what doctors are in network.  the drawback to zocdoc is that contract status is doctor-reported, so if the doctor’s office in question is slow to update, the records may be out of date.  

another option to determine network availability for a specific doctor or care group is, if you’re okay hopping on the phone, to just give them a call and ask outright if they’re going to be in network for plan ___ in 2018.  

if you’re like me and hate talking on the phone, the other option is that large provider groups, and a good number of smaller groups and individual providers, will often also have accepted insurances on their websites.  in my experience almost all providers who have privileges at a hospital will have that listed on their pages on the hospital’s website.

copay: this is a flat fee you pay to a provider when you see them.  it’s like the cover charge at a bar: you pay $20 to get in the door, and then you get the dubious honor of also paying for the drinks and food you buy inside on top of that.  

coinsurance: this is a percentage charge for seeing a provider.  instead of a $20 copay for the cost of the visit to see doctor bob, you’re charged, say, 10% of the total cost of all charges associated with you visit to see doctor bob.  if you don’t get much done, this may only like $10; if you get a full metabolic panel run and a bunch of xrays, it might be $100.  

and the plan types:

hmo: health management organization.  the concept of this plan is that you have a pcp (primary care provider - your regular doctor) who functions as your primary point of contact for all medical care.  if you want to see a non-pcp doctor, you have to first see your pcp, who will write you a referral to see said specialist.  specialists include orthopedists, physical therapists, neurologists, ob-gyns,  etc. - any provider who isn’t your pcp, basically.  

hmos tend to be cheaper for you, the beneficiary

this is because of how they’re paid out: pcp doctors receive a capitation (aka, a set flat amount) payment from the insurer for each beneficiary (you) who has them as a pcp.  

so, if i’m a primary care doc and i have 200 blue cross hmo patients and i get $100 per patient, i get $20,000 from blue cross, ostensibly for the cost of care provided, but the provider keeps all $20,000 even if they only end up incurring $15,000 in costs.  the downside of this for you as a patient is that this encourages pcps to get a lot of people to sign up as their patients, and then to see them as little as possible/push them out to specialists for actual care, as this lowers their costs and increases their revenues.  

you may end up feeling like you’re going in circles trying to get actual care because you’re getting pushed from one doctor to another.

note: hmo plans sometimes do not cover out of network providers at all.

ppo: preferred provider organization.  this plan is a free for all: if they’re in network, you can go to whomever you want.  they tend to be a bit pricier (almost always on premiums, 50/50 on deductibles) than hmo plans, but you’re basically paying for ease of access.  you can make an appointment directly with any specialist you so choose.  these plans are ideal for people like me, since i have to see orthopedists and hematologists and physical therapists pretty regularly, and going through a pcp for each of those would be a pain.  

you’ll tend to have relatively low copays within the network and higher ones outside of it

unlike some hmo plans, most ppo plans will provide coverage for out of network providers, just at a less favorable rate

epo: exclusive provider organization. this is the bastard child of the hmo and ppo and is also an increasingly common option on most of the exchanges.  like a ppo, no pcp or referrals are provided; however, the network tends to be narrower and you have less choice of in-network providers and, crucially, they don’t tend to cover any out of network providers except for emergencies 

important note: the classification of “emergency” isn’t just “emergency situation”, but generally is limited to a proven medical emergency in which you go to an actual emergency room or emergency department.  

insurers will frequently challenge ER/ED bills to confirm medical necessity because– 

in their defense, since they’re meant to cover almost the entirety of emergency bills and also because one of the quantifiable measures of success in moving to value-based care that the ACA established is lowering avoidable ER/ED admissions

–they don’t want to encourage people to go the ER/ED for just anything

high deductible/catastrophic: these are exactly what they sound like– plans for healthy young people who are pretty much only going to wind up with medical costs if something terrible and, well, catastrophic, like a car accident, happens.  they have low premiums and very high deductibles (often approaching ~$10,000).  these are only available to people under the age of thirty, because clearly as soon as you turn thirty you must turn into a total drain on all healthcare resources :|

so what does all of this boil down to for you and your enrollment?

start by figuring out what financial help you’re eligible for!  the exchanges generally have an option at the front end of the process for you to identify your annual income and number of dependents on your plan.  this will let you know if you’re eligible for a subsidy or other financial help, and, if so, how much; you should also have an option when searching through plans on the exchanges to input estimated financial help, which will adjust the premiums in the search engine.  

after that, start digging into the individual plan options.  every exchange plan should provide a summary of benefits and coverage.  it’ll be a pdf and will look like this:

that red circle in the top right there? that’s where you can identify what type of plan you’re looking at.  the first page in the summary of benefits will always look the same– it’s the basic overview of the costs and definitions.

this document will also list excluded services.  it’ll generally be somewhere in the middle/back half of the document and will have a clear header like this:

for me, this is the first thing i look for after verifying premium and deductible amounts.  as the above picture indicates, you can find more information in the plan documents.  these aren’t always directly linked to on the exchange website, but you can generally find them on the insurance providers website.  these will be a lot more detailed and can be anywhere between twenty and 200 pages.  ctrl + f your heart out: as frustrating and complicated as insurers can be, they can’t actually fail to disclose if they, for example, don’t cover all forms of contraceptives.  they’ll disclose it in the plan documents, even if they don’t, unfortunately, have to be clear and up front about it.

NOTE: MINIMUM VALUE STANDARDS

towards the end of the summary of benefits document will be a page that looks like this:

minimum value standards roughs out to basically meaning that at least 60% of all medical charges are covered.  if the plan you’re on does not meet minimum value standards, you might be able to get a tax credit to help you buy another marketplace plan.  always check for this verification when you’re researching plans.

what does all of this shit mean? 

it means start here and then find your state’s exchange from there.  the garbage carrot in chief established “maintenance times” on this website throughout the open enrollment period (sunday afternoons, i believe), so schedule around that.  sit down on a monday or wednesday or saturday with some snacks and a cup of your favorite beer/wine/tea/whathaveyou and crank up some good music to jam to and do some research:

start with figuring out what you can afford monthly and if something terrible happens and you have to cover ER and/or surgery bills

if you have a specific doctor you want to stay with, figure out which insurances they’ll be accepting

check for coverage info in the summary of benefits documents and, if you want more detail, in the plan documents

narrow it down to a few and compare the prices

take a break and have a cookie, you deserve it at this point

pick a plan!  if you’re not feeling super certain about it, go for a walk, do some laundry, pet your cat– just take a break, walk away, come back to it with fresh eyes.  this is a big deal, so you don’t want to wear your brain out and give yourself a headache and then just pick one at random because you have eye strain and want to be done.  open enrollment goes until december 15, so don’t rush yourself.

sign up for your plan

have another cookie and pat yourself on the back, because you just signed up for health insurance for 2018!

now take a nap because that was fucking exhausting and you deserve it

as always, i’m here for any questions you might have!  

there will be basically zero advertising for it this year, bc of the current administration and also bc alex azar is a shithead, so.  put it in your calendar so you don’t forget, expect them to roll out another maintenance schedule on the website that will fuck with weekends and usual enrollment times, and get started early this year.  

i’ll also make a more detailed addition later, but be really careful looking at what the plans offer. there are shitty junk plans allowed on the marketplaces now so don’t assume that just because they’re on an aca state exchange that they’re good, or even decent coverage. i know health insurance is expensive and overwhelming to look at, but there are affordable, decent plans in most marketplaces, even if you have to dig for them.

But as the bus approached Seventh Avenue, the driver got on the intercom. “Folks,” he said, “I know you’ve had a rough day and you’re frustrated. I can’t do anything about the weather or traffic, but here’s what I can do. As each one of you gets off the bus, I will reach out my hand to you. As you walk by, drop your troubles into the palm of my hand, okay? Don’t take your problems home to your families tonight—just leave ‘em with me. My route goes right by the Hudson River, and when I drive by there later, I’ll open the window and throw your troubles in the water. Sound good?”

It was as if a spell had lifted. Everyone burst out laughing. Faces gleamed with surprised delight. People who’d been pretending for the past hour not to notice each other’s existence were suddenly grinning at each other like, is this guy serious?

Oh, he was serious.

At the next stop—just as promised—the driver reached out his hand, palm up, and waited. One by one, all the exiting commuters placed their hand just above his and mimed the gesture of dropping something into his palm. Some people laughed as they did this, some teared up—but everyone did it. The driver repeated the same lovely ritual at the next stop, too. And the next. All the way to the river.

We live in a hard world, my friends. Sometimes it’s extra difficult to be a human being. Sometimes you have a bad day. Sometimes you have a bad day that lasts for several years. You struggle and fail. You lose jobs, money, friends, faith, and love. You witness horrible events unfolding in the news, and you become fearful and withdrawn. There are times when everything seems cloaked in darkness. You long for the light but don’t know where to find it.

But what if you are the light? What if you’re the very agent of illumination that a dark situation begs for?

That’s what this bus driver taught me—that anyone can be the light, at any moment. This guy wasn’t some big power player. He wasn’t a spiritual leader. He wasn’t some media-savvy “influencer.” He was a bus driver—one of society’s most invisible workers. But he possessed real power, and he used it beautifully for our benefit.

When life feels especially grim, or when I feel particularly powerless in the face of the world’s troubles, I think of this man and ask myself, What can I do, right now, to be the light? Of course, I can’t personally end all wars, or solve global warming, or transform vexing people into entirely different creatures. I definitely can’t control traffic. But I do have some influence on everyone I brush up against, even if we never speak or learn each other’s name. How we behave matters because within human society everything is contagious—sadness and anger, yes, but also patience and generosity. Which means we all have more influence than we realize.

No matter who you are, or where you are, or how mundane or tough your situation may seem, I believe you can illuminate your world. In fact, I believe this is the only way the world will ever be illuminated—one bright act of grace at a time, all the way to the river.“

Beyond the intolerable treatment this country has shown Undocumented/Refugees, ICE is Drag Netting people they deem POTENTIALLY Undocumented. Profiling people, scooping them up, and tossing them into their Deportation Machine. The number of Established Citizens (Both Apllied&Acquired and Born-in-this-country) being snatched up in misidentifications, errors, simple lazy incompetence, and malicious false witness has TRIPLED possibly QUADRUPLED in the last 2 years alone.

don’t just pay it. do not automatically pay the hospital bill when you receive it. call your health insurance provider and POLITELY say, “excuse me, i just received a bill for $1200 for my hospital visit/ER visit/etc., is that the correct amount i’m supposed to pay?” because hospitals bill you before your health insurance and they will take your money no matter how the amount due may change based on your health insurance looking at it. 90% of the time, if your health insurance is in any way involved in the payment of that bill, you do not have to pay as much as the hospital is billing you for. call your health insurance provider first, and POLITELY request clarification, always remember that the person you are talking to is human and this is just their job, and then you will very likely find out you actually only owe $500.

Also, it is important [for people receiving medical care in the USA] to carefully read all of the items on the medical bill and look for errors and overcharges. I know that the normal feelings of avoidance and dread can make it hard to look at scary hospital bills, and that’s okay! But as the OP mentions, private orgs like hospitals don’t monitor overpayment of bills - they are motivated to charge you extra - and it is basically impossible to get your money back. Read the bill carefully and make sure that the charges are correct, using the links below for help if you need. If they haven’t sent you an itemized list, you can ask for one. Sometimes you will be charged extra for items or treatment you didn’t receive. Most people don’t know that you can dispute medical bills! But in 2009, Consumer Reports stated that 8 out of 10 medical bills scrutinized by a watchdog had errors, and generally you are not obligated to pay for someone else’s error.

You may be charged for using medication that you actually brought into the hospital with you - that’s easy to dispute! You may be charged for the consumables used during your stay such as sheets, gloves, gowns, etc - the hospital should actually cover that under its running budget. You may be charged for a brand name drug if the generic was available for cheaper - the links below explain how and when you can dispute this. You may be charged a surprisingly expensive “oral administration fee” (where a nurse puts pills for you to take in a little clean paper cup and then hands it to you) but that’s worth disputing if you were actually able to take the pill out of a bottle and put it in your own mouth. And so on.

8 Things You Should Know About Challenging a Medical Bill (FORBES) (includes links to sites that help you calculate how much a procedure/treatment usually costs in your area, if the costs seem super high)

7 Tips for Fighting and Paying A Huge Medical Bill (FORBES) This explains briefly how to negotiate costs, and payment plans.

10 Common Medical Billing Overcharges You Can Prevent (Bill Advocates) A breakdown of errors and overcharges to double check.

Post 10 gifs of your top 10 favourite movies without naming them, then tag 10 people.

Jaime:

Brienne: *stands up for the innocent*

Jaime:

Brienne: *fights like a beast on the battlefield

Jaime:

Brienne: *screaming* STAND YOUR GROUND

Jaime:

Tormund: *tries to flirt with Brienne*

Jaime:

Brienne: *exists*

Jaime, every minute of every day:

Jaime:

Our time is ours and it is valuable. Just because I don’t have to schlep my kids to soccer practice twice a week and pick them up from daycare doesn’t mean I’m not busy. I’m allowed to go on vacation. I’m allowed to say “no”. I’m allowed to be busy.