seguransa madness!

Insurance companies.  Necessary evil or just evil?  I’m an anal, detail-oriented person whose favorite job was doing accounting, but I despise dealing with our insurance company.  We pay people money so that we don’t have to pay a lot later, and their job is to deny/minimize those future claims whenever possible, and our job is to monitor, harass, beg, cajole, and threaten them into paying what they’re supposed to.  Who thought this up?  The kingdom won’t be like this.  Heck, CANADA isn’t like this.

So, the reason for this post is my total confusion regarding my current insurer’s policy regarding double coverage.  This will be a long, boring post with lots of photos of boring stuff.  The only ones who could care about this are those who work in the field or who find themselves in the belly of the beast as I am now and turn to google in desperation.  Here are some photos of “explanation of benefit” (EOB) statements from a doctor visit in April.  At that visit, we paid $30.30 up front since our plan usually requires us to pay 90%.

So for those of you scoring at home, the total due is $303, $51.87 of which Premier (our insurance company, aka PCA) says “exceeds usual & customary.”  Of the remaining $251.13, they apply a $10 deductible, then pay the rest at 90%.  My wife is the one who went to the Dr, and this is applied to her insurance.  Then check out the EOB below, which is applied to my insurance (same insurance company, same employer, same benefits, etc).

So if you can’t read that, the total due is $303, $51.60 of which “exceeds usual & customary.”  No idea why the amount that exceeded usual and customary changed slightly.  Of the other $251.40, they apply the annual $150 deductible, and then pay $85.98, which they claim is 90% of the remainder (even though it’s not – it’s just the amount needed to get to $303 in total).

So taken together, they applied $160 to deductibles AND paid the full $303 despite the fact that $51 and change exceeded usual and customary.  Is that normal?  Plus we paid $30.30, and haven’t seen any refund.

Fast forward a few months to a dental visit.  This one also has charges that exceed usual and customary, but they’re not picking them up this time.

Tammy is again the patient in this example, and the above is her EOB statement.  Below is the same thing, but applied to my insurance.

So why did they pay the charges that exceed usual & customary in the first case, but not this one?  Our dentist sent us a bill for the $65.69 for each of the 3 of us, and I’m unsure whether I should pay the dentist or try to get the insurance company to pay it.  Some of our other medical providers will write off the amount not covered by insurance that is labelled as exceeding “usual & customary,” but not apparently in the case of Dr Nick Feldman!  Who, I must say, although it was only one visit, appears to be a superb dentist.  In addition to the usual stuff, the guy takes digital pics of each of your teeth from 3 different angles, and you watch it all on a color monitor – even with Claire they let her hit the button to take each picture – she left the dentist at 38 months thinking that going to the dentist is fun fun fun.

About now you are thinking “What a huge waste of time.  Did you consider CALLING the insurance company??”  Yes, I did and spoke with a woman there for literally like over an hour trying to make sense of the 4/30/09 EOB statements.  We got nowhere.  She was very nice and professional and patient, but we just repeatedly missed each other and both left the conversation very frustrated.  She even called me back at home (unexpectedly) a few minutes after we hung up and we went around again for like 20-30 more minutes, me asking earnest questions 10 different ways and her endlessly explaining but to me she was not understanding my questions and answering questions I hadn’t asked and repeating the same information every time.  The conversation ended with her basically saying she has lots of work to do and can’t spend all day repeating the same information to me that I can’t absorb.

Much of the confusion is because for the last 5 years Tammy had the only job and all our insurance was through her.  But for the 14 months since that time we are both working for the school district and have dual coverage.  And a big part of the problem I think is that our medical plan book that has all the details doesn’t have a section on dual coverage that spells out how it will work.  Another factor is that we have significant history with this company with lots of mistakes in their payouts, like an average of a couple errors per year probably, to the point that I keep all the charges from all the EOBs in 3 big excel spreadsheets.  Tammy adds that another reason not to trust them is that our insurance company changes its name every 6 months and is based in Reno, NV.  : – )

I have to admit that this probably WAS a total waste of time, but for whatever reason I was compelled to do it.  Now I can just send an email to Premier with a link to this blog post and not have to explain it all in the email.  ; – )  So for all of you insurance experts – do you have any insight for me?  Am I screwed up or is it them?  Should I pay the dentist?

****UPDATE as of 10/22/09****

I called the dentist to schedule a visit for a new crown I need.  I asked what my balance was, and they told me zero.  Apparently PCA paid my entire bill, including the $65.69 that exceeded usual and customary rates (UCR – I’m learning the lingo here).  So I took the plunge and called PCA.  They sent me to the same poor woman I spoke with at such length before.  I’m sure she remembered me, or certainly did after a few minutes.  She explained that they paid the eligible expense on mine at 70% (because I’m in my 1st full calendar year with LKSD, it goes up year by year by 10%), then they coordinated it with Tammy’s coverage, which paid 100% of what was left, including the amount that exceeded UCR.

So my question for her was how come they didn’t coordinate Tammy and Claire’s visits with my coverage so that mine would pay 70% of the amounts that exceeded UCR from their appointments?  She couldn’t get it, but was convinced that I wasn’t understanding her repeated explanations.  She was unfailingly polite and patient, and it really pains me to email or call PCA and ask for anyone but her in order to get this resolved.  I think she is assigned to our company, so we’re sort of stuck with it.  It may well be that they have a solid rationale or explanation, but I didn’t hear it.

So now it’s some time later and I called them and asked for anyone but the first person and was directed to Suzi.  She listened well and after 10 minutes of explaining and some confusion she spoke with her supervisor with me on hold for 5-10 minutes and then came back on and said I was absolutely right, it was inconsistent and the amounts in excess of UCR should always be paid by the other spouse’s coverage at whatever their coverage is (in my case 70%).  So instead of owing $65.69 on each of Tammy and Claire’s accounts with Dr Feldman, we’ll only owe 30% of that (about $20) after PCA coughs up their 70%.  In a diplomatic way she closed by saying that things aren’t always as consistent at PCA as they’d like and they’re working on it.  I’m thrilled, not for the $90 or whatever they will pay, but that there is an end to this long story.  Speaking with that first employee was like being on the eternal treadmill elliptical of insurance futility.  And the worst part is she was as nice as your grandma so I can’t hate her.

30,000 pounds of bananas

I have tons of random things I’ve meant to post on for ages, and I’m finally doing one of them now.  Back in March when this occurred, I wrote some friends asking for any help they could give with it.  Here is most of that email:

“My supervisor at work just now showed me her yahoo account.  Up to yesterday she had a normal yahoo mail account, receiving around 5 messages per day in her inbox.  Today when she logged in, she has 5 BILLION messages in her inbox (it wasn’t such a round number, it was a huge string of digits without commas and I rounded it).  According to a December yahoo article, the world’s total email volume per day is right around 100 billion.

When she logs in there is a message to the effect that “we are protecting your account and you won’t be able to send or receive mail for the next 48 hours while we address this.”  If she goes into her inbox, it only shows what she saw as of yesterday (she can’t receive mail, basically).  I googled this problem and have found nothing.  Have you guys ever heard of it?  At first I just thought she gave her address out to the wrong site, or that someone was out to get her and used some malicious spam-creation program against her.  But 5% of the world’s total emails?!?  Maybe a yahoo internal error is more likely?  If any of you have an answer, we’d love to hear it.  I must say I find it all rather amusing.  Poor Tammy would have an aneurism.  She **hates** having too much unread mail in her inbox.  Must…keep…READING!!!!!  : – )  I told my supervisor she is living a jr highers dream.  She truly is the most_popular_person on the planet.

It stayed that way for a few days and then all of a sudden everything was back to normal.  So I have no answer, but if someone googles this topic NOW by golly they’ll find this thread and know they’re not alone.

one economist’s perspective

“In Galena and the six related villages the annual average suicide rate was 141 per 100,000 over the period 1979-1989. In Nome and the 15 related villages it was 89 per 100,000. In Bethel and the 48 villages of the Yukon-Kuskokwim region it was 56 per 100,000. Galena was awash in booze, with a store in Galena, one in Ruby, in, and one on the Yukon near another village. The Nome villages were dry, on paper. But residents brought booze in from the liquor store in Nome and arrived home drunk from its bars. But the Y-K region had no liquor stores or bars, except for the store in Red Devil, 150 miles up the Kuskokwim from Bethel. The three studies, which included accidental deaths as well as suicides, showed alcohol was involved in over two-thirds of all the deaths they reported.  What else should these suicide rates be compared with, besides each other? The annual average suicide rate in the U.S. has been around 12 per 100,000 since 1900. It fluctuates a little, but not much, through two world wars, the Depression, the entry of many more women into the labor force during and after World War II, increasing drug use, race riots, anti-war protests, a huge influx of immigrants, and other major social changes nationally.”

Here is the link to the full article.

our friend Troy, the global-human-trafficking-fighting-lawyer

Our dear friend Troy heads up an organization called Speak Up for the Poor.  Here is the website, and there is also a facebook page, and a fantastic blog.  Want to help change the world with Troy and Jesus?  The door is open.

LKSD! Speaking UP!

I wanted to thank the LKSD board for their recent resolution opposing Proposition 1.  Also for the policemen who have spoken out in opposition.  It took some courage and wisdom and I’m so glad they did it!

As Dr King said:  “History will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people.”

The delta has been in a state of upheaval and ’social transition’ for well over a century now.  I’m proud of LKSD for taking a stand.  As I’ve related in other posts on this subject, I’ve been told in the past by actual Bethel city council members that they oppose it, but if they come out publicly against it they believe they’ll be removed from office by the people.  Argh.

car buying

OK, so we recently bought a used ‘07 Subaru Forester from affordable used cars in Anchorage, the largest used car dealer in the state.  We’re pretty happy with it.  $15,000 and it has about 37,000 miles on it.  5.45% from Alaska USA, 60 monthly payments of $244.87.  We will probably pay at least twice that every month, and throw some PFDs on as well to minimize the interest we pay.  But I wanted to share a few things from the process that were interesting.

The dealer ALMOST sold me on the $2,500 optional warranty that would last 7 years and cover most everything.  But there were some exclusions, and it was 7 years or 100,000 miles from when it was NEW, so actually more like 4.5 years and 63,000 miles for us.  I waffled back and forth, but then reasoned that since we will leave our car in the city and only drive it when we’re in town (maybe 2-4 thousand miles a YEAR), it was probably a bad idea to pay a boiler-plate price for something that is priced based on people who drive 5 times that much or more per year.

Have you heard of “GAP Coverage?”  It pays the difference between the insurance settlement check and the amount you owe on the car in the event of a total loss.  Like if it was totalled tomorrow and the bank values it at 10,000, the GAP coverage would pick up the other $4,500 we still would owe in that scenario.  This seems like a fairly unlikely scenario, with a pretty small potential payoff, especially if we will pay large amounts of the amount we owe over the first several months.  They wanted several hundred dollars for this coverage (can’t quite recall exact amount.  $500 maybe?)  No thanks.

Much worse was the disability/loss of life payment protection plan.  This would pay my monthly payment for me in the event that I died or was disabled and unable to work.  But not if it happened within 6 months of signing up for it.  This is a 60-month loan (that I’ll probably pay off in 30 months or less), so losing the first 6 months is a big deal.  They did up all the paperwork at the bank (Alaska USA FCU) and had this plan automatically included.  They were having me sign everything, I asked what this piece of paper is, she explained and I checked the amount and said “What??  Uh…  No thanks.”  They were a little snippy and annoyed that I turned it down and said “All right, well, that means we’ll have to start all this paperwork ALLLL over again…”

The plan costs $3.25 per $1,000 of principal for the given month.  So initially, with a $15,000 loan we’re talking about $50 per month!  For perspective, I pay $12 per month for a 30-year term $100,000 life insurance policy.  It would cost much LESS if it wasn’t a term policy with about 25 years to go, but even so, I’m paying about $.12 per $1,000.  And of course since I already have life insurance (even a small policy), do I really NEED what is essentially a second (tiny and overpriced) life insurance plan?

OK, so how much should disability insurance cost?  I went to an online site that offers you quotes from different brokers, and got 3 quotes.  One was for disability coverage that would pay me $1,800 per month for a max of 5 years, which is a handy comparison because the longest the car one would matter for is 5 years, or actually 4 1/2 years because the first 6 months aren’t eligible.  The monthly cost was $22.50 and it doesn’t kick in until I’m disabled and unable to work for 90 days.  The car one kicks in after I’m unable to work for 30 days.  $22.50/month for a maximum 5-year payout of $108,000, or about $.21 per $1,000 maximum payout.

I know we’re plowing through the weeds here, so to speak, but we’re almost to the conclusion.  I could go out on the internet and get disability and life insurance from reputable companies for far more money, for far longer terms, and pay far less.  Specifically, they wanted $3.25 per $1,000 of maximum payoff.  I could get it for $.33 ($.12 + $.21) per thousand. And keep in mind that what I’m getting for $.33 is something that someone is still making a PROFIT on.  The real cost of course is less, may be $.20 or something.  I hadn’t done the math when I was sitting in the chair trying to scan the fine print and not sign it as she was pressuring me to do, but I could tell right away it was a stinker of a deal.  I don’t mind paying above cost, everyone has to make money.  But that kind of a markup is offensive, even wrong.  Opting out changed my 60 month payment to drop from $276.03 to $244.87.  Note also that they build the extra price in as if you were going to make the minimum payment for 60 months.  If you pay it off way early, you should theoretically pay less toward this fee because your monthly principal will be less than they projected, every time.  But you’re stuck with it.

The last thing I should mention is that the loan process took…for…ev…er.  The sales guy at the dealership said he has been doing this for many years and had **never** seen it take that long.  He called me on my cell hours after we left and thought I had changed my mind.  The bank is literally across the street from the dealership, and we learned later they are crosstraining everyone to handle loans because they got rid of the “community liaison” person who used to open new accounts and do all the loans.  So we had a newbie.  My wife and the 3-year old had to stay right there because my wife was a cosigner (she is the main breadwinner these days).  From the late morning it rolled on and on, about 4 hours (maybe 4.5?) in all.  Oh well.  I also later heard that Credit Union One in Anchorage was financing some people at 4.5%, so I’d at least check them out in addition to Alaska USA.  I had misunderstood a conversation the previous day with Alaska USA and thought we were getting 4.45, not 5.45, and by the time I learned, we were so far in I didn’t care I just wanted it to be over.  We will pay it down very aggressively so the interest won’t matter as much.

OK, so this was an amazingly boring blog post.  Read it when you are having trouble sleeping.  I just wanted to get it all out there.  For more info on the whole car-buying process, one place that was helpful for me was this site.

We also were looking at buying an ‘03 Ford Windstar minivan.  Blue Book value is around $5,000, the guy wanted us to assume his remaining payments of around $7,500, so we had to turn him down.  Sounds like he paid around $14,000 for it just a couple years ago.  It occurred to me that he is probably paying for things like GAP coverage, and the disability/life thing, and he probably got killed on the interest rate (might not have great credit).  He was a nice guy and I was a little sad we couldn’t help him out.

alcohol issue (local option) coverage from ADN

Hey, the ADN has a big spread on the current movement in Bethel to do away with local option. This would essentially remove the monthly alcohol importation limit (It would not, as I understand it, necessarily mean that alcohol could start being sold legally in Bethel). OOPS!  Quoting from the article:  “If the vote passes, Bethel would be eligible for two bars and two liquor stores based on its population, according to the state Alcoholic Beverage Control Board that awards the licenses.” As I’ve pointed out previously in this space, the monthly “limit” is absurdly high.

Here are the ADN pieces: article, audio slide show, and short video. Good stuff, hopefully Bethel voters see it and do the right thing.

Just had to add this from the article:  “”We want the citizens of Bethel to be able to choose what they want or don’t want on these alcohol issues. We don’t want the state to continue to flog us with these rules,” said Tom Hawkins, 60.”  Yeah Tom, it is BRUTAL being limited to 20 drinks a day (not an exaggeration, that is the current limit if you do the math).  I feel so flogged.  This is the sort of person I was referring to when I wrote:  “If your desire to cling to your “right” to import ludicrous amounts of booze every month is so much stronger than your compassion at the state of your fellow man (even if they have made many crappy choices), then you have a serious problem.”

Or how about this guy:  “Meet 33-year-old Jeremy Westlake, a mechanic and pilot who by his estimate handles at least 70 percent of the legal alcohol that arrives in Bethel through a contract with ACE Air Cargo.  Westlake, one of the petitioners who put the question to a vote, says it’s a smaller-government thing. “I don’t want the state involved in our day-to-day life.”"  HMMM, no conflict of interest there.

“If the liquor vote passes, authorities will lose control over how much booze arrives in Bethel, [trooper] Evan said. “I can imagine we’re going to see a lot more problems out in the villages.”"

Precisely.

ridonkulous!

So apparently people are freaking out about whether Michelle Obama can wear shorts (shortPANTS as the locals in my neck of the tundra prefer.  Shorts would be something that…a whole lot of people wear).  Note that she was sited in those shorts in the summer.  In Phoenix.  SPAAAARE ME, as my sisters used to say…  And I thought my obsession with baseball was a colossal waste of time.

a lunch tray victory!

Remember this post?  LKSD recently voted to get rid of the styrofoam trays and go with “disposable, biodegradable, and compostable lunch trays are made from 100% “bagasse”. Bagasse is the residual sugarcane fiber remaining after extraction of juice from the sugarcane.” (quoting from the Delta Discovery, click here and scroll down to 4-29-09 article).  So that’s good news, albeit about 20 years overdue.

In addition, Bethel City Council has completely banned all plastic sacks and styrofoam trays from local businesses.  I know I’m sounding like a raving environmentalist, but if you could see the amount of plastic littering the tundra you would understand.

Frozen Beast!

Short clip taken from our friend and coworker, who has tons of clips of life in Kasigluk.  And Germany, Australia, you name it, that guy gets around.  This video gives a little perspective on life here.  Our school food is pretty typical:  pizza, corn dogs, egg rolls, and….

While it may seem odd to you lower 48ers, you see this (especially birds) all the time here, but usually in people’s entryway, not the school freezer.