StatisticalOutlier
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6 hours ago, aghst said:
Well they're discovering there are health issues with gas stoves.
I thought she said her fear was that it would spontaneously explode.
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22 hours ago, Hedgehog2022 said:
Say what you will about Brianna... and there are plenty of negative things to say...she is a good mom who puts her kids first and provides for them. Her two baby daddies don't even see their kids let alone even try to co-parent with her.
And yet she keeps trying to force it, because she is bitter that she didn't have a dad. I don't see that as putting her kids first. If she would just admit to herself that she made two very very bad choices on whom to procreate with, and quit reveling in the disappointment when they don't come through, I'd have to grudgingly agree that she's a good mom.
Or, well, maybe I could once I managed to forget the story line about offering Stella up for adoption. That was heinous.
22 hours ago, Hedgehog2022 said:Jade's massive boobage was vulgar. She looked so trashy and cheap. All that cosmetic surgery and all the pain she endured was a waste of money and time.
You're discounting the entertainment value, which for me was quite high. Seeing her waddle in her bandages and beached in the back of the SUV was a sublime experience.
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15 hours ago, Grrarrggh said:
Now, the gas thing was a bit off but everyone has their phobias.
Or made-up phobias. How did she get over it, so she was able to live in a place with a gas stove that she was afraid would explode? I was assuming they'd explain, but they didn't.
I can tell you for sure that if I looked at a house that had snakes all in it, I would not be able to live in it as long as the snakes were still in it.
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On 12/21/2022 at 10:50 AM, amarante said:
Since the OP practiced telemedicine a good Wifi connection would be essential. ...
I live in a metropolitan area so "rays" from cell towers is the least of my concerns in terms of pollution
As I said, I'm not clear on his objection. Wouldn't wifi in one's house have "rays" too?
8 minutes ago, mojito said:I throw the liner in the washing machine, too. Just did that yesterday.
She also complained that the shower curtain billows and touches her. I don't like that, either, but I think it happens only with the fabric-y ones that hotels have and not the vinyl/plastic ones I've always had.
But that reminds me of a recent trend, where showers have a partial glass wall and no door or curtain. I took a shower at a health club just yesterday that had that, and I noticed that the glass wall was fully wet all the way to its trailing vertical edge, and investigated further and water had splashed out the opening you walk through.
I'm gathering that in order for water not to splash out the opening, it would have to way far back, which seems like it would be a big waste of space. I'm wondering if they look cool but aren't really all that functional.
8 minutes ago, mojito said:Did anyone else find themselves thinking, "You might have better luck conceiving if you slept in the same bed"?
I certainly did.
That guy had a strange build--very top-heavy--and a strange walk. I was imagining that he'd take up an inordinate amount of room in a bed, operate like a furnace, and maybe snore, and if he snores, he'll snore loud. Although she said he could have a separate bed in the same room if the room is big enough, but no room is big enough if snoring is going on.
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On 12/14/2022 at 1:36 PM, mojito said:
It was nice to see Vancouver, WA instead of Seattle, Tacoma, Bellingham, Everett. The prices are more reasonable down there and it's still a pretty area.
I'm sure they pointed this out in the episode, but Vancouver, Washington, is across the bridge from Portland, Oregon. I've heard it referred to there as "Vantucky." They really do feel like very different cities, and I wonder if that is reflected in the housing prices between Portland and Vancouver.
Portland is the side of the river to be on to shop, because there's no sales tax. Unless you're buying Sudafed, which is prescription-only in Oregon but available from the pharmacy without a prescription in Washington.
Hey, wait a minute. I haven't bought Sudafed there in a few years, so I was doing due diligence before posting and found out that starting this year, you can now get Sudafed without a prescription in Oregon. No more traveling to Vantucky to get your meth materials!
On 12/16/2022 at 10:56 AM, CrazyInAlabama said:In the middle of summer there will be an even louder noise, frogs.
I have a friend whose house is built over a creek in the middle of old Austin. We were talking on the phone one night and there was this unbelievable racket in the background, and I finally said, "What is that?" Frogs. We were having to talk over it, and then he said, "And that's with the windows closed." He opened the sliding door and we were having to shout over the frogs. It was unbelievable.
Otherwise, the Vancouver HH would love the house--there's no usable cell signal, regardless of the carrier. A text will eventually make it, but talking is impossible. But I do wonder whether the HH has wifi in his house; I'm not very clear on his specific objections.
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On 12/15/2022 at 2:40 PM, eel21788 said:
It seems as though she would have an easier time finding clients in the good, old US as long as she was willing to keep traveling been Half Moon Bay, CA, Nederland, CO and Vashon Island, WA.
I assume Ashland, Oregon, isn't on the list because she'd have too much competition.
On 12/16/2022 at 10:50 PM, howiveaddict said:Did anyone notice they let the dog stand on the bed in apartment number 2. I thought due to that it would be the one they would pick and already lived there.
They also let it up on a couch in one of the apartments. I can't remember if it was sitting or standing, but both present a contact point with upholstery I don't think should be imposed without permission.
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12 hours ago, Chalby said:
Why is it, when a woman (who wants a longterm beau) decides to take a break from guys lying to her, is seen as "devaluing herself" because she wants to have fun with someone with no strings attached.
I question Tim's use of the word "devalue," but otherwise I'm in line with @bichonblitz's reading of the situation, upthread.
I found it interesting that Veronica and Tim met in a bar or something and had sex that night, and it led to a very long-term relationship. Then she was lingerie-ing all over Mr. Cold Sore on their second(?) date, and she read him the riot act when she found out it couldn't lead to a long-term relationship because he was going to move away. I think she likes strings.
Maybe she's done a 180, but that's a big 180. (Although, actually, I think all 180s are the same size.) Tim's been very close to her for a very long time. And there's an element of self-protection, since he's going to be the one deal with the fallout. I'm reluctant to dismiss Veronica's claims of wanting an easy breezy long-distance relationship because I don't like it when my claims are dismissed, but I'm going to have to side with Tim on this one. Maybe in return he'll apologize for inflicting Jeniffer on us.
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32 minutes ago, cinsays said:
a radical birthkeeper? wonder what that actually means
I'm just as curious about "Birth Story Listener." Who's telling the story? The baby?
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10 hours ago, Corgi-ears said:
He said that the sign for Matt Hancock is *jerk off motion*
That's what I thought. What I don't understand is why they cut it out for the American version. They already edit the version we get, presumably for time. I don't know how many Americans would know who Matt Hancock is; I didn't. And only by seeing the sign or hearing its description would I infer that he's not a popular guy. So just cut it out.
Oh well, we still had Daniel Craig.
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This is all so sad. Mr. Outlier and I met on matchmaker.com (a free site) 24 years ago. I've never liked pictures of myself, and hate having my picture taken, so my profile photo was me in the 1st grade, in my Catholic school uniform, complete with beanie. I recall going to Kinko's to digitize it and put it on a floppy.
Mr. Outlier used his Malibu Grand Prix driver's license photo, and being the computer sophisticate he was, added some clouds to the background to make it look less driver's license-y.
Not once did anyone I corresponded with make any crude remarks, and I don't recall anybody simply not replying. In fact, only a couple of times did I get just a "you want to meet?" with no other emailing. The guys I met were pretty much as they represented themselves, except one was only aspirationally 5'7", but that happens all the time. (And he would have no way of knowing this, but my previous boyfriend was shorter than I was; we never measured him but I'm guessing 5'5" or maybe a hair under--about this guy's height, as it turned out. He could have saved himself some embarrassment. I feel so sorry for short guys--if they tell the truth, the vast majority of women will reject them out of hand, but if they lie, the lie is going to be revealed. It's a no-win situation.)
Anyway, there was no dishonesty that I ever uncovered, and certainly no fake profiles. I said I didn't want kids (of my own or anyone else's), and one guy was persistent in telling me how great his kids were (via email--I never met him because I said I didn't want anybody with kids) but that is as annoying as anyone got.
I look at what people go through these days and my heart breaks, knowing what a civilized place online dating used to be. Back then, it was kind of embarrassing to say we'd met online but it gradually became more common and therefore less embarrassing. But now I'm embarrassed again because unless people are paying attention, they're liable to think I would put up with what online dating has become, and I wouldn't touch it with a ten-foot pole.
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6 hours ago, aghst said:
Would help if there were at least some expats but maybe a small French town on the Belgium border is not a big draw for English-speaking expats.
Didn't Adrian say it was like the third biggest city in France? I'm continually surprised that cities I've only vaguely heard of turn out to be huge.
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On 12/5/2022 at 12:19 PM, dubbel zout said:
Craig is a very good guest, at least what I've seen of him on GNS. He's always listening to the other guests and isn't afraid to be the butt of a joke.
He's a fantastic guest.
I saw the U.S. version, and noticed a very wonky edit when John Bishop was showing what some things are in BSL (British? Sign Language). They zoomed in tight on his face, and I think it was done in post-production, which makes me think the sign was vulgar. It was certainly hilarious, to judge by everybody's reaction.
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11 hours ago, dogdays2 said:
Sorry, but I had zero sympathy for the woman in Lille. Embrace the adventure. Wichita will be there when you return.
I have a little sympathy, because there are people who are just wired not to embrace the adventure. Or who have spent so long in their cloister that they don't even know if it's their wiring or their habit.
Then again, I once spent almost two months in Wichita. They call it the "Air Capital of the World" and I really did think it was because there's nothing there but air, and appreciated their sense of humor. Turns out it has something to do with aviation.
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I thought the movie wasn't as treacly as the trailer, and that's a good thing.
I saw it with an audience of old people and they laughed like hyenas at the monkey wreaking havoc. But I got the last laugh, literally, when in the final scene, the camera pans up; I don't think anybody else got it.
And according to Spielberg, the John Ford scene is absolutely true (although he was a little younger than depicted in the movie when it happened).
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14 hours ago, roseha said:
@Yeah No in case anyone hasn't replied to this, I see my doctor for a "wellness visit" every year which covers what he would cover in a physical. The first time I went to him under Medicare Part B the office didn't code it as a wellness visit and I almost had to pay about $550. The office fixed the coding and I didn't have to pay for it.
And that's the problem. They didn't "fix" the coding, because it wasn't wrong. If what your doctor did was what he would do for an annual physical, it was not a wellness visit. When it was properly coded as an annual physical, Medicare properly rejected it.
What your doctor's office did was change the coding to something Medicare would pay for, even though the service performed does not actually meet Medicare's definition of a wellness visit. It's not that Medicare insists on calling an annual physical a wellness visit and won't pay for it unless it's coded that way. It's that Medicare doesn't cover annual physicals but does cover wellness visits, but they are not the same thing and coding for them isn't interchangeable.
It's always possible to ask/demand that a doctor's office change the coding for an annual physical to something Medicare will pay for, but they're under no obligation to do so because the coding isn't actually wrong. And some doctors won't do it; I don't know if it's because they want to extract more money from their patient or if they're simply complying with Medicare's rules, but nobody should expect an annual physical exam to be covered by Medicare because annual physical exams aren't covered by Medicare. Wellness visits are, but they're not the same thing.
People will rant about the doctor's billing office's incompetence because they can't get the coding right, but what they don't realize is that the coding isn't wrong. The billing office is coding it correctly, but the result isn't what they want. But that's not the billing office's fault; it's their fault for expecting Medicare to pay for something Medicare is prohibited by law from paying for.
14 hours ago, roseha said:I would think a supplement would also help if you get it but I haven't needed it in the past (only got it this year for other reasons).
I'm not sure what you're referring to. A supplement would help what?
Have you not needed a supplement in the past because your 20% responsibility under Medicare has never been more than the Part B deductible?
I'm a very very infrequent consumer of healthcare, but when I got on Medicare, I was like Yippee! and decided to get some physical therapy for my knees. They hurt like hell going up and down stairs and Dr. Internet told me I needed to strengthen the surrounding muscles, but all the exercises (like leg extensions on a machine) hurt my knees.
I wanted a physical therapist to tell me what I should be doing, and in Illinois you don't have to have a prescription for physical therapy. However, Medicare requires a prescription order to pay for physical therapy. So I grudgingly went to the doctor and it turned out great because he prescribed some steroids plus physical therapy, and the steroids were a miracle drug. I went to physical therapy 6 or 8 times, found out I should actually be strengthening my hips and legs and not the muscles around my knees, and was able to start the exercises without pain because of the steroids. I'm good as new.
I almost never go to the doctor and got a supplement mainly to cover me if I'm hospitalized (Part A), which could be financially ruinous without a supplement (this is something I haven't even touched on here--traditional Medicare has no out-of-pocket limit). To my surprise, just that little bit of medical care for my knees pushed me over the Part B $233 deductible, even though under Part B I'm responsible for only 20% of the Medicare approved charges.
Also...even though I have Part D coverage, I used GoodRx for my steroids prescription because it was cheaper than going through my Part D. I hate the data collection and brokering that GoodRx is no doubt doing, but I leaven it a little by not having their app on my phone (ha ha ha--my flip phone), and looking at the prices on their website on my computer, and printing out the coupon.
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9 hours ago, Misslindsey said:
Kody is probably jealous of Gabe's hair.
No doubt. And, sadly, he'll no doubt be thrilled if Gabe's hairline goes the way of his.
I hate that guy.
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7 hours ago, Dancing bear said:
A month or two ago I posted on this forum, asking questions about part D plans.
I don't see that post here. I've been embroiled in Part D for a couple of months now, and surely would have responded if I'd seen it.
7 hours ago, Dancing bear said:The one that sticks out in my mind is the WellCare part D plan. I guess I'd have to change from Walmart to CVS to reap the most prescription benefits but that's not a problem.
Why does the WellCare plan stick out in your mind? Have you run your drugs through Medicare's cost-estimator plan-picker?
If not, go to the Medicare website and click on FIND HEALTH AND DRUG PLANS. Input your zip code and select DRUG PLAN (PART D) and then click APPLY and then click START. When it asks if you want to see drug costs when you compare plans, say YES and enter your drugs. If you're logged in, it might populate the list for you (it (surprisingly) did for the friend whose Part D I'm helping him with).
Once your drugs are in there, what I do is click on a few representative pharmacies (like Walgreens, CVS, Walmart, and the local grocery stores convenient to you) to "compare," and click DONE in the lower right corner. That will bring up a list of all the plans available (including the plan's "star rating"), and you can sort by "lowest drug + premium cost." Then on any of the plans, click VIEW DRUGS & THEIR COSTS and you'll get very detailed information about the cost at the pharmacies you are "comparing."
Of course that tells you absolutely zero about a drug you don't know you're going to be taking, and whether it will even be on a given plan's formulary, but it's all we've got.
7 hours ago, Dancing bear said:So NOW FINALLY - anyone who has Wellcare, are you happy with the plan? Any other info helpful.
It all depends on what drugs an individual is prescribed and how the plan treats them (e.g., which tier, what the copay is, whether they're on their formulary at all). So a plan that one person is happy with might make another person very unhappy due to which drugs they take and how the plan treats them with respect to tier and copay. And a person might be very happy with a plan when he's taking his usual maintenance drugs because they're zero copay, but become very unhappy when he's prescribed a drug that isn't on that plan's formulary at all.
Generally, the advice is to put the drugs you know you take into the cost estimator thing and go for the cheapest one. You can look at a plan's star rating, but click on STAR RATING to see what gets factored into it and whether those consideration are important to you.
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1 hour ago, shapeshifter said:
So then if I understand correctly, if I go with an Advantage plan——which includes "creditable drug coverage" in lieu of (I guess?) Medicare Part D——I cannot change my plan again until open enrollment next fall for the following calendar year?
(in NY state)Of course not, because this is Medicare and there's an "extra" open enrollment period during which the changes you can make are different from what you can do during the Fall open enrollment period!
We're currently in what's called "Medicare Open Enrollment" (October to December). Confusingly, there's also a "Medicare Advantage Open Enrollment" period from January 1 - March 31, during which you can switch from one Advantage plan to another, or "revert" to traditional Medicare However, I've never found a definition for "revert" in this context--did you have to originally be on traditional Medicare at some point in order to be able to "revert," or does "revert" actually mean more like "default" to traditional Medicare even if you've never had traditional Medicare? I'm pretty sure it's the latter, but have never found anything that makes that clear; everything uses "revert."
One way to think about it is that everybody on Medicare can make changes during the Medicare Open Enrollment period, and only people on Medicare Advantage can do things during the Medicare Advantage Open Enrollment period.
If you have an Advantage plan and change from that to traditional Medicare during the January-March Medicare Advantage Open Enrollment, you can also get a Part D prescription drug plan at that time. That makes sense. (Hurrah! Something makes sense!) And in your case you can get a supplement to go with your Part B traditional Medicare with no problem because New Yorkers have guaranteed issue rights to supplements. People in other states would be able to move from Medicare Advantage to traditional Medicare during the January-March Medicare Advantage Open Enrollment period and get a Part D drug plan, but might not be able to get a supplement if they have health issues that run afoul of medical underwriting.
So if you choose a Medicare Advantage plan during the current open enrollment, you actually have until March 31 to make a decision between Medicare and Medicare Advantage (or between two Medicare Advantage plans) that can't be changed until next year's Fall open enrollment period. But be aware that if you do change to a different Advantage plan during the January-March period, you'll get the deductibles and out-of-pocket limits reset when that plan becomes effective.
One difference between the Fall open enrollment and the January-March open enrollment is that in the Fall period you can choose a plan and then unchoose it and choose a different one, as many times as you want, until the last day of the open enrollment period. All changes that everybody makes during the Fall open enrollment period take effect January 1, and whatever plan you're on record as choosing when the enrollment period ends is the one you will have on January 1.
But during the January-March Medicare Advantage Open Enrollment period, you can change once, and only once. The date the new plan (either a different Advantage plan or the switch to traditional Medicare and a Part D drug plan) takes effect will depend on when you made the change (unlike the Fall open enrollment period's January 1 effective date for all changes anybody makes, the January-March period has a rolling effective date that is triggered by the date you make the change).
And just to not let this get lost in the mush: the only changes you can make to Part D drug coverage during the January-March Medicare Advantage Open Enrollment period is to buy it anew due to switching from Advantage to traditional Medicare. If you're on (or change to) traditional Medicare during the Fall open enrollment and pick a Part D drug plan at that time, it becomes effective on January 1 and you're stuck with it for the rest of the year. That's because you're on Medicare, and only Medicare Advantage people can make changes during the Medicare Advantage Open Enrollment Period.
(Actually, you can qualify for a special enrollment period if you're defrauded in making your choice of a Part D drug plan, but I'm not going there.)
Just so you know, we'll be on the road tomorrow so I won't be on the computer. I hope a moment of clarity bubbles up to the top for you.
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Gabe has a magnificent mane now. Who knows what it will be in the future.
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Where I feel really sorry for Gabe is that he looks exactly like Kody. If I were him, it would kill me to look in the mirror.
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2 hours ago, supposebly said:
Holy Hell, this sounds complicated. While I can complain about the Canadian system all day long, at least it's simple and doesn't require spreadsheets!
What's even worse is that THIS is the SOLUTION to our health care coverage crisis. It's horrible, but at least it's somewhat affordable, although you could have knocked me over with a feather when I found out that Medicare isn't free. Everybody has to pay the Medicare Part B premium of $164.90 a month, including Medicare Advantage plans that advertise $0 premiums. That's $0 in addition to the $164.90. Although some Advantage plans actually kick back some of that to you. That seems like one hell of a deal if you're poor--money ADDED TO YOUR SOCIAL SECURITY CHECK! So of course they get a Medicare Advantage plan without understanding it's not "real" Medicare.
That's one thing about Obamacare. It's excellent insurance, and it's really really cheap for low-income people. Of course they can't be TOO low income because then they're put on Medicaid, which is health coverage for poor people. Or, poor people in states that expanded Medicaid to adults. In states that didn't, if you don't make enough money to qualify for Obamacare, there's no health care coverage for you. Nada. Zilch. If you need health care, you either go to the emergency room and rack up enormous bills there that you have bill collectors coming after you for, or if you're lucky your city might sponsor a clinic for low-income people.
But I'll tell you--you get a single adult who's making $18,000/year who's been getting a free insurance policy under Obamacare, and if he was savvy enough to pick a Silver plan, it's likely to have an out-of-pocket limit of like $500. Then he turns 65 and has to go on Medicare and finds out he has to pay $165/month no matter what kind of plan he picks. That guy's not going to be thrilled about getting on Medicare.
6 hours ago, Yeah No said:Also, plan G for me does provide coverage for gym memberships although I'm not seeing the particulars on that.
If it's an AARP/UHC plan, then it's Renew Active (their proprietary version of Silver Sneakers). You can go to the link I provided upthread and put in your zip code (it always uses zip code, which is SO annoying for those of us who travel because I don't ever know what zip code I'm in) and find the participating locations. I listed the "premium" places, where you get 4 classes a month, but it's also good at lots of YMCAs, as I said, plus national chains like Planet Fitness, Anytime Fitness, and Crunch, and some awful boot-camp type places that sound like real exercise. Yuck. You get a code number from Renew Active that you give to the gyms when you sign up for the membership, and they bill Renew Active when you visit.
6 hours ago, shapeshifter said:I'm leaning towards staying with the Blue Cross Advantage plan for the next year, despite the obnoxiousness and incompetence of their agents and their website dysfunctionality. I will just have to stay on top of things to avoid paying for things I should not have to pay for.
I can't say enough how lucky you are to be in New York, where you can change your plan without medical underwriting. So you can try the Advantage plan for a year, and next open enrollment decide whether you want to switch to traditional Medicare without worrying whether the supplement will accept you. (Anyone can always switch from Advantage to traditional Medicare during open enrollment, but if you're in a state that doesn't have any guaranteed-issue periods, you might not be able to find a supplement that will accept you.)
And remember, if you're on traditional Medicare Part B, you can change your supplement any time during the year. People think it's only during open enrollment, but it's not. The only issue is passing medical underwriting, if you're in a state that allows supplements to do that.
In fact, I'd suggest if someone wants to change their supplement, they do it outside open enrollment because it won't be such a busy time for insurers and brokers/agents.
But if you want to change your Part D prescription drug coverage, that can be done only during the Fall open enrollment that's ending this week.
6 hours ago, Yeah No said:Am I wrong to think that there are other ways people on Medicare handle getting lab tests covered other than at an annual physical, though? These days I'm finding that by the time I go for my annual physical I've already been sent for most of the tests it covers within the past year by specialists monitoring my "numbers", such as blood sugar, thyroid hormone, cholesterol, etc. Should I presume that tests ordered by specialists monitoring these things would be covered if one has regular Medicare plus a supplemental or an Advantage plan? I'm still learning about this stuff!
It's the screening tests, I think they're called, that Medicare doesn't cover. Like you go for an annual physical even though you don't have any complaints and the doctor orders blood tests to see if anything's wrong (which is why I don't have annual physicals 😀--I'm still smarting from being deemed uninsurable by Blue Cross many years ago because I'm hard of hearing, and I didn't want to uncover any other conditions that don't bother me and I wouldn't seek treatment for but would similarly make me uninsurable, or at least be considered a pre-existing condition that results in an increased premium). (Never mind that my insurer at the time I applied to Blue Cross (I was looking for cheaper insurance) subsequently went out of business and transferred everybody to...Blue Cross. To whom I dutifully paid my premium for years and didn't have any claims, even though they insulted me by deeming me uninsurable. God damn, I hate health insurance in the U.S.
But back to the tests--it's all in the coding. A doctor can do what is actually a physical exam but code it as a "wellness visit" and get it paid for by Medicare. And maybe he doesn't even know that's what happened--his billing people did it. Who the hell knows.
And some people say that anybody who's 65 will be having tests done for actual problems, so they'll get covered that way, wink wink, but NOT everybody has regular tests done. And LOTS of people are surprised when they go for an annual exam and get hit with a bill from their doctor because among the forms they sign is one that says if insurance doesn't pay then they'll be responsible for the charges. And since insurance (Medicare) didn't pay, the amount charged is the retail rate, not the Medicare-approved amount.
It's possible to badger a doctor's billing office to get them to code it in a way that will get it paid, but I've read stories about people who just couldn't get their doctor to bill it "right." (Depending on one's definition of "right," of course.) And there are doctors who (or whose billing people) know how to bill things in a way they'll get covered by Medicare, but you can't know going in if your doctor is one of them. I do know that one person said their doctor is a gerontologist and doesn't know how to work the Medicare system to get annual physical exams covered.
And there are some people whose doctor does it without their even knowing it's hinky. They'll insist to their dying day that Medicare covers their annual physicals.
1 hour ago, ebk57 said:Mr. ebk was just reading an article about Medicare advantage plans that said the way they make money is by denying claims. If the claim is appealed, there's a very high chance it will be paid, but over 90% of denials are not appealed. Sigh...
Not long ago I found an actual government document that gave the numbers for appeals, for each Advantage plan in each state. I was surprised by how many denials were reversed, because of Advantage's reputation for denying claims. But then I noticed just how few appeals there were in the first place. Shit, they could reverse every one of the appeals without even considering the merits and still make money overall.
(Something similar happened with Social Security Disability in the 1980s. The government started a policy of rejecting every single SSDI claim automatically, and actually looking at them only if they were appealed. I knew a couple of lawyers who did nothing but SSDI appeals, and it was really depressing because sure, there are people who aren't really disabled and file for SSDI, but there were plenty who very obviously qualified for SSDI but whose benefits were delayed because of the automatic rejection AND they had to pay a lawyer to get them the money they deserved in the first place. Massive rejection followed by massive reversals on appeal is not a good system. Or, not good for the people with the claims, anyway.)
Another way Medicare Advantage makes money is by "upcoding." That's where they get doctors (remember, Advantage plans have networks of doctors they contract with) to diagnose people as sick as possible, because the government pays Medicare Advantage more for members who are sicker.
Basically, the government pays Medicare Advantage for each person who enrolls in the plan, and the payment is higher for sicker people. Advantage gets the money and in return pays for all the healthcare for its members. So the less they spend on healthcare claims, the more they get to keep. That presents an incentive to deny claims.
Medicare Advantage initially came about because, as usual, private industry said they could do it better and cheaper than the government. And, oops! The government actually pays out more for Advantage members than it does for people on traditional Medicare. So Advantage members cost the government more AND they have to deal with denials of coverage and other Medicare Advantage hoops.
That was actually another reason I was resisting Medicare Advantage for my coverage--on principle. I understand why people would choose an Advantage plan over traditional Medicare, but I just don't feel good about supporting that model. I just saw an article from 2018 that said 1/3 of Medicare people are on an Advantage plan, and I think the current number is like 40%. That's the future.
Actually, I just checked actual numbers and the Kaiser Family Foundation (who I trust) says it was 37% in 2018 and 48% in 2022. I guess those TV commercials work. This is where Medicare is headed, and I don't like it. And they're making inroads even outside Advantage with "Select" supplements that have networks, which COMPLETELY messes up the simplicity of "If Medicare pays, your supplement pays."
Nobody's ever going to repeal Medicare, but they're going to cause its death by a thousand cuts.
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9 hours ago, shapeshifter said:
I thought: Whoa. This is going to be a nightmare to get them to cover anything.
So am I right that the Blue Cross is an Advantage plan? If that's the case, they do have a say in what they'll pay for, which is one of the disadvantages of a Medicare Advantage plan. Of course if you have traditional Medicare, Medicare dictates what is covered and what isn't, but it doesn't seem to be as capricious as Medicare Advantage plans have a reputation for being. And with traditional Medicare, there aren't delays waiting for approval.
Then again, supplements with traditional Medicare can be expensive, and Advantage plans generally aren't. And Advantage plans provide coverage for things like hearing aids, eyeglasses, rides to the doctor--all kinds of stuff. (I'll add that they also pay higher commissions to brokers than supplements do, which isn't of utmost importance but should be kept in mind if dealing with a broker.)
I don't know about New York, but some states have Medicare Advantage plans that look pretty good. They have a network, but they do provide coverage if you go out of network (unlike most HMOs, where it's the network or nothing, and only certain Advantage plans have this out-of-network coverage--look carefully when shopping). Like, you'll have a $20 copay if you go in network, and a $70 copay if you go out of network. And there are Advantage plans that say they'll cover any doctor who takes Medicare, although I can't really get a bead on the on-the-ground operations of these plans, like do you just go to whoever you want, or do you have to ask your Advantage plan first? Also, some providers are saying they won't accept any Medicare Advantage plans (e.g., the Mayo Clinic has announced that it won't take Advantage at its clinic in Phoenix). I guess they ask when you make an appointment what insurance you have, and refuse to see you?
It's all that uncertainty that made even a cheapskate like me with zero healthcare costs go with traditional Medicare and a Plan G supplement and Part D drug coverage. And I could have saved money by getting a high-deductible plan, but as a present to myself, I got a plan that I don't have to hassle with. I'll have to pay my 20% to providers until I meet my $233 deductible, but after that, I won't have to ever even look at a bill for the rest of the year. And I have hearing aids and wear glasses, so the Medicare Advantage extra benefits would indeed be beneficial. But no, I'm willing to pay extra to protect my sanity.
And @shapeshifter, if you get Plan F (which you can do because you meet the age restriction--65-year-old enrollees can't get Plan F), you won't ever have to look at a bill at all because Plan F pays your deductible for you. My friend with Plan F is paying more in premiums than what Plan G +$233 (the deductible) would cost, so he'd like to switch to Plan G, but he can't because he can't pass medical underwriting. That's where being in New York is a HUGE advantage.
And to reiterate--Plan F and Plan G are exactly the same when it comes to coverage (they simply pay your 20%), except Plan F covers your $233 deductible for you while Plan G doesn't. So if Plan F premiums are more than $233/year more than Plan G premiums, Plan G is the better deal, except you'll have to pay some of the early bills yourself.
At first I couldn't figure out why Blue Cross was so insistent about your previous drug coverage, but maybe it has to do with the penalty people incur if they ever don't have Medicare drug coverage when they were eligible. It's a lifetime penalty that is added to your Part D drug premium if you ever decide to get drug coverage after all, but I don't know how it would work (or if it's even applicable) if you have a Medicare Advantage plan that includes prescription drug coverage.
But if Blue Cross is an Advantage plan, there will very likely be interactions with them over approvals and referrals, and your experience so far doesn't bode well for your sanity when dealing with them. I hear you loud and clear, and that's why my advice is that if you can afford it, get traditional Medicare and a supplement. You'll never have to deal with your supplement company because they pay the provider directly. Really, the only time I ever hear about people fighting about provider bills under traditional Medicare is on the annual physical thing, plus the "wellness visit" thing because Medicare has very strict rules on when those can be done and if you get one even one day early they'll reject it.
As for your drugs, what a mess. Have you put them into Medicare's cost calculator? Or at least the ones you know you'll have to be taking? You don't even have to worry about what tier they are--you put in your dosage and how often you get them and it calculates all that for you.
My friend who I'm saving $1600 for by changing his drug plan found out the other day that he might have to be on a new drug permanently. He got his first batch and the pharmacist said, "That'll be $1,468" and my friend balked. The pharmacist fiddled around and then said, "Okay, that'll be $45." Huh?? Of course my friend thought Walgreens was giving him some sort of generous discount.
But I figured out that by getting the three-month supply that was prescribed, he entered the donut hole of Part D coverage, where you pay a percentage of the retail cost of the drug rather than a copay. So the pharmacist gave him just a one-month supply, the retail cost of which wasn't enough to push him into the donut hole, and he just had to pay the usual $45 copay. HOWEVER, this worked only because it was at the end of the year, and if he gets it filled again before the end of the year, he's going to be in the donut hole. And if he gets it filled next year, he's going to go into the donut hole almost immediately.
And of course all of this depended on the pharmacist understanding the donut hole and working around it. Good for him, and good for my friend that he has a pharmacist who can understand the impossibly complicated donut hole. But needless to say, it shouldn't be this way.
And as annoying it is for people who do take drugs, it's not much better for those of us who don't. I just pick whatever Part D plan has the cheapest premium, and hope for the best if I end up being prescribed drugs. I suppose I could pay $11/month instead of $6/month, but that doesn't mean the particular drugs I end up getting will be covered better. You simply can't know, and that's ridiculous.
10 hours ago, shapeshifter said:I hate this.
The process feels like cruel and unusual punishment just because I was forced to retire, and am too old (and tired) to start over, and am not a member of congress with free health care.I think it's a bit like childbirth (not that I've ever given birth). It's horrible and painful, but you somehow forget it after it's all over. People go through this when they first go on Medicare, and then they just stay with whatever plan they have and forget how awful it was.
Well, assuming they even know what they have. My brother is a psychologist and can't count the number of times a prospective patient would call for an appointment and he'd ask what insurance they have and they'd say Medicare, but it was Medicare Advantage, and he didn't take any Medicare Advantage plans. They had no idea they didn't have "Medicare." That's one reason to do some questioning if you're asking people what they have--get a feel for whether they even know and if there was any decision-making that went into it.
I have a friend who went on Medicare last year and I asked what she has, and she said traditional with a G supplement, as suggested by a broker her financial advisor referred her to (she's rich). (Although I'll note that it's a Mutual of Omaha supplement, which I warned against upthread, but it doesn't really matter for her because the only problem with closing the book on a plan is that the premium will go up, but she can afford it. However, I look askance at brokers who sell the MofO plans with warning about (or probably even knowing about) closing the book (including Boomer Benefits, which is very popular).)
But my friend warned me away from "crappy" Medicare Advantage plans like her husband has, who's been dealing with colon cancer for like five years. I have no idea how he ended up on a Medicare Advantage plan (he's a smart guy and he certainly didn't need to save money), and I don't want to ask because she's already mad enough at him for not getting timely colonoscopies.
Let's just say there's a lot of ignorance out there about Medicare, and I feel deeply for people who actually try to be informed consumers. I cut my teeth on Obamacare for traveling fulltime RVers, and naively thought such expertise wouldn't be necessary when I moved to Medicare. I couldn't have been more wrong, but hey, I'm already used to digging into the impenetrable.
One more thing about supplements: One of the benefits Advantage plans tout is Silver Sneakers, which provides free gym memberships. Supplements don't offer that, or didn't, until AARP/UHC started its own "Renew Active." You can get Renew Active if you buy an AARP/UHC supplement that comes with "wellness benefits." (Not all areas have plans with wellness benefits.) My G Supplement costs like $10 or $15 extra a month over the G without wellness benefits. Also, the wellness benefits purportedly give discounts for eye care and dentists and hearing aids, but in the little bit of calling around I did, they're bogus. And really, the Renew Active is kind of bogus--on its list of providers, it has all sorts of places that aren't even gyms, but for example are an early learning center by a YMCA.
However, despite its bogosity, Renew Active worked great when I was in the Chicago suburbs. It got me a free membership to the YMCA down the street, and it gives me four reformer classes a month at Club Pilates, which I used religiously. It also includes Yoga Six, Pure Barre, Orange Theory, and some others that might just be regional. I'm in Orlando now, and went to the Y here and told the guy I was Renew Active, and when he found out I was going to be here for only a week, he just gave me a week pass instead of having me do an actual membership with key tag or whatever, which was easier for both of us. I also squeezed in three classes at Club Pilates.
Because I travel, Silver Sneakers was an attractive benefit and actually had me considering Medicare Advantage so I could go to gyms wherever I happened to be, even though Medicare Advantage is generally not a good fit for people who don't stay in one place. With Renew Active, I get the benefit of Silver Sneakers (there's a lot of overlap between Silver Sneakers and Renew Active) without the restrictions of Medicare Advantage.
And it made it easy to pick my G Supplement, because AARP/UHC is the only one that has it.
Anyway, if anybody wants gym memberships included with their Medicare, it's possible to get it with a supplement. You can see who participates here:
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8 hours ago, Yeah No said:
I haven't found anything specifically about supplemental Plan G coverage and these things, though it probably wouldn't cover an annual physical with lab tests based on everything I've read.
Supplements don't cover anything on their own. Medicare Part B pays 80% of medicare approved charges, and you are responsible for the other 20%. If you buy a supplement (like Plan G), it pays your 20% on your behalf. The supplement company doesn't determine coverage any more than you do. If Medicare pays, the supplement pays; if Medicare doesn't, the supplement doesn't.
And even if you think paying the 20% on your own isn't a big burden, and it probably isn't because 20% of the charge Medicare allows generally isn't very much, be aware that there is no out-of-pocket limit if you're on traditional Medicare. The only way to limit your exposure to financial ruin on Medicare is to either have a supplement with traditional Medicare, or go on a Medicare Advantage plan (all Advantage plans have an out-of-pocket limit).
(And actually, some supplements do provide standalone coverage, for international travel; in that case they get to decide what they'll pay for. Medicare isn't involved in that coverage at all.)
ETA: I forgot to point out that every Medicare Advantage plan I've seen DOES cover annual physicals as most of us understand them--an exam where the doctor puts his hands on you and orders tests to see if anything's wrong that you don't know about. Medicare Advantage is a managed care operation, and as such, likes preventive care and encourages people to get it by making it free. Traditional Medicare was originally enacted as paying for hospital bills, and its focus has never been on keeping seniors healthy. Its enacting legislation prevents it from covering annual physicals and hearing aids, two things that Medicare Advantage plans tout as benefits. And they definitely are benefits, but come at the cost of having your care managed.
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On 12/2/2022 at 3:07 PM, Roslyn said:
Black water is from toilets flushing and all that goes with toilets flushing and isn't microbially safe to just dump on the open ground where rain water can take it to water sources to contaminate a LOT of water. Sure, urine and poo is "organic", but it is also full of microbes that can make people very ill and that is why septic systems etc have a lot of rules and regulations.
Also, while it's possible to let gray water trickle out of a hose, if you're emptying a black tank, you can't let it trickle because the liquid will trickle but the solids will stay behind, and without liquid the solids will harden and turn into what's known as a pyramid of doom at the exit to the black tank. So the contents of a black tank have to come out all at once, the more whoosh the better, and that will make a large and very gross mess on the ground even without contamination issues.
But gray water can be surprisingly gross, too. If you leave dirty dishes soaking in soapy water overnight in the sink, the water smells really bad the next morning. That's what's going on in a gray tank, only with much more water and much longer than overnight.
If you drain gray water directly from a sink without letting it sit in or pass through a holding tank, it doesn't smell anywhere near as bad. But in Janelle's trailer, the sink water has to go into the gray tank, and as I noted upthread, apparently her trailer is unique in that you can't dump the gray tank without opening the black tank, too, so there's not even the possibility of trickling gray water onto the ground.
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House Hunters International - General Discussion
in House Hunters International
That story is giving me life. If I were them, it would be the first thing I ever tell anybody.