Preparing for Stone Mountain

There's been a lot of talk recently about Confederate monuments and whether they should stay where they are. I never really paid attention to them growing up. Yes, if you visit places in the south you're going to see statues of Jefferson Davis and Robert E. Lee. It has been normal. No one ever questioned the appropriateness of those statues until now. You  never stopped to think that these guys were traitors to the United States. Aside from that, they lost the war. Typically the victors are the ones who erect statues. No statues for losers. Of course all the statues are in the south. You're not going to find a statue of Jefferson Davis in Boston.  And not only did they put up statues, they even named US military bases after these guys. You don't have any military bases in the United States named after General Cornwallis, or Field Marshal Rommel. But I'm getting sidetracked. My personal belief is that those statues belong in Civil War Battleground Parks, like Vicksburg and Gettysburg. They do not have a place in the town square. So if you've never been to Stone Mountain, you may not realize that it is the granddaddy of all Confederate monuments.

I hesitated to go this time. Again, until recently, I hadn't given much thought to Confederate monuments or the people who wanted to keep the spirit of the Confederacy alive. Even though I grew up in Ohio, there was no shortage of people claiming southern roots. At one time, I had a set of beach towels, one looked like a Union flag and the other a Confederate flag. I thought nothing of it. But amidst all the cries of "it's our heritage" and "it's our history" in regard to eliminating monuments to Confederate soldiers, I'm not sure what is going on. Most of these monuments weren't even put up until the 1920s - over 50 years after the war ended.

It's s interesting. Our heritage and our history. Just what is the heritage of the Confederacy.? A willingness to fight to the death for the right to own another human being. The idea that you could own a human being, just like you own a horse or a dog. And you can treat them like livestock and no one can say a word. 

So how about the history? I've been trying to think back to what I was taught in school. (I know, it was a very long time ago.) At least I was typically one of the kids who was actually paying attention and there are only a few things I remember. 

In elementary school we were taught about the Merrimac and the Monitor, a famous Civil War sea battle. I don't remember them saying much about the war, but I do remember that battle. I also remember being taught about Harriet Beecher Stowe, who wrote Uncle Tom's Cabin but I don't remember actually reading it, although I probably did. We also learned the Battle Hymn of the Republic. And we learned that the South lost and Lincoln freed the slaves. 

I think it was junior high when we read The Red Badge of Courage. Can't remember much else about what we might have been taught. But that was Ohio history and it would only have been discussed from a state history perspective. 

In high school they started teaching about the causes. Up until then, I think I must have assumed that slavery was the sole cause of the war. And if you look closely, it was. Trying to blame economics isn't going to work because the plantation economy depended on slave labor. The two are tied. But everything was glossed over and presented in a very "matter-of-fact" way. Plantation owners couldn't afford to pay people to work in their fields or houses. Slavery was essential. And abolitionists were painted with the crazy brush. 

In college they wanted to make it all about state's rights. But still, what it comes down to is a state's right to allow it's citizens to own other human beings. We're seeing some of this states rights stuff rear it's ugly head again as some states want to be able to limit voting rights and feel that it's their right to do so. 

We were told that most of the slave owners were benevolent masters - providing food, clothing, and housing for all their slaves, as well as education for some. They didn't mention that families could be split up on a whim.  It wasn't considered rape if you owned her and any children born to her were yours.  People could be beaten nearly to death (and in some cases were beaten to death) to set an example. These are things that most of us find repugnant, but there are those people out there who want to preserve their "heritage" and their "history" and the right to own a person and exercise complete control over them figures predominantly in this heritage and history. 

I've been struggling with writing this since July. It's now November. In the end, I recognize that no one actually cares what I think about any of this. So I'm just going to go on record and publish it. 

The "heroes" of the Confederacy were traitors to the United States and should not have statues put up in town squares. Leave them to Gettysburg and Vicksburg. You're not going to find a statue of Benedict Arnold anywhere in this country. Why should you find one of Robert E. Lee? 

Higher Prices and Bad Food

 

The last time we took a trip when we needed to book hotels was in 2019 when we went from Florida back to Texas to pick up a UHaul full of stuff that we missed when the movers came. We planned to stay in the same places again. For both the outbound and inbound legs of the trips we were staying at Hilton Garden Inns and Holiday Inns. 

So this is what I know about hotels in the time of Covid. You pay more and get less. The average price per night on that 2019 trip was $120 per night. This time it was $180. Seems significant to me. 

The Holiday Inn hadn't really changed their menu but the Hiltons and the Embassy Suites, where we spent four nights in OKC had what they called a "limited" menu. In Mobile, they were serving their limited menu on real plates but with plastic cutlery. But the food was awful. The young man who was bartending and serving in the dining room was very personable and friendly but in my old-fashioned opinion, dressed totally inappropriately for the job. (He was wearing a hoodie with the sleeves cut completely off.) I'm just going to say that if I owned the hotel, people working in the dining room would at least be wearing shirts with sleeves. But let's get back to the awful food. I ordered a Cobb salad. There are a few things that a Cobb salad should have. Avocado, bacon, tomato, blue cheese crumbles to name a few. This salad had no avocado or bacon and the blue cheese crumbles had been replaced by dried out grated cheddar cheese. It was served with fried chicken rather than grilled or roasted chicken which would have been okay except that the chicken had probably been fried two or three days before it found it's way into the salad. Totally dried out with the meat and breading separating. Mark had a BBQ chicken salad. The young man told him no one had ever ordered that before. Probably not a good omen. It really wan't too different from my salad except that there was BBQ sauce on it instead of vinaigrette or blue cheese dressing. So there was no way we were going to brave that place for breakfast, especially at 14.95 each. 

On to Shreveport. Another Hilton Garden Inn. Another "limited" menu. The only thing that wasn't "fried food" was the grilled chicken breast. It was okay. Nothing stellar. Very bland and served on a paper plate with plastic cutlery. They also had signs all over the dining room indicating that breakfast was no longer free. Again, I don't want to pay for whatever they're serving on their plastic plates. 

Then we arrived at our destination - Embassy Suites in Norman, OK. We were informed when we checked in that the bar/restaurant was open from 5 until 10, again with a "limited" menu, which we noticed was served in boxes and on plastic. Fortunately, there were multiple restaurants very close by, so we only got stuck eating their very limited menu one night. The odd thing was that they did a breakfast buffet. With real plates. But plastic cutlery. You could even get a custom order omelet. So apparently Covid precautions are only important after breakfast. 

The other thing they were being cheap about was cleaning the room. We were told when we checked in that housekeeping would only be performed by request. What that means in real life is that they aren't planning on cleaning your bathroom, making your bed, or providing you with more towels unless you make a special call. As my British husband would say "Sod that!" Assume that I'm calling you every day. The sheets don't have to be changed every day but I do want you to make the bed. I also want the bathroom tidied on a daily basis. 

On our return trip, we spent the first night in a Holiday Inn. To their credit, they really didn't have many changes. (We'd stayed at that one in Pearl, MS before.) The menu may have been slightly different because it wasn't the glossy Denny's type menu they used to have, but a simple printed page. But it was easy to find the grilled shrimp salad that I like. And it was all served on real plates with real cutlery. 

Which brings me to that last night in Tallahassee at a Hilton Garden Inn with yet another limited menu with food in boxes and plastic cutlery. We just couldn't bring ourselves to eat there. But there was a Texas Roadhouse just down the road...

Scammed

 

Nobody likes to be scammed. I hate that it happens to anyone and I really hate that it happened to me. Our recent trip to Oklahoma was the first trip we made without the benefit of an internet connection for the computer in the car. It was a necessity when we were running a business. Now it's a luxury and one we decided we could live without, particularly in light of Covid. Bottom line, we had to rely on our phones to make reservations. 

The thing I know about the Internet in general and Google in particular is that when you search on something, you don't necessarily get that. You get what other people have paid Google to show you. And there might be a whole page of people who paid for you to see something you didn't want to see. 

I wanted to see the information for the Hilton Garden Inn in Daphne, Alabama. If I'd been on a computer instead of a phone I might have seen the fine print of the URL that belonged to a third party reservations company - not Hilton Hotels. 

And now, for a brief moment, I'm going to rant about the "web economy" because most of it, near as I can tell, is a bunch of people who are getting between businesses and their customers and providing very little no value. But they add on fees making whatever you wanted to buy (in this case, a night in a hotel) far more expensive than it would have been if I'd phoned the business direct. But I was prevented from doing that because these third party creeps paid Google to show their contact details along with a map of where the hotel is located and I thought I was phoning Hilton. 

It took longer than I thought it should for the phone to be answered. And when they did answer, all the said was "Reservations". I thought I was talking to Hilton. They never told me I wasn't. The guy's name was Danny (or so he said) I had to repeat the name and city of the hotel for him at least three times, so I'm pretty sure he knew where we wanted to stay. I even asked if he needed my Hilton rewards number and he said they'd take care of that when I checked in. 

When we got to the Hilton Garden Inn in Daphne, they had no record of our reservation. But Danny Boy had texted me a confirmation. I pulled it up on my phone. Danny had booked us into the Hilton Garden Inn by the Airport in Mobile. Apparently our long day of driving wasn't over. They had no availability in Daphne and were powerless to change a booking that originated with a third party service anyway. 

So we trudged on to Mobile. I tried to phone them to see why they had switched hotels on me without my consent, but when you select the option to talk about an existing reservation, those people are NEVER going to answer their phone. 

So my credit card has been charged $50 more than it should have been to stay in a hotel that's a bit out of the way, and not the one I asked for. I didn't get any points on my rewards card, because of the third party people. All I got was complimentary water. I was not happy. I'm still not happy about this. But I've learned a thing or two about searching for something on a phone. 

Going forward, we should decide how far we're going to drive and book the hotel on a computer so we don't have to deal with the small print on the phone. An expensive lesson in money and time. It makes me hate scammers even more. 

The Tyranny of Networks

Last week I received an EOB (explanation of benefits) from our health insurance company. (I won't call them a provider because they don't actually "provide" anything.) It seems I'm expected to pay over 50% of the ambulance bill because the ambulance (which is a county service) is not in the network. 

I'm going to date myself here. It's okay. I know I'm old but I remember when you actually paid your own medical bills. After you met your deductible, you filed a claim with your health insurance company and were reimbursed for what you'd paid over your deductible. You could choose any doctor you wanted. You didn't need to worry about networks or referrals.

When insurance companies decided to start paying the doctors directly, eliminating our need to pay up front and then file for reimbursement, we thought it would be a great convenience.  I am convinced that we, as consumers got the short end of that stick (as we usually do). Aside from the occasional dispute about "usual and customary charges" (a term you don't hear anymore) the old plan worked. 

I think it was the early to mid-80s when my employer, who was self-insured, decided to switch over from being self-insured to using a third-party insurance company. Initially, it all worked pretty much the same - you filed your claims after you'd met the $100 deductible and they sent you a check. But with this changeover they introduced what became known among the employees as "the $5 doctors". If you went to one of the doctors on this list, you paid $5.00. It didn't apply to your deductible but you'd have to go to the doctor 20 times to equal your $100 deductible. (Back in those days, the average doctor visit was $15 to $20 dollars - so it was a cost savings to you.) Again, it seemed like a good deal for the consumer. After visiting two of the $5 doctors, I came to two conclusions. 1. You DO get what you pay for. If the average price is $15 and you're paying a third of that, there is a reason. 2. If the office furniture and paint was last updated two decades ago, leave. Leave now. This is not a doctor you want to see.

But then came the day when we no longer had a choice. We had to see a doctor who was "in network". Well, you didn't have to but there were serious financial consequences if you didn't. I lived in a very small town and I remember my doctor asking me to get him whatever paperwork he needed to join whatever networks his patients were in. I also remember a number of friends being duped into high charges because they phoned the doctor's office and asked "Do you take XYZ insurance?" And of course the response was "We take ALL insurance." The correct question is "Are you an "in network" provider with XYZ insurance?" 

I had a car accident in the 90s. Not my fault, but I had to keep track of what I paid and what the insurance company paid so a claim could be filed with the "at fault" party's auto insurance. That's when I first realized that I paid more than the insurance company. I paid almost two thirds more than they did. 

The same was true for prescriptions. Back in the 80s and 90s I paid less than $3 for a 90-day supply of a generic muscle relaxer. Then the insurance company got involved with it and the minimum charge for any prescription was $5. AND now I could only buy a 30-day supply. So it was now going to cost me $15 for something that had previously cost less than $3. And don't get me started about all the times we were going to run out of prescription meds while we were out of town and couldn't get refills because the insurance company couldn't be reached for a vacation override approval.  

But back to the EOB. I called the insurance company to ask, for future reference, how I could be sure that I got an "in network" ambulance when I called 9-1-1 in the middle of the night. The customer service rep clearly had no genuine thoughts on that so I asked to speak to a supervisor. Even though I was told it would be no more than 48 hours for a supervisor to call me back about that, perhaps I misunderstood. Maybe she said 48 weeks, since it's already been a week and a half. And even though I'm retired now, I still have more to do than sit on hold with insurance company representatives for the entire afternoon. And the thought of calling them back makes my jaw clench. 

So here we are over 30 years in to letting the insurance companies pay doctors direct instead of reimbursing us and they now drive the entire process. Insurance company executives make an obscene amount of money. Healthcare costs in the US have skyrocketed since we allowed the insurance companies to take over. And apparently calling 9-1-1 at 3 am is something that could cost you several hundred dollars. 

I've heard so many people who are fearful of the evils of socialized medicine (and there are evils to be fearful of) because they don't want the "government" meddling in their healthcare. Does it really matter to anyone whether the high-school educated clerk who is going to determine whether you get care or not works for the government or a private insurance company? I'm in favor of putting doctors and patients back in charge. 

Rant over.

Against Medical Advice

Before my mom died, she was released from the hospital into a "rehab" facility. It was a nursing home masquerading as a rehab facility. I didn't see any evidence of "rehab", at least not where my mother was concerned.  It had the best reputation of any nursing home in the area but it was still awful. One of us, me or one of my siblings, a sister-in law or my dad was with my mom all day. Not only to keep her company, but to advocate for her. I don't know how anyone without an advocate survives the place.

At first, I asked her doctor how long she would likely be there. His answer was that it was up to her insurance company. Wrong answer! I expressed our (the family's) concerns about her care - more specifically the lack of care ( I won't get into the specific issues) but he brought the head nurse in to speak with me.

I do my best to avoid confrontation. But her approach was to try to make me believe that I'd "misunderstood" everything that I'd been told since my mother's arrival. (I think we call that gaslighting these days.)  I countered that I had always done extremely well with English comprehension and although I may have been misinformed, I did not misunderstand. It was then that she played her big card.

"If you remove your mother from this facility AGAINST MEDICAL ADVICE, her insurance will not cover this visit or any subsequent problems she might have when she is at home." That was probably the first time since becoming an adult that I wanted to punch someone in the face.

But for the past year now I've been watching half the country going against medical advice. And I'm wondering who's going to pay for that. Where I live the number of cases and deaths is going down - finally - thanks to the availability of a vaccine. I'm old enough to stay home. I can continue to order online and have things delivered if I think we're moving too fast to open up. But if you're still working and not fortunate enough to work from home, if you don't want to go back to work, it will be assumed that you quit and you will be ineligible for unemployment benefits.

Is the economy in a shambles? I suppose it is. Small businesses didn't really getting any help while national restaurant chains got millions. The airlines got big bailouts - seriously, with their revenues and profits, you'd think they could survive a few months - after all individuals and small businesses are expected to. For years, financial advisors have been suggesting that individuals and families have money set aside to pay six months of expenses in case of job loss, sickness, or maybe a global pandemic. But how many people do you know who actually have that money set aside? I can tell you that when I was a single mom, I was living paycheck to paycheck and according to a survey by Forbes in January 2019, 78% of Americans live paycheck to paycheck.(To be fair, some other surveys set the number at 49 to 53%, but that's still a lot.) Not sure how a one or two time stimulus check is going to help, especially if they have to wait months for it. 

Which is worse, financial ruin or death? I suppose it depends on whose financial ruin we're talking about. States opened up before they met the recommended criteria because they didn't want their unemployment funds depleted, particularly in a time of reduced tax revenues. They don't really care about deaths because it's a number on a spreadsheet. As Dan Patrick in Texas pointed out, seniors should be willing to sacrifice themselves to benefit the economy their grandchildren will inherit. I think he should go first. 

So on a personal level, which is worse? Financial ruin or death? They're both game changers, that's for sure. I'm going to say I'd rather be ruined financially than be dead. But hey, that's just me. I got the vaccine at my earliest opportunity and I'm feeling far safer than I did this time last year. 

Death Panels or Angel of Death

Since Mark's experience with Devoted Health Care had been pretty good, all things considered, he planned to renew with them and I applied for coverage with them. I wasn't exactly married to the GP and as long as my cardiologist was in network, I was going to be happy. I hadn't actually been able to find an OB-Gyn, or a dermatologist and the podiatrist I had was in network. 

We are all set to go. We received our id cards which identified our GP as Dr. Arrocho. Who is he? Not our doctor. We called them up and they reissued the cards with the correct doctor's name. Then we got a letter from our doctor. He would be leaving the network effective February 1. But I still want to choose my own doctor. A careful reading of recommendations on NextDoor indicated that Dr. Fernandez was the way to go even though there were numerous rumors that she was leaving to go to Miami. 

We asked Devoted to assign us to Dr. Fernandez, which they did. Her office policy was that we had to see the nurse practitioner before we could see the doctor. We saw the nurse practitioner in February and then, the week before our March 1 appointment with Dr. Fernandez, we got a call from Soni Family Practice to inform us that Devoted had transferred us to them. Wow. No. These are the people who threatened to call the police when Mark asked if the driver's license requirement was office policy or state law. No way do I want anything to do with them. But the downside was that on March 1, Dr. Fernandez would no longer be in the network. (A fact that her office wasn't even aware of.) My appointment, that I'd been trying to get since January wasn't going to be covered unless I changed insurance companies that week.

And since Devoted seemed to be hemorrhaging doctors and we'd been assigned to four since January 1, (Shamim, Arrocho, Fernandez, and Soni) and hadn't actually been able to make an appointment with any of them that would take place while they were still in network, we decided to leave Devoted on the spot. 

The first thing that came to mind was Florida Blue. It was going to cost us more - $20 copay instead of $10. But if you can't actually see a doctor, it doesn't make much difference about the copay. Drugs were going to be about the same, but we had to change pharmacies. Most importantly, we would be able to keep our appointment with Dr. Fernandez on Monday, which was critical because we couldn't get a referral to the hematologist Mark needed without seeing a primary care doctor.

Dr. Fernandez was wonderful. I asked for a referral to my cardiologist, which was processed (not without  drama, but before my appointment), and a dermatologist. Mark asked for a referral to a hematologist and an endocrinologist. She also wanted both of us to see an ophthalmologist. And then the real trouble started. For some reason, these referrals were not going through. Everyday I called the doctors offices to be told that the referral had not gone through. We never had issues like this in Texas. What was going on in Florida?  I immediately suspected the doctor's office staff.  (After all, these were the people who told me they didn't take Medicare, told me I needed a referral when I didn't, and threatened to call the police when asked about driver's licenses.) 

My first thought (having spent so many years in Texas) was to go over to the doctor's office with a gun or a baseball bat and stay there until they processed the referral. It's rare that people inspire me to violence, but it can happen. 

Mark had a different idea. He suited up and took a folder with all of the paperwork in it and surprised the office staff. He followed up with them in person and on the phone until he had the hematology appointment, which was the most critical. The dermatology appointment came through, but nothing on the endocrinologist or ophthalmologist. 

The problem must now be with the insurance company. I phoned them and got answers that once again inspired me to violence. Time for Mark to take over. He had a conversation with them and that's when we discovered the death panels.

As it happens, your doctor can write all the referrals he or she wants, but the final decision on whether you actually get to see the specialist is made by an RN. We should be grateful that it isn't made by a bookkeeper.  (Okay, so panel is an overstatement. An exaggeration. It's not a panel. It's ONE individual. You can have a panel discussion. How do you do that with one person?  Perhaps it's the angel of death.) My feeling is that if you can't trust the doctors in your network to make referrals, then perhaps they shouldn't be in your network. 

The bottom line is that we couldn't get the referrals through with Florida Blue, so we once again changed. We're trying CarePlus. We've had a discussion with their customer service department so we understand how their death panel works. They've assured us it's a doctor. The term she used was "medical professional" which could be an X-Ray technician, but Mark pressed her until she said "doctor".  (But again, it's a doctor who hasn't seen you and knows nothing about you who is questioning the judgement of the doctor who has seen you and knows your medical history.) 

We've been assigned to a new doctor with the new plan. I'm not going to fight it. We're just going to go with it, unless we have our first visit and it's a complete disaster. But I'm still trying to figure out how anyone benefits from having a doctor that I'm going to meet today, refer me to a cardiologist that I've been seeing for two years and then have someone else, whether it's a doctor, nurse or bookkeeper put their stamp of approval on it. 

These Medicare Advantage plans offer great advantages to the insurance companies - not sure what the advantage is to the consumer. But if you have pre-existing conditions, you're stuck with an advantage plan because you can't buy a supplement. Also, it's a good thing I'm retired because dealing with medical offices and insurance companies has become my new full time job.  

But in truth, I worry about this because I can advocate for myself and I have the time. At least I can now. Ask me again in 10 years when my health may be worse than it is now and I have less patience. (Trust me, that is in short supply already.) But there are people who just don't understand how the system works, don't have anyone to advocate for them and don't do a good job of advocating for themselves. There are also people who are working and don't have time to navigate the convoluted system.  What happens to those people? 

It Beats the Alternative

Every time anyone says anything about getting older, someone invariably says "It beats the alternative." Does it? After a solid week of dealing with medical office and insurance company personnel, I've concluded that if this is what I can look forward to for the rest of my life, well "Jesus, take me now." 

I've struggled to navigate the healthcare system in Florida ever since we arrived here in the summer of 2019. Mark had an Aetna Medicare PPO plan when we left Texas and we were able to transfer it to Florida for the remaining five months of the year. But not without cost. They actually sent me an invoice for the $2.10 difference in the price for those remaining five months. (Anyone care to calculate what it cost them to send that invoice and then process my check?) 

At the time we moved, I had regular medicare with a supplemental policy. Time and time again I was told by the doctor's office staff that they didn't take regular medicare but they'd be happy to refer me to an insurance agent who could set me up with the Humana Advantage plan that they did take. I ended up calling Medicare to try to find a doctor and they confirmed what I already knew - if they take an advantage plan, they take regular medicare. But if the office staff won't make an appointment for you, it doesn't matter. 

And since Mark was on a  PPO, we didn't think it was critical that we were having such a hard time finding a GP (general practitioner). Until I called the specialist he wanted (needed) to see and was told that they didn't make appointments for anyone who didn't have a referral. Foiled again by the office staff!

We had to go to an urgent care facility to get our prescriptions renewed and then we went to a doctor who was able to write a referral, even though we technically didn't need one.  

So for 2020 we switched Mark to a different Advantage plan. The doctor he was going to see also took regular Medicare and he put through a referral to the hematologist. All is well, or so we thought. Then came COVID. We did not want to sit in crowded waiting rooms, so we took advantage of the telehealth visits. That worked fine for the GP but for the hematologist, not so much. You see, the hematologist needs to have blood test results. In order to have blood test results, you have to have a blood test. In Texas, the doctors did that in their offices. In Florida, they want you to go to a lab. The lab needs to have an order from the doctor in order to know what tests to perform. The doctor can give you a sheet of paper with the order or they can send it to the lab electronically. Since we weren't going in to the office, they told us they would send the order to the lab. 

Mark scheduled his appointment and went to the lab who claimed they didn't have an order. He called the doctor and the young lady there said she'd send the order over. Again Mark made an appointment. And again he went to the lab who once again claimed they didn't have an order. The result of the next call to the doctor was that she'd sent it and she was not sending it again. Alrighty then! We need a new doctor. But it didn't seem urgent since he was pretty much in remission. 

And that brings us to 2021 and Death Panels. We'll talk about that tomorrow.