Healthcare Fail/s

Fail #1 – I take medicine.  I don’t think that’s an Earth moving statement.  Many of us do.  Mine happens to be required every day.  Fine.  Another non-statement.  And, insurance covers much of the cost of the meds.  Now, that’s different for everyone, but as a State employee, it’s a little better for me than you.  I haven’t gotten a raise in 7 years, but I get healthcare.  Which would you rather (a blog post for another time)? 

So, when Medco/Express Scripts said, “We’ll reduce your payment on your meds further if you just subscribe with us for automatic refills and mail-order delivery,” well, hot damn, that’s just too good to be true.  And it was. 

I could end this blog here and you’d be stuck nodding your head in agreement without any good story behind it.  Frankly, it’s not a great story, but you asked (or didn’t) and here it is.  The drug I need is name brand.  Insurance companies and their subsidiary pharmacies (i.e. Medco) don’t like giving those out.  Why?  It costs them more while my premium stays the same.  So, routinely, after a script is up, they try to switch my meds.  I get the letter/e-mail indicating that there are other generics that could work as well and if I don’t get a special note from my doctor, they’re going to switch me.  I’ve got a “if it ain’t broke” mentality about meds, so, every 3 refills, I get my doc to write another script and letter as to why I need name brand.  Fine?  Fine.  My issue is that, instead of working from health-related science in order to change my script, they’re looking at their bottom line.  It’s cheaper for them, so let’s short our patient of what they need/works for them.  The problem is that there’s practically no financial difference for me.  So, why should I switch?  And so the game goes on.

This time around, Medco sent a letter indicating that my refill was being processed followed by an e-mail saying that I couldn’t get a refill now because it was too soon since the last one.  Uh, hello?  You, Medco, sent me the last one.  It’s time for more meds, you incoherent bastards.  Can’t you imbecilic idiots count to 30?  That was a 20 minute conversation with their customer service, a number I’ve called too many times.  Effing computer.  Effing Medco.

Fail #2 – I got a letter in the mail regarding my physical therapy.  (You didn’t know I broke my leg?  Fall down go boom, yadda yadda yadda, PT for weeks, pain killers, etc.)  I’ll paraphrase:

“Mr. August, based on the PT reevaluation information provided to us by the therapist, your reported pain and range of motion tests indicate that you don’t need PT any more.  Good day.  I SAID GOOD DAY!.”

Riiiiiiiiiiiiiight.  OK, so the decision to end my therapy was based, not off of physical ability or level of healing, but on reported pain…which is an arbitrary fucking number between 1 and 10 without any unit of measure associated with it…and my range of motion…which I was nearly 100% 2 weeks after surgery.  Never you mind that the muscles were so atrophied that it looked like I was peg-legged in a pair of shorts.  In fact, the same reevaluation indicated that I had between 50% and 75% strength in the bad leg, and had a marginal level of ability to do simple things like jog, jump, etc. compared with the good leg.  MEASUREABLE STATISTICS NEED NOT APPLY.  Again, if the insurance company doesn’t want to pay then you need to beat feet and get going because you’re not going to get the medical treatment you deserve.  Don’t let the door hit you on your crippled ass on the way out.

I guess it’s just amazing that we allow this to continue to happen.  I’m willing to bet that for every person like myself that needs treatment, 20 are perfectly healthy and are just paying into a system that they’ll never fully take advantage of…leaving the insurance companies fat and logy.  To be fair, I did have an opportunity to appeal, but then I’d need to solicit not only my PT, but also the orthopaedist to send letters on my behalf.  And, by the time I had gotten the letter of denial, I had been out of PT for 2 weeks already because the insurance co. put them on notice that payments were going to stop after a certain number of sessions.  They just didn’t get around to telling me until 3 weeks later…through snail mail.  Welcome to 1956. 

No matter what you think of Obama-Care, it’s there.  And, in my opinion, it was like a 3-legged horse right out of the gate.  I know that it works…but it works like all the other insurance companies.  In my limited opinion, we as a people really, missed an opportunity for true healthcare reform.  Your health was never meant to be a money making venture.  It shouldn’t be.  I understand that every time someone is covered, that provider is taking a risk that the money going into the system will not equal what needs to come out when a tragedy happens or medical treatment is absolutely necessary.  So, how do they buffer that?  By taking on thousands of patients in hopes that everyone doesn’t get the flu at the same time.  That should be it.  Instead, the companies are constantly looking at ways to cut corners, offer less to their subscribers, and profit on your obligation to carry insurance in the first place.  What’s worse is that there are plenty of other nations out there that have figured it out, and instead of embracing something that will reduce costs for EVERYONE, we call them socialists or communists and point fingers and say “that won’t work here” without any substantial logic backing up the claim.  That’s an ignorant “freedom fries” mentality.  Instead, we should be taking notes and start employing strategies that are good for people, not corporations, which would make things cheaper and more comfortable to everybody.  I don’t know what that is, but I know that we’re a smart enough country to figure it out…that is, if everyone can take a break from eating freedom fries.

Homeless and misrepresented

When we last left our hero, we were on the way to being homeless...but only for a short period of time.  A house was found, bid on, accepted, and final preparations were underway...until we had a boo boo with a holey oil tank that was being extracted, which killed the deal for us, immediately.  But let me explain...there is no time, let me sum up.

Said oil tank was conveniently left off the seller's disclosure.  And, paperwork regarding its whereabouts in the front yard wasn't discovered until after attorney review concluded.  Fishy, you say?  "Don't worry," they said, "we're willing (and legally responsible) to take it out.  Doing it ASAP," they said.  The tank, as it seems, was located adjacent to the foundation in the front of the house.  Now, during our inspection, the only structural question mark came when the inspector showed us a horizontal crack along the same wall indicating that there may (or may not) be an issue.  Now they're messing around on the opposite side of that wall during the tank extraction, exposing the foundation, and potentially doing more damage (if it was already damaged).  Also, the tank was potentially under some of the driveway and front walk.  Seller's realtor said, 3 weeks, tops.  No worries.  We'll get'er done!  Fun-ness!

IN ADDITION...Mr. Tanky had holes in him.  He didn't feel so good.  And, even though the tank was decommissioned a while ago (around 20 yrs), it still could have contaminated the soil around it; "could" being the operative word.  I called the tank removal company where the woman at the desk told me way too much information.  I'm a concerned party.  I'm not paying them to remove the tank. She's got no obligation to me.  Still, some of the things I was able to confirm was that a) Mr. Tanky left a smell and residue on the soil where he was sitting all these years; and b) the owners of the house were likely going to have to pay out of pocket for this project because it wasn't impacting a 3rd party (i.e. neighbors/water source).  The nice lady at the company said that they were likely going to have to take a minimum of 6 core samples of the soil, test them, and, if they're negative, generate a report finding that no further action would be necessary to the Department of Environmental Protection where they're inundated with the review of these types of reports because, hey, this is Jersey.  Don't worry, she said, this won't take more than 6-weeks, tops.  No worries.  We'll get'er done! ...(unless there's contamination, then that's closer to a couple months, four tops.  Don't worry!)

Rizzzz.

So we bailed.  The owners already requested that the closing date be pushed back to August 27/28 from the original date of the 18th.  And, we couldn't imagine that, after spending nearly $10,000 for this effort, that they were going to be willing to fork over another $5,000-$7,000 for the necessary asbestos removal and basement re-carpeting (read: cat pee/mold/rabbit shit on carpet, stink/funk).

My guess is that, when this family bought this house in 2007, they were given a credit or seller's concession to remove the tank.  Instead, they pocketed the payola and let it ride for the 7 years they were in the house.  Then, rather than scare potential buyers away, they hid the tank (illegally) from perspective buyers by not disclosing it as they're required to do.  I feel badly for that family as the dude was transferred to an office in Tennessee and he, obviously, wants to get his kids in school there ASAP.  They're now in the middle of a messy situation with the house still off the market, a major project underway, and responsibilities 12 hrs away.

Oh, and we're still homeless.  But, family and friends have been HUGE in taking us in/letting us use their houses for a bit until we can find either a rental or new house to buy and get on with our lives.  A big shout-out to my parents and in-laws, and especially the Linton/Whitten family who have let us invade their personal space for the last 2 weeks.  Oh, and my beagle wants to thank my parents personally, by allowing them to pick up after her.  She keeps leaving them presents and they keep throwing them out.  Go figure.  I guess, in this case, the gift really is (only) in the giving!

(P.S.  We're fine, have a bid on another house and a really nice rental lined up should we have issues with that.  Just not as dramatic a post if I wrote that everything is awesome...unless I'm describing the action scenes in the Lego Movie...but I digress.)

Fargen Icehole

So, now I’m an idiot.  I’ll readily admit that.  If you’ve watched TV, been on FaceBook or Instagram lately, between posts about Robin Williams, you’ve undoubtedly seen your friends and family dumping large quantities of ice water on their heads in the name of ALS.  My issue is that, for the most part, many if not most of the people believe that, in lieu of making a donation, they can do this “challenge” and shame others into either, taking the challenge, or ponying up the cash for the organization…all in the name of ALS awareness.

If you follow me on FaceBook, you know that I’ve already called “bullshit.”  I don’t have confidence that most of the dumpers have any clue about what ALS is...or, for that matter, who Lou Gehrig is…and, even worse than that, I don’t have faith that those who do the dumping are committed to donation.  (I won’t divulge how I came to these conclusions, but know that I spoke with several who have taken the “challenge” to confirm this fact.)

That said, the response to my pessimism has been “but, it raises awareness!”  I contend that, by merely saying “ALS” in a video is not “awareness.”  But, admittedly, the stunt has caused a media frenzy…and, more people, people in the public eye, people with money, are subjecting themselves to a small amount of ice-water in the name of Amyotrophic lateral sclerosis…including, most recently, Mark Zuckerberg…who after his dump, nominated Bill Gates.  How did Zuck get involved?  The Love Gov, my own Chris Christie called him out.  Now, that’s some heavy hitting.  I would like to believe that these high profile personalities are, in addition to getting chilled, donating as well.  And, according to several news agencies, the ALS Association is reporting a 1000% donation increase from this time last year (2013, $22,000). 

Good is being done, but at what risk?  Just like reality TV, society will have a threshold of overexposure or saturation where this shit just won’t work.  Other charities are soon/sure to follow suit…the outpouring of attention this has gotten…FOR FREE…is ridiculous.  So, my request to you, the people, is to keep donating for all of those other organizations who need funding as much as ALS.  There are soooo many debilitating diseases out there that would benefit from 15 minutes of fame, but now will be called out as “copy-cats” based on the successes of one or a few charities able to cash in on this latest phenomenon.  To quote a friend…do things, donate stuff, do stuff, all year round.  Charities and the diseases they support aren’t going away anytime soon.  Robin Williams didn’t kill himself, the man died of depression, a debilitating mental disorder which causes the person of the disease to become delusional that the best option is to cease existing.  It’s a disease, and his disease killed him.  With the outpouring of sympathy for Williams and his family, here are several organizations you can make a difference about TODAY.  

And, if mental illness isn’t your thing, go support your thing…whatever that thing is.  Do something…and don’t be compelled to pass the buck, or excuse yourself, by dumping a bucket of ice water on your head.  Because making a video and posting it on-line doesn't really help anybody, unless you go the extra mile.

Movin' on up!

Swirling mind turd.  Moving sucks.  Sara has packed 95% of the house while I've helped reach the stuff off the top shelves, un-hang pictures, and provide emotional support?  That last is probably debatable.  However, as moving day is tomorrow, it's been a tough (mentally) couple of weeks.  But, I digress, a synopsis is in order.

I mainly started this blog with an entry about how we needed to get the eff out of our house (see: The system is still failing blog post).  It's a sordid tale, but one you've no doubt heard a dozen times, of a man, his wife, children and dog, stuck in a house amid abandoned homes, ex-con squatters in foreclosed residences, and, generally, unable to do squat shit about it.  The history is that we've been trying to sell since Sara was preggers with Jude.  That's nearly 6 years of "trying".  Well, folks, sometimes there's a happy...no no, too cheery, satisfactory ending to the story.

The long and short of it is that we have been able to sell our house.  A young couple who are expecting.  They ran us through the ringer about some of the questionable conditions we were living in (their questions, not ours) and we got nearly asking price.  Immediately Sara went into emergency where-the-fuck-do-we-go-from-here mode.  The house search took her, and us, as far north as West Orange, and as far west as Bernardsville.  And, at the last minute, Sara found a couple of houses in, of all places, the town next door, that might work.  Bids went in, one was accepted, and our closing date is 2 1/2-weeks away.

So, you see the dilemma: moving tomorrow...homeless for 2 1/2 weeks.  And that's the rosiest outcome.  New house has a couple of flaws...let's call them oil-tank and asbestos or OT&A for short.  (Inspections are great, aren't they?)  Family has come to the rescue, but it looks as if we'll be negotiating right to the closing date.  We've got places to crash, but no permanent address...something that's fairly common.  Our life will be housed in my gracious father-in-law's garage.  Pray it all fits. 

Until then, wish us luck.  Upwards and onwards. 

(P.S. new house has a pool and really nice deck/patio, so when are you visiting?)

Jerry's Day

I’ll keep this short since I heaped praise on Weird Al a couple weeks ago.  That said, Happy Jerry day.  Today would have been Jerry Garcia’s 72^nd birthday.  Regardless if your impression of his contribution to this world, whether it be positive or negative, you can’t argue that the man wasn’t musically gifted.  His life’s work was a blend of folk, rock, jazz, country, bluegrass and gospel and left an indelible mark (4-fingered) on the American music scene for over 30 years.  And, you don’t have to go far to find contemporary musicians who emulate and/or cover his body of work in modern arenas (see: Dark Star Orchestra). 

So with that, I leave you with one of my favorite Jerry-sung tunes that the Dead performed between 1969 and August 9, 1995 when Jerry passed.  I hope you enjoy it as much as I do.