Not today Justin
$LAYYYTER
ojovivo
izzy's playlists!
PUT YOUR BEARD IN MY MOUTH
h
ellievsbear
art blog(derogatory)
Aqua Utopia｜海の底で記憶を紡ぐ
EXPECTATIONS
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2025 on Tumblr: Trends That Defined the Year
Today's Document
Game Changer & Make Some Noise
🩵 avery cochrane 🩵
Fai_Ryy
macklin celebrini has autism
sheepfilms
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@fleetwoodmacaroniandcheese
The night Mizuki got pregnant
Mizuki: I need your help
Wuyang: sure thing dude, what's up
Mizuki: I need you to get me pregnant
Wuyang: b- but we're both boys how would that even work?
Mizuki: will you do it or not?
Wuyang: man, is it even possible? Plus I don't even know you like th-
Mizuki: I heard that good boys can get boys pregnant. Are not even gonna try at least? Are you saying that you aren't a good boy?
it is once again... binturong appreciation hour
baby
Yeah that's an animal
Creechur
the space race may be the funniest point in history period and i'll stand by that. the US is like "yes whoever gets into space first will prove once and for all that our economic model is superior and that we are, in general, the superior country of superior and smarter people." then the soviets just went and did it and the US freaked out and needed to cover their ass so were like "WE MEAN THE MOON, WE MEAN THE FIRST TO LAND ON THE MOON."
the mediocre gatsby
the decent wall of china
the ok depression
alright britain
The mildly interesting barrier reef
somewhat fulfilled expectations.
alexander the good enough
Sufficient apes
Not-too-bad white sharks
The acceptable pyramid of Giza.
Ivan The Meh
Casimir III the Average
Peter the Typical
romb
All these big companies changing their logos a dozen of times for something that looks worse every time, while the real all-time GOAT found the winning formula on the first try and then even did a victory lap with it:
Even if it’s bad writing! Write Anyway! Just keep writing or drawing or creating however you want! You don’t have to share it but someone will probably enjoy your art!! Dooo iiit!
Insurance PSA Master Post from a Bitch Who Knows Her Shit and wants to make sure you don’t go bankrupt
Why am I littering your dash with mind-numbing insurance crap?
Because the world of health insurance is complicated, and you can still lose everything if you have coverage and fail to navigate it correctly.
Even if your eyes glaze over instantly at the subject, I suggest you bookmark this as a future reference, because you either have your own insurance now, or you will someday soon, and there isn’t anybody who doesn’t need this knowledge. (Yes, I know there’s a double negative in that sentence. This is a financial post, not a grammar post.)
If you think this is valuable info, I ask you to please share it. You could help somebody save money/sanity.
My cred:
I write health plan docs for a living. I’m an Obamacare expert. I help clients with plan design, so I know the tricks. I implement federal mandates from HHS, IRS, DOL, and state agencies in order to keep my clients legally compliant. I know how to avoid penalties and coverage gaps. I know the tricks of plan design that are implemented to save employers money. I know which laws apply to which types of plans. I know how many ways participants can get severely burned if they don’t know how this works.
1. Your network is everything.
Never visit any type of practitioner without first checking if they are in your network. This is gospel. Many plans have separate INN and OON deductibles and out-of-pocket maximums that do not accumulate together. Some plans have an unlimited OON out-of-pocket limit, so you can still go completely bankrupt if you go OON.
Most plans have network provisions that will cover some OON providers at the INN level: emergency services until you’re stabilized (this is a federal mandate for non-grandfathered plans), No Choice of Provider provision if ancillary services are performed OON (e.g., if an INN physician sends your labs to an OON facility), and various out-of-area provisions. If you don’t know, call the customer service number and ask.
Physicians join & leave networks all the time. Even if your doc isn’t listed in the most recent Provider Directory, it never hurts to ask.
Many plans also have wrap networks that will negotiate with OON providers and facilities, so if all else fails, ask if your plan utilizes one of these to negotiate on your behalf.
2. Understand when your deductible accumulates & resets.
Your deductible is the amount of $ you pay for all services & prescriptions (except mandated preventive care on non-grandfathered plans) before your insurance pays a dime. This is in addition to the $ you pay for your premium. If you’re on an HDHP (high deductible health plan) or CDHP (consumer-driven health plan), your premiums will be very low, but your deductible will be very high. I’m on an HDHP, and my individual deductible is $2,600. Steep.
Deductibles usually reset every January 1, but some plans run off-year. Know your dates. If you’re on an HDHP, use the hell out of the HSA (health savings account) if available.
3. Preventive care is free!! Woohoo!!
The Affordable Care Act mandates certain preventive services be covered with no cost-share.
You can find the list of services here: https://www.healthcare.gov/preventive-care-benefits/
The woman-specific list is here: https://www.healthcare.gov/preventive-care-benefits/women/
These lists are updated frequently, and new services are added every few months. My $500 Mirena IUD is now covered 100%, and the deductible is waived. The HPV vaccine is now covered for everybody between age 19-26. Depressing screening is covered. Tobacco cessation, immunizations, STI screening & counseling….all covered.
4. Preventive care isn’t free under every plan! Booo!!!
If your plan is grandfathered, they will likely opt to cover preventive services at the general benefit percent. The deductible will also apply. They are still allowed to exclude any preventive services they want.
Your plan document will (should) state whether your plan is grandfathered or not. If the doc is silent, call the carrier’s customer service line and ask.
5. Assume every EOB/bill you receive has at least 1 error, ESPECIALLY on hospital visits.
For the most part, claims processors have ZERO medical background. They’re paid just above minimum wage and are paid based on how many claims they process per hour. So you can guess how often errors happen.
I just had a preventive OBGYN claim come back as not covered, even though it should have been covered at 100%. If I didn’t know about the PPACA mandate, I would’ve just paid $219 out of my own pocket for an office visit that is supposed to be free.
You are paying enough/too much already for your premiums and deductibles. Make damn sure your claims are being processed and paid correctly. Raise hell if not, and get familiar with the appeals process.
6. Check your Medical Plan Exclusions before you go for any service.
Can’t stress this one enough.
7. Some plans offer surprisingly generous benefits such as 3-D mammography, genetic/genomic testing, acupuncture, and bariatric surgery.
Look at your Schedule of Benefits, but also check your Covered Charges for details on coverage and limitations.
There are federal mandates like the WHCRA, which requires all plans to cover the cost of breast reconstruction after mastectomy. Your plan document should have a section that lists federal notices.
The Mental Health Parity & Addiction Equity Act also requires plans to cover mental health & substance abuse services & facilities at the same level as the medical services & facilities. For example, a plan that covers a skilled nursing facility (medical) must also cover a residential treatment facility (MH). This is a bigger deal than it probably sounds like.
8. Check pre-certification requirements.
This is a cost containment strategy, and a lot of people aren’t even aware that covered charges are often denied/penalized if you don’t obtain pre-cert before the service. Again, check your plan document or call customer service. The most common services requiring pre-cert are: all hospitalizations (excluding routine labor/delivery), surgical procedures, transplants, clinical trials, outpatient rehab therapies, chemo & radiation, speciality drugs, home health care, durable medical equipment, prosthetics, and advanced imaging (MRI/MRA, CT scan, nuclear imaging, etc).
Any penalties you pay for failure to pre-cert won’t apply to your out-of-pocket maximum, so they really super suck. Some plans outright deny all claims for services that aren’t pre-certed.
9. You shouldn’t go broke.
Under PPACA, your in-network out-of-pocket maximum is limited. This means that you will never spend more than that amount in any year for covered services received from an in-network provider. The key here is the network, which I have to mention again since it is so critical.
Watch your EOBs carefully and monitor your accumulators (deductible and out-of-pocket limit). You can’t rely on the claims processors to get it right. I know it sucks and isn’t fair, but it’s the reality, and it’s your money on the line. There isn’t a claims processor or appeals lawyer in the world who will care more about your money than you do, so it really is up to you to be aware.
Godspeed, friends, and good health to you.
THIS NEEDS MORE NOTES
As much as this advice needs to be spread, it makes me so fucking furious that we live in a country where it needs to be spread.
And PSA #1 works adequately (I am not going to say well, because I think in/out of network is some of the worst of the bullshit of US health insurance) for most uncomplicated physical health needs.
Mental health? Not so much.
And if you get charged for failure to pre-cert, that’s the doc’s fault and you shouldn’t be responsible for the charges.
Also if you do get misbilled, don’t pay it - call to complain first, then ask if the doctor can submit anything to help
I once spent a year and half fighting an mri bill that they incorrectly labeled as frivolous until a doctor got involved
Also: keep calling. Get it in writing if you can. I just had a medically-necessary pre-cert-required drug not counted against my annual deductible (and our work shoved us all on high deductible plans which is SUPER GREAT for a family with 3 disabled people in it) because despite my calling multiple times and being assured it was taken care of, my pre-cert wasn’t done. Then I was told I could just pay for it out of pocket, and they would go back and count the drug against my deductible after the fact.
HA HA HA HA LIARS.
Also in my area the hospital is in-network but the ER doctors are out of network.
No shit.
For reference.
So I’ve been walking around with a runny nose and a sore throat being like “Oh well, just a cold! Definitely couldn’t be COVID!” but it turns out those ARE Omicron symptoms and I didn’t know that.
Omicron symptoms include:
-Cough
-Fatigue or tiredness
-Congestion and runny nose
-Sore throat
Breakthrough infections of the coronavirus are increasing in Chicago and Illinois, but health experts say it’s likely that the symptoms you
I have a sore throat and a runny nose and I assumed it couldn’t be COVID until my sister told me that I was wrong.
I didn’t know this and I’m assuming I’m not the only one who didn’t know this, so I thought I’d post about it here.
Great, now I’m back to “is it a cold or covid?”
Urgent Help Needed
New post bc our situation changed drastically.
My roomate and I have been homeless for months now, and we are staying in an extended stay hotel right now. I got a call yesterday that a long dead relative never had their will acted upon, and so I am receiving just enough money to set us up in an apartment. We'll be able to get on rent assistance after and things can improve. However, the check isn't gonna get here for at least a week and may take another to cash.
Our hotel bill is due on the 15th of December though unless I can get it to budge a few days and we are several hundred short. We also need groceries, and I just had to pay for medication. The storage bill is late too. Not to mention the fact that we lost our bed, bedframe, towels, and every other damn home-good in the eviction. So we truly need all the help we can get, but we are now definitely not going to be homeless soon.
@hostile-flower is still doing art for anyone who d*nates $50 or above
https://www.paypal.me/creepiecrpple
Venm0: @tab-99
Cash@pp: $creepiecrippl
Dec. 11 2021
We have a hotel bill due Jan 5
We are less than half way there. The bill will total about $1,700 without tax. It started snowing with sleet today. It isn't sticking bit the temps are well below what could kill my disabled self. We need help. Please donate or share if you can. We are not going to make it without help, and we are literally just waiting for the apartment money which guaranteed. (Dm me if you want details on that, or proof for any of this) Being able to get this hotel bill and maybe just a grocery order would mean a lot to is. This past month we have spent in poor health and dealing with abusers. Its getting more sticky as two of them are diagnosed with covid and I'm having to plan for the worst bc they won't.
okay i really wanted to like the new trump-clinton movie because !!! period dramas!! but the costumes are so bad if you know anything about the era like—
• i get that they gave melania trump an older look to emphasize her seriousness but her dresses are way too fifties and not twenty tens enough, corsets had actually pretty much fallen out of favor a few decades before the twenty tens
• hillary clinton was a politican so her makeup shouldn’t have been that neon. that wouldn’t be a thing for like three more decades.
• donald AND bill literally look like they could be from the modern day. people had sleeves back then, guys. even MEN wore clothes with sleeves and no one thought it made them look less manly (also side note if anyone knows anything about history they know that trump and clinton were both like seventy years old when he ran for president. but the actors they used were hot so i don’t really care l o l)
• seriously this upsets me so much when is a costumer gonna be brave enough to put a man in sleeves in a period drama?????? it was a weird time for fashion but that’s just how it was
• (and in the same way, men wore very little makeup until like a hundred years ago WHY do all movies insist on putting all the men in full makeup when that’s not how they looked back then? like yes it looks weird but that’s the past!)
• ugghhh apparently no one told the costume department that strapless floor length gowns were only a formal thing for women. so many background characters are just wearing them all the time. look in the scene in the coffee shop and the barista is wearing a floor length strapless gown. they were actually called "evening gowns" back then because they were only worn in the evening!
• by the way midriff tops were a peasant thing you wouldn’t see anyone in the upper class wearing them of either gender so idk what all of those were doing there
• hillary's gown at the inauguration ball scene was LITERALLY copied from the wedding dress of an english princess from the eighties. i read somewhere it was because they wanted it to look regal and it was beautiful but like......if you know the era that’s actually a couple decades off, and stuff like big sleeves (at least the women had sleeves in this movie lol) had actually not been fashionable for a while when the movie is set
anyway the acting was good and Donald/Hillary are my historical OTP so that was cute but the costumes really took me out of it :/
