Houdini

stuff

[finnglas]

I’m going to give you the best piece of Adult Life Is Hard advice I’ve ever learned:

Talk to people when things go to shit.

I don’t just mean get it off your chest, although that’s good. I mean: Something’s wrong with your paycheck/you lost your job/you had unexpected emergency car repairs and now you’re broke so your credit card payment is late. Like, not just 15 days late. We’re talking, shit got crazy and now you’re 90 days late with compounded interest and late fees and the Minimum Payment Due is, like, $390, and you’ve got about $3.90 in your bank account. Call the credit card company. 

I know it’s scary. I know you feel like you’re going to get in trouble, like you’re gong to get yelled at or scolded for not having your life together. But the credit card company isn’t your parents; they’re just interested in getting money from you. And you can’t squeeze blood from a stone or money from someone who doesn’t have any. So what you do is you call them. You explain you’re experiencing temporary financial hardships, and you’re currently unable to bring your account up to date, but you don’t want to just let it get worse. Can you maybe talk to someone about a payment plan so you can work something out? Nine times out of ten you’ll be able to negotiate something so that at least it’s not just taking a constant, giant shit on your credit score.

- Can’t pay your power bill? Call the power company.

- Can’t pay your full rent? Talk to your landlord.

- Had to go to the hospital without insurance and have giant medical bills looming in your place? Call the hospital and ask if they have someone who helps people with financial hardships. Many do.

- Got super sick and missed half a semester of class because flu/pneumonia/auto-immune problems/depressive episode? Talk to your professor. If that doesn’t help, talk to your advisor.

You may not be able to fix everything, but you’ll likely be able to make improvements. At the very least, it’s possible that they have a list of people you can contact to help you with things. (Also, don’t be afraid to google things like, “I can’t pay my power bill [state you live in]” because you’d be surprised at what turns up on Google!) But the thing is, people in these positions gain nothing if you fail. There’s no emotional satisfaction for them if your attempts at having your life together completely bite the dust. In fact, they stand to benefit if things work out for you! And chances are, they’ll be completely happy to take $20 a month from you over getting $0 a month from you, your account will be considered current because you’ve talked to them and made an agreement, you won’t get reported to a collections agency, and your credit score won’t completely tank.

Here’s some helpful tips to keep in mind:

1. Be polite. Don’t demand things; request them. Let me tell you about how customer service people hold your life in their hands and how many extra miles they’ll go for someone who is nice to them.

2. Stick to the facts, and keep them minimal unless asked for them. Chances are they’re not really interested in the details. “We had several family emergencies in a row, and now I’m having trouble making the payments” is better than “Well, two months ago my husband wrecked his bike, and then he had a reaction to the muscle relaxer they gave him, and then our dog swallowed a shoestring and we had to take him to the emergency clinic, and just last week MY car broke down, and now my account’s in the negatives and I don’t know how I’m gonna get it back out.” The person you’re talking to is aware shit happens to everyone; they don’t need the details to prove you’re somehow “worthy” of being helped. They may ask you for details at a certain point if they have to fill out any kind of request form, but let them do that.

3. Ask questions. “Is there anything we can do about X?” “Would it be possible to move my payment date to Y day instead so it’s not coming out of the same paycheck as my rent?” The answer may be “no.” That’s not a failure on your part. But a good customer service person may have an alternate solution. 

Anyway! I hope that helps! Don’t just assume the answer is “no” before you’ve even begun. There is more help out there than you ever imagined.

[finnglas]

Hey guys, this is an old post, but it’s still relevant, and I thought I’d re-up it for living in COVID times when a lot of people are losing income. Don’t be afraid to toss that in when you call to ask for help! “I’ve experienced a loss of income due to COVID-19″ is gonna be all you need to say for most places, because wow let me tell you how much this is the case. A lot of places are setting up COVID-19 specific relief policies, so this may be even easier than normal. 

Good luck, stay safe, stay inside if you can, and wash your hands. <3 

[darkalleysunflower]

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.

[smallrevolutionary]

THIS NEEDS MORE NOTES

[minim-calibre]

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.

[libertinem]

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.

[eye-of-orion]

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

[vaspider]

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.

[aberrant-eyes]

For reference.

[biodiverseed]

IN DEFENSE OF TOPPED TREES

A Permacultural Perspective

Most arbourists these days will tell you that tree topping (the practice of pollarding large trunks and branches on mature trees) is an excessively destructive process: it’s largely been replaced in the trade with spiral thinning.

There are a variety of reasons for this advice against tree topping: all having to do with the long-term health and integrity of the tree. The caution against topping trees is relevant for gardeners, landscapers, horticulturalists, arbourists, and city planners, but not neccessarily a hard and fast rule for permaculturalists.

The reasons for this have to do with differing ideas about the function of a tree:

In a heavily-landscaped garden or city street, there may be a few trees that constitute a significant investment, and the aesthetics and maintenance of those trees tie in to property values. Topping compromises the health and durability of the tree, which is fundamentally an economic concern.

In the permacultural ‘food forest’-style garden I’ve built, I currently have 50+ fruiting trees, and I am planting and grafting new trees every day, so it’s not a big deal if one dies. I use pruned lumber for a variety of purposes, and sometimes I deliberately do things that impair the health of a tree – such as planting parasitic mistletoe – in order to create wildlife habitats.

Last year, I topped one apple tree, and did some drastic ‘spiral thinning’ on another. Both survived, with the topped tree sending up much-maligned water sprouts, and the spiral-thinned tree leafing out as usual (albeit with a little sun scorch on the leaves).

Topped Crabapple, with grafted water sprouts

Drastically spiral-thinned canopy on a Skovfoged apple

I’ve noticed that on the topped tree, fungus has begun to be established on the two stumps. Far from being dismayed by this, I am actually overjoyed! If you want to understand why fungus on my apple tree is welcome, look no further than the first picture accompanying this piece of writing.

Topping can stimulate the development of tree hollows, which are vital habitats for bees, beetles, birds, and tree-dwelling rodents like squirrels.

Tree hollows in living trees are cavities where the heartwood has been degraded by fungi or bacteria. Trees compartmentalise decay, and the only actively growing or vascular tissues of a tree are concentrated towards the bark. This means a tree can potentially be almost completely hollowed out, but still continue living.

Bees in a tree hollow

Topping provides an opening for fungi and bacteria to create a cavity in the tree, and thus creates habitat. The excessive growth of water shoots is also a benefit, as timber is a valuable resource for mulch, hügelkultur, and carbon-sequestering soil building.

I’m doing my best to preserve these cavities in trees in the forest garden, even in trees that otherwise seem doomed. In the case of my European Ash tree with developing fungal lesions, instead of getting rid of the tree, I’ve done a bridge graft around the lesion. The hollow will continue to form, but the vascular pathways will remain intact.

Topping trees, like sheet mulching, can essentially be an accelerated way of promoting ecological succession in a forest garden. Fungi and bacteria also have a place in the ecosystem, and naturalistic garden maintenance means embracing those forces, rather than trying to control or eliminate them. We can always plant new trees, but bringing species back from the brink habitat loss-induced extinction is a little harder.

To me, local wildlife is included in the permacultural ethic of ‘fair share,’ as in, they too deserve a fair share of the space and harvest from this garden. You may be surprised at who moves in, when you make them welcome!

Tree Hollow Dwellers