ralph robert moore
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Copyright © 2002 by Ralph Robert Moore.
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in any event
october 5, 2002
Because of Mary's recent stroke, I spend a lot of time on the phone making doctor appointments, straightening out prescription mix-ups, untangling insurance problems.
I love doing it, because doing it means Mary survived her stroke, and is getting better.
The speech rehabilitation center Mary goes to five days a week charges six hundred dollars a day, three thousand dollars a week. Mary's insurance covers most of it. A couple of months ago, I received a bill from the center for eighteen thousand dollars. Her insurance had refused to pay for any additional treatment, saying she reached her benefit maximum. I pulled out her benefit booklet, which showed there was no maximum, went on the phone with the insurance company. After a long conversation, with lots of "on hold" time, during which I got to hear quite a few sixties rock classics, frankly more than I wanted, her insurance admitted it made a mistake, there was no maximum, and the claims would be reprocessed. A few weeks ago I received another bill, this time for twenty-four thousand dollars. More time on the phone, more walks down rock and roll memory lane. This time, they had coded the services incorrectly, as physical therapy rather than speech therapy.
The worse experience I've had with insurance though has been with coverage through my own insurance for Mary's illness.
Like a lot of couples, Mary and I both work, and are each covered for insurance not only under our own coverage with our employer, but also under each other's coverage, as a spouse. Mary, in other words, has two insurance coverages for her stroke. Her primary coverage (the one that pays most of her medical bills) is through her own employer. Her secondary coverage, which normally should pay the remainder of any charge, the amount not paid by her primary coverage, is through my employer. This whole process of dual coverage, which is quite common, is referred to as "coordination of benefits".
Mary's hospital stay in April for her stroke, nine days, came to $39,061.75.
Because that hospital is a member of a PPO network, the hospital reduced its charge by $24,096.25, to $14,652.00 ($13.50 was disallowed as an ineligible charge, and $300.00 was a patient co-pay). For all the work they did for Mary, saving her life, getting her back on her feet, $14,652.00 was a real bargain.
After Mary's primary insurance paid, that left a balance owed of $1,491.00.
This is the amount my insurance should have paid.
Except it wouldn't.
The hospital filed a claim for this balance with my insurance on at least three occasions, but each time, my insurance stated it never received the claim. After waiting on hold for about forty-five minutes, and being switched from one department to another, I finally got someone who gave me a fax number the hospital could use to fax the claim.
I thought the issue was resolved.
A few weeks later, I received a questionnaire from my insurance, saying it couldn't process the claim until I provided them with information about Mary's primary coverage (which they already had).
I filled out the form, sent it in.
A few weeks after that, I got a weird feeling, like you do when you know there are children in the next room, but it suddenly occurs to you they're too quiet, so I called my insurance to check on the status of the claim.
Had they received my completed form? Yes. Were they processing the claim? No. They now announced they needed copies of the Explanation of Benefits (EOB) from the primary carrier, which details what the primary insurance paid. If they needed the EOB, if they hadn't already received a copy of it from the hospital, why didn't they ask for it the same time they asked me to complete the form? "Well, in any event, we can't process the claim until we have the EOB." 'In any event', of course, is the new polite way of saying, 'Fuck you'.
So I faxed my copy of the EOB to them, about eight pages long.
A few more weeks passed. I started getting dunning notices from the hospital, to the effect that almost five months have gone by, we still haven't received the payment from your insurance company, could you please contact them again.
I felt really bad, because I respect the effort Medical City Dallas made with Mary, I have nothing but praise for them, and here they are making an entirely reasonable request, that they be paid, and my insurance company is hanging them up.
I debated paying the fifteen hundred dollars myself, and then either pursuing it on my own with my insurance company, or simply dropping the claim altogether, as not worth the aggravation.
However, although fifteen hundred dollars is not a huge sum, and we could easily afford it, it is still quite a bit of money (I don't even know who's on the thousand dollar bill), plus we've had all kinds of additional medical expenses we'd already had to pay our portion of as a result of Mary's hospitalization, and her subsequent outpatient care. And, as always, there was also the 'principle of it' factor, which can be compelling. I've paid for this insurance for over ten years, and this was the first time I had actually filed a claim. It was a legitimate claim, and they should be made to pay it.
So I got back on the phone with them, had to wait through their long, long opening statements (have you noticed how companies using recordings all start them now with, "We've recently changed our options, so please listen carefully", and also give the entire URL of their website not just once, but twice?), listened to old music, got shuffled around to different people, and finally wound up with someone who could check the claim status.
"That claim's been denied."
"We need information on your wife's coverage, and we also need copies of the EOB's."
I had all my paperwork in front of me. "I mailed the other coverage information on such-and-such a date, and faxed the EOB's on this date."
"We don't have any record of receiving them."
"I have a confirmation for my fax." I read them the fax number I used. "How could you not have it?"
"Well, in any event, we don't."
"Can I at least give you the information on my wife's coverage while I have you on the phone?"
"We only accept that information in writing, sir."
I knew the worse thing I could do, in this situation, is get mad. Once you start yelling, or swearing, you put a whole new element into the argument, one that is distinctly not to your advantage. So I kept my cool, and told her to put her supervisor on the phone.
"She's out to lunch."
"Let's try her anyway."
I got her voicemail, left a detailed message about the problems I was having, told her I expected a quick resolution. Then I called back, waited twenty minutes, during which I had to listen to Simon and Garfunkle's 'Feelin' Groovy' twice, incidentally, not just once, but twice, two times, and then I was finally connected with another Customer Service Representative. I had written down the supervisor's name, and asked now to be connected to the supervisor of that supervisor.
"She's out to lunch."
"Then put me in her voicemail." I left a detailed message.
An hour later, I got a call from the first supervisor, apologizing for my problems. They had found my form and the EOB's I faxed. She had personally processed the claim, and a check for $1,491.00, the full amount owed Medical City Dallas, would go out the next day. I thanked her.
A year ago, this would have seemed like an incredible hassle to me, but now that I deal with these problems every day, sometimes two or three in a day, it's actually not so bad.
You can get used to anything, in time.
The only problem I've been completely unable to solve is feeding our cats.
As those of you who read this column on a regular basis know, we have four cats.
Because of kidney ailments and other issues, each cat is supposed to eat a specific food, and only that food. To make this even more complicated, the food that's good for one cat is bad for the other three (not real bad, but they shouldn't eat it).
The other morning, about four o'clock, I prepared everybody's food, set each cat's bowl far away from the other bowls, corralled each cat with the side of my foot to their proper bowl, watched a while to make sure they were obeying the rules, then went upstairs to get something.
I was gone about five minutes. When I came back down, everybody was eating out of the wrong bowl.
I stood in the middle of the kitchen, looking from one bobbing head to the other, and just felt absolutely exasperated.
Because Mary has had a large number of medical bills, I thought it might be prudent to supplement our income, so I purchased a small herd of farm animals.
I don't intend to slaughter them. If you slaughter them, you no longer derive income from them. That's not smart. That's known as 'stupid'. I intend, instead, to sell their milk.
As you can see in the picture below, taken yesterday, I wound up with a mixed bag of animals, and in fact there are quite a few dogs thrown in, which I didn't realize during the giddiness of my purchase.
Since the animals are quite small, I don't believe they'll produce a great quantity of milk. The cows, I estimate, should each yield about one cc per day. One of the pigs is nursing a group of piglets, which gives me hope that I might be able to pull the piglets off their mother, and harness that unused milk. I seem to remember that goats, also, produce milk.
A problem I'm having in obtaining a reliable estimate of daily milk production is that despite repeated close inspections on my part between the different sets of hind legs, it has been impossible for me to ascertain each animal's sex. In fact, it appears I was sold animals that have no genitals whatsoever.
By my calculations, assuming all the cows are female, and that at least one of the pigs (the one nursing) is female, and that half of the goats (I think a fair estimate) are female, I should be able to produce seven cc of milk per day. (As a side note, I'm investigating the possibility of supplementing this production by including milk from the various dogs packaged with my set, assuming that dogs do, in fact, produce milk. To this end, I've already stopped a number of shoppers in my local supermarket to ask them how they would feel about drinking milk that came from a dog).
To stay on the up and up, I'll include a notice with each container which states, "Contains cow milk, pig milk, goat milk, probably horse milk, and may also contain dog milk." The 'may' is the spark of genius, of course. I believe most shoppers will purchase my product thinking, Who knows? Maybe my container is the one without dog's milk.
Using dog's milk will boost my daily production to 10cc.
Even with a daily production of 10cc, however, there's a marketing problem, in that since the milk must be sold fresh, it means my factory could only ship 10cc of milk a day. Since most milk in supermarkets is now sold out of upright coolers with wire racks, my milk, packaged in a container somewhat larger than the eraser on the end of a pencil, would likely fall through the spaces between the wire racks, ending up on the bottom floor of the cooler, where it would likely have a disadvantage in displayability.
One way around this is to package the pencil eraser of combined cow, pig, goat, horse and dog (perhaps) milk in a much larger container, let's say gallon size, to compete with the big boys, with the pencil eraser of actual milk affixed inside with plastic rods so that it doesn't rattle.
Given the cost of the technology needed to create such a package, and introducing it to the market with a suitable campaign, I believe I can get my pencil eraser's worth of cow, pig, goat, horse and dog milk on the market for a cost of approximately twelve dollars and sixty-eight cents per container. About ten such containers would be enough for use with the average-sized cup of coffee.
Those of you with a knack for business might be thinking at this point, But if a shopper buys ten gallon-sized containers of your milk, won't those containers fill up their shopping cart, making it impossible for the shopper to buy anything else?
I have not one, but two solutions to this 'problem'.
One, the shopper can make two trips to the store. One to buy my milk, the other for all the rest of their shopping.
Alternatively, the supermarkets can discard their current inventory of shopping carts, and purchase new ones approximately two and a half times as wide (rather than two and a half times as long, because then the carts wouldn't be able to turn the corners in the aisles. See? I've already anticipated that 'problem').
You might say, but even if the supermarkets are willing to go to the significant expense of completely revamping their stock of shopping carts, simply to accommodate your product, if the carts are two and a half times as wide as before, won't it be impossible for two carts, being pushed from opposite directions, to fit down the same aisle at the same time? To which I say, Hasn't anyone ever heard of the police? What's wrong with the supermarkets hiring police to stand at each end of each aisle in a supermarket, directing traffic so that only one cart gets to go down the aisle at a time, swiftly arresting those shoppers who try to disobey, beating them mercilessly with their clubs right there in the supermarket for all to see what happens when someone tries to get around the one cart at a time law?
My slogan, provisional at this point, is, "Moore's Milk! You're only one hundred and twenty six dollars and eighty cents away from having enough milk for a cup of coffee! (May contain dog's milk)."