A QUICK GUIDE TO NOT GETTING RIPPED OFF BY A DOCTOR

 

  I recently had some dental work done. I had to get a few wisdom teeth removed. I was in some pain and was not in much of a mood to slow down and evaluate the process the dentist was recommending.  I almost made a gigantic mistake but we were saved by a friend with special insider knowledge. I am going to give you some of that knowledge right now. 

You need to know what happened. 

Read on...

It is Orange County, CA, 2024, and I had selected a dentist who was "in network" meaning they have an agreement with my insurance plan. They evaluated my situation (extraction of three teeth) and said it was going to be about $2,300. They set me up right there in the office for a payment plan with Lending Club and I was scheduled for surgery in about a month.  The first payment for the yet-to-be-performed surgery came in a few weeks and I was thinking, hmm, this seems weird. I called the office and they said that was normal. My wife got more suspicious than I did because I rarely go to a doctor or a dentist for anything more than a checkup, so I did not know that this was NOT normal.

That's when she started talking to her friend who saved our butts. This friend who we will call "Joni" used to work for a doctor's office and for an insurance company and she told us to put everything on hold because the dentists was stealing from us. 

Joni said flat-out that $2300 seemed very high for a few teeth to be extracted. She said to first make sure the involved technicians (dentist, anesthesiologist, surgeons) are ALL in network. Because, guess what, if one of the team of medical people in a procedure is "out of network" then the ENTIRE procedure is billed "out of network" so your "in network" dentist can now bill whatever they want. 

My wife, bless her, called the dentist for me and found out that, "Gosh, we put you with an out-of-network doctor, oops!" Now, I had been asking throughout this process if the doctor was in network and the answer seemed to be "yes" each time so I was not worried.-- they totally have my back, right?  Well, no, they often care not about "your back." 

After they reorganized the procedure to fix this "error" and got me set up with in-network  surgical people, it still seemed an abnormally high cost. They explained to my wife that, "Well, the insurance only covers this much but we charge this much so you have to pay the balance. Joni said that this practice is called "balance billing" and is ILLEGAL for a doctor to do when they have contracted with an insurance company. (don't worry, I will lay this out in bullet points at the end) 

Joni instructed my wife to call the office and use the words: "That is illegal and you cannot charge over the contracted rate." The answer was, "Oh, gosh, you are right. We will 'resubmit' the claim."  We found out from Joni  that "resubmitting" a claim basically means, "Oh, they caught us stealing, let's redo it correctly this time."  We eventually arrived at the insurance-contracted rate which was somewhere around $287. 

Yes, they were financing me for $2,300 and I was making payments BEFORE THE SURGERY ( an illegal practice for insurance-contracted doctors). They applied the payment I had already made on the illegal loan to that bill so we ended up only paying less than $300 for the procedure. 

Quite  a saving yes?

Months later, a friend of mind went in for his scheduled colonoscopy and they said, "Yeah that will be $1100."  He was stunned and had to lay down a credit card. I knew something was up, thanks to my recent experience, and told the wife (who had become a bit of an expert now) and she said, "Hell no." She instructed my friend to call his insurance company and ask about it and, lo and behold, it came out that the doctor's office had "used the wrong billing code" and it was actually only $100.  Oops!  Well, he got a refund.

THIS IS COMMON PRACTICE. 

Let's recap. Here are a few easy ways to remember what you should do in the event you need a medical procedure beyond of that normal doctor visit for a bad cough or earache.

Check if Provider is In-Network:

Call your insurance or check their website (calling is better) to make sure the provider is IN NETWORK. Do not mess with an out-of-network doctor -- unless you are very certain what the price is going to be and maybe you know this person and they have some specialty that you know is gonna be worth it for you. 

Get an Evaluation From Doctor 

They need to evaluate your situation and see what is needed. If the copay is appropriate then things are looking legit so you can proceed with evaluation, if they charge more for that then something may not be right.

Surgery Predetermination:

Before any services, ask the doctor to submit a "predetermination" to your insurance. They'll need to provide their tax ID, CPT codes, and medical records. Insurance will likely take weeks to respond with a letter of predetermination, so expect that.

If Doc Refuses To Do a Predetermination:

Get the doctor’s tax ID, CPT codes, and the name of the surgeon. Call your insurance with this info to verify network status and expected costs.

Watch Out for Extra Charges:

Doctors might claim they charge more than what insurance states, but if they're in-network, they can't legally charge you the difference. This is the "balance billing" I referred to earlier. They are not allowed to do this.

Extra things to remember: If ONE member of the surgical team is out of network then the whole surgery is billed "out of network" and "balance billing" is where they try to charge you MORE than the rate they contracted with your insurance provider.

Emergency procedures are rather a different animal and one cannot expect you to be able to do these things if you crack your head open on the street and are unconscious. Happily there seem to be safeguards set up for this and hospitals will have to figure out all that stuff in case you are incapacitated because most likely if they over charge you without your consent they open themselves up to legal challenges.  SO they are rally protecting THEMSELVES in that case so they will actually do the work. Remember if they trick you into agreeing to an out-of-network procedure or a "balance billing," then you are on the hook and it will be very hard for you to set things right.

I hope these tips help you as they did me.

To tighten it up even a more, remember this little acronym 

N.E.P. (Network, Evaluation, Predetermination)

Bookmark this article and refer to it because eventually as Father Time does his dastardly work on us all, the time will eventually come where you need this information.

Comments from people in the medical and insurance industry are appreciated here. Do let me know if I got anything wrong.

FAKE CHECK - POPULAR NEWS STORIES YOU THINK ARE TRUE BUT AREN'T

A LIST OF POPULAR NEWS STORIES 

THAT ARE MISLEADING OR JUST FAKE

____________________________________________

JOE BIDEN WANDERS OFF AND STARES AT NOBODY WHILE AT G7 CONFERENCE?

Didn't happen: https://www.youtube.com/watch?v=O-0zT4VN-dw&ab_channel=FRANCE24English

DONALD TRUMP REFERS TO NAZIS AS 'FINE PEOPLE' AT CHARLOTTESVILLE STATUE EVENT?

Didn't happen: https://youtu.be/9ovkMSJ6svc?si=-YunOsaLVMdGXDcR&t=1157

DRINK BLEACH TO CURE COVID

Did Donald Trump suggest that people drink bleach or some disinfectant to fight Covid?

Nope: https://scottadams.locals.com/upost/5120768/how-the-drinking-bleach-hoax-was-created

JOE BIDEN REFERS TO HIMSELF AS FORMER PRESIDENT

Did it happen? Not really: 

https://x.com/dom_lucre/status/1818051430613176322

He maybe could have meant"no former president and not me" but it was rather humorous

Underwhelming Ancient Greek Philosopher’s Works Discovered

 Underwhelming Ancient Greek Philosopher’s Works Discovered

Recently unearthed documents have delighted archeologists and historians alike with the discovery of a literal treasure trove of discarded writings from the almost entirely forgotten and universally ignored philosopher Moronocles (more-on-uh-cleez) who, like Plato, was also a student of Socrates. Little is known about his early life and education, but unlike his famous teacher, Socrates, who never wrote anything down, Moronocles seems to have written everything down. Every thought, no matter how useless, was preserved with painstaking accuracy and stored in a dumpster behind the home of his friend and contemporary, Plato. The voluminous cache of well-preserved documents are sometimes neatly chiseled into tablets, others scribbled on worn-out sandals or cocktail napkins--one entire manuscript is written in tiny print on the discarded toga of Moronocles’ morbidly obese neighbor Diabetes. 

Based on ancient sources, modern scholars believe he was born in Athens between 422 and 426 BC. He was not a good student, receiving barely passing grades, and in high school his class mates voted him “Most likely to need to remind everyone what his name was.” Moronocles gives us little biographical information, but refers at various points to some of his relatives with precision, including his brother Sarcassus, whose manner of speaking annoyed people to no end, resulting in his never being invited to parties. And his sister, Felatia, who seemed to be invited to all the parties.

Moronocles traveled in Italy, Sicily, and Egypt resulting in a lengthy and tiresome treatise on the almost imperceptible differences between styles of mustaches worn in those regions. At forty, Moronocles founded a school of philosophy in Athens on a cheap plot of land near a strip club in an industrial business park near Hecademus. He called the school The Enkósmios, meaning “mundane” or “uninteresting” which some think may have been responsible for its lack of students. The school nearly closed at one point, but thanks to a slip-and-fall accident at an outlet mall in Athens, Moronocles was awarded a healthy settlement and was thus able to keep the school open indefinitely. The Enkósmios operated until his death in 351 BC when he was killed while trying to re-shoe a galloping horse.

Many philosophers visited The Enkósmios, less for study than to take advantage of the complimentary finger snacks that were always on hand--the most prominent of those philosophers being Aristotle, who marveled at the tiny hotdogs wrapped in a flaky dough. 

In one of his more well known exercises, Moronocles seems to borrow rather heavily from Plato’s “Allegory of the Cave.” In Moronocles’ version, he imagines a group of people who have lived their entire lives with their lower lips glued to the floor of a public bathroom, and then they are forced to watch shadows of dwarves baking loaves of bread that are shaped like human genitalia, while people dry their hands on the backs of their togas. It was not clear what this was to illuminate and it drew only snickers from the intelligentsia.

What follows are a few of Moronocles’ most notable scribblings from his magnum opus, “Kápoia Prágmata Skéftika” or loosely translated, “Some Things I Thought.”

Ran into upstairs neighbor while checking out the new Euripides play. He was drunk and made a stupid pun that angered me. “Euripides - I rippa doze,” he says.  I confronted him about wearing his sandals late at night on the hard-wood floor. He also does not believe that the earth is a giant disk resting on the back of an enormous turtle -- the man is an idiot.

Have not had sexual relations in many months since adopting strategy of telling women that I do not want a relationship and only want sex. Should probably cry more during first meeting.

The man who named the Parthenon had a lisp, so is it possible we have all been mispronouncing it?

If Women Played in the NBA

 

If Women Played in the NBA

There is no rule that says NBA players have to be men, yet there are no women on the court. Since most of our institutions are designed to please women, there may come a time when teams will be required to play at least one woman, but more likely, teams would be required to make half of their teams female.

If this happens, we may begin to see the following:

Woman: His hand brushed against my breasts!

LeBron: I was just trying to get the ball!

Ref: Your intentions don’t matter! [blows whistle]

By the way, these are not jokes….this could actually happen. 

Some other future quotes from the female players:

“The coach said I needed to lose some weight, I have filed a lawsuit because I am being body-shamed!”

“These men are too rough! I keep getting hurt!” (prompting new rule that players cannot touch each other)

”You called travelling on me for taking three steps but I should be allowed to take three steps because they are taller than me and I cannot go as far with two steps.”

“The 3-point line is too far from the basket, the men have an advantage because it’s easier for them to shoot that far, so that line needs to be moved closer to the basket.”

“You called that foul because I am a woman!”

“I should be able to shower with my teammates…hey, they are looking at my body and they have erections! This is a hostile work environment!”

It is coming…you just wait.

Patriarchy Schmaytriarchy

 Question: Why are there Pop Tarts but no Mom Tarts?

Answer: It’s because of the Pastryarchy!

And here’s an older one I used to enjoy…

Question: How many feminists does it take to screw in a light bulb?

Answer: That’s NOT funny.

Okay okay, settle down, ladies, and beta males under their control.

Dammit, I just alienated a bunch more people…come now, only a true beta male would be offended enough to stop reading after that, so keep reading, fellas — unless you’re a beta male!

See what I did there?

Full stop…on to the subject, wherein we will see if I can convince you that we live in a matriarchy that pretends it is a patriarchy so that we can continue deepening the matriarchy.

For many decades since the feminist revolution in the 70s, in America, it was simply stated by TV pundits and celebrities as fact that we live in a patriarchy. Indeed the entire world was, and is, it is still said, a patriarchy. I don’t claim to know the ins and outs of what EXACTLY would constitute a patriarchy, but certainly things like the fact that it was common throughout the world that women could not own or inherit property surely seemed to advantage men in an obvious way — but what about the times we live in now in America and the west? Things have changed decidedly and nothing in the world makes me more angry than outright lying to people. Well, I am also annoyed by endless reboots of superhero origin stories for Spider-Man and Superman. Please knock that off, studios. And when you do make another infernal superhero movie, please stop having invincible people punch each other. Why do they do this? Sigh. Full stop again…

So the political Left has adopted women’s rights as a pet issue, but unlike groups that arise, say, in the private sector, political groups don’t tend to achieve an objective and then move on to some other project. They need the issue to remain forever so they can continue to “gits paid” no matter what ill effect that may have on society. Have we not achieved equality for men and women yet? That is a trick question because I think we have now given women MORE rights than men while SAYING women have fewer rights, and this pendulum probably should swing back to the center, maybe starting twenty years ago. Why does this writer have such a bizarre and obviously stupid, uninformed and mean-spirited opinion? Well here are a few things that are informing me:

1. There is no right that I know of in America that men have that women do not have. They do however have an extra right in that they can choose to abort a fetus over the father’s objection and he cannot do anything to save it. Men do not have the right to do this even with the recent advent of the newfound ability for men to “have babies” which everyone knows they cannot really do unless you pretend a woman is a man, and then go from there.
2. Following that, some say men are restricting the rights of women to have abortions in some states, but the idea that it is just the men against the women on this is silly. If the women in those states wanted to change the laws, they could easily do it as they have the numbers. Many women simply want to restrict abortions too. Mostly for religious reasons but some just find it abhorrent.
3. Again, on that front, if I am setting up an evil patriarchy, as a man, I would make it easy as pie to get an abortion, and I would give men the power to abort babies against the will of the mother, or at least give the father the right of financial abortion. That is, opting out of parenting just like the woman can unilaterally do right now. His wages would not be affected were he to be given that same right. As it stands now, if the mother does not want the kid, she can kill it, if the man does not want the kid, the woman makes all his choices for him. What kind of patriarchy is this?
4. In this supposed patriarchy, prostitution is illegal (in most places that is, and heavily restricted where it is legal). Why would men make it illegal for them to simply lay down some cash for a side piece? Prostitution is really illegal because women want it that way. Not in my evil patriarchy it ain’t. In mine, prostitution is perfectly legal in any way anyone likes but there would be heavy penalties, like maybe the one that has the word “death” in the title, for anyone forcing anyone into prostitution. Trafficking might get you executed in my patriarchy.
5. In my patriarchy, women would NOT get automatic custody of children, like women do now.
6. In my patriarchy there would be just as much money spent on men’s health issues as there is on women’s issues like breast cancer.
7. In my patriarchy there would be as much focus on male suicide, which is much higher than women’s but gets pretty much no attention,
8. Men are much more likely to be killed in accidents or violent crimes as women are, so that would get some focus in my patriarchy.
9. Men who commit violent rape in my patriarchy might get executed. It’s only because of the feminine energy of the Left that we shy away from executing criminals that should be executed. Women tend to be easier on crime, and that trickles out the Left which adopts that feminine energy.
10. In my patriarchy we would explain to every person that men and women ALREADY DO get paid the same job where the same hours are worked. Men only seem to get paid more because they go into different careers that may require more schooling, or that are more dangerous or simply work more hours than women do.
11. If I set up an actual patriarchy there would be equal focus on getting both men and women to either get a college degree in something useful like nursing or engineering, or get some certification, and not keep hyper focusing on women who have already eclipsed men in those areas, yet we are still told women are falling behind the men.
12. In the weird patriarchy we have now, women are constantly told how beautiful and perfect they are and men are happily encouraged to lie to them and tell them they are gorgeous princesses, even if they are not. If you say Lizzo is not as attractive as Beyoncé, you may lose your job. This causes confusion with women who are expecting to marry a Tom Brady but he’s passing them over because he is “programmed” by the evil patriarchy to believe in some other standard of beauty. Males have always liked a lean healthy body, and I don’t care about that blip in time when some of the renaissance paintings featured plump babes. First off, none of them were Walmart Scooter-fat, and that was a time when we had bread and pasta and beer, so fatness became a little more common.
13. In this strange patriarchy we have now, women find about 80 to 90 percent of men “unattractive” according to dating app data whereas men rate HALF of women as attractive. This means that average-looking women are chasing after the top tier of good looking men (like the Tom Brady scenario) who are happy to have sex with all of them, but have no plans of “wifing” them. This is causing women to say that men are all dogs. Hey, try going out with a guy who is moderately attractive like you and you might be surprised how well that works out.
14. Women who come into money are much more likely to initiate a divorce and more likely to leave a marriage than a man is if he starts to make more money. In general about 80 percent of the time, the woman will initiate a divorce. Odd patriarchy that.
15. Virtually all of the therapy world, it is asserted by more than one recent article, has been feminized and has taken a very female-centric stance that basically has become a way to train the man to “behave as the woman wants him to behave because he is not a man but rather a hairy, misbehaving woman who needs to just act like a woman and everything will be fine.” Those quotes were mine, not from any article I read.

I have two daughters and love the fact that they are coming into a world that has given them a huge leg up, but this “patriarchy” we’ve got going on has created a bunch of men that young women do not want and it seems to be a combination of women being pandered to and being told that they are all beautiful princesses who deserve that man with all the sixes: six figures, six-pack abs, six feet tall. Ladies, those guys are selling their penis and it is a sellers’ market for them. You have to be Taylor Swift or the hottest supermodel to get them to marry you. Again, I want there to be a lot of men out there who are WORTHY of my daughters. I will actively teach my daughters that men and women ARE INDEED different and that we actually LIKE having different roles and that you should figure out what those roles are in a relationship and respect them and live them. I will tell them that if they have expectations that a man needs to meet for them, then there will likely be an equal and opposite set of expectations that they should be meeting for the man in their lives (they are too young now but both seem to be like most women who are attracted to males).

On many many episodes of Just Pearly Things video podcast (and a new one called Pearl Daily), there will be a room full of women and men together, the women all generally rate their attractiveness much higher than the men rate them, and then the men are chastised for being wrong. Sometimes the men say what they are looking for in a women, and one of those things is invariably a level of “purity” as in a virgin (which is pretty much unheard of in the west) or at least a very low “body count” and then the women will generally spend the next hour telling the men why they should not want that.

On that count I tend to have a little bit of jealousy and contempt for women who think they are pulling off some sort of skillful feat by saying yes to a lot of guys who want to have sex with them. A woman can rack up a body count of 20 in one day if she wants to. You know how hard that is for a guy who is not Tom Brady? I can tell you it is pretty hard. Might take a lifetime of normal relationships and dating and having girlfriends and such. So, ladies, your high body count is seen as gluttony or perhaps rubbing it in our faces. I will happily have sex with a girl who has been ridden by all my friends but I am not going to be the poor sap who buys her a ring and a white dress and marries her. You wanna pay the “new car” price for that Tesla that everybody drove and tore up in high speed chase or are you gonna want a discount on that thing? You pay full price for it you are just a door mat. If you get a deal that you like, go for it.

And women still do want to get married, despite pretending to agree with those feminists who tell them the “patriarchy” wants them to get married and they should resist it, those feminists who pretend there is “still so much work to do,“ have damaged the very people they aimed to help. But they don’t care because the money keeps coming in to their various organizations.

The patriarchy “wants” women married? Look, in my evil patriarchy, we would encourage women to have lots of anonymous sex with all men, not just that top tier of guys they think they will marry, and abortions would be available at any 7–11.

One final thought. These laws that take the “fun” out of life for men were actually passed by men before women had any power. It’s as if they knew society would be better if these things were discouraged and I wonder…have women followed suit with that notion? Would women make a law that bettered society but made things less fun for them or harder on them specifically? If you come up with something shoot me a comment and let me mull it over.

PHOTOS FROM THE FUTURE - GAVIN NEWSOM TAKES OVER AS DISNEY CEO

 

PHOTOS FROM THE FUTURE...

HEADLINE: GAVIN NEWSOM TAKES OVER AS DISNEY CEO

Still Life Paintings Inspired by Elon Musk

 MARTIAN SURFACE STILL LIFE

STILL LIFE ABOARD THE SPACE STATION X