The Skewer #2

 

"The Skewer" Issue #1

 

Birthday gift from my daughter today

 

Joe Biden left two astronauts in space

Joe Biden left two astronauts in space for an extra year because he did not want an evil Nazi to get credit for rescuing them. 

And now the evil Nazi has sent a rocket to rescue those astronauts.

You all saw that right?

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

The Unplugged ZEN Walk - Why Silent Walks Boost Your Mental Wellbeing

 

THE UNPLUGGED ZEN WALK

Why Silent Walks Can Boost Your Mental Wellbeing

(not making any promises that your butt will look as good as hers, but read on)

If we could just take a walk the way our hunter-gatherer ancestors used to do it, we'd all be a little better off. In our fast-paced world, bombarded by constant stimulation, finding the most miniscule moments of peace can feel like a luxury. Yet, a simple solution for improved mental health might be hiding in plain sight – a brisk walk, minus the headphones. While music and audiobooks can be enjoyable companions, ditching them for a silent walk offers unique benefits that can significantly enhance your emotional well-being.

The Power of Physical Activity

We all know exercise is good for us. Brisk walking, in particular, offers a readily accessible form of physical activity. Studies by the American Heart Association highlight the numerous benefits, including improved cardiovascular health, weight management, and even a reduced risk of chronic diseases like diabetes and heart disease. But the advantages extend beyond the physical. Exercise has been shown to trigger the release of endorphins, natural mood elevators that combat stress and anxiety.

The Silent Advantage: Mindfulness and the Present Moment

While music can energize a workout, it can also distract from the present moment. Walking in silence allows us to tap into the power of mindfulness. Mindfulness is the practice of focusing your awareness on the present moment, without judgment. Studies published in the journal "Arteriosclerosis, Thrombosis, and Vascular Biology" suggest that mindful practices like meditation can significantly reduce stress and improve emotional well-being. Silent walking offers a similar benefit.

Imagine yourself walking in a park. With music playing, you might miss the gentle rustle of leaves or the chirping of birds, or that hot soccer mom stopping to tie her shoe. By quieting the external noise, you become more attuned to your surroundings. You feel the sun on your skin, the ground beneath your feet, the rhythm of your breath. This heightened awareness allows you to truly appreciate the beauty around you, fostering a sense of calm and grounding. With practice walkers following this method have found that they have been able to NOT think about Donald Trump for up to 7 minutes in a row!

Benefits for the Busy Mind

Our brains are constantly bombarded with information. The constant notifications, to-do lists, and social media feeds create a state of mental overload. A silent walk offers a much-needed escape from this mental clutter. Without music or audiobooks, your mind has the space to wander and process. You might find solutions to problems that had been eluding you, or simply allow yourself to daydream. This mental break can be incredibly restorative, allowing you to return to your day feeling refreshed and focused.

Boosting Creativity

Research by Stanford University suggests that a wandering mind is a creative mind. When you allow your thoughts to free-flow, you unlock the potential for new ideas and solutions. Walking in silence provides the perfect environment for this type of creative thinking. Studies have even shown a link between spending time in nature and increased creativity. So, take your silent walk to a park or nature trail, and see where your mind takes you!

Strengthening Your Inner Voice

In our technology-driven world, we often rely on external sources for information and entertainment. Silent walking allows you to reconnect with your inner voice. You might find yourself reflecting on recent events, processing emotions, or simply appreciating the quiet solitude. This introspection can lead to a deeper understanding of yourself and your needs.

Finding Calm in the Chaos

Life throws curveballs. We all experience stress, anxiety, and negative emotions. A silent walk can be a powerful tool for managing these challenges. Studies by Harvard University have shown that mindfulness practices like meditation can effectively reduce stress and symptoms of depression. By focusing on the present moment and appreciating the world around you, a silent walk can help you detach from negativity and find a sense of inner peace.

Getting Started with Silent Walks

Ready to give silent walking a try? Here are some tips:

• Start small: Begin with short walks (10-15 minutes) and gradually increase the duration as you get comfortable.
• Find a pleasant environment: Choose a scenic route, a park, or a peaceful neighborhood and plot a course that avoids any homeless encampments that may be full of drug addicted street campers.
• Focus on your body: Pay attention to the rhythm of your steps, the feeling of your breath, and the sensations in your body.
• Don't force it: If your mind starts to wander, don't judge yourself. Simply acknowledge the thought and gently bring your attention back to the present moment.
• Embrace the quiet: Allow yourself to appreciate the sounds of nature and the quiet hum of your own thoughts.

Taking a silent walk might seem counterintuitive in our world of constant stimulation. However, the benefits it offers for our mental well-being are undeniable. By ditching the distractions and embracing the present moment, you can unlock a sense of calm, creativity, and self-awareness that will enhance your overall well-being. So, lace up your shoes, sandals, or stilts if you are into that sort of thing, step outside, and embark on a journey of rediscovering yourself, one silent step at a time.

NOW: SHARE THIS STORY WITH SOMEONE 
WHO MIGHT NEED TO TRY IT!