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Update - Insurance and Other Stuff - Mo's Journal
July 28th, 2011
04:35 pm

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Update - Insurance and Other Stuff
My insurance woes, as described here, seem to have been resolved. The insurance company finally approved the one-night hospital stay my doctor had requested. They did it on the second level of appeal. The first level of appeal is something called "Peer to Peer" where the doctor who is appealing speaks to a physician who works for the insurance company and tries to come to an agreement. In all other cases this particular issue had been resolved through Peer to Peer. In this particular time the insurance company doc called my surgeon at 4:00 on a Friday afternoon and my guy wasn't in the office. He got the message on Monday morning and called back first thing. The insurance company told him that since he'd tried on Friday and hadn't gotten a call back within 48 hours it was denied. That's why we had to go to second level appeal, which requires writing a letter and providing supporting documentation, after which the insurance company has 15 days to respond.

So they really hadn't even followed their own procedures, since my doctor didn't get a chance for Peer to Peer. It was unclear to me whether they'd purposely skipped that step (calling at the end of the day on Friday and counting the weekend hours - when that insurance company doc wasn't working anyway - could be either stupidity or stacking the deck), and actually it still isn't clear, but I did feel it was worth complaining about. I called multiple times and also marshalled some supports, including a state legislator's office. My doctor's admin person also called her usual contact at the insurance company to complain. So who knows what made the difference? But, in any event, it was approved. However by the time it was approved I'd lost my surgery date. My new date is 8/29 and I expect it to stick. I'm more and more uncomfortable (physically) and more and more eager to get this done.



I saw the new HP movie last weekend. I have never been involved in HP fandom but I have been a fan in the mundane sense of the word since a time when there was only one book and for years when I brought the new books in the series home from business trips to London before they were published in this country. I enjoyed the books a lot, and reread them all last year, as recounted here. I do feel that the last book was the weakest - JKR tried to cram too much into one book - but I did enjoy part 1 of the movie version of it and was looking forward to part 2. I thought it was quite good, and so did Doran. They did a good job of simplifying the story; it felt complete; the effects were very good. We saw it in 3D. There aren't a lot of gee whiz 3D effects, but it definitely adds something. I think it's sort of where 3D is going - not so gimmicky, just a way of making it look more real.



Same sex marriage is legally recognized in New York state, as of last Sunday. Well, actually it has been legally recognized - to the extent that any same sex marriages are legally recognized in this country, which is to say not very much - for several years now. The difference is that now New York State is not only recognizing marriages contracted elsewhere, but also issuing marriage licenses for same sex couples. As Jon Stewart says, it represents a great advance in equal rights for gay men and lesbians in New York who wouldn't be caught dead stepping foot in Connecticut. Joking aside, it's an important symbolic step and I'm glad our governor came through on it. Interesting (to me, anyway) is the fact that two of the biggest proponents and the two politicians who really pushed this advance are the governor of New York and the mayor of New York City and both are heterosexual men in long-term committed relationships with women, but not married. It's all about choice, and same sex couples should have the same choice to get married or not that Cuomo and Bloomberg have. So this is a good thing. Now if only there was someone in my life I might want to marry sometime...

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From:fgherman
Date:July 28th, 2011 10:28 pm (UTC)
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I am so happy that the insurance situation has been sorted out in your favor.

I saw the last HP movie with friends from Virginia last week - I really wasn't ready to deal with the issues it brought up. Seeing Captain America this week was a lot more fun.

I just hope that Minnesota soundly defeats the Gay Marriage amendment.
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From:mofic
Date:July 29th, 2011 11:24 am (UTC)
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I'm sorry you couldn't enjoy HP. I haven't seen Captain America, or the new X-Men movie.

I'm really relieved about the insurance.

The Amendment thing - it's always struck me as pure meanness, like it's not enough to have a law saying we're less than, it has to be bigger than that. Here's hoping Minnesota is the first state to have such a referendum and decide not to be mean!
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From:lilacsigil
Date:July 29th, 2011 01:52 am (UTC)
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I'm so pleased that ridiculous insurance company crap is sorted.
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From:mofic
Date:July 29th, 2011 11:27 am (UTC)
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Me too! I think this is so illustrative of what happens when profit is the deciding factor in medical decisions. They'll push as much as they can for the cheaper alternative, regardless of patient safety.
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From:hitchhiker
Date:July 30th, 2011 08:21 am (UTC)
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yeah, i can't wait to see if obama manages to make any sort of real changes in the system.
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From:mofic
Date:July 30th, 2011 01:53 pm (UTC)
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Well, he did manage to get a health care reform bill passed. It's not what I would have wanted but it is an improvement. Only most of the provisions don't come into play for a few years and with the Republicans in power in the House now, they're intent on gutting the law bit by bit before they do. So it mostly depends on what happens in the elections next year.

There are some provisions that have come into effect already, though. One important one is that kids can stay on their parents insurance until age 26 if they don't have employer-based insurance options. Young people in this country have huge rates of lack of insurance because low level jobs often don't provide insurance. It's not expensive to cover them, since they tend to be healthy, but it's catastrophic to not be covered if you're a man or woman in your twenties who gets sick or hurt. So that's an important one.
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From:kosiah
Date:July 31st, 2011 04:05 am (UTC)
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You have to be off synthroid, right? To get surgery? And they pushed it back a month?

Oh, man. You are handling this with more grace than I would. I'm glad you finally have a surgery date. And I hate health insurance companies in this country. Can you continue to complain and appeal, just to cause them more grief?
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From:mofic
Date:July 31st, 2011 12:06 pm (UTC)
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You have to be off synthroid, right? To get surgery?

I was never on it! This all started because what's left of my thyroid stopped working and my astute internist said that rather than just putting me on meds, given my history, he wanted to find out if there were new tumors. There were and this time the FNA biopsy says they're malignant (last time they were benign, just large enough to be closing my trachea, which is how I lost the first half of my thyroid). I can't go on meds until treatment is all done.

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