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Archive for January, 2011

Green Cleaners – Change the World Challenge

Posted by eemilla on January 30, 2011

It’s been a while since I’ve participated in a Change the World Challenge from Reduce Footprints, but I’m going to give it a go this week.

For the most part we aren’t using green cleaners aside from the vinegar and water that my mom always used on windows and mirrors, which by the way is really cheap and works well.  I tried using borax in the bathroom for almost a year, but I could never get the toilet really clean even with soaking overnight and scrubbing so we’re back to using a non-green cleaner with bleach alternative.  I hate to say it, but I love how much easier it is to clean the toilet with the non-green cleaner.  The shower liner remains a constant struggle to keep from molding, even with weekly soaking then washing with vinegar and detergent and line drying; however, I have decided not to resort to bleach because it wasn’t that much better anyway.

For hand washing dishes we use Ecover, and the dishwasher gets Palmolive phosphate free.  I use the Dr Bronner’s to scrub the counters before rolling dough, and my husband used some less nasty than expected oven cleaner.  For the floors, we’ve used hot water and either the dish soap or Dr Bronner’s.  When we camp (mostly only at festivals), Dr. Bronner’s get used for all soap needs, including washing dishes (although of course not the cast iron!)

Writing this post, I decided to Good Guide what we use, and after this bottle we will no longer pay the premium for Ecover Dishwashing liquid.  Much to my surprise, Clorox’s Green Works scores much better than the Ecover although I cannot purchase the Green Works at FBFC.  Our automatic dishwasher liquid also scored poorly on the health side of the equation so we’ll be looking for an alternative there too.

For the laundry, we use Ultra Purex, but I think again we might try Green Works because it has a better health rating.  My husband adds washing soda to his work laundry to help make it smell better (because as anyone who has worked in food service knows even after washing those clothes still have a smell), and of course we dry as much outside as possible (which really works to freshen up his work clothes).

I will be interested to get some more ideas on homemade green cleaners from everyone else participating.

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Why I Despise my HSA – Part Three

Posted by eemilla on January 30, 2011

Continued from last week’s Part Two (and Part One previously).

My second rude awakening came when I changed providers from an obstetrician to a midwife.  The OB had the ultrasound equipment in their office so I didn’t even think of going anywhere else to obtain my twenty week ultrasound, but the midwife contracts with a different OB to perform ultrasounds and to be the back-up if the delivery becomes high-risk so I had the option of using their OB’s office or Mission Hospitals Radiology.  Knowing that I would have to pay for this out of pocket, I decided to call the insurance company to find out the cost as the midwife’s office only knew the uninsured price ($300).  In my naivete, I called the insurance company expecting a simple answer; but I failed to remember what I was dealing with.  After navigating their automated service, the human operator needed the CPT code; I explained I didn’t know it or even what it was, and I asked if he could look it up by the name of the treatment.  He declined so I called the midwife’s office to obtain the requisite information, and if I had been smart, I would have put him on hold while I did so.  I obtained the CPT code along with the diagnosis code, and I called the health care company back to price shop my twenty week ultrasound.  My second health insurance employee took the CPT code after reading through her script then informed me the price isn’t guaranteed and is only an estimate.  I asked if there was anyway to obtain the actual cost to which she replied once the service had been billed, the claims department would know the actual cost of the service.  I then asked if I could speak with the claims department or if she could request the price from the claims department?  She explained that even if she could transfer me or contact the claims department, they would not know the exact cost because the doctor’s office might not use the CPT code or diagnosis code they provided me.  With a rising temper, I asked why I needed the CPT code, which I assumed would allow the operator to pull the contracted price from my specified provider, if there was no way to know how much any procedure would cost until it was billed?  She advised that without the CPT code the estimate range would be even greater like those provided on the health insurance company’s treatment cost estimator website.  As the point of the call was to compare between the midwife’s OB office and Mission Radiology ultrasound, I asked her to provide the cost for Mission.  However, she was not able to even provide an estimate as facilities don’t always publish their prices.  After this answer, I was incensed so I retorted how ridiculous this whole situation was; if the whole point of an HSA is to encourage patients/insureds/consumers to price shop why is it impossible to obtain a price for a basic service that is performed on virtually every single pregnant woman in the US, and not wanting to hear her script I hung up after thanking her for being completely unhelpful and wasting my time.  On another note, I was never able to speak with anyone at Mission Radiology to find if they could provide the cost of the twenty week ultrasound on a first pregnancy.

The cost for the ultrasound in my first OB’s office was $120 (per the billing plan provided by the obstetrician’s insurance liaison), which is the same cost the health insurance company estimated for the midwife’s OB’s office.  The actual amount billed by the midwife’s OB is $225 less a $104.35 discount for having health insurance so $120.65 is what we’ll pay.  There again, the uninsured pay $300 while the insured pay $120 for the exact same service.

To be Continued.

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Why I Despise my HSA – Part Two

Posted by eemilla on January 23, 2011

Continued from last week’s Part One.

Ha!  I did get pregnant right after signing up with my HSA, although it was another few weeks before I knew.  I then brightened at the idea that the HSA covers preventive care fully, so I just knew all of my prenatal visits would be taken care of.  Well, health insurance companies are wily so they devised a way to not pay for prenatal visits.  They still consider them preventive care in their marketing materials and other publications aside from the policy itself (keep in mind the policy will always supersede all other communications), but all pregnancy care is billed at one time in what is called a global package.  The global package isn’t billed until the baby is delivered, and because the preventive care prenatal visits are thrown in with the delivery they lose their full coverage.  It’s like Spanish grammar, a group of females uses the female pronoun, but if there is one male in the group then the male pronoun takes over.

Once I got over the injustice of my prenatal visits not being fully covered as all preventive care is supposed to be, I was hit hard with almost five hundred dollars in lab work.  Now I know lab work is expensive; in 2003 I did some basic blood work at my provider’s suggestion, and the lab billed over $275.  The insurance company paid about $63 (thanks again to the uninsured for subsidizing my health insurance company).  Although I’ve been in a sexually exclusive relationship for over a decade, and neither of us have ever tested positive for any sexually transmitted infections or diseases (we have both been tested a few years back), I had to pay over three hundred dollars to confirm that I didn’t have syphilis, HIV, or gonorrhea.  The other tests were to confirm I had sufficient levels of iron and no urinary tract infections or proteins in my urine, so even though I was shocked at the cost, it didn’t upset me like the wasteful other tests.  If I had been found to have an STI, I might be singing a different tune, but really it was my first wake up call to ask my providers why each and every test or procedure was recommended and to weigh the risks myself and provide either my informed consent or informed declination.

This is the point of the HSA; it was created in 2003 and signed into law by President George W. Bush in order to reign in ever increasing health care costs by making patients more aware of the actual cost of care and encouraging them to shop for price and quality.  With traditional health plans, a doctor visit might appear to the insured/patient/consumer to cost a mere $15-20 rather than the $180-$250 the doctor actually bills; not to say the health insurance company is actually going to pay the $180-$250, they’ll likely have negotiated a price closer to $100, which brings us back to the uninsured subsidizing the insured and insurance companies.  As I said earlier, my honey and I are blessed with good health, and we take care to eat well, relax, and exercise so we don’t generally get sick enough to go to the doctor, which makes us the prime market for an HSA/HDHP.  The fully covered preventative care and the thought of turning my husband’s HSA into an IRA in the future (once his employer provides group insurance again) were the major selling points for me.

Continued next week in Part Three.

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Why I Despise my HSA – Part One

Posted by eemilla on January 16, 2011

For the past couple of years my employer has given the option of being in a traditional health plan with co-pays, co-insurance, deductibles, and maximum annual out of pocket expenses or an HSA package, and I’ve resisted the HSA until this year.  The hesitancy hinged on the lack of significant savings to offset the greatly increased risk that having a health savings account (HSA) and a high deductible health plan (HDHP) entail, but my employer contributes a moderate sum each year so I decided to forgo my reservations and sign up.  My HSA/HDHP went into effect about four days before I conceived the baby we’re expecting this summer.

HSAs are supposed to be ideal for the young and the healthy, which thankfully we are (although now that I’m pregnant I’m really sick in the eyes of the insurance company).  Preventive care is fully covered with no co-pays (unless you are pregnant because pregnancy is an illness), but everything else, including prescriptions and lab work and sick visits, must be paid out of the HSA until the deductible is met; with our plans once we meet the annual deductible we’re covered 100% (until the year starts over that is even if the sickness/treatment straddles two years).  With the HSA, we still get the health insurance companies’ contracted price with the provider, so the uninsured still subsidize our care.  By law the deductible has to be over $1,200 (but not greater than $5,950 in 2010); frankly, many deductibles for traditional health plans are higher than or equal to HDHP then follow with 20% or more co-insurance until the even higher maximum annual out of pocket expense is met.  However, one does need to set up an HSA (which not one of the local credit unions we are eligible to be members of provide) and then contribute to that account.  The contributions are tax free, and an individual can contribute up to $3050 for 2010.  Unfortunately, this breaks down to about two extra car payments so maxing out our contributions won’t be something we will generally be able to do with the minimal premium savings between the HSA/HDHP and traditional health insurance.

My husband’s employer decided to stop providing health insurance under a group plan last year, but  they do provide a monthly healthcare reimbursement (which covers about half of the monthly premium based on 2010 premiums).  Due to the thirty dollars a month cost savings along with the hoped for tax benefits and the long term savings we decided to move to the HSA for him.  Even though his employer is still covering some of the cost, moving from group insurance to the individual market (even with the increased risk we carry with the HSA/HDHP) his premium increased by about thirty dollars a month (so if we hadn’t gone with the HSA we would be paying sixty dollars more a month, again all based on 2010 premiums).  As an aside, the 2011 HSA/HDHP premiums are about the same as the 2010 traditional health plan premium (which represents about a 20% increase in one year with no claims).  Finally, we can use the HSA to pay for his contacts and eyeglasses, which are not covered by most traditional health plans.

Since we were already dealing with one HSA, I figured it was time to jump on the bandwagon and collect my employer’s much more generous contribution; my employer pays about 90% of my health premiums (if I added my spouse it would basically cost three times as much as his current policy, which is why we have a two individual policies), so my monthly premiums are three-eights of his, plus my employer contributes an additional moderate sum each year to my health savings account.  I reasoned if I got pregnant I could always change back to the traditional health plan, because of course the timing would work for me to do that.

To be continued in Part Two.

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