Our kid won’t . . .

It is possible that I could give birth to this kid any day now, and as I am officially over the forty-week mark I’m certainly ready.  In talking with experienced parents from friends to family to co-workers my husband and I have said more than once that we will not be doing this or that or allowing our kid to do this or that, so I thought that it might be interesting to post some of them here as a reference and check back over the years to see how our opinions changed.

Cloth Diapers

Before I got pregnant or really even thought seriously about having children, I always knew that I would use cloth diapers.  Most striking is the explicit cost to diaper a child; I checked with Ingles and EarthFare for the Seventh Generation brand diapers, and they run about $12 plus tax for 44 diapers in the infant size.  Based on what I’ve read a breast feed baby will go through about eight diapers a day, which means about 5.5 days for one pack of diapers (Pampers at Ingles were only a bit less at $10 plus tax of $50, and I didn’t write down Target’s prices).  An organic cotton pre-fold cloth diaper costs about $3.25 plus the $13 waterproof cover; this diaper can be used until the kid outgrows it, and then it could be used as a doubler for a pocket diaper or a cleaning rag even later.  The pocket diapers resemble disposable diapers more than the pre-folds which are what my mom thinks of as a cloth diaper, and they are a bit more expensive (about $18); however, since our kid will be in day care we’ll have to use them.  While we have spent a good bit of money on getting our stash set up, in the end we’ll come out on top.

The explicit costs are important, but the health and environmental costs should weigh even heavier.  Dioxin is a known carcinogen, but it is used in diapers, maxi pads, and tampons to bleach the cotton or paper bright white.  Then you have the polymers that are used in the soaking layer to be concerned about; how long did we use plastic before it was discovered that some plastics leach endocrine disrupters and hormone mimics?  Finally the environmental cost is staggering.  Not only will the diapers far out live their users, they require lots of water and oil to produce.  The water is a double whammy because most diapers wind up in the landfill with the poop in place rather than having the poop emptied into the toilet for sanitary processing.

Anytime I bring this up, I hear about what an onerous choir laundry is for any baby much less a baby soiling cloth diapers.  I can always safely counter with the example my mom set.  She worked full time outside the home and used cloth diapers with all three of us, and my dad was absolutely no help.  Although I could be mistaken based on our ages she most likely had two of us in diapers at all times.  My husband is an absolute foil of my father so between the two of us I know we can make it work, and really the economic incentive is just too tantalizing to forgo.

Electricity Rate Plan

About a year ago we decided to change our electricity rate plan to time of use which encourages one to use energy on off peak times.  This has easily lowered our electricity bill by about $10 a month without creating any undue hardship.  We were really concerned about adding the air conditioner, but after its first month we haven’t seen an increase, even though when it was being installed the contractors were using huge lights to see in the crawl space during peak energy time.  The challenge with the peak energy use is going to be the laundry because we only use our major appliances (aside from the air conditioner and furnace) during off peak hours, which are currently from 9pm to 10am Monday through Friday and excluding major holidays (they change from September to March to 6am-1pm and 4pm-9pm), but I am determined to at least try it for a few months.  We can continue to do the bulk of the laundry over the weekend, and as long as the weather cooperates we’ll continue to dry most of the laundry on the clothesline.

Exclusive Breast Feeding and Making our own Baby Food

We’ve decided to breast feed for many of the same reasons that we are going to cloth diaper, and although I’ll be returning to work about three months postpartum, I plan on exclusively breast feeding for at least six months then allowing self weaning as the kid expresses interest in what we eat with the expectation that I’ll still be nursing at least once a day for at least a year.  In conjunction with this resolution, we’ll be making our own baby food.  Again the explicit costs of buying baby food just don’t jive with the time savings, and being the dedicated environmentalists that we are, why should the baby eat food with more miles on it than we do?  Also all those little jars and containers would be one more thing to find new uses for or to recycle.  Of course, we will continue to limit the amount of processed foods that enter our house.  I grew up in a house free of fruit roll ups and soda, and the tradition will continue.

Screen Time

Neither of us were allowed to spend all day inside watching TV or playing video games, and we plan on continuing that tradition with our little one.  We don’t want to ever use the TV or computer or iPod as a babysitter, and we would like to limit daily exposure to the less than two hours a day recommended by the American Academy of Pediatrics.  We both realize what a challenge this might become, especially on long road trips and as the kid spends more and more time outside of the home.

Daily Reading

By reading each and every day to the little one, we hope to make it easier to limit the screen time as well as foster imagination and diction.  Reading and books were so important to me growing up, and I still love them (although I don’t prioritize reading as much as I should).

Wretched Excess

We are both relatively frugal when it comes to material purchases, although we make up for it with our epicurean expenditures, and this is something we want to continue with the kid.  Again we recognize that we won’t be able to completely stop family and friends, but there are strategies around the excesses of others.  In the line of regifting, I’ve heard of parents going through gifts sent by family who refuse to stop going overboard and culling the keepers and donating the rest.  Of the keepers, some go into storage to be gifted at a later time.  We’ll try to give experiences over stuff, and with the stuff we’ll try to be pragmatic with some and fun with others (here’s a great idea to help).  Besides our tiny little house is almost busting at the seams already with baby stuff, dog stuff, cat stuff, and our stuff.

Any thoughts or suggestions are appreciated!

 

Earth Day Rant

In honor of Earth Day, I’m hopping on my soapbox and giving my Earth Day Rant about three things that drive me crazy.

My largest pet peeve related to shopping is when my husband buys a beer or a box of beer that comes with a convenient handle, and he has to literally argue with the cashier that he doesn’t need a bag; many cashiers claim it is illegal to allow him to carry the beer outside of the store without a bag (I’ve worked as a cashier in a few different stores, and I was never required to do this).  I also get irked at the assumption that regardless of the number of groceries or items one might have a bag is requisite; nevermind that I walked through the store carrying everything I am buying without the assistance of a bag or a basket or a cart.

Earth Fare both irritated and cheered me for changing their bag donation policy; for the longest time, if you brought your own bag OR didn’t use a bag, Earth Fare would either donate $0.10 to the charity of the month or give you a $0.10 discount.  I believe it was around a year ago, they reduced the donation to $0.05, and it is only applicable if you have a reusable grocery bag (not your purse or backpack).  I don’t mind losing the discount as I always donated it, but I do hate that Earth Fare won’t give up the donation unless I put my half pound of mozzarella in a reusable bag.  They cheered me when they began requiring a donation for paper bags and eliminated plastic bags altogether (thewebsite says the donation is voluntary, but it also says if you chose not to donate the $0.05 then they give you a cardboard box not a bag).  They also sell reusable bags near the check out and at most of the checkout lines at the South Asheville location.

Along with the annoyances I have to also applaud Target for giving a $0.05 discount for reusing a bag as well as selling cheap $0.99 bags at the front of the store and at every checkout lane.  My favorite grocery store, the French Broad Food Co-op, charges for the plastic containers in the bulk room as well as selling heavy duty cotton bags and more light weight less expensive bags like those at Target.

I wish all stores would encourage customers to bring their own bags and containers either by giving a discount or by charging a fee for the bag; I also want the Coop and Earth Fare to stop providing the really thin plastic containers that are not dishwasher safe.  One of my resolutions was to stop using to-go containers for leftovers at restaurants, but unfortunately, I have failed miserably.  On the upside, we are not using new bags in the produce or bulk department when we go shopping.  Following the example set my mother and my step mother in law, we are washing out sandwich bags and  the green bags we use for produce (which purportedly keep produce fresher longer, but I like because they are strong enough to be washed unlike the freebies in the produce isle).

Secondly, I don’t want to hear one more word about how much gas costs.  I, too, hate paying almost fifty dollars to fill up the gas tank; however, we pay much lower gas rates than the rest of the world, and we generally have a choice in which vehicle we drive.  There are also many well published tips to reduce your fuel consumption (combine trips, drive less aggressively, fill up after the sun is down, carpool, or don’t drive).

Before my pregnancy we were a one car household even though we both work full time jobs with different hours.  We were able to make this work because neither of us mind walking along a busy road without sidewalks or even much of a shoulder; we live about a 1.25 walk from the bus line; and my work commute is a less than two mile walk.  Sadly, the bus runs every 1.5 hours between about 6:30a (1st run out of downtown) and 5:30p (last run out of downtown), which means we couldn’t even use it for an early night out much less a night shift commute.  I should note that there is a night route but the closest stop is about five miles from the bus stop that is 1.25 miles from our house, but again most of the five mile walk is along a five lane road with several hundred feet of sidewalks interspersed with parking lots and grassy stretches (some of which are steep banks that are difficult to traverse).  While I could walk the almost two miles from my work to my home, much of the walk is along the same five lane heavily travelled road, but this stretch contains not one sidewalk.  Fortunately much of that stretch is through parking lots, but there is a stretch that is like a goat trail which leads to a vacant lot.  Neither are generally cut so the weeds can and do hide broken bottles and various other trash (I never encountered any used condoms!)  Please note that both stretches of road mentioned above have been a part of the city for years, but sidewalk construction hasn’t been anywhere near a priority for this part of the city.

We decided that having a little one and not moving precluded us from remaining a one car household.  In the two and half years of being a one car household I can only recall a handful of times the bus was critically late, and at a cost of $0.75 per ride (if you buy the ticket book, but only $1 per ride if you pay singly), it is certainly cheaper than gas or parking.  Maybe one day we’ll return to being regular bus riders, but I cannot imagine hauling a stroller and all those baby accoutrements to the bus stop then on the bus then off the bus then all around town then repeat for the return ride.  Then again we never thought we could make do with one car for as long as we did.  Unfortunately, this will be the first Strive Not to Drive that I will not join in the past few years because it coincides with my 38th week of pregnancy.  I can only hope that you might decide to participate.

Rather than subsidize multi national companies that don’t even pay taxes on their billions in annual profits to begin with, we need a New Deal type program that gets the unemployed constructing sidewalks, repairing bridges, and building rail.  Public transit eases congestion, and for those of us that like to go out and knock a few back, it provides a much cheaper alternative to a taxi (which allows us to spend more money knocking a few back and eating a good meal).  Transit jobs cannot be outsourced, and public transit encourages private investment along its corridors much like roads.

Happy Earth Day.

Why I Despise my HSA – Part Four

(Continued from Parts One, Two, and Three)

Dealing with the global billing package is working against us again because we decided to change providers.  I initially went to the obstetrician because when I called the midwife last year to see if they contracted with my health insurance company they didn’t, and out of network benefits have a higher deductible and coinsurance.  However after three visits with the obstetrician, I decided to at least explore the increased cost of out of network care only to find out the midwifery practice had begun working with my health insurance company.  The first visit at both the OB and the midwife left us with a payment schedule, so we have already paid the OB practice a few hundred dollars towards our estimated share of the global package, and they have yet (after about two months of being aware of our transferring our care and a phone call requesting it) sent a statement of our account.  I called back with my health insurance statement in hand, and after two more phone calls they issued a refund check, which includes treatment they billed for that I never received.

As previously stated I have a real problem with the uninsured subsidizing the health insurance companies.  I understand statistically the insured are healthier than the uninsured (due to obtaining preventative care and getting early diagnosis and treatment), and I understand the benefits of buying in bulk; in most cases I support it (we’re members of the French Broad Food Co-op, and I used to belong to Sam’s Club).  However, it is morally devoid that people trying to take care of themselves should subsidize companies that basically have monopolies; over 70% of health policies in North Carolina are with Blue Cross Blue Shield, and they even promote themselves as having the largest market share in the state.  According the NC Department of Insurance, in 2008 United Health Care ranked second for NC policies with less than 13% of the market.  In 2009, the CEO of BCBSNC earned almost $4 million all the while raising premiums for policy holders in a down economy, and BCBSNC is a non-profit (although thankfully not tax exempt).  Both my husband’s and my premiums increased from 2009 to 2010 and again in 2011 (I sincerely appreciate my employer not increasing my portion of my health insurance), and we can only expect another increase next year plus what we will have to pay for a third policy for our little one (as it is prohibitively expensive to add anyone to my plan, and we are probably not going to do an HSA with the kid).  In 2004 the Kaiser Family Foundation found that the uninsured paid about a one-third of the cost of their medical care, leaving the rest to be paid by charity, federal, state, or local governments, or the providers, and in 2008 Families USA found little had changed.  However, the uninsured is billed double (in most cases based on numerous personal experiences) what most insurance companies are billed.

Before this year,  I would have thought an HSA/HDHP would have been fine for a child too since most of the visits would be for wellness check-ups and vaccinations (although we might be struck with the new parent urge to rush to the doctor at every little “symptom”).  However, in reviewing my policy there is no mention about the global billing package so what surprise might be waiting for us for the little one’s care?  My policy does state that “all maternity-related medical services for prenatal, postnatal, delivery, and any related complications” are covered, and when I refer to the Schedule of Benefits I find that in network services are the same “as those stated under each Covered Health Service category in this Schedule of Benefits except that an Annual Deductible will not apply for a newborn child whose length of stay in the Hospital is the same as the mother’s length of stay.”  The term “global billing package” is absent from the definitions section of my policy, too.

In shopping for health insurance it is impossible to know what you are truly purchasing because even though the marketing material might imply or explicitly state one thing the policy will always supercede, and until the policy is purchase I don’t know of a single insurance company that will provide a copy of the policy for perusal.

To be continued.

Why I Despise my HSA – Part Three

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.

Why I Despise my HSA – Part Two

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.

Why I Despise my HSA – Part One

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.