COBRA – Nice in theory

Capitol Building CobraAbout a week ago I wrote a post detailing my family transition from a company subsidized health care plan to bearing the full cost of the plan under COBRA.

I’m astonished to report that the bureaucratic ineptness and bungling continues. As of yesterday, having invested just under $3,000 of my own money I find myself… still without any kind of coverage whatsoever. Effectively, we have been without any medical coverage since the beginning of November and that doesn’t look like it’s going to change any time soon. Were I to visit a physician’s office, the pharmacy, the dentist or the Emergency room all will tell me that, according to Aetna I have no medical coverage at all.

Of course some day all this will likely be reconciled but that does not eliminate the possibility of financial ruin and rejection of medical care due to lack of insurance. My credit card limits are sizable but it is doubtful that even they could handle more than a couple of days in any hospital.

The added twist comes with the new year when my new insurance company is introduced (my former company is switching from Aetna to Cigna). Who knows how it will play out when one of us visits a pharmacy or medical clinic in the next month or so?

Sadly, it appears that your best bet is… well… there doesn’t appear to be one.

The COBRA system was likely conceived in good faith by beltway individuals who may understand theories of economics but have assistants and enough notoriety that they remain effectively shielded from the “normal” experience of dealing with the systems that evolve to administer such legislation. It’s long been my opinion that things only get fixed when those responsible for them must endure them directly. This does not happen with health care and legislators, doctors or anybody with a say in how such things run.

Health Care – How Broken Must it be Before We Fix it?

By now most of you who know me know that I changed jobs at the beginning of November. As of this posting I still don’t *have* medical coverage although I apparently *am* covered.

COBRA is an option that exists for folks who wish to protect themselves from America’s disastrous health costs by maintaining their former employer’s insurance for up to 18 months. Supposedly the only catch is that you must also shoulder your employer’s share of the premiums in addition to your own plus a 1% administration fee. Of course that doesn’t include poor implementation and incompetence on a massive scale.

For my situation probably my biggest avoidable error is that my last day of work was on the 29th of  October. For my company at least, your health care coverage ends at the end of the month in which you terminate your employment. Knowing this, I would have set that last day as November 1st. Not only would I have saved myself an entire month of premiums but some of the delays I’m seeing would have been mitigated.

So, according to COBRA, your medical coverage is guaranteed to continue – in theory at least – for some time after you end your employment to allow you to get through the paperwork and get everybody on the same page. That’s supposedly where Ceridian comes in. Part of their mandate appears to be to not only muddy the waters but also to ensure that it takes as long as possible for your payments to reach your insurer.

A wrinkle in my situation is that, come January, my company will have a new health care provider – Cigna – and so, therefore, will I.

A few days after I left my job I received a packet in the mail indicating that I can expect a package to arrive from Ceridian two or three weeks after my last day at work. I was VERY busy with the new position so I did not chomp at that bit, assuming that this sort of thing goes on for thousands of people every day, companies that specialize in it would have a clue.

So the package *did* arrive about 3 weeks later. It told me that my insurance rates would go up from about $300 a month to about $977 per month – which was actually somewhat better than I was expecting. I just needed to make my elections on the Ceridian web site.

In the process of making those elections (health care for me only or for the family? dental coverage too? etc.). They then indicated that I needed to set up bill pay between my bank and Ceridian and wait for my first bill. Apparently paying right away is a bad thing.

So I waited for a few days for the first bill until Michelle told me that her doctor’s office had called to indicate that Aetna had declined coverage for her recent office visit. OK, I guess that means they *really* want the money in their hands before they’ll agree that you’re covered. So I went onto Ceridian’s site to see if there was a contact number I could use to help sort this out. After logging in I see, *surprise* there’s a bill waiting there for me. Apparently this is not the sort of thing they’d think to send out some kind of notification about.

Good enough, let’s pay that bill and get our ducks back in a row. But hang on a minute. *now* the web site is telling me that not only do they not do the bill pay thing, they don’t even do credit cards or any other form of convenient payment. It’s got to be some kind of check or money order. hmmmm…

So, I send off a check which apparently takes about 7 days to arrive and get cashed. Allowing a few days for them to get the payment and notifications to Aetna, Michelle contacts her doctor’s office who inform her that it’s still a no go insurance-wise. They are sympathetic, apparently this is not unusual.

So Michelle calls Ceridian, Aetna and my old comany’s HR department in turn to find out that:

1) Ceridian is aboslutely certain that the money should go to and did go to Cigna, what is this calendar thing you speak of?

2) Aetna may be sympathetic, but no info from Ceridian (and especially no cash) equals no insurance benefits.

3) Huh?

So, after Michelle has presumably clarified the situation with the people whose job it is to do this efficiently every day, we’re told to give it 2-4 more days.

I’ve been delaying picking up some allergy medication while all this is going on just to avoid tossing more fuel in the dying fire of American health care insurance, but today I called up my pharmacy to renew the prescription and *surprise* Aetna is still refusing to pay.

This is now December 23rd. My check for 2 months worth of alleged health coverage, to the tune of $1,954 has yielded me exactly … nothing. Well… maybe I may eventually be able to claim contiguous coverage, but if I fell down a flight of stairs at this moment, it would no doubt cripple me financially while this fiasco works itself out.

One tiny bright spot in all this. I contacted Aetna regarding my FSA (Flexible Spending Account) and, the way mine is configured it remains valid for the amount that I specified until the end of the year regardless of my contributions.

This means that, having specified an FSA of $2,000 this year and contributing about $1,630 they will still cover the remaining $370 for me. Just a generous perk from my company for which I will offer them kudos. I actually called about it because I was inspecting my balance and saw the mismatch between the money I’d paid so far and the $1,890 in charges they’d covered so far.

So the lesson here (for me at least) is:

a) quit as near to the beginning of the month as possible,

b) quit as early in the year as possible,

c) Contact HR constantly after you’ve given your notice until they can tell you that they’ve notified Ceridian,

d) get registered on Ceridian’s web site a.s.a.p. (all the info was there, I didn’t need the paper package) and register,

e) visit the site daily after that to pick up the bill and send your check a.s.a.p.

f) start contacting Ceridian about a week after you’ve sent them the check (or sooner if you can see they’ve cashed it via your online banking system) and verify that they know who should be getting the money and when they’ll get it

g) about two days after that start contacting BOTH Ceridian and your insurance provider to verify that payment has been received.

I really don’t know if I’m going to have to keep on Ceridian for every month’s payment – I tend to pay my bills as soon as I get them so I *shouldn’t* risk any lapses. But I’m not the only player here.

Why I can’t simply pay my insurance company myself I don’t know. This is equivalent to those crazy escrow accounts for your property taxes. The bank has your money and has to pay the bill, but *you’re* the one on the hook for it and have to chase everybody around to ensure they do their job. I got out of that racket as quickly as I could after buying my house.

I’ve said it before and, tragically, I’m sure I’ll be saying it for many years to come. I *love* living in America – but the thing I am absolutely most terrified of is getting sick or injured here. I’m sure the quality of care will be excellent but I am scared witless that it would come at the price of every last penny of savings and every ounce of credit I would be able to acquire.

That ain’t right.

So, is this a common story? I imagine it only affects folks who have moved into a contracting position such as myself or those who have been laid off work and are not moving into a position where their benefits will be provided again.

Oakley Glasses warranty worth about as much as the paper it’s printed on

About a year ago I decided to splurge and get myself some Oakley glasses. I’m much more of a Sams Club fanboy for my glasses but I was looking for something that could provide good dust and wind protection while bicycling and most of my options seemed to involve glasses that could be best described as “goggles you’d find in grade 10 science class”.

Oakley GlassesEnter the Oakley Tightrope. Originally sold as sunglasses they are RXable and after MANY tries we managed to get the lenses ground correctly by sending the glasses to Oakley themselves. Throughout the process I was dealing with Pearle Vision (MERCHANTS FESTIVAL SHOPPING CENTER) and, as far as I could tell at the time, they did their utmost to get me situated. One thing that I noted while watching them pop the lenses in and out of my frame (something done quite often as they tried different lense curvatures) is that they did not even loosen the screws that supposedly secured the lenses therein. This gives me pause now as I deal with my current issue.

Oakley Glasses Upside DownFast forward to about a year later and I come to find the paint is actually flaking off of the glasses. Given that I’d blown $400 on these I was naturally miffed. I had checked beforehand on the web and could see that Oakley generally seems to be pretty good in the customer service arena concerning issues like this. So I brought the glasses back to Pearle Vision (dealt with Elena) and was told that it is unlikely that paint chips would be dealt with under warranty but they would check with Oakley to verify this.

A couple of days later Elena called and said they could ship the frames in to Oakley so they could be evaluated. A week after I dropped them off she called back to let me know that Oakley considers such chips to be “normal wear and tear” and would not repair or replace the frames. So now I have nice brown frames with the bonus that you can see silver (titanium?) shining through in places. I suppose I should be happy that my primary use for them is sports although I do enjoy wearing them to social events when I’ll be out in the sun as they have transition lenses in them.

Lessons learned:

1) My opinion of warranties is validated. They exist as a sales tool and do not serve any significant function after the sale except to make you feel cheated when you get repair work done on your own dime while the warranty is still in effect. I do not let a warranty factor into my buying decision, ever.

2) It is MUCH better to purchase inexpensive glasses frames and simply replace them if they have issues rather than investing in what should be “quality” frames. I’ve worn glasses from budget shops for 3 and 5 years at a time with no issues.

3) Not being an overly emotional person doesn’t help me at all when I’m working to sway someone to live up to their obligation. Next time I need to bring an excitable friend with me who can explode and yell and cause mahem until my need has been satisfied. The retail world caters to emotional wrecks.

Color me not impressed. My lesson has been learned. No more Oakleys for me.

Socialized Medicine – Looking Better and Better – I’m about to do the MRI Thing

For those that don’t know, I hail originally from Canada. There is a lot about America that attracts me and “Government staying out of my affairs” is a biggie. It is with no surprise then that I was very much in favor of shucking off a socialized medical system and its shortcomings for a more pay as you go system.

When I arrived here I was healthy and did not have kids so my contact with the medical system was minimal. Pretty much limited to a general physical now and then.

As I live here longer, I’m starting to grow more and more fearful of the financial repercussions of even a modest illness and find myself hesitant to take advantage of what is arguably one of the best medical systems in the world.

I’ve had a couple of procedures done over the past half decade or so and found myself annoyed that it is very difficult to get a cost for a procedure. They seem easily able to give you a bill before you go into the operating theater but try to get that bill amount when you are setting the appointment and people seem confused. On top of the, rather substantial, bill that you pay up front. The little bills that keep floating in weeks or months later are unexpected and annoying. When you call about them you will find that they are “usual and customary” but that is only for folks in the billing departments of hospitals or in insurance departments.

If I went to a mechanic and had my transmission replaced you can be sure that I am going to get an estimate from him. That estimate better be what I’m charged at the end unless something unusual comes up and, if it’s substantial, I expect a further call to ensure that I want the extra work done (maybe they notice a broken support for the engine while they’ve got the car up on the lift). You can be damn sure I’m not going to be receiving a bill from the “Oil Support Technician” or “Hydraulic Lift Specialist” two months after the fact because they consider it “Usual and Customary”.

In medicine it seems perfectly OK to have essential folks’ services completely omitted from any estimates. I had a hernia operation about 6 years ago and the anesthetist’s (or anesthesiologist’s – can never keep those two straight)  services, something that I consider quite essential when I’m to be rendered unconscious for surgery, were charged for separately at least a month after the fact. I had to call to see if this was legit or some kind of scam because I was so amazed at this boldness.

I need to have an MRI to sort out some issues left over from my bicycle accident a few months back. On Friday my doctor tells me he’ll begin a precertification for this. Today I receive a call from the MRI place to schedule an appointment. I went ahead and set up a date and decided to persue this to see if it’s possible to determine one’s liability and maybe plan for this kind of thing.

The girl on the phone for scheduling, of course, can do nothing for me to help nail down the cost of this thing. So I contact my insurance company. After 15 minutes waiting on the phone I find out that my insurance company contracts out radiology type stuff to a 3rd party precertification company. I’m told I need to call back if I want to find out more about costs because their department also doesn’t handle that.

So I call the insurance company back. We’ll leave the sorry-ass IVR system out of this conversation suffice it to say that it aided me not at all in getting to a customer service rep. All the rep is able to tell me is that I’ll have a $500 deductible and then I’m responsible for 20% of the cost beyond that. OK, that’s in my benefits plan. How much does this kind of procedure cost?  All he is able to tell me is that it will be a negotiated amount and that my liability will be as he’s already said.

So I contact the third party pre-cert group and find that my doctor’s office hasn’t yet initiated the precertification process with them and that my plan is the kind where only a doctor or the MRI folks can initiate the process. But that this process typically takes one business day, so my appointment (scheduled for next week) is not yet in jeopardy.

So I contact my doctors office to see what needs to be done, they acknowledge that they need to initiate this and that they’ll call me back.They call back within the hour and it turns out that this is the normal way that things are done since the pre-cert company likes to know where and when the procedure will occur. So I’ve jumped the gun on this part but they tell me that everything is now in place.

Finally I call the billing department of the MRI folks. It took them 10 minutes to figure out how much this was going to cost me. When I asked if this was an all inclusive price, explicitly mentioning that there’ll be someone administering an IV they did agree that I can expect another, separate bill from them that should only be in the range of “a hundred or so dollars”.

So, an MRI of my head, both with contrast and without will cost me no less than $868. With a little math that puts the “negotiated cost” at $2,340. Then I can expect at least another $100 bill to come floating in sometime after that for the IV person and I have no idea how many other folks it is “usual and customary” to have wander into the room while the procedure is under way and then send me a bill.

The care we have available might be some of the best in the world, but the cost for that care is terrifying – for its magnitude certainly but more so for its quixotic cost. For all its pitfalls, under a socialized medical scheme for all but the most catastrophic of issues my liability is capped so I do not have to put my self or my family at financial risk – heck it’s not even a risk because you cannot even begin to forecast the costs before you begin it’s really more of a game of chance than anything that can be calculated.

So color me leaning back in favor of the socialized medicine side of the debate.  If we can get to a system where I can get off the phone with an appointment and a guaranteed estimate (representing the cost both with and without insurance) and none of those “gotchas” that make this such a risk I will rethink this. Hell I can do it for my car, my cat and my washing machine. Surely we’ve got enough knowledge and experience to estimate simple procedures accurately by now.

Alienware and good customer service experience.

Several years ago I had a terrible experience with Dell’s customer service and a video card on my still-under-warranty system. The experience involved me being hung up on and eventually sourcing my own parts from my local Microcenter.

After ignoring them for my subsequent computer purchase I’ve since ordered other Dell products, mostly because they offer IMHO the best combination of customizability and pricing that I’ve been able to find. My Inspiron 530 worked pretty well except for the “missing RAM” problem that a lot of people both with and without Dell products got stung by. It was that missing RAM experience combined with my earlier customer service issue that had driven me to try a boutique online computer shop instead of Dell originally.

Once that was all sorted out I decided to go with an Alienware machine in spite of my concerns. The costs and ability to get pretty much exactly what I wanted won out in the end.

About 3 weeks after I received the new system, the fan on the Video card (ATI Radeon HD 5870) started making noises that told me that it was giving up the ghost. It was especially disappointing given that all the other fans on that computer stay very quiet depending on the load. This one fan was louder than my nearby fridge when it’s in full swing.

So I called Alienware support (still separate from Dell’s support ultimately even though the front end is the same) and all the horror stories I had heard about Dell ruining the Alienware branding proved… unfounded.

The tech was knowledgeable, we quickly came to an agreement as to the issue. They shipped out a new card which arrived a few days later and whose box I used to return the failing card with no hassle or cost.

The new card is working great and I’ve had no other issues. The Alienware machine is pricier than piecing together a machine for yourself, but that also depends on how much you value your time. I much prefer *using* my computer to tweaking it, generally speaking.

I wanted to put this kudo out there for Alienware’s support and say that my experience, at least, was just fine.

Kudos to Flushmate

About 3 years ago I had all 3 toilets in my house replaced by with new ones powered by Flushmate’s pressure assist systems (the actual toilets are made by Gerber).

A few days ago one of them stopped working so I started pulling it apart to figure out what the problem was. I ended up on Flushmate’s website and found a wealth of information, most useful were a series of videos showing how to test and replace various components of their system. I was originally a little hesitant to go for the new technology since I *knew* that I could always get parts for conventional toilets at my local hardware store but was not sure what would happen should I have issues with these new units.

After watching the videos I could tell right away what was not obvious from reading the install manual, the actuator shaft of the flush cartridge was sheared through, but the break was smooth enough I did not initially recognize that it was not *supposed* to be in two pieces. I called their 1-800 number and, as it was a Saturday, I ended up leaving them a voicemail with the particulars of my situation.

Come Monday morning, Dawn from flushmate called me back and we determined that the flush cartridge was indeed broken and covered under their 10 year warranty. Even though the toilet had not originally be registered with them they honored the warranty and immediately shipped out a replacement cartridge.

Thursday the part arrived by regular mail and half an hour later the toilet was right as rain.

So I wanted to toss up my story of an easy to work with company that honors its stated commitment to its product without a lot of fuss and bother.

And these are still the best toilets we have ever owned. Three years and I’m sure they can flush anything Consumer Reports can throw at them. Exactly what our sewage system needs!

Can’t Fathom why Kindle versions would cost more than Physical

** Update June 27, 2010 **

Amusingly, the day after I posted this, the Amazon price for the physical book jumped up to $10.19 and has remained there ever since.

Not saying it’s related to *my* post, but amusing nonetheless. Just saying to anybody at Amazon who happens across this, the thrust of my post was that the Kindle price should come *down*, not the other way around…

** End Update June 27, 2010 **
I was hankering for a new book to read yesterday so I went to pick up Peter F. Hamilton’s “Fallen Dragon” from Amazon.com.  I see that the current price for the Kindle download is $9.99. But I can purchase a brand new physical copy of the book from Amazon for only $8.24. In fact fully 7 of the 22 retailers offering the book are doing so for less than the $9.99 kindle price.

Most of those are also charging shipping fees which will put them over the Kindle price. I use Amazon so much that I’m experimenting with their “Prime” service which means that I’ve already paid a flat fee for my shipping for the year so there is no additional cost to me when I purchase anything that is sold BY Amazon. It will arrive two days later for exactly the purchase price that I see listed.

With the iPad coming on the scene I’m a little surprised to see that Amazon has chosen to go this path. The price difference is trivial, only $1.75, but it certainly rankles to pay *more* for something that requires far less overhead to print, store, handle and ship than its physical counterpart. I’m sure that the price is being driven by some odd publisher-determined model.

Companies have always been in business to make money. But am I mistaken in that, in this era, they are so much more brazenly about squeezing every last penny out of you and being completely blatant about it?

Heck, I understand that both AT&T and Verizon Wireless, instead of continuing to offer a somewhat reasonable value with their unlimited plans, are looking to move BACK to forcing you to purchase buckets of minutes / data and then gleefully charging you overage fees again.

I’m personally looking for companies that I can partner with – someone that I can pay a fair price to and expect fair service from them. They make a reasonable profit and I get value for my investment. It seems many businesses today are intent only on adversarial relationships with their customers and spend a tremendous effort on extracting every last cent from you for their services. It’s no wonder that brand loyalty and customer satisfaction are so low these days. If you are squeezing your customers so hard, it does not take much to push them over the edge to find another provider or to become upset with your services. People are a lot more tolerant of companies that work with them rather than against them.

RosaMia Restaurant Alpharetta

I’ve been to RosaMia 3 times now and each time have been very pleasantly impressed.

A little on the large side, their lasagna is spectacular. Gastronomic athletes may be willing to finish it but I find it much more satisfying to share it or take some home with me. Equally good has been their pizza and their Panini sandwiches (with a salad) which are exactly the right size and surprisingly tasty.

The service has always been pleasant, timely and efficient and the price is exactly in line with what I am willing to pay for a lunch trek to a restaurant.

Definitely a keeper, I have yet to be disappointed here.

Cabernet Restaurant Alpharetta

I’ve been to Cabernet Restaurant for lunch a few times in my 5 plus years working in Alpharetta and it’s usually been just OK. That atmosphere  and pricing has always been a little higher-end than I tend to favor. But it seemed like it should be worthwhile as a treat.

Today I suggested to the group I was with that we should try Cabernet to see how it’s doing these days.

I have to say I was somewhat disappointed.

The service was just slow. From arriving at the front and waiting for someone to show up to seat us to every interaction with the waiter it just all took too long.  I think the situation was, even though the dining room was not even half full, there were simply not enough wait staff to host even that small a lunch crowd.

I was going to order their Filet mignon but waiting for the waiter to show up to take our order made me rethink trusting them to cook a steak. I figure that a restaurant that cannot manage its dining room probably isn’t doing so well managing the kitchen either.

I ended up ordering a Turkey Wrap which was the best thing on my plate but still pretty bland. It came with “hand cut potato chips” that were among the most tasteless I’ve ever come across. If I had been able to find a server I’d have asked for ketchup to at least give them some semblance of vitality. Also included was coleslaw – I’m more a fan of vinegar rather than creamy coleslaw – this had the distinction of being neither one nor the other and still retaining its ability to be unappetizing.

For the occasions when my drink glass was not empty it was half the time filled with the wrong drink.

One of my party did comment that the waiter knew how to deliver the menu recitation and, when he had made his way to our table I must admit he was effective at making choice items on the menu sound appealing. But that, alas, had to be the only really good thing I can say.

I will not be returning.

CyberPower Refund Finally Realized.

It took a while but I just wanted to wrap this up.

Yesterday (April 7, 2010) my credit card finally showed the refund! The amount was, as expected, the price I paid minus the shipping costs.

Here is the the final exchange we had in email leading up to the refund.

My follow up on April 2, 2010:

Hi,

Another week has passed. I’m not sure how you personally regard $2,500. But I regard this as a large sum of money.

It has now been 3 weeks (15 of your business days) since you have received the PC that I returned.

I elected to do business with Cyberpower on the strength of a friend’s recommendation in spite of your B+ rating with the Better Business Bureau ( http://www.la.bbb.org/Business-Report/Cyberpower-Inc-13080817 ).

Please respond to this email with your confirmation that the refund in full has been issued.

Marc

With the response being (April 5):

Dear Marc,

According record for RMA under 181144, refund was credited back to your account on 3/31/2010, bank or credit card company will take 2-3 business days to process, if you have any question please email or contact us.

Thank you.

RMA Status

Cyberpower Inc.(888) 900-5180 Ext. 151

I’m pleased that things have finally worked out. It was somewhat disconcerting to have to go around like this to elicit the refund. At the back of my mind I was still holding on to the option to dispute the credit card charge but – looking at the credit card fine print – this option is supposedly one that’s limited to businesses within my physical locale (within about 500 miles). But I imagine in this day of internet purchases, that that anachronism is one that is largely discounted and trotted out by the credit card folks only when they no longer wish to retain a particular customer.