July 2024

S M T W T F S
 12 3456
78910111213
14151617181920
21222324252627
28293031   

Style Credit

Expand Cut Tags

No cut tags
ritaxis: (hat)
Sunday, July 3rd, 2016 11:30 am
Friday I decided that, since my blood counts were so close to normal, I could probably stop cowering before my exhaustion. I could spend less time napping and lounging in bed, and try to work up my stamina gradually (of course, this may be obsolete as of the first taxol infusion on Wednesday, we'll see). So I decided to dance more than I had the Friday before (seven dances instead of four, oh well, it's still more). And also to walk more. Yesterday in the late morning I took Zluta to Antonelli Pond and we walked almost a mile, which is not much but I'd been turning around way before that and we both had more fun. Then in the evening we went on the old rehab route around the soccer field, which is also almost a mile. And this morning! We went to Pogonip, met up with a Bernese mountain dog and her nice man, and walked to the place where the spring runs over the Spring Trail. Round trip: 2.8 miles. And I am no more tired at this time of day than I have beem, though my calf muscles are trying to get me to agree that they have been mighty today and deserve a medal (to which I reply, no you have not been mighty, you have been normal, all you get is this nice bed we're sitting on).

So I think I was correct in my assessment that I had reached the point where more resting was counter-productive. It's always a question with tiredness or pain: "does this need rest or exercise or both? How much does it need?" The most common answer, I think, is "both." And I think also, that with exercise, if it's not making things worse, it's making things better.

Meanwhile Blue Shield and Sutter are up to shenanigans again. A year after my first knee surgery I get a bill from Sutter saying that Blue Shield has paid everything they're going to pay and now I owe 400 dollars. Of course I don't have 400 dollars. Even more to the point, last year I paid every bill I was given, and Blue Shield said I had hit the limit of what I had to pay in that year, so there's no reason for them to refuse to pay, and no reason for Sutter to expect me to poay instead. I've Twitter-shamed them both,because that worked before,  but since it's a weekend, they might not see it. So I may reply to my Twitter chain on Monday to make it new again.

Another nice effect of the morning's walk is that the Bernese mountain dog played with Zluta on the way and now Zluta is willing to crash. She coughed kind of a lot on the way back, which I attribute to dust on the trail.She's had this particular cough as long as I've known her. She doesn't cough often but when she does it's always the same kind of deep, honking cough that moves her whole body. She never seems to slow down after coughing like that. The vet thought when I first got ZLuta that the cough would be self-limiting and didn't indicate a bigger problem. I'll bring it up when we see her again, but I think it's functional, not easily treatable, and it doesn't seem to bother her except while she's actually coughing.

And now for some more writing!
ritaxis: (hat)
Friday, January 30th, 2015 01:18 pm
I just got a call from Bill Monning's office. He's one of the state legislators I wrote to about Blue Shield's bad faith behavior concerning their contracts. The person I spoke to said that "a compromise has been reached" and she doesn't know the details, but there will be a contract in place for the next two years., She said that there had been a lot of pressure on Sutter(PAMF) and Blue Shield, and of course I don't know about Sutter's shenanigans since Blue Shield didn't choose to complain, but I do know that Blue Shield was behaving badly on the face of it even without Sutter complaining about them. Seriously, if the open enrollment season starts in October and ends in February, and you know you're cutting people off from their providers as of Dec 1, you don't display good faith by not telling them until well into January...

Anyway, I can schedule the second surgery according to my recovery from the first now, instead of having no option but to do it by May. I might still do it in May, but I'll wait till March to decide,

Two weeks until surgery!

In some ways,, I've been ready. In other ways, I'll never be ready. But shiny new titanium knee! My body will welcome its new inoganic cohort.

I have no idea what role, if any, Bill Monning played in the negotiations.
ritaxis: (hat)
Thursday, January 22nd, 2015 06:01 pm
I'm talking aboiut Blue Shield's behavior right now, but I don't know that the other companies are behavin better. So you already know that Blue Shield customers in California had their rates jump at the New Year (since the good people of California bought the idea that having the [elected] Insurance Commissioner be able to regulate health insurance rates is--somehow tyrranical? Somehow is bad for consumers? anyway, they voted against it). For example, the part I pay after my subsidy has increased 220%. I'm still not paying much, but we have no apparatus to keep it from increasing at the same rate year after year, do we?

What else happened after the New Year--not quite after open enrollment has ended (that'll be February 12), but contemplating changing my insurance while I'm in the middle of preparations for surgery (February 15) is not a happy thought, and I imagine a lot of other patients have similar issue to changing abruptly--is this:

Blue Shield has announced that as of December 31, 2014, they've ended their contract with Palo Alto Medical Foundation (Sutter Hospitals). They magnanimously conceded that they'll cover us through June 30, but after that we all have to get new doctors. PAMF has been sending us letters about how they're trying to re-open negotiations and how they're trying to get us covered through the year, and Blue Shield is not cooperating.

Nobody's ever said what Blue Shield and PAMF are disagreeing about in the negotiations.

My belief is that it has nothing to do with anything PAMF is doing, or anything they're asking for, or anything they're saying. I have believed it is a simple attempt to deny coverage to a large number of patients while still collecting their subsidy money.  Because in my part of California, there's not another large organized health provider which is not connected with a religious organization. The next available places are forty miles away over a narrow winding mountain road. The fact that a lot of people in my community drive that road to go to work every day makes this situation worse. But wait, I have another thought down the line.

Did I say that for the Affordable Care Act some wit invented the EPO--Exclusive Provider-- which means that if you go to a doctor, etc., that's not "in network," they don't pay reduced rates, they pay nothing? Which means if you don't find a doctor from the network, you're screwed, right? Remember what I said about PAMF being the only large organized health provider besides the Catholic Church in the Monterey Bay Area? There's a passle of tiny hospitals and physician's groups, but nothing like Kaiser down here. And we're short of medical providers of all kinds anyways because the only doctors who establish independent practice here are ones who will sacrifice making the normal doctor's living for a chance to go surfing in the morning. I'm serious: the fixed costs of doing medical business in this area are as high as they are in San Francisco, but Medicare (for example) pays the "rural" rates -- that is, the amount of money they would give to a doctor in the middle of the country.

My point, and I do have one: when we have to get new doctors in May and June, there will be none. Every doctor who actually is covered by Blue Shield at that time, if there are any left, will have no places for new patients.

I don't remember and I'm not in the mood to check to see whether I told you about the shenanigans I experienced at the beginning of this, where my old doctor was listed on the EPO website during signup time but it was revealed months later, after I (like many others) had accrued hundreds of dollars of costs, that in fact the Physician's Medical Group had not achieved a contract with Blue Shield, and eaqch doctor had to contract indivually and in the meantime... in the meantime, I had to pay for all the healthcare I had received at the outrageous uninsured rates that still pertain in this stupid stupid country.

So the thing I just realized is this: last year, Blue Shield used the new enrollees under Covered California as a lever to effectively break up the collective bargaining power of the Physicians Medical Group. This year, they're using us to attack PAMF.

I don't know what they're doing in the rest of California, and I don't know what they're doing in other ACA states, and I don't know what the other insurance companies are doing, but I know for sure it's not even a little bit benign.

The thing about being used as a weapon is that weapons get used up in the process. And that's what's happening in the marketplace.

So I'm getting all the healthcare I can before June, because after that I don't know if I can get any.

Edit: as the letter from PAMF points out, also:"Blue Shield sold health plan products during open-enrollment that featured the doctors and hospitals of Sutter Health; and then just days into the New Year abruptly announced plans to reassign members to non-Sutter doctors." That's what they did to Physicians Medical Group patients last year.