Friday, April 10, 2015

Health Coverage Frustration

Josh had pink eye a few weeks ago.  I took him to the doctor and they prescribed him some eye drops.  The doctor told me that it may not be covered under our insurance.  I was certain it would, because a few years ago he had the same thing, and was prescribed the same medication. 

I picked up the prescription and the pharmacist told me that our insurance, in fact, didn’t cover the meds.  I paid for the medicine anyway because we needed it to make the infection go away.  I paid my $136 and went home to put the drops in Josh’s eyes.

Once I got home, I called my insurance company to find out why it was no longer covered.  What was different from two years ago when we had the same medicine filled?  From what I know, nothing has changed with our plan other than the premium going up.  The rep explained to me that the drug was covered, but on a step therapy plan.  What that means is this drug is expensive and they want me to try a cheaper version first.  The pharmacist never explained that to me.  All I was told was that it wasn’t covered.  

I did a little research and found a coupon online for the medication and went back to the pharmacy to have them re-run the script so I could get back my $80. 

Now on to my frustration…..

We pay quite a bit of money each month for mediocre insurance.  It does what it needs to do if we don’t require anything other than antibiotics for strep throat or bronchitis, it covers yearly physicals and my monthly birth control, but if we ever had any really big issues, we’d be screwed with all the deductibles we’d have to pay before they cover procedures at a discounted rate. 

From time to time we’ve dealt with the practice being covered under our plan, but the individual doctor not being contracted with the plan.  I’ve since sorted that out but at one time or another, I needed to make sure the doctor had a contract with our insurance plan before they put their hands on me. 

The list of providers online is outdated. 

Our plan year lapse’s every year due to errors with data input. 

Just recently, I found out that our insurance is not accepted at our local hospital.  How is that even allowed?  All hospitals should accept all insurances.  

The list goes on.  It’s beyond frustrating.

I am saddened with how difficult it is to go to the doctor, get medicine and not have to worry about the financial burden of medical bills.  I have done research and learned how to maneuver through this insurance plan, but there are people out there who aren’t as savvy as I’ve been and they are riddled with medical expenses and having to choose whether to get medical help for them and their children in fear that they’ll get more medical bills.  It’s just not fair. 

Medical insurance is just that – insurance to pay for medical expenses and prescriptions.  It’s quite simple.  I pay for a service from a company, they provide that service.  For example, I expect my life insurance plan to carry out its contract if something were to happen to me and Joel.  Not say “well, you can’t have your money that you’ve paid for because there’s a step therapy plan (that no one knows about) until it’s time to utilize the insurance.  No, they should give us what we pay for.  All insurances – medical, dental, life, car, home, etc. - should be held to that standard. 

I hope one day we can live in a society where people can receive medical care and not have to worry about the financial stress.  I also would like to see lifesaving medicines (Epi Pens, etc.) be given to patients for free.  If you need those medicines to keep you fromdying from an allergic reaction, they should be provided for free.


Until then, I’m back to fighting the battle over doctor’s appointments they say aren’t covered and prescriptions that are considered step therapy.  

Friday, March 27, 2015

Live Eagle Cam

Earlier this week, my friend share a link from the PA Gaming Commission of a camera that was set up directly in an eagles nest.  All week I've been addicted to watching.  There's a mama and papa eagle and two baby fledglings born this week just a day apart.  It's a live feed so what you are seeing is what they are doing.  It's a intimate view of how they live and take care of their little ones.  They switch off on keeping the babies warm.  You can watch them feed the babies.  And I caught a moment where they were helping each other with "housekeeping" in the nest.  The babies are expected to be in the nest until late June or early July when they will learn to fly and join the adult world.  I hope you enjoy watching as much as I do.

http://www.portal.state.pa.us/portal/server.pt?open=514&objID=1592549&mode=2

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Friday, March 20, 2015

Friday Favorites

I’m baaacckkk!  I got my new camera and I can’t begin to tell you how utterly enamored I am with it.  It takes much better pictures than my old one. 

I’m trying to get back into the swing of things.  The weather has gotten nicer, but not nice enough that we can stay outside for too long.  The flowers haven’t bloomed yet and the trees are still bare.  I’m sure I’ll be a picture taking fool in the next couple of weeks.  We’re going to Charleston, SC for spring break and I know I will be taking picture taking fool.  That place is a photographer’s dream! 

Here are some of the things I’m loving lately.

Clay Creations.  Starting in first grade, every year in art, the kids do a clay creation.  I just absolutely love them!  It shows off their creative side and it’s a treasured keepsake.  This is Josh’s sun creation.  I can’t wait for Gavin to start making his creations next year.

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Ortega Flat Fiesta Taco Shells.  We started a standing tradition to make tacos on Tuesday.  The boys like the crispy shells.  I recently found these and they are so easy to eat and much less messier than the folded shells.  We missed taco Tuesday this week due to St. Patty’s Day and boy did I get in trouble for it!  I made it up to them by having tacos on Wednesday.

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Special K Pastry Crips.  These little yum-yums are a great way to fight the sweet tooth craving after dinner and they are only 100 calories!  The chocolately delight ones taste like the Keebler fudge swirl cookies for half the calories.  Can’t beat that!

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Wavy Lays & Heluva Good Dip.  Growing up I ate chips with lunch.  I also ate chips with sour cream and onion dip.  So much so that one Christmas I received chips and dip in a box.  I will always be a chip and dip girl and these two combined are my favorite.  I could literally eat the entire tub in one sitting.

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Medical Gloves.  Josh had pink eye this week.  In an effort to keep it contained to just him, I bought these at the pharmacy when I was there picking up his prescription.  They fit my little hands and have kept the gunk to just Josh.

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Antiques.  I’ve been looking for a little table to put next to my chair so I can set my drinks down.  We have a couple antique stores in town that I checked out and found this cute little table.  I’m debating on whether to paint it another color.  I’m no DIY’r so it will most likely stay this color for some time until I’m ready to take the risk.  I need to find a small plant to add and maybe a cute picture of the boys.

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Spring/Easter.  It's getting warmer, which means spring is almost here.  I've slowely begun decorating my porch.  I've had this egg wreath for years and this may be the second time it's ever been hung up.  We're usually out of town for Easter, and we may be this year, but I just had to put it up.  I have it so why not hang it?!

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Thursday, March 5, 2015

Winter Blues

For those of you that live under a rock (or in Florida), the winter up here has been BRUTAL!  Snow, ice and school closings every week since Christmas.  I think we had one or two normal weeks meaning no snow or school closings, but those weeks came with extreme cold.  High of 14 degrees with it feeling like 3 degrees because of the wind.  I don’t like winter past Christmas because it’s just cold and gray.  Winter makes the holiday season but not much else after that!  I tend to get in a funk, and this year was the worst so far.  The last couple of years, the boys and I would go to Tampa for a month and get away from this crap.  Now that they are both in school, we can’t do that, so I’m forced to stick it out.  It’s almost over!  Next week there will be life back in me.  The forecast is high 40’s/low 50’s and party sunny.  There is a light at the end of the tunnel!

And on top of it all, my camera broke.  It just stopped working.  It was 6 years old.  It got a lot of use and I had been wanting to get a replacement anyway so it was perfect timing.  Rest assured, I am getting a new one (by Friday) and will be taking sunny happy pictures very soon.  We are getting ready for baseball season to start and our spring break trip to South Carolina.  There’s a lot of picture taking opportunity going to happen very soon. 


In the meantime, I’m looking out the window with the snow coming down and the plow trucks coming by every 20 minutes seeing the light at the end of the tunnel with this last hoorah of a snow storm.

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Monday, February 16, 2015

Lent

Gluttony is one of the seven deadliest sins.  In the past year, I’ve been pretty gluttonous, and in turn, have gained close to 20 pounds. My blood pressure is a little higher than normal and I attribute it to the weight gain.  I’m at the tippy top of what I should weigh for my height and body frame.  Any more weighed gained, I’m considered over weight.  I’m not happy with my body and I’m a little worried about my health.  My family suffers from heart disease and they say heart disease is the number one cause of death in women.  I’d like to be around for a while to see my kids experience life. 

Wednesday starts the season of lent.  A time when we reflect on the extra things in our lives that we don’t necessarily need.  It’s a time of fasting, and penance, in hopes that we refocus our lives from distraction.  I’ve been distracted by extra food, sweets and wine.  So......for this Lenten season, I will be giving up sweets and extra helpings at dinner.  I won’t give up wine for the entire 40 days (I’m not crazy!) but there won’t be any wine during the week.  Only on Fridays and Saturdays.  I need to refocus my lifestyle to a healthier one. 

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It’s painful to be disciplined in eating healthier and exercising, but the rewards I’ll reap will be so worth it!


The boys haven’t decided what they’d like to give up for Lent.  I’m trying to persuade them to give up sweets as well.  It’ll make my life a whole lot easier without the temptation of candy in the house! 

Thursday, February 12, 2015

Eight.

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Happy 8th birthday Bird!

Thursday, January 1, 2015

2015

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As I reflect back on the past year, it’s been a year of many changes.  Emotionally.  Spiritually.  Mentally.  And physically.

In all honesty, it was a tough year.  I took on the challenge of being the president of the PTO.  I didn’t realize what a big role the PTO plays at the school.  It’s been an overwhelming and challenging position.  I’ve learned a lot.  I’ve learned what not to do and I’ve learned that I have a lot of people who I can lean on who support me 100%.  I’m half way through my first year and I’ve decided that I’m going to step down next year.  I’m not cut out to be the head person.  I like being that organized admin person.  Not the person who is front and center.  I also miss being a regular old parent, so that’s what I’m going to go back to being.  I will have more time for things that matter most to me.  I will still volunteer because I like being at the boys’ school and seeing them, but just in a smaller role. 

I also took on having to adjust to working again.  Albeit, it’s part time.  My job requires me to work on weekends.  Because of that, there’s time away from us as a family unit.  The blessing is that Joel gets more one on one time with the boys.  It feels good knowing I’m earning a pay check and contributing a small amount to our household (a.k.a. car payment - will work for new car!). 

I’ve given up a few friendships along the way this year too.  As I get older, I realize that some people just aren’t meant to be in your life for the long haul.  Some relationships can be toxic and bring you down.  I had a few that I needed to detox from, and I can’t tell you how much of a difference it’s made in my life.  My life has been calmer, less dramatic and balanced.  It’s actually quite boring but so exciting at the same time.

I’ve started going back to church.  The main reason being that Josh is making his first holy communion.  I also find that it makes me feel more centered.  I also get that feeling after leaving a yoga class.  Maybe I need to add more yoga into my life too.  That feeling of being centered and balanced leaves me to feel like I can conquer anything.  I feel more self-confident.

As the New Year starts, my goal is to keep the calm.  I want to refrain from making resolutions, so let’s call it lifestyle changes. 

New Year’s Lifestyle Changes:

1.  Get back to the gym.  Not too much to elaborate on this.  Gained 20 lbs. and it MUST come off.  No more excuses.

2.  Eat out less.  Cook more.  It’s healthier for us.  I plan to join our local CSA from the farm I work at (well, the one that owns the winery I work at).  It’ll give us vegetables and fruit in a box each week, and we’ll have a chance to pick fruit that is in season each week.  I’m sure we’ll get some weird vegetables, but it doesn’t hurt to try new things.  I recently tried kohlrabi while at a friends for dinner and loved it. 

My plan is to only eat out at fast food restaurants when we travel, and even then, try to make it as healthy as possible – Subway, Panera.  There aren’t too many options when it comes to fast food.  I could really go the extra mile and pack food for us on our trips. 

I’m also looking into joining a local CSB – community supported beef, whereas CSA is community supported agriculture.  My friend belongs and she gets really nice cuts of meat from a local farmer.  The cows are grass fed and grass finished so you know you are getting quality food.  The more local and organic I can get, the better for our family. 

3.  To piggy back on eating out less and cooking more, I’d like to get back into my clean eating.  Eating better will help me lose weight, focus on my health, and improve a junk food-rich diet.  No more candy, cookies and processed crap.  I’m going to eat fresh fruits and vegetables and lean meats or fish.  Add in 72 ounces of water and I should be back in tip top health in no time.    

4.  Date night with my hubby once a month.  Joel and I are so busy that we need some one on one time.  I’d like to try some new fun dates like rock climbing or painting.  Keep date night alive and fun!

5.  Use my father in law’s new beach house as much as we can!  It’s right on the water and has a pool.  It’s free and only a 2 hour drive.  How can we not use it?! 

All these lifestyle changes are a work in progress.  After all, they say is takes 21 days to make a change.  It’s tough to always be good and make time for myself and our marriage, but as long as I’m giving it the old college try, that’s all I can ask of myself. 


Wishing everyone everything they want in 2015.  Here’s to a great new year!