Author Archive
Healthcare. Groan.
Posted by: Josh in Uncategorized on November 24th, 2009
Healthcare can be a pain in the ass.
This is the first post from one of the site’s new contributors. Josh is a personal trainer and actor living in NYC. In addition to being one of my best friends, he’s one of the most frugal and sensible people I know. Since he writes well and I trust him to do a good job, I’m always asking him to write content for the blog. When something happens that makes him angry, he calls me and takes me up on it. That’s his way of being a media watchdog. - Ed.
Healthcare. Groan. Most of us have been bombarded with “news” about healthcare recently that lacks any substance. I for one am as tired of watered down, promises of miracle fixes as I am of the ridiculous, unsupported scare tactics of the other side. I want to share a personal story about my experience with my health insurance company, Blue Cross Blue Shield, and then give you some accessible resources that explain why we are in this mess and what can be done to help us out of it.
My story is a unique one in the healthcare discussion. Rather than being a life-or-death-Canadian-border-jumping-page-turner, my story involves the mundane realities of our normal healthcare needs. I was bit by a dog at 5:25PM. My skin was broken in several places, but I wasn’t going to need stitches. My first call was to a vet, who instructed me of the dangers of bacterial infections from dog bites and said I needed to get it taken care of that evening and not wait until the morning. My next call was to my doctor, whose office was closed. My third call was to my insurance company, whose office was also closed. My first annoyance: the local vet stays open later than both my insurance company and my doctor.
My bite was clearly not an emergency, so I went to the medical clinic around the block to see if I could be seen. This clinic informed me that insurance companies will not pay for tetanus shots (I later learned this was false…the first of many misinformed statements of the evening) and that I would have to pay out of pocket. I don’t pay a premium every month to then also pay for care. I went another two blocks to another medical clinic who said they could see me. Victory! Then I was informed that I couldn’t be seen because I needed a referral from my primary care physician. Defeat. I explained that my doctor’s office was closed. They asked that I get clearance form my insurance agent. I explained they were closed. They said then there was nothing they could do for me.
“Can I bring a referral tomorrow?”
“Nope. That’s what everyone says and no one does.”
“I’ll leave my credit card and driver’s license as collateral.”
“Nope.”
They recommended I go to an emergency room, where I would have to be seen. But I wasn’t having an emergency. This is what drives up costs. I went to the emergency room this summer after waking up during an allergic reaction, unable to breathe. They gave me a shot of adrenaline and some Benadryll and charged my insurance over $2,000. Although I have no regrets about that visit (not being able to breathe is scary), I knew there must be another option for my minor needs of a tetanus shot and some antibiotics. I refused to be another person who raises everyone’s premiums unnecessarily.
I remembered I could change my general practitioner at my whim online, and I asked if I could use their computer to do so. I could see eight from my perch at the window. I would change it to the doctor practicing here (the one they told me to change it to) and therefore wouldn’t need a referral. “No,” came the one word reply. I didn’t have enough time to make it to a computer and get back to the clinic before it closed at 8:00. My iphone didn’t support the website, so I couldn’t do it on that. I called my girlfriend. She, after much effort, managed to change it. I had her email me my confirmation. Victory! I strolled up to window with iphone in hand.
“Here. I changed it.”
“We need a hard copy.”
“Can you print it out on your computer?”
“Nope.”
Defeat.
Seeing my temples redden, the woman at the window leveled with me. “Insurance companies suck. If they can find a reason to not pay us, they will.” But the thing is, this doctor office sucked to. How hard is it to print out an email confirmation? Everyone was so angry at everyone else that no one would make any common sense concessions to streamline the arduous, expensive process.
At this point, I had been at this clinic for over two hours and the bacteria from the bite was getting a head start. Remember, the bite hadn’t even been cleaned out yet. I made a call to a friend who lived nearby and had a car. He printed out the confirmation and brought it to me. I slammed it on the counter.
The woman said, “Sorry, the doctor is on his way out the door.”
“What?!?!?!?!? Stop him!”
“Wait, Dr., you have another patient.”
He turned and looked me in the eye before he begrudgingly went back into his office.
I asked the woman if I should follow him, but before she could answer, he retuned and said, “Do you want to be seen or not? Hurry up…it’s now or never.”
I had a strange unflinching courage from my 2 and a half hour stint in the waiting room and I replied, “Don’t talk to me like that. I’ve been waiting forever to get clearance to be seen because I didn’t have a referral.”
He launched into a huge diatribe, “I hate insurance! What does your general practitioner have anything to do with me treating a dog bite? Is he a bite specialist? It’s infuriating.”
I suddenly liked Dr. Asshole. We were on the same team now.
“I know,” I replied.
Then he saw the bite. “Oh, that’s bad. That can easily get infected.”
I gritted my teeth from quipping something that would ruin our new-found friendship. He ordered the nurse to give me a shot, clean the bite, and gave me a prescription for antibiotics, and then he disappeared. The whole meeting took less than a minute. That’s what I waited all night for? That’s what my insurance company wanted my general practitioner to okay before agreeing to pay for? That was the precious meeting the lady at the window was trying so desperately to protect?
My fury didn’t end there. As I was leaving they said I needed to schedule a check-up with Dr. Asshole. I refused. He was an asshole.
The woman said, “Well, you have to schedule an appointment with your new general practitioner so the insurance company will pay for this appointment.”
“I don’t need to see a doctor for anything.”
“You don’t need a physical?”
“No. I got one 5 months ago.”
“Well, just stop by and say hi so we can bill your insurance company for that appointment so they will accept payment for this appointment.”
“But I just saw him.”
“No, he isn’t in today, you saw Dr. Asshole, his partner.”
“Why didn’t you tell me to change my general practitioner to him and not Dr. Asshole?”
“He doesn’t accept your insurance.”
“But Dr. Asshole, who practices in the same office, does?”
“Yes.”
I was outraged at the waste, the senseless red tape piling up the bills. I begrudgingly agreed but called Blue Cross Blue Shield the next day (when they were open). They informed me that an additional appointment was unnecessary, and Dr. Guy-I-Never-Met could write a referral for Dr. Asshole. I almost screamed “IF I NEVER MET HIM, THEN WHAT QUALIFIES HIM TO WRITE A REFERRAL ON MY BEHALF?!?!?!?!?,” but instead I said, “Thank you, you have been very helpful.”
I then called and canceled the appointment.
Clearly the system is broken. One step in the right direction is that most people are willing to admit that now, although even now some still don’t. There are so many insurance companies and they create different rules and the doctor’s offices sometimes can’t even keep them straight. There are wasted appointments. There are forced trips to the ER when no other options are available. I saw all this first had from a minor dog bite. In this specific case, I don’t see why there’s not a law, or policy if that term scares you, that allows things like tetanus shots to be administered by any clinic or doctor’s office, and the patient’s insurance will pay a set fee regardless of where it was done. The same for throat cultures and other simple treatments. That seems like an easy way to cut some costs. Hell, maybe it is one of the 2000 plus pages of one of the current bills. Maybe I’m missing something, but the cries of death panels and abortions are too loud for me to hear the details about what is actually happening. Let’s start a meaningful discussion. Please share your stories, opinions, and comments.
Also, If you want incredible information on how we got were we are and how we can get out of it, listen to these two This American Life episodes. They are truly fascinating.
Thanks for reading.
The Home Gym?
Posted by: Josh in Uncategorized on March 19th, 2009
Editor’s Note: This is a guest post from Josh, founder of Foundations Training in New York. Josh has been reading Consumer Reports and comparison shopping since he was about 13. He first entered the business world in junior high school when he began buying candy in bulk and trading it for people’s lunch money to finance his obsession with gadgets. He’s been a personal trainer in New York for about the last five years and recently went into business for himself. Hopefully he’ll be stopping by from time to time to give us a New York spin on fitness and/or frugality. Check out his site and stop by his new fitness blog.
So we all know that the economy is in the toilet. People are tightening their budgets and at some point they might ask, “Is my gym membership worth having or could I workout at home?” A few factors go into this, your workout tendencies, the current cost of your gym, and your available space (you need less than you think for a home gym).
As a personal trainer, my advice is to choose a setup that will encourage you to work out the most. With medical advances, we will be living longer and longer so it is imperative we take care of our bodies. So ask yourself, “What are my workout tendencies?” And be honest. If the daunting trek to the gym keeps you from working out, you might use a home gym more. If you are the type of person who needs to leave the house and its distractions to be productive, keeping a gym membership might be the better option.
I live in New York and have a 20 minute subway commute to the gym with a 15 minute walk to top it off. An hour workout is actually over a 2 hour commitment with commute. Even though I am a personal trainer, you can probably imagine that any time or weather-based excuse I can conjure keeps me from the gym.
The next consideration is the current cost of your gym. Some people have incredible deals through work or a college rec center and pay sometimes less than $20 a month. That is a great deal…if you are using it. If it isn’t convenient and you never go, it doesn’t matter if you are paying $5 a month, it is wasted money. My girlfriend was paying $40 at the YMCA which she never used. I know others who pay $150 for a swanky New York gym that they use once a week. Not a great move.
So the cost of your current gym needs to be considered against the cost of setting up a home gym. In my opinion, you need adjustable dumbbells (up to 50 lbs for most men or 25 for most women), an adjustable pullup bar (this one allows you to “work up” to a pullup if these are difficult for you), and a bench or stability ball. Be sure to check craig’s list, ebay, overstock, and amazon, all of which frequently have sales or free shipping offers that will enable you to cut costs. In my opinion, anything you need to do can be done with this equipment. I also got a series of workout videos called P90X (yes, the ones from TV, don’t judge me until you’ve tried them). It includes 12 workouts that combine core work, kickboxing, yoga, weight training, and cardio on a rotating basis. Warning: these videos are not for the faint of heart; they will kick your butt. There are several exercises that I can barely do, yet alone make it through with grace and ease. I highly recommend them, and I was able to get them for half their retail value by buying them on ebay. If the videos aren’t your style, I still recommend researching working out with dumbbells. There are countless exercises you can do with a set of adjustable dumbbells, and a book or online resource will expand your current possibilities and keep your workouts challenging and engaging.
I was able to find dumbbells and a bench on craig’s list for $100, bought the videos for $55 on ebay, and got the pullup bar with ab straps for $75, making my grand total spent $230. I have had this setup for over a month now and without having to make the commute to the gym, I have increased my workouts from 2 per week to 6 per week. My neighbor also works out with me and my girlfriend uses the system as well, so the total cost per person is just over $75, which is only 1.5 months of our normal gym membership costs. And we use it a heck of a lot more.
The last issue to consider is space, which many people list as the reason a home gym won’t work for them. My pullup bar can disconnect form the doorway and go under the bed. I have the dumbbells in the bottom of my closet, and the bench stands up in our coat closet while not in use. When I want to workout, I move the coffee table over and workout in my living room. My point is you don’t need a special workout room in your house. You can easily store and unstore these items as needed.
I sure you have deduced that I am a fan of the home gym. Gyms make their money off of convincing people they need a lot of bells and whistles to get a good workout (I should know, I’ve worked in a few). But the truth is your body only moves in so many ways. With a little creativity, you can get a full body, balanced, butt-kicking workout in your home for a fraction of the cost.
Live well.
