My ThingsTo Smile About

So this is my new goal, to find things each day that made me smile. Some days it might be 2 things, but I promise to keep it to no more than ten lol

1) The new sub choir teacher (for the rest of the year!!) at SG'school. We're hoping this sub turns into the new permanent teacher because the one she has now... well. SG has no problem with an 85% in that class. Her current teacher doesn't even play piano & All music is generated via cd player. They only sing one day or so a wk & the rest of the time they get to do homework or watch movies! New one... 27 yrs experience, trained in opera, plays several instruments, etc. Whether he gets to stay or not, it was so wonderful to hear her singing again tonight!!

2) 5 am. Yes, I said 5 am. That is the time of day that my house is nearly silent. I get to take my shower in peace without a two year old stalking me, I get to read my book, etc. The little things that I don't have time to do throughout the day with three kiddos.

3) My Hurricane. Today, he decided he really wanted to help with my daily chores. He loves throwing clothes into the washer then into the dryer and tries to help with the dishwasher. Give that kid a broom and he'll go to town. I'm not saying he really sweeps anything up but still, he's two and he tries and it brings a little sparkle to my heart!

4) Tuesdays... Tuesdays are the nights when dh & I have decided is going to be our movie night. All the kids to be on-time and then just snuggle up & watch a movie. Tonight's show will be The Blind Side!!

5) The weather. There really is nothing better than a good kick butt snowstorm but... today's rain and the smell of the rain was a fabulous thing. I apologize to my friends in CO that are getting hammered with snow right now, but hey what can I do!! Tee hee hee

6) My mama. We always have the greatest conversations, and when I don't call her by 11 or so she always wonders if something has gone wrong. Today's snippets were nothing more than hilarious. I know she misses my dad horribly, which is why she always gets excited when I suggest that she come visit or that we might come up to visit her. Needless to say she's looking forward to a few days with SG over Easter very much so!!

7) Debates!! I love debating with other people, I really do. That is by far one of my fave things to do and there are many things to be well spirited about! My friends and I do this well each other which is why I love the people I feel close enough to to actually call friends!! We can spar and still love each other no matter what our opinions are about things!

10 Things That Made Me Smile...

So I need a positive blog today, with all the other crap that's been thrown around!!

1) I got to sleep in until 630 this morning. Normally up by 5ish so that was a blessing!

2) I got to sleep in until 630 because BOTH my lil men slept all through the night, in their own beds!

3) I did a mini pedi all for my self satisfaction (part of finding that happy place)! There really is nothing better than cute toes for #4

4) I got to wear flip flops for the first time. I know I've done it prior to now, but only for the running out to the garage & such so it really didn't count. That is, not until this afternoon when added to my fave pair of comfy capri's!!

5) My earliest of spring bloomers are blooming!! That means that spring really is coming!! They're little and purple and adorable. Don't ask me what kind they are because I can never remember lol

6) My little Hurricane came up to me as I was brushing my teeth this morning and said "mama, I wuv you diiiiiisssss much" stretching his arms as far as he could!

7) The fact that my lil Monkey is such an easy going baby. He smiles, coos and does all that new discovery baby stuff and how can a smile like that not make your heart melt!!

8) I got a card in the mail today. On the front it has a little white mouse sliding down the inside of a delicious red heel and it says "A little fun... is good for the soul!" It made me smile & reminded that there are people out there that still know how to write using an ink pen or pencil, and not just write using the keyboard! There's always something special about getting real mail. It takes a lot more thought and presence of mind to handwrite anything!

9) Easter's coming up. A time to connect with family. This year will be spent with dh's family. The kids are going to have the most amazing time hunting eggs at Papa & Grandma R's house. The backyard is huge. I smile because I love dying easter eggs and watching the surprise on little ones' faces as they find the eggs, plastic or not! Maybe it's the kid in me lol

10) I love the fact that I'm not cooking dinner tonight. I've turned the reigns of the kitchen over to my Sugar Glider. It may only be spaghetti & garlic bread but ya know what... I'm not cooking!!!

What is even one thing that made you smile today?!

The Prescription Pad Pt 2

Hmmmm healthcare reform.

This is something that's been brewing a blog within me for quite awhile... Keep in mind, this is my blog so it's my opinion. Like it or not, this is what this mama thinks about the whole situation! I worked in the healthcare industry for several years. My niche was geriatrics. Those of you that think the system isn't broke, it doesn't need fixed, there's nothing wrong with it, etc etc well I think you're wrong & here's a few examples why...

Pre-Existing Conditions...

My family is drenched with pre-existing conditions, which is why this is a biggie with healthcare for me. The new healthcare bill will make it "illegal" for ins companies to deny coverage for people with pre-existing conditions. Not for 4 more years for adults, but still. Even then, however, it's still a slippery slope full of loops I'm sure. I do plan on reading more about this in the bill before the end of the day, I hope!

Three examples of pre-existing conditions just that are close to home. I could think of beyond SEVERAL more examples but we'll all get the drift and all know someone who's had a pre-existing condition. If not, go ask someone & I'm sure they can fill you in...

My mom. My mom is one of the most dedicated, hard working, selfless people I know. She's busted her butt for 25+ years as a well awarded teacher in this country. She deserves a golden halo when she's called home because all but two of those years have been spent teaching special ed. My niche was helping the elderly, hers was helping the most special of the big guys angels. Unfortunatly she's a walking billboard for pre-existing conditions. My mom didn't choose to get rheumatic fever when she was very young. She didn't choose to spend months upon months a full days very expensive train ride away from her family nearly two states away. But she did get rheumatic fever. That rheumatic fever is the suspected cause for her mitral valve prolapse. That resulted in mitral valve replacement surgery 20 or so years ago. It's also caused a miriad of other heart related issues for her. She's had a few small strokes. She's had her blood so thin that she'd lost so much blood unbeknownst to her, her doctor was wondering how it was she was even still walking let alone alive. Even through all this my mom still taught every single day. She was there by 715 at the latest and never left before 530 or 6 unless one of us drug her home. Thanks to all of these issues, plus knee replacement, plus ankle surgery, and other things she's a classic "pre-existing condition" case study. My dad's health insurance was MUCH better than hers when he started his job, but his ins denied her coverage because she had pre-existing conditions. She stuck with her school districts coverage which is still pretty good. A lot of hoops for basics but still. It's insurance. Now my mom is considering retiring early due to health reasons. No retiree benefits if you retire early. We've called nearly every insurance company known to man to see if she can get insurance through them, and they've all denied her a policy. The only company that would give her one wanted nearly $1500 a month in premiums plus all the bs $$$$$.

So now mom has to choose... work for another 4 years, hoping she makes it that long, so that the new healthcare initiave will cover her maybe, or bite it in the butt & work another 11 so that medicare will cover what her retiree benefits won't cover...

My dad. Due to where he worked 20+ years ago, in a betonite plant, his insurance company wanted to consider that a pre-existing condition when they were initially enrolling him. They said that an environment like that is just a medical claim waiting to happen. After a week of testing, finding him oober healthy, they finally approved him. He was on "medical probation" for the first 2 years but he still had insurance. He was, afterall, a healthy guy other than his weight and a few other typical, as you get older, ailments. However, they did throw a microscopic clause in there that if he were to get some type of illness that might be potentially be related to his work with the betonite, that all claims have the potential to be denied. Guess when we found out about this little addition... when my dad found out he had cancer. The first 6 mo. of treatments were all denied by his insurance company because he might have gotten melanoma from esposure to betonite. WTF?!?! That first 6 months alone nearly bankrupted my parents. They nearly lost their home, everything. All because of what some jackass behind a desk deemed a pre-existing condition. And then, after we thought it was gone and it came back the second time, the insurance company actually had the gall to tell him they were going to drop him. Finally, after 3 leading oncologists from Mayo clinic sent numerous letters to the ins company stating that his prior working conditions had nothing to do with his being stricken with melanoma, they finally started to cover his cancer treatments. It was all in vain however, but a lot of lessons were learned from that experience.

Me. I might by far be the most rediculous of the three cases of "pre-existing conditions" LOL My prior blog explained our ins woes. Well, here's why I'm not on his insurance. I'm considered to have a "pre-existing condition". Do you know what my pec is? Any guesses? Well, it's the fact that I'm of child bearing age, had two kiddos and a third on the way. Yep, with that company it's actually a pec to be a mom. It would nearly double our premiums. All for being a mom. Seriously?!?! WTF So we had to make the choice, line the silk pockets of the insurance gods or pay the occasional $120-$200 for a dr. visit for me. We decided that being a mama aka pec soooo wasn't worth the extra amount taken out of the paychecks every month. After all, that would've left us with only a thousand or so to pay all of our bills, and possibly less those months where there are three paydays.

So, my question on pec's is... Who gets to decide what a pec is? Why does it vary from company to company? Why is something you were born with allowed to curse you or your family for years to come? Why is something completely out of your control a reason to deny you the ability to get insurance? Anyone have the answer for that? Anyone???

The Prescription Pad Pt 1

Hmmmm healthcare reform. This is something that's been brewing a blog within me for quite awhile... Keep in mind, this is my blog so it's my opinion. Like it or not, this is what this mama thinks about the whole situation! I worked in the healthcare industry for several years. My niche was geriatrics. Those of you that think the system isn't broke, it doesn't need fixed, there's nothing wrong with it, etc etc well I think you're wrong & here's a few examples why...

Part 1... In-network vs Out of network
So my dh's company merged with another one last fall. Mind you with either company there are only about 30 or so employees in the 3 state area surrounding us. Around the nation, however, the company has several more heavily "employee populated" areas. We're the forgotten few around here we say lol Things were supposed to be better with this new company. Insurance was going to be much better, afterall this company believed in taking care of their employees ha ha ha ha ha

Premiums with old co's ins were around $10,000 a yr for dh & Hurricane. $25 copay for dr, $50 for specialist, $20 for urgent care, $75 for ER. Standard everything else. Only had a few issues with them, those who know me personally know those issues. Otherwise they were really great to deal with.

Got the insurance info for the new company. What a joke is all I have to say. I spent nearly 3 weeks, DAILY, on the phone & on the net researching our options and speaking with reps both at dh's new company and the new proposed ins company.
See, in "our area" aka that little 3 state area, we were given the choice of two policies within one company. Everyone else could choose several policies within 3 companies. Their reasoning with such a limited choice: You are in such a secluded area medical wise, that we couldn't find a company with reasonable rates that could cover you guys in network so we looked at our options and chose the best two that we felt suited our employees in your area." Obviously you didn't look very far because our old ins had no problems covering us as an ungodly, yet apparently reasonable rate.

So our two choices were rediculous no matter which way you went. Premium up to around $1000 a mo for dh & Hurricane. No in network providers within 100+ miles unless you count the visiting pediatric oncologist & three geneticists from the other side of the state. Local hospital here not even covered. Insuring dh alone, however, was only around $150 a month.

So, what if dh or H becomes ill, what were our choices? Take to a preferred provider or hospital 100+ miles away in another state, or go to our regular long standing family physician here. Either way we'd have to pay $4000 per person before anything's covered, and only at 75% at that. So who's benefiting from us having dh and Hurricane insured. I'm pretty sure that it's not our bank account either way lol

So, what are the reprocussions of going to our doc here? Well...
a) $8000 yes, $8000 in o.o.p. expenses had to be met first, PER PERSON.
b) After that $8000 was met, then ins would pay "up to %50" of incurred costs. But before that "up to %50" will be paid all claims must be paid in full by us, then will be reviewed by ins, then we will be reimbursed any amt that ins deems "true and necessary incurred cost" by the insurance company.
c) what are "true and necessary costs" I ask. Ma'am those are costs that our company deems true and necessary to the care provided at that time. Needless to say she couldnt' give me an example of something covered or not covered. AKA, we'll deny everything we can to save us money and make it like pulling teeth to get us to reverse our decision.

So, what are the benefits/reprocussions of going to a doc 100+ miles away:
a) driving all that ways with a sick little one, or sick dh - no fun
b) if you had to go to the hospital in an emergency you'd be treated by a "hospitalist" and not by your regular physician anyways because it's more cost effective for the ins company.
c) having to drive all that ways for regular checkups and the weather isn't exactly friendly around here most of the year. Either we've got blizzard season or tornado season... take your pick. Most offices these days are now implimenting a fee for canceling within that golden 24 hour window.
d) also, because we're more than 100 miles away from the nearest physician, we'll have to pay the office visit fee plus our co-pay at the time of the visit. We'll be reimbursed the cost of the office visits once our deductible has been met. That reimbursement will come within 120 days.

Our only other option was to look into our state's supplemental insurance for kiddos under 18. At our old income we qualified. Were told by a tech that "yes, you guys more than qualify. come in, fill out the paperwork, and you'll be good to go." So we did, and were pre-approved for the insurance for Hurricane. So, we decided to save ourselves a ton of money and only put dh on his works policy. Ha ha ha ha ha. Well, thanks to a last minute DC deal, we had to "requalify" using our income from Jan 1-31. Well, that boosted our income quite a bit because we were no longer having to pay so much for ins. Guess what, we no longer qualified for insurance.

So we're back to step one, but not until Nov, when open enrollment for the silk lined snakes opens up again...

Pay out the @ss to insure the Hurricane, or pay out the @ss to not insure the Hurricane. Either way it's a matter of "hmmmm, do we line the pockets of the insurance company, or the CEO of the local hospital?"