Ginger Exchange
July 2018
Overall: Faster delivery than estimated. Portions are small, but prices are not crazy.
Orange Chicken: 4/5. Sweet, not spicy. All white meat chicken (rare around here), no gristle at all, good flavor. Not much sauce, which was great. Broccoli was fresh and undercooked (as many people prefer). If only they could deliver it with any crispness to the coating. Came with a choice of white or brown rice. Brown rice was fine.
Sweet Garlic Udon with Chicken: 3/5. Slight gumminess to the noodles. Somewhat different vegetables than usual mixed in. Decent flavor.
Chow n Joy
July 2018
General Gao’s Chicken: 2/5. Tasted like mall food, and not in a good way.
Chicken Udon: 2/5. The noodles were gummy, there was too much sauce, and almost no flavor. Reasonable vegetable selection.
White rice and brown rice: Both fine.
The Great Chow, Malden
Overall: Wow, dinner was delivered very hot. Packaged well. Standard entrees do not come with rice. Easy enough to order via grubhub, though dishes do not have useful descriptions or ingredients.
Chicken Lo Mein: 3/5. You know how typical Americanized lo mein has that certain lo mein flavor? I have no idea what that flavor is, but it’s not here. The noodles are ok, the vegetables are ok, the flavor is not quite what I expect, and the chicken is perfectly tender.
General Gao’s Chicken Rice Plate: 3/5. The rice plate is a nice quantity of dinner for 1. The rice is kept separate in the container. There was no real heat level, the chicken was thighs, the pieces were large, and the dish wasn’t quite as steamed to death from being delivered as I’d expected.
Cheng-Du Spicy Chicken: 4/5. Too spicy for me, but I knew that when I ordered it. The texture was very good for delivery, and both the texture and the flavor reminded me of a Tibetan dish I used to order many years ago. Flavor was a bit too intense for my boring palate even with a lot of rice. Smaller pieces of chicken than the General Gao’s.
Shanghai Moon, Medford
Overall: This was pickup rather than delivery. Packaged well. Bonus package of dumplings was unexpected.
Chicken Lo Mein: 4/5. Good flavor, not a lot of vegetables or chicken, not exciting but met expectations.
Egg roll: 2/5. Wrapper was not quite right, drifting a little from proper bumpy egg roll wrapper towards a smooth spring roll wrapper. Contains small amounts of pork. Flavor was odd, a little sweet in a weird way. Duck sauce fixed that, but shouldn’t be necessary.
Vegetable dumplings: 3/5 towards 4/5. A proper dumpling wrapper in texture and flavor. The contents were similar to a vegetarian egg roll, and are not a great substitute in a dumpling. But better than not having dumplings.
Pork dumplings: 4/5. A proper dumpling wrapper in texture and flavor. The contents had some odd lumps, which may have been an incomplete grind or may have been mixing in edamame or something. Flavor was convincingly pork-like. Since I had ordered vegetable dumplings and not pork dumplings, I was at first quite impressed at how they had managed to mix together mushrooms and edamame and who knows what else to make a decent substitute for a dumpling filling. Sigh.
Sesame chicken with rice dinner: 3/5. Not enough flavor. A bit too much sauce. A generous quantity of dinner for 1. The rice is kept separate in the container. On the bright side, it was white meat chicken.
House Chinese mustard: Not the mustard I was looking for.
Rose’s, Medford
Update: Metal shaving in the food, and they didn’t even care.
Overall: Fast delivery, packaged well, piping hot. Rice is not included with entrees. No fortune cookie? Grrrr.
General Gao’s Chicken: 4/5. Chicken was thighs, with some gristle. But the batter was perfect, with some crunch that actually survived delivery, and the flavor was very good. Broccoli was quite undercooked.
Chicken Lo Mein: 1/5. No flavor, flat noodles instead of round, completely uninspiring.
New Hong Kong Village, Medford
Overall: No online ordering, but phone ordering worked smoothly.
Chicken Lo Mein: 4/5. Good flavor, lots of chicken, but the chicken was a bit dry.
General Gao’s Chicken: 1/5. Chicken was quite dry, coating was mushy, sauce had no flavor.
Chicken Wonton Soup: 2/5. Turns out this is pork wontons with chicken pieces in the soup. Soup had no real flavor, wonton wrappers were mushy. Packed well, though.
Friday, December 25, 2015
Chinese food dinner delivery in Medford
Monday, November 23, 2015
Life update
House: still broken. We have water damage from ice dams last winter. We replaced the roof, but still need to repoint the chimney (and foundation for a separate problem), replace the gutters, fascias, and soffits, and replace the enclosed front porch and skirting. It’s been incredibly hard to find people to talk about options and give quotes. I don’t know when we’ll ever get the big stuff fixed. We also have many small unrelated broken things that we have not gotten fixed, with more breaking each week than we can tackle.
House insurance: still broken. We contacted our insurance agent last winter, and filed the claim in August. Sent in a ton of info and asked a bunch of questions, spent hours dealing with an adjuster and a building estimator hired by the insurance company. We’ve received no money from the insurance company, no answers to any questions, and no assurance that we will ever receive anything. Tried to talk to 3 public adjusters about dealing with this on our behalf: one never replied, one is taking no new clients, and one sounded like such a horrible person that we just couldn’t see dealing with him. (Update to the update: Spent several days trying to hire a public adjuster who, it turned out, wanted us to do literally all of his work for him, which is not what we wanted. The insurance company is now offering us $17K on a $50K claim, and being incredibly rude and dishonest about it in the process.)
Cars: working. Still liking the new car.
Dog: vet couldn’t figure out what was causing the vomiting and frequent startling, so she’s ok.
Health: mostly endless appointments between the three of us, and a lot of experiences of doctors not paying attention or not answering questions. No hospitalizations so far this fall, which is a major improvement over last year. Michael’s knee recovered well from surgery last year.
Health insurance: still broken. Dozens of denied claims, endless errors and lies, way too much time spent trying to figure out how to correct the errors.
Lisa’s work: ok! This has been a bright spot, which is huge.
Michael’s work: not ok!
Temple board: unproductive, and too much disconnect from the rest of the board to feel like there’s much hope for improvement. (Update to the update: Turns out much of the board is disaffected or potentially mutinying. I feel less lonely in being dismissed and powerless.)
David: healthy, rowdy, not listening well. Lots of joy, lots of frustration, flipping back and forth repeatedly within minutes.
David’s preschool: suddenly a complete clusterfuck. He’s having a good time, but we need to do a new search for next year for reasons I can’t go into publicly. Have lost a ton of sleep over the situation, tried to offer advice and solutions that have been entirely dismissed, and can neither tolerate nor believe the callously destructive attitude of the people in charge of the situation. I could almost understand the choices they are making if they were gaining something by hurting everyone else, but they aren’t.
City government: difficult and painful.
Search for where to live: Difficult and slow. We cannot afford the places we like, we don’t like the places we can afford. For place, read both house and community.
Hobbies: What? We used to have those? Everything is endless crisis management. We do occasionally get an evening out, which is lovely. I like the aquarium and the science museum and other destinations for David, but I don’t get to do any of it at the pace I want. Travel has been impossible to plan. Hell, meals have been impossible to plan.
Friends: What? We used to have those? We see a few friends regularly, some friends rarely, and too many friends not at all. I find it hard to have conversations when talking about my life reminds me of what my life is actually like, when national news is so horrifying, and when David won’t actually let me have a conversation if he’s in the same building. I want to hear other people talk about their lives without making me talk about mine.
Stress levels: through the roof. Not coping.
Wednesday, November 18, 2015
Billing for allergy skin tests
Suppose you want to do an allergy skin test for food and environmental allergies. This is where they poke your skin with little amounts of different allergens, wait 15-20 minutes to see how big a welt each one causes, and jot down the results. (The false positive rate is estimated to be 40% to 50% for many allergens, so there’s usually something to write down.) They also do two controls: histamine and saline. If you don’t react to the histamine, then there’s a problem. If you do react to the saline, there’s a different problem.
These are billed as procedure code 95004, with the number of units corresponding to the number of different allergens tested (plus two units for the two controls). It’s somewhere between $5 and $38 per unit, according to different numbers from Cigna at different times. But when you do lots of units, the difference starts to multiply.
Cigna knows the procedure code, but they keep that a secret. Cigna knows how the units are counted, but they keep that a secret. Cigna knows how many units you were billed for, but they keep that a secret. Cigna knows how much they pay different providers per unit, but they keep that a secret. The only non-secret is the total amount they settle on.
You can get the procedure code from the provider, maybe. Or you can get the procedure code from various web sites about medical billing. That’s also how you can find out how the units are counted.
You can find out the number of units you were billed for from the provider, and Cigna is willing to confirm that number.
Finding out how much Cigna pays different providers so you can comparison shop? Forget it. That would be treating health care like a rational marketplace, and Cigna refuses to enable that.
The non-secret is that the final total is $578.51 for 16 units of 95004. That’s $36.156875 per unit, which is obviously not the contracted price. It’s also a touch higher than the approximately $90 total that Cigna said it should cost from this provider. And only 13 tests and 2 controls were done, so the number of units is overbilled.
Fortunately, I called Cigna and got this straightened out, with a clear explanation for what went wrong.
Tuesday, November 10, 2015
Follow me, and I will make you baristas of men
In the midst of the darkness of the world, God sent us a light.
In the dark midwinter sky, the wise men followed the light of the Star of Bethlehem.
John 8:12: When Jesus spoke again to the people, he said, “I am the light of the world. Whoever follows me will never walk in darkness, but will have the light of life.”
So there’s your design brief. Nothing should distract from that core message: light from darkness. But we want to reach beyond the reductionism of a point of light. The message is bigger than that, because Christianity is bigger than that. The Good Word has saved us all, and we need to show that sense of collective uplift. Show a rising upwards of humanity’s soul, for that is the true meaning of the holiday.
Red is a classical Christmas color, so start there. An ombre color shift from darkness up towards light, that’s the solution. We don’t dare claim that we’ve yet achieved true salvation, so let’s stick with a gradual lightening of color.
No more winter iconography. Snowmen and snowflakes are cute, but they distract from the purity of our cup’s message of a journey towards salvation.
In the dim pre-dawn hours, before other shops are open, we light up our stores to show people the way. We are each block’s Star of Bethlehem writ local. As our coffee wakes up our minds, let our cups remind us all of the need to wake up our souls. We can serve Jesus as we serve our customers. We are Starbucks, and we are being sorely misunderstood.
Wednesday, November 4, 2015
Lessons learned from Medford’s 2015 local election
1. There were originally going to be three mayoral debates. The first was cancelled, so there were only two, and the second was only a few days before the election. That leaves most people’s opinions set before the debates, which makes them spectacle instead of information. Recommendation: Be clear about the schedule and venue, schedule them earlier in the election cycle, and make sure they are available online.
2. The city council forum happened after the primary, which meant that the most interested voters had to vote once for city council before that forum. It also was not a real debate of any sort. Recommendation: Schedule an actual debate earlier in the election cycle, and make sure it is available online.
3. The school committee forum happened shortly before the election, and was never made available online. Recommendation: Schedule an actual debate earlier in the election cycle, and make sure it is available online.
4. The city completely failed to make videos available, despite having multiple public access channels and a lot of video equipment. There should have been clear videos from the candidates, and clear videos of the debates and forums. An informed electorate makes for a better community.
5. The city mostly failed to publicize the primary and the general election. Other communities near us do a much better job. We should be trying to increase public participation in our elections.
6. Candidates did not want to run in slates, and no community group stepped up to create a slate. It is difficult to do research on 28 candidates for various local offices, and it is difficult to decide whether to prioritize bullet voting for your favorite candidate or to use all your votes to try to vote against your least favorite candidate or to increase the chances of electing incumbents or challengers. Slates simplify research and help elect people. There are principled reasons to oppose slate voting, but there are practical reasons to support slate voting. The only time that a slate was used in the last 8 elections was when a local school advocacy group formed and recommended a slate of 4 candidates for the 6 school committee slots. That slate won.
7. Voters are actually willing to support a tax override for a reasonably specific purpose.
8. Voters elect incumbents, even when there are highly qualified challengers.
9. Voters rejected the only two teachers running for school committee, the only city planner running for city council, and the only two minority candidates for city council.
10. There’s a lot of noisy fear-mongering and hate-mongering on social media.
11. Penta seemed to have a huge advantage in yard signs, advertising, noisy supporters, social media presence, and actual campaigning in the community. It was not enough to overcome his long history of alienating people as a hateful politician. He tried to make this election a referendum on McGlynn, but it ended up being a referendum on Penta.
12. Falco has huge support in the community. It would be interesting to see him run for mayor.
Tuesday, October 27, 2015
Milk in dark chocolate, brands tested by the FDA
Last Valentine’s Day, the FDA issued press releases about having found milk in a lot of dark chocolate samples that they tested, including some that claimed to be dairy-free or vegan as well as in a lot that claimed to only have traces or a risk of milk from shared equipment. I submitted a FOIA request to ask for details, and last spring the FDA put up a lot more details at:
http://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAllergens/ucm446646.htm
However, this didn’t include the actual brands and manufacturers of chocolate that they tested. It just included internally-assigned ID codes. After some pushing they sent me the list of codes for the report they put online. I’m not sure this has been publicly released before now.
A few of the FDA’s results stand out to me, as a concerned consumer. I was sad to see that “Ghirardelli SemiSweet Baking Bar” and “Ghirardelli 60% Bittersweet Baking Bar” both had more milk than two of the chocolate bars that listed milk as an actual ingredient, but better safe than sorry. “Rescue Chocolate 66% Dark Chocolate” claimed to be vegan on the packaging, showed no warning about milk, and contained milk. “Ethereal Confections; 66% Cacao, Strawberries, Rose Petals, Pink Peppercorns” and “Oskri Almond Dark Chocolate Bar” claimed to be dairy-free or lactose-free on the packaging, showed no warning about milk, but contained milk. And most of the chocolate bars tested that had warnings about shared equipment or possibly containing traces of milk, while not listing milk as an actual ingredient, in fact did have milk in them. Some of them had more milk than chocolate bars that listed milk as an actual ingredient.
Here you go, world:
Related to http://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAllergens/ucm446646.htm
Saturday, October 24, 2015
Jump on in
There’s a poster up at my synagogue which reads:
GET SCREENED!
YOUR GENES MATTER...
1 in 4 Jews is a carrier for at least
1 of 19 Jewish genetic diseases
Jewish genetic diseases are preventable. All it takes
is a simple blood test to find out if you are a carrier.
Yup. They’re also preventable by widening the gene pool. You know what does that? Being welcoming towards interfaith families.
To the thought leaders of the Conservative movement, intermarriage violates Jewish law. But life and health are more important than observing Jewish law, which is why we are required to violate the Sabbath to save a life, why we are not supposed to fast on Yom Kippur if it will make us ill, etc. Why is this different? Jewish genetic diseases are a solvable problem, which over half of Jews getting married today are already solving by marrying someone with different genetics. This should be celebrated!
So here’s my new poster text:
GET SCREENED!
YOUR GENES MATTER...
1 in 4 Jews is a carrier for at least
1 of 19 Jewish genetic diseases
Jewish genetic diseases are preventable. All it takes
is a larger gene pool, so let’s welcome interfaith families.
All fixed.
Friday, October 23, 2015
I paid for this back seat driver, so I want my money’s worth
Have you ever had some electronic equipment get bogged down over time? It happened to our Garmin, which after some years of use started to get slower and slower at giving directions. It started to tell us to turn after we had passed turns, instead of before the turn.
It’s mildly annoying when it happens to a Garmin, which you can replace. It’s more worrisome when it happens to your Subaru’s Eyesight system, which is a suite of safety software built into the car. One of the features is a lane departure warning, which beeps when it notices you cross a lane marker without having your turn signal on. Over the course of 10,000 miles, the Eyesight system gradually stopped noticing so often that we were crossing lane markers, and it wasn’t because we had suddenly become more precise drivers.
Around that time, Subaru posted a recall for the Eyesight system for an unrelated bug, and our Eyesight system got reinitialized. Hey, look, the lane departure warnings are back! This seems like good confirmation that the system had stopped working correctly over time.
But Subaru doesn’t seem to have any standardized testing approach for the lane departure system, so they have no way to verify with any precision what was happening. The dealer’s mechanic took it out for a test drive, and he got it to beep, so it must be fine. That’s not exactly comforting when you think about how complex the code must be for this system. And other parts of the suite of safety software are actually intended to change the speed of the car autonomously to avoid accidents, so it would be nice to both trust the software and verify that it’s working.
Someone needs to take a Subaru with Eyesight at 0 miles driven and compare its responsiveness to a Subaru with Eyesight at 20,000 miles driven since the last software reinstall or reinitialization. Try crossing a variety of stripes at different levels of wear or fade with both cars, and see whether both cars alert equally. We don’t expect the system to be perfect, but we do expect it to keep working the way it worked when it was new. And I hope that Subaru would not just expect the same, but would test that the system met their and our expectations. Self-driving cars will be a lot less fun if they only work correctly for a year or two.
Friday, October 2, 2015
Silence = EpiPen
As David’s parents, we need to communicate with other people about his life-threatening allergies. We need to tell people what his allergies are, and what the best steps are to keep him safe. We need to do this when people come to our house or when David goes to someone else’s house, when we leave David in someone else’s care, when we sit down at a restaurant, when we plan to share a meal with someone, and when David goes to school. Any failure on our part to do that is a risk to David’s life and health.
Yesterday the preschool director tried to tell us not to do that. She apparently feels she has the right to stop us from communicating with other parents about our son’s life-threatening allergies. That is wrong.
She can offer to help. She can provide us with contact info for other parents in the classroom. She can offer her advice and expertise as someone who regularly deals with the parents of 100 preschoolers about how best to communicate the necessary information. She can reinforce our message, and she can add her voice. She can offer to lend her voice of authority, and she can offer to substitute her voice of authority to better convey the needed message. Offer, not demand.
But she cannot try to silence us.
Leave aside her duty of care to the children in her preschool. Leave aside the fact that it is widespread practice for preschools themselves to communicate with parents about classroom allergies, and that she refuses to do that. That’s a separate failure.
When she tries to stop us from communicating with other parents about David’s life-threatening allergies, she raises the risks to David. She also makes us more reluctant to speak up about his allergies, which is the opposite of what every pediatrician and allergist and child psychologist recommends. That in turn makes it harder for us to teach David to speak up about his allergies himself, which every pediatrician and allergist and child psychologist will tell you is what David needs to learn to do in order to keep himself safe.
When other parents come to her with questions or doubts about David’s allergies, she has an obligation to either forcefully agree with our message or to ask those parents to talk with us directly (which is actually part of our message). If she contradicts our message, she is crossing the line from irresponsible to dangerous. She did not tell us how she actually responded to those parents, but her willingness to try to silence us does not inspire confidence.
I won’t be silenced when David’s life and health are at stake.
Lisa thinks we might have educated this preschool director, that she might have learned something from us. I hope that’s true. Because if it’s not true, I need to spend far too much time trying to find a new preschool for David and trying to find a new director for this preschool.
Thursday, October 1, 2015
Not a good start to the second year of preschool
At the start of the school year, we spent hours crafting a letter from us to David’s classmates’ parents asking them to please be careful about tree nuts and mango at preschool to help keep David safe. (He is 3, and is unable to fully advocate for himself or keep himself safe.) We included all of our contact info, and we asked the preschool director for email addresses for the other parents so we could send it to them. She refused, and insisted on emailing it out herself. She didn’t send it out before the first full day of school, so we printed it out and asked the teacher to send it home with all the kids. Even if it had gone out by email, it seemed like a good idea to do it on paper as well, since email isn’t perfectly reliable.
The director finally emailed our letter to all of the parents after the second day of school had started, after we told her that we would have to remove David from the school until we knew the other parents had actually been contacted. She included our cover note asking her to send this out on our behalf.
Not a single other parent contacted us. No questions, no complaints, no reassurances, nothing.
Today the director told us that she had multiple other parents complain to her about our letter. The director was angry with us that we had sent a note to other parents without having her review it (the same note that she had reviewed and agreed to 2 weeks ago). She was also angry that “we” had put stickers about David’s name and allergies on various pieces of paper outside his classroom. Those were stickers we offered to the teacher in case she needed to label David’s possessions, the same stickers that we used on his possessions all of last year at this preschool, and that the teacher decided to plaster all over the place 2 weeks ago. The director, who prides herself on knowing everything that happens at the 7-classroom preschool, hadn’t noticed for 2 weeks, and had decided incorrectly that it must have been us doing it yesterday.
Back up a little. On the visit day before the first day of preschool, we heard the teacher tell other parents that there were no kids in the classroom with allergies. We had to vocally correct her, but many of the other parents had already left and we don’t know if the teacher had told them the same thing.
This was the same visit day where they refused to put David’s classroom EpiPen in the classroom with him that day. (Their broken protocol is to put it in the classroom after the visit day, before the first full day.)
When we asked the teacher in the first week of school for details about how they handled food in the classroom, the teacher responded by telling us to trust her.
When we asked the teacher on a different day about checking the lunches of the kids sitting next to David, she told us that she doesn’t have to because she knows that every parent was told about David’s allergies, and besides the school is peanut-free. (Peanut is not one of David’s allergies, so that doesn’t actually convince me that she even knows what his allergies are.) And she repeated that I was supposed to just trust her instead of asking any questions.
Yesterday, as part of a 2.5-hour appointment with the doctor who heads the Boston Children’s Hospital food allergy program, we reviewed with that doctor what we guessed were the necessary classroom protocols to keep David safe (hand-washing, checking lunches of adjacent kids, etc.). He added some things we hadn’t ever thought of, and we typed it all up and gave it to the director this morning. She blew a fuse, telling us that she didn’t trust the list because it wasn’t signed by the doctor, that the school did everything required by the state, that she couldn’t possibly do everything on the list, and finally decided that they already did everything on the list. She listened as we tried to explain that we can’t know what they do or don’t do on that list if they don’t tell us, that the teacher had been substituting demands of “trust me” for actually telling us what they do in the classroom, and that the teacher had specifically said that they were not doing some of the things on the list. She then dragged the teacher into the office to have the teacher reassure us about what they actually do in the classroom, and the teacher was very concerned that we had not simply trusted her.
It’s the same director as last year, when the school seemed to have perfectly good protocols and good communication and well-trained teachers. Every school year is different, apparently. And while I’m sure we finally have the director and the teacher paying attention, it now appears we have classroom parents who are deeply offended by someone else having life-threatening allergies. As if this is something we chose.
There are a huge number of people who complain bitterly about their child being deprived of the right to eat whatever they want wherever they want, just because of some other child’s silly life-threatening allergy. It's an astonishing level of self-absorption and self-centeredness. It’s disturbing that we have some of those people as fellow parents in David’s very small class, but we’re unlikely to fully escape them anywhere we go. We were just lucky last year.
Do we start over at a new preschool, pulling David away from all his friends, hoping that a new preschool will behave better and have more civilized fellow parents? A new preschool will have more parents, none of whom know David or us, and an entirely new set of communication challenges. And it will take us a long time to learn whether it’s actually a good fit for David socially and intellectually, which this preschool was last year.
This is all exhausting. It should have been one conversation at the start of the school year, with the school then communicating with the other parents and the teacher telling us exactly what protocols they follow around food. Instead it’s been an endless struggle, and that’s baffling.
Thursday, September 17, 2015
Possible foods for kiddush
Here are the rules: No nuts, no mango, all kosher. This list should grow over time.
Kosher brands to buy
Food Should Taste Good (Whole Foods, Costco): no nuts, all kosherhttp://www.foodshouldtastegood.com/about-fstg/faq/view-all-faq/products
Treasure Mills School Safe (Whole Foods): no nuts, all kosher
http://www.treasuremills.com/about-us/plant-certifications/
Kosher brands to avoid
Entenmann’s: nut cross-contamination known in all productsAllergies and trust
Friday, August 28, 2015
Dear Abby, my playground is a wreck!
Playstead Park is today in the condition that Cummings Park was in six years ago: graffiti, vandalism, broken equipment, trash everywhere. The discussion about it on Facebook is heartbreaking. Many people want the playgrounds maintained, want the damage fixed, and want the vandals caught and punished. None of those people work for the City of Medford.
The police department is responsible for preventing the vandalism and catching the vandals. They refuse to patrol the parks, refuse to install video cameras, refuse to send officers when they are told that vandalism is occurring, and refuse to investigate. Whose fault is that? It’s the fault of the individual officers who refuse to do their jobs, the police administration who refuses to exercise any control over the police department, the mayor who oversees the police department and sets the city budget, and the city council who approves the city budget. If you want this to change, show up at community police meetings on the first Wednesday evening of every month at the police academy and say that you want the police to start doing their jobs. If you want this to change, take photos of the damage and show up at City Hall, demand to speak to the mayor, and tell him that you demand he instruct the police to start taking care of the parks.
The parks department is responsible for repairing the damage and maintaining the parks. The head of the parks department is Mike Nestor. The parks department is part of the Department of Public Works (DPW), and they all report to the mayor. The parks department does not repair most damage and does not maintain the parks. Whose fault is that? It’s the fault of the mayor and the city council, who jointly control the city budget. Many DPW employees are well-intentioned and hard-working, but the department is understaffed, underfunded, and has been given other priorities. If you want this to change, call DPW every day with complaints about specific damage at specific locations in the parks. If you want this to change, take photos of the damage and show up at City Hall, demand to speak to the mayor, and tell him that you demand the parks department start taking care of the parks. If you want this to change, do not vote for any incumbents on the City Council.
What can you do today? Voice your displeasure to City Hall. Call the mayor, call DPW, call the police, call every member of the City Council. Be clear, firm, and specific about what you want them to do. Keep calling until you get what you want.
What can you do on Tuesday? Vote, and do not vote for any incumbents for City Council. The current City Council is fully aware that the parks are not maintained and they are comfortable with that. We need a new City Council.
What can you do in the longer term? Keep voting, and do not vote for anyone who has held public office in Medford recently. Encourage new people to keep running for office, and pray that we get someone new to run for mayor in 2017, since 2015 is just a race between a current member of the City Council and a former member of the City Council. Support an override to increase the city budget to invest in our city. Support a change in the city charter so we do not leave all of the power in the hands of the mayor with no power in the hands of the residents.
DPW can repair equipment, can clean the parks, and can also hire contractors to do both of those tasks. The mayor can ask the county sherriff’s graffiti removal unit to come remove graffiti. (There’s no charge for that, and it baffles me that the mayor refuses to use their service and instead leaves our city covered in graffiti.) The police can patrol the parks, can remove people at night when the parks are closed, and can arrest people they catch vandalizing the parks. These things are all possible, but they will not happen routinely until the city government changes.
I’ve done everything a resident can do. I’ve called the fire department when items in the park were set on fire at night, which used to happen with surprising frequency. I’ve called a homeless services agency when a homeless person started staying in the playground. I’ve called DPW and the parks department, I’ve emailed DPW and the parks department, and I’ve shown up at DPW in person. I’ve gotten a mix of rude answers and polite brush-offs, and occasional action when I’ve emailed Mike Nestor. I’ve shown up at police community meetings, spoken with individual police officers and police administration, and called the police when I’ve seen vandalism occurring. I’ve gotten a mix of rude answers and polite brush-offs, and occasional promises of increased patrols that rarely actually happen. I’ve been cursed at by police officers on the phone and threatened by police officers in person. I’ve gone to a Parks Commission meeting, which was utterly useless for action on playgrounds. I’ve contacted the county sherriff’s graffiti removal unit directly, obtained the form for requesting their services, filled it out and given it to City Hall to act on. That last action embarrassed the city into actually removing some graffiti themselves. Once.
My one real success was around six years ago. After over a decade of complete neglect of Cummings Park by the city, which was in at least as bad shape as Playstead Park is today, I went to City Hall. I brought some large color photos of the damage, and demanded a meeting with the mayor. He called in the head of DPW and the police chief, and we all sat around a table while I laid out their decade of neglect, showed them the results in color, and told them that it was simply unacceptable. They acted surprised and appalled, and within a week at the order of the mayor, DPW repaired and replaced the broken equipment and broken structures, and the county sherriff’s graffiti removal unit came in and removed the graffiti. The police actually responded to a few phone calls in a professional manner for the first time in over a decade, and explained to a number of teenagers that the playground was no longer an acceptable place to drink and do drugs at night and that tearing apart the park equipment was no longer an acceptable activity. That turned out to be enough to turn things around. Within the next couple of weeks, little children started using Cummings Park in far greater numbers. (It used to be largely abandoned during the day, and with good reason.) Parents started contributing toys and play structures to the playground. (This had not happened in over a decade, but it started then and has continued for the past six years.)
The cost is that we have to keep volunteering our time. We have to call the police, clean up garbage, call DPW for continued maintenance, report damage and graffiti and vandalism, throw out toys that are broken beyond usefulness, and trim weed trees. We have to put up with frequently unprofessional and hostile responses from the police and DPW, and put up with complaints and threats from the minority of neighborhood residents who would prefer to see the park go back to falling apart. But we’ve seen how bad it can get, and we’ve seen how much better it can be, and we made our choice. Any parent in Medford knows (or should know) Miss Andrea at Medford Family Network. She runs playgroups that go around to all of the city parks, and if you ask her, she will tell you that all of the parks need that sort of care and attention from neighbors.
A functional city government would not rely so heavily on us to do their jobs. But that’s not the city government we have, and it won’t be until more Medford residents wake up, realize that the deplorable condition of much of our city is not inevitable, realize that the unprofessional and hostile way that city agencies interact with residents is not inevitable, and demand both a change in attitude and increased investment in our city.
The city could make Playstead Park look ten times better tomorrow (and will if you scream at the mayor loudly enough), but until enough neighbors take on enough responsibility themselves and/or the city government changes, it will all be torn apart again in a matter of weeks or months.
Thursday, August 20, 2015
Furnace notes
Our basement furnace heats the basement as well as the house. We like it that way, since it keeps the basement at a reasonable temperature.
Part of the way it heats the basement is through a series of 150 micro-vents in the ducts, also known as leaks. Heating contractors want to seal all the leaks and put in a normal vent for the basement, which would certainly give us more control over how much heat we put into the basement if we ever wanted to change that amount. What surprises me is that the heating contractors all claim that this will make our system much more efficient.
I think it’s because they cannot get past viewing the leaks as waste heat, even if the leaks are actually putting the right amount of heat where we want it. If the new vent puts as much heat into the basement as the old leaks, then the furnace will still be using the same amount of energy and the basement will still be receiving the same amount of heat. The system therefore cannot be more efficient.
The furnace itself is currently operating at an unknown efficiency level, which makes it hard to know how much energy we would save by replacing it with a higher efficiency furnace. The current furnace could in theory last another 10 years. The current furnace is no better than 80% efficiency, and we could get one that would be 95% to 97% efficient. That would lead to a 16% to 18% savings on our gas bill, which would have been a $300 savings last winter. Gas prices fluctuate quite a lot, and it’s hard to know what they will do over the next 10 years. Over the past 10 years, it would have meant saving anywhere from $200 to $500 per year. A guess would be saving at least $3000 over the next 10 years? If the furnace is actually 70% efficient (either because it’s older than we can prove or because efficiency drops with age), then the savings would be 60% more: a guess of at least $4800 over the next 10 years.
Sila wants $10,000 to replace the furnace and add a good filter. Papalia wants $6800 to replace the furnace, $1300 to add a great filter, and $3200 to replace all the basement ducts. Online info suggests that replacing the furnace is only supposed to cost $3000 to $4000, so I’m not sure why the quotes are so much higher.
Sunday, August 2, 2015
Supporting the shul's college students
After a long time with very few children, our synagogue now has many kids, and is going to start having its first Bar and Bat Mitzvahs in a year or two. (Hold the date for David’s Bar Mitzvah, by the way: 12/14/24.)
Some of those kids may continue with some Hebrew School, but 5 years later they’ll be going off to college, and I’d like to support the kids continuing to practice Judaism at college and keep their families connected to the shul. Some families tend to drop synagogue memberships after the Bar or Bat Mitzvah, and having a sensible program for supporting kids in college might help keep those families connected for longer, particularly when finances get strained by college tuition.
Lots of organizations give scholarships to college kids, so we could look at that idea. It would have to be significantly less than the dues revenue coming in from those families, or funded separately somehow. Should it be tied to taking Jewish Studies classes?
Assistance with going on a birthright trip to Israel?
Gift certificates for Jewish books? Kids still read in college, right? The PJ Library program is great for little kids, and we could create a college version.
Care packages? Shabbat candles and candlesticks (if the college allows candles), Chanukah candles and menorahs, Passover seder kits, mezuzah for the dorm room door, apples and honey — there are lots of possible needs that could be met. Would we ask parents to cover the cost? Should the shul provide or subsidize everything? Some kids will connect with the college Hillel, which will meet most of those needs, but others won’t. Do we focus on items for the student by themselves, or items they can share with fellow students?
Wednesday, July 22, 2015
By the by(laws)
As part of joining the board of my synagogue, I was given a copy of the bylaws. Some items of interest to me as a Jewish parent with a non-Jewish spouse, jointly raising a Jewish child and both being active in synagogue activities:
Article III, section 1: “Any person of Jewish faith and the spouse or committed partner of such person (whether or not he/she is Jewish), who are at least 18 years of age, and willing to support the principles and objectives of the Conservative movement, are eligible to become a member of the synagogue.”
The phrase “person of Jewish faith” can include people who are not halachically Jewish under the rules of the Conservative movement. I’m happy about that, since it includes any self-identified Jew who is ok with the Conservative movement without worrying about matrilineal vs. patrilineal descent, details of conversion as a child or as an adult, bet din paperwork, etc.
Only adults are members. My child is not a member. I guess I was never a member of my shul growing up, despite having attended services religiously, having led services, having taught and tutored in the Hebrew School, having worked in the shul office, and having participated in the youth group. That seems a little odd. It feels like children should be considered members (at least non-voting members) if they are part of a family membership.
Article III, section 5: “Only Jewish members in good standing shall be entitled to one vote at membership meetings.”
Um, wait a second. This is not an implementation of section 1. This is a contradiction of section 1.
This is just about electing officers and board members, but it’s not consistent with Article III, section 1.
Article XV, section 2: “A two-thirds vote of the members in good standing present and voting at a meeting of the Corporation shall be necessary to amend these Bylaws.”
And under Article III, section 5, that would only be Jewish members.
So Article III, section 1 is apparently meaningless. Non-Jewish members have the right to vote, but not at membership meetings. I’m not satisfied with that. I can understand saying that only Jews can fill certain roles at the synagogue, and perhaps that list could be tweaked, but not being allowed to vote? I protest.
http://www.thejewishweek.com/editorial-opinion/opinion/making-place-non-jews-our-synagogues
http://www.interfaithfamily.com/news_and_opinion/synagogues_and_the_jewish_community/Shuls_Face_Hard_Questions_about_Non-Jews.shtml
http://www.jta.org/2013/11/13/life-religion/conservative-synagogues-wrestle-with-non-jews-in-the-pews
Wednesday, May 27, 2015
The numbers are all approximately the same
Cigna Carelink is a problematic arrangement between Cigna and Tufts Health Plan. All medical claims go to Cigna. For claims in most states, Cigna uses Cigna’s network and Cigna’s pricing. For claims from Massachusetts providers, Cigna uses Tufts Health Plan’s network and Tufts Health Plan’s pricing. So the claim comes in to Cigna, Cigna sends it to Tufts Health Plan to process and assign a price, and then Cigna gets the relevant info back from Tufts Health Plan and Cigna generates the EOB and sends payment.
As a Cigna Carelink customer, I can only talk to Cigna. I cannot talk to Tufts Health Plan.
Tufts Health Plan has just priced a simple claim for us three times. The billed amount was $156.00 for seeing a doctor. The first two times, Tufts Health Plan priced the claim at $90.59. The third time, Tufts Health Plan priced the claim at $138.54.
When you provide the same input, you should get the same output. This is a single claim, with no change in the patient, health care plan, date of service, location of service, provider ID, procedure code, or diagnosis code. Why are the numbers changing?
This is not the first time I’ve seen erratic pricing and processing by Tufts Health Plan. I called Cigna today and asked why the pricing by Tufts Health Plan seems to be assigning random numbers. The supervisor I spoke with at Cigna said that the pricing from Tufts Health Plan is random. Too bad we weren’t on a recorded line.
Cigna cannot speak directly to Tufts Health Plan about pricing. When Cigna sends a query to Tufts Health Plan pointing out pricing problems or processing problems, the only response they have ever received from Tufts Health Plan has been “the claim processed correctly.” Tufts Health Plan has never admitted a mistake, has never acknowledged a difference in how they are processing identical claims for different dates of service, has never even acknowledged a difference in how they are processing the same claim when they process it a second or third time. The answer is $90.59. The answer is $138.54. The answer is correct, regardless of which answer it is.
Cigna claims they cannot audit the pricing from Tufts Health Plan, because they have no way to see any of the numbers themselves. They simply have to trust that it’s correct, and in turn assure us that it’s correct. Even when it clearly isn’t.
This is separate from how the pricing interacts with our deductible and our out-of-pocket maximum. That part happens after the pricing, as part of deciding how much we pay and how much Cigna pays.
Would you get away with this at your job? Provide an arbitrary answer, change the answer whenever you feel like it, and refuse to answer any questions about it?
Cigna claims that they offer this arrangement because Tufts Health Plan has a wider network in Massachusetts, and because Tufts Health Plan gets better pricing in Massachusetts. We haven’t personally run into any providers who are in-network for Tufts Health Plan and out-of-network for Cigna, and on the rare occasion that Cigna has been willing to look up their own pricing for a claim to compare it to the Tufts Health Plan pricing, the Cigna pricing has been comparable or cheaper. So why are they really doing this?
Wednesday, May 20, 2015
Contract, contract, who has the contract
A patient goes to the doctor. The doctor has a list price, the doctor agrees to bill the patient’s insurance, the patient agrees to pay whatever portion insurance doesn’t pay, and the doctor (being in network) has a separate agreement with the insurance company to accept the negotiated price as payment in full.
In a normal scenario, the doctor’s list price (full billed amount listed on the chargemaster) is $300, but the negotiated price with the insurance company is $200. The insurance company pays somewhere between $0 and $200, the patient pays the rest to a total of $200, and that’s the end of it.
In a screwy scenario, the doctor’s list price is $300, but the negotiated price with the insurance company is $350. The insurance company pays somewhere between $0 and $350. What does the patient owe?
The doctor can seek payment from the insurance company, and presumably is entitled to collect up to $350 from the insurance company under the terms of the doctor’s contract with the insurance company. But what exactly entitles the doctor to seek more than $300 from the patient, if the insurance company has paid less than $300?
(In a sane world, the insurance company would never agree to pay more than the list price. We don’t live in that world.)
My feeling is that when I provide the doctor with my insurance information, I am allowing him to bill my insurance and keep whatever he collects from my insurance. But the fundamental debt is mine, and the insurance company is simply helping to cover that debt. If I can owe more than the list price simply because the insurance company has negotiated an even higher price, then my relationship with the insurance company is backwards and I’m helping to cover the insurance company’s debt.
I’ve seen this sort of too-cozy relationship with auto body shops and car insurance, where the body shop feels that the insurance company is the customer rather than the car’s owner being the customer.
Suppose that the fundamental debt is mine, and suppose that the doctor cannot seek more than $300 from me, but is allowed to keep $350 from the insurance company if the insurance company decides to pay the bill in full. What if I see the doctor twice with a list price of $300 each time, and the insurance company pays $350 for the first visit and only pays $100 for the second visit? Should the amounts be aggregated? If each visit is treated separately, then I owe $0 for the first visit and I owe $200 for the second visit. If the visits are aggregated, then I only owe $150.
You know what we need? Some sort of clear rules about how all this works. I’m surprised that I’m having so much trouble finding those rules. If we had insurance regulations, those would probably address this sort of question, wouldn’t they?
Sunday, May 10, 2015
Cigna refusing to pay for Early Intervention
Summary
When Cigna refuses to pay for Early Intervention services, the taxpayers of Massachusetts get stuck with the bill. This could easily be costing Massachusetts $1 million to $2 million per year or more. We had an employer-provided health insurance plan through Cigna in 2013-2014. Our child received Early Intervention services. Despite our plan documents saying that Early Intervention services were covered, Cigna denied every single claim when it was first submitted. Our experience on more than 40 claims totaling over $8000 was that Cigna consistently lied about our plan coverage in an attempt to make Massachusetts pay instead of Cigna. After more than a year of appeals, we were able to correct our claims, but that only corrects the payments for one child out of the 36,000 who are in Early Intervention. Massachusetts should investigate how many times Cigna has pulled this scam, and stop it from continuing.
What is Early Intervention (EI)?
Early Intervention is a set of developmental services provided to children from birth to their third birthday. It includes evaluations, individual home visits by social workers and developmental specialists, and group services. Each EI agency that provides EI services in Massachusetts covers a specific town or region. You can find a lot of information about EI at http://www.mass.gov/eohhs/gov/departments/dph/programs/family-health/early-intervention/family-info/about-ei.html.
Who pays for Early Intervention in Massachusetts?
Early Intervention services are sometimes covered by health insurance. Massachusetts has a coverage mandate for EI services, but that mandate is not obligatory for self-insured plans. The Massachusetts Department of Public Health pays for any costs not covered by insurance, including co-payments and deductibles. The EI provider submits claims to health insurance when health insurance is available, and then any remaining amounts are submitted to the state for payment.
What happens when an insurer like Cigna wrongly refuses to pay for EI services?
The state gets stuck with the bill instead, while the insurer (or the employer in the case of a self-insured plan) saves money. The EI provider still gets paid, and the families still receive EI services, so the state is the only party that suffers a loss.
DPH makes EI providers report when services are not covered by a commercial plan, but that process assumes that the insurer is being truthful about whether EI services are covered. This assumption that an insurer will be truthful is a huge vulnerability which Cigna is able to take advantage of.
How much money could be involved?
The most expensive month we saw was $1207.01, while other months were typically $800 to $900. From our experience, this could easily mean costs on the order of $10,000 per year for one child. In Fiscal Year 2014, there were over 36,000 children enrolled and receiving EI services. Over 16,000 had commercial insurance. The state paid over $147,000,000 for EI services, which would be on the order of $7000 per year per child on average.
As of a few years ago Cigna covered over 10% of the people in Massachusetts with commercial insurance. That could translate into 1600 children covered by Cigna who are receiving EI services. At $7000 per year per child, if Cigna is wrongly denying even 10% to 20% of those services, that would be $1 million to $2 million per year.
How did Cigna treat Early Intervention claims for your child?
Cigna denied every single Early Intervention claim that was submitted for our child. There were over 40 EI claims over the course of a year, many covering more than one date of service, and Cigna denied every claim. Our Summary Plan Description said that Early Intervention services were covered. Whenever we called Cigna, we were told that Early Intervention services were not covered. The EI provider successfully appealed a few of these denials, but they eventually gave up and started to believe Cigna when Cigna wrongly said that EI services were not covered. After we placed many phone calls appealing these denials, persisting through repeated denials and incorrect statements from Cigna, Cigna eventually reprocessed and paid these claims.
The initial claims processing from Cigna was completely consistent: no EI claim was paid on the first submission.
Was this deliberate fraud on the part of Cigna?
When an insurer shows a pattern of denying every legitimate claim, lies about coverage whenever a customer questions the denials, ignores the statements in the Summary Plan Description, and knows that a third party will end up footing the bill instead, it certainly doesn’t look good.
Was the problem with Cigna or with Tufts?
Our self-insured plan is administered by Cigna, but the claims that Cigna receives within Massachusetts are sent on to Tufts Health Plan for processing. Cigna created the Summary Plan Descriptions, we only interacted with Cigna, and Cigna consistently refused to acknowledge that there was anything wrong with these claim denials, so it looks to me like a problem with Cigna.
(It is clear that the problem was not tied to the employer, who put together a perfectly good insurance plan and chose a major health insurance company to administer the plan.)
How would Massachusetts recover money from Cigna?
1. Identify which EI claims are being submitted to Cigna and are being denied on the basis of services not being covered by the plan. This information should be known by EI providers and by Cigna, and should be collected by DPH.
2. Total up those denied claims per child.
3. Start with the children with the largest total dollar amounts of denied claims in a year. Check the Summary Plan Description or other plan documents for each child’s plan to see which plans are supposed to cover EI services. It should rapidly become apparent how widespread this pattern is, and how much money the state stands to recover from Cigna.
Who should investigate?
The Massachusetts DPH is losing money because of Cigna. The Massachusetts Inspector General might like to save the state some money. The Massachusetts Attorney General might like to put a stop to insurance fraud that directly impacts the state’s budget.
How could state laws or regulations be changed to reduce this problem?
Whenever an insurer denies a claim for EI services, the insurer could be required to provide a copy of the actual plan documents (such as a Summary Plan Description) to DPH. DPH should check the actual plan documents for each child once per year to confirm that the denial is correct.
When an insurer wrongly denies EI claims on a repeated basis, there should be clear and significant penalties assessed. An insurer like Cigna apparently needs a financial incentive to avoid defrauding the state.
Friday, May 8, 2015
Some resources about epi pens in Massachusetts schools
The law:
https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXII/Chapter71/Section54B
DPH regulations:
http://www.mass.gov/eohhs/docs/dph/regs/105cmr210.pdf
State Dept of Education:
http://www.doe.mass.edu/cnp/allergy.pdf
2015 survey for schools about epi pen use:
https://www.surveymonkey.com/s/EpiPen2015
504 plan recommended as a mechanism for ensuring allergy safety in school:
http://www.mass.gov/eohhs/gov/departments/dph/programs/family-health/directions/chap-8/504-plan.html
(And by the way, Mass DPH issues an annual report on EpiPen use in schools which always concludes with recommending that students with allergies have a 504 plan.)
Some overall info about 504 plans from the Office for Civil Rights:
http://www2.ed.gov/about/offices/list/ocr/docs/hq5269.html
How anaphylaxis works on a cellular level:
http://luriechildrens-salubrity.tumblr.com/post/118705177170/the-science-of-anaphylaxis-an-allergic-storm
Non-negotiable points for an allergy plan:
http://foodallergyconsulting.com/top-3-non-negotiables-food-allergy-plans-2/
Sunday, May 3, 2015
Not happy with our Samsung refrigerator
We have a Samsung French door refrigerator. We like it. Well, we like some things about it. It’s large, it keeps our food cold, and it turns out that we really like having the freezer on the bottom.
But it’s also a defective piece of shit, and we don’t like that side of it as much.
Nothing interesting. Flames don’t shoot out the doors when you open the fridge. It doesn’t wobble its way across the kitchen and start molesting the microwave. But the glides that let the freezer drawer open broke after a year. Samsung replaced the glides, and the replacement glides stick all the time, making it very difficult to open the freezer all the way. Samsung says it’s supposed to be that way, because who wants to open the freezer?
Oh, and the door and freezer gaskets aren’t really all that strong. And food along the back wall of the refrigerator compartment tends to freeze, so you can’t use the back couple of inches of the refrigerator, but that’s ok because the refrigerator is really deep so there’s a lot of room anyway.
But the truly annoying thing is when you go to close the left refrigerator door, the one that has the little divider flap that seals up the space between the left and right doors, and the divider flap doesn’t flip itself to the right position and your door bounces back open because the divider flap won’t let the fridge door close. Until you put everything down, hold the divider flap in the right place, and carefully close the door, because that’s convenient. Every. Time. You. Use. The. Door.
Why would that happen? Well, Samsung used a crappy little spring to manage the divider flap, and that spring lasts about 16 months before snapping into two pieces. And the plastic sleeve that it goes into also breaks apart after a bit over a year. Next week we’ll be on our third of each in less than four years. So you have to keep replacing these little pieces, and apologizing to your family and friends for your defective refrigerator until the parts arrive, and explaining that no, you really don’t recommend Samsung appliances, but you also don’t feel good about throwing out a $2000 refrigerator after just a few years, so you’re reluctantly living with it.
Samsung’s attitude is telling. A one-year warranty, because most of the refrigerator parts last at least a year. (Yay?) A one-time repair out of warranty, because that gets you in the habit of repairing your refrigerator instead of demanding a refund. And then an insistence that you start giving Samsung more and more money for repairs that don’t even hold up, with the excuse that they’ve already covered repairing their defective appliance out of warranty once, and how could you possibly expect them to keep repairing their defective appliance without bleeding you for more money? I mean, that would clearly be unreasonable, because an appliance company shouldn’t have to pay for five repairs in four years. With no acknowledgment of the fact that an appliance shouldn’t NEED five repairs in four years, and that if it does need five repairs in four years, that’s their fault and they should absolutely be on the hook for repairing it or replacing it.
Saturday, April 11, 2015
Not that the city website will bother to tell you
Wondering where to legally dispose of sharps (needles, syringes) in Medford, MA? Since 2012, Massachusetts has not allowed used sharps in household trash, but the state did not set up any consistent plan. Some health care facilities might take them, or perhaps you can find a friendly pharmacy or doctor’s office.
Here’s the official answer: Sharps can be disposed of either at Medford City Hall outside the Board of Health Room 311 or at the police station next to the prescription drug take-back box.
Leaving your used needles on the sidewalk next to the playground is not recommended, though it is an improvement over leaving them in the playground itself. So if you’re one of the people in our neighborhood who has been doing that, now you know.
Problem solved, right?
*Opiate addiction is a serious problem. The Medford Police Department documented 39 non-fatal opiate overdoses between January 2014 and January 2015. Armstrong Ambulance’s first responders used Narcan on 94 patients in Medford in 2014. Apparently the police do documentation about as well as they do anything else. And they still aren’t bothering to carry Narcan themselves, nor is the fire department. If you need help, please seek help. If you seek help, I hope you get it. But if you keep leaving your used needles where toddlers can get to them, I hope someone kicks your fucking teeth in.
Wednesday, April 8, 2015
As much fun as having your liver eaten by an eagle every day
Prometheus Labs offers some rather expensive laboratory tests, most of which are only available from Prometheus. The blood is drawn anywhere, shipped to Prometheus in California, and the results are sent to the ordering physician.
The pricing is pretty arbitrary. The first time that Prometheus does a remicade trough level for a patient, they bill $2500. After the first time, it’s just $375. There’s absolutely no justification for this sort of price difference.
Prometheus is not in network for most insurance plans. It’s not clear if they are in network for any insurance plans. They do participate in multiplan, which can reduce the bill by 10% if your insurance plan has a deal with multiplan. Prometheus does bill insurance plans, and they file appeals on (some) larger bills, but they don’t generally count on insurance companies paying them.
Our insurance has denied Prometheus claims, saying at various times that they are not medically necessary, not preapproved, or out of network. The denials are arbitrary, and we’ve been able to appeal them to have them processed either as out of network, or even processed as in network based on the lack of an in network provider who can offer these tests. The appeals process is also arbitrary and can take months (the longest so far took close to 2 years). When we tried getting a prior authorization for a Prometheus test, the insurance company waited over 3 months to give a reply, and then denied the prior authorization. In the meantime, they had already approved the actual claim for the Prometheus test. Left hand, right hand, miles apart.
If your insurance does not pay, then Prometheus will offer to reduce the bill to $250, or possibly less if your income is low enough. This can be a great deal on the first remicade trough level if your insurance applies the $2500 (or $2250 with multiplan discount) to your deductible on a high deductible plan, but you only have to pay $250 at most. Even with a $375 bill reduced to $250, you can save a little bit on your deductible. The same logic applies if you’re likely to hit your out of pocket maximum for the year. It can get complicated with in network and out of network cross-accumulations, which are very dependent on your particular insurance plan. We now know ours much better than we used to.
After years of struggling to understand how to navigate all of this, we discovered that Prometheus has a deal with a few of the thousands of third party labs and hospitals that can draw the blood to have the third party do the billing. The third party pays Prometheus and bills your insurance. If the third party is in network, all of a sudden there’s no more arguments with the insurance plan (at least in our experience). And bizarrely, it can be much less expensive than the direct billing from Prometheus, even with the discounts that Prometheus offers for moderate income patients. For one recent test, the options were $270 from insurance to Prometheus, $250 from us to Prometheus, or $100 from us to the third party (with an unknown amount going to Prometheus out of that). Quest, that wondrous nationwide megalab agglomeration, can draw blood and ship it to Prometheus and bill the insurance plan for the test as Quest, but only from some regions of the country. Ours is not such a region.
Why does Prometheus charge $2500 or $375 for the same test at different times? Why does both a $2500 test and a $270 test get reduced to the same $250 for an individual paying the claim? Why does Prometheus accept $100 or less as full payment from a third party lab, while they demand far more from an individual even if the individual offers to pay in advance? And since their prices are completely arbitrary, why not let the patient request a higher bill to the insurance company if that will help the patient?
Depending on the details of your plan and where you are personally in your plan year, you might be better off paying a $100 in-network bill, or you might be better off paying $250 while having your in network or out of network deductible reduced by a higher amount. This isn’t a path towards rational or transparent pricing for health care. It’s not even a path towards giving patients an incentive to choose the lowest price.
Monday, April 6, 2015
Keeping us in the dark (chocolate)
The FDA made a big announcement in February, right before Valentine’s Day, that they had tested 100 different dark chocolate bars which supposedly do not contain milk, and found that many of them actually did contain milk. But the FDA refused to list the specific bars that tested positive or negative for milk.
I’m a little baffled by the FDA’s continued failure to release this information. So I’m trying a FOIA request: “The FDA recently tested dark chocolate bars for the presence of milk,
and announced a summary of the results:
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm433555.htm.
I am requesting the specific results underlying the summary: which bars
were tested by the FDA (brand, flavor, and any other identifiers), and
the amounts of milk found in each bar tested.”
If I get any actual information by doing this, I’ll share it here.
Wednesday, March 18, 2015
Sock puppets
Health insurance is all about limits. You can only see a chiropractor 20 times in a year. You can only pick up a 30-day supply of your prescribed medication. You can only see a specialist if you get a referral.
My question today is whether there should be any limits on the health insurance company? I’d like to cap the number of lies they can tell at a reasonable number, and require them to go through a medical review before telling more lies.
This morning’s example: Cigna denied a claim from March 3, 2015, because of a lack of precertification (prior authorization, prior auth, PA, precert, it’s important to keep shifting the terminology). But we had a precertification approved by Cigna last year, valid until April 14, 2015. When asked this morning, Cigna said that the precertification did not exist. Then Cigna said that the precertification had never existed. It took some forceful arguing before they were willing to admit that the precertification actually was on file exactly where it was supposed to be in their system, and that Cigna needed to approve the claim. But nowhere in there did the Cigna rep think there was any problem with her script or training requiring her to lie repeatedly, nor did she think that there was any good reason for me to be aggrieved about being lied to.
I think there’s a way to fix that. Require that all health insurance companies keep records of all communications with customers, including recordings of phone calls, along with all notes made by CSRs. Customers should have full access online, the same way that I can access claims information. (Right now, I theoretically have the right to get copies of those notes, but it requires notarized mailed paperwork, months of waiting, and an incomplete reply on disorganized printouts.) Then establish a Consumer Health Insurance Protection Bureau modeled on the Consumer Financial Protection Bureau, whose complaint system works quite smoothly for simple problems. Along with straightening out simple problems, the CHIPB could have a swear jar with a set penalty for each time the health insurance company lies to a customer in a recording or in their own notes. Maybe $20, with half going to the CHIPB budget and half being given to the customer? And a higher penalty for the health insurance company “losing” recordings or notes.
At the moment, Cigna doesn’t care whether they lie to a customer about a precertification, or about whether a procedure or medication is covered, or about whether a provider is in network, or even about what they themselves have said within the same conversation. Cigna loses nothing for lying, so over time they lie more and more. That needs to change.
If we ever shift to single-payer, we’re going to have a reintegration problem for health insurance company employees. We’ll have to train them not to lie, not to erase records and evade responsibility, not to see the customer and the provider as enemies. Because having thousands of Cigna reps working in Target without a lot of retraining is going to be hell on everyone. What, you want to buy socks? There’s going to be a waiting period for that, you can only buy 1 sock per week, we’ve never sold socks, the socks that your wallet covers are only available in a single store in New Hampshire, you have to prove that you tried stockings and those didn’t work, and the price for the socks will be randomly assigned 3 to 12 weeks after you’ve worn them.
Monday, March 16, 2015
Release your wrath
A friend came over yesterday to talk about one of the most problematic passages in the traditional Passover haggadah where we ask God to pour out His wrath:
Pour out Your wrath against the nations that know You not, and upon the kingdoms that call not upon Your name; for they have consumed Jacob and laid waste his habitation. Pour out Your rage upon them and let Your fury overtake them. Pursue them in anger and destroy them from under the heavens of the Eternal.
After much of the seder, after the festival meal, after much reading and singing and talking, after the third cup of wine, we fill the fourth cup, open the door for Elijah, and let loose with that righteous anger. It’s quite the contrast to when we start telling the Passover story early in the evening and say “All who are hungry, let them come and eat. All who are needy, let them come and celebrate the Passover with us.” But we don’t open the door for that part.
Who is the righteous late-evening anger directed against? Surely we are not asking for vengeance against the non-Jews who are at our seders and in our families, nor our actual non-Jewish neighbors with whom we just shared roof rakes and calcium chloride in the midst of a record-setting winter. But ritual language does not just express what was in the hearts of those who wrote it. It shapes how we see ourselves, every one of us who recites and hears those words. It shapes how others see us. And it shapes how our children come to understand who we wish for them to become.
An unbroken continuation of this anger is not what I wish for my son.
My friend’s haggadah had replaced this passage with a Holocaust remembrance passage before the door is opened for Elijah:
On this Seder night, we recall with anguish and with love
our martyred brothers and sisters, the six million Jews of Europe who were
destroyed at the hands of a tyrant more fiendish than Pharaoh. Their memory
will never be forgotten. Their murderers will never be forgiven.
Trapped in ghettos, caged in death camps, abandoned by an
unseeing or uncaring world, Jews gave their lives in acts that sanctified God’s
name and the name of His people Israel. Some rebelled against their tormentors,
fighting with makeshift weapons, gathering the last remnants of their failing
strength in peerless gestures of courage and defiance. Others went to their
death with their faith in God miraculously unimpaired.
Unchecked, unchallenged, evil ran rampant and devoured the
holy innocents. But the light of the Six Million will never be extinguished.
Their glow illumines our path. And we will teach our children and our
children’s children to remember them with reverence and with pride.
We invite the souls of all who are missing, the souls of all
who were snatched from our midst, to sit with us together at the Seder. This
invitation was uttered by Seder celebrants in the Vilna Ghetto in 1942...and we
repeat it tonight. For on this night all Jews are united in history and in
hope. We were all in Mitzrayim. We were all at Sinai. We were all in the hell
that was the Holocaust. And we will all be present at the final redemption.
Saturday, January 31, 2015
Distributing the herd
Because of the spreading Disneyland measles cases, there’s been a lot more national conversation about vaccination, exemptions, and herd immunity.
Vaccinations aren’t 100% effective, and populations aren’t 100% vaccinated. Herd immunity protects the unvaccinated as long as the vaccination rate is high enough overall, because there aren’t enough new people for a sick person to infect for the disease to keep spreading. However, our herd immunity to measles is visibly facing two challenges: declining vaccination rates and clustering of unvaccinated populations. An insufficient herd immunity means that parents who choose not to vaccinate their children are endangering lots of other people in addition to their own children.
We have to allow medical exemptions to vaccination, because of allergies and certain medical conditions that would make the vaccine unsafe for those people. A tiny fraction of people claim a religious objection, but an increasing number of people are claiming a nebulous “personal beliefs” exemption. And because those personal beliefs are spread through personal conversations between parents and local peer pressure, there are clusters of people refusing vaccination for their children.
Requiring that parents consult a (hopefully sane) pediatrician and get the pediatrician’s approval before being allowed to opt out of vaccination is a reasonable step, but it doesn’t go quite far enough. There are pediatricians who are willing to go along with skipping vaccinations, as well as many who are not. We need to limit how many exemptions an individual pediatrician can hand out, and setting that limit to the percentage that would preserve our herd immunity is the only safe approach. If we need 97% of people to be vaccinated against measles in order to preserve our herd immunity, and a pediatrician has 1000 patients, the pediatrician should only be allowed to have a maximum of 30 patients who skip the measles vaccination. If you’re the 31st patient and you really want to skip the measles vaccination, you’ll need to find a different pediatrician.
This approach makes it more difficult for parents who want to skip vaccinations for their children, at least until this anti-vaccine nonsense dies down. Good. It should be difficult to endanger other people. This approach prevents pediatricians who don’t have the courage to stand up for their medical training and their other patients from causing too much damage by handing out obscene numbers of exemptions. More importantly, it forces some distribution of the unvaccinated. And forcing the unvaccinated to step away from each other is an important step to take.
Water, water, everywhere
Yesterday our water heater tank failed, leaking water onto our basement floor. The water and mold damage nearby suggests that some leaking started over a week ago.
Step 1: Turn off the incoming water supply. And eventually turn the water heater control knob to off as well, though we should have done that sooner.
Step 2: Get the water heater replaced. A direct replacement would be a 50 gallon gas water heater with chimney venting. A potentially better replacement for us would be a power-vent (aka direct-vent) version, but that would require adding some PVC vent pipes.
The water heater was still under warranty with Sears, so they were my first phone call. After an hour on the phone, I learned the following: Sears was grudgingly willing to admit that I had a warranty, but I would have to pay Sears $79 to have a technician come out in five days to look at the water heater and deem it in need of replacement. At that point, I would have to pay Sears $280 for installation of the replacement, plus $75 for a permit fee, plus unknown other amounts for other unspecified charges, and then Sears would decide when to install a replacement. Which could be weeks later. Total cost: $434 plus. Total time to new water heater: minimum of 1 week, probably 2-4 weeks.
Our furnace maintenance company was here yesterday morning, so their office told their salesman Jason to give me a call about having them replace the water heater. Jason told the office that he would call immediately, but did not actually call until 25 hours later. He had no pricing. That was ok, because I had told their office late yesterday afternoon to have another salesman actually get in touch with me. That salesman did call yesterday, and quoted me $2300 for a direct replacement or $3100 for a power-vent replacement. They could install next Monday or Tuesday, maybe, but definitely sometime next week.
Home Depot could do same-day installation, according to their web site. They actually could not install until next Tuesday at the earliest. Could not do a power-vent replacement, and would cost about $1400 to install a direct replacement. Since the water heater is only $600 in the store, that’s $800 for installation by their poorly-rated local contractor.
Independent top-rated plumber #1 required photos and time before quoting a price. He estimated $3200 for a power-vent replacement. Getting a quote on a direct replacement took until after 5 pm. The quote was $1325 with a 6-year warranty, with installation on Saturday. It would have been another $250 to bring that to a 10-year warranty, but the plumber said he would not recommend that since he thinks it’s the same water heater with a different label. Fastest turn-around time, and a reasonable price.
Independent top-rated plumber #2 did not answer his phone and never called back.
Lowes could do next-day installation, but their phone rep was fuzzy on numbers and dates and recommended going to the store. So we went to the local Lowes in the late afternoon and ordered an $1100 direct replacement, including the $600 water heater and installation. They’re installing the replacement on Monday morning. It would have been another $250 to do it on the weekend.
Warranties are weird on tank water heaters, especially since they’re all made by a couple of companies and then rebranded to lots of different name brands. From a plumber, you get either a 6-year or 10-year warranty. In a big box store, you get 6, 9, or 12 years. Some places claim the primary difference is in the tank lining or insulation or construction, others claim it’s entirely about the anode rod. One guy said there actually was no difference. But there’s no labor warranty on any of them after the first year, and labor is a huge cost component. We paid an extra $115 to Lowes to get a 12-year labor warranty, so hopefully this is the last expense we have from the water heater for a while. I’m guessing there’s a greater than 25% chance that the water heater will need to be replaced in less than 12 years, in which case the warranty was statistically a good deal for us. And as a purely labor warranty, it’s one of the few cases where the insurance math can work out well for both parties, since I pay retail for labor without the warranty but they pay wholesale for labor with the warranty.
A direct replacement, just for the tank itself, would be $400 to $600. The installed quotes ranged from $1100 to $2300. A power-vent replacement, just for the tank itself, would be $900, and would require about an hour or two of additional labor and $50 of PVC. The installed quotes were $3100 to $3200.
And now we can go back to throwing out the ruined lumber that was stored too close to the water heater.
Update a few days later: Lowes showed up with a water heater that needs a power outlet for no apparent reason. Shouldn’t be a problem since there’s an available outlet right there, except for the installers claiming that it also needs a dedicated circuit. So they left without replacing the water heater.
Meanwhile the condensate pump on our furnace’s humidifier leaked water all over the floor last night, just like the water heater had previously. Hmm. Maybe it was the condensate pump all along. We had asked Central Cooling to check the condensate pump last week, and they had told us that the pump was fine and that the water heater was to blame. But now there’s a new condensate pump in place, this time with a wet switch so it should turn off the humidifier if it overflows, and our old water heater is back in service while we keep an eye on everything and our wet vac at the ready.
I can’t believe that just one malfunctioning device, or possibly two, could make Central Cooling, Sears, and Lowes all look bad. But none of them did what they should have done. Central Cooling didn’t adequately check the condensate pump, and even told us today that they could have changed things around last week really easily so that we wouldn’t have had today’s mess. Sears showed me that their warranty is useless. And Lowes either sold me a water heater that they couldn’t install (and they knew that our previous one didn’t plug in) or sent installers who refused to install a water heater for no good reason. And I’m still throwing out lumber. And carpeting. And a power tool. And some furniture.
