ILiveInFlipFlops
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Posts posted by ILiveInFlipFlops
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Egads! Have you talked to anyone at the therapist's office about this, or have you just tried reaching the billing people? It's possible that the therapist's office may be using an outside billing service and has no idea the mess the billing people are creating.
Who is your insurer?
You likely won't get detailed benefits information online, but you should be able to get PDFs of your EOBs, and that's where you'll find the information about allowed amounts, contracted rates, etc. If you log into your online account with your insurance company, you should be able to find a section called something like Claims and Statements, or EOBs. If you go in there, you'll be able to see claims for each date of service your insurance has been billed for, and if you go into each individual claim, you can usually download the EOB associated with it.
Here's an example of how in-network claims work for Blue Cross Blue Shield in New York. I work for a therapist (doing billing and insurance for the whole practice). If you don't have BCBS insurance, the visit fee is $150 per visit. If you do have BCBS insurance, we bill each claim at $150 per visit, but the BCBS contracted rate is capped at $95 per visit, so that is the maximum that we are allowed to charge. The client may have a $20 copay, so they'll pay $20 and BCBS will pay $75, but the total amount will never exceed $95. This is where the provider is never allowed to bill the client for more than the contracted rate (AKA balance billing).
We will bill out of network as well, and that's where allowed amounts and balance billing come in. Because we are not in-network providers with other insurance companies, we will bill those claims at $150 per visit, and the insurance company will tell us what they "allow"--basically, it means what they've decided is a reasonable and customary amount for that service in that area for the plan the client has. The allowed amounts via more expensive plans are higher, and with cheaper plans the allowed amounts are lower. The insurance company will pay whatever they pay based on their allowed amount, but in this case the clinicians ARE allowed to bill the balance to the client because they are not bound by any insurance contract. I can explain more about that, but it shouldn't matter if you're positive your therapist is in-network.
If you want to PM me, I can try to help you sort some of this out. I'm happy to look at an EOB, if you can find and download one.
The bottom line is this: The absolute last thing any network provider wants is to be audited by the insurance company. If they're audited and inconsistencies are found, they face fines, interest fees, and possibly being de-credentialed by the insurer. If that happens, they'll likely lose most of their clients because they're no longer in-network. And it sounds like this practice has a LOT to hide. The first thing I would do is get an office manager or supervisor AT THE PRACTICE and find out who is doing their billing. If it's a third-party service, the practice manager needs to know what's going on and will likely step in. If it's in-house staff, that will be trickier. Can you reconstruct a list of dates you were in based on your records? Dates you canceled? I'd put together a list of bullet points detailing the inconsistencies you're seeing in the billing they're trying to push on you. Under no circumstances should you pay them ANY MONEY until you get this sorted to your satisfaction.
I wouldn't report them to the insurance company just yet. That's your leverage in getting this straightened out. I would absolutely let them know you're willing to do it if they don't handle the problem.
Let me know if you have questions. This is what I do for a living. Some things may be different based on whatever state you're in, but the bottom lines should be pretty much the same. Here, legally, the therapist is responsible for the billing, even if they pay someone else to do it, so they'd better be on top of what's going on there.
One last point: I'm willing to bet that your insurance company has not been paying anything like $400 per visit. That may be what they're billing the insurance company, but as noted above, if the providers are in-network, there's almost no chance that the contracted rate is $400 per visit. If your options are so limited that you want to continue at this practice regardless of all of this, you need to find out what the contracted rate is that insurance is paying them and tell the practice that you'll pay that amount for all the visits insurance didn't cover, minus a hefty discount for the financial stress and inconvenience of them dumping a year's worth of billing on you all at once.
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7 minutes ago, vonfirmath said:
Is moving an option?
Listen to audio books on the ride.
I wish! I totally would, but DH is a no-go. We definitely have audiobooks aplenty. I'm also thinking that maybe if we just leave enough time in the morning so that we're not feeling super-stressed for time, maybe it won't be so torturous. But that's easier said than done for these night owls.
3 minutes ago, Bambam said:I agree with audio books.
But one word of caution - will the time once a week fill your extrovert's needs? When we lived in a place where everyone was at least 30 minutes from us, there were few people willing to meet for playdates/lunches/picnics/parties/etc unless we came to their area or I went and picked up their children and returned them after the event.
Weeelllll...I did think of that. That's one of my fears, her making friends so far away that we then feel pressured to keep up with. But she does have friends and a teen group here as well (and one who will also be attending the co-op), so hopefully we won't have too much added driving (or it will be on Fridays, when DH can do it!). I need a teleportation system. Or maybe Mrs. Todd's Shortcut!
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I just wanted to update here and say that I ended up coordinating the TGC videos with Spielvogel myself. BUT! I also figured out how to get myself registered with Cengage as a teacher (it's a process, but they are very helpful and willing to work with homeschoolers), and that connected me to a whole bunch of teacher resources, including test banks and essay questions, and access to the MindTap for the class. So if you're looking into using Spielvogel (or any Cengage resource, really), consider contacting them to get registered as a teacher.
If you call, they'll email you a form to fill out and submit via fax (actually, I might be able to upload it here, but it's on my other laptop--I'll try later). I also included a letter stating which resource I want to use, and when they set up my account, they connected that at the same time, so it was all there waiting for me. Then they emailed me my login info. It took a little time to figure out just how to use it all, but now we're rolling.
HTH someone!
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We have an opportunity to join a great co-op, but the drive will be an hour and 20 minutes each way, one day a week. I just managed to offload my once-a-month, 45-minutes-each-way drive to DH, and now I'm considering this new thing? It's crazy, but the new thing will meet a bunch of needs for DD13, who has really been struggling emotionally and educationally (an extreme extrovert in a house full of extreme introverts).
I would love any suggestions for making this work. I pretty much dread getting in the car these days--not from anxiety, but from burnout, really. Does anyone have any magical solutions they can offer?
Thanks!
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Thank you all! We ended up just going with the wine, since DH could just pick it up on his way home. It was all fine. I worry too much, but there's so much family baggage. Bleh!
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Long story short, we have family visiting tonight, and while I knew it was my cousin's birthday, I just discovered that it's his 30th birthday. We have a card and cake, but I'm thinking this maybe calls for a gift as well. Worst case scenario, we'll give him a bottle of wine, but I'd like to put a little more effort into it if possible. Can anyone suggest something small but useful/thoughtful/creative?
He's a well-educated, thoughtful, intelligent history buff, eeeever so slightly to the right of center on the political spectrum (but he doesn't really talk politics much), family-oriented (lives with long-term GF), lives in a major city. We're close enough to see each other comfortably at family gatherings but not so close that I know too much about his personal life outside of the big things.
Thank you in advance!
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I guess I don't understand the reaction to someone not flushing? I mean, I'm in the "always flush" crowd, but sometimes people forget, especially when the environment is a little different. I've been known to have to go back and double check, especially these days. But if someone forgot, or even chose not to...I close the lid and flush. I mean, even if she left the lid open but didn't flush, then what's the problem? No flush vapor occurred anyway.
I kinda feel like I'm missing some part of the equation!
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I'm agreeing with the others--it's not necessarily a huge thing, but it IS a thing and should be addressed. About four years ago I had a period that came late, then when it finally started, it was normal heaviness for the first couple of weeks, then it got heavier and heavier and just didn't stop. Finally it wasn't quite hemorrhaging, but it was hard to leave the house, so I went to the doctor. She gave me progesterone, which stopped it temporarily, but when it started back up she had me take birth control pills in a specific combination over the next couple of months and then taper off...and the problem was solved. Further tests showed no problems, and my period was normal for the next year or so. (Then it started going wonky again, but nothing like that whole episode. This just looks like perimenopause BS!)
My point is, it could be as simple as a hormonal blink and easily fixed. Or there's a teeny weeny chance it could be more serious. But either way, you don't want to ignore it. I did end up with chronic anemia from the blood loss that I'm still fighting years later. An annoyance, but one that's easily headed off if you address the problem now. Best of luck to you!
ETA: I'm assuming that you mean you've been bleeding for three weeks. If that's not right, then just ignore me 😄
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Has anyone coordinated Spielvogel's Western Civilization with The Great Courses Western Civ 1 and 2? If so, would you be willing to share your schedule? Lesson plans? Can you recommend anything else you liked to go along? I just made a sea change in our history plans, so I'm hoping to save some time on the front end. Thank you!
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Thank you all! Funda Funda and AIM are pretty much what I found, along with maybe Homeschool Connections too. Trying to make a fast decision now. I hate to have her first online class be something with higher stakes, but we may just have to make do.
TarynB, thank you for that link--it gave me more to think about and led to me to a few different ways to search for more info here.
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Can anyone recommend (or even just suggest) a secular online high school biology class that isn't crazy rigorous? Or maybe a CC Bio 101 class is an option? Would that be considered high-school credit-worthy? This is for my anxious and slightly ADHD but science-loving 15-year-old.
Alternatively, feel free to offer me advice on how to manage this myself. We're currently using M-L Macaw with the Kolbe Honors syllabus, and she likes the book a lot. However, I don't feel like I'm helping her learn very effectively. Science is not my area of expertise at all, and while I have a good basic understanding and working knowledge, I'm having a hard time determining whether her answers on the assessments and quizzes are fully correct most of the time. Obviously multiple choice or single-word answers are no problem, but a lot of questions are looking for explanation, and often I can't figure out whether what she's giving me is technically correct if it doesn't match the answers in the TM exactly, where an experienced teacher would be able to look at her answers and be able to see that she got the important points correct, so the answer is acceptable (or not). She's getting discouraged and I feel like I'm both frustrating and shortchanging her.
Anyway, I'm thinking a class with a professional is the way to go, but she's also nervous about not being able to keep up, so hopefully someone can recommend something that won't make her weep in frustration. I did consider just having her do the Kolbe class, but I don't really want her to have to deal with the extra church vs. science stuff, as we're agnostic.
Thanks all!
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For the IP-obsessed among us, LOL!!!
https://www.mcsweeneys.net/articles/faq-your-new-cursed-instant-pot
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16 minutes ago, Barb_ said:
The news of a thwarted school shooting doesn’t somehow balance out the news of a successful school shooting. A thwarted school shooting isn’t even good news because IT IS STILL AN ATTEMPTED SCHOOL SHOOTING.
The stubborn allegiance to the NRA party line is obscene.
THIS.
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Thank you, everyone. I'm working my way through your great suggestions!
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Can anyone recommend secular middle school science (ideally, life science) materials for a not-terribly-academic student? This is for my kid whose strengths do not lie in this area, who is overwhelmed with a lot of reading, and who does very well with workbook-y type stuff. She wants more hands-on science, but maybe not every single week?
We've looked at RSO Bio 2, but I think it's going to be too much for her (and maybe me!). We currently have Elemental Science's Bio for the Logic Stage, but we're not loving it--we both find the instructions confusing, we don't love picking around at the reading, and she wants more experiments (which I know is harder to do in Bio). A PS-type textbook approach might be good, but I don't know what's recommended there, so I'm hoping some of you might have some guidance for me, or some suggestions I haven't come across yet. Thanks!
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On 5/5/2018 at 9:22 PM, wilrunner said:
I'm glad you're feeling better!
I've never heard of baking soda water. Is it similar to Tums?
It works similarly to Tums, and is maybe just a little less pleasant to take! For me it works way better than Tums does. I do maybe 1/4 to 1/2 teaspoon baking soda in a 2-3 ounces of water, swirl it around so that it's all floating, and swallow it down fast. I used to have to rinse out my mouth afterward because of the taste but now it doesn't even bother me.
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For what it's worth, my younger DD started at not quite 11 1/2, and while her first was a pretty normal-seeming period, she's only had two other real periods over the past year, as well as some random spotting. She's only just now starting to get on some sort of schedule with period-like signs. So it might not be full-blown menses just yet.
Hugs to you both!
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Thank you, everyone. I guess it must have just been gas or indigestion. Not long after I posted, I started feeling reflux symptoms, so I drank some baking soda water, and the pain dissipated somewhat. It went away entirely after we ate dinner. I've just never had it happen quite like that! It really felt like some inflamed organ. I'm keeping tabs on the area just in case it happens again, but I guess I'm in the clear. Thank you all for your voices of reason.
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And do you think it's an emergency, or even kind of urgent?
I met a friend for lunch today, and I had a half a sandwich and a cup of soup. Then I had a tall iced coffee from Starbucks. After that I came home and sat on the couch and did some work, and slowly started realizing that I have a dull pain on my left front side, below my ribcage. Not major, but definitely there. When I stood up, I could press in that general area from outside and make it hurt from there, but then after a few minutes I couldn't make it happen again. But the dull pain is still there. Now that I'm sitting again, I can feel it kind of pushed up under my ribs.
My gallbladder is already gone, and I do have kidney stones, but this is almost definitely not a kidney stone. The urgency question is because I am between doctors at the moment, so getting in to see someone new is going to take a couple of weeks. We have a good urgent care nearby, but they don't do x-rays anymore.
Any thoughts, good doctor?
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8 hours ago, sassenach said:
That eight-legged thing? What magnification? There’s a reason I don’t look at stuff from my house under our microscope- shudder!
Seriously! It was only at 40x, so I think rebbyribs is right, it's too big to be a bacterium. I was more afraid of some kind of waterborne organism! I did another clean water sample after this one and it was very clear though, so it must have been from the dust.
6 hours ago, Cecropia said:Interesting!
4 hours ago, Hen said:yikes!!
Yikes is right. Now I feel the compulsive need to keep looking through the dust in my house for more weird stuff *shudder*
4 hours ago, rebbyribs said:My guess would be trichomes (plant hairs). I don't think it could've been a bacterium based on the size of the blue thread. Even under 1000x magnification, most bacteria still look pretty small.
Huh! I was looking at Google images and thinking it didn't look like any of them until I came across this:
http://www.microlabgallery.com/gallery/Plant Hair945-12 2a.aspx
I did initially think it was maybe some kind of pollen, but when I Googled, I decided it wasn't. It's definitely not plant hair season here yet, but that doesn't mean it couldn't have come from the dusty heating ducts.
Thanks everyone! I'm a little less freaked out about it now :D
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I decided to try to see dust mites under our microscope today. I didn't see any (that were recognizable, at least), but I did find this! I did some googling but I'm not coming up with anything. It was either from the drop of tap water (or contamination from the tap itself) or in the dust I scooped up from our TV stand.
Can anyone ID it? Thanks!
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1 minute ago, Penguin said:
Same problem.
Where is the support page?
Penguin, I only see your username.
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Someone posted that they're working on it and would post a solution on the support page. Off to go find that.
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Darn, still my email...
Court....have you ever been to court? Testified?
in The Chat Board
Posted · Edited by ILiveInFlipFlops
I was 43 the first time I was in a courtroom. It was the first time I'd ever actually gone in for jury duty, and I was called in for the start of jury selection for a murder trial. Sat for a couple of hours through a jury survey and the judge's explanation of what to expect and the jurors' responsibilities. Broke for a couple of hours for lunch, went back in, the judge asked for volunteers, sent us all out, and an hour later we were all dismissed. I have a health issue that had me incredibly anxious that I'd end up on the jury and was so thankful to end up excused, but it was an emotional and eye-opening experience.