Turn Your Head and Cough

Until recently, our family was on a high premium / low deductable insurance plan.  A trip to the doctor would set me back $20.00.  The problem with the plan was that the premiums were going up, up, and up.  Last year I took a serious look at the low premium / high deductable plan and after some serious consideration, we switched. 

In a nutshell, my premiums are pretty low (compared to what I was previously paying) but the exchange for that is we pay the first (roughly) five thousand dollars out of pocket.  Completely.  No co-pays, no deductions, nothing.  I pay the FULL amount of the cost of a office visit, urgent care, emergency room, or hospital visit, but thankfully we are allowed annual check ups at no out of pocket expense.  It sounds pretty ominous, but truth be told, the premiums on the other plan cost us more than the maximum out of pocket expense for the current plan.  So far, it has generally worked out for us.

Last week we received a pretty significant medical bill.  It came from our kids’ regular clinic.  The bill covered one office visit, and two check ups – so I assumed there may be some sort of error in the billing.  I talked with the Mother of Five about the various visits – and determined that we did indeed have one office visit (billed), and two check ups (non billed) – and that during one of the check ups a “procedure” was done.  This caused the one “check up” to become an “office visit”.  Considering the fact that an actual procedure was done (equipment and supplies) I was willing to pay for that but the overall bill was still too much.


I called the Medical Billing company.  They could not help but referred me to the insurance company.

I called the insurance company.  They could not help but referred me to the clinic.

I called the clinic.  The office manager could not help me but referred me to someone called a coding specialist.  The coding specialist would be given our case for review and then call us back.  Roughly a week later, the coding specialist did call me back. 

Boy oh boy did I learn a few things. 


What it boiled down to was this.  Yes, a “check up” has no out of pocket expense for the patient, UNLESS you and/or the doctor actually do or say anything other than… well… pretty much ANYTHING.

Want a no out of pocket expense check up?  Go in and keep your yap shut.  Don’t ask any questions, and don’t answer any either.   And if you have anything wrong with you for goodness sake, DO NOT BRING IT UP!  It would seem that a check-up is NOT for discussing your medical health.

The particular patient in question has had an ongoing problem with nasal congestion resulting in a number of sinus infections over the past two years.  Sinus infections that have been treated by the same physician that was doing the annual check up.  During the check up, the physician asked my wife how the sinus infections were going (remember, this was brought up by the physician).  My wife told the physician that there were still some lingering effects, but nothing significant.  The physician then prescribed one more round of meds to hopefully finally free her from what was causing the infections.  The whole interaction with the physician about the sinus infection took less that three minutes.  It was one question asked, one answer given, and one prescription re-issued.  My wife never gave it any thought before, during, or after the exam.

The coding specialist explained to me that the three minute discussion (even though initially brought up by the physician) is what resulted in a $150.00 medical bill.  The act of writing a prescription caused the physician to (and I quote) “make a decision”.  The act of making any sort of decision during a annual physical will result in that office visit getting doubled coded as the “check up” and as an “office visit”.  

Don’t forget folks… This $150.00 is on top of the amount that the insurance company is paying the clinic for the check up.  Just because there is no out of pocket expense for me does not mean the clinic is doing the check up for free.

She also went on to explain to me that it does not even have to be a “procedure”, or a “decision”.  If we even discussed anything about the patient’s health it may result in additional coding (and billing).

During my “lesson” I asked the coder how my wife could have / should have answered the physician's question that would have prevented the bill.  She had no concrete answer.  I asked her why the physician did not stop my wife from answering, or warn her that by answering that one simple question, we would be billed for an office visit.  She had no concrete answer.  I asked her if (in the future) we should simply be deceitful about our health when it comes time for the check ups.  She didn’t say no!  She told me that “I can’t tell you that’s what you should do”.

“Turn your head and cough??”  Nope.  This feels a lot less like a hernia exam and a heckuva lot more like a procto-exam.

Our Home Town – The Introduction

“Our Home Town" is a new series of articles where I will share with you some of the unique aspects of life in our small town of Jordan, Minnesota.  If you are interested, you will be able to access each of the posts in this collection by clicking the "Our Home Town" link in the "Perpetual Posts" group on the sidebar.

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Jordan, Minnesota - Our Home Town! Jordan, Minnesota.  It’s where we call home.  We quite frankly “stumbled” into the area.  We were looking to upgrade our house and were pretty much exclusively searching the Farmington / Lakeville areas for pre-existing homes.  It was during the early stages of the housing boom and my brother-in-law was working for a home builder.  On a whim we drove out to where he was building.  That just so happened to be Jordan.

I’ll be honest.  Initially the most intriguing aspect for me was seeing what we could get for our money building a new home in Jordan versus buying a pre-existing home in the Lakeville / Farmington area.  We did a little checking on the schools (noticing they had a Catholic elementary school – a HUGE plus for us) and liked what we were seeing.  After a little discussion (and “what-if’ing” on my part) we took the plunge.  While our house was being built we took many opportunities to visit the construction site and spent time getting to know our new area.

We have been in Jordan for more than 12 years (at the time I am writing this post).  I have come to know and love Jordan as “home” through that time.  From early on it felt right.  The more time I spend in Jordan, the more I love its charm and characteristics.  Jordan like any other city or town is not without its challenges, and skeletons in it’s closets.  While it may not be the perfect place, it feels like a good fit for me and my family!  I have seen many changes throughout the years.  Some for the better and some for the worse – but they all add up to give Jordan it’s unique flavor and character.

Before I delve into the unique flavors and characters of Jordan (i.e. future posts), I’ll educate you with some of the cold, hard, and raw facts.


Jordan, Minnesota (via Google Maps) The City of Jordan is made up of 2.6 square miles located 42 miles Southwest of St. Paul (the capitol of Minnesota).  It is located along the hills and bluffs of western Scott County and is nestled between Spring Lake and St. Lawrence Townships.  Jordan is just south of the Minnesota River (which is the natural boundary between Scott and Carver Counties).     

According to the US Census in 2000 (one year after we moved here) there were 3833 residents living in Jordan.  The 2010 US Census reported 5470 residents. 

Highway 169 cuts through the middle of our town.  It also meets up with Highway 9 / 282.  Highway 282 also crosses Highway 21.  There is almost a triangle of highways that cut through our town.  We have two stoplights.  One at 169 / 9 (282), and the other at the intersection of 282 / 21.

We have two rail lines that run through town.  The Chicago-Northwestern on the northern edge of town that runs along highway 169 and Minnesota Prairie Line that runs through the heart of our downtown.

One thing is certain!  We have a rich and colorful history, and a number of landmarks, destinations, shops, and amenities – both civically and privately owned.  Too many to mention in this brief introduction. 

Over the next several months – I hope to build on the “Our Home Town” series by highlighting one of the many unique and wonderful aspects of living or maybe highlighting a specific item of interest within Jordan.  

The goal is build an extensive collection of posts that share what I love about living here!

Another Midnight Release

It was one year ago (well, an year and two days) on 11-11-11 that madness broke out at midnight.  This was the release of the eagerly awaited Xbox360 game that #2 of 5 had previously reserved a copy of.  We waited in an hour long line (at 28 degrees) for his copy of Skyrim (The Elder Scrolls V).

Call_of_Duty_Black_Ops_II_Game_Cover November must be the month for video game releases (anticipated Christmas sales?) – because last night on 11-13-12 the eagerly awaited Xbox360 game Call of Duty - Black Ops II that #3 of 5 had previously reserved a copy of was scheduled for release.  Since I had done it for #2 of 5, I felt I should do it for #3 of 5 too.

I had very little sleep the night before, and had to be up by 4:45 am the next morning.  I was actually looking forward to going to bed a little early when #3 of 5 arrived home from school, and it hit me (like a ton of bricks).  Today was the day.  Tonight was the midnight release of the Call of Duty game that #3 of 5 was so eagerly awaiting.  Technically, the release date was 11-13-12 – but the “midnight release” meant that we would have to line up and wait on 11-12-12.  I was very grateful when the Mother of Five actually suggested I lay down and take a nap beforehand.

Since he was using gift cards from games he previously sold back to pay for tonight’s purchase we were pretty much stuck going to one of the larger national chain stores (Gamestop) nearby.  It’s not that I don’t like Gamestop – I actually do, but we have a similar business (HighScore) that is locally owned and half the distance away.  Their store is fun to visit, and they also have some fabulous customer service!  So I was saddened when I woke from my nap and noticed that HighScore updated their facebook page with an announcement that they would be providing free pizza and a Monster for the customers in their line.  

Black Ops 2 midnight releaseWe headed out by 9:15pm and arrived at the store at 9:30pm.  #3 of 5 paid his balance and was given his spot in line.  #10-4 (group 10, customer 4) – this made him #104 in line because each group had 10 customers.  For the next 45 minutes we lingered in the store.  I played on the new Wii U controller, Unchartered, and some Gran Turismo and browsed around the used game area.

Behind the counter were stacks and stacks of the game, in Xbox 360, PS3, and Wii platforms.  There was also the deluxe collectors edition, and the “Pièce de résistance” – The Call of Duty Black Ops “Care Package”.  (Those suitcase like objects)

 

Black Ops 2 midnight release  Black Ops 2 midnight release

Throughout this year’s experience I noticed a couple of things.  One very similar, and one polar opposite from last year’s event.

Similar to last year, the crowd “demographic” remained remarkably unchanged.

- Predominantly male (while borderline crude, to call it a “sausage fest” would not be an exaggeration)
- 16-25 years old
- “I still live in my parent’s basement” (Need I say more?)
- A fair amount of acne. (Too busy gaming to worry about hygiene.)
- Goth, emo, skater, or just plain unkempt (hobo like) appearance.
- A large representation from extreme ends of the “body frame bell curve” (“emaciated” or “corpulent”)
- Black clothing (skinny jeans, trench coats, Converse All-Stars, etc)
- Body piercings
- Overly caffeinated bravado and machismo. (Not sure why, see first observation)
- Extreme braggardly, theatric and exaggerated stories, jokes, and tales told from their tremendous base of knowledge and life experiences.

But, unlike last year’s “gaming grandma”, I experienced the opposite end of the age spectrum this year.

A toddler, her “Teen Mom”, and her mother’s friend were also in the store waiting for the midnight release.  I mean a toddler?  Really??  I won’t lie.  I was, quite honestly, a little relieved when I saw them leaving around 10pm. 

I was hopeful that the little girl would soon be tucked into her own warm and cozy little bed, surrounded by her dolls and stuffed animals.  My hopes were dashed when the trio returned shortly thereafter.  It would seem that they did not head home, instead they headed to the nearby convenience store to load up on sugar and caffeine. 

 Toddler drinking Mountain Dew Toddler drinking Mountain Dew Toddler drinking Mountain Dew 

Yup folks, that is a toddler drinking sucking down her very own 20oz bottle of Mountain Dew “White Out”, just before midnight…  But don’t worry.  I overheard her mother say she got a nap earlier in the day, so it’s all ok, right?


IMG_2304Black Ops 2 midnight releaseOnce 11pm rolled around, the store staff kicked everyone out into the harsh Minnesota cold.  They helped collect and gather the “groups of 10” (#1 - #20) into a semblance of a line, and the waiting began. 

It was cold out.  Seven degrees colder than last year!  It was 21 degrees with a wind chill of 11 degrees.  Most folks were bundled up quite nicely – but others were just wearing street clothing – and even a few (at least two) were wearing SHORTS!!??!?   

Knowing I had a full hour to go yet, I (like Mountain Dew Girl’s mother) also ran to the nearby convenience store.  I filled my tank with gas, and grabbed two hot chocolates.  We enjoyed the hot chocolate as we patiently waited our turn trying to keep warm. 

I enjoyed the “people watching” factor of waiting in line.  I listed to all the caffeine fueled “smack talk” – dudes exaggerating their “skills” and “experiences” in various video games, other guys calling them out on their stores, then turning and telling a “yarn” of their own.  Listening to packs of 17-25 year old males is quite entertaining!


The time arrived.  Midnight.  The first group of ten were let in the store.  Then the next group, and the next group.  Finally, it was time for Group #10 – Our group!  #3 of 5 headed into the store, and quickly exited with his loot in hand. 

Oh yeah…  One other little “observation”.  Want to know who bought one of those “care packages” (besides the guy in the video)? 

Yup!  Mountain Dew girl’s Teen Mom did!  She dropped almost 200 bucks for the “care package”.  Want to know how I know?  Because while we were still waiting in line, she held her care package above her head and made an theatrical announcement (laughing quite unashamedly) that she would be willing to trade her (almost $200.00) “Care Package” for anyone who get her keys out of her locked car…  (sigh)

On the way home I told #3 of 5 that this was my last rodeo.  I did it for #2 of 5, and now I did it for him.  By this time next year either one or both of these boys will be drivers and they can transport and attend their their own midnight video game releases in the future!

(YEAH!!!  I’m off the hook!!)

At least I can say I have done it… Twice!

The Start of Something New (and hopefully great!)

The problem with maintaining a blog for 6+ years is that you start to run out of new and fresh ideas.  When the kids were younger there was plenty of things they did, said, and / or got into that would inspire the creativity inside me.   As the kids got older, a lot of the things they did and said had already been talked about.  Then, even a little further down the road and kids got wind that many of their antics became blog-fodder.  At this point they could (and did) voice their displeasure with my use of their lives as content – eliminating even more inspiration for “The Life of a Father of Five”.

I don’t know how, when or why I ever had the notion that as the kids got older that my life would get easier, but somewhere along the way I did.  That factoid, my dear readers, is a misnomer.  As these kids get older, it’s even more difficult to find time to dedicate to maintaining something as frivolous as a website.

It is a recipe for killing creativity.

When I do get inspired with an idea it’s pretty rare that I can take the time to begin the creative process.  When the time comes that I finally do have some time, I have lost all inspiration.  Sometimes, I have time to start a post, but never get around to finishing it, having lost interest.  I also have an “incomplete” series of posts that I am struggling (internally) with posting. 

I need / want something more.  Something a little less controversial.  Something a little more creative.  Something new, fresh, and fun!  Something to add a little “pop” to “The Life of a Father of Five”.

Recently, I was mildly inspired by a singular idea, but as I developed that idea in my mind, it began to expand.  If I do “this” post, why not do “that” post.  If I do “that” post, why not “another” post?  Ideas came to me one after the other.  In fact, the ideas came so fast, it was almost overwhelming.  The more these loosely related ideas came to mind the more I noticed the thread between them strengthened and how easy it was to “stitch” them all together!  I put the idea(s) on the back burner (see “not enough time to dedicate” above) and focused more on the concept of these posts as a series.

It’s time has come. 

I am feeling inspired again.  It is time to take that simmering pot on the back burner, move it to the front burner and start a rolling boil.  I hope to introduce to you and the world my new concept in the next few days! 

Wish me luck!    

My Faith in Humanity Was Restored... Almost

Halloween and all its associated hoopla and hype had wound down.  The Mother of Five and I had taken #4 of 5 (and her friend) along with #5 of 5 on a whirlwind tour of our neighborhood, filling their pillowcases with as much Halloween treats as they could muster to carry.  About three-fourths of the way around the neighborhood #5 of 5 had her fill, so the Mother of Five and #5 of 5 took the “short cut” home while I tagged along with #4 of 5 (and her friend) as they finished off the neighborhood.

When we arrived back at our house the Mother of Five and #5 of 5 were attending the fire bowl set up in the driveway as the treat-giveaway area.  When #4 of 5 (and her friend) arrived home, they quickly ran into the house to take a look at the loot they gathered.  #5 of 5 ran inside to join them.  The Mother of Five and I sat around the fire bowl visiting and handing out treats to the now dwindling numbers of trick-or-treaters.  After 15-20 minutes, the Mother of Five headed in.  I wanted to finish my cigar, and let the fire burn itself down a little, so I remained at the bowl handing out treats.

It was getting late now, maybe 8:30 or so (late for trick-or-treating).  There were not too many more trick-or-treaters, but that was ok.  I watched as our supply of treats dwindled down.  With only 4 more treats to give out and only one group of three on the horizon, I began packing up the chairs, putting the pumpkins back to their rightful place by our doorstep, and handing that last group of three out their treats.  I then extinguished the fire in the fire bowl and was cleaning up the last of my mess when out of the corner of my eye I noticed three young children coming out of the darkness and across my yard towards me.  The first of this group?  A young lady not more than 8 or 9 years old dressed as a princess.  She was ahead of two boys who were still just crossing into my yard when this conversation took place (actual conversation – not embellished).

FOF:  “Happy Halloween!!  Bad news though, I only have one left to give out.”
Little Girl:  “Ooo!!  I want it!!  I’ll take it!!”
FOF:  “Ok, here ya go!  (putting treat in treat bag, then turning to the two boys) Sorry guys, but ladies first, right?“

Then the little girl took off running behind me.  As she reached my patio, turned to the little boys and said…

Little Girl;  “Hey (name of little boy) do you want this?  I’ll give it to you if you do!”
FOF:  “Wow!  I am so impressed!  That has to be the nicest gesture I have seen all night!”
Little Girl:  “It’s ok.  It was pretzels.  Pretzels suck anyway.”
FOF:  (silence)
Little Girls Brother:  “No way.“

Then, the three final trick-or-treaters of the night ran off to the next house.

Hopefully they got something a little less “sucky”.

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