Insurance Freeze

When you apply for insurance, you must disclose any "conditions" and up until Sept 23rd (supposedly) EVERY insurance carrier would deny you covereage.

The new law addresses those outrageous practices first. It was supposed to take effect on Sept 23rd, but it turns out, the insurance industry has decided that they don't like these rules so they are going to sidestep them by refusing to write any policies for children. In other words RIGHT NOW YOU CANNOT BUY INSURANCE FOR A CHILD. All the carriers have stopped writing policies except BLUE SHIELD.

I had the rare priviledge of speaking to a senior account specialist at Blue Shield today in a conference call with an agent. We were trying to see if we could switch to blue Shield and thus be able to get Nico's operation.

First thing to know is that they are all guided by the electronic "bible" that they can search within their network only. This document is the absolute final word on how they write business and what their policy is on all things.

It is a document that is issued by the teams of Harvard MBA's that are tasked with the job of squeezing every last cent out of this business and signed off by the senior bean counters.

The current rhetoric from this document is that because dedcutables are calcualted each year, they are "not able" to issue new policies to children with "pre-existing" conditions until Jan 1st 2011. I guess it would make their accounting difficult.

So even though there is black letter law to the contrary, you cannot get an IFP (Individual Family Plan) until Jan 1st with Blue Shield, the only carrier writing new business.

Meanwhile, insurance rates went up as much as 48% this month. After Jan 1st, rates may go up again. Well now, there is a shocker.

Currently, they rate you from Tier 1 to Tier 5. Tier 5 is about double the cost of Tier 1. If one member of the family has a pre-existing condition, then they will be at Tier 5 while the rest of the family may be at Tier 1, putting the plan somewhere around Tier 3 (50% more expensive).

If you need a procedure and are thinking of doing it on your own dime, dont bother. It takes two years before that rate decreases after a surgery because of the risk of complications. So even if you pay for your own surgery, your insurance will be the same rate as if you had not.

Apparently, Blue Shield is swamped with new business right now and MANY MANY parents are demanding to know why they still cannot get coverage. I am more interested in why the politicians are not all over the insurance industry for flouting the new law?

Kaiser Denial

From BambiniPt2

Video:
Mirror mirror on the wall

Well after all that work, Kaiser has denied our request for an outside referal to a specialist surgeon. A month has been wasted (not to mention the insurance plan premium) and despite a letter from the specialist and a letter from the Senators office, they have the gall to refuse us a simple outpatient operation. Incredible.

Both the boys are crawling well now, and Barbara has decided to conduct bath time in the bath tub. They are like slippery snakes in there. You have to hang onto a limb otherwise they dive in.

Barbara had a tough adjustment from the jet lag and lack of sleep during her trip and return. There have been some rough nights with the babies as we try to desperatly find a combination of feeding and sleeping schedule that will get them to 6am. Barbara still gets up at 5am and does a full days work and it is taking a toll.

barbaras joints, knees in particular are causing her pain. We think this is "normal" after giving birth, but the Kaiser doctor says its nothing to worry about. Standing up with babies is not helping, but there is little to be done about that.

We have had to put our search for a new place to live on hold while we try to put out all these other fires. Our landlord has been very acomodating and allowed us to stay a little longer and pay a little more. How thoughtful.

Ciao Zia's

From BambiniPt2

Videos:
Prison Bed

A big CIAO to the Zia's, Anna maria and Letitcia in France with Barbara. Below are all the video links for you to enjoy

Both babies are mobile now and they are very adventurous. Nico is faster than a bullet train when you take you eyes off him and he wants to open drawers and pull things off shelves. We need to do some more baby proofing soon.

As a result, I put the cribs back together today. The one thing they offer is a high prison wall of wooden bars. This is not so important duing the day, but at night, Nico has been waking up with more energy than the morning.

We have beentalking about sleep training and bougth several books on the subject, but so far they just seem to make big claims like "12hours spleep by 12 weeks" which may sell books. but bears no relation to reality.

From talking to a ouple of nurses, we may try a technique that involves comforting them for a few minutes and then leaving the room. Without a bed that can restrain them, this is impossible. Now the cribs are no longer beds, but Prisons.

Previous Videos:
Nico first Crawling Video
Nico mist facial
Tickling Chairs
Nico Chair Assault
Valerio tastes a lemon
Visiting friends
Sunday park lunch band
Nico demonstrating his dexterity with the vertical blinds
Working in the office with two little helpers
Taking a little video break
Jumperoo
Swing
Weekly Farmers Market Band
5amForFiveMo
FirstImpressions
CameraConscious
Road Trip Excitement
FloorTickle
CribMobile
Bath Time Terror
StreetDancing

Survivor - One man, two babies, one week.

From BambiniPt2

Barbara has gone to France for business. I have begun a one week looking after two babies by myself. My first lesson came first thing Monday morning (don't they always)

Last night I put the two babies to bed... alone. We have done this together since they were born. This is a challenge as it usually takes two of us the better part of 30 minutes to calm them down and get them to sleep.

Nico can be tough. He is heavy, strong and wants to keep going. Luca with a little gentle rocking can go to sleep quit easily.

So we began with idea #1. put them both in bed and rock both beds. That lasted about ten seconds. So to idea #2. Hold Luca and rock him in my arms while rocking Nico in his crib with my feet. Nico was out of the crib and bolting across the floor in no time.

So to idea #3. Get Luca to sleep and then work on Nico. Luca was going nicely until Nico started making a ton of noise and that woke him up. A little more persistence and I got Luca nearly asleep before I had to drop him in the bed to wrangle Nico. This woke him up

and so to Idea #4. Sit on the floor with head in hands praying they would fall asleep on their own


and so to Idea #5. Exercise extreme patience and wait for an hour until Nico has tired himself out. Mean while, rock Luca and just wait to see what happens. This did eventually work. I had to wrangle Nico with my feet a few times, but he stayed in the nursery and stood up to engage the humidifier, his new alter.

He is obsessed with the remote controls, so I give him an old one to keep him amused. His new puzzle is trying to figure out how to hit the humidifier with it so that the two fit together like other puzzles. The noise is not conducive to sleeping!

I decided to practice patience (not that I had a choice) and by some baby miracle, Luca went to sleep amid the clattering. As soon as he was well enough gone, I scooped up Nico and Viola, two sleeping babies.

Unfortunately that was not the end of it. At 2am Nico woke up for a feed, and when I put the helmet on him, he became completely awake. There is no easy way out of this. It requires at least 45mins persistent effort, usually walking a round the living room, until he calms down enough to rock him to sleep.

His former record was 90 minutes.

I rocked him for 30 mins, he was more awake than ever. I put him in bed he crawled out. I rocked him some more, nothing. So I put him back in the chair we feed him in and he just rolled over and over like an alligator with prey locked in its jaws. I tried the other chair and clambered all over it like a climbing frame. I put him the master bed. He screamed.

Yes two hours of this, 2am to 4am. Every combination and permutation you can think of I tried. We watched TV, we played, I rocked and rocked. We made a sandwich, we laughed and joked. NOTHING would get the baby back to sleep. Finally at 4am he started to show a little weakness in the struggling, so I rocked with more determination and he slooooooooooooowly went to sleep. I collapsed on the sofa covered in sweat, exhausted.



Last week my server died, on Saturday, my desktop died. Both Motherboards. This machine is my daily workhorse that has run perfectly for almost ten years. They don't sell these in stores anymore.

If I buy a new motherboard, I have to buy a new processor and memory - basically a new computer. So I fired up my old laptop and began searching for a solution. After 6hrs I was no closer. I did not want to buy a new machine but it makes little sense to put more money into this old one. So I went to bed. I woke up this morning with a great idea. I could just turn the crash course in baby wrangling into a dual project: Baby wrangling + sleep deprivation.

The babies are acting up cos mom is gone, the phone is ringing, I have a dead computer and I finally got a letter from the Doc in Dallas that has to be faxed.

It has to be faxed because Senators office deletes all attachments and will not download anything without some complex screening process that no one that works their can seem to understand or be bothered with. As a result, we have to use stone age technology. Luckily, amidst Barbara's collection of old business technology, she has a fax machine that works. The problem this morning was printing.

HP make printers that seems to require the installation of more software than is needed to run a NASA space mission. It takes about an hour of clicking and patiently watching progress bars crawl across the screen just to get the printer to print. Since my desktop is dead, I decided to use Barbara's.

It was at the exact moment that I had two babies perched on my knees, and Barbara on Skype waving to the babies (who were wondering why she became a 'flat' person where the Rhino marches around) that the printer died... bright flashing exclamation point and dead as a light pole silence.

It was a long couple of hours after that, but I did get the letter faxed to the senators office. Hopefully now they will apply a little pressure.

Sleep Crawling

From BambiniPt2

Nico first Crawling Video
Nico mist facial

Nico has been sleep crawling the last couple of nights. The first thing we know is when the breathing detector alarm goes off because he is no longer on the bed. It is dark in their room and as we slide the door open, light spills onto the floor to reveal Nico frozen in motion like an escaping convict hit with a searchlight. Its a hysterical moment... Baby break out.

After a week of very sleepless nights and more baby snot than I care to think about, it seems their colds are getting better. The current Indian summer with temperatures in the mid 90s doesn't hurt either.

After a few days the Similac recall hit the news and we wondered if there was a connection. Since the taste of baby powder with bug guts additive is probably reminiscent of pure bug guts you get familiar with on a motorcycle, I decided to become the food taster and ya know, I think I fell more energetic like my hairdresser said. Best of all I know have a legitimate title for the deposits on my waist... baby fat!

First Cold, Car Seats & Health Care Reform

From BambiniPt2

Most babies get their first cold before their first birthday, and it seems our boys are no exception. Thankfully it does not seem to be too bad. They are ok during the day, but at night they are blocked up and wake up every hour crying. After three nights of this I have given up trying to keep them from waking Barbara, and just give her one of them so I can get the other back to sleep.

I rushed out and bought another humidifier as the moist air makes it easier for them to breath. Babies don't know how to breath through their mouths so they get very freaked out when their noses don't work. This is our second humidifier. The last one smells bad and probably has mould growth in it. They are virtually impossible to clean properly and all the water additives and silver anodes don't seem to do the trick. The only solution is to use distilled water which is totally impractical.

We have been having a big debate about PJs for the babies and this week we are trying out two flavors, both with long sleeves. One his a long tube and the other completely encloses their feet and zips up. They always seem to have cold arms or legs in the morning and any blankies just get thrown aside as they toss and turn.

Nico is getting heavy and he is quite strong. Luca has a vice like grip and can case pain if he grabs the skin on your forearm for example. They are growing so rapidly we are afraid they will no longer fit in the car seats, so this week we worked on buying them new seats.

The Britax model has been on the market for many years with excellent reviews. Luckily there are many families in the bay area selling car seats so we started looking for one used seat to see if Luca would like it.

It seems that car seat manufacturers have colluded to propagate the myth that a car seat has a shelf life of only six years. The carseat "lifespan" was touted as being ten years, but I guess someone realized that a few extra billion dollars could be extracted from the market by changing this to six years supported by "fear of death" marketing with "official" statements that the seat is "not safe" after six years.

This is complete nonsense of course. Just to check, I thought it might be amusing to start a thread on an engineering forum to see what people in the industry had to say. Generally speaking polypropylene has some very long lasting durable qualities, which is why they made the car seat out of it in the first place!

One of the major advantages of polypropylene is its complete resistance to attack by environmental stress cracking (which causes other plastic to become brittle and crack). The principal problem is solar radiation (UV) from sunlight (p133). The surface deteriorates by crazing to a chalky friable material of very low strength. In mouldings, the surface can be scratched away and bleaching is visible.

This is all good news for car seats because they are mostly completely shaded from sunlight. They sit with their back against the seat and the front is completely covered with a fabric seat cover. Some small unimportant areas of the base may be exposed, but if they were effected it would be immediately obvious.

Now why am I bothering to explain all this? Because people believe this industry BS, and when you mention car seats they get this intense stare as they repeat the same thing every time: "We bought new car seats. Our babies safety is worth it." This is exactly what the manufacturers want the public to think.

In fact, the statistics show that this scaremongering has nothing to do with the reasons infants are killed in cars every year.

"In the United States, more than 2,000 children under 14 years of age die each year in vehicle crashes. Most of the fatalities happen because the children aren't secured in specially designed car seats. Instead, they are strapped in the wrong kinds of seats...or they aren't wearing any restraints at all. Child seats are also often incorrectly placed rear-facing in front of air bags. In 1997, six out of 10 children who were killed in vehicle crashes were unbelted."



Notice nowhere is deterioration of plastic leading to failure mentioned. This is because it is JUST NOT AN ISSUE. In fact you could place the child in a bucket so long as it was secured properly in the car and he would probably survive just fine. Car seats do not go flying down the tarmac and impact solid objects. The just provide a seat to restrain the child in for goodness sake.

Fortunately for those of us that are able to discerne these simple truths, this leads to a large supply of perfectly good car seats that nobody wants. Since people believe that a car seat is useless after six years, and junior is going to need it for about four years, they all look for a 2yo seats. Seats that are four or five years old are virtually worthless in the market.

Just about every website now quotes the shelf life number of six years so it has become a self perpetuating "truth". About the best they can offer as a reason is the the belts and buckles wear out. This is even more insulting to the intelligence than the plastic degradation (which I have not seen mentioned).

Safety belts and buckles have to be about the most rigorously manufactured items in any vehicle. They have triple stitching everywhere and are made from materials that are designed to never fail. They are not affected by UV or heat or freezing or water or any elemental force. I have actually used these belts to tow vehicles. I could probably tow city buses when they break down for the next twenty years with any child car seat safety belt, and this is what they allege is going to wear out? Its absurd.

Wear on this kind of belt is visually evident. There is obvious fraying. Buckles are engineered very well in the first place. How are they going to wear out? Is the metal going to be worn away by the friction or something. It's just ludicrous rubbish.


So anyway, we picked up two very nice examples of these "worthless" car seats this week for $40 (they retail for $280 + tax). We actually paid more for two brand new seat covers that we did the seats. When the original covers were removed, a perfect car seat was lurking underneath. It will probably be just as good in 60 years.





Today the first part of the US health care reform took effect and.... the insurance industry completely ignored it. This is an industry that takes real money from millions of people and promises services that they employ an army of people to deny you when you need. This is true of car insurance as much as for health insurance. It is the business of scam artists in suits that spend more time and money lobbying congress to make .living without their "products" illegal than they do providing the service they claim to sell.

The original concept of insurance, was as a general fund for securing provisions to widows, sisters and other females related to soldiers during the Napoleonic war. It was started in March 1812 by a number of "eminent Scotsmen" gathered in the well established Royal Exchange Coffee Rooms, and called; Scottish Widows Fund and Lif Assurance Society.

Since then, this concept has been twisted, manipulated and distorted into the joke that passes for insurance "industry" today. This is a place where teams of Harvard MBA's spend the bulk of their careers working on "products" designed to separate people from their money with the promise of "coverage" that to actually benefit from, requires hours and hours of reading fine print to determine how to get a simple referral.

Then when you actually make a claim, whole departments of employees spend their days finding ways to deny the benefits you paid for and desperately need. Instead, your premiums have essentially paid the salaries of the people who are working to deny you the coverage you thought you were paying for.

This situation is not new, or limited to the US. This country just happens to have the most egregious examples of desperate people being denied life saving treatments, coupled with blatant industry wide predatory practices.

Today we were supposed to be able to change insurance plans. The US government wrote legislation that mandated change. The insurance industry has done nothing except spend our money trying to fight the change, spreading misinformation and hiking the rates by as much as 30% in a political move to blame the administration for the hike!

In fact a misbegotten last-minute bill using exactly the insurance industry's language on actuarial justification passed on the last day of the session. And an effective bill to regulate health insurance didn't. You could almost predict the votes by how much each legislator got from the $800,000 the insurance industry recently contributed in the state Senate.

I have called many insurance agents trying to find someone that can write us a policy. Not only do they have NO IDEA if this is possible, they say there is "confusion" in the industry right now.


Contacting people in hospitals is hard. It took a week to get the Dallas administrator to respond and the news was not what we expected. I had asked her to confirm the rates that the Doctor told us. Somehow the facility fee was double. When I asked about this, they said they were trying to negotiate this with the hospital.


Meanwhile, since it may make sense to go to San Francisco, I have been attempting to find out how UCSF has the gall to charge $5500 per hour for an operating room that the insurance industry "negotiates" for somewhere around 10% of that. The answer it seems is a national disgrace recently highlighted in a recent 60 minutes story.

I called the billing department and after being transferred to Siberia and back, got a monotoned Asian woman that was obviously the designated bearer of bad news for the faceless hospital administration. She told me that this rate was in fact 40% off the actual rate (which would make the actual rate $18,333.33, an improbable
number if every I there was one).

I asked her if she could give us the "MediCAL rate". This would be a fair
price negotiated by the industry. She said she could not. So I asked her why this rate was so high? She had no answer. I explained that other facilities around the country charge self pay patients between less than 1/4 this rate. She simply said that this was "real rate" that other people had paid.

Next I asked if this was an example of price gouging reported in the 60 Minutes show and read her the quote: "Basically, hospitals charge uninsured people four or five times more than what they would accept as payment in full from an insurance company. Simply put, it's price-gouging,". There was no response.

Finally I asked her why a hospital would impose such a hardship on the uninsured?
you would think they would be the group that was offered a lower rate than
the insurance industry. No answer. I pointed out that people that
come into the emergency room and cannot pay inflated bills are often offered
steeply discounted prices. I asked her if this was possible. You can guess what the answer was.

After I got off the phone with her I wrote to the Doctor again and asked him if there was anything that could be done or if we could perhaps use a different facility? I got the customary one line answer with no preamble whatsoever: "you can check with Children's hospital of Oakland". You would think this man has a tooth extracted for every word he uses in an email. I have never seen anyone this economical with words. So I called Oakland.

I had along conversation with the pediatric urology administrator who loosened up after a few minutes and told me things that "I didn't get from her". First she pointed out that Oakland sends its billing through UCSF and so their rate is whole $1000 cheaper. Some grey little administrator probably finds that amusing. After that she revealed that this practice is common and many people suffer from it... except of course other doctors dentists and hospital employees and their friends and families.

She then revealed that the Doctor is the one that sets this pricing and he has the power to set it at some other level as a "professional courtesy" for another doctor for example. I could appeal to this Doctor again and beg for a courtesy, but I don't know why he would extend this to us.

So I asked her if she thought our state senators office might be able to apply enough pressure to the hospital administration. They can write letters asking for explanations and apply the scrutiny of a US senator. She applauded this idea (but she didn't say that) and said anything like that would help everyone.

So next I contacted Barbara Boxers office. A very eager young man responded immediately and sounded like this was just the kind of thing he would like to sink the teeth of her office into. He wanted me to fax him release forms so that he could begin gathering information and get to work.

Since I don't think any of this is going to resolve itself in the next four weeks, it looks like we are going to have to scrub his operation for now.

Crawling

From BambiniPt2

Nico is crawling. he went out of the nursery, down the hall and into the living room before he collapsed in a heap. We are not sure if the helmet is weighing him down or if it is just exhausting. Luca is not quite there yet.

This has put added pressure on us to move forward with his surgery. My trip to Dallas was a long two days of flying, and a day with a short meeting sandwiched in the middle. It was a lot of effort for such a short meeting, but when after five minutes with this surgeon, I finally understood what he was all about.

His staff suggested I paid $180 for the "consultation" I suggested that spending $1000 to get there was probably enough. The Doc was to the point so I suppose he was not thrilled at being questioned about his work, but as i explained, I am leaving no stone unturned for such an important procedure. There is really only one shot at getting it right. Any follow surgeries will be to repair the first.

He explained a technical aspect of the procedure he invented (actually a variation of a basic procedure). His procedure is not officially named after him. He recently published his results. He has performed this procedure on 500 consecutive patients in the last ten years. His complication rate was 4%.

He explained that there is a checklist he goes through once the patient is on the table and if all the criteria are present he can proceed with his procedure. If not he has to break it up into two steps, but that is rare.

I brought with me about five pages of text and illustrations photocopied from some medical textbook that our Kaiser Doc had sent us. I showed these to him and asked what he thought. He immediately recognized the procedures and declare that he had tried these years ago and they had an almost 100% complication rate. Then he said "you can quote me on that".

As I asked a few more questions about the procedure he finally declared "this is just really hard to picture until you see it in front of you on the operating table. I studied it in medical school and still didn't get it until I saw it for the first time"

However, I finally did understand why he does what he does, and why he always does it. Initially it was not known if his technique would impact healing, so he began to keep careful notes and do extended follow up with patients to find out. He kept all this data and has published it. In fact the point of publishing the data was to answer that question.

Finally I asked him about the anesthetic. He said they do put a tube down his throat because otherwise the anesthesiologist would have to hold the mask in place for three hours and if he needed to do something else he would not be able to.

This sounded a little like justification for "we do it the way that makes our lives easiest" but he assured me that even though the tube has a fairly severe impact on adults, it is not like that for infants. Hmmmm. I was not convinced. I wondered if this was a case of a "physician minimizing". I decided I needed to speak to an anesthesiologist next.

So with this Doctor we get a procedure that has been tried and tested and the surgeon that invented it and has his reputation is tied to it's success. I don't think you could ask for better. We have to take on faith that the anesthesiology will not mess up his throat. The downside is we have to fly two infants to Dallas and stay for a week or two.


By contrast, we have been waiting for two weeks for a cost estimate from the prestigious UCSF. I finally ran out of patience today and called again to be told the person that handles this is on family leave and the guy that is filling in is "swamped". I wrote to the Doc again and asked as politely as I could if there was anything he could do to help, 20 mins later a PDF estimate arrived in my inbox.

Upon opening it almost had a heart attack. The surgeon fee and anesthesiologist fee were about the same as the Dallas Doc, but the "Facility Fee" was 3x higher. Considering Nico will not be staying overnight and the operation will be three hours, I can see no way to justify this. I replied explaining that this is coming out of our pockets, and asked for something more reasonable. Since this is unlikely, our decision is probably made for us.

This Doctor is very well known and mostly uses the same procedure. He has less investment in the outcome as he does not publish his results (he has attained all the status he needs as a professor, research director and lead surgeon of a prestigious hospital). He claims he uses a simple mask to deliver the anesthetic.

Although this location is more convenient, everything is difficult and there are layers of incompetence at this large, old "facility", and their fees are outrageous. We have to schedule this soon so we have to decide.

I wrote the first "demand letter" to Kaiser this week. I can't wait to see what that yeilds. It was fairly general and made the main point in our argument; that they do one or two of these per year, and the specialists do 150! I saved the complication quote for the next one which will enumerate the list of reasons we are not willing to let them experiment on our son. Sheesh. Most parents would never know until it was too late.