After receiving another notice from our insurance company that a payment for service was denied, I thought it was time to share my family’s experience with the American healthcare system. I’m not going to get political about it. Individuals will define root causes based on where they lie on the political spectrum. I am not interested in placing blame, because it is far too convoluted. I am more concerned about how the disarray built in to the American healthcare system is going to give an otherwise healthy individual like me, a stroke.
I am not a healthcare expert, nor a political pundit. But I am one of those Americans who falls in that gray area that none of our politicians seems to know what to do with. I’m self-employed, and I make about as much as a public school teacher. My wife Anne is in graduate school full-time along with an unpaid internship, so as a family of four, we’re making just enough to shave by. Thankfully we have some savings from a house sale, along with a thoughtful extended family. Many Americans in our situation don’t have those safety nets to utilize in the case of an emergency. I don’t really know how they can manage.
15% of my gross income goes toward healthcare expenses, after the subsidy. If it weren’t for the subsidy, it would be 30% or more. The important thing to note here is that we are a healthy family. Outside of routine checkups, there is the occasional issue that Anne and I have to deal with as part of the normal aging process. We don’t have cancer or kidney disease. The good news is that, as a small business owner, I can write off a chunk of those expenses. The bad news is that when there is a billing dispute between a provider and the health insurance company, I take on a second job as a liaison, despite having no experience or qualifications to do so. If I lose the negotiation, then we’re fronting another few thousand dollars that might otherwise go into that thing that people keep talking about. I forget what it’s called. Oh yeah, “savings.”
A couple of years back I listened to an interview with a healthcare economist who described her experience after a cancer diagnosis. I am paraphrasing her statement, but it went something like this, “I am a healthcare economist with a PhD, and I don’t understand the bills and letters that I am getting from my insurance company. So if I can’t understand it, then it will definitely be impossible for anyone not in this field to understand it.” I continually have this experience with what should be routine procedures for a 42 year old man in generally good shape. I never know if I commit to a procedure whether it’s going to cost me $0 or $7,000. Here is a copy of a letter I wrote to a vascular surgeon after receiving a varicose vein diagnosis. I’ve omitted the first couple of paragraphs because they’re just boring details about the procedure:
“…To be perfectly frank, out-of-pocket medical fees have just been killing us for the past 3 years. It never lets up. I spent an hour on Friday trying to get someone at the imaging facility/health insurance company to give me a general idea of what I would be paying for just the MRI/MRA, and no one was able to give me any kind of answer. Our savings is dwindling, and I’m still negotiating other hospital bills. I’m not mentioning this because your office has anything to do with that stuff, as I realize you all have to deal with the same health insurance billing frustrations that I do as a small business owner. Your team is simply practicing safe care and presenting me with viable options. I’m mentioning it because my wife will be done with grad school and working in a couple of years…right about the time we stop paying $1,500 per month to put two kids through preschool. Point being — if this can wait a couple of years without doing irreversible damage do my leg, then it needs to wait. But if I’m playing with fire then I just have to suck it up and move forward into this year’s medical cost black hole. So I need an honest opinion about what my wiggle room is here.”
Fortunately, she responded by telling me that this condition has a slow progression, and unless certain symptoms begin to arise, there is no rush. But this is the standard medical routine in my experience. Specifically, with this vein diagnosis:
– Step 1. See a PCP about an issue, where I sit in the waiting room for almost an hour.
– Step 2. 3 weeks later, take 3 hours off work and drive 45 mins to see a specialist. Get a diagnosis.
– Step 3. 3 weeks later, take 3 hours off work and drive 45 mins to get an ultrasound.
– Step 4. 3 months later, take 3 hours off work and drive 45 mins to get a follow up about the ultrasound. Get a prescription for an MRI.
– Step 5. Start paying the out-of-pocket expenses for the previous 4 doctor visits and the ultrasound.
– Step 6. Contact the hospital that does the MRI to find out how much it might cost me out of pocket. Get transferred to a billing estimate place. Get transferred to a billing counselor. Call my insurance company. Find out absolutely nothing.
– Step 7. Ask the doctor if I can put this process off for a couple of years.
– Step 8. Cancel the MRI.
Four months, a couple hundred dollars, and about 12 combined hours of driving, waiting, consulting, and calling. The only thing that has changed since step 1 is that I bought one pair of vein compression hose for $70. Insurance doesn’t pay for that after all. I mean, how else are they supposed to rake in billions of dollars in profits?
Two days ago, we received a new notice from our insurance company stating that they are denying payment for a procedure that my wife had done last May in the amount of $4,500. The reason for the denial is that the claim was not submitted by the hospital in a timely enough manner, despite being in-network, and previously approved. Nevermind that insurance companies and hospitals can send the patient a bill out of the blue whenever they feel like it. Apparently those rules don’t apply if it’s a major corporation billing another major corporation.
I’ve been through this song and dance before. Ultimately what this means is that the hospital will now send us a bill for $4,500. I will then spend hours working my way up the chain to explain to a disinterested supervisor that, “I did my part. I pay my premiums on time. We made sure that the procedure was in network, and that it was approved. I don’t file insurance claims, you do. If I had known that a billing window was closing, I would have filed it myself. But I did not know this. No one tells me these things.” To which they will reply that since the insurance company isn’t paying, I will have to take it up with my insurance company, or pay the bill myself. To which my insurance company will reply that the hospital did not submit the claim in a timely manner, and I will have to take it up with the hospital.
I already went through this last summer over Anne’s same procedure. The insurance company denied a claim for the testing of a tissue sample, because the lab wasn’t in network, so we received a bill from the lab for around $1,000. I called the hospital, lab, and insurance company to find out why, if we had chosen a doctor in-network, a tissue sample would be sent to a lab that was not in-network. Turns out that the lab was in network when the tissue sample was sent, but it was no longer in network when they billed the insurance company. So…naturally, after all of these companies finish arguing over who is supposed to pay whom, I get the bill. To which I patiently and calmly responded to the last person I spoke with, “I know that you personally are not the orchestrator of this confusion, but please put yourself in my shoes, and then explain to me WHY THE FUCK any of this is my responsibility.” “Sir…I can understand your frustration…”
This situation wasn’t actually resolved. It is under review. I was told it could take 9 to 12 months before a resolution is reached. I assume that once I’ve completely forgotten about this whole thing, and just as I’m thinking about doing something wacky crazy like putting some money into an IRA, I’ll get another bill for $1,000. Because, why shouldn’t I? I don’t have a team of lawyers to fight this screw up. I’m the low-hanging fruit. It’s easy for the hospital, or insurance company, or lab, to sue me if I refuse to pay it. They have a lot less to lose. So I’ll just pay it, and then cynically wait for the next costly expense that I didn’t know was coming. Oh, wait, there already is one!
For this same procedure, we also received another bill last fall from the hospital for around $5,000 (separate from the most recent insurance company denial). Look, I know that we are required to pay a certain amount of money out of pocket each year to meet our deductible. We paid a $500 co-pay, along with another amount up front that I can’t remember. But this was all really starting to add up. The bill indicated that the hospital had been trying to collect the money from the insurance company to no avail, and that I needed to call my insurance company to try to get them to pay. You know, my volunteer job as a debt collector when I’m not at my actual job, trying to raise my children, or on the phone with some other medical organization about another bill that doesn’t seem quite right.
Insurance company — “They aren’t supposed to send you a bill for that amount. Your responsibility is $200 something plus your $500 co-pay.”
Me — “But they did send me this bill.”
Insurance company — “But they’re not supposed to. You’ll have to call them.”
Hospital — “The amount due is $5,000.”
Me — “The insurance company said it’s $200.”
Hospital — “It’s $5,000.”
Me — “Here’s a crazy idea. I know this is totally insane, but how about if YOU call the insurance company. Here is their phone number. They have customer service representatives available 24 hours per day.”
Hospital — “We don’t do that.”
Me — “You don’t talk to the insurance company?”
Hospital — “No. But what we can do is submit this for review, which could take about 9 to 12 months…”
If you’ve made it this far through this rant, I’ll go ahead and share a final medical anecdote from a couple of years ago. We had just relocated to Texas, and most of our life was imploding due to circumstances outside our control. I’ll spare the details, but it was getting pretty ugly. One afternoon, Anne decided to take our son Parker to my Mom’s house so that Anne and I could try to figure some things out without downloading all of the stress onto our 3 year old. A few minutes after she left the house, as I was walking down our hallway I began to experience stabbing chest pains and pressure that pulsed in time with my heartbeat. This had to be a heart attack. I quickly chewed a baby aspirin and drove to the ER a half mile away. In hindsight I probably should have called 911, but you just do what you do in those situations.
The staff quickly hooked me up to a bunch of monitors, gave me some medication to ostensibly calm the effects of a possible heart attack, and conducted a prompt interview. Within a few minutes I was sent through a battery of medical tests. After the doctor reviewed the information he concluded that my heart was fine, and that I had probably pinched a nerve somewhere in my thoracic cavity due to the extreme stress, which was mimicking the symptoms of a heart attack. Whew! What a relief. He also told me that the symptoms I was describing were either a pinched nerve, or an aortic dissection, which would have killed me within a few minutes. Thankfully he didn’t tell me that until after I was in the clear.
Well, it’s a good thing I have health insurance and that the ER is only a half mile away. Sometimes there are happy endings. Oh, wait…the ER isn’t in network and it cost me $2,500. Since the source of our stress was a near disastrous financial situation, I had to ask myself, if I had known in advance that it would have cost me $2,500 to go to the ER for what I thought might be a heart attack, would I have gone? Might I have just taken the aspirin and waited around until I was sure it was a heart attack? Then what? My wife finds me dead on the living room floor? Or maybe I was supposed to call around to different hospitals, and wait on hold with the insurance company, to see which provider was in network, all while possibly in the midst of having a heart attack. If I had called 911, would the cost have doubled or tripled for the ambulance ride?
I am well aware that there are countries which have no hospitals at all. Many don’t even have safe drinking water. I have much for which to be grateful (no debtor’s prison in the U.S. for one). But I can’t help but think that in one of the wealthiest, advanced, and most powerful nations in the history of the world, something is seriously wrong here. To be perfectly honest, I often think about what I could do to help people who aren’t as lucky as I am. Unfortunately, when I have any sliver of free time or extra money that might be dedicated to such a cause, it gets parasitically absorbed by this kind of bullshit.
Stay healthy! (No, I mean really stay healthy so that you don’t have to go see a doctor for any reason…ever).
As a good friend likes to say about most things in life…”It’s simple, but it’s not easy.” There is no secret to maintaining a healthy bodyweight. Unless there is an underlying metabolic issue (rare), or an addiction that requires mental health treatment, we generally just have to become more conscious about our daily habits. I often hear people approaching this subject as if there is an ancient magical formula that can only be found by searching the farthest reaches of some tropical jungle.
Here’s the straight talk: All of us can do this, but most of us don’t want to. In a culture that prides itself on abundance and indulgence, we expect our struggles to be overcome in a passive manner that is seriously lacking accountability. “The Cheesecake Factory should have known that I couldn’t resist a second helping of dessert. I’ll sue them.”
What do you really want? Do you want to look and feel good? Or do you want to binge watch Netflix while polishing off a king sized bag of M&Ms every night? The choice is yours, and so is the result. Healthy people do healthy things. Now…before you fall into the “Easy for you to say personal trainer and colossal douche” mind-trap, it is important to re-state where I came from: Pack of Marlboro reds, 3 pints of vodka, Double Quarter Pounder with Cheese meal (super-sized) — every day for years. After watching my life crumble from the inside out, I decided I wanted something different, and then I did something different.
Here’s an anecdote that one of my former clients shared with me a few years back. She and her husband went on a spring trip to Boston with another couple. My client couldn’t wait to walk around the city and take in its rich history. The other couple wouldn’t have it. Their legs were in too much pain as a result of diabetes and obesity. So the couple offered an alternative: During lunch, they would spend all of their time discussing options for dinner.
Nothing will ever happen if you “start tomorrow,” and you will never have time if you don’t make time. Incidentally, you do have time. You just don’t want to give up resentful Facebook rabbit-holes in which you conclude that everyone else’s life is better than yours (it’s not). Just stop it.
Without further ado, here are the keys to a healthy bodyweight (and a healthier mind for that matter).
— Drink a gallon of water per day.
— Use My Fitness Pal.
— Keep your net carbs at 100 grams or less (total carbs minus fiber).
— Get at least 7 hours of sleep. (Turn off the screens 8 hours before your alarm is set to go off, and get into bed).
— Meditate 10 minutes every day. (Headspace is a great way to start learning).
— Get your 10,000 steps. (There are plenty of wearable fitness devices that can help you track).
That’s it. 6 things. Here’s the Stephen Hawking scientific explanation: It works if you do it. It does not work if you do not do it.
For no particular reason I spent some time today reflecting on pivotal moments that have changed my life in dramatic ways. Moments that changed the trajectory so drastically that I cannot retroactively anticipate what my life might have been like had I chosen “the road not taken.”
I’m not necessarily referring to large decisions that take a great deal of planning, such as college or a career move. Clearly those things have an impact on a person’s life. However, in that kind decision making process there are additional plans that need to fall into place, along with a significant amount of psychological preparation for the change to come.
I’m referring to moments that were either beyond my control, resulted from a chance meeting, or required a simple yes or no at a moment’s notice. I’m sure the list could be quite lengthy, and some I have likely forgotten. I decided to narrow it down to 4, as they are probably the most significant events in what I would consider to be my independent adult life.
— Losing everything I owned in a fire in 1999. I had no insurance. I was an irresponsible kid floundering through college with no real plan. Then I lost everything. A few months later, my girlfriend left me. It was one of the lowest periods of my life, and really about the time when I started drinking to cope with it. That worked for a little while. Even though I didn’t see it at the time, there was a silver lining: I owned nothing, and was accountable to no one. I could literally do whatever I decided I wanted to do. So that’s what I started doing.
— Showing up to work on a non-paying independent film set to work as a grip in Dallas in 2001. I had already been doing the job for a couple of weeks, but on this particular day I was exhausted and dealing with a pretty bad head cold. My job wasn’t terribly important. I didn’t have any experience, and there were other grips. I was basically just volunteering out of curiosity. I intended to call the director to let him know I’d be skipping that day, but I kept hearing my Dad’s voice rattle around in my head about finishing what you start and keeping your commitments. Begrudgingly, I showed up looking like hell. While there, I met my future best friend Ethel Lung. She was working as an extra and had a great sense of humor. We stayed in touch, started a band called The Ethels, moved to Los Angeles together on a whim in 2002, recorded one album, and ended up with a song featured in an episode of “How I Met Your Mother.” Ethel didn’t know how to play any instruments when we started rehearsing, and since it was just two of us, she became the drummer.
— Agreeing to assemble a band to accompany the live show “Mortified” in Los Angeles in 2006. I had doubts about my abilities to lead a large band like an orchestra, and my (more skilled) music writing partner Gordon Bash was out of town on tour. My first instinct was to say no to Dave Nadelberg, the show’s creator. I just didn’t have the confidence. But after some coaxing by Gordon, and a couple of hours to think about it, I said yes. The first show wasn’t exactly pretty. But Anne Jensen, one of the show’s producers, became my future wife. Lol Tolhurst of The Cure joined the group a few months later. We went on to perform for 8 more years, and after Anne and I relocated to Texas, the group continued to play music for a show that is now in a dozen cities all over the globe. Because of my participation in Mortified, I was inspired to get sober once and for all. At the rate I was going, I don’t know that I had much time left to get that done. Anne and I now have two great kids and a lot of incredible memories.
— Agreeing to teach someone to box for the first time in 2010. A personal trainer acquaintance asked me if I could teach his gym manager to box. I honestly had no idea. Even though I had several years of boxing and kickboxing training under my belt, I never fought, and had never in my life taught anyone to do anything as far as I could recall. I wasn’t even a personal trainer. I was a part-time musician, part-time bartender/waiter. Again, I wasn’t sure if I had the confidence, but I said yes anyway. Christie trained with me for over a year, and became a pretty solid boxer and legitimate sparring partner. That experience led me to become a personal trainer — a job I still have and love.
If you could pick 4 pivotal moments, what would they be?
Don’t make them. Just do something different starting now.
Don’t let the mirror determine how you feel about yourself on any particular day. All mirrors are funhouse mirrors. They distort what you think is an objective image of yourself, and then feed on that day’s sense of self-worth. It can quickly devolve into a fiery crash if you’re not careful. For example:
You didn’t sleep well last night. Money stress is lurking around the mind’s back alleys. You had an argument with your spouse before work. Negativity is a magnet. The day’s first look in the mirror is going to send staples and knives in the direction of that magnet.
“Why are you so fat? You look ridiculous in these stupid clothes. Great, another gray hair. You look like Tales From The Crypt. Is that cancer?”
You are destined to carry that image of yourself into the rest of your day as it plays ping pong with the other stressors in your life. It will impact your interactions with co-workers and loved ones as the inner-dialogue negativity magnet continues to pick up needles and rusty nails.
“Glad to see Julie is wearing shorter skirts to work…the kind that whores wear.” “Oh, I see. The Keurig machine is out of water. Again. Thanks honey. It’s obvious you want out of this relationship.”
The day becomes unproductive as the negative distractions pile on. Another night of lost sleep. Another barbed remark toward your spouse. Another look in the mirror in the morning, and you’re in the Guinness Book of World Records for being the fattest, ugliest, most unlovable human being ever born.
The mirror is a reflection of everything that is going on inside. You cannot see yourself objectively. While a look in the mirror may seem like a clinical evaluation about whether or not your new diet is working, it can easily and destructively become derailed by a culmination of regret and worry.
For some tips on how to escape this cycle, see https://ificandoit.blog/2017/11/07/recovering-from-life-pt-3/
These days it takes me a little longer to get up off of the floor. When I attempt to sprint, I curse the practical joker who put concrete in my shoes. My shoulders are beginning to feel like my knees, and my knees feel like a migraine. At 42, I’m not an old man, but my body is approaching middle age with an ego that still thinks college dorm life is a real possibility.
I have done a lot to my body over the years. There was a time when I didn’t notice any real consequences from the abuse. I assumed that I had dodged all of the bullets. Turns out that the ramifications of that abuse wake up all at the same time, sometime after 40. Disc compression from high school football. Worn out knees from distance running. Dodgy shoulders from kickboxing. Several years of drug and alcohol dependency. I don’t regret any of it. Even the substance abuse. While I am not proud of that particular decade, I learned a lot of priceless lessons while fighting for sobriety that I may not have learned otherwise. When my clock runs out, the “bucket list” won’t be very long.
Even into my mid-30s, I wanted to be as strong, fast, and powerful as my genetic limits would allow. I pushed, and pushed, and pushed. But it’s harder to recover from that kind of training now. At this age, living as healthfully as possible, I’m still not faster than the chain-smoking 23 year old me. My goals had to change. I’ll never be a professional fighter. I’ve injured myself twice while training for powerlifting competitions. My knees won’t allow running on pavement anymore. Most of my goals were about serving me anyway. I don’t think there is necessarily anything wrong with that, at least in terms of athletic endeavors. Competition can be healthy, particularly if you’re competing with yourself.
Something changed after I became a parent. Anne and I got started late. Parker is 5 and Max is 2. This peculiar sense of mortality and danger emerged in a way that hadn’t existed 20 years ago. I jumped out of small airplanes a few times. Now I won’t get in one. I’m more cautious when I climb ladders. I am continually on the lookout for sharp objects. Everything shifted from a focus on competition, to a focus on surviving an emergency. I don’t obsess about every possible danger in life, lest I become agoraphobic. But there is an awareness about things that simply weren’t on my radar before. Am I fast enough to push one of my kids out of the way of a speeding car? Am I strong enough to lift a store display rack that falls on one of them? Can I catch and overpower a kidnapper? Can my ribs withstand a flying elbow from a 5 year old who attacks me while I’m napping on the floor?
Thankfully, at this point in my life, I can safely answer yes to those hypothetical situations. But I don’t want to take it for granted. I also can’t afford to train like a Navy SEAL to single-handedly stop a Red Dawn (aging myself) that only hits our house. There has to be a realistic balance somewhere. Most possibilities in life exist on a spectrum:
Church Softball <—> The Olympics
A cold <——> Ebola
Ronald McDonald <——> It
It is impossible to prepare for every emergency. But people often lose their lives in emergency situations because they simply aren’t fit enough to remove themselves from the danger:
*Unable to break a window in a submerged car.
*Loss of balance while standing on a roof.
*Unable to move out from under a heavy object.
*Unable to climb to avoid danger on a lower level (flooding, dogs, Ronald McDonald)
So what kind of fitness should we seek to maintain in order to survive emergencies that primarily require fitness as a survival tool? This is not an exhaustive list, and while these are bare minimums, it is a good place to start. If you can achieve any of these standards without much effort, but struggle on others, then spend time on the most difficult movements:
— At least 1 solid chest to floor pushup with a perfectly planked body. 1 perfect pushup is a lot more challenging than 10 sloppy ones. (A 50 lb box has fallen down the attic ladder and you will suffocate if you can’t push it off of you, or squirm your way out from under it).
— At least 1 kipping pull-up. It is very challenging for most women over 40 to do one strict form pull-up. But I’m talking about being able to climb over a fence or wall, in which you’ll be using your feet and legs to assist you. You gotta get over that wall by any means necessary. It doesn’t matter how pretty it looks.
— At least 1 partial range dip. You’ve pulled yourself to the top of that wall, now what?
— A smooth, balanced Turkish get-up on each side of the body using only your bodyweight. If a bookshelf falls on top of you, getting out from under it by maneuvering away from it is a lot easier than trying to bench press it. The get-up is a great way to learn to coordinate the entire body.
— At least 30 bodyweight squats, a little above parallel is fine. Your legs should always be stronger than your arms. If not, you will eventually have a problem.
— Drag yourself across the floor 15 feet using only your elbows. You fell and broke your hip. Nobody can hear you. The phone is in the other room. Incidentally, if you’re over 65, store your phone where you could reach it from the floor.
— Deadlift 45 lbs with perfect form. This is not a heavy deadlift, and it is unlikely that you’ll have to deadlift your way out of an emergency, though you might have to one day lift something off of someone else. However, perfecting deadlift technique by practicing with a light to moderate weight will help prevent future emergencies (throwing out your back while doing yard work).
— Walk for 2 hours. Your car broke down in the middle of nowhere. There’s no signal and you haven’t seen a car since morning.
There are an infinite number of physical standards that you can apply to any potential emergency. Soldiers, firefighters, and police officers obviously have to maintain a more rigorous set of standards. But this list will give you a fighting chance if you’re surprised by something in your day to day life. When was the last time you tried a pushup? Feel free to add to the list.