Friday, July 27, 2007

The Spam Files: Episode II

Spam makes the everyday exciting!

spam that passes the buck.
from: Michelle
subject: Maria wants to know what you think

spam that's easily obeyed.
from: Ed
subject: Don't let Ed ruin your sex life!

spam that... wait, what?
from: Milli Kopra
subject: The permission entry for which to search

Mangled care

Mrs. Gerbil and I finally went to see Sicko last night. I was very impressed. I'm not a Michael Moore groupie--perhaps because my parents had me watch Roger and Me when I was a mere pre-teen, and I was rather bored by it--but I do appreciate a good exposé when I see one.

And it got me thinking about what I currently do for a living.

The insurance group I work for was not featured in Sicko. My actual company was not even mentioned; the behavioral health insurance system is a whole 'nother movie. So in that sense Sicko was not about what I do 40 hours a week.

Another sense in which Sicko has nothing to do with my job is that I never have to deny coverage for any individual person. I can tell a member that his plan does not cover couples therapy, but I never have to say that his particular request for couples therapy will not be approved. There are two reasons for this little bit of relief. First, "adverse determinations" can only be issued by reviewers with clinical licenses. Second, as long as a person's plan permits a specific type of treatment, it's my job to say "yes."

(And here's a third sense: I hear that the medical carrier under our corporate umbrella no longer does procedure reviews, as nearly all requests were being approved anyway.)

But this movie was about what I do simply because I work for managed care. I believe that the health care system in the US should do its darndest to promote preventive care. HMOs--health maintenance organizations--started with this very same philosophy. I also believe that, when a person needs medical treatment, he or she should get it. There shouldn't be a need to call within 24 hours of admission, or to expend time/money/emotional effort filing appeals, or to hire an attorney... or to have to decide to skip treatment altogether because insurance won't pay. Health care should not be about money--and there is where the Big Bad System and I diverge.

All of my statements above, about why Sicko doesn't point its finger at me personally, are really just displacements of blame. Like most of my co-workers, I took my job because Mrs. Gerbil and I were hurting for dough. It's been less than six months since I began, and already we're financially back on our feet. And (not surprisingly) we get really cheap health insurance, with more-than-decent coverage for what we're likely to need. Yup, managed care treats its employees well; and I think my company is one of the best in this regard.

Still, I'm part of the Big Bad System, and I'm just doing it for the money. My paycheck might not be the direct result of in-house adverse determinations, but many of our plans are carve-outs from other medical carriers. And those carriers do issue adverse determinations. There aren't many degrees of separation here.

So, no. I'm not directly involved. But lest I be accused of sounding like a complacent WWII-era German (Godwin's Law, anyone?), I hasten to point out that I do have a well-established history of fighting the system.

And on that note, I offer the following tips to anyone who might need them:

1) If you have insurance, read your Evidence of Coverage Document. Cover to cover. As soon as possible. Call member services if you don't understand the terms of your policy.

2) If you believe your claim has been wrongly denied, raise a stink. File an appeal. File a second appeal. Then contact the state oversight body for your plan. This might be the state board of insurance, the state commission on managed care, or some other such body; and you can find out which one applies with a single phone call to member services. Just don't call me about your claims.

3) If you get stuck with a huge hospital bill, contact the patient advocate about financing options.

4) By federal law , virtually all US hospitals are required to provide examination and stabilization treatment for truly emergent patients, regardless of their ability to pay. If your plan refuses to cover non-network care you received while completely unconscious, raise a stink (see #2 above).

5) Above all, don't give up. A cynic might say that somewhere, someone is counting on you to give up ("Baby needs a new pair of shoes!"). But I am not that cynical. Yet.

(For the record: Appropriately, I used a tiny little portion of my paycheck to take Mrs. Gerbil to the movies.)

Sunday, July 22, 2007

The Battle for the Toy Box

Next month, select Wal-Mart stores are supposed to begin stocking the Tales of Glory line of Biblical action figures.

Apparently there is a "Battle for the Toy Box!" going on. It seems to me like a pretty one-sided battle, declared by the side that perceives itself to be under attack. But that is a snark for a different day.

For today, I bring you: The Nativity Play Set.

You will notice, in the lower right-hand corner, a choking hazard warning. Presumably this is due to the diminutive size of the molded PVC Baby Jesus.

Now I may be a heathen Jew--and a secular heathen Jew at that--but it's always been my understanding that one is supposed to take Jesus into one's heart, not one's trachea.

But then I wonder: if you successfully swallow the plastic Baby Jesus, does it transubstantiate itself into a plastic Communion wafer?

I would test my questions myself, but I don't want to lend credence to the old fear that Jews eat little Christian babies. Then again, PVC was not around during the early days of blood libel. So perhaps my excuse should be that I just don't want to set foot in a Wal-Mart ever again.

Tuesday, July 17, 2007

There's no place like someone else's home

For Christmas last year, Mrs. Gerbil and I ordered her father a great new doormat.

There was a problem with the way the order was processed, however. It was supposed to be shipped directly to him in Seattle, but billed to us in Berkeley. What actually happened was that the order was shipped to him at our Berkeley billing address--where he obviously does not live. Having already paid a stiff UPS rate for the initial wrong delivery, we sucked it up and paid a stiff US Postal Service rate to get it to its rightful location. We were not pleased.

But our troubles did not end there.

Apparently, our innocent, incorrectly processed doormat order landed Father-in-Law Gerbil on a "new homeowner" list--for Berkeley, where (as previously stated) he does not live. At first we got a few Bed Bath & Beyond coupons, addressed to "Our New Neighbor." We were confused. We'd been in Berkeley for a year and a half and had been getting at least two BB&B coupons per month, addressed directly to me. But BB&B coupons never expire, so the more the merrier, right?

Then we--or rather, Father-in-Law Gerbil--started getting ads from exterminators. And roofing companies. And house painters. And Lasik eye surgeons. And gyms. And the AARP. And real estate agents looking to sell his home for him, which is even funnier given that we pay rent for the address at which he does not live.

I dutifully cross out the address on each piece of mail, scrawl NSR (no such recipient) in big bold letters across the front, and stick it back in the mailbox. This works fairly well, although not for all the mail we get for people who don't live here. Some church has been trying to get a former tenant (who hasn't lived here in at least six years) to attend their Christmas and Easter services, and they do not seem to know from NSR.

But what really got me is yesterday's mailing from the PG&E Care program. Like all good utility programs, PG&E has a discount program for customers with low incomes, disabilities, or assorted other things which might interfere with paying ridiculous energy bills. Father-in-Law Gerbil was thereby informed that he may be eligible for a discount from a utility company which serves an area in which he does not live.

Our PG&E account is in my name. I pay the bills every month, and occasionally I get medieval on their asses. Occasionally I get something from the Care program, but since we don't qualify, I just toss the mailings in the recycling. Anyway, the important part of this is that there is already an active PG&E account at this address, in excellent standing, and it is not in Father-in-Law Gerbil's name.

Even better: Just before said mailing went out, PG&E cashed my check for our most recent bill. Which bill, I hasten to add, does not bear any part of Father-in-Law Gerbil's name.

Father-in-Law Gerbil loved the doormat, by the way.

Monday, July 09, 2007

The Spam Files: Episode 1

I find spam simultaneously very annoying and very funny. This is in sharp contrast to my opinion on junk mail of the paper variety, which I find very annoying (and not funny at all). I have, in fact, been known to call companies which persist in clogging my home mailbox, in order to ask them please to stop killing trees in an attempt to get my business.

(Admittedly, I have also been known to attempt to get exceptionally annoying spammers in trouble with the help of Sam Spade, but I soon realized the futility of such pursuits.)

Mrs. Gerbil and I have very different approaches to spam. Whereas I will clean out my spam folder multiple times a day, she lets the messages in her spam folder ferment quietly until Gmail deletes them automatically. At any given time I have between 10 and 60 spam messages; but her spam census is consistently over 2000. I've asked her many times why she doesn't just delete them all periodically, now that one can do this with a single click. Her philosophy: Why bother? Every deleted message will just be replaced by one more, so every 30 days her spam folder goes through a complete turnover all by itself.

In my opinion, however, deleting spam by hand has its advantages. For one, I get to laugh at the randomly generated subject lines. For another, I get to share the most ridiculous ones, right here on this very blog!

So, without further ado, I bring you The Best of the Worst. Or something like that.

spam that makes you feel good about yourself.
From: Jimmie Weeks
Subject: You're not ugly

spam that tells it like it is.
From: Beatrix K. Clark
Subject: fraudulent

spam with problems.
From: Cruz Y. Lara
Subject: Hi, how your dink?

spam that knows just a little too much about our personal life.
From: Amazing Performance
Subject: Turbo sperm for you and your girl!

spam that got it backwards.
From: Relaxation
Subject: How Cialis works!

Ah, yes. The joys of randomly generated text.