A brief rant

I deal with ignorance a lot at work. Not bigotry, just lack of awareness about things. And I really don't blame people for it too much. But today I encountered a pretty ridiculous example, and I would like to share it with you.

A patient is having trouble getting her insurance to cover a couple of routine screenings and another test. She called about it today. Apparently the insurance company is saying they have the wrong diagnosis codes for the procedures she had done. So I called her insurance company to see if I could help her figure things out. Here is how the call went.

[Holds for 10 minutes.]
Customer Service Rep: Blue Shield of California, my name is [name]. This call is being recorded. How can I help you?
Me: I'm calling from a doctor's office, and I have a patient who is having trouble getting you to cover some tests we ordered. Can you please tell me what information you have on file for [date of service]?
Rep: Do you know how much the claim is for?
Me: Around $2000? I don't know exactly, I don't have the patient's bill in front of me.
Rep: It must be this claim for $2210. I show that the services were not covered benefits. Oh wait! It looks like we covered $220.
Me: And what was that for?
Rep: Diagnosis code V76.12 and procedure code 00403.
Me: Okay, V76.12 is "need for screening mammography." What is 00403?
Rep: It's the procedure code.
Me: What type? It's not a CPT code [standard procedure code]. It must be unique to your system. What does it mean?
Rep: Uhh... let me check.
[Puts me on hold for 2 minutes.]
Rep: Hemo- hemoglobin.
Me: Hemoglobin is not a procedure. There is no way that's right. The only procedure code that should go with the diagnosis code "need for screening mammography" is a procedure code for a mammogram.
Rep: Uh... hold on.
[Puts me on hold.]
[Disconnected.]

SERIOUSLY. WTF. This guy works in the health insurance industry and he doesn't know what hemoglobin is. It's the protein on red blood cells that transports oxygen. It is NOT a procedure. It's like saying "eyeball" or "toenail" or "skin cell" is a procedure. What a dumbass. I would like to say I can't believe insurance companies hire people who don't know anything about medicine or medical terminology, but I can. This guy was clearly not familiar with the word "hemoglobin" and he definitely didn't even realize the idiocy of what he was saying to me.

O nata lux

I struggle with Easter. It is the pinnacle of the Christian liturgical calendar, the highest of holy days. And yet, it has not resonated with me.

The coming of spring and new life is part of my life experience and is welcome. Easter is happily aligned with the vernal equinox thanks to pagan influence. There is, as Christians say, new life in Christ. I've even had to remind myself that the Latin phrase-concept nata lux, "birth of light" refers to Christmas, not Easter. Yet Easter could be described as a birth of light -- as the days get longer, the stone is rolled away from the tomb. Jesus, light of the world, is reborn through resurrection.

But as we celebrate it, Easter is about the resurrection's implications for salvation, the defeat of death. "Up from the grave he arose, with a mighty triumph o'er his foes!"; "Christ is arisen and we shall not die!" the hymns go. But my faith is not one of Christus victor theology, not one that emphasizes salvation, and certainly not personal salvation. And to me, what comes after death is less important than what comes before. The gospels, which come between Christmas and Easter, which are elevated above the rest of the Bible in Mennonite theology, are the heart and soul of my faith.

And on Easter, when the gospels come to an end, perhaps it is natural to feel a little lost. It's like finishing a captivating novel -- I'm never satisfied with the ending, and I wish to be back in the throes of the narrative. On Easter morning, I'm with the disciples. I want to be with Jesus again as he heals and multiplies food and drink and speaks in parables and teaches what is dangerous, exciting, new, even revolutionary. I want to come along with this Messiah as he brings in the Kingdom of God. I am not comfortable with Easter morning reality. I do not want this empty tomb, this figure who is unrecognizable even as he speaks to Mary in the garden and the disciples on the road to Emmaus, whom Thomas must touch to believe.

And then, one by one, the disciples recognize Jesus. They come to terms with the new, impossible reality that their belief was not in vain. This miraculous reappearance cements their certainty that this Messiah was for real, although this new reality was unexpected and maybe even a little disappointing for some of them who were expecting a significantly different manifestation of God's kingdom. But here among them was the impossible. This experience would be the push that gave the early church momentum. Rather than return, defeated, to their hometowns, they would "make disciples of all nations."

As we observe Holy Week, we know what's coming. Part of our yearly cycle, it lacks the despair it held for the disciples; it is preparation for the celebration of Easter, not the end of everything we hold dear. Easter is not a surprise for us. And there is a lot of theology between us and those who experienced the resurrection in the gospel stories. Easter means both more and less. This - this separation - is where Easter loses meaning for me.

With the disciples, we have learned from Jesus how to build God's kingdom. And today, Jesus, our teacher, the prophet, is born anew from the grave. The birth of light, which the darkness has not overcome. As we, with the disciples but in a different way, suspend reality to experience the risen Christ, we come to know beyond a shadow of a doubt that this is the anointed one, God's son, love embodied, the light of the world. In Jesus' resurrection, our journey is validated. The end of the gospel story is satisfying.

Why I support health care reform

As a political enthusiast working in the health care field, I have been following the health care reform debate fairly closely. I was upset -- but not surprised -- when single payer was never put on the table, and when a public option was dismissed. I think that either of those would be a major improvement to the system we have.

I have some issues with the new law -- mainly that it effectively cuts Medicare payments to health care providers. Medicare reimbursements are already low, and this cut will probably lead to a decreased pool of providers willing to serve America's elderly and disabled populations -- groups that need medical care more than most.

However, I ardently support the legislation that passed on Sunday night.

Why?

It regulates the insurance industry. From an AP article that seems to be fairly comprehensive in its summarization of the law, here are some new regulations to insurance companies:

- Prohibits insurers from changing an existing policy to exclude payment for a child's medical condition.
- Prohibits lifetime coverage limits.
- Prohibits insurers from canceling policies except for fraud.
- Prohibits denial of coverage or higher rates for preexisting conditions.
- Though it's not in the article, I believe that the law requires that no less than 80% of insurance company income be spent on medical payments.

Insurance companies are infamous for doing all of those things and more. It's disgusting and immoral, and if health insurance must be private, it must be regulated. This law is a good start.

Real food

After four years of college cafeteria food, it continues to be delightful to eat real food. In the eight months of having an independent household, Ross and I have not had a prepackaged meal for dinner. We have bought some Lean Cuisines for lunches, and recently we bought some ramen bowls (I hate ramen and will not be eating those, but the idea was that Ross and Jess could eat them for lunch). We eat a lot of vegetables and whole grains. I always buy organic, cage-free eggs and frequently buy organic, free-range meat. High-quality meat is expensive, so we don't eat that much meat.

This afternoon I made granola. The great thing about granola is that there are a few basic ingredients (oats, oil, honey, cinnamon, salt) and after that you can really use whatever grains, nuts, seeds, spices, or dried fruit you want or have handy. Today I used flax seed -- I bought some yesterday at the natural grocery because I'm trying to diversify my grain intake and flax is high in omega-3 fatty acids. I modified this recipe and it is good. Here's what I did:

2 and 2/3 cups old-fashioned rolled oats
1/3 cup golden flax seed
1 tsp cinnamon
1 tsp salt
3 tbsp plus 1 tsp canola oil
1/4 cup honey
1/4 cup packed brown sugar
1 tsp vanilla
2/3 cup slivered almonds

0. Preheat oven to 375 degrees Fahrenheit.
1. Combine oats, flax seed, cinnamon, and salt in a large bowl. Set aside.
2. Combine oil, honey, brown sugar, and vanilla in a medium bowl. Whisk until combined.
3. Pour wet mixture over dry mixture. Combine using your hands until oats are evenly coated.
4. Spread granola evenly on a cookie sheet and bake for 10 minutes.
5. Remove cookie sheet from oven. Turn granola with a spatula. Add almonds.
6. Return cookie sheet to oven and bake for 15 more minutes.
7. Let cool and store in airtight container.

Menu Plan!

I got a new cookbook -- The Tropical Vegan Kitchen -- which I am very excited to use. No, we have not gone vegan. However, we do limit our meat consumption, and I have been looking for low-fat vegetarian recipes. I usually hesitate to use vegan recipes because of either a great deal of soy (which I avoid for health reasons) or dairy substitutes. However, this cookbook promised to not use things like that (except for the occasional tofu) because many of the recipes from tropical regions are vegan anyway. So 3 of this week's meals come from that cookbook.

Monday - Black bean & avocado enchiladas w/ chipotle sauce
Tuesday - Brats & sweet potato fries
Wednesday - Thai pumpkin curry over rice
Thursday - Hot mango pilaf w/ almonds
Friday - Pizza
Saturday - Chili
Sunday - Leftovers

I also bought supplies for guacamole from this recipe. It really is perfect, only Ross hates tomatoes so I don't always use them.

I just returned from shopping and my cart was full of fruits and veggies. What a good feeling that is!

I get to...

The other day at work I heard something that really struck me. In a conversation about New Year's resolutions:

"I've resolved to say 'I get to' instead of 'I have to.'"

Wow. What a simple way to change an attitude. I've been thinking about it ever since.

For example,

I have to get to go to the grocery store. I have the means to buy food for my family, and furthermore, I have the power to make decisions about what food to buy. I can pick up a bag of kettle chips, see what novel citrus fruits are there this week, maybe find a great deal on manager's special organic free-range meat.

I have to get to work out. I am blessed with a young, healthy body that I can control. I have access to safe places to exercise. I get to feel my body work as I push myself. I can make myself become stronger, faster, healthier.

Or even something like this: I have to get to call this patient and tell him he has diabetes. If someone has to call with bad news, I know I can be kind and reassuring while I deliver it.

Think about these...

I get to work. I get to give a speech. I get to go to the doctor. I get to go to a funeral. I get to buy a present for someone. I get to write thank-you notes. I get to stop eating so much sugar. I get to cut back on spending. I get to pay my taxes.

Not that I think people should actually SAY some of these things. After all, it's socially inappropriate to say things like "I get to go to a funeral." But I still like the thought exercise. Even the mundane and unpleasant things can have a silver lining when you change that one word.

How I feel about drug reps

So the office I work for is visited regularly by pharmaceutical company reps. Before I started working there, and when I first started, I was pretty unilaterally opposed to that. I tended to think that offices that barred drug reps from their doors were providing better patient care because they weren't under the influence of the drug companies' bullshit. Now that I've worked there longer, I have mixed feelings about it. For one thing, the providers I work for have told me that they take everything the reps say with a few giant chunks of salt -- they're not passive listeners. For another thing, some of the drug reps are in the business to help the patient/consumer -- you can really tell the difference between reps who are in it for the money only and reps who do truly want to help get good treatment to patients.

But my mixed feelings are primarily because letting drug reps into the office provides samples, and those samples can sometimes be lifesavers for patients.

For example, we have a patient who is an insulin-dependent diabetic. He has private insurance, but not very good coverage. I don't think insulin comes as a generic, and it is expensive. One brand of insulin pen, for example, costs around $200 out of pocket for about a month's supply. We give him his insulin -- via samples -- on a pretty regular basis. It's a similar situation for a lot of patients on anti-osteoporosis medication, testosterone gel, sleep aids, and several medications for acid reflux.

Another thing is that insurance companies are ridiculous and, as you know, enjoy denying coverage as much as possible. One thing that you may not know about is the "prior authorization." It works like this: You go to the doctor for, say, acid reflux. You have already tried a bunch of OTC medications and they're not working for you. Your doctor prescribes Nexium, AcipHex, Prilosec, etc. or their generic forms (which are not on the $4 list). The pharmacy runs the prescription through your insurance and they receive a message that says "Requires preauthorization."

This means that insurance will not pay for the medication your doctor wants you to have unless the doctor's office calls the insurance company and convinces them to cover it. It is usually the same deal for MRIs and CT scans. This call takes about 20 minutes for most insurance companies and sometimes takes up to 2 weeks for the insurance company to decide (Medicaid and TriCare are the easiest -- they have one-page paper forms and reply in 1-2 days).

During this time, what are you supposed to do? Your chest is burning, you can't sleep, and you're at your wits end. Answer? Get samples from your doctor.

To me, it's clear that the real problem here is our fucked-up private health insurance system. It would be awesome if there were a national healthcare system that did not "come between doctor and patient" as we hear pretty frequently these days. Even if that system did continue to require prior authorizations, the government model works much, much better than the private model as it stands (and Medicaid and TriCare approve most submissions).

However, since over half the country insists that socialized medicine is Satan incarnate, we're going to keep having evil insurance companies that refuse to cover necessary medications, and as long as that's the case I think it's good medicine to provide patients with samples. Remove the insurance industry and the need for samples it generates, and there's no need for drug companies to insert themselves into offices. And then the drug companies take a big hit too. Everyone wins.