Thursday, October 09, 2008

So much has happened the past few months!

We opened a store in our little town on Sept.1st. It's almost overwhelming for me because I've been out of the work force for 8 years now! Suddenly I'm working full time and still trying to be full time housekeeper/laundress/cook/chauffer... it's crazy.

Right now things are still relatively slow because we are out of the city limits. We really had no choice when looking for a location because the major real estate players in Forsyth, Georgia seem to think that they are in Atlanta! You can actually rent a quality retail space in excellent areas of the ATL metro area much cheaper than you can in this little podunk town! Also, there is the parking issue. If you were to open a store on the town square not only are you paying insane rent but there is zero parking. This was the reason my husband shut down his first store. Business drops when your customers can't park.

So, now I'm on a mission. I have always hated that there is no LYS close to me. I have to drive 35 miles to buy good yarn. I typically don't use stuff off the shelves at WalMart, that's pretty much only good for dishcloths and afghans, of which I knit neither. If I can find enough people in the area that would regularly buy yarn in our store then my husband says I can stock it. Problem is I have to have a minimum of $1000 order to start with. Needless to say funds are tight all over right now and since we have already stocked our store, it's going to be a few months until I can get it unless a miracle happens. I keep thinking about going to my bank and applying for a line of credit, but I just don't know. With the economy the way it is right now, that's just so "iffy".

Regardless of it all though, I'm going to try to write at least once a week. I did finally finish my Hempathy tank top, still need to take pics. It turned out really well considering the pattern I used. But I wear it in public and I've had several people tell me how much they like it... they just don't know I MADE IT! LOL

~~Ciao

Wednesday, August 13, 2008

Self-Funded Health Insurance.... SUCKS!

So, I learned yesterday just why I'm having such a hard time with our health insurance company. It's self funded. Basically it means that the company my husband works for, Flying J, incurs the cost of all claims, they also are the ones that in the end get the premiums that we pay each pay period. I didn't know this until I got so pissed off that I called the Insurance Commissioner's office. This explains a lot. I surely didn't appreciate being treated like a piece of dirt by our plans benefit administator either. Honestly, if we could afford for my husband to quit, I'd tell him to tell those low lifes to kiss his ass and get the hell out of there!

What has happened at this point is that, although $4400+ has been paid out for my medication, by a co-pay assistance program, the insurance company, who had orginally told me this was fine and had applied the cost to my deductible, has now come back and told me that since I personally didn't pay the money, they are going to reverse the amount applied to my deductible and they will not pay the 70% that I should be getting at this point toward my medication. They consider it "double dipping" so to speak. What they want me to do now is to pay another $3000 in medical/prescription costs and they will apply THOSE to my deductible. Somehow they are not grasping that this co-pay assistance is to help people like me with these insanely high deductibles cover the total cost for medications (such as mine which is nearly $1500/mo), in essence it's a gift from the company/organization that issues the co-pay assistance. I don't have to pay it back, but it can only be used for my medication. I don't have a problem with that, I feel very greatful that there are programs out there that help people obtain there medications.

In the end, what it amounts to is, we will have to continue paying not only our premiums, but any doctors visits or prescriptions on our own until we reach that $3000 PER PERSON deductible. Considering I've been to the doctor 4 times since May, that means I'm now in debt to my doctor's for over $300. That does not make a dent in that damn deductible now does it???? And since it's an ANNUAL DEDUCTIBLE that must be met before the insurance plan will pay anything at all, I have to start over in January. In the meantime, no more medication for me. The funds attached to my co-pay assistance have been used, I've gone 2 months without medication while I was trying to get all of this sorted out and now, I have to apply with yet another co-pay assistance program, which is time consuming and no guarantee that I'll even qualify.

So - to any of you out there that are considering working for Flying J, Inc. I highly recommend that you not participate in their benefits program. It's not worth it. You will be lucky to reach your annual deductible and God help you if you do reach it, that reimbursement... well, self funded insurance programs can kind of change the rules as they go to suit them. Nowhere in the handbook does it say that I personally must pay that deductible, but now they come back and tell me that they can do whatever they want to and I can't do a damn thing about it. Personally, I'm just pissed enough to be on the hunt for an attorney. If you are going through anything even remotely close to what I am, take the time to pick up the phone and call your state's Insurance Commissioner's office. They can answer questions and if they can't, they will direct you to who can.

Wednesday, August 06, 2008

What a wow!

As I was rounding up various school supplies for the boys I dove into my horrible closet in search of a binder & pencil pouch. What I found instead was something that really brought back some seriously good times in my life.

Way back in the day, my hubby, then boyfriend, had purchased a container for me to organize all my press releases/photos/mementos and other stuff related to my job as a music reporter. I saw that container sitting there in the back of the closet under all the clothes that I have hung on to thinking some day I'd be a size 7 again... and couldn't resist a trip down memory lane. I've just spent 2 hours looking at all the articles I wrote, the notes from interviews, press releases, press photos and personal pictures, stickers, press passes, just tons of stuff. I decided to do some weeding out and basically hung on to the things that meant the most. Like the invitation to a small private party for Shawn Mullins at his manager's house. I didn't actually get to go to that party because I was seriously preggers with the twins and on strict bed rest, but the fact that I, a lowly internet reporter, ranked an invitation was enough to make me hang on to it. There's also the memorabilia that actually got me started in the biz. Tickets, backstage pass & pre/post party invitations to an Edwin McCain concert that a friend of mine presented to me for my birthday in '99. That was an amazing night in more ways than one. I will always be greatful to my friend Bill for the best birthday ever.

The most interesting thing I found amongst all the stuff was an address book with tons of contacts in it. I seriously don't remember who half of those people are! Not sure why I hung on to that particular addy book anyway. The one that I kept all my music industry contacts in is actually in my desk. Something must have made me think that book was important though. Maybe if I look through it again later it will come to me.

Looking through the pics of me with the guys from some of the bands I interviewed made me realize that I'm aging fast. I look so damn young in all of those pictures and at the time I was already 30. Now, 9 years later, I look my age! Argh!!!

It was fun while it lasted, but doesn't the saying go "all good things must come to an end"? I miss it a lot, but I know that being a mom is the most important job I've ever had or ever will have and that's what really counts isn't it?

~Ciao

Friday, July 25, 2008

Well, today reinforced my belief that insurance companies are a freakin' rip off. I DESPISE with a passion our current health insurance company. First DH had to wait 6 months after being hired to even qualify for benefits. Ok, I read every piece of information the company sent regarding our new health insurance, I thought I understood it... apparently I was wrong! Not only did I have to wait an additional 3 months after our insurance went into effect in order to see my doctor, I find out our deductible is $3000 EACH. Not what the info said, but oooh kay.

So, 3 months ago I finally got to go back to my doctor, I was thrilled beyond belief because this meant I could finally get back on my Enbrel. Dr. Cohen's office also hooked me up with an Enbrel Easy Step card which helps to pay insurance deductibles! How great is that? So, I go home & call my pharmacy. They call me back and tell me that my primary insurance won't pay anything toward my prescription. What? How can that be? I call the insurance company. They tell me that lovely little deductible must be met first, then they will pay 70% of the prescription until I've paid an additional $2250, which at that point they pay 100% of my prescription. Ok, this is a slight problem, but not horrendous because I have that Easy Step card!

Pharmacy processes my prescription through Easy Step card, which leaves just enough money on it to cover the next 2 months of prescriptions since my insurance will pick up 70% now. In the meantime, I spend numerous hours on the phone with various customer service people at Regence Blue Cross Blue Shield trying to find out why it's not showing that my deductible has been met (they also told me to change my pharmacy to one that they use regularly). Oooooh... I have to FILE THE CLAIM MYSELF? Hmmm... didn't see that in any of the original info. So, I fill out a form, I fax it to them, I'm assured that it's going to be expedited. Yeah, 2 months it takes for them to post the deductible to my account. :::sigh:::

In the meantime, it's now been 2 months with me NOT getting my medicine. So I call the new pharmacy and am told that they have filled my prescription and want to set up delivery (specialty pharmacy mail order thing). First I blasted them for filling the prescription without my calling them. Then they tell me they are sorry for the confusion, but that's their policy, they get it from the doctor & fill it immediately. Since I'd called them and had them retrieve my prescription from my old trusted specialty pharmacy and told them at that point that I would call them when I was ready, this just didn't sit well with me. All that aside, the gentleman I spoke to told me the prescription was ready and would I like to pay my co-pay with Visa, MC or other, then proceeds to inform me that I owe $954!!!! WTF??? How in the hell have I gone from paying $50 to nearly a thousand? Oh, well, they charged the amount to my Easy Step card and that's the balance that was left. OMGOMGOMG

Finally, today, seeing as the call mentioned above was over a week ago now, I call the pharmacy again to see if they have gotten my insurance straightened out so that I can pay my $50 and get my damn meds. They now tell me that my primary insurance is showing that they won't pay anything for this prescription. Now, another call to Regence. I'm informed by the CSR that we have a REIMBURSEMENT plan! OMGOMGOMG again!!! Once again, nowhere in the benefits package does it tell me that I have to pay not only $3000 to cover my (keep in mind that's just for me)annual deductible, then also have to pay $2250 before they will pay 100% of my claims. So, this means that out of pocket each year, regardless of what they claim, $10,050.00! PER PERSON!

So, now I realize, my dreams of having my Enbrel back were pipe dreams. I never should have started taking it again. When I first found out back in April that we had to met the deductible first, I debated about even taking the first shot. Seriously, this is unbelievably depressing. The CSR's that I talked to at Regence in April, May & June, not once did they ever tell me that we have to pay EVERYTHING then submit it to them for reimbursement. Had they been kind enough to do that, I would have called my doctor & asked for something else. Yes, there are programs available to help me, but it takes 6-8 weeks to get into them to begin with, then they have limits of $4800 (max for most) per year, there is a ton of paperwork that has to be filled out and you can only be in one program at a time. For instance, with my Easy Step card, I have $1800 left on it now, but I can't even apply anywhere else until I use all of those funds. Then I have to get a letter or something from them to pass on to the next assistance program.

The super ironic thing about it all... Amgen Wyeth actually has a program for Enbrel patients that provides FREE medication... if you don't have any insurance that is. The reason my husband works where he does is so that we will have decent insurance. Little did we know when he accepted this job over the others that he could have taken, that the insurance this company offers is a freaking joke! I would have been better off had he just gone to some small company that didn't offer health insurance!

I am soooo sorry for my verbal abuse to the CS lady that answered my call to Regence today, I truly am, I know it's not her fault, so I guess I shot the messenger when I shouldn't have... but what the hell do we pay nearly $400 a month for to this damn insurance company when it does us no good?

For all of you out there that read this and have similar insurance, and are quite happy with it, keep in mind, my husband brings home less than $4000 a month after insurance, taxes, etc. My Enbrel right now costs nearly $3000 per month. We have a mortgage, we have 4 children and only the one income. Why don't I work? Because I can no longer work in the fields I've been trained for, I'm disabled to a point, but SS says I'm too young and too white to be disabled. Actually, I do have a job and it's a damn hard one, I'm a stay at home mom. I take care of my children, I clean, I cook, I do laundry and I haul them all to their various extracurricular activities. I'm the first one up & the last to go to bed even when I'm running a fever of 105 and can barely move. That's my job, I just don't get paid for it and seldom do I ever hear the words "thanks mom" just because.

Regence Blue Cross Blue Shield SUCKS - Cigna ROCKS! My husband has been informed that when he changes jobs he is to immediately ask who the company has health benefits through, if it's not Cigna, he must end the interview and go on to the next one. I could just strangle the man anyway for leaving his previous job!

Wednesday, July 23, 2008

I am a SAMERICAN!

American Samaritan

This morning was insane I tell you... INSANE! Woke up at 6:45 and headed out about an hour later to get the Marine girl to the Macon airport. She, being the super smart kid that she is, had printed her boarding passes & checked in her baggage online. I love computers. We got to the airport about 20 minutes before her connector flight left (Macon only has 2 flights a day and both are to Hartsfield). There was a lady in front of us, that the clerk was insisting she was too late to check her baggage and she could take a flight in the morning. Well, she was from out of state, had been in GA on business and needed to get to her next stop. There are no motels/hotels/otherwise near the Macon airport, so this lady was going to have to either rent a car or take a cab either to a hotel or to Atlanta in hopes of getting her flight out.

Well, lo & behold, stupid clerk tells Lauren that we are too late for her to check her baggage. Heh, it never occurred to either of us that her baggage WAS checked, he just needed to take it! Lauren turns to me and asks if I could run her up to Atlanta, well, sure, her actual flight out of Hartsfield isn't until 12:45 anyway, that's plenty of time. As we leave, the lady that had been ahead of us asked if we were going to the Atlanta airport could we give her a ride. Absolutely! Somebody in this state has got to show everyone that southern hospitality truly does exist.

So, with luggage & passengers loaded up we head back north. I was going to buy gas in Macon because it's cheaper than our little podunk town of Forsyth, but realized I would be ok until I got past our house and on up a ways (yeah, that's a southern thing) to McDonough where I could fuel up at one of the truck stops. We pull off to get gas and Judy, our passenger, offered to buy. Lauren & I both told her no, but she insisted, so I told her just put $20 in, that's all I'd planned to get anyway. I ran into the store to use the facilities & get a Fuze (yes, I must be specific - Fuze is nearly as needful a thing for me as SOBE). When I came out I glanced over and saw that Judy had FILLED MY TANK!!!!! We are talking $60! I was flabbergasted. I didn't expect her to do anything at all, we were going to Atlanta anyway, we were trying to help her out and she turns around and did that. According to her it would have cost her more money had she rented a car or called a cab & went to a motel for the night. Well, maybe so, but still. It was greatly appreciated and I wish I'd thought to at least exchange email addys with her.

In the end, one good turn deserves another and there ARE still good samaritans out there in this world. I was lucky enough to meet one today. I hope she made her flight, but maybe if she didn't she was able to get another one later today.

Yes, I am a very proud Samerican and so is Judy!

Friday, July 18, 2008

~*~Indie music is alive and well, thankyouverymuch~*~

The most excellent email I've received in a long time came yesterday! So exciting I almost can't stand it.

Mark Gaignard, former lead singer of Big Sky, has returned to the music scene with a vengeance in all the right ways. The Also Ran. I know former Big Sky fans like me are anxiously anticipating the release of Mark's new album. Selections can be heard at Mark's Myspace page (Google him people!) or at Backspace records site.

Courtesy of Mark, I've also learned that Ben Rowell, former Big Sky bass player, has opened a recording studio in Atlanta (as well as a label, all you up & coming indie stars) - Backspace Records.

Now, any of you surfers that come across this particular blog may not be familiar with either Mark, Ben or Big Sky... that's your loss and I urge you to correct that right this instant. I could go on for hours about all the guys from Big Sky, they are just GREAT people, fun, talented, smart and damnit, just great all around.

True Big Sky fans abound, they are like me, they yearn for more from this band that most certainly is missed. Their sound was unique, yet would have fit right into the commercial mainstream. Unfortunately, those big eat 'em alive record execs at all the commercial labels just didn't see what Big Sky fans saw. Big Sky electrified it's audiences in every state & venue. Like fantastic sex, Big Sky always left their fans sated, but also wanting more, because you just couldn't get enough and never wanted it to end.

I'm happy. This is a great event. I can't express clearly enough how much I miss the music scene, but such is the way of life I guess...

Wednesday, July 16, 2008

Sometimes life smacks you in the face & says "Wake the hell up you stupid bitch"!

Monday was one of those days. I dreamt about a former boyfriend. I actually couldn't STOP thinking about him (still haven't) the past couple of days. This guy was great, yes, in all aspects. I really wish things had worked out between us, but his parents hated me and I couldn't cope with that. Apparently I was not good enough for their son. :::sigh::: Anyway, in the end, I was a complete bitch to him. Nope, nothing new as far as me being a bitch, but it was to the point I was actually ashamed of myself!

Well, today I spent some time trying to locate said former boyfriend. I think I might have succeeded LOL I left a very odd message for someone that might be a complete stranger, but he has the sexiest voice I've heard since my Hilton Head days. *Ooh la la*

I'm on a mission to get my karma back on track. After all, this year is the big FOUR OH MY GOD! There are people from my past that meant a lot more to me than they ever realized, the memorable people, the people who in some way (big or small) were influential in my becoming the person I am today. Some of those people I owe apologies to, said former boyfriend being one of them, some of those people I just need to reconnect with. Once again it's ~*~just do your thing~*~ I waited too freakin' late to tell Mrs. G and now look at me! Haunted by memories & things left unsaid. I know she knew she was important to me, I know she knew I loved her son and I also know she knew why her son & I could never be together, but she didn't get to know about the twins born just 3 days before her death. I didn't call her during my pregnancy, the longest period ever of not talking to her... a day late, a dollar short is extremely understating the situation.

No, I'm not being morose, I'm just taking action before I screw up and wait too long again! Wish me luck.

~Ciao