It's 104℉ Right Now

[yogi]

CONTINUED FROM: viewtopic.php?f=23&t=2565&p=49124#p49124

I pay for my drug plan, and for my supplemental insurance plan, and naturally Medicare takes out the cost of Medicare from my SS check before they send me any money. So we ARE funding the insurance programs ourselves already.
I could start talking about my friend in the UK, who has found almost nothing his family needs, and many other families, is covered at all.

I'm a diabetic so vision tests are free, however, I have to pay 45 dollars for a refraction to get glasses, which I also have to pay for, and man have they gone up in price too.
The last time I bought glasses, the price was a little over 250 bucks, now those same types of glasses are over 420 bucks. So I've not got new ones yet. I'm getting by with four-dollar readers for a couple of things but they are not good for distance.

I don't know about a hearing test. Seems I always had to pay for mine, so don't get them any more, other than the annual exam where they whisper something and asked what I said. I usually don't know because I didn't hear it over my tinitus.

Can we change this thread to a new one with a different title?

This is the continuation of the quoted previous thread. The title there was appropriate for the starting topic, but I can't recall the last time we stayed on topic. LOL

Anyways ... I pay for Medicare insurance as well, but that was not my point. If the Medicare program did not exist we would be buying private insurance and paying whatever those insurance companies decided is fair for them. If you think that might be a better deal, think of those Medicare Advantage Plans. They are run by private companies that use the limited funds given to them by Medicare. Those Advantage Plans would not get cheaper nor would they cover more items without the Medicare reimbursement.

The first eye exam I had here in O'Fallon was mostly paid for by Medicare and my supplemental insurance. One of the battery of tests was not covered and cost me something like $40 out of pocket. The glasses resulting from that exam were out of pocket.
The second eye exam done about a year ago was with a different service provider and the entire exam was paid for by Medicare. It seemed as if both times the same tests were performed, but there could have been a difference. I had to agree to pay for whatever Medicare did not, but I was not billed anything for the eye exam. The glasses where relatively cheap in that they were "on sale" for something like 40% off. The choices were limited but the price was right, a few hundred dollars for two pair as I recall.

It's too early to know how much, if anything, Medicare will pay for my hearing testing. The next visit is a consultation and they told me that would not be billed. It is just to explain what my choices are. Regardless of what I choose, I expect to pay the full price for the hearing aids. To my way of thinking that is equivalent to Medicare paying for the tests to discover if I have cancer, and then refusing to pay for any hospital stays or drug therapy.

And, it has become obvious that you and I know people in England who have vastly different opinions of the healthcare system there. People I know admit private care is better if not more expensive, but there is no shortage of treatment from the National Health Service. I guess it's the same situation here in America. Some people have no problems with healthcare, and others simply can't afford it. Depends who you talk to.

[Kellemora]

Whatever you get we get three days or less later.
It is so hot here today, I'm having trouble breathing, but at least the humidity came down 2% is all.

I'm having trouble keeping my heart rate down. I was late getting up here this morning because of that too.
Along with this heat, I'm shaking like a leaf, still.

Dealing with Medicare and health issues is going to be the death of us all.
Due to some form the doctor didn't fill out right, my breathing drugs were delayed by 2 weeks.
I borrowed some from other folks who could spare a couple, but I had to return them when I got mine.
Now they are saying it is too soon for me to order again, I should still have two more weeks left. Bozo's!

I do have a couple of drugs medicare does pay for on the drug plan, however, I never need to order them, because a relative who doesn't take those drugs is stuck on an auto-mail program and keeps getting them, so she passes them on to me. She has told them to stop at least ten times, and they keep sending them anyhow.

Paying for healthcare, and them not covering much, is a royal pain in the arse!

[yogi]

I read yesterday where Phoenix has experienced 25 days of 110+ ℉ for the last 25 days. It seems as if Texas is also being broiled this entire summer. Us folks in Missouri have had several 90 degree days but yesterday was the first time this year we flipped over 100 degrees. We can do the same today, but it will cool down into the 90's over the weekend. In the mornings the temps are low 80's and the relative humidity is over 90%. Right now in the middle of the afternoon the humidity drops down to around 40%. You would think that is great but it is actually way too high for this kind of temperature. Still, bad as the humidity seems to be, it's not like I recall it in Chicago. I was outside yesterday for about 15 minutes in 98 ℉ and felt fairly comfortable. it was too cold when I finally came back into the air conditioned house where the air is around 80 ℉.

As much as I favor the government taking care of our healthcare costs, I have to agree with you about the bureaucracy it takes to get there. There are so many rules and forms to be filled out that I can't imagine who is keeping track of any of that information. The reality is that healthcare is expensive regardless of who pays for it. There are a lot of high priced machines and highly trained professionals involved and they need to be paid well. It takes at least twelve years to become a doctor and the cost of that education has to be astronomical. I am certain they get it all back eventually, but guess who is ultimately paying for it? mhmm. You and I.

[Kellemora]

You probably felt cold when you came back inside since your clothes were damp from the humidity.

Inside my office, over the past 24 hours, my humidity high was 73 wet, low 62 normal range. Don't know outside.

Doctors who do accept medicare, you get a quarterly statement showing how much medicare paid, and how much you paid, and if you had other insurance that may have picked up the rest, you get a statement from them too.
I have Plan N which covers most of what medicare don't cover as far as doctors go.

[yogi]

Our Medicare is on plan F if I recall correctly. It's a legacy plan and no longer offered to new patients. All I know is that it pays for everything that Medicare does not, assuming Medicare pays in the first place. This is the insurance that costs us about $1000 a month in our ripe old age. The day surgery I had to repair a hernia came to about $24k in total for tests, doctor's visits, and the procedure. The statement from Medicare showed that they paid out less than a third of that. Everybody seemed to be happy with what they got paid, or at least I didn't get any extra bills. The payout was not quite a year's worth of premiums and I've been paying for more than a dozen years now. So, if Medicare is so stingy, it might not be worth paying the premiums for the supplemental. Put it in an interest bearing account instead and pay as you go might work out better.

[Kellemora]

From what I understand. Plan N and Plan F1 cover the same things except F1 covers Medicare Deductible and excess charges.
I forget now how much the annual deductible is, but it is somewhere between 400 and 600 bucks now.
And my doctors told me they can never collect on the excess charges anyhow, unless you have Plan F1, then they can.
Plan F is still available, but not the high deductible one.
Plan N pays 100% of Part B coinsurance, but not for doctors office co-payments of 20 bucks, or 50 bucks for an ER visit where you decide to go home instead of being admitted, which is why I had to pay the 50 bucks.

I did hear from someone, nobody in the know though, that if my Medicare, Drug Plan, and Supplemental is higher than my Social Security and Pension if I had any, then they move you to Medicaid without the hassles of getting on Medicaid.

[yogi]

Not that Medicare is simple, but Medicaid is a bag of worms. Every state has their own version with some being better than others. I too am fairly uninformed, but my understanding is that if your income is at or below the poverty level, you are eligible for Medicaid. I suppose that applies to income from Social Security as well as any other sources. The question to be answered is if Medicaid is better than Medicare. My guess would be maybe and that it depends what state you are in. I've heard and read several stories about funding for Medicaid being cut in some places and increased in others. Medicare does not have that problem, yet. Medicaid is great for people who have no other insurance whatsoever. Those of us who have a choice must choose wisely.

And to be honest I don't know if I have plan F or plan F1. My drugs had to meet a deductible but i have no co-pays at the doctor or the ER. If it's truly just a matter of co-paying, that $20 per doctor visit might be well worth the price. It depends on what the premiums are for Plan N. However, I have a feeling the deductibles and excess charges are killers.

[Kellemora]

My supplemental insurance for Plan N, went from 255 to 273 in February and I think it stays that the rest of the year.

I pay 20 bucks to doctors, 50 or 60 bucks to ER room with no being admitted, else that is covered.

Down here they have Tenncare which you don't want if can avoid it.

But I thought Medicaid was on top of what Medicare already covered, but perhaps I'm wrong.

[yogi]

Apparently you can have both Medicare and Medicaid. Medicare would be the primary insurer and Medicaid the secondary. If your income is less than $20,100 (for one person) then you might qualify for Medicare. I'm reading that Medicaid would pay whatever Medicare does not. Don't know if it would be worth your effort to look into it, but I did think at one point it was either/or and you could not have both Medicare and Medicaid.

Saw the audiologist today and we talked hearing aids. I'll be getting a pair in about two weeks and have more details for you then. Right now I am super impressed with the technology. The processor is in a case about the size of a large kidney bean, and comes in colors to match my hair or skin. LOL That bean sits on my ear and has the mic in it with a button to adjust the response. Out of that bean comes a wire something like the end of a bobby pin. There is a bulb at the end of it that goes into the ear canal and produces sound. I don't think it actually touches anything. Plus, you really need to look closely to see that wire, so that there is virtually no cosmetic issue with this device.

One of the cool things is that the batteries are rechargeable. Like my smartphone it comes with a box that is a dock for charging the hearing aids. The box too is battery operated and it also needs to be charged via a USB-C cable which I have for charging my clever phone. These hearing aids work like wireless speakers in that they can be connected via Bluetooth to my clever phone that has an app for fine tuning the response on the fly. For people without Bluetooth there is a button for adjusting things on that kidney bean processor case. So it's pretty darned fancy and high tech compared to what my mom had. The price for two is $6,600, but I get a $1,000 discount because I have supplemental insurance. I didn't ask why that was possible but have a feeling the state of Missouri is somehow involved. They give me an income tax break for exactly the same reasons.

[Kellemora]

I have tried to get Medicaid a couple of times. I don't have a disability type that will get me on their plans here. Such as blind or totally disabled, like as if I'm not, hi hi. Just having to use a wheelchair to move around doesn't count as a disability.

Wow, I hope they work as well as you expect them too for you. But that price still seems like it would be unaffordable to me.

[yogi]

Walgreens sells affordable hearing aids, but the sad truth is that you get what you pay for. Those drug store models are merely amplifiers which is all many people need. My particular hearing loss justifies a higher performance device. The audiologists didn't provide a lot of technical details but kept referring to the increased processing power as the prices go up. There were four levels of processing power each separated by about $1000. My intuition tells me that the highest level has some fancy noise canceling capability not found in the lower priced models. Also, I gather by intuition that the audio I will hear is not the true audio presented to the device. The processor mixes the ambient sounds with my specific response curve for the given ear and reproduces something that is linear at all frequencies. I was warned that the sound will not be perfect because my hearing simply isn't there at certain frequencies regardless of the sound manipulations. However, the much improved sound will overcome the shortcomings and the brain will eventually straighten it all out after a period of time. So, of course, I went with the high end model and was surprised to learn that my wife's sister got something similar up by Chicago for $7,000. That's another reason why I suspect the state of Missouri is applying some pressure here.

As I noted earlier each state has different rules that apply to Medicaid. The general qualifier, however, is your income. People below the poverty line pass the first qualifying test. I don't know what to tell you other than perhaps you should learn to play the political game and talk to your state representative about waiving the rules for you.

[Kellemora]

I'll bet it doesn't cost as much to make those things as they want you to think.
But then they have to pay the technicians and sales folks who handle the tests and fittings for them out of what they charge for the also.
My uncle Leonard wore hearing aids that were not cheap. He managed to drop one and it got stepped on. They replaced it for him for only a few hundred bucks, not thousands of bucks.

I don't have that much longer to live to worry about getting things changed now.
My brother is helping me with the cost of a couple of my medications, which is much appreciated.

I wore a newer pair of my compression socks yesterday. Darn near killed me trying to get them back off before bedtime.
They were just as easy to put on, but I didn't have the strength to get them over my heel to take them off the way I normally did. Is there some trick to taking them off? I did it by pulling them inside out and down, but even that was still hard for me.
Made my heart rate go up and my O2 go down for a bit.

[yogi]

Going by what you told me about how businesses operate, my $6,600 hearing aids cost the audiologist half that. Since I have supplemental insurance, they took off $1000 from the price. I don't understand why the insurance matters because I am the one paying for the hearing aids. The insurance, however, does pay for the testing diagnostics and the ENT doctor to interpret the results. So, if they make a $2,800 profit on the sale (half of the $5,600 I'm being charged) that covers, for one thing, the "free" consultation I had the other day. I'm pretty sure that for the first three years I get a free office call every six months for any checkups or maintenance. Then there is the commission that I'm sure the audiologist gets. She is also the sales person as it turns out. A company named Starkey makes a brand of hearing aid called Genesis AI - I'm guessing the AI means it has some intelligence built in. If they too are selling the hearing aids at 100% markup, that means the cost of producing a pair is about $1,400, or $700 each. Seems right in my opinion given that is about what I paid for my new clever phone.

The heel of the compression stocking is THE problem both putting them on and taking them off. I put a sock on my right arm and pull the top down to the toe. That makes the length of the sock about half of what it normally is. I take the folded sock off my arm then and put it on my foot. Sliding it on up to the heel is no problem, but tugging it past the heel can be an effort when the arthritis gives me problems. Usually tugging on the sock with the thumbs from both hands will get it past the heel. Taking off the sock is the reverse process. Roll the tops down to the toes then thumbs inside the socks pushing downward on the back side, the heel. For some reason pushing the shock down past the heel is more difficult than pulling it up past the heel. The strength of your fingers is what makes it all easier or more difficult, but it really helps to have dry skin too. You don't want to do any of this immediately after a shower. The skin acts like glue in that case. LOL So, while I've never tried it, maybe a little bit of talc down the inside of the sock where the heel is could help things slide along.

[Kellemora]

I thought almost everything considered medical had a 1000% markup, just like jewelry, and a few other things?

I've not had any problem putting my compression sock on, it's getting them off at night after my feet are more swollen.
Taking them off by just pulling them inside out, instead of trying to get the leg part bunched up and pulled over the heel seems to work best for me, but even that is still hard after the feet have swelled up.

I do know my grandmother used to have this 2 foot long shoehorn she used for taking off those socks she wore many eons ago.

[yogi]

I don't know how businesses determine their need for profit on any given product. All I recall is you telling me it's 100% markup by the retailer. It could be !000% or 1%. Never had to run a business and figure that out. I do know that if I did run a business my profit would be calculated and not set by arbitrary industry standards.

I do pretty much what you do with the stockings. Taking them off is a matter of pulling them off inside out. Sometimes getting past the heel is an issue and that is when I apply the thumb pressure. You could just leave them on overnight and take them off in the morning when the swelling is down. I was told that I do not have to keep them on at night, but some people do.

[Kellemora]

In many businesses, they don't always quite get the 100% markup if it pushes the price over what the market will bear for that item. That's why it is good to provide some service you don't get from the bigger stores.

I don't see that these sock really help all that much with the swelling, a little bit of course.
Putting my feet up high seems to work better when I can do that.

[yogi]

Charging what the market will bear seems reasonable. The idea under capitalism is to maximize profits which is why companies such as Apple can get away with the high prices they charge for most of their products. People will pay for the name. In more competitive businesses, such as restaurants, I would guess the calculations for profit have to be refined to suit the local market. I know my own enjoyment eating out has as much to do with the staff and quality of service as it does with the prices.

My feet would swell due to blood clots, and for a time as a reaction to some meds I was taking. The stockings did help in that regard, but as you point out it is not a significant difference. In my case the main benefit is to reduce the likelihood of clots forming, thus the TED type stockings I wear. My legs still swell a bit from time to time even with the stockings. But, I think it would be a lot worse if I didn't wear them.

[Kellemora]

As far as the pizza business went, getting and keeping customers required they understand how much pizza they get gyped out of at other places. Not covering that outer circumference of the pizza saves almost 1/3 of the ingredients, but gyps the customer out of it too.
We proudly showed our product ratios on each type of pizza. NONE of the other guys dare do that!

I don't think I have any blood clots, leastwise none that I know of.

I'm having a super bad morning, and doing you while I'm up here, just in case I don't make it back after lunch.
I've been right at panic mode all morning, couldn't get my pulse below 100 until around 10 am, and then it was only down to 92, which was too high for me to try to make it up here at all.
Debi may make me go to the hospital since I'm doing so poorly, even here in the comforts of my office.

[yogi]

That old trick of not covering a pizza to its outer edge has been around forever. In most cases it's pretty obvious what they are doing and why, but my all time greatest pizza place ever was a exception. Sparga's Pizza was THE place to get your pizza fix back when I was living in the city as a kid. My favorite part of the pizza was that edge crust they never covered with ingredients or sauce. It was an exceptionally thin crust and most crispy at the edge. That combination did something yet to be matched by any other pizza palace I've been to. I roll my own these days and come close to the ingredients, but can't do a crust anywhere near what Sparga's did.

I'm sorry to learn about your terrible morning. I know a trip to the hospital is nothing to look forward to, but if it can bring your heart rate back into the acceptable zone it might be worth the inconvenience. Plus, I greatly appreciate your efforts at posting. But, you know, you got to take care of yourself first.

[Kellemora]

Momma Russo made pizza like that, with a wide uncovered edge that was a joy to eat also.
But she didn't cheat anyone either. A 12 inch pizza was on a 14 inch crust, and you were only paying for a 12 inch.
Same way with the other sizes, you were not paying for the uncovered portion of the pizza, even though it was there.

Momma Russo, at the age of 81 sold her recipes and formula's to Two Nice Guys who just couldn't get them right.

I went to my heart doctor first about my heart racing, and he said it is because my lungs are failing. It has to pump faster and harder to get the O2 distributed throughout the body. But part of the higher speed is the CO2 staying in my blood is elevated now too. I may have to start on some type of dialysis after I make my rounds of the doctors again.
Ultra Sound on the 8th, GI roto rooter on the 10th, and Pulmonologist on the 15th.
Odd thing though, it is my regular doctor who ordered the ultrasound of my aorta, not my heart doctor.
He said the Pulmonologist will want that info before my appointment with him anyhow, so git er done.

I didn't make it up here to my office until around 11. Each time I tried, I only got outside the door and had to go back inside to sit down and wait until my heart slowed down enough to attempt it again. It is getting scary Yogi!