Mellow Yellow

Sorry, crankyjewishguy (CJG) got a late start this morning owing to the fact that he spent a couple of hours walking along the beachfront in Santa Barbara where the sky is blue, the sun is shining, and the home prices are exorbitant. You see, CJG and his older son, the one who attends Harvard on St. Charles a/k/a Tulane University, have been spending some quality time taking one the great American road trips down the California coast. CJG figures, if your 20-year-old son is willing to spend a week with you (a) you've done something right as a parent and (b) seize the precious moment because it may not come again. There isn't much to be cranky about when the scenery is jaw-dropping, the air warm, and the seafood fresh. So, amigos, hasta manana. Tomorrow, CJG and son will be in L.A. That should give us plenty to complain about.

You Call this Health Insurance?

If you pay for your own health insurance, as crankyjewishguy (CJG) does, you probably get really cranky once a month when your health insurance premium is due; it's a bill that could easily be confused with the bill for your mortgage payment. CJG pays $1,600 a month for a plan that has $50 co-pays for office visits and a $500 family deductible for prescriptions, but, mercifully, all diagnostic tests are covered at 100%.

If the doctor doesn't charge you for an office visit,
Tufts Health Plan says your $50 office visit co-pay still applies. Huh?

Now, generally, CJG has been pretty happy with his health plan, which is provided by a company that shares a name with a small liberal arts college in Medford, Massachusetts that happens to be where his wife, and two of her siblings went to college, and whose mascot is a stuffed elephant. Oh, OK, it's Tufts Health Plan. But yesterday CJG got into it with Tufts over a reimbursement claim he filed for services rendered to his son, the one who is a sophomore at Harvard on St. Charles, otherwise known as Tulane University. CJG's son is covered for "urgent" care while away at school since no one within a thousand miles of New Orleans is an approved Tufts provider. Urgent care is care that could not be foreseen before the patient left the Tufts coverage area, and so far there's been no problem there. But in early December, CJG's son went to Student Health Services with a bad sore throat and three lab tests were performed and they determined he had strep. The total for the three lab tests was $85.

When CJG got the bill from Tulane, he sent it in with a claim form to Tufts to get reimbursed. The bill listed the three tests and the prices and also included a line that said "Regular Physician Appointment $0." You see, included in tuition are office visits to doctors at the Student Health Center, so CJG had, in effect, already paid that.

Now, two days ago CJG got a check in the mail from Tufts for $35 calculated by taking the $85 in lab work, which is covered in full under CJG's plan, and subtracting $50, the office visit co-pay. So, CJG called Tufts and spoke to a customer representative and a supervisor who insisted that even though the office visit was "billed" at zero, it was still "billed" and the $50 office visit co-pay therefore applied. When CJG pointed out that a "co-pay" means that the insurer, in this case Tufts, has also paid something -- hence the term co-pay -- and in this case they had not because there was no charge for the office visit, they said that's not the way they do it. If it's on the statement, even at $0, the co-pay applies. But on the statement Tufts sent with the check they actually subtracted the $50 on the lines for the lab tests. "That's the way the system works" and "that's they way we have to do it," they said, as if "the system" was set up by some foreign being that has since left the galaxy leaving Tufts with this system they have no choice but to live with exactly as is from now 'till eternity.

Well, bullshit, said CJG. You set up the system and you didn't "have to" set it up that way. You can set it up so that you honor your contractual commitment to pay 100% of all diagnostic tests. If they'd billed $25 for the office visit and done no lab work, by Tufts reasoning CJG would owe Tufts another $25.

Then CJG asked, what if he'd whited out the line for the office visit and sent the bill in, would Tufts have then paid the full $85 for lab work? Yes, they replied. OK, then, CJG will call Tulane and get a bill for the lab work only -- one that doesn't show an office visit billed at zero dollars -- and resubmit the claim which will probably cost you more to process (especially when you include the time we're arguing about this on the phone) than the amount you're trying keep from paying. So, CJG called Tulane and with ten minutes he had a revised bill by e-mail for the lab work only and today he's sending it to Tufts. It'll be interesting to see what happens. This is the kind of bullshit that can drive a cranky jewish guy over the edge, in which case Tufts will be paying for his mental health services.

Perhaps it should say, "no one does more to try and keep your money."

P.S. CJG is on the road again for the next week, this time to California. He can't promise he'll be posting every day. If this causes you anguish or distress, or makes you feel ill in any way, call Tufts Health Plan at 800-462-0224.

Ask Crankyjewishguy Vol.6: NOLA

Knowing that crankyjewishguy (CJG) is currently in New Orleans, Brett in Minneapolis e-mailed CJG this New Orleans related question.

Dear CJG,
I know you are Jewish so let me ask you Four Questions: what makes New Orleans so different from any other city?
Brett in Minneapolis

Dear Brett,
First, you only asked one question, but CJG assumes that's because you are in on the little secret that even very few Jews know: that on Passover, it's really one question with four answers, to wit, "why is tonight different from every other night?" The answers, as you probably know, include, "because on most nights we eating sitting up and tonight we eat reclining," "because on most nights we eat leavened bread and tonight we eat only unleavened bread," and "because on most night Uncle Hesche isn't here with our bratty cousins boring us to tears with stories about his medical problems."

But to answer your question, what makes New Orleans -- or NOLA as we who are really cool and in the know like to call it -- so different is that only in New Orleans two weeks before Mardi Gras can you see about a dozen major pre-Mardi Gras parades that make moving around parts of the city nearly impossible. Only in New Orleans is a "major police presence" defined as a dozen on-duty uniformed officers on parade duty helping themselves to drinks at a local bar along the parade route. And only in New Orleans can you sit down at a restaurant with beer you've brought in and without a thought the waiter opens one for your 15 year-old son who looks about four years younger. Let the good times roll, indeed.

This is not a Mardi Gras scene. It's an
official college tour of Tulane University.

CJG is Now Facebook Friends with God!

crankyjewishguy's (CJG) wife is pretty savvy about social networking and she is trying her best to drag CJG into the 21st century. She explained to him that to build an audience for a blog you have to create lots of links and cross-links and you have to learn to use Facebook. So, CJG immediately went on God's Facebook page and "friended" him (or "liked" him). Whatever. Now, CJG is hoping that God, who has like 4 billion Facebook friends, will "friend" or "like" him back. CJG is praying God isn't too selective. For those who don't know God (so to speak), this is his Facebook picture (you think he could have put on a shirt for the photo?):

Anyway, enough about God. Yesterday, CJG and his wife drove from San Juan to CJG's hometown of Aguadilla, Puerto Rico while the boys sat in the back seat and watched Jackass 2.5 on a laptop. After all, why would you fly all the way from Boston to Puerto Rico? To look at the scenery?

As in San Juan, CJG was disappointed in the reception he received upon arriving in the town of his birth after a 57 year absence. The bagel, lox and cream cheese reception never materialized. Even Gerard Depardieu got a warmer reception in The Return of Martin Guerre and that was after the locals figured out he wasn't Martin Guerre after all but an imposter. It's not that there weren't plenty of people in the streets for CJG's homecoming. There were. Unfortunately, all of them were in cars trying to get to one mall or the other. Though Aguadilla isn't much to look at from street level, CJG and his family are staying in a clifftop condo with a spectacular view of the ocean and beach below. This makes CJG very mellow, except that the neighbor with the adjoining rooftop patio has outdoor stereo speakers that play bad music all day long. CJG guy and his college age son spent a good part of the afternoon trying to figure out if they could take out the speakers with a few well placed fastballs.

Now, it didn't take more than five minutes on the beach for CJG to be reminded that no Jew can truly get away no matter how far he travels from home. At Crash Boat Beach, a surfing spot frequented by locals, but few tourists, CJG's older son immediately ran into two guys he knows, brothers, actually, and Jewish, of course, who attend college with him at Harvard on St. Charles, otherwise known as Tulane University. And once the parents started talking they discovered that three of them, out a possible four, attended Tufts University at the same time, CJG being the exception as he is both older than the others and attended a different and, according to the infallible U.S. News and World Report college rankings, slightly more prestigious institution of extremely higher learning. 

Crash Boat Beach without people, as CJG would have preferred it.

Now CJG can be very sociable if he tries, and he enjoys chance encounters as much as the next curmudgeon, but sometimes he just wants to get away from it all. So next year he's taking the family to the Falkland Islands in February. With his luck he'll be standing in a penguin rookery and Howie Finkel, his arch nemesis from junior high school, will walk up and give him a wedgie.