The Right Thing

I have been working in the Health Insurance industry for 9 years, this is an industry that has its own language and rules and is very confusing for those who don't speak "health insurance"

Many people know that they have insurance they may not understand their plans but they have it and use it, receive EOB's (explanation of benefits) in the mail when a claim has been processed, most toss them and some hang onto them since they know that they are important.

On any given day I answer questions for many of the member's of the health plan I work for and walk them through the way a claim was processed. Most of the time they are happy with what I tell them, with a few instances of people being angry because something wasn't covered.

When I had Adrianna in September I had a c-section which require not only my doctor but also an assistant surgeon. I knew this going into the procedure as this was my second c-section.
Adrianna was born on September 9 at 9:58 AM - the atmosphere in the OR was so fun, the anesthesiologist was cracking jokes, Dr. Whitefield (my doctor) was talking about his trip to Brazil, the assistant surgeon was talking about Mexican food she had for dinner the night before. At one point I looked at Joe and said "I hope that they don't forget the task at hand here" he just laughed. They remembered because my beautiful daughter was born with out any problems, beside the cord being around her neck 3 times.

I had a wonderful recovery at Providence Alaska Medical Center, the care was great and the nursing staff top notch.

In November I received a bill from my doctor's office that stated I owed $447.18 for the assistant surgeon fees. I pulled out the EOB that I had from my health plan to see what they had paid. I was covered at 100% at the time Adrianna was born and should owe nothing. The EOB showed the total billed was $1435.00 for the assistant surgeon my health plan paid 25% of the surgeon's fee (standard payment for any asst. surgeon) at 100% so my health plan paid $987.82. Now standard practice is that the amount that was denied as assistant surgeon reduction is written off and not balance billed to the patient, so I ignored the bill in November.

In March I received a statement from my doctor's office showing that the balance owed for the assistant surgeon was +120 days and now due. I called and spoke to the billing office and was told that they were not networked with my health plan and that I would be responsible for the denied amount. They also said that they bill 35% of the surgeon's fee for assistant surgeon. This surprised me as I was expecting the balance to be written off as it had been when I had Quentin in 2004 and as is the standard. I politely said thank you to the billing clerk and hung up.

Red flags were going off all over the place in my head because of my background in insurance. I knew that the industry standard is to bill 25% of the surgeon's fee and that the patient should not be balance billed. I also knew that in Alaska we do not have a network and our plans are written that we can see which ever doctor we want to see without being penalized.

I thought a bit and decided that I would write my doctor a letter. I have learned through dealing with the pediatrician's office that the doctor's don't always know what is going on in the administrative part of the office. I had a feeling that Dr. Whitefield didn't know that the policy his office was using was outside the standards in both the community and the industry and was penalizing his patients financially.
The worst that would happen was that I would have to pay the statement, the best outcome would be that the office would do the right thing and write off the balance owed.

I composed a letter directly to my doctor explained the situation and requested as a long time patient of the practice (10 years) they adjust my bill. I mailed the letter out on March 13, 2009.

I waited for a response, I was pretty sure that Dr. Whitefield would call to discuss my letter with me. Saturday Cassie from the billing office called and said that Dr. Whitefield had received my letter and that my balance was zero - they wrote off the reduction amount. I said Thank you, and her response was that it was the right thing to do.

So the moral of this long story is that if you have questions about your bills and you don't like the answer you get from the billing office go directly to your doctor. Also since I know a thing or two about health insurance and all kinds of plans please don't hesitate to call or email me with a question that you have - I will do my best to help figure out the issue.

Olive Juice Bags

Anyone who knows me well, knows that I LOVE handbags!!! Poor Joe is getting inched out of the closet with all the handbags that have taken residence in our home.

I have stumbled upon a company that I am VERY excited to share with you all, I am getting ready to place an order for my first bag, The Anna I just need to decide which sash color I want ! The name of the company is Olive Juice Bags, a company started by two moms who I can tell LOVE a good quality handbag as much as I do!!!!

So I will keep you all posted as I add to my collection with these bags!!!

One busy weekend!

We had an unusually busy weekend, we usually have one or two activities but this weekend was jam packed with activites for everyone!!!

Friday Night: Joe worked early so Quentin and I ordered pizza and watched The Bee Movie.

Saturday: Hope hair cut, Joe dropped the kids at Grandma's house, after hair appointment lunch at Humpy's and then shopping. Joe needed new jeans and I got some good deals and Gymbucks at Gymboree. After shopping we had dessert at Starbucks and then picked up the kids!

The Before Picture of my hair!

The After Picture of my hair - I LOVE IT!!!

Sunday: This was the fullest day for us!

We had a birthday party for Quentin's girlfriend, Maddy at Chuck E Cheese at 11AM stayed for 2 hours then home for a QUICK nap and Quentin and I were off to the circus. It was a fun afternoon Quentin loved the circus. The show lasted 2 hours. Then it was off to Subway to pick up sandwiches for dinner and then home. While we were at the circus Joe and Adrianna were at Joe's volleyball game.

Quentin showing his cotton candy tongue during intermission at the circus!

Needless to say I was exhausted after Sunday and was happy when both children went to bed - and was not ready for the alarm to go off this morning - Monday always seems to come more quickly than Friday in the work week - why is that?

The Volcano FINALLY BLEW!!!!!

From a previous post in January where we were all on alert for Mt. Redoubt the dang volcano finally erupted last night around midnight. It has erupted 5 or 6 times since then. I have to say that I was proud to be prepared!!! I had my masks, and air filters and emergency kit!! YEAH ME!!
So I wake up this morning because I was asleep whent he eruption occured to find 5 text messages on my phone all about the volcano. The ash was supposed to hit Anchorage around 2 AM it never did and now we will most likely only get a dusting of ash - PHEW!!! ASH is nasty to clean up! The Mat-Su Valley is getting most of the ash - although we are tough in Alaska and all schools are open!!!
I will keep you all updated on the happenings of the Volcano!!!

Only in Alaska...

My office is located in a residential area so every morning I see the school bus stop in front of our office, nothing unusual about that. This morning I was sitting at my desk and noticed this car hitting the brakes and sliding I look out the window and the school bus has thier red flashing lights and stop sign out not for children crossing the street or getting on the bus but for a moose - yes I said a moose!

I took a picture of the moose after she had crossed the street - only in Alaska does a school bus put thier red flashers on for a moose to cross the street.

My New Family

In a previous post I wrote about my sister, Brittney finding Ryan and I. Well there is some errornous information in that post that I feel I should correct.
I emailed Brittney after she contacted me again and let her know that I was not upset at her but was caught off gaurd that she has a relationship with our father.
I got a response last night - I was way off - Brittney has never even met our father in fact he is more of a dirt bag than I thought or knew he was - apparently he didn't even acknowledge Brittney until 8 years ago when she was 14 years old.
So moving forward Ryan and I are planning a trip to Spokane, Washington to meet our sister! Apparently we have a neice and nephew as well - this is very exciting!!!
I have a new attitude about this new sister - I will keep you posted on the developments. It will be really neat to be called Aunt Hope from kids that are actually my neice and nephew! Silly I know!

Snack Mix

I have discovered a new website that has yummy HEALTHY recipes on it. Eat Better America you can choose from all kinds of recipes and they even have coupons that you can print out - I LOVE COUPONS!! I have made a few dishes and only one was a dud - The Lime Chicken it was not good - too much citrus. Anyway I love that trail mix that you can buy with the M&M's and pretzels but it isn't very healthy and it contains peanuts so poor Quentin can't have it as he is allergic. On Eat Better they had a recipe for Snack Mix - I made it (it was a lot cheaper than buying it from Sam's) here is the recipe try it out or check out the website and find some other yummy healthy recipes to try!!

4 cups Cheerios
2 cups pretzels or oyster crackers or popcorn (we used the pretzels)
1/2 cup peanuts, raisins, miniture marshmellows or M&M's (we did a batch with peanuts and one without and used the M&M's -0f course)

Mix all ingredients in a large bowl or ziploc bag and then store in an airtight container!

With the Holiday M&M's that always are out in the different colors you can change it up when you make it! And you can choose whatever type of Cheerios you want - Quentin wanted Fruit Cheerios for his snack mix and I used the honey nut for our snack mix - the possiblities are endless!!!

ENJOY!!!

Kids Eat Free -

Last night we had the worst service at Denny's - on Tuesday nights Kids Eat Free - anytime this occurs you can expect a free for all, Denny's was no exception. I didn't feel like cooking last night. So we embarked on the adventure of Kids Eat Free night. We were seated and it took what seemed like forever for a server to come to our table. So when the goof ball (who was the manager) finally acknowledge our table we were ready to order - the drinks arrived at 5:50 PM (I only know the exact time because I took the attached picture). Joe had ordered a salad with his meal which took forever to arrive - not a good sign. A couple of tables were seated in the time we had ordered our drinks and Joe's salad arrived. The next thing I know I look at the clock on my phone it was 6:20 - Still no food had arrived at our table, however the tables all around who were seated after our order had been placed were receiving thier food. The ding bat manager came to our table and I ever so polietly (Not) asked what the estimate time for our food to be done was, he said the standard it is coming right up. So then it was another 5 minutes before he surfaces again and says the kitchen messed up and hadn't even started our food yet - WTH - so now I am really pissed (anyone who knows me can imagine my reaction) I just rolled my eyes at him and glared. At this point Adrianna was done - Quentin was STARVING, they did manage to get Quentin's food out after my glare. Joe and I ended up getting boxes for our food as it was 7 PM by the time our food arrived at the table and Quentin was done eating by that time.
The manager said he was sorry and handed us our ticket - I told Joe DO NOT LEAVE A TIP - he always leaves a tip because he says it isn't the servers fault - WHATEVER. He looks at the ticket and the only thing we were charged for was Quentin's drink which he got in the Orbit Cup which was $3.00 Joe left $10 on the table - I did not approve but at that point just wanted to get the hell out of there.

We decided we will not be attending anymore KIDS EAT FREE nights.....

6 Months Old - Already!!

Adrianna just had her 6 month well baby check up I can’t believe that she is already 6 months old. Joe took her to the appointment today and then got to be the hero when she got her shots.

Anyway here are the stats:

She now weighs 14 lbs 15 ½ oz ( 25 – 50%)
Her height is 26” (75th Percentile)
Head is 42 ½ CM (50th Percentile)

Dr. Lyon said that her ears are clear now (just finished 10 days of antibiotics for ear infection) but did say that she may get another one between now and her 9 month well baby check up (Lets hope not)

I also noticed a rash on her face last night – which FREAKED me out – it looked very similar to Quentin’s when he has an allergic reaction to foods, however I guess I am just sensitive to that because Dr. Lyon said that he is not worried about her having allergies and that her rash was due to dry skin (I guess I better put more lotion on her little cheeks)

Other than that she is rolling all over the place – she finally figured out how to flip from back to front – she also has started scooting by kicking her feet she ends up on the other side of the living room before we know it and she is still on her back – very crazy. She is starting to want to sit up too so it is just a matter of time before she is sitting unsupported.

The picture is from last night she was eating a rice cracker she really likes these!!!

Just call me Lady Luck

This weekend was almost perfect - the only reason it wasn't perfect was because nothing really is.

Saturday started out great both children slept in until 8AM - I made blueberry muffins, eggs and turkey bacon for breakfast. Once the kitchen was cleaned we (myself and the children) got ready to go to Target, the purpose of the trip was to get some baskets to organize some areas of the house, however I think that I only purchased one basket. I did get the bargain of the year (so far) this wool coat was marked down from $75.00 to $16.24 I didn't think twice about putting it in my cart!

Feeling GREAT about my new coat, we headed to the baby department. Adrianna is ready for an exersaucer so I thought I would check out what they had, we got the Jumperoo also on sale that day! As I was looking at the Jumperoo I glanced down the aisle that the binkies are on - THEY HAD THE BINKIES that I was looking for with a bright red sticker that said NEW ITEM. I about screamed I was so happy!! I purchased all 5 packages that they had!!

We finished up our trip to Target and decided to that it was time for lunch, we called to see if Joe was awake and if he wanted to go to lunch with us. We ended up going to LaCabana, which is our favorite place. As we headed downtown it occurred to me that LaCabana was on 4th Avenue, usually not a big deal however the Iditarod Sled Dog Race was starting on this day and they block 4th Avenue. With a little manoeuvring and driving down the wrong way on a couple of streets and sidewalks we made it - it was perfect too because the teams had to pass right by the restaurant, it was so beautiful outside that Quentin wanted to watch a couple of teams - so Joe and Adrianna went inside while Quentin and I watched the last 5 teams take off on their journey to Nome.

After lunch we decided that we needed to go to GCI, our cellular service carrier, and switch out our SIM cards. They are updating their service and have been requesting for people to come in a switch out the cards since October, we have drug our feet until receiving a text message that said if we didn't switch out our cards we would have an interruption in service. Joe waited in the car with both sleeping children and I went into to switch out the cards on our phones. Now usually I do things right away - however AM SO GLAD that I procrastinated. I waited in line and when it was my turn I gave the lady our phones and said we needed to switch out the SIMS. She smiled and said ok and thank you - as a thank you gift for the inconvenience of having to switch the cards I got to choose a prize for each number we had on our account. I got to choose two "gifts" The first ticket I chose was FREE CELLULAR SERVICE FOR ONE MONTH! I was happy with that choice - so as I reached in to choose my second "gift" as I was doing this I asked the girl what the gifts were - she said a little of everything, Airline miles, a 4wheeler, free service, free phones etc. So I pulled out the ticket and handed it to the girl it said FREE PHONES - now anyone who has cell phones knows this can be deceiving because they are usually cheap - so I was not as excited to see this prize. The girl says that they had not given many of the phones away so I should feel lucky - I asked her what phone it was, she said it was the Blackberry Pearl!!!!!!! I could not believe it I have been bugging Joe for this phone since Christmas but have been told no as they are $499.98 each - obviously way to expensive to pay for a dang phone. So imagine how STOKED I am that we won them! Since we have two numbers associated with our cell account we each got a new Blackberry!!!

So after spending 45 minutes in the store for a quick switch out - I get back in the car and Joe immediately says "what did you do?" I just looked at him and handed him the new phone - he didn't say anything and then looked at me I was totally CHEESING and said "it was FREE"

he was relieved that I didn't just drop $1000 for new phones.....

Anyway I just was on such a lucky streak on Saturday that I decided to purchase lotto tickets - we will see if my luck continues!!!

Breaking up is hard to do - UPDATE -

I totally drug my feet on breaking up with my hairdresser Rhonda - explained in a previous post. SHE CALLED ME - I broke up with her and felt totally bad about it.

The thing is that kills me is that she totally damaged my mom's hair and then tried to cover it up. She called my mom too who told her that she was seeing someone else which probably is the reason that she called me.....

At any rate she will not take responsiblity for the fact that she overprocessed my mom's hair and it broke off -

I am totally happy with my new girl and can't wait to go and see her on the 21st. I have requested a totally new do with hair flare (color) so I will post a picture after my appointment!!

I still feel bad about the break up - but I know that it had to be done! Just so you know I didn't go out and buy ice cream or anything - it wasn't that bad of a break up!! LOL!!!

A Growing Family

My immediate family has always been very close - we consist of my mom, myself and my brother, Ryan. I consider Ryan one of my very best friends. Growing up in a single family home we had very little contact with our father (Rick) - totally his choice, we did however have great contact with our Aunts, my dad's sisters. When I was in college at St. Martin's I was able to become very close to my cousins who lived in Olympia. Through this relationship with my cousins I learned that Ryan and I have a 1/2 sister. My cousin, Regon, didn't know much about her except that she lived in Walla Walla and her name was Brittney. Ryan and I thought this was pretty cool - and asked Rick on many occasions for her information, we were ignored. Our Aunts, Rick's sisters also would avoid the question - this always seemed very strange to me but whatever. I tried to google her name but nothing ever came up - I would try every now and then but didn't really activley pursue it.
So fast forward 14 years, I am on maternity leave and Ryan calls to tell me that Brittney emailed him, I was totally excited what are the odds that she would find us - Ryan gave her his contact information as well as mine, apparently she contacted Ryan through MySpace. So we didn't hear back from her for about a month, and then she called Ryan - they had a nice chat he then said that she was going to call me, and that I really needed to have an open mind when she called. I said well of course I would why would he tell me this? Apparently Brittney and Rick have had a good relationship her entire life - WTH - this really pissed me off and then Ryan says that she got our contact information from Rick - double WTH now I was pissed and insulted. When Brittney called I ignored her call.
Last week she emailed me and wanted to make sure that she had not upset Ryan or I for contacting us and that she really wants to get to know us. After thinking for a bit and realizing that I didn't have so many raging hormones anymore I responded back to her - and told her my feelings and that I would like to get to know her too. How cool I am a BIG Sister - of course I have always been the Big Sister but now it feels fresh again.

Around the sametime that Brittney found Ryan and I - my Uncle's daughter found him. Long story short my uncle and his girlfriend in college gave up a baby - fast forward 32 years - my uncle and his girlfriend (now wife, my aunt) are still married and thier daughter found them and wants to meet them. HOW EXCITING! The strange thing is that Heather is 32 she was born in October 1976 - I was born in August 1976 - her adoptive parents lived on the same side of town as my family and went to the same catholic church that my family went to - our families probably gave each other the sign of peace and didn't even know it. Anywho my uncle and family moved to Washington - they are coming up this summer to meet Heather and her family - then we will have a family BBQ - for those who know my crazy extended family it will be overwhelming I am sure for Heather but we are all excited to meet her and welcome her into our family!

The fact that Heather's adoptive family and her birth family were in the same area shows what a small world we truly live in.

BINKY CRISIS - UPDATE!!

SHE HATES THE NEW BINKY! I gave it to her last at bed time and she just looked at me and then spit it out....CRAP CRAP CRAP......

Going to Target this weekend hopefully they will have them, I have not seen them there and the selection at our target for this particular baby supply is very bad.

BINKY CRISIS!!!!

I am usually pretty easy going about things, however this is a true crisis for my house. Adrianna will only take one kind of binky she isn't dependent on it or anything but it sure does make car trips and going to bed a bit easier.

Since we just got done with being sick at our house for the second time I decided that it was time for new binkies, I have already boiled the ones we have 2 times so it is time for a fresh start!!! So today at lunch I decided to take a trip to Babies R US, since I have not been able to locate the items at Wal Mart, my beloved Target or Fred Meyers. We originally bought them at Babies R US I thought for sure they will have them. I first went to the aisle that has the breast pump accesories I needed cleansing wipes and bags. I then made way to the wall of pacifiers, I noticed it was pretty empty as I got closer but I was hopeful that they would have what I needed.
CRAP I don't see the package that I am looking for, calm down maybe you just missed it, I thought to myself. I scan the wall again - not only do I not see the package that I need but I don't see a tag that indicates that they are just out of stock.

I then stood in front of the wall of pacifiers with a blank look on my face - I had to find a new type to try - she doesn't like the Nuk or the Playtex ones so the choice was difficult. I hope that the one I picked will be sufficient!

I googled the type and found them at Walgreens - hello Alaska does not have Walgreens - so then there are multiple listings on EBAY for the damn things. I am an EBAY addict but I will not purchase binkies on ebay.

So I have attached a picture of the package - if any of my friends in America see these when you are at Walgreens or some other civilized store could you pick me up a package or two? LOL!!!!

I am changing my address...

I have decided that I am going to move my family to the pediatrician's office, they have plenty of space in the waiting room for my family to have a nook! In the past week Joe or myself or both have been at the doctors office with the children in what seems every day. In reality we were there 4 days, however I am a little tired of seeing my children's doctor.

The germ fest started last Friday evening, Quentin was running a fever so we watched him and laid low for the weekend, when he wasn't better on Monday and a runny nose and cough had developed we thought just a cold - no big deal. Tuesday Adrianna started to run a fever - this of course is a bigger deal as she is only 5 months old, fearing that she had another dreaded ear infection so I called my mom to come and hang with Quentin so I could take Adrianna to the doctor, as I was walking in Joe was out the door to work and my mom was already there, THANK GOD FOR HER!
So the Dr. Hepler (a different one we had not seen before) looked at Adrianna and said her ears looked good and not infected - PHEW, but that there is A LOT of influenza going around so that we needed to watch the temp and if she was still fevering by Thursday to bring her in so they can look at her again. Then he proceeds to tell me that they had admitted 4 children that day to the hospital - GEE THANKS not that I don't have enough to worry about.

Wednesday Quentin wakes up at 4 AM crying and saying that his ear hurt - this freaks me out as we are only 2 months into our 4th set of ear tubes (YES I SAID 4th SET) so as soon as the doctor's office opens I make an appointment for Quentin to be seen - Joe takes the kids to this appointment, Dr. Lyon said his ears were fine, and that he has the viral cold. Adrianna seemed fine this day - still a little warm but not fevering.

Thursday - no visits to the doctor this day! YAHOO, foolishly I thought we were on the path to recovery.

Saturday - again no visits to the doctor this day - Quentin actually had some color back in his face and was running around, I knew he was feeling better. Adrianna was still looking puny, after her nap I was changing her diaper and took her temp 103.6 - CRAP of course the doctor's office was closed by this time, so I called the nurse line. She said that the doctor would want to see her Sunday. The highest her fever got on Saturday night was 104.2 the lowest was 102.3. Saturday night was not a good night for sleep at our house, Quentin finally slept all night!! Adrianna would only sleep in her bouncy chair or on me - we camped out downstairs on the couch.

Sunday - I called the doctor's office as soon as they opened 10AM so we got an 11:20 AM appointment - My mom (AGAIN THANK GOD FOR HER) came and took Quentin to church and then to hang out for the afternoon. The waiting room at the doctor's office was packed for a Sunday I was surprised - anyway finally our turn and the doctor comes in the room and says that he was thinking that we needed to collect labs and urine - HELLO, even in my sleep deprived moment I knew that was not good. Labs for a 5 month old are horrendous enough but urine the only way to collect that is cather. He says that with the fever being so high with the medication there is something else going on. I just looked at Joe and almost started to cry thinking about the labs and urine collection.....Dr. Penman started the exam looks at her right ear and says it was fine - DARN secretly I was hoping for a good infection in order not to have to do the unpleasent labs - he looks at the left ear - BINGO she has a "raging ear infection" (those who have children - you know the poster in the doctor's office that shows ear infections, ok her's is the upper right picture with the bubble of puss- GROSS I KNOW) I was so relieved, no labs needed! He said she also has a sinus infection - he gave us an anitbiotic and ear drops - by Sunday evening she was much better she even slept for more than 45 minutes at a time!!

As we were leaving the office yesterday I did tell Dr. Penman that we would be moving into the nook of the waiting area, he laughed, and suggested that he get a plaque for the exam room and name it THE CHAVEZ FAMILY ROOM - he said that we could reserve our room the next time we came in.

Our next appointment is not until March 10 for Adrianna 6 month well baby check up - I told Dr. Penman that I really did not want to see anyone in thier office until March 10. He agreed!

Hopefully this week everyone will be better! I will be DISINFECTING the house again tonight.