Archive for the ‘costs’ Tag

My Costs for Pregnancy and Labor   Leave a comment

I have found myself missing blogging very much during the past year. On a regular basis my mind comes up with ideas for blog posts, but the reality of being a new mom has meant that I never managed to get any of those ideas typed up. I’m hoping to resume blogging, maybe on a monthly-ish frequency, now that Conan is a year old.

Shortly before Conan’s first birthday, I finally got resolution from my health insurance company regarding coverage for the cost of his birth and I’ve been wanting to write about my experience with the cost of homebirth. I must emphasize that this is my experience and should not be generalized.

Cost was not a significant reason for why I chose to give birth at home in the first place, and it probably doesn’t make an difference to someone who is not comfortable with the idea of homebirth. In retrospect I feel that within my values it is a strong plus in the homebirth column, though. There is a lot of complaining going on now about the cost of health care, and this is an example of how we have the power to make choices that affect the cost of health care for ourselves and others.

When I looked up the cost for a normal vaginal delivery last summer while writing my grievance letter to my insurance company (story to come later), the estimated range for Sacramento was $10k-21k. Checking again right now the website says the estimated range for three major hospitals in Sacramento is $15k-23k (approximately $3k of that out-of-pocket and the remainder paid through insurance). My total cost was $4,955, with $2,932 of that ultimately out of pocket. Yes, my cost was $5k. Between one fifth and half the cost of a normal hospital birth. My out of pocket expenses ended up being on a par with what they would have been for a hospital birth, but that is because I fought for reimbursement.

What was included in my total cost?

  • Midwife care (13 prenatal checkups, attendance of 2 midwives for the birth, 6 postnatal mother & baby checkups)
  • Two ultrasounds (nuchal translucency and 2nd tri)
  • Genetic Disease Screening Program
  • California Newborn Screen
  • Other lab tests
  • Birth kit
  • Six visits to a chiropractor

Nearly all of our costs were initially out of pocket. We paid our midwives out-of-pocket because the total fee is less if you pay out-of-pocket instead of having them go through insurance. And since I assumed that my insurance company would reject the claim, it just made sense to go the route with less cost even if it meant more effort on my part (to submit a member claim to insurance). I have a high deductible health insurance plan, so for the first $1.5k (in-network) each year it is all out-of-pocket, and the only thing that put us over that deductible was the charge for midwifery care.

When I submitted my member claim, my insurance company applied the charge to the out-of-network deductible ($3k) and stated that only half of the fee was allowed for the procedure. I submitted an appeal arguing that since there are no in-network midwives I couldn’t choose an in-network provider so I should not be penalized and the cost should be applied to the in-network deductible. I also pointed out that even applying the cost to the in-network deductible and reimbursing me at that rate, their total cost is still significantly lower than it would have been had I had a hospital birth. I’m guessing that the reason their allowed cost was so much lower than my actual cost was because their allowed cost was for the “childbirth, normal vaginal delivery” procedure only. When I got a $2k reimbursement check I figured that was good enough.

I did get a laugh when I got the response to my appeal. It read: “This administrative decision represents an exception and does not change Anthem’s position regarding plan benefits, as detailed in your EOC form. … Please note that your EOC specifically states that if there are no contracted midwives you may call customer service for a referral to a participating OB/GYN. …” Why on earth would I trade the awesome care I received from my midwives in my comfortable home for mediocre care by a doctor in a medical facility? (No offense to the vast majority of people who prefer birthing in the hospital. I’m just a li-i-ittle bit jaded about medical doctors having had more negative experiences than positive.)

Posted February 1, 2014 by mayakey in money, pregnancy

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2010 Water Quality Report   Leave a comment

Our annual Water Quality Report recently came in the mail. It’s a good document to get in the habit of reading. As an environmental professional, I always find these reports frustratingly skimpy on the data; but I’m guessing most people find them hard to read and would prefer to ignore them. Water agencies are required by law to collect a certain number of samples and analyze for a certain number of analytes. These reports are how they communicate that information to their customers. It’s how you can know that your water is safe, at least when it is in the distribution system. Lead or copper can get into the water in the pipes inside the building, but that’s not the responsibility of the water agency.

A short water quality report is a good thing. Water agencies only have to report detections, so the shorter the table, the fewer analytes were detected over the course of the year. Sometimes I think it would actually be good PR for a water agency to print in the background or in fine print in a corner somewhere the complete list of all analytes so that consumers can know what’s NOT in their water in addition to what MAY BE in the water. There are two major categories of analytes: those with primary Maximum Contaminant Levels (MCLs) and those with secondary MCLs. Primary MCLs are health protective. Secondary MCLs are more aesthetic (i.e. taste, color, or odor). Some chemicals have both primary and secondary MCLs, in which case the primary MCL is naturally the most important one. For primary MCLs there is the MCL and the MCL Goal. The goal is the level below which there are no known health risks. Unfortunately it is not always possible to treat water down to the goal because of technological limitations and/or cost, so the MCL is set as the lowest level that is actually feasible while also being protective of health. Especially since I am trying to get pregnant I am very interested in comparing the detections to the MCL Goal, instead of just the MCL.

In our case it is somewhat comforting to know that the only regulated organic compound detected was dibromochloropropane (DBCP). This is on the one hand comforting to know since our water agency is situated right on top of an area with significant groundwater contamination from AeroJet. I have several coworkers who work with local water agencies to protect their well fields from these groundwater plumes. On the other hand, however, I am not pleased to see that there was at least one sample where DBCP was detected at a concentration several times above the MCL Goal. To be completely honest, it doesn’t worry me that much, though. I still have no plans to filter our water at home. Just because one sample (ok, I don’t know how many) over a two year period was above the MCL Goal and below the MCL doesn’t mean that I’m getting constant exposure to that chemical. And the MCL is still considered health protective. For all I know they may have turned off the well with that detection anyway. It may be contrary to my devotion to the precautionary principle to not want to filter my water now, but I’m looking at it from a cost/benefit side. A carbon filter for our drinking water wouldn’t provide protection from the exposure through skin and lungs in the shower. Right now the cost of a whole house filtration system is just not high on the wish list. I’d rather replace our 19-year-old sofa so that I’m no longer exposed to any fire retardants and other chemicals in the exposed foam.

On top of these regulated substances, there is unfortunately also the issue of unregulated contaminants and emerging contaminants, but that’s a whole different topic for another post someday.

Stupid Cable Box   Leave a comment

I have hated the cable box since the moment that it first entered our house. Maybe even earlier, actually. We were one of those hold-out families that didn’t  jump to digital until forced. It was a joke to me watching cable channels slowly move from the basic cable package to the digital package, and watching the price differential slowly decrease. We waited until the price differential reached $0, at the time of the digital switchover. Unfortunately, the cable box is large, and there wasn’t a good place for it in our entertainment cabinet, so it is balanced on top of the TV. The day we hooked it up was a grumpy day for me because I hated the thought of being forced to add an extra cumbersome piece of electrical equipment that would draw ever so much more electricity for no other purpose than entertainment. To add insult to injury, it is harder to watch TV using the cable box because there is now a lag between channel changes. Yes, I know I could have chosen to stop watching TV completely, but neither my husband nor myself really wants to do that.

In our old house the power strip for the entertainment cabinet was not easily accessible, so we only powered down completely when leaving for vacation. In the new house we were able to arrange the furniture so that the power strip was reachable and we could turn off the power every night. I don’t know if everyone understands phantom power. Many pieces of electrical equipment are always drawing power. Sometimes it’s obvious, like a microwave with a clock that is always lit. It may not be drawing a lot of current, but unless you unplug the microwave, it is always using electricity. Often it is not obvious, like a TV, which appears to be completely “off” when it is turned off. However, in order to be able to use a remote control to power up, the thingy that receives the signal from the remote has to be on at all times. Phantom power load can add up in a typical house: water heater, thermostat, refrigerator, freezer, microwave (with clock), stove (with clock), alarm clocks, cell phone chargers, computer power adaptors, TVs, VCRs, cordless phones, cable boxes, modems, CO monitors, doorbells, etc. To figure out your phantom power load, you can read your electric meter at night right before you go to bed when all of your lights, etc. are off. (and during a time of year that A/C and heating are not required), and then read it in the morning before turning anything on. Or do it while you are at work, or anytime that everything is “off” for several hours. In the summer of 2005 I did a personal energy audit and determined that my phantom power usage ranged from 0.15 to 0.3 kWh/hr (this did include some lights and occasionally a fan, which might explain the range). That comes to 1300 to 2600 kWh/yr. At my current electric rate that is $125 to $250 per year.

I wanted to start off on the right foot in this new house with lower energy usage, hence the reason we made sure that the power strip for the entertainment center was accessible. In the fall, after getting ourselves settled, we started turning off all of the power strips every night, including the one for the entertainment center. My husband complained a little bit about having to wait a minute or so for the cable box to reset itself the first time it was turned on each day, but considering how much heat it gives off when “off” it was obvious that it sucks a lot of electricity even when not in use. After a while, though, we started noticing that it took several minutes for some channels to come back on line; and then some of the channels didn’t come back at all. Unfortunately a couple of our usual channels got lost as either blank error screens or super-pixelated sound and picture. This week I finally got around to calling Comcast to schedule a technician. We had already tried power cycling, checking the wiring, etc. and determined that a technician needed to come out. So yesterday the technicians spent about an hour to determine that the box was broken. They replaced the box and we have all of our channels again. Unfortunately, when I asked if turning off the cable box was the culprit, he thought that it might have been. Apparently it is not uncommon for them to see this problem after a power outage.

So we now have TWO power strips for the entertainment center. One for the cable box and modem that will always be on (I’m sure the modem would be fine with shutting power off, but we use internet constantly, and often while the TV is off), and one for the TV, VCR, etc. that will be off when we are not at home. It’s not perfect, and now I really hate the cable box, but it’s what we’ve got to do for now. I just wish they could build a hard switch on appliances so that you could choose to shut off the phantom load. I’d be perfectly fine turning the TV on at the TV, and then settling down with the remote.

Posted January 29, 2011 by mayakey in energy use, home

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