"I'm an old Marine. I'm going to follow the chain of command. I can go until we hit God."
I finally went back to
Learning to be organized and persistent in wrangling my college bills is proving far more educational than any of my actual classes. I want credits for it!
I have an entitlement complex about software. The universe of applications is so vast these days, and the barriers to creating new ones so low, that I expect some clever programmer to have solved pretty much any problem I can dream up. So when I have a problem that seems ideally suited for a software solution, but can't find a good application, I get vexed. Vexed and cranky.
Right now, the gaping void vexing me is software for tracking medical expenses. I take a fairly laid-back approach to budget administration in general. I use PocketMoney on my Palm for day-to-day tracking of money flowing through my checking account. That's all. I have about six regular bills I pay each month in a batch when I get my mid-month paycheck, and it's easy enough for me to remember to do it. My bank information and my regular bills (cable, student loan, credit cards, etc) are all available online. My own personal budgeting approach doesn't demand a Quicken or Microsoft Money; I have little enough to track that I can keep it in my head, and I don't care about the detailed data like "how much did I spend on entertainment last month?" that such programs would offer.
However. I do care about that data mining when it comes to medical bills, now that we have so many. In past years, we've incurred one or two doctor co-pays annually; now we've got a dozen every two months, along with regular prescription costs. We've also got a stack of hospital bills -- one hospital stay, I've learned, can incur at least a half-dozen separate invoices, which show up sporadically.
Our medical paperwork is still not so out of control that a really good tracking system is mandatory -- I've been processing things manually, and everything that needs to get paid is getting paid. I have a good memory for what I've already taken care of, so we're not overpaying. But this is bringing out the information-freak in me. This time, I do want to data-mine the details and have lots of fancy spreadsheets I can run reports against to find out exactly what we're spending, what our insurance company is spending, etc.
Medical bills have lots of specialized wonky wrinkles, like the pile of EOB "this is not a bill" statements they bring in their wake that require tracking and reconciling against the actual, separately mailed billing invoices. The wonkiness means regular budgeting software isn't ideal. So surely some clever programmer has coded up a nifty program tailored for medical bills, right?
Read my first paragraph again. *Sob.*
I can find precisely one major commercial application: Quicken Medical Expense Manager. It's expensive -- $50 -- but if it were fabulous, I'd suck it up, pay, and be happy to find what I was after.
It's not fabulous. Quicken doesn't offer a free trial, so I can't offer a firsthand report, but I probably wouldn't download the trial even if there were one, because user reviews suggest it would break my computer. It seems Quicken Medical doesn't play well with the .Net framework changes in Windows XP SP2.
There's probably a workaround to the .Net issue, and I'd chase it if Quicken Medical had good feedback on its functionality, but it doesn't. The screenshots don't thrill me, and the reviews I've read paint it as an obviously version-1.0 product with a number of gaps and annoying details. I'm not inclined to pay $50 for software I won't love.
However, I'll settle for software I don't love if it's free. Much bashing on Google and Nexis turned up only one serious alternative to Quicken Medical: SimoHealth, a free desktop application from a start-up company funded by Steve Case's Revolution Health. It looks like Simo Software's vague plan is to sell its application to employers and insurers. The company seems pretty dormant at the moment, and I don't know if the application is being supported or maintained, but it's available for free at SimoHealth.com.
I spent about six hours last weekend entering our medical paperwork for the year into SimoHealth. This is not for the fainthearted. The software lacks modern niceties like import and entry-cloning tools; it feels like a version-1.0 GUI slapped over a spreadsheet backend. If you have the same appointment every week, you'll be entering all the details for it 52 times. I didn't run into any glaring bugs, but there were a number of rough edges. Most problematically for me, I couldn't find an obvious way to handle bills incurred over multiple visits but settled all at once. I kluged my way around it, but my solution is an ugly hack that wrecks the elegance I'm seeking from a software solution in the first place.
Still, at the end of my labors, I had data-mining opportunities my paper solution doesn't offer. I can use SimoHealth to quickly total what we've spent to date, and to parse that spending in a few different ways. Keeping it updated will be annoying, given the program's clunkiness, but for me, it's probably worth the pain.
I could do much of this myself in Excel, but I'm a UI snob, and even SimoHealth's basic interface is better than what I could throw together for myself in Excel. But it's a shame there isn't something better out there. (And if you've read this far and know of something better I've missed, please, speak up!) Sod privacy; I think most of us who deal with stacks of medical bills would welcome a Web 2.0ish (aiee, I can't believe I voluntarily typed that) online application for tracking and reconciling medical bills.
I and my entitlement complex look forward to the day when I can settle down at my PC with a bowl of soup, which I will enter in Meal Bandit, and catch up on my medical paperwork with Billing Bandit.
Business Week inspired much yelping in the blogosphere this week with a splashy cover relying on some incredibly dodgy math. "How This Kid Made $60 Million in 18 Months," touts the cover ... glossing over the small detail that the profiled digg founder hasn't "made" any major cash money from the site and that the $60 million is a plucked-from-the-vapor calculation based on some unnamed sources' estimates of digg's worth. (The site currently claims $3 million a year in revenue. Mature companies generally get acquired for a single-digit multiple of their annual revenue. Early-stage ventures with very bright prospects go for higher multiples, but still, this is some impressively bubble-era math Business Week is doing.)
Plenty of others have kicked and dismantled this article in better detail than I can, but what caught my attention about the story from a personal-finance perspective is how nicely the flap over it illustrates the difficulty of valuing illiquid assets. Not many of us own potentially million-dollar Web companies, but almost all of us have assets that are valuable but not easily valued.
Homes are the most obvious case: a house is worth only and as much as a buyer will pay for it. What makes an apartment that sold for $200,000 in 2001 "worth" $400,000 today? Only the complex magic of supply, demand, and all the real-estate-ecosystem forces acting to influence them.
But houses, at least, have established guides for estimating value short of actually selling them, including appraisals and the constant data flow of nearby home sales. There are lots of assets we pick up with even more opaque financial valuations.
For me and David, the big financial X is our book collection. One of the items on my 'I really will deal with this ... eventually ...' list is getting renters' insurance. If our apartment flooded or burned down, one of our biggest financial hits would be writing off or replacing the 2,000 to 3,000 books we cohabitate with. (I'm slowing cataloguing the collection over at LibraryThing.) The overwhelming majority of our books are very standard, easy-to-find items that could be replaced for less than $5 over on Abebooks. Our "collection" is hardly the sort of thing Nicholas Basbanes will one day lovingly chronicle.
Still, hoovering books at the rate we do means you're bound to sweep up a few valuable ones, both intentionally and serendipitously. But attaching a "valuation" to books -- or any other collectable with a secondhand sales market but little intrinsic value -- is a tricky business.
I end up thinking of three separate "valuations" for our books. First, there's the dollar figure of what it would cost to replace them. If my copy of the Codex Seraphinianus were destroyed, I'd need to budget a few hundred dollars to re-buy a similar one. I could go through every book in our library, figure out a reasonable replacement cost to re-purchase the book, and assign a "value" to our collection that way.
But that value would have little relation to the dollar figure our collection would bring in if it were sold, either piecemeal or as a whole. Every bookseller knows that the retail price of a book is a significant markup over its wholesale cost. Bog common books that cost me $1 to buy on Abe would fetch me only pennies if I tried to sell my copy. For 95% of our collection, the replacement cost "valuation" would be significantly higher than the dollar amount for which the books could actually be sold.
Which leads to the third "valuation" for our collection: the wildly variable "value" of the handful of genuinely scarce items. Here, the value is directly dependent on how much time you have to seek a buyer. If we had a financial catastrophe and I needed cash immediately, I could eBay our Codex for $100 or so and get that price fairly quickly. But if I wanted to get top dollar for our copy, I could probably hold out and eventually get at least $350 (it's a very nice copy of an in-demand edition) for it from a dealer or another collector. So what's a more accurate valuation for the book: the 'liquid' value for which it is immediately sellable, or the harder-to-realize, higher price an appraiser or collectors' guide would assign to it?
This is all fairly academic, since I'm not planning to sell of our books or stress about an appraisal for insurance. I'm sure that if I really cared, there are formal answers for how to value things. I just find it intriguing to have a portion of my 'wealth' tied up in something that can't sensibly be given a fixed financial value.
And hey, my valuation challenges are minor compared to what art collectors must go through.
The Washington Post's Checkout blog picked up my Time subscription saga today, so here's an update: I eBay'd it. Paid $10, and didn't end up missing any issues after all. Looks like eBay will be my route for all future magazine subscriptions! And just in time. New York magazine has this crackheaded notion that it's going raise prices to $40 per year, up from the $15 I've been paying ...
(As someone who makes a living writing things for Big Publishing, I'm very sympathetic to publishers' need to turn a profit. But trying to pry high subscription rates out of loyal subscribers isn't the way to do it -- I imagine the sales departments, which bait advertisers with big circ numbers, scream in horror every time nasty renewal practices force churn.)
Lately my main financial occupation has been researching medical parity laws and investigating the likelihood of successfully challenging an insurance company's coverage caps.
I like my new job a lot, but as I've mentioned earlier, one area where it falls way short of my last job is on insurance. I'm now with Blue Cross/Blue Shield. I've always chosen PPO options for my insurance, even when it costs more, because I want the option of going out of network if I need to. I was prepared to choose the PPO option and pay more with Blue Cross -- until I realised that it not only carries a higher monthly premium than the EPO (that's fine), it pays less on in-network services. Unlike every other insurance plan I've had, Blue Cross doesn't cover all in-network medical costs (minus co-pays and deductibles). It pays 90 percent -- but if you're on the PPO plan (paying the higher monthly premiums), it only covers 80 percent of in-network services. The PPO plan also carries a higher deducible and an out-of-pocket maximum that's twice the EPO plan's maximum.
That is one hell of a stick Blue Cross is wielding to get you on the EPO plan.
Which I grudgingly elected. And now, of course, the doctor I want to see is out of network, meaning I'll be paying out of pocket for my visits. Even if I'd gone with the PPO plan, I probably still would be -- I don't think this routine stuff will exceed the PPO plan's deductible.
Meanwhile, David is separately insured through his company's plan, with Aetna. Overall, I suppose I can't gripe too much about Aetna. We've had annoying problems with bills being processed incorrectly, but that seems par for the course with medical paperwork. The overall coverage levels at Aetna are way better than mine through Blue Cross, and apparently better than industry average.
However. Like pretty much every insurer, Aetna caps outpatient visits for some conditions at 30 visits a year. After 30 visits, no more coverage -- it's like being completely uninsured.
This strikes me as a financially stupid approach, for both the insurer and the customer. Medical conditions requiring treatment don't magically disappear after a set number of treatment visits. If the condition gets worse, it could result in hospitalization -- and that's much, much more expensive for Aetna than continuing to pay for outpatient care would be. If a doctor is still saying the care is essential, then the insurance company should at least consider paying for it.
With insurer decisions to stop paying for treatment, you can appeal. It's a frustrating process with no guarantees, but the research I've done suggests that if you squeak loud enough and have the resources and persistence to jump through all the spiky hoops the insurers lay out, you stand a reasonable shot of getting what you're after.
But with these preset limits on coverage outpatient care, the insurers fall back on policy and flatly refuse to make exceptions. An appeal from the doctor handling our case was apparently rejected. A really well-done article in the Times Union newspaper last year found that no provider interviewed had ever heard of an insurance company making an exception.
I'm still going to file a written appeal with Aetna, even if it's fruitless, just to get a written response. I want papers I can hold in my hand while I continue yelping.
But what is really infuriating me about all this is the idea that we're paying $250 a month for medical coverage that is going to be utterly useless for the services we actually require for the rest of this year. Yes, if one of us breaks a leg, it'll come in handy again. Great. But for the care we actually need, we'll be paying out of pocket. Which would be much easier to afford if not for the whopping bill we pay each month for insurance.
