Running Bear's July 2025 Coffee Shop
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Todd: Welcome to the wild uncertain world of Cardiac Solutions. Blood thinners are a standard treatment.
(They're [Aetna] not my insurer, but my son was covered by them in 2023 when he worked at UPS. He didn't know he was covered by them -- it was his first real job etc and we had him on our family insurance so he never bothered to figure out what the union offered as benefits when he finally joined. We submitted to our family insurance his appendectomy and a bunch of other checkups and tests and stuff he needed for his trip to Japan and living in Japan and our family insurance paid it. In late 2024 we started getting all these bills form his services and re-calculated EOB [explanation of benefits] from our family insurer. Turns out they had run audits and found he was insured by Aetna as primary and them as secondary and had reversed all the payments. So I had to contact all the providers and ask them to submit to Aetna. And Aetna then rejected them all due to the time elapsed from the service to when they were submitted to them. But that was wrong because the providers had submitted everything timely to the original insurer and then as soon as they found out to Aetna. I've been fighting this since late 2024. [It's called coordination of benefits and is a PITA]. Each individual one I have to fight. They've accepted some appeals and paid and others they've rejected twice and have sent them to the company who provides the insurance to their covered -- in this case UPS's union. So they get sent to the union's executive committee where they sit a couple months until the insurance committee meets. The one I've finally gotten feedback on was adjudicated in our favor and sent back to Aetna but I have not yet heard back from Aetna since.
A few have been sent to the union. One stupid one was where they rejected the initial appeal, saying I waited too long to appeal their decision -- I had to appeal within 180 days of their original notification of rejection of the claim. Well, 2 or 3 weeks is less than 180 days and I wrote to tell them that and that they were wrong in not even looking at my appeal for that reason as I had sent my appeal well within 180 days. Despite the fact that they had never even adjudicated the original appeal, they considered this a second level appeal which had to be sent to the union executive committee... The people at Aetna are dumber than a door nail.
Luckily the big $22-23k one was accepted on original appeal and paid and paid at face value. They claim they don't have a contract with this hospital system but they were going to consider it "in network" anyway and they seem to have paid the whole thing. Which meant that the hospital got almost double the original payment as the original insurer has a contract and only covered the bill at the contract amounts for each service, which was about 1/2...
There are still several small rinky-dink $100-$1000 claims that they're being stupid on. The good thing is if I cannot force these through Aetna, I can resubmit it to the original insurer, who is secondary. So we are covered in any case. But it's been a monumental waste of time and energy and it makes me extremely angry.)
I have an E*Trade account with the opposite problem. I withdrew the complete balance but then one or two cents showed up when new interest was posted. They’ve tried to charge me a statement fee (pushing it to a negative balance) but I just ignore it. The account was used two employers ago, now, to handle stock grants. They can do whatever they want.
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Boris
Beach Bum
Todd: Welcome to the wild uncertain world of Cardiac Solutions. Blood thinners are a standard treatment.
Boris
Beach Bum
Reminds me of the Tank Crossing I saw at Ft. Jackson. Impressive!
Bruette
Well-Known Member
Karl, thank God you have insurance! Most of all; don't forget you a priceless!Got some interesting mail today, the statement from the hospital for the bypass operation and the pacemaker, 4 day stay including 3 days in ICU and 1 day of a regular room.
In big letters at the top, THIS IS NOT A BILL.
$67,048.52
Now it goes to Aetna for payment , fingers crossed!!
chadbag
Well-Known Member
Let's not talk about Aetna. My problem with them is unrelated to Karl's procedures and services but they've been totally incompetent in our case.Now it goes to Aetna for payment , fingers crossed!!
(They're [Aetna] not my insurer, but my son was covered by them in 2023 when he worked at UPS. He didn't know he was covered by them -- it was his first real job etc and we had him on our family insurance so he never bothered to figure out what the union offered as benefits when he finally joined. We submitted to our family insurance his appendectomy and a bunch of other checkups and tests and stuff he needed for his trip to Japan and living in Japan and our family insurance paid it. In late 2024 we started getting all these bills form his services and re-calculated EOB [explanation of benefits] from our family insurer. Turns out they had run audits and found he was insured by Aetna as primary and them as secondary and had reversed all the payments. So I had to contact all the providers and ask them to submit to Aetna. And Aetna then rejected them all due to the time elapsed from the service to when they were submitted to them. But that was wrong because the providers had submitted everything timely to the original insurer and then as soon as they found out to Aetna. I've been fighting this since late 2024. [It's called coordination of benefits and is a PITA]. Each individual one I have to fight. They've accepted some appeals and paid and others they've rejected twice and have sent them to the company who provides the insurance to their covered -- in this case UPS's union. So they get sent to the union's executive committee where they sit a couple months until the insurance committee meets. The one I've finally gotten feedback on was adjudicated in our favor and sent back to Aetna but I have not yet heard back from Aetna since.
A few have been sent to the union. One stupid one was where they rejected the initial appeal, saying I waited too long to appeal their decision -- I had to appeal within 180 days of their original notification of rejection of the claim. Well, 2 or 3 weeks is less than 180 days and I wrote to tell them that and that they were wrong in not even looking at my appeal for that reason as I had sent my appeal well within 180 days. Despite the fact that they had never even adjudicated the original appeal, they considered this a second level appeal which had to be sent to the union executive committee... The people at Aetna are dumber than a door nail.
Luckily the big $22-23k one was accepted on original appeal and paid and paid at face value. They claim they don't have a contract with this hospital system but they were going to consider it "in network" anyway and they seem to have paid the whole thing. Which meant that the hospital got almost double the original payment as the original insurer has a contract and only covered the bill at the contract amounts for each service, which was about 1/2...
There are still several small rinky-dink $100-$1000 claims that they're being stupid on. The good thing is if I cannot force these through Aetna, I can resubmit it to the original insurer, who is secondary. So we are covered in any case. But it's been a monumental waste of time and energy and it makes me extremely angry.)
Bill Tidler Jr.
Retired N&W/NS Signalman
Good morning! It's 68°F and partly cloudy. 
Have a great Thursday!
traiNscale
Well-Known Member
howdi coffee people!
sun is back out in switzerland. last two days we had a temperature drop from 30celcius down to around 12 Celsius in the mornings..
well at least the sleep was great.
airport ZRH is busy and getting busier every day. summer vacation incoming. upcoming weekend we have the every year event where iam the host on the microphone. its called www.freestyle-night.ch its a competition where riders on ski and bikes (we also had snowboarders) jump over a ramp into water. always nice and after there is e party all night long, so i know how my sunday will look like
here is a picture from my coffee break from yesterday.
cheers
Marco
sun is back out in switzerland. last two days we had a temperature drop from 30celcius down to around 12 Celsius in the mornings..
well at least the sleep was great.
airport ZRH is busy and getting busier every day. summer vacation incoming. upcoming weekend we have the every year event where iam the host on the microphone. its called www.freestyle-night.ch its a competition where riders on ski and bikes (we also had snowboarders) jump over a ramp into water. always nice and after there is e party all night long, so i know how my sunday will look like
here is a picture from my coffee break from yesterday.
cheers
Marco
I think I mentioned my credit union's movement toward more fees, less interest, etc, and that I'd had an issue when I made a payment on a personal loan with them. This morning, I paid off the loan--I thought. After paying it off, I still have a balance of thirteen cents.
Sigh...
Sigh...
NorthBrit
Well-Known Member
Pay it off Terry before the cents become dollars in interest. (Been there.)
troyphoto
Snarky Old Fart (in training)
I'm back from the grocery run. Wife wanted a shepherds' pie tonight. I use pre-packaged ingredients for this... beef roast au jus packaged in a tray, instant mashed taters, baby carrots... No Peas! I hate peas!
Why all the prepackaged stuff? I'm not a fan of making a mess doing up stew beef, nor of making au jus. And, when I was in the dorm in college, I had mashed potatoes every night. I rarely ate vegetables outside of green beans and corns. (I'm a finicky eater) so I consumed a few tons of spuds in the mashed variety. Peeling, mashing and cooking those just to relive the memories of stirring the grey-white goop that came out of the dorm kitchens? Nope.
Instant work well. Boil water, stir in the dehydrated taters. Done.
As a topper under the cheese in a shepherds pie, they work fine. Coat them with cheese, and we're good.
When we were in Gettysburg, we stopped at the Garryowen Irish pub for dinner. Wife spotted Shepherd's pie on the menu. In the blurb it said that shepherds pie in Ireland is traditionally made with beef not lamb. It's a mistaken notion that lamb was used.
So, we're back to calling it Shepherd's pie.
Why all the prepackaged stuff? I'm not a fan of making a mess doing up stew beef, nor of making au jus. And, when I was in the dorm in college, I had mashed potatoes every night. I rarely ate vegetables outside of green beans and corns. (I'm a finicky eater) so I consumed a few tons of spuds in the mashed variety. Peeling, mashing and cooking those just to relive the memories of stirring the grey-white goop that came out of the dorm kitchens? Nope.
Instant work well. Boil water, stir in the dehydrated taters. Done.
As a topper under the cheese in a shepherds pie, they work fine. Coat them with cheese, and we're good.
When we were in Gettysburg, we stopped at the Garryowen Irish pub for dinner. Wife spotted Shepherd's pie on the menu. In the blurb it said that shepherds pie in Ireland is traditionally made with beef not lamb. It's a mistaken notion that lamb was used.
So, we're back to calling it Shepherd's pie.
TLOC
Well-Known Member
Good morning forum viewers! It’s 67f degrees (up 5 degrees in 50 minutes) heading to the mid 80’s. Cloudy skies, winds at 5 mph, the humidity is at 89% and the dew point is 63 degrees. Right now it feels sticky out there. I checked the rain gauge this morning and there was zippo there. So. Central Wisconsin yesterday was a perfect day but it was clear skies all day. We already are cloud covered.
No plans even though it’s breakfast out day! We shall see what the wife wants when she wakes up. We still have not finalized the end of August and start of September travel schedule. I’m not sure why but I got that wifey stare when I asked last week. So when she decides I’ll know.
I talked yesterday to an old friend and co-worker on the phone. She’s a mess, her hubby has been battling anal cancer over the last 6 years. It’s back for the 4th time and he’s refusing anymore surgeries. They moved around 18 months ago to be closer to the Mayo Clinic in Rochester, Mn and within 45 minutes to all their kids from Summer in the Wausau, Wi suburbs and Winter in Gulf Shores, Alabama. She loves where they’re moved to but now the kids rarely come to see them. Like I wrote she’s a mess and needs a break. Terry spoke to her for sometime and last night sent info to her for a Respite person to come in for a few hours a couple days so she can get away. It’s a 4 hour trip for us but in the next 2 weeks we will make it an overnighter and go see them
I returned to the weathering bench and yesterday I also spent some time at the spray booth. Sprayed many tank cars and intermodal well cars with an initial matte clear coat. These are for September delivery.
Enjoy the day
No plans even though it’s breakfast out day! We shall see what the wife wants when she wakes up. We still have not finalized the end of August and start of September travel schedule. I’m not sure why but I got that wifey stare when I asked last week. So when she decides I’ll know.
I talked yesterday to an old friend and co-worker on the phone. She’s a mess, her hubby has been battling anal cancer over the last 6 years. It’s back for the 4th time and he’s refusing anymore surgeries. They moved around 18 months ago to be closer to the Mayo Clinic in Rochester, Mn and within 45 minutes to all their kids from Summer in the Wausau, Wi suburbs and Winter in Gulf Shores, Alabama. She loves where they’re moved to but now the kids rarely come to see them. Like I wrote she’s a mess and needs a break. Terry spoke to her for sometime and last night sent info to her for a Respite person to come in for a few hours a couple days so she can get away. It’s a 4 hour trip for us but in the next 2 weeks we will make it an overnighter and go see them
I returned to the weathering bench and yesterday I also spent some time at the spray booth. Sprayed many tank cars and intermodal well cars with an initial matte clear coat. These are for September delivery.
Enjoy the day
We're going into some hot summer weather starting tomorrow. 90's-100's for 5+ days. Humidity stays in the low 20%-mid 30% range....thankfully. Dew points are usually in the 40's-50's also......thankfully. The peak temperature doesn't hit until around 5pm either.
I was in the backyard yesterday afternoon to water stuff and noticed that the BIG black tail buck was back in the neighbors yard. My dog must think it's a goat because she didn't react. I was able to get a good shot through a gap in my fence. The far neighbor has a low fence that makes it easy for the local herd to come and bed down. I have a 6' cedar fence and a dog that protects my veggies.
The Velvet is still on.
I was in the backyard yesterday afternoon to water stuff and noticed that the BIG black tail buck was back in the neighbors yard. My dog must think it's a goat because she didn't react. I was able to get a good shot through a gap in my fence. The far neighbor has a low fence that makes it easy for the local herd to come and bed down. I have a 6' cedar fence and a dog that protects my veggies.
The Velvet is still on.
santafewillie
Same Ol' Buzzard
Good Morning All. Partly cloudy and 73° going up to 97° later on. I saw 94° yesterday. Cooler weather returns for the weekend.
Nothing special about yesterday, I picked Yellow Squash and Tomatoes, pulled up some more Johnson grass and spread some more grass clipping mulch. Later, taking advantage of no wind, I irrigated. I did some other stuff that I don't remember. Had to take down the shade umbrellas over the pool around 9:00 due to the out-flowing winds from a nearby thunderstorm, which didn't reach me. Wind was quite severe and I think that one umbrella was damaged. It was dark by then so I will have to inspect it this morning.
The weekly grocery trek is this morning, I have a pretty long list already. Pharmacy is on the itinerary as usual. Wife is going for sure, since Kroger has their wine on sale for 35% off if you buy 6 bottles.
While I made it out to the train shed yesterday, not much was accomplished. I put the maintenance train on the upper level and set it to go on a continuous run for a few minutes to ensure that all cars were still running well. Whooops! There was a low-hanging coupler pin that caused a derailment at a grade crossing. Should have caught that when I replaced that coupler the other day. Parked the train on a passing siding and ran a few others, but no switching. I also resumed the structure clean up on the selected quadrant, but only removed three from the layout and moved them to the workbench.
Google street view? I don't think that they know our road exists!
Joe -
News - Interestingly enough, I find the most unbiased and reliable news on the Al Jazeera news site. They are out of Qatar.
Dave - I didn't know that anyone else ever knew about the "Obscured by the Clouds" album. It was an early favorite of mine and I have some of those tracks on my Ipod player in the train shed with 6000 tracks on random play.
Todd - Glad to read that you came through the medical ordeal OK.
Today is the birthday of the late singer Ronnie James Dio. He sang for Deep Purple and Black Sabbath among others.
Everyone have a great Thursday.
Nothing special about yesterday, I picked Yellow Squash and Tomatoes, pulled up some more Johnson grass and spread some more grass clipping mulch. Later, taking advantage of no wind, I irrigated. I did some other stuff that I don't remember. Had to take down the shade umbrellas over the pool around 9:00 due to the out-flowing winds from a nearby thunderstorm, which didn't reach me. Wind was quite severe and I think that one umbrella was damaged. It was dark by then so I will have to inspect it this morning.
The weekly grocery trek is this morning, I have a pretty long list already. Pharmacy is on the itinerary as usual. Wife is going for sure, since Kroger has their wine on sale for 35% off if you buy 6 bottles.
While I made it out to the train shed yesterday, not much was accomplished. I put the maintenance train on the upper level and set it to go on a continuous run for a few minutes to ensure that all cars were still running well. Whooops! There was a low-hanging coupler pin that caused a derailment at a grade crossing. Should have caught that when I replaced that coupler the other day. Parked the train on a passing siding and ran a few others, but no switching. I also resumed the structure clean up on the selected quadrant, but only removed three from the layout and moved them to the workbench.
Google street view? I don't think that they know our road exists!
Joe -
All the more reason to streamline government operations.
News - Interestingly enough, I find the most unbiased and reliable news on the Al Jazeera news site. They are out of Qatar.
Dave - I didn't know that anyone else ever knew about the "Obscured by the Clouds" album. It was an early favorite of mine and I have some of those tracks on my Ipod player in the train shed with 6000 tracks on random play.
Todd - Glad to read that you came through the medical ordeal OK.
Today is the birthday of the late singer Ronnie James Dio. He sang for Deep Purple and Black Sabbath among others.
Everyone have a great Thursday.
chadbag
Well-Known Member
Yeah that happens. The balance you saw didn’t include the day’s interest, which posted at the end of the day or whenever.
I have an E*Trade account with the opposite problem. I withdrew the complete balance but then one or two cents showed up when new interest was posted. They’ve tried to charge me a statement fee (pushing it to a negative balance) but I just ignore it. The account was used two employers ago, now, to handle stock grants. They can do whatever they want.
chadbag
Well-Known Member
It’s blue haze from looking out the window and warm. 90 or low 80s. I’ve not looked at forecast but probably mid 90s. Yesterday it was breezy and half way through the day we got heavy scattered clouds that came in off and on. I’ll see what it’s like in a few minutes when I go out to walk. Hopefully not too hot (yet).
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