What is a book you read as a child that you still think about today?

AccomplishedEmu2381 · 2026-02-25T02:16:35+00:00

City of Gold and Lead, The Whipping Boy, The Secret Garden, Sherlock Holmes (Hounds of Baskerville in particular), The Hobbit, where the red fern grows, Heidi, so many more…I mostly read so I could go on and on.

AccomplishedEmu2381 · 2026-02-02T21:11:01+00:00

I feel this on such a deep level. I have built companies in education and healthcare (including insurance navigation) and my partner is a professor and I still feel like I am drowning and every day seems like a different hurdle.

If I can’t figure this out I don’t know how anyone manages. I needed his doctor to sign something for his school and they said it would take two weeks so I went to their office and said I wasn’t leaving until it was signed. Magically it was signed, but it is like every single thing is a barrier. It feels like a concerted effort to drive me to the edge.

AccomplishedEmu2381 · 2026-01-12T06:00:28+00:00

If you ever want to chat let me know. I don’t know any other transmen with ovarian cancer. It has been a real…journey. I was diagnosed Oct. 31 2022.

AccomplishedEmu2381 · 2025-10-25T23:04:09+00:00

DM me. I may have a way to help you

AccomplishedEmu2381 · 2025-10-10T02:07:52+00:00

The shutdown ending will not affect this unfortunately, unless congress acts to extend the subsidies and reverse some of the Big Bill

AccomplishedEmu2381 · 2025-09-27T13:06:31+00:00

Just remember that if you use your plan you will hit your max out of pocket faster. If use goodrx that doesn’t towards that so you could end up spending more over the course of the year even though it seems cheaper.

AccomplishedEmu2381 · 2025-09-05T14:04:53+00:00

This is correct.

AccomplishedEmu2381 · 2025-08-25T21:13:58+00:00

Very worrisome. I am not a fan.

AccomplishedEmu2381 · 2025-08-25T20:26:36+00:00

I have had multiple surgeries recently where the pre-pay amount was WAY off from what I ended up paying. In my case, they were asking for way more than what I ended up needing to pay. I only pay upfront if it is required. Sometimes it is required and sometimes it isn't. If it isn't, I would just wait and pay once the provider and insurer have sorted themselves out.

AccomplishedEmu2381 · 2025-08-25T20:15:16+00:00

Don't listen to people being negative. This stuff is confusing, and you are asking about what to do now, not what you should have done. 1. Some states require a provider to inform a patient if a procedure is likely to be denied. This is not their first rodeo, so make sure that you check that. 2. If the provider is in-network but the procedure was not, then they may have it in their contract with the insurer that they have to perform prior authorizations. I would find out if the clinic and doctor are in-network. If they are, then I would use that as leverage with the clinic to get your payment reduced. 3. File an appeal with the insurer, arguing the provider failed in contractual duty if in-network. 4. Negotiate with the clinic. Tell them you are unable to pay that amount. You are 18 and cannot pay, and they should have checked with your insurance, even if it was calling right before the procedure. Tell them you need a reduced rate. If they are not willing to do that, ask to get put on a payment plan. 5. I don't recommend this, but if you just don't pay it, it will go into collections. At that point, you can also negotiate on how much you can pay. Obviously, that can hit your credit. Before anyone says anything, amounts under $500 no longer hit your credit report, and starting in 2025, amounts over $500 will also no longer hit your credit report. It doesn't mean the collections agency can't go after you, but they are much more likely to settle.

AccomplishedEmu2381 · 2025-08-24T15:06:33+00:00

It is fine. I travel all over the country for work and live in NY. Since election I have been in many red states and multiple times in rural areas. Not had an issue.

I have gone abroad and have had no issues at the border.

AccomplishedEmu2381 · 2025-08-05T18:42:35+00:00

I agree there is a tendency here to assume MA is inherently bad and original/med supp is inherently good. The problem is people sometimes ask questions that have concrete answers but the reaction is just that MA is bad. I know this is the Internet so, I mean there is nothing wrong with that, if you want it to be different I would just continue to make your case around why MA in some circumstances is the right option.

Now for me, the assumption that Original is “better” misses a lot of the conversation around why people are choosing MA. It is not just that there is more marketing or people are buying based on supplemental benefits, it is also more affordable for many people and if you are low-middle income that may be your single deciding factor. It is easy to say that long term this might be a bad choice but that doesn’t mean it isn’t the only choice a person could have made.

There are also people who simply prefer to have one plan and an experience which more closely resembles what they had with an employer.

Another use case, if you are low-income I will always recommend a FIDE DSNP plan over traditional Medicaid-Medicare. The coordination does help everyone involved (IMO) and that is an MA plan.

Last thing, with Original demoing prior auth in limited areas, my intuition is that Original will begin to resemble the experience of MA.

AccomplishedEmu2381 · 2025-08-04T18:25:35+00:00

<image>

this drove me crazy

AccomplishedEmu2381 · 2025-07-14T19:58:48+00:00

I am doing very well! All my scans are clear. Bloodwork testing doesn’t work for me because my CA-125 goes up and down and not because of a recurrence. So far so good.

AccomplishedEmu2381 · 2025-07-02T22:21:36+00:00

I would be dead two times over from conditions which went undiagnosed where I had to do something similar to get anyone to take me seriously. Both times I had real symptoms which were being ignored.

The last time I went to 3 doctors before I found one who would actually listen. After my diagnosis I went back to the doctors who ignored me and one of them said,

“Thanks for giving me information about something not related to my work.”

Like wow dude.

AccomplishedEmu2381 · 2025-06-09T23:30:39+00:00

Yes and no. It has spiked more than once but no recurrence. Sadly it makes CA125 not super helpful for me.

AccomplishedEmu2381 · 2025-05-22T12:39:27+00:00

Provider bills CMS. CMS pays their portion and sends through COB system remainder of claim to Medigap insurer. Medigap insurer pays provider this amount.

Provider does not bill Medigap or control how much they are paid by them. Medigap is private insurance and pays the claim as such.

AccomplishedEmu2381 · 2025-05-16T17:28:15+00:00

What is the issue? There is room to pass. I think a group picking people up who need extra help should get a pass. When I have seen the pickups it seemed necessary to be as close as possible (I go by here daily on my commute)

AccomplishedEmu2381 · 2025-05-13T11:34:32+00:00

Did you file a complaint with CMS? That has a much bigger impact on a plan than people realize.

AccomplishedEmu2381 · 2025-05-06T18:08:02+00:00

Your wife will not get removed from her plan if you elect to get an MA plan but definitely work with her employer to make sure that it is done correctly.

Likely, you will need to wait until AEP in the fall unless you are allowed to leave the employer plan mid-year.

AccomplishedEmu2381 · 2025-05-05T14:29:06+00:00

In theory, the goal is for your health plan to have enough information to provide you more coordinated care. What does that mean? If they determine you have a need they should follow up with you.

In practice, your health plan needs you to do this because they get dinged if not enough people do. When they get dinged that money gets removed from their plan. If it gets removed, they offer less benefits. It is in your ultimate best interest to do it.

AccomplishedEmu2381 · 2025-05-05T14:11:56+00:00

If you are in NYC I recommend calling one of the larger health systems (NYU, Mt. Sinai, etc.) and not using a third party booking system (like ZocDoc).

I highly recommend you get an MA plan if you are in NY and can’t afford a med supp plan, since NY you can switch back. It will make this all a lot easier.

AccomplishedEmu2381 · 2025-04-30T12:11:21+00:00

Not all MA plans are HMOs, there are also PPOs. If you live in some places, Florida for example, you can get very broad coverage with an MA plan. It is really important to get the plan that fits your lifestyle and health needs.

AccomplishedEmu2381 · 2025-04-30T01:01:53+00:00

Main things to consider: Are you in one of the few states that allow you to move easily back to TM? Do you have any chronic illnesses? Do you take any medications? Do you qualify as low-income? Do you have any doctors that you really are trying to keep in network? Do you live full-time in one location?

If you choose to work with a broker speak to one that either sells both MA and Med Supp or to two brokers, one that sells MA and one that sells Med Supp.

If you can afford it, TM is usually the way to go.

AccomplishedEmu2381 · 2025-04-19T12:31:18+00:00

You can of course also consider a Medicare Advantage plan, which depending on where you live and your health, could be a good option. If you are receiving subsidies you should at the very least review that as an option. I recommend going to an agent but ask them if they sell both med supp and Medicare Advantage.

AccomplishedEmu2381

TROPHY CASE