27% BF

Not a bad result.

Pinch Test on Thursday

Has it been 6 weeks already?  Thursday marks another 6 point skinfold body fat measurement day.  From memory, my BF% numbers have been (roughly):

• 34% @ 0 weeks
• 31% @ 6 weeks
• 30% @ 12 weeks
• 29% @ 18 weeks

If hoping makes any difference, I'm looking for 26% this time.

Stuff Fat Guys Can't Do #5 - Order a Small Anything

I'm in my truck waiting for my daughter to finish her Girl Scouts meeting.  I'm sipping my XL coffee from Dunkin Donuts, and it reminded me of how I fall into the value trap.  I have never ordered a small coffee.  Or a half-dozen donuts.  I look at the menu and I'm sucked into ordering one of the larger sizes simply because I get more for my money.

I know in my head that ordering a small would satisfy my desire, but I just can't do it.  The simple advice would be to break the habit, but with respect to Ralph Ellison, "I yam what I yam.". I've adapted by getting the big size and then sharing it with my wife.  How she manages to stay thin and tolerate not having her own item is beyond me.

And that's part of it too.  I don't want to share.  It's mine, dammit!

This isn't a particularly insightful or helpful post, but it was on my mind and I had some time to kill while I sit in my EXTENDED CAB, LONG BED pickup truck.  Damn, I can't even buy a small truck - and I don't even need one this size!

F*** Anthem BC/BS

I'm trying really hard not to go nuclear over health insurance. These fucks screwed up yet another claim. I don't give a shit whose "fault" it is for not submitting something right, and I don't give a shit about the number of people and offices the claim is routed through. I pay my $20,000 a year to cover my family. This should be turnkey for the end user (me).

Instead, let me share with you a letter I wrote a couple years ago about some of the problems I was having with Anthem.  It hasn't improved significantly since then.  Lately, it's "only" been that they don't pay out perfectly legitimate claims, take 90+ days to process (from date of service to paid claim), and risk having the provider send me to collections (who then ultimately "forget" to remove the debt from my credit history).  Today's failure-to-pay was over $668 worth of bloodwork that was performed in my (in-network) provider's office.

The Anthem Shakedown

[Name of HR Director], I've included you because the buck needs to stop with you. You need to put the screws to whoever is responsible, or at the very least provide me with their names, addresses, and a few pieces of hardware from Tonya Harding Plumbing Supply (kidding, although I do live in NJ). I've got no one else to contact. Anthem won't do anything besides placate me with condescension and insincere apologies. They are the ones responsible and there's no one there I can tear into. You are my voice. You are my advocate. I have no way to air my grievance other than to write you this entirely-too-lengthy-but-sadly-necessary email. Help me [First Name]-One-Kenobi. You're my only hope. If you think it will help, please share this email with anyone at Anthem that can work towards making this better for all of us.

[Name of local HR rep], you're on the list because you're our office's HR contact. You will probably have to monitor my desk for sharp objects and Blue Cross voodoo dolls (and also just to be aware of what's going on for the folks who have to deal with NJ/DE/PA providers who don't often have to bill/interact with Anthem... our other employees may be facing the same frustrations; or maybe they're just paying and keeping their mouths' shut).

[My direct supervisor], you're on the list so you can see the stuff that makes me unhappy and has so far sucked 3+ productive hours from our team today. I've been on the phone with Anthem for an hour tonight and at least that long trying to make sense of EOB's, bills, and reconciling the two. I came down to my home office tonight to knock out some work before I head out on vacation. Now I'm wasting it with this nonsense.


I spend a ridiculous amount of time talking to Anthem. I've got 2 kids & a spouse. We're all relatively healthy. Please allow me to share with you my recent experiences with Anthem. I'm so angry I could scream.

I've paid a lot of co-pays, and historically, I've just written checks for the extra bills that come through. But at some point, I started to question it. Why am I getting these bills? Why wasn't this covered? Why wasn't that covered?
Tonight alone, I'm staring at 4 bills and a pile of EOBs. An hour of phone calls resulted in me not having to pay for 2 out of 4 of the bills. Why did I have to call to get this covered? This wasn't some wacky exception or billing error. THIS WAS STANDARD STUFF AND THEY ARE TRYING TO F*** ME OUT MY MONEY.

A note to the reader: These stories aren't in chronological order.

Pre-note is good for that Doc. You're all set! (except if you go there)
HIPPA and good taste tell me to keep some details private, yet here I go... My son was born with a minor genital deformity. A pediatric urologist was on staff at the hospital to check him out. His twig was too attached to his berry basket and needed to be corrected in a "complex penoscrotoplasty" operation (I may have the name slightly wrong, but surely I've said too much already). We got our referrals, set up a schedule of office visits, consultations, and ultimately a date with the Edward Scissorhands of penis fixing. After leaving the hospital, we did the right thing and got our pre-note for the good doctor. He'd be doing the consult, the check-ups, and the surgery. The surgery comes and goes and then the bills roll in. We end up owing $800 or so because we didn't prenotify correctly. Apparently our pre-note was good enough for seeing the doctor in his office, but if we met him at the surgical center (or Starbucks, for that matter), different rates apply.

So I call and complain about it. The folks at Anthem charitably offered to let me burn a once-in-a-lifetime free pass on pre-notifications. They tell me over and over that this is the only time they'll do it, and ask me over and over again if I'm sure I want to cash-in this good will gesture now. Hey, $800 is $800. Cash it out, baby. Pay me... but next time, remember to prenotify before the doctor does so much as give your kid a lollipop outside of the approved prenotification boundaries. Mea culpa. Lesson learned, but I needed to share this story so that the next one would be clear.

Oh, and it took 90 days for them to finally pay out the doctors & staff. In the meantime, I had bill collectors calling me for unsettled medical bills. It's probably still on my credit report.

9 Months of Pre-Notification
Our daughter was born in 2006. We had an HMO through Independence BC/BS. From the point of "Yep, you're pregnant" to "It's a girl!" the total out-of-pocket expense was 1 crisp $10 bill.
My son was born on April 9, 2009. No pre-note necessary for OB/GYN. We had what I'd call a straightforward pregnancy & delivery. Drink martinis, wait 9 months, go to hospital, push, congrats.

Then the bill arrives. $1400+. We never had a kid on this insurance before. The only thing out-of-the-ordinary while covered by Anthem WhoCaresPowerlessAdvocate Plan was my daughter's ear tubes. We forked out 200 bucks or so for it. In hindsight, that was probably a "billing or claims error" that I wasn't responsible for; or maybe we had to prenotify for the surgery that we had already prenotified for a consultation before... I don't really know. Water under the bridge, right? But back to this $1400. The enforcers from Virtua's billing department start calling me. They do their best Monty Hall impression. If I provide them with a valid credit card today (and today only, act now, operators are standing by), they'll only bill me $1000 or so. Hey, I'm all about the discount, so I pay right then and there.

Yikes, that was expensive. But hey, that's the cost of kids these days. But remember that last story about Dr. Scissorhands? Yeah, I called Anthem about that during my lunch hour one day. Remember that free pass I burned? I got to thinking about it as soon as I got off the phone with them. I pulled all the EOBs fromwww.anthem.com and saw that for the childbirth, I was billed 20% of the total hospital bill! It dawned on me that 20% is exactly what they charge when you don't prenotify. So I call back. I even get the same representative (awesome technology that gives you priority to talk to the same rep... it's happened to be several times when I've called them). My hunch was right. We didn't prenotify for the birth. Mind you, my wife had been going to the OB/GYN for 40 weeks. The insurance company had been paying out for pre-natal care for 40 weeks. What exactly did they think we were going to do at the end? Maybe it was just gas? Were we seriously supposed to prenotify that we were going to the hospital to give birth? When was the right time to call? Should I have talked to the 24-hour nurse line to aid in timing the frequency and duration of contractions? Was the right time to call just after her water broke? I mean, really, is a prenotification necessary here? 

I beg the representative to stop burning my free pass and to instead apply it to the birth. Too late.

What? Too late?!?! You tell me it's going to take 60-90 days to process but somehow within a couple hours, it's suddenly too late? GET THE F*** OUT OF HERE with that nonsense. I was born at night, but it wasn't last night. I told that rep to get back with her supervisor and do whatever it was she needed to do and roll back that transaction. Surely there must be some facility to account for mistakes. Several phone calls later Anthem, they say that they processed the claim wrong and that childbirth is covered 100% with no pre-note.

That's the end of the fight for me, but I'm still left wondering if they got tired of me or if I was really right. Lord knows I'll have the pre-notification number handy if we wind up with another 9-month period of severe bloating.

Emergency? Let me bill you for that again.
So I went to the emergency room on Saturday, 5/08/2010. I had a kidney stone once before. I waited too long to go to the hospital that time and, well, it wasn't pleasant. At all. This time I felt a similar pain and I was determined to go sooner rather than later. Plus, the next day was mother's day... I knew if I waited through the night, I was going to be suspected of trying to get out of making breakfast in bed. I wait in the ER for 3-4 hours (not Anthem's fault!). I get a couple CT scans done; funny thing is that in this story, it really was just gas. I'm sent home with some stickers, a roll of Tums, and pat on the head for dealing so well with my tummy ache.

$100 co-pay. Expected. No problem.

$101.97 bill for radiology? I suspect someone is double-dipping. And given the history of incorrect bills, I call. According to the representative, everything was billed correctly, but it should've been covered. Radiology services are covered 100% with no prenotification at in-network providers when services are rendered for and during your ER visit. Why did I have to call about this? Now the radiology people are going to have to wait 30 (more) days to get paid. That's not right either. This is another case of Anthem trying to short change their contracted providers and make me foot the bill.

Mr. Saturday Night Special (Services).
I mentioned that we're all relatively healthy. True, except for ear infections. My daughter, age 3, got lots of them before she got the ear tubes put in. As a family, we're on high alert for runny noses and ear tugging. I've even got my own otoscope to check out her ear drums. I don't want to waste the doctor's time or Anthem's money on a visit for a common cold. One recent Saturday morning, I dutifully stop the mucus that has been marching south from her nose to her mouth. I light up the 'scope and see the tell tale signs of an ear infection. We call and the doc tells us to come in. My guess was right; another ear infection. Every other ear infection cost us the same thing. $10 co-pay for an office visit.

This time? $10 co-pay, and later a $38 bill for "Special Services." The doctor bills differently for Saturdays. Not remembering a specific exclusion in our policy for Saturdays, I call Anthem. YET AGAIN, Anthem says there's a mistake. They should've covered and they'll resubmit to the claims dep't for review. Ultimately, they paid the claim and I didn't have to pay the $38. One time mistake, right? Of course not.

My son went to the doctor on the morning of Saturday 5/08/2010 to have a possible ear infection diagnosed. Same special services charge. Same failure by Anthem to pay it. Same bullshit excuse. I just got off the phone with them about this one. I don't know if they'll cover it, but I'm sure I can keep calling until they do.

This isn't a one-time problem. This isn't an issue with some doctor's underqualified and overworked sister-in-law mishandling claim submittals. This is multiple providers from several small and large health care provider companies. Two unrelated, competing hospitals. Pediatricians. OB/GYNs. Specialists. Internists. Outernists. Everyone. Easily 20% of my claims are screwed up in some way, meaning that 100% of them require LOTS of attention. What I'm supposed to do is pay my premiums, co-pays, and deductibles, get my coverage, and have Coke and smile. That's it. I shouldn't be expected to be a benefits expert, nor an actuary, nor know the ins-and-outs of health care billing.

What is our time worth? What if we were *really* sick? How would I keep track? How would I know who to pay and who to fight? What if it were some horrible, gotta-be-at-the-bedside-all-the-time cancer? When then would I find the time to call and prevent this extortion? The best I can do is keep a diary of dates-of-service and who did what, where, when, and who I talked to at Anthem. I spend HOURS every month talking to these thieves, these charlatans, these absolute swindlers AND WE'RE ONLY GOING FOR BASIC, EVERYDAY SERVICES. This is supposed to be turn-key. Between [Company Name] and me, we must cough up more than $20,000 a year just for me and my family! What are we paying for when we have to second guess every claim? They are throwing shit against a wall and seeing what sticks. Don't pay. See who just writes the check, and cover anyone who complains. That's The Anthem Shakedown. We shouldn't have to take it.

Between figuring the bills out, calling Anthem, and writing you this email, I've wasted 4 hours. I really intended on working. Now I'm going to bed. Fix this, please.

Letting my mouth write checks

When I started going to the gym, a fitter co-worker talked about his training for the Broad Street Run in Philadelphia.  Having run 2 half-marathons while in relatively poor shape, I claimed that anyone can finish the BSR.  All it took was some determination and discipline.  I dug my heels in, and insisted all it took was putting one foot in front of the other and repeating.  I let my mouth write the proverbial check.

Entering the BSR is done via a lottery.  You register, and then if you're selected, they take your $40 and you're in.  Registration opened 2 weeks ago, so I entered the lottery.  Today I learned that I "won."  It looks like it's time to deposit the funds over the next 11 weeks so that my ass can cash the check.

I'll be doing the Galloway method.  It served me well in the past, and I was about the same weight then as I am now.  If anything, I'm starting from a better spot this time (in terms of relative fitness).

Here's my plan:

5 months, before & after

Wardrobe Archaeology

When my first college roommate, Ed, announced he was moving in with a fraternity brother the next year, he added that he hoped I find someone special.  He wasn't being sentimental.  He was tired of my laundry on the floor the entire year.  Clean.  Dirty.  Didn't matter.  I had some other slovenly habits (sorry, Ed!), but it's the laundry that comes to mind today.

There were some clothes in my college closet that lived there semi-permanently.  The clothes that continually lived on the hanger were the ones that never fit.  The ones on the floor (under the hangers) were the ones that used to fit.  You could dig through them and see the progression.  At the bottom of the pile were the first to not button; at the top were the latest casualties of my gluttony.  The clothes that still fit were piled up on the floor around my bed.

But there on the hanger was a single pair of pants.  A size 36, olive-green, heavily pleated pair of Z-Cavariccis.  They had the label on the fly and everything.  Those were the pants that didn't fit.  Those were the pants that never fit. I moved them from dorm to home, from home to apartment, and so on.  I probably should've ditched them before I left for college in 1994, but they were a hot item on the Jersey Shore... maybe not in 1994, but certainly well into the early 90s.  I just needed to lose a few pounds to make the largest Zs available fit.  So what if they were a couple years out of date.

Back to present day, today was laundry day.  I scooped up my clothes from the floor next to the bed, from the floor near the hamper, and gathered all my dirty socks from the four corners of the Earth.  I may no longer steal toiletries and deny it (or do I?), but I'm still a laundry slob.  I try to be better.  Today I hung and folded all of my clean laundry, rather than leave it haphazardly piled in the corner of the room.

As I hung some pants that are starting to get too large, I looked down.  On the floor was a pile of clothes that hadn't fit.  I wondered if I the Z-Cavs were still down there.  The archaeological dig was on. I found a surprising number of pleated pants (they'll come back!), but alas, my unused fist pumping pants weren't there.  They had unceremoniously made their way to Goodwill a few years ago and are undoubtedly being worn by a suspender-clad hipster right now.

I did find some forgotten clothes though.  I bought the shirt I'm wearing in this just-taken picture a couple years ago.  It's "slim cut."  I bought it when I needed a shirt & tie for a cruise Steph and I were going on.  I couldn't even button it.  It was at the bottom of the pile.  I'm kind of excited that it fits now.  I might actually wear it... once I get around to ironing.

When I bought this, I cursed the man who invented the 2XL "slim cut"