Hospitality violation


My neighbor, whom I’ve written about before Here.  Came over today to buy some eggs.  Three dozen eggs.  She paid cash for them.

Now, I’m never really happy to see her, she wore out her welcome a while ago by constantly begging for food when she was here.  That finally stopped when we started telling her “No, we need that for lunch at work.”  Well mostly stopped.

Let me give you some more history and background.

She was discharged from her own medical practitioner last year because of drug shopping.  She came to me to gripe about it, and I told her they have that right.  She is the one who agreed to the terms when she began going there, she has no one to blame but herself.  She then tried to say she has the right to get a second opinion and I agreed with her, but told her she is the one who signed the contract, she maybe should have read it a little more closely before deciding to get a second opinion AND filling a narcotic script from the other practitioner.

She has no job, no visible means of support, yet she gets tattoos regularly – she is covered from neck to feet.  She says people just give them to her, my husband says she is trading sex for them (which might actually be true).  She worked for many years as a stripper.

She has tried to tell me for a year that there is something wrong with her thyroid (there’s not, I saw the tests myself), that there’s something wrong with her sinuses (she saw a specialist who told her there’s nothing wrong), that there’s something wrong with her heart (there’s not, she had an angiogram but before that for months her excuse for lying in bed all day was chest pain), that she has anxiety and insomnia (but when asked how much she sleeps she says about 12-15 hours per day), that she can’t lose weight and feels tired all the time (yes you probably do, you sleep too much and you don’t exercise – and you’re nearly 50!).  There’s a word for this:  malingerer.

She says she can’t get a job (well probably not, your top lip is pierced twice and your bottom lip once, your head is partially shaved and neon red where the hair is actually growing, and your tatted from neck to toes).  This is rural Arizona.  That crap is seriously frowned on.

Today was the final straw.   Nearly every time she comes over here she tries to use me as a free second opinion.  Today she asked me about doxepin.  And tried to tell me she’s going to try to get on Adderall.  Which is legal meth.  I lost it.  I told her flat out that I’ve known her for a year and she does NOT have ADD.  Or ADHD.  She said that yes she does, she took a test and it said she probably does (one of these on line self tests mind you).  Now seriously.  Think about the previous two paragraphs, what I’ve said about her, and tell me if that looks like ADD/ADHD to you.  She’s spent the last year bitching about her heart, her metabolism, her fatigue, her sinuses and NOT ONCE about anything remotely compatible with ADD.  Other than the changing focus on different body parts when they are proven to be just fine, mind you.

I actually began yelling at her.  “Bull $h!T!!  Bull $h!T!!  No you do not! You F*ing do not!  I’ve known you for a year, you do NOT have ADD!  You took a F*ing self test, they’re very easily manipulated to get the results you want!  You just want F*ing legal meth!”  I basically threw her out of the house.  I actually told her right before I shut the door in her face that she just wants it to sell it.  Which is probably a huge hospitality violation.  But really.  Does coming over and bouncing a bogus diagnosis of ADD/ADHD off your practitioner neighbor when you’re purportedly there to buy eggs really count as visiting?

I seriously think she wants the meth so she can sell it – there are several people here in the community who were getting it from the previous physician (who has since gone on to more lucrative pastures) and were selling it as well as using it.  I know there’s a market.  And I know who was selling it.  And she can’t get a job, so the logical thing would be to fake an illness in order to get a controlled substance for sales purposes.

Man I get sick of the people who are bleeding the system dry.  I work 6 days per week, and I have insurance that I can’t use because the deductible is $6500.  My husband doesn’t even have insurance, we can’t afford it.  I’ve been to the doctor maybe once for an actual physical since we’ve been together (nearly 20 years) and twice for employment related physicals, and maybe 3 times for urgent care type issues.  He’s been to the doctor three times  for a physical (all employment related) and once to the emergency room for an allergic reaction.

Our neighbor goes to the doctor, courtesy of the taxpayer, at least once a month!  And gets very expensive medications prescribed, for which she pays nothing, courtesy of the taxpayer!  And then proceeds to refuse to take them.  And there’s no reason she can’t work other than the fact that she deliberately makes herself unemployable!  These are the people who are breaking the system, not the hard working poor people who really do need a little help.  And believe me, I live in a very low income community.  I know which of my neighbors work and which are milking the system.  For all the good it does.

I actually do not have words for the amount of anger I am feeling right now.  And a little shame that I let her get to me.

 

 

 

 

 

 

 

 

 

 

 

wyrd. It’s a thing.


So I’ve been working 6 days a week for several months now, since the beginning of February.  I have to say I’m getting more than a little burned out.  I work 3 days a week for another provider and 3 days a week building my own business.

This has been QUITE the learning curve.  I have a subscriber who is a physician in Canada who I envy because he has no concept of the hoops that must be jumped in order to become credentialed AND contracted with the insurance companies here in the US!  Suffice it to say they seem to, from my point of view, have a slew of employees that get paid a very good wage to do a whole bunch of nothing much.  And blow lots of sunshine.  And pass the ball.  But not actually come through and do what they say they will.  Not all, mind you.  Some have been exceptional.  And some employees have been quite exceptional.  But overall….yeah.  Just wow.

So the reason this is about wyrd is because of two (well three really) things that intersected in the strangest and most wonderful way today.

  1.  The credentialing/contract thing.  And the continuing non responses.  I have a friend who is helping me out of the goodness of her heart.  She has been involved in contracting/credentialing for 40 years.  She knows her stuff and she believes in my business and what I want to do for our community.
  2. My son.  He works for a business in our closest big city, where he started out as a data entry person and is now a vice president.  Hard work, dedication, and literacy *are* rewarded on occasion.  He has contacts in high places thanks to his position.
  3. I’m a devotional polytheist.  And I believe in making offerings to my ancestors, the land spirits, and the Gods because I’m grateful.  That’s all.  To me the whole Germanic gifting cycle is us being grateful for what we have, not in order to get anything.  It’s not a transactional relationship.  And if you think it is, then you don’t understand the gifting cycle.  Now, when you need something that’s different, and a different thing, and not directly related to the gifting cycle.  At least not to me.  No tit for tat in my devotions.

So how these all intersect is that my friend and I had a very frustrating and relatively unfruitful day following up on these contacts I signed months ago with no provider privileges in sight.  Which means no ability to bill and get paid for the work I’ve already done, even as an out of network provider.  Which I was promised I would be able to do when the contracts were finalized.

And a phone call from my son.  In which he had some questions about my university, and about my degree program, and what was involved (for reasons which shall go unsaid).  And his frustrations.  And I shared my frustrations with him, and named names about insurance companies we dealt with today.  I did NOT realize when I was dumping on him that he actually is on a first name basis with some of the very top power players with the same insurance companies.  But I found that out in short order!

Long story short.  Son and friend were put into contact.  Son and friend are pulling strings on a level I would quite simply be unable to accomplish on my own.  Things are going to happen now that might have taken a year or more without them both working on this.

And how does that relate to the gifting cycle, or to wyrd?  Well, if you’re a heathen you already know.

Quite simply, I firmly believe that my gifting prompted a return – not as a transactional relationship, but as an outpouring of blessing for my devotion and offerings.  I also believe my investment in my children, my insistence on personal responsibility and work ethic – even when they were VERY sadly off track, has paid off.  Not that I expected that, I’m just glad they are happy and feel successful in whatever they do.   But the fact that others recognize them for their dedication and responsibility is an amazingly reassuring thing.

And my wyrd, the web that I have woven using the ancestral heritage, and adding my own actions, has made my luck good.  I’m able to call on the help of friends, the help of family, and the help of people I don’t even know to aid myself to serve my community (and make a *small* living doing it).

This is what it’s all about.  My gratefulness meter is just about pegged out.  And my pride in my children is too.

 

 

So. Running a business.


Well, I got a Medicare number which enables me to back bill for up to 6 months worth of visits.  I got a Medicaid number which enables me to back bill for up to a year’s worth of visits (though I will only be reimbursed at the out of network rate for those that occured before credentialing with the contracted insurance companies).  I am in the process of credentialing with the insurance companies and have signed contracts with several – which completes my part of the deal, it’s them I await.

I also got a part time job with a physician in town.  I wasn’t planning on taking a job, but my friend talked me into applying.  We, the doctor and I, are a good fit – she is interested in alternative therapies and tries to keep people off meds if possible.  It was also apparently in the Gods’ plans, because my husband got laid off from his job a month after I started.

Anyone reading this remember back this past summer when it was predicted that the Wild Hunt would ride early and ride hard this year?  Yes…well.  When one’s husband is a hospice nurse, and most of his patients die all at once, it means no work.

I am working 6 days a week now, 3 for my employer (and busting my @$$ to make sure she doesn’t regret hiring me!) and 3 for myself.  The paperwork, as with any job, is the time sucking mind killer.

My spiritual practice has shrunken considerably, mostly due to fatigue.  It’s hard to remember to do more than a ‘hey hail thanks’ and leave an offering on my way to bed.  I do a lot of devotional stuff on my way to appointments and to/from work.  Probably not the best solution but it’s the one I’m currently utilizing.

The good part?  I spend the better part of three days every week working for myself, and the business is at least paying for itself in co-pays.  I have not had to come up with money out of pocket for supplies, the co-pays are paying for them.  Doing house calls means almost no overhead – no separate office, no separate electricity.  My office is on the wall right as you come in the front door, and my exam room is the patient’s own home.

So business has been going, not expanding as quickly as I had hoped, but expanding all the same.  An ad placed in a local free paper paid for itself in one house call.  Word of mouth has been my best advertising though. My hunch was right, there really is a need for this business in this community – and word is getting around.

 

 

 

New Year, Big Changes Part 3


Gods I hope I can get this into one last post.  I tend to elaborate too much or else I assume people know/understand things they couldn’t possibly, unless they were there.  so.

I incorporated, I got a Tax ID, I got a group NPI (a must to take insurance payment), a bank account, and I researched what all was involved in getting credentialed with Medicare and Medicaid (or in my state’s case, AHCCCS).  But.  I drug my feet HARD on actually starting it.  Because that, in my mind, was the final step – the step that meant I was really going to do this.  Which meant I was really going to quit my not cushy but mostly predictable job.  Which is a rather frightening thought.

I suppose I should say what I wanted to do for a business.  I never wanted to compete with the other office, that was never my intention.  What I wanted to do was make it easier for those with debilitating chronic illnesses, those without their own vehicles and dependent on medical taxi services, those who were too sick to go to the office, to see a medical provider.  I wanted to do HOUSE CALLS.  I did a lot of research on the idea and it really seems like an idea whose time has come once again.

Mr. TinFoil was initally EXTREMELY against the idea of starting our own business.  He asked one of his medical directors for advice – without consulting me.  The medical director, who just the week before had told Mr. TF he was making so much money working for Mr. TF’s company that he was only seeing patients in his *own* practice 2 days per week, said it was a very bad idea and “the only way to make any money at this is to save up to buy your own business and have the waiting room full all the time.”  Hmmm…not a very reliable source in my opinion, given the apparent hypocrisy and inconsistency between the two statements.

But then he asked some of his coworkers what they thought of it, and all were universally enthusiastic about it.  One of the NP’s who works for his company even asked him to keep her in mind if I expand enough to hire someone else.  Which I thought was a fairly ringing endorsement.

I had already done WEEKS worth of research on Medicare pricing structures for our area so our superbill could be updated (and corrected).  It was simple enough to add in the pricing for home visits to my research.  I kept the results of my research in a separate folder on my computer and also in hard copy to make sure I had access to it even in the event of a computer failure.  Thank the Gods I did, because with the change in ownership and the loss of my job, it was already done and easy enough to put to use.

So after I got canned, I started the processes for getting credentialed.  UGH.  It took me 2.5 days to wade through the Medicare applications, IRS forms, etc I needed for myself and for the business.  And I mean 10 -12 hour days, not 2 hours here and there.  I suppose it’s faster if you’ve done it before though.  Then I began the process for getting credentialed with the insurance companies.  Which has been a problem, because if you don’t have a Medicare number you basically can’t get credentialed with the insurances.  Much of that work time has been wasted, and will have to be done all over again when I get my Medicare number.

This week I will begin marketing my business in earnest.  I live in a retirement state, there are huge numbers of people that this will appeal to!

 

 

New Year, Big Changes Part II


So, I lost my job.  But I didn’t lose my dream.  You see, I knew this wasn’t going to be a long term place for me unless my friend and colleague the doctor went in with some other people I know to buy the practice.

My first paycheck bounced – I had to wait until the next paycheck a month later to get what I was owed, and I still had to insist on a separate check to cover my credit union’s bounced check fee from his bad check.

Then I discovered the owner cheating us, the contracted providers, out of money two months in a row.  When I confronted him about this he denied me access to the accounting section of the electronic health record program (EHR) we use – which is technically illegal to do to a contract employee working on a percentage.  No big deal, when I told the doctor how he was being cheated he offered me his user ID and password which I did not take him up on, because the biller was happy to print out the information I needed.

The owner refused to sign a contract with me, and paid me 5% less than his original offer.  To be cheated on top of it was an insult that could not go unchallenged.  But he stopped returning calls, texts, and even coming to the office.  October 29th was the last time he returned a text message.

So why would I stay there?  Because it was my own community, it was NOT his.  My dream was to work in my community.  But working in this office was not the original dream.  My dream was to own my own practice, to go to the people without transportation, the home bound people with major health problems.  Working here was a stop gap, a way to try to save money to get to a place where, if we were the owners, me and the doc, I could incorporate it into our business; or, if we didn’t, I would start doing part time.

I had, in fact, already been doing home visits as part of my work week, and gaining business via the percentage he collected for the use of his EHR that he never would have had without me as a result.  When I was let go so suddenly, those people were more than happy to stay with me.

The response in the community has been universal shock and outrage – and concern over what will happen to the doctor who remains.  I’ve had patients calling me both to see how they can continue to keep me as their provider and irate that this happened to all of us.  And more than a few to complain about the new staff’s treatment of them.  One of my patients was given a drug screen – I would as soon suspect my cat of drug use as this person.  Way to go there, way to alienate an entire family of 9 patients.  Nice job.

Well, I had suspected something was up for a while.  And in the first part of December, I decided to take action.  So I began looking at available names for incorporating my own business.  Come to find out, the legal name of the business, the name they received their billing under, was NOT the name they had been using before I was hired  – and it was available.  So I trade marked the name and incorporated my business under the name.

The day I was let go, I heard the new front desk person answering the phone with *my* business name, the one that hadn’t been in use since I was ‘contracted.’  I informed the new owner that he could not use that name.  He, rather pompously said he could do whatever he wanted since he owns the business, and since he rather liked that name he planned to change the name to that.  I responded, “That’s nice.  But you can’t.  Because I own it.”  Stunned silence was his response, and the accountant for the former owner (who was there helping them) asked me how I did that.  I said, “It was easy.  I researched the name, it was available, so I bought it and incorporated under it.”  Again, stunned silence.

Score one point for me.  One small satisfaction in a morass of disappointment and disgust.

To be continued….

 

 

 

 

 

New Year, Big Changes


So.  Working in my own community has been a dream of mine since I still worked for the local fire department.  Yes, I worked for my community, but I wanted something more.  Then I hurt my back on the job and re-evaluated my entire career choice.  I went back to school, then went back for more, then went back for my master’s degree.  And got my national certification.  And started working.  In my own community.

Well, the lesson was Be Careful What You Wish For.  My boss literally hated his business and all of the people working for him.  When I started there he was on the verge of both business and personal bankruptcy.  He hired someone I’ve known for years to be office manager/biller and then we hired someone who has extensive (30+ years) experience in the medical field for the front desk/referrals.  We brought in friends and spouses and we spent our weekends there, unpaid, working to make the office presentable.  We cleaned carpets, washed walls and windows, scrubbed floors.  We brought in our own cleaning supplies because he wouldn’t furnish them.  I brought in my own furniture to make the waiting room more pleasant and less like a bus station.

We turned the practice around.  When I started there it was losing about $15,o00 per month (estimate).  Every month since I’ve been there we’ve made at least enough money to pay the bills, and every month since September we’ve made a profit.  A small one, but a profit nonetheless.  In December we made nearly double what is needed to break even.  We brought people back into the practice that had left years ago due to bad management.  We were nice to the patients.  We knew many of them because we too live here.  And they knew us.

But he lied to us the whole time.  He wouldn’t even buy supplies needed to see patients, the doctor bought our supplies out of his own pocket.  He sold the business out from under us – the doctor and I were working on a deal to purchase it – to someone else with cash in hand and a slick line.

And the new owner let all of us go.  He bought the practice on a Tuesday night, and we were all fired by Wednesday at 130pm.  He said he didn’t need us, he was bringing in his own staff.  The irony of this is that if he had seen the practice when I came on board, or when the office manager came on board, he NEVER would have looked twice.  We made it work.  And for that we are out of jobs.

The new owner is from the East Coast, New York or New Jersey, and he doesn’t understand how word travels.  He’s a physician’s assistant, and he needs a doctor at the office to be able to work – the doctor is the only one who didn’t get fired.  But he doesn’t like him, and he doesn’t like how he works.  Which is very slowly.  Because, while he wants to make a living, he’s not in this to get rich.  Which is why he is still here in this community – the patients know that.  And they are loyal to him.

I don’t think this new owner understands small town politics.  At all.  The patients who were coming to see me were coming to me, for the most part, because they wanted to see ME.  Not just anyone.  I’m not a number to them, I’m their neighbor.  The office manager is as well, and so is the front desk person he let go.  And by firing us, by assuming that people would just see him instead and just have to deal with his new office staff, I think he has badly miscalculated.  We are not interchangeable.  If the phone calls I’m getting are any indicator, I think the physician’s assistant owner may be in for a nasty surprise in the financial department.

You see, common sense doesn’t mean what most people think it does.  Common sense is what the peasants have – hard won experience based on the realities of struggling for a living day to day.  It isn’t common, and it’s not something wealthy people have in any degree whatsoever, because they lose it as they get more out of touch with every day realities.  And this guy has no common sense.  He sees dollar signs instead of patients.  I see my neighbors.

What I have been doing with my extra brain bandwidth. Or, Reindeer Games.


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This is a hat. I spun and dyed the yarn and while the overall design is my own, the chart for the reindeer and trees I got from Ravelry. This one is for sale, it is $35 plus shipping if you might be interested. I am making another with opposite colors but that one is already spoken for.  The colors are a bubblegum pink  and grapey purple.  I can’t remember the name of the dye I used for the pink, but the purple was called ‘amethyst.’

I have not been knitting much the past month or so, no time thanks to OfficeAlly, our EHR program. Which SHOULD be named OfficeEnemy. Or OfficeOpponent. I lose work every single day and find myself having to waste large spans of time on tasks which should be easy but aren’t. Every time I click on a medicine to enter it I have to wait for the page to reload which take 30-45 seconds. And it is not very user friendly because of this. The autosave has been responsible for me losing more work than any other single feature of the program. Plus it bumps us off several times a day and you have to waste precious time logging back in, going back into where you were, and redoing everything you just lost.  Honestly paper is so much faster.

Some people make beautiful jewelry, I make silly crap like this.  The doctor I work with said after seeing this hat that I’m twisted in all the right ways and that’s why he likes me.    I figure I’m doing my part with sympathetic magic to ensure that we have future populations of deer and reindeer to enjoy 😉

And yes, I realize this is a pretty awful photo.  Sorry, my photography skills seem to actually getting worse rather than better.  The brim does not roll, and if I can get a photo on an actual model tomorrow I will try to post that.

Sometimes….


So I started working in my new field.  Well really, an extension of what I was doing before, only now I’m accountable to myself and the board of nursing and my malpractice insurance issuer and my boss.

I’m an independent contractor and I get a straight percentage of the collections on patients I see.  Not a bad gig, I don’t get benefits, insurance, or retirement – but I set my own hours, and my income is limited by how many patients I see and how much income my billing brings in.  The worst part is I only get paid once a month.  And our old biller, who hopefully will fall into a great chasm and never been seen or heard from again, hadn’t even begun to bill for July 29th as of Sept 1.  Jerk.  I’m so glad we have a new biller!

Well the other office got broken into last month, the safe was stolen,and the checks for the business account were in the safe.  My already meager check bounced because the office manager apparently forgot to include my name on the list of checks that were supposed to be allowed to go through on this account, which had been frozen due to the checks being stolen (and four forged checks have already been presented and refused).  So I did not get paid at all this month after all.

I haven’t had a paycheck since July but I’ve been working my @$$ off! The July paycheck is from the old job…the new one hasn’t paid my a penny that I’ve actually gotten to keep.

Sometimes…I think I must be wearing a “kick me” sign on my back, spiritually speaking….

Still waiting.


Our camping trip was amazing.  We met some people, including someone (who shall remain nameless) that I never in my wildest dreams would have imagined meeting at a little tiny camp out in Northern Arizona!  We also met several Arizona heathen families, some wonderful New Mexico heathens, along with a fellow mead maker/brewer, and lots of other people, all of whom were talented and giving of their time and skill.  It was, all in all, a lovely weekend.

We got an incredible amount of rain!  Mr. TF and I were married in Grand Caymen during Hurricane Michelle in 2001.  I don’t think I’ve experienced sustained rain with winds like what we had on Friday since we were in the hurricane!  People’s tents got filled with 2 feet of water!  A few tents collapsed!  We were luckier – we were camped out farther from the common ramada, but on not such a steep slope and thus avoided some of the problems others had (and that was purely by chance, I assure you).  We did get water in the tent, but it was because the wind was blowing the rain horizontally and it lifted the rain shield, allowing rain into the tent.  Not so bad, though.  Only one half was actually wet (with about an inch of standing water in places) but most of our stuff was still in the plastic totes and thus dry.  Most importantly, our bedding remained mostly dry (yay wool!) and we were cozy every night.

I took not a single picture.  In fact, our phones remained either in the truck’s glove box or charging with the solar charger on the hood.  We were pretty much technology free during our 3 days there.  I didn’t miss it much either.  I did notice I had missed a phone call from someone very important when I finally picked up my phone around 10pm on Friday night – luckily said person also sent an email and I spent an agonizing 15 minutes trying to sign into my email and waiting for his letter to load…but it was good news and well worth waiting for.  Mr. TF and I drank two drams of scotch each (LaPhroaig) to celebrate, and sat outside in the beautifully clear night, watching the meteor shower and the stars.  Other than sharing the good news with family and close friends the next day though, no phones for either of us.

I did NOT win the antler handled, hand forged skean dhu I had hoped to bid on….I was too busy running my mouth visiting and missed the auction for it entirely!  Ah well, not meant to be I guess.  There will be others.

All the crap that has gone on since January…if it all hadn’t gone down the way it did I never would have met any of these people, at a time and a place in my life when I really NEEDED to meet them.  I humbly apologize to the Universe.  Things do in fact happen for a reason.  And sometimes wyrd/karma takes really some really strange twists to get us where we are supposed to be and in contact with those we are supposed to know.

But now, home for nearly a week, I am like a caged panther.  I’m not particularly good at waiting.  But wait I must.  I guess the Powers are making sure I get some actual rest time in before I start my new job with its associated stress and all consuming lifestyle (if my fellow workers are any judge, that is).

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Maybe some time to knit while I pet the cat….

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Or knit while I chat with friends….

 

A'Knittin' while you work

A’Knittin’ while you work

Or knit while I get this amazing craphole of a dirty house back into shape 🙂  Are you sensing a pattern here?  Of course, I also have wool tweed on the loom I need to weave off to make a vest with, and POUNDS of alpaca and wool to spin up – including a commission for lace weight suri yarn.

I’m behind on holiday gifts too…

Yep, waiting is hard, but I think I might be able to fill my time.