Diet, Day 19 - Rant About Health Care Costs

Wanna know why health care costs so much? Ask a doctor and he’ll tell you it’s those fucking lawyers and tell you about some shyster that recovered $10 million for a family because a doctor fucked up and killed his patient. Never mind that it was the doctor who committed malpractice; the lawyer still gets blamed.

But the real reason for high medical costs is the doctors themselves -- not only do they sometimes fuck up, they often overcharge. A few weeks ago I went to a dermatologist to have him look at a couple of discolorations on my skin. He did and gave me an Rx for an ointment. He also took the opportunity to check my head for skin cancer and froze a few “benign lesions”. There were no more than a half dozen of them. I paid my co-pay and thought all was fine, but in a week or so I got a letter from the doc’s office saying my insurance hadn’t paid the whole bill and he wanted to collect the rest.

This caused me to examine the bill, and I discovered something known as CPT codes. These are codes established by the US government in connection with Medicare reimbursement. They are the Bible in terms of what Medicare and insurance carriers will reimburse to a doctor for particular services performed. Each number corresponds to a specific service and a specific amount of money that will be reimbursed for that service. You’ve seen these numbers on your doctor’s invoice and probably didn’t pay much attention, because they’re usually just numbers with no explanation of what they mean. There’s a reason they don’t provide an explanation – they don’t want you to know that they’re screwing you or, more accurately, they’re screwing your health insurance carrier.

Here’s what they do, or at least what my ex-dermatologist did. CPT code 17003 is for the treatment of 2 to 14 benign lesions. It pays $6.86. CPT code 17004 is for the treatment of 15 or more lesions and pays the doc $162.72. Which one do you think he billed the insurance company for, even though he treated no more than 6 or 7 lesions? To make matters worse, he also billed under CPT 99202 (new patient visit – 20 min.), which pays $67.57. I wasn’t in the doc’s presence for more than 10 minutes. He should have used CPT 99201 (new patient – 10 min.), which only allows $39.81. The insurance company paid based on the CPT codes and gave the guy $230.29 minus my co-pay. If he’d billed properly, they would have paid only $46.67 – a whopping difference of $183.62! To make matters worse, he billed me even more than the CPT codes allowed, and his letter was to collect the amount the insurance company didn’t reimburse. Upon my calling his attention to the “mistake” in billing, he “graciously” agreed to write off the balance; but he didn’t offer to reimburse my insurance carrier for the extra 180 bucks he’d swindled from them.

Let’s put this in perspective. According to the 2000 Statistical Abstract of the U.S. there were 76,000 practicing dermatologists in the US in 1998 (that number has undoubtedly grown). Let’s assume that a mere 10% engage in this scam and further that each only does it with one patient a day (conservative assumptions without a doubt). That means there are 7,600 instances of improper billing every day. Normal people have about 245 working days in a year after accounting for weekends, holidays and normal vacation times; but let’s give doctors the benefit of the doubt and say they only work 200 days each year. Given those assumptions, there would be 1,520,000 instances every year where a dermatologist fucked a patient’s insurance company. If each screw job resulted in an overbilling of $183.62, as did mine, that amounts to $279,102,400 that insurance companies overpaid in just one year – and that’s assuming only 10% of the dermatologists engaged in the scam and that each one did it to only one of the many patients he or she saw during the day. And that’s only the dermatologists!!!

Word to the wise -- examine your doctor's bill and look up the CPT codes (they can be found on the internet).

By the way, there’s still zero visibility with my dick even though I’ve steadfastly remained true to the diet and have worked out 6 times a week.

Diet, Day 13 - Performance Criteria

A few days ago I suggested that dick visibility was a better measurement of diet progress than the scale, but it occurs to me that there must be objective standards to make this test meaningful. For example, quite different results can be observed merely by testing the dick while it is turgid, rather than flaccid. What if the shower temp is too cold, resulting in the George Costanza problem? Are you allowed to hunch or lean when looking for it? Is it permitted to suck in the gut to achieve greater visibility? I’ve considered these important issues at length and have decided on the following testing rules:

• Test cannot be taken during or after a cold shower - water must be lukewarm to avoid unintended shrinkage

• No hunching, leaning, thrusting forward of the hips – body must be erect (not the dick, the body) and you must look straight down without bending anything other than your neck

• Dick must be in a flaccid state. Turgid would probably result in a more consistent measurement, but I fear that it could result in my achieving the visibility goal prematurely (that is, before I’ve really lost any weight). More importantly, if I have to get a leaner every time I undergo the visibility test, I’ll either be exhausted or there will be many days when testing is not feasible.

• You are allowed to suck in the abdomen. After all, if you’ve improved the abs to such an extent where this means anything, then you deserve some credit.

Any questions? By the way, today I achieved 0% visibility (with a chance of thundershowers); but the scale indicated a weight of 258.

Diet, Day 10 - 21st Century Workout Tunes

A few days ago I received a comment suggesting that playing rock from the 70’s and 80’s still placed me firmly in the old fart category. To quote my friend, Dr. Jude, “You should try some music from this Century.” Well, I am an old fart, a genuine baby boomer and teenager during the Sixties. When I was growing up, my parents listened to Mancini and Lawrence Welk. When they got real daring, they’d throw Belafonte on the turntable. I found the Beach Boys and Four Seasons more to my liking. Given that background, it certainly seemed like Van Halen and Def Leppard were a huge move forward. Nonetheless, I acknowledge Jude’s comment has some validity, so I went to Billboard’s “Hot 100” and tried the top three tunes in the country. “Love the Way you Lie” by Eminen (with Rihanna) was firmly entrenched in first place, both this week and for several past weeks. Watched the video on U Tube and read a review -- “Rihanna’s hook portrays the deep emotions of the female in this situation,” and “Em simply kills it across all three verses.” I actually thought it was pretty good - liked the contrast of Rihanna’s soothing voice with Eminem’s staccato rap. But “portrays the deep emotions of the female”? Gimme a break! More importantly, it’s not workout material, at least for me. “Dynamite” by Taio Cruz was next. It had a decent beat, so I might be able to incorporate it in my workout tunes. However, I have no idea what the fuck the lyrics are and don’t really like the music. Then there was “Teenage Dream” by Katy Perry. Much too teeny-bopperish and definitely not a workout song. So I got out of the top hits and found a song I thought might have possibilities – Lady Gaga and Beyonce singing “Telephone.” It had a pretty good workout beat, but was interrupted too often with silly sound effects and trying-too-hard-to-be-clever spoken word. Will admit I liked the half naked video - the beer can curlers were an especially nice touch - but I’ll take a pass. Sorry Jude, I’m open to suggestions, but for now I think I’ll stick with Metal as my workout vehicle. Oh, by the way, today I was at 262 and my appendage was still not visible (no surprise there). Disappointing progress, given the daily workouts and diet. Yesterday, for example, I had nothing but a steak and salad all day, supplemented with a carrot for a snack.

Diet, Day 9 - New Goal

263!! Disaster! Yesterday all I had to eat were 2 apples and an omelet. My workout today was great, and now I find that I’ve gained 2 lbs. What the hell is going on? I’ve no idea but have a possible solution -- I’m just not going to weigh myself anymore. This occurred to me during my shower this morning, when I looked down and discovered that I couldn’t see my dick. My line of sight was completely obstructed by a protruding abdomen. So forget about weighing myself every day, my new goal is to see my dick. No scale necessary – just look down and that’s all you need to know about the progress of your diet. Now, I recognize there is more than one factor involved with my problem. I could try more vigorous exercise of the dick while showering in the hope of enlarging it, but I’ve been doing that for quite some time with no apparent effect. So I’m pretty much convinced there’s nothing to be done on the dick side of things. Guess I'll stick with the diet. Of course, I’d be happy to achieve my goal either way, so let me know if there are any suggestions. Honestly, I’d accept the protruding gut, if someone can offer guidance on how to get the dick big enough to be visible. Peggy would probably be happier, too.

Diet, Day 8 - 1st Week Recap

Yesterday I ate eggs scrambled with cheese, ham and sausage for brunch, had chicken chili for dinner, and an apple for a late night snack. This a.m. I had a great workout, increasing the resistance on the bike, doing core and leg exercises on the weight machines and doing some crunches and stretching. Incidentally, I’ve got a tip for using the weight machines. First thing you do is drape your towel over the weights, so bystanders have difficulty seeing how ridiculously weak you’ve become. Then, when you’re finished, you either take out the pin thingy altogether or surreptitiously move it to a higher weight. Personally, I opt to take the pin out altogether. It just seems fraudulent to do reps at 40 lbs. and then move the pin to 120 after getting your fat ass off the machine. To recap my first week, I started last Monday at 277; but I had scale issues, so I’ll throw out that weight and start with last Tuesday instead -- 271. Tuesday was the first day my scale didn’t rebel against all the fucking poundage by giving me an “ERR” message. That means I’ve dropped 10 lbs. in a week (261 was my weight today). The best news – no more “ERR” messages. I figure an “ERR” message on the scale is kind of like the absence of a yardage marker on the golf course. When you check the sprinkler head nearest your ball and find that it says nothing other than “Rain Bird,” you know it’s really saying, “You are a weak ass sonuvabitch and not even John Daly could reach the green from here.” When your scale says “ERR” it’s a similar message – you are a fat fuck and health and happiness are out of reach. Anyway, I’m still a fat fuck, but now I look more like Charles Barkley than Jabba the Hutt. Guess that’s somewhat encouraging.

Diet, Day 7 - Don't look for me at the World Series of Poker

Yesterday I weighed 261. Same today. No workout today (c’mon, it’s Sunday) but did 35 min. of cardio yesterday. This weekend has been tough. Haven’t screwed up the diet but have been tempted. I’m not a religious man, but I could use some external help with my will power. Last week I tried no limit Texas Hold ‘Em for the first time. It was only a bar league (I drank nothing but water) with no real money at stake but it seemed like the real deal for a rookie. And basically, I sucked. It’s no wonder that when the guys have a poker night, they send a limo for me. Jeezuz Christ, I think my cards must have been visible on some hidden camera. Every time I bluffed, the other guy (or actually, the fat girl) not only called me but went all in. So I’d fold. Then the fat bitch would show her cards – queen high nothing. Every time I had a decent hand, they backed off and I’d only win diddly squat. Of course, Karl and Michael, the guys who lured me there, did okay, making my debut on the poker tour even harder to swallow. Good news is … well, there really isn’t any on the poker front. On the other hand, it’s been a week on the diet, and I’m hangin’ in.

Diet, Day 5 - Metal is the Key

Too busy to write anything yesterday (4th day), but worked out and stuck with diet. Weighed in at 266, and today I’m 265. However, I almost skipped my workout today. I got to the club and discovered that I’d forgotten the earbuds for my phone/music player. Pretty marginal excuse, but the way I felt it was excuse enough. But then guilt set in, so I went home to retrieve my equipment. Got the earbuds untangled with great difficulty. How is it that no matter how carefully you wind them up and put them away, when you take them out again, the cord is a goddamn Gordian Knot? We put a guy on the moon for crissakes; can’t someone invent a cord that doesn’t foul itself. Anyway, after that minor trauma, I made a discovery -- the secret to a successful training session is nothing more than music selection. You see, I’d been listening to some of my faves but they were just too slow. Mel Carter is okay while you’re reading a book, but doo-woppers from the 60’s don’t cut it for a workout. Hey, I know I’m social security age, but I still got a pulse; so today, I programmed my Pandora app to play songs like “Jump.” It’s not surprising that I just now figured this out, as my last workout was when Elvis was still alive; but 70’s & 80’s Metal is the answer! I just sailed through my time on the bike, and my cadence was at all-time high levels. I can’t say that I’ve reached a spot where I actually enjoy being out-of-breath and sweating like a fucking pig in an overheated sauna, but this made it bearable. Trust me, if you want a good workout, try listening to Van Halen (“Dreams” or “Jump”), Def Leppard (“Photograph”), and Survivor (“Eye of the Tiger”). Aerosmith and Bon Jovi ain’t bad either.

Diet, Day 3 - NFL's

Remember Dr. Vaughn who started me on this thing? Thought I might mention that he also is putting me through some distress on another front. You see, when I had that physical a couple of weeks ago, I reported to him that I’d recently experienced some “NFL’s.” The good doc was unfamiliar with this term, so I explained that it had nothing to do with football but was an acronym for “non-fart leakage.” Don’t they teach these doctors anything? Unfortunately, the doc’s a young guy, so he doesn’t always relate to some of the ignominious afflictions of those who are a bit older. He seemed to think my NFL’s might be an important medical issue when really it’s nothing more than an extra brown spot on my underwear. He required that I undergo an “occult blood guaiac screening.” I always thought “occult” had something to do with the supernatural; but after going to the lab and picking up the packet they provided, I discovered this is a “shit test.” Incidentally, if you’re a Scrabble player, you might store “guaiac” away for future use. You’d also be well advised to not play Scrabble with people in the medical profession. Anyway, the test requires that for 3 consecutive days I have to carefully float a piece of paper in the stool, shit on it, then use a little wooden stick to take 2 samples and paste them in a folder that is provided. The directions dictate that each sample must be from a different part of the turd (are you kidding?) and caution me not to contaminate the turd with the stool water. Is it really possible to further contaminate a turd? To my way of thinking, with the exception of radioactive waste and blood samples from an AIDS testing clinic, things don’t get much more contaminated than turds. So, I made my first sample collection yesterday and quickly discovered there are two problems not covered by the directions. First, it’s nearly impossible to accomplish the shit collection process without getting the stuff on your hands. Second, waddya do with the shit stick when you’re done? That was a bad start to the day. On the other hand, things went well on the diet and fitness front. Had grapes for lunch yesterday and a steak and Caesar salad for dinner. Now I’m at 269 and no longer get the “ERR” message on my digital scale. That’s good news; because apparently if I stay below 270, I can weigh myself in the privacy of my home, instead of using the scale at the club while contorting my body to shield the results from bystanders.

Diet, Day 2 - Scale Malfunction

271?! Obviously, a scale malfunction. At this rate, I’ll be under 200 within 2 weeks and can get back to cheeseburgers, chips, potatoes and gravy. Worked out again this morning, but maybe “working out” is not an apt description. I think of my eldest, Chris, running up 14,000 foot mountains or the conditioning drills we used to put basketball players through (I used to coach b-ball), and it’s really unfair to them to call what I did a workout. It amounted to pedaling 30 minutes on a bike that doesn’t move, kind of a metaphor for my fitness progress. Then I tried a few of the Cybex machines. They’re actually pretty comfortable to sit on, but less relaxing when you use them. And they’re downright torturous when you insert that little pin thingy in the stack of weights. I also did some stretching. God was that depressing. I used to touch my toes with ease. Now, it’s as if they’re in another county. But the worst thing was the mirrors. Mirrors on damn near every wall forced me to watch myself and try to avoid retching in the process. It didn’t look like me, but since no one else was in the room, I deduced that it had to be. It was like watching a sweating, quivering Chris Farley having a seizure. So far, no food today, but yesterday I dined sumptuously on an apple for lunch and a 5 egg omelet for dinner. That’s it, no post-dinner chips or snacks, no candy or sweets. It wasn’t as if there was no temptation. Not knowing I’d embarked upon this venture, Peggy felt bad about the dog sitter’s plundering and brought home a box of See’s chocolates to replace the pilfered ones. I held firm, though, and didn’t touch them. You might ask about the 5 eggs, which in retrospect seems a bit excessive. But gimme a break. I’d had only 1 apple all day and was fucking starving.

Diet, Day 1 - Fat Fucker

This whole idea had its genesis a couple of weeks ago when I had a physical exam. Dr. Vaughn walked in the room, looked at his assistant’s notes, raised his eyebrows and said, “So, you’ve gained a little weight?” Those were the first words out of his mouth -- not “Hi, how ya doin’;” no pleasantries; just, and I’m reading between the lines here, “You fat fuck! How can you do this to yourself?” I decided maybe I should do something about it. I say “maybe”, because I needed a little time to gear up. You see, my birthday was coming up, along with my 39th anniversary of wedded bliss to long-suffering Peggy. My plan was to get by the celebratory dinners before beginning the regimen.  My birthday came and went, as did our anniversary. The latter was Saturday, 2 days ago, and I figured the time had finally come. But when I arose on Sunday, I thought it made sense to start the following day. After all, Monday’s the first day of the week, and that’s when you start things. If God rests on Sunday, then I would too. Moreover, on Sunday I had a modest hangover from Saturday’s anniversary celebration. There was also the problem that our pantry was filled with nutritionally evil, tempting shit. The practical approach would be to wait just one more day and use Sunday to clean out the crap in the pantry. I don’t mean throw it away. What I meant was I intended to eat it all. I ate two bags of potato chips, finished a bag of licorice and would have polished off a box of See’s candy, except that our dog sitter – the bitch – had eaten it all while we were off celebrating our anniversary. I finished the day with a sausage pizza – that’s good old country pork sausage, not that turkey crap. Anyway, Sunday came and went, and D-Day has arrived. I’m writing this because I’d read somewhere that it’s best to keep track of one’s progress on a diet, something I’d never done before. In fact, I’ve rarely weighed myself, not seeing the point.  I know when I’m fat and when I’m okay. Now I’m fat. No question, and a scale is not really necessary to confirm it. When you look in the mirror and see Jabba the fuckin’ Hutt looking back, you know. But, sticking with the plan, I weighed myself. Or, to be accurate, I tried to weigh myself. I stepped on our digital scale, and it said “ERR.” Are you fuckin’ kidding me? Does “ERR” mean I’m too fuckin’ fat for the scale? That was depressing, but I was not deterred. I went to the club to work out. Did 30 minutes on the Lifecycle and got through it okay. Afterward, I tried the scale at the club. Unfortunately, it didn’t work either, as it said I weighed 277. My God, that’s NFL lineman territory. Jeezus!  I’ll update my nutritional intake in tomorrow’s notes. Wish me luck.