The More You Know - Health Coverage

My career is in the health care/insurance world and I often either get questions from people about how things work or see comments from people who don't understand some concepts, which are understandably confusing! So, here's my little mini-training:

Q. Why doesn't my health insurance cover (insert care/item here)?

A. There are quite a few reasons. The first may be that in all the large-scale studies that have been done, that care/item hasn't been shown to be more effective than another option, and it costs more money. It may seem more effective to you, but insurer has to think about everyone they cover and can't make broad decisions based on individuals - they have to think in terms of serving the greatest number in the most quality and cost-effective ways that it can. And when they make a decision for one person, that could set a precedent that they have to follow for everyone who comes next, increasing everyone's costs.

Second, the health insurance company may cover it in some plans, just not yours. When your employer chose your health plan from the insurer they had many different options. Some plans covered a lot of things and cost more, some had less coverage but a lower price. Your employer decided, based on cost and the needs of the demographics of the staff and a lot of other factors, which plan to go with. That's why people who have the same insurance company can have different co-pays and different things covered. It may not have been your insurance company's decision to cover something or charge a certain amount - it was just one of the options offered and your employer made the ultimate decision. Health insurance companies don't say this because they want to maintain a good relationship with the employer and keep their business.

Think of it like this:

Your mom (employer) buys a box of chocolates (health plan) from the candy store (health insurance company). She had a lot of boxes to choose one, but she went with the one that she thought everyone in the family could share and that she could afford. You want a chocolate with caramel (gastric bypass). Unfortunately, the box she chose doesn't have caramel so you're out of luck. The candy store has caramel, but that wasn't what she bought!

But, the next time she buys chocolates, she remembers how important it was to the family to have caramel and it turns out that she has enough money this time! Now you ask for the caramel-filled chocolate and you find out that in order to get it you have to clean your room (meet established clinical criteria). If you don't meet the requirements, you can't have the caramel, even though it's right there in the box.

So, if the caramel chocolate is in the box and someone is telling you that you haven't cleaned your room yet, find out what the definition of "clean" is. Actually, that's good advice even without the metaphor.

Such is the weekend

Sean informed me this weekend that college football was over and that only a few games remained in the NFL. In my head I was doing the Snoopy happy dance. You know, the one where his arms are tight to his sides, his head is turned to the sky and his feet are flying beneath him. That was me on the inside.

It's not because I don't like football (although I really, really, really don't - it could cease to exist and I wouldn't notice), but because I miss my husband. I would never ask him to give up something that was important to him (What if someday he asked me to give up reading or gardening or napping? The horror!) and so between the Sundays spent at the home games and the remaining Sundays spent in the garage watching every other game, we haven't had a lot of time together lately. I'm really looking forward to post-Super Bowl weekends!

On Saturday I took the girls to visit with some of my friends and their munchkins at a place called Kidz n Coffee. It's a coffe shop that specializes in, you guessed it, people with kids. They have a supervised play area that is gated off from the rest of the room, but you go there knowing that there will be kids in and out the whole time. They also have kid's foods like bowls of Cheerios, cheese sandwiches, chocolate milk, and adult foods like espresso-based beverages. It's a great place if you want to have grown-up time but can't leave your little ones behind.

When I got there, I sat Charlotte down on a table for a moment and noticed that she was doing pretty well. I took a chance and parted my hands away from her, careful to be ready if she toppled. She lasted a whole minute sitting unassisted before tipping to the side! Way to go, C!

The girls were on great behavior, as is luckily the case when we're out and about. And, thanks to our sleep system, when they got cranky I plopped them back in their car seats, pulled the top up and turned them to the wall underneath a table. Within a few minutes they were asleep and they napped for a good 45 minutes before waking up refreshed and cheery. They are such great little babies!

I have some pretty great friends, who brought their pretty great husbands (or whose pretty great husbands came on their own) and they all took each chance they got to hold a ladybug. It's worth mentioning because you don't often find guys who take joy in holding other people's children and these men were clearly eager to get their chance. Unfortunately for my friend Cara, who has two boys, aged 14 months and 4, her husband also noticed how good the girls were. She said, "Britt, if my husband wants another kid after this, I blame you!" and not long after that he said, "Honey, I want twin girls!" Hopefully he can get his fix with mine because I'd really like to keep Cara as a friend! : )

When we got home, I thought about how much progress the girls had made recently and how great Lilah had been lately at standing up in our laps when we try to hold her, so I decided to test her. I put my feet on either side of the exersaucer to hold it steady and stood her in front of it so she could grab on and be interested enough in what was in front of her to stay there. She stood unassisted for a full minute, and even though she tips to one side occasionally, I think she is well on her way to making a circle around the coffee table before we know it!

Sean mentioned that it would be a little creepy if they started walking already because they're still so tiny and I completely agree. I had a nightmare when the girls first came home that one of them came running down the hallway to greet me and I freaked out because she was like a tiny little doll come to life, or an infant possessed by something, and it was super creepy. Yeesh. Looks like I might have to get some holy water or suppositories, or whatever else they'd be afraid of, just in case.

7 months old! Time flies.

We've started to see the girls make advances nearly every day! Charlotte has slept through the night for the last 5 nights, which is outstanding. Lilah is still waking up once a night and for some reason she's started to have trouble falling back asleep - babbling to herself for about 10 minutes before starting to cry because no one has come to get her yet. We received stuffed talking frogs from Sean's brother, Scott, that have a "nighttime" features. When you press the hand, (Is it a hand on a frog? It's not a paw. It's not a flipper.), a a light on his chest gets bright and a lullaby comes on for 5 or 10 minutes. It's practically hypnotic to the ladybugs and has made bedtime a ton easier.

Charlotte discovered this week, while Sean was home with them on Monday, that she's a huge fan of tummy time! She spends nearly all day on her stomach now, flipping over nearly the moment she touches the ground. She pushes up on her arms, looks around, and has started trying to bend her knees, although she hasn't had her butt in the air yet. She's perfectly content to do it, occasionally taking a break and setting her head on the ground before pushing back up again.

Both girls have developed a lot of core strength and we can hold them with an arm under their butt and not need to support their head or back. They aren't quite ready to sit unassisted, but they're soooooooo close! And they just discovered their feet.

And I'm finally posting photos of the girls in their holiday dresses. I wanted to wait until I had given them to our family as gifts before putting them online, but now we're set!

From Charlotte and Lilah together

From Charlotte and Lilah together

From Charlotte and Lilah together