Boots, illness updates and…figuring out our insurance needs…

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Oh, the Clark’s boots!  I wanted to keep them so badly that I took them to a long established boot and shoe repair company in Wayzata, Minnesota, Bob’s Shoe Repair.  

Brian, a young, although highly skilled leather craftsmen at Bob’s was confident he could cut out three inches out of the calf of the boot, put them back together leaving me satisfied with the comfort, look and fit.  He succeeded.  Thanks Brian!

I picked them up yesterday and couldn’t be happier. The cost for the repairs: $100.  Total investment in the boots including repairs: $249.   With the promise of a great rating online, I offered the seller of the boots a five star rating, if he’d credit me the $14.95 I paid for shipping.  He immediately posted the credit to my PayPal account.

Why did I deserve a credit for the shipping? The online description of the boots indicated a 14″ calf circumference when in fact, it was 16″ resulting in the necessity of the repair. I would have been satisfied with 14″ circumference. (My outrageously skinny calves measures 12.5″).  Now, I’m beautifully repaired, I’m content.

The sinus infection I reported on two days ago is improving without seeing the doctor or taking antibiotics. The pulsating headache would have driven me to seek help had it not begun to dissipate later in the day yesterday. Today, I awakened with only a slight headache for the first time in eight days. It’s on its way out.  
Thanks, Neti Pot, Aleve, Tylenol PM at night (with acetaminophen and Benedryl), lots of water, less dairy and light activity, coupled with periods of rest, good food and the loving support and comfort from my hubby.  Now, I know I will most likely survive a sinus infection without antibiotics.

In the beginning stages of figuring out our insurance needs, I spent a few hours yesterday with our long time highly competent broker/owner of our local State Farm Insurance office, Chad Babcock.  Having worked with  State Farm for the past 40 years, we have never had a problem.  

Before we begin traveling we must address these three major insurance concerns:
1.  How will we insure our luggage, computers and equipment without the security of homeowners insurance or a permanent home?
2.  Will we be able to buy a policy to avoid the high cost of insurance when renting a car abroad, which may be as high as $30 a day in certain locations?
3.  Medicare doesn’t cover seniors traveling out of the US and its territories. What type of policy will cover me, turning 65 in six months, while out of the country?  

With Chad’s help and a few phone calls later at home, we came up with the following scenarios:
1.  Baggage Insurance:  Once we acquire our Nevada residency and address, we will be able to purchase “renter’s insurance” covering the value of our belongings traveling with us, attaching a “rider” for our computers and digital equipment.  
2. Car Rental Insurance:  Many have the perception that one’s own auto insurance will cover a vehicle and liability while traveling in a foreign country. Not the case!  Plus…we won’t be owning a car here in the US, if it did.  We’ll bite the bullet on this one  We’ll pay the insurance at the time of renting the vehicles throughout the world.
3.  Health Insurance:  Without Medicare, a senior cannot purchase a supplemental policy which usually covers most of the costs Medicare doesn’t pay. Thus, I will be required to apply for Medicare (Tom will have five years until he is 65), pay the monthly fees out of my monthly Social Security in order to receive the supplement.  
Plan A:  The cost of the supplement is $185 a  month at this time along with the required Medicare payment for a monthly total of approximately $285.  The hitch:  traveling out of the country allows a total lifetime benefit of $50,000, rather skimpy.  Our insurance guy gave us a quote for me for $432 a month for full coverage, with no limits but add the approximate $99 a month for Medicare, we’d be paying $531 a month, a huge chunk. Tom, obviously younger than me by five years, will be covered up to 94% with the policy offered to him by his employer plus the necessary supplement until he turns 65.  His total cost (for the next five years), $207 a month.   GRAND TOTAL FOR BOTH:  $738  (Yikes! I hadn’t budgeted for this amount)!

As of this writing, I had a light bulb moment!  Duh??? This is not rocket science!
Let’s look at the realities. Tom with better health than I (as hard as I have fought to win over my genes), rarely visits the doctor.  Would the 80/20 (OK out of the country) company provided policy be sufficient for him, saving us $207 a month on the supplement?  

Plan B:  The only difference is 14% (based on the 80/20 coverage without the supplement, as opposed to 94% coverage with the supplement). Then, we purchase the “big guns” policy for me with a $1000 max-a-year out-of-pocket policy with no limits?  GRAND TOTAL FOR BOTH: $531 a month!! 

The financial risk for me?? None! The financial risk for Tom? We’d have to pay a maximum of 20%. Sure, I did the math, the savings of $207 a month over let’s imagine five years, is $12,420.  If he had a $60,000 medical bill, we’d be even.

For now, until we get our feet wet on this adventure, its worth the risk.  In the meantime, this pays for the insurance on the rental cars.  (If a traveler has an accident in certain foreign countries and doesn’t have insurance, they can be detained until the bill is paid in full.

Tom just returned home.  We discussed the above options A and B and we choose B, freeing up the $207 a month to cover the insurance on the rental vehicles.  (We don’t plan to have a rental car more than half of each month to keep costs down, vital all month in some locations and seldom needed at all in others). 
Of course, all of this could be a moot point when Obamacare kicks in. Not intending to get into politics on this site, this uncertainty faces all of us income earning citizens.  Where will Medicare be in the next few years?  None of us know at this time and, probably won’t be able to figure it out in the future.

Hum….
 

Final decisions on prescriptions dilemma…

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In my post of June 12, 2012 (please see archives), I discussed our concerns for bringing our medications with us while we live about the world, often in remote areas, far from a post office.

We’ve discovered that in certain areas, the receipt of packages is not only risky due to potential theft, but also inordinate delays. The thought of worrying every few months about receiving our refills will be an infringement upon our level of enjoyment.  What me, worry?

In the June post I explained that we had sent our prescription plan a comprehensive package of personal information, our itinerary, lists and reasons for medications, doctor’s information and a completed litany of forms, along with a detailed letter explaining why we wanted to take no less than 12 months of prescriptions with us.  

Thus, we began the wait for approval for our “vacation request.” Three to perhaps 10 years is hardly a vacation, as Tom often reminds me saying, “We will be living, not vacationing.”

In speaking with our doctor, we discussed an annual Skype appointment with him whereby he could “see” us in order to meet his ethical criteria of an annual appointment in order to write refills for yet another year. This was satisfactory to us.

I weighed the package, loading it with postage and left it for the mailman almost six weeks ago.  With no response, it was hovering in my mind to call and check on the status of the request.  Friday, I called.

An hour later, after explaining the story to five different employees, none of whom could find a record of my filing for the request, my temper began to flare. It is seldom that my feathers get ruffled.  But, I knew remaining calm would get better results than to expose my ire.

In a firm, yet pleasant voice, I explained to rep #5 that I needed to be sent to someone who would be able to find the file.  I was sent to the supervisor of the “vacation request” department, explaining a very shortened version of what we needed and focused more on the location of our file.  I looked at my cell phone. I had been on this call for one hour and five minutes.

The supervisor left me on hold, returning a full four minutes later to explain that she had found the file and our request was denied! “Where’s my denial letter?” I inquired.  No response. Finally, she stated, “Your insurance plan doesn’t allow for vacation requests.”  

“Why, may I ask,” again in a calm voice, “didn’t the agent tell me this was the case after I spent an hour on the phone in June asking them how to handle a vacation request and if we were potentially qualified?”

Why did he send me a packet of no less than 10 pages, explaining the process requiring me to include information they already had in their system, asking me to hand write in the forms on the few lines provided?” 

(No, I didn’t hand write in the forms!  I printed the 12 pages of information using our printer and paper, directly from their system!)  She apologized for my inconvenience. I hung up trying to mumble some sort of a thank you. (Can’t escape my ongoing effort to have good manners, I guess.)

Inconvenience? Ha! Doesn’t incompetence sound more like it? Usually, I am a very calm person. My heart was racing. I paced around the room, adrenaline thumping through my body, heading directly to my brain for a solution. I paced. I ruminated. I paced some more. I poured a fresh glass of iced tea. 

I had an idea! Why didn’t I think of this to begin with?

My simple idea was to pay for our own prescriptions out of our pocket! Forget the prescription plan!  Forget the co-pays! Find the best possible prices for a one year’s supply (the maximum time for which the doctor can ethically write)!

The comfy chair was calling me. Sitting down, with the frosted glass of iced tea in hand, I grabbed my laptop quickly bringing up our prescription plan records to determine the co-pays we had paid in the last 12 months. The total was $1542, the new number to match!

Now, the challenge was to find a way to buy all of our prescriptions for one year for as close as possible to this number, thus justifying buying outside of the plan.

My phone in hand, I looked up the phone number of the local Cub Foods Pharmacy and had the honor of speaking to Pharmacist Renee, a breath of fresh air after that grumpy “supervisor.” She confirmed that “yes” we could buy any amount of medications for which we had a prescription. She priced 365 days of each of our combined seven prescriptions. (Numbers coming here in a minute).

Next, I called Walmart Pharmacy. What about their $4 per month prescription? Wait a minute! The $4 theory went out the window when I received the pricing from their pharmacist for the seven drugs. Our drugs were not in the $4 plan.

Here are the cost comparisons for the two locations:

Cub Foods Pharmacy $2445.80

Walmart Pharmacy:   $3022.48

Hum, not good enough. However, Cub agreed to match the Walmart’s best price on any single medication, only a slight improvement in the total, bringing it down to $2390.45, still $848.45 short of our goal.
Gulp. Gulp. Gulp. More iced tea. Wheels turning. Here we go! 

What’s the commotion among senior citizens, without access to a good drug plan, buying prescription drugs from Canada?  I tried to picture myself bobbing up and down on a bus traveling to Canada with a bunch of seniors. 

Fingers flying across the keyboard, 1/2 hour later, web sites searched, reviews read, to discover that CanadaDrugs.com may be a partial solution.

(Please understand, we are not involved in this or any other companies in
any manner, and kindly ask you to do your own research as to what pharmacies/plans may work for you).

While considering the best prices at Cub, based on best prices at Walmart, matching the best prices at CanadaDrugs.com, I came to this conclusion:

We will buy some of the drugs from Cub Pharmacy and the better priced drugs from Canada which Cub can’t match. Considering these two combined costs, we are at $1749, only $207 more than we’ve been paying for co-pays on our current plan, now to pay in full for each drug out of our own pocket, no insurance plan involved.  (I won’t get into politics in this blog, but who’s making money here? Are our own seniors being robbed?)

Before leaving Minnesota, we will purchase our last three months of prescriptions, using the plan and then use the 12 months prescriptions between Cub and CanadaDrugs.com.

We won’t have to worry about prescriptions for 15 months out. Our doctor will write us new prescriptions in a year, while we still have three months on hand, plenty of time to repeat the entire process, while awaiting for the drugs to arrive. Both Cub and CanadaDrugs.com will mail to any address.

Moments later I was back at my laptop, sitting in my comfy chair, smiling from ear to ear, freshened glass of iced tea in hand, realizing that the New with Tags, 100% silk designer tie I was bidding on at eBay for Tom’s dressy cruise outfits, was now up to $2.10 with free shipping and, ending in three minutes.

I won.

Medical woes abroad?…

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The uncertainty of the quality of medical care in the many countries we will visit, undoubtedly presents us with cause for concern.  Overall, we are both in relatively good health after working so hard to improve it these past few years.

With our healthful, low carb diet of organic, grass fed meats and produce, exercise (mostly me), reduction in exposure to toxic chemicals in our home, low stress and a happy relationship, we feel we can manage our few complaints easily from afar.

Our doctor will be available via the Internet should we have questions and we’ll be well armed with a wide array of preventive and emergency medications should an illness arise.  In the past almost year, neither of us has had a cold, a virus or illness requiring a trip to the doctor.  

Our recent medical appointments have been for the sole purpose of reviewing our travel medications, receiving our vaccinations and having blood tests with an annual exam thrown in for good measure, all of which showed tremendous improvement from a few years ago.  We are hopeful.

Assuming we don’t get bitten by a snake or warthog, break a leg or have a sudden gall bladder or appendicitis attack, we should be fine. But, of course, we must plan for the possibility of illness in the following manner:

  • Emergency evacuation insurance
  • Supplemental insurance for Jess (Medicare won’t pay for any care out of the US). Only 60 at retirement, Tom will be covered by his regular insurance.  Proof of insurance documents.
  • Prescription processing from afar (as mentioned in prior posts, we’re awaiting a response from our prescription plan as to whether they will provide us with 12 months of prescriptions at a time).
  • Emergency medication for infections, bee stings and/or allergic reactions (EpiPen) and gastrointestinal distress.
  • Copies of all of our immunizations (proof of yellow fever vaccine required with passport upon entry into Kenya).
  • Copies of all of our prescriptions (in the event we are asked during customs inspections or going through security).
  • First aid supplies: Bandages, antibacterial and cortisone creams, alcohol, hydrogen peroxide (small bottles).
  • Over the counter medications.
  • Vitamins/Supplements we currently use.
  • Medical records for both of us (scanning these).
  • Optical needs: extra sets of glasses/prescription sunglasses for Tom,  three years of contact lenses for me. Both of us are yet to have our final optical appointments.
  • Final dental appointments and supplies: Our teeth will be cleaned two weeks prior to leaving the US, while visiting Las Vegas over Christmas. The past few years, we both had all the crowns done that we’d needed.  
  • Copies of our living wills and legal designation for medical advocacy in the event of an emergency.
A neat stack of medical forms and documents sits on our kitchen table with Post-it notes reminding me to complete the above tasks on the appropriate dates.  
This Saturday is the free shredding event.  After going through every file  folder, cabinet, drawer and piece of paper in our entire home, we are ready for the event.  No words can describe the freedom we feel from unburdening our lives with paper.  
Other than the required medical documents, passports and  travel documents we’ll need to have on hand, we’ll leave a “paperful” life behind us, instead relying on the latest technology to provide us access as needed.  Yeah for technology!  Without it, planning for this adventure would be more of a headache than it already is!   

The continuing prescriptions saga…

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On May 17, 2012, I posted concerns about our prescription refills when we are out of the US. As is the case with most insurance plans, the servicing mail-order pharmacy will not send more than three month’s of medications at any time.

Writing that post prompted me to contact the mail order pharmacy to request an exception, due to our unusual circumstances of our being out of the country for years as opposed to months.

Here was the conversation with them: 

“We’d like to request that we receive 12 months of prescriptions in October 2012 before we depart for our journey. A year later, we will ensure we are at a location with an address and have you mail them to us for another year. Our doctor has approved this.”

“Oh, we don’t send the prescriptions outside of the US,” he said with authority in his voice.

Hum…I mused to myself. My choice was either to alienate him by complaining about their policy which was surely futile or, give him a proposal. Here’s what I proposed:

“Sir, we will be getting a new address in the US when we establish residency in another state in December 2012.  Also, we will be obtaining the services of mail handling company in the same state.  Could you send the prescriptions, 12 months at a time, directly to that address?”

“Gee, I don’t know,” he quips, question marks flying around his head.

“Can you find out?”  I asked.  This was like pulling teeth!

“Uh, yea. Can you hold?”  The authority was gone from his voice.

On hold for 15 minutes, he returns with his answers. “Thank you for holding. We’ll be sending you forms in the (snail) mail with instructions.” 

“Oh, I have poor handwriting (true).  Can you email them to me or are they available online?”  I asked with the utmost of sincerity.

“No, they have to be snail mailed and completed by hand,” he says, sounding annoyed with me.

Good grief! Where’s my old typewriter?

Within days of my inquiry, we received a packet of complicated forms, stating not only our standard identification information (OK, I get this) including every word on our ID cards (they have this). We were asked to list one prescription per page, reasons for the prescriptions, how long we’d had the illness, the diagnosis and the prescribing physician’s information.  

With our regular daily prescriptions plus an additional prescriptions for preventive and emergency travel conditions, this would result in completing 20 pages!  It would take days.  

Yes, I could manually enter the repeated information, for example; ID information, addresses and prescribing physician information, etc. and then proceed to copy and print the 20 pages, subsequently, manually entering the requested lengthy medical information.  This still would take days!

Yesterday, I called asking to speak to a supervisor, asking that our conversation be recorded (it was) and documented (hopefully, it was) and here was my proposal:
1. Complete one page with the pertinent basic information.
2. Print all of our prescriptions directly out of their system. (They could have done this!)
3. Write a letter, signed by both Tom and I, explaining our circumstances, reasons for the request, including our itinerary for the next 949 days thus far.
4.  Staple this together.
5.  Snail mail.

The supervisor agreed to my proposal.  I reminded him to post it in the system as to his agreement with my proposal.  Otherwise, they will receive the packet, send it back to me, complaining I didn’t fill it out correctly and this entire process would begin again.  Of course, I made copies of everything.

Does this scenario sound familiar?   I’ll keep you posted on the end result.

The continuing medical concerns…

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When meeting with Nurse Marcia a month ago at the Park Nicollet Travel Clinic, in St. Louis Park, Minnesota, we had discussed the rabies vaccine.  The cost is outrageous at $350 per person per injection, a series of three injections spread a month apart at a total cost of $2100 for both Tom and I. 


At the time, I suggested we hold off on rabies until further down the road. With only a little over five months left to departure date, the time had arrived to investigate this further.  I called our insurance company.  Much to my surprise, they will cover the cost in full! Thus, we decided to proceed with the rabies series.  My first rabies vaccine will begin on June 5th with Tom’s over the next few months.


We made this decision based on a few concerns; one; we will want to explore the bat filled caves in Belize (guano!) next February and two; while living among the animals in Kruger National Park in South Africa in December 2013 we will be exposed to a possible incident.  Surely, these two situations warrant a radical precaution such as the rabies vaccines.  


Is it likely a rabid bat will bite us while riding in an inner tube through the caves in Belize?  Highly, unlikely. Is it possible we will be bitten by a rabid wildebeest while lounging by the pool in South Africa?  Possible, yes. Likely, no.  


We have decided that any precautions we can take in the planning of our lengthy journey will be well spent both in time and in money. Unquestionably, situations will occur that we aren’t able to anticipate at this point, in regard to health and well being and their resulting costs.  


The more we prepare, the less likely we will experience angst and frustration. Remember, our journey…”wafting through our worldwide travels with joy, simplicity and ease,” requires as much preparation as possible.  Thank goodness, we’ve had the time and the determination to plan ahead to this extent.  


Yesterday, I had an appointment with our long time family practice physician, Dr. Dennis Showalter, a fine youthful doctor with a bright smile, kind and uplifting demeanor, sharp knowledge and a passion for his work.  

An advocate of main stream medicine, he and I have butt heads over the years with my penchant for alternative medicine and my obvious obsession with online research, (albeit reliable medical schools, universities and research institutes). All in all, Dr. S. always sought the best course available for any of our various ailments, real or imagined, and has provided the utmost of care.


Now, as our journey approaches, he and I discussed the challenges we may experience along he way, requiring medicine and/or medical care.  Here’s are a few of our concerns and possible solutions:

  1. Prescriptions:  Our insurance company only allows refills every three months with no regard to the willingness of the physician to write the prescriptions for longer periods.  With little access to mail as we flit about the world, receiving the prescription can be tricky.  Solution:  With our mailing service in the US, they can receive the prescriptions and forward them to us at the post office closest to our current location. We must ensure that we have an ample “extra supply of meds” to account for the extended mailing time. In the interim, I have requested a “travel waiver” from the insurance company which I will receive soon and process.
  2. Illness:  How often does one become ill at home in the US in 949 days?  For us, seldom, perhaps a cold or flu once every year for one of us.  Do we normally go to the doctor or get medication in these cases?  No. Tom and I seldom visit the doctor other than the required once a year exam in order to refill our medications. 
    Solution: Dr. S. can accommodate this requirement by conducting an online appointment with us as offered by our medical group. Should we require emergency medical care, we’ll seek out the closest, most highly recommended, medical facility within reach of our location.
  3. Emergency Illness:  Hopefully, we won’t require emergency medical treatment/surgery due to illness or injury. 
    Solution:  Many countries we will visit have excellent medical care and we’d go to the nearest hospital for care as one would here in the US.  If we are in a country with inferior medical care, we will use our then in-force Emergency Evacuation Insurance, a plan we have investigated and yet to purchase. (Many plans will not cover our extended period out of the US.  This particular company, requires an annual renewal.  However, they will provide coverage for us at about $100 a month per person, a cost we have budgeted).
  4. Preventive Medications:  As most of us, from time to time, we use over the counter medication that may provide temporary relief from annoying minor ailments which includes: antihistamines, aspirin, ibuprofen, antibacterial cream, cortisone cream, anti-itch cream, etc. 
    Solution:  Dr. S. and the travel clinic will provide us with prescriptions as preventive measures: Epipen (both allergic to bees), various antibiotics, allergy meds, anti-viral, ear patches (sea sickness, highly unlikely for either of us as long time boaters) cough medicine and other non-narcotic medications in the event we are far from medical treatment.   

In September, after having completed all of our vaccines with the travel clinic, we will book our final appointment with Dr. S. to review all of our medications, conduct last minute tests, perform our annual physicals, and send us off with his medical blessings for a safe and healthy adventure.