Someday A Goat

Slapped silly by a housing disaster

Late last August, we came home after a weekend away at a wedding to the damage of 16,000 gallons of water on the main floor and finished basement levels. A part of the tank-filling mechanism in the toilet on the main floor broke and the water flowed all weekend. All things considered, we didn't lose anything irreplaceable, and the house was fixable. The repairs were thankfully covered by insurance, so the situation was much easier financially than it might have been, and we made several upgrades. Our damaged house is lovely and finished now, but it's still hard to relax after all the time and energy in the past 6 months focused almost exclusively on the house repairs.  

One of the rooms in our basement right after we got home. 

Damage in the main room of the basement.

Basic lessons from dealing with a big dang mess of a house 

• First call is to insurance company, not your mother. Although there are benefits to freaking out on the phone with your mother as opposed to a stranger. Of course, no phone calls are made until the water is turned off. 

• Take pictures. Really if you do one thing, take lots of pictures. We ended up with more than 1,200 images related to the project, mostly of the damage. Take a picture of every single thing, and all rooms from all angles. During the repair process, document every change as it happens. I can't tell you how many times I referred back to pictures. 

• Being prepared helps, except when it doesn't. We did have quite a few damaged items that were recorded in a home inventory, but had I taken the time to do a complete home inventory in the past, it would have been hours less work during a stressful time.  

• Prevention rocks. Most of my books are in the basement, several hundred of them. As it happens, they're all off the floor on shelves, and I only lost 3 books. Our holiday decorations were on the floor, but in a big plastic bin -- the prelit tree wasn't so lucky. Be aware of how you're storing things. We don't tend to just pile boxes clothes and knick knacks in the basement, and it worked to our benefit. 

• Take the time to think things through. Since the cabinets had to be ripped out anyhow, we took the chance to improve the layout and storage capacity of the kitchen drastically. We spent weeks coming up with convoluted solutions; just at the point of giving up, my husband came up with the simplest solution, so easily explained and executed that we were embarrassed at the time spent. We tried in every step to make sure we were making choices that went with the flow of previous choices.

• Watch the details of repairs. Paying attention to every single trivial change, and making sure that all work is done well is a long process. This is not the place to be shy about working with the contractor and communicating any problems early while still fixable. 

• Don't expect business as usual. We went multiple months without a dishwasher, and several weeks during that time we wouldn't have access to our washer/dryer, stove, microwave. Many of our habits -- frequent home cooking, regular laundry shifts -- had to change and it was hard. Nothing went according to schedule, but sometimes that just life. I can't imagine dealing with this and children. 

About a month after the incident, Atlanta saw serious flooding from rain, and so many of those homeowners faced the same process as us, but on a much larger scale, and with no insurance coverage. It's hard to feel self-pity when houses and schools had water up to the roof line. 

I'm 30 years old, and it is only during the past 6 months that I have truly felt like an adult. I've had a "real" job for a long time, we've been married for almost 4 years and owned a house for just over 2 years. But it is only now -- having to deal with contractors, making decisions that have a long-term effect on my house's value, tackling the mountain of paperwork dealing with insurance, and keeping track of every detail and phone call -- only after all that do I feel grown up. Home ownership for us has been a lesson in endurance and fortitude. 

A lesson well learned, it appears. In the 2 weeks since the house has been done, we had some serious vet bills and what we thought was a water heater that needed replacement. Nothing could change the vet bills, but today we found out a relatively inexpensive repair would fix our water heater problem. We've managed to remain relatively calm, and it's nice to not freak out at everything.

Making open enrollment decisions

My husband and I are insured under his work health insurance, and open enrollment just ended in mid-November. We decided to keep our PPO plan the same, but we’re adding a small flexible spending account (FSA) annual contribution. I’ve always reviewed paperwork for open enrollment, but I paid a lot more attention this year.

He works for a large company, so the benefits are really good. There are three levels of health insurance, select PPO, standard PPO and HMO. The company also offers dental, vision, and FSAs for medical/dental, dependent day care and transportation reimbursement.

We’ve carried the more expensive select PPO since he started, and we’re keeping it. The payroll deduction is the highest, but since we cut the budget so close every month, and it looks like my husband’s health care expenses will be higher next year, we don’t want to open ourselves up to high coinsurance costs.

I didn’t realize this, but chiropractic and acupuncture services are each covered up to 30 visits per calendar year. We definitely might look into taking advantage of this coverage of alternative therapies in 2009, especially the acupuncture.

The copays are the same between the select and standard PPO, but the main reason we’re not downgrading to the standard PPO is the coinsurance requirements for hospital care, lab tests, radiology and outpatient surgery, in addition to coinsurance for out-of-network coverage. Jeremy at Generation X Finance has a great primer on the differences between copay and coinsurance if you're not entirely clear.

For in-network care, the select PPO has 100% coverage after deductible, while the standard requires 20% coinsurance. For a $450 lab test my husband had this month, that would have meant a difference between paying just $150 for our deductible under select PPO to paying $150 deductible plus $60 coinsurance. For out-of-network coverage, the coinsurance costs are lower under select (30% v. 40%). All it would take is one hospital visit or outpatient surgery to really throw our budget for a loop.

We typically only use preventative care, which is 100% covered in-network after the copay, but you never know. I plan on tracking our health care spending next year so that we can possibly move down to standard PPO in 2010. If the out-of-pocket max is less than what we can save in the FSA at that time, and still use the FSA up by the end of the year with other expenses, the much-lower premium for standard PPO may make sense for us (the difference is premiums for standard PPO is less than half of what it is for select). Of course, we’ll have to also consider what this will do to how much of our income is taxable. Since the HMO has no out-of-network coverage, it’s not really an option, especially since the payroll deduction is only a little bit less than the select PPO.

While we are absolutely not planning on having children, we both have all the working parts, so to speak, and the maternity coverage for in-network services has a huge difference in coverage. For the select PPO, the in-network coverage for maternity is 100% after the $15 copay for the initial office visit and the deductible. Standard only offers 80% coverage in-network after copay and deductible.

The company also offers personal health resources: personal health support, maternity support, autism advocate and 24/7 Nurseline. I’ve already put the number for the NurseLine on our fridge, but we may look into the personal health support (if we qualify) for my husband.

Included in either PPO coverage is prescription drug coverage, mental health and substance abuse coverage, and vision coverage. I learned that we can save a significant amount of money by using our provider’s prescription-by-mail service, so that’s something to keep in mind in the coming year for the small number of prescriptions that we get filled. In addition, if you have the same prescription filled more than three times at a retail pharmacy, the coinsurance increases.

The only real change that we’re making is adding the flexible spending account. We’re not making a huge annual contribution to avoid losing any money, but quite a few of our out-of-pocket costs would be covered if we had already enrolled, so we’re going to start small. I take allergy medicine March – November, and wear glasses and contacts. My husband has just been put on Prilosec daily, and he has significant dental expenses not covered by our dental insurance. In addition, we could apply copays, coinsurance, deductibles and lab tests that are not covered by the health plan.

We probably had at least $600 in FSA-eligible expenses this year, and I wouldn't be surprised if it were more than $1,000. While I’m looking forward to reducing our taxable income, until we’re on steadier ground as far as finances, I don’t want to reduce my husband’s paycheck by much. They also offer a debit card linked to the account, so we’re opting to receive that also. Five Cent Nickel posted about FSAs and open enrollment recently, as did Clever Dude.

For dental coverage, well, we’ve been battling them all year, so I don’t even want to think about it. But the payroll deduction amount isn’t very high, and we earn that out based on my semi-annual visits alone, so we’re going to keep it. I hate giving them our money, though.

Consumer Reports also has a handy guide to choosing health benefits (via Lifehacker).

Dealing with insurance can be maddening

We've been trying to get our dental insurer to cover my husband's periodontal maintenance for more than 3 years, with no success.

We've been paying out of pocket for almost all of his dental work, to the tune of several thousand dollars over the years, and not only has it added to our credit card debt, we can't really afford to continue.

This is maintenance that should be covered under our plan, and it feels like the insurance company is doing anything it can to avoid covering his periodontal work. It seems illogical, because if he doesn't have regular periodontal maintenance, he will likely need much more expensive work in the future.

Today I had to send off an appeal on a benefit determination (via certified mail, of course). Here are some tips for communicating with insurance companies.

• Keep good records. I have a folder for all dental insurance paperwork, and when I'm dealing with issues, I carry it with me so I have what I need on hand should I call the insurance company.

• Note it all. When you make a phone call, make sure to write down the date, time and the person you spoke with, and include any details from the call you need to remember. I often do this straight on the bill or explanation of benefits—less paper to file and keep track of. Because I could look back over phone records, EOBs, emails, faxes and notes, complete with date and time, it was a lot less frustrating to write an appeal of a benefit determination. I always make sure to print a report when I fax something important so I have a date and time and that the transmission was successful.

• Always keep a copy of all documents. Finding a copier before heading to the post office might seem like a huge pain, but dealing with the insurance company "losing" your only copy will be worse. 

• Don't procrastinate. If we had taken care of this when he first started his job in early 2005, we could have avoided A LOT of wasting time and money on this. Part of the problem was that for the periodontal maintenance to be covered, the insurance company basically needed evidence that it was necessary, in the form of a specific periodontal procedure. Well, my husband had that procedure years before he started working at his current job. Fast forward to last winter, and he actually needs the procedure again. He calls beforehand to make sure it will be covered, but didn't do a formal precertification. We get the EOB, and it says nothing will be covered. I cry. We left to go overseas for his brother's wedding two days later, and got caught up in life after the holidays. Since then, it's been back and forth with the insurance company, his periodontal maintenance wasn't covered again in May, and he has an appointment next week. There are also specific time limits in which one must file a claim after the service is provided.

• Send important documents via certified mail. It's simple to do, and the best way to have a paper trail of communication. I note on the letter itself that it had been sent certified mail.

Now that someone at the insurance company must sit down and review the claims file, and our very detailed letter, there is a glimmer of hope that this will work out and he will start receiving coverage. Our budget could sorely use the relief. Otherwise, we might start contributing to his flexible spending account, if we're going to pay out-of-pocket, we might as well use pretax money. Forgoing the extra periodontal maintenance on top of regular cleanings is not an option at this point. Because he takes good care of his teeth and gums, and is proactive about the maintenance, he'll hopefully avoid more expensive dental work in the future. I guess it's a good thing our insurance plan is under open enrollment.