Know the Code

I had my regular annual physical and anal probing last week but I had to make an earlier visit to the doc’s office that they might let some blood.

Regular readers might be aware that I am pugnaciously parsimonious (Rufus says that is spelled “c-h-e-a-p   b-a-h-s-t-i-d”) so I was curious about how much the tests cost and whether or not my Obamacare Gold policy would cover them.

Drawing Blood for a TestObamacare covers preventive care.

I called my insurer, Blue Cross.

“Blood tests aren’t preventive care, even if they are done as part of a preventive care visit,” the rep said. Unless they are coded as preventive care and they fit the government guidelines. And the test is done on Wednesday after 5 p.m. or any time Saturday morning. With a blue-topped test tube. Not the red one.

That means I could need to make my deductible before they would pay 80% of the cost of the two or three hundred bucks worth of tests. Amount I’ve spent toward my deductible this year: $0.

My Blue Cross rep was very knowledgeable about my concerns. I couldn’t tell him exactly what tests the doctor wanted, so he volunteered to call their office to find out.

The doc’s office has no idea what codes they use; they order the tests from the lab in English. Or Latin. Or maybe Abenaki. They sent the Blue Cross guy to “billing.” Billing has no idea what codes they use; they simply invoice Blue Cross for the needle stick.

Ah hah. The LAB codes the analysis but they won’t know what codes they will use until the doc’s office sends in the request. In some non-accounting language.

The doc’s office did admit that they draw blood for three tests.

Complete Blood Count
▪ White blood cell count.
▪ White blood cell types.
▪ Red blood cell count.
▪ Hematocrit.
▪ Hemoglobin.
▪ Red blood cell indices.
▪ Platelet count.
▪ Mean platelet volume.
Comprehensive Metabolic Panel
▪ Albumin
▪ Alkaline phosphatase
▪ ALT (alanine aminotransferase)
▪ AST (aspartate aminotransferase)
▪ BUN (blood urea nitrogen)
▪ Calcium
▪ Chloride
▪ CO2
▪ Creatinine
▪ Glucose test
▪ Potassium test
▪ Sodium
▪ Total bilirubin
▪ Total protein
Lipids Panel

The Complete Blood Count is diagnostic, not preventive, and not covered under ObamaCare. Ditto the Comprehensive Metabolic Panel, except when it is. Both plus Lipids, a PSA (Prostate-Specific Antigen), and even the Shingles vaccine could be covered if you code them correctly.

The hospital did tell me a not-covered Complete Blood Count costs about $29 and the Comprehensive Metabolic Panel, $35. The Lipid panel is $46. A PSA test costs between $60 and $80. I don’t get one anymore because the doc says my anal probe is always “fine.” And because it is known to be diagnostically flawed. The shingles shot cost between $200 and $250 alone.

There is a catchall code V70.0 that identifies many of the tests as “preventive.” I just had to remind the doc’s office to use it.


But wait. There’s more!

I should not have to manage this.
As she was filling and filling and filling the gallon-sized test tubes with my blood, I told my favorite nurse she should have a price list on the wall.

“The corner gas station does it. The grocery store does it. Restaurants do it. Even Walmart does it,” she agreed.

She doesn’t know how to get the prices, though. They are hidden and scattered and seem to change by the time of day and color of my belt buckle.

The doc also thinks providers should post a chart of charges. He doesn’t know how, though.

Everyone seems to agree. No one seems able or willing to do it.

As anti-regulation as I am, I suspect regulation or law
will be the only way to get ‘er done.
 

Rewind

“There is no rewind button in life,” Jamie Lee Thurston told me.

No, but if there were I’d surely use it to redrain my pipes better last fall.

It was a rough winter in North Puffin. Fortunately, I was in South Puffin at the time. We had a difficulty with the frig. And the coffee maker. And it turns out we also had some plumbing issues.

SWMBO started the house back up after its winter hibernation and called to say, “There’s water running everywhere.”

Uh oh.

“Define ‘everywhere’,” I replied wisely.

Split, Leaky PipesAfter we got past that exchange, she told me there seemed to be a split in the PEX manifold from the water tank. Splits in the cold water copper pipe to the domestic water coil in the furnace. Some separated fittings in the hot water out from the same coil. A couple of burst fittings over here. Another one over there. And so on.

Last Fall, we were very, very careful. I installed a new water makeup to pump propylene glycol in the furnace. I filled all the fixtures with potable antifreeze. Every toilet and tank, every sink trap, every appliance. I drained the water system from the top down. I even completely drained the PVC pipes to the outdoor faucet and shower. Let me repeat that. I drained the water system from the top down. There should have been no water in those pipes anywhere.

Note to self: close the washer lid to keep the mice at bay. They like the sweet smell of antifreeze and then can’t get out. That does not make a pleasant homecoming. SWMBO will not clean it out. Mouses are man’s work.

It was a brutal winter. Even the cellar froze. I think even the water in the cistern froze and it has never frozen.

I may be a great mechanic but I AM™ the world’s lousiest solder jock.

I can blame 10% of that on my torch and 90% on my technique. I can almost always sweat a clean, empty fitting. I can almost never sweat a clean fitting that has ever had any water within a mile of it. Oh, I know the “drain the pipes” trick. I know the “push bread innit” trick. I know most of the tricks. I’m glad they work for you.

The pipes in the cellar apparently didn’t all drain then. And a stub line on the porch blew out. Apparently it didn’t all drain, either.

I started the repairs by repairing the outdoor pipes and extending the stub over to a new hose bib I installed near the kitchen door. I’m good with PVC. That gave us cold water at the kitchen. We have a nice 5 gallon jug (a square-ish, translucent, left over container of teat dip) but that is a PITA to lug up from the cellar.

Then I fixed the PEX. Everyone tells me PEX won’t swell and split when it freezes. PEX swells and splits when it freezes. I’m good with PEX.

Copper. Sweating. Oh, my.

The pipes in the cellar drained completely when they split. I started at the furnace end and simply worked my way back. I took out a rat’s nest of copper around the furnace; a real plumber had added a mixing valve (sometimes called a “tempering” valve) several years ago. It allegedly mixes COLD water in with the hot water to “ensure constant, safe shower and bath outlet temperatures, and preventing scalding.”

Horse puckey.

I’ve had it replaced twice and it has consistently given us a minute (somewhere in the cycle) of pure cold water in the shower. Plumber said it was code. Same plumber installed a “boiler drain valve” (a sweated in stop valve on the end of an open stub) pointed up. Up? I took the mixing valve out and plumbed the furnace outfeed directly to my shower (and the rest of the hot water service). Fewer joints. Cleaner. That opened the bottom of the tee up so I could hang his drain valve pointing down, at the lowest point of the hot water system. Replaced a blown out elbow in the cold water feed and used a tee in that line to install a new drain valve pointing down, at the lowest point of the furnace cold water system, too.

So I had worked my way back to the cellar wall by the crawlspace under the kitchen. I added shutoffs and drains where they should have been, so each leg could be independently controlled. Hot and cold water everywhere but the kitchen, baby!

I tried an air pressure test on the hot and cold lines running into the kitchen. The cold didn’t hold air at all. The hot pushed air back at me, so it may be sound beyond one blown out elbow. I desoldered that fitting, drained and cleaned the pipes, installed shutoff valves, and replaced the blown out fitting. One side didn’t take, something I didn’t learn until I foolishly turned the water back on.

That’s when my 1968 torch crapped out.

It’s always been a bit cranky in that it doesn’t necessarily shut down the propane bottle, but I could solve that by taking it off the bottle. Now the valve is just plain stuck. I don’t think operating a propane valve with pliers is very safe.

No local store carries the self-lighting Mag-Torch I want, so I ordered it online. It should be here tomorrow. Or Friday.

The water system continues to frustrate me in spite of getting it working everywhere but the kitchen. I still have to struggle with at least that blown fitting, I’ll have to crawl around in the crawl space, and I’m really nervous about the life expectancy of the furnace.

The 36-year old furnace started right up and has been running as it should, but it is 36-years old and it lives in a dirt floor cellar.

Harper’s Second Law: Rust Never Sleeps.

At least we got to shower!

We changed the sheets, too.

I know there is an end to this job somewhere but I’m not getting anything on my own list done.

SWMBO is happy to have water in the rest of the house so now the fact that the coffee maker makes coffee but doesn’t keep it warm is at the top of her list.

I suspect the coffee maker is a separate issue from all the freeze damage.