domain:asteriskmag.com
SSCReader
1d ago
Time for an Ulcerative Colitis and medical billing update! Paging @Throwaway05 and @self_made_human.
I’ve mentioned elsewhere that I have been diagnosed with Ulcerative Colitis, a couple of years back, but that finding out in advance how much treatment was going to cost was nearly impossible. My colonoscopy to diagnose the disease cost me about 1500 dollars out of pocket. My doctor then put me on Velsipity, which was not covered by my insurance, but did have 2 years supply covered free by the drug company. My drug company did in fact approve the drug and add it to their formulary list, a couple of months ago. Just in time for my doctor to decide it wasn’t actually really stopping the progression of my disease, so we had to look for another drug to try. So it goes.
But before that I needed another colonoscopy! Again, no one could tell me how much it was going to cost me. It ended up costing me about 2,900 dollars out of pocket this time. Why the difference? Well because the first one was coded to my insurance company as routine, while this one is diagnostic. Nothing was different about the procedure at all. Diagnosis? My Ulcerative Colitis has progressed from mild to moderate to moderate to severe. So, my doctor decided we were going to try Tremfya, a biologic medication.
If you anticipated my next question was “How much is this going to cost me?” Then have a cookie or three! And if you correctly anticipated the answer was “I don’t know” then take the whole box. I can’t eat them now anyway. Tremfya is on my insurance companies list, but it has a whole bunch of caveats attached to it. They only cover so many doses; they only cover it from certain pharmacies they only cover it after you’ve tried other medications.
The drug manufacturer has a payment program, which may help people cover the out-of-pocket costs. Up to 20,000 dollars a year. Which sounds pretty helpful! But there is a twist. For Tremfya, your first 3 loading doses need to be delivered by slow infusion, which means you either need to go to a medical facility, or have a nurse come out and hook you up to a drip. Once again this will have a cost attached to it separate from the cost of the drug itself. I’m told having a nurse come out is by far the cheaper option. So, I pick that and see the Tremfya program may also cover up to 2,000 dollars for infusion costs per annum as well.
Note the important words there, however. May. It is not guaranteed, and the drug company can stop it at any point for any reason. So, I talked to the specialist pharmacy that is contracted to come out and do my infusion. How much will I have to pay? If you guessed the answer was “I don’t know” then you are to my shock, wrong for once. They said 40 dollars per infusion. Which sounds downright reasonable!
So, I go ahead and book the first treatment. The nurse comes, she is very nice, gets a vein on the first try and we spend 2 hours filling out multitudes of forms. I don’t immediately die or go into anaphylactic shock as some of the dire warnings on the medication indicate so I’ll count that as a victory. But now the time has come to pay the piper. I log into my insurance portal a couple of days later and I see the charges for the drug and infusion costs are pending. I wait a few more days with bated breath and then I am both unhappy and happy. For my cost for the drug itself was 0 dollars!
Let’s go back and look at the breakdown. A single dose of the drug was billed to my insurance company for 17,000 dollars. Normally I’d have to pay 20%. But my insurance company very kindly registered me for the Tremfya manufacturer program and that reduced my OOP to zero. Great. But that is 3400 dollars from that 20,000 dollar pot, for one dose. So let's put a pin in that.
Now let’s revisit the infusion cost. This is not for the drug, this is for the cost of having a nurse come out and administer it (and I was told it is much cheaper than having to go to a medical facility). Just close your eyes for a moment and guess how much the initial bill is. Got it?
Well, it is 35,000 dollars. My insurance company negotiated a discount to only 15,000 dollars. So I am billed around 3000 dollars out of pocket. Except the pharmacy had said after checking with my insurance I would only have to pay 40 dollars per infusion. So what gives? Well we have to go back to the OOP maximum! Because the insurance company administered the Tremfya program and got the money from them directly, the 3,400 odd dollars for that didn’t go towards my OOP maximum, because I didn't pay anything. So I am on the hook for the co-insurance here, not just the 40 dollar co-pay.
So, I looked up this on some UC forums and discovered this is indeed a thing. Many people have to force their insurance company to let them apply for the program on their own, because if you do that, it counts towards your OOP maximum. As you are billed, pay the balance and then get re-imbursed. So, while it looks like the insurance company is trying to help you, it actually screws you over. I call my insurance company and after two escalations and some back and forth they agree to apply the amount to my OOP maximum. This plus the previous colonoscopy costs means I now don't have to pay co-insurance costs for the rest of the year. Just co-pays.
I guess I'll worry about next year when I get there though at least I'll just be on 17,000 dollars a dose pen injectors by then. I'll hit my OOP max 3 doses in, which should be covered by the Tremfya fund.
Also don’t get me started on what the difference is between Annual Maximum Out-of-Pocket and Total Yearly Out-of-Pocket Maximum which are two entirely different figures and are very unclear as to the difference.
The Tremfya does appear to be working, for anyone in a similar situation. Although improvement in UC is measured in months and half-steps so we will see where I am in a while. Velsiptity did nothing but I also had no major side effects.
I'm not sure the NHS is better than the US system, but it's certainly less stressful and complicated from the point of view of the end user. Slower and less efficient though most likely.
Rov_Scam
1d ago
Have you actually read the published report on his death? If you haven't, read it before you start theorizing about how he couldn't possibly have committed suicide. If you have, I'd like to know which parts you find credible and which parts you find incredible, and for you to offer evidence as to why you find those parts incredible. And no, I'm not going to link it, because if you're so interested in saying this you should at least do the work of finding it yourself. It's not that hard.
ABigGuy4U
1d ago
Trump is scared even if he’s not on the list, because a full accounting of the truth would have people seriously calling for revolutionary tribunals and guilotines. And not just the types that are always calling for that.
Rov_Scam
1d ago
Are you basing this on actual knowledge of the prison system, or your own interpolations based on TV and movies?
voters-eliot-azure
patently unbiased
1d ago
The point is to ensure students know that there are opposing viewpoints, and that they are mainstream and not "alt-right propaganda". And to do that, the university should break through its own departmental balkanization.
Like many arguments about the liberal bias of college graduates, this is doing immense work of denying those college graduates agency in their own process of academic discovery. But, I guess this is like the "nature" vs. "nurture" debate, except "reality has a liberal bias" vs. "higher education is liberal brainwashing". Maybe somewhere, someone is begging that the truth lies somewhere in the middle.
Every political dialogue I had in college, often frequently with people who I had very little to agree with, was emphatically more informed and nuanced than any YouTube gotcha shitpost (Charlie Kirk) that tries to paint college students as some misinformed monolith. It was a period of rapid opinion changing for me, and I only took one or two "woke" courses. I guess maybe my foreign language classes could be considered woke, as the literature we focused on was mostly from the times of massive political upheaval in those nations thanks to radical reactionary politics (I didn't study Russian or Chinese)...
Most of my opinion changes came from the fact that I went from a town where we could see the stars because there wasn't enough light pollution to drown them out, where people still used the word "Jew" as a derogatory verb, to a college campus where I met (and even dated) a Jewish person for the first time, and realized that I actually wasn't 10% as smart as I thought I was even though I was at the top of my class. Humility and worldliness liberalized me, personally. If I had stayed home I would've continued to be one of the smartest assholes in my hometown, and probably would've made a good chunk of money doing some regional white collar work. I didn't, though.
thejdizzler
1d ago
I seem to have lost the ability to focus on a book for more than 30 minutes in the last month, which is concerning. Maybe this is just an ebb in the tidal process that is my relationship with reading, but this time it feels different. It's not so much a lack of time, but feeling like I should be doing something else (working, running, or texting mainly). Sometimes this feeling is valid, but mainly reading is for time when I don't have the energy to do these things (run, work, or be social).
What can I do about this? Or do I just need to chill?
the_Culture_is_great
1d ago
If he had expressed basically any level of care, even a small amount I wouldn't have kept beating the dead horse here.
I also don't like these people! I also want the worst offenders removed from public spaces! Prison, involuntary commitment, etc are all valid tools here.
I think harm to them can absolutely be justified for the greater good of peaceful society.
faceh
1d ago
Is that any different from checking a girl who looks questionable's ID to check the age?
Throwaway05
1d ago
Right most people know "open secrets" in their community or profession. Sometimes they get picked up by the public, sometimes they don't, but conspiracy theories that actually come out are almost always in this category.
No_one
1d ago
They would surely have killed him when he was a private citizen and before he was arrested and locked up in a jail in the middle of NYC.
Not everyone has perfect knowledge of what's going to happen.
Epstein’s lawyers told him he was going to die in prison and it is very plausible he told them that in that case he wanted to do it now
Why are his lawyers insisting they don't believe he killed himself? Some self-serving ploy to keep being paid by his estate or what?
ABigGuy4U
1d ago
You can’t prove that the mob killed Jimmy Hoffa either. Sure he had been in bed with the mob for years, had recently pissed them off, and disappeared on his way to meet with a high ranking mobster. But there’s no smoking gun, no witness testimony, no body. Shockingly enough the organization of professional murderers that specialize in getting away with murders made sure there wasn’t any definitive iron clad evidence of the murder.
No_one
1d ago
He was a psychopath who has been getting away with it his entire life. I don't think it's plausible, at all, that he killed himself. These people are optimistic and never really give up. You could maybe expect a guy like that to kill himself once he's in a supermax with no parole, etc.
Rov_Scam
1d ago
And what, pray tell, are the illegal or dangerous acts that Alan Dershowitz has committed on behalf of Mossad?
FtSoA
1d ago
Pulling the trigger to the point that it's just barely not going off and then wiggling it is going to cause problems on a lot of firearms. The trigger should not be pulled as a part of the holstering process, and supposedly the existence or not of a manual thumb safety (standard on the military models) is irrelevant for this kind of failure.
Most of these guntubers are just fucking around until they make the gun go off, without any relevance to the reality of the known cases.
There are so many P320s out there, like 3 million in the US, that the base rate of these discharges is still tiny. In some cases it's just people claiming the gun went off without them having done something stupid. In other cases, it might be poor customization contributing to the problem.
It could be a slight manufacturing defect that is rare, but still enough to cause these discharges in certain circumstances.
Sig has not handled the PR well at all, but it genuinely is still a mystery for what the hell is going on.
I'm sorry, man. We had our first pregnancy self terminate early and while I wasn't affected much, my wife took it really hard.
Aren't early miscarriages really common? I thought like a 1/5 of known pregnancies miscarried in the first trimester and some 30-50% of all pregnancies.
Are you sure two early miscarriages really puts you in 30% chance of being unviable with eachother? It sounds high.
atokenliberal6D_4
Defender of Western Culture
1d ago
Rat races are only an issue when being at the bottom is so horrible that people are desperate to avoid it. In this case, any way you set up society is going to be horrible---what's the alternative to the rat race? Most people are just screwed because of the circumstances of their brith and can never have a reasonable life no matter what they do? If we actually do as you say and make chicken farming less miserable, then the rat race would also weaken.
I think this is a little bit of a distraction though since you aren't supposed to try to justify meritocracy by fairness. Someone has to be the surgeon hypothetically operating on me and I would much rather they were chosen by meritocracy---it's not about the person who gets the position but an instrumental goal to make things best for everyone else. Like many more things than people realize, surgery is really hard and it does actually matter to have the 0.1th percentile performer instead of just the 10th percentile one. Being "competent enough" is beyond humanly possible---medical errors are the third leading cause of death in the US according to this.
Finally, while the Korean educational rat-race has gone way over into Goodhart territory, a little bit of rat race is great for motivation and helping everyone become the best version of themselves. I am very happy for the extra motivation this gave me to study for math contests since that made me a much better technical problem solver. I am even more happy for the extra motivation it gave me to do the much less fun writing practice for English class.
Rov_Scam
1d ago
Bribing guards to either kill him, let an assassin kill him, or assist him with suicide doesn't strike me as a particularly complex mechanism.
Well, that's why you're not paid to investigate these things. Just consider the probabilities involved. If someone came to your house claiming to be from Mossad or Bill Clinton's people or the Royal Family or whoever and told you that they would totally pay you a lot of money if you committed murder on their behalf, what would you do in response? What would the average person do? What would the average person who has no criminal record and has a job in law enforcement do? If you read enough true crime cases you'll learn that finding a hit man among the general public is incredibly difficult in the best of circumstances because the vast, vast majority of the time the guy you meet in a bar who's short on money and has a checkered past inevitably goes straight to the police.
In this case the murderer wouldn't even have the luxury of picking a vetted assassin from among the general public; he'd be relying on two specific people who are members of the law enforcement community to conduct the hit. People who are specifically screened for not having any criminal record, let alone murder. And you're asking them not only to commit a capital crime but commit it in such a way that will fool the medical examiner and require them to stage the scene. And they would be the only two people with access to the target at the time of the death and be the obvious first suspects in any investigation. And this person is a high-profile inmate whose death will be national news. One of these people is a woman (this detail never seems to get mentioned for some reason). And there are two of them.
And if they do accept your offer and successfully kill Epstein, then what? Given that they've never killed anyone before, there's a good chance that they get prosecuted for his murder. Do you really think that someone under indictment for a capital crime is going to keep his mouth shut for your benefit? What reason could they possibly have to keep quiet?
If you're one of the guards in question and someone offers you money to kill Epstein, why would you even believe that they are who they say they are? How much money would this person have to pay you to take on this kind of risk? At the very least, it is guaranteed that you will lose your job in the aftermath and be virtually unemployable at the same salary you were making, so it would have to be enough money to live in New York for another 50 years, and with a high standard of living, at that. Of course, if either of this guards were living the high life with no discernible source of income, that would raise all kinds of red flags (or at least pique the interest of the IRS), so you'd have to keep this money hidden away so it didn't look like you were living beyond your means, working at whatever menial rent-a-cop job you could get. What would make you think that some rando you met in a bar actually has this kind of money? Of course you're going to demand prepayment. After all, once a man commits murder, breach of contract doesn't seem like such a big deal.
If I'm the guy ordering the hit, how to I get this money to him? Write him a check? How easy do you think it is to transfer that kind of dough without raising any red flags among the banking community? Or maybe you think it would be easier to show up with a suitcase full of cash to a bugged hotel room with Federal agents waiting for you in the parking garage. Or maybe NYPD if he happens to go to them instead. Getting someone to commit murder on your behalf is hard. Getting someone to commit a murder that he will immediately be suspected of is harder. Getting two people to do the same? Damn near impossible.
Consider the probabilities here, just for fun. Let's generously assume that 5% of the extremely law-abiding-background-check-passing population would commit such a murder for the right price. The odds are already 95% that your attempt to off Epstein will end with you in handcuffs. Add in a second person (required here) to be in on the plan and the odds of failure are now 99.75%. Add in a generously high 75% chance that they can actually commit the murder without arousing any suspicion, and you're now down to about 6 hundredths of a percentage point likely to succeed. Even if I use the impossibly optimistic assumption of 50/50 all around, you still wind up in prison 7 out of 8 times. And why are you taking such a huge risk? To prevent the theoretical uncorroborated testimony of a guy who is wholly incredible and has nothing to gain by talking. These conspiracy theories make no fucking sense whatsoever.
ABigGuy4U
1d ago
You are sidestepping my assertion. Blackmail isn’t needed to ensure general support. Blackmail is needed to get people to undertake specific illegal or dangerous acts.
The trick here is claiming there's such thing as quantifiable "use value". It's actually two tricks. The first one that there's some objective fixed value that an object has, regardless of anybody's opinions, and it can be calculated, even if it required omniscient entity having total view of the economy. The second trick is that a specific person or organization (Gosplan if you will) can calculate it. Both are wrong. This is actually one of the fundamental reasons why socialism fails - it can not produce proper prices, and without proper prices, economic cooperation can not function, as prices drive resource allocation. The Soviets tried to implement non-price resource allocation and failed miserably. You can just "assign" prices but as they would be disconnected from actual economic value, you will either get massive deficits, or a ton of resources wasted on producing useless widgets. In a socialist economy, you usually have plenty of both.
And also equally applies to capitalist speculative bubbles
Sure, bubbles are a consequence of resource misallocation. But you know what is also true of bubbles? None of them can last for long. Exactly because this is a self-defeating process - the longer the price remains misaligned, the higher is the pressure to correct. Until the bubble bursts. On the contrary, the misallocation that is driven by directive prices and resource assignment can last indefinitely, it does not have the feedback mechanism.
No_one
1d ago
He has some sort of trauma because someone in his family died bc of alcoholism? I've seen similar behavior in Russian expats. They won't even have a beer bc of what they saw in 1990s Russia. Very odd people.
No_one
1d ago
I don't think he actively prefers them.
A single look at the period photo of the prostitute he got into trouble with - Stormy Daniels(middling tasteful nude) makes it pretty clear he's not interested in teens.
self_made_human
Grippy socks, grippy box
1d ago
That's very kind of you, and I'll see if I can take you up on that! The Florida climate should feel like home, and I'm used to handling packs of street dogs. What is an alligator but a very slow, cold-blooded and 'ornery dog?
When it comes to Boston and their brahmins, alas, I'm a lower caste than that, and it'll come down to fists and concealed carry laws.
I understand they're fucked because initial design had a Glock-style trigger insert safety that would have prevented firing unless it was depressed.
Sig claims some potential customer was against it, so they removed it, and then went on to produce guns which will fire at the slighest shock if a certain combinations of part sizes is involved.
Seems like an incredible management oversight, because the gun designers must have been aware of this, and if the management did not test out how a gun with maximally bad part tolerances would behave, they basically fucked themselves.
That's the least what you should do - the people who engineered the trigger mechanism should have been able to figure out how to avoid this and what's the most dangerous combination of sizes.
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