Tuesday, November 27, 2012

Formula Fact Vs Fiction - Part 2

We're about a week out, and Child2 is doing great with his surgery. Now I have time to return to the questions that I regularly get asked about formula.

What about Soy?
Nutrionially speaking, soy formula is pretty much the equivalent milk based formulas. People used to switch to soy if their infant is spitting up alot or they were concerned about milk protein allergy - which can result in cranky babies with blood in their poop. An allergic baby is reacting to the milk proteins which can come from the formula or via breastmilk if mom eats dairy. If the child didn't have milk protein allergy while breastfeeding, she/he doesn't need soy. Also, milk protein allergy often is cross reactive with soy so you aren't helped at all by switching to soy. I have met some hardcore breastfeeders who cut dairy and soy of of their diet for months with the hope their child would outgrow the allergy. (which they often do)

What about medicinal use of soy formula?
Soy absolutely has a place for certain medical conditions like a rare disorder called galactosemia - can't digest galactose - or parents who have ethical concerns with using animal derived products. On the flip side, premature babies are NEVER fed standard soy formula because it can prevent absorption of calcium and phosphorous - giving a child ricketts!

Should I switch formulas because my newborn is lactose intolerant?
No. Your infant is NOT lactose intolerant. Infants cannot be lactose intolerant; all infants are born with enzymes to break down lactose because it is a main component of breastmilk. Lactose intolerance refers to the loss of that lactose breaking up enzyme which occurs at about about a year of age. Many Caucasian populations keep a much higher concentration of that enzyme after 1 year old. Other ethnic groups do not keep so much. Truthfully, most lactose intolerant people have enough of the enzymes remaining that they can eat small amounts of dairy. If this describes you, four pieces of extra-cheese pizza or an extra large Dairy Queen Blizzard are not good options without enzyme replacement (lactaid) - though one small piece or a small cone may be doable.

What about Gentle/Sensitive/Low iron?
Welcome to another marketing ploy. This plays on parents belief that their child is lactose intolerant and the gentle formulas are 'lactose free.' As already discussed, not really the issue. It may give a parent a sense of control that they are trading formulas, but their child's spitting up/irritability will probably improve with time and or technique. These formulas still contain milk protein so if the child has milk protein allergy it won't make a difference.

Most pediatricians will roll their eyes outside of the exam room and let people change formulas because if the parent perceives something relatively harmless to be true, it's not worth the battle. For example, refusing vaccines is very harmful and needs to have time spent on that issue. Changing from a nutritionally sound standard formula to a nutritionally sound 'senstive' formula is safe and fighting it is generally not a good use of time for the doctor.

Low iron formula is not marketed in the US because it is DANGEROUS! The best iron bioavailability (gut absorbing) food is human milk. Human milk has a fraction of the amount of iron in commercial formula, but it is absorbed so well iron supplementation is not necessary unless there is an additional health problem. Commercial formula's iron is not absorbed as well and must have more iron in it to let babies reach a safe level. If you have located low iron formula, it was manufactured in a foreign country, and you are facing a HUGE danger of feeding your child a questionable, potentially non-safety controlled substance that could easily lead your infant to becoming severely anemic.

What about Nutramigen/Alimentum/Elecare/Neocate?
These formulas fall into the 'elemental/amino acid' based formulas. Each of these is an expensive, semi-digested formula for infants with major health issues that cannot safely digest normal formula or breastmilk. They actually smell like they are partially digested and taste horrible too. The closer you get to elemental (Neocate) the nastier it tastes/smells. No one should be using these formulas without the blessing of their doctor. Some of the things that would make a physican consider these formulas include severe reflux, consistent weight loss, failure to thrive, genetic disorders, digestive surgery, and cancer treatments.

My baby was premature - what about him/her?
It's standard practice in the United States to give infants with normal digestive systems milk-based higher nutrient higher calorie formula. Normal formula/breast milk is 20 calories per ounce. Neosure/Enfasure 22 are 22 calorie formulas with a different protein/iron/fat ratio than standard formulas because premature infants have different needs for growth and weight gain. The powdered formula can also be added to pumped breastmilk to increase the calories content to 22 calories. Preterm infants generally stay on these formulas at least six months with some adjustments for weight gain and gestational age. Infants with severe digestive system problems/surgeries will be put on special specific formula diets with consultation of pediatric gastroenterology.

Long story short, it is totally fine to buy generic formula because it is almost identical to name brands. Your child only needs formula till one year of age and the various stages and additives are generally marketing ploys.

Tuesday, November 20, 2012

Saving health dollars with paperwork

Just to follow up on my bill paying section, I wanted to give a little advice about dealing with insurance companies since Child2 is about to have outpatient surgery this week. (That belly button thing I posted about a while ago)

1) Get a referral: If you go to your primary care physician (PCP) for anything and you anticipate the need to see a specialist, ask for a referral AND get a copy of it. So if you are visiting your PCP to get a blood pressure check and you were thinking about seeing a dermatologist for a skin check sometime, physical therapy for nagging back pain, or plastic surgeon for skin tag removal, etc - ASK FOR A REFERRAL. It costs the doctor nothing except a piece of paper. It's great if you have a specific physician in mind, but if not, just get it on a prescription pad and take it with you.

2) Touch base with your insurance company: patiently wait on the phone to talk to a human being and ask if they cover X service and what the copay will be. Ask if there are limits to how much they cover and if you will be charged separately for hospital, lab, and office charges. Mention that you have a referral, even if you don't officially need one. Be nice; we'll discuss that in a minute.

3) Confirm your appointment and referral: When you set up your appointment with a specialist, make sure they have your referral on file. If they don't, give them your PCP's office information and bring your copy of the referral to the appointment. Everyone's office is interested in getting paid.

4) Review your bill and your insurance statements: If you get approved for a specialist or procedure, you should receive notice that you can see specialist Z for X number of visits. When you get your bill from the physician/hospital/lab (or all 3 separate bills), make sure insurance covered your visit. If you need to, ask for an itemized bill. Then call your insurance company and discuss what they did and did not cover. BE NICE. They get yelled at all day by irate people. If you are nice, they will be willing to refile claims for you, resubmit them, contact the doctor's office, or take it up with their supervisor.

5) Record name, date, and activity: Get the name and number of every person you talk to. Write it directly on the bill, '11/20/12 Talked to Sherry in customer services, will forward info to her supervisor and hear back in 30 days. 777-664-9041' Insurance companies and doctors office employees know each other and can confirm that type of information. Insurance companies generally will have an electronic record of this type of correspondence and will look toward that date you tell them in followup. It will also keep them from turning your over to collections.

6) Keep your records together: Come up with some type of filing system that keeps your medical bills in once place. I personally have a file on top of my desk that I keep the current projects in. I put sticky notes that say 'pending' on the ones that are in process. I move them to our general file system the main portions once they are resolved and shred the ones that were minor correspondence or extra copies.

Now for my true story. I was able to save somewhere in the range of $700 for medical bills during my pregnancy by calling and talking to hospitals, insurance offices, and doctors offices. I was in a car accident and had to be seen in the ER. Since I was pregnant, once they all agreed I didn't have a broken neck, they sent me up to OB floor. I was later asked to pay for the copay for the ER and then 'out of network' OB office costs because that was how the hospital charged for OB services. I was able to successfully get my out of network fees waived because it was an emergency visit and I didn't get to 'select' which OB was on call.

Furthermore, I had some bleeding at the start of my pregnancy and was referred to the high risk specialists. I was also going to VBAC, so when everything was okay, the high risk specialists kept me on as a patient even though I was not high risk at that point. I was just receiving normal care from their office. My insurance company would usually pay $6,000 for my entire pregnancy care and I'd be responsible for $300 as a bulk payment. However, since I kept seeing the specialists, I was getting extra bills for $50 after every visit. It took a bunch of phone calls, but I got the office to re-code for almost all of the visits and I only paid an extra $25.

Keep in mind, there was alot of waiting on the phone to get all of this done over a period of weeks, but it was WAY cheaper than actually paying all of those bills.

Thursday, November 1, 2012

Better Bill Pay in 5 steps

We just had a bit of a financially harrowing incident over a bill which has led me to create "Better Bill Pay in 5 Steps" so it won't happen to you. Anyone can accomplish this with 1 or 2 hours of work.

1) Electronic bill pay: Examine all the bills you're paying via checks or mail. Can it be faxed? Can it be paid electronically? Can you place it on autopay, and your bank mails the check for free? Are your student loans on autopay? You should get a 0.25% interest rate discount if you place them on automatic electronic payment for government loans. 250K loans at 6.8% over 30 years with a monthly $1630 payment comes to a total savings $40,000 and 27 fewer months.

2) Personal bill pay: Are there any bills that you can pay in person? This is much more likely to be effective at a local organization like a church, synagogue, landlord, or small doctor/dentist office than a larger organization that has its billing off-site/out of state. Combine it with a grocery trip and stop buying stamps.

3) Confirm your address: Make sure that any correspondence that needs to reach you has an appropriate forwarding address available. Bizarrely, the post office charges to do address changes online so ask for the paper forms. Then fill them out for any address you have moved for the last 5 years. Mail forwarding only works for one year and then needs to be renewed.

4) Consolidate/phase out your email accounts: If you have moved jobs/graduated school, it is very possible that your email address is still receiving mail. I recommend getting a dignified name of some type on gmail and filtering all your email into that. Whatever you do; if an email is going to be shut down or essentially unused, set up the auto-email informing mailers of your new contact information.

5) Know how to access all of your accounts electronically and check them weekly: This way you will know if any strange chargers appear or if your scheduled electronic payment suddenly stops. Even better, be familiar with when your electronic payments are scheduled versus when you get paid to know when you can put aside extra money or make the extra payment.

Now onto our story. Our out-of-state condo is undergoing a re-finance that will remove that pesky first-time homebuyer residency requirement. Our renter pays into the local account and the mortgage and condo association dues came out of that account on autopayment. Unfortunately, the condo association moved to a new management company last year, but we were never informed because they sent that information to the condo itself (haven't lived there in 4 years) and HubbyJD's law school email account. The old management company forwarded our checks to the new company every once in a while, when they felt like it. Then they just stopped and the checks expired so the money was credited back to our account. HubbyJD finally checked that account and noticed the credits.

He immediately followed up on the electronic trail in his old email and found we about to have a lien placed on the condo we were trying to re-fi! I had also made an extra $1.8K loan payment THE DAY BEFORE. He contacted the mortgage companies lawyer and straightened things out - provided we pay everything immediately. Fortunately I knew exactly where we were in our monthly banking cycle to come up with an extra $1.5K that afternoon. Since I run the household finances, I immediately enacted steps 1-5.