Random Image

Twins

Owner: Beverly
Welcome to Seniors & Friends. Please login or sign up.

March 29, 2024, 03:00:20 AM

Login with username, password and session length

Shoutbox

2024-03-22, 14:15:18
Domestic Goddess: Pollock Fillets seasoned with Mrs. Dash Lemon Pepper, Bush's Best Brown Sugar Hickory Baked Beans, Green Grapes and Chocolate Chip Cookies that my husband prepared.  Sorry about the previous type error with my last post.

2024-03-22, 14:03:04
Domestic Goddess: Pollock Fillets seasoned with Mrs. Dash

2024-03-22, 09:31:45
Domestic Goddess: Is this correct, if one would like to post/share a recipe, we do so here?  If so, was searching to see if there were separate recipe categories?

2024-02-21, 22:30:59
Oldiesmann: The chat can be accessed from the menu but I don't kow how often anyone is in there

2024-02-20, 23:18:48
alpiner1: Is the chat live ?

2024-02-19, 23:20:20
junee: Junee

2024-01-30, 11:45:01
Astro: Periodically I use it.

2024-01-29, 20:17:44
mycheal: Love the chat  off and on

2024-01-14, 21:12:20
Oldiesmann: Just curious. Does anyone still use the chat? It doesn't make any difference to me since it's a free service. Just wondering

2023-11-28, 19:23:29
JeanneP: Stiil trying to let Julee know that my EM is   gmjeannep2@gmail.com  and that the  old Comcast on is no longer work, it was to old and they dont do EM anymore


D

Norms Bait and Tackle

Started by dapphne, March 30, 2016, 09:23:16 AM

Previous topic - Next topic

Mary Ann

My idea for Tom to go to summer school to get a teacher's certificate won't work.  We discussed it and he said he had investigated it some time ago.  In the first place subjects he took to get his Masters of Divinity degree aren't what he would need for a Master's degree.  Not only that, but with two Masters, school systems would have to pay him more.  So - nice try.

Marilyn, both of my schools are still standing but my high school no longer exists because it was closed and turned over to City High, a school for high achieving students.  My elementary school was a magnet school for a while and I think it was closed for a year or so.  It is back to being an elementary school - K-6.  They have a unique situation in that area.  After their kids move on to high school, the parents stay in the area and new people can't move in.  I've been gone 40 years from the area and I know of four families who have lived in the house in that time.  I don't know how many, if any, kids they had.  I lived there 50 years.  I also helped open the elementary school, starting in kindergarten in 1929 the year the school was built.  I've been in this condo 37 years.

Mary Ann

angelface555

#10921
Since I've returned to the city I grew up in, all the schools are here, and several others built. I went to a large school that at the time served kindergarten through high school. The only other school was a grade school and a high school in the Catholic private system. By ninth grade, a new high school was built, and I went to that.

Now, there are three high schools, (ninth through twelfth); four or five junior highs, nine grade schools, and the equivalent on the five bases. There are also several religious, charter, magnet, homeschooled, and whatever else you can dream up for today's children.

Since this city was built in the eighteen hundreds, first as a gold rush, tent city, gold camp, then supply hub before being incorporated in 1903, all this is relatively new. The old one size fits all school I started with is a historic property now housing school district offices with the occasional attempt to revitalize the building.

MaryTX

Mary Ann, I don't know about Michigan, but Texas has an "Alternative Certification Program". If you have a degree (BA, BS, MA in any field, you can apply for the alternative program.  It usually takes a year of online classes, etc and once you are in the program, you can apply for an emergency conditional teaching certificate.  Once you finish the program, you can take the examination for a teaching certificate.  Cathie said you can have a 100 Master's Degrees here in Texas and they only pay you an extra $1000 a year!  In her school (middle school) she is one of only a handful that have an actual education degree.  Most of the teachers have alternative certification. She said there are several different alternative programs in the state. 

Mary 

Click for Arlington, TexasForecast

Mary Ann

#10923
Patricia, I would not attempt to count the number of schools in the City Proper (I live in a suburb but like most suburbs you cannot tell where one starts and the other leaves off, except for a sign telling you you're in a different area.  Grand Rapids is surrounded by suburbs and cannot expand except by annexing a suburb and the suburbs would never agree.  There are four public high schools now including City High, two Catholic, one Christian, several Charter and I have no idea how many middle schools and elementary schools.  We also have the high schools in the suburbs of Walker, East Grand Rapids, Plainfield Twp, Grand Rapids Twp, Grandville, Kentwood, Jenison; I think I got them all.  Each of the suburbs has more than one high school. 

The City of Grand Rapids has about 200,000 people but the entire county has about 600,000.  I did not mention the outlying towns with their individual school systems. 
 
I kind of smile when I look at the clock and it's nearly time for the cat and me to go to bed and in Alaska it is approaching 6 pm, time for supper!

MaryTX, I don't know if Michigan has a program like that, but Tom is 61 and feels it would take too long to get anywhere before he'd have to retire. 

Tom just got home from a potluck and brought some home and I'm going to eat some of it.  I don't usually eat supper at 10 pm but my tomato bisque soup didn't hold me.  I had ham, scalloped potatoes and green bean casserole.

Mary Ann

larryhanna

Hi Everyone.  We have a beautiful sunny and 60 degree day ahead of us.  I expect this one to be a very enjoyable, sort of laid back day.  Mid-afternoon Pat, Scott and I will go to Cracker Barrel for what will be our Thanksgiving Dinner together.  We won't get to spend very long with him after the dinner as he has to work tonight.  I hope he will come out again tomorrow and spend some time with us on Thanksgiving.  The kitchen chores are done for this morning except to fix Pat's breakfast when she gets up.  Yesterday we completed the laundry so that won't have to be done today.

Mary Ann, it sounds like Tom was thinking about you when he attended the potluck meal.  The population of our entire county is only about 170,000 and it is a very large county.  I just looked it up and for the 2018-19 school year, there are 40 public schools in Aiken County, South Carolina, serving 24,309 students.  My phone rings and I can look on the screen and see it is a call I don't want to take so press the button to silence the ring.  I don't answer the call. 

Mary, it sounds like Texas must have a teacher shortage and not much incentive to get a Master's Degree.  I have an education degree in Business Administration but it was not in the cards for me to be a teacher and have never really regretted that I didn't go into that profession. 

Patricia, in rural Missouri, where I was raised, there were many one room school houses with one teacher for all 8 elementary grades.  They were built so that all the students would be in walking range of a school.  Then there was one high school for all of the surrounding grade schools.  I did have good teachers over the years and think that is what influenced me to want to become a teacher.  There was one young teacher I will never forget as she had all of her lesson plans in a neat spiral notebook.  I am sure the other teachers had lesson plans but don't remember seeing them use a neat notebook.  Funny what we remember after so many years.  Interesting information on the PISA results. 

Marilyne, it sounds like time schedules don't mean a lot to those big ships.  When I went to school there were no kindergarten's and you just attended 1st grade when you were of age.  I think my love of reading came from observing my grandmother, who loved to read, and also my father.  My mother encouraged me to read but she was never able to stay awake to read a book as she had narcolepsy and would fall asleep if she was up and doing, which she seemed to be most of the time.  Many years ago the one room schools were all closed and where I went was torn down a long time ago.  We have always liked the Honey Baked hams and turkey.  with those you have a good foundation for your Thanksgiving meal.  I have enjoyed Jeopardy on TV the last few days as they had their Teen Tournament and had very bright students.  The final two day event had all young ladies, two who were seniors and one a junior.  One of the Seniors won the $100,000 first prize and the Junior won the $50,000 prize with the other young lady winning $25,000.  I am not sure what type of schools they attended but they were very impressive. When I was in High School there were no advanced classes and I had to fight boredom and usually worked my lessons in advance so had time for other school related activities such as year book and annual staffs or helping in the Superintendent's office (which was the same as the Principal's office since there was only one administrator with a local school board.  I think the reason I enjoyed my college courses so much is that they were not dumbed down to the   slowest student. 

JeanneP, glad to read your were feeling better yesterday and got a good report from your checkup.  Once we have people we can rely on it is sad where they pass from the scene.

Sandy, it is through change that we continue to stimulate our minds and learn new things.  The software is a good example.  We can still do all the same things we have done here but some of the commands have been moved or renamed and it takes a little hunting.  Fortunately, we can ask questions about where to find things or how to do them and usually someone here will know and certainly Michael has been such a help and is patient with us.  

Mary Ann

#10925
Larry, as I have written, my dad was a printing (press) teacher and every year before school started in the fall, he would work on his lesson plans for the next year.  He didn't use a ringed notebook, which is a good idea, but he did print his plans and probably set the type for them too, and had them in a booklet.  Thinking back, he possibly waited until school began then had some of his advanced classes set the type and print the pages.  Dad would have worked on the plans at home.  I took printing one semester but never got involved with the lesson plans.  I did lots of sorting pi before getting a ride home!

Larry, one of the ships in Duluth was to have left about 6 pm last night - it's still in port. 

I just went online to verify the population of Kent County MI - as of 2017 it was 648,500. 

Mary Ann

angelface555

#10926
Goodmorning from the Interior. We had mingled snowy rain, then snow and finally topping it off, more rain with another rainbow yesterday afternoon. Today's forecast is for more rain, and the roads are dangerous with a lot of cars slipping and sliding, sometimes into each other. I hope all the drivers are especially wary tomorrow. City trucks have been out all night every day this week, plowing and laying down gravel.

Today will be a busy day finishing up last minute cooking, cleaning, and other odds and ends so I'm ready when they pick me up tomorrow. They live in the lower foothills, so I hope the roads are good.

I don't know why I didn't think of Googling schools, MaryAnn, Larry; there are in the public system, sixteen elementary schools, grades kindergarten through sixth, and six junior or middle schools for classes seven and eighth. We have nine high schools for grades nine through twelve. There are nine districts in the city with eight charter and one magnet schools. I'm not quite sure what a magnet school is.

The Catholic school system has a campus according to their info for junior and one for high school as well as a building for elementary students. Then there are twelve schools run by area churches, something called an alternative school system, grades K through twelve and many privately homeschooled as there are not one but two organizations for student field trips and social events.  And on each military base, they have their own separate school system for grades K through twelfth. It must be a headache for school systems in larger cities in the lower forty-eight!

Main School, now city hall, is a city fixture. The building covers the entire city block and is a 35,500-square-foot, reinforced-concrete building with Art Deco exterior design elements. As initially constructed, the building had three stories with a ground floor daylight basement. The building faced Cushman Street, with classrooms and office on all three floors and a 4,000-square-foot gymnasium extending to the rear.

"A burgeoning student population meant the addition of a south wing in 1939 and a north wing in 1948. With both additions, close attention was paid to blending in with the old exterior. However, consistency between old and new interior floor plans was not maintained. Differing floor levels and confusing connecting hallways made the interior a maze. In his booklet, "The Spirit of Old Main," Chris Allen related a joke that, "suggested that any senior who was able to find his way from the center of the building to the outside should be handed a graduation certificate."

 "Old Main School is in the National Register of Historic Places, and the city has a goal of restoring the building to its original floor plan. Some major renovations have already been accomplished, such as fixing the roof, refinishing the gym floor and bleachers, replacing all the windows that had been boarded up, and opening up all the hallways. Much of the credit goes to former Mayor Jerry Cleworth, who attended Main School." 

angelface555

#10927
While spending time Googling for area students, I came across some odd statistics. You know, coldest or warmest temperature, populations, school districts, etc. I also learned that Costco, after renovations, finally reopened in their old building previously used by Sam's Cub, yesterday.

These are the top paying professions in Fairbanks, outside of the University, hmmmm...why did I think it would be geology or transportation related?

Physicians and Surgeons, All Other.
Psychiatrists.
Dentists, General.
Internists, General.
Family and General Practitioners.
Nurse Anesthetists.
Chief Executives.
Optometrists.

Now I know why my insurance is so high as medical personnel in Alaska have the highest salaries in the nation, but quantity doesn't always equate quality. Many came here via military service and stayed.




Joy

Larry, I, too, always enjoy when the teens are on Jeopardy.  The "little" girl who was the first one on the left. Emma. was from Owings Mills, Md.   That area is only about 25 minutes from where I live.  And, yes, they all were very smart young ladies. Emma was a little slow getting into answer sometimes...  I was hoping she would have won the $10,000. However, $25,000 isn't too bad.  I especially liked the way the one in the middle, who was the winner, motioned for each girl on the end to come over to her for a "group hug".

And, Larry, thanks for explaining your way of posting here now.  I was doing it like MaryAnn, highlighting each change, but now that I have gotten onto your way, it goes much smoother.  I just wasn't sure after you put in all the opening and closing codes, where you started typing. But, with the cursor blinking, it is very plain to see. 

So, I guess us "oldies" are starting to "get it".  LOL

Joy
BIG BOX

Joy

MaryAnn,  I meant to ask you.......Have you looked at the webcam for where they have that Christmas village set in the daytime????   It sure doesn't look anything like it does at night. The website for the village shows different kinds of shops and different activities, but none of those things even look like they are there in the daylight.  It must really be pretty there walking around with all the snow they have now.  That must be a very expensive operation for them to put on, and not charging to go through it.  The electric bill must be  astronomic.

Joy
BIG BOX

Mary Ann

Joy, yes I have looked at the cam for the Christmas village.  I didn't notice any particular detail but I did notice during the day that the place looked empty compared to night.  The Christmas tree is interesting with all of the different colors and patterns.  It's dark here now so I might go there to view it.

Mary Ann

Marilyne

Good News from Shirleyn!  She got the results from her CT scan, and the cancer has not spread anywhere else in her body.  It is only in her leg, and she will start chemotherapy and radiation right away.

Joan is unable to post here, because she also hurt her hand when she fell and broke her hip.  However, she is home, and feeling better.


I will give "Thanks" tomorrow, on Thanksgiving, that they are both doing well, and will be back with us soon.

Hoping that all who post here, or who read this folder, will have a nice Thanksgiving weekend! :thumbup:   

Lindancer

[/Patricia, I am going to take your advice to morrow and try and turn the post, I am so confused, with reading replys and then later reading what someone is replying too. I went in to last posting here and came up with Kelly, Now thats years ago size]

Click for Riverhead, NY Forecast

Lindancer

[Mary Ann, Taffy likes to sleep on my leg in the winter, all summer she was at my back, All my neighbors are going to be away to morrow, even the one across the street,  SHer son wants them at his new house. I shouldhave bought a turkey TV dinner. /size]

Click for Riverhead, NY Forecast

Mary Ann

Happy Thanksgiving to all the Bait & Tacklers - and everyone else too.

Gloria, I know I did this but did not know how it would turn out, but I am getting my messages at the top of the folder but I have to scroll up to read others messages.  I'm getting used to it and maybe at some future time, I'll try for a return to what we had.  In the meantime, it does work for me, but I'd never suggest it to anyone else.  Right now, I'm too tired to do much.

Mary Ann

Joy

#10935
HAPPY THANKSGIVING to all the friends here.  I hope your day is a good one and the you can spend it with family and friends.  It is a pretty sunny day here, but oh, so cold. Supposed to be one of the coldest days ever.  I am glad that I won't have to be outside for very long.

I need to do some straightening up, put dishes in the dishwasher and put together my sweet potato casserole.  It won't take long and I don't have to be in a big hurry.  I won't have to leave here until around 3, so I have plenty of time.

Will try to check back later.

Larry, when I went back to re-read some of the posts,  I noticed that I had made a mistake when I said I was hoping the little girl from Maryland would have won the  $10,000 prize and I  did mean $100,000.  Big difference. !!!


Joy
BIG BOX

larryhanna

Hi Everyone. This Thanksgiving morning is starting out clear and sunny and cool.  However by afternoon we will be seeing some partly cloudy skies but still getting up to around 60 degrees.  We have a very quiet day planned.  Scott will be here part of the day.  Yesterday we did go to Cracker Barrel for our official Thanksgiving meal and we all enjoyed what we ordered.  Pat and Scott even ordered some blackberry cobbler to bring home to enjoy today.  I passed as while I like the taste of blackberries I do not like the seeds.  Around 5 pm last evening a friend from our Sunday School class called to see if we were home and then he brought us a delicious smelling homemade just out of the oven pumpkin pie.  So we will also have that for a special Thanksgiving treat today.  I plan on watching some of the pro football games and perhaps some of the college basketball preseason tournaments that have their finals today.

Mary Ann, what was sorting "pi" in the print shop?  You live in a much bigger county population wise. 

Patricia, when ice gets under snow it can be so dangerous for cars and for people.  I hope you have a great time with Dora and Alan and enjoy the special Thanksgiving meal.  Also hope the roads are not a factor in your getting their or getting home.  The county we moved from in Georgia has the   largest school system in Georgia, with 143 schools and an estimated enrollment of 180,000 students for the 2017-2018 year.  They have constantly been building schools for the last 30 years as the growth in the population has continued to increase each year.  It sounds like Fairbanks has made good use of their old Main School by now using it as the city hall.   I just looked it up and the highest paying jobs in South Carolina are also medical or dental related. 

Joy, I could hardly stand to listen to Emma speak on Jeopardy as she had such a little girls voice.  However, she was really intelligent.  Apparently those teens become quite bonded during the filming of that program, which I expect is done in a day or two period of time.  Fortunately as with most things involving computers there are several ways to do things and we each find what works for us.  I hope you can stay warm up your way today.  We had such a beautiful and reasonably warm day here yesterday and expect pretty much the same for today.  I did reread your comment about the young lady winning $10,000.  Your explanation explains what you wrote.  It is easy to look at something we have written and see what we intended rather than what is actually there. 

Marilyne, thanks for sharing Shirleyn's good medical news.  At least they now know what they are dealing with and hopefully can isolate it to the leg.  I join you in hoping that both ShirleyN and Joan will soon be back to at least say hi.  I hope your Thanksgiving day and weekend is nice for you and your family.

Linedancer, since I have Administrative rights in this discussion I did a quick edit to see the coding you used.  If you start typing right after the 4] your message will be find.  The [/ belongs with the size code at the end of the message although you can eliminate the ending codes and just use the two beginning ones and start typing after the 4] .  Does Taffy help you keep your leg warm during the winter.  I know our cat generated a lot of heat. 

Sandy

:frog: :jump: :pineapple: :headspin:
Happy Thanksgiving,
Everyone!
:woohoo:
  "It pays to keep an open mind, but not so open your brains fall out."

― Carl Sagan

Joy

Larry, I, too, had a problem listening to the girl, Emma, on Jeopardy.  She sure did have a squeaky little girl voice. I don't think they mentioned the school she went to, but, yes, they all were very smart.  That takes a lot to have to remember so many different things in so many different categories.  I am always so proud of myself when I know an answer.  LOL

Joy
BIG BOX

Mary Ann

#10939
I'm another one who found it hard to listen to Emma on Jeopardy with her little girl voice.  Joy, it was mentioned she was from Owings Mills MD and that's where Lou Rukeyser's program was based.

Tom and I just returned from breakfast out; we went to IHop where I had a Belgian waffle and he had a combo omelet and pancakes.  He is going to Holland to have T-Day dinner with a friend, since we as a family will not have ours until Saturday.  I bought a frozen turkey dinner for me tonight. 

When I got up about 7 am, our temperature was 20 degrees and it is only 24 degrees now at noon.  Luckily, it is not snowing or raining.

Larry, "pi" is spilled, mixed type, kind of like 52-pickup except there are many more pieces of type.  With type, you read it upside down or backward.  Type cases have compartments for each letter or number. 

I hope no one eats too much today so everyone will be back tomorrow.

Mary Ann

angelface555

#10940
Good morning from a still dark,still mixing snow and rain, icy, plus 16 Interior! The city gravel trucks were again out all last night clearing and laying gravel. My relish is prepared and boxed in the fridge ready to go with a nice merlot they can enjoy later after all the guests have gone. I imagine Dora is in her element right now altho she'd never admit to it!  :coolsmiley:

Larry, you have a larger population than us. I looked up our county or as it's called here, Borough and it is 7,444 miles, and we are the borough seat. However, the bush population is only 99,703 as of 2017.

Besides the separate Catholic school system, Main was the only school for decades, and now we're overrun. Getting new schools built or repairs are always a contentious subject with the Borough Assembly. It was shall we say, due to voter apathy, filled with conservative members of the squeeze every penny until it squeaks club. They refused to fund needed repairs to the Unversity until it flat out threatened to move to Anchorage. Then they approved repairs in a "special session" that included some area schools.

I was delighted to hear Shirleyn's news and hope both she and Joan are soon able to return!

It sounds as if everyone is enjoying or preparing to enjoy their day so I'll leave you to it! I'm thankful for all of you!

I'm sorry, I tried looking up a Youtube interview recently of Vulture Magazine with Alec Trebec and got sidetracked with other videos. I do remember that he said his pet peeve was contestants who jumped all over the board.



angelface555

#10941
From an NPR article

"Last March, Tony Schmidt discovered something unsettling about the machine that helps him breathe at night. Without his knowledge, it was spying on him.

From his bedside, the device was tracking when he was using it and sending the information not just to his doctor, but to the maker of the machine, to the medical supply company that provided it and to his health insurer.

Schmidt, an information technology specialist from Carrollton, Texas, was shocked. "I had no idea they were sending my information across the wire."

Schmidt, 59, has sleep apnea, a disorder that causes worrisome breaks in his breathing at night. Like millions of people, he relies on a continuous positive airway pressure, or CPAP, machine that streams warm air into his nose while he sleeps, keeping his airway open. Without it, Schmidt would wake up hundreds of times a night; then, during the day, he'd nod off at work, sometimes while driving and even as he sat on the toilet.

"I couldn't keep a job," he said. "I couldn't stay awake." The CPAP, he said, saved his career, maybe even his life.

As many CPAP users discover, the life-altering device comes with caveats: Health insurance companies are often tracking whether patients use them. If they aren't, the insurers might not cover the machines or the supplies that go with them.

In fact, faced with the popularity of CPAPs, which can cost $400 to $800, and their need for replacement filters, face masks and hoses, health insurers have deployed a host of tactics that can make the therapy more expensive or even price it out of reach.

Patients have been required to rent CPAPs at rates that total much more than the retail price of the devices, or they've discovered that the supplies would be substantially cheaper if they didn't have insurance at all.

Experts who study health care costs say insurers' CPAP strategies are part of the industry's playbook of shifting the costs of widely used therapies, devices, and tests to unsuspecting patients.

"The doctors and providers are not in control of medicine anymore," said Harry Lawrence, owner of Advanced Oxy-Med Services, a New York company that provides CPAP supplies. "It's strictly the insurance companies. They call the shots."

Insurers say their concerns are legitimate. The masks and hoses can be cumbersome and noisy, and studies show that about third of patients don't use their CPAPs as directed.

But the companies' practices have spawned lawsuits and concerns by some doctors who say that policies that restrict access to the machines could have serious, or even deadly, consequences for patients with severe conditions. And privacy experts worry that data collected by insurers could be used to discriminate against patients or raise their costs.

Schmidt's privacy concerns began the day after he registered his new CPAP unit with ResMed, its manufacturer. He opted out of receiving any further information. But he had barely wiped the sleep out of his eyes the next morning when a peppy email arrived in his inbox. It was ResMed, praising him for completing his first night of therapy. "Congratulations! You've earned yourself a badge!" the email said.

Then came this exchange with his supply company, Medigy: Schmidt had emailed the company to praise the "professional, kind, efficient and competent" technician who set up the device. A Medigy representative wrote back, thanking him, then adding that Schmidt's machine "is doing a great job keeping your airway open." A report detailing Schmidt's usage was attached.

Alarmed, Schmidt complained to Medigy and learned his data was also being shared with his insurer, Blue Cross Blue Shield. He'd known his old machine had tracked his sleep because he'd taken its removable data card to his doctor. But this new invasion of privacy felt different. Was the data encrypted to protect his privacy as it was transmitted? What else were they doing with his personal information?

He filed complaints with the Better Business Bureau and the federal government to no avail. "My doctor is the ONLY one that has permission to have my data," he wrote in one complaint.

In an email, a Blue Cross Blue Shield spokesperson said that it's standard practice for insurers to monitor sleep apnea patients and deny payment if they aren't using the machine. And privacy experts said that sharing the data with insurance companies is allowed under federal privacy laws. A ResMed representative said once patients have given consent, it may share the data it gathers, which is encrypted, with the patients' doctors, insurers and supply companies.

Schmidt returned the new CPAP machine and went back to a model that allowed him to use a removable data card. His doctor can verify his compliance, he said.

Luke Petty, the operations manager for Medigy, said a lot of CPAP users direct their ire at companies like his. The complaints online number in the thousands. But insurance companies set the prices and make the rules, he said, and suppliers follow them, so they can get paid.

"Every year it's a new hurdle, a new trick, a new game for the patients," Petty said.


Tony Schmidt is one of the millions of Americans with sleep apnea. He can't sleep through the night without his continuous positive airway pressure, or CPAP, machine.

The American Sleep Apnea Association estimates about 22 million Americans have sleep apnea, although it's often not diagnosed. The number of people seeking treatment has grown along with awareness of the disorder. It's a potentially serious disorder that left untreated can lead to risks for heart disease, diabetes, cancer and cognitive disorders. CPAP is one of the only treatments that works for many patients.

Exact numbers are hard to come by, but ResMed, the leading device maker, said it's monitoring the CPAP use of millions of patients.

Sleep apnea specialists and health care cost experts say insurers have countered the deluge by forcing patients to prove they're using the treatment.

Medicare, the government insurance program for seniors and the disabled, began requiring CPAP "compliance" after a boom in demand. Because of the discomfort of wearing a mask, hooked up to a noisy machine, many patients struggle to adapt to nightly use. Between 2001 and 2009, Medicare payments for individual sleep studies almost quadrupled to $235 million. Many of those studies led to a CPAP prescription. Under Medicare rules, patients must use the CPAP for four hours a night for at least 70 percent of the nights in any 30-day period within three months of getting the device. Medicare requires doctors to document the adherence and effectiveness of the therapy.

Sleep apnea experts deemed Medicare's requirements arbitrary. But private insurers soon adopted similar rules, verifying usage with data from patients' machines — with or without their knowledge.

Kristine Grow, spokeswoman for the trade association America's Health Insurance Plans, said monitoring CPAP use is important because if patients aren't using the machines, a less expensive therapy might be a smarter option. Monitoring patients also helps insurance companies advise doctors about the best treatment for patients, she said. When asked why insurers don't just rely on doctors to verify compliance, Grow said she didn't know.

Many insurers also require patients to rack up monthly rental fees rather than simply pay for a CPAP.

Dr. Ofer Jacobowitz, a sleep apnea expert at ENT and Allergy Associates and assistant professor at The Mount Sinai Hospital in New York, said his patients often pay rental fees for a year or longer before meeting the prices insurers set for their CPAPs. But since patients' deductibles — the amount they must pay before insurance kicks in — reset at the beginning of each year, they may end up covering the entire cost of the rental for much of that time, he said.

The rental fees can surpass the retail cost of the machine, patients and doctors say. Alan Levy, an attorney who lives in Rahway, New Jersey, bought an individual insurance plan through the now-defunct Health Republic Insurance of New Jersey in 2015. When his doctor prescribed a CPAP, the company that supplied his device, At Home Medical, told him he needed to rent the device for $104 a month for 15 months. The company told him the cost of the CPAP was $2,400.

Levy said he wouldn't have worried about the cost if his insurance had paid it. But Levy's plan required him to reach a $5,000 deductible before his insurance plan paid a dime. So Levy looked online and discovered the machine actually cost about $500.

Levy said he called At Home Medical to ask if he could avoid the rental fee and pay $500 up front for the machine, and a company representative said no. "I'm being overcharged simply because I have insurance," Levy recalled protesting.

Levy refused to pay the rental fees. "At no point did I ever agree to enter into a monthly rental subscription," he wrote in a letter disputing the charges. He asked for documentation supporting the cost. The company responded that he was being billed under the provisions of his insurance carrier.

Levy's law practice focuses, ironically, on defending insurance companies in personal injury cases. So he sued At Home Medical, accusing the company of violating the New Jersey Consumer Fraud Act. Levy didn't expect the case to go to trial. "I knew they were going to have to spend thousands of dollars on attorney's fees to defend a claim worth hundreds of dollars," he said.

Sure enough, At Home Medical, agreed to allow Levy to pay $600 — still more than the retail cost — for the machine.

The company declined to comment on the case. Suppliers said that Levy's case is extreme, but acknowledged that patients' rental fees often add up to more than the device is worth.

Levy said that he was happy to abide by the terms of his plan, but that didn't mean the insurance company could charge him an unfair price. "If the machine's worth $500, no matter what the plan says, or the medical device company says, they shouldn't be charging many times that price," he said.


Schmidt went back to an older model, the ResMed S9 Escape, after learning that a newer version of the device would be sending details about his sleep habits to his insurance company.

Dr. Douglas Kirsch, president of the American Academy of Sleep Medicine, said high rental fees aren't the only problem. Patients can also get better deals on CPAP filters, hoses, masks and other supplies when they don't use insurance, he said.

Cigna, one of the largest health insurers in the country, currently faces a class-action suit in U.S. District Court in Connecticut over its billing practices, including for CPAP supplies. One of the plaintiffs, Jeffrey Neufeld, who lives in Connecticut, contends that Cigna directed him to order his supplies through a middleman who jacked up the prices.

Neufeld declined to comment for this story. But his attorney, Robert Izard, said Cigna contracted with a company called CareCentrix, which coordinates a network of suppliers for the insurer. Neufeld decided to contact his supplier directly to find out what it had been paid for his supplies and compare that to what he was being charged. He discovered that he was paying substantially more than the supplier said the products were worth. For instance, Neufeld owed $25.68 for a disposable filter under his Cigna plan, while the supplier was paid $7.50. He owed $147.78 for a face mask through his Cigna plan while the supplier was paid $95.

ProPublica found all the CPAP supplies billed to Neufeld online at even lower prices than those the supplier had been paid. Longtime CPAP users say it's well known that supplies are cheaper when they are purchased without insurance.

Neufeld's cost "should have been based on the lower amount charged by the actual provider, not the marked-up bill from the middleman," Izard said. Patients covered by other insurance companies may have fallen victim to similar markups, he said.

Cigna would not comment on the case. But in documents filed in the suit, it denied misrepresenting costs or overcharging Neufeld. The supply company did not return calls for comment.

In a statement, Stephen Wogen, CareCentrix's chief growth officer, said insurers may agree to pay higher prices for some services, while negotiating lower prices for others, to achieve better overall value. For this reason, he said, isolating select prices doesn't reflect the overall value of the company's services. CareCentrix declined to comment on Neufeld's allegations.

Izard said Cigna and CareCentrix benefit from such behind-the-scenes deals by shifting the extra costs to patients, who often end up covering the marked-up prices out of their deductibles. And even once their insurance kicks in, the amount the patients must pay will be much higher.

The ubiquity of CPAP insurance concerns struck home during the reporting of this story, when a ProPublica colleague discovered how his insurer was using his data against him.

Sleep Aid or Surveillance Device?
Without his CPAP, Eric Umansky, a deputy managing editor at ProPublica, wakes up repeatedly through the night and snores so insufferably that he is banished to the living room couch. "My marriage depends on it."

In September, his doctor prescribed a new mask and airflow setting for his machine. Advanced Oxy-Med Services, the medical supply company approved by his insurer, sent him a modem that he plugged into his machine, giving the company the ability to change the settings remotely if needed.


But when the mask hadn't arrived a few days later, Umansky called Advanced Oxy-Med. That's when he got a surprise: His insurance company might not pay for the mask, a customer service representative told him, because he hadn't been using his machine enough. "On Tuesday night, you only used the mask for three-and-a-half hours," the representative said. "And on Monday night, you only used it for three hours."

"Wait — you guys are using this thing to track my sleep?" Umansky recalled saying. "And you are using it to deny me something my doctor says I need?"

Umansky's new modem had been beaming his personal data from his Brooklyn bedroom to the Newburgh, New York-based supply company, which, in turn, forwarded the information to his insurance company, UnitedHealthcare.

Umansky was bewildered. He hadn't been using the machine all night because he needed a new mask. But his insurance company wouldn't pay for the new mask until he proved he was using the machine all night — even though, in his case, he, not the insurance company, is the owner of the device.

"You view it as a device that is yours and is serving you," Umansky said. "And suddenly you realize it is a surveillance device being used by your health insurance company to limit your access to health care."

Privacy experts said such concerns are likely to grow as a host of devices now gather data about patients, including insertable heart monitors and blood glucose meters, as well as Fitbits, Apple Watches and other lifestyle applications. Privacy laws have lagged behind this new technology, and patients may be surprised to learn how little control they have over how the data is used or with whom it is shared, said Pam Dixon, executive director of the World Privacy Forum.

"Your Medical Devices Are Not Keeping Your Health Data to Themselves
CPAP units, heart monitors, blood glucose meters and lifestyle apps generate information that can be used in ways patients don't necessarily expect. It can be sold for advertising or even shared with insurers, who may use it to deny reimbursement."

"What if they find you only sleep a fitful five hours a night?" Dixon said. "That's a big deal over time. Does that affect your health care prices?"

UnitedHealthcare said in a statement that it only uses the data from CPAPs to verify patients are using the machines.

Lawrence, the owner of Advanced Oxy-Med Services, conceded that his company should have told Umansky his CPAP use would be monitored for compliance, but it had to follow the insurers' rules to get paid.

As for Umansky, it's now been two months since his doctor prescribed him a new airflow setting for his CPAP machine. The supply company has been paying close attention to his usage, Umansky said, but it still hasn't updated the setting.

The irony is not lost on Umansky: "I wish they would spend as much time providing me actual care as they do monitoring whether I'm 'compliant.'"

This story is part of an ongoing series from ProPublica and NPR called The Health Insurance Hustle.

https://www.propublica.org/article/you-snooze-you-lose-insurers-make-the-old-adage-literally-true?utm_source=pocket&utm_medium=email&utm_campaign=pockethits

angelface555

"remember grown-ups joking that any deep hole (that I was digging in a sandbox, perhaps) would go "straight down to China." So, of course, I had to find a globe and verify. Surprise: I'd actually end up in the ocean, somewhere off the coast of Australia. Today, you can answer the same question online with Antipodes Map."

https://lifehacker.com/see-whats-on-the-opposite-side-of-the-world-from-you-1830588226?utm_source=lifehacker_newsletter&utm_medium=email&utm_campaign=2018-11-22


Mary Ann

Patricia, that is a very interesting article on the CPAP and I sent the link to Tom, who uses a CPAP.  I know of none of the restrictions he might have.  I do know he uses it even for naps.

I'm saving the other article for later (digging to China).

Mary Ann

MarsGal

Thanks for the CPAP article, Patricia. While this article focuses on CPAP, just think of the other devices that this can and does apply to. I've sent article links to my sister and best friend. Neither use CPAP, nor do I, but we are all concerned about overpricing and the credentials of who gets to call the shots on treatments. If a manufacture wishes to monitor their devices for the purpose of checking how well their device is actually working in order to help develop better devices, the customer should be made completely aware and give specific consent whether or not they wish to participate.

This article does not alleviate my concerns over the growing trend of insurance companies, hospitals and physician practices being owned by the same organizations. It smacks way too much of anti-trust and collusion and is likely to give the patient very little choice regarding treatments. https://www.ftc.gov/tips-advice/competition-guidance/guide-antitrust-laws So far, they seem to be getting away with it.

Sandy

Good freezing cold morning here from the
rocky coast of Maine.  

Inside I woke up to a temp of 52 deg/f. 

So I have put on layer of clothes.   (Some wool)..
I have my electric kitchen stove turned on to 450
degrees,  and my little heater right here next to
me ,   and slowly my living space is warming
up. 

Tomorrow the  temps are suppose to get more
back to normal with out the wind chill factor...


Daily record low and coldest Thanksgiving temperature records were set at Portland and Augusta. ... November 22, 2018.

Yikes...   Soon to be better I hope.  
I am SAFE....

Sandy !
:thumbup:
  "It pays to keep an open mind, but not so open your brains fall out."

― Carl Sagan

larryhanna

Hi Everyone. We are expecting a cloudy day today with the high in the low 50's.  Nothing particular on the schedule for today.  I do need to get some air put in one of my tires that seems to have a very slow leak and Pat said she wanted to go to the grocery store with me when I go to get some lunch meat.  Yesterday was very quiet.  Scott finally got out here around 7 pm and had dinner with us and spent a couple of hours.  He really looked rested as had spent the entire day, or most of it, sleeping.  I do hope to finish reading a paperback book I have been reading this week so I can return it to a friend who loaned it to me Monday.

Sandy, hope you had a Happy Thanksgiving with your family yesterday.  Wow, your apartment was really cold for you this morning.  I hope this isn't an indication of what your winter is going to be like. 

Joy, occasionally I know an answer to one of the questions asked on Jeopardy but many of them are beyond me. I don't remember where Emma was from either.  I think the young black woman was from around Atlanta. 

Mary Ann, you have a better memory that Joy and I do in regard to where the contestants said they were from.  I hope you enjoyed your turkey dinner last evening.  I thought maybe that is what "pi" was.  Pat actually has one of those type trays that her uncle who was a printer with the St. Petersburg Times newspaper gave her.  We have it up on the wall for miniatures.   

Patricia, your weather sounds just dreadful.  I tried to find the number of square miles in our county without success.  Interesting fact about Alex Trebek's pet peeve.  I guess that makes his job a lot harder than running one category.  Both Pat and I use the ResMed CPAP machines and certainly relate to what was said in the article.  At least our machines are quiet.  I wish I could say the same for the oxygen concentrator that supplies oxygen to the CPAP hose.  I know our co-pay was based on 13 months and I understand I have the same situation with the concentrator.  The supplies are expensive. 

MarsGal, I agree that there is too much centralization of ownership in the medical field.  Now a lot of the doctors work for the hospitals where their administrators call the shots.  My previous cardiologist told me that one reason she left the contract involving the hospital was they were always pushing them to do expensive procedures like the Caths and MRI's.  It must be terribly frustrating to the doctors to have to check their every decision with the Insurance companies.

Mary Ann

Larry, that is a good use of a type case - holding miniatures. 

There was an article in the Detroit Free Press this morning about fraudulent claims against insurance companies and the use of companies to combat that.  So it seems while insurance companies dictate at lot of what we pay, they do try to combat some costs too. 

Sandy, don't you have heat in your apartment?  52 degrees is too cold and what will it be like in January and February? 

Larry, I don't always remember where the Jeopardy contestants are from, but Owings Mills MD was familiar because of Rukeyser as I used to watch his program which was from Owings Mills.  As for memory, mine is pretty good, but it is kind of selective, remembering things that are not important for the most part.  I'm not good at Trivia, however.

Mary Ann



Joy

Good morning.  It is a partly cloudy day, and maybe a little warmer than yesterday.

I had a nice Thanksgiving day. Lots of good food and nice company.  I ever got some leftovers to bring home for dinner tonight.  I am not a big fan of turkey, but I do like to have a turkey sandwich the next day.  I have enough for the sandwich and my dinner, along with some other things.  Even got a piece of pie to bring home. 

Larry, the reason I did remember where Emma was from is that Owings Mills isn't too far from where I live.  And, Mary Ann, if I remember correctly the show with Louis Rukeyser was on PBS, and Owings Mills is where the PBS station is located. 

Tomorrow morning, my son and I have to attend a funeral for an old friend.  He is the brother of one of my best friends, and even tho my friend has passed away, I am hoping to see some of her family at the funeral. My son worked with him a while back.  It is supposed to rain, but not until the late afternoon.  So, I do hope it holds off until after I get home.

Sandy, your place sure was cold this morning.  I know mine wasn't that cold, but I still pushed the thermostat up until it warmed up.  Sounds like you were prepared for the low temperatures, tho.

I have been on this computer for a too long a time this morning.  I really need to get something accomplished before that time gets much longer. 

I hope everyone has a  good afternoon and evening. 

Joy
BIG BOX

Sandy

I am prepared for when the temps are very low
and the winds coming from the North/East/west
are high.   

The down side of living in a "corner" apartment,
with a great view of the Main  Street here in the
city of Portland Maine. 

I am prepared for these days and
hopefully we will not have too many
of them this Winter.     

But, of course, one never knows..   I would
rather it be too cold then too hot.   Because I can
always throw on another layer.     I really hate
the heat.   

All is well. 
Sandy
:knuppel2:
  "It pays to keep an open mind, but not so open your brains fall out."

― Carl Sagan