....enjore....

sherpaa: An important part of our job here at Sherpaa is...

Fri, 29 Mar 2013 07:40:57 -0400

An important part of our job here at Sherpaa is helping our clients understand healthcare. As we all know, it’s super complicated and when you’re the CEO concentrating on building the awesomest company you can possibly build, you just have no time to dive into the nitty gritty of all these details. Unfortunately, without understanding the details of health insurance, you could be wasting a ton of money— healthcare is the second largest expense behind payroll for most companies. So, in the spirit of clarity and transparency, here is Sherpaa’s Ultimate Health Insurance Lingo Dictionary.

Looking at a typical health insurance information booklet or a claim or an explanation of benefits can be incredibly confusing. There are so many terms and acronyms to try to decipher that it can sometimes seem like you are learning a new language. But fear not. We are here to help you understand some of the most important terms you are bound to come across:

Allowable Amount: Also called a UCR (usual, customary, and reasonable), this is the
dollar amount your health plan considers appropriate for a service provided in your area. In network doctors agree to charge no more than the allowable amount. If you go to an out of network doctor, you will have to pay any fee above the allowable amount

COBRA (Consolidated Omnibus Budget Reconciliation Act): A federal act that requires group health plans to allow employees to continue their group coverage for a stated period of time (18 months) once they leave a company. The employee has 60 days post departure to decide whether to take COBRA coverage.

Co-Insurance: The percentage you must pay of any additional bill after you have met your deductible. For zero, or in some cases low deductible plans, this kicks in immediately.

Co-pay: A fixed dollar amount that you are required to pay for a covered service in order to receive care. Typically, you will see co-pays for primary care physicians, for specialists, for prescriptions, and for hospitalizations.

Deductible: A fixed amount of the eligible expenses you are required to pay before reimbursement by your carrier begins.

EOB (Explanation of Benefits): The form sent to your home or office after a claim has been processed by your insurance carrier. The EOB details the amount the service cost, the amount paid out by the insurance carrier, the benefit available, and (when applicable) the reasons for denial of payment. It is very important to compare your EOB with your claim to ensure that there are no errors.

FSA (Flexible Spending Account): Allows employees to pay for medical expenses on a tax free basis. This is a “use it or lose it” plan, meaning that whatever funds you have contributed to the account will be lost if they are not spent at the end of the year. You also cannot take the account with you when you leave your company.

Health Care Claim: This is a fancy term for your bill. Along with the claim is a claim form which is initially filled out by your health care provider and then submitted to your insurance company for consideration of payment of benefits under your specific plan.

HMO (Health Maintenance Organization): A health plan that consists of a network of contracted doctors and hospitals to provide treatment for HMO members. HMO plans require PCPs to coordinate all health care. This plan type is the most restrictive in terms of options for care.

HRA (Health Reimbursement Arrangement): An account open and funded by an employer which gives employees tax breaks and reimburses them for health care expenses. Unlike an FSA, the balance on an HRA can carry over year to year.

Network: The doctors, hospitals and other providers that a health carrier has contracted with to deliver health care services to their members.

In Network: Covered services provided or ordered by your Primary Care Physician or other network provider

Out of Network: Services not provided, ordered or covered by your Primary Care Physician or other network provider

Out of Pocket: This refers to the maximum amount, per plan year, that you are required to pay out of your own wallet for covered health care services.

PPO (Preferred Provider Organization): A type of plan that is more flexible than an HMO, but still operates with a list of physicians/hospitals that are in network. With a PPO, you are able to see out of network providers, but they are only partially covered.

POS (Point Of Service): A plan that is, essentially, a combination of an HMO and PPO plan. You are required to have an in network PCP. You are able to see out of network providers, but will have to pay the cost unless your PCP refers you.

PCP: This is an acronym for Primary Care Physician

Preauthorization: The process by which a member or their Primary Care Physician notifies the health plan carrier, in advance, of plans for the member to undergo a course of care. This can include a complex test or a hospital admission, as two examples.

Premium: The monthly fee for your insurance coverage. The total monthly fee is often split between employers and employees. Premiums are often deducted from your paycheck on a pre-tax basis.

malformalady: Yoko Ono has tweeted this image of John Lennon’s...

Fri, 22 Mar 2013 20:29:03 -0400

malformalady:

Yoko Ono has tweeted this image of John Lennon’s bloodstained glasses together with a message about how many people have been killed by guns in the U.S. since his death. The message reads: Over 1,057,000 people have been killed by guns in the U.S.A since John Lennon was shot on December 8, 1980.

"Growing old is terrible. They say these are supposed to be the ‘Golden Years’ — but the only thing..."

Thu, 21 Mar 2013 23:59:30 -0400

“Growing old is terrible. They say these are supposed to be the ‘Golden Years’ — but the only thing Golden about them is my pee.”

- A patient’s grumpy Grandpa, in reply to my simple “And how are you doing today?” (via cranquis)
Aging

cranquis: baffledinbrooklyn: Stolen from Facebook. How to...

Thu, 21 Mar 2013 23:56:37 -0400

cranquis:

baffledinbrooklyn:

Stolen from Facebook. How to photobomb a chest x-ray.

I can just see the radiologist’s report now: “Possible cranium-shaped opacity in left chest of uncertain significance; clinical correlation recommended.”

malformalady: Yoko Ono has tweeted this image of John Lennon’s...

Thu, 21 Mar 2013 23:43:38 -0400

malformalady:

Yoko Ono has tweeted this image of John Lennon’s bloodstained glasses together with a message about how many people have been killed by guns in the U.S. since his death. The message reads: Over 1,057,000 people have been killed by guns in the U.S.A since John Lennon was shot on December 8, 1980.

The Not Quite Doctor: Does where you go to undergrad matter?

Thu, 21 Mar 2013 23:39:06 -0400

The Not Quite Doctor: Does where you go to undergrad matter?:

thenotquitedoctor:

I’m currently in community college, thinking about medical school or pharmacy school. I was set on transferring to a school in the University of California (UC) system but my parents want me to transfer to a less competitive, state school so that I can hopefully get a higher GPA than I…

“The goal is to be competent. ”
I think this could apply to any profession

Ithaca is gorgeous

Fri, 05 Oct 2012 23:04:17 -0400

Ithaca is gorgeous

"Before & after arw made to walk not to run: CAMPER is grateful to all the feet included in this..."

Fri, 05 Oct 2012 23:01:09 -0400

““Before & after arw made to walk not to run: CAMPER is grateful to all the feet included in this pair, but does not necessarily take responsibility for where they walk” kindly reminder from my shoes manufacturer http://www.camper.com/en”

studying/ interrupted/ tempted to call you

Fri, 05 Oct 2012 22:57:49 -0400

studying/ interrupted/ tempted to call you

"My House i only want to be there to kiss you as you want to be kissed when you need to be..."

Fri, 05 Oct 2012 22:53:18 -0400

“

My House

i only want to
be there to kiss you
as you want to be kissed
when you need to be kissed
where i want to kiss you
cause it’s my house
and i plan to live in it

i really need to hug you
when i want to hug you
as you like to hug me
does this sound like a silly poem

i mean it’s my house
and i want to fry pork chops
and bake sweet potatoes
and call them yams
cause i run the kitchen
and i can stand the heat

i spent all winter in
carpet stores gathering
patches so i could make
a quilt
does this really sound
like a silly poem
i mean i want to keep you
warm

and my windows might be dirty
but it’s my house
and if i can’t see out sometimes
they can’t see in either

english isn’t a good language
to express emotion through
mostly i imagine because people
try to speak english instead
of trying to speak through it
i don’t know maybe it is
a silly poem

i’m saying it’s my house
and i’ll make fudge and call
it love and touch my lips
to the chocolate warmth
and smile at old men and call
that revolution cause what’s real
is really real
and i still like men in tight
pants cause everybody has some
thing to give and more
important needs something to take

and this is my house and you make me
happy so this is your poem

”

- Nikki Giovanni

(via addismusikainmyheart)

For those pedestrians texting while crossing intersections!!

Sat, 25 Aug 2012 16:03:16 -0400

For those pedestrians texting while crossing intersections!!

warsan versus melancholy.: 3.53 am

Sat, 28 Jul 2012 04:00:47 -0400

warsan versus melancholy.: 3.53 am:

warsanshire:

our men do not belong to anyone. even my own father, left one afternoon, is not mine. my brother is in prison, is not mine. my uncles, they go back home and they are shot in the head, are not mine. my cousins stabbed in the street for being too black or not black enough, are not mine.

then the…

early works of Aster. Thanks DJ Mitmitta for this jewel....

Fri, 27 Jul 2012 01:17:03 -0400

early works of Aster. Thanks DJ Mitmitta for this jewel.

mitmitta:

The first track on the first album from Ethiopia’s pop-queen Aster Aweke. Acoustic guitar and vocal. Wiki. Here is Ante Ledj.

TSK: Dr. Cranquis is afraid FOR you.

Sun, 17 Jun 2012 22:25:56 -0400

Cranquis: Well, sir, I checked with your pharmacy, and apparently you just got 180 Vicodin tablets 2 weeks ago, so I really don't think I can prescribe you any more Vicodin today, even though you are "leaving on a trip tomorrow".
Patient: WHAT? YOU WON'T GIVE ME ANY EVEN THOUGH I RAN OUT? THAT'S A LOAD OF %$#@!
Cranquis: Well I suspect part of the reason you ran out of your Vicodin too soon is because you were just in the hospital 10 days ago for a Vicodin overdose. I saw it in your chart.
Patient: THAT HAS NOTHING TO DO WITH THIS! I NEED MY VICODIN! YOU'RE JUST AFRAID TO PRESCRIBE IT TO ME!
Cranquis: You're darn right, I'm afraid! I'm afraid you're gonna KILL yourself. So you're not getting any Vicodin from me, today or ever, and I hope you live long enough to someday thank me for NOT prescribing this to you.

Letters of Note: I like words

Mon, 07 May 2012 17:49:52 -0400

Letters of Note: I like words

NJ cars in NYC (Taken with instagram)

Fri, 02 Mar 2012 13:55:13 -0500

NJ cars in NYC (Taken with instagram)

Fantasy vs Realty: A domestic worker's life in the Middle East

Sun, 19 Feb 2012 10:04:12 -0500

Fantasy vs Realty: A domestic worker's life in the Middle East:

destination-x:

Here is one testimony from Rahel Zegeye who has also made a film titled “Beirut” about maids’ experience in the Middle East:

Ten years ago, my plan was to jet off to Beirut in search of domestic work without telling my family. My military veteran father was unemployed and our family had to pinch whatever pennies we had. Besides, there were limited opportunities to continue my education after high school, especially without high grades and test scores.

Unfortunately, they found out about my secret mission two days before I was to leave Addis Ababa. My father was especially upset because of the negative reports he heard about girls who went off to work in Arab countries.

Like thousands of African, Sri Lankan, Indian and Filipino women, I saw Beirut as a place to improve my economic outlook. But I was met with a reality much starker than my dreams. With this opportunity also came reports of verbal, physical and sexual abuse as well as withheld payments, excessive work hours, and confinement to the employer’s house.

I experienced some of this mistreatment during my early years [in Beirut]. Four days after my arrival, I was on the balcony of the home where I was assigned to work, brushing my hair. I saw an Ethiopian woman on the top floor who looked down and warned me to be careful. As she said, there came a day when I feared for my life in that house. The woman I was working for was very strict and made work difficult for me.

Fortunately, the agents who made my arrangements moved me to another house. My second employer seemed much nicer. I found myself in a better situation and tolerated the new challenges I faced. I kept working, telling myself that this house was better than the last. That’s mainly because I had no other choice. Life was hard but I could not do much to change it.

After six years of silent obedience, I could not take it anymore. There came a day when my employer refused me food and water for 13 days. I finally decided to leave and asked her to give me the money she owed me. She refused to pay me the two months worth salary she had withheld from me and kept all of my clothes.

I found myself on the move again. I was lucky enough to find a third employer who is kind and compassionate. I haven’t budged from his home since, working for a man of mixed Lebanese and Armenian descent. He’s good-natured and supportive of my ambitious goals of filmmaking. Now I’ve found a bit of freedom.

This new environment allowed me to begin documenting the stories of less fortunate Ethiopian domestic workers. Five years ago I made a film, “Beirut,” which chronicles the lives of a group of women. It is a personal look into their social interactions and aspirations outside of work. I set out to show the reality of their lives, which sometimes include prostitution, drinking and smoking.

I used the money I saved from four years of working to fund the film. I paid two cameramen U.S.$200 each to film once a week on Sunday afternoons, my day off. The actors are all domestic workers themselves who portray the real stories of women I’ve encountered over the years. “Beirut” took a total of two years to make and had to be edited down from four hours to about an hour and a half.

My aim is to advise prospective domestic workers in Ethiopia to learn from my own experience and the experience of many women like me. There are many problems they could find themselves in after arriving. It is important for them to understand the potential dangers that come with the job. This is the spirit of the film.

I would not recommend for young girls to come to the Middle East to wash dishes and clean homes. It is dead end labor that leaves no room for personal advancement. In the 10 years that I’ve been here, my place in Lebanese society hasn’t changed much. I make a mere $250 a month. People still hurl insults at me as I walk down the street. I don’t enjoy the same rights and privileges as the natives or the freedom to pursue business opportunities. But this reality is not broadcast in the romanticized brochures young women in Ethiopia read, desperate to go abroad for work.

I’ve reached a roadblock in the distribution efforts for “Beirut” since the Ethiopian embassy [in Beirut] denied final approval of the film. But I’m working on drumming up support, such as from the wife of famed Ethiopian runner Haile Gebrselassie. I am determined to show the film in Ethiopia, where it really counts. —Via Allafrica.com

Pambazuka - The political economy of remittances in Ethiopia

Thu, 09 Feb 2012 19:14:16 -0500

Pambazuka - The political economy of remittances in Ethiopia

Give a Gift of lifetime smiles :-)

Sun, 29 Jan 2012 22:19:47 -0500

Give a Gift of lifetime smiles :-)

"“All Water has a perfect memory and is forever trying to get back to where it was”..."

Tue, 10 Jan 2012 21:31:44 -0500

“

“All Water has a perfect memory and is forever trying to get back to where it was”

Toni Morrison

”