Ambergris

On a related subject, here's part of an article I thought people might find interesting: Opinion: Same hospital, same injury, same child, same day: Why did one ER visit cost thousands more? Renee Y. Hsia Mon, December 11, 2023 at 6:30 AM GMT-5·5 min read Two emergency room visits on the same day provided a dramatic example of the arbitrariness of medical billing in the United States. The Kaiser Family Foundation recently reported that the annual cost of family health insurance jumped to nearly $24,000 this year, the greatest increase in a decade. While insurance executives and employers may cite a plethora of reasons, one of the chief culprits is lack of oversight over the Wild West of healthcare prices. My friend encountered a dramatic example of this last year after her 4-year-old daughter had the misfortune of suffering the same injury twice in the same day. The girl’s parents were getting her ready for school one morning when, as her hand was pulled through a shirt sleeve, she experienced severe pain. They took her to the children’s emergency department down the road from their home in the Bay Area, where she was diagnosed with “nursemaid’s elbow” or, more technically, a “radial head subluxation.” Common in young children, whose ligaments are looser than adults’, the partial dislocation is straightforward to diagnose and treat. A simple maneuver of the elbow put it back in place in seconds. After coming home from school that afternoon, my friend’s daughter was playing with her babysitter when her elbow got out of place again. They went back to the same emergency department and went through the same steps with another doctor. My friend, who is fortunate enough to have good insurance and the means to pay her share, knew the bills wouldn’t be cheap. What she wasn’t expecting was such a stark illustration of the arbitrary nature of medical billing. While the bill for the first visit was $3,561, the second was $6,056. Same child, same hospital, same insurance, same diagnosis, same procedure, same day — and yet the price was different by not just a few dollars or even a few hundred dollars, but nearly double. How do we make sense of this? How can a patient be charged such wildly different prices for the same treatment on the same day? Emergency room billing consists of hospital fees and professional services fees. The hospital fees include a “facility fee” that is part of every emergency room visit and coded at one of five levels. Level 1 is the simplest — someone needing a prescription, for example — while Level 5 is the most complicated, for problems such as heart attacks and strokes that require significant hospital resources. And of course there can be additional hospital fees for X-rays, medications and the like, which weren’t necessary in the case of my friend’s daughter. The professional services fees are for the emergency physician and other providers such as radiologists. In this case, there were no fees for professionals other than the emergency room doctor. But the itemized charges showed the two visits were billed completely differently. The first was charged a Level 1 facility fee and a Level 3 professional fee. And the bill tacked on additional fees, including hospital and professional charges for taking care of the patient’s injured joint. The second visit, meanwhile, was charged a Level 2 facility fee and a Level 4 professional fee, both higher than that morning. But in contrast to the earlier visit, no other charges appeared. Why was the same injury coded as more complex and expensive to treat the second time than the first? Why did the coding and billing company decide to charge for additional services for the first visit but not the second? I know both of the physicians who treated my daughter’s friend; they work in the same group, use the same billing and coding company, and charge the same rates. So the different doctors don’t explain the discrepancy. In my practice, even treating physicians have no access to information about how billing for our services is determined. My friend and I contacted the hospital’s billing department repeatedly, but they proved unable to provide any rational explanation. Unfortunately, this isn’t new. About a decade ago, I published a series of studies showing how arbitrary medical billing can be. Hospitals charged fees ranging from $10 to $10,169 for a cholesterol test; $1,529 to $182,995 for an appendicitis hospitalization without complications; and $3,296 to $37,227 for a normal vaginal birth. It goes on with more opinions...

Yanking is a sign of impatience.

Okay, after watching a minute or two of this, I remembered binge-watching it with a bunch of her other videos. So it's not new information. It's information that got crowded out of my head when I needed it.

I ran across a comment today that an Instant Pot Max (and only the Max) was tested by Rose Red and found safe for canning. Instant Pots of various kinds are available here. I have not specifically looked for the Max. There's a service called Tiendamia that allows Amazon deliveries of a limited nature (as in, they track your lifetime dollar amounts and cut you off when they decide you've had enough) (as in, they allow in less than one percent of Amazon's variety). Tiendamia right now is allowing orders of the Max. I find this tempting, but I would like to see if I could buy it in cash locally (meaning in the city) first. Edit: Has anyone seen canning guidelines or instructions geared to the Instant Pot Max?

Quince has a lot of pectin too. I haven't found quince here yet, but I'm still looking.

We used to make banana bread using persimmon instead of banana. Such a lovely orange color, and nice to alternate slices on a platter. Not something to do unless you have a tree-full of persimmons, of course. I am laid up in bed with ice on my knee and arm from two fun little episodes with Bear this morning. This afternoon we are taking H's itty bitty dog to a vet in Loja, the one she came from, because she was too quiet Sunday and has not eaten since early yesterday afternoon. I also need to pay bills, meaning visiting the ATM in Loja, and buy canned cat food.

Oh, Miki, don't rush through the mourning. I still tear up over my little Kismet, after all these years, and I only had him a few months. Some become part of you. Edit: not suggesting you would rush...just don't let anyone tell you to brush it off

My Merlin gets salmon, canned chicken with mayo for his constipation, and more, so I know what you mean. But when life becomes a burden, you will know what to do. My heart is heavy for you.

Forgot to mention the other day: went to a hardware store and noticed that there was a baby store up the street. Asked if diapers would cost less there than at the department store. We went to see. For $41 got two big packs of the 5X natural care (red bag) Huggies plus a 300-count package of wipies plus a small package of wipies plus powder plus a covered bowl with a baby spoon that snaps into the lid for traveling plus a one-week sample of maternal vitamins. The vitamins might have been free. Not sure why such a little thing is wearing 5x, but that's what her mom wants. Basically, shopping more direct instead of at the more convenient places. And, from her mom's angle, getting godmother to pay for things.

Supper was air-fried plantains, H's version instead of mine, and a thick slice of the local crumbly cheese, with tea. H's version is sliced in slices and cooked a lower temp, so they do not caramelize and stay more starchy, while my way is to cut them in wedges and cook them at a higher temp to maximize caramelization, getting all the sweet taste on that outside and getting a softer interior. Both versions are good, and either way this is my favorite simple meal here. We were going to have avocado too, but the avocado was not quite ripe and I was not real hungry, so that's set aside for breakfast.

You too!

Can't go wrong with deviled eggs.

Black-eyed peas soaked last night, but without baking soda because I couldn't find it. Also, we are making corn bread with corn meal sifted out of the freshly ground chicken feed and some pancake mix, because the box of pancake mix is open, the new bag of flour is not, and it's the rainy season. Don't have an oven, so the cornbread will start in the rice cooker and probably finish as two or three large broken pieces in the air fryer--which makes it wonderfully crunchy. Not sure what else will end up on the menu.

I look forward to having a freezer again. What I have now sits on top of the fridge and has less than two cubic feet before the frost builds up. It needs defrosting on a monthly basis. Sigh. Food would not be good more than a month or so after going in there. Separate freezers are not a thing here, but side by side fridge/freezers can be found in a lot of the appliance stores. That's what PM has and what I'll be looking at when I get my own place. Shouldn't be hard to get plastic boxes to fit each shelf of a side by side to hold the cold in better. Tried that with my stand-up porch freezer in Florida, but needed two boxes per shelf, and with both of us loading the freezer (three or four of us sometimes) it stayed chaotic. I always wanted a side by side.

I suspect he's been waiting for her.

I might have mixed up the yellow and red, but there are jersey types (rich in flavor, low in production) and there are holstein types (huge production, less flavor).

Mmmm.....chocolate. Wild tree with photo of the flower: Fruits from two kinds of chocolate trees. Yellow is from a holstein-cow type tree, red is from a jersey-cow type tree. The fruit is sweet and juicy, around a bitter purplish core. People can eat the fruit, which is kind of banana-y, but that's not real sanitary or economically viable if the point is to sell chocolate. So they just wash and ferment it away to get to the valuable purple part (which also needs to be fermented, dried, ground, etc).

My recipe for possum is to hang it over a likely fishing spot in the summer and come back a couple of weeks later to fish under that spot, where the fish have become used to maggots falling off the corpse. Otherwise, it's too greasy and stringy to enjoy. Knew someone with a pet possum once, nice critter. DX despised them. Done right, barbecued coon is as good as barbecue gets. I haven't had bear in so long I'm not sure I can really remember what it's like. (Wasn't just bear we were having.)

Squirrel is really good with gravy over biscuit. I told my boys I was practicing my recipe for their friend D's father (who characteristically would ask for "fried rat's a** with coffee.") I did serve him squirrel with red-eye gravy before he passed. It was fricasseed, not fried, but close enough. I do eat bugs, or rather grubs. I like them cooked, and preferably in gumbo or stir-fry.

Leftover cheese empanadas today.

Don't feel good today. Not anything identifiable as bad, except tender tummy, just not good. Cancelled shopping trip and exercise class and stayed home to watch the rain. It's raining. This is good.

Big Red Hen made her debut in a soup for lunch, very rich and full-flavored, but I'm under the weather and didn't enjoy it much.

I didn't buy one either. Where I am now, they hand-build them.

Not exactly canning, but we are crystalizing a few pounds of ginger today and tomorrow.

Sigh. The red hen got egg bound yet again. This has been averaging more than once a week, poor thing. She's basically been in a constant state of egg-constipation or recovery from egg constipation for a couple of months now. So today we put her out of her misery. To me, she was verging on a pet, and letting her go was as far as I thought. I was sad to see her go. To H, she is several pounds of good, solid meat. She's been plucked out already. Sigh. Only one of my three baby dinosaurs from a year ago is left now. She's the matriarch and egg-laying queen of the yard, but H's father sent a giant cream-colored beast to be the god-baby's pet a couple of weeks ago, and that one is residing in my yard now too. I don't know if the beast is male or female, but it's not crowing nor laying. I also have three dainty little white silkie retirees (one a rooster) who among them put out an egg every other day or so. and three black creole egg-layers about their size who are half-grown, and five babies who have now entered the looks-like-a-dinosaur stage. Edit: She had some broken ribs that had healed wrong, as it turns out, and was grossly over-fat.