#every step of the way from filling out a health insurance request all those months ago has been nothing but an obstacle

[devotioncrater]

i do ALLL the right steps and I STILL cannot get medicine.

i do not have enough antipsychotics. after 3 months of back-and-forth with the health insurance company, i finally get health insurance. i go to my primary care doctor. i get a psych referral from her. with this referral i wait one month for an introduction appt with a psychiatrist. i see the psych doctor. i get yet another referral for a specialized clinic. twice i attempt to go in person to the clinic to make an appt but both times cant make it before they close. their appt wait time is 6-12 weeks. this is already pushing it in the psychiatrist’s eyes bc he said there is a high risk i will have an episode before i see anyone from the clinic. but he refers me anyway. gives no meds due to regulations. tells me to finish the rest of my pills in the meantime. all 10 of them. and to call him in the event of an episode. of which i will not realize i am in. so instead of going in person, i call the clinic. the clinic says they are specialized and cant take me. i tell them i am specifically referred to go to them. they tell me no. they refer me to a normal hospital. i ask if i can come in person to show them my referral. they say i can but they still wont take me because i don’t live in the neighborhood. they tell me only the hospital can take me. i tell them i have been diagnosed with their specialty. they repeat their no and hang up. i have the biggest nosebleed of my life. i have 5 antipsychotic pills left

[nothorses]

Top Surgery Journal

I figured it was time to share my top surgery experiences, so folks can potentially learn from them! I'll be updating this as I have more to add.

For context, I am in the U.S. (specifically Washington state), and a legal adult. A lot of my process may not apply to everyone.

Getting Coverage

The first step to scheduling top surgery is getting insurance coverage for it. Talk to your insurance first to figure out if they do cover top surgery, and what you need to do in order to obtain coverage. Oftentimes it won't be listed officially on your plan, but you can get coverage as long as you can prove you need it.

I was lucky enough to have good insurance with trans healthcare included, so all I needed was a letter from my PCP, and a letter from a behavioral health counselor specializing in gender dysphoria. I didn't need any diagnoses, any specific length of time on HRT, any particular presentation, etc.

(If you live in Washington, state law requires that top surgery be fully covered under Medicare. It might be worth it to check your state's laws as well!)

Referrals

I tried to schedule with a surgeon myself, thinking it was my responsibility to get the documents sent over and everything, but my PCP actually referred me when I first told her I had gotten coverage from my insurance.

I ended up going with that referral because the other surgeon was so hard to get ahold of, but my PCP did also send a referral to the surgeon I'd chosen before. I recommend going through your PCP for referrals first, as it takes a lot of the workload off of you- and they'll likely write a referral anyway when sending the documents needed for coverage over.

You may also find that the surgeon you talk to has different requirements than your insurance before performing top surgery. A referral from your PCP might bypass these requirements, but be sure to call them yourself and double-check. Your surgeon's office is supposed to call you to schedule a consultation, and they may not call you at all if you don't have all of those documents in- which means you can be left in limbo indefinitely, not knowing you need to send them more than you already did.

The Consultation

I was able to get a consultation about 5 weeks after calling, which was great! The consultation is your opportunity to ask the surgeon any questions you have, for them to evaluate your chest and what methods might work for you, and for you to see their results (most surgeons do not post result photos online for privacy reasons).

Come into the consultation with all the questions you have written down somewhere, so you don't forget. I asked:

If I could see photographs of his top surgery results

Which incisions he thought would work for me, stressing the things that were important to me: minimal recovery time, no free nipple grafts (I wanted to keep mine, but without risking a failed graft), and minimal chance of needing revisions

What my recovery would look like for the recommended incisions

Whether I will be getting drains (ideally, yes: drains reduce recovery time and the risk of needing revisions)

If he's had patients who have had complications (failed grafts, infections, need for revisions, etc.) and what he's done to reduce the chances of that happening again

My surgeon's results looked good (scars were even and symmetrical, healed nicely, etc.) and he answered my questions really well, so I was happy to go with him!

He recommended the fishmouth method for me, because recovery time would be minimal, there would be no need for nipple grafts, and my chest was small enough for it to work really well.

Scheduling the Surgery

My surgeon didn't have a very long waitlist, but it still took about 3 weeks for the clinic to process my request with my insurance (yes, even though I already had coverage). Once they'd processed that, they called me with a window of time I could schedule within; after a few months, insurance would no longer cover the surgery.

I got an extension, as I was working an intense summer job that I couldn't really take a few weeks off of to recover, then scheduled my surgery over the phone. They asked if I wanted a pre-op appointment, and I declined, as it'd mostly be information covered in the consultation or that could be given to me over the phone.

Preparing for Surgery

I wasn't given a check-in time for the hospital until about 2pm the day before, but they finally did call me and give me some instructions, including:

My check-in time and place

The hospital's phone number, to give to my ride/caretaker in case they had questions

That I was not to bring visitors (cause covid)

To bring my ID, insurance card, and credit card

That I was not to eat or drink anything after 12am that night (I did drink a bit of water with my meds, which they seemed fine with)

To shower with antibacterial soap the night before, and the morning of the surgery

Not to wear hair or skin products like deoderant or gel

Not to wear any jewelry, or anything else removable that wasn't just a clothing item.

When I checked into the hospital, they had my fill out some paperwork including the name and number of my ride and caretaker (which could be the same or separate people; they called the ride number when it was time to pick me up, and the caretaker number with detailed updates on my progress). Then they had me change into the hospital gown and answer some medical history questions, prepped me with an IV, and had a nurse, both anesthesiologists involved in my surgery, and my surgeon check in with me for more information and to answer any last questions I had.

I was told to use the bathroom about 20 minutes before I would be going under for my surgery (to avoid needing a catheter), and once I did, they injected some anesthetic into my IV and I passed the fuck out.

After Surgery

I showed up to the hospital at about 9am, and the prepping ended around 11am. The surgery was scheduled to end at 2pm; I wasn't conscious until about 3pm.

They had me use the restroom again (I passed out on the floor of the bathroom because it was way too soon, lmao), and I was in and out of sleep until I finally used the bathroom on my own at about 5pm. At that point I was a lot more lucid; I had some toast and pudding, and the nurse called my caretaker to go over post-op instructions with us both.

After that I dressed myself, was wheeled out to pick up my pain meds at the in-hospital pharmacy, then hopped in the car with my ride (the wonderful @lillia-pad) at about 5:30pm.

Recovery

I have a pretty high tolerance for anesthetic, so I was mostly just tired during the 36-ish hours the anesthetic continued to wear off. I didn't experience any nausea or lightheadedness either, but I was given an anti-nausea patch behind my left ear, plus some anti-nausea meds, just in case.

My post-op regimen sort of looks like this:

Take 1-2 tablets of oxycodone every 4 hours (for pain)

Take 2 tablets of laxative meds twice a day (cause pain meds cause constipation)

Empty drains twice per day, and record how much was in them

Get up and walk around every couple of hours to reduce the risk of blood clots

Ease into eating again: start with clear fluids, and work up to crackers/bread/etc., to avoid nausea and vomiting.

Lay down propped up on plenty of pillows, and only on your back (no side-sleeping!)

Keep the compression binder/gauze on for the first 48 hours, then remove them to shower as needed (but put them back on after!)

I was pretty lucid by the third day post-surgery, and was able to scale my pain meds down pretty quickly from 2 tabs on the first day, to 1 tab for the next two days, to 1/2 tab. Meds are much more important at night, when there's nothing to distract you from the pain- don't be afraid to ration them for nighttime.

Oxycodone also definitely causes drowsiness, so I took a lot of "oxy naps" about 45-60 minutes after I took my meds, which last between 20 minutes and 2 hours depending on how tired I am.

I have my post-op this week, so I will update this post with more details on my scars and healing then!

[victoriareyloficlists]

09/01/2021 Additions to Reylo Angst

These fics have been added to the Angst list located here.

Say it With Sugar by fettuccine_alfreylo (AO3 2016  Rated E Complete, 20 Chapters, Modern AU, Quick Synopsis: Ben Solo is the owner of his family’s small chocolate shop. Rey Kenobi is a talented chocolate maker he hires. They both share the same passion for chocolate. Unfortunately, they share the same kind of anxiety, too.) Java Empire And The Rebel Café by fairytalesandfolklore (AO3 2019  Rated T Complete, One-Shot, Modern AU, Quick Synopsis: A Reylo Coffeeshop AU. Rey works for the Solo's coffeeshop and finds out their son has gone to work for the competing corporate chain. She tries to get him to reconcile with his parents but a misunderstanding makes him push her away.) Your Half by Celia_and (AO3 2020  Rated E Complete, 4 Chapters, Modern AU, Quick Synopsis: Classmates Rey and Kylo get off on the wrong foot. Too bad they’re partners for the whole semester...) Dumpster Dive Into My Heart by commandercrouton (AO3 2019  Rated T Complete, One-Shot, Modern AU, Quick Synopsis: Inspried by a tweet from Reylo Prompts: My art professor told us a story about how he hated all his art and threw it out at a dumpster by his campus and then a little while later he went to a girls dorm (who is now his wife) and she had it hanging on the wall :) Love Makes Fools Of Us All by Darkcat18 (AO3 2020  Rated E Complete, 5 Chapters, Victorian AU, Quick Synopsis: Poe Dameron and Armitage Hux take their friend Ben Solo to Madam Natal's high end brothel so that he can be rid of his virginity. Ben, though nearly thirty, has no desire to lose his virginity to a whore. When he sees Rey, laundress and cook, he strikes a deal with Madam Natal to spend the night with her. Rey agrees after he offers her a very large sum of money, to be paid directly to her. What neither realize is that this deal will change the course of their lives.) It Feels Like Christmas by juniorstarcatcher (AO3 2017  Rated G Complete, One-Shot, Modern AU, Quick Synopsis: When Rey discovers she’s not the only one staying alone in her dorm during Christmas break, she tries to share the holiday spirit with the intimidating and solitary Ben Solo.) A Scandalous Match by Musickat18 (AO3 2019  Rated T Complete, 18 Chapters, Regency AU, Quick Synopsis: Despite a very poor first impression, Rey has found herself forced to wed the mysterious and intimidating Ben Solo, Duke of Ren. The marriage is deemed highly scandalous by society as Rey is no more than an orphan living on the good graces of Mr. Unkar Plutt. Rey, now Duchess of Ren, finds herself forced into a role for which she has no training, with a husband who does not even seem to like her.) Wash Over Me by Twisted_Mirror (AO3 2021  Rated M Complete, One-Shot, Modern AU, Quick Synopsis: This fic was based on a real life inspired prompt where a guy had posted about an experience with his girlfriend of tender intimacy and healing after past unhealthy relationships.) Those We Love by Everren (AO3 2020  Rated E Complete, 6 Chapters, Modern AU, Quick Synopsis: Rey and Ben used to be friends, best friends, until one night and some bad news changed everything. Now, after not speaking for months, Rey is about to make the hardest day of Ben's life take a turn he could never have expected.) Off guard by TheReadingNook (AO3 2019  Rated M Complete, One-Shot, Modern AU, Quick Synopsis: The last thing Rey is looking for is love. As a single mom, her plate is as full as she wants it to be, but her son seems to think otherwise. And when he sets out to fill that void, they learn some interesting things about life, love, and the bonds of family and friendship.) A Reylo Christmas by Biekewieke (AO3 2018  Rated E Complete, 8 Chapters, Modern AU, Quick Synopsis: So when Leia Organa asks her Personal Assistant Rey to join her on a family vacation in Mon Torri for the holidays and highlights a big bonus, what is she to do? Only catch... Leia's son is coming along... Ben Solo is the enfant terrible of the family. Broody, sullen and with a huge chip on his shoulder, the young man is notoriously difficult.) A Dinner For Two by Ayearandaday (AO3 2019  Rated T Complete, 7 Chapters, Modern AU, Quick Synopsis: When Finn gets caught while hacking for the information about Rey's parents she agrees to spend an hour every day doing whatever Mr. Ren requests to save her friend from prison. But what could her mysterious employer want from her?) In Sickness And In Health by Theyna_Shipper (AO3 2020  Rated T Complete, 8 Chapters, Modern AU, Quick Synopsis: Rey knows it's not an ideal situation, but it's a situation thousands of people are in. It's not like there's much she can do about it right now, anyways. She can go a little while without health insurance. Until she gets breast cancer. The treatment will be simple if she can get it. But she's worried she can't, until her old co-worker Ben offers a solution: "We could get married.") Convergence by kuresoto (AO3 2018  Rated T Complete, One-Shot, Modern AU, Quick Synopsis: Not everyone had an Other, and the only way to find your Other was by saying their name. When that happened, memories of their life, where they grew up and the steps that led them to you, would be condensed into a single flashback that passed in a blink of an eye. The fact that someone had said Rey’s name and didn’t bother approaching her hurt, especially since she had a good idea why. Her parents tossed her aside when she was barely five, so she shouldn’t be surprised that her soulmate had done the same.) Chef's (Uns)Table by TheAlchemistsDaughter (AO3 2019  Rated T Complete, One-Shot, Modern AU, Quick Synopsis: Kylo Ren is a high-powered chef with an explosive temper. Nevertheless, Rey likes him. To get him to come out of the kitchen, she and her friends try to wind him up. When someone asks for ketchup, it works a little too well.) les amoureux des animaux by reylomami (AO3 2019  Rated T Complete, One-Shot, Modern AU, Quick Synopsis: Rey leaves her job in a whim after a quarter-life crisis. With too much time suddenly in her hands to rethink her life and her identity, Rey finds money-making respite in a pet-sitting job from Pawshake. A Reylo Pawshake AU with poor time coordination and fluff out of meet-cutes and mournings.) daylight by sparklylulz (sparklyulz) (AO3 2020  Rated T Complete, 4 Chapters, Modern AU, Quick Synopsis: Coffee shop employee Rey has a run in with one of the difficult professors. Thus starts a very turbulent friendship until Ben needs a fake date to go with him to see his parents, the first time he's seen his parents in a while.)

[pillowfluffs]

Soulmate!Wonho // Chapter 1

Pairing: Wonho X Reader (female)

Genre: Soulmate!AU, fantasy, fluff, slight angst

Summary: You’re a first year at Mapnerry Academy of the Arcane, in a world where everyone has a soulmate. If you draw on your skin, it show’s up on your soulmate’s skin and vice versa, how magical.. You’ve learned many things growing up, but it seems you’ll learn something pivotal to your life one day while being at home..

Author’s Note: This honestly was supposed to be a short story for my english class but I just couldn’t help myself and I decided to polish things up on my own accord. This is my first official series! I know there’s pigtails!Hyunwoo but I didn’t finish and that was an unintentional “series”  I will be posting a new chapter on Saturdays 5:30pm Eastern Standard Time (U.S. Time) ((4:00pm Central Time // 2:00pm Pacific Standard Time)) Please Enjoy part 1!

The small lines appeared on your skin as you sat in the library, studying for a somewhat challenging class you took. Everyone, well about ninety five percent of everyone born is destined to be with a soulmate that fits them perfectly spiritually, personally, physically, every way perfect. Those paired had their skin connected so if you drew on your skin, the drawing would show up on your soulmate’s in the exact same place as you drew it. Luckily for you, you were shown at an early age that you indeed had a soulmate; your soulmate had been drawing on their skin since the moment they could pick up a pen. When the drawings first appeared on your skin, you drew in response, making your presence known because there were also others, the five percent who were born and unfortunately paired with no one. Their fates were destined to be alone, so their abilities as mages were not as full as paired ones. No matter how long it would take to meet your soulmate, everything was destined since birth and even before. The only thing to be let done was time.

You sat comfortably in your seat for who knows what time it was now as your ancient runes textbooks and notebooks sat open in front of you. You needed to focus but the whimsical lines which kept appearing, fascinated you. You’ve been here since the doors opened for the day, first no one but you, but now a good amount of people since it was around the middle of your first year. Since the the library was filled row after row of neatly lined up books with their spines facing outwards and considering how spacious it was, you barely heard any noise, if there even were any being made. The books ranged from centuries old to months old; some more worn out than others. The large windows filled the grand room with a cool light. Archive mages flowed through the aisles, making sure no one was squandering their powers and were returning books to their rightful places. Archive magic allowed the user to convert information to magical data, which can be stored, enabling the mage to gain access to previously stored information, such as magic or in this case, books.

It was your first year at Mapnerry Academy of the Arcane, a school created by the government to enhance the skills of young and promising mages such as yourself and ranked one of the highest and most challenging school to be accepted. It was always your parents’ dream for you to attend this school the moment you were born, so, when you received an envelope saying that you got a full scholarship, they were ecstatic. You applied like millions of others, hoping but also accepting the fact if you didn’t make it, it would be fine. You wished, however, to not go to school; all you simply wanted to do was travel the world, meet your soulmate, do whatever you wished without following any of your parents’ or anyone’s orders on how to use your gift. The way the school’s acceptance worked was based on your level of skill and power. To be honest, you didn’t think your power was all that strong or powerful; it was simply imitationis. You had the ability to mimic the power of anyone else, no matter who they were and how powerful they were. Mages born from paired ones usually have their abilities stemmed from their parents’ abilities. You guessed the only related aspect of your ability to your parents’ were your father’s ability to absorb and redistribute energy and your gift to copy others’ power.

“Holding this power means holding great responsibility,” your parents had always told you, but you saw no problems with your power, as long as you didn’t misuse the powers of the ones you absorbed so far, no harm done. Growing up, your parents weren’t as fortunate as you to be gifted with such a singular and robust power. Your mother was gifted with the power of sanitatem, meaning she could heal others, herself, anyone and anything at any rate she wished, which especially came in handy when it came to health insurance. As for your father, he was given the capability of effusio, the power to absorb any force, elemental or energy, and use it in various ways by changing it throughout their body, and if they were against an enemy, they could use the absorbed energy as an advantage. Your father was often out on missions, which were the only way for mages to make a living; taking on missions put out by less powerful mages. Of course with your father’s power, your mother was his partner in business and life so she tagged along. To be very honest, both your mother and you believe that if she hadn’t gone along with him, he’d be dead by now.

You were often left alone as a child but not completely as your soulmate kept you indirect company and you turned out fine, evidenced by where you were now. The moment you could activate your power, your parents had you mimic theirs so now you could absorb energies and heal others and yourself, which came in very handy when you were left home alone and had to make food for yourself for the first time. Growing up, especially in elementary school, you unintentionally absorbed the powers of almost everyone you made contact with; teachers, friends, family, everyone. The other end never felt anything when their power was mimicked, but for you, it was like a chill running down your spine. Your powers weren’t in control until the end of elementary school as your parents started training you to finely tune your new powers, training you on strategies for defense and offense, preparing for the worst no matter the situation.

Here at the academy, you had a good amount of friends but you never saw them and they never seeked you out so you didn’t really mind. Plus you were one of those kids growing up who got their work done than make friends, so you didn’t really mind having friends or not. School and academics were your number one priority and it showed how well it worked in your favor. Like mentioned earlier, when your parents were out on missions mostly, you had to learn to take care of yourself and not depend on others. Yes, you admitted, it was lonely and you wished your parents were there more often for you, but you were blessed with Wonho, though at that time you didn’t know his name. You didn't know how he did it or if he could feel how you felt but at the very moment you felt your worst, something new would appear somewhere on your body entertaining you. You laid in bed, sat in the kitchen eating, or just doing whatever around the house as you watched as if your life depended on it. It was so intriguing how almost everyone’s skin worked like this. You were captivated with how he chose to draw something; the style, how the ink spread through the minuscule wrinkles in your skin, how he was so creative behind every drawing and doodle.

At this point in your life, you had a good number of powers but you mainly trained the ones you deemed the most essential. The first was demoniaco from the headmaster of the academy, the ability of demonic possession. He, and soon you were able to allow malevolent creatures take over with their own abilities and powers your bodies, allowing you to be a living nightmare in combat. When you received your acceptance letter, you also received an additional letter, requesting a meeting with him alone. Headmaster Voeks, or Jeremiah Voeks and even also known as the legendary prodigium (monster in latin), wished to meet you in person to have a special presentation of your powers. He was a middle aged man, dark black hair with a few light streaks of gray hair showing, but that’s normal for anyone if they were running an academy. His face was stern and serious, slight wrinkling here and there, but that was simple aging, but despite this dark aura, his silver eyes glinted with intrigue. He, as long with all professors at the academy wished for every student to enhance their aptitude profoundly.

Your heart was calm but filled with anxiety as you slowly neared the academy, towering over you as it was immensely larger than you imagined or saw from afar. You remembered visiting this school once, when you were very young. Some things looked familiar and different but it all didn’t matter. The first and last time you were here was when you were about three years old or younger. You easily could’ve teleported to the front gate, but for some reason you couldn’t bring yourself to do so. You pulled your phone out of your pocket, peeking at the time. “11:34 am,” you tucked it back in to your black jeans pocket. You took a deep breath before the gate, your hands clutching on to your black trench coat sleeves, your hands in front of you as you took a step toward the black iron gates. You could practically feel the energy radiating off the gates themselves, most likely acting as a security. You looked around, seeing no one in sight, no one to ask for help. You didn’t know what else to do but to simply trigger the alarm. You slowly raised your left hand, prepared for whatever the security mechanism would do to your body. You pressed your hand slowly against the invisible barrier, instantly feeling jolts of electricity surging through your body, but easily adapting to it due to your electrical ability from your aunt on your father’s side. You were able to promptly absorb almost all of the energy of the electricity, allowing the gate to open with ease. You stepped in as your short heeled ankle boots clicked against the pavement, closing the gate behind you, only to turn around to multiple security mages ready to restrict you, their hellhounds ready to pounce and rip you to shreds. A pang of fear shot through your body as you instantly raised your hands in surrender.

“WHO ARE YOU?” bellowed a mage, his pyrokinesis ability showing as his fists were beginning to glow red. He stood tall, more built compared to the others and even had a different pin on his silver uniform. You assumed he was the leader or captain or something, but pushed this thought aside.

“This doesn’t matter right now,” you thought as your voice choked in your throat. You could see other people looking out through windows, most likely students trying to see what was the commodity occuring outside.

The mages which stood next to him showed their different abilities as well, a blonde one with blue eyes with the ability of toxikinesis, you could see the poisonous gas fogging around his hands, two dark skinned officers with vision abilities, one with heat and the other with freeze. The officers’ grew tenser by the minute; the longer you didn’t respond, the more suspicious you looked to them.

You were afraid, helpless but this was an abnormal feeling. You noticed a smaller officer between the visions. He didn’t visibly have an ability but now it was clear; he was amplifying your emotions and feelings and you filled with fear was not a good thing. Your heart raced heavier and heavier by the minute the longer he stared at you. You felt the electricity beginning to spark in your hands, threatening them as if you were about to attack. They stepped closer, ready to end you as you stood there frozen.

“ANSWER, NOW!” A black haired officer with green eyes whose voice boomed in your ears. His voice was a low deep baritone, powerful for a small built person. His voice made it feel as if an earthquake occured, yet the guards who stood around him seemed as if nothing happened.

“A sonic,” you shrunk to your knees, covering your ears as everything around you rattled. You should have known the moment you saw him open his mouth and how strong it was when directed at you. The guards saw this as a chance and made their way to you, holding you down. They swiftly deactivated their abilities, surrounding you in just a few short seconds.

“End this at once,” a low authoritative voice resonated between the guards. All movement stopped as the guards all looked up as a figure stood at the end of the staircase. Silence filled the atmosphere and all that was heard was a gust of wind and birds chirping in the nearby pine trees.

“Prodigium,” your voice barely above a whisper choked out. A heat of embarrassment washed over you as now you realized how bad it must look; a promising student he believed to be is about to be arrested and most likely thrown off of campus forever.

“Release miss Y/L/N, immediately,” his eyes glowed from a dark brown to a red. A cold shock ran down your spine as all hands released you. You fixed yourself up, your once tucked white shirt had got pulled out as you made your way up the stairs, following the headmaster as he wore a black suit shirt with black pants and shoes. You followed behind on the stairs, watching the steps until you approached the top of the stairs. You were stopped by a figure as you bumped into it, almost pushing you back down the stairs. The figure stood firm. You caught yourself as you shyly looked up to make eye contact with the headmaster.

“Thank you,” you shied away as your hands reached for your sleeves once again. You bowed in respect to who you considered in this moment, the strongest you’ve ever gotten near. He seemed much taller this close than before when you were almost pinned on the ground. He gave off an aura that you could not notably describe; it’s wasn’t all good, but it wasn’t all bad either.

“Please, there’s no need, and follow me.” He turned once again, walking swiftly, hidden doorways and hallways appearing which made it a much faster trip to travel from the front entrance to his office. He wore shoes which clicked against the marble floor as a moderate pace. Despite his long legs, he could’ve easily walk at a pace which you would have to jog to keep up, but fortunately he did not.

You felt tickling lines beginning to appear on your left wrist as you followed behind through the grand hallways with the intricately detailed pillars and doorways, but you were much too captivated by the unique architectural designs in this antediluvian building. Light filled the hallways from the extensive windows, open as some weren’t able to open but they were filled with beautiful stained glass. The ceilings held world renown paintings such as the Sistine Chapel ceiling but with a twist. From what you gathered, it was a history and a summary of the world; how there are the paired ones and the lone ones. Your mouth hung slightly agape your eyes wandered around the sumptuous victorian styled building as students were around every corner, talking amongst themselves, in classrooms. A hum of chatter filled your ears as you tailed behind. The walls a cream color and were decorated with meticulously painted paintings of mages from the past. You walked by the individual portraits hung in dark wood frames which complimented the walls. The walk was silent as your senses were slightly on edge due to the fact that you were in the presence of the Prodigium himself. You made a right turn, passing what seemed to be a way which lead to what you assumed was the library as there were signs on the doors warning those to enter to remain silent. Passing it, there were now only a few students here and there occasionally. You made a left turn into a doorway which appeared in a wall before the headmaster which led down a somewhat dark hallway and led to a broad darkwood door with a single silver doorknob in the center of the door, which seemed rather peculiar to you, but you pushed the thought away as it must have been in fashion when the academy was built.

You stepped forward, but was stopped as an imperceptible barrier blocked you from entering. You looked in awkwardly, unsure of what to do next as you stepped back. Despite you feeling very nervous this morning as thoughts from the night before plagued you the night before, you felt quite tranquil. Some of the thoughts were hypothetical situations such as what if the academy overestimated your ability/ abilities and you were just a disappointment. You got an insufficient amount of sleep the night before one of the biggest moments of your life.

“Please, won’t you come in,” the headmaster made eye contact with you as you stood in the doorway. He waved his hand which a thin black fog surrounded his right hand, deactivating the barrier. You were able to feel the strength and power he held from simply removing the barrier from your way, which was a rare occurrence as you were rarely ever able to feel the power behind the mage.

You stepped once again up to the door, now able to stick your foot through, following your body. A smell of the fresh earth filled your nostrils once the barrier disappeared as the room was much darker than the hallway that led up to this area of the school. You pushed the door closed behind you, a dark aura swallowing you, but candles and lamps around the room lit up immediately once the door shut. The left wall was a bookcase which reached the ceiling, filled with books of all sizes, their spines reading in latin texts such as Possessionem and Mentis Imperium.

“Possession and mind control books.” You walked past, looking at as much as you could. In all your life, you had never really seen a true magus liber (mage book) until now, and they were truly beautiful. The magus libers in bookstores were all simply modern ones that always taught basic skills and training routines; they were no use to you at all.

“Intrigued?” the headmaster stood to your right as you stared at the books in awe. “These books are centuries old, even older than the academy itself.” He looked down to your eyes shining with appeal.

“I’ve never seen real magus libers.” you turned to glance at the professor. “The current ones are too modern and if they do sell authentic ones, they’re much too expensive.” A feeling of disappointment bloomed within you as you looked at the books. You wished so deeply that you could have all these books at home for yourself, but if you did and brought them today, it would cost your life as they were that expensive.

“I see.” he looked back up to the shelf, a sense of nostalgia washing over him as he recalled every exact moment his eyes met these books. “Now, we shall begin what you were truly invited here for.” He gestured to a black leathered arm chair in front of his desk, inviting you to sit as he made his way around his desk which was littered with papers you assumed were other application forms and sat in his own large black leather seat.

You nodded and sat down, ready for anything to he would ask your way. You peeked down to your wrist, seeing small lines creating small flowers and meager shapes. There were about three flowers, two with a stem and one without, but the one without was drawn in a black pen as the other two were drawn in red pens. The shapes were unclosed, not completely finished but you assumed they had a reason for it. You peered up as the headmaster pulled your application form, along with numerous recommendations from multiple teachers, tutors, parents, everyone who was able to write a recommendation.

“You my dear, sound gifted and powerful for your age division of eighteen to nineteen. Never in my time have I ever received an application with as many recommendations and support for a mage as you did,” he sat against the back of his chair, his voice as flat as the papers spread out before him. “You hold the ability of imitationis, mages who hold this gift are one in ten million. Tell me,” he leaned forward, resting his elbows on his desk. “What gifts have you mimicked so far? Please demonstrate the most powerful ones you have so far.” He held his hand palm up, insisting you to exhibit your abilities.

“Um, the most powerful ones in my opinion..” You stood up thinking about which ones you really considered the most powerful. “One which I’ve copied are my grandfather’s aciukinesis when I was eight years old.” You pushed the chair you sat in further behind as you quickly scanned his desk and around to see if there were any sharp objects. “Do you have a blade of some sort perhaps that I may use?”

Without any response, the headmaster snapped his finger, summoning a blade of black steel before your eyes. It was a dagger with a white rose engraved into the handle. You picked up the blade, feeling the aciukinesis essentially turning on as if the ability and the others were a switch inside your body. Your eyes glowed a light blue as you focused on the sharpness of the blade, making it as dull as you could. You rolled up your left sleeve, bringing the blade to your wrist and pulling it across as if to cut yourself. But no damage had been done. Your aciukinesis faded away the less you focused and you placed the dagger back onto his desk.

“Next, from one of the guards earlier, pyrokinesis, but due to the fact that I already had hell’s fire ability, these two simply merged, increasing that power.” You raised your hands up, palms down and fingers spread out, closing your eyes and feel all the space in the room. Silence was the only noise in the room, not a single breath was heard. Suddenly your eyes opened glowing a bright orange imitating the colors of fire. You set the room on fire all around, releasing the hottest flames ever felt, but they had no effect on you as you walked around sticking your hand the flames. The headmaster sat still, observing in silence as not a word was spoken from him since the beginning. You closed the palm of your hand, suffocating the burning flames causing them to die. “With my gift, I am able to control any flame and create any flame.” You walked back to where you stood before the professor at his desk. “And since I can create the flames such as I did just now, I controlled the temperature so if you look around.” You looked around the room, as nothing was burned. “Nothing in this room burned. The flames and the heat had no affect on me so it allowed me to reach my hand in and not feel any pain.”

“But you also said just moments before that these flames did not actually burn anything, so how may I believe your true statement?” His voice remained flat, but you heard there was a hint of interest.

Without speaking, you sat back down in the chair, pulling it back to its original spot and raised your left palm. You opened it causing a flame to spark to life. “If you feel yourself, you can feel that this flame is very hot and if I sparked this earlier, the room would have burned down.” The headmaster reached his hand towards the flame, feeling the heat radiate out of your palm, proving it was lethal. Once you saw that he had evidence, you stuck your hand in and you sat there without flinching for about forty seconds before killing the flame and pulling your hand out. Since it had no affect on you, your hand had black ash on it even though it did not burn anything.

“See? Nothing happened.” You gave a small shy smile, feeling better about this interview. “Now my nex-”

“Enough,” the headmaster’s voice now cold cut you off as he sat back. “Like I said before, you my dear are very powerful, but I strongly believe the abilities you are holding as I’ve seen so far could be much stronger. I hereby accept you into the Academy.” The headmaster stood up and made his way around his desk to shake hands with you. “But I also request you do something for me as I’m sure it will increase your power.”

“Thank you sir, but what is it?” Your curiosity piqued as happiness filled your body. Your head tilted slightly to the side as you looked up into his eyes. Your hands’ stopped shaking as he insisted you to sit once again and he sat on his desk.

“I request you to mimic my demoniaco, with it, I will be your personal mentor which no other student has ever had this privilege. Remember my gift is somewhat rare as well, one in seven million.” He stared into your eyes as his voice made you feel he strongly hoped you would accept. You had always heard stories of the legendary Prodigium eliminating those who stood against him to nothing, how he had immense powers far beyond anyone’s mind, but those were days of the past. And like he said, this would be a very big leap in your power level.

You stood there mouth agape in shock from what you just heard. “Did.. Did I hear that right??” you thought to yourself as you sat there speechless. “Wait but, will be mimicking your ability and you being my personal mentor, does this mean it’ll be like a class?” Your voice raised a frequency as you asked.

“If you would like, I could make it a class but only for you. But if you wish to continue your current studies, we can meet every weekend and practice for about a whole school day.” The headmaster offered. This was a bit to take in, but enough where you could process slowly. “What would you like?”

“Uhm, I don’t even know what classes I will be taking yet. I haven’t applied to any classes nor do I know what they offer.” You’ve only heard about some classes from your cousins, but they were always complaining about how easy it was, but then again, they were really smart. You meant to look up some of the offered courses on the website too, but you wanted to spend this summer before school to yourself, before you were officially on your own at school.

“We can easily fix that right now.” The headmaster stood up, sitting back down in his chair and pulling out a syllabus of the school. “From your records, it seems that you exceled promisingly in the basic necessities of life such as mathematics and language. As you enter this academy, you will be focused on the more advanced classes of somewhat complex subjects such as runes and increasing power capacity. I suggest making our meeting as a class period than a weekend. You would like to explore and make friends, correct?” He spoke so fluidly, as his voice was monotone. He was a living statue as he barely moves any facial muscle when he spoke.

“I guess that would be the best..” You sat and thought. A blossom of worry bloomed as you wondered. “Could I handle it?” The worry died down a bit once you felt lines being drawn on your right thigh now; you couldn’t see it but you had a vague idea of what was being drawn. You placed your hand over the slight sensation.

“I assure that you will be academically fine, and as for your powers, the capacity will increase dramatically. For your classes, you may look over this syllabus tonight, fill in the form at the end for your first year classes, and then return this to me tomorrow. If you mimic, you must come in tomorrow to begin the basics for they are difficult to adapt to.” He slid the brown leather syllabus towards you.

You took the syllabus in your hands, studying it making up your mind. “I’ll do it.” Your eyes locked with the professors and decided you were ready and the only way to be successful in this world was to be powerful. A gentle smile grew on his face as your hand clutched your pants.

“Excellent.” He stood up shaking your hand. You stood as well taking his large hand in yours. You mimicked his ability, instantly feeling a heat wave wash down your spine than a cold one which you normally felt. Your eyes instantly glowed a dark blood red as block fog started forming around your feet. The headmaster was surprised with you at first, unknowingly how fast you mimicked, but now it was clear how you mimicked; by physical touch. A vast amount of power surged through your body as you were becoming unstable.

You felt a darkness taking over and no matter how hard you urged your body to stop, it was no use. It was as if you were beginning to drown, the water entering your mouth and filling your body. You felt a slight pain spreading through your veins, a warm subtleness.

“Y/N,” a demonic voice called your name, pulling you out of the darkness. The fog faded away as your eyes returned to their normal color. You realized your body had gone numb, frozen similar to a statue, your muscles sore. You felt all over your left wrist new lines forming and just knowing the presence of your soulmate through your skin calmed you, physically feeling them appear on your skin was enough to make your day.

“What happened to me?” your voice quivered, fearing that if that were to happen again, how would you come out of it? You wondered if it happened again, what would actually happen and what you could possibly do if you lost control.

“The ability activated immediately. You were beginning your first process of completely mimicking my abilities. This is why you will need the classes as I will be your mentor.”

At that time, there was only about a few weeks of Summer before school began. In those few weeks, you were with the headmaster fine tuning your abilities, learning the additional powers that came with demoniaco. Every few days were new lessons for you as a few days after each new lesson were for your to fine tune the best you could.

Once school began, you moved into your down and due to the low acceptance level, almost everyone had their own dorm room to themselves. Your dorm at the end of the hallway, had a lovely view to a courtyard with a small pond filled with rainbow koi fish, pine trees which were almost taller than the school. Your room was filled with essentials from home such as pictures, pillows and blankets, but they were also filled with your own magus libers, the cheap ones from local bookstores, but also some authentic ones, gifted from the headmaster himself. Stress with the classic schoolwork and testings were somewhat more difficult that you imagined, resulting in the balance of your abilities to be off. You were excused from absences but during those times, you would lay in bed. You laid there for hours throughout the day, eating very little but eating when they told you so. You would talk with your soulmate as you drew on your arm and they would reply seconds later. Though you have not them them face to face, the longer the two of you talked, the longer you felt a stronger connection growing and growing between you two. You realized in those times how you were truly cared for especially by someone you’ve never even met. You were happy as you were fortunate enough to be born paired with someone. As the school year was coming to an end, a few months left exactly, you began feeling a weight lifting off your body, more and more so that you did not need to be sent home. The stress were simply vanishing, but you figured it was most likely because of testing ending. As the year went by, you began feeling dramatic changes with your abilities, gaining more as you made new friends, but to your friends, they just knew you as the mage with the powerful ability of pyrokinesis. The headmaster made it clear that your true ability of imitationis must not be revealed as his reasons were simply because “you never know who you could trust” were his exact words so you did not object. As spring break came along, your arms and legs were filled with new pieces of art on a daily basis. For some reason, bodies connected were also restricted. An example would be that you could not write direct things such as “my name is..” Those types of messages would not show up on the skin but you could spread letters out. Bodies paired are like this because soulmates are supposed to meet each other at the right time they were destined when they were born.

One day as you read in your home basement, the air cold enough for you to have an oversized white hoodie on with a blanket. Your parents had left a few days ago to go on a mission, dealing with thieves in a different country. Most missions were from those in third world countries, mages too weak in ability or lacked the knowledge to train, defend, and use their ability properly. You suddenly felt a peculiar cold tingling on your legs and you placed your book down on a glass coffee table, sliding the maroon furry blanket off of your legs to reveal white flowers painted onto your thighs and calves. As long as it showed on your skin, it would show up on your linked half as well. As you stated at your legs, the white paint showing up, you were able to see some letters forming, unsure if it was coincidence or not, however.

“Is that a..W?” Your head tilted left and right, eyebrows furrowed. The paint stopped until you felt two new marks on your right arm. “O-N.. W-O-N? Are they spelling out their name?” You thought to yourself as you scanned your body for more new letters, awaiting for new ones. There was about a brief pause before you felt more scribbling on your arm. You studied your wrist as you brought it closer. “H..O..” Then the writing stopped as you sat there for a minute or two, a smile creeping on your face. “Wonho?” you said aloud as you sat before you reached for a black pen. You opened the cap, writing on the back of your left hand, “are you ready?” It wasn’t long before there was a checkmark drawn next to the question. You moved the blanket off of your legs, revealing your thighs. You took the pen, drawing out five letters of the alphabet before you wrote out the next five a row below. You reached for a red and blue pen off of the coffee table next to your homework and circled the letters “I” and “S” in red. You spelt out the sentence “Is your name Wonho?” from your leg, switching pen colors after every word. You sat there waiting for a response for a moment or two until he responded “yes” on your knee. Even without knowing this person, your heart felt bubbly inside. It was as if it was swelling even though you did not know your soulmate well.

You sat in the bathroom for who knew how long, writing and drawing back and forth on while also scrubbing things off your legs to make space for more writings. He learned your name and many other broken small details, cause again, you couldn’t straight out facts about yourself to your soulmate, which was the only thing you found strange in this world. The topic of where you went to school did not come up until you were about to pass out from exhaustion. The last word you saw appear on your skin was Mapnerry.

~~~~~

Next Chapter

Masterlist

[cosmicsynthetics]

Heyo to all my followers or anybody else who’s here! It’s still kinda crazy to think that I’ve been freelancing for about 9 months now. I wasn’t sure how jumping right into self-employment would go, but for all the financial difficulty, it’s proven to be very rewarding and is something I’ve wanted to do since I was very, very young. I know that awhile ago, I already advertised my Patreon, but I’d like to say some things and pass it around again. I’m going to add a READ MORE, but I’d appreciate it if you took a look - it’s very important to me. It’s relevant to whether or not I’ll be able to keep producing content.

This year’s been (and likely will continue to be for some time) a crazy one in terms of money, health, and immigration matters. Here’s a list of things that have already happened or will happen that @altamaranempire​ (Jess) and I are dealing with that have kept our backs against the wall this year:

My old laptop totally died, which required me to buy a new one.

Jess’ old harddrive died, which required us to buy a new one and pay for installation (her laptop is a macbook). This same computer is currently having other technical issues that will need fixing. Right now, you literally have to open up the back, unplug the battery, reset the SMC, and unplug the powercord a couple of times every time you want to boot it.

I still need to pay for data recovery to get my old art back from the dead computer. There’s way too much on there for me to afford permanently loosing, so this is an eventuality.

The breaks on my old car finally went, which cost me both tow and a new (used) vehicle. This used vehicle now needs its own repairs done.

I needed to set up a new car insurance policy because my father no longer wanted me on his (I paid for my portion and always did so on time. He said I was too old to be on it, but I suspect he just didn’t like the confusion of me having to make a separate payment from him). This made insurance more expensive for me.

I took out a renter’s insurance policy for Jess and I to insure our computers and the basics, because this apartment is and has always been prone to problems with water damage, mold, and crappy insulation. It’s the cheapest place we can afford ($790 a month not including electricity/heating), and we do not have the savings for a house yet.

Jess had to get some medical tests done and also got very sick for a bit near the beginning of this year shortly after everything else above. She is not yet able to qualify for medicaid because of her immigration status, so this collectively cost us a bit.

Jess and I still need to go through the final steps to get her PERMANENT residency card (her current is a 2 year conditional). That will cost in the ballpark of $600 NOT counting biometrics if they want those again. This also doesn’t count the second “immigration interview”, which was horrendous last time and involved a lot of uncomfortable interrogation regarding our sexuality in relevance to the legitimacy of our marriage. I really hope they waive that this time, especially during this presidency, because I think it was much more cruel than warranted.

I’m trying to sort out some health things on my end. I’m getting tested for sleep apnea soon and I’ve lost a lot of weight which SHOULD be good but I’m keeping an eye on it considering how little I exercise and how I wasn’t all that overweight to begin with. I’ve been put on birth control pills as well to help stop my lifelong issues with near-debilitating dysmenorrhea, and even then I’m probably going to have to bounce between some different kinds. I think the current one I’m trying is literally causing hair loss and huge spikes in anxiety that I’ve never dealt with before. Think wanting to cry at least once on most days.

Simply put, since January, our savings took a huge hit and it’s been one hell of a job recovering that money, let alone staying on top of all our utility bills and rent while keeping ourselves in good shape. We already live off of 50 cent tinned veggies, powdered milk, big boxes of bulk ramen noodles for all sorts of cooking purposes, discount bread, etc. Everything we buy has to be less than a dollar or otherwise very, very worth the money. This has put me in a tough position. Though Jess will probably continue doing her commissions and art no matter what as the one with medically diagnosed anxiety and autistic spectrum disorder, if we have to buckle down too hard for art to handle, I’ll be the first one going back into a low wage, long hour job. I do not want to go back to that kind of environment unless there’s literally no other way. I didn’t realize how stressed, overtired, and generally miserable I was until getting out of that 3 year cycle of grinding retail work to pursue art. Honestly, I’ve found this more fulfilling than anything else I’ve done with myself, and I want to keep doing it. Please understand that if I need to return to “regular” work, you will be seeing very little of me. There will be very few or no slinks - there will be no other adopts - there will be no commissions - there will be very little or no “for fun” art involving my worldbuilds - and that is the last thing I want to happen. Both my art and my audience mean so, so much to me, so that’s why I’m making this post and putting all this info out there. If you want or need MORE information on all this, contact me or @altamaranempire​ and we’ll be happy to fill you in and provide details, receipts, etc. I promise this is not a trawl for $$$cashcashmoney$$$; I just wanna be able to do a job that makes me happy and makes YOU GUYS happy. SO, YOU WANT TO HELP? THEN YOU CAN:

Reblog this post and/or my commission info and Jess’ commission info! Reaching out to as many people as possible is essential to keeping a business alive - even tiny ones like ours.

Reblog art of mine and/or Jess’! I know you guys are out there faveing, but I see very few reblogs. They really do make a big difference, so if you really like something, sharing it would mean the world to me!

Commission art from us! As usual, our commissions are always open, but this is becoming make-or-break, especially for me. Feel free to poke us on tumblr or any of our other accounts.

Become a patron on my Patreon! Having a monthly assurance of some sort of income, however small, takes some of the stress off. You might get a little something for it too! I may expand my Patreon a bit with more interesting rewards/Patreon specific content updates if everything works out and I manage to make some more $$$.

Donate to my Ko-fi! Don’t worry if it’s tiny - any amount will help us. Remember, $3 is SIX CANS of veggies for us!! A few days of food if necessary.

✒ My COMMISSIONS are always OPEN! ✒ ▶ Check out my Tumblr commission page OR my DA exclusives commission page for more information! Message me anytime with your questions or requests. ▶ I’ve also got a Patreon! If you enjoy my content, please consider becoming a patron. Every dollar counts. ▶ Lastly, here’s my Ko-fi if you feel like making a donation. Thank you! <3   

[olgagarmash]

Pharmacies face extra audit burdens that threaten their existence

The clock was about to strike midnight, and Scott Newman was desperately feeding pages into a scanner, trying to prevent thousands of dollars in prescription payments from turning into a pumpkin.

As the owner of Newman Family Pharmacy, an independent drugstore in Chesapeake, Virginia, he was responding to an audit ordered by a pharmacy benefit manager, an intermediary company that handles pharmacy payments for health insurance companies. The audit notice had come in January as he was scrambling to become certified to provide covid-19 vaccines, and it had slipped his mind. Then, a month later, a final notice reminded him he needed to get 120 pages of documents supporting some 30 prescription claims scanned and uploaded by the end of the day.

“I was sure I’d be missing pages,” he recalled. “So I was rescanning stuff for the damn file.”

Every page mattered. Pharmacy benefit managers, or PBMs, suspended in-person audits because of covid last year, shifting to virtual audits, much as in-person doctor visits shifted to telehealth. Amid added pandemic pressure, that means pharmacists such as Newman are bearing significantly more workload for the audits. It also has allowed benefit managers to review — and potentially deny — more pharmacy claims than ever before.

According to data from PAAS National, a pharmacy audit assistance service, while the number of pharmacy audits in 2020 declined nearly 14% from the year before, the overall number of prescriptions reviewed went up 40%. That meant pharmacies had to provide more documentation and stood to lose much more money if auditors could find any reason — even minor clerical errors — to deny payments.

The average audit in 2020 cost pharmacies $23,978, 35% more than the annual average over the previous five years, the PAAS data shows. And the number of prescriptions reviewed in September and October was fourfold over what PAAS members had seen in previous years.

Pharmacists have long complained that audits seem to have little to do with rooting out fraud, waste and abuse, but have become a way for these intermediary companies to enrich themselves. According to business analysts at IbisWorld, the pharmacy benefit manager market in the U.S. has grown to nearly $458 billion this year, up from less than $300 billion eight years ago.

Even before the pandemic, independent pharmacies were struggling financially with reimbursement rates they say are too low, the loss of customers to mail-order services or chain pharmacies, and a variety of measures by the benefit managers, including charging pharmacies fees and keeping manufacturer rebates for themselves.

Adding insult to injury: Many independent pharmacies report having received buyout offers from the large drugstore chains that own the PBMs, which pharmacists see as the primary reason for their financial struggles.

At a minimum, pharmacists say, virtual audits increase wait times and drive up costs for customers. At worst, the audits cost pharmacies thousands of dollars in payments for drugs already dispensed to customers, and may ultimately drive them out of business.

“It’s definitely pulling pharmacy staff away from their duties, and it’s become an administrative burden, which does have a direct impact on patient safety,” said Garth Reynolds, executive director of the Illinois Pharmacists Association. “They have to be the de facto audit team for the pharmacy benefit managers.”

Trent Thiede, president of PAAS National, said many of the more than 5,000 pharmacies he works with stepped up to offer covid testing and shots and to become an even bigger resource for customers during this health crisis. “With vaccinations in full swing, priorities should be focused on serving patients and our communities, not responding to audit requests,” Thiede said.

When auditors come in person, they primarily do the review themselves, occasionally asking pharmacists to pull additional documentation.

“In these virtual audits, you have to pull the prescription, put it through a copier of some kind, get everything aggregated, get all the signature logs. They want your license off the wall. They want all the employee licenses faxed,” Thiede said. “It’s a lot more laborious for these pharmacies.”

Express Scripts, one of the nation’s largest benefit managers, moved to virtual audits as a safety measure, said spokesperson Justine Sessions. “The virtual experience is very similar to the in-person audits in both scope and scale, and are conducted with the same frequency,” she wrote in an email. “When it is safe to do so, we intend to resume on-site audits.”

CVS Caremark, a benefit manager affiliated with the CVS pharmacy chain, and OptumRx did not respond to requests for an interview.

Dave Falk, who owns 15 Illinois pharmacies, said the largest audit he had ever seen before the pandemic was for 60 to 70 prescriptions, valued at $30,000 to $40,000. Then, last fall, his pharmacy in Robinson had to defend $200,000 in prescriptions in a virtual audit.

“None of these prescriptions were below $450,” he said. “These audits are not random. It’s a money grab by PBMs.”

He was appalled when the auditor asked his pharmacist to report the temperature of the refrigerator for perishable medications. The information has no bearing on whether prescriptions filled months earlier were appropriate.

“They’re looking for any reason to recoup funds,” Falk said.

After Falk and his pharmacist spent hours providing the documentation, the auditor initially denied $36,000 in drug payments, mostly because of missing patient signatures. Like most pharmacies during the pandemic, Falk’s had stopped collecting patient signatures last year for safety reasons. Major trade associations representing the PBM companies and pharmacies had come to an agreement last year that patients wouldn’t need to sign for medications provided through mail order, delivery or curbside pickup.

Nonetheless, Falk’s staff had to track down dozens of patients to have them sign affidavits that they had received the prescriptions, reducing the auditor’s denial to $12,000.

“That’s $12,000 for ridiculous reasons,” Falk said.

In Newman’s eight years as a pharmacist, he said, he has undergone six audits, all but the most recent done in person. In the virtual one, conducted on behalf of the health insurer Humana, Newman uploaded his documentation before the deadline. But he, too, was flagged for missing signatures.

Dan Strause, president and CEO of Hometown Pharmacy in Madison, Wisconsin, said his pharmacies received more than 1,000 pages of audit requests last year, covering more than $3 million in prescription claims. That represented 1.5% of his company’s total annual revenue. He said pharmacists saw a surge last year of what they call predatory audits, which look for ways to deny legitimate payments for prescriptions.

“What they did in 2020 was reprehensible,” Strause said. “While we were taking care of patients, they’re sitting back in their comfy offices figuring out ‘How can we make money off this? Can we find a loophole? Can we find a missing document? Can we find a reason to take back stuff?’”

Lisa Dimond, a spokesperson for Humana, said the company is required by the government to perform audits to see if pharmacies are adhering to regulations, but conducted fewer audits and reviewed fewer prescriptions in 2020 than in 2019.

“We have worked to reduce as much administrative burden as possible on our network pharmacies, offering extensions, when needed, while still working to ensure pharmacies are filling prescriptions appropriately for the safety of our members,” she said in a statement.

Pharmacists bristle when large pharmacy chains that operate their own benefit managers offer to buy their stores, acknowledging that times are tough. Joe Craft owns the Happy Druggist chain of pharmacies in central Ohio. He said he regularly receives letters seeking to buy his business from the same companies that cause him to lose an average of $6,000 in payments with every audit, about a week’s worth of revenue for a single drugstore.

“When you read that letter, you’re thinking to yourself, ‘Hell, yeah, times are tough,’” he said. “Of all people, they should know.”

And oftentimes, when independents are sold to bigger chains, those drugstores are shut down, and the chain pharmacy directs customers to one of its locations miles away.

Thiede and many pharmacists believe that, while in-person audits may resume after the pandemic, virtual audits may be here to stay as well.

“They can do more because they don’t have to travel and fly across the country and sit in your pharmacy all day long,” Thiede said. “They can just do it from their home and accomplish more.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Photo: Ridofranz, Getty Images

source https://wealthch.com/pharmacies-face-extra-audit-burdens-that-threaten-their-existence/

[braindamageforbeginners]

Ice Floes

Quickly, before we begin: 1. this is a mostly-true anecdote that ties together several different, ideas I’ve had in the last two-ish days, including... 2. There are no ice floes here, it’s a reference to senecide in certain cultures (rarely practiced in Norhern Tribes and never practiced in the usual, “Send Grandma floating away on a chunk of ice!” way).

So, the first concept idea for this pieces my younger brother, Andy, who is working this summer s a fire-spotter in Idaho and/or Montana (he’s stationed in a national park that covers really big portions of both states). This is a cool, Norman Maclean manly-man style job for a grad student, and we were all fairly certain Andy would like his job (which, as a per-diem, is hard to beat, I’ll admit), and we’d all love to drop in and say hello, except I’m in very specific chemo ward 3-4 times a month (and that last week when I don’t have chemo, I still have to get them to draw my blood and run labs), so my schedule’s a little hard to work. And I started joking that, with our family’s luck, Andy would wind up in someplace with a name like ‘Dead Man’s Gulch” or “Rattleasnake Ridge” (remember that line) that we’d just as soon not bother with. Well, parents won’t be discouraged, so Dad’s thinking he might scratch off a bucket list item AND visit Andy... by backpacking to him (or near him). Which, even though he’s a nut for the treadmill, is not exactly the first phyisical task you’d nominate Dad for if you saw him in person. However, he’s decided to start training to address that very problem. Also, Andy’s fire station is somewhere in the Rattlesnake Mountains. I’m absolutely not making that up, Also, since my more-twisted jokes are apparently reshaping reality in their wake, I’d like to joke that I’ll be a multi-gabillionaire in a few years after someone reclassifies these scribbles as science-fiction.

One of the issues/questions I’m faced with all the time (aside from, “Why did we catch you tying truck nuts to Deputy Pierson’s police vehicle*?”) is how much of my time I really do devote to staying healthy and managing your disease/prescriptions/insurance/appointments. The short answer is, almost all of it. I know I spent a post last week essentially boasting how healthy I was, apart from having Stage IV cancer. What’s important is to know is that I take a weird sort of pride in that, and, as Dad has pointed out, in most cancer cases, the death/survival rate refers to elderly people who have other diseases or health issues in addition to cancer; he hasn’t heard of patients who get chemotherapy, then go for a 3-hour leg day the next day (I’d point out that having a pediatric cancer - as I did, sort of (another brain tumor) has serious long-term health implications for survivors, and now that I’m having toxic sludge pumped through me on  regular basis has a few more long-term associated-problems that I’d like to avoid. The point is, it is slowly starting to dawn on me that he might have a point, and I’m definitely doubling down on that bet, too. Which Dad knows, and knows I’ll be up for any dangerous stunt, as long as there’s even a minor probability of increased healthfulness. Which is why Dad and my step-mom invited me on Dad’s inaugural training hike; The Path of Pain (that’s not the official name, but it’s more accurate than the real thing). Now, bit of context; it’s not true that the Inuit would kill people by putting them on an ice flow and then sending them off. What is accurate - from my sources  - is that in times of famine, some Northern tribes (probably including the Inuit) would suddenly decamp in the middle of the night without telling Grandma and Grandpa. effectively leaving them to the mercy of the elements and luck/fate (to be fair, if the grandparents made it to the new camp, they were honored and informed of all future camp locations). So, I was aware of this when the following conversation occurred: SELF: This hike isn’t one of those obscure traditions where you’re going to leave the sick, infirm, and old - the societal deadwood, if you will - out in the elements to save the rest from starvation or something, is it? DAD: No. Why, are you worried we’d leave you behind? SELF: Nope, just stating - on behalf of the ill - that I have absolutely no intention of being out-distanced by the old just so I can be dire wolf bait. Also, I am absolutely prepared to lie and cheat in the name of that goal. Other people probably have better father-son chats. Other people are boring.

So, before I start describing the festivities - which involve a severe and horrifying betrayal - I might need to describe my disability status, and disability as it stands. GBM diagnosis is an automatic disability according to social security, because of that whole “really, really, high fatality rate and incredibly fast progression (although I’m okay now - I think, maybe - when I fist met Radiation Oncologist, she said the tumor had a 20% growth rate, which means it would double in size every five or so days - I shudder to think how bad, how quickly that could’ve gotten). And, even though I’m mostly-fine at the moment, for the first two weeks after my neurosurgery, I couldn’t walk. This was because I was completely numb on my left side for that time. Remember the last time you got a cavity filled and the dentist used novocaine? Imagine that sensation - or lack thereof - throughout your left side. Walking was a problem because I had no idea where my feet were (unless I was looking). I’ve come a long, long way since then, but that was not even eight months ago (before anyone asks, after a rather dismal showing by the physical therapists at the hospital, I haven’t been doing anything special to recover, other than exercising like my life depends on it). So, testing it on a steep, dangerous slope seemed bright.

Those of you who’ve been hiking with me probably have no trouble picturing the image. I don’t exactly skip up paths, but I do power through them the same grim, pig-headed determination that I’m bringing to the rest of this damned disease. The peak in question is about 1500 ft - not a prize-winner, to be sure, but it’s not a bad accomplishment for someone who couldn’t even go 150 feet not too long ago.

Now, with that smirking sense of triumph and gold star accomplishment, imagine my dismay when my wicked step-mother announced that this wasn’t the goal of the hike, the actual peak we were looking for was... 22 miles away. Okay, so that’s a bit of an exaggeration, the sum-total route was six miles, all on difficult trail. Greek heroes in classic tragedies endured less betrayal.

Now it would’ve been well within my power to request to go back; but, at that moment, I was feeling physically good at marching a mile in less than an hour, and that sensation somehow fused with testosterone, the Stetson, and male vanity, so, even though I knew at the time it might not be a good idea, all I could do was just grimly forge on with a few complaints. Good news, after a severe challenge to my dexterity, balance, and endurance, I’m still mostly-intact. I’m painfully sore from the waist down (I’ve said before, I’ll say it again, why isn’t codeine OTC in this Godforsaken country like it is in every civilized place on the planet). Left leg (and side) are not too bad, but the right foot’s killing me (I’ve tried stretching and rolling it on my yoga roller, which helped, but it’s still not up to snuff) - when I first got out of the car after arriving home (it’s a California thing; we drive for an hour to walk), I couldn’t, because that stupid right heel was too tender, And after all this, my reward to myself was an extra beer and another Tylenol. What have I become? Anyway, Dad and I have quietly agreed that sitting up and getting out of bed should definitely count as a trip to the gym (he’s also ordered a tree that’s sitting by the garage, so there’s a distinct possibility he has darker plans in store for me), and I’m personally going to try and keep my step-mother from any and all topographic maps. Still, you can’t outpace time and you’ll die if you ignore new constraints placed by disease, so I’ll look into some sort of walking stick (I spent the first five minutes back in the car slumped in the driver’s side because that’’s how achey/creeky I felt all on the left) before attempting anything that stupid and arduous again *I’ll credit Dad with this joke when he discovered that you can get a discount on these items if you order them online in bulk

[gabriellamontoya-blog1]

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[bregjetokorea]

3. University application

In this post I was initially going to track all the preparations I am doing before leaving for Korea but I realized it was going to be too lengthy. I did try to code in page jumps but Tumblr didn’t want me to do that, so I decided to break it up into two parts: application and final preparations. This is the first part. It’s still long because the entire process, from being nominated to being accepted, took over 3 full months! I tried to just create a log of each step I took in this process. Perhaps boring, perhaps not. Here we go.

  Nominated for a semester at Myongji

September 24, 2019 

Today I received the news that I have been nominated for a semester abroad at Myongji University (명지대학교)! I am very happy because it was my first pick. My dad is also really happy because I told him Park Ji-Sung is a Myongji alumnus (actually, he really didn’t care). Next to being happy I’m also relieved because my friend and classmate Bo-Jenna was nominated as well, so we get to go together! Maybe it’s my anxiety playing again but going together feels a lot more comfortable than going just by myself, knowing that I’ll always have a friend there who is going through the same culture shock as I am, who I can always check with and I won’t ever feel like a complete loner. So, there’s that, I am really excited!

Getting nominated is however just the first step of a semester abroad and a torrent of information will be coming my way in the next few weeks. Below is a broad overview of some practical things that I should expect the next coming weeks:

My home university will send a nomination to my partner university in the next two weeks, and they will tell them that they wish for me to study at their university.

Within a few weeks, the partner university will send information about the application and possible forms.

I will register with the partner university, following their guidelines and submitting the requested documents. It is very important to familiarize myself with the deadlines of Myongji university!

After submitting the application, the partner university will inform me about the status of the application.

Once I have been accepted, I can make all the necessary arrangements, for example flight tickets, visa, etc.

So that’s it for now. I will update once I know more.

  Application time!

September 30, 2019 

I received the application information from Myongji University! The deadline is quite tight so the first thing I did was try to make an appointment with my doctor for a consult on which vaccinations I need for traveling. I need to provide proof of vaccinations and test results in my application. I also checked my health insurance but so far it seems nothing needs to be changed for traveling abroad and even my vaccinations will be insured (when I found out my brain made a mental dance of joy because dear lord jesus I didn’t know vaccinations were that expensive). I still need to look into other insurances like liability and travel insurance but I’ll save that for later, it’s not part of the application. I have 2 months to prepare all the documents I need. Usually deadlines and me are not the greatest duo and I end up submitting everything the latest possible moment, but now I am really serious when I say that I’d really like to have everything ready within the next month. That way there might be a small chance of being accepted sooner so that I can apply for a visa well in time. And let’s be real, I think I’m really gonna need this attitude in Korea too considering the competitive culture.

  Getting vaxxed

October 16, 2019 

Today I finallyyyyy had my doctor’s consult regarding my vaccinations. I guess I was a little too enthusiastic when making my appointment because initially I booked with an institution that wouldn’t insure my vaccinations (always check the fine print, guys), so I had to cancel that one and wait LONG (only two weeks but I’m impatient). But in conclusion, the consultation really is something you cannot skip because which vaccinations you’ll need to get all depends on your personal situation and your budget. The ones I got today are: Hepatitis A/B and DPT. I need to get a few repeat vaccinations and have a blood test done, but I’m not sure if I can do all of this within one sit yet. Which is kinda annoying because I have to take a half-day session off for it. But it’s all for a good cause of course and I’d rather not have jaundice or putty-like stools or whatever may be the weird ass symptoms of all those scary diseases. 

Going to my doc is of course not the only thing I have done so far. A few days ago I had my visa pictures taken. It’s early but I needed new pictures for the application so I thought it would be wise to combine these. Visa photos can be no older than 6 months so I’m good. There’s a lot more to it actually. Korean visa photos need to have a white background and a whole lot of other specs that are different from Dutch passport photos. This is another thing that I never would have thought about, but I’m glad the kind man at the photo studio knew exactly what to do. Furthermore, I have filled in most of my application forms and have received all of my recommendation letters. I requested all of these from the international office at the beginning of the application because apparently every document needs to be signed and it could take some time. But honestly everything is going a lot faster than I thought. The only documents I still need are my blood test results and a transcript from my home university, but that is just a waiting game for now.

  The things I’m willing to go through for traveling... amazing

October 28, 2019 

And yet I got jabbed another needle in my arm; a Mantoux shot to test if I’m tuberculosis negative. It hurt a LOT more than the vaccinations... like a burning stingy sensation, so you’ll be warned if you ever need to have this done. I would have gone to get this tested way earlier but my doctor was quite confused about how to test for tuberculosis at all. I don’t blame them; Myongji is saying some contradicting things in the application form (the language barrier problems have started, guys). After some consulting I am now pretty sure I just need to provide negative test results. But… my doc called me last week telling me I couldn’t get it done with them, so, today, I traveled all the way to the health services location, that of course is nowhere close to my home, to get my shot. Also, I was a bit stupid and got lost in the hospital while looking for the tuberculosis center (it isn’t located in the hospital itself, lol) so I came in late. But everything else went pretty smoothly, I told them to have the statement prepared in English, and I will need to come back in 2 days to pick it up. 

Meeting my travel buddies

October 30, 2019 

This morning I picked up my tuberculosis test results. They were negative, luckily; I didn’t endure the veritable hell that was ~ that shot ~ for nothing. Or maybe I’m exaggerating a little bit about how intense it was, who knows. Anyways, the morning was a fast process (I didn’t get lost this time) and I could, fortunately, get my statement written in English like I had indicated two days ago. 

After that, I went to Eindhoven, where my home university is, because they organized a pre-departure event this afternoon for all students who are going abroad in the Spring semester. It was nice coming back to university for once and seeing my friends again, as this internship life is draining all the energy out of me and don’t meet with them often anymore. It was also fun to see how many people from different study programs chose to go abroad. We first sat in on a plenary session on how to prepare for our minor abroad. Then a student shared her experiences of living abroad in the US. But then came the fun part: a networking event where students could mingle and meet the other students travelling to the same country! So, I finally met a bunch of people who are going to South Korea! I was so surprised to see how many people are actually going and even more surprised plus a little relieved to hear that most people’s main motivation to travel wasn’t because of Hallyu. I also heard from a bunch of people they didn’t get to go to their first choice, so I’m obviously really happy that Bo-Jenna and I do. Eventually I met the 4 other students who are going to Myongji. They seem really nice and everyone’s super excited. We created a group chat in which we can discuss the application. This one girl had asked Myongji for a course list of the English courses and she shared them with us, so we can actually start to already make a selection for the learning agreement! We also talked about housing and gained some helpful insights from the others. It for sure was an interesting afternoon!

  Finishing touches

November 13, 2019 

Another afternoon was spent at the doctor’s to have my final vaccinations injected. An interval of a month was needed in between the first two hepatitis combo vaccinations. I will receive the third one once I return from Korea to be fully protected. I also had a regular checkup including an eye test and blood pressure check. What I still need though, is a blood check for hepatitis B. I thought I could get this done today, but apparently I can’t. My doc told me to come by next week but I am scared I won’t make the deadline so I made sure to plan for this in two days, which could be too soon, but I’m willing to take a risk. Not sure if the results are going to be what I hope for, but they have to be.

We also found out a couple of days ago that all Myongji students, including exchange students, are required to take Chapel classes (?? are they called classes, I don’t know??), which will be FUN because we didn’t know about it before applying. I of course knew Myongji rests on a Christian founding spirit and education policy but I never thought Chapel is a must thing for every student. Myongji students actually opposed resistance to chapel requirements over a decade ago. And classes will nowadays, apart from praying, singing hymns and listening to sermons, also feature different programs like dance performances and lectures that convey Christian values to students in a more friendly way, and to attract the attention of non-Christian students. So, I’m guessing it will actually not be that bad after all and I’m quite interested in learning how this works in an educational environment. It’s funny because the country expert we met at the pre-departure event told me we would tops see a cross on the classroom walls when it comes to Christianity presentation. She didn’t know about it either. But I’m fine with it really, I am Christian after all, I just need to get used to the idea.

Last doctor’s visit

November 15, 2019

In the early morning I went to my doctor’s again to get tested for hepatitis B and to check my blood type because I didn’t know. I called my GP and the hospital I was born in but there weren’t any records of my blood type so only thing I could do is get tested for it as well. I will get the results of both hopefully early next week. And then I’m done y’all!!

Bo-Jenna has already sent her application to Myongji and the housing company URSeoul a couple of days ago. Which is good because we are planning on sharing a room together, which she mentioned in the form, so they already know that we are going to be applying together. We will be living in Twin City Namsan which has the most convenient location ever as the building is connected to Seoul Station and subway station. They have partnered with Myongji and therefore also offer shuttle buses to the university. They work with a first come first served principle so it’s a good thing they at least know us now. They told us that I need to send my registration form, for them to send us invoice, so I’m just waiting until I get the results right now. Kind of a bummer but we need to pay all of the rent up front but I guess that’s normal in SK.

It’s getting annoying now

November 21, 2019

More waiting! I called in on my doc two days ago but the blood tests results weren’t in yet. They told me to call them today, so I did. But when I called, the results still weren’t there. My doc said they would call the lab asking why it took so long. Turned out, the results were actually already there so they faxed it to my doc. My mom picked up the documents, and everything was fine, until I saw they put on my sister’s name on the document.... Apparently, the lab made a mistake... The correct stickers were stuck to the blood tubes, but because my sister had done a stools test earlier this year, she was in their system and I wasn’t yet. And since we’re twins, they blatantly assumed it was me that was in their system. The lab promised me that the correct documents will be digitally forwarded to my GP tomorrow. I’m really mad because they haven’t even checked my social security number which is like ?? normal procedure ?? So goes to show, I am glad I set the goal of being done a month early because if I hadn’t then maybe I would have missed the deadline.

I applied...!!!

November 22, 2019 

My sister picked up the correct test results for me today. Luckily they came in well. With this, I could finish my application!! I have applied!!!! This afternoon I sent my application to my home university and they will send it to Myongji. I also applied for the housing right after. So now we wait!!

mmm

December 6, 2019

It’s been two weeks since I applied, and I feel a bit weird by just waiting, especially since I have been so busy until now. I have been looking up information about applying for a visa and I have started picking courses. Only thing is, I think the course list we were provided with isn’t really up-to-date. I feel like courses are not described well etc. I e-mailed them about it but they sent me the same one. I know the official course list is not going to be out until February, so I guess I’ll need to be making changes to my learning agreement when I arrive in Korea. But my home university told me it happens a lot and that it’s not that big of a deal.

Furthermore, the housing company has never replied or affirmed my application. They also said they would contact Bo-Jenna last week, which they didn’t. I decided to shoot them a message on KakaoTalk (most popular instant messaging app in Korea) yesterday but they haven’t replied to that either, while I can see it has been read. So yeah, don’t know what’s up. Guess they’re busy but I think it’s a bit strange. And so we wait!!

Housing Problems

December 13, 2019

Received an email from Myongji today regarding the second Seoul off-campus dormitories (the one we applied for). I now understand why they never replied to me. Myongji partnered with the housing agency, but apparently, the contract between the housing agency and the landlord is no longer available due to an internal problem. They said that if we want to stay in the building (Twin City Namsan), we have to contact the landlord ourselves and it would mean the condition of the contract (room type, cost, etc.) would be different from what they offered initially. For this reason, Myongji gave us the alternative option to stay in the on-campus dormitory. We have to decide on this quickly because we need to send the application form in 5 days.

Decisions

December 16, 2019

Myongji sent us a different application form for the on-campus housing that allows us to choose a roommate. Bo-Jenna and I discussed it and we are going to apply for a double room. It’s quite the downgrade from the room we initially opted for in Yongsan but there’s not much time to find some other place anymore without spending all my savings on rent. Location-wise it’s great; we won’t have to take public transport to go to class every day. It’s only 20 minutes by bus to Hongdae. And it’s suuuuper cheap compared to Twin City Namsan. But there’s a lot of rules and restrictions that come with living on-campus. There is, for example, a curfew, the room is super limited, probably not that many international students, just a lot of strictness. Which isn’t necessarily bad, but I would like a liiiitle more freedom to... you know... do whatever. I guess we’ll have to live with it. I’m glad we at least have a place to stay. And we do save a ton of money so there’s more room to do fun things.

University Acceptance

January 7th, 2020

Hooooray. It took a while, but I received the UAL today which means that Myongji has accepted my application. We were sent the certificate of admission and the rest of the acceptance packet by email and they will send a physical version to my home university as soon as possible. However, I was checking if all my personal information on the certificate was correct and found that they made a mistake in copying my passport number. I emailed them about it as fast as possible (which was 5:30 am for me, rip) so I hope it can be changed in time. 

Also, my learning agreement got accepted by my home uni faculty and the exam committee so I now have official permission to follow a semester abroad. I only still need to have it signed by Myongji but that will happen soon so I won’t mention it anymore.

January 8th, 2020

Myongji took care of the mistake and has been in contact with the Korean embassy in the Netherlands to verify. Everything is ok now. I was also added to a Naver Band group chat by Myongji with other exchange students where all information regarding the exchange semester is discussed. They promised to send housing updates in there as well. I’m so excited, guys!!!

As these were all the preparations I needed to do for the university app, all the next steps (visa, flight, insurance, etc.) will be discussed in a different post which you can find here. :)

[bigyack-com]

What to Consider Before Trading Your Health Data for Cash

After I signed up for my insurance plan, I got an email with a link to a “wellness program” that, if I traded some health data — such as steps from a pedometer or smartwatch exercise data — could earn me a small monthly payout and some gift cards. But the second I logged in, I felt paranoid about the whole thing.If you work for a company with employer-sponsored health insurance, there’s a chance you’ve come across wellness programs such as UnitedHealthcare Motion, Humana Go365, Attain by Aetna, and Vitality (The New York Times offers Vitality to its employees). Each program works similarly, offering some type of discount or financial incentive in exchange for reaching goals, usually verified by requesting health data collected by a phone or fitness tracker. Insurance companies offer these programs to encourage people to begin or maintain healthy habits, like eating well and exercising, thus reducing health care costs. Employers offer them as a way to provide financial rewards you can use toward the cost of insurance or gift cards.Financial rewards and gift cards are tantalizing incentives, but you shouldn’t make the choice to trade away your health data without considering the potential issues first.

What laws protect my health data?

The laws surrounding health data are complex, and your wellness program may not include the data privacy you expect. The health information you share with insurance companies, H.M.O.s, health care providers, or company health plans is protected by the Health Insurance Portability and Accountability Act (HIPAA), which helps keep your data private. But not all workplace wellness programs are covered by HIPAA. If a program or wearable tracking device is covered by HIPAA, your employer will never have access to the data collected, but if HIPAA doesn’t apply, you’re trusting those entities to not share the data with your employer, third-party ad agencies, or anyone else. Without HIPAA, a wellness program (or, more accurately, the operator or administrator behind it) may sell the health information it collects, which could put you at risk of having your data used against you or unlawfully in some way.Pam Dixon, executive director of the World Privacy Forum, told me, “The best thing to do is take a close look at the privacy policy for that program. If it is a HIPAA-covered program, they’re going to have something called a Notice of Privacy Practices.” Look for phrases like “your rights under HIPAA,” “Notice of Privacy Practices,” or “NPP” in the privacy policy.“If you see the term ‘we are HIPAA-compliant,’ the basic rule of thumb is the program does not fall under HIPAA,” Ms. Dixon added.Yes, it’s confusing — although a program may call itself compliant, that doesn’t mean it’s regulated, she said. If it’s not covered by HIPAA, that opens the door for any data you provide to potentially be shared with third parties for advertising and marketing purposes.The U.S. Department of Health and Human Services also adds this distinction: If a wellness program is offered as part of a group health plan, your information is protected by HIPAA rules; if the wellness program is offered directly by an employer, the information is not protected.When I asked Anna Slomovic, Ph.D., a data management and policy consultant, about this, she told me, “You have to remember when data is shared between organizations, what is happening is the data is copied and the copy is handed over. So one copy may be covered by HIPAA and the other copy may not be.” This could include data from the devices you track activity with, like a Fitbit, where the data is covered only by Fitbit’s privacy policy — unless it gets moved over to a HIPAA-covered entity or someone acting on its behalf.

What are the problems with this type of data sharing?

Health data is some of the most private data you have, so it’s worth being mindful of where that information is shared and how it could be used. You may not have an issue sharing the number of steps you take on your pedometer, but consider what other data your fitness tracker might gather. Referencing a chapter from the 2017 book, “Under Observation: The Interplay Between eHealth and Surveillance,” Dr. Slomovic showed how much data wearable devices, apps, and health portals collected. Even in 2014, this information ranged from location history to the modes of transport wearers tend to use.As to how your health data could be used, we can all imagine the worst-case scenarios of sharing info about our eating, dieting, and exercising habits (or lack thereof) with insurance companies, but it’s what we haven’t thought of yet that’s more worrisome. “You don’t think this data means anything, and then all the sudden somebody else takes the data and rearranges it, and all the sudden it’s a big deal,” Dr. Slomovic pointed out. We’ve already seen some surprising ways that fitness data can be repurposed, like when Nathan Ruser, a student at Australian National University, used data from the fitness app Strava to reveal the locations of military bases.Many wellness programs ask you to complete surveys and risk assessments to earn points. These surveys may also ask questions you’re not comfortable answering, like whether you plan to get pregnant in the next year or two. There’s not much to gain from sharing this type of info, and you should avoid doing so — you don’t have to answer every question.If your family is covered by your health plan, it’s important to consider their privacy as well, especially your children. Make sure your children don’t fill out any health surveys that aren’t covered by HIPAA, and watch out for programs that overreach for their data (and your partner’s, too).Even if you trust all these companies to never share your health information, don’t forget about the possibility of data breaches. In a paper published in the Annals of Internal Medicine (subscription required), researchers found that 71 percent of 1,461 reported data breaches at hospitals between October 2009 and July 2019 included sensitive info, such as patient names, addresses, email addresses, or other personal identifiers. These breaches exposed millions of people to the risk of identity theft or financial fraud.

What should I do?

Wellness programs are often marketed as a way for you to earn money, but you can also view your participation as a cost.Still, the financial benefits are hard to ignore. Though it’s important to consider the potential issues, participating in a wellness program is not universally bad. Aside from considering HIPAA coverage, it’s best to steer clear of participating in programs that ask for more info than you’re comfortable sharing (like genetic test results) or that pay based on specific outcomes, like weight loss.Beyond that, Dr. Slomovic suggested considering two questions: Do you have a choice in the first place, whether you can afford to not be in these programs, both financially and in terms of being seen as a team player? And if you can afford to choose, do you care what’s going to happen to that data?If you don’t like the potential that your data could be used in ways you don’t like, you should avoid these programs. If you’re still undecided, Ms. Dixon recommended using what she calls the “five analysis” to decide whether a program is worth it for you: “How does it impact you five days from now, five months from now, and five years from now?”Even if you’re comfortable assuming data security risks — and you consider yourself “healthy” — there’s always the possibility that your health status could change during the course of your participation in any wellness program.Sign up for the Wirecutter Weekly Newsletter and get our latest recommendations every Sunday. A version of this article appears at Wirecutter.com. Source link Read the full article

[lawlight-week]

Lawlight Week Exchange

Title: Cavalier Youth

Name of Creator: @ruindunburnit

Created For: @abillionsecrets-literally

Prompt: L and Light try to make each other jealous by dating other people.

Characters: Light Yagami, L Lawliet

Rating: Teen and up

Warning: references to (in-story) stalking and psychological torture prior, incomplete fic - to be completed/hosted at @ruindunburnit

No. of Words: 5,851

Part 1:

The case had hit a dead end.

The Kira known as Kyosuke Higuchi had been dead for over two days. His notebook had been in their possession for exactly that long. With nothing else to do, the task force was still filling out paperwork at midday when Soichiro Yagami clasped his son’s shoulder. “I know we’re not quite done here,” he said, “but have you thought about going back to To-Oh University?”

L had been working through the glass dessert bowl of gummi bears set in front of him. Footage from Higuchi’s momentary arrest played on mute on his computer. Reviewing the tapes was his newest obsession, but he turned at the sound of the chief’s voice. Light rubbed his left wrist reflexively. “What do you mean, ‘not quite done’?” he asked, gesturing to the paperwork over on the coffee table. “We’re far from done. Kira’s still out there. All we have is his notebook and his mess to clean up.”

“The notebook is almost irrelevant unless it lives up to its reputation,” L drawled.

Matsuda and Aizawa looked up from the sofas. “Come on, Ryuuzaki,” Matsuda groaned, “not this again!”

“I agree,” Aizawa said. “There’s no point to debating this crap again. If we don’t test it, we never find out if it’s the murder weapon, we’re not doing our jobs as investigators and the notebook is just a notebook. If we test it as Ryuuzaki suggests and a criminal dies, we’re no better than Kira, and if no one dies, then Kira gets the best of us. We stand to lose either way, so unless someone finds a loophole to work out if Schrodinger’s Notebook is the murder weapon, let’s drop it and get back to work.”

Both L and the chief glared at him, and yet Aizawa stood his ground. Surviving the arrest and re-joining the task force had made him brazen. Seeing a shinigami may have made him at least a little bit mad. It did, however, save them about ten minutes of an argument they’d already had.

“As I was saying,” Soichiro said to Light, “as long as you have your freedom and we don’t have a solution concerning the notebook, there’s nothing wrong with you re-enrolling and helping out at headquarters part time. Watari and Ryuuzaki both agree there’s no risk to the investigation if you do.”

“Well, as long as Ryuuzaki thinks so,” Light said. Of course, the detective wouldn’t allow a risk no matter where he was, but it didn’t stop the bristle of irritation he felt that his father brought it up. Ever since he’d regained his memories during the arrest, it had taken a little time for his mind to recover and reintegrate. As much as he knew he was Kira now, even gloated inwardly at the brilliance of his gambit, months of constant prodding and taunting had given him a bit of a complex for proving his innocence. He still saw doubts in all their eyes and he couldn’t blame them; he was only under suspicion to begin with because L knew Kira was utilizing a leak to the NPA’s investigation. As much as he knew his father would expect him to be defensive since he’d seen the constant accusations first hand, he didn’t like how it made him feel – like a child rebuked.

“No one will doubt your innocence if you take up your studies again,” L chimed in. “You’ll need a degree if you intend to be a detective for the NPA.”

At least I only missed one semester,” Light said. He could only guess at what they’d said to excuse his absence.

“You could stay at headquarters,” his father pressed, “if it helps you balance your school work and the case.”

Light nodded and looked over to L. He was back to watching the arrest footage, the screen displaying the cockpit of the helicopter. Only Light’s face remained unblurred in the film. “Sure,” Light said, “but only if Ryuuzaki can spare an afternoon for another tennis match. Right?”

“Mm.” The detective wasn’t paying attention, apparently.

“Another tennis match?”

“Yeah, Dad. It was just a friendly game on campus in April and—” he paused, remembering what had also happened that day.

“Yagami-san was very stressed,” L said. “I did mention it to him, but then, he was on strict bedrest before the–”

“You said yourself,” Light said. The last thing he needed was to be reminded of his responsibility for his father’s health. “College can be fun when no one’s trying to kill you. What would you say?”

“Work comes first,” he said, “but I’ll see what I can do. We can’t all afford to take reduced hours on full time pay.”

“Funny, I wasn’t aware you were paying me anything.”

“That’s not true. We set aside a sum under your life insurance. Of course, that money is for your family, but it covers every eventuality.”

For a moment, Light blanched. “You’re lying.”

“I wouldn’t lie about something like that,” L said around another mouthful of gummi bears. “If you want, Watari can show you – it’s under the folder marked ‘Compensation’.”

“Or,” Soichiro said, shuffling the documents in his hands, “if you want, you could move in with Miss Amane. You’re eighteen years old, and your mother and sister believe we had a disagreement about your relationship with her, so it wouldn’t be unexpected. I… spared the details.”

Light looked to L, to the expression on his face. It was entirely too interested. “I couldn’t do that,” Light said. “I know I’ve said it before, but I was only pretending to go along with Misa’s delusion for the sake of Ryuuzaki’s investigation. Her feelings towards me are completely one-sided, but he suggested I get close to her anyway. Now that the suspicions have been dropped, there’s no point to continuing that charade. It would be cruel.”

“Ouch, Light,” Matsuda said. “I’m glad she’s not around to hear that.”

“Matsuda’s right,” L said, with a tone of ‘for once’, “that’s a little cold.” The others were too busy looking at Light to notice the smirk on the detective’s face.

“Those were your orders,” Light said. From the corner of his eye, he spotted the shinigami Rem floating in through an inner wall. Although everyone in the room could see her, acknowledging it didn’t exactly make them feel at ease with the situation. “Continuing any sort of relationship with her would be wrong because, to be honest, she’s a stalker.”

Within moments, the mood of the room had shifted. “What?” Matsuda stood up from the sofa. “Misa-Misa wouldn’t do that.”

Aizawa rolled his eyes. “So a pretty girl throws herself at you. That doesn’t make her a stalker.”

L considered it. “That’s why she claimed to fall in love with you the day she saw you in Aoyama. Stalkers develop intense feelings for their victims extremely fast. If that’s the case, why didn’t you call the police?”

Light exhaled. “When we first met, it was because she followed me home. I thought she was just a lost Goth Lolita until she threatened my life on the porch step, so I invited her in and told my mother and sister that she was my girlfriend. I didn’t want them to worry or feel unsafe, and Misa seemed appeased when I played along.” He paused, taking in the concern on his father’s face, wondering just for a moment if he was actually concerned or doubtful. “I thought if I kept up the act until she left again, I could phone the police later and, if necessary, keep calling whenever she came back. I didn’t know until she was in my room that she knew who my father was, or that she had anything to do with those occult tapes, and by then she was insisting on making me her boyfriend, demanding constant contact, threatening to kill any girl she saw me with…” he shuddered, appropriately. “Naturally, I feared she might be the type to turn on my sister, so I complied and got her to go home again. I thought I could wait until the morning to file for a restraining order…”

L picked a few gummi bears out of the bowl. “Which was when you found out she was an up-and-coming idol, correct?”

“Right. And whether she was physically capable of committing murder, I realised she didn’t have to. Idols like her aren’t allowed to publically have boyfriends, and if I upset her, all she would have to do is hold a conference, tell a few lies about a boyfriend and drop his distinctive name to the press. It wouldn’t matter to a girl like her if it ruined her career, because if I survived the media storm, the NPA would find it in a background check. I’d be lucky if I got away with moving to Sapporo, changing my name and joining a tech company.”

“That’s specific,” Aizawa muttered.

“So,” Light said. “I asked my mother and sister to keep her a secret from Dad, even though her involvement in the tapes could have been a lead to the real Kira. She knew I was interested in the Kira case, and if it was a lie, the last thing I wanted to do was mislead you. I would have broken it up with her, probably received a few odd parcels in the mail and requested a restraining order, but she had to find me at school and mislead the whole case as a result.” He focused his gaze just above L’s right ear, where he watched as Rem fixed him with her yellow eye, listening almost unseen.

“Light,” his father said. “Why didn’t you say anything about this before? We could have taken measures, moved house.”

“And disrupt everything for Mom and Sayu? Besides, it would have only sounded like a convenient excuse to Ryuuzaki. He doesn’t need to investigate his way out of a paper bag – he’d assign blame until it ripped itself.”

“But Light, I thought I taught you what to do in situations like these. I thought I told you to tell me if a stranger followed you home.”

Light sighed, meeting his father’s eyes. “You were already falling ill over the case. You were already stressed because of all of L’s suspects, I alone fit both Kira’s profile and his movements. If I was Ryuuzaki, and I knew my prime suspect had been spontaneously contacted by a dangerous individual who fit the Second Kira’s profile, I wouldn’t have waited on a cover story or for my prime suspect to confess; I would have brought them in for questioning immediately.”

When he looked back at the detective, he was stuffing a dainty handful of gummi bears in his mouth. He stared at him chewing. “I agree,” L finally said. “Light-kun’s involvement with Miss Amane was the piece that was always the most suspicious. If Light-kun were Kira,” if L noticed the way Soichiro stiffened, he ignored it completely, “and he decided to find an assistant, he would have also known he was being followed from class to class. He would also know that, thanks to the sheer number of young women he was seen with, his signature ‘type’ had been noted and the least suspicious option would be to choose a woman who fit the type. Maybe what they say is true about the rules of attraction being unfathomable, and maybe it’s not unusual for an attractive man like Light-kun to simply date an attractive woman like Miss Amane, but…”

“But what, Ryuuzaki?” Light asked. He picked a couple of gummi bears from the bowl; not to eat, just to let them sit in his closed hand.

“But, Light-kun,” he pushed the bowl slightly closer to himself, “there wasn’t any chemistry, was there?”

“Absolutely none.”

“If Light-kun were Kira, he would never allow himself to be saddled with such a dangerous woman, not unless the pros of keeping her around outweighed the cons and, if you don’t mind me asking, you weren’t interested in intercourse with her, were you?”

“Not even given the circumstances,” Light said. “She would be much happier with someone else.”

“As I thought,” L said. “I’m glad you could be honest with me.”

Light set the gummi bears back on the desk and wiped his hand on a tissue from a box by his computer. L’s sweet tooth had its risks, which tended to triple when handcuffs were involved. “Thank you,” he said, “but tell me – if I was still under suspicion of being Kira, would confessing this have confirmed your suspicions, or contradicted them?”

The glass bowl was still half full, but L smiled and picked up the discarded candy. Light hid his revulsion under his current expression – concerned conviction – as L proceeded to eat them. Light’s face felt warmer at the sight, waiting. “I might have reconsidered allowing her association with you to continue,” the detective said. “But it would have been a pity to lose such a lifeline.”

So it didn’t matter after all.

“If that’s how you feel,” his father said, “then you shouldn’t continue to let her think she’s dating you. You should break up with her soon, as quickly – and gently – as possible.”

“I don’t think that’s an option,” L said. “Anything too subtle and she could convince herself it never happened.” He swivelled the chair round to find Watari wheeling in a large white cake with a pile of marzipan strawberries arranged on top. He just caught the panicked expression beginning to cloud the shinigami’s eye, willing her not to act. “If I were Light-kun, I would rip the plaster off immediately.”

“That’ll work!” Aizawa scoffed, “‘I’m breaking up with you, Misa. I just need some space from you – a hundred square feet of it, to be exact, and if I never see your face again, it couldn’t be too soon.’” He huffed again. “The Chief would fit what’s left of him in a matchbox.”

Matsuda sighed. He’d looked so uncomfortable hearing all this talk about Misa, but he knew where his loyalties lay. “Sorry, Light. At least you’ll save money.  Or, you won’t, you’ll be dead, but that won’t be so bad.”

“Don’t be an idiot,” Aizawa said. “This isn’t what he had in mind when he said he was willing to give his life for the case. It isn’t noble – it’s pathetic.”

“Both of you,” his father admonished, “think about what you’re saying.”

“I’m just saying,” Matsuda said, “there’s no Misa-Misa in the afterlife, right?”

Light sighed. He already knew what was in ‘the afterlife’, and by the look on Rem’s face, he was going to have it confirmed sooner than he had in mind.

Part 2:

Light had been too distracted by the gaps in his memories, by the question of why L would suspect him so strongly without evidence nor knowledge of committing murder, to notice it before. It had taken until that morning of the 31st, watching from the corner of his eye as the crouching detective replayed the footage from the helicopter cockpit, as he requested for the seventh time in two days permission to prove that the killer notebook did exactly as its rule-page suggested, for Light to realise that the way he felt towards him was a little more strong than ‘admiration’.

He told himself it only took so long because his mind was healing, in its own way. It would often throw out thoughts that would make sense once and then never again, and that was just the process. Having traumatic memories ripped from your brain and replaced months later alongside new traumas could do that to you. Which was why his brain had decided to reframe their months handcuffed to one another in such an absurd light.

Well, we were sleeping in the same bed – still sleeping in the same bed actually. We showered together sometimes, ate together always, fought each other. Accidents happened. It’s not like a conclusion like that was completely impossible.

He tried blaming his hormones at first. He was eighteen – still an adolescent. Superior intellect didn’t make things less intense, didn’t make the thoughts flitting through his head at the sight of the detective less confusing, but then it didn’t ebb once he sat down with a clear head to think it through. Even when he told himself that it was just the psychological effect of L’s brand of investigation that made him think of the detective as ‘desirable’ and himself as dependent on it (just that and his curiosity hanging onto the memory of stolen looks in the shower, accidental touches in bed, wondering with a quickened breath how it would feel to have him so close and have him wanting to be so close in turn) it didn’t change the fact that the detective was the closest thing to compatible he’d ever known in a human being.

In other words, he tried telling himself, it was just the relief of finding someone who could properly challenge him. It was an almost classical dilemma. He imagined numerous superheroes and villains had felt that for each other at one point or another. “It’s for more than the fight between good and evil that Professor X and Magneto stay in touch!” He’d laughed it off when Yamamoto exclaimed it back in high school – if Magneto got all hot and bothered for Professor X, he’d have the sense to take it in hand at the end of the day and not let it get in the way of his work – but that was before he experienced it first-hand.

It wouldn’t matter in the end, he knew, not for much longer. It would fade once the challenge was over and Kira won. His perfect victory was so close he could almost taste the soil they’d be throwing on L’s coffin.

That thought had made him shiver visibly. His father had asked him what was wrong, to which he had simply said that he was a little cold. He continued to work, as though he’d forgotten for the moment that if he wanted to go up to the bedroom and find a sweater, there was nothing to stop him. As though he didn’t actually have a hard time remembering that he was no longer limited by a six foot long chain with a human pivot on one end. This was not the moment to let him out of his sight.

It was worse than he thought. It was one thing to find someone – and a deadly opposition to all his plans at that – who was both compatible on a personal level and attractive in a way he’d never felt for anyone else. It was one thing to want someone so badly he’d found himself about to Gentle search ‘Stockholm syndrome’ before he remembered who would be looking through the browser histories, and on more than five occasions. It was quite another to react so strongly to the thought of that same deadly rival no longer being alive.

He thought he knew the risks going in. He was willing to sacrifice his soul, his sanity, even his family if there was no other option, and although he proceeded with his mission holding onto to all of those pieces so close-fisted, he accepted that accomplishing noble goals came with accepting a certain degree of self-sacrifice. He was ready to give up everything if it meant a better world for everyone else.

So it wasn’t exactly welcome news when he realised where exactly he was willing to draw the line. His conscience? His family? Yes, if it came down to the wire. Any hypothetical threat to his ability to act as Kira is a threat to the good of the world and the many come before the few. The obsessed investigator/warden who just wouldn’t get off his back no matter how little evidence he had? The actual, quantifiable threat to his ability to act as Kira? And give up the chance to fuck the world’s three greatest detectives all at once? No, that would be too much! He would lose his mind first.

He probably had. To think, after all he’d done, after everything he’d sacrificed already, he was still exactly as cowardly as he used to fear he was. That had to be why his priorities were so irrevocably screwed.

Light watched as L’s screen displayed the Kira known as Kyosuke Higuchi’s last moments. He saw the man seize up in the officers’ arms and drop, again, again, again. Light knew, ever since he held the notebook in his hands, his memories fully restored, ever since he caused the Straw Man Kira to drop that he could have turned his back on his duties as the First Kira. If he’d allowed L to take the notebook from him, allowed himself to lose his memories again without writing a single name, he could have stepped out of his responsibility as God in a flash. If he’d just done that and let L’s investigation peter out, he could have eventually returned to his normal life. He could have simply joined the NPA with an impressive ‘worked on the task force against Kira’ note on his resume and the Great Detective L’s representative acting as his reference, risen through the ranks. Knowing his own fate – and he’d learned a thing or two about fate in the last year – he would be back to working with L on another great case. (Maybe as the very head honcho of the NPA, he thought).

And there would be another great case, he countered; whenever Kira paused in his judgements, the crime rate only hesitated a moment before rising right back up again. He initially thought his judgements would only make potential criminals think twice before committing crimes, but in reality it didn’t make them think hard enough and it definitely didn’t eliminate crimes of passion. The crime rate would always lower by 70% while Kira was active, but that margin didn’t completely cover the spontaneous. The criminals that continued in Kira’s world were altogether worse than the ones he’d already judged; their lives meant nothing to them and they simply had nothing left to lose. He used to think it was the failings of the criminal justice system that rendered the threat of state-administered execution useless.

In reality, that was only a portion of the truth; capital punishment was never an effective threat to begin with. Now that Higuchi was gone and Misa still lacked her powers and memories, Light was currently the only Kira left – or would be, once he could get himself access to a notebook. Even if he could, the only thing that kept him in this holy justice business was knowing that, without Kira, the crime rate would be higher. Not ‘present’ – ‘higher’. If he stopped, everything he’d done as Kira would be pointless. If he stopped, every person he’d disposed of for the crime of posing a threat to his spotless record would have been killed for nothing. Since the actions of every dead or dormant Kira stemmed from him, that put the deaths of innocent police officers and detectives, scandalous celebrities, numerous businessmen at Light’s feet alone.

If he stopped what he was doing now, his dream of a crime-free tomorrow would not only have been inefficiently executed, it would remain incomplete and completely useless. Since he didn’t stop to take the easy way out while he could still lose his memories, he would know it for the rest of his life. It wasn’t a fate he was looking forward to.

–

He picked up the thread of this thought later. When he retired to the break room to eat a timely dinner alone at a table laden at one end with slices of Victoria sponge cake slices on bone-white china plates, the question rested on what he was going to do about it all.

It wasn’t all bad news. For the first time in almost a full year, he wasn’t under any formal investigation. He was still at the task force headquarters, this time under his volition, where he could keep an eye on the threats of L’s investigation. Now that the task force had possession of Kira’s ‘killing power’, the investigation had just hit a significant standstill caused by their own lack of conviction to ‘do what it takes’ to capture Kira. Taking into account that they’d lost the one person they had in connection to the original Kira, and this original Kira was apparently taking a break to let the heat die down, the standstill would remain as long as they remained paralysed by the thought of testing the notebook.

Just as Light expected, this was already driving L to boredom, and the detective had exactly two ways of dealing with boredom. If he couldn’t sate it quickly enough, he hit the ground and stayed there. If he didn’t hit the ground, he found his own fun and refused to let go. It was the detective’s worst quality, the one that could halt dangerous investigations or drive them in their own circles.

In other words, re-establishing regular judgements wasn’t at the top of Light’s to-do list. Now that it was no longer part of the plan to dispose of L either, Misa no longer had a use to him. Without her eyes, without even a notebook, she was just a walking reminder of how close L had come to winning, how close he had come to executing the both of them. She was a complete liability, and the sooner he got it squared away, the better.

It wasn’t all bad news, but the situation was a precarious one; L’s restlessness would only last so long, so if there was a time to give him something to latch onto before he found it for himself, this was it.

Light let out a deep breath he hadn’t realised he was holding, and looked up to see Matsuda resetting up the coffee machine. He was filling the top with the bitter French coffee that Light knew the detective would only have immediately after waking up and never in the middle of a work day and smiled to himself. He would have thought a man whose only quantifiable job was fetching coffee would remember a little detail like that, but neither did he get up to show him the milder, inexplicably fruitier blend that could have saved his job. As much as his claims of innocence as well as the investigation were preserved by keeping L happy, as much as he actually wanted to keep the detective happy, he’d done nothing but cause the tension to rise all day.

That settled it. L’s very presence in his life was integral to Kira’s success. Whatever he did from now on, it would be in the interest of pursuing his feelings for him. As much as L would destroy Kira at the first opportunity he had, Light knew that he’d only come as far as he had because he’d had a rival in the Great Detective L. It was a fated part of his rise to Godhood – yes, fated, not conditioned, not at all humiliating – that, if it hadn’t been for those intrusive investigative methods, he wouldn’t have grown into his role as Kira quite so well. So, it wasn’t just about his stupid desires: getting rid of the detective now while he had the upper hand would only ruin him. If he wasn’t under his watch, working closely with him just as much as he was working against him, he’d grow complacent and his progress now would mean nothing. He could already see the writing on the wall: the role of Kira uninterrupted, society eventually moulding to his vision, with no one to try to stop him but a task force he could already lead by the nose… he’d make mistakes, ridiculous ones, and for those he would pay with his life.

That didn’t mean he was necessarily going to wait until they were both in the bedroom they still shared and jump him – as things stood, that would be a suicidal move. That wasn’t to say he thought L would be against his attentions if he did; the detective just needed to learn new ways of dealing with his obsession with Light first, outside of calling him Kira and slapping handcuffs on him. The way he showed affection needed a little work.

No, more finesse was required. Unless he was careful now, L could still find him out and destroy him, and that could not be allowed to happen. If he was to remain free and have L too, it was a matter of neutralising him completely. He had to make him care for Light more than he hated Kira.

It would have to be a lot. He still wondered how he managed to rationalise the same dilemma, even wishing in the back of his mind that the man he wanted was simply ‘this man Ryuuzaki’ rather than the world’s three greatest detectives who wanted him dead most of all. He even considered that it would have made these choices easier to make if he was just his father’s boss; he knew he couldn’t help that this was how he was fated to meet the only person he could ever truly stand for more than an hour, but it was still, well, scandalous. (In which case, it was a good thing this was L rather than someone with a face to show the public – at least it couldn’t reach the media).

If Light was still having these thoughts, how was L going to rationalise being with a former suspect on a major investigation? Light didn’t think he had any illusions of integrity to abandon first, but with Watari looking out for him and the task force (including his own father, of course) who would have something to say no matter how many times Light had them wrapped around his little finger, L would have to believe that Light was worth more than losing a little face with his employees.

Matsuda picked up a slice of the cake and one of the forks left on a little tray on the counter, taking the confection back to the coffee table in the main room while he waited for the coffee machine to brew. He only paused to smile at light quickly, apologetically, as if his sweet tooth was something he ought to apologise for as a man of the law. . Light refrained from rolling his eyes, for the sake of being polite; the older man’s hang ups about performing his own masculinity were not his problem.

As to his own problem, it wasn’t quite as big as he was making it out to be. He would be making his calls to To-Oh starting tomorrow morning, beginning the process of getting re-enrolled. From as soon as next week, his time at headquarters would suddenly become limited. Just as Light knew he was used to finally working alongside someone on his own level, he knew L would begin to rue his absences when he only had the task force for company in an idling investigation. Since the suspicion on him was only dropped so recently, since his innocence depended on a circumstance not a one of them had the balls to disprove, Light was about ninety percent certain he’d put a tail on him just to have something to occupy himself with. ‘It’s just to make sure Light-kun isn’t using his new freedom to set up some Kira business – it’s best to be safe than sorry’, as the detective would tell himself.

And that is when Light will use the detective’s one truly fatal flaw: L’s desire for anything positively quadrupled when he thought he might not be able to have it. It was why he took on the most challenging cases. It was why the idea that Light couldn’t be Kira only made him hold on all the harder to the conclusion. And it was why, once Light got back to university, he’d use the oldest play in the book.

Dating other people, right where L’s tail could see him do it, acting intimately, even romantically, with anyone but L himself… it would be just the right incentive to have the detective act on his feelings. And since Kira wasn’t doing anything, the question of his feelings toward his former suspect, his want for him, would consume him above even the investigation. He’d truly regret letting Light scale back his hours. He’d have no choice but to come back to university and watch him personally. Whatever plan he might have to use the notebook against the task force’s wishes would simply have to wait until Light could stop even that.

That left Misa, the Littlest Liability herself. He’d already set up the reasons with the task force why he might want to drop her in the near future – hell, he even had their permission to dump her as soon as he could. It would help, but it wouldn’t be enough. From the moment she’d found him, she’d latched on to a near abusive, definitely dangerous degree; if she wasn’t putting his life at risk with her reckless behaviour, he was risking his life just to clean up her messes. That her very proximity to him was suspicious, it was a waste of his time and effort to say the least. When he thought he could exploit her superior power to kill L, she was just worth keeping around, but now that he’d made his decision to keep him alive…

Obviously, he couldn’t kill her. Rem would never allow it. The shinigami might consider L’s existence in perpetuity to be a threat to Misa’s life, but that didn’t mean he couldn’t extricate himself from her clutches completely either. It would just require something a tad more effective than a harsh break-up: Light wasn’t fool enough to brush off her death threats, and while she knew where he went to university, where he worked, where his family lived, she was a threat to his current plans. If she found out about his plans to seduce L, the detective would definitely wind up dead.

He meant it when he told the task force that Misa would be better off with someone who could return her feelings. But as long as Rem refused to see it that way, he could complain as much as he wanted: he was going to be stuck with her regardless. Which, obviously, was a problem.

Light sighed and lifted his head to see Matsuda heading out with L’s coffee. Setting his empty plate in the sink, he followed behind the rookie with the full pot of sugar cubes he’d forgotten. He knew it was petty, but after months of being accused of murders most foul, after two days of the black cloud of rebuilding his plans and working around L’s restlessness, watching the great detective accuse the rookie of trying to poison him seemed righteous somehow.

[stephenmccull]

Lights, Camera, No Action: Insurance Woes Beset Entertainment Industry Workers

Before the coronavirus pandemic shut down the entertainment industry in March, Jeffrey Farber had a steady flow of day jobs in film and television, including work on “Hunters” and “Blue Bloods.” But when theaters, movies and TV shows stopped production, not only did Farber lose his acting income, he also stopped accruing the hours and earnings he needed to qualify for health insurance through his labor union, SAG-AFTRA.

Without the acting jobs, his insurance would be ending this month.

“This is an unbelievable situation,” said Farber, 65, a survivor of pancreatic cancer. “There are going to be so many people who aren’t going to be able to make it.”

From Broadway to Hollywood, many actors, directors, backstage workers, musicians and others in the performing arts face similar coverage suspensions. Those in the entertainment industry often have several employers over the course of a year as they move from show to show. In some ways, they’re quintessential gig workers.

Their employers generally make financial contributions to a benefit fund under the terms of the union contract. And the workers pay premiums on their coverage. If workers accumulate a predetermined number of hours or earnings, they can qualify for coverage for up to a year. Coverage is typically comprehensive and quite inexpensive. Farber paid just $408 every three months to cover him and his husband.

It’s a model some academics think might work for others in the gig economy. “It makes coverage possible in industries like retail, construction and entertainment where it might not otherwise be offered,” said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms.

As the COVID pandemic period has shown, it doesn’t always work well. Someone in the entertainment industry may be able to weather a dry spell without any work because he’s already qualified for coverage based on past employment. But once coverage lapses, this system could leave entertainers at a disadvantage over other workers returning to a more conventional job, where coverage can start immediately. Plus, members may continue to owe union dues, even though they aren’t eligible for health benefits.

The timing of the shutdown couldn’t be worse for Farber, who needed just 12 days of work or $249 in earnings by the end of June to qualify for continued coverage in October. Accumulating that would have been “easy as pie,” he said.

In the entertainment unions’ benefit plans, “coverage is always prospective,” said Phyllis Borzi, a former assistant secretary in the Department of Labor who headed the Employee Benefits Security Administration and is now a consultant. “That works fine if you have a short interruption, but they’ve been out so long, to the extent they have hours banked, they must be out of them by now.”

SAG-AFTRA represents about 160,000 professionals in TV, radio, film and other media. The union requires that members this year generally must accumulate at least 84 days of qualifying work or earn $18,040 over four quarters to be eligible for coverage for the next four quarters.

Farber eventually got a temporary reprieve because he learned he could qualify for coverage with lower earnings under a separate category for people who are least 40 years old and have 10 or more years of health plan eligibility. But he doesn’t know how coverage changes planned for next year will affect his eligibility.

The health plan has taken some steps to alleviate concerns raised by members. In April, it cut health care premiums in half for the second quarter and this month announced a temporary reduction of COBRA premiums for some members.

The SAG-AFTRA benefit fund didn’t respond to requests for comment.

Even in the best of times, it can be difficult for those in the entertainment industry whose names appear in small print in the credits to string together enough work to qualify for coverage. If social restrictions were to ease and people could get work heading into fall, any accumulated hours and income may be too far in the past to count toward future coverage, leaving them no choice but to start accumulating them all over again.

In contrast, when employers hire someone eligible for on-the-job coverage, they typically can’t impose waiting periods longer than 90 days for health insurance under the Affordable Care Act.

Like people who work for a single employer, workers who lose coverage through their union benefit plan can continue their coverage for up to 18 months under federal COBRA law, but workers who make that choice generally have to pick up the entire cost of the plan. And COBRA coverage is not cheap. They may also enroll in a plan on their state marketplace set up by the Affordable Care Act or, if they qualify, in Medicaid, the federal-state program for low-income people.

When the pandemic hit in mid-March, Dee Nichols had logged 512 of the 600 hours he needed to accumulate in a six-month period to qualify for health coverage with the Motion Picture Industry health plan.

Nichols, a camera operator in Los Angeles who is a member of Local 600 of the International Cinematographers Guild, had two shows lined up in early March that would have brought him up to the threshold by March 21, the end of his qualifying period for coverage. Then production was canceled.

It wasn’t the first time that Nichols, 49, had missed the hours target for coverage through his union plan. “You’re trying to fill a tub of water and it keeps getting holes,” Nichols said. Meanwhile, he pays $400 a month for an individual marketplace plan with a $6,000 deductible. “They’re fine with guys like me contributing and then not being able to pull [benefits] out of it,” he said. “It drives me insane.”

The Motion Picture Industry health plan also offered some relief to members, including extending them some hours of credit, waiving premiums for dependents and offering COBRA subsidies.

But the assistance didn’t help Nichols qualify for coverage.

He and another member are part of a class action lawsuit arguing that the health plan has a responsibility under federal law to treat all plan participants equally.

The health plan didn’t respond to a request for comment.

Unclear When ‘We’ll Work Again’

To assist its members during the pandemic, the Actors’ Equity Association health plan waived premiums for three months starting in May and is temporarily offering a lower-cost plan through the end of the year.

But since these multi-employer plans are self-funded, they pay members’ claims directly. That can cause problems when work is scant and employers aren’t paying into the fund.

“All of these health funds have different financial positions, and they have to maintain reserves in order to maintain coverage for their members,” said Brandon Lorenz, communications director of the Actors’ Equity Association, which represents approximately 52,000 actors and stage managers.

SAG-AFTRA, which has projected a $141 million deficit in its health plan this year, announced far-reaching changes to coverage for next year, including higher thresholds on earnings and days worked to qualify for coverage.

That could prove an added challenge for Jeffrey Farber, who is concerned about what job opportunities will be available when the industry recovers.

“None of us knows when production is going to start again or if we’ll work again,” he said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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This story can be republished for free (details).

Lights, Camera, No Action: Insurance Woes Beset Entertainment Industry Workers published first on https://smartdrinkingweb.weebly.com/

[dinafbrownil]

Lights, Camera, No Action: Insurance Woes Beset Entertainment Industry Workers

Before the coronavirus pandemic shut down the entertainment industry in March, Jeffrey Farber had a steady flow of day jobs in film and television, including work on “Hunters” and “Blue Bloods.” But when theaters, movies and TV shows stopped production, not only did Farber lose his acting income, he also stopped accruing the hours and earnings he needed to qualify for health insurance through his labor union, SAG-AFTRA.

Without the acting jobs, his insurance would be ending this month.

“This is an unbelievable situation,” said Farber, 65, a survivor of pancreatic cancer. “There are going to be so many people who aren’t going to be able to make it.”

From Broadway to Hollywood, many actors, directors, backstage workers, musicians and others in the performing arts face similar coverage suspensions. Those in the entertainment industry often have several employers over the course of a year as they move from show to show. In some ways, they’re quintessential gig workers.

Their employers generally make financial contributions to a benefit fund under the terms of the union contract. And the workers pay premiums on their coverage. If workers accumulate a predetermined number of hours or earnings, they can qualify for coverage for up to a year. Coverage is typically comprehensive and quite inexpensive. Farber paid just $408 every three months to cover him and his husband.

It’s a model some academics think might work for others in the gig economy. “It makes coverage possible in industries like retail, construction and entertainment where it might not otherwise be offered,” said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms.

As the COVID pandemic period has shown, it doesn’t always work well. Someone in the entertainment industry may be able to weather a dry spell without any work because he’s already qualified for coverage based on past employment. But once coverage lapses, this system could leave entertainers at a disadvantage over other workers returning to a more conventional job, where coverage can start immediately. Plus, members may continue to owe union dues, even though they aren’t eligible for health benefits.

The timing of the shutdown couldn’t be worse for Farber, who needed just 12 days of work or $249 in earnings by the end of June to qualify for continued coverage in October. Accumulating that would have been “easy as pie,” he said.

In the entertainment unions’ benefit plans, “coverage is always prospective,” said Phyllis Borzi, a former assistant secretary in the Department of Labor who headed the Employee Benefits Security Administration and is now a consultant. “That works fine if you have a short interruption, but they’ve been out so long, to the extent they have hours banked, they must be out of them by now.”

SAG-AFTRA represents about 160,000 professionals in TV, radio, film and other media. The union requires that members this year generally must accumulate at least 84 days of qualifying work or earn $18,040 over four quarters to be eligible for coverage for the next four quarters.

Farber eventually got a temporary reprieve because he learned he could qualify for coverage with lower earnings under a separate category for people who are least 40 years old and have 10 or more years of health plan eligibility. But he doesn’t know how coverage changes planned for next year will affect his eligibility.

The health plan has taken some steps to alleviate concerns raised by members. In April, it cut health care premiums in half for the second quarter and this month announced a temporary reduction of COBRA premiums for some members.

The SAG-AFTRA benefit fund didn’t respond to requests for comment.

Even in the best of times, it can be difficult for those in the entertainment industry whose names appear in small print in the credits to string together enough work to qualify for coverage. If social restrictions were to ease and people could get work heading into fall, any accumulated hours and income may be too far in the past to count toward future coverage, leaving them no choice but to start accumulating them all over again.

In contrast, when employers hire someone eligible for on-the-job coverage, they typically can’t impose waiting periods longer than 90 days for health insurance under the Affordable Care Act.

Like people who work for a single employer, workers who lose coverage through their union benefit plan can continue their coverage for up to 18 months under federal COBRA law, but workers who make that choice generally have to pick up the entire cost of the plan. And COBRA coverage is not cheap. They may also enroll in a plan on their state marketplace set up by the Affordable Care Act or, if they qualify, in Medicaid, the federal-state program for low-income people.

When the pandemic hit in mid-March, Dee Nichols had logged 512 of the 600 hours he needed to accumulate in a six-month period to qualify for health coverage with the Motion Picture Industry health plan.

Nichols, a camera operator in Los Angeles who is a member of Local 600 of the International Cinematographers Guild, had two shows lined up in early March that would have brought him up to the threshold by March 21, the end of his qualifying period for coverage. Then production was canceled.

It wasn’t the first time that Nichols, 49, had missed the hours target for coverage through his union plan. “You’re trying to fill a tub of water and it keeps getting holes,” Nichols said. Meanwhile, he pays $400 a month for an individual marketplace plan with a $6,000 deductible. “They’re fine with guys like me contributing and then not being able to pull [benefits] out of it,” he said. “It drives me insane.”

The Motion Picture Industry health plan also offered some relief to members, including extending them some hours of credit, waiving premiums for dependents and offering COBRA subsidies.

But the assistance didn’t help Nichols qualify for coverage.

He and another member are part of a class action lawsuit arguing that the health plan has a responsibility under federal law to treat all plan participants equally.

The health plan didn’t respond to a request for comment.

Unclear When ‘We’ll Work Again’

To assist its members during the pandemic, the Actors’ Equity Association health plan waived premiums for three months starting in May and is temporarily offering a lower-cost plan through the end of the year.

But since these multi-employer plans are self-funded, they pay members’ claims directly. That can cause problems when work is scant and employers aren’t paying into the fund.

“All of these health funds have different financial positions, and they have to maintain reserves in order to maintain coverage for their members,” said Brandon Lorenz, communications director of the Actors’ Equity Association, which represents approximately 52,000 actors and stage managers.

SAG-AFTRA, which has projected a $141 million deficit in its health plan this year, announced far-reaching changes to coverage for next year, including higher thresholds on earnings and days worked to qualify for coverage.

That could prove an added challenge for Jeffrey Farber, who is concerned about what job opportunities will be available when the industry recovers.

“None of us knows when production is going to start again or if we’ll work again,” he said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

from Updates By Dina https://khn.org/news/lights-camera-no-action-insurance-woes-beset-entertainment-industry-workers/

[seanmalatesta]

5 Reasons You Need a Business Coach

In early 2002, I was the general manager of Nelson Books, one of Thomas Nelson Publishers’ fourteen divisions. In eighteen months, we had gone from number fourteen—dead last—to number one in terms of revenue growth and profit margin. I felt great. I was proud of myself and my team for the results we’d achieved.

That euphoria lasted for about a day. 

Then it began to dawn on me that I was out of tricks. I’d harvested all the low-hanging fruit in an effort to turn the business around. I knew that continued growth would be difficult. And, I wasn’t certain I could deliver it. Getting to No. 1 and staying at No. 1 are two different things.

That’s when I first considered hiring a business coach. I asked John Maxwell, a leadership expert and one of my authors, if he could recommend one. He introduced me to Daniel Harkavy, the founder of Building Champions, an executive coaching company. We hit it off from the start.

After my initial call with Daniel, I went to my boss, Sam Moore, to explain why I wanted the company to foot the bill for Daniel’s fees. He was surprised by my request. “Why do you need a coach?” he exclaimed. “You’ve just transformed our worst division into our best. You’re our most successful publisher!”

I replied, “Yes, but the world’s top performers all have coaches. That’s how they get there and stay there.” I then went on to point out that even Tiger Woods—the world’s best golfer at the time—had a coach. So did Tom Brady, who had just taken the New England Patriots to their first (but not last) Super Bowl win. 

I then said, “You want me to keep winning, right?”

“Of course,” he said.

“Then I need a coach.”

He laughed and then approved my request.

Daniel and I talked every two weeks. I shared my problems and opportunities. He advised me and held me accountable to my commitments. He helped me see what I couldn’t see. He challenged my thinking and expressed his belief in my leadership, even when I felt less than confident.

Coaching had a direct, positive impact on my results. 

I led Nelson Books for two more years before I was promoted. It remained the top-performing division in the company for more than a decade. When I left the company in 2011 to found Michael Hyatt & Company, it was still Thomas Nelson’s most profitable division.

I’ve had a formal business coach since 2002 when I met Daniel, with the exception of very brief transition periods. It’s the single best investment I’ve ever made in my professional success. It’s also why I’m so passionate about coaching and why our BusinessAccelerator coaching program is the single most important thing we do at Michael Hyatt & Company.

So I’d like to make the case for hiring a business coach. If you already have a coach, this will explain why you’ve made a smart decision. If you don’t have one, this will hopefully convince you why it’s important to get one—and, frankly, the sooner the better. 

There are at least five reasons why you should hire a business coach.

1. Because you recognize the need for a change.

If you’re happy with the status quo—business-as-usual—don’t hire a business coach. You don’t need one. But if you’re unhappy with the results you’ve been getting, you need to consider it. For example, perhaps—

You feel overwhelmed with what’s on your plate and don’t know where to focus.

You keep missing your goals—or don’t have any goals.

Your professional and personal life are unbalanced. You’re spending way too much time at work.

Your sales have stalled or your margins have eroded.

You’re not sure you have the right people. Your hiring process feels risky and unpredictable.

Your competitors are getting more aggressive and you’re fighting harder than ever to acquire and retain customers.

You know you need to grow professionally in order to lead your organization to the next level.

If this sounds like you—if you want something to change—you need a coach.

2. Because you want an edge against the odds.

Let me state it bluntly: the odds are stacked against you. According to the Department of Commerce, entrepreneurs start four million new businesses a year in the U.S. Eighty percent of those will fail within the first five years. Of those that survive, eighty percent of those will fail in the next five years.

This means you have a 96 percent chance of failure in the first ten years of starting a business. Or to flip it around, you only have a 4 percent chance of surviving your first ten years in business.

Those aren’t great odds, are they? 

Let’s switch contexts. Imagine you’re facing a daunting challenge in some area other than business. Let’s say you wanted to climb Mt. Everest. You know the journey will be difficult and dangerous. You read that in 2019 alone, eleven people died in the attempt. It’s a risky venture but you’re excited about the possibility of achieving your goal.

Do you think it would be smart to go-it-alone? I don’t think so. I’ll bet you’d hire a guide, right? That would be the smart thing to do. You want someone who has made it to the top and back, preferably multiple times under a variety of weather conditions. 

The truth is that there is only one way to learn: trial and error. But it doesn’t have to come from your trials or your errors. By hiring a coach, you outsource your mistakes and dramatically improve your odds for success.

“ By hiring a coach, you outsource your mistakes and dramatically improve your odds for success.

—MICHAEL HYATT

3. Because you want to fill in gaps in your knowledge or skills.

In business, you will eventually reach the limits of your own knowledge and skills. If you don’t continue to grow professionally, you limit your company’s ability to grow. You become the governor on the engine of growth. As John Maxwell says, “everything rises and falls on leadership.”

Sadly, even if you have a business degree or even an MBA in business, you probably didn’t learn:

How to set and achieve clear business goals

How to translate your annual and quarterly goals into daily actions that drive growth

How to align your team around those same goals so everyone is “rowing in the same direction”

How to stay focused on your most important priorities so you aren’t distracted by the deluge of requests, demands, and even opportunities

How to find, hire, and develop world-class teammates

How to build a culture that drives operating results

How to delegate in such a way that the work product meets or exceeds your standards

How to find new customers or retain the ones you have

How to do real-world strategic planning that creates a filter for what opportunities you pursue and what opportunities you don’t

How to identify the key metrics you need to monitor to insure the health of your business

How to use financial reports, not only to tell you what happened, but what’s about to happen

How to transform setbacks and failure into the jet fuel you need for rapid iteration and improvement

Good coaching is based on sound theory, but it doesn’t stop there as it often does in a university setting. Instead, it includes practical frameworks and step-by-step processes for delivering real-world results.

4. Because you know you need to work on your business not just in it.

If there’s one thing I hear from business owners and senior executives the most, it’s that they are so busy working in the business, they don’t have time to work on the business. This is crucial. If you are going to scale your business and do it in a sustainable way, you need time to think.

Specifically, you need time to think about what you really want. For example:

How do you want your business to look in three to five years?

How can you engineer your role so you are doing more in your Desire Zone and less in each of the other three zones?

Are you happy with your company’s culture? What could you change to make it better?

Are your compensation and benefits sufficient to attract and retain top talent?

Do you have the right organizational structure for this stage of your business?

How could you sell more of your existing products or services to your existing customers? Are there new products you could create to better serve your existing customers? Are their new customers in markets you don’t currently serve who could benefit from your existing products?

What processes need to be re-imagined or re-engineered, so you can produce results faster, cheaper, or better?

Where in your business do you need a break-through?

These are just a handful of the questions that deserve serious reflection. But you’ll never find the time unless you are intentional. Coaching provides the opportunity—the context—where this can happen on a regular basis. It’s a chance to poke your head above the clouds, evaluate where you’ve been, embrace the reality of where you are, and chart a course to where you want to go.

By the way, I occasionally hear clients complain about the time required to participate in our coaching program. This is especially true for clients who live on the west coast or in another country. “I’m not sure I can afford two (or three) days out of the office each quarter.”

My response is, “What does it make possible?” What if you dedicated this time, including time on the plane, as “think time”? This is what Megan Hyatt Miller, my COO, and I enjoyed getting coaching together. 

We would determine in advance a problem we want to solve or an opportunity we want to exploit. That became the theme of our trip. We would talk about it on the plane, then interact about it over meals. We typically stayed an extra day to use the morning after our coaching sessions to reduce our discoveries to specific action items.

Coaching time has become so valuable to our business that we literally can’t afford to not take time for it once a quarter.

5. Because you want to go further, faster.

There are two ways to get ahead in business: the slow way and the fast way. The slow way is to rely on your own knowledge, experience, and skills. The fast way is to rely on someone else’s knowledge, experience, and skills.

For example, I am an avid fly fisherman. I have all my own gear. I know how to set up my fishing rig. I know how to tie the knots. If I decide to fish a particular stream, I can usually find an online “Fishing Report” that will tell me exactly what bugs the fish I’m hunting are eating. I know how to cast, how to untangle my line, and how to net a fish and correctly release it unharmed.

So why do I always hire a fishing guide when I go fishing? Isn’t that just a waste of money?

No. Here’s why. When I go fishing, I want to catch as many fish as possible. I also want to catch the biggest fish possible. I like fishing, but I love catching!

There’s no way my amateur skills can produce the same results as a professional guide. Even if I have fished that particular stream before, I probably haven’t fished it in this season or in exactly this weather. I can’t compete with a guide who fishes that same stream all day every day. Using a guide helps me get bigger, better results, faster.

The same is true of a business coach. If they have the right experience, they have dealt with the problem or opportunity you are facing dozens of times—maybe hundreds of times—in a variety of contexts. They can help you get the results you want sooner rather than later.

Coaching is what gives an edge to professional athletes, renowned musicians, and successful business leaders. There’s no question that you need it. Every leader does. The only real question is this: When will you start? 

from Michael Hyatt https://ift.tt/2W54uZa via IFTTT

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Lights, Camera, No Action: Insurance Woes Beset Entertainment Industry Workers

Before the coronavirus pandemic shut down the entertainment industry in March, Jeffrey Farber had a steady flow of day jobs in film and television, including work on “Hunters” and “Blue Bloods.” But when theaters, movies and TV shows stopped production, not only did Farber lose his acting income, he also stopped accruing the hours and earnings he needed to qualify for health insurance through his labor union, SAG-AFTRA.

Without the acting jobs, his insurance would be ending this month.

“This is an unbelievable situation,” said Farber, 65, a survivor of pancreatic cancer. “There are going to be so many people who aren’t going to be able to make it.”

From Broadway to Hollywood, many actors, directors, backstage workers, musicians and others in the performing arts face similar coverage suspensions. Those in the entertainment industry often have several employers over the course of a year as they move from show to show. In some ways, they’re quintessential gig workers.

Their employers generally make financial contributions to a benefit fund under the terms of the union contract. And the workers pay premiums on their coverage. If workers accumulate a predetermined number of hours or earnings, they can qualify for coverage for up to a year. Coverage is typically comprehensive and quite inexpensive. Farber paid just $408 every three months to cover him and his husband.

It’s a model some academics think might work for others in the gig economy. “It makes coverage possible in industries like retail, construction and entertainment where it might not otherwise be offered,” said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms.

As the COVID pandemic period has shown, it doesn’t always work well. Someone in the entertainment industry may be able to weather a dry spell without any work because he’s already qualified for coverage based on past employment. But once coverage lapses, this system could leave entertainers at a disadvantage over other workers returning to a more conventional job, where coverage can start immediately. Plus, members may continue to owe union dues, even though they aren’t eligible for health benefits.

The timing of the shutdown couldn’t be worse for Farber, who needed just 12 days of work or $249 in earnings by the end of June to qualify for continued coverage in October. Accumulating that would have been “easy as pie,” he said.

In the entertainment unions’ benefit plans, “coverage is always prospective,” said Phyllis Borzi, a former assistant secretary in the Department of Labor who headed the Employee Benefits Security Administration and is now a consultant. “That works fine if you have a short interruption, but they’ve been out so long, to the extent they have hours banked, they must be out of them by now.”

SAG-AFTRA represents about 160,000 professionals in TV, radio, film and other media. The union requires that members this year generally must accumulate at least 84 days of qualifying work or earn $18,040 over four quarters to be eligible for coverage for the next four quarters.

Farber eventually got a temporary reprieve because he learned he could qualify for coverage with lower earnings under a separate category for people who are least 40 years old and have 10 or more years of health plan eligibility. But he doesn’t know how coverage changes planned for next year will affect his eligibility.

The health plan has taken some steps to alleviate concerns raised by members. In April, it cut health care premiums in half for the second quarter and this month announced a temporary reduction of COBRA premiums for some members.

The SAG-AFTRA benefit fund didn’t respond to requests for comment.

Even in the best of times, it can be difficult for those in the entertainment industry whose names appear in small print in the credits to string together enough work to qualify for coverage. If social restrictions were to ease and people could get work heading into fall, any accumulated hours and income may be too far in the past to count toward future coverage, leaving them no choice but to start accumulating them all over again.

In contrast, when employers hire someone eligible for on-the-job coverage, they typically can’t impose waiting periods longer than 90 days for health insurance under the Affordable Care Act.

Like people who work for a single employer, workers who lose coverage through their union benefit plan can continue their coverage for up to 18 months under federal COBRA law, but workers who make that choice generally have to pick up the entire cost of the plan. And COBRA coverage is not cheap. They may also enroll in a plan on their state marketplace set up by the Affordable Care Act or, if they qualify, in Medicaid, the federal-state program for low-income people.

When the pandemic hit in mid-March, Dee Nichols had logged 512 of the 600 hours he needed to accumulate in a six-month period to qualify for health coverage with the Motion Picture Industry health plan.

Nichols, a camera operator in Los Angeles who is a member of Local 600 of the International Cinematographers Guild, had two shows lined up in early March that would have brought him up to the threshold by March 21, the end of his qualifying period for coverage. Then production was canceled.

It wasn’t the first time that Nichols, 49, had missed the hours target for coverage through his union plan. “You’re trying to fill a tub of water and it keeps getting holes,” Nichols said. Meanwhile, he pays $400 a month for an individual marketplace plan with a $6,000 deductible. “They’re fine with guys like me contributing and then not being able to pull [benefits] out of it,” he said. “It drives me insane.”

The Motion Picture Industry health plan also offered some relief to members, including extending them some hours of credit, waiving premiums for dependents and offering COBRA subsidies.

But the assistance didn’t help Nichols qualify for coverage.

He and another member are part of a class action lawsuit arguing that the health plan has a responsibility under federal law to treat all plan participants equally.

The health plan didn’t respond to a request for comment.

Unclear When ‘We’ll Work Again’

To assist its members during the pandemic, the Actors’ Equity Association health plan waived premiums for three months starting in May and is temporarily offering a lower-cost plan through the end of the year.

But since these multi-employer plans are self-funded, they pay members’ claims directly. That can cause problems when work is scant and employers aren’t paying into the fund.

“All of these health funds have different financial positions, and they have to maintain reserves in order to maintain coverage for their members,” said Brandon Lorenz, communications director of the Actors’ Equity Association, which represents approximately 52,000 actors and stage managers.

SAG-AFTRA, which has projected a $141 million deficit in its health plan this year, announced far-reaching changes to coverage for next year, including higher thresholds on earnings and days worked to qualify for coverage.

That could prove an added challenge for Jeffrey Farber, who is concerned about what job opportunities will be available when the industry recovers.

“None of us knows when production is going to start again or if we’ll work again,” he said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Canadians with lifelong disabilities can lose disability tax credit: ‘It’s concerning’

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Canadians with lifelong disabilities can lose disability tax credit: ‘It’s concerning’

When Robert Morley got the news that his application for the federal disability tax credit (DTC) had been denied in December 2019, he felt a mix of emotions, he said.

“On the one hand, I wasn’t at all surprised. On the other, I had kind of hoped that [since] I’ve been approved once, they would know I have the disability.”

Morley, 49, was diagnosed with myalgic encephalomyelitis, commonly known as chronic fatigue syndrome, in 2010. The condition means even small, routine tasks of everyday living leave him utterly exhausted and in need of prolonged rest, he said.

“If I shower, I have to take a break,” he said. “If I cook a meal, I have to take a break. I can’t go out. I can’t see friends.”

And the illness makes him unable to work, he said.

But it wasn’t until 2015, after a byzantine bureaucratic process and multiple initial denials, that the Canada Revenue Agency approved him for the DTC, a non-refundable credit for people with disabilities and their families.

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At the time, the agency made the approval retroactive to the 2006 tax year, when Morley’s condition started.

2:05 CRA denies criteria change for disability tax credit, will review rejected application

CRA denies criteria change for disability tax credit, will review rejected application

But CRA also told him he’d have to re-apply for the DTC in 2019, so the agency could reassess his eligibility for the tax break.

That deadline had been looming large for Morley’s partner, Patrick, who told Global News he started to feel anxious months ahead of the new DTC application as memories came back of the couple’s first, multi-year attempt to claim the credit.

“I felt stressed about this all year, knowing the difficulty we had the first time.”

The credit works out to around $1,500 to $2,000 per year, a significant amount for the couple, who lives on Patrick’s modest income as a communications coordinator at a non-profit, Morley said.

READ MORE: The CRA makes it so hard to get the disability tax credit, many don’t even try

Despite their apprehension, the couple had held out hope their second time applying for the credit would go smoothly. After all, the CRA had already approved Morley once, and his doctor agreed the condition had not improved since then.

Instead, their application was denied. In August, the couple received a first denial letter from CRA, stating: “Although we do not question the seriousness of your medical condition, we must base the decision on the specific eligibility criteria in the Income Tax Act.”

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“Based on the information we received,” the letter continues, “you do not meet the eligibility criteria because the cumulative effect of your restrictions is not equivalent to a marked restriction in one basic activity of daily living.”

READ MORE: The disability tax credit was an explosive issue for the Liberals. Will the next government fix it?

That obscure language is familiar to anyone who’s been dealing with the DTC.

Canadians with disabilities have to pay a physician or other qualified health professional to certify that they are “markedly” restricted in at least one activity of daily living all or most of the time, or that the cumulative effect of restrictions across several activities is equivalent to being markedly restricted on one basic activity. (Those who require life-sustaining therapy at least three times a week, for a total of at least 14 hours a week, also qualify for the credit.)

A copy of Morley’s DTC application viewed by Global News shows his doctor deemed that while he doesn’t meet the bar for a “marked restriction,” the sum of his symptoms — which include cognitive impairment and difficulty walking — is equivalent to a marked restriction.

2:47 Verdun woman denied disability insurance

Verdun woman denied disability insurance

Accessing the DTC is a struggle, experts say, especially for those with ‘invisible disabilities’

Being approved for the DTC once does not guarantee reapproval, even for disabilities that are widely known to be lifelong conditions, said Jennifer Zwicker, director of health policy at the University of Calgary’s School of Public Policy.

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Families with dependents with autism, for example, are often asked to reapply for the DTC every few years, Zwicker said.

“It’s concerning because it’s not like autism is going to go away.”

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In general, qualifying for the DTC has become significantly harder over the past five years or so, said Jason Heath, a financial planner in Thornhill, Ont., who’s helped many clients apply for the credit.

“It was very common in the past for a child with a learning disability, for example, to qualify for the disability tax credit,” he said.

While the rules for accessing the DTC haven’t changed, the way the CRA interprets them seems to have become stricter, he added.

A 2018 paper co-authored by Zwicker found that only 40 per cent of adults who live with a severe disability in Canada use the DTC. The study also suggested the rules used by the CRA to assess eligibility for the credit are likely one of the main reasons for the poor uptake.

READ MORE: Canada’s disability tax credit program needs major overhaul, Senate committee urges

The application form has a check-the-box format that doesn’t fit the reality of many disabilities, the report suggested. Physicians sometimes struggle to describe how the applicant’s disability affects their daily lives, and sometimes they receive confusing follow-up requests from the CRA for additional information, according to the report.

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There is also a lack of consistency and transparency in how the tax agency reviews applications.

In Morely’s case, documents reviewed by Global News show doctors struggling to fill the forms correctly. Morley also said the CRA failed to notify him of follow-up requests to the physicians, which made it difficult for him to ensure additional information would be sent back to the agency by deadline.

People with so-called “invisible disabilities” are especially likely to struggle to access the DTC, both Zwicker and Heath said.

Those who are deemed ineligible are denied not only the possibility to pay lower taxes but also access to a number of other, often more financially significant benefits.

Among them is the Registered Disability Savings Plan (RDSP), a registered savings plan that’s eligible for a lifetime maximum of up to $70,000 in government matching grants and $20,000 in government bonds.

2:13 Moncton man with diabetes denied disability tax credit

Moncton man with diabetes denied disability tax credit

Change afoot in Ottawa

The good news for Morley and others in a similar situation is Ottawa has taken steps to address the issues around the DTC.

In its 2019 budget, the Trudeau government proposed to axe a rule that requires those who lose their eligibility for the DTC to close their RDSP and return to the government any grants or bonds received in the previous 10 years.

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The new rules “intended to come into effect on January 1, 2021 and would become law when the enabling legislation receives Royal Assent,” a spokesperson at the Ministry of Finance told Global News via email.

In the meantime, RDSP issues aren’t required to close an RDSP account simply because its beneficiary is no longer eligible for the DTC, the ministry also said.

Still, those who lose eligibility for the DTC still stand to lose access to any future government RDSP contributions.

READ MORE: Cancer patient was cut off from work disability benefits for 10 months — his story has warning for everyone

Efforts are underway to improve the DTC application and review process as well.

In 2017, public outcry over denials of DTC prompted the Liberal government to reinstate the Disability Advisory Committee (DAC), a body tasked with providing advice to the CRA that was disbanded by the Harper government in 2006.

Last year, the committee published a report with detailed recommendations for an overhaul of the DTC, including rewriting the eligibility criteria, streamlining the application process and making the tax credit refundable.

The report also notes: “a particular concern is a notable increase in the rejections of individuals reapplying for the DTC after receiving it for 5, 10, and 20-plus years, even though their medical condition remains the same.”

READ MORE: ‘I couldn’t believe it’ — why disability claims for mental health are often a struggle

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While some of the committee’s recommendations require legislative action, the CRA told Global News it’s on track to implement most, if not all, of the recommended administrative changes by the spring of 2020.

“The CRA is proud to support the important work of the Disability Advisory Committee and is committed to providing open, transparent and ongoing communications to Canadians on the progress made by the Committee to help improve the lives of Canadians living with disabilities,” the agency said via email.

Among the changes already adopted are a redesigned application form, the ability to file electronically and a new “navigator” role to liaise among the applicant, the CRA, and medical practitioners.

For his part, Morely said he and Patrick are planning to take their case to the Tax Court of Canada.

“There’s something so desperately wrong here.”

© 2020 Global News, a division of Corus Entertainment Inc.

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