#just remember that the reps you talk to are often minimum wage people working overseas

[tinybluealien]

ask for it in writing. and honestly, just asking for the name, npi, and specialty of the medical director who denied it is often enough, especially if you've appealed and they denied the appeal.

a depressingly lot of the time, the medical director who signed off on the denial? practicing out of specialty, and may not have a valid npi anymore. if the npi isn't valid, it's often because they were sued for malpractice of some kind and their state medical board told them they're no longer allowed to see patients.

insurance doesn't want you to know that, because if you do, you can sue, or use it to argue in front of the state medical board as a final appeal (yes, that IS a thing. if you exhaust your appeals, you can appeal to the appropriate state board and try your luck.).

so instead, insurance will often just reverse your denial, rather than admit they have someone incompetant or dangerous or practicing far out of scope making decisions on whether you are actually allowed to get the care your doctor says you need.

because the dr making the preauth decision for your appendectomy isn't supposed to be a podiatrist. the dr making the preauth decision for your c-section isn't supposed to be an ENT. but insurance companies don't get audited about that, and they don't want you knowing it.

so ask. make sure you have all your i's dotted and your t's crossed and your office notes and testing all in order and when they deny your appeal - asl for the name, npi, and specialty of the medical director who made the decision to second guess your doctor and deny you the care you need.

more often than not, they'll reverse the denial, rather than admit that they aren't following the rules.

[phoenixyfriend]

What can I do to limit Amazon’s* negative impacts without harming vulnerable communities who rely on their services?

* or any similar company that people are forced to use to survive if they are poor, disabled, elderly, rurally isolated, or any combination of the above

My post on Amazon has been circulating pretty far these past few weeks, and a lot of people keep trying to argue about what can be done right now. 

1. Contact your representatives

If you live in the US, there are several sites you can use to figure out your senators (you have two) and your representative (you have one). Call them if there’s a phone number. Email them if there isn’t. They’re obligated to have SOME form of contact. If your rep is already on your side, they can use your email as evidence for how citizens feel about the issue when Congress is in session to argue. If your rep is NOT on your side, they will see the email as evidence that a portion of their constituency is NOT willing to reelect them if they don’t play nice, and that scares them a lot. Either way, make yourself heard. Harass them if you have to.

(For more local issues, especially things like minimum wage and labor laws, you can find your representatives for your state or city government, like your mayor or governor or county rep, and contact them as well. Make yourself heard.)

Write emails in your own words about one of the following subjects:

Supporting the USPS. It’s the backbone of the US shipping industry, and major shipping companies like UPS, FedEx, and Amazon use it for overflow.

Monopolies and antitrust acts. Reference past antitrust acts leveled against oil, railroad, and telecom monopolies.

Raising the minimum wage. Reference inflation.

Enacting a marginal tax rate on high earners (re: the 1%, but phrased in a way that they’ll take seriously). Reference the marginal tax rates of the fifties.

Increasing disability benefits. Try to work something in about how stringent the requirements to qualify are, and how benefits don’t cover enough for medical care, transportation, assistive technology, and so on.

Increasing social security benefits for retirees. People pay into this fund all their lives as part of their income tax; it’s supposed to benefit them right back! (You can circle back to marginal tax rates and how the rich usually have savings and don’t need social security, but the poor often don’t have savings and rely on it.)

Enforcing corporate taxation. Find some statistics on who paid corporate  taxes in the past few years and who didn’t. Make sure to find a few big names and what their tax rate SHOULD have been. Emphasize how much extra money the government would be making.

Nationalizing the health care industry. Reference how well it works for countries like Canada, Korea, or Sweden, and how often hard-working Americans are bankrupted by unexpected medical emergencies.

Enacting or enforcing higher standards of employee rights. Did you know that minimum wage employees in Indiana don’t have the right to a lunch break unless they’ve been working at least twelve hours?

Legal repercussions for predatory pricing practices. Walmart is the best-known for this, but Amazon does it too, and they’re a fair bit sneakier about it.

Capping rent prices. Housing costs are among the highest financial pressures Americans face right now, and the fact that housing costs have risen SO much faster than the minimum wage is why it’s impossible to rent a one-bedroom apartment on a minimum wage anywhere in the US right now.

Capping upper management incomes. A CEO should not be earning several thousand, or several million, times as much money as their employees. It’s a long stretch (so argue the more achievable things first), but imagine if we could convince the government to say “actually, you can only make up to twenty times as much per hour as your lowest-paid employee.”

Banning police as threats against unions. UNIONS ARE GOOD THINGS. SUPPORT THEM.

Anything else that comes to mind! There are lots of subjects. This list is not an exhaustive one.

2. Vote

Pretty self-explanatory, I think. Vote in every election. Sometimes you won’t be able to vote for your top choice, and that sucks, but remember that our system is fucked and you have to go for the lesser evil that’s still capable of winning. So vote Blue (because ambivalence to our desires is better than glee at our suffering), and then send as many emails and make as many calls as you can to force them to recognize that, since you helped them get into office, they have to honor the deal to actually represent you now.

3. Support small businesses

Okay, so supporting local businesses probably isn’t too easy in a pandemic. You can’t just walk to your nearest mom and pop store to see if there’s an affordable option. That said, if you can afford to do so, try to see if there are small businesses in your area that are doing delivery or curbside-pickup.

If you live in a more rural area, see about ordering from small online businesses for non-essentials. If you’re thinking “hey, I’d like a new scarf” or something, check Instagram or Etsy first. All faults aside, Etsy is only a marketplace, not a seller themselves, so they rely on the vendors using their site to remain in business. (Whereas Amazon tries to drive their vendors out of business to take over their market share.) You can also use Google Shopping, eBay, or Craigslist.

4. Don’t Use Amazon (or similar), but don’t shame people for using it either

Some people rely on loss leaders to survive. That’s a fault of the American economy being a horrifying mess, and I listed a whole litany of the causes above. Money talks, so avoid using Amazon unless there is NO other way to get your product, but if someone you know uses Amazon, and you know they’re struggling, keep your mouth shut. If they’re not struggling, mention your distaste for Amazon but don’t push the issue; they’re more likely to come around if they feel like you’re not passing a moral judgement on them for it.

5. Recognize that many fairly-priced products are more expensive than you’re used to

The example I usually use is fashion. We’re used to a shirt costing ten or twenty dollars, even at places other than Walmart or Target. This price is what we’re led to believe is reasonable, but it’s really a factor of incredibly underpaid workers, usually overseas. If you can’t afford it, feel free to blame the low minimum wage (I certainly do), but remember to take a step back and remind yourself that it’s not that the piece is expensive, it’s that you are underpaid, and the current system is trying to teach you to expect cheaper items as the norm so they can get away with paying even more people less than they deserve.

6. DONATE

Yeah! There are a whole lot of nonprofit agencies that focus on issues that relate to this topic. I prefer to donate to organizations that focus on enacting systemic change through legal or institutional channels, like the ACLU and AAPD, but there are a lot of options, some of which focus on more direct help, or on specific parts of the country. Figure out one that speaks to you, check it against a trusted charity rating system like Charity Navigator, and set up a monthly donation if you can afford to. Constant support can cause compassion fatigue, but consistent support is how you Get Shit Done.

7. March

Join an activist group and march. Sometimes there are other major events going on (hijacking one of the current marches against racism and police brutality in favor of one about monopolies would be in bad taste AT BEST), but there will come an opportunity to make your voice heard by showing up on the street and just yelling with a sign.

Now go forth and unleash hell.