Got a statement of benefits from my work insurance regarding my fistulagram procedure on August 21st. The whole thing was billed at $14,261, and the Medicare rate was $5,744. My work paid 20% of that, which was $1,149. Again, not really knowledgeable about medical costs so I don’t know if that’s a fair price. I did spend a bit of time in the hospital, and was in an intervention radiology operating room with several OR nurses. However, this only covers the hospital portion. I’ll probably get another bill/claim from the vascular surgeon. Some of the line descriptions are not very detailed: Outpatient surgery, Medication, Medical equipment and supplies, etc. I wonder if I asked, someone (hospital, Medicare, Blue Shield) will send me a more detailed statement.
Also, I did a drive-thru COVID-19 test on August 18th, prior to the procedure. That was billed at $65 and the reduced Medicare cost was $33.72.
A few weeks ago, I decided that since I’m working from home for the foreseeable future, I would have time during the day to watch the stock market so it was time to open my own stock brokerage account. I ended up picking Fidelity and transferred some money into the account so I can buy stock and mutual funds for myself. I also opened an account for my mom, thinking I would help her invest. Well, I was quickly overwhelmed by reading prospectuses on funds and research on public companies. At my job, my previous responsibility was being the Treasurer, which meant investing the company’s free cash. That ranged from ~$50M to over $500M. However, the company had a very conservative investment strategy so it was all bank accounts and government bonds. I have a lot less cash to invest and I can take a bit more risk.
Anyway, Chase was offering $2,000 to sign up as a Private Client. Sounds fancy, but mostly you get a dedicated banker each time you walk into the branch, and there’s also an investment guy that you can utilize. I met both guys at my local branch and they seem very knowledgable and cool so I went ahead and converted my checking/savings accounts plus opened a couple investment accounts. My tax guy also invests for me but it’s almost all in mutual funds and has a pretty conservative strategy. The Chase accounts will be a high-yield account that buys bonds for cash, and a large cap investment account buying individual stock. The account has been open for a few days and already has lots of stuff in it. Here are the top 10 holdings by value:
AAPL (Apple)
TSLA (Tesla)
MSFT (Microsoft)
AMZN (Amazon)
PYPL (Paypal)
FB (Facebook)
AMD (Advanced Micro Devices)
NVDA (Nvidia)
MA (Mastercard)
SGEN (Seattle Genetics)
The portfolio only has several shares in each stock as the investment advisor tries to mimic the market but actually hold shares. He could have bought into Large Cap or Index funds but that would mean investing in the fund issuing company and not the companies themselves. I had wanted to avoid investing in Tesla since it was so volatile but now I’m the proud owner of 41 shares of TSLA. I usually don’t like to hold individual stock since I feel like I need to watch the price movement all day. Hopefully with someone else managing it, I will be more hands-off.
Even since being diagnosed with End Stage Renal Disease (ESRD), I’ve noticed the huge need in funding for research, dialysis, transplants, and medical care in general. It’s a bit on the selfish side, but I’ve been donating to the UCSF Kidney Project as they develop an artificial kidney. I also got a mailer from UCLA this week about donating to UCLA Health in general. I went to their website and found a kidney transplant specific charitable donation for their kidney exchange program. I guess the cost of matching live donor kidneys is not paid for by Medicare or other insurance. I think I’ve also made a donation to The National Kidney Foundation.
I know that whatever I give, it’s a drop in the bucket compared to the huge needs we have in America. It’s a shame that there’s so much waste in government when there is so much need.
I came into work again today. Like the last time I was here, there’s almost no one in the building. This weekend is probably even more unlikely people will show up since tomorrow (Monday) is Labor Day. Not sure if anyone is traveling though. There was one person here in my department but he sits in the next row over. We talked for a bit since I haven’t seen him for about six months.
It’s super hot outside. Weather app on my iPhone says 99 degrees. It’s even hotter at home; City of Orange is at 108 degrees now. The air conditioner better not fail. I don’t think we’ve ran it 24/7 for this many days before. Inside the office however, it’s freezing cold. It’s been a problem since I started working here nine years ago. Our CEO likes it cold but also wants an open floor plan. I don’t know how much energy we waste by keeping 3000 people cold instead of just him (CEO).
I was actually just here to pick up some stuff from the office. Since less people are coming in physically to the office, it’s hard to find a coworker to drop stuff off for me. The environment is also more work-conducive; I tend to take a lot of naps when working from home. I actually have a lot of work to do in the next several weeks. If the live donor kidney transplant actually happens, I don’t know who is going to take over my project since we’re aiming for a Dec/Jan implementation date. The schedule doesn’t have me leaving for 2-3 months.
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Ugh, I walk outside to another building to pick up a package. It’s like walking into an oven. I was actually okay until I had to bend down to get my package from a lower locker (we have an automated locker system for packages). That seemed to put pressure on my chest cavity and then it was difficult to walk back to my cubicle. I also got chills when I walked back into the office because it’s so damn cold in here.
I can see the status of my car using an app on my phone. Usually if you park out in the open and it’s hot and sunny, you can turn on the air conditioning a few minutes before you go to the car, and it will be nice and cool. The car also limits the temperature to 103-104 degrees so it will kick in automatically when the interior temperature gets beyond that. The car is currently parked inside a parking structure, shaded from the sun. It should not be that hot inside the car unless the ambient temperature outside is that hot.
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Update: 9/7/2020 9:01 pm
Dang it. I was trying to get some work done today at home even thought it’s Labor Day and I’m not getting paid. This 3/4-time is a bit weird to manage. Between the toothache and multiple naps, I didn’t even sign on to the computer. Hopefully I can find some time tomorrow after the CT scan to finish the one task I need to do for a Thursday meeting.
Since I have a finance degree, my mom has always been bugging me to invest her money. However, I am very risk adverse and my work has basically been budgeting and planning for companies. I only started doing some investments after working in Treasury, but the company’s investment strategy is also very conservative.
For the past 10+ years now, I’ve give a bit of money to an accountant friend who also does financial planning. The thought is to earn some investment income but also look for ways to reduce taxes. I don’t think he’s been too successful on the tax target since it seems like I’m paying a lot of taxes. Over the ~10 years, he’s probably averaged 10% returns post fees. Not bad, but in comparison, the S&P 500 averaged about 12% gains annually. I could have done better if I just bought SPY ETF with the money I gave him.
Since I’m working part time now, and I’m starting to really plan for retirement, I’ve been looking at the investments I have position in and trying to understand the mutual fund market. To start, my mom is giving me about 10% of her retirement to invest. Right now it’s almost all in cash, making 0.80%. I started with an account at Robinhood but heard it’s not a great choice for research so I opened another account at Fidelity. I then picked out some funds that seem interesting. I think I’m going concentrate on a bond fund, and a stock index fund. Still debating whether to buy SPY for the stock portion of the portfolio, or go with a Fidelity mutual fund.
I’ll probably also take some cash and open an account for myself. I want to see if I can outperform a “professional” in picking mutual funds or justify his 1.5% fees. If this works out, maybe I can just day trade as part of retirement. Just kidding.
This post will be a bit different since we found out someone in our department tested positive. HR is notifying everyone he came in contact with, and they like will need to self-quarantine for 14-days. I only received a forwarded partial email but it appears he was in the office last on Thursday 8/13. I went into the office on Sunday 8/17 and did spend some time near his desk since it’s right beside the shredding bin. I think four days is enough for any virus in the air or on hard surfaces to dissipate or become inert. I also didn’t touch anything on or near his desk. Still, kinda scary.
Anyway, my test on Tuesday came back negative. Even if I was infected on Sunday, it’s probably not detectable after only two days, but makes me feel a bit better.
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Also got a group text that one of my cell group member’s wife is sick with fever and tachycardia. She got tested but he said it may take 14 days to get the results back. That’s almost useless. Until now, I didn’t personally know anyone that was infected. Now I found out about two (maybe) in one day. I feel we’re far from done with this pandemic, regardless who is president.
Joe will bring us together to end this pandemic and make sure that we are prepared for the next one.
While I was driving home from taking the COVID-19 test, I heard some discussion on KPCC (public radio) about Biden’s plan to get rid of long-term capital gains. In addition to raising the top marginal income tax rate, long-term stock gains could be taxed at 39% instead of 23.8%. That’s about 15% difference. This is important to me since I am planning a long slow retirement if I can’t get a kidney transplant soon. My current compensation at work had a fairly large stock component, and right now, there is an offer out to buy employee stock. The most important decision on which shares to sell always comes down to complex tax regulations.
Currently, the thought is to sell shares with the highest cost basis that’s been held for more than a year. This way, you minimize the capital gains due to the high cost basis, and qualify for long-term capital gains tax rate. If you think the tax rate on the stock sale will increase by 15% next year, then you would sell the cheapest stock to maximize gains, which are taxed at 15%-24% (capital gains). Otherwise next year you may have to pay a lot more for the same stock sale.
It all depends on who you think will wind the election in a few months. I already got screwed by Trump over his $10,000 limit on SALT (state and local tax deduction). It’s only fair that I get screwed by the Democrats too.
Ooh, I just got the email update on case count at my work location and it went up by 3 over the weekend. We now have had 114 cases. Hopefully they were infected offsite, i.e., at home or in the community instead of at work. By going in Sunday, I did not come close to anyone else in the building. I probably only saw about 5 people anyway.
When I went to my office today, there was a washable cotton face mask on my desk. It’s all black with our company’s logo on the lower left (my left). I saw a few on other people’s desks. I think they handed out one per employee. It’s pretty cool as our CEO wore it on TV; there is also a huge market for our company logo’ed clothing. It still smells funny since the masks are made in China, apparently a few months ago in May, so it may take time for the chemicals in the material and dye to dissipate. I’m actually worried that if I wear it to dialysis, a few of the techs will want one too, and I don’t know how to get more, even if I have to buy them.
I heard my parents’ church is also making some custom masks to give out, although I heard they are only making 200. The setup costs got to be pretty high for such a small run as they are printing the church name on the mask in Chinese. Maybe I’ll wear a surgical mask over the church mask… for extra safety.
Well, I made it to work. Left my house around 2:00 pm and got here in about 45 minutes. As expected, the office is deserted. I brought in a duffel bag full of documents to dump in the shredding bin, and also dumped some old papers from my desk. After three months, my desk was filthy. I had to clean a bit before disconnecting the 30″ monitor and reconfiguring the desktop to work with 2 x 24″ monitors again. Since I didn’t have breakfast or lunch so far today, and it’s almost 4:00 pm, I went downstairs to the cafeteria and grabbed a sandwich from the fridge for $3. Not as good as Jersey Mike’s but much cheaper.
Now I have to figure out how to carry the 30″ monitor to my car in the parking structure. There is a handle on the back of the monitor but it’s still awkward since it’s bulky. I don’t want to get harassed by security on the way out. The monitor is probably over 10 years old but still works great. I think the company originally spent over $1,000 on the 30″ monitors; they’re much cheaper now.
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The monitor is a HP Z30i. They’re $300 used on eBay now. Here is the specification sheet from HP.
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Dang it. The monitor was heavier than I thought. The specs said 22 pounds but it felt like more. Luckily I have one of the newer ones, which is thinner than some of the older ones in the office. The older monitors are probably even heavier. I was totally out of breath when I got to the car with the monitor, and had to sit in the car for 5 minutes before going back to the office to finish some stuff.
The monitor is also very large compared to my desk. I already have my Mac Air connected to a 21″ monitor plus two KRK Rockit 5 studio monitor speakers on the desk already. I managed to get the 30″ set up but had to place the 24″ monitor vertically to fit the desk. I guess I can keep Outlook up and just have emails on that screen and free up the 30″ for spreadsheets and other work.
There are now five computers plus a PS3 in the home office hooked up to six LCD monitors and a 42″ LCD TV.
I didn’t know about the EPTS score. That was never mentioned to me at either transplant centers. I was led to believe that the wait list mainly depended on blood type and geography. The wait list in Southern California for B-type blood is 9-11 years and approximately 4 years in Phoenix, Arizona. If the organ recipient selection is based on this EPTS score, then I’m screwed. I found a calculator online and my number is 64%. I guess that means about 2/3 of the patients on the wait list will live longer than me post-transplant. The website also has a PDF that helps explain the EPTS score.
Interpreting the EPTS Score
The EPTS score, which ranges from 0% to 100%, represents the percentage of kidney candidates in the reference population with a higher expected post-transplant survival. Lower EPTS scores are associated with higher expected post-transplant longevity, and vice-versa (Figure 1).
Candidates with EPTS scores less than or equal to 20% will be prioritized by the kidney allocation system to receive kidney offers from donors with the highest estimated quality (KDPI ≲20%). Candidates with EPTS scores exceeding 20% will be eligible to receive these offers. They will be prioritized after candidates in the EPTS top 20%.
I think what it says is that I won’t get the best kidneys available. Those will be offered to patients with EPTS scores <20%. After that, I can’t tell if it’s wait time based or still ranked by EPTS scores. If I put no for diabetes, the number drops to 27%. I guess that’s a huge determining factor on post-transplant survival. Also, I think the patient’s age and years on dialysis affects the score negatively so in long wait time areas, your score gets worse every year, while younger and newer patients get priority. Maybe this is why some people have had three or four kidney transplants by age 20, while older patients have to wait 10+ years for a deceased kidney and one of lower quality.
I don’t know what the right answer is. The video did mention Iran’s experiment with using a market based approach eliminated the wait list. However, it did not mention whether poor people were priced out of the market. How do you determine the ethics of saving a small random number of transplant patients versus saving more lives but biased toward more well-off patients? I guess our society has decided that more people should die so we can have wealth equality.
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Ironically, dialysis and kidney transplants are covered by Medicare in the US. That means almost everyone’s treatment and surgery costs are paid by taxpayers anyway. There’s got to be a way to calculate the cost savings between a live donor transplant versus dialysis until death. Based on my dialysis statements, we can use $5,000/month or $60k/year for dialysis on Medicare rates. If a typical patient stays on dialysis for 10 years, that’s $600k. This website quotes a kidney transplant will cost Medicare $100k so we can double that for live donor transplants since there are two surgeries. That’s $400k of savings.
So it appears that Medicare can offer donors $100k for a kidney and still save $300k if the patient would have lived >10 years on dialysis. They can still have their “ethical” wait list but vastly increase organ supply, improve the quality of donated organs (live vs. deceased donor), and save taxpayers money. Maybe the complaint will be that only poor people will be incentivized to donate or some people are not healthy enough to donate, and that will be somehow unfair. Meanwhile, you are saving thousands of additional lives each year and reducing the number of suffering dialysis patients.
Then there’s the China model where government officials harvest organs from political prisoners and sell them on the black market.
Ugh, my stomach is growling. As I mentioned in the previous post, I skipped breakfast and lunch, and only had about half of what my mom made for dinner. It’s a local Malaysian dish call laksa and it has a lot of spices. The flavor pack came straight from her hometown in Malaysia.
I’m afraid of drinking a pre-made protein shake (Nepro, Ensure, etc.) since the last two gave me diarrhea. Don’t want that to show up during dialysis. It’s monthly labs day so no disturbing the dialysis cleaning process. I have Honey & Bunches of Oats (HBO) cereal from Costco but I’m afraid that will mess up my chipped tooth some more.
Man, life is so complicated. Not sure what I’m going to eat for breakfast in a few hours so that I don’t pass out during dialysis. I may also need to skip my typical post-dialysis take-out lunch since I have to rush home to get on a work call. I picked a bad time to go “part-time” and lose part of my salary while seemingly doing the same amount of work.
Heh, I feel kind of stupid. I’ve been reading the case statistics from work all wrong. The Intranet webpage lists cases-to-date by location, and the total number of recoveries. I just assumed the total number was adding up the individual cases. So today, the number of cumulative cases at our work location is 111 and 326 for the total company. However, 271 have recovered and cleared to return to work. So, there are only 55 active cases across the company out of 7,500+ employees. The number at our work location should be even smaller, likely in the range of 20-25. That makes me feel better. I thought there were 111 active cases. Hopefully that decreases the chance of having an asymptomatic employee show up to work.
Since almost no one shows up on Sundays, chances are very low that I’m going to encounter an asymptomatic carrier. I think it’s safe for me to run in the office, dump off some documents to shred, clean up my desk a bit, and steal my 30″ monitor on the way out. My coworker said a lot of people have taken IT equipment home recently and physical security seems to be okay with it. She walked out with her 24″ monitor recently and no one said anything. Maybe I’ll put that theory to the test this weekend and see if anyone grabs me coming out of the building with a huge (but old) LCD moniutor.
Even though I don’t have direct staff anymore, I still have several (6) one-on-one meetings on my calendar. One with my boss, two with peers, and three with ex-staff members. Our company asked all the managers to set these up weekly to improve internal communications. However, our CEO is a terrible communicator and we often have to check Twitter or Reddit for updated information on our own company.
Usually we hold these meeting in our lunch area or just at our desks. I typically try to talk about non-work related stuff since we’re a small department and I usually talk to my staff all the time. When we started working from home, these 1:1 meeting were held over the phone with is a very different dynamic. I also started skipping a lot of them since all my staff have become ex-staff. Anyway, I had two 1/2 hour meeting scheduled today and I spent almost 3.5 hours on the phone just catching up. I haven’t talked to anyone at work for about a month so it was good to talk to someone other than family or doctors for once.
I finally made some progress with my work project. Since agreeing to go to part-time status with my boss, I’ve been trying to get my one project off the ground. It takes a lot of coordination with the rest of the team even if everyone was in the office. With half the team working from home, it’s even harder to collaborate.
Anyway, I spent the last two weeks going back and forth between Purchasing and Information Security on my request for proposal document. I finally got it cleared up and received an okay to send it out. The document went out to ten suppliers so I had to send the same info ten times, making sure I have the right email address matched with the email contents. Nothing more embarrassing then to send an email to your intended recipient’s competitors.
I think I sent out the emails at 3:00 pm and already got a bunch of replies with questions and request for more information. Ugh. I think work will be a lot busier starting tomorrow. Good thing I’m now part-time and working for less money.
The latest count is 107 cases at my work site, and about 280+ across the entire company. That number seems to have steadied a bit, much like the rest of California, but it’s weird that is not decreasing. Is nobody recovering in the two months the company has been reporting the number? Or are new cases still greater than those recovering? If the pandemic is being contained, the total number of active cases should be dropping. Right?
I still think I should go into work at least one day a month to check if anyone left anything important for me at my desk. I do have another manager checking it periodically but I don’t know if she feels comfortable opening all my mail. I still have a ton of old bank statements that I want to shred and don’t want to do it four pages at a time with my home shredder. And there’s always the 30″ monitor on my desk that I want to bring home.
Everyday is an adventure at dialysis-land. I found out today that Tuesdays and Saturdays are busier than Thursdays because some patients only come twice a week for dialysis. When I started, I was only on dialysis twice a week for three hours per session. Over time, this has become three times a week for four hours per session. That an increase of 100%.
Since it was busy, the nurse connected me via the chest catheter first so I get all my dialysis time in. Later, after I had fallen asleep, she came and woke me up to try and stick me with the needles. She used short 17-gauge needles again even though the throughput is less. The venous needle went in okay after some digging around but the arterial one wasn’t cooperating.. After a few tries, she gave up and another tech came to try. He stuck me a bit lower in the arm and was finally able to get good position. I think it was about 7:00 am by this time so only a bit less than three hours remain.
I was tired again so I slept some more. The nurse came by and woke me up at ~8:30 am because she wanted to flush and tape up my catheter. Then she changed her mind and decided to wait until the end of the session. Great, I got woken up for nothing. Anyway, disconnecting went mostly okay. The venous needle site bled through the first gauze bandage so they had to change me while I was applying pressure to stop the bleeding. I just took off all the gauze and the hole from the missed attempt is still bleeding after ~7 hours. Ugh. I hate this fistula. Almost makes me want to ask them to keep using the chest catheter regardless of the infection risk.
Also, the second tech that stuck me is a big fan of the company I work at. Last year, I bought for him a lot of logo’ed clothing with my employee discount. He kept asking about our stock. We’re a private company so the stock is not listed on any stock market. He said to give him a day’s notice if we ever go public. He wants in on the IPO shares. Sure, so does millions of other investors. Like I have enough clout to get additional shares in an IPO. Most of the time it’s like getting free money.
We had a big week this past week at work so our CEO gave everyone the day off. Supposedly he sent out an email to everyone that I didn’t see. Then the VP of HR sent out a more detailed email that I also didn’t see. I usually read emails from both those people so I’m not sure what happened. Anyway, Friday (today) was classified as a paid holiday, which I think I won’t get paid since I switched to part-time this week. What shitty timing. I’m not sure how this works though. If I’m getting paid 75% of my salary, does that mean I get a day taken off my pay? So instead of paying me 30 out of 40 hours, I only get paid 22 hours? Also, since I didn’t know about the “holiday”, I scheduled a bunch of calls to external suppliers and was answering emails. It wasn’t a full-day but I worked quite a bit today. I was also wondering why I wasn’t getting the regular volume of emails. Duh!
I just got the billing from 9/1/2020 through 11/30/2020 and it was for $1,388.10 or $462.70 per month. I think it’s the same as what I paid since the beginning of the year. It’s much higher than the base $144/month premium but worth it compared to the cost of dialysis, even at Medicare prices. For comparison, I also got the EOB (explanation of benfits) for May from dialysis:
Cost without benefits = $32,687.23
Your plan rate = $4,047,42
Your plan paid = $810.81
This is from the perspective of Blue Shield, my work insurance carrier. On medicare.gov, I found the same claim and Medicare paid $3,236.61.
Medical insurance is weird in the US. If I didn’t have insurance, my dialysis center would initially charge me the $33k for services in May, but we will probably negotiate that down to some lower number. If my work insurance was paying, then the “plan rate” would be around $26k, and Blue Shield (or ultimately my work) would pay it. With Medicare, the dialysis center only gets $4k of which Medicare pays 80%. Again, with Medicare for All at the current pricing, all hospitals and clinics would go out of business.
So just for dialysis, I’m paying $463 per month and Medicare is on the hook for $3,200. The difference comes from Medicare taxes paid by everyone receiving a paycheck.
I got the letter from HR today confirming my conversion to part-time status at work. In addition to what I wrote previously, I will also only accrue vacation at 75% so only 3-weeks instead of 4 annually. However, all my stock awards will still vest at 100% of schedule plus I’m still eligible for full benefits.
I’m not sure how long they will allow me to stay part-time since it’s very rare at our company. There’s probably only a handful of part-time salaried employees out of the 7,500 people working there. I think it will depend on transplant news, whether UCLA accepts my sister as donor, or if I transfer my UNOS wait time to Arizona.
Life with chronic diseases 