Friday, September 12, 2008

Molly Janczyk's experience with medical supplies: Who covers what

Molly Janczyk to Shirlee Zerkel, September 11, 2008
Subject: Supplies
Hi, I read on the blog your concern. I can tell you from my husband's coverage with such supplies as listed, it is under medical not RX. Medicare, the Primary pays the 80% and STRS pays 80% of the remaining 20% which leaves you with 20% of the 20% -- normally a small charge. After you pay your $500 deduc and your $1500 out-of-pocket for the year, then STRS pays 100% and you pay -0-.
My husband had to get supplies recently while out of town and the pharmacist told him to bill Med. Mut. for reimbursement. Plus we have had other items fall under medical not RX and therefore falls under the medical format.

Thursday, September 11, 2008

Best Reform in Education? End Poverty

From John Curry, September 11, 2008
"Low scores are not a sign of a poor school. They are a marker of an impoverished neighborhood."
Best Reform in Education? End Poverty
Richard Doak
DesMoines Registry

Aug. 17, 2008
The elementary-school teacher in a mid-sized Iowa town came across the little waif of a girl standing in the hall, sobbing. The child said she was crying because her teeth hurt.
A look inside her mouth stunned the teacher. All the girl's back teeth were rotting.
The school managed to get her to a dentist that very day, but it was apparent the little girl had been in pain for a long time. She had never been to a dentist and had no one at home who cared about hygiene. With pain on top of an unsettled and impoverished home life - the parent was angry that the school sent the kid to a dentist - it's no wonder the child was having trouble learning. You can't concentrate in school if you hurt. Or if you're hungry. Or abused. Or worried about your parents being evicted. Or if your parents are druggies who take the Ritalin that was prescribed for you. Or if your older sister entertains gentlemen callers in the next room all night. Or if your mom has a new live-in boyfriend every few months. Or if your job-losing parents keep moving you from school to school with long truancies in between. Or if you don't know where you'll be sleeping tonight because your dad's in prison and you get shuffled from one relative to another, and no one really wants you.
Any teacher in Iowa can tell stories that both tug at the heart and stir anger. Such stories are probably more common, in large and small schools alike, than Iowans would like to believe.
What's remarkable is not that the stories are commonplace - anyone who knows a teacher has heard them - but that they are heard so little in the public discussion about education.
As another school year is set to begin, the focus is once again not on the kids themselves. It's all about test scores, teacher quality and education standards. This year features a national advertising campaign from Strong American Schools, partly financed by the Bill and Melinda Gates Foundation.
The campaign notes that schools in most other industrial countries outperform American schools. It advocates higher standards, more time in school and better teachers. The Register's editorial page has been urging higher, uniform standards for Iowa, too.
All well and good, but once again the discussion studiously avoids the elephant in the room.
Student achievement in this country is never going to significantly improve until attention is directed to the root causes of low achievement: failing families in a low-wage economy.
Sure, teaching can get better and schools can adapt their methods to help low achievers. Individually, caring teachers do what they can to overcome poor parenting, but they have the children only a few hours a day. The larger influence is at home.
If fundamental improvement is going to occur, it must happen primarily outside the classroom.
Test data firmly link income, achievement
The most firmly established link in education research is the correlation between family income and student test scores. Poverty is the single biggest predictor of low scores. It's a greater factor than class size or per-pupil spending.
Low scores are not a sign of a poor school. They are a marker of an impoverished neighborhood.
A student's low scores are not evidence of bad teaching. They're most likely a reflection of the child living in poverty.
Yet this overwhelming truth is virtually absent from the political debate over education.
The debate should be about how to increase the number of American children who grow up to become well-educated, successful adults. A clear-eyed, rational approach to doing so would not focus on test scores and on punishing "bad" teachers and schools, as the No Child Left Behind program does. It would focus on eliminating poverty.
To boost scores, close gap between rich, poor
Poverty in itself does not produce low student achievement, but the conditions of life for children in poverty are not conducive to learning. Conversely, the conditions present in higher-income families - stability, educated parents, security - are conducive to learning.
Teachers know that any student who has two parents in the home and can afford to pay full price for school lunches will do just fine on standardized tests. The goal should be to get every kid into a home like that or something close to it.
That's a long way from happening. In the richest country in the world, a certain level of poverty seems to be increasingly intractable, chronically pushing down the average on test scores, among other social pathologies.
Finland, South Korea, Canada, Japan and other countries that outperform the United States in education are not as wealthy as America, but their gaps between rich and poor are not as wide. The wealth they do have is more evenly distributed. So is their student achievement.
Politicians dodge issue of educational underclass
We might not want to talk about it, but one of the most serious problems in contemporary America is the deep and widening chasm between rich and poor. There is a segment of the population - think of the poor waif with rotten teeth - who are almost invisible to most of us but who are at risk of becoming members of a permanent underclass.
It would be an educational underclass, really, in which poor and undereducated parents beget poor and undereducated children.
The political establishment has not faced up to the problem. Looking at poor student achievement, politicians find it convenient to blame the schools, bash teachers and demand non-solutions such as vouchers. The political right chants a mantra that is uttered like one word: thefailingpublicschools.
Wrong. It is not the public schools that are failing. It is the larger American culture and economy.
Change economic policies that encourage low wages
Perhaps politicians fall back on non-solutions because the real solution - ending poverty and the conditions associated with it - seems impossible.
No law could persuade every couple to delay childbearing until they are financially secure. No government program can ensure that every parent provide a secure, stable, encouraging environment. No magic wand can rid America of the family-destroying ravages of drugs. No public policy can undo the damage done by incompetent parents or those who are scornful of education. No amount of scrimping can make the minimum wage a living wage.
A general rise in the level of wages might help, at least with respect to the all-important financial security of children, but the country is locked into economic policies guaranteed to hold down wages.
Those would be the first policies to re-examine if the country ever gets serious about raising student achievement. Then concentrate on changing the cultural traits that reinforce poverty, such as single parenthood and scorn for education.
The No Child Left Behind Act should be repealed as an education bill and reshaped into an antipoverty program.
Improve the economy, especially at the bottom, and strengthen the American culture. Better schools will follow.
Richard Doak is a retired Register editor and columnist, a lecturer in journalism at Iowa State University and an adjunct in history at Simpson College."

Not another runaround, surely, Shirlee?

Shirlee Zerkel to Sandy Knoesel, September 11, 2008
Subject: Need help with NationsHealth
Dear Ms. Knoesel: I want to thank you for your prompt answers to me regarding no-copay questions. I have had a problem getting information from NationsHealth regarding the process and cost in obtaining ostomy supplies. I have called 3 times and still do not know the cost and procedure needed.
On Aug. 22, I spoke with Jessica who assured me that they coordinated with Medicare B and STRS. Yesterday I spent over an hour trying to get info about the process of how these supplies are covered. I spoke with Tiffany, Mary and Damion. The only piece of real info I received was that Medicare B paid 80% and then they could tell me no more until I actually ordered some. They wanted my Medical Mutual ID number and they still could not give me an answer.
I am asking you for this information for those retirees who may need this service. How is the remaining 20% of the cost worked out? Does that part go to our major med plan or what? Please give me the details of the pay procedure for a client. I feel that retirees should be able to find out this information without placing an order.
Thank you,

Wednesday, September 10, 2008

STRS recently got "dinged" with Fannie Mae but...remember when the same thing happened with Enron?

Come to think of it...didn't we also "buy" when Enron was tanking? John
Ohio will share in Enron payout
Columbus Dispatch
September 10, 2008
HOUSTON (AP) -- A federal judge has approved a plan to distribute more than $7.2 billion recovered as part of a lawsuit by Enron Corp. shareholders and investors in connection with the company's collapse. About 1.5 million individuals and entities will be eligible to share in the payout. The amount coming to Ohio has not been determined, according to a spokesman for the Ohio attorney general's office. Ohio agencies and funds expecting to receive payouts include the Public Employees Retirement System, the State Teachers Retirement System, the State Highway Patrol Retirement System, the Bureau of Workers' Compensation, the Tuition Trust Authority and the School Employees Retirement System.
Dispatch reporter Tracy Turner contributed to this story.
[From John Curry]

Fed up with political phone calls? If so, here's what you can do about them!

From John Curry, September 8, 2008
Even though you might be on the register to prohibit annoying salesman phone calls you are NOT prevented from getting political "vote for me" phone calls. This site will take care of that.

President of the Ohio State Medical Association speaks out against healthcare insurance companies

Toledo Blade
September 10, 2008
Health-care series show patients' plight
As the president of the Ohio State Medical Association, I want to thank The Blade for its recent series on the impact of health insurance on patient care. The eight-month investigation and resulting series, "Not what the doctor ordered: How health-insurance plans shape patient treatment," does a very effective job of highlighting the problems that Ohio physicians and their patients face daily.
As a physician, I see firsthand the impact that unnecessary and arbitrary insurance restrictions have on quality patient care. In fact, your articles clearly illustrate for the public something that physicians have known for decades: heavy-handed cost control measures by insurers are having a negative impact on patient care.
Physicians are sensitive to the expense side of medicine. One reason is because, as business owners, we want to provide health coverage for our own employees and their families. However, we feel the same cost pressures as any other business. One difference is that we are in a better position than most other employers to truly understand how insurance company interference is affecting the quality of patient care.
That's why the OSMA's number-one priority is reining in the abuses of the health-insurance industry. We must fight to keep medical care between the patient and the physician and prevent insurance companies from interfering with this care.
Dr. Warren F. Muth
Ohio State Medical Association
[From John Curry]

Tuesday, September 09, 2008

John Curry to Laura Ecklar: How many shares and how much?

From John Curry, September 9, 2008
Subject: Laura...a question...
Could you also state how much STRS has lost on its Fannie Mae and Freddie Mac holdings during the last year...and not just the one day that you said we lost "$3 million on Fannie Mae and Freddie Mac stock yesterday" in the quote taken from today's Columbus Dispatch? Retirees would like to know this figure also.
"The State Teachers Retirement System of Ohio lost about $3 million on Fannie Mae and Freddie Mac stock yesterday. However, it made $40 million to $50 million from about $4 billion in bond investments because of the government's move to firm up the balance sheets of the two companies, said Laura Ecklar, spokeswoman for the $70 billion pension fund."
The Dispatch article goes on to say: "The Ohio Police & Fire Pension Fund holds about 5,500 shares of stock in the two companies; the shares were bought months ago at about $28."
If the OP & F can state the amount they paid several months ago for Fannie Mae stocks ("about $28") and the number of shares held ("5,500 shares of stock in the two companies") I would also ask you, "How many shares of Fannie Mae and Freddie Mac stock did STRS own, as of yesterday, and what price(s) did we pay for these?"
Thank you, John Curry
P.S. So that there will be no confusion let me restate my questions:
1. Could you also state how much STRS has lost on its Fannie Mae and Freddie Mac holdings during the last year...and not just the one day that you said we lost "$3 million on Fannie Mae and Freddie Mac stock yesterday" in the quote taken from today's Columbus Dispatch?
2. How many shares of Fannie Mae and Freddie Mac stock did STRS own, as of yesterday, and what price(s) did we pay for these?
Wild day for public pension funds
Fannie, Freddie shares sink, but gains made on mortgage-backed bonds

Columbus Dispatch
September 9, 2008
By Steve Wartenberg
[Click to view larger image.] Ohio's police officers and firefighters took a beating in the stock market yesterday as Fannie Mae and Freddie Mac shares plummeted to less than $1 on news of the federal government's takeover of the mortgage giants.
The Ohio Police & Fire Pension Fund holds about 5,500 shares of stock in the two companies; the shares were bought months ago at about $28.
However, the pension fund also owns Fannie Mae and Freddie Mac mortgage-backed securities that trade like bonds, and they did well yesterday.
"Actually, it was an overall plus at the end of the day. We came out ahead," said David Graham, spokesman for the $11.5 billion pension fund.
Wall Street came out ahead, too, as the Dow Jones industrial average soared 289.8 points, or 2.6 percent, to 11,510. Financial stocks did even better, rising 3.42 percent as a group.
Figuring out the financial winners and losers in the aftermath of the Fannie Mae and Freddie Mac takeover will take months to sort out, but the experts say some things are already clear:
• Individual owners of the two stocks will lose a bundle.
• Most mutual funds and pension funds are diversified enough to minimize the effect of the Fannie Mae and Freddie Mac meltdown and could offset those losses with overall gains in the stock market spurred by the takeover.
• The two stocks have been on a downward spiral for so long that most of the damage to mutual funds and pension funds already has been done.
• Banks will benefit from an increase in the stability of the mortgage industry.
• Banks, pension funds and mutual funds that own Fannie and Freddie mortgage-backed securities will do well because of increased stability; banks that own significant stock in the two companies will suffer.
"There is a very significant short-term positive for (Fannie Mae and Freddie Mac) bond holders," said Jim Coons of J.W. Coons Advisors of Columbus.
The State Teachers Retirement System of Ohio lost about $3 million on Fannie Mae and Freddie Mac stock yesterday. However, it made $40 million to $50 million from about $4 billion in bond investments because of the government's move to firm up the balance sheets of the two companies, said Laura Ecklar, spokeswoman for the $70 billion pension fund.
The Ohio Public Employees Retirement System has not yet tallied gains and losses, but spokeswoman Julie Graham-Price said that as of Friday, the $82.9 billion pension fund had $2.9 billion in Fannie Mae and Freddie Mac bonds and $21 million in stock.
In Sunday's announcement of the government's takeover, U.S. Treasury Secretary Henry Paulson stated that Fannie Mae and Freddie Mac "will no longer be managed with a strategy to maximize common shareholder returns."
This statement all but assured that their stocks would tank yesterday, and they did: Fannie Mae closed yesterday at 73 cents, down 89.6 percent; Freddie Mac closed at 88 cents, down 82.8 percent.
"You generally only see this when a stock is on its way to zero," Coons said.
Nationwide Bank does not own Fannie Mae or Freddie Mac stock but does have more than $1 billion in mortgage-backed securities issued by the two companies, President Anne Arvia said.
She said most financial institutions invest in mortgage-backed securities, and the government's takeover means that Fannie Mae and Freddie Mac will not default on these bonds. And banks can breathe a big sigh of relief.
Click to enlarge


Want to see OEA's payroll?

From John Curry, Sepember 8, 2008
Want to see the most recent OEA payroll stats? Just click on the link below and enter 512-490 in the box labeled "File Number" and click on the "Submit" button. Then, when the screen comes up, look for the column "Fiscal Year." Now, you click on "2007 Report." You will then receive this information. If you scroll down to schedules 11 & 12 you will find individual salaries associated with individual names. Remember, this report was filed late last year so the salary info is almost one year behind today's date. This is the most recent information and will be replaced with more recent information when it becomes available from the U.S. Department of Labor. Educators' salaries are public information AND so are the salaries of the OEA. John

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Thanks to Shirlee Zerkel, we have info re: coverage for shingles shots

From Sandy Knoesel, September 8, 2008
Subject: RE: question about shingles shot
Dear Mrs. Zerkel:
Thank you for your question about coverage for shingle shots. This immunization is covered under the Aetna and Medical Mutual medical plans. The percentage of coverage is based on how the service is provided. Some providers have the shots available in their offices while other providers require the enrollee to obtain the medication at a retail pharmacy before going to the provider’s office for the injection. For example, if the physician requires that the enrollee obtain the medication, the enrollee could present a prescription at a contracted retail pharmacy and have it processed through Express Scripts. In this scenario, the enrollee would pay $30 for the medication under the Plus Plan and $0 under the Basic Plan because this shot is covered under preventive services. The administration costs for the physician who does the injecting would be covered under the medical plan with benefits determined by the plan in which the individual is enrolled. Enrollees who have questions or need additional assistance should call STRS Ohio toll-free at 1-888-227-7877 and ask for Kathy Crawford or Brenda Foster.
From Shirlee Zerkel, September 4, 2008
Subject: question about shingles shot
Dear Ms. Knoesel:
This question has come up about immunization shots for shingles. Does STRS cover those shots? If so, what % are they covered? SERS covers them.
Larry KehresMount Union Collge
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