Anatomy and Art

This is a nice little story about an anaplastology case covered by Fox News.
http://www.foxnews.com/health/2010/12/21/hollywood-style-special-effects-girl-new-ear/?test=faces

The anaplastologist featured, Jerry Schoendorf, was once a student at UIC in the very same program I am currently finishing.  He is currently working with The Anaplastology Clinic out of Durham, North Carolina.  Judging by his bio there, he certainly sounds like a real leader in the field.

I just wanted to take a moment to wish all of you reading the happiest of holidays.  May you all enjoy good health, good company, and good fortune in the year to come.

I was recently asked about a comment I had made in another post regarding insurance policies and their coverage for anaplastology.  The other post wasn’t really about that, but the truth is, this is something I think a lot about.  It isn’t really something I know much about though.  I mean I’ve certainly kept my ears open for snippets of information here and there around our clinic, and the clinics I’ve visited over the years.  Most of what I’ve gathered from all of that though, is simply that dealing with insurance companies is going to be a royal pain if I should ever open my own clinic.  And given my own skill set and history with handling bureaucracies I’ve pretty much decided well ahead of time that I am not someone who should open a private practice until I believe that I can cover the costs of hiring someone else to handle that aspect for me.  I’m more the type who has spent large swatches of their adult life without any health insurance because I find such bureaucracies so challenging to navigate.

But here I am, author of this little blog, and it occurs to me that maybe I should do a little looking into just what kind of coverage is available out there for anaplastology cases.  So I called a couple of places with questions.  Now, my first attempt at this was late on a Friday night (which sadly probably does speak zounds about my personal life these days.)  I tried to reach Blue Cross Blue Shield, but found myself on hold for roughly half an hour.  It was at this point that I came to the conclusion that I was likely waiting on line with people who had real emergencies and not just a curious streak, so I decided to call back later.  The following week, I found myself thinking about it again during regular business hours and I decided to try again.  This time I started with Medicare.

The number I called to reach Medicare was 1-800-633-4227.  I was on hold less than six minutes, but then when I did reach someone, it was impossible to get any real answers.  First, the woman answering had never heard of anaplastology.  She was very nice about looking up as much as she could for me though.  Eventually she was able to tell me that they covered the replacement of arms, legs, eyes, and orthopedic braces for the back, foot, or neck.  She suggested that I call individual clinics to ask about whether Medicare was accepted or not.  After a 25 minute conversation she attempted to connect me with another branch, but there was no hold music this time, and after 15 minutes I decided that the transfer must not have gone through and hung up.  So that was disappointing.

Next I went back to Blue Cross Blue Shield.  The number I called was 1-800-633-4227.  They were much trickier to even get to the hold part, with a lot of push button questions, none of which offered an option for questions about anaplastology coverage of course.  And then when I did get to the hold part of the call, I couldn’t help but write down the phrase “discussing policy benefits is not a guarantee” which was actually part of the recorded loop playing while you were on hold.  I mean I guess I get it, but hearing it over and over again while I waited just played into some pre-conceived notions I already have going about these guys.

When I finally did get through with someone, he was very adamant about how there were no over all options or plans.  It got me wondering about how much negotiation is really involved in setting up an insurance plan.  I tried to use the example of seeking coverage for visits to an anaplastologist regarding two missing fingers.  I thought that would make things easier, and also should let me know if there are differences in the way facial and somato cases are handled.  I was told that the question didn’t really make sense, because coverage packages vary, and as an individual seeking to set up a service plan, you wouldn’t be able to get care for a pre-existing condition anyways.  So basically it could only ever come up if someone with a coverage plan in place was to loose those fingers while insured and they would then have to check their plan for coverage at that point.  I was shocked.  I didn’t think discluding coverage for pre-existing conditions was even legal anymore, but I guess it is.  The man I was speaking with then tried asking me about the code for the service I was trying to ask about.  It sounds like there are ways to look up specific procedures if you have the right insurance code to search under, but I didn’t have anything like that.  In the end, the most information I was able to gather about BCBS’s coverage was at the following link which describes prosthetics coverage, discluding lower limb prostheses.

http://medicalpolicy.hcsc.net/medicalpolicy/home?ctype=POLICY&cat=DME&path=/templatedata/medpolicies/POLICY/data/DMEQUIPMENT/DME104.001_2009-04-01#hlink *

*On second review, I realize that to get to the intended page you must first click to agree (I believe the agreement is not to hold them to anything they say), and then perform a search for the word prosthetics, search all, and then select “Prosthetics, Except Lower Limb Prosthetics”

I was also given a number to dial for providers, 1-800-972-8088, and I tried that but it was after hours when I did.  I did notice that the initial phone options were limited to the categories, medical, pharmacy, dental, and behavioral health.  So I think that even if I had caught them in their regular hours I might not have been able to establish much.

Honestly I think I’m more confused now, having attempted to clarify information than I was before making these calls.  I’d made the calls in an attempt to understand how anaplastology was covered by the major insurance providers.  I was interested specifically in if there is a difference between how facial and somato prostheses are covered, or if that idea is just a misconception I picked up by not having the full story.  But in the end, I think I just learned more about why no one likes dealing with insurance companies.  And I once again spooked myself about the prospect of ever needing them with regard to my own health.  To be fair, I spook easily about that particular topic, but really, I have yet to understand how anyone ever gets treated for anything in today’s day and age.  And I find that terrifying, both as a human who sometimes needs medical care just like anyone else, and also as someone learning to be a clinician, who at some point will need to understand the system from the side of the care-givers as well.

Recently I went through the process of getting prints made of a painting.  Real ones.  Good ones.  Expensive ones.  I have to say that the process has been a little bit terrifying.  For starters, let’s face it… I’m not exactly the greatest business mind out there.  But I gave this some thought as to what was reasonable to charge, how many I would make, how many I thought I could sell, and did a little research into what it would cost me.  Unfortunately, the first estimate of what it would cost me reflected less than half of the ultimate total costs I wound up spending.

At first it was a matter of having having gotten my estimates based on the image size without doing the math on what the added border for framing would be.  I’d expected there to be added cost for that, but I had underestimated how much.  Secondly I had to rescan the image.  Letting the printers scan your painting is not an inexpensive endeavor.  But in this case, I believe it was both necessary and worth it.  Between those first two points though, I wound up deciding to make fewer prints than I had originally intended.  It’s good that I didn’t make as many though, because the next blow came when I went to pick up the prints and found that their scan had picked up so much detail, that it had practically x-rayed my painting.  I didn’t catch it immediately.  At first glance, all I saw was that they had gotten the red right (no small detail, that), and that the new scan had not shown the same problem as the scan I had done previously.  I left happy.  But then as I was packaging up my first print for shipping, I saw that there were mistakes, familiar mistakes.  I kept wanting to dab a bit of paint here or there to fix them, and then I realized that I was having the exact same thought process I’d had while finishing the painting in the first place.  I was seeing mistakes brought back that I had already fixed, and I couldn’t send that to paying customers.  So I called the printers back.  I went through Gamma to do all of this.  Their tech who had done the scan for me had already left for the day, so I had to make plans to go back later that week after my finals (and yeah, taking on this process at the end of my semester, maybe not the greatest plan of action.)

I had purchased a digital copy of the scan as well, so I was able to review that as well.  I was surprised when I didn’t see the same detail from the under layer there.  But just now, just today, when I opened the image in Photoshop I did.  It’s the strangest thing, the detail is in there, but I wasn’t seeing it in the raw file.  It’s actually kind of a relief to see it now.  I couldn’t for the life of me figure out how I was getting added detail from the printing process.  Anyway, despite picking up those covered brush strokes, it really is a beautiful scan.  Here is smaller version of what they got…

So I was able to go back in and discuss things with them.  It’s been a good thing, having the painting handy for all of this, not just for rescanning purposes, but also as something to bring in while talking about the desired outcome of the prints.  I’m fortunate that the buyer wanted me to hold on to it for the time being, and that I’ve been able to do all of this despite the sale.

They saw the problem, and we decided to have the prints redone with different settings.  Unfortunately, this brought my costs up considerably.  Since I hadn’t paid for giclee printing (which comes with the opportunity to approve proofs) my options were limited in terms of how to handle this.  They did make an effort to work with me though, and while I lament loosing so much of my profit margin, I am very happy with the way the 2nd set of prints came out, and the product I can now deliver to my clients.

In the end, I only wound up making six of them.  I’d initially thought about leaving the window open to further printing down the line, or making 12 all at once and just selling them off over time.  Especially considering the added costs along the way, I am happy that I only opted to create the six of them.  At present three of them have been paid for and shipped off to buyers.  One is spoken for, to be paid for and picked up in January.  And I may have a fifth buyer in the works.  All in all, this has been quite the learning experience, and something that I hope to do again and again with other works, though hopefully with less nervousness and better planning along the way.  It’s tricky though.  You don’t know if something is right or not until you see it.  You can’t know.  But I do know a little more about what to look for, and what to ask for now.  So here’s hoping that next time I can be a little less neurotic artist about things, and a little more savvy seller of my art.

Well today pretty much wraps the semester for me. It’s been one long and crazy stressful week, but I’ve survived it now.   I need to say that part of this week’s stress comes down to a request I have received to censor certain information from this very blog.   I hope to say more about that in the weeks to come, but I’m not entirely sure how to even discuss the situation at this point.  I did want to say however that there are at least a few posts I will be altering or cutting outright.  And I wanted to make clear that I will always be upfront about edits that happen long after initial publication. I believe that a blog like this looses authenticity when an author is constantly going back and re-writing things, changing the past.  This is, at its root, a log of my experiences delving into medical art.  And at present it is a log of my experiences in grad school.  So it is my promise to you, my awesome readers, that any changes made or information removed will be clearly labeled as such.  I also promise to keep changes to a minimum.  I feel good about the work I’ve done here, and I don’t plan to go undoing it all now.  Can you believe I’ve been doing this since 2008 now?  It’s about to be 2011 already!  Time does fly.   But I have to say that this particular week, I am happy to see flap it’s little wings on by.  I am ready for a break indeed!

So, this is a pretty interesting animated statistical representation of world health over the last 200 years…

I just felt the need to repost this from XKCD.
It’s called “Positive Attitude”

It sounds like the author of this, my favorite web comic strip, has been dealing with some family health issues lately.  Wishing him all the luck in the world, and thanks again for writing such brilliant and poignant comics.