Hassle With the Health Insurance

Michael Last summer, I had the dubious pleasure of having my meniscus, which I tore playing soccer, surgically repaired. In Figure 2, you can see the total cost of this adventure. The hospital charged a whopping $43,696. However, our health insurance had a deal with the place, so we got a discount of $27,775.55, leaving $15,275.10, which the insurance actually paid. That means everything except for the so-called "Copay," a deductible of $645.35, was charged to me as the patient. What went on there?

Health insurance companies in America offer, either through an employer or a government agency like Covered California various so-called "plans," which are insurance contracts at different costs. Typically, the insured pays a monthly premium but often must also chip in a co-payment for medical bills. For example, our co-payment is $30 for doctor visits, but for more extensive procedures during hospital visits, it's a hefty 10% of the bill, up to an annual maximum of $2,000. This is intended to motivate patients to minimize visits to the doctor or other costs. For plans with lower deductibles, the insured must pay correspondingly higher monthly premiums.

Under our plan, until we reach the yearly maximum (in the example, $2,000 per year), each doctor visit costs us $30. So, if the insurance company agrees to pay the doctor $400 for a 10-minute visit (which is not unusual as health costs are out of control), because that's the negotiated rate between the doctor and the insurance company, the insurance later transfers only $370 to the doctor. The remaining $30 must be collected by the doctor from the patient. This is usually handled at the reception desk, where the patient typically pays the owed amount by credit card in advance, before even seeing a doctor. However, sometimes the staff forgets to collect the copay, and a few weeks later, the delighted patient receives a bill for $30 by mail, which they can also usually pay by credit card.

During my aforementioned operating room visit last year, the hospital's finance people mysteriously estimated the cost of the surgery at $9,000, and a few days before the appointment, they charged me 10% of that amount, or $900, which I paid by credit card, to give the go-ahead for the surgery. However, in the meantime, several charges from various other service providers had been filed with the insurance: the radiologist wanted money, as well as the treating orthopedist who had recommended surgery after an also expensive MRI. Quickly, my annual maximum amount of $2,000 had been reached. Hooray? That's why, later, despite the higher-than-estimated surgery costs ($15,275.10 instead of $9,000), the insurance calculated my co-pay not as $900, but only as $645.35. Wait a minute, so had I overpaid the hospital by $254.65?

Now, it must be said that many Americans wouldn’t bother to check this, but you might have heard that I once called eBay to get a refund of 10 cents that those crooks had overcharged me. So, I called the hospital, navigated through a thousand menu options, and asked if I would get my money back. No, they told me, I was lucky because the insurance had negotiated a lower amount. Apparently, the finance person on the phone had no clue because, according to my research, my insurance had reimbursed the hospital the requested amount except for exactly $645.35, which I was willing to contribute, but not a penny more. The hospital lady advised me to call my health insurance to clear up the matter.

I got right on it. Since our health insurance is still managed through my old employer, the staff there are incredibly sharp, quite different from what one typically expects of health insurances in America. The employee on the hotline immediately saw the problem and, while I was still on the phone, contacted the hospital. Apparently, the billing department there got an earful because, after a few minutes, I received the pleasing news that the hospital would of course refund my money immediately.

What do we learn from this? Not even billing departments of hospitals know how to bill correctly. Most patients are also overwhelmed by the regulations or unwilling to familiarize themselves with them, and out of ignorance, they leave their hard-earned money on the table. The service providers may even factor this in and keep quiet if the patient overpays, while in the opposite case, they of course immediately pull all levers to receive the cash.

So, as always in America: Keep calling until everything is correct. Be friendly but assertive, never scold, but patiently explain the situation and maybe even inject a bit of humor. After all, the people on the other end of the line are just humans doing a tedious job and yearning for some entertainment. At the same time, you get to improve your English and negotiation skills for free.

Anyways, four weeks later, a letter from the hospital arrived in our mailbox via snail mail, with a cover letter that defiantly claimed that an 'Internal Audit' conducted by the hospital had discovered that too much money had been taken from me. Enclosed was a check for the exact $254.65 I had disputed. Life is full of coincidences.

Trouble with Amazon

Angelika In November 2023, two dubious letters from amazon.de landed in our snail mail mailbox with a postmark from Malta and a letterhead with the Amazon logo, which wasn't even in color. Allegedly, I had ordered something from Amazon, but the direct debit could not be processed, and I now supposedly owed Amazon 101 euros each, which I was requested to promptly transfer to the banking institution HSBC Trinkhaus and Burkhardt.

Neither letter said precisely what I had allegedly ordered. Also, it was strange that I had received two separate letters with the exact same demand, both sent to my American address. Sadly, nowadays, scammers are becoming increasingly cunning. By now, it's well-known that one should not respond to any payment requests via email or SMS. So, I suspected that this must be a new snail mail scheme to scam people.

And since I don't have a German Amazon account but only an American one, and there were no strange orders there, Michael and I initially ignored the letters, believing it to be a bold attempt at fraud. I did some research on the internet and found that other Amazon customers had experienced the same thing. There were two explanations for these letters: first, that the letters were not genuine. The second, more concerning explanation suggested that someone was using my data to set up an account in my name on Amazon, but with incorrect banking details. It's still not entirely clear to me how this could be exploited, but let me highlight the absurdity that Amazon in Germany allows customers to shop both by invoice and direct debit, and seems little interested in closing the fraud opportunities that this opens up.

You guessed it, the story continues. In February, again via a grey envelope sent from the tiny country of Malta, a letter arrived from the debt collection agency Riverty. Here, too, it wasn't clear whether it was a very good forgery or a legitimate claim. According to the internet, Amazon actually does work with this collection agency. With debt collection firms, you always get the impression that they are essentially an arm of the Mafia. The letter was also full of red flags, such as the suggestion that I could set up a SEPA direct debit mandate and then the collection agency would take care of everything, and I would have no hassle.

Now, I know that you shouldn't randomly call any phone numbers listed on such letters, as they might also link to scammers. So I thought, first I would contact amazon.de to see if they could help, because an internet inquiry revealed that such letters should not be completely ignored due to the possibility of identity theft.

So, I logged in with my American Amazon account credentials on the German Amazon site and started a chat because I wanted to have something in writing. I had only had positive experiences with Amazon's American customer service up to that point; they are sharp and always solve problems immediately. Naively, I thought that Amazon Germany applied similar standards.

It initially took me three attempts before anyone understood what my problem was and was willing to help me. At first, I wasn't even sure if I was speaking to a machine or a person. The first piece of information I received was that I had received the reminder due to a technical problem and should ignore the email.

Wait, stop, you attentive readers noticed it. I hadn't received an email, but two letters by mail! Then I was promised that my inquiry would be forwarded to the appropriate department and that I would receive a copy of this inquiry and could expect a response in 2-3 hours. Neither one happened.

On the next attempt, I was simply told that I had not paid for a so-called Amazon Kids subscription and that was why I received the reminders. It goes without saying that I had already explained to the lady named 'Meri' that I had not ordered anything and did not have a German Amazon account. When I asked her if she could at least tell me if someone had created an account in my name, she wrote in the chat that she could not tell me that for data protection reasons. That's just scream-worthy.

She also promised to forward my concern to the security department, and that they would then contact me. I'm still waiting for that. On the third attempt, I spoke with the agent Kirtiman Singh Rajavat, and he finally took decisive action. He instructed me to send the reminders and the letter from the debt collection agency to a special email address at Amazon, which I did. It was not exactly confidence-inspiring that the request was full of typos, but I then received a message that no further action was required on my part for the time being.

Although I was again told that I would receive further feedback, I am still waiting for it to this day. Madness! I am still not sure if the matter is now closed or if I will soon receive a letter from a German court. Sometimes I really long for the days when you could simply pay in cash for merchandize in real stores.

Anza Borrego Desert

Angelika Anyone who works at a school like I do enjoys the benefit of generously alotted vacation time, which is a real luxury in the USA. And now that Michael has recently become a freelance programmer and surfer, and is therefore very flexible with his time, we can use my vacations for traveling together.

Around Christmas, I had more than two weeks off, and we spent one of those weeks driving down to the Anza-Borrego Desert, which is located about 85 kilometers northeast of San Diego. We had been there many, many years ago, and had long intended to return. We packed our Honda Fit, affectionately called Brummi, and zoomed down south, making a stop in Santa Barbara, where we also hadn't been in ages.

Before we moved to the USA many years ago, I had a somewhat one-sided view of desert landscapes, thinking: It's hot, there's a lot of sand, it never rains, and hardly anything grows. Of course, that's not entirely true. The temperatures are indeed brutal, especially in the summer months, but the plant life is rich and very fascinating because it consists of particularly robust plants that withstand the dryness and weather conditions. The same is true for wildlife: In the Anza Borrego Desert, for example, there are lizards, mountain lions, coyotes, and bighorn sheep.

It's true that it rarely rains in the desert, but nonetheless, they do record precipitation during the winter months, about 6 inches, or approximately 150 millimeters, per year. For example, it was drizzling on the day we left. You can best imagine the Anza-Borrego Desert as a mountainous terrain with hidden canyons, but also magnificent expanses, a paradise for every hiker and nature lover. What always fascinates me the most in the desert is how quiet it is. A delight for city dwellers like us.

We rented a great Airbnb in the town of Borrego Springs. The cottage was not only superbly equipped but also extremely affordable by California standards, which made me initially think there must be a catch. But there wasn't. There was a horse living in a corral behind the house, but of course we weren't required to take care of the horse. However, Apache Tears, as the horse was named, always enjoyed some petting and attention, and contributed to our holiday idyll in the desert. The accommodation also had bicycles for free use. Since Michael couldn't go on long hikes every day due to his meniscus surgery, but cycling was no problem, we were pleased to have this mode of transportation.

Despite the many years since our last visit, the desert landscape had pleasingly not changed, and we were just as thrilled with the Anza Borrego Desert as the first time. Borrego Springs had improved its culinary offerings, though. However, what really caught our eye were the huge metal sculptures that stood out almost surreal against the blue sky throughout Borrego Springs. They hadn’t been there during our first visit. Rusty dinosaurs, eagles, horses, as well as prehistoric animals were now spread throughout the desert landscape. There are 130 of these sculptures! How did these end up in the desert? What’s the story behind them? An artist named Ricardo Breceda created these on behalf of Dennis Avery since 2008. Dennis Avery was an American philanthropist whose father had built the quite successful Avery company.

The brand 'Avery' is as well-known in the USA as 'UHU' is in Germany. Avery developed the first self-adhesive labels. The owner's son did not join the company himself, but as an heir, he had a substantial amount of money. Having lived in Borrego Springs with his own family for a long time and loving and wanting to protect the desert landscape, he acquired quite a bit of land there. He then met Ricardo Breceda and installed the idea of sculptures in the desert landscape, placing them on his private land, which is open to the public.

One can certainly debate the artistic value of these metal sculptures, but Borrego Springs has definitely gained a new tourist attraction. And if the area is kept free from being filled with houses because of it, I'm all for it. By the way, Dennis Avery passed away in 2012 at the age of 71, but the sculptures are now managed by a foundation. We toured the sculptures on our bicycles, as the area is quite expansive, and felt like we were on a movie set.

Salton Sea

Angelika Right around the corner from the Anza Borrego Desert is Salton Sea, an oversalted, practically dead lake, behind which tells the story of a major environmental disaster. It's an unreal, fascinating, but also somewhat eerie landscape in the middle of the hot desert. An area that once saw glorious times with major Hollywood artists visiting, and nowadays attracts bohemians with interesting, but often also tragic life stories.

Such areas also have a magical pull on me, so it was clear that we would make a trip to Salton Sea from our base in Anza Borrego. But now what happened to the lake? Even the lake's origin story is crazy. How does such a large lake end up in the California desert? It was due to an oversight by an engineer.

First, you must know that a sophisticated and now very controversial canal system, which taps into the Colorado River, irrigates farmland in Southern California's Imperial and Riverside Valleys. Without such water sources, no vegetables would grow on Californian fields. One of these canals, namely the Alamo Canal, became clogged with mud around 1900, and it was not possible to clear it. The farmers urgently needed the water and protested and pleaded with the responsible company, the "California Development Company," to let the water flow again.

Since the company was already on the verge of bankruptcy, their engineer Charles Lockwood must have thought, everything's lost anyway, so I might as well make a breakthrough at another location along the Colorado River and let the water flow uncontrolled by dams through different channels to the farms in the Imperial Valley. Naturally, this didn't go well for long, and in 1905, due to heavy snowmelt, the Colorado River had high water levels. Because of the overburdening of the canal system and further breaches, the river water flowed unhindered into the Salton Sink for two years, forming the lake.

This inflow was stopped in 1907 by repair works. Now, however, the lake hasn't had any natural inflow or outflow and its level has been maintained for decades by agricultural wastewater. However, this wastewater carries pesticides and other chemicals, making the lake practically completely saline. Its salinity is higher than that of the Pacific Ocean! As the water level in the lake continues to drop due to various environmental factors such as higher evaporation due to rising temperatures and less wastewater inflow, the salinity continues to increase, and chemicals that have accumulated in the mud of the lake bed over decades are released. The air quality in this area is often poor, and diseases such as asthma and cancer are increasing, not to mention the death of fish and other species. The state of California has been trying to find a solution to the problem for decades, but the responsible authorities and politicians cannot agree on the right approach, and then they prefer to do nothing.

Strangely, in the 1950s and 60s, when the salinity of Salton Sea hadn't reached today's levels yet, it was a popular excursion and swimming destination, with resorts bearing such glamorous names as Bombay Beach. Day-trippers came from Los Angeles and Palm Springs, bathed in the lake, zipped around on motorboats, and even fished. Nowadays, that's a somewhat absurd notion.

Today, the area around Salton Sea is generally inhabited by bohemians and people who need affordable, cheap housing. These enthusiastic residents fight to ensure that the area is not forgotten. There is an annual art festival in Bombay Beach with many art objects on the beach that then are simply kept there. Parts of the area resemble old ghost towns with many abandoned and collapsed buildings. It's a paradise for every photographer. Despite the harsh and toxic environmental conditions, many birds, such as snow geese, settle by the lake. And there's also a nice bar with the funny name 'Ski Inn' with a beautiful garden, where we stopped by and enjoyed delicious hearty burgers. At places like Salton Sea, I always find myself philosophizing about life in general and in particular.

New City Hiking Website: hikethiscity.com

Michael During the Covid lockdowns, we got into the habit of going for a walk every day, and at that time you either couldn't leave the city or had to quickly get a walk in before sunset, so I began to scope out intricate city hiking trails using websites like Google Maps and Komoot.com. San Francisco offers not only the well-known attractions for tourists, and even someone who has lived here for 20 years may not know every hidden staircase, urban hill, or mini-parks with breathtaking views, whether in rustic working-class neighborhoods or luxury districts built with old money.

And so, for a while, I put together new city hiking trails almost daily behind closed doors in stealth mode, which we then actually hiked, recorded, and reviewed. From the very best, which led through winding alleys, crossed the freeway on pedestrian bridges, or where you could admire beautiful old grand villas or simply enjoy an elevated panoramic view over the entire city, I created a coffee table book titled "San Francisco Urban Hikes", a heavy, splendid glossy photo volume with maps for the routes.

But as you know, my production mill never stops, so recently it occurred to me to throw the accumulated treasure all at once at the public’s feet by putting it out on the web at hikethiscity.com. And just like that, 57 of the best hiking trails in San Francisco are now online! So if you’re ever in the city, you can pick a few trails and navigate through them with the free Komoot app, which the detail pages on the website link to. You’ll be amazed!

Now you can guess where the cover photo in Figure 23 was taken. Clearly in a more urban area of San Francisco, with a pedestrian bridge over a busy street, but with a wide view of the Bernal Heights and Potrero Hill neighborhoods. No tourist has wandered there yet!

Top Product: The Flexible Cable Organizer

Michael I still type a lot on the computer, writing articles, creating open-source software, and sending sharp-tongued emails or posts on social media. In my later years, I have also discovered the standing desk for myself. Or, rather, an adjustable desk that moves up or down with a motor, depending on whether I want to sit down or stand up while working.

The problem with this flexible setting, however, is that the cables running from the power outlet to the desk, which include monitor and computer power, a network cable, USB connection to the scanner, and so on, tend to coil loosely on the floor when the desk is lowered, but need to tighten when the desk is raised for standing. Additionally, one should be able to walk around the desk or quickly vacuum under it, and with my previous setup, due to a lack of cable management, thick dust bunnies had already formed under the chaotic tangle of wires. Unacceptable!

By chance, I discovered some newfangled cable guides on Amazon called "Vertebrae," which, similar to a spine, assume a curved shape without kinking when compressed. The links are freely attached to each other like vertebrae and allow rotation around a single axis (unlike the spine in two dimensions!). The size is sufficient for up to half a dozen cables to stay neatly within the vertebrae, and on Amazon, several vendors offer this product for around 35 dollars. I got it on eBay from a Chinese seller for just over 20 dollars. Worth every cent, as my study has never been this clean since I started whizzing around with our also brand new Dyson vacuum cleaner. Top product!

Whitewashing Greta

Michael As for glueing climate activists, you in Germany probably know better than we do here in the USA, but of course, we are also familiar with Greta. That's why I had to laugh when about six months ago, I discovered this wall portrait of her, a so-called 'mural' in the middle of the city, right around the corner from my dentist. The image had something eerie about it, like a doll sitting on a shelf staring at you.

But now, Greta has fallen out of favor due to her political statements, and recently, passersby in downtown San Francisco reported that the painting, which, to my knowledge, had not been officially commissioned there, is now broadly covered with a beige hue, also apparently in a covert operation carried out by youthful rebels. Well, it doesn't matter to me, I just found it interesting how quickly fans nowadays hype up their idols and then drop them just because they said something controversial. As I get older, I also realize that I used to talk a lot of nonsense in my youth, but hey, that's just how it is when you're young, talking nonsense is part of the learning process! Luckily, no one canceled me, that wasn't a thing back then.

Greetings from Germany's future:

Angelika und Michael