Doctors Don’t Know Everything

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[istockphoto.com]

I went to the doctor the other day. Even retired doctors have to go to other doctors sometimes.

Whenever they ask me what pharmacy I want a prescription sent to, I tell them I don’t have one because I shop around for the best prices, and that I need a paper script.

The doctor wrote a script, so I looked it up on www.GoodRX.com.

To use the website, there is no sign-in, no personal information, no membership and no fee.  Just type in the drug name, put in the form (pill, capsule, tablet, cream, solution, etc) and the dosage (mg, gm, mcg, ml, etc) and your zip code.

 

Immediately, it tells you the prices at a lot of the pharmacies in your local area (such as Walgreens, CVS, Rite-Aid, Safeway, Wal-Mart).

The lowest price for my prescription was $740.00!!

 

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[istockphoto.com]

I don’t have drug coverage with my insurance. No way was I going to pay that price!

So, I looked up alternative drugs in the same category, and found one that only cost $70.00. I marched back into the doctor’s office and spoke to the nurse (and the doctor who just happened to be passing by)– they were both shocked at the price and happily changed the script to the cheaper alternative.

Why are drug prices so different, even for the exact same item between different pharmacies?  Health insurance companies have departments that negotiate for drug pricing on their formularies (a list of medications they will cover for their members).  These ‘Discount Prescription’ cards and apps do the same thing, only you are not tied to the insurance company’s formulary, so you might have more options for medications.

Some electronic medical records your doctor uses have downloaded specific drug formularies covered by your insurance company.  But it’s not a perfect system.  As a surgeon, there was no way I could keep up with all the insurance formularies, but I always told my patients, “When you get to the pharmacy, if the price of the drug I prescribed is too much, have them call my office and we’ll discuss alternatives.”

Sometimes, there is only one drug in a category that will work for your specific condition.  Or serious drug allergies preclude other options. And that one drug may be expensive.

In that case, you might be able to get help directly from the drug manufacturer to cover all or part of the cost.  Most drug company websites have an option for financial assistance.  Look into it.

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Although there’s no such thing as a money tree, drug companies may be able to help with the cost. [clipartpanda.com]

But most often, there is probably a cheaper alternative.  If your overworked doctor won’t work with you on keeping prescription costs down or gets snippy when you ask for more economical choices (especially if you ask nicely and give them time to fix things), then consider changing providers.

 

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We’re all in this together.

Takeaways:

1.  Do NOT assume your favorite pharmacy is the best place to go with your scripts because it feels comfortable and they treat you well. There can be a huge difference in price between getting a drug at Safeway, Wal-Mart, CVS or some other place.  Wal-Mart offers a 90 day supply of some meds for only $10! Think about it;  would you be willing to pay $900 for a plain white shirt at Neiman-Marcus when the same one, or a close facsimile, can be found at a discount store for $25?  Just because you like the sales lady?  Remember: she doesn’t get one dime of the money you pay for the shirt.  Just her salary.  The same thing goes with pharmacists.

2.  Take a paper script with you from the office and look it up on http://www.GoodRx.com– it doesn’t cost you anything and there are no memberships or log-ins involved. Then, you print out or show the coupon code on your phone to the pharmacist and they accept it. Verify the price before they fill the script, though.

3.  Doctors don’t have the time to find out what drugs cost, and usually (but not always) there is more than one drug they could prescribe for you for the same medical condition.

4.  If it’s available for the particular drug, ask for the generic version (also known as ‘may allow substitution’ on the script), as it can sometimes save you a lot of money.  There is usually no difference in formulation between brand name and generic.  As an example, go to your local pharmacy and look on the allergy shelves at the price for brand name Claritin (an allergy med) and generic Loratadine.  Or brand Flonase (nasal steroid spray) and generic Fluticasone.  Or Prilosec (stomach acid med) and Omeprazole.  Same drugs, different prices.  Get used to looking at the ‘Active Ingredients’ on the label.  If it’s the same name, it’s the same drug. Only cheaper.  Store brands are usually cheapest.

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A drug by any other generic name… will act the same [clipart-library.com]

5.  It’s YOUR money! Even if you have health insurance, please don’t be a blind consumer– the global economy cannot support the rampant over-cost of drugs and healthcare.
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[vectorfreak.com]

6.  If you get to the pharmacy and ask about the drug price, and it is too expensive, have the pharmacy call the doctor’s office to prescribe something else.  Be kind to your pharmacist– they have absolutely no control over drug pricing.
7.  In a lot of instances, the cost of drugs in the United States far exceeds the cost paid by other people in distant countries for the exact same drug from the exact same manufacturer.  Hence people who medication shop in other countries across our borders (but be very careful if you are considering this:  have you ever seen high-end knock off purses, watches and shoes at hawker’s tables in big cities?  Imagine what some people will do to fake a drug tablet to look like the real thing– and you might have no way of knowing the difference).
We subsidize the world with the prices we pay at our local pharmacies.

 

8.  On a future post, I’ll give you some ‘doctor insider’ ways on how to research possible alternative prescription drugs to discuss with your provider.

9.  GoodRX:  I’m not a stock holder in the website, but it improves my personal portfolio when I don’t spend as much on medications!

Compare prescription drug prices and find coupons at more than 60,000 US pharmacies. Save up to 80% instantly!
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Be a wise consumer of healthcare [printablee.com}

– Wendy
Retired Otorhinolaryngologist, Head & Neck Surgeon
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RESET

Farewell my Lovely

2018-04-25_14-54-22_371In April 2018, we rolled Zane (our motorhome) into an impossibly tight spot between evergreens at a beautiful little RV Park in Show Low, Arizona for what we thought would be a month’s stay.

If you’re in Casa Grande, Arizona in April, it starts to get hot, really hot in the desert.  But at 6,350 feet elevation, Show Low is perfect.  Ahhh.  Time to relax and explore the area.

But after a week of cool relaxation, there was something rattling around in my mind that needed resolution.  The “rattle” had to do with our finances.  When we bought our beautiful 2004 Newell motorhome in 2014 we were making significant income and our plan was to retire with $X in the bank at some future time.

Fast forward to 2018 and our plans had changed.  We were now officially retired, significantly earlier than we had originally planned and with ½ $X in the bank.

Hmm.

When Wendy indicated in June 2017 that she was done, done, DONE with her medical career (but would still finish out her 6 month Eureka California contract),  I quickly began to adjust our investment portfolio so that I could pluck every piece of fruit (dividends) out of it without chopping down the orchard (stocks).  Then I created a budget based on that annual dividend income and we began living on that projected amount while she finished her last 6-month assignment. And we kept to our new, leaner, meaner budget.

Freedom is a wonderful thing.  It feels great!  But financial freedom requires some sacrifices.  If we were going to be done working, we would have to stay within this new budget.

And the one thing that was rattling around in my brain was the fact that Zane had a habit of requiring costly repairs.  She’s an older coach.  She has a massive diesel engine.  No, make that TWO massive diesel engines; one to drive her and another in the PowerTech generator which produces 20 kilowatts of electricity (enough to power a motorcoach and a house at the same time).  Everything in her is high end, including a Sub Zero fridge that keeps requiring $800 repairs, would cost $12,000 to replace, is custom built into the cabinet walls, and no appliance repair guy wants to work on it.

In the four years we have lived in Zane, we’ve budgeted $12,000 per year in maintenance and upgrades. And every year we blow through that $12,000 budget.  Like the Roadrunner zooming past Wile E Coyote.  Beep! Beep!

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[credit:Warner Brothers via twistedsifter.com]

How could we remain financially free (live within our budget) with this budget-busting motorhome?

Hmm.

But we love her so much!

One day, Wendy and I are sitting outside under the pine trees when in rolls a gold Ford F-350 pulling a 5th wheel into the spot next to us.  It looked very —nice! I turned to Wendy and said, “I could do that.”  (Meaning, I could imagine us trading down to a truck and 5th wheel.)  Next thing, Wendy and I are making new friends, taking a test-drive in their pickup (smooth ride, not clunky and mean-spirited like big trucks I had driven before) and walking through their spacious 5th wheel.

Hmm.

With a new pickup truck and 5th wheel we could cut our yearly maintenance budget to $2,000, or maybe even lower.  Especially since a new one would have a 1-2 year all-inclusive warranty! And by selling the motorhome, we could buy the truck and 5th wheel with a significant amount of equity left over to provide more cushion in our bank account.

Just for grins, let’s throw in the decrease in RV insurance:  $733 a year for a 5th wheel instead of $4700 for the Newell.  That’s a big, huge, whopping incentive to re-think this whole motorhome issue.

Hmm.

Do I love my freedom more than I love my motorhome?

The answer is a resounding “YES”!

Time to press the RESET button.

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credit:ThisTimeIMeanIt.com

Once the decision was made, Wendy went into action.  She is amazing!  She loves these types of challenges.  Ergo:

  • Where and how do we sell the motorhome? At what price?
  • Which 5th wheel should we buy?
  • New or used?
  • How do you determine which truck to buy? F250? F350? Single rear or dual rear wheel axle?
  • How do you manage the logistics of moving your stuff from a motorhome to a 5th wheel?
  • Should we wait to buy a truck & 5th wheel until the motorhome sells? Or should we cash out some investments to cover the cost and then reimburse the investment account after the motorhome sells? Or should we (No, don’t say it) borrow for the truck & 5th wheel until the motorhome sells?

At the time, these questions were almost overwhelming.  But we’ve dealt with much bigger challenges, so we could handle this one.  Here’s how we ordered our thinking:

  1. Research 5th wheels.  When we bought the Newell we had researched motorhomes using www.rvreviews.net, which is an independent reviewer for recreational vehicles, similar in nature to Consumer Reports. So we got their guide for 5th wheels and began to pour over the reports.  We were looking for a 4-season, high quality product for full-time living.  Answer: DRV, followed by Redwood and then Grand Design.  We’d have to look at them and see where the price point / quality met our comfort zone.
  2. Where can we find some 5th wheels to look at? We can go anywhere in the United States to look, but let’s start where we intend to sell the motorhome.  So we set off for the Dallas, Texas area and unloaded all of our earthly possessions into a 10’ x 10’ storage unit.
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    Our few earthly possessions.  Something of which to be proud.

    Then we put eyes on some 5th wheels and selected a brand new 2017 DRV that had been sitting on the lot for over a year (the 2019s were coming in and they were ready to deal!).  We negotiated a great price with the full 2-year warranty.  We gave them a couple weeks to clean up some issues we found before we would come back to pick up the 5th wheel (by which time we hoped to have a truck with which to pull it).

  3. Where to sell the motorhome? That was pretty easy for us.  Motorhomes of Texas (MOT) sells used high-end motorhomes like our Newell and they draw buyers from all over the continent into their little town of Nacogdoches, Texas. What an amazing experience.  It took less than an hour.  We signed consignment papers with them, they suggested a listing price we liked, and the coach went immediately into their shop for a thorough review.  Their technicians were highly skilled and their service was reasonably priced.  They polished, spiffed it up, took pictures, video and advertised it on their website as well as on RVTrader.  Our experience with Motorhomes of Texas has been excellent!
  4. Next up, lose the Jeep and buy a truck. It’s important to identify the 5th wheel before you pick the truck so you know what pulling capacity you need.  Or be extremely realistic about what your current truck can haul.  The DRV is well built (a.k.a. heavy).  So we did the research and  determined we needed an F-350 Duly.  And thank goodness Wendy’s sister Kerry is married to Jeff who retired from Ford and was kind enough to give us the magic code for family to purchase a Ford for a killer price (Thank you Jeff).  With all these moving parts it just was not practical to try to sell the Jeep on our own so we traded it in as part of the transaction.
  5. So now we’re driving this big Ford beast and it’s surprisingly comfortable and quiet. 2018-06-12 Ford F-350We headed back to Dallas, picked up our DRV, loaded it with our stuff from the storage unit, and off we go.  We also went to the Cat Scale at a truck stop and went through the rigamarole to weigh the truck and fifth wheel using the workbook page in our B&W Hitch instruction booklet to calculate the final weight.  We are not overweight! Those who do chose not to weigh, do so at their own safety and insurance risk should their rig and truck go turtle.  And, you really should know if that bridge tonnage limit will hold before you try to cross it.
  6. We chose to buy the truck and 5th wheel using credit as a temporary stopgap until the sale of the motorhome. We HATE being in debt and it pained us every month to make payments, most of which was interest.  Interest is just — poof — money down the hole.  But it provided us the convenience of staying on the road (and visiting lots of family that summer) while we waited for the right buyer for the motorhome.  And wait we did.  We put our Newell up for sale in May 2018 and she did not sell until January 2019.

So that was our RESET. And it feels like we made an excellent decision.  Yes we loved the Newell.  It was a sweet ride!  There is nothing like rolling down the road sitting way up high and watching the world roll by in a Newell, with the massive semi-tractor engine 45 feet behind you.  You just have to experience it to appreciate it.  We miss her.  But she was demanding.  Her complex systems required constant maintenance and money.

Meet Zane Too.  Our 39 foot, 2017 DRV Mobile Suites 38RSSA.

2018-06-07 Zane Too

Uuuhhh… which way do we tow this thing?? There’s gotta be a manual around here…

We chose to make Zane Too as simple as possible, with no washer/dryer or generator.  Just pull her to the next RV park and plug into the power pole. The truck’s alternator charges the house batteries as we go down the road to keep the residential fridge contents cool.

I find myself with much more free time because I don’t have anything to fix on her.  And our budget is much happier with Zane Too.  And we remain free.

Life is soooo goooood!

~ Clay

 

Retirement 3.0

I haven’t personally contributed to the blog lately– Clay has done all the heavy lifting. He does such a good job with painting word pictures.  Yay, Clay!  But I have a great excuse:

I am too busy reading novels.

On my floaty thingy.

In an 80 degree pool.

Being truly and completely retired now (which is supposed to mean there are more hours in the day),  I’m back on the blog road again.  This time, giving my impressions of Retirement 3.0 (as in 3 months since my official last day of work).

On our motorhome bookshelf, sits “The Escape Plan” binder.  Its maroon cover is faded from years of fondling, perusing, journaling and researching.

Not everyone has an escape plan in life. That big red ejector seat button riiigggghhhhttt under their finger (“Don’t pusha da button!!!” as our son Jesse used to say, after he willfully pushed the elevator Emergency Stop button and the ear-splitting klaxon of alarms scared the soup out of him).

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We like pushing da button.

And we were feeling the urge to un-merge from our current lifestyle and change things up dramatically.

Clay and I would look each other in the eyes after a particularly trying day, week or month and desperately say,

“You and Me . . . right?”

Since the answer was always a heartfelt resounding, “Yes!”  then it didn’t really matter what storm or life quake was currently happening.

Our mantra became (because we were thinking of moving to a Spanish speaking country such as Uruguay or Ecuador), “Vayamos, muy muy legos, sin los pantalones.”  Loosely translated: “Let’s go far, far away, without long pants” (nice weather all the time, wearing shorts and flip flops).

The true germination of this wild idea came in March of 2012, on a piece of lined notebook paper, “The Start of It All”.

Our original questions was, “What do we actually want to do when we retire?”

I adore, love, can’t get enough of world travel. Packing for a plane trip makes me grin. Having a passport gives me wings.  Settling into a cruise ship melts my bones. Being somewhere I’ve never seen before makes my pulse quicken (in a good way– not like an anxiety attack). Picking up phrases in another language is a game for me (Please. Thank you. No thank you. Don’t touch me. Left, Right. I don’t speak your language. Do you speak English? Where is the toilet?).  Learning about other cultures and art from a knowledgable native tour guide is like taking a mini-college course and I suck it up like chocolate milk.

Clay also likes to travel, but really loves being in any allergy-free season/zone so he can be completely engaged in what’s going on around him.

I have spent the past 27 years of my life studying to become a physician, going through residency, solo surgical practice and temporary medical assignments on the road. It’s who I am and what I do.  A few years ago, Clay asked me, “I know you are ready to retire, but what are you going to do with yourself to keep fresh, alive, fulfilled and entertained when you’re no longer wrapped up in life as a doctor?”

“You mean, after I sleep for 6 months?”

“Of course.”

“I will be a writer!”  The idea popped into my brain as a full-fledged Aha! moment.  I have children’s book ideas, young adult fiction, medical memoirs and this blog.  Our daughter Caroline introduced us to Scrivener (www.literatureandlatte/scrivener) a word processing program for authors that organizes writing of any sort and gets it ready for publication.  Thanks, Caroline!

And Clay will continue to do what he has been doing:  thoroughly enjoying doing investment research analysis. When he’s not writing his thoughts down or studying astronomy, astrophysics and history.

So we’ve pushed da button.  And virtually every day since, we have a moment when we look at each other and just giggle with delight at our new-found freedom.  We’re flapping our arms and flying away!!!!

-Wendy

Merry Christmas from Tucson

Wendy and I rolled into Tucson Wednesday (Dec. 20, 2017) after spending 6 months in Eureka, California where Wendy completed a work contract for St. Joseph’s Hospital.

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Hmm. Let me just root around in there.

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Surgery co-workers in Eureka

We’re in our pajamas today, but if motivation overcomes us we might change into shorts and bicycle to the store to pick up a few groceries.

Then again, we might just stay in our pajamas because —– (drum roll please) —- we’re officially retired.  Wohoo!  Can you believe it?  On Friday, December 15th, 2017, Wendy saw her last patient.  That’s it and that’s all.

So, on to our next life.  Time to once again reinvent ourselves.  We’ve done this reinvention thing so many times in our lives.  We think up a goal, we research it, we talk about it incessantly, and then if we like what we imagine, we jump in with both feet.IMG_7066

We’ve actually been transitioning into full retirement for several years.  It started decades ago when we became serious about becoming financially independent.  It accelerated 5 years ago when we hired a consultant who asked us lots of questions and helped us envision our future retirement and helped us identify the interim goals needed to get there.

It helps that I have been a lifelong investor.  One core principle I learned at a young age: To become financially independent, you need to be a business owner (i.e., stock holder).  So rather than being the guy who hires/fires employees and invents products and manages services and sweats over the details, you need to be the guy that provides the capital for the business, which in turn manages the people who hire, invent, manage and sweat.  Their work each day produces the income (dividends and interest payments) that we now live on.  And we are very grateful for their daily efforts.

What are we going to do in retirement?  First of all, we’re going to rest.  This first year in particular we’re going to enjoy the simple things that we’ve been too busy to appreciate.  The simple mindfulness that comes from enjoying each day.  I will continue to study history and astrophysics.  Wendy will see if her creative desire to write stories and illustrate her children’s books returns.

Most importantly, we’re going to goof off.  And we’ll continue to improve our health.  Over the past six months, Wendy and I have developed the habit of walking about 3 miles each day.  It takes about an hour.  We listen to books as we walk and enjoy nature.

Northern California had some amazing scenery to walk through from canyons of ferns to  giant redwood forests to spectacular and remote beaches.  We’ve both lost weight this year, so whatever we’re doing seems to be working.

In 2018, our first year of retirement, we’re going to travel, but not too fast.  Here’s our travel plan for 2018:

Be sure to honk and wave as we roll by.  And if you want to hang with us when we’re in your neighborhood just send us an email or text.

MERRY CHRISTMAS to all of our family and friends!!!

– Clay