Follow-up: An Example of Insurance Companies Focusing on Profits, Not Patients.

I received a letter today from Deseret Mutual Benefit Administrators (DMBA) re: an appeal I had filed on behalf of one of their members (our patient).  As I described in my previous post, I work very hard to provide our patients with accurate information as it relates to their out of pocket expense.  I had contacted DMBA prior to providing services to their client and was told that their plan would pay 100% of allowable charges after co-pay.  This means that the patient is only responsible to pay their co-pay, DMBA would pay the rest. Great news, right? Well, based on my past experience, too good of news.  So, we called DMBA a second time and talked to a separate representative.  She provided the same information, 100% of allowable charges after co-pay. The reason this sounds too good to be true is that our office is an out-of-network provider for DMBA, which both representatives were aware of. Logic would hold that the insurance company should know their benefit information.

We completed the evaluation and sent the billing to DMBA.  We received an EOB (explanation of benefits) along with payment. DMBA sent 60% payment on the allowable charges. I called and explained that we had been told by TWO of their representatives that they would pay 100%.  I was instructed to file an appeal.  

I received the appeal decision today.  Although DMBA acknowledges providing us with incorrect information (they reviewed both phone call recordings), their obligation is to pay as outlined in the "member handbook". So, who loses?  First off, the patient, because they are ultimately responsible for the incurred charges.  Second, the provider.  The patient made the decision to pursue testing based on the estimate I provided and may not have the financial means to pay for the services.  It is not uncommon in this situation for the patient to take out their frustration at the provider instead of where it rightly belongs, on the insurance company.

The denial letter also stated that, since the service was "medically necessary", it would have occurred regardless of the percentage the plan paid. I think the patient would strongly disagree.  They had other choices.  They could have taken responsibility for submitting the billing paperwork directly to their insurance, allowing them to be eligible for the cheaper "self-pay" rate. They could have also chosen an "in-network" provider that would have been reimbursed 100%. Everyone has a right to know what something is going to cost.  It frustrates me that in healthcare, this answer can be so hard to come by.


I still can't understand how an insurance company acknowledges providing incorrect information but won't take accountability for it.  I'm sooo frustrated!  I have offered to help the patient file their own appeal. For most patients, this is an intimating process and many just choose to pay (or not pay) the bill. 

What the Affordable Care Act Means to Me: Health Insurance Companies Focusing on Patients, Not Profits

In my first post about The Affordable Healthcare Act, I discussed what it means to me as a consumer of healthcare.  Now, I would like to share what it means to me as a healthcare provider.  My husband (a neuropsychologist) and I (a physical therapist) have a healthcare practice that provides services to individuals who have experienced some form of neurological injury (ie. traumatic brain injury) or neurodevelopmental disorder (is. Autism, ADD etc.). For many of these individuals, the long term consequence of their injury is cognitive / behavioral.  Even though the source of their problem was medical, they are now labeled with a mental health disorder.  Mental health coverage by insurance companies is typically quite poor; in many plans it’s non-existent.  There are very effective treatments but people can’t access them due to cost and availability. Without treatment, many of these individuals are unable to be productive members of society.  With treatment, they are able to work alongside of us!

So, what will the ACA do to change this?  The ACA expands the parity in healthcare between physical and mental health.  It also expands the coverage of prescription medication.  This will allow patient’s with disabling mental health diagnoses to receive appropriate care, allowing them to be productive citizens. Supreme Court Decision Benefits People With Mental Illness.

Alongside of providing services to patients, is the issue of getting paid. One of my jobs is billing insurance companies for the services we provide to their members.  Our practice believes in complete disclosure re: costs. I contact each insurance company prior to a patient’s appointment to obtain “verification of benefits”. My goal is to answer the following questions. 1) Are “x” services covered by the patient’s insurance plan? 2) If so, what portion of the service is the patient responsible for paying? The following list of variables factor into finding out the answer to these questions.

• What type of provider is providing the service (ie.,MD, Psychologist, Counselor, Speech-Language Pathologist)?
• Is the provider in-network or out-of-network?
• In what environment is the service being provided (ie.,inpatient, outpatient, in home)?
• What diagnosis are you treating? (More specifically, what diagnoses are excluded)
• What is their deductible?
• Does the service “apply to deductible”?
• How much of the deductible has been met?
• Is there a co-payment or co-insurance?
• Is pre-authorization required?

Oh, I forgot to tell you that this conversation always starts with the disclaimer, “The information provided is not a guarantee of payment.” This is why it is so important to get answers to all of the above questions. For example, if you don’t ask about exclusions and bill the service with an excluded diagnosis, the claim will be denied.  If you don’t ask about pre-authorization and pre-auth is not obtained, the claim will be denied.

After obtaining, what I hope to be, accurate information about the patient’s benefits, I can then provide the patient with an estimate of cost for the requested service. I have had several occasions where I have obtained all this information, billed the service as the insurance company instructed and it was still denied.  Then we start the process of appeal which can take months to complete.  There have been cases where we have literally lost money when it is all said and done.

The reality is, insurance companies are profit-driven; they will do whatever they can to get out of paying for a service.  As soon as you think you know “the rules”, they change.  It’s not in their primary interest to ensure their members receive needed services and even less important for healthcare providers to be paid for services.  In some cases, we can’t even hold the member responsible to pay for the service due to the fine print in the contract between the insurance company and the provider.  If the healthcare provider ends up not being paid for the service they provide, they can’t even claim it as a loss on their taxes.

Insurance companies first and foremost accountability is to provide their management structure with exorbitant salaries and their shareholders with hefty dividends. According the an article in American Medical News, a publication of the American Medical Association (AMA), insurance companies provided their CEO’s with the following annual salaries in 2011:

• Aetna: $14 million
• Coventry: $13.6 million
• Wellpoint: $13.4 million
• United Healthcare: $10.1 million
• Humana: $6.1 million

What is the ACA going to do to change this? Most importantly, it will require insurance companies to make providing healthcare to their members their first priority.  Insurance companies must now spend 80% of premium dollars collected on healthcare costs.  The remaining 20% can be used for administrative cost, salaries, advertising etc.  If an insurance company does not comply with the 80% guideline, they must provide rebates to the members.  It is estimated that insurance companies will be paying an excess of $1 billion dollars in rebates to their members this year. Insurers Say Health-Reform Related Rebates To Exceed $1Billion.

I welcome questions, comments, experiences!  Please share.  My goal is to create a dialogue.

What The Affordable Care Act Means to Me: Personal Accountability While Allowing For Accommodation

Why do I care about affordable healthcare?  First, I’m alive therefore I am a consumer of healthcare.  Second, I have been a healthcare provider (physical therapist) for 16 years.  Third, my husband and I are small business owners and have made the commitment to provide health insurance to our employees.

In the 38 years (almost 39) that I have been alive, I have never been without health insurance.  The thought freaks me out.  I have been in the position of making a choice about where to spend my money and health insurance has trumped many things over the years.  But I also have never had a major health crisis, nor have I ever been unemployed.  Yes, I could puff my chest out and say I’m better than “those people”, but I know better.  The reality is, those circumstances are a moment away.  They are for everyone. 

I have seen / worked with individuals for whom that moment has come.  They have spent their lives being responsible, law abiding, GOOD people but something happened (health crisis, accident, job loss etc.) and the rug was taken out from under them.  I worked with a woman once who too had health insurance all her life.  After 17 years with the same company, she decided to take a temporary leave of absence for a couple of months.  One month into that absence, she had a cerebral hemorrhage (a blood vessel in her brain burst).  Her family had retirement, saving etc. but the expenses quickly piled up and that was spent. Her family had to file for bankruptcy due to her medical expenses. 

At one point in my career, although I was employed in a job I loved, health insurance was not provided. I had previously been covered by my husbands health insurance.  We divorced and I was no longer eligible for his insurance. In order to obtain health insurance, I quit a job I really enjoyed to take a job that offered health insurance. Several years later, realizing I wanted to return to job setting I really enjoyed, I contacted my health insurance company (who had been my insurer since graduating college) about obtaining an individual health insurance policy.  The only plan I could get was for catastrophic coverage.  I had faithfully used my preventative benefits but had never had a major expense. I was floored.  My thought was, “I am 34 years old, healthy and this is the only plan I qualify for?” Health insurance was now dictating my career path.

So, what will ACA do to change this?

• Individuals will have access to affordable individual health plans through the Exchanges that will be created as a result of this law. This exchanges will will carry affordable healthcare options by private insurance companies.
• Individuals, who use to have to forgo any coverage because of cost, will now be able to afford good health insurance.  This will prevent them from needing to use indigent services or government sponsored health insurance.
• Second, if you have a pre-existing condition, you cannot be denied health insurance, forcing the individual to use indigent or government sponsored health insurance.
• If your healthcare becomes costly, your private health insurance cannot drop your coverage, again forcing the individual to use indigent or government sponsored health insurance.
• If you are age 26 or younger, working to establish yourself as a responsible adult, you can stay on your parent’s health insurance until age 26.

Some thoughts on the individual mandate, the most controversial point of the legislation. People still have the right to choose to not get coverage.  If they do, they will then be required to pay a penalty (or not, depending on circumstances).  This penalty will be put into the government coffers to be used to pay for their healthcare when they require it (lets be real, at some point everyone requires it).  Isn’t this the logic used when they instituted a tax on cigarettes? As a former smoker, the smoking tax always made sense to me. If you smoke, you should pay more tax because smoking increases your healthcare cost.  If you are alive, you will require healthcare therefore you should be taxed to offset that cost.  It’s all about choices and accountability.

An example.  I worked with a man who was a successful real estate agent.  He chose to spend his money acquiring lots of stuff (cars, electronics, etc.) He also chose to not buy health insurance.  While he was spending the weekend at the lake, he chose to dive into the lake, head first and broke his neck.  Because he didn’t have health insurance, nor did he have any liquid assests, he qualified for Medicaid. Maybe, had the mandate been in place, he would have thought twice about getting health insurance and would not have ended up on Medicaid.  Or, he could still have chosen to not get health insurance and would have contributed to the government through the penalty.

In my next blog I will talk about my role as a healthcare provider in the context of the ACA.  Any thoughts? Questions?  Please leave a comment!  My goal is to inform and there is a lot of misinformation floating around.  

What's the Rush?

I feel frantic. I'm in a rush.  What for? Nothing, seriously, nothing . I have to actually tell myself "what are you rushing for?" Again, Nothing. It is something inherent in me. Something I must talk myself out of.
Most if my rushing is self imposed. I need to be efficient and productive is what my inner voice tells me.  But I also know that I am, in fact, more efficient and productive when I slow down. I make mistakes when I rush. Not to mention that I lose track of the present moment.

If it's not one thing, it's another.

I've had rheumatoid arthritis for 13 plus years. It really hasn't been a big deal, just a pain (literally) once in awhile. Until now... About a month ago, I went into a bad flare. It's taken the wind out of my sails and made me SLOW down, WAY down. This is not in my nature and I am not happy about it.

I'm trying to stay optimistic but I don't want to confuse optimism with denial. This has been quite an eye opener for both myself and my husband. I need to make some life changes but I am really resistant. I just want to feel good, do good things and be an asset to the world. Is this too much to ask??? Ok, so now I am moving into a pity party which I don't want to do either.

I had been feeling so good from an anxiety standpoint. It was no longer interfering with my daily life and I was being productive. Then, this hits. Now I hurt everywhere and am exhausted! Shit!

I am feeling really discouraged.

Freedom

I'm taking the time today to appreciate the freedoms I enjoy. I thank all the people who sacrificed to allow me to enjoy these freedoms.

The freedom I appreciate the most is the freedom of CHOICE. The freedom to believe what is in my heart and not be driven by the "I should" and "I'm supposed to".

To not have my choices restricted by my gender. There are still a lot of woman in the world who do not have this same freedom.

I appreciate the freedom of not being controlled by cigarettes.

I appreciate that I can love children but I am able to choose whether of not I want to have any of my own.

The freedom to be grateful for my past, excited for my future and the ability to be present in the now.

Happy 4th of July!

Right Where I Am Supposed to Be.

I can get so overwhelmed by everything I want to do and become. The beautiful things is, compared to any other point in my life, I am more content than ever before. Today, I am at peace with being right where I am. I am moving in a direction that is feels right in my soul. Am I there? No, but then I think, where is there? Can I just enjoy today for the gifts it brings?

I am happy to be present. To know there is is no "there". There is only today. There used to be someone in my life that thought that to be content was a negative thing. I am grateful to now know the wonderful beauty in contentment.

Happy Anniversary.

It has been four years since I quit smoking! Wow. In some ways it seems like so long ago, other times, not so long. I still crave the peace and serenity I felt smoking a cigarette. Everything seemed ok, if only for a short while. It was a short break from the insanity that was my life.

I think the bigger issue is how much my life has changed since I quit smoking. There really isn't much of my life that is the same. My home, career and car are different, I am now happily married. Most of the changes bring me great joy and happiness. I have a purpose and passion to my life that I never imaged I could have. I used to be so jealous of people who lived their life with passion. I would think "what is my passion?" My mind would literally draw a blank.

My core group of friends has completely changed. This was something I really didn't anticipate happening and I still don't understand why it did. But...it did. I have a wonderful group of friends today but I still feel a sadness for the ones that are no longer in my life.

Such is life. A subtle balance between happiness and sadness. There is joy in feeling both emotions because it reminds me that I alive.

Would I ever start smoking again?

We flew down to Salt Lake City and were walking by the "smoking rooms". My husband asked "sure you don't want to go back?". We have this conversation periodically. Would I ever start again?

I've learned "never say never". I, of course, have pondered this question many times over. My initial response is always, NO. But, then again, if life circumstances were different, maybe. If I lived alone...in Europe maybe where smoking is better tolerated. Sitting in an outdoor cafe with a cold beer and a cigarette is an occasional fantasy.

Then logic takes over. I remember how much smoking controlled my life. My next cigarette was never far from my thoughts. About an hour after my last cigarette, I would start thinking about how I was going to have my next smoke. Looking at my schedule, thinking where will I be? Will I be in a position to step out for a smoke? If I wasn't, I would start to feel a little panic. My mind would be problem solving...how can I make this work? I would be distracted by this problem solving that I really wasn't very focused on what I was doing. Do I miss this? NO

Walking by those smoking rooms at the airport is another good reminder of why I quit. Flying was always a bitch. Salt Lake City is one of the very few airports that still allow smoking in the terminal (yes, SLC allows smoking in the airport, what's up with that???). Most airports, you need to go out through security, smoke a cigarette (or two, ok sometimes three) and then go back through security. Other times, I would panic if my layover was tight. I would evaluate the security line and weigh my options. Did I have time to go out, smoke quick and go back through security without missing my flight? Oh the angst!

If only I could be just a casual smoker! Having that occasional cigarette. But I know better, I can't be a casual smoker. If I started again, I would quickly be back to a pack a day. I know that. I am very aware that if I ever started again, that would be it. Quitting was so horrible, I could never do it again. I would be a smoker for life.

So, with that, starting is really not an option. Except...I did tell myself when I quit that if I was still alive at 70, I could smoke again! I guess the answer to the question is: Yes, in 32 years.

What to do?

I'm angry, sad, optimistic, and confused. I feel like I have so many options yet no options. I lack focus. There are so many things up in the air right now, I am not sure where to put my energy. Where will it be of most use?

This all leads to my feeling over-whelmed. When I get over-whelmed, I shut down. It's one of the things smoking did for me. It gave me a fresh start. I would go outside, have a smoke and things would seem to come into perspective.

It's Monday morning, time for a fresh start, hoping this week brings a new perspective.

Anyone have any thoughts on gaining perspective on life when your feeling overwhelmed?

Today I Gave Into Laziness

I slept in til almost 10 o'clock this morning! For me, this is just craziness. As a smoker, I was always up late and had no problem sleeping in. Since I quit, I am early to bed and early to rise. Usually, the latest (and this is a rare occasion) I sleep into is 8am.

The last six weeks have been crazy, lots going on, lots to do, deadlines to meet. Today my body said "Uncle" and I gave in. Not only did I sleep in late but I took a 2 hour nap this afternoon. All day, I have felt soooo relaxed. It has been heaven. I told my husband that I felt "mellow". His response was "that is not something we have much of around here".

On these rare occasions that I have a day like today, I get a little worried that I have lost all motivation and will never be productive again. Today has been different, I have been at peace with my laziness. I know my drive will come back soon enough and I will be longing for this feeling of mellowness again.

Yes, I do see the irony. I long to feel at peace then when I get it, I am worried about it. Sometimes, I really don't know what to do with myself.

Tonight though, I am going to go back to the couch and knit.

Again, I Cried

Again, it felt so good.

I am taking an organic gardening class. As part of the class, we have to do "homework" every week. Which just means we have to go to the garden outside of class and put in some sweat labor. I am taking this class for a variety of reasons. I have discovered a love of cooking over the past couple of years. What better way to supplement our meals than with fresh veggies!

Another reason is that Mike was an organic farmer. Mike is my cousin who was killed two and half years ago. He was more like a brother to me and I still miss him terrible. In some way, I hoped to feel a closeness to him by taking this class. Tonight, I did.

I had done some very basic pruning in the garden and was walking back home. Lucky for me, the garden is within walking distance of our house. My thoughts drifted to Mike and I started to cry. The tragedy of his death haunts me. As I was walking and crying, for a brief moment, I felt like someone was giving me a hug. It was brief but significant. I felt comforted.

Mike's death has made me look at what I believe in with regards to the after life. I still don't know what that is but for a moment tonight, I felt he was with me. I cried most of the way home. Some were tears of joy for the moment of comfort, others were of grief, others were of gratitude. All of them felt good.

Anything Worth Doing is Worth Doing Poorly

Yes, you read that correctly. I have to say this to myself every time I have a task in front of me that I just can't seem to get started on. The "roadblock" is up.

I never, ever, ever thought of myself as a perfectionist. In fact, I thought of myself as just the opposite. The terms lazy and procrastinator seemed to fit me better. If I had a task, I would put it off, and put it off until I ended up doing it at the last minute (example... school paper) or not at all (example... sew the button on the sweater that fell off). The other classic was for me to do 90% of task but never really finish it (example... home improvement projects). I was always so jealous of those individuals that could get started on a task and give it 110%. I always felt like I gave everything 50%.

My problem is that I always make a task out to be far bigger and more complicated than it needs to be. I have an idea of how it "should" turn out. I then proceed to get overwhelmed with this vision how the task should turn out. Hence, avoiding the task or not doing it all.

When I first heard this saying "Anything worth doing is worth doing poorly", I thought they were joking. Isn't it supposed to be "Anything worth doing is worth doing well". For some folks that saying works. But for me, I need to be ok with doing a project poorly to get started on it at all. With the notion that it doesn't have to be done perfectly, it takes away the roadblock that was stopping me from getting started.

So, the roadblock has been up for blogging. Hence, why no blogs in awhile. Well, I have to keep telling myself that my blog can be shit and that's ok. Cindy...just blog. Always a work in progress.

This Morning, I Cried.

And it felt so good! Crying has always been something that has not come easily for me. The only time I cried growing up was out of frustration. I don't ever recall crying out of sadness or joy. I remember watching "Where the Red Fern Grows" in Middle School. All the girls were crying at the end and I was a stone. There wasn't even a hint that I wanted to cry.

I have realized how much my anxiety has put up walls for me. I work so hard to keep myself under control that I keep everything under control. I am just surviving. Trying to keep it together, keep focused on the task at hand. All the while, the joys of everyday life pass me by.

With my anxiety under control, I really started to experience the great range of emotions. From great sadness to great joy. Over the last six weeks, as my anxiety has been high, I had returned to survival mode. No tears, for joy or sadness.

As we started tweeking my meds a couple of weeks ago, the emotions started to come back. Ahhh, how I have missed you. So, this morning I cried. The tears were initially out of sadness. I am starting an organic gardening class tonight. My cousins, Mike, who was killed two years ago was an organic farmer. As I was thinking about the class starting, I started to think about Mike and the tears started to flow. As they flowed, I started to realize how little I cried anymore. The last time was on Mike's birthday a couple of weeks ago.

Crying had been a near daily occurrence for me. In a good way! It meant I was feeling and experiencing life. They were not tears of depression, just an expression of myself. I would hear a sappy song, read something in the paper, see something beautiful, grateful for the life God has given me. It wasn't until this morning that I realized I had not been doing that.

The tears of sadness then became tears of joy. Joy for feeling again. Joy that my anxiety is getting back until control and I am feeling like myself again. Joy that I am beginning my gardening class and joy of being reminded of Mike.

Feeling Better

"The only true comparison we can make is with ourselves." Maybe the experience I had this week was to remind me of how far I've come. I am feeling much better but still trying to wrap my head around what happened. It was a reminder of where I have come from and how bad things were at points in my life. The feelings of despair, hopelessness, pessimism and I couldn't write it before...but suicidal ideation. (No need to worry for my safety, they're just thoughts, no intention to act.)

Those were pervasive feelings for me for many months. As I dealt with divorce, quitting smoking, financial crisis and my cousin's death. I remember thinking... What's the point??? Why was I put on this earth? I felt so completely out of control. I could accept that I didn't have control over many things in my life. What was so hard after I quit smoking was that I didn't even feel like I had control over myself. My emotions were all over the place. I so struggled to just feel at ease.

The last six months have been so wonderful in that I finally felt like I had control over myself again. I was pursuing my dreams and living my purpose. I have felt like "ME".

Thankfully...those feelings did pass. It was only a few days this time instead of months. I have a greater appreciation for where I've been and where I'm going.

I Had Forgotten...

The last two days have been pretty scary for me. Before I go into that, I need to give a little background first.

I haven't really talked much about meds. At various times over the last 10 years I have tried various medications to manage my mood. I hadn't had a lot of success but I hit another mood crisis about six months ago and decided to try again. I have a good / knowledgeable support system in both my husband and my healthcare provider. The meds this time have been wonderful. I have felt better than I ever have. I've gotten the benefit from them that I needed without unacceptable side-effects. The problem is, after about 5-6 weeks on a dose, the effects start to wear off. So, we increase my dose. Again, I feel great for about 5-6 weeks, then my anxiety starts to go up again. I hit a point a couple of weeks ago when we decided my dose was now too high and we lowered it.

The last two days have brought back feelings I have not felt in over six months. Frustration, despair, hopelessness, pessimism, anger, resentment, lack of empathy etc. Fuck! I had forgotten how this felt and it sucks. It is really scary to be back here. My husband and I had a long talk about it last night. Poor guy...he thought he had done something. Nope, just me! We have come up with a plan and I'm feeling a little better today. Hence, why I am able to write about it.

I'm really hoping "This too shall pass". But then again, I'm not feeling real hopeful right now.

Shouldn't I know better?

There have many times in my life that I have wanted to change. To do something that I knew was in my best interest. I wanted to lose weight, exercise more, quit smoking etc. The reason to do these things was clear. I can go through the list of the positive benefits: feel better, look better, more energy, live longer, smaller global footprint. The list of negatives to making these changes, hmm...... can't think of any. So what stops me?

For me, I had to look at what I was getting out of not changing. Smoking made me feel better emotionally and mentally. I felt serene after a cigarette, the world seemed manageable. My mind was clear, I able to focus and organize better. It's been over 3 years since my last cigarette, the nicotine has long since left my system. Serenity is still something I wish just "came naturally" to me. In fact, serenity is quite elusive. Damn you Serenity!!! Ok, so I now have that episode of Seinfeld in my head. The one where George's Dad is screaming "Serenity Now!" I digress...

There were a lot of reasons to quit.

1) The obvious...it's gross.

2) It bothered the people around me.

3) Shortened my lifespan.

4) Expensive ($4/day, $1460/year)

5) It controlled my life. I needed a cigarette every two hours. Pretty inconvenient at times.

6) Lost productivity. This is one I could argue because I was actually more alert, focused and calm after a cigarette.

7) I coughed a lot

8) My mouth tasted like shit every morning.

9) I smelled bad, my car smelled bad.

10) My boyfriend complained about kissing me.

11) Although I mentally felt alert, I was physically tired, low energy.

The list could go on and on. My point is that the negatives clearly out weigh the positives. Seems like a slam dunk decision...you would think.

What did it take to quit? For me the primary motivation in quitting was that I felt like crap. Physically I mean. This motivation would only get me so far.

What did it take to stay quit? I had to find a (healthy) way of getting the same feeling I got from smoking.

Staying quit had NOTHING to do with "knowing better". I knew all too well the negatives of smoking. That's the thing about addictions. My inability to quit was not a moral short falling, it wasn't bad parenting, it wasn't lack of education of the dangers of smoking, it wasn't that I didn't care of myself and others. The bottom line is I needed to calm the chaos that was going on inside of me.

Happiness is...

For me the answer is ACCEPTANCE. There is so much peace in acceptance. When I am at place of acceptance, no matter what it going on; good or bad I can be at peace with it.

To get to our home, we have to drive up into the foothills. If you like winding roads, it's a fun drive. :-) I was driving home yesterday and I got behind a slow driver. My first thought was "SHIT!", there goes my fun drive home. Then I had a moment of perspective. I was able to look at the situation a little different and thought "Today, I am going to slow down and enjoy the drive from a slow speed." Instead of fighting reality and wishing things were different, I was able to be at peace with how things actually were.

I have spent a lot of my life fighting the desire to be different that what I am, always feeling inadequate. I thought to accommodate for my weaknesses was to fail or to be lazy. If I allowed myself accommodations, I wasn't trying hard enough. Bullshit, life is challenging enough as is, why do we keep making things even harder?

I have weaknesses, I'm not good at everything. I can let go of focusing in on what I'm not good at and focus on what I am good at. I accept that and I have never been happier.

Roadblocks

All my life I have felt like I have had to work really hard to do anything. There always seemed to be roadblocks in my way. I had great ideas, the best of intentions but I struggled to follow the intention with action. Does that make any sense???

Once I quit smoking and started treating my anxiety in earnest, the roadblocks started to go away. It was a strange concept for me but suddenly I would think of something to do and I would do it. It used to be that I would think of something, think that I won't be able to do it the the way it "should" be done and so I wouldn't even try. If I did do it, it took a whole lot of "mustering" to get it done and I put it off as long as I could.

A friend pointed out that this was a form of perfectionism. I was like "I don't think so. I am a lazy procrastinator. That is far from a perfectionist.". He explained further..."You envision how you think something should be done, the perfect way it should be done. You then decide that you will not be able to accomplish it perfectly so you don't do it.". Ahhhh, light bulb moment!!!

I am so grateful for the smart people I have in my life!

Transitions

Smoking was a "transition" for me. Something to fill in the gap between activities. When I woke up in the morning; I got out of bed, grabbed a Diet Pepsi and went outside and had a cigarette. When I finished eating, I smoked. When I finished dusting, I smoked then I moved onto vacuuming.

The transition I still struggle with, three and half years later is when I don't know what to do next. It's not that I lack things to do, I just don't know what I want to start on next. Tonight, I finished working on a project that I had been working on for most of the weekend. As I sat on the couch, I thought "this would be a good time for a cigarette". Smoking a cigarette was a "transition", a chance to take a deep breath, clear my head, and ponder my options. By the time I finished the cigarette, I usually would have it figured out what I would do next.

After I quit, the worst transition time was when I would first get home from work. I would stand in my kitchen and think "now what?". Again, I had lots that needed to be done but I just couldn't quite get going. Something was missing.

I needed to find a new transition. This is still a work in progress. Like dealing with my anxiety, I have to have a "bag of tricks". Get a drink of water, go to the bathroom, knit, sit and stare, read a magazine. Tonight, I took a shower. When I got out, my husband looked at me confused and asked why I took a shower. I said something witty but the reality is I needed a transition. By the time I got out of the shower, I knew what I was going to do next and a blog post was born.