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Every once in a while I travel a lot for my work. Depending on the gig, either I make the reservations or the company makes them. Over the past few years I’ve picked up a few things that I want to share with you concerning whether you should book your flights through an online travel services or through the airline you want to fly.

RC Air Show
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Just so you know, I’m coming at this from the perspective of someone who travels a lot, so I have airline travel cards. I know a few other things, which I’ll also mention here.

First, let’s look at price. You will almost always save money by going through a service than the airline. You’ll save more money the further out you book though.

For instance, when I had the ability to book 3 months in advance, the savings were astronomical. The closer you get to the date the savings start to drop. The only difference might be if you can package your deal with your hotel and a rental car, which you can’t do through the airline.

Second, let’s look at conveniences. If you book through a service, depending on which one you select, you’ll get to pick where you want to sit based on what they show is still available.

You get to do the same if you book through the airline. However, if you happen to be a member of good standing (which means you fly a lot) you possibly qualify for a lot of free extras that will cost you going through a travel site. For instance, not only do I get my first bag fee waived but I get bumped up to first class if there are any available seats.

Even if I don’t get that, just being a member means I get to board the plane before most everyone else who’s not in first class, which means I always get my bags in the cubby on the plane instead of having to check anything. Trust me, that’s a major benefit of convenience!

Now, if you’re not a member but still book through an airline, you get the opportunity of paying for a minor upgrade which allows you to get on the plane early. You also get to pay for the option of moving to seats closer to the front, which you don’t always get if you book through an online travel service.

Third, problems with travel plans. Whenever I booked through an online travel service and things went wrong with the flight that were out of my control, they become pretty useless. That’s not their forte, and some of them direct you back to the airlines to take care of your issue. The thing is, since you didn’t book through the airlines they’re not as inclined to work as much for your benefit. That’s not the best customer service but it’s the truth.

When you booked directly through the airlines they’re a bit more accommodating. At least they’ll work with you to try to get you either where you’re going or back home. However, you’re still just a step ahead of those folks who booked through a travel service, though it’s always nice being ahead of the game.

If you have a rewards card life is sweet. More than half the time, when I finally find out that I’m about to have an issue I’ll check email to find that they’ve already re-booked me, and often in first class. If I want I can call to change flights, but most of the time I let it go, especially if it looks like an improvement over what I had.

Other times, when they haven’t heard about the problem before me, it’s been very easy to make changes to my flights without any extra cost. That’s something else you have to worry about when you book through other sources; there might be fees for changing flights, even if it’s not your fault.

My conclusion… if all you want to worry about is the cost savings, you’d be wise going through an online travel service. If you want to protect yourself for all the other things (which, by the way, you can also get by going through a travel agent; didn’t want to leave that part out), then it’s smarter going more direct.

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As a health care finance consultant you can imagine my disgust and shock at seeing a headline and news story like this one: This $153,000 rattlesnake bite is everything wrong with American health care.

As a potential patient, I know something like this flames people’s emotions. As someone in the industry, I was also inflamed… but for a much different reason.

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Molly Marshall via Compfight

First, let’s dissect the story. This poor patient got bitten by a rattlesnake and had to be rushed to the hospital. He went in through the emergency room and, based on his injury, I wouldn’t doubt that he got the highest level of care charge, a step below trauma since he didn’t have to be operated on. He did have stitching and some other things that occurred, but whether they occurred in the ER or in another room… hard to say.

The cost was over $5,500 dollars; that’s high in at least 97% of all American cities in the nation but San Diego is an expensive city. I still think it’s possibly outrageous, especially based on some of the other charges on the bill.

Second, the emergency room bill was outrageous because he left there and was taken to the intensive care room. That’s where most of his treatments would have taken place, since he was admitted to the hospital as an inpatient. Thus, he probably didn’t spend much time in ER (because they would have known what was wrong with him & moved him fairly quickly), unless they had to revive him from shock (which we don’t know), the ER charges seem inflated… but truthfully might not be. Being bitten by a rattlesnake is pretty serious stuff.

Still, seeing that the intensive care room is over $17,700, and there’s an intermediate care room coming in around $21,000, it seems like the ER charges are still way too high.

Here’s a reality most people don’t know. Each level of room charges comes with a level of care and procedures that justify charging for them. Those charges are supposed to capture expenses for whatever it is they do. Intensive care is never inexpensive because, other than surgery, it’s the most critically care area in every hospital as it pertains to patients.

So, he was an inpatient for 5 days (we don’t count the day of discharge) and, based on the cost of ICU, that’s not bad at all. I don’t have a problem with ICU. His time spent there is probably what kept him alive.

I do have a problem with the intermediate care level charges. When patients are at that level it’s basically considered a maintenance level, relatively minimal services. He probably got moved there to receive more of the anti-venom serum and was monitored but way less so than if he’d stayed in ICU.

However, it’s possible that the terminology is different than what I’m expecting. In most hospitals regular inpatient rooms are usually categorized as semi-private or private. Calling it intermediate care level might be what they call those rooms; without an itemized bill we wouldn’t know. It’s possible that he spent one day in ICU and 4 days in a regular inpatient room. For San Diego that’s probably a normal inpatient charge.

Third, the lab charges. Actually, that’s the one area where I have no problem with the cost of services. That’s because he’d have not only needed those, but lots of them, probably hourly, to see how the medication was working in getting the venom out of him.

Fourth… here’s the biggie. The pharmaceutical charges are over $83,000! The bulk of that is the anti-venom serum, and according to the story they used so much on him that they depleted the reserves of two other hospitals in the area (ask me at another time why I prefer to live in the northeast…).

Fotografía Clínica Granados
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Years ago I wrote a story here telling people why prescription drugs cost so much. This story is a little different because it seems that there’s only one lab that makes this stuff, and with no competition the cost of this stuff is pretty high.

This is a tough one for people to understand but rattlesnakes, as bad as they are, really aren’t as common as people might think they are. So, there’s no clamoring by other pharmaceutical companies to get into the product line. When that type of thing happens the cost of making these types of drugs are higher than they are for making things like over the counter medications. Thus, the high cost of getting it.

So, when you look at the bill like this, based only one what we know, a 5 day hospital stay for something relatively uncommon that ended up involving 2 hospitals that came to $159,000 isn’t really all that bad.

If that’s the case, then what’s wrong with health care?

What’s wrong with health care is that, if you read the story at the link, it seems no one could tell either the press or the patient why the bill was that high, and no one could really explain why, even with the bill that high, the patient wouldn’t really have to pay all of that out of pocket. For that matter they’re not even sure if that’s true because this guy did something dangerous and fairly dumb, and depending on what his insurance is it’s always possible that they could deny it for just that reason.

Transparency is a major topic in health care these days. There are two truths to this discussion. One, hospitals don’t do a good job in helping patients understand why their bills are like they are. Two, patients don’t really care about their bills until they get them, and then they’re mad.

When transparency first came up, some hospitals across the country put their list of charges on their websites; some hired people to handle patient calls about charges before they came to the hospital.

What happened is that the pages with the charges got almost no views and the phone calls amounted to fewer than one a week. Folks, you can’t complain about hospital bills one day and not care about hospital charges another day and call it fair.

What’s wrong with health care? For the most part the people who should know how charges work don’t, and the people the charges affect most don’t care until after the fact. That’s a broken system, but until you, the people, actually care more there won’t be much encouragement to change things.

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A month ago I wrote a post here giving a nice little blueprint to millennials on how to start investing by age 20 and, following my plan, showing how much money they could have by age 65. I wish I’d known that when I was at that age, but I didn’t; always glad to pass knowledge when I can.

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Although I stick by that plan, I thought it was important to follow up with a few more things. Investing is great for long term success. However, there are things that everyone needs to at least consider, if not address, before getting into investing too deeply. Thus, a follow up that’s actually a prequel; can one do that with blogging? Let’s find out, as I talk about 3 things that should be done before investing money.

1. Learn how to budget your money.

I started out by telling you in the other article to just start putting money away. Well, that’s pretty easy to do when I started you off with only $10 a month. It’s not as easy when you’re getting close to $100 a month or more to do that without a budget.

If you have a budget you know where all your money is going and, by including the money you’re taking out for investing, because you’re used to that (hopefully), you could make things easy on yourself. However, if you’re putting money away that you can’t afford… that doesn’t help you at all in the “now”, which is just as important as your future.

2. Keep debt as low as possible.

It doesn’t pay to have a lot of money saved if you have big bills to pay or continuing bills to pay. For most people, the interest rate on debt is higher than on savings (most credit cards average around 14.9% a year while saving might average 5% a year). Therefore, it’s not only smart to pay it down, but also to keep it as low as possible. Buying things like cars or homes is an investment so those are good, but maybe some other things can be budgeted for instead.

3. Put some money away for a rainy day.

Okay, that’s a stupid catchphrase someone came up with centuries ago so let’s update it. You know the recommendation is to put away enough money to last you four to six months in case you lose your job? I’m going to go you one better. Try to save up enough money to last you 9 months to a year, and not only because of your job.

Basically, the savings recommended is to allow you to pay bills. My recommendation is to try to allow you to have a life, which means eating, going out from time to time, being able to pay to fix your car or refrigerator, pay the doctor or dentist if needed… stuff like that. It’s smart to save for the minimum but if you can save for more you’ll be way ahead of the game.

Taking care of yourself means both your present and future. By making sure you address these 3 things, you should be fine.

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