Hoboken Mom Condo Living
Planning the long-term & juggling the everyday

Medical records are stored on paper at 90% of hospitals and 83% of physician practices. What that means is that bits and pieces of your medical history are scattered across the state you live in, if not across the country. It never ceases to amaze me that health insurers can pick up tiny bits of data, like having acne, and use that to deny you coverage, and yet every time I see a physician, they have almost no information about the conditions I have experienced or the medications I have taken -I could totally lie to them and they would have no way of verifying the information I provided.

Okay, so it’s bad enough that the vast majority of your medical records are on paper and have no backup, right? Well, it gets worse. A lot of physician practices make it difficult/expensive to get copies of your medical records. Talk about a hostage audience. Another mom on my favorite Moms group recently sent out an SOS since her pediatrician was refusing to provide copies of her daughter’s records. Within a few hours of her post, six moms responded with valuable advice garnered from similar experiences -the highlights are below.

9/9/09, 3:17PM

Hi all -

I have been trying for almost 2 months to get copies of my daughter’s medical records transferred to a new pediatrician. In the meantime, I am leaving the state and am trying to get a hard copy to take with me. During this time, my new pediatrician will not immunize my daughter without these official records. As a result, my daughter is behind two cycles of shots. I have called, sent letters, tried to contact the previous pediatrician and still no records. The front office staff basically tells me that these take time and I will just have to deal. I am at my wits end. I feel like we are being held prisoner and am not sure what other steps can be taken to get these records? Do I have an attorney send a letter? Do I log a complaint with the medical board? Do I go and sit there until they give me the records?

Anyone know or have suggestions on how to get attention from this office? I want them to understand, especially the twits at the front desk, this is serious.

Any advice you have would be greatly appreciated!

Thanks in advance!

T.

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9/9/09, 9:15PM

I’ll preface this with the necessary “I am a lawyer but not a benefits/health attorney so don’t view this as true legal advice” disclaimer, but you stirred up a memory and so I did some research…try this:

To add a hammer to back up your physical presence in the waiting room, before you show up send them a certified letter (and fax it too) stating that their failure to timely turn over the records and permit you access represents a violation of the “Standards for Privacy of Individually Identifiable Health Information” (”Privacy Rule”) issued by The U.S. Department of Health and Human Services to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (”HIPAA”). Specifically, the HIPAA Privacy Rule states that Providers (like your child’s doctor) must comply with an individual’s right to, among other things, ask to see and get a copy of his/her health records, and have corrections added to such health information. In the case of a minor child, a person with parental rights (that’s you) is deemed a “Personal Representative” of the child and has the same rights as if the records were their own.

State in the letter that following repeated attempts to obtain these records (cite your previous attempts, with dates, and reference and attach copies of any letters or emails you sent), if you are not provided with the records when you arrive at their office on [X date], you will exercise your rights under HIPAA by filing a complaint with the U.S. Government (specifically the Office for Civil Rights which has responsibility for implementing and enforcing the Privacy Rule and with the Secretary of the HHS).. Since that can incur fines, it may light a fire under their arses….

To view the entire Rule, and for other additional helpful information about how it applies, see the OCR website: http://www.hhs. gov/ocr/hipaa.

And yes, the laws permit them to charge a reasonable fee for getting the records, but it can’t exceed the costs of copying and any postage.

Good luck!

K.

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9/9/09, 9:24PM

T & K,

Can I repost your two posts on my blog ? I occasionally write about our broken healthcare system and the fragmented nature of US medical records is a huge part of why medical care costs so much -every hospital and physician practice maintains separate records and don’t like to share with each other because they don’t want to lose market share. It’s like paying for six real estate management companies when you only need one.

Kathy

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9/9/09, 9:45PM

As long as I’m being used as an example and not a “source” and you make sure you include my disclaimer (that I am not an expert on health law and i don’t intend my post as legal advice - I can just see someone picking apart my response as “incomplete” somehow) and include the links to more complete information that I had in my post, I would be fine.

I should note that HIPAA doesn’t have (at least based on my quick research) any time period set out for how quickly a provider must provide the records (maybe case law covers that, but that’s a huge research project) ….and also that an individual seeking records needs to (and should) put his/her requests in writing (the rules lay out what “proper” requests for records should include) and - for prudence purposes - keep copies of his/her and the provider’s correspondence (as well as noting dates of calls and names of individuals he/she spoke with - not just “receptionist” but “Cathy” - since it’s easy to play the “gee, no one gave so and so that message” but harder for Cathy to say “gee, i never spoke with you”).

Interesting Blog, by the way.

Buying a home is one of the biggest financial transactions you are ever going to make. So why don’t people do proper due diligence before jumping in? Maybe I’m old-fashioned, but being sure that I will like living in a place is kind of key to buying a home there.

I have purchased three times (once in Brooklyn Heights and twice in Hoboken).  My husband and I loved living in Brooklyn Heights, absolutely loved it, but once we needed more space and a car, we figured Hoboken was the next best option since it is very similar in terms of demographics and proximity to Manhattan, plus it is much cheaper. So after we sold our 1BR, we rented for two years on River Street. And we liked it so much that we bought a 2BR because it seemed like our lease renewals kept coming up at the blink of an eye, and then five years later bought a 4BR three blocks from the 2BR because we didn’t think we would be happy living anywhere else (except Brooklyn Heights, but maybe one day we’ll win the lottery.)

I think too many people lump Hoboken, Jersey City and Weehawken together because they are geographically so close and they are all on the waterfront. From my limited experience with JC and Weehawken, I can tell you they are quite different. It is too easy to assume that living in Weehawken will be just like living in Hoboken, only with more space and cheaper! People really need to consider the pros and cons of their housing choices and decide what is a true dealbreaker to avoid expensive and futile exercises.

My husband and I have two Tivos with lifetime service plans, a 37″ flat panel TV, four computers on a wireless-N network, four printers, a scanner, two digital cameras, one digital camcorder, you get the idea. With the exception of our router and HD Tivo, we bought all these items when the technology was well established and a new model was about to come out. You can spend your life chasing the cutting edge of technology, but we buy for the long haul.

When my beloved Palm Tungsten E2 died recently, I had to make an involuntary technology shift because Palm no longer makes standalone PDAs. I decided to stick with the familiar Palm OS and make the leap to a smartphone. From there, the most logical choice would have been the Palm Pre. The problem is that I use Verizon Wireless, and lord only knows when the Pre will be available at a reasonable price (probably a year). Also, do I really need all those features to chase my kids around Hoboken? And I don’t want to pay a lot for a data plan. These conclusions led me to settle on the Palm Centro.

The problem is that I seem to have missed the boat by about a week. Amazon Wireless and Verizon Wireless literally just stopped stocking the Centro. I started calling around to local stores, only to discover that the Centro is considered a specialty item and wasn’t heavily stocked in the first place. I kept getting referred to ebay, where used Centros are selling for $80 and new ones for $150. Without a warranty, that was a no go.

After much desperate internet searching, I found a store with Centros in stock. It took several hours of calls to two customer service departments (Verizon Wireless and the store) but I finally got the order processed as an upgrade to my existing cell phone, for a total cost with accessories of $72.84. I have a 2-year contract for a data plan ($24/month after the employee discount ain’t bad), so I have finally joined the 21st century and can google product reviews at Target to my heart’s content.

I have a confession: I have never tried to rent a 3BR in Hoboken. 2BR yes, but never a 3BR.  We jumped right from owing a 2BR to owning a 3BR because that’s how much I hate renting. So I had a glaring blind spot in my knowledge base that I have recently been educated on.

The short answer is there really aren’t any Hoboken 3BRs. Or to be more precise, there aren’t any that families would want to live in. Apparently the overwhelming majority of 3BR condos are floor-through penthouse units in walkup buildings, with smaller units on all the lower floors. Great for views, not so much for those of us toting strollers and small screamy people. An elevator and parking spot were dealbreakers for my family.

Let’s look at the numbers. Searching for 3BR+, 2BA+ on the MLS yields 21 rental listings, ranging in price from $2,200 all the way up to $9,500 (yikes). It’s really hard to tell which units are acceptable and which ones aren’t since details like floorplans and square footage are optional on the the MLS (I know there are 1,000 SF 3BRs out there -how big are the bedrooms, the size of shoeboxes?), but it looks like the decent ones start at $4k/month, and there are only six units total from there to the top of the heap.

Okay, so maybe the 3BR owners just aren’t renting their units right now. Let’s take a look at the sale side of things. Apparently there are 69 3BR units on the market right now, or 12% of the total inventory (the lion’s share are 2BRs, with 54%). Ouch. And most of them are either too small or too expensive for your average Hoboken 2BR owner to upgrade to.

Talking to some of my realtor contacts confirmed my suspicions about the 3BR market in Hoboken. There really aren’t many large units, and the nice new ones are heavily concentrated in the southwest and northeast, not the areas that are most desirable in Hoboken (SW still has a ways to go in terms of curb appeal, and NE is crazy expensive, double the price of southwest). Both areas are pretty far from the PATH, although NE has the ferry and SW has the light rail.

This is really bad news for all those families crammed into 2BRs who assume they can sell their units and rent larger ones nearby. If you have a family and want to stay in Hoboken, your options are a lot more limited than I realized. No wonder so many people head to the suburbs. I wonder how many would stay if they could get the golden trifecta: space (1,700+ SF), amenities (elevator and parking) and price ($600k-$800k)?

When you read real estate articles and blogs, it is very easy to think you have a solid handle on the real estate market. Every single person I have met in connection with real estate has been cocky at the outset. Buyers, sellers, renters, developers, their position relative to the market made no difference. They were all convinced they were a great position to buy/sell/rent. I have patiently waited for them to physically get into the market and watched their illusions slowly fall away.

Assumption #1 was that I was going to find a fantastic, huge apartment to rent for a song. That illusion was the first to go. Yes, there are a ton of apartments available for rent. But most of them were too small for my family (a 1,400 SF 3BR is not going to cut it long-term for us) and they weren’t all that cheap. I also didn’t like the layouts or finishes, which were pretty crappy. And I REALLY hated the renter mentality of the buildings I looked at; everyone kept to themselves, the other tenants were rowdy and inconsiderate, and I felt like an ATM being wrung by the management company, with high stated fees for every possible repair/service.

Assumption #2 was that there would be a huge selection of apartments for us to buy, and we would be able to bargain sellers down an enormous amount. Um, no. There were a total of 10 apartments available in our location (Hoboken), price range ($600k-$800k) and size (3BR+, 2BA+). That’s not a whole lot of options. And when we went to look at properties, our options got a lot more limited because we hated about 80% of the properties we saw. We now know we will never live on Willow Terrace. And when we found the perfect home, we wound up spending about $100k more than we planned because that’s where the market was.  It’s very rare to find a seller who is going to sell for a lot less than recent sales, and short sales have their own set of headaches.

Assumption #3 was that we would be able to clear at least $100k on the sale of our 2BR. Every realtor I spoke with assured me my apartment would sell somewhere in the $500k range. It appraised for $585k in 2005, so $500k+ was a reasonable assumption, right? I’ll never know now if we could have gotten that much if we had waited longer (our second offer was above $500k but the buyer needed more time than our sale-contingent purchase allowed), but our unit plus two others sold in the mid $400s this spring. Either we dragged down the values in our building with our sale, or we were prescient. I really hope it was the latter.

Theory is great, but until you actually get out there and actively try to buy or sell a property, you don’t know what you are truly dealing with. The best thing to do is to establish a range of expectations (ie. absolute minimum sale price for your 2BR, up to what you expect to get) and then throw your hat in the ring and see where the chips fall.

Private mortgage insurance (PMI) is required on all mortgages in which the buyer puts down less than 20% of the loan to value (LTV). It is not a huge amount, typically less than $100/month on a conventional loan (under $417k).

According to the Federal Reserve Bank of San Francisco, under the Homeowner’s Protection Act (HPA) of 1998 , you have the right to request cancellation of PMI when you pay down your mortgage to the point that it equals 80 percent of the original purchase price or appraised value of your home at the time the loan was obtained, whichever is less. You also need a good payment history, meaning that you have not been 30 days late with your mortgage payment within a year of your request, or 60 days late within two years. Your lender may require evidence that the value of the property has not declined below its original value and that the property does not have a second mortgage, such as a home equity loan.

I bought my 4BR in early March. It appraised for $750k in February, but for $910k in May. My 4BR appraised $160k higher within two months because some big (expensive) units sold in that time and helped push up my property value. This is a classic reason why I don’t stress too much about how much my unit is worth at a given moment. I do my financial analysis in advance and then don’t worry about it because factors will change over time. For example, the rental market has softened in the last few months but was extremely strong for the six years before then. And the rental market shifts much more rapidly than the sales market, so I don’t worry about it since I am not planning on renting my unit.

There are two ways to cancel PMI. The first is to pay down enough of your mortgage so that your LTV is 80%. The second is to have your property value increase to the point where your loan amount is 80% of the appraised value. The catch with the second approach is that appraisals can be quite expensive, so it doesn’t make sense to pay for one unless you are pretty sure the value has gone up. And given my frugal nature, I would not pay for an appraisal if I could avoid it. The one caveat is I don’t think you can remove PMI from FHA loans.

My recommendation is to kill two birds with one stone -apply for a home equity loan so you have emergency liquidity and use the free appraisal to remove your PMI (but do it before you close on the HELOC -this can be tricky because the application only lasts for about 60 days before you have to refile). The best way to get a sense of whether your appraisal will come in higher is to watch the market to see if there have been expensive units in tour size and area sold recently. Appraisers look at comparables from the last three months, so once you see a couple of pricey sales (look at the $/PSF) that will help push your appraisal higher.

The HELOC lender can use the appraisal for six months after its completion, so even though you will have to refile your application, get rid of the PMI first with your primary lender and then close on the HELOC. It will be a juggle, but one that lowers your monthly costs and gives you an emergency line of credit that won’t charge exorbitant interest (and is potentially tax deductible!)

A while back I posted my standard weekly grocery list. It made me start thinking about my daily menus. My kids rotate their favorite foods, which makes me cycle menus (my son loves blueberries about 50% of the time), but this has been a pretty standard menu for the last three weeks.

I tried to figure out the cost of each item but had trouble breaking out stuff like the meatloaf since I make two huge ones that last about 10 days. Ditto for the chocolate chip cookies. Also, I have no idea how much the energy costs to cook all this stuff (don’t think it’s much since our PSE&G bills are really low) so I gave up on trying to estimate costs. I’m pretty sure all the stuff listed below cost less than $20.

Breakfast

Noah: Yogurt, shredded wheat, OJ

Kathy: OJ, chocolate chip cookie*

Boy & girl: Milk, highly dilute organic white grape juice w/iron fluoride supplement, cheerios, zucchini bread*

Lunch

Noah:  Wall Street restaurant ($8)

Kathy: Breaded fried eggplant*, white rice, milk, another chocolate chip cookie*

Girl: Meatloaf*, chocolate milk, chocolate chip cookie*

Boy: Breaded chicken breast, sippy cup of milk, chocolate chip cookie*

Dinner

Noah: The rest of the fried eggplant*, root beer, chocolate chip cookies*

Kathy: Meatloaf*, rice, salad, milk, chocolate chip cookie*

Girl: Croissant, dilute apple cider, milk

Boy: Chunks of cheddar cheese, rice, dilute apple cider

Bedtime snack

Boy: Blueberries or stewed apples*, milk

* homemade

I received the following email from a reader:

I discovered your blog from a comment on another blog. I have read all your posts and I love them all! I’m very glad to find a like-minded person in Hoboken.

My family is somewhat similar to yours, maybe a few years behind. I’m a new mom. I just had my daughter 9 months ago, still adjusting myself to the new life. My husband and I both work in the city and we send our baby to a daycare in town. We live in a 2b/2b condo in downtown Hoboken. We are on the fence of having a second child but get intimidated by the work-life balance issue…the space and financial dilemma.

I think we have to sell our home by next summer to accommodate the 2^nd child in the fall. My home is on the small end of the 2b/2b condo pool, it has about 900sqft. But I don’t know when the best time to put it on the market is. Do you have any suggestions? I heard that winter is not a good time. But it seems that it takes a lot longer to sell a condo nowadays. After selling my home, we will probably rent a bigger place for a while since the rent has come down and we might live in Asia for a while, for work. Thus, my sale won’t be a purchase-contingent one. We will be flexible on the closing too…unless my deliver schedule for the 2^nd baby force us to move.

We are also flirting with the idea of moving to JC heights to save money and get more space, but I’m not sure if I’m ready to give up Hoboken lifestyle. Have you heard anything about living in JC heights? Is it a good Hoboken alternative?

Sorry for so many questions. I feel overwhelmed by those decisions that I need to make soon.

Thanks. I’m looking forward to reading more of your posts.

–KC

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My response was:

Hi, Kathy C,

Glad you like the blog! I get so few comments that it is always a pleasant surprise to hear someone is reading it religiously.

In general, the best time to sell an apartment is in the spring (April-June). That is when the biggest bump of the year happens. However, I had an easier time selling my 2BR in December 2008 than many of my fellow moms did this spring. The reason for that was because many realtors were telling their clients (including me) that the spring would be stronger, so a lot of owners held off on listing their units until January. The entry of all those 2BR units into the market made the supply of inventory much higher, which led to significant price drops.

You want to give yourself plenty of time selling your 2BR, but you also want to be smart about the way you sell it. If I were you, I would be concerned about the following things: 1) pricing and staging your condo, 2) effective marketing (message & penetration), and 3) getting valuable feedback and quickly responding to it (ie. dropping the price below a certain psychological threshold like $500k for a 2BR or $700k for a 3BR so it appeals to more buyers, staging your unit better so it is less cluttered in certain areas/has less baby stuff)

Whether you sell FSBO or through a realtor, you need to make sure all three of those items are covered. I think that it is very difficult to cover all three of those items, no matter how you choose to sell your unit. I have found that most people have one or two but almost never all three.

Since you know you need to sell your unit by a certain time, I would start trying to sell as soon as possible. There is a sense that the market is starting to turn around, both nationally and locally, and buyer optimism is very important. the other factor is that you can try to sell for three months, get feedback about how your apartment shows, then pull your unit off the market, take a few months off, and try again in the spring.

I like JC Heights very much. I have friends who live there, and the area is charming. The reason why we didn’t look there is 1) the schools stink, which would not be a factor for you since your baby is too young for that and you are moving overseas, 2) the property taxes are quite high, higher than Hoboken, 3) the housing stock is older, which generally means walkup, and 4) we were looking to buy and feel that Hoboken has better long-term desirability because it is smaller (a mile square = limited potential development).

Hope this helps answer your questions!

Kathy