Who's In Your [Healthcare] Network?

Recently, an old friend heard her colleague's complaint about painful sciatica. "Call my guy," was her quick response to his agony, and my phone rang.

How does one build a healthcare network (distinct from an insurance network)?


It's Who You Know AND What You Know

The principles for building a reliable local healthcare network are the same as finding reliable sources of information: seek resources and providers that inform rather than sell a product or service. Locate practitioners who want you to be independent with your health, instead of dependent on them. Then, consider the following checklist:

Science: Does the information given by the provider comport with principles of biology, physics, chemistry and anatomy? Does the information make sense?
Credibility: Consider the credentials, experience, reputation and success ratio of the healthcare provider being vetted.
Network: Discuss the results of your search with dependable friends who have found successful solutions for their own comparable health issues.
Trust: Rely on your existing skilled and trusted healthcare providers to be a filter in distinguishing among fact, opinion and marketing, and to provide context.

What Are Your Needs?

Keep your network simple. Not everyone needs a nutritionist, OB-GYN, or pediatrician, but you might. A basic network should include:

• a general physician
• 
  
• a physical therapist
• 
  
• a dentist

These three, plus your family, social and professional networks, can help refer to medical specialists, nutritionists, fitness and wellness professionals, orthodontists, and others.

Tech Tools and Referrals


On-line professional listings can be a good place to begin your search, but won't substitute for personal referral and research. Many worthy professionals are not included in on-line listings. Most on-line professional listings lack filters or useful distinctions to match your needs. Ratings systems such as Yelp or GooglePlus may overlook high-quality practitioners who are not engaged with social media. Web search can be more helpful; the more you know about your condition, the use of specific search terms, and the ability to analyze medical research and conference proceedings, the more specific to your needs your results can be.

Starting Fresh In A New Community

If you've recently moved, here are four good sources for building your local healthcare network:

• your relocation specialist and/or realtor
• 
  
• your old, hometown healthcare network -- professional collegiality is now global
• 
  
• family, business and social networks (including digital) in your new community
• 
  
• a local nurse you've met through schools, work, or community. Nurses often reflect the 'oral tradition' in any healthcare scene.

Keep Your Network Fresh

Once you've created or refreshed your healthcare network, keep it strong and vital by referring others into it. Your doctor, nutritionist, specialist, etc., will remember your referral and be grateful for your confidence.

Who's in your healthcare network? Share a good word and send the names (plus town, specialty) of your trusted practitioners to me at t.edelson@montclairphysicaltherapy.com or join in a Facebook group and post your recommendations to Who's In My Network.

Good luck as you develop or re-develop your network, and contact my office if we can be of assistance. We enjoy more than thirty years of healthcare relationships in the New York metro area, and share worldwide relationships with the most highly-skilled McKenzie Method (MDT) pain solution & prevention practitioners.

Next week: developing national healthcare networks.

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The Smug New Neighbors

Let's consider the empty house on the street where I live.

The house is empty because the owner, Sammy, a guy about 30, suddenly moved out after living in the place for 3 years. I remember the day he moved in. He came with his cars and bikes after his suburban parents bought the house for him. During his first weeks here some of the neighbors went out of their way to say hello but Sammy was aloof. He obviously didn't want to be bothered to get to know the people on the block.

What Sammy did for a living was a mystery, but his pattern was to leave the house everyday around noon and return in the early evening.

Sammy could have been living on a mountain top because he never made eye contact with neighbors. You could pass Sammy in the street and he'd have one of those Village of the Damned 'straight on' stares like he was sleepwalking.

Sammy's house was a large space with interesting room patterns. I know because I used to be friends with the couple, Walter and Betty, who lived there before their move to Washington State. Walter, Betty and I didn't become friends until their last two years on the street. Who knows why it took us so long to strike up a friendship. One day they invited me to dinner so I got to sample Walter's gourmet cooking. On warm summer days, Walter would invite me over for a swim in his pool. The pool was a fairly deep above ground monstrosity with a sturdy wooden deck, set among some of the largest trees I've seen in the neighborhood. After a swim, we'd catch an iced tea during which Walter would talk about his favorite poet, Gary Snyder.

I wasn't happy when Walter and Betty announced that they were moving west. I was getting used to going over there for dinner and swimming in their pool, and then inviting them over to my place for patio parties. Friendships like this don't come easily. You can say hello to neighbors, even chat with them on the street for years and still never be invited over to their place.

When Walter and Betty moved out the house wasn't empty for long. One day I spotted a suburban looking couple talking with the realtor. The couple had driven up in a Lexis, which spelled m-o-n-e-y. A week or two after that a big moving truck appeared, and Sammy appeared with his bushy black hair and an army of friends. The friends, all men, were scruffy in a hip way although they all had the same type of manufactured beard.

They moved in quickly and within days held a massive outdoor party around Walter's old pool. Sammy's friends built a large bonfire and started a barbecue. The party lasted until the wee hours. Then at 4 or 5 am I was awakened by a suburban girl, one of Sammy's party guests, crying under my bedroom window. She was so drunk she found it hard to put together sentences however I tried to make out what she was saying. In the end, I couldn't decipher her drunken valley girl 'up talk' although it seemed that some boy had dumped her.

I was curious about Sammy for a short time but after a while I stopped caring. There was no reason to say hello, especially if his response was going to be something like a smug nod.

Sammy's outdoor parties were becoming more and more frequent. Party guests, driving in from the western Main Line, were double parking on our tiny street. Sammy acquired strings of Japanese party lights and strung them along the tree branches so that from my house his yard looked like a massive house boat in New Orleans. The parties got progressively louder and wilder yet it was fascinating to see how every party began as low key events but as the night wore on, and as more alcohol was consumed, the voices got louder and louder. Eventually the voices became so pitched it sounded like twenty men screaming at one another.

If the screaming prevented me from falling asleep, I assumed that many of my neighbors were experiencing the same thing. I'd turn on the AC or put fans in my bedroom window to muffle the noise but like the racket from a plague of locusts, the voices would always resurface.

And among these voices there would always be the sound of a woman crying. .

"That makes 4 crying women in 30 days," I'd tell friends. 'What do they do to women over there?"

Sammy acquired a succession of roommates to help pay the mortgage. Generally the roommates were in their twenties and never stayed long. At first the roommates were part of Sammy's social circuit but then I noticed a change. They seemed to be living independently, especially the lost looking Irish guy who seemed to be terrified of strangers and whose large dog seemed to be his only friend. He would sit glum faced on Sammy's stoop staring into space. For a time I thought he was hearing impaired.

Some of Sammy's roommates moved out in the middle of the night although they were very quickly replaced with new roommates. At one of the parties, the invited guests double and triple parked on the sidewalk up and down the street, upsetting the neighbors. Somebody called the police, and ten of Sammy's party guests got parking tickets.

"These people have no idea how the city works," I told a friend.

Sammy acquired so many roommates I lost count of them. Prohibitive housing and rental costs were really impacting people in their twenties, and Sammy's house was proof of this. Nobody could afford to live on their own. I called Walter and Betty and told them that their former home had become a gigantic hipster commune complete with dogs, motorcycles, bonfires, and beautiful white women in long dreadlocks. "It's a sight to behold although nobody on the street has made friends with them because they don't seem to want to get to know anybody."

I told Walter and Betty that Sammy had decided to get rid of the pool and chop down the oldest and grandest tree on the property. Walter and Betty were meticulous home owners, but very soon Sammy began to let things slip. After all, it really wasn't his house. His parents found the house for him. They were the ones who appreciated the house but they probably had high hopes that Sammy would come to appreciate it someday.

It wasn't long before the house began to look shabby, although all the women who visited or lived there seemed to be the same type: they were tall and elegant looking with long beautiful hair. They also dressed like fashion models, mostly in long flowing dresses. Even if beautiful women are not your thing, no one could deny the astounding beauty of these creatures. They seemed to go in and out of Sammy's house at all hours.

The men, by contrast, were doughy looking with thick Clark Kent glasses and hairy necks. "This is proof," a comedian friend of mine commented, "that pretty women like money and power."

For a period of a year, especially in winter when there were no leaves on the trees, anyone walking on the sidewalk could look right into Sammy's front window and see somebody watching Homer Simpson.

The parties continued, the beer kept flowing, and the male chorus of voices kept getting louder and louder. Sometimes I could make out what was being said. There were stories about work but more often than not there was no smooth narrative at all, just discombobulated half sentences with long pauses as well as the overuse of the word 'like' (let's not forget beer burps), and finally unexplained yells as if someone had inadvertently sat on a possum.

"Like...I mean, but like....Yeah, you know. What the fuck!"

(Repeat 50 times and you have the party conservation).

A few neighbors, eager to build bridges, continued to attempt to make contact with Sammy, but to no avail.

Two weeks ago in a bizarre replay of 3 years ago, the suburban parents returned in the same Lexis. Standing in front of the house they whispered to one another before knocking on Sammy's door. The parents had to knock a long time before one of the roommates answered although he didn't open the door but talked to them through an open slat.

Some sort of negotiation seemed to be in progress, but what?

The very next day at least two of the roommates moved out and the day after that it was Sammy's turn. Sammy left on his bike, never to be seen again.

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Design Firm Marmol Radziner’s Must-See Modern Marvel in Los Angeles

Sean Garrison of Shooting LA

Design firm Marmol Radziner, known for creating modern masterpieces throughout California, has a new design worth a second (and third) look: a brand-new home up for sale in Los Angeles for $6.5 million.

To enter the angular two-story home, you must first pass through a courtyard set between the gate and the front door. It’s an architectural flourish employed to inspire a sense of reflection and homecoming.

“It allows for a bit more of a progression to the house, allows you to slow down, take one step at a time—like a visual bit of a pause or the first point of decompression as you leave the street,” says Ron Radziner, co-owner of Marmol Radziner.

Peace-creating courtyard

Sean Garrison of Shooting LA

The 4,775-square-foot house, completed in June, incorporates an extensive use of glass, including 11-foot sliding doors in the great room. The walls, which sometimes angle at a sharp 90 degrees, incorporate glass and result in a spectacular feeling of openness. “You really do have a good view anywhere in the house,” Radziner says.

“In a contemporary home, the goal is not to feel cold, but warm and natural,” Radziner explains. “We tried to maximize that sense of indoor-outdoor space inside the home. The exterior light flows in and bounces off the walls. It makes the interior feel open and inviting.” Radziner notes the firm chose a “light palette of materials” throughout the home to create warmth.

Tranquil living

Sean Garrison of Shooting LA

The floor plan is similarly designed with openness in mind. On the main floor, the open kitchen is set in at the end of an L-shaped design, which places it “right at the heart of the house,” Radziner says. A dining area extends outside to a covered patio with fireplace. It’s situated near the rectangle pool and is designed to make you feel like you’re still inside.

Upstairs, the home’s five bedrooms connect to a lounge, a “semiprivate transition space” that “gives opportunities for a family to be together,” Radziner says. The whole house is designed with this concept in mind—an informal architecture with open spaces and a multitude of windows where a family “can be in different parts but still be visually connected,” he says.

All that remains is for a buyer to connect with this sublime modern vision in Los Angeles.

Neutral backdrop

Sean Garrison of Shooting LA

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What a Deal! Howie Mandel Loves Loft-Style Living in Santa Monica

Jason LaVeris/FilmMagic

“America’s Got Talent” judge Howie Mandel is now the owner of three condos in the same downtown Santa Monica building, according to the Los Angeles Times.

The larger of his two recent purchases measures 1,900 square feet and features three levels with steel beams, high ceilings, a galley-style kitchen, and south-facing windows. The upper floor has two bedrooms, two bathrooms, and a media room. Mandel scored this unit in January for $2.5 million.

Staying in the same building, he closed on a smaller $1.5 million unit in late July. The apartment is 1,450 square feet and has two bedrooms, two bathrooms, mahogany wood floors, and raised ceilings. This unit last sold for $760,000 in January 2011.

After these two deals, the comedian now owns three units in the loft-style William Dale Brantley–designed building, including a two-story residence he bought last year for $5.3 million. All the purchases have been off-market.

Mandel, who has openly discussed his pathological fear of germs, regained career momentum when he hosted NBC’s game show “Deal or No Deal” from 2005 to 2009. Now he’s best known as part of the judging panel on “America’s Got Talent,” NBC’s annual summer competition show now in its 11th season.

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Why You Can’t See Kim and Kanye’s Home on Google Street View

Ernesto Ruscio/Getty Images; Peter Meißner/ullstein bild via Getty Images

Who doesn’t like snooping, in a nonstalker way, on the rich and fabulous—and maybe an ex-flame or two—through photos of their real estate? God bless you, Google Street View! It allows anyone with a reliable internet connection and an address to zoom in on the curbside views of properties. It’s almost like standing right in front of them—and taking a stroll in their hood!

Except, as it turns out, not every home in purportedly “covered areas” of large U.S. cities is viewable on this free service of Google Maps. Not one of the 648 homes in the appropriately named, swanky community of Hidden Hills—a Los Angeles enclave of A-list celebrities and the one-percenters—appears on Google Street View, according to a recent Financial Times article. Not one!

Inhabitants of these multimillion-dollar homes reportedly include the likes of Kim Kardashian, Kanye West, Miley Cyrus, Justin Bieber, and Jennifer Lopez. The median list price of a home in the gated community is a cool $1.9 million, according to realtor.com®.

And Hidden Hills is far from the only pricey community that’s photographically MIA. Bradbury, CA, also in Los Angeles, and Bell Canyon, CA, about an hour outside of the city, aren’t on Street View either. And apparently the more you look for cool panoramic views of some of the nation’s truly exclusive über-priced real estate, the more you might come up with nothing but internet static

That’s because these communities have reportedly banned Google’s distinctive photography vehicles from entering their gates, according to the Times. Most of the Street View pictures come from Google’s tricked-out cars, but the company reportedly also uses pedestrians, bikes, boats, and even snowmobiles to get its shots.

All of those have probably been banned, too.

Those intent on eyeballing the luxe mansions in such communities can still check out the “God’s eye view” aerial shots of Google Earth. But if you want to check out what kind of front door knobs are favored by Kimye, you’re straight out of luck.

The anti-Street View measures are purportedly taken to protect the privacy of these communities’ affluent residents. It helps keep crazed fans and paparazzi at bay—as well as potential criminals. Anyone remember the Bling Ring, a group of young adults who broke into the homes of celebrities like Paris Hilton and stole their stuff?

“Out of sight [means] out of mind—and out of the reach of burglars,” Geoff Manaugh, author of “A Burglar’s Guide to the City,” told the Times.

But that could make selling one of the luxury properties in such communities a bit harder. Buyers, for example, can’t get a street-side view of the Hidden Hills six-bedroom home with a chef’s kitchen and pizza oven, dog kennel, and pools with cascading waterfalls for sale at $6,895,000. Or the $4,890,000, four-bedroom, French estate that comes with a wine room, outdoor kitchen and pavilion, and fruit orchard.

Many wealthy individuals are so worried about unwanted attention that they use shell companies and other methods to buy property to make it harder to trace the purchases back to them. They’re also spending more on security.

“There are always people who want what’s known as curb appeal, but there are many others who don’t want anyone to know where they live. They want to be discreet,” David Forbes, head of private office at estate agent Savills, told the Times.

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Airbnb Income: How It Can Mess With Your Mortgage ‘Refi’

BRIAN SMALE FOR THE WALL STREET JOURNAL

Room-rental services such as Airbnb Inc. are blurring the line between residential and commercial property. That is causing problems for some homeowners looking to refinance mortgages. (Read what Airbnb hosts need to know.)

Big banks including Bank of America Corp. and Wells Fargo & Co. are subjecting some refinance customers who rent rooms to additional scrutiny. Some borrowers have been told they were no longer eligible for certain kinds of loans or would have to pay higher interest rates, according to the customers.

“This is kind of novel,” said Jeffrey Naimon, a consumer-finance attorney and partner at law firm BuckleySandler LLP. “I don’t think the market has gotten its arms around it.”

The issue for lenders is how to classify loans in the Airbnb age. Historically, that has been easy: A house usually was either a principal residence or an investment property. Mortgages on the latter are often viewed as riskier because owners had less of a personal connection to the house and rental income isn’t always reliable.

Now, the distinction isn’t so clear-cut. Online-rental services are spreading rapidly; Airbnb’s website had 455,223 active listings in the U.S. as of July, up 80% from a year earlier, according to research firm YipitData. That is posing challenges to lenders and frustrating some customers, illustrating how fast-paced technological change can reverberate in unexpected ways.

Brad Severtson says he earned about $30,000 last year from renting out a cottage in his Seattle home’s backyard.

BRIAN SMALE FOR THE WALL STREET JOURNAL

The issue comes up when borrowers report income from services such as Airbnb when applying for a new loan, often in hope of improving their credit profile. That, they hope, can lead to a better interest rate on a loan.

Brad Severtson, a resident of Seattle’s Ballard neighborhood, earned roughly $30,000 last year from renting out a cottage in his Victorian home’s backyard. He thought that would work in his favor when he applied in early 2016 to refinance a home-equity line of credit at Bank of America.

The bank turned him down, saying it didn’t allow home-equity lines of credit on properties in which the homeowner is operating a business, including Airbnb. Mr. Severtson, a 61-year-old data scientist and former Rhodes scholar, was taken aback.

“Here’s a bank I’ve had a relationship with for 30 years,” he said. “The assumption to me was the more your income is, the less risk to them. That assumption was wrong.”

Mr. Severtson ultimately refinanced with Umpqua Holdings Corp., a Portland, Ore.-based bank.

A Bank of America spokesman said the bank doesn’t provide home-equity lines of credit on investment properties.

He said the bank would consider a customer’s primary residence an investment property if there was a “material amount of commercial activity,” but that “incremental renting” wouldn’t be an issue.

A spokesman for Airbnb said such incidents “are incredibly rare.”

Mortgage lenders typically apply tougher underwriting standards, including larger down payments and higher rates, to second homes or investment properties that owners don’t live in for most of the year.

For mortgages made this past April that went toward the purchase of a home, lenders on average were willing to finance 84% of a property’s value if the borrower intended to live there, according to data from real-estate analytics firm CoreLogic Inc. The average interest rate was 3.76%. For investment properties, lenders only financed 72% of the home’s value, on average, and charged an average interest rate of 4.29%.

That is because borrowers have shown a greater propensity to default on investment-property loans. Cumulative losses on investment-property loans included in private-label mortgage bonds issued in the four years before the financial crisis reached nearly 20% in early 2016, according to data from Moody’s Investors Service and ABSNet Loan. For owner-occupied mortgages, the loss rate was about 14%.

An additional worry: Defaults can trigger requests from mortgage investors and government agencies for a lender to repurchase the loan. So, many lenders proceed with caution when a loan doesn’t fit neatly into a predefined category, although that is less true for “jumbo” mortgages on high-price homes that often stay on bank balance sheets.

For mainstream lenders in the postcrisis mortgage world, “the last thing they want is someone coming back to them later” with a request to repurchase soured loans, said Christopher Mayer, a professor of real estate at Columbia Business School.

That, though, can cause issues for some borrowers. Stephen Labovsky this spring applied to Wells Fargo to refinance the mortgage on his home in San Francisco’s Glen Park neighborhood.

Mr. Labovsky, 72, and his wife were active Airbnb hosts and had registered their property with the city government. That permits them to rent space for an unlimited number of nights a year while they reside in the home and for no more than 90 nights when they aren’t on the premises.

But because the couple were operating short-term rentals for much of the year, Mr. Labovsky said, Wells Fargo recommended he apply for a mortgage as if his home were an investment property. That would have increased the interest rate by up to 0.5 percentage point, he said. Mr. Labovsky, a retired filmmaker, stuck with his existing mortgage.

Greg Gwizdz, national sales manager for Wells Fargo’s mortgage division, said the bank has no policy of restricting short-term rentals on its borrowers’ properties.

He said that services like Airbnb haven’t caused changes in the bank’s position on what constitutes a primary residence or an investment property.

Still, he acknowledges there may be confusion within the industry offering hosts free, primary liability coverage. Similar questions were raised a few years ago about whether homeowners’ traditional insurance policies would also apply to their Airbnb activity. The startup eventually responded by offering hosts free, primary liability coverage up to $1 million per incident.

In the case of mortgage refinancing, though, banks will likely have to gain more experience with Airbnb hosts.

“Some of the programs that are new that allow people to rent out their properties short term or in different ways that may not have existed 10 years ago may not be fully understood by every lender across America,” Mr. Gwizdz said.

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$1 million Ponte Vedra house for sale

A 4,480-square-foot house is for sale in Ponte Vedra for $975,000. The property, 52 Bermuda Greens Avenue, has five bedrooms and four baths and includes a four-car garage. The house has a split floor plan with the master bedroom and guest suite on the first floor. Secondary bedroom are on the second floor. There's also a large pool, Summer kitchen and outdoor fireplace. Anita Vining, a Realtor with Berkshire Hathaway HomeServices Florida Network Realty, listed the property. She can be reached…

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