It is 6^th century Britain. War is a commonplace in this kind of land. This land called Britain. For the last hundred years, tens of thousands of warriors had been placed in the field of battle. Lucky for me however, for only thirty of these years have I been a first had witness. The elders, who are old enough to tell the tale of the Breaking, are truly holy in this tribal society. The year of Breaking varies from tribe to tribe, due to the fact that it affected different places at different times. After some research, I have found the correct Year of Breaking to be 423 A.D. This is not long after the Roman’s left our lands to ourselves. They had helped instigated the uniting of Britain by slavery and war, but without this current enemy, we fought amongst ourselves. Dozens of tribes, which were previously allied, made war with each other in an attempt to salvage control of the land. This greed led to our downfall as a unified nation. Few who kept fair to their alliances were only backstabbed. And the cunning leaders who betrayed their nations grew in power, and corruption. Instead of treating captured fellow tribesmen with the respect their code called for, they were enslaved.

Torture, backstabbing, blood, steel and famine plagued the land. It was only a matter of time before a single tribe would raise themselves above all the rest. For the next 45 years, unchecked civil war raged throughout Britain. Among the tribes to be completely decimated were the Carvetii, a small farming tribe, Taexali, a tribe of coastal villages, and Demetae, a relatively unmilitaristic nation. When the year 468 A.D. dawned, it was definite that one tribe was the victor: the Regni. This tribe was the friendliest with the Roman Empire, and thus was given the most technology. Better yet, many Roman Legionaries settled in the Regni regions. When the Breaking of Britain came about, to protect their families and land, these Roman veterans fought with the Regni. They were the key in defeating the surrounding tribes and establishing a foot hold on the west peninsula of Britain. In 470 A.D., the battered Regni tribe had spanned across much of Britain. Like a spreading brush fire, territory grew exponentially as submitted tribes were forced to fight. It was dirty business, but we prevailed.

The Regni had one sure ally throughout the war, the Dorsaetas. The Dorsaetas had protected the massive fortress that housed the Regni’s chieftain, and the rest of his household. This castle was built by the Romans, and then given to Cogidubnus, our kind King who befriended them. He cooperated with the Romans in their takeover of Britain. The reward was great, but during the Breaking, the Regni was attacked the most viciously for our betrayal. Not soon after the Regni tribe dominated Britain, did Caledonia attack. This elusive barbarian horde resided in the northern most regions of Britain. The Caledonians were aggressive and very graphic. They practiced the demonic teachings of some rejected Pagan gods. When prisoners were caught, these satanic worshipers would perform rituals of astronomical evil. For whatever reason they did this, you do not want to be a prisoner of Caledonia. The horde pushed halfway across Britain until they were stopped by the brittle alliance formed to wall the threat. The Regni was at its weakest at this point, and all the other tribes knew this. Maybe one tribe knew it better than another. Being on the most vulnerable south east side of the Regni Empire, the Silures would push their autonomy inward. With enemies on two fronts, Regni territory shrank rapidly. The Caledonians and the Silures were not allies, but they attach their differences aside for the sake of conquering as much land as possible. After 4 years of unfavorable warfare, an uneasy peace finally settled. But, when everyone though it ended, war decided to dawn anew.

A new enemy, called the Saxons started their invasion of Britain. The Caledonians were an easy target for the Saxons, who attacked from the far north. Hiberni, the country off the west coast of Britain was conquered first. The Saxon attack was so frail, there was no eye diverted at first. They attacked every four years for the next fifty. Their numbers increased, as well as the experience of their soldiers. The Regni would be the second to encounter this barbarian hurry, and this is where my yarn begins. My parents were descendants of Christian Romans, and taught me all my life about Jesus and the Lord. Although the Regni were mostly followed Paganism, I believed in Christianity, and took it as lessons for life to live by. Growing up in a village constantly attacked by Saxons, activities never ceased. I learned the diagram of the warrior from a village elder, named Arthur. He was a pureblood Brython. These Brython consider themselves apart of the common “Britain” collective due to their keener understanding of war. My parents told me I was born in 544 A.D., soon after the largest Saxon advance yet. My village was able to defend against an entire army until the Regni cavalry could ride in and save the day. My father, along with Arthur led the men of the village, young and old, to victory. The only casualty was an venerable man, filled to the brim with alcohol and happiness. I trained for twenty years, literally my entire life, but no different from any other man during this time. Well, the Saxons kept attacking all three nations. A common enemy, remarkable like the Roman times, once again united Britain. The Silurians called upon the Regni for a quick peace.

I have retold my lands past hundred years, as any man should: with truth and dedication. I apologize before hand, for I am neither a scholar, nor a teacher. The path of the soldier has very little peacefulness, and I write when possible. Although the art of writing was taught to me when I was a child, it is a wonder I can even write at all. The other warriors can barely read. Taking myself as lucky, I look at the calendar on the wall in front of me: the Year is 577A.D. It is the the 37^th day of summer. It is warm, but still raining. I sit on my primitive desk and chair in the Palace of Cogidubnus. My name is Ezekiel, son of Mathwy, God’s Man, Slayer of Darkness, and Champion of the Regni.

Chapter 2: “Faith keeps him true, and, even in the darkest hours, illuminates him like a candle flame. Faith guides him surely, from birth to the grave. For a man without faith will no longer be honest, and a mind without purpose will dart in dark places.”

Dawn has come. Weary, and tired, I rose from my do shift tent and slip my arms through the light tunic. I remember that day crystal clear, as it is embedded into my memory like a brand on a cow’s arse: always indicate, and always painful. I roused the rest of my troops from their sleeping mats, and slowly made my way to the commander’s outpost. His name was Numitz, a beast of a man, but not very knowing. I figured the only reason he received a promotion was through intimidation. The freshly dewed grass pricked my body awake as I finished donning the rest of my attire. Numitz was conferring with his strategy advisor about today’s belief. Secretly I thought his advisor was sent to sabotage our work.

Numitz proudly called from his desk. “Ah! Ezekiel, my man,” He was tired of his advisor though, I noticed, and was eager about my entrance. He was not usually this kind to men he despised. One night when he was filthy drunk, he chose to recall a fight with me. After humiliating him in front of his men, the rivalry between us was never going away. I did not care about the fat bastard, or for his position. I merely was looking for survival. As tired as any soldier was, I was equally tired but lost the thirst for battle that many younger recruits mild retain.

To counter his quick disrespect, I casually replied with “What are your orders? ” Now, commanding twice as many soldiers have he did, it is a wonder how he is still able to recount my army. His rank denotes that, yet I am trusted to handle the victory.

“You attack today.” responded Numitz with added happiness. I knew that the Saxons landed today at the beaches with over four thousand men. We barely had over a hundred. I commanded eighty, and Numitz lead thirty. Even though I knew Numitz was a numb-tit, I was sure his conscious would look after his own corpse. Attacking a massive army such as that would be absolute suicide. I wondered about his mischievous looking advisor.

“Sir, that is not an option. We do not stand a chance!” I contended.

“No. You will attack today. The Saxon army advances, and with all our supplies, we can’t be caught in the back. You will deter the Saxons long enough so we can report back to Fishbourne.” Numitz answered smugly. He would love to send me to my death. This was his perfect chance.

“You fool! My men will die! They will shatter us! We will be a ready carcass under their boots!” I shouted angrily. I noticed Numitz’ guards slow me topple into the tent. Numitz for saw my anger.

“Then while they feast on your bones we will speed.” Numitz said. He had the most dastardly smug look on his face. Like the first stage of his master plan had been completed successfully.

“You stool-eating idiot!” And before I knew it, the bodyguards grabbed my arms and threatened me with a sword to my neck. I couldn’t fight them, for risk of them accidently slicing my throat, so I listened to the man inching above my face.

“You will obey my order. Or you will die. Do you understand? ” I spat in his face. “Good. Give him my armor. Pleasant luck Ezekiel.” I was seething with infuriate. The only reason his guards obeyed him was because he promised an dash. Numitz’ bodyguards knew that they had no reason to restrain me. It was right for me to kill a fellow officer if his judgment was not safe to three fourths of his men. So, I took it to my men. Having told them of my orders to attack the invasionary army, every single one of them protested. Weapons that were at the ready were now on the ground. Most of the armor pieces had been stripped off, and most men were about to walk away. After much persuasion however, we marched into battle. As preparation I prayed to my Christian God with a few of my men. I believed he would protect me, and my men. God is a loving entity, but has different uses for everybody. When my village was attacked, I was positive that I am the savior who was entrusted by God to protect the dimming light in the world.

The forest was teeming with enemies. My men were all demoralized, and disheartened. I could feel the tension as the Saxons closed in. Justin told me he would be happy to join the Saxons, as long as it gave him the right to reduce Numitz’ throat. Our shield wall was planted on top of a hill, directly in front of our advancing rival. I stood in the middle of it all, adding my own spear to the porcupine. The Saxon horde had no use for spears, but did have javelins, axes, broadswords, maces, and great little bows that could pierce chainmail. They were a rowdy bunch, especially the moments before the battle. Our enemy abruptly stopped behind the tree line. The hill we stood on was cleared of trees. It gave a good advantage of sight. A single man rode out on a horse to the bottom of the slope. He wore a horned helmet and chainmail torso armor.

“Any of you, who wish not to die, may flee. We will not pursue!” The man, now illuminated by the sun, was dressed in brilliant green colors of Saxon, and held a long white lance. The lance was probably ransacked from the eastern tribe of White Knights. Putting two and two together, and estimating that the battalion of Saxons from the east probably joined with the landing party, I was clear their army would be severely swelled. God’s favor determined by logic, was not on our side.

“We are men of Regni. We do not surrender!” Justin shouted after a brief pause. None of my men abandoned the shield wall. The men unhurried the shield wall were all young. Fierce but stoic faces prepared their soul for death. Our continuous jeering and mocking of the enemy urged them to charge. The first wave was of light swordsmen, who were easily cut down. I thanked God for the easy victory, and prayed for continued encourage, but felt my grip on life slipping away. The second wave consisted of axmen and ample swordsmen. These were tougher, but coupled with arrows, impossible to break. They cut down my first men in the front, and plowed into the line. To the left and right of me, men died by arrow or steel. I hacked and slashed, but in vain. Looking around, I could study the rest of the Saxon army just ignoring the light skirmish and running around the hill. Young men panicked and were chop down. Justin blew on the horn reform the line. Some men who fell inward on the flanks pushed into the enemy, temporarily giving us an advantage. When it seemed we would be victorious, with our spears pointing towards the next wave, we became surrounded. The rest of the remaining men broke. God’s fingers touched my legs, giving me the energy to rush into the trees like a stallion. “Near with me!” I yelled as loud as I could, but my men broke into another direction. They were already cut off. I heard my name being called a few instances, but were then drowned in blood curling screams. Wings felt like growing on my ankles, and I flew across the land. I ran west and prayed for a nearby village or outpost to save my tired legs.

It grew darker yet, as daylight slipped away. I had stopped running after knowing the Saxons lost me, but continued to amble. I was becoming unsure of my direction until I reached the top of a hill. Looking out onto the horizon, I saw a plume of smoke. It wasn’t that of a town, but maybe a limited group of soldiers. There was no longer any light in the sky as I neared the camp. A few figures danced naked around a campfire. The timbers from the fire similarly danced to the beating drums. Immediately then I knew that I had hasten into the wrong direction. God’s guidance has far from left me, but I felt it, at that moment, slip away. Instead of running west, my legs took me north. I supposed the heat of battle racked my brain, and the sun being highest in the sky, made it hard for me to discern between west and north. The figures in front of me were neither with the Regni nor the Silures. Dread filled my already draining face as I said out loud: “Caledonians.” Their satanic rituals surely cancelled out God’s care after me. I knew that if I was discovered I would be a lost soul. Slowly backing out of the camp onto the hill, my worst nightmares were fulfilled. The image of a frightening, tattooed warrior was stamped slow my eyelids.

I woke with a fright. They laid me down on a thin mat of cloth on the ground in front of a dying fire. I had learned the language of the Saxons, and almost all dialects of tribal British, but Caledonian speak always baffled me. It has become more of grunts and whistles, rather than characters and spoken language. God’s will deemed these barbarians too inferior to even be paid attention to, but Satan gave them the power of strength and body. As long as they keep sacrificing agreeable souls, the rumors say, they win to keep their gifts. I, a man of God, am the most valuable type of sacrifice. I dared not stir; however, I knew that if they discovered the torque that held the cross around my neck, I would be dead within an hour. Three men around the campfire were eating, but I did not see any weapons. A human skull lay down next to a burly Numidian. These Numidians were dark skinned monsters. They possessed great power and skill in combat, having been trained almost their entire lives. Their British counterparts are men like me. The night composed prevented me from catching sight of any other men, but I took my chances with these. I quickly rolled to my right, gripping my sword and pulling it in front of me as I rose. All three men stood up the same time I did. They were ready. Even though I was the only armed man, I was intimidated by their body and facial tattoos. One of the white Caledonians had a horse and and the other, a snake. The Numidian had none I could see.

Their blue markings seemed to wail when they flexed their muscles. A tall, probably shapely man drew a deafening scream and attacked. He lunged at me with an open palm, but I beat him with my handle to the ground. Looking behind me, I saw the horse had gathered a skinning knife from the ground and charged at me. The snake grabbed my shin and bit in, paralyzing my leg with pain. With my left side pinned, I shuffled and sliced at the horse, slitting his wrist. He dropped his knife but swung his free arm at me. All the while the Numidian stood watching and chuckling. As the snake’s bite dug into my calves, I felt the sword in my hand plunge deep into his neck. I knew the strike was fatal because his body went limp immediately. The horseman was soon dead, after a few final strokes. The Numidian whistled and I was suddenly surrounded with another thirty or so Caledonians all with a different animal on their chest. They obviously wanted me alive for the ritual because they knocked me out again.

“You will submit to Kybele! Let him draw you to his caves! Into the depths you go, radiant soul!” I reflexively spat into the direction of the voice. Kybele was the Caledonian god of the Underworld. Although, this man was trying to make Kybele sound more Satanic than the brutes give him credit for.

“Submit! You are a man of God, yes? God will never forgive you for coming to this place willingly! Kybele is first-rate! Allow yourself into his dimension! Submit!” The voice was very grave. Grave in the way that his absorb life is in danger, and like he was convincing me to say what he wanted. I slowly opened my eyes to see the man, but I was dripping wet. They tried pouring water over me, I guessed, but they gave up and figured I would wake in the middle of the ritual. In the many lessons of religion I was taught that for your soul to be sealed by Lucifer, he needs your consent. Nobody can force you to submit, but persuasion is always an option. The damn Caledonians had me up on a crucifix. They dare not harm me, because torture is forced consent. They tied me up with rope and keep me through lectures about the old man’s preaching. This went on until mid day. Hours of discomfort and malnutrition disheartened my resolve to resist, but I kept faith. Maybe one of my wishes was granted, because not one of the Caledonians came near me.

Until one of them cut me down. In the middle of the night, three or four others pushed me toward a circular orifice coming out of the ground. I felt the stinging gripes from the beatings on my head, but it alerted me enough to know the disaster in front of me. The Caledonians led me to a death pit. The awkwardly mangled bodies already in the pit had jagged splinters of wood protruding from them. Strong arms grabbed my neck and started to push me down onto my knees. They pulled my hair and de-clothed me. I might have put up a mediocre struggle, but their numbers always just seized me again. Looking into the pit, some of the bodies still moved. Some even were able to wail out the occasional moan or “help”. I felt sympathy not for those who died, but those who lived. I prayed for a quick death. The brutes tilted my body horizontally and pulled my legs up. Then a whistle cooed from behind me. Scared, the men pulled me back from the pit and parted to let the shaman pass. He was an “elder”, and a smelly one at that.

“Excuse my fool tribesmen,” The man said in broken British. “But they have no intellectual of proper sacrifice ritual.” His accent was purely Caledonian. Different from the Satanic Preacher, I thought there could be no man worse. The shaman gave a cold stare to the surrounding tattooed men and they finally backed off. Even though I knew I could physically beat the shaman who was now alone, the thought did not comfort my soul. God had deserted my soul for gone, but the Devil was the one who saved me.

“We won’t kill your body, of course!” the man chuckled. “It will be useful to us later. But your soul is a different story.”

“You are a man of God, am I just? A Christian? ” He continued. “Well you will be treated gentler, I promise that.” Proceeding to sprinkle me with some kinds of smelly herbs that made me very delirious, he laughed again. I tried to blow it away, but with my tied hands and my depleting strength, it was no use. The ground seemed to treble and split below me as the witch doctor stamped his feet and chanted. I knew it was only the poison, but my imagination kept playing tricks. Now, this moment I will try to narrate as best as I can. Have you ever heard of an out-of-body-experience? Well this shadowy magic separated my soul from my physical body. I actually witnessed myself rising as a spirit looking down on my body. It was still staring adamantly at the dancing and hollering shaman.

The barbarians moved to encircle me. The charmer was the only man who was not naked, wearing a loin cloth and bundles of animal skin. He inspected me closely: sniffing, pondering, and poking. That was the only moment I saw there were other prisoners. The two of them were brought out with the same zombie movements that my body made. They were both of the Regni tribe, clean shaved and tattoo-less. The Silurians had tattoos, but small and usually reserved to their chests. Saxons had long Slavic beards and small marks on their arms. I was too far to notice any details, but it felt that there were other souls around me. I tried to talk, but found no sound came out of my mouth. This was my first hand experience of dark enchantment. I kept repeating in my mind: “In the name of the Father, and of the Son, and of the Holy Ghost. Amen. We beseech thee through Jesus Christ our Lord. Amen. From the snares of the devil, Deliver us, O Lord.” As I attempted to say this, the shaman might have caught on to my life line. I know God would help me in this time of need, but the only thing blocking my prayer was the shaman’s magic. The chanting barbarians continued to march towards my body.

“You are a fighter, I can advise!” The same old shaman shouted in British. “Well, if I can’t talk it out of you, then we’ll have to choose, it out of you.” The same smug smile that grinned over Numitz’ face bore into this man’s. Oh how badly I wanted to kill every last one of those demons, but unless I could rush, there would be no hope. One thing that was kept however was my determination to live.

I could not talk, and therefore could not pray. I repeated the lines over and over until a crack of my say came back. The shaman burned some kind of incense that made my throat dry. It also sent a cold tendril up my spine to the base of my neck. It felt like the slithering evil of Satan’s Sin climbing aboard a mortal being in order to drag him away from God’s mercy. These few moments were absolute torture, because my mind told my body to give in. Fire and brimstone seemed to burn in my heart. The Devil ushered my utter to bawl yes. The pureness ushered my screech to shout no. This battle would be fought in my psyche. I am a man of God, and I will crush down all enemies of my Church. The moment I felt my spirit had gone far enough from the shaman’s magic, my spirit went back to my physical being. I guess heaven didn’t accept me just yet.

I repeated the same lines, and actually heard my own jabber amidst the rhythmic music. “Deliver Us, O Lord!” And the shaman drove his blade into my breast. My screams could not beget the forest with more pain. Blood stained the already soaking shirt, and the agony was unbearable. I caved the man’s face in with a single punch. “You shall not be my end! Deign, Oh vast Lord, to grant us thy powerful protection and to keep us safe and sound. We beseech thee through Jesus Christ Our Lord.” I yelled at the top of my lungs.

Suddenly, white men came in from the trees with beaming armor and weapons. They seemed to glide through the air and only aimed to destroy the Caledonians. “And the Lord shall deliver thee!” I heard behind me through the grove. It was a deep, commanding inform, spoken in perfect British. Later I was told it was King Daniel. Another voice claimed that the prisoners were friendly. These glimmering Angels, was what I called them at that time, tore apart the unarmored barbarians with the power of God himself. Blood and carnage was everywhere as the lustrous warriors killed anything that moved. The Caledonians put up a worthy fight with sticks and fists, but victory was not awarded to them this day. I did not realize my depletion of strength. A man, by the name of Antares, which I was later told, took me on his horse and led me back through the woodland. I fill he was a monk. As the gentle trotting of the mare lullaby me to sleep, I lost track of time and drifted into the world of dreams.

Chapter 3:”Faith shows him the path, and prevents him from straying into the lightless thickets where insanity awaits. To lose faith is to lose purpose, and to be bereft of guidance.”

Dyrham is a castle. Nay, it is a fortress. It rests above a rocky quarry, and a hilled terrain. The southern wall was built on top of a fifty meter cliff, while the fortification itself stood twenty meters high. And the towers rose even higher than that. Spread about eighty meters apart, the turrets swelled to nearly twenty more meters above the walls. Massive stoned structures and the sound of marching could keep anyone except for the keenest invaders out. Upon arrival of Dyrham, the sun had yet to show itself. The morning mist along the ramparts gave the eerie feeling of a ghost castle. It was anything but. Behind the colossal walls life was teeming. Many peasants and nobles alike lived in Dyrham, hoping to save themselves from the Saxon onslaught. Perhaps the current celebrity to live within the castle today is King Cynlas.

I got up drowsily from a nearby abbey overlooking the castle. Through the window I noticed the stunningly gorgeous structure looming in the distance. I knew a lot about this castle since I was a boy. It is the “Castle of Fame”. It is where all the heroes ever lived will live and forever will stay. Arthur Pendragon, Gildas of Mercia, Ida of Bernicia, Aelle of Sussex, and dozens more have all lived and prospered in that very castle. I was blessed to be this close, and blessed if I ever find the chance to enter it.

“Ah! So I see you know the Castle Dyrham!” The exclaim behind me startled me, but it was so merry, I barely took notice.

“Yes, Father Antares,” I replied. Turning around, and donning a brilliant smile, he nodded happily. He brought food through the door into the quiet cell in which I stayed the night for.

“Well, well then. You are now a scholar!” Chuckled the unpleasant passe monk. I had high respect for the man. He had such sadness in his eye, such pain. Any veteran of war could instantly tell, but Antares chose to screen the suffering. I only hoped he opened to the Lord when he deemed it fit not to willingly fraction with another man.

“I am terribly sorry for all your time I have wasted, Father.” I quickly blurted. Subsequently, he smiled. “I mean, you healed me, gave me a room… with a view much less!”

“It’s the least I could do for a fellow devotee.”

“Thank you.” The bandages were right. An impressive amount of blood that stained the cloth still was displayed.

Antares’ expression filled with memory. “You know, I do wish it were the Angels of God that saved you last night.”

“They weren’t? ” I questioned.

“No. Commanded by King David of the Kentishmen, the White Knights saved you.” He replied with a giggle. “The King told his men, who I followed around being their preacher, that God directed his mission. Everybody had faith in David, but after two days of straight marching, we almost lost hope. That night while camping, we heard drums and screaming. As the men assembled we heard even Christian prayers; your prayers, Ezekiel.” So God had not abandoned me after all.

“How do you know my name again? ” I wondered. “Sorry for intruding…”

“No worries, boy. I asked you, and you replied. It was the only way I could keep you conscious until we arrived at the abbey.” Antares slowly made his way to the small wooded cabinet and set the tray of food on top.

“I don’t really remember… anything after the King David charged the camp.” I touched my dressings again.

“Oh yes. I plan so. Not one of his knights was injured. Not only that, but we did not even know the Caledonians came this far south. As we enlighten King David speaks with Cynlas in Dyrham.” Smiling, he left me to myself. After I consumed the bread and soup, I prayed for forgiveness and gratitude. I really felt guilty for the Antares. I knew monks did not receive more food than needed, and I deduced he probably gave me his lunch this day.

After swearing to pay the man back someday, I took my tunic and leather drawers. The only goal I had in mind was to visit Dyrham. I took the scenic view, walking on the west hover, facing the shores of Britain. And yes, from the open windows of the abbey, you could see the British Channel. The green meadows dipped sharply to yellow beaches and blue ocean. This, in my opinion, was the absolute most perfect area for a monastery. It was fit for heaven itself. I reached a flight of stairs, routing me to the front gates, but it was filled with monks. I saw Antares in the midst of the crowd. A man in Silurian chainmail was desperately trying to control his haunted warhorse.

“Stop! No! Antares! He is an ally!” I shouted out of panic. The Silurian reared his horse and backed away from the crowd. It had seemed the monks, carrying their makeshift weapons did not even attack the soldier. I should not call it a warhorse even. It was only a mare. Nobody turned to face me, they only parted. Their heads were bowed as I passed through the aisle.

“Are you of the Regni Clan? ” The Silurian asked in partial Britain. He dismounted his horse and displaced his helmet, but kept his sword drawn. The red came signified royalty, but I believed it to be fallacy.

“You should put that toy away, before you pain yourself, boy.” I dictated in perfect Silurian. The young warrior did look like a boy, not even into his twenties yet, thus analogical to his young mare. “What is your name? “

“I am sorry, sir.” He stammered, sheathing his sword. The boy had trouble saying the word “sir”. “My name is Herald. Son of-”

“King Bran of Siluria. Where is your entourage? ” I demanded. The Prince probably did not have anyone else talk to him that way. I scared the rascal I believe. He looked over his shoulder when I reminded him of his Royal Bodyguard.

“I rode ahead, to deliver the message myself.” Herald quickly retorted, keeping an ogle on a young monk with a pike in hand.

“What message? “

“Saxons, eight thousand strong, and Caledonians, two thousand strong are two days march from Dyrham; with speed, one day.” I gave Herald my sword, which he bagged on his mare, and took dwelling behind him.

“We ride to Dyrham.”

Herald merely nodded and galloped away from the stone abbey. There was a clear path that led towards the castle, facing its western entrance. The fortress looked impregnable, but I would be soon disproved. The south wall was protected by a sheer drop cliff, the north wall defended by the most elite guards in all of Britain, the east wall had a vantage point over a square league of flat land, and finally the west had rows of ramparts and an army of White Knights on the horizon.

We gained unrestricted access into the beautiful castle. As I dismounted from the Prince’s horse, we made our way to the doors of the palace. Another wooden gate separated the outer walls from the inner walls. From above, I imagined the castle to be a square shape circumscribed about a series of circles. The smallest circle was being the Palace, and the largest was the commercial region. I passed through many merchant stalls, inns, apprentice halls, and homes on my way to the gate. Some peasants cheered at the Prince’s arrival, but I was relatively unknown. A man walking with only a tunic and tights did not win as much renown as a fully dressed and armed Prince.

The gates opened majestically as soon as the guards saw Herald. I could hear the faint gallops of what I suspected to be the boy’s bodyguard as soon as the conduit closed. Herald turned to me and smiled. We finally entered the Sustain. My prayers were answered, for I now walked where Heroes of past walked. I was embarrassed, being not dressed for the occasion, but the status was dire. The Prince seemed calm enough, but he was only a boy looking for fame or battle. King Bran, King Cynlas, and King David all sat at a wide table, drinking water and pondering over a laid out procedure.

“Lord ‘Numitz’ of Regni is a coward. Did you hear, he abandoned his men at Winchester! He will find an excuse not to commit. I promise you that,” said the deep voice that I heard last night. It was of King David. David reigned over Eastern Britain, or Kent. They specialized in their elite Cavalry corps. In combination with Regni spears, the alliance was a double threat.

“Is the rest of your armies in western Regnenses this cowardly, King Cynlas? ” This man’s demeanor was accusing, yet slightly pleading. Worry with a tint of hatred. It was full of bravery, but withdrawn and lonesome. King Bran of the Dorsaetas tribe, the oldest ally of Regni. It was surprising that he would use such a tone against his own brother. Of course they were not blood brothers, but Kings of alliances were considered family. The Dorsaetas tribe controlled Central Britain, and therefore had the most trouble defending their lands. Then again, it was not surprising that he had such an outburst. He was a kind man; I would come to know, and cared for his people deeply. All these men cared for their people.

“Nay! We defend our coasts every morning and night against these Saxons! I have no forces to recall except for our tribesmen in the woods of this station here. And even then they only venture to gather wood and stone for our defenses. Forgive me Bran, but my army is not what it used to be!” Engrossing, yet smart. King Cynlas. He ruled over the entire Regni territory, which were West Britain and all its coasts. The three most powerful men in Britain all in their evening gowns discussing plans in front of me was a blessing. I was graced greatly enough to be in their halls, but to be in their presence!

“Father! I return with a Silurian… General? ” Herald suddenly interrupted. The men’s faces were weary, but slightly relieved at the little misunderstanding.

“I am sorry for the misunderstanding. But I am not Silurian,” I quickly interjected. Herald glared at me accusingly. “My name is Ezekiel of the Regni. I overheard you talking about Numitz.”

“Yes. That filthy coward.” King Cynlas replied. He obviously was as hateful of the man as me. I did also believe Numitz turned out nation into a blubbering pile of lazy idiots. Men like that should be burned on the stake.

“Well I led the detachment that was ordered to camouflage his retreat. I believe I am the only survivor.”

“How can you prove this? Where is your armor, your weapons, man? ” I was not surprised at King Bran’s suspiciousness. His fathers before him had been betrayed too many times in previous trusts. Bran would not manufacture the mistake of repeating their stupidity.

“I can vouch for him,” spoke King David. “I led my army through the forests of Winchester looking for this man. God led me to him, and I liberated him from the prisoner camp the Caledonians held him in. If it not were for this man, I would not have discovered the army of those beasts I have near to tell you about just now.” The man still had his helmet on the floor, and the heavy bright white armor under the table. I could see now why I had mistaken him for Saint Michael. He looked at me with fierce respect. He too was Christian, and I gave a bow of thanks.

“I understand. Ezekiel of Regni, I give you two hundred of my men. You will hold the south wall from the Saxons. You have experience with the bow? ” Cynlas ordered. He leaned over the table and handed me a folded note.

“Yes, sir,” I bowed and took the designate.

“Good. Fifty of them are archers. Give this to Lord Gildas.”

I gaped in excitement as he said the name. After being dismissed by the three Kings, I went off in search for Gildas, Darkness Bane, and Champion of Dorsaetas. He was half the man in battle, due to his mature age, but his mind had not faltered for a second. His strategic planning actually sharpened even more with experience. I found him in the Palace Library at a table with a middle age officer.

“Ha! Victor, you are getting old!” Ironically, Victor had brown curly hair and an outstanding demeanor. He sat straight up, but I knew he had no skill at Halcyon.

“Lord Gildas? ” Both men looked at me. Victor stood up, as if to defend the man. The old man seemed to read me, remarkable like a I read people. We looked eyes for a moment. I was about to apologize for the disrespect but the old Hero responded first.

“Well met, friend. I am this ‘Lord Gildas’ you reveal of,” the man said. With whiting gray hair, and thinning muscles, it seemed almost impossible that this man fought through an army of Saxons in a cave with nobody else but his four companions. They call him Darkness Bane because of this. He also commanded the men that defended Fishbourne palace from Caledonian siege, giving him the title Champion. Throughout his life, he moved from town to town, giving aid and defending strategic points when needed. All his experience would lead up to this point. His final battle was afoot.

“Lord Cynlas told me to give this to you,” and I handed him the price. After a moment of detached contemplation, the old man stood up and walked past me.

“Come, Ezekiel of Regni. We must prepare.”

And so we did. I addressed my new army of three-hundred, and with it, a promotion. I felt proud of my new responsibility, but had that shadow looming over my figure. The shadow of what was to come. Faith had guided me just so far, but will it help me again? God is immense, god is good, and we thank him for our food. But will he save our lives when most appropriate? I believe so. He saved mine.

I perched on the innermost wall as the new day came, spectating the business of Dyrham’s worried citizens. The first tier of the castle, the commercial center, was tiled with black roofs. It was teeming with though-provoking bodies and very little noise. The second tier contained a white barrier of calm. Few guards inhabited the crosswalls, but it served as a defense purpose only. The new execute of the crosswalls could only be described as an obtuse V shape. The angle pointed toward the east kill of the castle, while the basin faced the west. The strategy was that men would try to file into the gate as fast as possible. But when met with a bottleneck, the archer ports could half determined shots on the enemy. It was ingenious, and developed by Gildas himself. Behind the crosswall were the barracks and tents belonging to our faithful warriors. Silurians, Kents, Dorsaetas and Regni alike were all encamped to defend their Kings. Gildas and I calculated five hundred expert bowmen from Siluria; three hundred White Knights from Kent, as well as another detachment of four hundred spearmen; a thousand swordsmen and archers from the Dorsaetas; and an army of spears from the Regni, eight-hundred strong. A thousand archers, twenty-two hundred men on foot, and four hundred men on cavalry defended the castle of Dyrham. We also took in account of the peasants, who were equally as distinguished to the warriors. There were about ten-thousand farmers, traders, and specialists living a normal life behind the walls, but they had to be extracted from their homes and transported to the nearest town, Badbury.

Such a castle was always built in the popular board game, Halcyon. Its shadowy and white striped board symbolized the different tiers of a castle, and each player had to fade their troops, archers, and cavalry accordingly in order to capture the fourth tier of the enemy’s keep. Gildas was the genius at it, he practically invented the game. Although it was imported as a game from Rome before even Christ was born, Gildas had managed to learn its secrets and infinite strategies. The venerable strategist place the Dorsaetas swordsmen and archers on the northern wall. It did not have a cliff, and was most susceptible to siege weapons by the Caledonians. They were sure to bring ladders, which were probably given to them by the Saxons. I was placed in charge of three hundred out of eight hundred Regni spearmen. The rest would wait at the cross gates, for horn that would call them for reinforcements. A man by the name of Herod, Champion of the Silurians was given one, the Dorsaetas Champion, Gildas was given one, and I, God’s Man, of the Regni was given one. They all had different tones, which denoted the gate they would race to. I did not want to be the one to signal the call.

With my full battle armor, shield, spatha and spear, I stood waiting. My men were also vigilant. Thankfully, not as young as the previous band of men I commanded, but equally as energetic. These Royal Guards had flashy yellow chainmail and skirts that looked pretty, but was questionable in battle. I did not want to test my men’s mettle, for if they failed, it would mean death. This was a battle forced upon us, you scrutinize. And we were prepared.

The Northern wall was guarded by Dorsaetas. The Eastern wall was guarded by my army and me spear. The Southern wall was guarded by Siluria. The Western wall was guarded by Kent. We were a small band, yet experienced and ready. I could not say for our enemy, but we would soon catch out.

The first signs of Saxons came about early morning. Mist still had befallen the country, which gave them the opportunity to sneak on our archers. The white clouds always came from the ocean, and with that, Saxon landing parties. They had waited until last night to depart, I reckon, knowing the morning mist would hide their attack. But we had it covered. We dug ditches around the castle walls to the south, ensuring their near to be a noisy one. Silurian archers opened fire before the Saxons even caught a glimpse of Dyrham. The second attack came from the east. I could hear war drums, and the footfalls of thousands of men nearing. The Saxon army that I had encountered in my deployment in Winchester with Numitz had come back. It seemed the spirits and ghouls of Satan’s army came back from the depths of my memory. The dim robed spearmen were thrown at us to test our strength. They brought exiguous siege ladders. We fired no arrows, and spilled no blood, except to throw down the ladders they had cast. The Caledonians did not show yet.

When the nebula cleared, the Silurians could see the entire Saxon army. I was told it was massive, maybe eight-thousand strong. With the eight-thousand we had at our wall, the enemy had a five to one man ratio. We watched the Silurian bows shoot volley after volley at the advancing Saxon army. They could not hope to scale the wall, so they took a detour west into the Kents.

The dark figured Saxons charged our wall with ladders and ballistae. It only took a moment for their massive arrows to near us, but thankfully only three existed in their ranks. Devoid of targets, the Silurians quickly moved to our wall and fired onto our targets. Men cheered and sang with joy. When the first Saxon climbed over the ladder, my men were ready. With spears out and shields up, Saxon men fell be the dozens. Whether impaled by the porcupine of iron or harassing rain, their casualties skyrocketed. Then a lucky ballista brought down a tower. A few archers had not yet bailed out when it fell. Those were our first casualties. In a cloud of rubble and stone, the Saxons redirected their attack on the breeched wall. If the Saxons poured in from the walls, and the hole, there would not be enough men to contain the first tier.

The Silurians retreated to higher ground as axmen and berserkers with spears blotted the beautiful city like ink. I flew down the stairs and dove at the first Saxon I saw. The men were invigorated. Having thrown my spear at the crowd of men, which I saw pierced the man through his breast, I drew my spatha. It is a short iron sword, perfect for messy fights like these. My men tried to surround the horde and contain the leak, but it was no use. Soon I would have to call in my brethren. My sword lanced a berserker through the neck, and reduce another at his waist. I placed my shield over my head and blocked a blow from a stone club that could have crushed every bone in my skull. Around me men of different ranks fell. In the heat of battle, only kills counted. We could not hiss for this type of psychological impact. Officers were regular soldiers who forced themselves to think straight when in dire situations. That is what separates leaders from the average.

God’s will was exacted on this blasphemous filth. I severed many limbs, and hewed many men that hour. The detachment of about a hundred or so spearmen I ordered to seal the gap was dwindling to fifty. I took a place unhurried my men and sent a scared boy to bring help from Dorsaetas. We retreated into the commercial piece. A few minutes had passed, and by then I didn’t know the spread of the Saxon fire. The Silurians had reached the crosswall safely, and I was about the sound the Horn when the Dorsaetas swordsmen arrived. My tired men happily pulled back and switched placed with the fresh. We ran around to camouflage the swordsmen’s flanks. The streets were packed with blood and soldiers. Some Regni spearmen holding Saxons in a narrow alleyway, or a flanking party stopping the ransack of a store. This part of the city was not meant for war. But it was perfect for the Regni. I sounded the horn and made my method through the streets inward. My men and I spotted the furthest Saxon advance, and two hundred strong, we created a shield wall blocking their escape. I ordered the reserve spearmen to defend the wall.

But what I had not foreseen was that it had already fallen. Another lucky ballista missile scored a direct hit and toppled the entire wall. Half of my reserves had disappeared in an instant. The Dorsaetas were farther away, but routed when they saw the wall had collapsed. The happiest conception it my mind was that I was gay to move at the last second. The five hundred spears had come relieve relatively unscathed and asked for orders. I was trembling at the news, but I had to keep objective. To sound the general retreat, I told them. Another messenger came in to express me that the Dorsaetas had begun fighting with Caledonians on the north wall. I had to compose the decision that would save Dyrham, or extinguish it. Should I rescue the surrounded Dorsaetas, and maybe risk the entire castle, or leave my brothers to die while I save what is left of the men? I took a detachment of eighty men and told the rest to sound the general retreat. Some protested, but I told them I had to do the accurate thing.

So I led them to the North wall. The Dorsaetas had our backs to us. And we saw Saxons creeping up the stairs to get them where their pants are down. I called for Gildas. A group of men surrounding his body looked at me. Their sad, customary expressions told it all. So as I screamed for my men to attack, I laid the path. Every Saxon climbing those stairs was touched by my sword at least once. Rage took me over as I saw the fallen Hero on the castle walls. I looked down at the Caledonians, and then I spit. My shield didn’t help me at all now, so I threw it into the mass at the bottom. With the back of a fellow Dorsaeta, we carried Gildas’ body safely into the crosswall gates. It was a rough journey, being attacked from all sides by Saxons and Caledonians, but nobody else touched him. I looked aid on the wall from the stairs that led to the division between the shaded and white stripe: it was flooding with savages. The rescued Dorsaetas thanked me for my bravery, but I did it because Gildas was in that battalion. He was the risk that I took.

Eight hundred Dorsaeta footmen had survived: four hundred swordsmen and four hundred archers. As for my army, only six hundred spears remained. When I entered the maintain carrying Gildas’ corpse, the surviving warriors led me into the keep. They asked if I wanted a replacement. Someone could wear my army, a man volunteered. I denied. I wanted revenge.

The crosswall gates were now closed. The Stone of Saturn, it was called, after the Roman god. No enemy of the Regni, Dorsaetas, Kent, or Siluria had ever crossed this holy strip of land. The only arrangement they could enter now was via the thick wooden gates. It was supported with iron and bronze bracing, much like the Romans did. Invulnerable to conventional weapons, but can crash down over time. As I came befriend out to the courtyard, I saw all the men assembled again. The Silurian archers crammed on the walls due to the fact that no other siege weapons could be brought to bear. Any other infantry took positions with tips at the gate. It was a sight to behold.

For the next few hours, enemy after enemy broke themselves against our walls. Thousands of Saxons and thousands of Caledonians working in unison serene failed to break through. We so smoke pyres rise from the commercial section, they were plundering it. The Stone of Saturn did not fall. But it was behind in the evening and I could glimpse that the Silurians had run out of missiles. We parted the gate. I think the enemy was surprised at that, as we no longer took defensive residence. Their numbers dwindled so much that we reckoned that this risk was safe. Swordsman, spearmen and pike men all rushed out of the gate to seek and destroy. I personally led the second wave.

Gildas eventually awoke to glean himself in our infirmary, alive and well. He owed his life to me, and after claiming he should actually be dead, passed the title of Champion. We had defended Dyrham from the attacking Saxons and Caledonians, defending our Kings and our people. Many warriors had died this day, but their deaths were not in vain. Not only had I been awarded the title, but I had inherited the reputation. Champion of Britain, they call me, all because I saved a man. They claimed I saved Britannia. I kept her culture and her vibrant beating heart of British warriors and peasants away from the gnawing jaws of terror and paganism. My warriors are faithful, and we had prevailed. It was the will of God, I knew. From birth I was devout, and until death I am devout. God’s will, always prevails.

Related Blogs

Many if not most, people have never heard of temporary health insurance until suddenly they need it. Into most lives a gap must drop. People are in between jobs, on strike; working but benefits have not yet kicked in. Or they may be recent graduates who had health insurance throughout college and now they are now they are out pounding the pavements without any health insurance. For these reasons temporary health insurance is there for all those in between times. It will cover you from one to twelve months.

***IS TEMPORARY HEALTH INSURANCE LIKE REGULAR INSURANCE?

Yes and no. For starters, it never ever covers pre-existing conditions. No, nyet, no way, nada, and N.O. Nor does it cover preventative, routine health care. That means no physicals, no routine blood work, no mammograms. There is no financial encourage whatsoever to a temporary health insurance company for providing this kind of coverage. Other than these exceptions, temporary health insurance is handsome much like regular health insurance.

***ARE THERE SPECIAL COMPANIES FOR TEMPORARY HEALTH INSURANCE?

Do you mean something like Temporary Contemporary or Memp Temp, headquartered in Memphis Tennessee? No, it’s the same old companies that you love, hate, or are indifferent to. Blue Cross, Aetna, Humana and many others offer a wide range of plans. There are a number of sites on the Internet where you can gather quotes and details. Always go to your library and read the back issues of Consumer Reports that rate insurance companies.

***HOW MUCH DOES IT COST?

Let’s say you are a 40-year-old woman. If you take no deductible, your rates will be around $200 a month but they go all the procedure down to $100 if you take a $5000 deductible. There are also co-pays running from 20% to 50%.

In other words, it ain’t cheap. If you are flat broke and have no income or assets-no savings, stocks or bonds, no petite chalet in Vale-you can go to your local welfare office and get your state’s version of Medicaid.

***DO I REALLY NEED TEMPORARY HEALTH INSURANCE? I’M VERY HEALTHY.

You’re out job hunting and you’ve got on your classy pair of spike heels. Your feet are killing you but you bravely pound the pavement. Suddenly that puny heel catches in a crack and you twist and drop. There is a sickening “thunk” as your head hits the pavement. Now you have a spiral fracture to the leg and a brain injury. The doctors have to operate on your leg and drain the fluid from your brain. You are now thousands of dollars in debt and your salary from any job you get will be used to pay off this debt. You decide. Do you need temporary health insurance?

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The structure of HMOs was also largely different than traditional indemnity plans. HMOs require primary care physicians to act as gatekeepers of advanced care and it empowered insurance companies to challenge the medical judgment of doctors. It restricted choice to those doctors and providers “in the network” and any care provided by outside providers, care that didn’t follow the accurate regulations or didn’t have the right referrals was simply not paid.

It is indisputable that we are currently in a health care crisis with skyrocketing costs and extreme customer dissatisfaction. It is never a good sign when medical providers have to market themselves on customer service. No other industry has to try to convince consumers that “we won’t abuse you” and that “you matter to us”. The current argument is that health care needs to be socialized because the free market hasn’t worked.

First, the central principle of the free market is that the individual parties of a transaction are able to negotiate the terms of that transaction themselves. For instance, if I want to buy a car, I can negotiate with the dealer the terms of the transaction and the dealer can do likewise. If neither of us wishes to proceed, we can fade on. Without free choice on both the provider and consumer in deciding terms of the transaction, there is no free market. There is no free market without choice.

The health care system in this country, developed by Democrat Ted Kennedy who now campaigns against his own creation, all but eliminates choice in both doctors and patients.

Limiting the Choice of Patients

Let’s say you, Joe Consumer, want health insurance. Because of the structure of the tax system that enforces what is basically an historical accident, you will probably get this through your employer. Your employer is limited by tax law to only let you perform decisions about your health insurance provider at certain times, basically when you are hired and once a year thereafter. You will likely get a few choices, an HMO with higher deductibles and lower premiums, an HMO with lower deductibles and higher premiums (from the same company), and a traditional indemnity plan. If your employer chooses Blue Inappropriate Blue Shield, you’re only going to be able to choose Blue Cross Blue Shield.

Employers decided which insurance company to work with. Their motivation is clear, to save money. As a secondary objective, they want happy employees. However, the insurance company is selling insurance to your employer, not you. So they craft policies that are lucrative to your employer. Maybe 60% of employees are happy with what they get, but the other 40% are pretty much hosed. If they want a different insurance company they need to pay full price and the employer is not allowed to compensate the employee on what their portion might have been. Demolish result: consumers do not choose their insurance company, their employer does. If they want to change their insurance, they can’t until the next benefit choice period dictated by the IRS.

Now you, Joe Consumer, want to go to the doctor. You take your handy dandy provider directory (or go online) and you choose from the list of doctors your HMO allows you to go behold. You may know you need an orthopedic doctor to deal with your knee problems but that’s too abominable, you need to go to a primary care physician first (and pay for that useless appointment that you don’t need). This primary care physician’s job is to limit the amount of advanced care patients receive. In fact, in some cases, distinguished care physicians get a bonus based on how few referrals they give.

Let’s say you do get a referral. Then you go to where the HMO tells you to go to with even more limited choices in the provider directory. Let’s change the scenario, let’s say instead of knee problems you have cancer. You hear superb things about the Mayo Clinic and you want to gain care there. Too bad, you need to go where your HMO tells you to go to. You may have a better shot at survival at Mayo, it doesn’t matter.

You may wish to explore alternative treatments, however, your doctor who knows what your insurance company will and will not pay for better than you ever will, simply will limit you to those choices which your insurance company has already decided you will have. He knows that they won’t pay (and he probably won’t bag paid) if his plan of care deviates from the dictates of the insurance company’s accountants. These people have never seen you, have no information about you but have near complete control over your health care decisions based on some sparse paperwork sent back and forth. The patient will never get the opportunity to talk to much less negotiate with these people.

Lastly, you want to choose a doctor among the choices that are provided to you in your provider directory. If you want to “effect shop”, well, you aren’t provided pricing before hand. This may be difficult in some cases, but patients simply have no pricing information with which to judge before they’ve already committed themselves to care (some exceptions, not many).

The net balance of all of this is that in every single step of the health care system, the consumer is removed from the decision-making loop. The only health care decision the consumer gets to make is whether to have the insurance company pay or to do what they think is right and pay full price out-of-pocket and risk bankruptcy, even if it is the right decision.

Limiting the Choice of Doctors

On the other side of the transaction we have doctors that also have their choices restricted and taken out of the equation. Before a doctor sees his first patient, before he gets an office or buys any equipment, he needs liability insurance. The premium he is charged will be identical to other providers with similar practices no matter what training, experience, qualifications or differences exist between them. A Saturday-night hack artist pays the same as a doctor who has won the Nobel Prize. In Illinois, the premium for an OB-GYN before they see their first patients is about $240,000. In surrounding states it is about one-fourth as mighty which is why Illinois in particular has a health care crisis. Providers are fleeing the state. Take a look approach any state border and you will search for a thriving health care practice impartial on the other side of the Illinois border with that state.

The terms of this insurance policy (in addition to the designate) are non-negotiable and designed to do one thing, prevent lawsuits or perform them easier to win. For OB-GYN’s the terms are the most notorious. For instance, a woman who has had 2 children already without complications, is having a third low-risk pregnancy needs to go through the same regimen of care as a first pregnancy. If you’ve had children you know how this works. Started second trimester or so, you go for bi-weekly checkups (that become weekly as you salvage closer to birth). You pee on a stick, you get weighed and they ask you if you have any questions. There’s an ultrasound in there and a couple of blood tests.

With my first child, after a few of these appointments, I began to wonder what was the point. We didn’t have questions. In, out, 15 minutes: that’s $50 (the copay in this case). Why do I bring up this story? Because if you, the patient, decide that these visits are superfluous, your provider is required to topple you as a patient. You may have no complications, you may have no questions and there may be absolutely no reason for these visits, but your provider is required to mandate that you go, regardless of medical need or you can’t be their patient anymore. By the way, you, the patient, pay for this decision made not by your doctor, but by some lawyers at a liability insurance company. The United States has the highest C-section rate in the developed world because liability insurance companies dispute that if anything is “abnormal” a C-section must be performed. Not because of medical need, but because of “limiting liability”.

In addition to liability insurance companies dictating the terms of care, doctors then have to deal with health insurance companies (or even worse, Medicaid). About 30% of medical bills sent to private individuals (not insurance companies) are paid. Doctors know that they are being paid by the insurance companies, not the patient. They know that if the insurance company isn’t going to pay them, they probably won’t be paid. The only exception to this is patients who walk into an emergency room or doctor’s office with a Platinum American State card. Providers know these people are paying cash and they get treated with far more respect than insurance carrying patients do.

Before the question of the “bonus checks” for limiting referrals even comes in to play, doctors know that the insurance company is calling the shots. They know they won’t get patients without joining a “network” of some providers in a given insurance company. The insurance company will then dictate what rates they can charge, what services they can provide, what drugs they can prescribe and in some cases how many patients they can see.

A doctor that practices without taking a major insurance policy will have a hard if not impossible time earning a living. A doctor that practices without a liability insurance policy (even in places where that’s upright to do and that isn’t many) can be considered certifiably insane.

Conclusion

Both doctors and patients have their choices and ability to negotiate their health care severely limited. There is some competition in a very exiguous sense where employers can decide from a cramped selection of HMO companies. Doctors can choose too and there is a small subset of liability insurance companies they can choose from as well. One of the major plans for “health care reform” is to simply have the government serve as the HMO instead of private companies. It is unfathomable to believe that taking away the trivial amount of choice in the health care system that is left will result in a better system that is more responsive to patients.

The solution to the health care system is to let those who are part of the transaction, doctors and patients, have the freedom and latitude to decide their possess plan of care. Removing the patient from the decision-making loop has only created a health care system that thinks of the patient last. Let’s give the free-market and freedom of choice a chance.

John Bambenek is the Assistant Politics Editor for BC Magazine and is an academic professional for the University of Illinois. By trade, he is an information security professional, part of the Internet Storm Center and a courseware author and certification grader for the GIAC family of security certifications. He is a syndicated columnist who blogs at Part-Time Pundit and the executive director of The Tumaini Foundation which helps AIDS orphans and other children in Tanzania to get an education.

1 Know thy needs
Before you get down to comparing different plans, it is well-known to determine your insurance needs. You may not gain a policy that will cover every contingency, but you should try to find a plan that at least covers the essentials, and meets your medical needs.
Does a family member have special needs? Do you plan on having a baby in the next couple years? Does a dependant need prescription drugs? Do you travel abroad? Thinking this through will enable you to match your next policy with your current and future medical needs, and accumulate the kind of coverage that is right for you.

2 Shop around
All health insurance policies are not created equal. You or your insurance agent should secure quotes from different insurance companies for comparison. You will find that there are broad differences in the cost, benefits and exclusions offered by various policies. By shopping around, you may not only effect money on your insurance premium, you may also procure a policy with benefits that are better honorable to your needs. While shopping, be sure to do an apples-to-apples comparison of the standard benefits that each company has to offer.
One of the most convenient ways to derive quotes from a number of health insurance companies, is at an insurance comparison website. You will fill out a single questionnaire and get several different quotes. Here are three comparison sites:
www.ehealthinsurance.com
www.netquote.com/
www.LowerRateQuotes.com/health-insurance.html

3 Review the Benefits
Before you commit to buying a policy, it is essential that you understand exactly what it will pay for and – just as important – what it will not pay for. Be sure to read the exclusions section of the policy very carefully, as many health benefits are strictly optional, and will vary from one plan to the next.
*Does the policy veil preventive care?
*Does it offer vision and dental care?
*Will the belief cover pre-existing conditions?
*Is ambulance service included?
*Are prescription drugs covered?

It can be financially disastrous if you fall ill only to find out that your policy does not cover your particular condition and you are left on the hook for the bill.

4 Out of pocket expenses
Your monthly premium is not the only expense you will incur as far as your healthcare goes. Whichever insurance plan you go with, there will usually be some out-of-pocket expenses that you will have to pay. Before you buy your policy you should fetch out upfront what these expenses are going to be. What is the co-pay on the policy? If there is a deductible or co-insurance, what are the amounts? What is the maximum amount you will have to pay out of pocket?

5 Choice, Cost and Coverage
There are several types of health insurance plans out there: the HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), POS (Point of Service), HSA (Health Savings Account) and traditional indemnity insurance plan.
The insurance plan you choose will determine:
*The flexibility you have in choosing your health care provider
*The cost in insurance premiums and out-of-pocket expenses
*The level of coverage offered and the benefits excluded

Form sure you compare and consider the pros and cons of each option when choosing your health insurance. If you are looking to save money, for example, an HMO has the lowest out-of-pocket expenses, but it has the most restrictions. Indemnity and PPO plans offer greater flexibility, but have higher out-of-pocket expenses such as a deductible.

6 The Price you pay
Price should not always be the determining factor in choosing a health insurance plan. Ensure that the plan you choose offers all or most of the health benefits you may need, particularly coverage for major medical conditions. Having to pay for a necessary medical service out of your beget pocket may cost you far, far more than what you could possibly save in premiums. It may also be financially devastating.
In the long rush, the plan with the lowest premium may not work out to be the cheapest plan. The least expensive plan is the one that offers the best price for the particular coverages that you need.

7 The “free look” Clause
Be certain your policy has a “free look” Clause. Most insurance providers allow you a 10-day period during which you can murder your policy and have your premium refunded with no penalty. This allows you time to carefully review the policies documents, and make a final decision as to whether or not you like the terms and the coverage offered. Take advantage of this provision to read and really understand your policy and the policy terms, and even get a second opinion.

8 Guaranteed renewable coverage
Some health insurance companies will cancel your insurance policy or hike your rates if you fall sick – grand like an auto insurer may cancel your coverage if you have one too many accidents. This is actually legal in certain states.
Look for a policy that offers non-cancelable coverage, guaranteed to renew each year. If this is not available, a “conditionally renewable” policy is another option. Under this policy, the company will reserve the proper to execute all its policies that are similar to yours, but you cannot be singled out for cancellation.

9 Maximum Life Benefit
Another important consideration is the maximum lifetime befriend. This is the total dollar amount your insurance plan will pay out as long as you occupy it. that your insurance company will pay over the lifetime of the policy. Ideally, this limit should be at least $1 million

10 Questions are the Answer
Choosing your health insurance concept is a crucial financial decision. Before you put any money down, be sure that you understand your new insurance contract. Ask your insurance agent or company to fully account for anything on the policy that you do not understand. Ask questions and be sure that you understand the answers. If not, ask again.

When soil containing these fungal spores is disturbed they become airborne and can be inhaled by humans and animals. This disturbance can be caused by anything from humans digging and animals playing in the soil to dust storms and earthquakes. Immunocompromised patients, young children, the elderly and members of several ethnic minorities have a higher risk of contracting Valley Fever (4). Although these groups have a higher level of risk, coccidioidomycosis has been known to affect a wide range of individuals from prison inmates and archaeologists, to drug sniffing dogs along the Mexican border. In recent years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).

The important things to understand when learning about this disease are its cause, what is being done to prevent and cure it, its prevalence, and risk factors. This paper has been assembled to address these issues regarding Valley Fever. This paper focuses on four main stakeholders in this Valley Fever epidemic, the medical industry, infected individuals and insurance companies, infected animals and construction companies.

Medical Industry

Valley Fever is a respiratory disease caused by airborne fungi spores from Coccidioides immitis that enter and grow inside the lungs and cause infections. About 60% of the people do not realize that they have this disease because it can cause no recognizable symptoms and can only be positively identified by a skin test. The 40% of the remaining population can get composed to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each form ranges from minor to severe consequences. Most significant of all, is to know what the symptoms of Valley Fever are. There are ways to tell if someone might be infected and those symptoms include chest pain-which is a constriction that makes it difficult to breath, fever, muscle stiffness, joint stiffness, wheezing, cough, loss of appetite, chills, and change in mental situation. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will start to develop painful rashes and or lumps on the lower region of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint pain, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from composed in some people to severe in others. Showing more then one of these symptoms should be a good indicator that the person has contracted the disease and should consult a doctor.

Once a body is infected, Valley Fever will show up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the perform that Valley Fever takes, the severity of the effects on the body and how risky it can be will vary. The acute form is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will show the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will proceed like the body has caught the flu. Chronic get is rarer and less common then the acute earn. It is more unsafe than the acute form and can cause more problems. The chronic fabricate can become evident and develop after 20 or more years from when the person first got the infection. This may not have been found, treated, or even discovered by the person with the disease.

Valley Fever can cause infections in the body and effect lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural space or the area between the lungs and the ribs. This can cause serious distress to the lungs and the person will have a difficult time breathing. Other symptoms include vulgar grade fever, weight loss, and nodules in the lungs. The disseminated form is the most dangerous and severe out of the three. This is when the disease spreads to the different parts of the body. The infection gets into the person’s bones, lungs, liver, meninges, brain, skin, heart, and around the heart. It is found that 30% to 50% of those people infected with this get also get meningitis. This earn can be very deadly as it can cause swelling around the brain and spinal cord. With this form, healthcare providers often see ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening form and can cause death if not treated correctly. It can cause brain damage as well and can affect the brain/mental status of the person.

Everyone in the world is different and so not every person is going to be infected the same plot. People of different color or speed can contract the disease more readily then others of another race can. The people of Asian, Hispanic and African descent are more susceptible to the diseases than Caucasians. Even though it is really unclear why, those of color are 10-20 times more likely to get the disease. Most cases that ended up in the emergency rooms were of Hispanic or African origin. Other people that have a high infection rate are people that are diabetics or weakened immune systems such as those with AIDS. Also women that are pregnant, in their third trimester or right after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will make it easy for them to glean the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight befriend as well causing them to net worse quicker and will be more severe. Age is a big factor as well seeing as older adults have a higher chance of developing Valley Fever then an younger age. This is because their immune systems are less active or have other medical conditions that lower their ability to fight off the infection. Individuals with weak immune systems are at higher risk for complications which may lead to the disseminated design. It lets the disease spread easier through out the body and lets it get into the vital systems of the body. This can build the body more susceptible to other types of infections because of the further weakening in the immunity from Valley Fever.

Valley Fever, as stated, gets stirred up into the air from new construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner part of the lungs. There it will grow and multiply inside the lungs. Depending on what form it takes it can clear up from there or release pus. This pus then can get absorbed into the body and stick to different types of organs. It can especially target places where it can build up in such as joints, feet, and legs. This is because the fungi get into the blood stream which will get absorbed by muscles, bones, and under the skin where it can deposit and grow. If the immune system is not strong enough, it can not kill the infection which allows it to further mitigate as it builds in different spots of the body. Since it goes into the body’s blood stream it can get to where ever the blood is flowing. This includes vessels around brain and the spine. This will cause different reactions such as the person affected might lose some perception and awareness because of the lack of trim blood being given to the brain. With the fungi being deposited in places such as the feet or skin it causes swelling because it will produce liquid or more pus-like substance. This will cause the joints to swell up because of excess liquid causing arthritis. Besides looking at the symptoms of the person there are many other ways to determine if there is a Valley Fever infection. Different medical professions use different ways to determine the infection in the body and depending on the degree of the disease.

A chest x-ray can be taken to figure out if one is infected. In the x-ray the doctor would be looking for light areas in the lungs that are poorly defined or patch areas. The place where disease is growing will show up usually near or next to the ribs as most of it grows and deposits there. A skin test can be given as well and it is called the spheriulin skin test. This test looks to see if the person is infected with the fungus and since it is more sensitive it can pick up signs of an earlier infection accurately. Spheriulin is an antigen that is connected with the fungi that causes Valley Fever. This substance is injected objective a little below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will look at the arm or the site it was injected at 24 and 48 hours after the test. If the body has antibodies to the fungus, and it is in their system, the body with react and the position will become red and swollen. Although this test is not being used as much anymore because it is not as specific, it however is veteran in researching to understand the disease. A more common test is a sputum culture. This is where the doctor or nurse retrieves sputum from the patient. Sputum is the mucus-like secretion in the bronchi tubes or where the air goes to the lungs, and comes up with deep coughing. The doctor or nurse will ask the patient to cough deeply and spit up any sputum into a sterile cup. This will be taken to a lab that allows it to grow to see if Valley Fever is present. The doctor my tap on the chest or have the person inhale steam-like mist to help cough up the sputum in order to get a better sample. One of the last tests that may be done is a coccidiodes antibody test. This test is where the blood is taken to analyze if there are any antibodies to the fungus in the body. If the antibodies are present it can mean that there is an ongoing infection or a prior one. The test and blood may be taken a couple of weeks after to eye if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may use in determining more accurately if the disease is present in the body. This is the only way to be 100% sure that there is an infection.

Depending on the magnitude of the infection different treatment options will be provided by the doctors. Some of the forms may even dissipate with no medical interactions as well. The acute disease will usually go away without medical intervention. Popular management is bed rest and treatment for flu symptoms until the fever goes away. With any of the other forms, medication would be needed to take care of the disease. If the problem persists or if there is a higher possibility of complications and it is in its more severe form, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic form or more acute form that won’t go away, amphotericin B is usually the medication given to help fight off the disease. Then the person is monitored as to make sure the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to take care of lesions that are localized. For the disseminated develop fluconazole or itraconzole is commonly stale. The dosage is usually 400mg per day and in some cases 2000 mg of fluconazole or 800mg of itraconzole per day may have to be taken in 200mg doses. Amphoterican B may be outmoded as an alternate in this location if lesions are getting worse more rapidly and is old to diffuse pneumonia. Surgery is essential in this case and in most reports at this stage it is necessary. This is used to take care of large abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on critical organs such as the heart or tissues such as the spine. Since this form is the worst and in most of the time fatal more actions are required in recovery as compared to the more acute forms. Treatment of the disease does not make it go away for good as relapses can occur or the person can get it again.

The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will determine the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance just like any time someone gets sick and the person can go on with their life with no harm. These people probably have higher immune systems. However, the longer the disease stays around in the body the more harm it will do. If it is prolonged in the body for an extended time it will start having more harsh affects on the body. The infection can spread to the bones in the body and cause deterioration or holes in the bones. This will stay with the patient through out their life. If it is in the body for the extended time it can cause variations of getting better then getting worse fluctuations as well as can cause relapses of the disease where it can come back. If not treated, the non-acute form will worsen over time and in most cases get into other organs of the body and form the disseminated type. Taking care of the infection early on would be a good strategy as Valley Fever can cause death if not treated at the right time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which make the condition that much more deadly and difficult to treat. As both of those diseases are fatal as well and can form bad mixes with Valley Fever. Bleeding and lung abscesses could form which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can place the person at extreme discomfort as the pus gets into the lungs and fills the lungs making them feel like they’re drowning and can’t breathe. This can cause many terrible effects as the body can’t get enough oxygen into the body. People that already have respiratory problems such as asthma can be compromised and hinder the lungs from working efficiently. This can cause a more acute form such as short of breath to something more dangerous as not getting any air in and cessation breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most dangerous forms in the body. Many problems and complications would have to happen in order for it to accept to that severe of stage. As long as the disease is recognized and treated (if need be) then the affected person can easily recover.

Many people who have Valley Fever don’t even know they have had it because the severity changes in everyone and 40% of the people would show symptoms and require tiny to major treatment. This disease changes over longer periods of time. A person may have some time to go see a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to seek medical care would not be beneficial to one’s health. This disease is taken in most of the medical field taken very lightly even though misdiagnosis and prolonged exposure to the disease can be fatal to the person’s health. It can have affects on the body that stay with them for years at a time or even there entire life. This is something that if in expect consulting a doctor would be the best course of action so treatment can commence so complications don’t arise.

Infected Individuals & Insurance Companies

There are many notable stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the issue of Valley Fever. Arguably, the role of infected persons or those that hold a unique vulnerability to the disease is top priority on the decision-maker’s list. Each year, thousands of people are diagnosed with Coccidioidomycosis in Arizona alone. In a 2007 article, the Washington Post wrote that Valley Fever cases diagnosed in 2006 were up fifty-six percent from a year earlier. This prompted Arizona health officials to label the disease at, “epidemic proportions,” as thousands of other cases likely went undocumented. It has also been reported that anyone who has spent enough time in Arizona, or any other fraction of the Southwestern United States where soils contain the Valley Fever fungus, will contract the disease at some point. Only a small percentage of people, however, are diagnosed with a severe enough form of the infection where medical treatment is needed. Anti-fungal medication is the most common treatment for Valley Fever. But, there are rare cases where surgery is required to fully recover from the disease. Overall, tens of thousands of cases are reported around the United States annually and the number of Valley Fever-related deaths is estimated at 50-100 each year. It is important to recognize individuals currently struggling with the disease as well as those who have recovered from a serious form of Coccidioidomycosis as a stakeholder with regards to this issue because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an effort to better support this claim, the lives of two patients that contracted a serious form of the infection, will be addressed and analyzed in the following paragraphs.

Before introducing specific cases, it is important to review some recent facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Narrate in October 2008. The report, co-compiled by the Office of Infectious Disease Services and the Bureau of Epidemiology and Disease Control, presents the amount of Coccidioidomycosis cases reported in 2007 through a myriad of graphs. These graphs convey the research information in a thorough and comprehensive way to the reader by dividing up Valley Fever statistics for the 2007 year in a multitude of categories. Some of these categories include: cases reported in ‘07 according to specific age groups compared years past and a five-year average, separating the number of Valley Fever cases reported by counties in Arizona, and separating the number of Valley Fever cases reported in both mining and non-mining areas within the state. Although many people think of this disease as a mild illness similar to the approved cold, Valley Fever is a key issue amongst Arizona residents as well as both local and national governments. In 2008, the Arizona Department of Health Services received funds for Valley Fever prevention and control from a legislative appropriations committee. The Center for Disease Control and Prevention (CDC) also awarded the department funds for continued research. As part of the 2007 report, Health Services interviewed roughly ten percent of all Arizonans diagnosed with Coccidioidomycosis during that year. According to the ADHS, the following are some of the most alarming facts that were discovered from the interviews:

• People missed an average of 1 month of work, for a total of 4,918 days

• People with Valley Fever could not perform daily activities for an average of 3 months or a total of 92 years

• People with the disease waited an average of 44 days before seeking healthcare

• Patients saw their doctors three times before they were tested for Valley Fever

• There were $86 million dollars in hospital charges for Valley Fever in 2007

Furthermore, Arizona has the highest number of reported Valley Fever cases annually in the United States, accounting for sixty percent nationwide. In total, more than 150,000 people across the country are estimated to contract some form of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the state continues to grow as do the overall number of persons infected each year. Due to the fact that currently there is no cure or vaccine for the disease, every person that is susceptible to the effects of Valley Fever certainly shares some kind of stake in the debates of the issue. Examining the personal accounts of two anonymous patients afflicted with a serious form of Coccidioidomycosis can bring further clarity to this claim. Any and all personal information for the following accounts has either been fictionalized, changed or generalized to maintain complete anonymity.

The first case will examine the despicable effects of Coccidioidomycosis on a male patient of early adulthood age. This individual will be referred to as Patient “V” throughout this paragraph. Patient “V” began his ordeal with Valley Fever in the summer months of 2001. A younger man in the final years of adolescence, Patient “V” experienced generic, flu-like symptoms, which he disregarded as nothing important like most other sufferers choose to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was fair a cold or some limited infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe pain in the left side of his chest. Although he made numerous medical appointments for this problem, the distress would subside by the time Patient “V” arrived, making it difficult to diagnose the problem. “What was happening was my left lung had a hole in it and it kept collapsing and then re-inflating by the time I got to the doctor’s office.” Eventually, a chest x-ray was performed on Patient “V” and this revealed a diminutive, gloomy spot on his left lung. The plot indicated a relatively small, but significant hole through the lung. The pickle required corrective surgery and Patient “V” was admitted to one of Arizona’s hospitals in August, 2001. Surgeons sewed up the hole in Patient “V’s” left lung and released him after a day of recovery. Within weeks following the surgery, Patient “V” experienced a relapse of his earlier symptoms. “…I was playing Volleyball one night and in an instant, there was this intense pain in my chest…I felt dizzy and could hardly breathe.” Patient “V” immediately returned to the hospital sometime in November of that year where further tests concluded that the infected part of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely remove this piece of infected lung was performed successfully and Patient “V” spent more time recovering in the hospital. “The effects from the disease itself were painful enough, but the worst pain came from the chest tubes that were inserted into me in the hospital…At one point, they shoved one of the tubes through my ribcage and into my lung and I wasn’t even on pain medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore build up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a common drug distributed to sufferers of the infection. Patient “V” was required to select this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.

The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in late 1995. Early symptoms experienced in this patient included chronic loss of breath and extreme joint discomfort. The form of Coccidioidomycosis contracted by Patient “F” was not diagnosed correctly until 2 ½ years after symptoms began. Before visiting a pulmonologist, Patient “F” was given a chest x-ray, where a large, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to lift the infected part (removed in wedge form) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at full strength for six stout months; and then half the dosage for another six months. The patient continued to have fevers following the surgery. She also had an excess amount of fluid in her lung. Patient “F” returned for a second surgery to further shapely the infected area and completed another sequence of antibiotics afterwards. The time spent in the hospital for recovery totaled at six days for each surgery. Patient “F” was fortunate enough to have flexible employment benefits to fully recover. “My company provided short-term disability; up to 6 months with 100% pay…I was very lucky.” As far as medical coverage is concerned, Patient “F” had little out-of-pocket costs through United American. However, she was level-headed shocked to perceive the total amount owed from her stay in the hospital. “The bill after six days in the hospital, which included one day in ICU and five days on a regular floor, was astonishing. Just for room and board and a little medication, the bill was $28,000.00.” Today, Patient “F” has fully recovered from the infection and only has one suggestion with regards to the convey of Valley Fever. “Educate physicians on the east coast and west coast, all over the Untied States to properly test for Valley Fever.”

Needless to say, there are always financial burdens associated with any type of surgery as well as prescription medication. In the case of Patient “V”, a total of nearly $180,000.00 was accrued in hospital bills after the two surgeries were performed. Additionally, the drug Diflucan can range from 36 dollars to 60 dollars for 100mg/10 pills depending on the location of purchase. It is considerable to recognize medical insurance companies as a stakeholder with regards to the issue of Valley Fever as well. Because there is no cure or vaccination for the infection, insurance companies limit the amount of coverage to persons with preexisting conditions. If a cure were to be developed and released into the market, insurance companies would most likely include Valley Fever coverage into any plan. Unfortunately, without medical insurance, the overall amount of money needed to recover from a serious infection like Valley Fever is simply insurmountable for the majority of Americans. Even with sufficient medical insurance, however, people who have had Valley Fever in the past are typically not covered for a relapse of the infection. Patient “V” currently receives individual health insurance under a PPO from Blue Cross Blue Shield of Arizona. As mentioned earlier, however, major insurance companies like this one tend to limit coverage to individuals with preexisting conditions. According to an article on www.howstuffworks.com, a preexisting condition is a health condition or illness that you have had before your first day of coverage on a recent plan with an insurance company. Typically under group coverage, such as that offered by a corporation under an employee’s benefits, a person with a preexisting condition can obtain full coverage, but will have to wait anywhere from nine months to a year before it kicks in. This period is enforced by insurance companies to insure that a patient is not constantly having relapses of the same condition. However, a person with a preexisting condition will rarely receive private health coverage that includes their condition. This is referred to as the preexisting conditions exclusion. Our attempts to contact major medical insurance companies or medical insurance agents for further clarity on this issue went unanswered. Unfortunately, people like Patient “V” who have preexisting conditions, are self-employed and do not qualify for group medical insurance will have to pay out-of-pocket if their conditions return. “I would have to declare bankruptcy if that happened…” Patient “V” explained. “I live in fear because I know that if I were to win it again, that would be disastrous.”

Currently, a vaccination for Coccidioidomycosis is under development at the BIO5 Institute on the campus of the University of Arizona. Leading the development is Dr. John Galgiani, Director of the Valley Fever Center for Excellence and Chief Medical Officer for Valley Fever Solutions, Inc. This vaccination will be intended for both humans and dogs, which can also contract deadly forms of Valley Fever (this topic will be further discussed in later sections of this behold). In March, 2008, Dr. Galgiani teamed up with fellow BIO5 colleague Dr. David Nix of the Department of Pharmacy Practice and Science to research the vaccination. “We had some complimentary expertise and mine’s mainly in the area of drug development and drug development science and so on. And Dr. Galgiani is kind of the world’s expert on Valley Fever,” Dr. Nix reported in a 2008 Valley Fever instructional video produced by the University of Arizona. The two physicians, under the company name Valley Fever Solutions Inc., are financially backed by the University, private donors and C-Path, a New York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first used to prevent fungal degradation in produce. With approval from the U.S. Food and Drug Administration, Nikkomycin Z is in Phase 1 of drug safety trials. According to a news release published on the BIO5 Institute’s website, “The company has already obtained a Science and Translational Technology Research (STTR) grant from the National Institutes for Health that will help fund pharmacology studies that will help design future clinical trials. The first phase of that grant is worth more than $100,000, with the potential for an additional $700,000.” If this vaccination proves to be a viable cure for Coccidioidomycosis, many aspects of the issue of Valley Fever would certainly change. Once a cure hits the market, the number of deaths and serious cases as a result of Valley Fever would drop significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any real threat of the infection anymore. Briefly returning to the topic of medical insurance, people with Valley Fever as a preexisting condition will be able to feel more secure because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Cross Blue Shield, Cigna and Humana will more freely distribute full coverage in instances of Valley Fever. Like most vaccinations and cures to common infections or diseases, there would be many positive outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.

As primary stakeholders with regards to the issue of Valley Fever, both infected persons and medical insurance companies would be greatly affected if an executive decision were to be made, or possibly a vaccination released into the market. While the future looks good with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people pick up a way to get health insurance coverage to some capacity. It is also important that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the harmful effects of Valley Fever, there are many people who think this topic is just as important to the animal world as well.

Infected Animals

Valley Fever does not only affect people but it is now more commonly being found in animals. Animals are just as likely to pick up Valley Fever as humans are. Animals get Valley Fever in the same way as humans do, by breathing the fungus. It has been found that more and more animals are being reported of becoming ill due to this fungus. It has been found the 30-40% of animals who breathe in the fungus get sick. Some of the most common animals to be reported with Valley Fever are dogs, cats, llamas, non human primates, horses, and zoo animals (3).

A golden retriever went into the vet’s office; the dog wasn’t feeling well and wasn’t acting himself. The vet takes an x-ray of the dog’s lungs and sees white spots in the lung area where there should normally be dark patterns. The white spots indicate that the dog might have cancer in its lungs. The dog is only four years old, which is when a dog should be at its prime and not getting lung cancer. Lung cancer isn’t usually found at this young of an age and doesn’t seem to get as fast as it has in this golden retriever. The owner had said objective two weeks prior to going to the vet that the dog was full of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to run a few more test before she starting treatment for lung cancer. The dog’s health over the course of time starts to go downhill and very fast. The dog starts to cough, has a loss of appetite, and little to no energy. The vet then found out where the human family had recently traveled and they were in the Southwest. After hearing this, the vet determined that it must be a fungal disease and it was just that, it was Valley Fever (1).

Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs get Valley Fever in the same way that humans do and in the same regions as humans do. The fungus is spread through spores which dogs can easily inhale. Once the fungus is inhaled, the spores grow into spherules which enlarge and eventually burst into hundreds of endospores (3). This causes the spreading of the infection into the lungs. A dog’s immune system should respond and surround the infection to destroy it. Dogs that do not become sick due to the fungus are considered to be asymptomatic (2). When a dog does become sick from Valley Fever, their immune system fails to demolish off the infection and the infection continues to spread into the lungs and then can travel throughout the dog’s body (3).

Once a dog is infected with Valley Fever, there are certain symptoms that become present. Some of the symptoms that are seen in dogs are weight loss, coughing, fever, lack of appetite, and lack of energy (3). The cough in dogs can be seen as early as the first week of getting the infection to as late as 3 weeks. The cough that dogs get is due to the development of pneumonia which is visible on x-rays. The coughing can be caused due to pressure on the lymph node arrive the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is present the loss of appetite and energy is soon to follow. If the infection is not controlled it can become much worse and spread throughout the body. When the fungus is spread throughout the body it causes systemic or disseminated disease (3). When this happens the symptoms and condition of the dog becomes much worse. The symptoms that become present are: swelling of the limbs, abet and neck harm, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, witness inflammation, and non-healing skin ulcerations (3). Not all symptoms are present right away and it can take several months before certain symptoms appear. It can be several months after a cough appears that other symptoms become present. There is typically an order that the fungus spreads throughout the dog’s body. The first organ to be effected is lung, and then the infection usually spreads into the bone, than eyes, heart, testicles, brain, spinal cord, and finally abdominal organs (2).

To determine if a dog has Valley Fever there are different test that can be done. Some of the most common test done to determine if a dog has been infected is blood tests, chest x-rays, bone and joint x-rays, and Valley Fever blood test (3). Test results may show up negative up to 3-4 weeks of receiving the infection so in some cases test need to be repeated to confirm that the dog does or does not have Valley Fever (2).

There are different treatments that be done to help fight the fungus. The process of treating Valley Fever may be long; medication can be given for up to one year (2). The length of time that the treatment will buy usually depends on how far the fungus has spread throughout the body. Most commonly oral antifungal medication is given to the dog. These antifungal medications are ketoconazole, itraconazole, and fluconazole (2). Ketoconazole is the most commonly prescribed medication due to the fact that is it the least expensive. This drug is usually given twice daily and with food. Itraconazole is a more expensive medication but has fewer side effects than ketoconazole. Itraconazole is also better for dogs that are having problems keeping their food down because it has a faster absorption rate (3). The third medicine most commonly given out for treatment is Fluconazole and it is also expensive with little side effects. This is usually given to dogs that have damage done to their spinal cord and nervous system (3).

Cats, llamas, non human primates, horses, and zoo animals are other animals that have been reported with Valley Fever. Cats that have Valley Fever show the same symptoms as dogs do but it less likely for a cat to get Valley Fever than it is for a dog. Cats get Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats get the fungus their symptoms are usually a little more advanced than dogs. Two of the major symptoms seen in cats that have Valley Fever are unexplained weight loss and skin ulcerations that won’t go device. The same treatment for dogs can be stale to treat cats with Valley Fever (3).

Horses are another animal that have been found to get Valley Fever. There have not been very many cases reported but in the ones that have only one horse has survived Valley Fever with treatment. All the other horses that were reported with Valley Fever had to be euthanized. The reports of these cases are not very unique though, and with medical technology improvement chance of survival with new medicine is much better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.

Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most common animals to get Valley Fever are: Monkeys, Apes, and other primates. These animals use the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).

Valley Fever is a very serious issue that is rising in animals. Currently there are no preventatives for Valley Fever. The treatments for Valley Fever for animals has become better and better over time. The advance in technology has allowed for veterinarians to be able to detect Valley Fever at a less advance stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus.

Construction

There is no doubt that construction companies contribute significantly to Valley Fever. According to the MayoClinic, institution known for prominence in the medical field recognized the increase in real estate has contributed to the spew of “thousands of tons” of dust carrying this fungus into the air. The article looks at how in the 1990s the accounts of Valley Fever increase in the states of Arizona and California due to some distinguished factors. Among those factors like dry climate, the recent building booms have been one of the most critical factors that have contributed to such increases. The quick clearing and building were a significant source for the increase in reported cases of Valley Fever. Among all the contributing factors of Valley Fever, environmental exposure ranks high, if not the famous cause. Experts also added that almost half of the people who live in areas where Valley Fever is prevalent have contracted the disease. Interestingly, people who are at most risk are those who are exposed to directly to dust like those who perform jobs in the field of construction, ranching and agricultural work (1).

The decade following the 90’s has had a great increase in reported cases of Valley Fever. Those areas that have reported such increases are the states of California and Arizona. These states have been induced with a massive building boom. The mass migration to these “sun belt” states made for a widespread land clearing and construction, which ultimately directly contributed the spread of the air borne fungus (2). Importantly, some measures are currently in residence to purposely lop the amount of dust construction companies contribute to the environment.

The Environmental Protection Agency (EPA) is an agency of the federal government of the United States who is in charge of protecting human health by maintaining the natural environment safe (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has set limits on how much pollution is allowed to be in the air. In its goal to believe and manage the air we breathe, EPA has passed several pieces of legislation that have reduced the amount of smog and pollutants in the air. Among important legislation is the Clean Air Act which has been passed to enforce neat air standards and improve human health. The Clean Air Act is an outline for what national, state, and local authorities must follow in order to protect air quality. Under the Clean Air Act, local and state authorities are responsible for abiding by the national ambient air quality standards. The Environmental Protection Agency states Maricopa Country cannot exceed the federal health standard for particulate pollution more than three times in a three year period (4).

According to the Environmental Protection Agency (EPA), Maricopa County has been in violation of particulate pollution since 1996. Particularly 2008, there have been nine different days where at least one of the monitors exceeded the federal health standard for particulate pollution. The health standard for particulate pollution is that it cannot exceed more than 150 micrograms per cubic meter measured over a 24 hour period of time. It’s important to know Maricopa County has 24 air monitoring sites in the Valley. The status of Arizona, under the Arizona department of environmental quality has its occupy air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will hold Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to reach attainment for particulate pollution and thus is under federal orders to slice particulate matter pollution. In an attempt to address the issue, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a plan to the EPA to demonstrate how the county plans to reduce PM₁₀ emissions by five percent each year until reliable levels are reached. The Five Percent Plan outlined more than 50 commitments to sever dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).

Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that come from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to maintain within safe dust standards. As part of the compliance, Maricopa County has devised that all sites with disturbed surface areas of dust must comply with “Rule 310″ (5).

Under Rule 310, the Dust Compliance Division has established limitations and requirements for the implementation of process controls as well as other guidelines that will help enforce proper fugitive dust control measures. One of the first major steps for construction companies to follow is the obtainment of a permit. The Air Quality Department requires a construction permit for companies who plan to conduct activities any that will disturb a surface area equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a significant and daunting task. Before applying for a permit, a belief that outlines the measures that will prevent the creation of dust must be presented. This plan also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This arrangement being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on site understand their responsibility while on site (6).

Another hassle that companies have to deal with is the logging of control measures. Once again, under Maricopa County’s Rule 310, construction companies who conduct a dust generating operations that require a Dust Control Conception must keep a written log recording the actual application and execution of the control measures previously outlined and approved by the Dust Control Plan. This is a daily detailed recordkeeping which records what actions are being conducted in dust-generating operations in what may include daily inspections for crusted or damp soil. Another piece of record keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and have terrified surfaces must install a trackout control devise. These devises are huge contributors to the retention of fugitive dust. Trackout is simply the particulate matter from tires and other sources that have fallen onto paved areas that are accessible to the public. The rule states that trackout must be limited to 25 cumulative linear feet (6).

Rule310 is an extensive and overwhelming set of requirements established to lower dust emissions. Section 309 list another requirement under Rule310 that companies must abide by. The rule says that if the site of interest is more than one acre a series of dust control training must take place. All workers directly involved in the containment of dust like the water truck drivers and water pull drivers must take a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this piece lists that a dust control coordinator must be present on job site if the dimension of the job site is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given proper training on regulating emission of fugitive dust and learn practical methods to do so, such as clean up, water and dust suppressant applications (6).

Construction companies are required by state and federal law to implement a diligent effort to control dust pollution. If at any time violations are committed, these companies will be subject a fines and penalties. This has been yet another problem companies have had to face on a regular basis. The penalty policy held by the Maricopa County Air Quality Department seeks to prevent future violations. Fines that are placed upon companies are determined by the severity of the violation committed. Several factors are used to calculate the amount of a penalty. In case there has been an economic benefit of noncompliance by the company, the penalty will consist of weighing out the benefits that were looked to have been extracted.

Dust control compliance has also become a financial setback for construction entities. The Maricopa County Air Quality Department announced that in the month of October $452,589.90 in air quality violations was collected (9). In the month of September, the amount of $471,613.30 was collected in violations all related in one arrangement or another to air quality control. This is the trouble construction company’s face for not correctly using effective measures to reduce dust in the construction sites, therefore causing potential problems to near residents and workplaces, eventually becoming a financial problem due to fines.

There is no better way to understand how troublesome the strict regulations have become a burden for construction companies. While searching for construction companies within the valley, Turner Construction Inc. drew attention as it is well known as a big construction company that has a corporate office in Tempe, AZ. With a request to speak to a construction manager, a brief conversation was held with a construction project manager from Turner Construction. The conversation revolved around how Valley Fever has affected their procedures during construction or related tasks. Immediately it became distinct just how much companies who are in the construction industry are affected by laws to help reduce the incidents of Valley Fever. Jason Jones, who is a project manager at Turner Construction Company, explained that all construction companies have been hit hard by Maricopa County. Amongst the things mentioned was the fact that the main concern for the county is dust control. As a result for the growing concern over dust control, they have to follow a “rigorous dust program” to comply with regulations. Jason explained how they are currently working on a 242 acre development complex and have had to use around 400,000-750,000 gallons of water to control dust governed by Maricopa country. He added that this adds to the costs of the construction project as trucks and workers are broken-down to have fugitive dust. If they ever do not comply with these regulations, fines initiate from about $1,000 to 10’s of thousands of dollars. He added that Maricopa is the “worst county in America for dust regulations” (8).

The main problem is that construction companies have to follow strict regulations on their dust production. The county of Maricopa has been enforcing even stricter laws to prevent and benefit maintain dust levels to a minimum as they have recently been under serious scrutiny from the Environmental Protection Agency. If for some reason these companies are not correctly using effective measures to reduce dust in the construction sites, grand fines will follow. This is yet another yell companies are dealing with. To the load even greater, these companies also deal with the economical space backs from following these regulations. For companies to cut and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies accomplish to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to reduce the incidence of Valley Fever cases. Valley Fever has come to cost companies thousands of dollars and is becoming every day more of an anguish.

Conclusion

After studying the stakeholders involved in Valley Fever, it is easy to see common themes between them. There is no doubt that while not known as a perilous disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively minute research being done for prevention and cures, Valley Fever has earned the title as an emerging epidemic. While Coccidioides immitis only lives in a few select areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and moving to endemic areas. It also must not be forgotten that Valley Fever has the capability to affect animals as well humans increasing the cost of the disease for these species. It is obvious that because of this, action must be taken in order to reduce the number of cases and to decrease the severity of the cases.

This case study points to a few relatively easy steps to take in order to decrease the severity of Valley Fever cases. The most important and most obvious step is early detection. It was shown that the earlier that the disease is diagnosed, the less severe the symptoms and the less impact it has on the infected individual. Despite this easy solution, doctors saw their patients and average of three times before they tested for Valley Fever and the patients on average waited 44 days before treatment. These statistics point to a general lack of awareness this disease in both the patient and the medical world. In order to promote early detection, there must be better instruction of symptoms and complications involved in prolonged disease available to both the medical community and the population of endemic areas. This in theory would do an awareness of the disease and encourage earlier testing for it.

There are a few steps that can be taken in order to crop the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also help cleave the number of cases. Public awareness of Valley Fever would reduce the number of cases by providing the people with knowledge of its causes and ways to avoid exposure to the Coccidioides immitis spores. The second step that should be taken is a national focus on research in vaccines and cures for this disease. From this case study it is obvious that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the status in some circumstances. These high costs are unacceptable when relatively little investment is being made in the research of a cure or vaccination.

When considering these recommendations, it is essential to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is disturbed. This fungus is endemic to large portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to get this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the area have a high chance of contracting the disease. The number of cases has risen consistently each year for at least the last seven years. After reviewing these facts it is obvious that Valley Fever has had a principal impact on our society and that steps need to be taken to reduce its prevalence.

References

Introduction

(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in New York City”. Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 82, No. 2, doi:10.1093/jurban/jti057

(2) Comrie, Andrew C. “Climate factors influencing coccidioidomycosis seasonality and outbreaks. Environmental Health Perspectives. June 2005 http://findarticles.com/p/articles/mi_m0CYP/is_/ai_n14816419

(3) DiSalvo, Dr. Arthur. Mycology – Chapter Six Dimorphic Fungi. 21 Nov. 2008 http://pathmicro.med.sc.edu/mycology/mycology-6.htm

(4) McKinley, Jesse. “Valley Fever hits epidemic numbers from Texas to Northern California”. New York Times. 30 Dec. 2007 http://www.sfgate.com/cgi bin/article.cgi? f=/c/a/2007/12/30/MN12U6OGF.DTL&feed=rss.news

(5) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

Medical Industry

(1) “Coccidioidomycosis..” NGC – National Guideline Clearinghouse . 1 Nov. 2005. 2 Nov. 2008
(2) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

(3) “Valley Fever – Valley Fever Connections.” Valley Fever – Valley Fever Connections. 22 Nov. 2008 .

(4) “Valley fever – MayoClinic.com.” Mayo Clinic medical information and tools for healthy living – MayoClinic.com. 15 Mar. 2008. 22 Nov. 2008 .

(5) Interview Roni Cummings, Quality risk management: Notes in hand

Infected Individuals & Insurance Companies

(1) Arizona Department of Health Services. (2008). Valley Fever Annual Report 2007 (1^st ed.). Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services.

(2) Interview with Anonymous Patient #1: Patient “V”. (Personal Communication, November 15, 2008).

(3) Interview with Anonymous Patient #2: Patient “F”. (Personal Communication, November 17, 2008).

(4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post. All Pages.

(5) Unknown Author. (2008, October 29). Arizona Company Seeks Valley Fever Cure. BIO5 Institute News Archives. All Pages.

(6) Arizona Department of Health Services Webmaster. (2008, November 3). Infectious Disease Epidemiology. Retrieved November 15, 2008, from http://azdhs.gov/phs/oids/epi/disease /cocci/index.htm

(7) Author Unknown. (Last modified October 30, 2008). How Pre-Existing Conditions Work. Retrieved November 15, 2008, from http://health.howstuffworks.com/pre-existing-condition.htm

(8) BIO5 Institute at the University of Arizona. (2008). BIO5 Institute Home Page. Retrieved November 15, 2008, from http://bio5.arizona.edu/index.php

(9) Pfizer Inc. (Unknown Date). Pfizer Products. Retrieved November 15, 2008, from http://www.pfizer.com/products/rx/rx_product_diflucan.jsp

(10) Roerig, Division of Pfizer. (Last revised March 2008). Diflucan (LAB-0099-10.0). Retrieved November 15, 2008, from http://media.pfizer.com/files/products/uspi_diflucan.pdf

(11) The Mayo Clinic. (2006, March 17). Diseases and Conditions Valley Fever. CNN.com & MayoClinic.com. Retrieved from http://azdhs.gov/phs/oids/epi/disease/cocci/index.htm

(12) The University of Arizona. (Video Production). (2008, March 8). Innovation Day at UA 2008, UA @ the Leading Edge [Episode 1]. Development of the Valley Fever Vaccine. Video retrieved from http://www.youtube.com/watch? v=kgT0hFo49G4

(13) Valley Fever Center for Excellence at the University of Arizona. (2003). Valley Fever Center for Excellence: Coccidioidomycosis. Retrieved November 15, 2008, from http://www.vfce.ar izona.edu/

Infected Animals

(1) Mitchell, Chris. Blastomycosis, Cryptococcosis, Coccidioidomycosis (Valley Fever), Histoplasmosis, Disease and more. Animal Shelter Org. 2004. November 4, 2008.

(2) Valley Fever (Coccidiodomycosis). Mar Vista Animal Medical Center. 2006. November 5, 2008. http://www.marvistavet.com/index.html

(3) Valley Fever in Dogs. Valley Fever Center for Excellence. 2008. October 18, 2008.

Construction

(1) “Valley Fever” 1998-2008 Mayo Foundation for Medical Education and Research. Outbreak grips Arizona. March 17, 2006

(2) Benjamin J. Park, Keith Sigel, Victorio Vaz, Ken Komatsu, Cheryl McRill, Maureen Phelan, Timothy Colman, Andrew C. Comrie, David W. Warnock, John N. Galgiani, and Rana A. Hajjeh. “An Epidemic of Coccidioidomycosis in Arizona”, 1998-2001. The Journal of Infectious Diseases, 2005. 1 June.

(3) U.S Environmental Protection Agency. The clean air act amendments of 1990. Clean Air Act. November 10th, 2008.

(4) MAG 2007 Five Percent Plan For PM-10 For The Maricopa County Nonattainment Area. December 2007. Maricopa Association of Governments. < (www.mag.maricopa.gov)>

(5) Maricopa Air Quality Department. (2008). Dust Control. [Brochure]. Dust Compliance Resources Maricopa County.

(6) Maricopa County Air Pollution Control Regulations, Regulation III-Control of Air Contaminants Rule 310.

(7) Toribio, Jeovanny. “Maricopa County and dust regulations‏.” E-mail to Erin Dunsey. Oct. 21, 2008.

(1) Jason Jones, Turner Construction Inc, Oral interview, Done 10-21-2008

Notes in Authors hand

(2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News.

Health care expenses are continuously on the rise, and so is the cost of health insurance. To rep health insurance is in itself a scrape, more so when you are self-employed and cannot earn insurance under a group opinion. In spite of the difficulties, there are ways by which a self-employed person can net or chop down the expenses of health insurance.

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Health care expenses are continuously on the rise, and so is the cost of health insurance. To net health insurance is in itself a predicament, more so when you are self-employed and cannot fetch insurance under a group understanding. In spite of the difficulties, there are ways by which a self-employed person can collect or slice down the expenses of health insurance.

In case your self-employed business happens to be a one-man prove, or a husband and wife venture, an individual policy or a family health insurance idea will suit you best if you do not belong to a relevant organization. If you have plans of expanding your business in the future, it is better for you to begin with a short-term policy and then determine on the type of coverage depending on the changes in position. If you opt for a short term policy, it will ensure you some sort of coverage and provide you an affordable premium.

In normal practice, a temporary policy hardly exceeds $100 per month. The premiums of self-employed health insurance screen are tax deductible. Self-employed persons can exercise their health insurance payments as a deduction on savings, which might give enough of a cost savings or refund to succor pay another premium or two.

In case your self-employed venture employs two or more people, it is treated as a combination of self-employed and little business, which can qualify you for group insurance. This health insurance draw would cloak you and your employees, and the premium could be 100% tax deductible. Under this insurance, your staff could also attach on pay-roll taxes.

It makes well-behaved sense for self employed people to leer associates while looking for health insurance. There are many professional associations which offer group coverage for self employed people. The schemes may not be exactly what you would have liked them to be, but they are enough to scrutinize you through an emergency.

If you are self-employed, you can occupy the abet of the National Association for the Self-employed for sound advice. The association will also formulate a generous health coverage conception to insurance companies, agents and members of their organization. Depending on their specific requirements, employees could lift supplementary coverage if they determine to. It is not mandatory for the staff to join, but there must be a minimum of two participating to be eligible for group insurance. Group plans will be cheaper for you and by joining an association of self-employed, you can buy advantage of this. It is always wise to check if the main policy covers your requirements before you choose to add any additional health coverage. Remember that group plans are cheaper. By joining an association of self-employed, you can rob advantage of this. Before adding additional health coverage, check whether the main policy covers what you need.

You will near across a number of websites that enable you to compare the terms offered by different providers of health insurance for the self employed. A self employed person can also commence a health savings anecdote that will provide tax-free savings and also position aside some money for medical emergencies. A health savings legend will enable you to lift a health thought with a higher deductible reducing the cost of your premium.

An overwhelming 95% of limited businesses will fail in the first five years, according to the Microscopic Business Administration. This is due to many different factors, including lack of interest in the product or service being sold, financial burden, taxes, unforeseen costs, and startup costs. Adding the cost of health insurance for even two or three employees can send a slight business into bankruptcy. Dinky businesses have to derive other ways to offer benefits to their employees so that they will remain sincere to the company. But these days with rising health care costs, many employees need the security of shiny that they have health benefits through their employer.

Types of Health Plans

Dinky businesses have options when it comes to offering dinky group health insurance plans. They can acquire out indemnity policies that would require employees to pay for medical costs up front and then be reimbursed. This execute of health is the least expensive, but rank to employees who cannot afford to pay out of pocket expenses. Another alternative is to offer employees a basic health care package that will screen hospital and some prescription costs. Again, this will cost employees more money. HMO’s and PPO’s are very expensive health plans, but will veil most medical situations. HSA’s are becoming more well-liked as a diagram to offer health insurance. These are health savings accounts. Each year, an employee will rep an allotted amount of money that they can spend for their health care needs. Dinky businesses and employees will gather tax breaks that will succor off station the cost.

Since group health insurance coverage for slight businesses will cost a lot of money each year, some minute businesses have decided to offer other incentives to their employees along with a basic health care idea. These incentives are sometimes enough to withhold employees sincere to a company.

Thinking Outside the Box

Employee motivation programs are a contrivance for exiguous businesses to offer employees extra benefits without adding to the cost of their health insurance.
Small businesses will offer incentive programs that include:

•
Personal Time or Floating Holidays
•
Company discounts on merchandise or services
•
Tuition Reimbursement
•
Extra Sick Days
•
Business Cards
•
Gym Passes
•
Parking Privileges
•
Direct Deposit Options

There are many other incentives puny business owners can give to their employees depending on the type of business they are in. Combining these incentives with a basic health care concept will aid to hold hard working employees from finding other jobs. Being lenient about leaving work early for a doctor’s appointment or other personal business is another map to support employer loyalty.

The Bottom Line

In the extinguish, the bottom line will always fetch because if a limited business cannot pay for itself, then everyone will have to earn a unique job. Miniature businesses can be a gamble. But with superior planning, thinking of creative ways to offer employees competitive wages, health benefits, and other incentives, a tiny business can succeed. Research is the best contrivance to rep out how to finance any business. Creativity and innovation are the ways to preserve a exiguous business on the correct track.

Many exiguous businesses have crucial decisions to beget concerning health insurance. Unfortunately, offering comprehensive health insurance plans to employees can cost a minute business a lot of money each year. The business will have to struggle to pay their bills and contain a healthy bottom line. If a miniature business chooses not to offer a health insurance concept, they may risk losing well-known employees.

An overwhelming 95% of tiny businesses will fail in the first five years, according to the Minute Business Administration. This is due to many different factors, including lack of interest in the product or service being sold, financial burden, taxes, unforeseen costs, and startup costs. Adding the cost of health insurance for even two or three employees can send a minute business into bankruptcy. Puny businesses have to derive other ways to offer benefits to their employees so that they will remain accurate to the company. But these days with rising health care costs, many employees need the security of shining that they have health benefits through their employer.

Types of Health Plans

Itsy-bitsy businesses have options when it comes to offering exiguous group health insurance plans. They can assume out indemnity policies that would require employees to pay for medical costs up front and then be reimbursed. This do of health is the least expensive, but nefarious to employees who cannot afford to pay out of pocket expenses. Another alternative is to offer employees a basic health care package that will mask hospital and some prescription costs. Again, this will cost employees more money. HMO’s and PPO’s are very expensive health plans, but will shroud most medical situations. HSA’s are becoming more favorite as a arrangement to offer health insurance. These are health savings accounts. Each year, an employee will regain an allotted amount of money that they can utilize for their health care needs. Microscopic businesses and employees will bag tax breaks that will assist off space the cost.

Since group health insurance coverage for miniature businesses will cost a lot of money each year, some runt businesses have decided to offer other incentives to their employees along with a basic health care belief. These incentives are sometimes enough to preserve employees trusty to a company.

Thinking Outside the Box

Employee motivation programs are a arrangement for puny businesses to offer employees extra benefits without adding to the cost of their health insurance.
Small businesses will offer incentive programs that include:

•
Personal Time or Floating Holidays
•
Company discounts on merchandise or services
•
Tuition Reimbursement
•
Extra Sick Days
•
Business Cards
•
Gym Passes
•
Parking Privileges
•
Direct Deposit Options

There are many other incentives miniature business owners can give to their employees depending on the type of business they are in. Combining these incentives with a basic health care idea will aid to sustain hard working employees from finding other jobs. Being lenient about leaving work early for a doctor’s appointment or other personal business is another diagram to maintain employer loyalty.

The Bottom Line

In the ruin, the bottom line will always pick up because if a limited business cannot pay for itself, then everyone will have to net a recent job. Puny businesses can be a gamble. But with righteous planning, thinking of creative ways to offer employees competitive wages, health benefits, and other incentives, a limited business can succeed. Research is the best device to collect out how to finance any business. Creativity and innovation are the ways to support a slight business on the accurate track.

These 5 major tips will go along arrangement toward helping you put money on your health insurance costs.

Cutback on coverages
This is one of the fastest ways to carve down the cost. You can also offer supplemental insurance to camouflage any gaps in coverage on the main health policy. Accidental and sickness policies for instance, are relatively affordable and can be combined with a higher deductible health concept.

Offer health savings record and high deductible plans
By combining Health savings accounts (HSAs) and a high-deductible health insurance plans, you will potentially nick your shrimp business health insurance costs while giving your employees tax breaks. HSAs are tax-sheltered accounts that can be traditional toward paying medical expenses, including the insurance deductible. High-deductible health insurance plans have mauch lower premiums than managed care health plans. By combining these two plans, you will build money while retaining considerable coverage for your employees.

Join a group health insurance plan
When you recall in bulk, the product’s costs comes down. Itsy-bitsy group health insurance view veil 2-50 employees and the larger the group, the lower the premiums will be. If you are running a puny firm with less than ten employees, you can partner with other businesses to enlarge your group health insurance belief and lower your rates.

Create a health-conscious work ethic and environment
*Limit smoking at work and then work to gradually eliminate it through incentives and health programs.
*Offer healthy drinks at the vending machine.
*Offer incentives to employees to enroll in weight-loss programs.
*Provide workshops relating to safety both at work and at home.
*Institute a policy of zero-tolerance for any drug or alcohol abuse.
*Offer low-calorie food and drinks at company events – do away with the pizza and beer.

Make the most of all the available tax incentives
There are a number of tax benefits provided to petite business owners who offer health insurance to their employees. For example, you may be able to deduct the plump amount of your group health insurance premiums, which may in turn nick your payroll tax.

By implementing these tips, you will go along intention toward providing your employees with a quality group health insurance concept at a reasonable, cost effective rate to you and your business.

As health insurance costs continue to rise by double digits, the increase in premiums is the highest for exiguous businesses that offer group health insurance plans. According to the Commonwealth Fund, a Recent York-based health advocacy group, the health insurance costs for little businesses are roughly 18% higher than those of great business. This is leaving more and more businesses with a choice between two evils: pass on the rate hikes to their employees or do away with the back altogether.

These 5 major tips will go along design toward helping you set money on your health insurance costs.

Cutback on coverages
This is one of the fastest ways to slash down the cost. You can also offer supplemental insurance to screen any gaps in coverage on the main health policy. Accidental and sickness policies for instance, are relatively affordable and can be combined with a higher deductible health concept.

Offer health savings story and high deductible plans
By combining Health savings accounts (HSAs) and a high-deductible health insurance plans, you will potentially slice your cramped business health insurance costs while giving your employees tax breaks. HSAs are tax-sheltered accounts that can be ancient toward paying medical expenses, including the insurance deductible. High-deductible health insurance plans have mauch lower premiums than managed care health plans. By combining these two plans, you will set money while retaining considerable coverage for your employees.

Join a group health insurance plan
When you hold in bulk, the product’s costs comes down. Cramped group health insurance opinion veil 2-50 employees and the larger the group, the lower the premiums will be. If you are running a petite firm with less than ten employees, you can partner with other businesses to enlarge your group health insurance belief and lower your rates.

Create a health-conscious work ethic and environment
*Limit smoking at work and then work to gradually eliminate it through incentives and health programs.
*Offer healthy drinks at the vending machine.
*Offer incentives to employees to enroll in weight-loss programs.
*Provide workshops relating to safety both at work and at home.
*Institute a policy of zero-tolerance for any drug or alcohol abuse.
*Offer low-calorie food and drinks at company events – do away with the pizza and beer.

Make the most of all the available tax incentives
There are a number of tax benefits provided to limited business owners who offer health insurance to their employees. For example, you may be able to deduct the burly amount of your group health insurance premiums, which may in turn nick your payroll tax.

By implementing these tips, you will go along method toward providing your employees with a quality group health insurance notion at a reasonable, cost effective rate to you and your business.

Health care expenses are continuously on the rise, and so is the cost of health insurance. To pick up health insurance is in itself a dilemma, more so when you are self-employed and cannot net insurance under a group concept. In spite of the difficulties, there are ways by which a self-employed person can accept or lop down the expenses of health insurance.

In case your self-employed business happens to be a one-man note, or a husband and wife venture, an individual policy or a family health insurance concept will suit you best if you do not belong to a relevant organization. If you have plans of expanding your business in the future, it is better for you to inaugurate with a short-term policy and then settle on the type of coverage depending on the changes in spot. If you opt for a short term policy, it will ensure you some sort of coverage and provide you an affordable premium.

In normal practice, a temporary policy hardly exceeds $100 per month. The premiums of self-employed health insurance conceal are tax deductible. Self-employed persons can exhaust their health insurance payments as a deduction on savings, which might give enough of a cost savings or refund to support pay another premium or two.

In case your self-employed venture employs two or more people, it is treated as a combination of self-employed and runt business, which can qualify you for group insurance. This health insurance device would veil you and your employees, and the premium could be 100% tax deductible. Under this insurance, your staff could also attach on pay-roll taxes.

It makes generous sense for self employed people to contemplate associates while looking for health insurance. There are many professional associations which offer group coverage for self employed people. The schemes may not be exactly what you would have liked them to be, but they are enough to study you through an emergency.

If you are self-employed, you can grasp the attend of the National Association for the Self-employed for sound advice. The association will also formulate a noble health coverage thought to insurance companies, agents and members of their organization. Depending on their specific requirements, employees could assume supplementary coverage if they settle to. It is not mandatory for the staff to join, but there must be a minimum of two participating to be eligible for group insurance. Group plans will be cheaper for you and by joining an association of self-employed, you can retract advantage of this. It is always wise to check if the main policy covers your requirements before you settle to add any additional health coverage. Remember that group plans are cheaper. By joining an association of self-employed, you can engage advantage of this. Before adding additional health coverage, check whether the main policy covers what you need.

You will arrive across a number of websites that enable you to compare the terms offered by different providers of health insurance for the self employed. A self employed person can also originate a health savings legend that will provide tax-free savings and also situation aside some money for medical emergencies. A health savings legend will enable you to select a health concept with a higher deductible reducing the cost of your premium.

Health care expenses are continuously on the rise, and so is the cost of health insurance. To score health insurance is in itself a predicament, more so when you are self-employed and cannot procure insurance under a group thought. In spite of the difficulties, there are ways by which a self-employed person can acquire or carve down the expenses of health insurance.

In case your self-employed business happens to be a one-man display, or a husband and wife venture, an individual policy or a family health insurance notion will suit you best if you do not belong to a relevant organization. If you have plans of expanding your business in the future, it is better for you to commence with a short-term policy and then choose on the type of coverage depending on the changes in status. If you opt for a short term policy, it will ensure you some sort of coverage and provide you an affordable premium.

In normal practice, a temporary policy hardly exceeds $100 per month. The premiums of self-employed health insurance conceal are tax deductible. Self-employed persons can employ their health insurance payments as a deduction on savings, which might give enough of a cost savings or refund to befriend pay another premium or two.

In case your self-employed venture employs two or more people, it is treated as a combination of self-employed and puny business, which can qualify you for group insurance. This health insurance way would shroud you and your employees, and the premium could be 100% tax deductible. Under this insurance, your staff could also achieve on pay-roll taxes.

It makes superior sense for self employed people to leer associates while looking for health insurance. There are many professional associations which offer group coverage for self employed people. The schemes may not be exactly what you would have liked them to be, but they are enough to perceive you through an emergency.

If you are self-employed, you can grasp the relieve of the National Association for the Self-employed for sound advice. The association will also formulate a respectable health coverage conception to insurance companies, agents and members of their organization. Depending on their specific requirements, employees could lift supplementary coverage if they settle to. It is not mandatory for the staff to join, but there must be a minimum of two participating to be eligible for group insurance. Group plans will be cheaper for you and by joining an association of self-employed, you can prefer advantage of this. It is always wise to check if the main policy covers your requirements before you determine to add any additional health coverage. Remember that group plans are cheaper. By joining an association of self-employed, you can engage advantage of this. Before adding additional health coverage, check whether the main policy covers what you need.

You will advance across a number of websites that enable you to compare the terms offered by different providers of health insurance for the self employed. A self employed person can also inaugurate a health savings sage that will provide tax-free savings and also state aside some money for medical emergencies. A health savings legend will enable you to consume a health concept with a higher deductible reducing the cost of your premium.

Companies that Specialize in Miniature Business Health Insurance

There are an wonderful number of insurance companies ready to abet the need- of slight businesses. Selecting from among them may seem like hard work, but overall, it’s critical to go with a company with a track recount and long-term reliability. There’s no sense in spending the next five-to-ten years switching from one insurance company to another. By doing your homework, you can hopefully eliminate this spot. Hiring a profitable accountant can actually set aside you a lot of time in finding the apt insurance packages for your itsy-bitsy business. Unexcited, it’s significant to be informed.

The Rising Cost of Health Care

Many people are poor from starting their beget slight businesses because of the rising cost of health care. In fact, the cost of healthcare in 2005 increased by abut 10% nationwide, according to the National Business Group on Health. Apparently these costs have increased for the last five or six years, making it tough for microscopic businesses to conclude afloat.

With rising costs, tiny businesses need to assume alternatives like Cafeteria plans, co-pays, employee contribution to health care and etc.

Understanding the HMOS and PPOS

HMOs

A Health Maintenance Organization or HMO is a chunky fledged organization of healthcare providers. This includes the whole gamut of doctors, hospitals, and other health agencies that contract with insurances companies. They usually offer their services at a fixed designate.

HMO plans are rather rigid and restrictive. They offer respectable care, but have many rules that must be followed. An insured person who is a member of an HMO, has to determine a indispensable care physician, who in turn manages all aspects of the person’s healthcare. Individuals are itsy-bitsy to choosing a physician who is a member of the HMO network. This vital care provider is the only physician who can refer the member to a specialist, if one is needed, and that specialist must be section of the network as well.

Itsy-bitsy businesses often go with HMOs because they are cost effective. Premiums are lower than most plans.

PPOs

A Preferred Provider Organization, or PPO, is less rigid and restrictive. Because PPOs have contracts with the insurance companies, the member is allowed to sight any physician he or she likes, but if the physician is not share of the PPO network, the member will probably pay more out of pocket costs. The whole premium isn’t covered. Unlike an HMO, you do not need a referral to view a specialist.

Although PPOs cost more, they are often the preferred choice of many employees because there are fewer rules.

Self-Insurance, Another Option

There’s an option to itsy-bitsy business health insurance called self-insuring where companies do not take health insurance for their employees, but assume paunchy responsibility, through their company assets, to conceal claims. If no claims are made during the year, the tiny business saves money, and can also provide rewards to employees with better health. Many shrimp businesses are switching to this option, which also provide wellness programs to attend people cessation smoking, lose weight, and come by into shape to decrease their chances of illness.

Of course, there are major risk factors fervent with self-insuring. For example, if a program member employee, becomes ill and their health care expenses very high, the dinky business can speed into major expenses it cannot screen. This is where a “stop loss” insurance company comes in. This gives the minute business a safety catch if claims are over a obvious predetermined level.

Health Care Scams

Because runt businesses are especially concerned with saving money, there are health care scam artists out there that target entrepreneurs. These companies spend professional marketing techniques, brochures, selling points, and they may even pay shrimp claims, but when a enormous claim comes in, they refuse to pay, and often travel. This is why it’s distinguished for the shrimp business owner to do his homework and only go with a company that has credibility and a track represent.

If you’re thinking about starting your hold shrimp business, one of the critical things to judge is miniature business health insurance. Whether it’s unprejudiced you and a secretary, or if you have an office corpulent of employees, determining the best options for insurance companies is a process that can’t be ignored. In this article, we’ll watch the various facets of insuring your itsy-bitsy business.

Companies that Specialize in Minute Business Health Insurance

There are an fabulous number of insurance companies ready to succor the need- of minute businesses. Selecting from among them may seem like hard work, but overall, it’s distinguished to go with a company with a track report and long-term reliability. There’s no sense in spending the next five-to-ten years switching from one insurance company to another. By doing your homework, you can hopefully eliminate this pickle. Hiring a agreeable accountant can actually assign you a lot of time in finding the correct insurance packages for your slight business. Unexcited, it’s distinguished to be informed.

The Rising Cost of Health Care

Many people are depressed from starting their enjoy microscopic businesses because of the rising cost of health care. In fact, the cost of healthcare in 2005 increased by abut 10% nationwide, according to the National Business Group on Health. Apparently these costs have increased for the last five or six years, making it tough for miniature businesses to quit afloat.

With rising costs, limited businesses need to reflect alternatives like Cafeteria plans, co-pays, employee contribution to health care and etc.

Understanding the HMOS and PPOS

HMOs

A Health Maintenance Organization or HMO is a chubby fledged organization of healthcare providers. This includes the whole gamut of doctors, hospitals, and other health agencies that contract with insurances companies. They usually offer their services at a fixed ticket.

HMO plans are rather rigid and restrictive. They offer suited care, but have many rules that must be followed. An insured person who is a member of an HMO, has to decide a indispensable care physician, who in turn manages all aspects of the person’s healthcare. Individuals are small to choosing a physician who is a member of the HMO network. This essential care provider is the only physician who can refer the member to a specialist, if one is needed, and that specialist must be portion of the network as well.

Exiguous businesses often go with HMOs because they are cost effective. Premiums are lower than most plans.

PPOs

A Preferred Provider Organization, or PPO, is less rigid and restrictive. Because PPOs have contracts with the insurance companies, the member is allowed to discover any physician he or she likes, but if the physician is not fraction of the PPO network, the member will probably pay more out of pocket costs. The whole premium isn’t covered. Unlike an HMO, you do not need a referral to gaze a specialist.

Although PPOs cost more, they are often the preferred choice of many employees because there are fewer rules.

Self-Insurance, Another Option

There’s an option to cramped business health insurance called self-insuring where companies do not catch health insurance for their employees, but prefer pudgy responsibility, through their company assets, to conceal claims. If no claims are made during the year, the cramped business saves money, and can also provide rewards to employees with better health. Many cramped businesses are switching to this option, which also provide wellness programs to support people terminate smoking, lose weight, and find into shape to decrease their chances of illness.

Of course, there are major risk factors interested with self-insuring. For example, if a program member employee, becomes ill and their health care expenses very high, the limited business can urge into major expenses it cannot mask. This is where a “stop loss” insurance company comes in. This gives the dinky business a safety salvage if claims are over a clear predetermined level.

Health Care Scams

Because puny businesses are especially concerned with saving money, there are health care scam artists out there that target entrepreneurs. These companies spend professional marketing techniques, brochures, selling points, and they may even pay exiguous claims, but when a spacious claim comes in, they refuse to pay, and often fade. This is why it’s valuable for the slight business owner to do his homework and only go with a company that has credibility and a track recount.