Tag: Rate

Reverse Mortgages: Best Deals – CBS News #reverse #mortgage #rate

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Reverse Mortgages: Best Deals

How can I get the best deal on a reverse mortgage?

1. Choose a Home Equity Conversion Mortgage (HECM). For most borrowers, it’s the right loan.

2. Compare the HECM with one of the jumbo loans if you have an expensive house. Sometimes the jumbo wins. Often, however, ‘ll find that the HECM gives you all the cash you need, while saving you thousands of dollars in costs.

3. Look beyond the upfront cash the lender offers. A jumbo lender might provide a higher credit line at the start. But because ‘s credit line grows every year, HECM will probably provide you with much more money in the end. Your HEMC counselor can help you figure this out.

4. The most expensive way to borrow is by taking a lump sum up front. You pay interest and fees on the whole amount, even though you intend to use only part of the money each month. Fixed monthly payments aren’t much better because your income won’t rise with inflation. The best option is taking the loan in the form of a credit line. That way, you can draw money as needed and will be charged interest only on the amounts you actually use. What’s more, a HECM credit line rises every year, so your borrowing power and future income will go up.

5. Reverse mortgages carry all the fees of regular mortgages and then some. You might pay $15,000 to $20,000 up front.

6. Most of these loans charge variable interest rates, adjusted annually. HECM gives you three choices:

  • A loan with a rate that adjusts monthly. You get higher monthly payments and a lower initial interest rate than on the alternative choices. Over the life of the loan, however, the rate can rise by up to 10 percentage points.
  • A loan whose rate adjusts annually. You get smaller payments and a higher initial interest rate. The rate can rise by up to 2 points per year and 5 points over the life of the loan.
  • A loan with a rate that never changes, but there’s a catch. You have to take the whole amount as a lump sum.

7. Finding the lowest-cost loan is tricky. Normal comparisons of rates and fees don’t work. Reverse lenders are required to calculate a Total Annual Loan Cost, or TALC rate, based on all projected costs. The TALC rate is far from a perfect disclosure, but it lets you compare two loans in a reasonable way. Always ask for the TALC rate.

You can get a better, more customized cost estimate from a good reverse mortgage counselor. The counselor should be working with special computer software developed for this purpose by the AARP. The program lets you enter specific interest rates, possible rates of home appreciation, and the rate at which you’ll draw money from your credit line. That shows you how the costs of the various loans change over time.

8. If your home rises substantially in value or interest rates drop, you might want to refinance your reverse mortgage. You’ll pay the closing costs all over again, so ask the mortgage counselor to show you, in real numbers, all the pros and cons.

Excerpted from Making the Most of Your Money Now by Jane Bryant Quinn

Copyright 1991, 1997, 2009, by Berrybrook Publishing, Inc. Reprinted by permission of Simon Schuster, Inc





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O-Fleet – Car Rental Management Software – Rental Management #car #rental #software, #car #hire

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Rental Management

Handle your reservations and rentals in a seamless way

Manage your reservations, plan your fleet utilization and keep tabs on your deliveries and returns calendars efficiently

Availabilities calendar

  • Display your vehicles availability calendar with regards to the commercial class, the transmission type and the ACRISS code of each vehicle.
  • Use the “Drag-and-Drop” feature to easily replace vehicles assignments on any rental.
  • Display your vehicle’s planned work orders in the availabilities calendar along with the reservations and avoid any overlaps or mix-ups.

Rental management tools

  • Handle short or long-term reservations from different sources (phone, walk-in or via the website’s booking engine).
  • Manage additional extras (equipment and insurances/waivers)
  • Get an at-a-glance view on the current status of each rental.
  • Keep everyone informed about your clients’ special requests, comments or delivery/drop off information. Save their arrival/departure flight numbers as well as their staying hotels.
  • Record all accidents, tolls and fines occurred during the reservation. Bill the amount directly to the client.

Vehicle Inspection

  • Define your own inspection checklist with items such as radio tape, lifting jack, seatbelts.
  • Create and fill online pick-up and drop-off inspection sheets to compare the vehicle state before and after rental for any loss or damages (scratches, dents, dings and cracks).
  • Record vehicle delivery and return information including the agent, the odometer value, the fuel level and the vehicle condition before and after rental.
  • Display and print the scheduled pick-ups and drop-offs of the day and assign the vehicles delivery or return to agents.

Electronic Documents

  • Generate automatically a printable rental agreement, inspection statements and customer invoices.
  • Enable your clients to sign electronically the rental agreements and inspection sheets on a signature pad device.
  • Print the rental contracts with both the signatures of your clients and assigned agents without having to ask them to sign again.

Invoicing management

  • Generate automatically your rental invoices and send them to your clients.
  • Track your clients payments, visualize your clients balances and display paid and outstanding amounts.
  • Manage your long-term rentals and generate recurring monthly invoices automatically.
  • Integrate O-Fleet invoicing with your favorite accounting software. We currently support Quickbooks and Xero software.

Ready to boost your fleet productivity ?

Try O-Fleet for free and learn how to unleash the power of your fleet.





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How to get the best mortgage rate #what #are #points #on #a #mortgage #rate

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How to Get the Best Mortgage Rate

You can trust that we maintain strict editorial integrity in our writing and assessments; however, we receive compensation when you click on links to products from our partners and get approved. Here’s how we make money .

Buying a home is a huge financial commitment. Finding the right mortgage (and how to get the best mortgage rate) can be a confusing process — especially for first-time homebuyers. Comparison shopping is the key to getting the best deal, and you’ll want to ask yourself, “How much house can I afford ? before getting too far into the process.

Here are six important questions to consider when deciding which mortgage is right for you:

1. Should I get a fixed- or adjustable-rate mortgage?

Mortgages generally come in two forms: fixed or adjustable rate. Fixed-rate mortgages lock you into a consistent interest rate that you’ll pay over the life of the loan. The part of your mortgage payment that goes toward principal plus interest remains constant throughout the loan term, though insurance, property taxes and other costs may fluctuate.

The interest rate on an adjustable-rate mortgage fluctuates over the life of the loan. An ARM usually begins with an introductory period of 10, seven, five or even one year, during which your interest rate holds steady. After that, your rate changes based on an interest rate index chosen by the bank.

ARMs look good to a lot of homebuyers because they usually offer lower introductory rates. But remember, your rate could go up after your introductory period, so be sure you’re comfortable with the chance your monthly mortgage payment could rise substantially in the future. As you try to figure out how to get the best mortgage rate. Use the terms of the loan to calculate what your payment might look like in different rate scenarios.

2. Should I pay for points?

A point is an upfront fee — 1% of the total mortgage amount — paid to lower the ongoing interest rate by a fixed amount, usually 0.125%. For example, if you take out a $200,000 loan at 4.25% interest, you might be able to pay a $2,000 fee to reduce the rate to 4.125%.

Paying for points makes sense if you plan to keep the loan for a long time, but since the average homeowner stays in his or her house for about nine years, the upfront costs often outweigh interest rate savings over time.

Alternatively, there are negative points. It’s the opposite of paying points: A lender reduces its fees in exchange for a higher ongoing interest rate. It’s tempting to reduce your upfront fees, but the additional interest you pay over the life of the loan can be significant. Carefully consider your short-term savings and your long-term costs before taking negative points.

3. How much should I expect to pay in closing costs?

Closing costs usually amount to about 3% of the purchase price of your home and are paid at the time you close, or finalize, the purchase of a house. Closing costs are made up of a variety of fees charged by lenders, including underwriting and processing charges, title insurance fees and appraisal costs, among others.

You’re allowed to shop around for lower fees in some cases, and the Loan Estimate form will tell you which ones those are. Shopping for the right lender is a good way to find the best mortgage rate, and save money on a mortgage and associated fees.

4. Do I qualify for any special programs?

Before you settle on a mortgage, find out if you’re eligible for any special programs that make home-buying less costly. For example:

    • VA loans. If you or your spouse are active military or veterans, you might qualify for a VA loan. Such loans allow low (or no) down payments and offer protections if you fall behind on your mortgage.
    • FHA loans: Like VA loans, an FHA loan allows low down payments, but they’re open to most U.S. residents. They’re popular with first-time homebuyers, because they require as little as 3.5% down and are more forgiving of low credit scores than traditional lenders.
    • USDA loans. If you live in a rural area, the USDA might give you a low- or no-down-payment mortgage and help cover closing costs. Like VA loans, USDA loans can also offer help if you fall behind on your payments.
    • First-time homebuyer programs: If this is your first go-round in the homeownership process, check out the HUD website for helpful information and a list of homebuyer assistance programs in your state.

5. How much can and should I put down?

Generally speaking, a lower down payment leads to a higher interest rate and paying more money overall. If you can, pay 20% of your home’s purchase price in your down payment. However, if you don’t have that kind of cash, don’t worry. Many lenders will accept down payments as low as 5% of your home’s purchase price.

Be aware: Low-down-payment loans often require private mortgage insurance. which adds to your overall cost, and you’ll probably pay a higher interest rate. Put down as much as you can while maintaining enough of a financial cushion to weather potential emergencies. As you ask potential lenders how to get the best mortgage rate. many will tell you that the more money you put down, the lower your rate will be.

NerdWallet s mortgage rate tool can help you see rates available to you with varying downpayments and purchase prices.

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Drug and alcohol recovery outcome and success over the long-term: Alcoholism and heroin addiction

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Drug and alcohol recovery outcome and success over the long-term: Alcoholism and heroin addiction and recovery may not be so bleak

Alcoholism may have a better prognosis than previously expected

Addiction psychiatrists and psychologists are often asked about successful recovery rates for addicts and alcoholics in their clinics and practice and until recently there have been few data to support most therapist s claims. Until now we have have relied on older research suggesting that when all studies and research is considered together that roughly ten to 30% of individuals in treatment for drug and alcohol use at any time will actually be clean and sober one year from the time they are initially assessed. Looking at it from this perspective has been particularly bleak. However, when considered from a longer term perspective, recovery rates for both hard drug addiction and alcoholism fare much better. Furthermore, in the past ten years there have been advances in the quality and quantity of longitudinal (long-term) research which supports claims that most individuals grappling with drug addiction or alcoholism eventually recover. Some even recover on their own without drastic intervention. These studies span from three to six decades of tracking the same subjects in terms of their drug or alcohol use and the consequences, mortality and acid test of abstinence and sobriety in their lives.

One such study in the March 1996 American Medical Association Archives of General Psychiatry concluded that alcoholics who had achieved five years of sobriety were much less likely to relapse than those with less sobriety time. Not exactly rocket science but finally there was solid research to back up common intuition about alcohol abuse and alcoholism recovery. George Vaillant MD published this famous study in 1996 and it received much attention and acclaim especially because of the magnitude of the work. They followed 724 men over a 50 year period to achieve their results. Relapse occurred 40 percent of the time after two years of sobriety but was rarely reported after five years of abstinence. Another major result worth noting is that in their study cohort there were two samples, one of college students and one of more disadvantaged subjects. Disadvantaged alcohol abusers were more likely to be sober over the long term which flies in the face of expectation. It is believe that this is actually because their situation demands it. When you are disadvantaged and struggling socially and economically there just isn t much room for alcoholism. Whereas the college educated and more socio-economically privileged subjects in the study sample were able to have their drinking excused. This doesn t bode well for the functioning alcoholic and suggests that sometimes a good career, family and economic resources and support are actually a disadvantage and present risk factors which can enable alcoholic drinking for some time. Go figure, but then again, this also has face validity (i.e. it just makes intuitive sense.)

In a follow-up study to Vaillant s 50 yr study, ten years later the same subjects were assessed. Vaillant reported that their results were similar to the results found in eight other similar studies. No major surprises. The death rate for alcoholics was 2-3 times the death rate of a non-alcoholic population. In general, they found the main factors critical for recovery were finding a substitute for alcohol use, close supervision, new relationships and involvement in some sort of spiritual programs. Since Alcoholics Anonymous comprises all these, AA involvement was the best predictor of abstinence. There was again the same finding of one major paradox. Socially disadvantaged men and men with early onset of alcoholism with strong family histories of alcoholism were more likely than other men to be sober. These men did better than men who were highly educated and had higher socio-economic privilege. In summary, the most severe and least severe alcoholics were most likely to have the best long term chance of remission.

Heroin Addiction seems to have a better outcome than previously expected over a person s lifetime.

Now turning our attention to heroin and opiate/opioid addiction. In a 33 year follow up of Narcotics addicts the Archives of General Psychiatry in May 2001, reported that it took a full five years of abstinence before heroin users would have a considerably reduced risk of relapse and that still a quarter relapsed after 15 years of abstinence. Compared to Vaillant s research with alcoholism this suggests that heroin is an altogether more challenging disease.

Another recent study is a little more promising. In the British Journal of Psychiatry in 2005 heroin dependence was assessed over 33 years and these researchers found very simply that the percentages of addicts achieving and maintaining long term abstinence increased over time and the percentage of those addicted declined over time suggesting that the majority of addicts who are compliant with some recovery plan will eventually become clean and sober or maintained with treatment. These major long term research studies into recovery rates for alcohol and opioid/opiate addiction shed a more optimistic light on recovery from addiction. It used to be that while in inpatient treatment for drug and alcohol abuse therapists and counselors would tell patients to look around the room at the people in their group. They would say for example that in this group of ten people only three of you are likely to be clean and sober one year from now. These recovery rates are actually fairly accurate but maybe what we should be telling clients is something more hopeful. It appears that if we look at lifetime recovery rates there is a good chance that most of you in the room will eventually recover. It s interesting to compare compliance to treatment and recovery among the disease of addiction and alcoholism to other diseases and their respective compliance to treatment and recovery regimens for diseases like diabetes, hypertension and asthma. In fact, researches have suggested that with these latter diseases the recovery rates are even more bleak. That with diabetes even fewer people will take their medicine, exercise and eat healthily and avoid people, places, and things, like chocolate cake. For diseases like diabetes, hypertension and asthma, recovery rates and compliance is more likely to be something like 8-25%. Yet addicts and alcoholics have a slightly better compliance and recovery rate approximating between 10-30 percent. The reason for this may be what Vaillant and other researchers found in these landmark studies. When addicts and alcoholics go to Alcoholics Anonymous they meet supportive people who remind them to be healthy, take their medicine, go to meetings, avoid people places and things, work the steps and call their sponsor. Someone struggling with diabetes or asthma may not be so lucky. To be sure alcoholism and heroin addiction are deadly diseases but many people can recover and do recover with sustained hard work and social support. In Alcoholics Anonymous it is said that alcoholism ends in jails, institutions or death. We should now actually be more hopeful. It is more likely that alcoholism and addiction will end in recovery.

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Mindfulness Based Addiction Recovery

College students in recovery from addiction in Philadelphia and Montgomery County: Alcohol and drug use in local colleges is met with strong recovery as students find meaning and purpose in Alcoholics Anonymous and Narcotics Anonoymous


  • Alcohol Calories and Health: A Philadelphia Psychologist Reviews the Data





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  • Flagship Merchant Services, The Leader In Credit Card Processing, lowest rate merchant services.#Lowest #rate

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  • Top 10 Ways To Lower Your Car Insurance Bill #car #insurance, #auto #insurance, #rate,

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    Top 10 Ways To Lower Your Car Insurance Bill

    If you’re shopping for car insurance, you know there are certain crucial factors influencing your rate that are out of your hands. Such factors include your age, gender and record of prior claims.

    Despite this, there’s a lot you can do to score a lower rate, and your choices bear more power than you might think. Here are 10 tips guaranteed to help you get the best rate possible on your auto insurance.

    1. Get more than one rate quote before you commit.

    “Company prices are very different, and it pays to shop around. You can easily wind up paying double from one company to the next,” says J. Robert Hunter, director of insurance with the Consumer Federation of America, a national watchdog group.

    Want to get a sense of who the low-priced carriers are? The National Association of Insurance Commissioners offers a map on its Web site that lists each state’s regulators. Click on your state and you’re taken to the state’s Department of Insurance Web site. Its consumer buying guide compares insurance premiums across a range of companies. You’ll also learn how many complaints each company has logged. Surprisingly, you don’t have to sacrifice service quality to score a low premium. “A lot of the lower-priced companies have the best service rates,” says Hunter.

    There are a host of independent Web sites, like CarInsurance.com. that allow you to comparison-shop by offering online price quotes. These sites can be incredibly useful. However, Hunter warns that these services which earn their keep by charging carriers a commission on each sale occasionally fail to include the insurance companies with the lowest rates, since these low-cost carriers are unwilling to pay commissions.

  • 2. Evaluate insurance costs before you buy your vehicle.

    The year, make and model of your vehicle can have a profound impact on your insurance rate. All else being equal, new, expensive or sporty cars will cost more to insure than older, cheaper and more utilitarian vehicles. But you could find a substantial discrepancy even when comparing the cost to insure similar cars. So if you’ve got a few models on your shortlist, contact your carrier to see what rate each vehicle commands. Doing so could ultimately net you a windfall in savings when the time comes to pay your premium.

  • 3. Go high on deductibles.

    If you’re willing to give a little with your deductible, you can wind up saving big on your rates. “If you go from a $250 to a $1,000 deductible, you can save between 25 and 40 percent on your policy,” says Hunter. You can then set aside a portion of these funds to cover your costs in the event of a claim.

    4. Nix collision and/or comprehensive coverage on older cars.

    If your older car has comp and collision coverage, you might find yourself paying more in insurance than the car is worth. “Take your comp and collision premium and add it up, then multiply it by 10. If your car is worth less than that, don’t buy the coverage,” says Hunter. If you’re worried about being left overexposed, consider this: The typical policyholder makes a claim only once every 11 years, and reports a total loss only once every 50 years.

    5. Mind your credit score.

    An increasing number of carriers are considering credit scores when making rate calculations. “Your credit score can be very important in determining your rate,” says Hunter. “You can wind up paying up to 50 percent more if you have a bad credit score.” Keep your credit score in tip-top shape by paying bills in a timely manner and by regularly checking that there are no items on your history that do not belong to you.

    6. Ask about low-mileage discounts.

    Many carriers offer discounts to policyholders whose annual mileage is lower than the norm. Maybe you have a short commute. Or maybe your participation in the office vanpool results in fewer hours spent in your daily driver. Whatever the case, your low mileage can score you a reduced rate with some companies, so be sure to inquire about available discounts.

    7. Ask about group insurance discounts.

    Oftentimes, insurance companies offer discounts to policyholders who are members of certain organizations or professions, such as veterans, engineers or teachers. Request a list of these groups from your carrier to see if you qualify you might be pleasantly surprised.

    8. Ask about all other discounts.

    Some carriers offer discounts to policyholders whose vehicles bear certain safety features, like anti-theft devices or motorized seatbelts. Others give reduced rates to senior citizens, and to students whose grades meet certain requirements. “Many carriers offer discounts. Ask for them when you’re shopping,” says Hunter.

    However, Hunter offers one caveat: “Some of the companies that offer the highest discounts have the highest rates, so don’t get too focused on discounts. Some high-priced companies offer high discounts, but at the end of the day you’re still paying more.”

    9. Avoid lapses in coverage.

    Even a brief lapse in coverage can disqualify you from receiving discounts. “They use lapses in coverage to increase your premium,” says Hunter. Pay your insurance bills on time. And if you’re switching carriers, make sure not to quit your previous carrier until the new coverage takes effect.

    10. Think twice about paying in installments.

    Most carriers charge an administration fee to pay in installments. One carrier surveyed levied a $10 charge per installment to those who opted to break up their bill. The solution? Pay your premium up front, if at all possible.

    Of course, this charge is more significant for those with small premiums. If you’ve got a king-sized premium and feel you’d get a better rate of return by investing your funds elsewhere instead of paying up front, then the installment route will probably best suit your needs.





  • Single Premium Whole Life Insurance #investing #with #single #premium #whole #life #insurance,single #premium #life

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    Investing With Single Premium Whole Life Insurance

    Single premium whole life insurance can be a wise investment if you have at least $5,000 you don’t need, want a generous death benefit, and need an investment that’s safe and profitable. It can be used to pay a non-taxable sum to beneficiaries immediately upon your death. It can also insure a child in your name while you retain the ownership and cash value of the policy.

    How Single Premium Whole Life Policies Work

    A one-time payment yields a fully-paid death benefit that’s valid for as long as the policy remains intact. The death benefit is substantially higher than the cost of the policy. At age 60, it can be double the initial investment. At age 50, it can be four times higher. The younger the insured, the higher the benefit amount will be. The policy grows as long as it stays in effect, yielding dividends at a competitive, fixed rate based on current market conditions and the standing of the insurer. The earnings can be withdrawn as cash or applied to what’s called “paid up additions.” These are additional single premium whole life insurance policies, just like the original, that also pay dividends. Single premium whole life policies come with the option to use up to 90% of the cash surrender value as collateral against a loan. The collateral amount reduces the death benefit and won’t earn interest as long as the loan remains unpaid. When the loan is paid off, the death benefit is restored and the policy again pays dividends.

    Other Uses for Your Single Premium Policy

    Up to 100% of the dividends earned or up to 10% of the premium paid can generally be withdrawn against the policy’s cash value. These instruments are considered modified endowment contracts. A 10% IRS penalty, in addition to income tax, applies to all gains withdrawn or borrowed by those younger than 59.5. As long as the dividends remain untouched, all earnings are tax-deferred. Some plans allow nontaxable access to death benefits for long-term care. Other plans let you withdraw part of the benefits without penalty if you’re diagnosed with a terminal illness. You can cash in the policy whenever you wish, but a surrender fee may apply. Terms and conditions of single payment whole life insurance policies vary widely. It pays to do your homework before making a decision – LifeInsuranceRates.com provides free, quick, and easy access to insurance quotes online. You’ll get unbiased information without the hype, and no personal information is required. Use the form above to see if a single-premium whole life policy is right for you.

    2017 www.lifeinsurancerates.com
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    Call Center (877) 407-6153

    All other trademarks and copyrights are the property of their respective holders.

    LifeInsuranceRates.com is not a covered entity for the purposes of the Health Insurance Portability and Accountability Act of 1996 (“HIPPA”). In turn, the additional privacy and security protections provided to individuals under HIPPA do not apply. There are certain state laws which may offer additional rights with regard to disclosure of information. If you are covered under these laws, you may have additional rights and some or all of the above disclaimers, exclusions and restrictions may not apply to you. LifeInsuranceRates.com is an insurance provider referral service and not a life insurance broker or provider. Not all insurers can or will offer you a quote. Rates and fees will vary between insurers and may be dependent on the state in which you live so be sure to compare the associated costs. You may receive a call from a LifeInsuranceRates.com affiliate to determine which policy will offer you the best coverage. None of the companies and/or brands referenced on this website either sponsor, endorse or are in any way affiliated with our company.





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    Answering Service Cost – How Much Should You Pay #answering #service #prices,answering #service #cost,price

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    How Much Do Answering Services Cost?

    How Much Does a Telephone Answering Service Cost?

    On average a live answering service is going cost a small business with normal usage times somewhere between $12 $43 a week. The real question is what determines the actual cost of an answering service and what can you do to control the price. There are two types of billing programs and those are pay per call and pay per minute. Pay per call answering services are just what they say they are, you pay a fixed rate for each call that the call center answers on your behalf. A per minute plan is billed according to the time that is spent with your customers and is generally billed in 12 second increments.

    How Much Should You Pay For Answering Services? This is probably the best way to address the question of how much a telephone answering service will cost. Depending on your specific needs (and they vary greatly) on average you can expect to pay about $0.79 a minute. So if you have a plan where you pay per call then you should examine the average duration of those calls and determine if you’re getting the best rate available. In other words if you’re paying $1.80 per call but your average call length is only one minute and fifteen seconds then odds are you may be paying too much the service.

    How Can I Get the Lowest Price on an Answering Service? Bottom line, make them fight for your business. When call centers service providers are bidding against each other for your business you can save as much as 25% off the cost of service. This also applies if you already have a service. When you have an existing service you can compare the prices of the competition and usually even enjoy a free trial. If you like the service you simply forward your line to the new number, or see if your existing provider will lower your rates to keep you from leaving them.

    What Can Select Answering Service do to Lower my Cost? To help you get the best price on your answering service solution we offer a totally free service so you can get top companies to go head to head against each other for your business. In other words you’ll get their best price because they’ll know you are shopping through our system. We don’t think businesses should pay marked up prices for answering services and this free, no obligation system lets you use a single form to communicate your needs to up to 5 top companies that match your needs.

    How Can I reduce the Cost of my Answering Service? There are a number ways to lower your answering service costs. The easiest way is to have the receptionist service only ask the questions that are required, which may be the callers name, telephone number, and a short message as to why they are calling. Also, if you’re paying for calls to be transferred but you are rarely able to answer those calls it’s a good idea to change your plan to just have messages sent by text, which can lower your bill by as much as 20%. Alternatively you have the ability to turn your service on and off at will. When you or your staff are in the office simple un-forward your lines, or your phone company can set up a “busy no answer” feature whereas the first 3 rings come into your office and if you’re busy and don’t answer then the call will be forwarded to the service.





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    Multiple Myeloma Symptoms, Treatments, and Survival Rates #multiple #myeloma, #multiple #myeloma #symptoms, #multiple #myeloma

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    Multiple Myeloma

    Multiple myeloma is a blood cancer related to lymphoma and leukemia. Though it can’t usually be cured, there are treatments that slow down its spread.

    What Is Multiple Myeloma?

    In multiple myeloma, a type of white blood cell called a plasma cell multiplies unusually. Normally, they make antibodies that fight infections. But in multiple myeloma, they release too much protein (called immunoglobulin) into your bones and blood. It builds up throughout your body and causes organ damage.

    The plasma cells also crowd normal blood cells in your bones. They release chemicals that dissolve bone. The weak areas of bone this creates are called lytic lesions.

    As multiple myeloma gets worse, those plasma cells begin to spill out of your bone marrow and spread through your body. This causes more organ damage.

    Causes

    No one knows what causes multiple myeloma. But you’re more likely to get it if:

    • You’re older than 65
    • You’re African-American
    • You have a family member with it

    If you have one these other plasma cell diseases, you may be more likely to get multiple myeloma:

    • Monoclonal gammopathy of undetermined significance (MGUS)
    • Solitary plasmacytoma

    Symptoms

    Early on, multiple myeloma may cause no symptoms. As time passes, you may have:

    • Bone pain
    • Weakness and fatigue
    • Weight loss

    In rare cases, plasma cells may form purplish lumps that you can see underneath your skin. Your doctor may call them extramedullary plasmacytomas.

    Continued

    Diagnosis

    Your doctor may test you for multiple myeloma if a blood test shows you have:

    • Too much calcium in your blood (your doctor may call it hypercalcemia)
    • Anemia (too few red blood cells)
    • Kidney problems
    • High protein levels in your blood combined with a low albumin level (your doctor may say you have a “globulin gap”)

    If your doctor thinks you have multiple myeloma, he’ll test your blood, urine, and bones. Some tests he may order include:

    • Electrophoresis, which measures immunoglobulin
    • Blood urea nitrogen, also known as BUN, and creatinine. These check how well your kidneys are working.
    • A CBC, which stands for complete blood count. It measures and counts the cells in your blood.

    After your test results come in, your doctor may want to do a bone marrow biopsy. He’ll insert a needle into a bone, usually in your hip, to get a sample of bone marrow to check the number of plasma cells in it.

    He may also want you to get X-rays. They can show spots of bone weakened by multiple myeloma. Sometimes you may also need a CT scan, MRI, or PET scan.

    Treatment

    Several drugs and types of drugs are used to treat multiple myeloma.

    Chemotherapy: You might get it alone or paired with another drug. The types of chemo most often used to treat multiple myeloma are:

    • Cyclophosphamide (Cytoxan)
    • Doxorubicin (Adriamycin)
    • Melphalan (Alkeran)
    • Liposomal doxorubicin (Doxil)
    • Panobinostat (Farydak)

    Corticosteroids like dexamethasone or prednisone are often given with chemotherapy to reduce side effects.

    Stem cell transplant: It won’t work for everyone, but if your doctor thinks you’re a good fit for it, they may start with a stem cell transplant. They will use a machine to remove some of your stem cells, then freeze and store them. Or they may use stem cells taken from a donor.

    Next, you get high-dose chemotherapy. This will destroy almost all the cells in your bone marrow — both healthy cells and the plasma cells that cause the disease. Then the doctor will injects the stem cells into your veins. They travel to the bone marrow, where they multiply and make new, healthy blood cells.

    Stem cell transplantation doesn’t cure multiple myeloma, but it often helps you live longer. It can also cause serious complications. For example, it can make you more likely to get infections.

    Continued

    Targeted Therapies

    These medications target proteins, genes, or tissues and prevent cancer from growing.

    Immunomodulatory drugs strengthen your immune cells to help them attack cancer cells. They also help starve the myeloma cells in your bone marrow by preventing new blood vessels from forming:

    • Lenalidomide (Revlimid)
    • Pomalidomide (Pomalyst)
    • Thalidomide (Thalomid)

    Monoclonal antibodies help your immune system spot and destroy myeloma cells. You might hear your doctor call this immunotherapy:

    • Daratumumab (Darzalex)
    • Elotuzumab (Empliciti)

    If you don’t have symptoms, your doctor might start you on one of these drugs to prevent myeloma from getting to a point where you need treatment.

    Proteasome inhibitors stop the process that eats up extra proteins in cells. Myeloma cells make lots of proteins. When they build up, the cells die:

    • Bortezomib (Velcade)
    • Carfilzomib (Kyprolis)
    • Ixazomib (Ninlaro)

    Your Treatment Plan

    If you don’t have symptoms, your doctor may choose to watch you closely rather than start treatment right away.

    If you do have symptoms, your doctor will work with you to come up with a treatment plan. It will aim to improve your quality of life by easing your symptoms and helping you get good nutrition. Your plan will have three main phases:

    • Induction therapy: Use medications to get quick control of the disease and its symptoms
    • Post-induction therapy: Add treatments like chemotherapy or a stem cell transplant (your doctor might also call it consolidation therapy)
    • Maintenance therapy: Keep your cancer at bay as long as possible

    Which drugs your doctor chooses depends on your age and how aggressive your cancer is. Multiple myeloma cases are usually graded as high, intermediate, or standard risk. Most people start with a three-drug mix that combines a proteasome inhibitor, an immunomodulatory drug, and a corticosteroid. If you’re considered high risk, you might want to look into a clinical trial for an existing or new treatment. Research is ongoing, including clinical trials to identify more effective drugs and combinations.

    Continued

    Treating Symptoms

    Often multiple myeloma has no symptoms. But if yours causes painful bone damage, your doctor might suggest:

    Bisphosphonates: These drugs treat bone damage. Your doctor may have you try:

    • Pamidronate (Aredia)
    • Zoledronic acid (Zometa)

    Be especially thorough with your brushing and flossing while you take these medications. It’s rare, but these medicines can damage your jaw. Dental work makes this more likely.

    Radiation therapy. The doctor will direct a beam from a machine to a bone or other affected body part. The beam kills plasma cells, which can ease your pain and strengthen weakened bones.

    What to Expect

    Multiple myeloma varies widely among people. Some will live for years with few symptoms. With others, the condition gets worse quickly. Identifying the forms of multiple myeloma is often challenging for doctors.

    Doctors have systems that predict survival rates. The simplest and most common uses the blood levels of two substances: albumin and beta-2-microglobulin. A higher albumin level and a lower beta-2-microglobulin level suggest a better chance for longer survival.

    Other systems use multiple lab or DNA tests in plasma cells.

    Knowing how aggressive your multiple myeloma is can help you and your doctor find the best plan for you.

    What Your Doctor Is Reading

    If you are interested in more advanced reading on this topic, we’ve made content from our health professional site, Medscape, available to you on WebMD.

    WebMD Medical Reference Reviewed by Neha Pathak, MD on July 20, 2017

    Sources

    Abeloff, M. Abeloff’s Clinical Oncology, 4th edition, Churchill Livingstone, 2008.

    American Cancer Society: “Multiple Myeloma: Detailed Guide.”

    UpToDate: “Overview of the management of multiple myeloma,” “Patient Education: Multiple Myeloma treatment (Beyond the Basics).”

    American Society of Clinical Oncology: “Multiple Myeloma: Treatment Options.”

    © 2017 WebMD, LLC. All rights reserved.





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