medgremlin @ medgremlin @midwest.social

Posts

7

Comments

487

Joined

2 yr. ago

I just want to clarify that these stories are about patients I have cared for. I have had my own personal fights with insurance regarding coverage for life-preserving medications and diagnostic testing for damage caused by incorrect medications that I used to be on, but what I discussed here are other people whose medical care I was involved in.

(& I promise you Chipmunk Cheek’s rich sociopath family is looking at every record in their business to find out who they ficked over so bad)

Having fought with UHC to get curative cancer surgeries approved, I promise you, that list is so long as to be basically useless. They're looking for a single fish in the Pacific Ocean here, and it's their own fucking fault. (I have literally had them approve the excision of a malignant melanoma, but require prior authorization for the 10cm diameter skin graft to repair the area excised because the procedure code technically falls under the plastic surgery heading.

They don't even look at what the procedure is or what it's for. All procedures and billing codes fall under various headings and more than half of them fall under headings that require prior authorization with a massive pile of documentation and justification attached.

I've also had them get pissy about things like medically necessary panniculectomies (removal of the skin/fat apron at the bottom of the abdomen) for someone that lost about 200lbs and was getting literal necrosis of the skin in the fold because of the irritation and friction from the pannus. Like, yes, I know that sometimes panniculectomies can be borderline-cosmetic, but this poor lady had over a foot of overhang after her diligent weight loss from diet and exercise and she had already had one hospitalization for sepsis from the severity of the skin infection from the skin breakdown. I had to submit those hospitalization records and 3 sets of photographs of the skin breakdown from 3 separate appointments to prove that it was a consistent problem.

If you can't tell, I am very angry about how insurance authorization works and I have intimate knowledge of the process. It drives me absolutely mad that people with MD, DO, or international medical degrees with no knowledge or expertise in the specialty at hand are the ones that review the appeals for the automatic denials. UHC was by far the worst offender and they deserve everything coming their way.

The Biden SAVE plan actually made a massive change that makes it a lot more viable, especially if you do the PSLF program. It's set up so that if you're on an income-driven repayment plan, any interest not covered by your payment does not capitalize. So you might not make any progress on the principal of the loan while you're in residency, but it won't spiral out of control and the reduced payments count towards the 120 PSLF payments. I'm planning on doing a 3 year residency at minimum, maybe more, and probably a fellowship as well, so I'll have 5 years of reduced payments, and then I'll be working in non-profit community/county hospitals after that so I'll be able to use PSLF. Running the numbers, I think the government will be eating about $275k-$300k of my loans.

I am quite familiar with this nonsense from the patient side as well. As a physician, I think I will be well-placed to ensure that my patients are getting appropriate care while not giving the insurance company bullshit reasons to deny claims.

From a medical student: There is a different problem coming up with the production of more physicians. There are more new medical schools opening and existing medical schools are increasing class sizes....but the number of residencies has barely moved in decades. Residencies are funded through Medicare and the number of them is determined by appropriation bills in congress. There are some privately-funded residencies being created, but a lot of those are hideously low quality and being used as a source of indentured servitude by for-profit health groups like HCA. (They won't even hire their own graduates from their emergency medicine residencies because the quality of the training is so poor.)

And if you don't complete a residency, you can't practice independently. You have to have a board certification from an accredited residency to be able to practice medicine, and the only alternatives are working under supervision like a PA/NP....or working for the insurance companies. And you still have a mortgage's worth of student loans to pay off.

A lot of the doctors working for the insurance companies are ones that couldn't get into residencies or ones that have not kept up with continuing medical education and likely do not have active board certification anymore.

I'm in medical school now and looking at either emergency med or family med, and either way, I am going to be exceedingly careful about how I construct my notes, diagnoses, evaluations, and treatment plans to leave as few cracks as possible for the insurance companies to try to weasel their way into.

I was the feisty little gremlin that fought with the insurance at a cancer-focused plastic surgery clinic. I got really good at stacking up all of the info in the first submission so that they couldn't drag their heels on shit that was time-sensitive.

When I was a clinic assistant in a cancer-focused plastic surgery clinic, it was my job to fight with the insurance companies. I did prior authorizations for every surgery and they would do shit like approve the removal of a melanoma without requiring prior authorization, but performing the skin graft to repair the 10cm diameter hole required a prior authorization because the procedure code falls under the "Plastic Surgery" heading and they wanted to make sure you're not getting skin grafts for cosmetic reasons.

In fairness to their argument, I have actually seen serious consequences from the mass theft of baby formula. When I worked in a children's hospital, we had babies coming in with malnutrition problems because they required a special formula that was completely unavailable. The parents couldn't buy the formula because it was out of stock at every store they were able to get to with the transportation and time available to them.

People stealing massive amounts of formula cause massive problems because the specialty formulas are hard to find to begin with, and these people are clearing out store shelves to sell it overseas.

The wealthy parents that live in nicer neighborhoods with fancier stores and fewer problems with shoplifting don't run into this issue. It the poor families in food deserts that are most impacted by this kind of mass theft, and they're the families least able to work around it by just going to another store to buy it.

The company already has a list. They can just look through their denied claims pile... That shouldn't be too hard.

... Oh wait, that list is millions of people long.

These days, an epesiotomy is done to direct the tear. If the tear is allowed to happen spontaneously, it can go through nerves, arteries, and pelvic floor muscles, greatly increasing the chances of permanent problems with things like prolapses or fistulas at worst, and more commonly, long term problems with incontinence.

Anterior Pituitary, Spinal Cord, Teeth, Thalamus, Limbs

Normally, I don't buy Israeli products wherever I can avoid it, but pelting these guys with the jumbo cans of Goya beans would be pretty funny.

There have been a lot of pictures of black cats, and black cats are lovingly referred to as "void cats" or "voids" because they just turn into a blob of black nothing if they close their eyes.

She's named Nova after the Waframe. All of our cats are named after various Warframes.

"Concerns about financial corruption"?

Really? There's no "concern" here for anyone with 2 brain cells to boop together. It's a known, reliable fact, not a "concern".

I said old or injured.

I love the absolute chaos you're bringing to this comment section. You're my kinda people.

As a healthcare worker who has had a patient try to strangle her before...I would like violence not to be an expected part of my job.

I'm not outright trying to be contrarian, but for some older people or people with things like arthritis, foot injuries, hip injuries, etc. walking or running on a treadmill is vastly less painful than walking or running on concrete.

There is absolutely a huge commercialization problem with fitness and health in the western world (and in America in particular), but if going to a climate-controlled gym and getting your steps in on a treadmill or elliptical is what it takes to get you to exercise, I'm all for it.

For the potato chips, that's really sleazy of the gym, but I do want people to know that even if you don't/can't make a bunch of changes to your diet and you don't lose weight, getting exercise of any kind as often as you are able is still a positive thing for your heart and metabolic health. Please don't let being fat, or out of shape, or an inability to overhaul your diet prevent you from doing something positive for your health. Losing weight and keeping it off is really only possible through major lifestyle change, and, for a lot of people, the only sustainable way to make the necessary changes is one at a time.