1 minute ago, HazletonEagle said:

Yeah. It may be understandable if your doctor cant do it, but if you are under a time crunch they need to be understanding of that and should have someone in their office who can. You are just as important as any of those other patients they are rounding on. Theres gotta be a nurse, or nurse practitioner, or PA who can do it. 

My primary has been good to me, he's gone above and beyond, so I think he'd do it if he can. It's odd because for a doctor who's usually super on the ball and good to me, the staffer I spoke to the other day was rather blunt. They were just like "he's unavailable to do the peer to peer, he only has one day in the office over the next week and he's absolutely loaded with pateitns that day and we have to prioritize the sick and needy patients, it's just the way it is." And didn't even offer like "We could have someone else here do it for you" or anything like that. I was taken aback and disappointed. I would try a specialist, but neurologists in this city have like a 6 month wait minimum. Longest wait times of any specialists I've ever experienced, it's crazy.

1 minute ago, RLC said:

I have no idea what these refs are watching.

Bad football.

I know there are multiple ways to get it done, but man I get annoyed when a losing QB doesn't look hellbent on the sideline after a mistake.

I’m here now

1 minute ago, Saltpeter said:

I know there are multiple ways to get it done, but man I get annoyed when a losing QB doesn't look hellbent on the sideline after a mistake.

It's why the great ones are great. How many QBs hate losing more than they love winning?

2 minutes ago, Sack that QB said:

My primary has been good to me, he's gone above and beyond, so I think he'd do it if he can. It's odd because for a doctor who's usually super on the ball and good to me, the staffer I spoke to the other day was rather blunt. They were just like "he's unavailable to do the peer to peer, he only has one day in the office over the next week and he's absolutely loaded with pateitns that day and we have to prioritize the sick and needy patients, it's just the way it is." And didn't even offer like "We could have someone else here do it for you" or anything like that. I was taken aback and disappointed. I would try a specialist, but neurologists in this city have like a 6 month wait minimum. Longest wait times of any specialists I've ever experienced, it's crazy.

Yeah. Good healthcare is hard to come by these days.

Smaller health systems are joining up with larger health systems, and family medicine ends up becoming corporate medicine. Understaffed, overworked, and while there are advantages, care suffers in a lot of ways.

Is there an online health portal? There are systems like MyChart which allows you to send messages to your doctor. Often times these are triaged by someone else in the office, but almost always they are still routed to the doctor, or another provider like a PA who can still assist you.  Its one way to make sure someone meaningful in the office hears from you rather than just a gatekeeper at the front desk who may not pass along your message.

A truly bad 2 minute drill by Atlanta. This is bad football

Are the Falcons even trying? Just ran the remainder of the half off for no reason

3 minutes ago, HazletonEagle said:

Yeah. Good healthcare is hard to come by these days.

Smaller health systems are joining up with larger health systems, and family medicine ends up becoming corporate medicine. Understaffed, overworked, and while there are advantages, care suffers in a lot of ways.

Is there an online health portal? There are systems like MyChart which allows you to send messages to your doctor. Often times these are triaged by someone else in the office, but almost always they are still routed to the doctor, or another provider like a PA who can still assist you.  Its one way to make sure someone meaningful in the office hears from you rather than just a gatekeeper at the front desk who may not pass along your message.

Yeah, I have an account on there for all my doctor's offices. It has been effective in communicating directly with my doctors at times, sometimes the staffers will respond instead. I don't like to use it for elaborate situations though, because it seems no matter what doctor, I could send like a paragraph long message that is fully detailed and I always get back like a 5 word sentence response at most. Part of me is like I know doctors are super busy and are pressed for time, but another part of me is like seriously? You couldn't put two more sentences in to make the response a little clearer?

"Hey doctor, I'm dealing with x,y,z I tried a,b,c any idea on what the next steps should be and if they don't work anything else I could try to make it better? Also, should I explore ___ test? Thanks"

Response: "Just try ___."

Me: 😑

Do you know how long the peer to peer things usually take? If they're like 45 minutes to an hour, I'd totally get them not having the time. But if they're like 5-10 minutes, I'll be pretty pissed if no one at that entire office can find the time to take care of this for me. They're supposed to call me tomorrow. I'm going to ask them if another doctor or NP can do it, and I always try to stay on the good side of my doctor's offices, but I'm gonna have to really bite my tongue to not give them an ear full if they **** off about someone else doing that peer to peer, especially if it's not some thing they need to carve out a big portion of their time on.

1 hour ago, Sack that QB said:

There are a lot of things I love about America but insurance in this country Fing sucks. It’s a terrible feeling when you need to get something done, your insurance company won’t cover it, and your doctors office kinda shrugs at you and goes sorry, nothing we can do and just sends you on your way like you’re at a convenience store looking for batteries and they say they’re all sold out.

My insurance company keeps denying this MRI for whatever reason. My doctor thinks I really need it, but because the insurance keeps denying it the doctors office basically is just telling me "so sorry, there’s nothing we can do, good luck with your pain”

The health care system in this country is beyond embarrassing.

1 minute ago, Sack that QB said:

Yeah, I have an account on there for all my doctor's offices. It has been effective in communicating directly with my doctors at times, sometimes the staffers will respond instead. I don't like to use it for elaborate situations though, because it seems no matter what doctor, I could send like a paragraph long message that is fully detailed and I always get back like a 5 word sentence response at most. Part of me is like I know doctors are super busy and are pressed for time, but another part of me is like seriously? You couldn't put two more sentences in to make the response a little clearer?

"Hey doctor, I'm dealing with x,y,z I tried a,b,c any idea on what the next steps should be and if they don't work anything else I could try to make it better? Also, should I explore ___ test? Thanks"

Response: "Just try ___."

Me: 😑

Do you know how long the peer to peer things usually take? If they're like 45 minutes to an hour, I'd totally get them not having the time. But if they're like 5-10 minutes, I'll be pretty pissed if no one at that entire office can find the time to take care of this for me. They're supposed to call me tomorrow. I'm going to ask them if another doctor or NP can do it, and I always try to stay on the good side of my doctor's offices, but I'm gonna have to really bite my tongue to not give them an ear full if they **** off about someone else doing that peer to peer, especially if it's not some thing they need to carve out a big portion of their time on.

They are a couple minutes. Person in your office says we are trying to get an MRI approved for patient x. He has so and so going on. These are the signs/symptoms/positive tests. 

Insurance company states why it is not being approved.

Person from your office usually responds with "Well didnt you read the notes? Its all in there that he has been exhibiting such and such symptoms that you are talking about."

Then, approved.

 

Its usually a brief discussion where the insurance company looks stupid like they didnt bother reading and denied your test. 

 

 

As far as typing a detailed message on mychart- Id figure you can briefly say something like- My insurance company has initially denied my MRI and is requesting a peer to peer. I only have until (date) to get this done. Your staff told me you are unavailable to do this. Can you please ask your nurse/pa/np etc. to do it for me before I run out of time? This is a time sensitive issue.

 

4 minutes ago, HazletonEagle said:

They are a couple minutes. Person in your office says we are trying to get an MRI approved for patient x. He has so and so going on. These are the signs/symptoms/positive tests. 

Insurance company states why it is not being approved.

Person from your office usually responds with "Well didnt you read the notes? Its all in there that he has been exhibiting such and such symptoms that you are talking about."

Then, approved.

 

Its usually a brief discussion where the insurance company looks stupid like they didnt bother reading and denied your test. 

 

 

As far as typing a detailed message on mychart- Id figure you can briefly say something like- My insurance company has initially denied my MRI and is requesting a peer to peer. I only have until (date) to get this done. Your staff told me you are unavailable to do this. Can you please ask your nurse/pa/np etc. to do it for me before I run out of time? This is a time sensitive issue.

 

I'll see what they say tomorrow. Not gonna hold my breath, but who knows maybe I'll get a lucky break.

1 hour ago, Sack that QB said:

There are a lot of things I love about America but insurance in this country Fing sucks. It’s a terrible feeling when you need to get something done, your insurance company won’t cover it, and your doctors office kinda shrugs at you and goes sorry, nothing we can do and just sends you on your way like you’re at a convenience store looking for batteries and they say they’re all sold out.

My insurance company keeps denying this MRI for whatever reason. My doctor thinks I really need it, but because the insurance keeps denying it the doctors office basically is just telling me "so sorry, there’s nothing we can do, good luck with your pain”

Did you appeal?  The basic fact about most health insurance is that they are driven by ICD 10 diagnosis and treatment codes.   Suspect the code used by your doctor’s office is such that the conclusion is an MRI isn’t medically necessary and that is the basis of the refusal on referral.  (Your doctor’s staff probably keep submitting the same referral and codes.).  Don’t get me wrong, the coding process is a nightmare with ICD10s.  

My experience is to call them out on the coding and ask if they actually read the medical records and the basis for referral. Do it in writing by post (mail).  Unlike property, automobile, liability and worker’s compensation, health insurers don’t have adjusters.   They run things through a rule driven engine with cursory review, if any.  They are code driven. In contrast, an appeal through a well worded letter does get their attention and can get them to actually review the medical notes.  

If that doesn’t work, consider a complaint to your state insurance department.   Most states require an answer from the insurer and frequently that includes documentation to support the position.  At my corporation, the response was sent by an executive. 

This officiating crew is worthy of this game.

7 minutes ago, Sack that QB said:

I'll see what they say tomorrow. Not gonna hold my breath, but who knows maybe I'll get a lucky break.

If it requires getting a little louder on the phone (without beingi a D to them) then you gotta do what  you gotta do to advocate for your healthcare. I would tell them I understand if the doctor is not available but this is a time sensitive issue and if he is not available there has to be someone in the office capable of doing peer to peers so that patients can receive appropriate care. 

Other options you have after tomorrow if it doesnt resolve to your liking are to ask to speak to an office manager. 

Going above that there is often a number to call in health systems for a patient advocate who you can voice your concerns to. 

When you end up dealing with the sort of issues corporate medicine tends to cause where some people can fall through the cracks, you can usually get places by complaining higher up because it becomes a customer service issue that the higher ups will want to resolve.

 

If none of that works you can always call and complain to your insurance company. And sometimes it works if you ask if they are prepared to pay for exorbitant medical bills after your condition deteriorates because THEY would not let you receive appropriate care- which is all documented in your health record.  Sometimes that works.

Mariota is pretty bad, isn’t he?

1 hour ago, Sack that QB said:

Absolutely absurd. Either super high premiums and low deductibles or super high deductibles with lower premiums. Either way, you pay out the ass.

Profits for health insurers are limited by the Affordable Care Act.  The deductibles were driven by a focus towards encouraging the consumer to actually shop medical costs like pretty much everything else we buy.  Medical care inflation is ridiculous compared to other inflation (except possibly college costs).

According to the U.S. Bureau of Labor Statistics, prices for medical care services are 5,928.96% higher in 2022 versus 1945 (a $1,185.79 difference in value). Between 1945 and 2022: Medical care services experienced an average inflation rate of 5.47% per year. This rate of change indicates significant inflation.

1 hour ago, Sack that QB said:

None of them want to pay and will deny as much as they can. "You must prove it’s medically necessary” yeah doctors order MRIs for fun! Not necessary.

Actually, MRI equipment is expensive and there has been a tendency to over recommend MRIs when they are not necessary.  CT scans are the norm in most instances.   

7 minutes ago, FranklinFldEBUpper said:

Mariota is pretty bad, isn’t he?

Yes. Just missed a wide open Pitts (again)

Just now, RLC said:

Yes. Just missed a wide open Pitts (again)

 

11 minutes ago, BigEFly said:

Did you appeal?  The basic fact about most health insurance is that they are driven by ICD 10 diagnosis and treatment codes.   Suspect the code used by your doctor’s office is such that the conclusion is an MRI isn’t medically necessary and that is the basis of the refusal on referral.  (Your doctor’s staff probably keep submitting the same referral and codes.).  Don’t get me wrong, the coding process is a nightmare with ICD10s.  

My experience is to call them out on the coding and ask if they actually read the medical records and the basis for referral. Do it in writing by post (mail).  Unlike property, automobile, liability and worker’s compensation, health insurers don’t have adjusters.   They run things through a rule driven engine with cursory review, if any.  They are code driven. In contrast, an appeal through a well worded letter does get their attention and can get them to actually review the medical notes.  

If that doesn’t work, consider a complaint to your state insurance department.   Most states require an answer from the insurer and frequently that includes documentation to support the position.  At my corporation, the response was sent by an executive. 

Yeah, either my doctor’s office or the insurance mentioned something about the codes. I forget which it was a long few days talking to so many people over the phone. I was told the appeal is an option if the peer to peer fails, but I’m not sure how the appeal specifically works. Will I get a chance to give a more detailed reason? Or does it vary by the insurer. I could have sworn last time I appealed something I didn’t have the option to give a more detailed explanation and it was just them passing off my case to another worker to have them review it. But I can’t be sure, maybe that wasn’t insurance and it was something else. It was a while ago.

The insurance company gave me a list of the criteria I’d need for it to get approved. But my doctor’s office told me those were in the notes. So I don’t know, maybe it’s what Hazleton said and someone over there isn’t reading the notes properly.

11 minutes ago, HazletonEagle said:

If it requires getting a little louder on the phone (without beingi a D to them) then you gotta do what  you gotta do to advocate for your healthcare. I would tell them I understand if the doctor is not available but this is a time sensitive issue and if he is not available there has to be someone in the office capable of doing peer to peers so that patients can receive appropriate care. 

Other options you have after tomorrow if it doesnt resolve to your liking are to ask to speak to an office manager. 

Going above that there is often a number to call in health systems for a patient advocate who you can voice your concerns to. 

When you end up dealing with the sort of issues corporate medicine tends to cause where some people can fall through the cracks, you can usually get places by complaining higher up because it becomes a customer service issue that the higher ups will want to resolve.

 

If none of that works you can always call and complain to your insurance company. And sometimes it works if you ask if they are prepared to pay for exorbitant medical bills after your condition deteriorates because THEY would not let you receive appropriate care- which is all documented in your health record.  Sometimes that works.

I’d be willing to call the insurance company back and complain. In my experience the people on the phone are basically like just operators, I could ask if they could transfer me to a higher up. 
 

‘Maybe it’s just my insecurities, but every time I call a doctor’s office I always feel like I’m annoying them because 90% of healthcare people whether it’s doctors offices or hospitals always sound annoyed on the phone. But maybe they just sound this way for everyone. Hard to tell. I’ve been off and on the phone with this office several times over the last couple weeks going back and forth with this and I feel they’re getting annoyed with me, but it’s not really like I have a choice and I’m calling about something stupid like an ingrown hair. They know damn well this is serious. So I’m going to get a little more adamant if need be.

14 minutes ago, BigEFly said:

Profits for health insurers are limited by the Affordable Care Act.  The deductibles were driven by a focus towards encouraging the consumer to actually shop medical costs like pretty much everything else we buy.  Medical care inflation is ridiculous compared to other inflation (except possibly college costs).

According to the U.S. Bureau of Labor Statistics, prices for medical care services are 5,928.96% higher in 2022 versus 1945 (a $1,185.79 difference in value). Between 1945 and 2022: Medical care services experienced an average inflation rate of 5.47% per year. This rate of change indicates significant inflation.

The biggest govt subsidies to demand…imagine that…

6 minutes ago, RLC said:

Yes. Just missed a wide open Pitts (again)

Brutal miss