American Healthcare continues to go backward
- Thread starter steross
- Start date
Trump did his own research.
And, thanks for sending me into that disaster pit I had mostly been avoiding. I couldn't help myself. I ignored the imbecilic, "Why should I get more than 1x boosters if I feel completely fine, let alone why should I get it at all if I was fine before?" Ummm, well, because you want to continue to feel fine.
But, the "control" thing.....I just......
But... don't they WANT unidentified masked government agents randomly pulling people off the streets?
The two red areas in South Dakota are the large Indian reservations. Many of the red patches in the west I believe are Indian reservations. Interesting that the Texas/Mexico border has a longer life expectancy than most of Texas when the governor acts like it is a lawless area. Looks like the major cities in Texas have enough healthy "city people" to overcome the unhealthy lifestyle that is the southern US. Oklahoma, not yet but the cities appear to be trying.
Maybe Trump should use this map to decide where to send troops as so far he is sending them into "hellholes" where people tend to live longer.
That math tracks here in MAGAstan, Michigan. One of my performance measures is percentage of diabetics on statins and I will never meet it, because there is a huge number of anti-vax, anti-pharma, anti-statin here in MAGAstan (but somehow okay with big tobacco). It would be interesting to compare the BMI between Up North and below the population line, but I’d be willing to bet it’s significantly higher (unfortunately my own BMI doesn’t help, but I am working on it).
But it’s socio-economic-cultural. That map as much as anything shows poor, rural, poorly educated areas. And I’ve spent most of my career providing healthcare in places like East Albany where the food choices are garbage. You eat garbage and you get fat.
This can't be more true. My patients on GLP-1s that do not lose weight, I firmly believe, continue to eat processed foods (some can admit it, some can't). The meds help stop those cravings but do not take them away completely. People in those habits that don't given them up but continue to believe that they can eat the same but just eat less fail each time. The ones that change their diet are generally wildly successful and many can get off, or mostly off the meds and maintain.
People who actually work with move and take the GLP1 lose weight. People who half ass with move, or drop out, don’t. We’re starting to take people off.
I have a housekeeper, someone who comes in once a week and does the cleaning that I don’t want to do. She’s ridiculously cheap. In the past two months I’ve started paying her more. She didn’t ask and she hasn’t said anything, I just started paying her more. I was at the grocery store one day and bought three small bags of groceries and it was $150 bucks. She’s close to my age. I can’t imagine what that’s like for her.
This country is so screwed up.
This country is so screwed up.
My SIL may have gotten bitten by a bat over the weekend. She went into the hospital to get rabies shots as a precaution (on the advice of her Dr.).
Before telling her the price of the shots, or if her insurance would cover it, they gave her 2 of the 3 injections. Turns out her insurance won't cover it, and it's $20k out of pocket. She didn't go in for the 3rd shot.
Before telling her the price of the shots, or if her insurance would cover it, they gave her 2 of the 3 injections. Turns out her insurance won't cover it, and it's $20k out of pocket. She didn't go in for the 3rd shot.
Good lord
That's a bunch of bs. The insurance company is saying her life isn't worth 20K
Also 20K for a shot thats been around for decades? That whole situation is messed up.
I have no idea why insurance won't cover it. But she's having to choose between a potential of rabies and paying off medical debt for years. They are self employed and live in Nebraska. I can't imagine what their premiums are going to be soon.
Ok, a lot to unwrap here.
1. When you get bit, you get the vaccine and HRIG- human rabies immune globulin. You get the HRIG on the first visit and it is wildly expensive as it is not easy to make immune globulin. You get sent to the ER because of this. It is typically injected 50/50 IM and at the site of the bite which can be difficult. No regular doc keeps it in the office as it is too expensive to keep and let expire for the unlikely event of a rabies patient at a clinic.
2. No ER doc is going to not give you a medicine for a 100% fatal disease because the healthcare financing in the country is f-ed. We cannot possibly know if your insurance will cover it. Even if we called (impossible to do in an emergency room) they would not tell us. This is a medical emergency and if you have insurance for medical emergencies I cannot see how it would not be covered. That is the f-ed up part.
3. We do know that if a person that came in with potential rabies, got told "this stuff is holy $#!^ expensive" causing the person to choose to forgo treatment, gets rabies and dies, they would have a wealthy family at the expense of that docs future earnings as such a case could go well above malpractice insurance limits.
3. The HRIG is the expensive part, not the 3rd dose of vaccine. She should get the series and now that the critical part is over, should be able to talk to someone in the financial part about the cost.
4. The "$20K" is almost certainly the cost off of the codemaster. Nobody who is not insane pays that. Basically, it is a made up price list that is used for insurance companies to say, "We will only pay ~20% of typical charges." Well, make a stupid list of "typical" charges as a negotiation tactic. She should just say, I cannot afford that. I can pay $100 a month up to $4000 dollars or I can pay you $2000 today as a total payment and then pay back my credit card. Hospitals like pay right now and will take a substantial cut to the price to get it overwith.
Last edited:
Also, denial is the name of the game for insurance. It is a no lose situation for them. If they pay the claim, it costs money. If they deny the claim, they put the onus on the patient to appeal and fight them. Some will and eventually they end up paying exactly what they would have paid. Some won’t so they keep their money.
I think insurance companies should be forced to pay for a panel that adjudicates all denials. And denials that the company made that the independent board overturns costs the insurance company 10% extra for wasting the patient’s time and money.
I think insurance companies should be forced to pay for a panel that adjudicates all denials. And denials that the company made that the independent board overturns costs the insurance company 10% extra for wasting the patient’s time and money.
Polds4OSU
Marshall
Hahaha they are installing AI software that denies at 90%+ rates
I was honestly hoping you would way in, I appreciate it, and totally understand all of your points. I hope that she doesn't have to pay the entire $20k, and also doesn't have rabies. Totally not blaming the Dr's in this instance, more just a symptom of our effed up insurance scam system
FYI for anyone that may need it:
My health insurance comes with "care coordinators" who fight on the patient's behalf to get things right with whoever is making things difficult. Long story short, if you're having a difficult time, they step in and handle the BS. In my instance, it was a billing F-up by Stillwater Medical Center that was trying to get dumped on us. It took a while, but the folks handling everything for me ended up being able to show that SMC screwed up, and told them to pound sand.
They were excellent, and the other folks I know that have used them said the same.
My health insurance comes with "care coordinators" who fight on the patient's behalf to get things right with whoever is making things difficult. Long story short, if you're having a difficult time, they step in and handle the BS. In my instance, it was a billing F-up by Stillwater Medical Center that was trying to get dumped on us. It took a while, but the folks handling everything for me ended up being able to show that SMC screwed up, and told them to pound sand.
They were excellent, and the other folks I know that have used them said the same.
I have a patient that was getting Leqvio infusions from cardiology for a year. Cardiology, not comm care cardiology. He submitted a request to the VA for the Leqvio. We denied it because: 1) we didn't have a comm care agreement and we don't approve ANY non-form requests where we don't have a comm care agreement, and 2) it's about $12k per dose including the cost of the infusion center and it has to be given every three months. He was told the VA was paying for it and got it for a year. Then he was told the VA wasn't paying for it and was sent to me to get it approved. I was like, I've never seen it approved ever, and it wasn't approved in your case, I'm looking at the denial, and I don't know how it was being paid for and I'm afraid you're going to end up getting a bill. "Oh no, we were told the VA was paying for it and that we wouldn't get a bill." <gasp!>
Talk with my superiors and none of that can possibly be true. My supervisor was the one who denied the non-form request.
But, back with the patient, here are the hoops we have to jump through if we ever hope to get the Leqvio approved. Did I mention that this was the patient that claimed that cholestyramine caused muscle cramps? For the non-medical, cholestyramine binds cholesterol in the GI tract and isn't absorbed. It has GI side effects, but because it isn't absorbed it can't really have side effects outside of the GI tract except for allergic reactions. Almost anything can cause allergic (immune) reactions. I spend close to a year going through non-statin meds with this guy... and in my last call with him he tells me that cardiology had called him and told him that Leqvio had been approved by the VA again and he had gotten another infusion. I told him, and I quote, "I'm happy for you and I'm going to pretend I know nothing about it." One thing I am absolutely certain of is that the VA isn't paying for it. I do not know who is. Another thing that I'm certain of is that it is doing amazing things for his lipids.
Last edited:
Similar threads
