Getting old sucks

[Crapinon 2250]

And doctors forcing people to pay up front, might not be legal. My son-in-law had surgery last year. The surgery center tried to force my daughter to pay for it all upfront. She pulled out the contract and told them to stick it where the sun don't shine because they couldn't do that according to their agreement with the insurance company. When I had my shoulder surgery, they made me pay $50 every rehab visit. When the new year rolled around I handed the desk my credit card to pay for my visit and they pulled up my account. Long story short they overcharged my almost $1800 the previous year and had to cut me a check. If i hadn't ask they wouldn't have paid me until they closed the books at the end of the year. The exact same thing happened with the MRI company. I got a check for $900 a year after I had my MRI because they "accidentally" overcharged me. I can't imagine how much money they bank with overcharges.  

Edited June 1, 2023 by Crapinon
I'm old and ramble incoherently

[SilasCoade 2620]

2 hours ago, Crapinon said:

They believe they can get around the limits set by insurance companies by submitting outrageously oversized bills, hoping that insurance will miss something and overpay.

That may be the motivation for some but for most it's actually just simpler to submit one charge that you know is higher than the highest charger altered by any of the 732 different benefit plans your bill could be subject to. Rather than waste the medical office staff time getting familiar with the details of every plan, which change randomly anyway, just bill the most and let them figure out how much they actually owe. If there were a single payer system this would all go away immediately.

[Crapinon 2250]

7 minutes ago, SilasCoade said:

That may be the motivation for some but for most it's actually just simpler to submit one charge that you know is higher than the highest charger altered by any of the 732 different benefit plans your bill could be subject to. Rather than waste the medical office staff time getting familiar with the details of every plan, which change randomly anyway, just bill the most and let them figure out how much they actually owe. If there were a single payer system this would all go away immediately.

This happens all the time; there is a set charge for a procedure. But instead of the doctor having a set cost for the whole thing, they a la cart the invoice hoping it will get around the insurance codes. They add separate lines for sutures, bandages, gloves, giving an injection (the cost of the medicine is covered but there is a separate line charge for actually giving the shot, etc.  Anesthesiologist get screwed all the time because of the way the hospital bills. You would assume that with a surgery you would need one to proceed but because they appear as a separate line on the bill, they are required to have preauthorization. If the hospital doesn't submit it for preauthorization, their fee can be declined. I know they are correcting this but the games that are played between the insurance companies and doctors/hospital are insane.

[SilasCoade 2620]

You keep saying doctors but

Quote

They add separate lines for sutures, bandages, gloves, giving an injection (the cost of the medicine is covered but there is a separate line charge for actually giving the shot, etc. 

That's mostly not doctors. 

[Not that Bob 734]

Went for "follow up" visit to sleep specialist who prescribes my cpap.

1) see nurse practitioner who takes follow up notes. Code 1.

2) See dme who has the machine and supplies. Code 2.

3) See nurse "specialist" who shows me how to use the machine...in the event I have forgotten over the 20 years I have been using. Code 3.

4) Doctor comes in, slaps me on the shoulder, says "You look good". Leaves after 20 second "visit". Code 4. 

4 billable codes in a 15 minute visit.

 

[SilasCoade 2620]

What are the codes?

[SHOOTER12 8787]

On 5/31/2023 at 2:54 PM, Armybrat said:

Mrs. Brat fell down a short 3 stair flight in London 5 years ago at St. Paul’s Cathedral.
 Hit the stone floor with her face….blood spattered, broke her nose, broke her left wrist (required surgery to put it back together with a titanium plate and a bunch of screws), and bruised her legs so bad she couldn’t walk for two weeks. Never mind all the swelling in her face and both hands & legs.
Pretty rough spill for a 73 year old woman. I thought briefly she had killed herself.

 

Dang brat....

[nnm 36041]

21 hours ago, SilasCoade said:

If there were a single payer system this would all go away immediately.

Yep, everyone knows there is absolutely no fraud on government-run systems. Road construction, garbage collection, defense spending—all models of efficiency and clean, pure, above-reproach taxing and spending.  Let’s do that.  

[Crapinon 2250]

20 hours ago, SilasCoade said:

You keep saying doctors but

That's mostly not doctors. 

Yeah, my family members who process claims would beg to differ with you on this one. 

[SilasCoade 2620]

1 hour ago, Crapinon said:

Yeah, my family members who process claims would beg to differ with you on this one. 

That's because doctors are technically the ones responsible and signing the charges but that's a farce. The doctors are just complying with the system. You don't want all those charges? Change the system.

[Crapinon 2250]

15 minutes ago, SilasCoade said:

That's because doctors are technically the ones responsible and signing the charges but that's a farce. The doctors are just complying with the system. You don't want all those charges? Change the system.

 

[SilasCoade 2620]

I just get so tired of people blaming doctors for a system that doctors don't control. There may have been a time that was the case but that time is at least 30 years in the past.

[Crapinon 2250]

1 hour ago, SilasCoade said:

I just get so tired of people blaming doctors for a system that doctors don't control. There may have been a time that was the case but that time is at least 30 years in the past.

Of course there are good doctors who just want the best for their patients. Mine is one of them. He has gone out of his way to protect me from some of the inane rules of insurance. But the insurance companies also have a long list of doctors who refuse to play by the rules and constantly try to scam them out of more money.

In the movie Patton, he made the comment (paraphrased) that Americans and Brits are basically the same people separated by a common language. And I think that's what happens in the medical/insurance business. Believe it or not, most insurance claims processors want to side with the patient rather than their own company because they understand the struggles people have with paying for costly medical. But if procedures are not followed correctly by the provider they are powerless to change the claims because the adjusters above them will shoot it all down and write them up. And the processors are not allowed to tell the doctors office how to fill paperwork out properly. They will ask for more information, hoping they get what they need. It's a constant back and forth with the patient in the middle. 

[SilasCoade 2620]

You have highlighted exactly what I'm saying. Doctors don't know how much your insurance will pay for anything. They don't know what sounding your insurance has for covering certain medications, tests, or procedures. So they shoot high on the bill and tell the insurance to sorry it out. They send all the information in the chart, which is seldom read, and wait for the denial too tell them what information the insurance actually wants. It's the worst possible system out of all potential systems, but it's is not primarily driven by the doctors acting or billing in bad faith.

Fwiw, absolutely there are crooked doctors doing crooked shit, but that's a small minority. The selection process for admittance to medical school prioritizes intelligence and following the rules. So those are the people you get being doctors, people who inherently want to follow the rules.

[Armybrat 40710]

59 minutes ago, Crapinon said:

Of course there are good doctors who just want the best for their patients. Mine is one of them. He has gone out of his way to protect me from some of the inane rules of insurance. But the insurance companies also have a long list of doctors who refuse to play by the rules and constantly try to scam them out of more money.

In the movie Patton, he made the comment (paraphrased) that Americans and Brits are basically the same people separated by a common language. And I think that's what happens in the medical/insurance business. Believe it or not, most insurance claims processors want to side with the patient rather than their own company because they understand the struggles people have with paying for costly medical. But if procedures are not followed correctly by the provider they are powerless to change the claims because the adjusters above them will shoot it all down and write them up. And the processors are not allowed to tell the doctors office how to fill paperwork out properly. They will ask for more information, hoping they get what they need. It's a constant back and forth with the patient in the middle. 

Yep, gotta get those codes right in the provider’s office in the first place. 
And there are a bajillion codes to screw up if the paper shufflers/office clerks aren’t competent.

[NeverMarryAStripper 21781]

1 hour ago, Crapinon said:

And the processors are not allowed to tell the doctors office how to fill paperwork out properly. They will ask for more information, hoping they get what they need. It's a constant back and forth with the patient in the middle. 

Even the IRS will tell you how to fill out their forms.  I think this right here just might be part of the reason our medical system is so fucked up.

[Crapinon 2250]

5 minutes ago, SilasCoade said:

You have highlighted exactly what I'm saying. Doctors don't know how much your insurance will pay for anything. They don't know what sounding your insurance has for covering certain medications, tests, or procedures. So they shoot high on the bill and tell the insurance to sorry it out. They send all the information in the chart, which is seldom read, and wait for the denial too tell them what information the insurance actually wants. It's the worst possible system out of all potential systems, but it's is not primarily driven by the doctors acting or billing in bad faith.

Fwiw, absolutely there are crooked doctors doing crooked shit, but that's a small minority. The selection process for admittance to medical school prioritizes intelligence and following the rules. So those are the people you get being doctors, people who inherently want to follow the rules.

Maybe not acting in bad faith but they don't know what they're doing and often ignore the information the  processors are requesting. If they send a bill and say "you can figure it out for me" they are doing their patients  a disservice. They may be great doctors but they are horrible business people. And you can say whatever you want but insurances are businesses and you have to communicate with them in a language they understand. A lot of the times the doctors will start a procedure without checking with insurance to even see if it's covered. Or if it is covered, are they following the guidelines of both the insurance company and the pharmaceutical company who invented the medicine/process. There a a lot of experimental procedures that have to be done in the correct order not only for billing purposes but also for the safety of the patient. If they call insurance before the procedure, they will give then the guidelines they need to follow. They rarely do.

If they would hire someone who knew what they were doing to do the billing it would simplify things. I keep telling my kids they need to leave insurance and go to work for doctors and work in their billing department. My daughter said every job she has applied for in a doctors office (and even some large rehab centers) offer $ 9-12 hour with no benefits. If they were serious they would up their game. We're just going to have to disagree on this. Yes there are good doctors. But there are hundreds of thousands of bad ones too. 

[Armybrat 40710]

Where do I sign?

 

Where do I sign?

 

[Crapinon 2250]

14 minutes ago, NeverMarryAStripper said:

Even the IRS will tell you how to fill out their forms.  I think this right here just might be part of the reason our medical system is so fucked up.

This applies to trying to correct claims. When a claim is filled out wrong they will ask for the necessary information to process the claim. If they call before the procedure they will get all the information they need to handle it properly.  

Years ago, I had a bunch of testing done at UTSW. Two days before the testing (scheduled months in advance) UTSW had not even called my insurance company to get approval for the procedure. I had to call UTSW and tell them to call my insurance company for approval.  She acted like it wasn't a big deal, when I felt it was kind of important. 

[SilasCoade 2620]

On 6/2/2023 at 12:40 PM, Crapinon said:

Maybe not acting in bad faith but they don't know what they're doing and often ignore the information the  processors are requesting. If they send a bill and say "you can figure it out for me" they are doing their patients  a disservice. They may be great doctors but they are horrible business people. And you can say whatever you want but insurances are businesses and you have to communicate with them in a language they understand. A lot of the times the doctors will start a procedure without checking with insurance to even see if it's covered. Or if it is covered, are they following the guidelines of both the insurance company and the pharmaceutical company who invented the medicine/process. There a a lot of experimental procedures that have to be done in the correct order not only for billing purposes but also for the safety of the patient. If they call insurance before the procedure, they will give then the guidelines they need to follow. They rarely do.

If they would hire someone who knew what they were doing to do the billing it would simplify things. I keep telling my kids they need to leave insurance and go to work for doctors and work in their billing department. My daughter said every job she has applied for in a doctors office (and even some large rehab centers) offer $ 9-12 hour with no benefits. If they were serious they would up their game. We're just going to have to disagree on this. Yes there are good doctors. But there are hundreds of thousands of bad ones too. 

Why do doctors need to speak the insurers language rather than the other way around? On the one hand you have a group of people trying to alleviate suffering and improve quality of life. On the other hand you have the business people. And you think the business people should be in charge of the system? Well guess what, they are in charge and that's why the system is totally fucked. Is really not the doctors John to know what form to fill out or what single keyword the insurance will accept as justification for a procedure or test. It is the doctor's job to know what test is necessary or what procedure can help the patient. In truth the doctor should NEVER even have a single communication with your insurance. The doctor should communicate only to the patient. The patient should pay the doctor. The patient should communicate with insurance for reimbursement. The insurance should communicate with patient for spring documentation. 

Edited June 6, 2023 by SilasCoade
Even better would be for insurance companies to cease to exist

[msbesq 385]

Just turned 65 and still alive. Phew!

[CycleTex87 2953]

2 hours ago, Armybrat said:

Yep, gotta get those codes right in the provider’s office in the first place. 
And there are a bajillion codes to screw up if the paper shufflers/office clerks aren’t competent.

They aren't

[Dennis Taylor 18690]

7 hours ago, NeverMarryAStripper said:

  I think this right here just might be part of the reason our medical system is so fucked up.

How many pharma commercials do you see in the average hour of TV? 

[GoPokes83 2236]

All I’m reading is a shit ton of humblebragging that you guys are seeing doctors. Other than the occasional specialist I don’t think I’ve seen an actual doctor in a dozen years! But the PA’s I’ve seen seem to do a pretty decent job.

[NeverMarryAStripper 21781]

18 minutes ago, Dennis Taylor said:

How many pharma commercials do you see in the average hour of TV? 

It’s important that all those people with a flaccid penis covered in moderate to severe psoriasis know that help is available

[tfoolry 8179]

[Not that Bob 734]

On 6/1/2023 at 2:23 PM, SilasCoade said:

What are the codes?

I don't remember the codes but they were each one listed on my receipt. I think this guy set up his office system to bill the maximum number of codes for each visit. I don't think all docs do that at all but some do. Worse is the corporate medicine that has taken over. No matter how well intentioned the doc is they are pushed by the "company " to rush and see as many patients a day as possible. I had a pcp that I loved. Smart. Up to date. He finally quit because the company that bought out his partnership wouldn't let him practice up to the standard he had practiced over the years. I respect him for quitting rather than practicing medicine that he considered substandard. 

[tfoolry 8179]

I’m on 3rd pcp in 3 years.  Apparently doctors don’t like Cigna.  

[Crapinon 2250]

8 hours ago, Not that Bob said:

I don't remember the codes but they were each one listed on my receipt. I think this guy set up his office system to bill the maximum number of codes for each visit. I don't think all docs do that at all but some do. Worse is the corporate medicine that has taken over. No matter how well intentioned the doc is they are pushed by the "company " to rush and see as many patients a day as possible. I had a pcp that I loved. Smart. Up to date. He finally quit because the company that bought out his partnership wouldn't let him practice up to the standard he had practiced over the years. I respect him for quitting rather than practicing medicine that he considered substandard. 

When my PSA numbers first jumped through the roof I had a female urologist who ended up quitting for the same reason. It made me mad. She was thorough, would explain things out, really seemed to care and she had very small hands.

[Armybrat 40710]

1 hour ago, Crapinon said:

When my PSA numbers first jumped through the roof I had a female urologist who ended up quitting for the same reason. It made me mad. She was thorough, would explain things out, really seemed to care and she had very small hands.

Mine did a very thorough job fondling my junk. She was pretty easy to look at too.

[Dennis Taylor 18690]

6 hours ago, Crapinon said:

When my PSA numbers first jumped through the roof I had a female urologist who ended up quitting for the same reason. It made me mad. She was thorough, would explain things out, really seemed to care and she had very small hands.

Maybe she does freelance work now with the insurance companies not involved, if ya know what I'm sayin

[nnm 36041]

In the middle of a meeting Friday afternoon, suddenly I felt like I’d been hit by a truck. I thought it was flu or Covid and came home to rest.

Rested Saturday. My whole body ached, chills, headache, etc.  Also started having trouble peeing.  

Went to ER first thing Sunday morning, negative for everything. Rested Sunday afternoon. 

Sunday night no sleep. Intense pain, couldn’t pee more than a few dribs and drabs, and it hurt like hell to try. 

Monday morning, back to ER. Tests, etc., etc.  Pain from not peeing, and from trying to pee, was worse than shoulder surgery, worse than ripping my ear halfway off, worse than breaking the many bones I broke in a misspent youth. 

It won’t be confirmed until I get in to see a urologist later this week, but it is probably severe prostate infection/inflammation.  I’m back home with a catheter, the insertion of which through that infected, inflamed prostate was like a red hot poker being shoved up my peehole. And having a catheter is pretty stinkin’ uncomfortable every time I move an inch. I can’t see myself sleeping tonight either.

Apparently this is a thing that sometimes happens to “older guys.”  
 

[Crapinon 2250]

7 hours ago, nnm said:

In the middle of a meeting Friday afternoon, suddenly I felt like I’d been hit by a truck. I thought it was flu or Covid and came home to rest.

Rested Saturday. My whole body ached, chills, headache, etc.  Also started having trouble peeing.  

Went to ER first thing Sunday morning, negative for everything. Rested Sunday afternoon. 

Sunday night no sleep. Intense pain, couldn’t pee more than a few dribs and drabs, and it hurt like hell to try. 

Monday morning, back to ER. Tests, etc., etc.  Pain from not peeing, and from trying to pee, was worse than shoulder surgery, worse than ripping my ear halfway off, worse than breaking the many bones I broke in a misspent youth. 

It won’t be confirmed until I get in to see a urologist later this week, but it is probably severe prostate infection/inflammation.  I’m back home with a catheter, the insertion of which through that infected, inflamed prostate was like a red hot poker being shoved up my peehole. And having a catheter is pretty stinkin’ uncomfortable every time I move an inch. I can’t see myself sleeping tonight either.

Apparently this is a thing that sometimes happens to “older guys.”  
 

Welcome to the old man club. I've never had mine shut down completely but I've seen older guys crying because they couldn't pee. Last time my PSA jumped to 15 it was because i had an infection/inflammation. My doc put me on 600 mg of Ibuprofen a day (1 600mg tablet a day) for a month and it cleared it up. Good luck

[GoPokes83 2236]

In the middle of a meeting Friday afternoon, suddenly I felt like I’d been hit by a truck. I thought it was flu or Covid and came home to rest.
Rested Saturday. My whole body ached, chills, headache, etc.  Also started having trouble peeing.  
Went to ER first thing Sunday morning, negative for everything. Rested Sunday afternoon. 

Sunday night no sleep. Intense pain, couldn’t pee more than a few dribs and drabs, and it hurt like hell to try. 
Monday morning, back to ER. Tests, etc., etc.  Pain from not peeing, and from trying to pee, was worse than shoulder surgery, worse than ripping my ear halfway off, worse than breaking the many bones I broke in a misspent youth. 

It won’t be confirmed until I get in to see a urologist later this week, but it is probably severe prostate infection/inflammation.  I’m back home with a catheter, the insertion of which through that infected, inflamed prostate was like a red hot poker being shoved up my peehole. And having a catheter is pretty stinkin’ uncomfortable every time I move an inch. I can’t see myself sleeping tonight either.

Apparently this is a thing that sometimes happens to “older guys.”  
 

Holy smokes! Counting my dang blessings!! Hopefully something extremely temporary.

[Elvis 3356]

I'm not old yet, but I got a prostate infection around 35 years old after a vasectomy.  That was not cool.  not cool at all.  I went to my uroligist and he stuck his finger up my butt in a very not cool way.  I saw stars and passed out on the floor right there.  They didn't pick me up or anything.  I woke up on the floor and I told him that was not cool.  not cool.

[Jerry Callo 8663]

[nnm 36041]

7 minutes ago, Elvis said:

I'm not old yet, but I got a prostate infection around 35 years old after a vasectomy.  That was not cool.  not cool at all.  I went to my uroligist and he stuck his finger up my butt in a very not cool way.  I saw stars and passed out on the floor right there.  They didn't pick me up or anything.  I woke up on the floor and I told him that was not cool.  not cool.

A question and a comment:

Question: Have you had more than one vasectomy?

Comment: I had a hematoma in my scrotum after my (one and only) vasectomy in 2001. Filled up with blood to the size of a softball.  Not fun. I spent almost a month in the jacuzzi tub, the only way I could get relief. 

[Elvis 3356]

Just the one vasectomy.  Wife had life threatening complications after an ablasion (it shuts down the baby maker but not the fun tunnel).  Well that turned into sepsis. A week in intensive care with her with a 1 year old and a 5 year old was also not cool.  not cool.

 

But no more kids!

[Jerry Callo 8663]

There are two vasa deferentia.  Thus, two vasectomies.

[CycleTex87 2953]

On 6/6/2023 at 12:53 AM, nnm said:

In the middle of a meeting Friday afternoon, suddenly I felt like I’d been hit by a truck. I thought it was flu or Covid and came home to rest.

Rested Saturday. My whole body ached, chills, headache, etc.  Also started having trouble peeing.  

Went to ER first thing Sunday morning, negative for everything. Rested Sunday afternoon. 

Sunday night no sleep. Intense pain, couldn’t pee more than a few dribs and drabs, and it hurt like hell to try. 

Monday morning, back to ER. Tests, etc., etc.  Pain from not peeing, and from trying to pee, was worse than shoulder surgery, worse than ripping my ear halfway off, worse than breaking the many bones I broke in a misspent youth. 

It won’t be confirmed until I get in to see a urologist later this week, but it is probably severe prostate infection/inflammation.  I’m back home with a catheter, the insertion of which through that infected, inflamed prostate was like a red hot poker being shoved up my peehole. And having a catheter is pretty stinkin’ uncomfortable every time I move an inch. I can’t see myself sleeping tonight either.

Apparently this is a thing that sometimes happens to “older guys.”  
 

but pipe laying is ok, right?

 

right???

[nnm 36041]

1 hour ago, CycleTex87 said:

but pipe laying is ok, right?

 

right???

Not an option with a hose coming out the end of one's member, connected to a bag.  

Morning wood is not pleasant under these circumstances.  

[CycleTex87 2953]

13 minutes ago, nnm said:

Not an option with a hose coming out the end of one's member, connected to a bag.  

Morning wood is not pleasant under these circumstances.  

Yep, sorry dude.  Just making light of your situation.

[UT_OB1 2200]

I think I’m peeing 6-9 times a night. I’m already about to make my 4 trip since laying down 3 hours ago. Wtf

[Not that Bob 734]

1 minute ago, UT_OB1 said:

I think I’m peeing 6-9 times a night. I’m already about to make my 4 trip since laying down 3 hours ago. Wtf

If you're serious, go to a doctor. Something is making your lower body retain water which sluffs off when you lay down and gravity helps expel the water. 

[UT_OB1 2200]

27 minutes ago, Not that Bob said:

If you're serious, go to a doctor. Something is making your lower body retain water which sluffs off when you lay down and gravity helps expel the water. 

Yeah. Serious. Been a 5th time since last post. We’ll fuck me that sounds bad. I don’t have a regular dr.  What type of dr should I be looking for?

[tbone_ 14020]

Probably a regular one to start with

[RPM 26208]

On 6/6/2023 at 3:34 PM, Elvis said:

I'm not old yet, but I got a prostate infection around 35 years old after a vasectomy.  That was not cool.  not cool at all.  I went to my uroligist and he stuck his finger up my butt in a very not cool way.  I saw stars and passed out on the floor right there.  They didn't pick me up or anything.  I woke up on the floor and I told him that was not cool.  not cool.

[Not that Bob 734]

UT_OB1. See pm.

[Crapinon 2250]

8 hours ago, UT_OB1 said:

Yeah. Serious. Been a 5th time since last post. We’ll fuck me that sounds bad. I don’t have a regular dr.  What type of dr should I be looking for?

It could be a lot of things causing it. If you don't have a family dr, I'd try to get in with a urologist to start. But I would get in ASAP to get it checked out.

[Underdog 28443]

Start prep for poop-chute procedure today, black coffee and Jello for breakfast and already have my Gatorade and exlax mixed and ready to go for later.  I'm already starving and only more jello, black coffee and fat free broth to look forward to.