RL Peeves
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@Aria It is possible for you to get what is called an ‘in network exception’ where you can use an out of network doctor and they’ll be treated as in network. Not every insurance company is okay with that and some are easier to deal with than others but it’s definitely an option you should explore.
Call your insurance company and ask what is the way to get an in network exception because no in network doctor offers what your PCP says you need. If the first phone rep can’t/won’t help you, ask for a supervisor.
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^ this, but also @Aria your PCP can advocate for you here. I would suggest this only if you have a good relationship with your regular doctor. You can ask them to write a letter of medical necessity (specifically use those words). This can underscore the importance of the condition and its assessment and eventual treatment if it is found to be medically significant.
It will still come down to the underwriter and staff reviewer, so you need to be your own advocate with your insurer as well. That’s so difficult and I’m sorry you’re going through this. I hope you’re able to find some resolution and you have a good RL support network in your corner.
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Thanks for the advice, guys. I literally broke down in tears in a conference room today about this and someone just being nice to me about it instead of an unhelpful, faceless bureaucrat reciting policy is a relief.
@Aria It is possible for you to get what is called an ‘in network exception’ where you can use an out of network doctor and they’ll be treated as in network. Not every insurance company is okay with that and some are easier to deal with than others but it’s definitely an option you should explore.
This is my hope because I spent 45 minutes on the phone yesterday with a rep at the insurer who only handles claims from my company. I was like, “Give me a doctor, any doctor, within two hours that does this, is taking patients, and in network.”
They literally could not find a single one after 45 minutes of digging through their own database.
Apparently my company also has advocates in our HR office whose only job is to help us navigate these bullshit Byzantine rules and I’m like, “So maybe if we have three people at our office whose only job is helping employees deal with this insurance company, the insurance company is kind of shit? Just a thought.”
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@Aria I have nothing at all useful to offer in terms of solutions or helping you to navigate this situation. But I absolutely see your struggle and additional stress amidst what is already a terrible situation. I’m so, so sorry that you’re dealing with the bureaucratic nonsense amidst obvious medical need. I hope you’re able to come to affordable and reasonable solutions. We’re here to hold space for you and to offer support in the interim. I’m sorry that your ‘coverage’ makes things all the worse rather than making things better. It sucks so, so much.
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My rheumatologist suggested for a degenerative condition, that is causing me debilitating pain, physical therapy and a nerve block. Which are not things that can actually stop the degeneration of my body. Thanks, doc.
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@Cobalt I swear. Sometimes I think we have the same damned rheumatologist. WHY is that specialty so shitty to non-elderly patients? I’m so sorry that yours is sucking extra hard lately.
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My rheumatologist suggested for a degenerative condition, that is causing me debilitating pain, physical therapy and a nerve block. Which are not things that can actually stop the degeneration of my body. Thanks, doc.
I’ve reached a point of strongly recommending that more patients (especially female patients) look their doctors in the eye and go “What the fuck is wrong with you?”
Like, just say it. Just say it outloud.
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@Aria I’m headed to my primary Monday to get a second opinion and probably argue for a surgery that I don’t want but know from family members with the same condition that if I don’t have it I’ll have permanent nerve damage which I might already have some because I’ve been having pain for ten years only the last two it has gotten to the point where I can’t function anymore.
And yeah, I really wanted to be like: “Do you think I like being like this? Do you think I want to be disabled and stuck in my house 24/7?”
My doctor was like “you know I see a lot of people who can’t work but just fill their time with travel and hobbies, and that’s no disability.”
Hobbies? Heh! I can’t even manage being active in a hobby that only requires me to sit at a computer and type! I wish I had hobbies.
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My doctor was like “you know I see a lot of people who can’t work but just fill their time with travel and hobbies, and that’s no disability.”
Seriously. These people. Do they just not hear themselves when they talk?
I once went to a gynecologist who - after telling me he would do nothing to treat the minor and easy to address issue that was causing me debilitating pain when walking - assured me that I shouldn’t worry, because it was still safe for me to have sex! A question which, notably, I didn’t fucking ask him.
I’m glad you’re working with your PCP, but I really do think the healthcare system would be better served by patients looking their doctors right in the face and asking them if they’re this stupid all the time or putting extra effort into it today.
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I’ve reached a point of strongly recommending that more patients (especially female patients) look their doctors in the eye and go “What the fuck is wrong with you?”
Last year, I started having breathing problems. My O2 saturation was going down to high seventies; most people get delirious in the eighties, but apparently I have stern lungs. Good for me. Anyway, I went to my PCP, told him my symptoms, and he said, without conducting any tests, “Oh, you’re just too fat to breathe. You need to lose weight.”
Later that week things got worse, so I went to Urgent Care. In ten minutes they diagnosed me with bronchitis. They gave me half a week’s worth of steroids and the problem went away.
I never got up the courage to ask my PCP what the fuck is wrong with him, but I did ask to be transferred to another doctor.
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@GF Medical fat phobia kills people. I’m so sorry that happened to you.
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…but I did ask to be transferred to another doctor.
I’m a little confused about this part (though good, you definitely should get rid of that one). Is it an outside the US thing that you need to request a new doctor? I pick my own and so long as they’re in network, the insurance covers it. I could change designated PCPs every day.
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@TNP My PCP works at a clinic. They assigned him to me at random when I joined. I asked to have a different doctor.
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@GF Ah. You should also file a complaint. Sounds like malpractice to me.
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I’ve reached a point of strongly recommending that more patients (especially female patients) look their doctors in the eye and go “What the fuck is wrong with you?”
Last year, I started having breathing problems. My O2 saturation was going down to high seventies; most people get delirious in the eighties, but apparently I have stern lungs. Good for me. Anyway, I went to my PCP, told him my symptoms, and he said, without conducting any tests, “Oh, you’re just too fat to breathe. You need to lose weight.”
I definitely feel this. Earlier this yeae I had a some light headedness, some wheezing, a cough, with difficulty breathing. He did my weight and got my BMI (as bullshit as that metric is). I’m pretty short (5’5") and my BMI came up as 30.1. I was told that I was having bad acid reflux due to weight, which can cause a cough. I pointed out that my daughter had a similar cough about a week prior and that I thought there were other kids at her daycare who were ill. No change to the prognosis. He prescribed me rx strength Prilosec.
Anyway so I wound up in urgent care because I had COVID.
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@somasatori just wtf. You’re so scrawny tho???
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@Cobalt a mix of grad school stress eating and weight lifting because it’s a quick way to do exercise without having to go somewhere.
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@somasatori said in RL Peeves:
grad school stress eating
This is so fucking real and so underdiscussed.
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Oooh medical peeves.
I have MS (it’s not about this but it ties in). Which means I’m in pain just existing. This also means that I have a very high pain tolerance because my body has adapted to my new normal.
I was injured and tried to walk it off, but I figured this is annoying pain I should go to the ER. I did. They did x-rays. The male doctor came in and sat down across from me. He gave me that patronizing smile and patted my knee. His words were along the lines of 'Sweetie, you just have a bad bruise. I know. I know. It probably doesn’t feel good. Just take an extra strength tylenol. You’ll be fine."
I had a moment that after the talk, he managed to make me feel like I had wasted his time over a bruise. I felt horrible. I felt like I can’t explain it. It was just not a good feeling.
We get my results of my x-ray. I have a fricken fracture. An easy to see fracture. My primary freaked out and demanded I come in. Cleared out her schedule to get me in to get it set.
So doctors sometimes suck.
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