Re: An Insurance/MRI related question

wellll.....golleeee...
sorta hurt him feelings now didn't I??

bye bye

ps...you may want to NOT list any of the multitudes of ailments you may have
on any insurance application...unless it is employment based..which cannot
allow pre existing conditions...you will never get any insurance

and never is a LONG time for a 26 year old...

and that is advice...not smart alecky....

I wrecked my neck when I way 31.....

which is why we pay thru the ass for Employer based insurance

and good luck


"nkerio" <nkerio@xxxxxxxxx> wrote in message
news:1151372947.845650.47670@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Oh wow, not bad finding me on the roommate thing. I gotta give you
credit for your investigative skills. Which site did you find it on?
cos I'm probably still on 5 or 6 of them.And, no, it wasn't a few weeks
ago. If you're that good you can even check for the dates of when I
started looking for a roommate if you're that good. It was once last
summer for finding my exroommate, and it was again for April and May,
to find a roommate for my exroommate and to move to Novi with my gf.
Call Apple Tree apartments in Ypsilanti, my case still bothers you. I
haven't cancelled because I'm lazy about it can't keep track and I
haven't been getting calls But doesn't matter if you're not convinced.
It doesn't add up for you because you're being too narrowminded to add
it up, because you want to prove to yourself that you're right, and
because you have probably don't have enough knowledge with what I am
going through.

See but the thing is it seemed like you were doing more than just
trying to help. You kind of had the "how dare you think you're entitled
to a lawsuit. The PCPs do the best they can etc." which really bugged.
It's one thing to say "the law is not on your side" but this is
something else.

I read some of your posts and I found out you're a nurse. I'm not going
to go through each one of them. As far as work, I'm interviewing now. I
quit my job from First Investors in March, went to New York for a
couple of months to visit my mom and came back applying and
interviewing. Trust me, I wouldn't lie to you, given you're a
semi-inspector.

And for the last time. I did not expect an ordering of an MRI by the
PCP. My question in the beginning was that if I had a positive MRI
would it give me a case against the PCP for not doing anything
including a referral.

The MRI I got, was in New York, ordered and paid for by my uncle. My
medicaid in michigan cannot even cover for it. It was for my head, when
I wanted to have it for back, but he was the one paying, and I thought
well if it's MS, it should show anyways. And if you're still convinced
a PCP's job is not ordering an MRI, then why are we even arguing this.

It's OD or DO. You see how far you're willing to argue.

http://en.wikipedia.org/wiki/OD

You're right that the osteoarthritis is not likely for me, but it's not
impossible. I addressed that question to the OD, and she said it's
possible. But that's the reason I want the right X-rays for my back for
reassurance.

as I said...reading your posts on your head MRI led me to believe that
you
are LOOKING for a diagnosis to pin your aches and pains on...as they told
you there...the results were NORMAL..yet you picked upart each and every
word...

that my friend is the textbook definition of the "worried well"...

I am not simply worried. I am trying to find what's wrong so that I can
find a solution.

no doubt you have aches and pains...no doubt you have headaches...many
many
of us here have both...plus plus plus...discs falling apart..multiple
back
surgeries...etc etc...pardon me if I don't have "empathy"...

And that's another reason you should empathize. Can we at least agree
that I should find what the source of my pain is. Or was I supposed to
settle for "Zoloft".

nahhhh...those that know me here...even those that don't like me...know
that
I have 45 years experience in nursing..and a master's degree as an NP....


and you are right..psych is NOT my forte....I lose my patientce way too
easily with folks like you....

Feeling was mutual. That's why there's all this.
and BTW...double up on the Zolft...you need it...

But I did try Zoloft for 3 months. No improvement. If you love it so
much you take it. Go ahead, triple on it
waiting for you to attack LC as well...or is it mostly female "nurse"
types
that you feel more superior to??

I'm not gonna attach LC. I'll just say sorry LC if I seemed to go over
the edge. But my smart ass remarks were as a result of what I thought
were other people's smart ass remarks. I just can't stand know-it-all
people.


last word...get a job...get a life..get real health insurance..and knock
yourself out getting every high falooting diagnostic out there...

I am getting a job. Got 3 interviews tomorrow at EMU. I have a life,
except the part that I wasted on you. BCBS is real insurance, and I'm
getting it. And I will exhaust every diagnostic for every possible
disorder/ailment, until I come up with a conclusion. I'll take this as
an advice from you.

I don't think I'll be arguing here anymore for the sake of arguing. It
was a pleasure. I am getting somewhere now as far as starting to
resolve the biggest problem in my life, and thank God I won't need a
nurse's view point here anymore. Bye bye.

awki63@xxxxxxxxxxxxx wrote:
"nkerio" <nkerio@xxxxxxxxx> wrote in message
news:1151362537.928177.44870@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Hah You know I gotta tell you. For someone who thinks about printing my
posts, googling "this guy" and printing my posts and studying them, I
don't think you have any grounds for criticizing others.

ths is done all the time to determine if someone is REAL or a troll

and in your case...to gather some info asto what you may have already
posted
or asked ?? of in other venues....

don't like it?? too bad....


You seem to be
too "worried" about proving your own point,

was trying to help you...not prove my point..in fact...I have no points
to
prove here



that it even outdoes
whether I am too insecure about my health. You think you've got me
figured out, and not one thing you said about me is true. I graduated
from EMU in 2005.

you obviously ARE intelligent well educated by your posts

my ?? is still...if you are 26 and a college grad...do you work?? if
so...WHY are you on Medicaid?? letting your govt support you?? if you
live
and love with a GF...funny that just a few weeks ago you were advertising
for a roommate...

sorry fella...it alll doesn't add uup

and I thank LC again for calling you on all your BS....yes ...you MAY
have
legitimate health issues...neither of us have challenged that...

but grow up fella...

and get yourself a job so you have decent health care...do NOT expect
those
who CANNOT work or support themselves to support YOUR mental
insecurities
regarding what YOU feel the "system" should provide you at OUR expense
right
out of the gate...

Medicaid is for the indigent...and as LC pointed out...if you persist in
using the gov't money..expect to play the game created


I live with my girlfriend who I love and yes, we all
feel a little lonely sometimes, or don't you "nurse"? I'll be happy to
email you a scan of my degree if you want. You read my posts so I don't
have to mention them again. You can drop your part time pscyhologist
position cos you're so lousy at it. Chances are you're probably a lousy
nurse.

LOL LOL LOL


From reading my posts, you should've gotten a big enough picture
to empathize and share your background,

I DID empathize and share my knowledge...until you jumped up and down
like a
spoiled kid...throwing around threats of negligence and malpractice
because
your PCP would NOT order the MRI you so thought was needed...

sorry pal....you want Mercedes Medicine...well..get yourself a job and
pay
for it...most of the rest of us here...who CAN pay for our care DO so (my
monthly premiums are $944 a month...and I would not DREAM of second
guessing
the experts I consult...if I was told I didn't warrant a $1200 test
first....I would either PAY for it...or shut up and follow the drill)

and BTW...you DID get your PCP to get you an MRI just a month
ago....think
Medicaid came down on her when she asked for another one??...


and not come up with the most
typical conclusion that I am "well worried". The MRI was the attempt of
ruling out any neurological disorders, like MS, which I thought
would've been possible from the symptoms I'm experiencing. And the
report had a part that was written a little unusually so I questioned
it, and now I know I've ruled some things out. I can either live with
my problem crawling through life and eluding myself that all the
physical symptoms are stemming from my head or research the hell out of
my experiences, rule things out, and then if nothing was found settle
for the notion that it's psychological like you "genius" implied.

Today, I saw an OD by the way, and finally things are starting to make
sense.

sorry here...do you mean DO??? not sure what an OD is...but as LC pointed
out...you seemed to find the money to fund the chiro...so no doubt you
also
funded this OD...actually in my memory bank...an OD is the abbreviation
for
Optometric Doctor...



She confirmed tender points in my back, listened for grinding
sounds in my jaw, which by the way, even I "the well worried" thought
was normal. She confirmed TMJ and was convinced that it's fibromyalgia.
My blood was drawn for the antibody test to rule out other things. The
arthritis, nerve pinching detection will have to wait for now, but
interestingly osteoarthritis can come along with fibromyalgia.

tho I realize fibro is the disease of the century...and I am NOT about to
say it does not exist...I can tell you one factoid...osteoathritis is
nicknamed "wear and tear arthritis"...thus is highly unlikely in a guy of
26...now there ARE over 300 types of arthritis....so knock yourself out
til
you find one you like...but I would lay odds that osteo is not your
problem



If fibro
is confirmed, guaifenesin will hopefully gradually alleviate my
symptoms. I'm glad now that I'm getting somewhere. Your accusations are
too stereotype for me to take seriously, so argue your heart out if you
want. Yeah Yeah Yeah it's all in my head. Or it could be that it's in
your head that it's in my head.

as I said...reading your posts on your head MRI led me to believe that
you
are LOOKING for a diagnosis to pin your aches and pains on...as they told
you there...the results were NORMAL..yet you picked upart each and every
word...

that my friend is the textbook definition of the "worried well"...

no doubt you have aches and pains...no doubt you have headaches...many
many
of us here have both...plus plus plus...discs falling apart..multiple
back
surgeries...etc etc...pardon me if I don't have "empathy"...




Oh and please don't waste your time discrediting the doctor I saw, or
telling me there is no such thing as fibromyalgia or anything like
that. It would just be too typical. And come on.. don't print my posts
and sit with a pen and a paper.. makes me kind of nervous. Instead I
suggest you do some research about neurological/muscular illnesses
which people get misunderstood for, and get your "mental accusation"
for. Just saying it would be better use of your time that's all.
Pscychology is not for you though, that's for sure.



nahhhh...those that know me here...even those that don't like me...know
that
I have 45 years experience in nursing..and a master's degree as an NP....


and you are right..psych is NOT my forte....I lose my patientce way too
easily with folks like you....

and BTW...double up on the Zolft...you need it...

waiting for you to attack LC as well...or is it mostly female "nurse"
types
that you feel more superior to??

last word...get a job...get a life..get real health insurance..and knock
yourself out getting every high falooting diagnostic out there...



You keep me wondering what you'll say next though, so I give you credit
for that.

Hawki63@xxxxxxxxxxxxx wrote:
top posted


LC,,,,,,I gotta give you credit...regardless of our past
encounters....you
have hit this issue square on the head...and done an excellent job of
countering Nkerio point by point...

I had even gone so far as to print out all of his posts...and was
planning
on sitting down with pen and paper and going thru each comment etc and
doing
exactly what you have already done....so thanks for saving me the
time!!

late last night I did a google on this guy...he only started posting a
week
or so ago...but Nkerio..unfortunately..is what we in the biz call the
"worried well".....

read some of his repeated posts on a few groups and you will get the
picture...he is so overly worried about everything that he over
analyzes
every word in every report...

perhaps the pCP was NOT so dumb by giving him an antidep first thing
out
....

Nkerio may WELL have some legitimate issues...but his major
problem..in
my
not so humble opinion..is that he is a sad..probably lonely and
stressed
guy...apparently still in college at age 26...his health issues are
consuming his life...and as you say...none of them are life
threatening
...annoying...perhaps

BTW...Nkerio did manage to get a head MRI in the past few weeks...and
agonized over every last word of the report....read the archives..and
you
will get the pic

Nkerio...with all due respect...you may want to see if your Medicaid
will
cover a shrink....


"LooseCannon" <lambchop.LC@xxxxxxxxx> wrote in message
news:e7paur$m9b$1@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
nkerio wrote:

I'm gonna do this your way cos maaannn you can type, and I thought
I
could type.


Its not just the law. When PCPs make a diagnosis or do some kinda
treatment, they dont look up laws. They use their judgement, do
what
they think is right based on their many years of training &
education.
They arent always right. Doesnt mean theyve broke or even bent a
law
or
are remotely liable. Being wrong does NOT automatically equal
neglect
of any kind. Doesnt even mean they arent caring, or its not what a
caring doc shoulda done. It means there can be a lotta ways to
approach
the diagnosis & treatment of a problem, and choosing one over
another
doesnt mean anyones done anything wrong, morally or legally!


I see. So you're saying she was experienced enough to give me
antidepressants instead of going about trying to find whether my
back
shows any signs of physical damage?

You have aches & pains and a chiro giving you a big line o'***.
Period.
That doesnt equal physical damage. And no insurance, medicaid or
private,
will spring for the expensive tests you want w/that kinda info.

That's some experience. Oh and,
there's absolultely nothing wrong about a doctor lying to her
patient
about referring him to a doctor, and when put on the spot, have her
nurse tell him he's denied. Innocent mistake, right.

No, but you jump to conclusions, assume the worst and come off
REALLY
in
yer face! It puts private ppl off. Why wouldnt it put off a doc?



You seem not to realize that your medicaid or insurance provider
may
have tied her hands. What theyll cover or will agree to cover can
completely and totally interfere w/what she wants to do.

And treatment for cp issues w/antidepressants is perty standard
these
days. It can often take going thru many of them till the right one
is
found. They dont always work the same. Sometimes they dont work
at
all, but its usually one of the first treatments outta the starting
block, so the doc has done NOTHING wrong from what youve described
so
far, not legally, not morally and certainly I see nothing uncaring
either.


Didn't know that piece of fact about the insurance, but for the
enlightenment. You seem to be a true believer in antidepressants.

Theres another HUGE jump to an incorrect conclusion. Where do you
get
this ***. Telling you whats done doesnt mean I agree with it or
believe
it helps, but the DOCS believe it, and I know that, and getting
around
that, or thinking you have the basis for ANY kinda lawsuit, is just
horse***.

I dont believe in em at all. But I also know they are generally
almost
always the first things docs wanna try (and the second and the third
and
so on and so forth). And when docs have established ways of doing
things,
we dont have much of a say in the matter. Ive been thru it, with
some
serious ass arthritis, no less. Hell, I have a friend who was put
on a
kazillion antidepressants for baaaaad migraines. Didnt help her at
all
either. Took her YEARS of suffering to chase down real help.

I'm
not. From the people that I know that are on antidepressants, not
one
can say that they work for them. They just keep taking them because
"they have to". I tried one and it made me feel more fatigued, and
my
backaches were miracuously any better. Do you suggest I take every
other kind.

No, but until you try SOME, no doc is gonna see you as cooperative.
Just
the way it is. Cuz right or wrong, unless yer willing to let the
doc
treat it their way, they are gonna see you as a control freak and
uncooperative and no one they wanna put allot of time into help.

Understand this: yer symptoms could have a hundred different
diagnosis's.
Or none. It could just be getting a bit older. YOU dont know this,
yer
chiro sure as hell doesnt know it, and the doc doesnt know it, and
they
are going to start w/the simplest approach, not throwing $1000's in
tests
at you, cuz most of all, NO INSURANCE, not BCBS, and not Medicaid,
will
approve of it!

How many are there anyways. Hundreds?? Thousands? Let me
check how many years I have left.

See, this is what I mean. This kinda smartass attitude gets you
nowhere.
And believe me, many of us w/chronic pain have been DIFFICULT AS
HELL
to
diagnose. No doc is gonna want to go thru a shitload of emotional
ups
&
downs with a patient, when many of them dont like ppl they cant
diagnose
outta the starting gate. Many docs dont like ppl they cant fix
easily,
quickly & cheaply. Finding a doc thatll stick w/you, thru the ups &
downs
and help you anyways is hard, but if you have THAT attitude, youll
find
no
one. And when yer in pain, its hard to be a 'nice guy'. Believe me,
I
know. But if yer not gonna let a doc at least TRY things their way,
yer
gonna go thru allot of docs, and that kinda record follows you, and
once
yer labeled difficult & uncooperative, and unwilling to try things
their
way, they are going to dismiss you w/emotional problems and will
NEVER
try
to help you beyond the first stage. Yer in the first stage. Wanna
get
to
the second? Let the doc do their thing and at least TRY it! You
gonna
hurt thru it? Sorry to say you are. Thats part of being human.
They
arent gonna throw opiates at you OR expensive tests for what yer
reporting. They will take the least expensive approach to find out
what
it is.

Let me regress a bit: the friend w/migraines, well, migraines used
to
get
2 ways of treating em first: antidepressants and prophylactics. (of
course, now theyve got other approaches too, to treat the migraine
when
it
happens, but the first and most desireable way to do it is to STOP
them
from happening, not kill them once theyve shown up). Sometimes an
antidepressant IS the prophylactic. Then theres BP & heart pills
and
stuff like that. The list is looooooong that they put those
w/migraines
thru. And while they do it, the ones w/migraines suffer. BADLY.
Cuz
no
docs wanna make their migraine patient into an 'addict'. Its a
torturous
process! Migraines are torture. Had a few myself, but never enuf to
need
to prevent em. Anyway, back to my friend... After a boat load of
thsee
prophylactics, my friend finally got a doc to rx painkillers more
regularly. It helped but it was no solution. Then one day shes in
for
a
regular checkup and the doc didnt like her pulse. Fast a fuckin
freight
train...resting pulse, over 100. Gives her something for it. 2
weeks
later, helped her pulse, but also her headaches are knocked back so
far,
they were practically nonexistent. It was a med no doc had ever
given
her
for proplylaxis. Hell if it didnt work too.
So yeah, you think theres a big bunch of antidepressants? Theres a
bigger
bunch of prophylactics for migraine patients! And the ones w/the
most
assaultive headaches get the fun job of going thru these, one after
the
other, along with a BUNCH of side effects that can be almost as bad
as
the
migraines. Yeah, with bad headaches, they HAVE to rule out things
like
brain tumors, so they do MRI's and Cat scans, but with the aches &
pains
you report, they arent life threatening, so no, no ones gonna do the
tests
you want unless YOu are willing to pay for em. And until then, you
get
to
suffer like hundreds of thousands of others get to, while docs try
the
safest, and least expensive approach. And while youve never met
someone
who responded to antidepressants, when you find someone who has gone
thru
the list of drugs and HAS finally hit one which work, other than
wishing
theyd found it sooner they are eternally grateful they found it--but
even
within specific diagnosis's, a caggle of differnt drugs work for
differnt
ppl, so theres no ONE DRUG to try! So no one can say X drug works
for
migraine prophylaxis and x drug works for other stuff. We're all
individual. Some ppl NEVER find that one drug. But until things
escalate
some, no ones gonna spring for the tests you want...and escalation
is
something you cant fake and cant force to happen.


But, here is the thing though. I'm
not saying the doctor was wrong for giving me antidepressants. I'm
saying the doctor was wrong for doing NOTHING ELSE.

Well, yer wrong. Cuz unless YOU are willing to spring for these
tests,
no
ones gonna let her do em. Not this early in the game. And yer
symptoms
dont warrant that kinda testing! Even if its osteoarthritis, the
diagnosis wont save yer life or even change it much.


> Chiros use plain ole xrays like everyone else uses! Amazing
that
they

can tell such fairy tales to their patients and are believed! An
xray
is an xray is an xray, and esp. in chiros offices! And if a
special
hi
def xray system (beyond reading traditional types of films put onto
on
hi def screens), you can bet no chiro, who has no real use for one
would
ever spring for one! Chiros have limited problems they are sposed
to
diagnose & treat w/xrays, which is why their training in that field
is
so limited. Expensive hi def xray systems would have no place in
their
practice.


Until I can prove whether or not my chiropractor report is a
fabrication, I won't share your opinion about chiropractors.

Yeah, and they gave you special, hi def xrays that they have no
reason
to
own or use and dont even fuckin exist. Yer worshipping a con man
and
hating a trained medical professional.

I don't
have enough knowledge to pass a judgement on what they can or
cannot
see, so I'll leave at that for now.

Gee, try looking up what chiros get in their education for xray
reading
and what a board certified radiologist gets. Then youll have yer
answer.
Not even in the same universe of backgrounds!


And believe me, for a long time women have had their legit aches
and

pains diagnosed & treated as hyteria, and given antidepressants and
tranq's, etc., so what yer going thru is nuthin new under the sun!
I
dont say that to put you down or devalue what yer going thru, but
its
the truth, and theres a chance that yer behavior is absolutely
influencing these docs to think this is emotional, not physical.
Just
yer posts here are showing things that I know would influence a
docs
choices in treatments and diagnosis's. I also dont know any
medical
doc
who is going to take a chiros report on xrays at face value. The
only
time I ever saw a chiro, the doc said they were the shittiest xrays
he'd
ever seen and wouldnt even send em to a radiologist to try to read.
He
had them redone.


I don't know if you're implying hysteria.

No, but yer NOT coming off as cooperative or even all that stable.

But for one I'm a 26 yr. old
man, so your example doesn't mean much. And just because there have
been cases of hysteria, that is no excuse for rationalizing all
cases
of backaches the same way and sending a patient on antidepressants.

Thats NOT why they use antidepressants. Antidepressants actually
have
a
real history of helping some ppl w/chronic pain issues, migraines,
and
its
not cuz they are antidepressants and not cuz they are also used to
treat
'psychiatric' problems. Its a separate issue altgoether. And many
ppl
get that confused.

And
even if I'm hysteric, Zoloft wouldn't be my cure.

Then all yer gonna get is another one to try. Or perhaps another
class
of
drug, but no testing.

Now if my behavior is
really bothering you, I could use a spank, unless you're a man. I
had
no clue you could tell so much from type. Ok, what how am I
behaving
now?

Badly, but I doubt you see that.

I've reffered to these groups for consultations, but for those
that try to impose themselves on me with their experiences and what
I
think is narrowmindedness, I can't help but counter them, and
ofcourse
you're not going to see my pleasant side.

And if yer like that w/us, who ARE trying to help, not hurt or get
you
to
suffer, I can only imagine how yer like w/the doc.

When I meet a doctor, I try
to be as informative and objective about my symptoms and I'm very
straightforward and polite. My frustration that you see here is 1.
as
a
result of real health care denial 2. The arguing back and forth. At
least Zomby has granted me that the PCP is a semi-bitch.

It abso fuckin lutely is. And they are ALWAYS gonna try the least
expensive route as long as its not life threatening. You still able
to
work? Thats another factor too. And they arent gonna throw those
tests
at you cuz you want em. And whether or not I see that as right or
wrong
(it depends, and I dont know enuf to say in yer case), thats the way
it
is. And no matter HOW much you dislike it, yer forced to deal with
the
same system most of us have to (in the US at least). Hell, in
Canada,
getting a referral, approval and appointment for a specialist can
take
years WHEN YOU NEED ONE RIGHT AWAY! Its not just the good ole USA.




Just cuz this guy accepted Medicaid doesnt mean that they are gonna
agree to pay for you to be seen by him without BOTH prior PCP
referral
AND prior approval by medicaid! Are you absolutely SURE that in
yer
docs decision process to make a referral that she didnt contact
Medicaid
and get told NO on their end? Can you say that with absolute
certainty?


If it was that, I would've been notified about it. The message I
got
was "we don't see a real need for your referral".

And you dont think that yer doc already KNOWS what Medicaid will
approve
and not approve? Think she hasnt been thru this dozens of times
before,
even when SHE thought it was absolutely necessary, I bet shes been
overridden ALLOT! And when yer a doc and ya piss off yer providers
(medicaid or BCBS or whoever), they are gonna drop yer arse if ya
dont
get
w/the program! Even if she didnt get the denial from Medicaid, Im
betting
either she doesnt think you need it OR even if she wanted to do it
to
get
you off her back, they'd STILL deny it so why bother even asking.

These providers think they are god. Yer a flea on the bacck of the
system. Think yer gonna do ANYTHING but piss off the docs with what
you
want? The docs arent the final say and they have learned to work
within
these cheap, restrictive options without even having to pick up a
phone
and know what they are gonna say?



So?


so she LIED. I guess that's from experience too, right.


And they wont, right? Cuz without the referral (which includes the
approval of Medicaid in advance...they arent separate issues!) they
arent gonna pay. And quite honestly, if you think that ANY
professional
is gonna CHANGE what they do for you cuz you go around and try to
work
thru another doc without first sitting down & talking to them about
their decision, in order to get them to do something different,
then
you
dont judge ppl very well. Dont you think that yer end run was poor
form?


You can calm down, because I never blamed the rheumatologist, and I
don't know how you got that impression. I was just saying I tried
to
go
directly to him because I didn't know much about the system.

I didnt say you blamed the rheumy. But when you went to the rheumy
and
it
was for all intents and purposes, going behind her back trying to
get
something she'd already denied, just how big of a good impression
do
you
think you made on her? You think what you did made her feel like
helping
you any further or going out on a limb for you? Want a doc to go
out
on a
limb for you? Then ya gotta go out on one for the doc too, and let
them
try things. Zoloft dont work? Giving you bad side effects? Call
and
ask
for something else, but no matter WHAT you do, you so far dont have
what
you need to get a referral thatll be paid for, let alone tests you
want!
You havent failed in trying x number of treatments yet, have you?
Hell,
youve tried how many so far? Youve mentioned ONE. Thats not what
gets
you specialists or tests. And thats not cuz I agree w/it either.
Its
cuz
it is the way it is, and no amount of complaining or doing end runs
around
the PCP will change that, so why not try it yer PCP's way for
awhile?
Who
knows? You MAY just find something that works.

You got $150 to pay BCBS? Pay for the rheumys initial visit
yerself!
Who
paid the chiro? Cuz I dont know about yer medicaid, but mine wont
pay
for
chiros anyways! (and believe me, if they covered EVERY chiro
service, I
still wouldnt walk in the front door, let alone let them get their
idjit
hands on my body!)



No ones defending her, the point is that you DO NOT KNOW if she was
the
ultimate reason yer referral was denied! Either doc isnt the
ultimate
say so in referrals, not w/medicaid and not w/private insurance
either.
They can say yes, but before they make the actual referal they
have
to clear it with medicaid or insurance, and if medicaid or the
insurance
co sez no, well, then its no, regardless of what the doc wants,
unless
yer willing to pay for it yerself. Of course there is an appeal
process.


If that was the case, don't you think that as a patient I should've
been told about it. Chances are it was a Medicaid problem.

And if thats the case, they arent gonna change for you. They are
going
to
EXPECT you to try it their way first. The PCP and yer provider are
the
profesionals, not you. ***, at least TRY it their way. Yer not
reporting anything life threatening, and believe me, most medicaid
programs are barely able to care for the life threatening problems.



No, it doesnt. Not at all. It coulda been a guess or dumb luck
too.


I can't believe you said that. Think in terms of probability, the
number of vertebraes and joints in the back and neck, the different
kinds of back problems, what are the chances that a chiropractor
had
good guesses about all of them. He either knew his stuff or he
didn't.

It wasnt rheumatoid arthritis. And if its osteo, well BFD! Thats
what
our bodies do w/time. Even at age 26.
Your problems could also be fibromyalgia. And no amt of expensive
testing
will find that. Ya just get to hurt like hell for life! Yeah, its
mostly
a female thing, but men get it too. I know. I have it.



They arent TRAINED to diagnose serious abnormalities or fractures
or
lotsa other things cuz they arent trained to TREAT EM! They are
mostly
trained to look for the kinds of things that they treat. If the
chiros
diagnosis matches, so what?. Board Certified Radiologists,
however,
are
trained to seek out all kindsa abnormalities and problems well
beyond
the spectrum of a chiro! The xray training chiros get compared to
radiologists is minimal. This is about specific kinds of xray
interpretations, whcih chiros just dont get. You compare the amt.
of
time chiros spend learning about xrays and compare it to a
radiologist,
and youll have a better idea of what the difference is.


So what?!!! if they match, he's either a psychic or damn good at
what
he does. I'll accept both.

OR HE GOT LUCKY! Wow, yer falling for a con man and ya dont even
know
it.
Yer so despret for answers that yer going anywhre who will cater to
yer
demands. Medicaid paying for the OD too? Or is this outta pocket?
If
you
can pay for chiros & OD's special treatements, why not the rheumy?




Hell, this guy has convinced you hes using special xrays, when hes
so
fulla ***. It would be ABSOLTELY POINTLESS for any chiro to spend
all
kindsa extra money on some kind of HI DEF XRAY MACHINE when he is
not
trained to treat the kinds of abnormalities they would be designed
to
find. The stuff chiros handle shows up on garden variety xray
machine
types of xrays, and the only thing that purchasing some new hi def
xray
machine, if it existed, would be to take a PHENOMENAL BITE out of
his
profits! All Ive ever heard of is a newer hi def screen to read
xrays
taken w/traditional machines. Now I could be wrong, but even if I
am,
I
cant see any chiro spending money for something like a new hi def
xray
system when theyd have no need for it!


He didn't convince me about any special x rays. We didn't even talk
about that.
Looking forward to arguing with you again, or maybe not.




LooseCannon wrote:

nkerio wrote:


Ok, now you're starting to make sense for me because it's the
first
time you're criticizing the system. At times, it sounded to me
like
you
were siding with the system and that my PCP. When I refer to what
the
PCP should've done, it is from a rational perspective of what a
caring
doctor should have done, not from the law's perspective, because I
still don't know the law and how it can be bent.

Its not just the law. When PCPs make a diagnosis or do some kinda
treatment, they dont look up laws. They use their judgement, do
what
they think is right based on their many years of training &
education.
They arent always right. Doesnt mean theyve broke or even bent a
law
or
are remotely liable. Being wrong does NOT automatically equal
neglect
of any kind. Doesnt even mean they arent caring, or its not what a
caring doc shoulda done. It means there can be a lotta ways to
approach
the diagnosis & treatment of a problem, and choosing one over
another
doesnt mean anyones done anything wrong, morally or legally!

You yourself mentioned

some reasonable stuff that you institute for your patients. What
did
my PCP do?? nothing but giving me antidepressants which actually
made
me feel worse.

You seem not to realize that your medicaid or insurance provider
may
have tied her hands. What theyll cover or will agree to cover can
completely and totally interfere w/what she wants to do.

And treatment for cp issues w/antidepressants is perty standard
these
days. It can often take going thru many of them till the right one
is
found. They dont always work the same. Sometimes they dont work
at
all, but its usually one of the first treatments outta the starting
block, so the doc has done NOTHING wrong from what youve described
so
far, not legally, not morally and certainly I see nothing uncaring
either.

By the way, when you mentioned X-rays, I believe you're

referring to higher definition X-rays that the chiropractor uses,
aren't you?? In that case, I wasn't even granted that.

Chiros use plain ole xrays like everyone else uses! Amazing that
they
can tell such fairy tales to their patients and are believed! An
xray
is an xray is an xray, and esp. in chiros offices! And if a
special
hi
def xray system (beyond reading traditional types of films put onto
on
hi def screens), you can bet no chiro, who has no real use for one
would
ever spring for one! Chiros have limited problems they are sposed
to
diagnose & treat w/xrays, which is why their training in that field
is
so limited. Expensive hi def xray systems would have no place in
their
practice.

And believe me, for a long time women have had their legit aches
and
pains diagnosed & treated as hyteria, and given antidepressants and
tranq's, etc., so what yer going thru is nuthin new under the sun!
I
dont say that to put you down or devalue what yer going thru, but
its
the truth, and theres a chance that yer behavior is absolutely
influencing these docs to think this is emotional, not physical.
Just
yer posts here are showing things that I know would influence a
docs
choices in treatments and diagnosis's. I also dont know any
medical
doc
who is going to take a chiros report on xrays at face value. The
only
time I ever saw a chiro, the doc said they were the shittiest xrays
he'd
ever seen and wouldnt even send em to a radiologist to try to read.
He
had them redone.


I think you missed it when I mentioned how I knew for sure that
she
denied the referral. After several months of no PCP contact, I
searched
for a rheumatologist that would accept my Medicaid, and I found it
in
the first one I talked to.

Just cuz this guy accepted Medicaid doesnt mean that they are gonna
agree to pay for you to be seen by him without BOTH prior PCP
referral
AND prior approval by medicaid! Are you absolutely SURE that in
yer
docs decision process to make a referral that she didnt contact
Medicaid
and get told NO on their end? Can you say that with absolute
certainty?

He was in the only major hospital in the

same city. Hint: she didn't really search for anyone.

So?

So I went to the

PCP's clinic and gave them the name and information to get the
referral. Next day, the nurse called me and left a message saying
"Doctor X reviewed your request and saw that there is no real need
for
your referral". Upon taking the message, I went to the
rheumatologist
to see if they can accept my insurance without the referral.

And they wont, right? Cuz without the referral (which includes the
approval of Medicaid in advance...they arent separate issues!) they
arent gonna pay. And quite honestly, if you think that ANY
professional
is gonna CHANGE what they do for you cuz you go around and try to
work
thru another doc without first sitting down & talking to them about
their decision, in order to get them to do something different,
then
you
dont judge ppl very well. Dont you think that yer end run was poor
form?

He

sympathized and didn't even understand himself why she would deny
the
referral. He made an appointment for me, and had his secretary
call
to
request the referral thinking it would be a piece of cake. After a
while, I got a call from the secretary saying "sorry. She denied
it
again." So there you go. It'd be ridiculous if you throw anymore
defenses for her.

No ones defending her, the point is that you DO NOT KNOW if she was
the
ultimate reason yer referral was denied! Either doc isnt the
ultimate
say so in referrals, not w/medicaid and not w/private insurance
either.
They can say yes, but before they make the actual referal they
have
to clear it with medicaid or insurance, and if medicaid or the
insurance
co sez no, well, then its no, regardless of what the doc wants,
unless
yer willing to pay for it yerself. Of course there is an appeal
process.



Why do you say "it proves neither" and then stop.

Cuz it didnt prove either. The point is you dont KNOW the details
for
sure.

If the MRI matched

the chiro's report, then ofcourse that means he's credible.

No, it doesnt. Not at all. It coulda been a guess or dumb luck
too.

You don't

supposed it would be a coincidence, do you? Now when you discredit
a
chiropractor's diagnosis is it because of the X-rays he uses

He uses the very same xray machines as everyone else.

or is it

because you think they're not knowledgable enough to distinguish
abnormalities in the X rays?

They arent TRAINED to diagnose serious abnormalities or fractures
or
lotsa other things cuz they arent trained to TREAT EM! They are
mostly
trained to look for the kinds of things that they treat. If the
chiros
diagnosis matches, so what?. Board Certified Radiologists,
however,
are
trained to seek out all kindsa abnormalities and problems well
beyond
the spectrum of a chiro! The xray training chiros get compared to
radiologists is minimal. This is about specific kinds of xray
interpretations, whcih chiros just dont get. You compare the amt.
of
time chiros spend learning about xrays and compare it to a
radiologist,
and youll have a better idea of what the difference is.

Hell, this guy has convinced you hes using special xrays, when hes
so
fulla ***. It would be ABSOLTELY POINTLESS for any chiro to spend
all
kindsa extra money on some kind of HI DEF XRAY MACHINE when he is
not
trained to treat the kinds of abnormalities they would be designed
to
find. The stuff chiros handle shows up on garden variety xray
machine
types of xrays, and the only thing that purchasing some new hi def
xray
machine, if it existed, would be to take a PHENOMENAL BITE out of
his
profits! All Ive ever heard of is a newer hi def screen to read
xrays
taken w/traditional machines. Now I could be wrong, but even if I
am,
I
cant see any chiro spending money for something like a new hi def
xray
system when theyd have no need for it!




Hawki63@xxxxxxxxxxxxx wrote:


"nkerio" <nkerio@xxxxxxxxx> wrote in message
news:1151270050.602340.160860@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx


I'm not suggesting that she should've ordered an MRI, but the
least
she
should've done is made a referral to a specialist. Let me
rephrase.
The
least she should've done was do what she told me she was going
to
do.

what patients don't always know....is that frequently the pCP
DOES
order a
referral...but it is denied...esp in instances with Medicaid...


I


was complaining about joint aches and I had a chiropractor
report,

joint aches and a chiro report do NOT mean ....send this patient
to
a
specialist..sorry that is just the way it goes "these days"...ask
anyone who
is PAYING for HMO coverage if they can simply ask for a referral
..and
get
it...no way JOse

I realize you may be in a tuf spot..assuming you are on Medicaid
due
to
financial need...

and as I said...I DO believe in and utilize and order chiro for
myself..family and patients...but I always made sure patients had
OUR
xrays
with them...which had been interpreted by a board certified
radiologist...even the best chiro is not a radiologist...




whether you believe in chiropractors or not. Forget the law
term.
She
was "neglecting" when she did what she did. That's all I'm
saying.
Whether I can sue for my costs if my MRI turns out to be
positive,
I'll
have to consult a lawyer. The MRI results will prove whether it
was
reasonable for the PCP to grant me the referral, and will prove
whether
the chiro was credible.

actually a positive MRI will do neither...

again..you need to understand the limitations on Medicaid and HMO
medicine...is this a cash based industry..you bet ya...


So I will take it from there. If you can come


up with one good reason why I was denied the referral, which for
God's
sake shouldn't have been a big deal, then I'll be convinced. I'm
trying
to figure out why she mislead me to believing she was attempting
the
referral. Whether you call it "thinking out loud", it was WRONG.

again..you do not know if she DID attempt a referral..only to be
turned
down..happens all the time




I understand you might be right, since you seem to be
knowledgable
about the law. But common sense tells me that I should've been
entitled to the right diagnosis, and not simply being given
antidepressants, even under Medicaid.


I agree you deserve the correct diagnosis...but involving a high
priced
specialist..and a test that costs over $1000...is usually not the
first
step...

I agree also that your PCP failed you...however...I still call it
"bad
doctoring"...

I worked for an HMO...we NEVER referred to specialists..and could
NOT
order
expensive tests like MRI in instances such as you describe...we
"could"
institute more reasonable stuff...like PT,,,behaivor mod
techniques...appropriate meds...etc...in fact...our specialists
would
always
ask (we had phone and email access to them ) what "we" had tried
prior
to
referring them...

still wondering about your talking about BCBS ?? if you are
applying
NOT
thru an employer based program...do NOT believe the premiums you
may
have
found ....private pay is the hardest coverage to obtain...just
mention
things like "chronic back pain,,,high
cholesterol..headaches..high
blood
pressure or the like"...and the small print will tell you not to
waste
your
time...employer based CANNOT refuse you coverage....individual
can

we have a shitty health insurance system in the US....


Hawki63@xxxxxxxxxxxxx wrote:


"nkerio" <nkerio@xxxxxxxxx> wrote in message
news:1151182113.824320.270470@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx


No, my BCBS is not through Medicaid. I even had no idea there
was
such
a thing. I thought it was only Medicare that BCBS gave a
supplement
to.

I wasn't thinking of a "supplement"...but as the primary
provider
of
your
health needs...

and yes..Medicaid itself in some areas does provide its
services
by
utilizing companies such as BCBS






This is actually the first time I'm attempting to get both
insurances.
My renewal of Medicaid and application for BCBS are in
process,
so I
don't know if Medicaid will deny me on the basis of being able
to
afford BCBS. My medicaid before was under the name Washtenaw
County
Health Plan. Now I've moved so I don't know what kind I'd be
getting. I
assumed I'd be able to get both, because my low income still
qualifies
for Medicaid, and if BCBS accepts me then I'd only be paying
about
$150/monthly or so.

I don't know the answer to the above ??.....personally I would
"prefer"
not
to be Medicaid if at all possible...for reasons you have
already
found....




I think there was a misunderstanding of my use of the word
"negligence". I meant it as an equivalent to "neglect", not
the
law
term which involves the worsening of the patient.


in medical services...negligence is a tad different animal
tho....it
is
NOT
neglecting ANY "law" for a healthcare provider to NOT give a
referral...or
not to order an MRI...again..I would use the more general term
of
"bad
doctororing"....

but I am not a lawyer




negligence

n 1: failure to act with the prudence that a reasonable person
would
exercise under the same circumstances [syn: carelessness,
neglect,
nonperformance] 2: the trait of neglecting responsibilities
and
lacking
concern [syn: neglect, neglectfulness]

From this perspective, the doctor has clearly not done what
she
was
supposed to do. And I know that I can't sue based on that.


according to your dictionary definition...what is "reasonable"
action
is
a
very broad action potential...ordering an MRI might not be
considered
reasonable either...

but I am not a lawyer

I just know enuf about malpractice in medicine to know that you
have
to
be
able to prove "damages"..ie they amputated the wrong limb...etc
the
rest
of
it is subject to interpretation to debate and docs and their
attorneys
are
able ...almost always..to find an "expert witness" that will
agree
with
what
they did...









.