Re: An Insurance/MRI related question

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...


Thanks Hawki. That means allot to me.

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!!

No problem. Whats going on is perty obvious. He doesnt like the system, apparently can afford allot more than Medicaid pays for, but saves his $$ for the charlatans, and expects Medicaid to ignore years of experience in treating these things and cater to his demands.


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".....

Whatta shame. If he ever gets a really difficult problem, he'll have run off all the docs able to help him already. And THEN he'll finally realize how many yrs he wasted worrying over nothing,and itll be too late.


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...

Yee-ikes! Ive read a few reports but generally leave those things up to the docs to interpret for me. Thats what theyre there for! They did the med school, not me.


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

Nkerio may WELL have some legitimate issues..

I agree, but until he lets the docs do things there way and gives up the quacks who are generally tell him anything he wants to hear as long as hes shelling out the bucks, hes gonna make his problems worse (at least some of them, if you get my drift.)

..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

Exactly.
None of our bodies come out perfect in those tests. We all have lil quirks that when read by laypeople like me or him can freak us out! But docs know how to read em and look at the bigger picture, beyond a quirk here and a bit of aging there...(even at 26 sometimes).


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

Wow. Whatta waste of time & energy! There are SO many health problems to worry about. A diagnosis of cancer. Heart problems. ALS. Theres so much baaaaad stuff out there, and even w/my health problems (rheumatoid arthritis, fibro, diabetes just being at the top of the hit parade, with many more and many sub problems like neuropathy from the diabetes) I try to focus on whats good, and other than following my diet and take my meds, its pointless to make a big deal out of what ails me if it aint gonna kill me.


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

I have a sneaking suspicion that even w/my posts and yers and even zomby's, nkerio's gonna go searching for what he wants to hear rather than accept what is. Even the diagnosis's he seeks wont change anything in his life!

Hell, hes trying to double up on private pay insurance and Medicaid to cover all his obsessive demands, like its even an option, and sees BCBS and "anything he wants to get" insurance! LOL If only... And hes NOT gonna get double coverage when one of those coverages is a freebie from the govt. The govt doesnt take it lightly when someone CLAIMS they cant afford healthcare and then tries to buy it and use Medicaid as a 'supplemental policy'. Hell, if I had $150 disposable income to pay premiums to an insurance co. every month, Medicaid would just turn around and put it in THEIR pocket as a 'share of cost' anyways!

And while much might not be wrong with him physically, his presentation of all these problems and continual demands on the docs is gonna label him as uninsurable thru private individual policies anyways plus he'll get labeled as difficult by docs and that follows someone around like a big neon sign. He thinks he NEEDS the rheumy but wants the gov't to cover it, but is throwing away good money on quacks he doesnt need who will NEVER help him! And I think right there thats pretty telling. I think on some level he KNOWS that paying for the rheumy himself will not get him the answers he wants, so hes instinctively seeking out and paying for those he knows will give him those answers (even if they are wrong) and refusing to pay for those he knows won't. Those he wants to pawn off those bills on the govt. To me, that sez volumes.




"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...






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