Re: Does a Uro. do kidney biopsy exams

In article <AK4eg.175120$eR6.22743@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx>,
Rich256 <nospam@xxxxxxxxxx> wrote:

Jason Johnson wrote:
In article <e5afif0229q@xxxxxxxxxxxxxxxxxx>, "Pete" <pete@xxxxxxxxxx> wrote:

Rich256 wrote:
> Pete wrote:
>> Jason Johnson wrote:
>>> In article <e58d69028ne@xxxxxxxxxxxxxxxxxx>, "Pete"
>>> <pete@xxxxxxxxxx> wrote:
>>>
>>> Jason Johnson wrote:
>>>> As a result of having red blood cells in my urine, my doctor
>>>> referred me to a urologist. I have edema and some other
>>>> symptoms of kidney disease. It's my "guess" that the blood
>>>> in the urine is the result of a kidney disease.
>>>> Is it possible for a uro. to do a kidney biopsy to rule
>>>> in or out kidney disease as a cause for the blood in the
>>>> urine? I already know that the uro. will conduct various
>>>> tests and exams to rule in or out the various causes of
>>>> blood in the urine.
>>>>
>>>> I should note that I asked my doctor to refer me to
>>>> a kidney specialist but he refused to do so because
>>>> of the rules of my insur. company.
>>>>
>>>> Jason
>>> Jason...please tell us what the rules were that prohibited your
>>> primary care physician from referring you to a nephrologist. I am
>>> interested. Sounds like more HMO bull*** to me :-) .
>>>
>>> It's HMO bull***. The rules state that my doctor needs a medical
>>> reason
>>> to refer me to a kidney specialist. I have edema but it's not a
>>> serious case of edema. There are several causes of edema. Perhaps if
>>> kidney
>>> disease was the only cause of edema, my doctor could refer me to a
>>> kidney specialist. Almost every item on my kidney function blood
>>> tests and urine tests are within normal limits mainly because I am
>>> now a vegetarian. Therefore, the insur. company would hassle him if
>>> he referred me to a kidney specialist. I don't know what sort of
>>> punishement they use on doctors to keep them from referring
>>> patients. I know that I have kidney problems since I read a book
>>> that was written by a kidney specialist. I have many of the
>>> symptoms that he mentioned in his book.
>>> In another newsgroup, some of the posters tried to convince me that
>>> I don't have a kidney disease. They may be correct but how could I
>>> know for sure unless I have the proper tests such as a kidney
>>> biopsy? I hate HMOs. Jason
>>
>> Jason...That's why I stay with my Blue Cross (every open season),
>> even though the doc's are dropping it because they don't pay enough.
>> I don't need a referral, but certain specialists may require one
>> anyway. I would think that your doctor would be able to short circuit the
>> bull*** (especially if you were close to him). In other words ("he
>> needs a medical reason") should be general enough just for him to go
>> ahead with the referral, unless he has no doubt whatsoever that you
>> do not have a kidney ailment (and he has no way knowing that
>> categorically - I do not believe). This is total bull*** IMO, if you
>> have a strong concern about your
>> kidneys. Are you able to switch to a non HMO provider, or are you
>> locked in with what you have.
>>
>> Having said all that, you do have to be cautious about self
>> diagnosing yourself, and "playing doctor" (as was discussed in the
>> sci.med ng). However, if you are truly concerned about your edema
>> (which you have the right to be), I think your doctor should refer
>> you to a nephrologist, if you request him to.
>>
>> Pete
>>
>>
>
> Being quite familiar with the structure of HMOs it may well be that it
> will be the URO that has to do the referral to a nephrologist. And
> that may be only after additional approval by someone (an
> administrative doctor?) in the HMO. The reason they can maintain
> their big staff and provide medical service at cost less than other
> insurance is sort of obvious.

I understand HMO's also Rich (as well as medical insurance in general), but
there are different kinds of HMO's (the Kaiser Permanente kind - ?sp - the
bad kind where you have to go to a doctor in one of their centers), and the
other kinds (eg MDIPA - MD is for Maryland, where I live - and is
offered by
my federal retirement insurance coverage during open season).

MDIPA, actually has more providers than my Blue Cross (and I can go to any
doctor in the whole state of Maryland), and it is way better from a cost
standpoint (premiums, deductible, catastrophic, etc). However, they still
have the friggen rules for the referral crap, and your primary doctor is in
charge (da da da da), except where a specialist may have to refer you to
another specialist, like you mentioned, which is just another level of crap.

It is a bureaucratic, administrative mess at best, and I don't choose
to get
involved it (with all my medical problems); plus with my Blue Cross, I can
go to any doctor in any city in my surrounding states (I live in a tristate
area so to speak), or any doctor in the country for that matter. I prefer
to be in charge of my medical management, and not have to kiss my primary
care doctor's ass every time I want to see a specialist, and that is all I
have done, is go to specialists, in the last 15 years.

Bottom line is that HMO's suck royally, hands down, non negotiable in my
humble opinion. Have a nice day :-) ...Pete

It's different in my town. Blue Shield has a terrible reputation related
to their PPO program. I don't think that my employer has a Blue Cross
program as an option. I will check during the next open enrollment period.
Some of the insurance companies are no longer part of the package--I don't
know the reason but it's probably related to money.
Jason


Probably money? There isn?t anything else. Although I often
sympathize with the doctors. After paying their malpractice insurance,
treating uninsured patients and accepting deep discounts from Medicare
and HMOS, paying their rent and help and supplies, they may end the week
or month at a loss.

Next question was going to be is there even a nephrologist that will
accept your Blue Cross? Maybe the URO is considered "close enough".

I don't know--it would be a good idea for me to find out if Blue Cross is
an option during the next open enrollment time period. It only happens
once a year. If we don't switch during the open enrollment time period, we
have to keep the plan we had during the prior year. My Blue Shield program
will pay any specialists as long as there is a referral. I don't know the
real reason why my doctor referred me to a uro. instead of a nephrologist.
It was probably a judgement call. Most cases of blood in the urine are NOT
related to kidney problems so therefore it made sense that he referred me
to a urol. I believe that he should have referred me to a nephrologist
since the nephrologist could have discovered the reason for the blood in
the urine as well as the cause of the edema. I doubt if insurance was an
issue related to this particular referral--just a judgement call. I
believe that the judgement was wrong but I can't tell a doctor what to do.
Perhaps I should have asked him for the reason he referred me to a
urologist instead of a nephrologist. If I had it to do over again--I would
have asked him for the reason. I now wonder if the nephrologists in my
town accept patients from Blue Shield. They probably do.
jason
.

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