Re: Does a Uro. do kidney biopsy exams

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
.

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