Re: Does a Uro. do kidney biopsy exams

In article <e5afpg022fr@xxxxxxxxxxxxxxxxxx>, "Pete" <pete@xxxxxxxxxx> wrote:

Jason Johnson wrote:
In article
<bNYdg.172945$eR6.40836@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx>, Rich256
<nospam@xxxxxxxxxx> 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 bullshit to me :-) .

It's HMO bullshit. 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

I doubt that the primary care doctor has any control. The HMO reviews
the test results and probably not authorize the kidney specialist. I
would say it is now up to your URO to determine if a kidney specialist
is needed.

Perhaps you can be thankful there is not a government bureaucrat
somewhere in the line deciding which doctor and treatment you will be
allowed to have (in the very distant future).

Your experience is exactly why I found a way out of HMOs about 10
years ago. I concluded the savings were not worth my not being able
to search out the doctor I want. Those that use them usually say "I
have no complaints". I then ask if they ever had a difficult medical
problem that needed a specialist or something that made you
uncomfortable with the specialist provided by the HMO.

I guess the bottom line is you get what you pay for.

The doctor of a friend recommended that he go to the Mayo clinic.
The HMO refused to pay saying there were adequate doctors available
locally. That doctor immediately dropped all patients from that
HMO. The local doctors (and there were several of them) all
concluded he suffered from
a bone infection. They removed large sections of his jaw bones and
did other treatment without success. Finally they sent him to Mayo.
It
took the Mayo doctors 20 minutes to point out he has a small tumor.
Fortunately very slow growing. The friend then remembered one of the
doctors commenting "I wonder what that lump is?". Several years of
cosmetic surgery followed.

None of the things that you stated shocked or surprised me since I
have had to deal with this issue for the past two years. I decided to
pay extra for a PPO (did I get that right?) since I was promised that
I could see any specialist that I wanted to see without getting a
referral from my GP. That did not work since none of the specialists
would see me unless I was referred from my GP doctor. I later learned
that specialists made that decision since my Blue Shield PPO program
refused to pay them if specialists determined that certain patients
did not have a medical problem. However, they would pay the
specialists if patients were referred even if the specialist later
determined that they patients did not have any medical problems. It's
a mess. I wish that I was rich and could therefore avoid dealing with
the insurance mess.
Jason

Jason...You really have me confused here. Do you belong to an HMO, or to a
Blue Shield PPO network, or both ????

Hello,
It's a Blue Shield PPO network but in my town it's nothing more than an
HMO since none of the specialists will see me unless I am referred by my
regular doctor. I was told that the reason is because they the specialists
are only 100% sure they will be paid is if their Blue Shield patients were
referred by their regular doctors. It's a mess.
Jason
.

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