Re: Does a Uro. do kidney biopsy exams

Jason Johnson wrote:
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

Jason...let me expand on Blue Cross/Blue Shield (B/C and B/S) a little (at
least my federal retirement coverage). I have both B/C and B/S. B/C is for
hospital stuff, and B/S is for doctor stuff (for a nutshell definition).
One is really useless without the other. I am surprised that you have Blue
Shield without the Blue Cross (ie, what happens if you require a major
hospitalization - eg, major car accident, or other serious condition). I
don't understand why you keep saying you will check on Blue Cross. You need
both the "cross" for the hospital stuff, and the "shield" for the doctor
stuff.

As far as your primary care doc referring you to the uro first (before a
nephrologist), that is the logical sequence and he probably figured the uro
will forward you on to the nephrologist if necessary, like Rich said. I can
see you need some minor tune up work on going to doctors :-) . I have been
to approx 75 docs in my life, and I hate the bastards (except for a few like
our marvelous Dr. Sancha in this group).

Call the nephrologists in your area and ask them if they take your Blue
Shield. It is a simple phone call. Take care :-) ...Pete


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