Re: Does a Uro. do kidney biopsy exams

Jason Johnson wrote:
In article <e5dfai02io0@xxxxxxxxxxxxxxxxxx>, "Pete" <pete@xxxxxxxxxx>
wrote:

Jason Johnson wrote:
In article <e5cn5702uth@xxxxxxxxxxxxxxxxxx>, "Pete" <pete@xxxxxxxxxx>
wrote:

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

I just checked my Blue Shield of California card and Blue Cross is
NOT written anywhere on that card. You may live in a different
state. We have different plans to choose from once a year during the
open enrollment period. I don't remember the plans (other than Blue
Shield) that were offered. I was only guessing when I mentioned Blue
Cross. It's possible that in this state--Blue Shield and Blue Cross
are combined and they just call it Blue Shield whereas in your city
or state--they are separate programs. I know that I can go to a local
hospital and use my Blue Shield to pay for it. I plan to ask the uro.
to refer me to a neprologist if he can not determine the source of
the blood in the urine. Once I see the neprologist I am going to
request a kidney biopsy to rule in or out kidney disease. One person
in another newsgroup indicated that I needed to see a psychologist
since I was obsessed about my medical problems. That made me laugh.
It makes more sense to try to find the reasons for the
1.edema
2.metabolic acidosis
3.blood in the urine.
If it's not a kidney disease--it's something else. My research
indicates that there is a medical problem (eg kidney disease, liver
disease) that causes those symptoms.
Thanks for your support. The insurance mess is making it difficult
for me to see the specialists that I would like to see.
Jason

Okay Jason...it appears there is a nomenclature/symantics issue here
- NBD. Many years ago when Blue Cross first started (back when an ER
visit was only 25-50 dollars), there were two distinct parts (ie the
"cross" and the "shield"). I just refer to it today as Blue Cross in
a generic sense, although my offiial insurance is called "Care First
Blue Cross Blue Shield - Federal Employee Program"- wow!

Take care...Pete

I work for the STATE of CALIFORNIA. It's possible that is the reason
for the nomenclature/symantics issue. It's just referred to as BLUE
SHIELD in relation to my insurance and the exact words on my
insurance card. The official name written on one of the booklets is:
"Blue Shield of California--An Independent Member of the Blue Shield
Association."
Does that help clear up the mystery?
Jason

Jason...I googled your insurance and apparantly you must have one of the HMO
versions (versus PPO) of "Blue Shield of California". I say this since you
have all the referral rules you mentioned. You may want to consider
switching to a non HMO type during open season, although it may cost more,
and may not suit your specific needs...Pete


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