Thankfully, I do meet criteria for medical necessity, it’s just a matter of getting it done in the middle of medical school instead of when I’m done with everything and actually have a substantial amount of time off for full recovery.
This is why I’m accelerating my plans for a hysterectomy by a year even though it will complicate quite a few things for me.
This is entirely unsurprising. Hopefully they can wrangle something functional out of the insurance at some point.
Also check out www.pirateship.com
In my family medicine rotation a couple months ago, we got it approved for someone with pre-diabetes, high blood pressure, and stage 2/3 kidney disease (which is not very advanced. A lot of people over the age of 35-40 can technically fall into stage 1/2.
If they have cardiovascular disease or kidney disease, those are getting added as indications for the GLP-1’s so they might be able to resubmit the authorization/claim with those diagnosis codes added to get it covered.
FIP Warriors is who we went through, but it progressed too quickly because the fluid accumulation was in his lungs, not his abdomen.
That medication is quite new to the market and wasn’t available when this happened about 4 years ago, but I will mention this to our current vet so that she knows about it.
Careful with that one. Big pharma killed my cat once.
My cat came down with Feline Infectious Peritonitis which is a coronavirus that is lethal to cats when the virus mutates and becomes FIP. FIP is 100% fatal without treatment, and there is now a treatment (originally developed at UC Davis) that is now owned by a big pharma company. They shut down the feline clinical trials in 2020 because they also make Remdesivir, and there was a concern that if there were any problems with the feline drug trial, the FDA might not approve Remdesivir for COVID. You can buy the drug on the internet from China, but it’s a 12 week course of twice daily injections, and you’re gambling on whether you got a good batch every time you get a shipment.
By the time we found this out, it was too late to save our kitty, so he crossed the rainbow bridge.
Unfortunately, the swing to the right and the rise of shit like “Blue Lives Matter” has changed this in some places. When I was in the western part of Virginia for school, there was a local car dealership called “Pinkerton” and I saw their dealership license plate frames and emblem on a LOT of cars in the area. Many of those cars also had the Gadsden vanity plates and a bunch of blue lives matter, trump, etc. stickers on them.
I just want to clarify that these stories are about patients I have cared for. I have had my own personal fights with insurance regarding coverage for life-preserving medications and diagnostic testing for damage caused by incorrect medications that I used to be on, but what I discussed here are other people whose medical care I was involved in.
(& I promise you Chipmunk Cheek’s rich sociopath family is looking at every record in their business to find out who they ficked over so bad)
Having fought with UHC to get curative cancer surgeries approved, I promise you, that list is so long as to be basically useless. They’re looking for a single fish in the Pacific Ocean here, and it’s their own fucking fault. (I have literally had them approve the excision of a malignant melanoma, but require prior authorization for the 10cm diameter skin graft to repair the area excised because the procedure code technically falls under the plastic surgery heading.
They don’t even look at what the procedure is or what it’s for. All procedures and billing codes fall under various headings and more than half of them fall under headings that require prior authorization with a massive pile of documentation and justification attached.
I’ve also had them get pissy about things like medically necessary panniculectomies (removal of the skin/fat apron at the bottom of the abdomen) for someone that lost about 200lbs and was getting literal necrosis of the skin in the fold because of the irritation and friction from the pannus. Like, yes, I know that sometimes panniculectomies can be borderline-cosmetic, but this poor lady had over a foot of overhang after her diligent weight loss from diet and exercise and she had already had one hospitalization for sepsis from the severity of the skin infection from the skin breakdown. I had to submit those hospitalization records and 3 sets of photographs of the skin breakdown from 3 separate appointments to prove that it was a consistent problem.
If you can’t tell, I am very angry about how insurance authorization works and I have intimate knowledge of the process. It drives me absolutely mad that people with MD, DO, or international medical degrees with no knowledge or expertise in the specialty at hand are the ones that review the appeals for the automatic denials. UHC was by far the worst offender and they deserve everything coming their way.
The Biden SAVE plan actually made a massive change that makes it a lot more viable, especially if you do the PSLF program. It’s set up so that if you’re on an income-driven repayment plan, any interest not covered by your payment does not capitalize. So you might not make any progress on the principal of the loan while you’re in residency, but it won’t spiral out of control and the reduced payments count towards the 120 PSLF payments. I’m planning on doing a 3 year residency at minimum, maybe more, and probably a fellowship as well, so I’ll have 5 years of reduced payments, and then I’ll be working in non-profit community/county hospitals after that so I’ll be able to use PSLF. Running the numbers, I think the government will be eating about $275k-$300k of my loans.
I am quite familiar with this nonsense from the patient side as well. As a physician, I think I will be well-placed to ensure that my patients are getting appropriate care while not giving the insurance company bullshit reasons to deny claims.
From a medical student: There is a different problem coming up with the production of more physicians. There are more new medical schools opening and existing medical schools are increasing class sizes…but the number of residencies has barely moved in decades. Residencies are funded through Medicare and the number of them is determined by appropriation bills in congress. There are some privately-funded residencies being created, but a lot of those are hideously low quality and being used as a source of indentured servitude by for-profit health groups like HCA. (They won’t even hire their own graduates from their emergency medicine residencies because the quality of the training is so poor.)
And if you don’t complete a residency, you can’t practice independently. You have to have a board certification from an accredited residency to be able to practice medicine, and the only alternatives are working under supervision like a PA/NP…or working for the insurance companies. And you still have a mortgage’s worth of student loans to pay off.
A lot of the doctors working for the insurance companies are ones that couldn’t get into residencies or ones that have not kept up with continuing medical education and likely do not have active board certification anymore.
I’m in medical school now and looking at either emergency med or family med, and either way, I am going to be exceedingly careful about how I construct my notes, diagnoses, evaluations, and treatment plans to leave as few cracks as possible for the insurance companies to try to weasel their way into.
I was the feisty little gremlin that fought with the insurance at a cancer-focused plastic surgery clinic. I got really good at stacking up all of the info in the first submission so that they couldn’t drag their heels on shit that was time-sensitive.
When I was a clinic assistant in a cancer-focused plastic surgery clinic, it was my job to fight with the insurance companies. I did prior authorizations for every surgery and they would do shit like approve the removal of a melanoma without requiring prior authorization, but performing the skin graft to repair the 10cm diameter hole required a prior authorization because the procedure code falls under the “Plastic Surgery” heading and they wanted to make sure you’re not getting skin grafts for cosmetic reasons.
The medical symbol of the staff with the snake is only supposed to have 1 (one) snake on it. A staff with 1 snake is the Rod of Asclepius (the son of Apollo and Greek demigod of medicine), a staff with 2 snakes is a Caduceus which is carried by Hermes as a messenger or herald.
Physicians get 1 snake. Couriers and heralds get 2 snakes. Any medical professional or organization that uses 2 snakes is wrong and needs to go study the humanities and classics for a bit.
It’s disappointing to see even Reuters dancing around the topic of the fully justified and wildly popular outrage against corporate America. They’re trying so hard to whitewash this and paint support for Luigi as “disturbing” while painstakingly tip-toeing around the actual issues. I expected better of Reuters than contributing to the bootlicking editorializing that’s going on in this article.