This is true and the healthcare access problem is more than just cost. If you’re an hour and a half away from any specialists, then the ER you went to likely doesn’t have access to set up those referrals. I have worked in both metropolitan and rural medical systems, and the biggest problems in rural healthcare are almost always access-based. If a hospital/ER is not in the same medical group as a specialist, they can’t put in emergency referrals to that specialist, and I have worked in rural hospitals that don’t even always have imaging services available. There’s an MRI on a trailer that gets brought around to the various hospitals in the group meaning that each hospital has one day a week or one day every other week where an MRI is available. The other option a small, rural ER has is to call EMS to transfer you to another hospital with more resources, but if your insurance doesn’t like the reason they give, you end up on the hook for that 90 minute ambulance ride. Small community hospitals are really between a rock and a hard place when it comes to connecting patients with resources while trying to avoid unnecessary expenses.

The best advice I have for anyone in a rural area with poor healthcare access is to establish care with a family physician for primary care because, most of the time, the primary care physician is the one that actually gets to the bottom of things or coordinates the referrals for specialists. If you have a standing relationship with a physician, it’s a lot easier to make an appointment and they have a baseline to work from as opposed to starting from scratch like an ER physician has to.

Unfortunately, a solid diagnosis can be really hard to find and there are a lot of diseases and conditions that require more testing than can be completed in the ER. Part of why the ER is expensive is because the tests they do get come back almost immediately, but they very rarely order the tests that take a long time anyways. Expediency and staffing are the main contributors to the cost of emergency care.

With the example of your case, how would the ER get you the diagnosis of a food intolerance without spending weeks on an elimination diet? There are some allergies that can be tested for, but that testing involves injecting a sample of the offending agent under the skin and watching to see if it causes irritation… but allergies and food intolerances are not the same thing and the only way to test for food intolerances is an elimination diet. For the allergy testing, the ER doesn’t have the samples to do the subcutaneous injections. It’s really only allergy specialists that have those available.

I’m very sorry that you went through that. I know it sucks with the American healthcare $ystem, but you are always allowed to seek a second opinion and any provider that is opposed to that is a bad provider and you shouldn’t see them again anyways.

One thing to keep in mind about the ER though, is that they’re there to rule out anything that is going to kill you quickly, and if you didn’t lose enough blood to drop your hemoglobin count (a measure of how many red blood cells you have), it is perfectly within the standard of care for them to discharge you and tell you to follow up with your primary care physician or a specialist. The ER has a lot of resources, but not enough resources to fully diagnose every possible problem. They can make sure you’re not on death’s doorstep, and stabilize you if you are, but beyond that, they’re pretty strapped for resources and staffing which make it hard to fully work up every mystery diagnosis.

Painless hematuria (blood in the urine without pain when peeing) is one of the first (and frequently only) signs of bladder cancer. Especially if it’s frank blood (meaning that you can see it without a microscope).

Don’t feel bad about that! There are no stupid questions when it comes to your health and it’s important to ask someone who can give you accurate answers (and there’s no one better to ask than your own physician that you have a relationship with).

If they are proportional to each other, you shouldn’t really be able to get more in your mouth than your esophagus can handle. There are some conditions that make the esophagus tense up wrong instead of making peristalsis.

You should ask about getting a swallowing study done to find out what’s going on because that isn’t normal. It might be an esophageal stricture or spasm that can be fixed.

This is entirely unsurprising. Hopefully they can wrangle something functional out of the insurance at some point.

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.

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.

In fairness to their argument, I have actually seen serious consequences from the mass theft of baby formula. When I worked in a children’s hospital, we had babies coming in with malnutrition problems because they required a special formula that was completely unavailable. The parents couldn’t buy the formula because it was out of stock at every store they were able to get to with the transportation and time available to them.

People stealing massive amounts of formula cause massive problems because the specialty formulas are hard to find to begin with, and these people are clearing out store shelves to sell it overseas.

The wealthy parents that live in nicer neighborhoods with fancier stores and fewer problems with shoplifting don’t run into this issue. It the poor families in food deserts that are most impacted by this kind of mass theft, and they’re the families least able to work around it by just going to another store to buy it.

These days, an epesiotomy is done to direct the tear. If the tear is allowed to happen spontaneously, it can go through nerves, arteries, and pelvic floor muscles, greatly increasing the chances of permanent problems with things like prolapses or fistulas at worst, and more commonly, long term problems with incontinence.

Thank you!

Do you know the name of this sculpture or the name of the artist?

They do feel hardship, but there are quite a few people that see donating to trump and trump merch as necessities (and not all of them are Americans).

I’m saying that getting methamphetamine as a replacement for Adderall is a terrible idea because of the problems with contamination and legal repercussions. If you don’t have access to the psychiatric care, getting started with drugs that are cut with god knows what at highly unreliable doses is not likely to make things much better, definitely not in the long run.

I would recommend against using street drugs in place of prescriptions because of the aforementioned reasons. I’ve seen what street drugs do to people while working in ERs and in a clinical setting, and it’s just not worth it.

The problem is that the purity of the drug you’re getting is not guaranteed or regulated at all. For a lot of recreational/street drugs, the bigger problem is often the filler and crap they get cut with. If you’re paying enough for actually reliably pure drugs, you might as well just pay out of pocket for the psychiatrist and avoid the risk of drug charges.