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Thread: *** OFFICIAL *** Colonoscopy Thread

  1. #81
    Silver Cerveza Fria's Avatar
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    Quote Originally Posted by Dan Druff View Post
    Quote Originally Posted by Cerveza Fria View Post
    Here's the transcript of the Pre-Op conversation between the Doc and Druff....


    Doc: It's ok. There's nothing to be embarrassed about. It's perfectly normal to experience an erection during this type of procedure.

    Druff: But, Doc, I don't have an erection.

    Doc: I know, but I do. Now just relax and count backwards from 100....

    Druff: WTF?
    That would have been an especially disturbing conversation, given that the doctor was female.
    Anything is possible

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  2. #82
    Diamond Walter Sobchak's Avatar
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    Never did I think I'd feel so relieved to read a wall of text about Druff's rectum.

    Glad you got it taken care of sir.

    Hope all continues to be all right.

     
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  3. #83
    100% Organic MumblesBadly's Avatar
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    Quote Originally Posted by Walter Sobchak View Post
    Never did I think I'd feel so relieved to read a wall of text about Druff's rectum.

    Glad you got it taken care of sir.

    Hope all continues to be all right.
    Actually, we didn’t read anything about Druff’s rectum. His colon, sure. But nothng about the passage to colon.

    Plus, if Druff had a precancerous anything on his rectum in such an examination, he’d be crapping “Oh-Shit!” bricks all over this thread given the much higher mortality rate for such a diagnosis.

    https://healthblog.uofmhealth.org/ca...-cancer-differ
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    I actually hope this [second impeachment] succeeds, because I want Trump put down politically like a sick, 14-year-old dog. ... I don't want him complicating the 2024 primary season. I just want him done.
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    Were Republicans cowardly or unethical not to go along with [convicting Trump in the second impeachment Senate trial]? No. The smart move was to reject it.

  4. #84
    [QUOTE=Dan Druff;957710]
    Quote Originally Posted by Cerveza Fria View Post
    That would have been an especially disturbing conversation, given that the doctor was female.
    Asian by chance?

  5. #85
    Puts His Dick in the Mashed Potatoes
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    Quote Originally Posted by Dan Druff View Post
    Finally, some good news in 2021.

    Sure, there have been some frustrations this week. Republicans lost the Senate, Trump's 2-month meltdown culminated in weirdos storming the Capitol, making my entire party look bad, and I had the wrong time for the easiest NBA under in the world, and didn't get to bet it.

    However, I got an e-mail from the doctor's office that they no longer do the horrible COVID test way up your nose, and instead have changed to a much easier one.





    I was really dreading that awful test. Now I don't have to take it.
    Don't know if you'd had one or you're just assuming it's terrible, but the covid nose test is no biggy. I found it to be painless. Just don't flinch.

     
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  6. #86
    Plumber tgull's Avatar
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    Quote Originally Posted by Dan Druff View Post
    Now onto the less important details.

    Honestly I don't regret any of my choices here, aside from waiting too long.


    The Prep

    Not pleasant, but not nearly as bad as portrayed by most. The fact that I went the Miralax/Gatorade route really helped. No nasty taste. Even though Miralax is tasteless, it does change the consistency a little bit, so something feels a bit "off" drinking it, compared to normal Gatorade. I'm also not a fan of the non-red (meaning not red, orange or purple) Gatorade, so there was that, too. When I first started drinking it, I got a bit nauseous right away, but I think it's because I gulped it down a bit too fast. I slowed down and that stopped happening.

    One big surprise was the fact that it did NOT act quickly. I took 4 Ducolax tablets at 3:30pm yesterday, and then drank 32oz of the Gatorade/Miralax from 4:30-5:30pm (also yesterday). It took until 8:30pm for me to start shitting. I imagined this would happen in about 20 minutes, but it took 3 hours. After an hour passed with no action, I thought maybe I did something wrong, and I pictured bottomset chiding me for choosing this version of the prep. I texted my sister, who told me she had the identical experience, and that hers took 3 hours. Indeed, so did mine.

    While I didn't love the watery diarrhea, it wasn't as bad as people say. Sure, I had to use the toilet a lot, but sometimes I'd go 1-2 hours between. Overall I think I went like 7 times. By the end, it was completely watery and clear yellow, like it was supposed to be, so I was confident I did it right.

    One thing that surprised me was that I was not hungry at all. I had prepared beef bone broth and Jell-O to eat. Didn't need it. I went the entire day yesterday without touching any food after 5:30am. The next food I ate was noon today -- over 30 hours later.

    It was a pain in the ass waking up in the middle of the night to take the other 32oz of Miralax/Gatorade. I also stayed up for about 90 minutes after that so I could use the bathroom, which would inevitably happen. I was paranoid about literally shitting the bed in my sleep.

    I went back to sleep but set an alarm for 5:25am. The procedure was to be at 9:30am. I chose 5:25am because it was my last opportunity to drink anything. I gulped down 24 ounces of water, and then had to decide whether to go back to sleep or stay up. I elected to stay up, because I tend to get very thirsty while sleeping, and I figured 4 hours awake would be an easier no-water fast than 2 hours sleeping and 2 hours awake. I was right, as this wasn't very difficult.



    The Leadup

    Because of the psychological damage I took in 2018, I was nervous about the falling asleep portion on the propofol. My biggest concern was that I would be in the "between sleeping and awake" state, which my brain now really hates, and I kinda freak out when I catch myself in that state. I explained this to the anesthesiologist, who was very nice, and suggested that she administer it quickly, rather than slowly. She said most patients enjoy the euphoric feeling of receiving it slowly, but since I don't want that, she would give it quickly and I'd fall asleep fast.

    They were nice/flexible there, and let me keep my phone until just before wheeling me into the room for the procedure. This helped keep my mind off of it. I was tweeting and texting with people up until a few minutes before the procedure! After I got on my side, they administered the propofol without warning, and I simply heard them say, "The sedation has started."

    I asked, "Wait, I'm getting the propofol now?"

    I felt nothing yet.

    They said yes, and after about 10 seconds, I started noticing I was rapidly getting tired, and I started to feel a bit dizzy, with my vision shifting back and forth. Not a bad feeling at all -- I'd compare it to the way you feel when you get in bed and are super tired already. I decided, "Well, might as well go with it" and just closed my eyes and attempted to fall asleep. About a second later, I was out.

    Apparently a burning sensation is common when administering propofol, but I didn't feel it, even though I was warned there was a good chance I would. Nobody in my immediate family has ever felt the burning, so perhaps it's hereditary.



    The Aftermath

    It then felt like about an hour sleep. No dreams. (Some report dreams on propofol, but I didn't have any.) It didn't feel instantaneous -- more like a short sleep, where you wake up aware that you were sleeping for a short time.

    I woke up back in the recovery room where I started. The first person I saw was the doctor. She told me about the four polyps, including the large, precancerous one, which was 1.5cm. As I mentioned, she said the colon itself looked good, and that cancer is unlikely, but they were sending all four to be biopsied. There is a good chance that the large polyp was the cause of my recent anemia.

    I have to go back in 3 years.

    Kinda strange to think about the fact that there's a fair chance I wouldn't have seen my 60th birthday -- or maybe not even my 55th -- if I hadn't done this. I will be very diligent about the follow-ups going forward.

    The doctor and staff were all very nice, and the place was run well. I will be returning to the same facility in 2024. If you haven't had a colonoscopy yet and are over 50, or are 45-49 and have a family history of colon cancer or precancerous polyps, you should 100% get this done.
    The Doctor Office Staff


    "You mean the guy that has been calling us about Gatorade colors is gone until 2024??

    "

     
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  7. #87

  8. #88
    Owner Dan Druff's Avatar
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    Faster test results than expected.

    The polyps have been analyzed:

    - The big (1.5 cm) one was a "tubulovillous adenoma" - precancerous, medium risk

    - One of the small ones was also a "tubulovillous adenoma" - precancerous, medium risk

    - One of the small ones was a "tubular adenoma" - precancerous, moderate risk

    - One of the small ones was hyperplastic (benign) - benign


    No cancer was detected in the polyps.

    Looks like I will be going every 3 years for the rest of my life.

     
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      garrett: lol Congrats, getting olds' no good =)...
      
      Cerveza Fria: good thing you got it done. Now go and enjoy life!
      
      IamGreek: OPA!

  9. #89
    Quote Originally Posted by tgull View Post
    Quote Originally Posted by Dan Druff View Post
    Now onto the less important details.

    Honestly I don't regret any of my choices here, aside from waiting too long.


    The Prep

    Not pleasant, but not nearly as bad as portrayed by most. The fact that I went the Miralax/Gatorade route really helped. No nasty taste. Even though Miralax is tasteless, it does change the consistency a little bit, so something feels a bit "off" drinking it, compared to normal Gatorade. I'm also not a fan of the non-red (meaning not red, orange or purple) Gatorade, so there was that, too. When I first started drinking it, I got a bit nauseous right away, but I think it's because I gulped it down a bit too fast. I slowed down and that stopped happening.

    One big surprise was the fact that it did NOT act quickly. I took 4 Ducolax tablets at 3:30pm yesterday, and then drank 32oz of the Gatorade/Miralax from 4:30-5:30pm (also yesterday). It took until 8:30pm for me to start shitting. I imagined this would happen in about 20 minutes, but it took 3 hours. After an hour passed with no action, I thought maybe I did something wrong, and I pictured bottomset chiding me for choosing this version of the prep. I texted my sister, who told me she had the identical experience, and that hers took 3 hours. Indeed, so did mine.

    While I didn't love the watery diarrhea, it wasn't as bad as people say. Sure, I had to use the toilet a lot, but sometimes I'd go 1-2 hours between. Overall I think I went like 7 times. By the end, it was completely watery and clear yellow, like it was supposed to be, so I was confident I did it right.

    One thing that surprised me was that I was not hungry at all. I had prepared beef bone broth and Jell-O to eat. Didn't need it. I went the entire day yesterday without touching any food after 5:30am. The next food I ate was noon today -- over 30 hours later.

    It was a pain in the ass waking up in the middle of the night to take the other 32oz of Miralax/Gatorade. I also stayed up for about 90 minutes after that so I could use the bathroom, which would inevitably happen. I was paranoid about literally shitting the bed in my sleep.

    I went back to sleep but set an alarm for 5:25am. The procedure was to be at 9:30am. I chose 5:25am because it was my last opportunity to drink anything. I gulped down 24 ounces of water, and then had to decide whether to go back to sleep or stay up. I elected to stay up, because I tend to get very thirsty while sleeping, and I figured 4 hours awake would be an easier no-water fast than 2 hours sleeping and 2 hours awake. I was right, as this wasn't very difficult.



    The Leadup

    Because of the psychological damage I took in 2018, I was nervous about the falling asleep portion on the propofol. My biggest concern was that I would be in the "between sleeping and awake" state, which my brain now really hates, and I kinda freak out when I catch myself in that state. I explained this to the anesthesiologist, who was very nice, and suggested that she administer it quickly, rather than slowly. She said most patients enjoy the euphoric feeling of receiving it slowly, but since I don't want that, she would give it quickly and I'd fall asleep fast.

    They were nice/flexible there, and let me keep my phone until just before wheeling me into the room for the procedure. This helped keep my mind off of it. I was tweeting and texting with people up until a few minutes before the procedure! After I got on my side, they administered the propofol without warning, and I simply heard them say, "The sedation has started."

    I asked, "Wait, I'm getting the propofol now?"

    I felt nothing yet.

    They said yes, and after about 10 seconds, I started noticing I was rapidly getting tired, and I started to feel a bit dizzy, with my vision shifting back and forth. Not a bad feeling at all -- I'd compare it to the way you feel when you get in bed and are super tired already. I decided, "Well, might as well go with it" and just closed my eyes and attempted to fall asleep. About a second later, I was out.

    Apparently a burning sensation is common when administering propofol, but I didn't feel it, even though I was warned there was a good chance I would. Nobody in my immediate family has ever felt the burning, so perhaps it's hereditary.



    The Aftermath

    It then felt like about an hour sleep. No dreams. (Some report dreams on propofol, but I didn't have any.) It didn't feel instantaneous -- more like a short sleep, where you wake up aware that you were sleeping for a short time.

    I woke up back in the recovery room where I started. The first person I saw was the doctor. She told me about the four polyps, including the large, precancerous one, which was 1.5cm. As I mentioned, she said the colon itself looked good, and that cancer is unlikely, but they were sending all four to be biopsied. There is a good chance that the large polyp was the cause of my recent anemia.

    I have to go back in 3 years.

    Kinda strange to think about the fact that there's a fair chance I wouldn't have seen my 60th birthday -- or maybe not even my 55th -- if I hadn't done this. I will be very diligent about the follow-ups going forward.

    The doctor and staff were all very nice, and the place was run well. I will be returning to the same facility in 2024. If you haven't had a colonoscopy yet and are over 50, or are 45-49 and have a family history of colon cancer or precancerous polyps, you should 100% get this done.
    The Doctor Office Staff


    "You mean the guy that has been calling us about Gatorade colors is gone until 2024??

    "
    He knows his shit

  10. #90
    Diamond Walter Sobchak's Avatar
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    Quote Originally Posted by Dan Druff View Post
    Faster test results than expected.

    The polyps have been analyzed:

    - The big (1.5 cm) one was a "tubulovillous adenoma" - precancerous, medium risk

    - One of the small ones was also a "tubulovillous adenoma" - precancerous, medium risk

    - One of the small ones was a "tubular adenoma" - precancerous, moderate risk

    - One of the small ones was hyperplastic (benign) - benign


    No cancer was detected in the polyps.

    Looks like I will be going every 3 years for the rest of my life.
    Totally tubular dude

    Consider this leak plugged.
    SOBCHAK SECURITY 213-799-7798

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  11. #91
    Owner Dan Druff's Avatar
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    BUMP

    Normally I wouldn't post about my insurance billing follies unless it was really egregious, but this information might help others here save some Jew Gold if you get a colonoscopy and try to charge you.

    Basically, most insurance companies have taken the position that a colonoscopy is "free" to the patient, as it's considered preventative. However, there are various ways you can get fucked by this, and will receive a bill anyway. It's important to know what you can do about this. I'm currently battling this out, and am most of the way there regarding success.

    Here are the places where you might get billed:

    1) The initial doctor's visit where they discuss the procedure and ask you if you have any questions. This can be billed as a specialist office visit. It shouldn't. This should be "preventative", and therefore free to you. I got billed $65 for this.

    2) The colonoscopy itself requires various outpatient services to make it happen, such as nursing services, equipment, etc. It's sometimes called "ambulatory services". This should be included as part of the preventative care. For some reason, I got billed $231 for this.

    3) If polyps are found, this can change the colonoscopy to be "diagnostic" rather than "preventative". This is stupid, because the removal of polyps IS the preventative part! If nothing is found, then it's not preventative, because there's nothing being prevented! So they have it backwards. For this reason, I was charged $40 for the colonoscopy, and $155 for the removal and analysis of the polyps.

    4) If you elected to have them use propofol to put you out, you can be billed up to $200 for it, as some insurances consider this unnecessary and voluntary. I disagree, but what I think about it doesn't matter for this discussion. Anyway, the $200 is legit, and you have to pay it. Strangely enough, the propofol WAS covered for me. While I was hit with those four bullshit charges mentioned above, the one potentially legit charge was actually covered! If you do end up wit the $200 charge for the propofol, you can still attempt to call up your insurance and argue it out. Make sure you get a rep in the US, and ask for a supervisor if the initial US rep refuses to help you. Be polite but firm. Your best bet is to argue that you have anxiety, and need the propofol for the procedure.



    I got the $231, $40, and $155 removed. I had to speak to US reps with my insurance company, who took care of it after listening to my points. They initially tried to argue, but they backed down quickly. You should be able to argue all of these off, by insisting that you were told the colonoscopies are free to the patient, and that a colonoscopy itself is always preventative -- that finding and removing polyps IS prevention!

    The last part I'm dealing with is the $65 charged for the first visit (see #1 above), and that seems to be a billing code issue. I am semi-optimistic that I will prevail there, as well. The one problem is that I paid it back in November, before realizing that this shouldn't have been charged, so that's made it a bit more challenging. I'm in the right here, but will give up fighting it if it takes too long, because it's 4 months ago, and I already paid, so it's a lot harder to get fixed at this point.

    This brings me to my final point. Do not pay ANY of these bills until you are satisfied that it has been adjusted properly. This puts the power in your hands.

    Anyway, this is all occurring as a side effect to Obamacare. This is because Obamacare forces insurance companies to cover "preventative" care 100%, and the definition of "preventative" is rather loose, so these problems occur. Often these are arbitrary coding decisions made by the biller at the doctor's office, and you can get it reversed just by calling and pleading your case to the insurance company. Even if you don't have Obamacare, this all applies. I'm just telling you the origins of the problem with the colonoscopy billing.

    But definitely dig in your heels and refuse to pay for anything except the propofol.

    If you are under 50, make sure they know you have a family history, so the "preventative" part kicks in. For me, that's the truth anyway.

     
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  12. #92
    Gold JeffDime's Avatar
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    Great info Druff. Unfortunately I have some experience dealing with medical billing and it can be infuriating. Like Druff did, the number one thing is to deal with it immediately. I have had very small amounts I was unaware of all of a sudden show up through a collection agency. You call them and they don’t even know where the charge originated from. So the bottom line is to be on top of shit like Druff was.

    I will say that I don’t believe that the medical billing personnel is in most cases sitting in front of the computer and trying to find loopholes in Obamacare or the Insurance Policy to squeeze every penny out of you. In my experience it seems like they don’t communicate well in many cases with the other staff, go along at their own pace and by and large just don’t have the expertise to interpret the law & insurance policies they should. If they had that kind of expertise they would make a hell of a lot more as an underwriter. So bottom line...things get fucked up.

    As a rule they will almost always over charge you. I can’t remember every being undercharged for a procedure. That surely is by design and a number of people do over pay for one reason or another. It is a boring subject in general but I’m glad Druff took the time to break it down. It can save you even more significant money when the procedure is not “ambulatory” and requires a hospital stay.

  13. #93
    Silver The Shrink's Avatar
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    Quote Originally Posted by Dan Druff View Post
    BUMP

    Normally I wouldn't post about my insurance billing follies unless it was really egregious, but this information might help others here save some Jew Gold if you get a colonoscopy and try to charge you.

    Basically, most insurance companies have taken the position that a colonoscopy is "free" to the patient, as it's considered preventative. However, there are various ways you can get fucked by this, and will receive a bill anyway. It's important to know what you can do about this. I'm currently battling this out, and am most of the way there regarding success.
    "Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?

    It's truly baffling how unnecessarily complex the American health care system is and yet you'd prefer it over Canada's dreaded "socialized medicine" in which every citizen doesn't need to be a fucking actuary to understand what they should be paying for medical care.

    Every time I see these threads on PFA I shake my head in wonder that your system is accepted as normal in the U.S.

     
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      Walter Sobchak: this

  14. #94
    Plumber tgull's Avatar
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    Quote Originally Posted by The Shrink View Post
    Quote Originally Posted by Dan Druff View Post
    BUMP

    Normally I wouldn't post about my insurance billing follies
    unless it was really egregious, but this information might help others here save some Jew Gold if you get a colonoscopy and try to charge you.

    Basically, most insurance companies have taken the position that a colonoscopy is "free" to the patient, as it's considered preventative. However, there are various ways you can get fucked by this, and will receive a bill anyway. It's important to know what you can do about this. I'm currently battling this out, and am most of the way there regarding success.

    "Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?

    Since I don't have a job, I have individual health insurance that I pay for myself. Starting March of this year, I was forced on one of the new Obamacare failplans. The cost of my insurance went from $172/mo to $255/mo, despite nearly identical benefits. Or so I thought.

    This past week, I needed to see an opthalmologist, due to some strange pain in my left eye. It did not seem serious enough to go to the ER, but something I wanted to have checked out.

    I looked up doctors on my insurance company's website. I found a large opthalmology office in my area where all of the doctors took my insurance.

    I called the doctor's office and made an appointment. I verified that they took my insurance.

    I got there on Monday afternoon, only to find out the bad news: They didn't actually take my insurance, because I had an individual plan. Basically they were not taking anyone on an individual plan, regardless of the insurance company.

    I called up another opthalmology group in the area. Same story.

    In fact, every office I called would not take my insurance!

    I called the insurance company to inquire what was going on. How was it possible that these doctors were listed, yet when I got there, they didn't take my insurance?

    What was I getting for my $255/mo?

    I was told that all doctors had an option to terminate the contract with the insurance company at any time, and that the IT people weren't fast enough to update all of the offices that had dropped out. Apparently there has been a mass exodus from taking these individual plans.

    But why?

    Apparently these individual plans pay shit to the doctors, so most doctors are rejecting them, figuring that they will focus on the patients with employer-based insurance, which still pays them well.

    And why does employer-based insurance pay better? Because the premiums are very high, so they can afford it. Individual plans only worked in the pre-Obamacare days because they could deny coverage to people with expensive pre-existing conditions. Now that they have to take everyone, there's basically no money left in the system to pay doctors the market rate, so they dramatically lowered what they pay, and doctors are dropping these plans like hotcakes.

    Of course, the insurance company doesn't tell you this until you show up to the doctor's office and get the bad news.

    And it's impossible to do a search for doctors who ARE covered, as these websites are not accurate. Even the phone reps cannot tell you, as they have the same flawed info as you.

     
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      garrett: LoL because you don't have the 'Caddillac' insurance you broke fuck... Wake up and admit your a fucking poor folk like many others in ugh....

  15. #95
    Quote Originally Posted by tgull View Post
    Quote Originally Posted by The Shrink View Post

    "Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?

    Since I don't have a job, I have individual health insurance that I pay for myself. Starting March of this year, I was forced on one of the new Obamacare failplans. The cost of my insurance went from $172/mo to $255/mo, despite nearly identical benefits. Or so I thought.

    This past week, I needed to see an opthalmologist, due to some strange pain in my left eye. It did not seem serious enough to go to the ER, but something I wanted to have checked out.

    I looked up doctors on my insurance company's website. I found a large opthalmology office in my area where all of the doctors took my insurance.

    I called the doctor's office and made an appointment. I verified that they took my insurance.

    I got there on Monday afternoon, only to find out the bad news: They didn't actually take my insurance, because I had an individual plan. Basically they were not taking anyone on an individual plan, regardless of the insurance company.

    I called up another opthalmology group in the area. Same story.

    In fact, every office I called would not take my insurance!

    I called the insurance company to inquire what was going on. How was it possible that these doctors were listed, yet when I got there, they didn't take my insurance?

    What was I getting for my $255/mo?

    I was told that all doctors had an option to terminate the contract with the insurance company at any time, and that the IT people weren't fast enough to update all of the offices that had dropped out. Apparently there has been a mass exodus from taking these individual plans.

    But why?

    Apparently these individual plans pay shit to the doctors, so most doctors are rejecting them, figuring that they will focus on the patients with employer-based insurance, which still pays them well.

    And why does employer-based insurance pay better? Because the premiums are very high, so they can afford it. Individual plans only worked in the pre-Obamacare days because they could deny coverage to people with expensive pre-existing conditions. Now that they have to take everyone, there's basically no money left in the system to pay doctors the market rate, so they dramatically lowered what they pay, and doctors are dropping these plans like hotcakes.

    Of course, the insurance company doesn't tell you this until you show up to the doctor's office and get the bad news.

    And it's impossible to do a search for doctors who ARE covered, as these websites are not accurate. Even the phone reps cannot tell you, as they have the same flawed info as you.
    Thanks Obama.

    Maybe join a co op?

  16. #96
    Silver The Shrink's Avatar
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    Quote Originally Posted by tgull View Post
    Since I don't have a job, I have individual health insurance that I pay for myself. Starting March of this year, I was forced on one of the new Obamacare failplans. The cost of my insurance went from $172/mo to $255/mo, despite nearly identical benefits. Or so I thought.

    This past week, I needed to see an opthalmologist, due to some strange pain in my left eye. It did not seem serious enough to go to the ER, but something I wanted to have checked out.

    I looked up doctors on my insurance company's website. I found a large opthalmology office in my area where all of the doctors took my insurance.

    I called the doctor's office and made an appointment. I verified that they took my insurance.

    I got there on Monday afternoon, only to find out the bad news: They didn't actually take my insurance, because I had an individual plan. Basically they were not taking anyone on an individual plan, regardless of the insurance company.

    I called up another opthalmology group in the area. Same story.

    In fact, every office I called would not take my insurance!

    I called the insurance company to inquire what was going on. How was it possible that these doctors were listed, yet when I got there, they didn't take my insurance?

    What was I getting for my $255/mo?

    I was told that all doctors had an option to terminate the contract with the insurance company at any time, and that the IT people weren't fast enough to update all of the offices that had dropped out. Apparently there has been a mass exodus from taking these individual plans.

    But why?

    Apparently these individual plans pay shit to the doctors, so most doctors are rejecting them, figuring that they will focus on the patients with employer-based insurance, which still pays them well.

    And why does employer-based insurance pay better? Because the premiums are very high, so they can afford it. Individual plans only worked in the pre-Obamacare days because they could deny coverage to people with expensive pre-existing conditions. Now that they have to take everyone, there's basically no money left in the system to pay doctors the market rate, so they dramatically lowered what they pay, and doctors are dropping these plans like hotcakes.

    Of course, the insurance company doesn't tell you this until you show up to the doctor's office and get the bad news.

    And it's impossible to do a search for doctors who ARE covered, as these websites are not accurate. Even the phone reps cannot tell you, as they have the same flawed info as you.
    I mean, this is exactly what I'm talking about. The fact that you have to look up doctors who are covered by your insurance, shop around, deal with insurance companies, etc. - it's all so bizarre.

  17. #97
    Quote Originally Posted by The Shrink View Post
    Quote Originally Posted by Dan Druff View Post
    BUMP

    Normally I wouldn't post about my insurance billing follies unless it was really egregious, but this information might help others here save some Jew Gold if you get a colonoscopy and try to charge you.

    Basically, most insurance companies have taken the position that a colonoscopy is "free" to the patient, as it's considered preventative. However, there are various ways you can get fucked by this, and will receive a bill anyway. It's important to know what you can do about this. I'm currently battling this out, and am most of the way there regarding success.
    "Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?

    It's truly baffling how unnecessarily complex the American health care system is and yet you'd prefer it over Canada's dreaded "socialized medicine" in which every citizen doesn't need to be a fucking actuary to understand what they should be paying for medical care.

    Every time I see these threads on PFA I shake my head in wonder that your system is accepted as normal in the U.S.


    I don't know what the answer is but you're right - our system is impossibly complex and stupid.

    Sincerely commend Druff for always digging in and fleshing out the bullshit behind this.

    I've started down this path before but always give up because I simply don't have the time to deal with it, which is likely by design. Gratefully have no health issues and only go in for my annual, but even understanding the billing behind simple blood work is obnoxious.

    Simply adding my son onto my dental plan took me three hours of jumping around from rep to rep with Kaiser.
    Quote Originally Posted by Tyde View Post
    I am a nice human being who enjoys being upbeat and affable with others

  18. #98
    Owner Dan Druff's Avatar
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    Quote Originally Posted by tgull View Post
    Quote Originally Posted by The Shrink View Post

    "Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?

    Since I don't have a job, I have individual health insurance that I pay for myself. Starting March of this year, I was forced on one of the new Obamacare failplans. The cost of my insurance went from $172/mo to $255/mo, despite nearly identical benefits. Or so I thought.

    This past week, I needed to see an opthalmologist, due to some strange pain in my left eye. It did not seem serious enough to go to the ER, but something I wanted to have checked out.

    I looked up doctors on my insurance company's website. I found a large opthalmology office in my area where all of the doctors took my insurance.

    I called the doctor's office and made an appointment. I verified that they took my insurance.

    I got there on Monday afternoon, only to find out the bad news: They didn't actually take my insurance, because I had an individual plan. Basically they were not taking anyone on an individual plan, regardless of the insurance company.

    I called up another opthalmology group in the area. Same story.

    In fact, every office I called would not take my insurance!

    I called the insurance company to inquire what was going on. How was it possible that these doctors were listed, yet when I got there, they didn't take my insurance?

    What was I getting for my $255/mo?

    I was told that all doctors had an option to terminate the contract with the insurance company at any time, and that the IT people weren't fast enough to update all of the offices that had dropped out. Apparently there has been a mass exodus from taking these individual plans.

    But why?

    Apparently these individual plans pay shit to the doctors, so most doctors are rejecting them, figuring that they will focus on the patients with employer-based insurance, which still pays them well.

    And why does employer-based insurance pay better? Because the premiums are very high, so they can afford it. Individual plans only worked in the pre-Obamacare days because they could deny coverage to people with expensive pre-existing conditions. Now that they have to take everyone, there's basically no money left in the system to pay doctors the market rate, so they dramatically lowered what they pay, and doctors are dropping these plans like hotcakes.

    Of course, the insurance company doesn't tell you this until you show up to the doctor's office and get the bad news.

    And it's impossible to do a search for doctors who ARE covered, as these websites are not accurate. Even the phone reps cannot tell you, as they have the same flawed info as you.
    This is all accurate. I ran into this same BS when I signed up for an Obamacare-era plan in 2014, after my previous individual plan was terminated. ("If you like your plan, you can keep your plan!")

    Almost no doctors took my plan, and the few that did either had a tremendous backlog of patients and/or were poorly rated.

    Keep in mind that, despite being a lifelong Republican, I was one of the few in my party who said we need to give Obamacare a chance, and how I felt reform was necessary to make all Americans eligible for insurance.

    Well, they screwed it up big time. In fixing one problem (people being denied individual insurance due to preexisting conditions), they broke something else (individual insurance, which was reasonably priced and had access to almost all doctors).

    Here's a recommendation: Switch insurance companies. For me that was huge. Not all companies are created equal when it comes to individual plans. It's not like I was signed up to a cut-rate insurance company. I was part of a well-respected, huge insurance operation, and they just had shit individual doctor coverage. I switched to another major company, and it was far better. I still run into plenty of doctors which don't take my insurance, but it's not nearly as bad.

    There's a myth that buying a top-tier plan will get you more doctor access. That's totally false. Your network is the same whether you buy a bronze (lowest) plan or a platinum (highest) plan. The only difference is amount of coverage. Also, this decision isn't automatic. Some people think poorer people should always get bronze, and rich people should always get platinum. Not necessarily. You need to look at the coverage, the monthly cost, and what you're likely to need/use. I actually started out with bronze, but as those benefits degraded and the price became too close to silver, I moved up to silver. Then silver's price went way up and got close enough to gold, so I switched to gold. I don't see a need for platinum. All you're doing is paying a lot of extra to have slightly better coverage of the bill. In the long run, most people will lose money with platinum instead of gold. The big difference is between gold and silver, because typically gold plans have no deductible, whereas silver plans do.

    Also, it sounds like you have a PPO, which is the right move. Do not succumb to the temptation to get an HMO. They're terrible. HMOs are notoriously frugal when it comes to authorizing tests and specialist visits, plus they're a pain in the ass because your primary care physician is a gatekeeper for everything. HMOs can save you money, but it's not worth it for anyone over 40. I know many people with HMO horror stories.

    You are correct that the doctor list on the websites aren't always accurate. That's arguably the most tilting part of this whole thing. The best thing you can do is look at the website AND call the doctor's office. Make sure to specify that you have an ACA plan. Don't just mention the insurance company name, say the company name and that you have an ACA plan. Ask them again if they're sure. Sometimes you'll get a scrub who just says "Oh yeah we take that" without listening to the details, so you want them to say it twice. Typically the insurance company will cover it if their website is mistaken, as long as you take a screen shot, file an appeal, and send it to them.

    Good luck.

  19. #99
    Owner Dan Druff's Avatar
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    Quote Originally Posted by The Shrink View Post
    Quote Originally Posted by Dan Druff View Post
    BUMP

    Normally I wouldn't post about my insurance billing follies unless it was really egregious, but this information might help others here save some Jew Gold if you get a colonoscopy and try to charge you.

    Basically, most insurance companies have taken the position that a colonoscopy is "free" to the patient, as it's considered preventative. However, there are various ways you can get fucked by this, and will receive a bill anyway. It's important to know what you can do about this. I'm currently battling this out, and am most of the way there regarding success.
    "Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?

    It's truly baffling how unnecessarily complex the American health care system is and yet you'd prefer it over Canada's dreaded "socialized medicine" in which every citizen doesn't need to be a fucking actuary to understand what they should be paying for medical care.

    Every time I see these threads on PFA I shake my head in wonder that your system is accepted as normal in the U.S.

    I have made numerous posts on this forum over the years criticizing the US billing system. It's insanely complex, opaque (there's no way for the consumer to know what he's buying before he buys it), and easily manipulated by healthcare providers to screw people. If you know your way around it like me, it's still a huge pain in the ass, but you can prevent yourself from getting fucked, after a lot of effort. However, very few Americans understand it to the level I do, and almost all of them get fucked by medical billing in some way or another. The saddest thing is when I see people -- many of whom aren't well off -- just throw up their hands and agree to a payment plan to pay down charges they shouldn't owe. They're talked into it with, "Well, I can bring it down to $100 per month", and people think, "Okay, I can handle that", because too many people live in the moment financially, rather than looking at the big picture. Really manipulative. I have helped a number of friends out with medical bill fiascos, especially the poorer ones who can't afford to pay them without real hardship.

    Is all of this absurd? Yes.

    Do I hate it? Yes.

    Does it really suck that the US system operates this way? Yes.

    However, that doesn't mean socialized medicine is the answer. It solves one problem (billing and affordability), but creates too many others. I don't want to wait 5 months to see a specialist or get tests. I don't want a primary care physician acting as a gatekeeper as to whether I CAN see a specialist or get tests. I don't want to wait 2-6 months to get looked at if I suspect cancer.

    The US will be especially bad at adapting to a socialized system, because it wasn't built that way in the first place, and because the US already has a doctor shortage. Even if the US is brought to work like the UK's NHS, that would be a disasterous system which I hate.

    For all of my criticism of the US insurance/billing system (which I feel needs major reform), I do love the fact that I can go directly to a specialist, see one within days (sometimes same day), and get whichever reasonable tests I want, without an idiotic approval process for the vast majority of them.

    I've had some baffling Facebook discussions with people from the UK, who defend their system, but then have weird justifications for why the flaws are okay. "Well yes I can't see a specialist for 4-6 months, but if you're not dying, why is that such a big deal?"



    Umm... that's a huge deal. Quality of life can go WAY down for issues which are non-life-threatening, treatable, but require a specialist's knowledge to diagnose and direct.

    It's really one of these things where the tradeoff isn't worth it -- not just to me, but to the average American. Some people don't realize how awful it is to not be able to get tests and specialist visits when you want them. It's one of those things where you don't know what you've got, 'til it's gone.




    We need billing/insurance reform in healthcare, not socialized medicine. Unfortunately, neither party wants this at the moment, though Republicans have warmed to it.

  20. #100
    Post Restricted limitles's Avatar
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    Quote Originally Posted by Dan Druff View Post
    Quote Originally Posted by The Shrink View Post

    "Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?

    It's truly baffling how unnecessarily complex the American health care system is and yet you'd prefer it over Canada's dreaded "socialized medicine" in which every citizen doesn't need to be a fucking actuary to understand what they should be paying for medical care.

    Every time I see these threads on PFA I shake my head in wonder that your system is accepted as normal in the U.S.

    I have made numerous posts on this forum over the years criticizing the US billing system. It's insanely complex, opaque (there's no way for the consumer to know what he's buying before he buys it), and easily manipulated by healthcare providers to screw people. If you know your way around it like me, it's still a huge pain in the ass, but you can prevent yourself from getting fucked, after a lot of effort. However, very few Americans understand it to the level I do, and almost all of them get fucked by medical billing in some way or another. The saddest thing is when I see people -- many of whom aren't well off -- just throw up their hands and agree to a payment plan to pay down charges they shouldn't owe. They're talked into it with, "Well, I can bring it down to $100 per month", and people think, "Okay, I can handle that", because too many people live in the moment financially, rather than looking at the big picture. Really manipulative. I have helped a number of friends out with medical bill fiascos, especially the poorer ones who can't afford to pay them without real hardship.

    Is all of this absurd? Yes.

    Do I hate it? Yes.

    Does it really suck that the US system operates this way? Yes.

    However, that doesn't mean socialized medicine is the answer. It solves one problem (billing and affordability), but creates too many others. I don't want to wait 5 months to see a specialist or get tests. I don't want a primary care physician acting as a gatekeeper as to whether I CAN see a specialist or get tests. I don't want to wait 2-6 months to get looked at if I suspect cancer.

    The US will be especially bad at adapting to a socialized system, because it wasn't built that way in the first place, and because the US already has a doctor shortage. Even if the US is brought to work like the UK's NHS, that would be a disasterous system which I hate.


    For all of my criticism of the US insurance/billing system (which I feel needs major reform), I do love the fact that I can go directly to a specialist, see one within days (sometimes same day), and get whichever reasonable tests I want, without an idiotic approval process for the vast majority of them.

    I've had some baffling Facebook discussions with people from the UK, who defend their system, but then have weird justifications for why the flaws are okay. "Well yes I can't see a specialist for 4-6 months, but if you're not dying, why is that such a big deal?"



    Umm... that's a huge deal. Quality of life can go WAY down for issues which are non-life-threatening, treatable, but require a specialist's knowledge to diagnose and direct.

    It's really one of these things where the tradeoff isn't worth it -- not just to me, but to the average American. Some people don't realize how awful it is to not be able to get tests and specialist visits when you want them. It's one of those things where you don't know what you've got, 'til it's gone.



    We need billing/insurance reform in healthcare, not socialized medicine. Unfortunately, neither party wants this at the moment, though Republicans have warmed to it.
    That's right, for those essential services like hospitals, hydro and highways you want to know there is a private monopoly that exists to please their shareholders above all else.

    The problems you imagine with socialized medicine are kept in check with regulations much more so than private interests who have convinced everyone that their big bank accounts are simply a coincidence and to not trust the people you elect.
    call out ignorance at every opportunity

    Have a good day
    Never Forget

    I got this whole board running tilt and all I did was use logic, fairness and critical thinking.
    desert boy

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