I finally got a diagnosis of the hips - arthritis, inflammation
and a torn labrum - on both sides. Being referred to a surgeon.
At least it wasn’t the drinking that caused this - I would never forgive
myself for that. It has taken me about 5 months of going to various
doctors, numerous x-rays, and making several requests to have an MRI
to get this far. And I still don’t know what is causing the pain in my
shoulder and knee.
Getting the MRI was a nightmare. I had to push the doctor to
authorize it. Once I got the authorization I spent about
a month trying to get the doctor’s office and insurance company
to work together. It took a couple weeks for me to figure out
that the reason that the insurance company was not getting a reply
for more information from my doctor was because they were faxing
to the wrong number (Why the heck are they still using fax machines
like it’s 1985?!). I was then told it would take 5-10 days for approval by
the insurance company but later another agent told me 20-30 days. In the meantime,
I found the MRI place would charge me LESS if I paid out
of pocket. I finally said screw it pulled out the credit card and had it done.
Insurance company is now telling me I can submit the bill to them if my treatment
is approved.
Been talking with physiatrist from time to time which has
helped a little with the stress It took only about 20 phone calls to find a
physiatrist that was available and would take my insurances.
I feel like I’m dealing with some horrible bureaucracy where
I get shuffled from office to office and not much gets done
unless I push and ask a lot of questions.
Sort of a medical version of the Department of Motor Vehicles.
I hope none of you have ever had to deal with something like this.
Coming up on the end of the third month of not drinking and
beginning to miss it. Feel so stressed right now. Haven’t
attended any AA meetings probably should go back.
Anyway, thanks for letting me vent a bit. I find it helps with
the stress. Guess I will have to read up on “labrum” and find
out more about what that is.
Forgot to add that I would be inereted in hearing about your experiences. Have you found that dealing with the medical system to be a pain? I am especially interested hearing from those of you who live in a country with a socialized medical system.
Reporting from socialized Canada. My first fifty years here, the system worked fine. My wife and I had a family doctor who took good care of us and, if we needed a specialist, found one (actually, his wife/receptionist made all the arrangements). Then he retired, a year and a half ago and it has been hell ever since. In order to rein in expenses the government has been restricting new medical licences. There are foreign trained doctors driving taxis. They are required to intern here to get a licence, but only a handful can get internships because the government allows very few.
About two years ago, my wife and I asked to be assigned a GP. She got one assigned last February. But whereas our old doctor was a few blocks from us (and we could easily drive over and park if necessary), the new one is in building on a very busy street that is almost impossible to park at. While there is bus that goes by, that bus doesn’t go by us. She saw him once and we took taxis both ways. (And don’t get me started on the difficulties getting taxis here.) Then in June, I was assigned a doctor in a neighborhood that is about a 40 minute drive from me. There is a small (free) parking lot there. But she has some, what I consider odd, ideas. She immediately ordered vitamin D supplements and, although they are harmless enough, it is not clear what they are doing. Now she is all upset about a high PSA reading, although my old doctor stopped doing them when I hit 70, for well-known reasons. I have an appointment with a urologist in 9 days to discuss it, but I doubt I will do anything at 85. Also now everything is a struggle.
On the other side, when I fractured an ankle in 2005, I spent days in the hospital. They had to let the swelling subside before they operated. When I left the hospital, there were no fees, not for the room, surgeon, anasthetist, nothing. In 2007, I had a pacemaker installed, replaced last January. Again no fees. So it is a mixed bag. I would gladly pay higher taxes for a friendlier system, one where, for example, there were enough places that my wife and I could use the medical clinic around the corner from where we live. But no, they can accept only patients assigned them by the province.
Several years ago I had three endoscopies. Of the three, one of them was denied by the insurance company (even though it was pre-authorized).
It took them about 6 months of letters back and forth of the hospital requesting payment (and/or appealing the denials) from the insurance company and the insurance company denying the claim over and over.
Every few weeks I’d get a letter from the hospital meant to sound like a ‘just wanted to keep you in the loop’ letter, but then suggesting I could fix all this by just paying them [the hospital] directly.
Yeah, no. It didn’t really matter to me how long they two of them went back and forth on this, and since I hadn’t actually been billed for it yet, there was no risk of ending up in collections.
I had exactly zero interest in getting in the middle of it.
I don’t have direct experience of the kind of situation X.L Ent describes, but as someone who’s been with the NHS since it was created, I can offer the following comments about what might happen in the UK:
First, everything goes through the GP practice you’ve registered with - they will do the initial assessment and judge what scans/tests/onward referrals might be needed to eliminate all the different possible causes of whatever pain is presented
Second, there’s no to-ing and fro-ing about reimbursement of costs - all parts of the NHS work to an annual block grant budget and fit patients in where they can and where clinical need requires
Third, that said, I’m no doctor, but my understanding is that aches and pains are a, well, pain(!) to understand and diagnose. There could well be a lot of clinical to-ing and fro-ing about possible causes. I think what might happen in my GP practice is that they’d ask for the more widely available scans first (Xray, ultra-sound), which can be a walk-in service (with the GP’s order form), and refer you on to a specialist in a hospital, who will do whatever they will do. You should get a choice of local hospitals (and access to information about their waiting times and patient reviews). However, the NHS has a backlog of non-Covid cases, particularly of conditions like this, and substantial staff shortages. Also, different parts of the country may be better or worse equipped. There is also a general cultural tendency to “watch and wait” anyway, so a GP might be thinking in terms of various sorts of pain relief first.
So you could find yourself waiting quite a time to get to a specialist. Plus, once you are, you’re in the hands of the specialist team - you don’t necessarily get an MRI scan because you think it might be a good idea, it’s up to the doctors.
Forgot to add - unless of course you can afford to pay to go privately, or have some private medical insurance cover - some people do, either because they want to or get insurance as a perk of their job. It’s mostly understood as a means of, frankly, jumping the queue, but I have no idea whether our insurance companies would jeopardise that by resisting payment as you describe.
Hari: Under the Canadian system if you don’t like your doctor can you request to be assigned to a different one? I would guess this might put you on another very long
waiting list.
My experience in Canada is that if a family doctor is willing to take you on as a patient, then there’s no problem with switching to that doctor. Whether you can find such a doctor depends on where you live, though.
It varies by province. In BC we are not “assigned” a doctor; we find one ourselves. This is both good and bad, especially when many doctors are not accepting new patients. It can be hard to find a GP willing to take you on.
Hospitals still use fax because it works, no matter what digital medical record keeping software each hospital uses. Medical record keeping software is often proprietary and won’t communicate with software from other hospitals. Fax represents a simple workaround that’s secure enough to meet patient privacy standards.
Some government legislators have considered simply banning the use of fax in medical communication. However, the incompatibility of medical record management software isn’t the only reason hospitals still use fax.
It may not even be the primary reason.
Fax is also secure enough to meet HIPAA privacy standards. And it’s easier to secure than any digital communication method.
Exactly that. I was on the original waiting list for 19 months and when her office called to schedule an appointment, they told me that I refused I would go back to the bottom of the list. I am 85, BTW. I think that’s elder abuse.
FWIW, in the UK, you choose which GP practice in your “catchment area” suits you. This obviously varies across the country - where I live there are eight practices in my area, in the Outer Hebrides there’s probably no alternative). You aren’t “assigned”, unless you’re having difficulty registering, at which point the local NHS organisation will find you someone. When you make an appointment, you could be seen by any of the practitioners, but you can ask to see someone else, though obviously if you reduce your options, you’re likely to have to wait longer.
If and when you’re referred on to a hospital specialist, you do get some choice of hospital, and if you’re not satisfied with their care, you can ask about alternatives/second opinions, but obviously that then risks moving you on to another team’s waiting list. That might, though, be the time for your GP’s other role to come into play - as advocate rather than just gatekeeper/diagnostician. If and when the system operates as it should, of course.
I don’t know how that works. When I first put my name on the list my GP had not yet retired and I continued to use him for about 5 months till he did. He also gave me a two year renewal of all my prescriptions. Prescriptions are normally limited to one year, so there must be a special dispensation in this case.
Some years back (this would be some time between 2004 and 2008), my office phone also doubled as a fax number - you could either phone me, or send me a fax.
I periodically got faxes - containing personal medical information.
I ultimately found out that people were putting the wrong AREA CODE - figured that out when one such fax had a cover page listing the correct code. Think, 202-555-1212 versus 212-555-1212.
After that, I made a point of calling the erroneous senders and saying “ya might want to check your records”.
While I get that different systems may not talk to each other, at least it’s less likely that the data will go where you do not want it to (it may not get to where you DO want it, but that’s a different issue). Those faxes I got were human error - and they came from different places.
Re the OP: It’s almost as if insurance companies’ profits depend on shelling out less money than they take in, as if denying care is better for their bottom line.
A friend needed an MRI for her back. She was in severe enough pain that we nearly called 911 just to get her to an ER. The doctor ordered it. It was never approved. For whatever reason, her back pain got better - but there was no reason to believe that would happen, and it might well recur, but there’s no way of knowing, and no information showing what really was going on.