Lunarr

185d

One of the things I hate most about the US healthcare system (and there are many many things) is the weird game doctors have to play to please insurance companies. Often times I'll read an after visit summary and notes and it'll include stuff we didn't talk about at all. My dad told me there are certain things they have to say in order for insurance to cover appointment and test costs even if it never happened.

Recently my cardiologist ordered an echocardiogram and, in the notes, wrote that this is because he thinks there may be a problem with my left valve or something to that effect. During the visit that prompted this test, he said he thought there was nothing wrong but wanted to have a final test to rule cardiac issues out once and for all. I'm assuming he wrote about the potential issue to goad my insurance into paying for it as they typically don't like tests that "rule stuff out".

I think the whole charade is kinda messed up! I know logically that this is most likely a tactic to save me money but my anxiety still questions it because I've heard stories of doctors lying to patients or not telling them certain info regarding their health...

Basically, in this system it's hard for me to wade through what's real and what's a ruse and I for one think it's stupid I have to in the first place

Chest pain

Dizziness

Chronic Headache

Anxiety (Including GAD)

Low Back Pain

Depression

acute lethargy

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  • mysterygirl

    180d

    Yes, docs are doing all kinds of unnecessary tests to bill insurance. Medicare docs are the worst. I have seen my bills and many of these docs are outright ripping off Medicare. I don't think that there is much that you can do. Although Medicare has paid billions of dollars in false claims they make it difficult to report these docs. The politicians go on & on about how Medicare is in trouble, but they won't pass legislation to stop it. They might have changed part of the law, but I'm not sure, that won't allow Medicare to negotiate medication costs. Every other insurance company does this. Drug companies can mark up drugs 500% & Medicare can't by law, negotiate a better price. It's disgusting that our own government keeps these drug companies ripping off Medicare and then they pass the cost on to us.I heard that a law was recently passed that allows Medicare to negotiate prices, but only for a few drugs. If you don't have 2ndary insurance, you would be bankrupt paying for meds b/c Medicare only pays for meds given in hospital and a few others. ( that might have changed ince I got on SSDI)Not for our prescription meds. They do not pay for dental or vision, either It costs me $250 per month for my 2ndary insurance, which is through my husband's work. We are getting divorced and I have no idea what type of 2ndary insurance will cover my meds, dental, vision and Medicare only pays 80% of all hospital& doctor visits. I wrote about this b/c If you are considering going on disability, you should know that you'll probably need a 2ndary policy or have to pay thousands out of your pocket. I'm pretty sure that you must pay for Medicare once you start getting SSDI. SSI, is for ppl who haven't worked enough to get Social Security. You will get $800 per month but you will get Medicaid, which pays for all medical except dental & vision. If anyone knows more about SSI, please comment. If u have a chronic illess, which interferes with your ability to work, please do research b4 you apply. When dealing with gov benefits, there is so much red tape.

    • Lunarr

      180d

      I was talking about tests I want that my doctor has to lie about to get me and have it covered/paid for since insurance is picky, but I totally understand what you're talking about, too! My grandparents are seeing a doctor like you described, who is clearly just using them to get money from insurance by telling them to come in twice a week and taking blood for the same test every week even though it's usually a twice a year test... Unfortunately my family cannot convince them that this doc is a sham. I also agree that our government isn't doing enough to fix the problems that exist in our healthcare system. Sorry to hear you might lose some coverage bc of divorce, I know my mom had some struggles with that when my parents split up

  • mysterygirl

    180d

    Ok. Sorry. What kind of tests are you referring to? If you are sick, your doc should be able to rule out anything

    • Lunarr

      180d

      You would think so but my insurance isn't the best, I don't think they will pay even partially for a test "without reason", and taking an EKG like I had recently to rule out heart problems even though my cardiologist didn't think there was an issue doesn't seem to cut it, I guess, so he had to make up a reason for ordering it. That, or, maybe it's a rule of the clinic, I'm not sure. My PCP also always writes in my annual physical notes that we discussed the importance of getting enough calcium (we never do), my dad told me she has to say that or insurance won't fully cover the visit bc of certain boxes I check that require discussion of specific topics according to them. It probably doesn't help that my illness isn't well understood medically and kind of vague and confusing in nature (dysautonomia/maybe POTS)

  • ginkgowink

    180d

    Yes I know what you mean! So confusing being a patient in this system. It’s messed up, but it’s awesome that you probably have a doctor who is jumping through some hoops to try to give you good care and save you some $$! If I were you, I would just ask your doctor if the valve thing (or other similar things) are actually a concern or not. Some doctors are so great and ready to put you at ease. And if your doctor didn’t share a real concern with you, that sucks, but also that’s one of the reasons why we have access to our medical records now. You can always take their notes to a new doctor :-)

    • Lunarr

      180d

      The results of my EKG came back as all good so I think I'm probably fine on that front. It's good advice though, thank you! Sometimes my anxiety gets in the way of me using the virtual patient portal to ask questions but that's what it's there for and I'm glad to have that ease of access to a care team and my records, as you said

  • mysterygirl

    179d

    I misunderstood. Do you not have a specific symptom, like pain in your back or headaches, depression, anxiety? Yes, docs have to put a code for everything they do. Wanting it isn't enough, you have to have a symptom. That's why most of us are here. We dont have a specific diagnosis or a one size fits all, like fibromyalgia or depression that isnt responding to antidepressants. I'm thinking that you have an issue that effects your heart, sometimes. Like it feels tight or races or you can't catch your breath. It sounds like a typical panic attack. If you get dizzy standing up, they will test you for orthostatic condition. They will do preventative screenings, which your PCP does every year. What do you want tested? Are you trying to see if there is some other cause of your diagnosis that they haven't thought of? I'm not sure why they wouldn't do testing unless you had no symptoms. I've been tested for almost everything, with no problem. So, I don't understand what you can't get tested or why, unless you don't have any symptoms. I'm sorry that you're suffering and I hope that you can feel safe enough to explain what they wont do for you & why you want it done. Maybe we can help.

  • Lunarr

    179d

    I haven't had a problem getting any tests so don't worry! I'm just lamenting on the strange relationship between doctors and insurance companies and that doctors have to lie sometimes in order to get coverage for their patients My offical diagnosis is dysautonomia, a dysfunction of the autonomic nervous system (controls things you don't think about like heart rate, blood pressure, and digestion). I have a myriad of symptoms that confuse doctors including constant lightheadedness and fatigue, dizziness, chest tightness and pain, and more. The chest tightness and pain was what my doctor and I were looking into but I've been told by two cardiologists now that my heart is perfectly healthy. The EKG I just had was to confim that statement once and for all so we know for certain it's not an underlying issue

    • mysterygirl

      178d

      Did they rule out MS with a lumbar puncture? It has some of your symptoms, esp tightness or pain around your back into chest( called an MS "hug") also POTS. I always thought that you had to have a foot drag to have MS. There are lots of other symptoms than that. Never heard of your diagnosis. I'm learning a lot on this website.

      • Lunarr

        178d

        I don't think it's MS after reviewing the symptoms and whatnot, but it might be POTS, yes! Dysautonomia, my diagnosis, is the larger family that POTS belongs to and I have been looking into whether or not I have it. I don't meet the heartrate and blood pressure spike upon standing requirements, though, so I probably have a different type of autonomic dysfunction. I learn a lot here, too! It's really interesting 😁

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