BG Medical Random Question Thread

[Byrthnoth]

Unless I'm misunderstanding, "Pending Insurance" are fees that the hospital is still trying to charge to insurance but they haven't accepted yet. Until that goes to 0, the amount is still potentially on Tyche's bill.

[Cantih]

'murrica!

[Tyche]

They also charged me over $800 for a brace (exact same brand and model) I can get on Amazon for $125.

Ortho appliances are a fucking insane money racket.

[Andalusian girls]

best healthcare system on earth never ever change to the models of every other first world nation

[Tyche]

From ER, radiology, OR, anesthesia, pretty much everything outside of the months of PT I'll be doing, running down my driveway in cowboy Boots has been over $110,000 of fun.

[kuronosan]

Unless I'm misunderstanding, "Pending Insurance" are fees that the hospital is still trying to charge to insurance but they haven't accepted yet. Until that goes to 0, the amount is still potentially on Tyche's bill.

Before co insurance, so depending on his annual deductible he'll like only owe the difference plus 10-20% of the remaining balance his insurance is trying to find reasons not to pay for.

Lol at the random sugammadex. They really spared no expense. Especially the cost of sutures and exploratory gear.

Keep in mind the amount they're saying his insurance paid for is probably the actual cost of everything. I'd be incredibly surprised if Tyche owes more than 10-15k.

[Meresgi]

Jesus.. You have some damn good insurance man.

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Yeah i'm honestly curious what your insurance is lol.

[Tyche]

Lol at the random sugammadex. They really spared no expense. Especially the cost of sutures and exploratory gear.

My understanding is that the surgeon asked anesthesia to use a new block that doesn't kill the quad and then used sugammadex too. Then I was running my quad through NMES several times a day to activate it. PT recommended UP TO 6 HOURS DAILY. Ain't fucking way.

[Outlaw]

From ER, radiology, OR, anesthesia, pretty much everything outside of the months of PT I'll be doing, running down my driveway in cowboy Boots has been over $110,000 of fun.

If you don't mind me asking how long did they keep you under? From the drug list I can see you had general anesthesia and also a hell of a lot of other stuff. Fentanyl, Dexmedetomidine, Propofol..

They could never brought me out of it lol.

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[Tyche]

I think 3-4 hours. ACL surgery times can vary wildly. If you get an allograft (cadaver), have no other issues other than ACL, the surgery can be done in like 30min.

I did an autograft (my on tissue). They took a small chunk of my patella tendon and used it as my ACL. Then, my medial and lateral menisii also required repair. The medial was a root tear. Those took awhile. Each one required 2-3 sutures and a screw. Back to ACL, once they get the tendon off your patella, they have to go to the back table and prepare it. In short, they run some threading around and through it, then run those threads through holes they've bored into the femor and tibia and use those to properly tension the ACL.

My longest surgery was my vasectomy reversal. Done by one of just a few urologists with microsurgery fellowships. Did both sides. Nearly 5 hours.

Surprised no one said anything about the 15ish bags of LR they used (guessing that's what they used to irritate the knee).

[Outlaw]

ha ha wtf?! I went back and looked. I did not notice the, "quantity 3" next to each one.

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[kuronosan]

If you don't mind me asking how long did they keep you under? From the drug list I can see you had general anesthesia and also a hell of a lot of other stuff. Fentanyl, Dexmedetomidine, Propofol..

They could never brought me out of it lol.

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We can only order these in units as they're pharmacy-managed. You can't order "250mcg" of fentanyl. You have to order 5x50mcg or "gtt" which means by drip - but even then you can only order it in units.

To put it in perspective, it would be like if you can't order 30 tablets of Tylenol because the pharmacy only releases 10 at a time, thus you order 10x3.

It's stupid but it makes billing easier and inventory easier for pharmacy to manage. I do it all the time with Ativan or Haloperidol. The pharmacy releases them in 1/5mg increments, respectively, so if I order 2.5 of Haldol they have to waste or hold the other half for dispensing, so if you were to be charged for getting one dose you'd be charged 0.5 units. On the other hand, since Ativan is 1mg, if you were dosed twice, you get charged for 2 units.

[Meresgi]

Hey Kuro, had some questions you might be able to answer.

For CEA i'm reading it can be done both via local anesthesia and general. Saw a few testimonials from UMASS and Temple Hospital in Philly about it. My mom is basically terrified of having to be awake during the procedure, one doctor she spoke to said it would be local anesthesia but she hasn't spoke to the actual surgeon yet so I told her to address that and the stress it would be causing her to have to be awake during the procedure. Obviously not sure if it falls in your realm of expertise or not, but have you heard of many CEA's done with putting the patient fully under?

her other concern is due to neurological disorders she has, she's afraid it will cause numbness/paralysis to her face, neck or other parts. I basically told her that if her Dr isn't going to do the general anesthesia I would drive her down to Philly/Boston or Maryland to get the surgery done elsewhere that might accommodate that.

[kuronosan]

Yes, they prefer local because it's not a highly invasive procedure (alternative being incision versus via catheter) and they don't have to intubate. They give sedatives to prevent too much movements so talk to the surgeon about both.

[Meresgi]

Sweet thanks, yeah found this: https://anesthesia.ucsf.edu/clinical...ral-anesthesia

7. Anesthetic Technique

While CEA can be performed under MAC with a cervical plexus block, at UCSF, the overwhelming majority are done under general anesthesia. Choice of agents for both induction and maintenance are at the discretion of the anesthesia provider and should be based on comorbidities in order to achieve stable hemodynamics throughout. Of note, if monitoring SSEPs, consideration should be given to using a predominantly IV anesthestic with propofol as the primary maintenance agent. Adjustments should be made when a TIVA in used to appropriately time emergence as the goal is for assessment of a neurologic exam as soon as possible following completion of the case.

And this: https://www.hopkinsmedicine.org/heal...endarterectomy

To help ease her fears. Also made sure she knew that we'd get a 2nd opinion just to talk to another surgeon, especially if the first doesn't seem to take into consideration her concerns about nerve damage, and that I would be coming out to drive her down to NYC/Boston/Philly or wherever needed to go talk to a surgeon there who may have even more experience then the one at Albany Med.

[Meresgi]

Been seeing an Endocrinologist for a couple years here in CA. They started charging me $425 out of pocket for my testosterone appointments and didn't think anything of it at the time since shit was hectic and I needed the TRT. Now i'm trying to file a claim with insurance and I just got a letter and check from insurance for $102.

On the form they say basically "You were charged $425, but insurance only pays out $102 and you have a $25 copay" and cut me a check for the $102...

I called UHC to ask wtf that means, since I paid the full $425. I didn't get a discount of any type or anything, that whole amount came out of my fucking pocket and they kept trying to tell me that there was a discount. I just checked and this doctor is still In-Network according to UHC website.

Sooooo am I just getting insurance frauded or some shit here? All I want is my fucking $425 reimbursed minus my co-pay or for it to at least go to my deductible.

[kuronosan]

Your insurance carrier fucked up, not your doctor. They probably refused to reimburse the visits so your doctor started charging out of pocket while appealing or while waiting to see if your insurance company would do their job. When the company realized they fucked up and should have covered it they refunded you the amount they should have paid for in hopes you would leave it alone.

I would have your doctor resubmit previous visits to see if your insurance company will actually pay for them, or you can call the insurance provider yourself and appeal because it sounds like they're trying to shift blame onto the doc.

[Salodin]

Been seeing an Endocrinologist for a couple years here in CA. They started charging me $425 out of pocket for my testosterone appointments and didn't think anything of it at the time since shit was hectic and I needed the TRT. Now i'm trying to file a claim with insurance and I just got a letter and check from insurance for $102.

On the form they say basically "You were charged $425, but insurance only pays out $102 and you have a $25 copay" and cut me a check for the $102...

I called UHC to ask wtf that means, since I paid the full $425. I didn't get a discount of any type or anything, that whole amount came out of my fucking pocket and they kept trying to tell me that there was a discount. I just checked and this doctor is still In-Network according to UHC website.

Sooooo am I just getting insurance frauded or some shit here? All I want is my fucking $425 reimbursed minus my co-pay or for it to at least go to my deductible.

That's a Dr office fuck up, not insurance. Dr office should be reimbursing you/giving you free visits for awhile.

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[kuronosan]

If the doctor's office fucked up his insurance wouldn't be giving him money.

[Meresgi]

If the doctor's office fucked up his insurance wouldn't be giving him money.

So the entire thing is fucking weird as shit. Just got off phone with 3rd person from UHC who laid it out as basically:

1) Doctor is in network, and my testosterone should be covered
2) I submitted the claim myself so they viewed it as a claim being submitted by the doctor but it was lacking certain codes
3) Doctor should be refunding me now because the insurance due to contract only allows the $127 per visit and not fucking $425.
4) Still not sure why I received a check though and it wasn't sent to the doctors office

I finally got in with UCSD health department to try to get a new Endo, which i've been trying for awhile just due to how flakey this one can be at times and trying to get my refills without running into 2+ weeks where I can't do any injections and my hormones drop crazy low. Going to set up an appt with Endo to get a refill before a trip and then hit them with the fact they owe me money and need to take it up with the insurance office.