primitive rants about insurance

[franksolich]

http://www.democraticunderground.com/11427365

Oh my.

evilhime (186 posts)    Fri Feb 15, 2013, 01:48 PM

General rant about insurance

My daughter in DE fell Monday and hurt her ankle - she literally heard a "pop" sound. It swelled to twice it's size and is bruised. That evening she went to an outpatient clinic where it was x-rayed. She was told there is no break evident, but she may have torn something and if it is not better or showing real improvement in 2 days to seek further care.
 
It has not improved, so she went to her regular doctor as the orthopedist was unavailable, and her primary care physician ordered an MRI. Aetna has denied the test saying she should wait six weeks to see if it gets better before getting further testing done.
 
In the meantime besides not having her injury taken care of, this is her right ankle so she cannot drive. She works, has two toddlers (2 and 4) that need to be picked up from daycare, and now she has to wait until it "spontaneously" heals which it is showing no signs of doing OR 6 weeks to be treated, whichever comes first.
 
How is this the BEST health care in the world, can someone explain that to me?

cbayer (117,663 posts)    Fri Feb 15, 2013, 02:03 PM

1. That sounds like pretty standard medical care for a sprain.

I can't imagine why she would need an MRI.

Did they not give her something to immobilize it and some crutches?

Unfortunately, there is not much else to be done except to allow time to heal. And even more unfortunately, it can take months to heal completely.
 
One of the problems with US medical care is over-utilization of services. I would be interested in why her PCP physician thought she should have an MRI.

sinkingfeeling (27,066 posts)    Fri Feb 15, 2013, 02:07 PM

2. And the doctor won't treat without a $3000 test? I wonder how in the world we survived before MRIs and CTs.

Sekhmets Daughter (3,857 posts)    Fri Feb 15, 2013, 02:45 PM

3. Far be it from me to defend the health insurance industry...

But this is the fault of the doctor who ordered the MRI. That's just absurd. Did he then advise her to see the orthopedist? If not, shame on him. She needs to see one because if she has torn something it needs to be treated, and I'd be willing to bet that if the orthopedist requests an MRI, it will be approved. Also, he may be able to fit her with an appliance that will allow her to drive. Best of luck to your daughter.

littlemissmartypants (2,513 posts)    Fri Feb 15, 2013, 03:10 PM

4. Ok, now before you get your hand close to your holster let me try the other perspective...

I may fail but I am giving it a shot...please don't hate me.

But, How persistent and intelligent is your daughter. Was she communicating with the physician as a participant or as a passive listener?
 
Some physicians will "order" anything to please (aka dismiss) a patient.
Done by CYA?
Done by request?
Or done as "defensive" medicine. (This is the one I have heard the most.)

Sometimes it is possible to find the patient's "sweet spot" and exploit it just to keep the schedule of patients moving.
 
Physicians also have to think of productivity. Have you never noticed the same quarter hour block with 4 patients scheduled at that same time? Reimbursement for services is a large concern these days.
 
What the hell is she expecting? Doctors are unskilled and not trained to respond with tenderness and compassion. They are scientists for Pete's sake.
 
How many years of experience with these issues (bones, sprains, ankles) do your daughter and the direct caregiver (doctor or not) have respectively?
 
Was the only "care" given a referral?
 
How did I do?

[Delmar]

My daughter in DE fell Monday and hurt her ankle - she literally heard a "pop" sound.

She works, has two toddlers (2 and 4) that need to be picked up from daycare

If she would've been at home with her two toddlers instead of going out and getting falling down drunk she wouldn't be in this fix.

[Jasonw560]

A) She could have gone to the ER, where they would have possibly ordered an MRI.

B) She has insurance. See A)

C) She went to a "treat and street" instead. Anyone with 1/4 of a synapse firing knows they don't have major diagnostic equipment.

D) She chose not to make an appointment with the specialist, which could have just been a couple of days wait.

[Celtic Rose]

I've sprained my ankles, and knees, multiple times.  I've heard a "pop" and had it swell up within minutes.  The only time I had an MRI done was after the last time, when my PCP referred me to an orthopedic doctor, who felt that my history, and looseness of my ankle joint, suggested that surgery was necessary.  He ordered the MRI as a pre-surgical test to determine what sort of damage he would be repairing.  Sprain diagnosis, as far as I can tell, it done on a presumptive basis in most cases.  If their isn't a broken bone, but there is swelling and pain from an injury that can result in a sprain, then they tell you to treat it as a sprain for at least a few weeks. 

[Tucker]

evilhime (186 posts)    Fri Feb 15, 2013, 01:48 PM

General rant about insurance

I detect a jooooo hating newb or a mole.

Evil Hi Me (hymie)= Evil Jew.

[Evil_Conservative]

Oh quit your bitching.  I sprain my knee all the freaking time and never go to the doctor for it anymore.  Some ice and a knee brace work just fine for less than my co-pay.

[BattleHymn]

In the meantime besides not having her injury taken care of, this is her right ankle so she cannot drive. She works, has two toddlers (2 and 4) that need to be picked up from daycare, and now she has to wait until it "spontaneously" heals which it is showing no signs of doing OR 6 weeks to be treated, whichever comes first.
 
How is this the BEST health care in the world, can someone explain that to me?

Where is the father?   

Oh, that's right.  You primitives say you don't need a two-parent household to raise children, because you're sooo independent. 

Carry on with your misery, then.

[Chris_]

Where is the father?   

Oh, that's right.  You primitives say you don't need a two-parent household to raise children, because you're sooo independent. 

Carry on with your misery, then.

Liberal family values.

[BattleHymn]

Liberal family values.

Yeah.

My heart goes out to single mothers, since they already made the right choice not to abort that life that was growing inside of them.  I can't imagine being a woman and raising a child alone.   

You helped make it guys, so do the right thing and marry the gal.  It's that simple. 

[JohnnyReb]

She can't drive because it's her right foot....

I hurt my right foot one time and then ran heavy equipment that required 2 feet to operate with just a left foot....Damn DUmmies.....always with excuses of why they can't do something.

[AprilRazz]

A) She could have gone to the ER, where they would have possibly ordered an MRI.

B) She has insurance. See A)

C) She went to a "treat and street" instead. Anyone with 1/4 of a synapse firing knows they don't have major diagnostic equipment.

D) She chose not to make an appointment with the specialist, which could have just been a couple of days wait.

Actually an acute care center was an appropriate choice. It was not an emergency and AC centers do have x-ray capabilities that would rule out a fracture. They will then stabilize the injury and refer them to the appropriate aftercare. The same thing an ED would do.
ED's are for life and limb threatening issues. This was not one of those. Sprain your ankle head to the AC center. Cut your leg off run don't walk to the ED. Have the sniffles AC, not breathing at all ED. You also have people that instead of treating a problem early, tend to wait until it is 10 times worse and clog up the ED at 2 in the morning.
If more people stopped treating the ED like a doctor's office we would not have the long wait times in the emergency department than we do right now.

Personally I think the primitive is mad that we didn't pull out the magic wand and make it's spawn all better.

[Lacarnut]

She can't drive because it's her right foot....

I hurt my right foot one time and then ran heavy equipment that required 2 feet to operate with just a left foot....Damn DUmmies.....always with excuses of why they can't do something.

She could slide her big Obama mama ass over and drive with her left foot. Did that year ago when I had to shift with my left hand with a manual transmission while my right arm was in a sling. Where there is a will there is a way.

[JohnnyReb]

She could slide her big Obama mama ass over and drive with her left foot. Did that year ago when I had to shift with my left hand with a manual transmission while my right arm was in a sling. Where there is a will there is a way.

We're talking DUmmies here.....no will, no way.

I knew a man that lost a leg at the hip in WW2....had only one good leg and no prosthesis that ran a crane/dragline and raised a family....a logger that was paralyzed from the waist down that ran logging equipment/business and raised a family.....a blind man that worked and raised a family.

Can't keep a good man down......and you can't snatch a bad man up by the hair of his head.

[Lacarnut]

We're talking DUmmies here.....no will, no way.

I knew a man that lost a leg at the hip in WW2....had only one good leg and no prosthesis that ran a crane/dragline and raised a family....a logger that was paralyzed from the waist down that ran logging equipment/business and raised a family.....a blind man that worked and raised a family.

Can't keep a good man down......and you can't snatch a bad man up by the hair of his head.

My dad got his foot smashed when a trolley car ran over it in New Orleans. His leg was amputated below the knee by the butchers at the Charity Hospital. Did not stop him from delivering papers as a young kid. He was on crutches for 6 or 7 years until he got his first wooden leg. As an adult, he lived thru the depression. I would hate to see people go thru those hardships like he went thru but the slackers would have to root hog or die cause the government could not afford all this free shit that they get now.

[seahorse513]

and these people want socialized medicine? got it....

[Lacarnut]

and these people want socialized medicine? got it....

They are going to find out that they got the ass end.

[BattleHymn]

My dad got his foot smashed when a trolley car ran over it in New Orleans. His leg was amputated below the knee by the butchers at the Charity Hospital.

Just out of curiosity, did they not perform the procedure properly?   

[Lacarnut]

Just out of curiosity, did they not perform the procedure properly?   

Not no, but hell no. Rather than trying to save his heel/foot, they cut his leg off about 6 inches below his knee. After that, they would come and pull the scab off about the time it healed up. My dad put on his clothes and took off on his crutches. His father cared for his leg and it healed up. This happened back in the 1920's 

[BattleHymn]

Not no, but hell no. Rather than trying to save his heel/foot, they cut his leg off about 6 inches below his knee. After that, they would come and pull the scab off about the time it healed up. My dad put on his clothes and took off on his crutches. His father cared for his leg and it healed up. This happened back in the 1920's 

Ouch, I'm sorry he had to go through that.  When you mentioned 'foot' followed by 'below the knee', I figured that might be a bit extreme. 

But I'm no doctor, except to the primitives.

[Lacarnut]

Ouch, I'm sorry he had to go through that.  When you mentioned 'foot' followed by 'below the knee', I figured that might be a bit extreme. 

But I'm no doctor, except to the primitives.

With Obamacare, po folks like my dad will get this kind of medical care. I can see the writing on the wall.

[BlueStateSaint]

I detect a jooooo hating newb or a mole.

Evil Hi Me (hymie)= Evil Jew.

Good catch.  H5.