Re: Re: Wasted Dr. Office Visits

[Guest guest]

I’ve gotten requests for writing a note that a hot tub is

medically necessary so they won’t have to pay taxes.

I like the twist on food and clothing. I mean It’s

bad enough trying to get luxuries written off taxes, insurance to pay for Botox

and skin tags, but now they are trying to get food and clothing too paid by

insurance too? What next? “Doctor, could you write a note

that I need a house with central air-conditioning and at least 4 bedrooms for

my health. While you are at it, through in a maid? “

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of pricklyfinger2007

Sent: Tuesday, December 23, 2008 5:25 AM

To:

Subject: Re: Wasted Dr. Office Visits

hey wayne,

can u ask your patient which foods she was allergic to?

i wouldnt mind swollen lips....

hah

(geez)

grace

>

> Ok, this takes the cake. The real reason for skyrocketing

healthcare costs is patients going for useless office visits (well,

ok, but this at least contributes).

>

> Here's the situation. Patient comes in. New preventive.

Apparently, this person only wants to eat organic foods, but doesnt

want to pay the premium price. How can I tell?

>

> " Whenever I eat fruits and vegetables that are not organic, I

get

itching in my throat and my lips and throat swell up. My health

insurance will pay for special food if its medically necessary. Can

you write a letter to the company stating that I have to have organic

foods to prevent this reaction.

>

> " Oh, this could be very serious. Sounds like an allergic

reaction.

I'll have to send you to an allergist and he will determine what you

are allergic to and write the letter " (man, he is gonna hate us for

siccing her on him)

>

> " Well, I'm not sure it swole up, I THINK my lips were a little

bigger though. "

>

> " Yes, you should see the allergist. "

>

> " Uh, uh, also when I were any synthetic fabric I break out.. Can

you write a letter to...... "

>

> " No, but the dermatologist can check for that and write any

necessary letter! "

>

> yep, she wants her health insurance to pay for her food and

clothing. Just plain rediculous.

>

[Guest guest]

We have had one patient go for the maid (officially, home health attendent). We also have alot of women that claim they have excruciating back pain and need breast reduction surgery. We tell them that only a specialist can obtain that pre-auth and send them to a physiatrist. No one has gotten the physiatrist to even attempt the pre-auth yet.

To: Sent: Tuesday, December 23, 2008 8:35:15 AMSubject: RE: Re: Wasted Dr. Office Visits

I’ve gotten requests for writing a note that a hot tub is medically necessary so they won’t have to pay taxes.

I like the twist on food and clothing. I mean It’s bad enough trying to get luxuries written off taxes, insurance to pay for Botox and skin tags, but now they are trying to get food and clothing too paid by insurance too? What next? “Doctor, could you write a note that I need a house with central air-conditioning and at least 4 bedrooms for my health. While you are at it, through in a maid? “

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of pricklyfinger2007Sent: Tuesday, December 23, 2008 5:25 AMTo: Subject: Re: Wasted Dr. Office Visits

hey wayne,can u ask your patient which foods she was allergic to?i wouldnt mind swollen lips.... hah(geez)grace>> Ok, this takes the cake. The real reason for skyrocketing healthcare costs is patients going for useless office visits (well, ok, but this at least contributes).> > Here's the situation. Patient comes in. New preventive. Apparently, this person only wants to eat organic foods, but doesnt want to pay the premium price. How can I tell?> > "Whenever I eat fruits and vegetables that are not organic, I get itching in my throat and my lips and throat swell up. My

health insurance will pay for special food if its medically necessary. Can you write a letter to the company stating that I have to have organic foods to prevent this reaction.> > "Oh, this could be very serious. Sounds like an allergic reaction. I'll have to send you to an allergist and he will determine what you are allergic to and write the letter " (man, he is gonna hate us for siccing her on him)> > "Well, I'm not sure it swole up, I THINK my lips were a little bigger though."> > "Yes, you should see the allergist."> > "Uh, uh, also when I were any synthetic fabric I break out.. Can you write a letter to......"> > "No, but the dermatologist can check for that and write any necessary letter!"> > yep, she wants her health insurance to pay for her food and clothing. Just plain rediculous.>

[Guest guest]

I actually look for groove marks on the shoulders from bra straps. If they are there, I ask about pain. Usually, anything over a D cup could be consider as an appropriate referral. Around here, I send them to a plastic surgeon. It's easy and many of these women start exercising afterwards because they aren't afraid of being hit in the face with their own anatomy ;-) Here's a blog entry about some of the science behind 'boobs and exercise'. http://harlemrunner.blogspot.com/2008/01/running-to-perfect-sports-bra.html

Sorry, may be more than you wanted to know, but I've had many women go on to lose 50-75 pounds after their breast reductions! Most women don't even know that breast reductions might be covered as a medical expense. Again, don't be too judgmental until you have walked in that persons mocassins.

-- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Go lynette! Underlooked casue of troubles.Once I was having dinner with my then boss in the small town before some board meeting ,the waitress came over and thanked me for sending her for breast redcuution surgery as it changed her life(I did not even recognize her or know who she was..)

You have to prove and beg to insurance they need the surgery after failing nsaids and PT but it can be wonderful for w folks. I did not stay at the job but it was good for some pr for a few hrs.-from a woman who uhh can only dream of having such issues....

Jean

I actually look for groove marks on the shoulders from bra straps. If they are there, I ask about pain. Usually, anything over a D cup could be consider as an appropriate referral. Around here, I send them to a plastic surgeon. It's easy and many of these women start exercising afterwards because they aren't afraid of being hit in the face with their own anatomy ;-) Here's a blog entry about some of the science behind 'boobs and exercise'. http://harlemrunner.blogspot.com/2008/01/running-to-perfect-sports-bra.html

Sorry, may be more than you wanted to know, but I've had many women go on to lose 50-75 pounds after their breast reductions! Most women don't even know that breast reductions might be covered as a medical expense. Again, don't be too judgmental until you have walked in that persons mocassins.

-- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Plastic surgeon should do the proving/begging.

Matt in Western PA

Re: Re: Wasted Dr. Office Visits

Go lynette! Underlooked casue of troubles.Once I was having dinner with my then boss in the small town before some board meeting ,the waitress came over and thanked me for sending her for breast redcuution surgery as it changed her life(I did not even recognize her or know who she was..)You have to prove and beg to insurance they need the surgery after failing nsaids and PT but it can be wonderful for w folks. I did not stay at the job but it was good for some pr for a few hrs.-from a woman who uhh can only dream of having such issues....Jean

On Tue, Dec 23, 2008 at 7:00 PM, Lynette Iles <liles64gmail> wrote:

I actually look for groove marks on the shoulders from bra straps. If they are there, I ask about pain. Usually, anything over a D cup could be consider as an appropriate referral. Around here, I send them to a plastic surgeon. It's easy and many of these women start exercising afterwards because they aren't afraid of being hit in the face with their own anatomy ;-) Here's a blog entry about some of the science behind 'boobs and exercise'. http://harlemrunner.blogspot.com/2008/01/running-to-perfect-sports-bra.html

Sorry, may be more than you wanted to know, but I've had many women go on to lose 50-75 pounds after their breast reductions! Most women don't even know that breast reductions might be covered as a medical expense. Again, don't be too judgmental until you have walked in that persons mocassins. -- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

Our patients don't appear to the be the same ones you have. And its not that we won't refer them. If they ask, we'll refer them. Their insurance won't cover it. Sometimes they ask for documentation that the patient has tried x,y, z, and may require the recommendation from a physiatrist. The patients we have can never this. We have a hard time getting them to go to the physiatrist.

To: Sent: Tuesday, December 23, 2008 7:00:55 PMSubject: Re: Re: Wasted Dr. Office Visits

I actually look for groove marks on the shoulders from bra straps. If they are there, I ask about pain. Usually, anything over a D cup could be consider as an appropriate referral. Around here, I send them to a plastic surgeon. It's easy and many of these women start exercising afterwards because they aren't afraid of being hit in the face with their own anatomy ;-) Here's a blog entry about some of the science behind 'boobs and exercise'. http://harlemrunner.blogspot.com/2008/01/running-to-perfect-sports-bra.html

Sorry, may be more than you wanted to know, but I've had many women go on to lose 50-75 pounds after their breast reductions! Most women don't even know that breast reductions might be covered as a medical expense. Again, don't be too judgmental until you have walked in that persons mocassins. -- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

A patient with large breasts needs a psychiatric evaluation? Boy, there's a good use of resources. What on earth would the psychiatrist do with her--- a breast exam?

When is the " system " going to let use be physicians again? Large breast cause a lot of very real physical problems. The " psychiatric eval " is yet another road block in the arsenal of the insurance cartel to avoid paying for people's needed health care interventions.

Sigh. I tried to stay out of this one, but couldn't.

Durango, CO (but currently in Alamagordo, NM visiting Carlsbad Caverns and White Sands....too cool. Wish you all were here!)

Our patients don't appear to the be the same ones you have. And its not that we won't refer them. If they ask, we'll refer them. Their insurance won't cover it. Sometimes they ask for documentation that the patient has tried x,y, z, and may require the recommendation from a physiatrist. The patients we have can never this. We have a hard time getting them to go to the physiatrist.

To:

Sent: Tuesday, December 23, 2008 7:00:55 PMSubject: Re: Re: Wasted Dr. Office Visits

I actually look for groove marks on the shoulders from bra straps. If they are there, I ask about pain. Usually, anything over a D cup could be consider as an appropriate referral. Around here, I send them to a plastic surgeon. It's easy and many of these women start exercising afterwards because they aren't afraid of being hit in the face with their own anatomy ;-) Here's a blog entry about some of the science behind 'boobs and exercise'. http://harlemrunner.blogspot.com/2008/01/running-to-perfect-sports-bra.html

Sorry, may be more than you wanted to know, but I've had many women go on to lose 50-75 pounds after their breast reductions! Most women don't even know that breast reductions might be covered as a medical expense. Again, don't be too judgmental until you have walked in that persons mocassins.

-- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Either you misread it or I typoed? Physiatrist--physical medicine. To work on possible excercises to strengthen back/shoulder muscles probably.

To: Sent: Sunday, December 28, 2008 11:32:13 PMSubject: Re: Re: Wasted Dr. Office Visits

A patient with large breasts needs a psychiatric evaluation? Boy, there's a good use of resources. What on earth would the psychiatrist do with her--- a breast exam?

When is the "system" going to let use be physicians again? Large breast cause a lot of very real physical problems. The "psychiatric eval" is yet another road block in the arsenal of the insurance cartel to avoid paying for people's needed health care interventions.

Sigh. I tried to stay out of this one, but couldn't.

Durango, CO (but currently in Alamagordo, NM visiting Carlsbad Caverns and White Sands....too cool. Wish you all were here!)

Our patients don't appear to the be the same ones you have. And its not that we won't refer them. If they ask, we'll refer them. Their insurance won't cover it. Sometimes they ask for documentation that the patient has tried x,y, z, and may require the recommendation from a physiatrist. The patients we have can never this. We have a hard time getting them to go to the physiatrist.

To: Sent: Tuesday, December 23, 2008 7:00:55 PMSubject: Re: Re: Wasted Dr. Office Visits

I actually look for groove marks on the shoulders from bra straps. If they are there, I ask about pain. Usually, anything over a D cup could be consider as an appropriate referral. Around here, I send them to a plastic surgeon. It's easy and many of these women start exercising afterwards because they aren't afraid of being hit in the face with their own anatomy ;-) Here's a blog entry about some of the science behind 'boobs and exercise'. http://harlemrunner.blogspot.com/2008/01/running-to-perfect-sports-bra.html

Sorry, may be more than you wanted to know, but I've had many women go on to lose 50-75 pounds after their breast reductions! Most women don't even know that breast reductions might be covered as a medical expense. Again, don't be too judgmental until you have walked in that persons mocassins. -- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Yes, I did misread. Sorry about that.

I am also not convinced a physiatrist can help what is an anatomical problem.

I have a lot more to say about the whole shuffling of patients from one ineffective intervention/specialist to another when the solution is clearly a surgical one, but I will end my rant here.

Durango, CO

Either you misread it or I typoed? Physiatrist--physical medicine. To work on possible excercises to strengthen back/shoulder muscles probably.

To:

Sent: Sunday, December 28, 2008 11:32:13 PM Subject: Re: Re: Wasted Dr. Office Visits

A patient with large breasts needs a psychiatric evaluation? Boy, there's a good use of resources. What on earth would the psychiatrist do with her--- a breast exam?

When is the " system " going to let use be physicians again? Large breast cause a lot of very real physical problems. The " psychiatric eval " is yet another road block in the arsenal of the insurance cartel to avoid paying for people's needed health care interventions.

Sigh. I tried to stay out of this one, but couldn't.

Durango, CO (but currently in Alamagordo, NM visiting Carlsbad Caverns and White Sands....too cool. Wish you all were here!)

Our patients don't appear to the be the same ones you have. And its not that we won't refer them. If they ask, we'll refer them. Their insurance won't cover it. Sometimes they ask for documentation that the patient has tried x,y, z, and may require the recommendation from a physiatrist. The patients we have can never this. We have a hard time getting them to go to the physiatrist.

To:

Sent: Tuesday, December 23, 2008 7:00:55 PMSubject: Re: Re: Wasted Dr. Office Visits

I actually look for groove marks on the shoulders from bra straps. If they are there, I ask about pain. Usually, anything over a D cup could be consider as an appropriate referral. Around here, I send them to a plastic surgeon. It's easy and many of these women start exercising afterwards because they aren't afraid of being hit in the face with their own anatomy ;-) Here's a blog entry about some of the science behind 'boobs and exercise'. http://harlemrunner.blogspot.com/2008/01/running-to-perfect-sports-bra.html

Sorry, may be more than you wanted to know, but I've had many women go on to lose 50-75 pounds after their breast reductions! Most women don't even know that breast reductions might be covered as a medical expense. Again, don't be too judgmental until you have walked in that persons mocassins.

-- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

I have tried to stay out of this, but I can't agree with you more , I have many women who after having the surgery, have come back with tears in eyes to thank me. No more back, neck, shoulder pain, better self esteem, etc. Most insurances around here require at most a modest attempt at weight loss, and then pay for the surgery.

--------- Re: Re: Wasted Dr. Office Visits

I actually look for groove marks on the shoulders from bra straps. If they are there, I ask about pain. Usually, anything over a D cup could be consider as an appropriate referral. Around here, I send them to a plastic surgeon. It's easy and many of these women start exercising afterwards because they aren't afraid of being hit in the face with their own anatomy ;-) Here's a blog entry about some of the science behind 'boobs and exercise'. http://harlemrunner.blogspot.com/2008/01/running-to-perfect-sports-bra.html

Sorry, may be more than you wanted to know, but I've had many women go on to lose 50-75 pounds after their breast reductions! Most women don't even know that breast reductions might be covered as a medical expense. Again, don't be too judgmental until you have walked in that persons mocassins. -- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Back when I had insurance, I had considered a gastric bypass or lapband to help with obesity. I have lost 127 lbs total but still weigh over 200 lbs. I looked into the procedure for me, went to the initial info sessions and even met with a gastric surgeon. I was told by my health insurance - BCBS that I would require psych evaluations from 2 different psychiatric professionals as well as cardiac and GI clearance for the procedure. My PCP and endocrinologist would also have to write letters advocating the procedure. These things all had to be submitted to their Prior authorization department for review prior to receiving a PA for the procedure. I had made the appointment with the first Psychiatrist and while I was waiting for the appointment date 6 months away, BCBS decided it was no longer going to cover any weight loss therapy - bypass, lapband or psych therapy. No medications are covered either. The resources and expense of trying to even get the surgery covered initially were ridiculous. Probably with the lab tests and other imaging studies required the preop costs for the procedure would run close to $5000. Then the procedure itself at well over $10000 and then post op follow-up. This procedure, done with proper education and follow-up post operatively could improve the quality of life and the over all health of many patients. But no, instead, we continue to have a country of severely overweight patients with several associated illnesses like diabetes, HTN, hyperlipidemia, PAD etc.

Healthcare in this country is a joke. We are not supposed to help people get healthy, we are just supposed to put a band aide on a problem and bury our head in the sand. I work out daily for total of 60 mins - 30 mins in the AM and 30 mins after hours. I have dropped 4 dress sizes but want to get back to where I was 25 years ago when I still was heavy to my way of thinking when I graduated from high school wearing a size 12.

Re: Re: Wasted Dr. Office Visits

I actually look for groove marks on the shoulders from bra straps. If they are there, I ask about pain. Usually, anything over a D cup could be consider as an appropriate referral. Around here, I send them to a plastic surgeon. It's easy and many of these women start exercising afterwards because they aren't afraid of being hit in the face with their own anatomy ;-) Here's a blog entry about some of the science behind 'boobs and exercise'. http://harlemrunner.blogspot.com/2008/01/running-to-perfect-sports-bra.html

Sorry, may be more than you wanted to know, but I've had many women go on to lose 50-75 pounds after their breast reductions! Most women don't even know that breast reductions might be covered as a medical expense. Again, don't be too judgmental until you have walked in that persons mocassins. -- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.