Yes, it’s unethical that the effectiveness of your treatment depends on your insurance coverage and the insurer’s ability to delay or deny care.
This isn’t the doctor (or PA) being unethical. It’s the doctor explaining how the system works. (Thus the original query by the PA, “Do you have a Tier One plan?”)
I wonder if there’s “gag rule” on the doctor explaining how your options differ at the whim of the insurer? Just like that at the pharmacy counter, there’s often a “gag rule” that prevents the pharmacist from informing the patient that paying cash for the drug is less than the insurance company co-pay. You’re required to figure that out on your own, or do without the medication.
I went through the intermittent claudication thing 25 yrs ago due to a hypochondriac doctor I had. The test is not elaborate. It’s like an EKG but the sticky things with the wires go on your legs.
Sit on a hard chair. Relax. Cross your legs. If you can see your lower leg pulse outward with your heart beat you’re getting plenty of blood flow. No, or no significant obstruction. (It’s named after The Emperor Clavdivs because, apparently, he walked with a limmp)
Bad news, everyone! Just because your aorta, carotid arteries, and all the arteries in your head and neck are clear doesn’t mean the arteries in your heart aren’t almost totally blocked. And the worst news of all is, being in good shape and getting lots of exercise can actually mask the symptoms of that kind of encroaching heart disease. Very counter-intuitive, I know. That’s what came out in the wash since my heart attack.
HINT: It pays to be a semi-hypochondriac. Go offline and spend some g/d money and get a treadmill test. If your arteries are =/> 70% blocked it will show up and you can do something. (I have a longer story about that but this is already long enough.)
The new information I got from the Physician Assistant on Thursday was that the source of the problem could be a blood vessel in your groin or lower abdomen, blocking the flow to the leg. All previous studies of my leg seemed to be from the knee down.
The ABI test compares the blood pressure in your arm to the one in your leg and big toe (they actually have a tiny blood pressure cuff for the toe.) If all three readings more or less match, it’s normal blood flow.
But the fact that all those other areas don’t have any plaque, lessen the chance they’ll find anything in your heart. It’s always about playing the odds.
You would go broke trying to do every possible medical test to prove you’re healthy.
Here’s a different way of looking at it. That collateral circulation that your exercise regimen built up, allowing you to function symptom-free while your coronary arteries were steadily occluding, is probably what allowed you to survive your heart attack! You might well have found that, even as a Connoisseur of the Couch, your very first symptom of coronary artery disease was a heart attack. The big difference being … it would’ve been your last. That’s still the case for a good many!!
At the very least, looking at the degree of occlusion and computed fractional flow reserve on my CTangiogram, I should’ve been suffering severe angina on brushing and flossing my teeth…but nary a symptom!! Srsly, it’s enough to make me think my patient records have been mixed up with someone else’s. I’m not willing to take a chance on that being the case, mind.
Has never happened to me in the entire time I’ve had MA, and I’ve had specialists for spinal spondylosis, spinal stenosis, neuropathy, asthma, skin cancer, hearing loss, double vision, various mysterious rashes, and other ailments as happen to people as they age.
I’m not saying it doesn’t happen to others, but I think you are vastly over-inflating the idea that you can’t get to a specialist if you need one. Heck, I’ve gone directly to some without a referral and had no issues at all.
If you throw a clot you will be in very bad shape if not dead.
You have zero time to waste.
Doesn’t matter if I am wrong. Your risks are far to high you throw a clot.
I am talking hospitalization if possible. I am talking specialists immediately.
PURE BULL don’t wait. Call the surgeon’s/Specialist’s office and put yourself at the top of the list.
She wrote a referral noting I needed to be seen on an urgent basis, and said I’d likely have an appointment with a vascular specialist in a week or two. In the meantime she warned me that if the symptoms worsen, to get to the Emergency Room right away.
That’s unlikely. I have had a medical evaluation of the problem. Been told that as long as I don’t have any pain at rest, I can wait to see the specialist. But, thank you for your concern.
This isn’t a sudden-onset problem. I’ve had specialists looking at my right leg for 25 years, and the consensus seems to be, “If you can walk 5 or 10 miles a day on it, there can’t be much wrong with it.”
Well, it’s good to remember (or be aware, if you didn’t know in the first place) that fee for service Medicare also denies claims and that providers will usually get a pre authorisation done before embarking on a procedure. Same with employer provided plans.
Quite possibly…but what I said is that providers (and institutions) will routinely get a procedure preauthorised ahead of time…not that procedures necessarily require it. The reason is obvious. Since providers…or institutions…that accept Medicare cannot come along and bill patients for unpaid claims, you will be very hard pressed to find any facility will to take it on good faith that any third party payer will cough up payment just for the asking. Too much of a chance of getting burned.
I could see lapiplasty, for instance, being one such procedure. Quite a big ticket item with a long continuum from pretty looking feet to just short of crippledom. Just because a patient wants a minimal issue sorted and can find someone willing to agree to it, doesn’t mean it’s likely to meet standards of medical necessity for automatic payment.