Carlin and Evan 13: Living on SM Income

[SassyPants]

In the U.S. Every medical procedure, appointment, or test outside of an emergency, is controlled by your insurance or your ability to self pay. 
 

In April my youngest brother had a medical incident that occurred during a work mandated treadmill stress test. He was taken to the ER, hospitalized for a week, and had a cardiac cath. He has been diagnosed with A-fib and needs an ablation. His heart function at that time ( pretreatment) was estimated to be 30%. Other than fatigue he had zero symptoms. Since this happened at work and his job exposes him to toxins that can contribute to heart and lung issues, this is considered work related and he must, if he wants this illness covered ( or a possible medical retirement) , use Drs that accept WC insurance. Heid scheduled for his surgery in July…3 months with a serious heart situation. He finally was stable enough to return to work last week.

US health care sucks for all but the billionaire group. They can afford to pay for all of their care. The rest of us work within the confines of the for profit health care system. Most can not afford to self pay triple digit (or more) health care bills. 

[CanadianMamam]

Is the US that drastically different than Canada because there is beyond zero chance you could schedule that kind of tst on your own. You need a referral and they will call you when there is an opening. My husband is actually waiting for a referral for an EEG and it could be 6 months to a year. His neurologist sent in the referral and we will get the call when we get the call.

I know the US system is different in some ways, but I assume that the red tape is still similar and you can't just book that kind of test yourself. 

[nvmbr02]

3 hours ago, CanadianMamam said:

Is the US that drastically different than Canada because there is beyond zero chance you could schedule that kind of tst on your own. You need a referral and they will call you when there is an opening. My husband is actually waiting for a referral for an EEG and it could be 6 months to a year. His neurologist sent in the referral and we will get the call when we get the call.

I know the US system is different in some ways, but I assume that the red tape is still similar and you can't just book that kind of test yourself. 

It depends on your insurance, the hospital/medical facility/doctor, and their policies.

[SassyPants]

In the US you have to be both a financial and medical advocate when navigating a serious illness. As I used the example of brother, a 55 YO man who has a cardiac condition likely work/industry induced or at the very least contributory, and so in order for his employer (the city) to cover this expensive procedure and possible lifelong pharmaceutical bills, he has to follow all the WC rules, including waiting in the queue. If he had used his own personal insurance, the procedure would have been done when he was in- patient 3 months ago, but all associated costs outside of his insurance, would be on him. So, you wait and hope you remain stable enough…he still has a-fib runs despite being on several meds. It’s a broken system.

i live in a medically underserved community. I have a large insurance provider and the closest MD open for patients in 2015 was 30 miles from my home, and in the next county. Most of the Drs in my area are over 60. It’s just too expensive for younger practioners. 

[WatchingTheTireFireBurn]

In the US so much depends on the insurance you have. And there are different price points which have more or less benefits. When Obama put in the affordable care act it increased some of the things all insurances have to offer. Before that if you didn't have insurance that was a part of the benefits of your full time job, insurance policies were insanely expensive and covered very very little. Now they are just very expensive and cover some basics in some situations.

Usually you have to get a referral to any specialist. But most of the situations I'm aware of  - you schedule that yourself. The referral is so insurance will pay their part. If you go without a referral they will say you didn't have permission to use your insurance for it and they won't pay. 

But if I wanted to get a test done and was willing to pay 100% out of pocket I'm pretty sure I could get scheduled for almost any test I want within a month. And some people do that rather than bother with their insurance, especially if their insurance is very bad or if they have a lot of money. I think though you could have problems later on getting the insurance to pay for anything related to that diagnosis since you sort of went out of bounds in the first place.

No matter what, nobody is carefully monitoring anything from the perspective of total care/overall care and I don't know that Americans have any expectation that a doctor would do that. I think most people I know of-they know that they have to be proactive to organize their care.

My grandmother got a referral for surgery for her hand and we got as far as sitting with the surgeon and him practically setting the surgery date when I asked about anesthesia. Because grandma isn't allowed to have anesthesia any more.

And his face! Clearly didn't read anything about her history (she nearly died under anesthesia not too long before this, ended up hospitalized and then rehab for months!) and the doctor who referred her to get surgery clearly didn't pay attention to or know about her history.  I'd like to think they'd have figured it out on their own but I don't know when they would have if I hadn't asked about it. (That Surgeon stopped that appt right there and was like. "yeah I'd need to check with your primary care dr. but I don't think you can have this surgery). And this was at a HMO where all the doctors are employed by the same company and use the same records.

[Ausje]

On 6/26/2023 at 5:10 AM, Keys said:

I work in the field, and can confirm that sometimes these kinds of delays do happen. Either a referral is faxed and the fax gets lost or doesn’t go through, or the physician may forget to send the referral in the slew of other paper work. Usually they tell the patient, “the wait time should be around xyz, but if you don’t hear anything, either call the place the test tasked place, or call us and we can look into it”

Really? Doctors are still using fax machines in the US?

[Expectopatronus]

On 6/25/2023 at 10:21 PM, marmalade said:

Delays are not the same as actually scheduling. They've implied that the doctor was going to do everything. They dropped the ball by not being proactive, which IMO is an indication that this wasn't a priority for them.

I think it depends on the hospital policy. Granted I’m not American so my health care system is different but when my daughter had a seizure at 5 months, we were admitted so we got the EEG quickly. Otherwise, it’s a 12 month wait. Patients cannot schedule tests; the dr refers and you wait. 

[Keys]

3 hours ago, Ausje said:

Really? Doctors are still using fax machines in the US?

Canada, but yes. 🫠 At least most faxes are digital now, though. Don’t even get me started on the fact that many hospitals here also still use paper charts… good luck reading 50% of people’s writing. 

Edited June 29, 2023 by Keys

[CanadianMamam]

Carlin just posted that she is going in for a CT scan today as hopefully the last step before her 5 day EEG. 

[HeartsAFundie]

15 hours ago, WatchingTheTireFireBurn said:

No matter what, nobody is carefully monitoring anything from the perspective of total care/overall care and I don't know that Americans have any expectation that a doctor would do that. I think most people I know of-they know that they have to be proactive to organize their care.

 

Proactiveness certainly is the key when it comes to navigating US health care. 

I returned home from my Alaskan cruise in May on a Sunday, and 2 days later, on Tuesday, noticed I had a sore throat and post-nasal drip.  I attributed it to seasonal allergies which I do have and am on medicine for.

3 days later on Friday, I felt warm and had a fever of 99.  I wasn't messing around, and I took a COVID test.  Positive. (I am fully vaccinated, right up to my bivalent booster).  

The next day, Saturday, I went to the walk-in clinic affiliated with the health group I primarily use in the hopes of getting a Paxlovid prescription, positive COVID test in hand.  You have 5 days from when symptoms show up to get on Paxlovid and I was on day 5.  The walk-in PA pretty much questioned me as to why I was there, chastised me for coming in and then sent me back into the waiting room with the general population!  When I was called back in I was told I was NOT getting a Paxlovid prescription and I should have "used my resources" to get Paxlovid prior to coming in.  Okay...first of all, what are my resources; second, it was a weekend, and my PCP was unavailable so what could I do; and third, if I knew I had resources I never would have gotten up to drive across town to be the first in line to be seen!

I was also told to call the health group's COVID hotline and let them know I was sick because they don't operate on Sunday, so they could call me back and get me Paxlovid.  I did and left a message. 

My after-visit summary did include some phone numbers to call, so after calling the health group COVID hotline, I took a shot and called one of the numbers.  It was the Commonwealth of Massachusetts' COVID telehealth program and guess what?  I got a Paxlovid prescription from the state sent to my pharmacy within the hour. My husband picked it up for me and I was good to go.  

Ironically, the COVID hotline called me on Sunday and asked me if I needed Paxlovid.  I said I was all set.  Mind you, by the time the health group hotline called me, we were now on Day 6-outside the five day window that Paxlovid can be prescribed.    If I hadn't taken the situation into my own hands, I would have been out of luck.  

And yes, I filed a complaint against the walk-in with the health group.  

 

Edited June 29, 2023 by HeartsAFundie

[marmalade]

7 hours ago, CanadianMamam said:

Carlin just posted that she is going in for a CT scan today as hopefully the last step before her 5 day EEG. 

I won't believe she is getting the EEG until she checks herself in at the hospital. 

[JermajestyDuggar]

We knew it would eventually happen. The BSB is selling pants. The horror! Erin is judging.

[WatchingTheTireFireBurn]

8 hours ago, CanadianMamam said:

Carlin just posted that she is going in for a CT scan today as hopefully the last step before her 5 day EEG. 

Can anybody remember has she had CT scans before?  I can't specifically remember it being mentioned but my memory isn't great the further back in time we go.

[marmalade]

1 hour ago, WatchingTheTireFireBurn said:

Can anybody remember has she had CT scans before?  I can't specifically remember it being mentioned but my memory isn't great the further back in time we go.

Even if she had, her medical status has changed, so she needs to update it. 

[llucie]

On 6/30/2023 at 3:05 AM, WatchingTheTireFireBurn said:

Can anybody remember has she had CT scans before?  I can't specifically remember it being mentioned but my memory isn't great the further back in time we go.

Yes she did had one, that came back clear. They mentioned the need for a new CT scan in a recent video too.

[gobucks]

This week’s video- She did a CT scan with contrast. They blew her vein doing it. That freaked Evan out a little bit but she said the worst part is the mental aspect. She was a little emotional. I feel for her health situation. They said this is the last step before the 5 day EEG. They showed today’s cash n carry as well. 

Edited July 2, 2023 by gobucks

[KWLand]

1 hour ago, gobucks said:

This week’s video- She did a CT scan with contrast. They blew her vein doing it. That freaked Evan out a little bit but she said the worst part is the mental aspect. She was a little emotional. I feel for her health situation. They said this is the last step before the 5 day EEG. They showed today’s cash n carry as well. 

A blown vein freaked Evan out.  I laughed.  I understand if it freaked Carlin out especially if the contrast was going when it happened because if they aren’t caught quickly they can get so painful.   Will say I’m jealous that he gets to be with her during those procedures.  And very jealous he didn’t decide he wanted a divorce because she was sick and that he goes to her appointments.  Although it is hilarious when the nurses start cussing about Dh once they find out he asked for a divorce after I became mostly bed bound. 
 

so I’m probably evil that I’m still chuckling at Evan and the blown vein.

a 5 day eeg sounds miserable.  Hope it gets her answers.  

[WatchingTheTireFireBurn]

He wasn't with her for the procedure. Just waiting room/car. Evan seems to get very anxious about medical stuff. Can't tell if it's because he's so worried about Carlin or if he's just naturally a person who is bothered by medical stuff. Some people are.

And yes, it's very nice he's supporting her so much/so well. Evan is being a very decent human being in that regard. I have questions about all the religious beliefs they conveniently never mention.

Carlin seemed *very* down in the car afterwards. And even at the Cash n Carry, there was little footage of her, but her smile didn't seem to reach her eyes and made me think of the Rods.

They have fans traveling from far away to bring them gifts to the cash n carry. Evans started to pull something out of the gift bag from the Scottish people but then quickly slammed it back in the bag and ran off from them. Could anybody tell what it was? They're selling t-shirts now that say Stew Crew. ...for their fans....who come to TN to see them. I'm so creeped out. But I'm very private about my space.

[rebeccawriter01]

9 hours ago, KWLand said:

a 5 day eeg sounds miserable.  Hope it gets her answers.  

They aren't horrible but annoying. Depending on the doctor's hypothesis she might not be able to watch television, for example. 

36 minutes ago, WatchingTheTireFireBurn said:

He wasn't with her for the procedure. Just waiting room/car. Evan seems to get very anxious about medical stuff. Can't tell if it's because he's so worried about Carlin or if he's just naturally a person who is bothered by medical stuff. Some people are.

And yes, it's very nice he's supporting her so much/so well. Evan is being a very decent human being in that regard. I have questions about all the religious beliefs they conveniently never mention.

Carlin seemed *very* down in the car afterwards. And even at the Cash n Carry, there was little footage of her, but her smile didn't seem to reach her eyes and made me think of the Rods.

They have fans traveling from far away to bring them gifts to the cash n carry. Evans started to pull something out of the gift bag from the Scottish people but then quickly slammed it back in the bag and ran off from them. Could anybody tell what it was? They're selling t-shirts now that say Stew Crew. ...for their fans....who come to TN to see them. I'm so creeped out. But I'm very private about my space.

This week's video got a little more on the religious side of things at times. For example the "inviting" people to their church. I get that most church people think that is great. I'm just not a big fan of recruitment. Rather than more questions in their next Q&A about plans for more children, I would be curious about what they would say (if they picked the question) about their actual beliefs.

[hollyfeller]

On 6/29/2023 at 8:42 PM, JermajestyDuggar said:

We knew it would eventually happen. The BSB is selling pants. The horror! Erin is judging.

Sad beige sweats for sad beige fundies

[WatchingTheTireFireBurn]

2 hours ago, hollyfeller said:

Sad beige sweats for sad beige fundies

I thought they were pretty fugly and basic. Couldn't you get generic droopy sweat pants anywhere?

They need some that say "stew crew" on the butt in rhinestones.

[0 kids n not countin]

8 minutes ago, WatchingTheTireFireBurn said:

I thought they were pretty fugly and basic. Couldn't you get generic droopy sweat pants anywhere?

They need some that say "stew crew" on the butt in rhinestones.

I would just buy them at Old Navy, much cheaper and they have petite sizes! 😅

For the price they're charging I hope the quality is decent, but somehow I doubt it.

I notice they also now sell leggings and biker shorts and these ugly (imo) things reminiscent of Layla's "naked hippy baby" outfits in my opinion (I wonder if Carlin chose these at one of those clothing fairs (or whatever they're called) they go to):

[fluffernutter]

31 minutes ago, 0 kids n not countin said:

I would just buy them at Old Navy, much cheaper and they have petite sizes! 😅

For the price they're charging I hope the quality is decent, but somehow I doubt it.

I notice they also now sell leggings and biker shorts and these ugly (imo) things reminiscent of Layla's "naked hippy baby" outfits in my opinion (I wonder if Carlin chose these at one of those clothing fairs (or whatever they're called) they go to):

Ok I'm older than dirt but literally why with those pants. Are they leggings? Bell bottoms? Yoga Capris? The seamstress ran out of thread and couldn't finish sewing them together? 🤦‍♀️

[0 kids n not countin]

29 minutes ago, fluffernutter said:

Ok I'm older than dirt but literally why with those pants. Are they leggings? Bell bottoms? Yoga Capris? The seamstress ran out of thread and couldn't finish sewing them together? 🤦‍♀️

Lol, I SO agree with everything you've just written!!🤣🤷🏽‍♀️

[AussieKrissy]

4 hours ago, hollyfeller said:

Sad beige sweats for sad beige fundies

possible new thread header lol