Blackjack's Thread of Illness and Ailments

[NTP66]

A high school in montco has a number of kids with whooping cough, and the sister of one of my daughter's soccer teammates has it right now (and actually fractured her rib because of the coughing!). PA law requires DTAP, meningitis, and other vaccinations, but I'm curious as to what their guidelines are for exemptions.

[shafnutz05]

A high school in montco has a number of kids with whooping cough, and the sister of one of my daughter's soccer teammates has it right now (and actually fractured her rib because of the coughing!). PA law requires DTAP, meningitis, and other vaccinations, but I'm curious as to what their guidelines are for exemptions.

Yep, I just heard that story yesterday. Numbers are way up this year. **** garbage parents

[NTP66]

Welp, my mom got covid, so Thanksgiving will now be at my sister's house, sans her and my dad. Feel awful for her, as she loves having us over for big family gatherings.

[dodint]

I'm somewhat relieved and also pissed off at the moment. Honestly not sure how to feel.

I've been fighting with BCBS since February to get on a Semaglutide treatment. Multiple doctor visits, documented execution of required treatment plans, etc. I finally gave up about two months ago and decided just to drop BCBS (in part because of the frustration of this process, but mostly because it's exactly 2x the cost of Aetna but has the same provider network). I also resigned myself to the fact I might have to cough up the $650/mo for the treatment, so I signed up for an HSA and set the maximum amount of $3500 for that.

Our open season ended at midnight last night, I'm locked out of making any changes.

Out of nowhere, I got an e-mail and texts that BCBS has approved my Rx, and the cost is $0. I logged into Amazon Pharmacy and placed my order; it should be here tomorrow.

I should be happy. But really, all this does is saddle me with the need to spend $2900 next year on medical stuff, or I lose those funds. And now that BCBS is actually paying, I've booted them. There is no guarantee that Aetna will cover the medication or at what cost; they have the right to change their Rx costs mid-plan year.

I'm going to bang BCBS for two months of this drug either way, we'll see what happens. Just frustrated at the new mountain of uncertainty that lies ahead.

[DigitalGypsy66]

We end up buying a bunch of medically-adjacent items at the end of the year with unused HSA funds, like bandages, OTC allergy meds, and stuff like that. I also use it for my 2 dental cleanings as well. It sucks, but there are creative ways to spend down that money. All of it is a pain in the ass.

[mac5155]

What was the basis for denying you?

I've been on the big O for about 8 months now. It's really a great drug in my experience. I've been diabetic for about 3 years now though, so I don't know if it was much of a fight. But, my A1C has been in the low 5s consistently now, my binge eating is almost gone, and I really find myself eating because others around me are, or out of boredom, more than hunger. I've dropped about 26 lbs since being on it and about 67 lbs since January 1 of this year.

[dodint]

They wanted to see a 90-day physician-guided exercise and nutrition plan. Which is fine, whatever. If you've been in the Fitness thread you know that's not difficult for me. So I jumped through the hoops and did all that, and then we submitted everything to BCBS and they stalled and wouldn't review the new chart information, this went on for months.

I have no idea what kicked him into gear today.

[NTP66]

Use your HSA as an investment vehicle, so at least it'll be doing something. It'll lower your taxable income for next year, too.

[dodint]

I should've been more precise with my language. I have an FSA.

[NTP66]

Oof... that's very different. It'll suck, but I'd submit claims for every possible eligible purchase until you've gone through it all then. Maybe browse https://fsastore.com, too. That really blows.

[dodint]

Yeah. My wife is thinking of getting a hysterectomy this year. Might just push her into that.

[faftorial]

I should've been more precise with my language. I have an FSA.

You can use FSA for eyeglasses if you wear them.

[NTP66]

I've said it for years, 'use it or lose it' for FSAs is a **** scam and should be illegal.

[dodint]

I should've been more precise with my language. I have an FSA.

You can use FSA for eyeglasses if you wear them.

Thanks. I already have an appointment in February to get new glasses, and I plan to get a new set of Rx sunglasses for flying.

[DigitalGypsy66]

That should eat up a bunch of that FSA. My wife got Costa Del Mar prescription sunglasses a few years ago for like $650. The following year? Her prescription changed.

[mac5155]

They wanted to see a 90-day physician-guided exercise and nutrition plan. Which is fine, whatever. If you've been in the Fitness thread you know that's not difficult for me. So I jumped through the hoops and did all that, and then we submitted everything to BCBS and they stalled and wouldn't review the new chart information, this went on for months.

I have no idea what kicked him into gear today.

I wonder if my doc had to do that. They didn't fight me, but doc did say since Id proven I was able to lose with diet and exercise she switched me to it.

My wife suffers from PCOS, and has irregular cycles. Ive heard it works well for treatment of that also

[Ad@m]

UnitedHealthcare taught us ways to deny claims: Former employee

A former UnitedHealthcare claims representative says employees were systematically trained to deny medical claims and rush distressed customers off phone lines, revealing internal practices at the nation’s largest health insurer amid growing scrutiny of the industry.

Natalie Collins, who worked for UnitedHealthcare for nine months, said Saturday on “NewsNation Prime” that staff received “so many different ways to deny” claims during their two to three months of training, with supervisors often standing behind representatives instructing them on denial methods.

“We weren’t given proper instruction to actually pay the claim, and there wasn’t enough monies in certain files in certain companies to pay medical claims,” Collins said. “We would have to just get the client off the phone as fast as we could.”

Collins described crying at her desk while handling calls from desperate patients, as supervisors laughed.

Collins, now the owner of “Mother’s Keeper Doula,” quit her position after attempting to approve payment for a widowed mother of five whose husband died of pancreatic cancer, saying supervisors had instructed her to deny the hospice claim and get the caller “off our phone line.”

“They just wouldn’t allow me to submit the claim. There would be alerts on each claim telling us that either we had to put it back in our queue and it would just go to someone else, 30 days later, 60 days later,” Collins said.

Collins’ experience comes after accused UnitedHealthcare CEO killer Luigi Mangione pleaded not guilty to murder and terror charges in New York State Court. Public support for Mangione has grown, with his legal defense fund reaching $250,000 in donations.

“It’s all about your employer and who they are negotiating with to get their employees the best health coverage,” Collins said when asked what she wanted the public to know.

A recent poll found that about seven in 10 adults believe insurance company denials and profits bear at least moderate responsibility for CEO Brian Thompson’s death.

Collins said that while she understands public anger, she condemns violence.


“We the people are sick and tired,” Collins said.

“I don’t believe anyone should die … but people are angry. People have reasons to be very angry, and I feel that to my bones. I’ve seen it, I lived it, I processed them and I denied them.”

[dodint]

A string of Influenza A flattened my ass completely, from Friday afternoon till this evening. 103f fever, splitting headache, chills, complete loss of appetite, and now that it's almost over I have mild congestion.

I feel bad for my wife. She finally got her sinus infection treated and got this bug two days after me. It knocked her completely down too.

[shafnutz05]

A string of Influenza A flattened my ass completely, from Friday afternoon till this evening. 103f fever, splitting headache, chills, complete loss of appetite, and now that it's almost over I have mild congestion.

I feel bad for my wife. She finally got her sinus infection treated and got this bug two days after me. It knocked her completely down too.

Oof, hope you guys recover quickly. I need to get that shot, had the flu for the first time in probably twenty years last year and had forgotten how awful an experience it can be.

[NTP66]

I was battling one of those annoying colds where it never actually turned the corner of being a full blown heavily congested, sore throat cold. All the while, I've had tooth pain (major sensitivity to heat) in the area where I had a filling replaced earlier this month. Went to the dentist yesterday, and he didn't see anything wrong on the x-ray, so before he recommended a root canal, he put me on a z-pack. Really hope it's an infection or something, because I'd have to go to a specialist for this particular root canal, and I doubt I'd get an appointment anytime soon. I'm burning through tylenol and ibuprofen at the moment.

[dodint]

Annoyingly we both did get the flu shot. Maybe it stopped a bunch of other strains in December but this particular one got through like **** through a screen door.

[MR25]

Tested negative this morning. Aside from a slight dry cough when I lay down, I feel pretty much back to normal.

[mac5155]

lil mac is on about his 9th round of strep in the last calendar year. Now middle mac has it too. Hoping the baby steers clear though the pediatrician seemed to think hell be fine

[Nuge]

lil mac is on about his 9th round of strep in the last calendar year. Now middle mac has it too. Hoping the baby steers clear though the pediatrician seemed to think hell be fine

My older son had it on the 23rd. Caught it early and started the antibiotics before it got too bad. My 1 year old never got it. Seems to be rare in kids that little.

[mac5155]

Yea I was told tonsils aren't developed enough. This is middle macs first time with it. Biggest mac gets it about once a month lol. He's scheduled for tonsillectomy in March. Can't come soon enough