“The algorithm cannot say no, however. If it finds problems, it sends the request for review to a team of in-house nurses and doctors who consult company medical guidelines. Only doctors can issue a final denial.”
As a physician, I’ve had to speak to these so called “peers” in a peer to peer denials with both my clinic and hospital setting. They are usually people who aren’t physicians as a first line of their defense, ie therapist, nurses, etc. This weeds out the providers who either don’t care about the patient denial and blindly accept the denial, or patient has to take matters in their own hands just to get the care they need/deserve. Or worse, in the hospital that means the patient gets hit with a huge bill (already an insane number in the US even with insurance, so don’t get me started on this) or it gets delegated to another provider who has to deal with it. Quite often patients get denied medical and rehab services, esp after something debilitating like a stroke, trauma/accident, etc. and at that point the peer to peer is to weed the provider out. Usually someone will tell the patient you’ve been denied, either go home without the services they need or you fight it.
I fight it. Can’t count the number of times I’ve spoken to someone not in the field of medicine or if they are, not my field of medicine (both Family/Hospital Medicine). Often I’m fighting with an MD or “practitioner” who is some other field like a gynecologist about hospital medicine services or rehab. I’ve even had the pleasure of talking to a physical therapist and didn’t let me get a word in as we began the peer to peer. I now start of by asking for their credentials and field of speciality and demand a peer of my field to do the denying if they are so adamant about it “not being medically necessary”.
I have so much to say and could write a book about it. I just wish I had the money and connections to actually change the state of US of Corporate Medicine.
I’ve saved a message that was reposted by Bill Ackman on dealing with denials. Thankfully, never had occasion to use it yet:
>> So, your doctor ordered a test or treatment and your insurance company denied it. That is a typical cost saving method.
OK, here is what you do:
1. Call the insurance company and tell them you want to speak with the "HIPAA Compliance/Privacy Officer"
(By federal law, they have to have one)
2. Then ask them for the NAMES as well as
CREDENTIALS of every person accessing your record to make that decision of denial.
By law you have a right to that information.
3. They will almost always reverse the decision very shortly rather than admit that the committee is made of low paid HS graduates, looking at "criteria words." making the medical decision to deny your care.
Even in the rare case it is made by medical personnel, it is unlikely that it is made by a board certified doctor in that specialty and they DO NOT WANT YOU TO KNOW THIS!!
4. Any refusal should be reported to the US Office of Civil
Rights (http://OCR.gov) as a HIPAA violation.
Seems useful, but bureaucracies don't refuse, they delay and obfuscate. So before trying this I would probably seek info on how to deal with bureaucratic realities.
Example: I had an inpatient hospital stay where the payment assistant person was never available, never returned calls. Not while I was in the hospital for days, nor in the weeks afterwards.
Technically, I "left against medical advice", though the last doctor I spoke to agreed with what I was doing.
Over two days of trying to manage costs, then 36 hours of planning and asking to leave all basically got me nowhere and I had to kind of force walk out.
It'd be pretty dystopian if in order to get medical care Americans had to pay some middle man app/service so that it can fight with the middle man the private insurance company they were paying had already inserted between them and their doctor. All if it just raises the total cost of care for the American and absolutely none of it is necessary. The actual fix is to just get rid of the private insurance company and cover everyone's medical needs under a single payer plan.
So far I only pay my insurance company to sit between me and my doctor and dictate what I need and I just do all the fighting with them myself instead of needing to pay someone else to do it on my behalf on top of what I pay the insurance company and the doctor.
I suppose that if I did pay someone else to more effectively fight the insurance company for me the insurance would have to pay for more of the medical care I need, and would invest in new and better ways to fight back, and my insurance costs would increase even faster. I'm happy that for now at least I don't have to finance both sides of an arms race in order to get the healthcare I've already been paying for.
IMO you're looking at it from your perspective only. Services to negotiate medical debt by interacting with the insurance company to find errors and/or intention denial -- these exist today -- you're giving me the impression you're healthy enough or well off enough to not need them?
I suppose we're not yet at the point where this gates services for all -- but we're CERTAINLY at the point where hospitals refuse to help you if you can't show ability to pay up front.
Ugh, this is a total shitshow. None of this is what it should be. Profit motive has absolutely corrupted everything.
I feel like this should really be something people should lose their license over.
By deeming something not medically necessary they are (in my opinion) effectively practicing medicine. If they aren't qualified to practice that specialty, or aren't acting in the patients interest we should really be getting malpractice suits on them and stripping medical licenses.
Legally speaking the health plan employee isn't practicing medicine in that circumstance. The requesting provider is still free to treat the patient, they just won't be reimbursed by the health plan. The requesting provider can do it for free, or the patient can pay cash. I do understand that those aren't realistic options in most cases, I'm just explaining the legal distinction.
If it's not medicine, why do they say the word "medical"? Why does the insurance company pay a doctor to do it, if they could pay someone cheaper to say those words? I'm not a doctor or lawyer, but if I had to guess, the answers are that the law requires it be a doctor exercising their medical training, while the company tries to hide behind arguments like this to get around the law.
This seems like a straightforward argument based on existing practice of medicine laws rather than anything specific. Your arrangement with the health "insurance" company is that they will cover treatments that are objectively medically necessary. In our society, such judgements are made by licensed domain experts with a duty of care (whether a doctor, attorney, professional engineer, etc). Someone without that license (and associated duty of care) is simply not qualified to render an opinion that counts as medical advice.
The overall situation is that the insurance company doesn't want to trust your doctor's judgement [0], so they insist on getting a second opinion about the care you might need to receive. That second opinion is still being performed by a licensed doctor who is supposed to be working in your interests - it's a straightforward practice of medicine the same as if you yourself were to go and seek out a second opinion.
[0] or really they want to play good cop / bad cop - remember "your" doctor themselves is essentially also an employee of the insurance company!
It might seem that way to you but that legal theory hasn't succeeded in court. Feel free to try again, though. I'm not claiming that the current legal situation is a good one but any significant change will require an Act of Congress.
Okay, I was too glib, but without specifically examining state laws and the percentages of patients they affect, this is also too vague. Yes, some states do require a doctor to review denials. https://www.ama-assn.org/system/files/prior-authorization-st... Now that I see this is not universal, I concede my argument doesn't prove much outside of those states.
> Legally speaking the health plan employee isn't practicing medicine in that circumstance
Feels like convenient lawcraft to wash the health plan employee’s hands of liability. I’m sure the prevailing popular opinion would be that this is practicing medicine.
If "convenient lawcraft" is the new slang for "words have meanings" then absolutely. Insurance company employees talking about insurance is practising insurance. Nobody wants them to practice medicine, the question is whether they are they going to hand over the money or not. Money is not a form of medicine, even if the person deciding where it gets sent is medically qualified.
Although on the words having meanings front, whatever is going on here is pretty clearly not insurance at this point; it'd be better just to honestly call it welfare rather than force people to redefine the word 'insurance'. It is hard to talk to people in the US about actual insurance now because they don't have a word for it any more. Politically redefining 'medicine' too would be a mistake, important conversations will become incoherent.
But you didn't build my house, and if I literally get angry with you because I think you should abandon your legal shenanigans, admit to being a builder and take on legal liability for the flaws in my house that would confuse you because you are, in fact, probably not a builder and certainly not the person who built my house.
The issue with teeray's original comment is that they are saying someone who isn't practising medicine should be considered to be a medical practitioner. In fact, in this context, teeray is annoyed with them specifically because they didn't practice anything. Your analogy became irrelevant the moment it involved you doing anything.
> “X is or is not medically necessary” seems like a decision a medical professional should determine, no?
No, that is ridiculous. If I think I need to go to a hospital I'm going to go to the hospital. I don't need qualifications to work out something is medically necessary. I'm unlikely to be involved with the medical industry at all unless I've already personally determined it is medically necessary that I consult a doctor.
As a rule of thumb, patients have the final word on what they actually consider necessary. Literally anyone can have an opinion on the subject. Like, for example, an insurance worker. If the patient or the doctor is of a different opinion then they can go pay for the work themselves. It isn't that uncommon to have to go through 3 or 4 medical professionals to find one who agrees that work is necessary; I have a cancer story like that in my family.
I think the right analogy here is that I'm a renter and the person who built my house (builder) is different from the person who paid for the house (landlord). The builder said the roof needed trusses but the landlord decided they weren't "structurally necessary" and refused to pay for them. The roof collapses on me...does the landlord escape liability?
Maybe an even better analogy is that I live in a rented home and after I report some weird respiratory issues, an inspector finds black mold all over the place. The landlord refuses to fix the issue because "black mold is totally fine, bro" and I get really sick. I could maybe have moved out, but I kinda feel like the landlord is going to have a bad time here.
That analogy would make sense if there were a credential that one had to have to make an authoritative decision, and the people making the decisions lacked the credential.
Words do in fact have meaning, which is why if you want your decision to be viewed as an insurance one rather than a medical one, you probably should avoid using phrases like "medically necessary" as justification for your decision to approve or deny insurance coverage. Using that phrase strongly suggests that while the ultimate decision was about providing or denying insurance coverage, what informed that decision was a medical determination about the actual necessity of the procedure. If you want to keep the decision firmly in the insurance realm, better considerations to mention might be expected lifetime payouts, shareholder value, and "because fuck you that's why".
> Nobody wants them to practice medicine, the question is whether they are they going to hand over the money or not.
This doesn't make any sense. They're not handing over money for fun, they are supposed to pay for the medical services the insurance is supposed to cover. And the only person qualified to decide if that medical service is appropriate is a doctor who specializes in the field of that specific area.
If you aren't legally qualified to make medical decisions then you are not allowed to use terms like "medically necessary" in your decisions. That our judges haven't bothered doesn't protect us from this obviously illegal abuse is just one of a million of illustrations of how poor our legal system is.
> The requesting provider can do it for free, or the patient can pay cash.
That might not be actually an option. Well the provider can do it for free, probably; but they may not be able to accept money for care that was denied coverage. A Medicare provider can charge patients for things outside the scope of Medicare, but generally can't charge for things in scope but deemed not medically necessary: ex if Medicare says 6 PT visits for whatever and you would like to have 8, you can't pay the provider for two more; you'd have to find a non medicare provider or come back with a fake moustache.
I had to take my kid to an express care doctor in the US. My wife had the insurance cards and was on travel. I said I would just pay cash. They said because I had insurance I was not legally allowed to pay cash.
Sorry, but this feels like a lot of weasel lawyer doublespeak nonsense. Denying insurance coverage for a specific procedure for a specific patient based on whether you think that procedure is necessary is absolutely making a specific medical decision that will impact the treatment of that patient. The idea that this does not constitute practicing medicine is absurd and the fact that the patient can potentially still obtain treatment seems immaterial. A doctor who flat out told a patient a certain procedure wasn't medically necessary could be legally liable if that wasn't accurate, so how is the same not true of an insurance company who has far more impact on the ability of the patient to obtain treatment?
The reality is that this is the insurance companies trying to have their cake and eat it too. They actually want to be making a medical decision in denying coverage since it gives them a legitimate reason to do so, but want to avoid any liability if that decision was wrong.
Right? Lawyers can get into deep shit if they misrepresent their ability to well, represent a client on a case outside of their area of competence. How are medical professionals that often won't even tell you what they think about a test result and refer you to a specialist to actually get a diagnosis able to ethically represent what a patient actually needs?
In the early 2000s I got a job right out of highschool working at a Blue Cross Blue Shields call center. I thought it was going to be customer service but it was insurance claims. Training was supposed to be 6 weeks but they pushed me live after just 2. I had no idea what I was doing. After floundering for a couple weeks trying to learn to basically be a fuckin doctor, I just started approving everything. "Patient needs emergency surgery for X" "Approved". The whole experience was completely insane.
I didn't stay long enough to find out, but yeah, they probably would have. The pressure was definitely to default to deny it. That's what the run books (very few) were defaulted to. It was really just a bunch of expendable people to deny claims. The turnover was wild for obvious reasons.
It's like any time spend on billing or administrative work, it's baked into the costs. (Administrative costs is a big component of rising healthcare costs.)
Depending on the issue, the patient may be needed to provide supporting paperwork, like previous diagnoses or treatment for providers. Other than that, not really, short of taking legal action.
1. It’s unpaid, short answer. Not part of your visit, usually a visit code is just one time based code for everything you provided and maybe a procedure if you did something like ear flushes, wart burning, quick wound fixes, etc. Long answer below.
If there’s a billing code for it, I’m not aware of it and frankly I shouldn’t have to use it. For providers, it’s part of their “administrative time” which used to be a full day of catching up. In most hospital or insurance-owned clinics, that admin day is gone. You now do this during your lunch break and anytime you can squeeze a phone call. Fun fact, in the hospital, these peer to peers are at the mercy of the insurance company and only give you 24-48hrs to do it, so the hell to the overworked provider and their schedule, again this is exactly what they want. A overworked provider who doesn’t have the energy to fight. Providers are so overworked, they no longer can you catch up on charts and hence why the patient-provider relationship has eroded and become so cold when you see your provider just typing away instead of focusing on you.
2. Fight. Appeal your denial. Make sure your provider does the same. Follow this: https://news.ycombinator.com/item?id=48126000#48128288
Can’t speak to all providers, but most of us are good people trying to do their best to help people. Few bad actors out there give us a bad name, but every field has good vs bad. It’s not right to make hasty decisions based on legitimately a few bad providers out there because of their greed, corruption, fraud, etc and lump everyone to prove they’re not fraudsters. Your basic primary care physician/NP/PA or surgeon isn’t the problem. It’s the conflict of interests of the health care industry, private equity groups, etc who create these issues, exploit the system and make it a breeding-ground for fraud/etc then complain that it needs to be fixed with more middle men.
First off, thank you for taking the time to do it. I know most people don't agree on many things today, but most Americans agree the current system is stacked against them. Not to search very far, I have good insurance and I still have to deal with things that border on criminal.
This is good to hear. My mother was a PA for a private practice and also would often call the insurance providers to challenge denials, often from people far from the relevant specialty. By her accounts she was usually able to reverse the denials.
seriously consider that book if you can fill it up with these types of stories. A book like this could be a huge hit, get this issue even more spotlight and maybe some fixes.
> I just wish I had the money and connections to actually change the state of US of Corporate Medicine.
It will never happen.
This is largely what at least half the country wants.
“If I need to take a drug test to earn a check you better take one to get welfare.”
I’ve heard a working class person say this. I guarantee you the people who own defense contractors, the real welfare queens don't need to take a drug test.
Likewise, the horrific thought that someone unworthy might get free healthcare is appalling to half this country. They’d rather go without just to ensure *those people don’t get free healthcare.
This country doesn’t want to be fixed. It wants RFK to tell you to treat Autism with raw milk and sunshine.
Nothing much to do but try to find a civilized place to live
Definitely write to NYT or Guardian or Atlantic about this stuff! Journalists probably have a ton of info on how messed up the system is, but if feels like you have data-backed opinions and documentation to remind yourself of examples!
Physician and Hospital resources is a real zero sum game, how do you fairly regulate the medical landscape so those who's lives will benefit most from a procedure will receive the procedure?
Who decides this? You?
Should we allow everyone in the world who needs a procedure to receive one free and get ahead in line for Americans who need the same procedure? That's what the current climate looks like with unbridaled immigration under progressives.
Why not pay for these things out of taxes? I don't think you'll be so quick to defend the system if you ever find yourself needing care beyond a checkup once a year. It's designed to make the insurance carrier money by constantly having little costs slip through the cracks that should be covered. Get a dental checkup? Sorry one of your X-Rays wasn't covered but the other ones were. Now you get to spend hours fighting for a $13.00 cost. Oh you're at the max for this service for the year because we accumulated the estimated cost when you started calling doctors about what the after-insurance cost will be. Wait a minute this out-patient consult is actually a surgery because you saw a surgeon so it must have been a surgery, and it's not medically necessary to have the surgery without the consult.
Because there are a finite number of doctors and hospital beds and you can't create either by throwing more money at the problem. You didn't actually read the content did you
The doctor has already managed to find time for the service - she’s seen you. Potentially even done the procedure. The hospital has made room for you. The resource is already consumed by you, like a restaurant meal. The question is who is picking up the check, when you already have a subscription service paid for.
The service is not “free healthcare for any procedure ordered by a doctor all the time without limits”, they have the right to refuse something they feel is unnecessary
Why isn’t it “any procedure performed by a doctor all the time with no limits”? Do you think there’s a cabal of doctors doing medical procedures for funsies? And that if such a thing did exist, it would be a bigger problem than some company who has never seen you, never examined you, and you’ve already paid money to, denying the claim because they judge it “unnecessary” when the doctor who did see you claims it is?
Wait times in my region are 12-24 months. My "annual" appointments with generalists occur roughly 18 months apart, and usually involve being seen by a PA or NP.
I live in Québec, Canada and the longest I had to wait was 3 months for a gallbladder ablation. And my wife, who is on her fourtht year of ribociclib to prevent her spinal metastasis (breast cancer) from coming back, have timely periodical CT-PET and IRM scans.
MAID is popular not because of lack of care but because Québécois values their autonomy and quality of life above being simply alive for the longest time possible.
In the US nobody waits three months for a simple gall bladder ablation. What's crazy is you think that's normal. She has 'timely' scans because they are made months in advance.
My dermatologist books nine months in advance. My wife’s neurologist books six months out. Long waits are absolutely a thing in the US. A surgery she needed took 18 months to go through.
In the US around 26 million people have no form of health insurance. These same people are unlikely to be able to afford a 'simple' gall bladder ablation out of pocket. Which implies an effectively infinite wait time. What's crazy is that some people think this is normal.
But it was truly not urgent, I would have been ok with waiting 6 months!
And the scans are not scheduled months in advance. We complained that we were only informed of the date and time of the next scan a few days before it... The explanation was that they have a must not be done before and a must be done after dates but the actual scheduling is done just in time so urgent case are prioritized before routine care.
I guarantee you that the insurance company has zero clue or consideration for any physician and hospital resource constraints.
Gating access to medical care is the job of the patient's PCP and or other doctor. If the care is truly, meaningfully rationed (like transplant organs and blood banks), there are triaged priority lists managed by medical organizations.
I distro hopped for a while and settled on Linux mint. Uses flat packs. Hits the spot for easy to use and easy to maintain without needing to use terminal scripts to get things my way. Just my opinion.
I am the same, used Little Snitch for a few years back in the late 2000s, I think like 2010 until a few years back when I moved fulltime to Linux. Back then, my parents had an iMac and I was the designated "IT" person to keep it running efficiently. My siblings had a bad habit of installing games and hack software on it for their games. I ended up purchasing a license and after the first few hours/days of configuring allow/block lists, it worked pretty well. It earned the label of "Little B*ch" from them since it would stop their gaming hacking apps from connecting and wrecking havoc. Eventually I learned to keep them on a standard user account and separate admin for installing software.
Long story you didn't ask for. Like I said, I haven't used Little Snitch in a while. I'll give this a whirl this weekend. What I have done over the past few years is run AdGuard Home on a min home server. This has helped keep ads undercontrol in our hoursehold and I have an easy "turn off adguard for 10 mins" in homeassistant for the wife so she can do some shopping online since it can occasionally break some sites, but overall they tolerate adguard and think it's a good middle ground. I have a few block lists, nothing too crazy or strict to avoid breaking most sites. On the desktops/laptops, they all run FireFox w uBlock origin.
"Dye also contributed greatly to the design language of iOS 7 in 2013. In 2015, Dye became the head of Apple's user interface design team. In 2022, he played an integral role in the creation of the Dynamic Island, a feature on iPhones and then in 2025, he led the design of Liquid Glass."
Left for Meta in Dec 2025. Hopefully things normalize a bit? Wishful thinking, I suppose.
What blogs do you subscribe to for tech stuff in your RSS feed? I still have Ars but I have to weed through a lot of stuff like the political articles. Really like just pure tech like how it used to be with the old Anandtech.
I do find a few smaller special interest open source ones like the dolphin emulator blog which still maintains high standards. I too am stuck with finding new high quality new sources for more professional purposes. Things have changed a lot. Open source is now just corporate shareware and most that is written is marketing.
I subscribe to some news site for hackers... "Hacker News" I think it's called. Not RSS, but I've never used that anyway. Google should be able to find it for you.
>> “I was stunned to learn late yesterday that after convening a task force of local and national experts, Mayor Johnston has been negotiating secretly with the discredited CEO of Flock Safety and signing another unilateral extension of this mass surveillance contract with no public process and no vote from the City Council or input from his own task force,” Councilmember Sarah Parady told The Denver Gazette.
I added google.com and it spit out https://twitterDOTc1icDOTlink/install_Jy7NpK_private_videoDOTzip
Interesting that it spit out a .zip url. Was not expecting that so I changed all the “.” to “DOT” so I don’t get punished for posting a spammy link despite this literally being a website to make links as spammy and creepy as possible.
Outside transfer switch and a 10-20kw portable generator is like $4-5k. It requires manual switching but it works for us in our hurricane-prone region. Helped with last years 1 in a 100 year winter storm in our southern region.
Battery/solar doesn’t make sense in my opinion. Too many years to break even like this parent comment said and by the time you break even at 10 years, your system either is too inefficient or needs replacing. At least with the portable generator, you can move it with you to a new home and use it for other things like camping or RVing.
Context: I’m in the Netherlands. With taxes, power is around 25cent/kWh for me. For reference: Amsterdam is around a latitude of 52N, which is north enough that it only hits Alaska, not the US mainland.
I installed 2800Wp solar for about €2800 ($3000, payback in: 4-5 years), and a 5kWh battery for €1200 ($1300) all in. The battery has an expected payback time of just over 5 years, and I have some backup power if I need it.
I’m pretty sure about the battery payback, because I have a few years of per second consumption data in clickhouse and (very conservatively) simulated the battery. A few years ago any business case on storage was completely impossible, and now suddenly we’re here.
I could totally see this happen for the US as prices improve further, even if it’s not feasible today.
It’s a physician who gets paid a subscription by a small panel of patients.
Pros: more time spent with patients, access to a physician basically 24/7, sometimes included are other amenities (labs, imaging, sometimes access to rx at doctors office for simple generics, gym discounts, eye doctor discounts, etc)
Cons: it’s an extra cost to get access to that physician yearly ranging from a few hundred US dollars per year to sometimes thousands $1.5k-3k (or tens of thousands or more), those who aren’t financially lucky to be that well off don’t get such access.
—-
That said, some of us do this on the side to augment our salary a bit as medicine has become too much of a business based on quantity and not quality. Sad that I hear from patients that said a simple small town family doc like myself can spent 20-30mins with a patient when other providers barely spend 3 mins. My regular patients get usually 20-30mins with me on a visit unless it’s a quick one for refills and I don’t leave until they are done and have no questions. My concierge patients get 1 hour minimum and longer if they like. I offer free in-depth medical record review where I get sometimes boxes of old records to review someone’s med history if they are a new concierge patient. Had a lady recently deal with neuropathy and paresthesias for years. Normal blood counts. Long story short. She had moderate iron deficiency and vitamin b 6 deficiency from history of taking isoniazid in a different country for TB and biopsy proven celiac disease. Neuropathy basically gone with iron and b6 supplements and a celiac diet after I recommended a GI eval for endoscopy. It takes time to dig into charts like this and CMS doesn’t pay the bills to keep the clinic lights open to see patients like that all the time and this is why we are in such a bad place healthcare wise in the USA were we have chosen quality than quantity and the powers that be are number crunchers and not actual health care providers. It serves us right for let’s admins take over and we are all paying the price.
So much more I want to say but I don’t think many will read this. But if you read this and don’t like your doctor, please look around. There are still some of us out there that care about quality medicine and do try our best to spend time with the patient. If you got one of those “3 minute doctors” look for one or consider establishing care with a resident clinic at an academic center were you can be seen by resident doctors and their attending physicians. It’s not the most efficient but can almost guarantee those resident physicians will spend a good chunk of time with you to help you as much as they can.
> It’s a physician who gets paid a subscription by a small panel of patients
That's how it works here too, in PCP-Centric plans. The PCP gets paid, regardless if the patient shows up or not. But is also responsible to be the primary contact point for the patient with the health system, and referrals to specialists.
As a physician, I’ve had to speak to these so called “peers” in a peer to peer denials with both my clinic and hospital setting. They are usually people who aren’t physicians as a first line of their defense, ie therapist, nurses, etc. This weeds out the providers who either don’t care about the patient denial and blindly accept the denial, or patient has to take matters in their own hands just to get the care they need/deserve. Or worse, in the hospital that means the patient gets hit with a huge bill (already an insane number in the US even with insurance, so don’t get me started on this) or it gets delegated to another provider who has to deal with it. Quite often patients get denied medical and rehab services, esp after something debilitating like a stroke, trauma/accident, etc. and at that point the peer to peer is to weed the provider out. Usually someone will tell the patient you’ve been denied, either go home without the services they need or you fight it.
I fight it. Can’t count the number of times I’ve spoken to someone not in the field of medicine or if they are, not my field of medicine (both Family/Hospital Medicine). Often I’m fighting with an MD or “practitioner” who is some other field like a gynecologist about hospital medicine services or rehab. I’ve even had the pleasure of talking to a physical therapist and didn’t let me get a word in as we began the peer to peer. I now start of by asking for their credentials and field of speciality and demand a peer of my field to do the denying if they are so adamant about it “not being medically necessary”.
I have so much to say and could write a book about it. I just wish I had the money and connections to actually change the state of US of Corporate Medicine.