u/Chipsandsalza

I had a surgical procedure done at an in network hospital recently.

The doctor’s office submitted the prior authorization request to my insurance. Insurance approved the code used for the main procedure, but denied two other associated codes that were submitted.

I didn’t have a lot of options, so I moved forward with the service with a plan to pay out-of-pocket for the denied codes.

I had the procedure done and the claim was sent to my insurance. And to my surprise, they paid for everything. Even the codes that they had previously denied.

I was really surprised by that. I am assuming there is a way that they can go back and rescind that payment.

What should I expect from a scenario like this?

I was actually still working through an external appeal and I am uncertain of how to proceed with that given that they paid these claims.

I recently started working at an IPR. This is my first time in this setting.

Couple questions:

The facility has a rule that no patient is allowed to have room independence. So basically even if the patient is modified independent or independent with mobility & transfers, they still have to use bed/chair alarms and call button for assist before getting up and doing things. Is that normal?

Also, therapy tends to use lifts more than I’m used to. If a patient is assist of 2, they will use a Sara steady or Hoyer. Using a lift also requires 2 people. The last building I was in, therapy rarely used lifts unless the patient needed a hoyer.

Just wondering what is normal from others who have worked this setting.

I’m an experienced OT of almost 20 years and I’m struggling with my new PRN role in IPR.

For background, I did acute care for a year as a new grad but worked mostly in a SNF (a very reputable one with a good rehab program). I left full time SNF in 2020 & now work non-clinical full time as a medical education coordinator for a hospital. I’ve done minimal PRN OT work since 2020.

The learning curve in IPR has been tough and I’m embarrassed. I’ve done 6 shifts so far with another OT observing me. I feel very rusty & have made clunky mistakes. Maybe I’m just not cut out for this.

For those with experienced in IPR, how long did it take for you to get comfortable? Any advice for someone trying to acclimate.

Does anyone else have this struggle?

If I put any sort of buttoned pants around my waist, my stomach will inevitably riot and puff out even more. Jeans-nope. Dress pants-definitely not. I tried pulling out my old belly bands from when I was pregnant, but they just rolled up and down, and I was constantly adjusting them.

The only thing I seem to be able to comfortably wear are cotton, light tummy control leggings. They must be high rise so I can pull them all the way up. They cannot cut mid-tummy.

And tunic tops. I don’t dare to ever try to wear a somewhat fitted top because my tummy is bound to push out during the day.

I get so jealous of other women who can dress cute and feel sad that my body doesn’t let me do that.

I recently became eligible/accepted for Medicaid in my state. So I called marketplace to cancel my plan. This was 2 weeks ago.

However, my marketplace plan is still showing up as active.

One person at marketplace said it can take up to 30 days to update, another said it should be updated within 5 days.

Does anyone have any insight into the process? Wondering what I should do next? I have an important treatment coming up in June and I was hoping to get things straightened out before then.

I’m in my early 40s and in perimenopause. The hormonal shifts are affecting me and my body image so much.

I struggled with body dysmorphia, depression and eating disorders for all of my teen years through my late 20s. At that point, I established better habits where I could feel healthy and was happy with my appearance at a normal weight. My depression disappeared. I felt great. That lasted until I turned 41.

My hormones are all over the place. I’m bloated and puffy. My boobs are like huge pregnant boobs. I can’t wear anything but stretch pants. I feel terrible and look terrible. This has caused me to spiral into depression.

For about 5 days a month the symptoms subside and then I feel great again. Depression is relieved and I feel like myself.

I’m just struggling so bad. My MD has recommended a hysterectomy(for other reasons) but I’m not even sure that will help with this. I feel like my ovaries are assholes. I tried HRT but didn’t do well with it.

I just feel so lost and miss who I was before all this.

Anyone else have any advice or commiseration? I don’t even know where to go from here.

I had an endometrial ablation (and salpingectomy) last year to help with heavy periods. It helped with that but I now have this ongoing pelvic pain. I still get PMS and when I do the bloating and pain lasts longer & feels worse.

Sounds weird but I think I actually felt better when I just bled and got it over with.

I think my uterus is mad at me. And my tummy feels perpetually puffy.

I’ve been checked out and my OB could not find any reason for my complaints.

Has anyone else struggled after an ablation?

*I know this is not the norm so don’t want to scare anyone who’s getting an ablation*

Just trying to get an idea of recovery. Obviously it’s all variable. I’ve had 2 c sections. Also a prior endometrial ablation.

I did well in recovery of my c sections. Minimal pain. Was up and moving as soon as I was able.

I’ve had so much ongoing pelvic pain these last few years I’m just wanting to get the hysterectomy done.

With your hysterectomy:

How was the pain?
When could you start walking around?
When did you return to work?

I’ve always dealt with bloating, pelvic pain, cramping and bleeding.

I have pelvic adhesions. My bladder and uterus are stuck together. I feel like I have a block sitting in my pelvis. Ultrasounds and testing have never found anything significantly wrong.

My lower stomach/pelvic area always seems bloated. I’m about a size 8/10 everywhere else but stomach area is like a 14/16 to be comfortable. My weight is normal. It’s quite distressing to never have things fit my waist comfortably. As a result, I live in yoga pants.

I think I just have an angry uterus that pushes everything outwards.

Curious if others have experienced this. I’m really hoping my hysterectomy helps with this.

This was actually the 2nd one I’ve had done in my lifetime. I had one done before my ablation and now this one before my upcoming hysterectomy.

The first one hurt like hell. I nearly passed out but didn’t cry.

Not sure what got me this time. I think I knew how it was gonna feel and that made it worse. Once she started scraping (or whatever they do) my uterus seized up with deep cramps. My leg muscles all contracted. And I couldn’t even do anything but lie there spread open and feeling disgusting.

I sobbed the whole way through. It just sucked. I don’t know why they think that OTC pain medicine is adequate for this sort of procedure.

I have a bunch of tattoos, breezed through my c-section recovery and can tolerate pain just fine but this was just something visceral.

I’m feeling deeply embarrassed of myself and wish I could have held it together.

Edit: I got the unfortunate news that they couldn’t get enough tissue from my biopsy so now it’s being recommended to have a hysteroscopy before I can have my hysterectomy. Super suck.

I recently became eligible for Medicaid. My doctor wants me to start treatment for my cancer asap.

He wants me to start in a clinical trial which I’m told is covered by Medicaid without prior auth. However, I’m nervous about what will happen when I’m moved into a Medicaid HMO next month. I was told that is a requirement to be in an HMO in my state unless you also have Medicare or SSDI.

How does this work? Do I need a new authorization? Can the HMO deny my services? I don’t want to start services and then have to stop.

Just wondering how to proceed with this.

My physician wants me to start on a clinical trial for my cancer.

I recently qualified for my states Medicaid program as I’m low income. Right now I’m on what they call straight Medicaid. This will cover the clinical trial that I am supposed to be participating in.

However, next month, I am being moved into what they call a Medicaid HMO. I was told that this is a Medicaid plan that is administered by a commercial health insurance.

Does anyone have any experience with this type of situation? How will this affect authorization for my clinical trial? My biggest concern is what if the Medicaid HMO does not give approval for the clinical trial?

I’ve had a tough week. I’ve been working my full time job and also finishing up orientation for a new part time job I took. Full time job has been extra busy. Orientation is very thorough and using all my brain power. On top of that, I’ve got a nasty sinus infection that has knocked me down. My nostrils are burning. I can’t breathe well. I got like 5 broken hours of sleep all week.

But somehow my husband is still more tired than me. He works full time as well. But he always goes to bed earlier than me. He sleeps later than me. The kicker for me was when I got home late from work today. I was hoping he’d have the kids ready for baseball practice. NOPE.

He was sprawled out in the couch when I got home; his mouth wide open snoring. Didn’t even know I took the kids to practice because he was asleep.

Now he’s in bed and I’m left shutting the house down.

Like omg what is wrong with some of these men? I legit want to look in his face and say “when you wonder why I don’t want sex with you-this is why”.

I’ll probably be stuck here til my kids are grown.

Essentially, I hate my job but it’s flexible. I work in healthcare. Worked patient care/on-site for years (not a nurse but in allied health). Took a hybrid role a few years ago. My department is disorganized. And I don’t enjoy the nature of the work (I deal with health insurance). I don’t give a darn about advancing in this area. BUT……I can be flexible with hours and remote as needed.

Last week my kid was sick 3 days. I worked remote the whole time. A couple months prior, he was out 3 days for illness too. I have another kid who randomly gets sick as well. If I didn’t work remote, I’d probably have to call out 10 days a year for kid sickness.

My husband works full time as well and has no flexibility because his company sucks. So it’s mostly me who works remote if a kid is sick.

Is anyone else in this position? I hate my job but I feel stuck.