Universal Health Care: from someone who lived under both ...

mrjurrs said:

Are you including the amount your employer pays for your coverage as well?

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That's not a cost that I bare, so no.
Why would I need to included it?

jaeger19 said:

Actually.. right now.. medicare and Medicaid are rationing using the mid management employee since Medicare and Medicaid are administered by private insurance companies.

Besides.. if you don't like your private insurance.. you or your employer can switch.

not so if its a one size fits none government program.

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In our employer based health coverage, a flippant 'you can change' is not based on any real ability to change.

Mustachio said:

So firstly, I have psoriatic arthritis (we can presume) and osteoarthritis along with bone spurs on the right hip with extensive damage - multiple surgeons have said when, not if - and so much knee trauma it would be funny were it not real.

And yeah, I have throbbing pain in my groin on the bad hip on the inside and then I'll have these shots of searing, horrific pain where the "holster would be."

And your points about conservative treatment are valid, but I do have to work so that I can have insurance so that I can pay for these procedures. I'd love to take 3 years off but my employer wouldn't remember my name were I to do that.

Last, I don't like anecdotal stories. That lady could have been jacked up on so much seroquel and percocet she wouldn't have known if she had been shot.

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So the pain inside the groin indicates a possible bad hip joint. Pain on the outside of the thigh usually originates from bursitis, or it can come from L5 nerve root impingement. And all three can refer pain to the knee.

Which is why they are probably going to give a hip injection first.

And your points about conservative treatment are valid, but I do have to work so that I can have insurance so that I can pay for these procedures. I'd love to take 3 years off but my employer wouldn't remember my name were I to do that.

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Well.. either way.. you are going to have to take work off. Currently.. you could take work off because of the hip pain per FMLA. (family medical leave act)… if you haven't looked into that.. you need to .. because unless you have a lot of time stored up.. you will possibly need it after the total hip. Your HR person may have to have you jump through some hoops to have the documentation so your employer cannot fire you for being ill.

That lady could have been jacked up on so much seroquel and percocet she wouldn't have known if she had been shot.

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She wasn't taking any pain medication.

mrjurrs said:

In our employer based health coverage, a flippant 'you can change' is not based on any real ability to change.

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True.. but I have seen many cases.. where employees complained enough.. that employers changed their insurance to insurance companies that offered better coverage and more choice.

Meanwhile.. people on Medicaid.. when they have crappy coverage etc.. don't have much of an option.

I used to sell group plans, and I never saw a group change due to employee feedback unless there was another issue the employer cared about as well. Medicaid does have problems, just like every government program targeted at helping poor people. Medicare is on better footing.

mrjurrs said:

I used to sell group plans, and I never saw a group change due to employee feedback unless there was another issue the employer cared about as well. Medicaid does have problems, just like every government program targeted at helping poor people. Medicare is on better footing.

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Well.. I see hundreds of insurance companies people come through my doors.. and we see the companies that change insurances and why. We have seen employers change insurance because employees complained enough. (though it never hurt that management got disgusted with their insurance).

jaeger19 said:

So the pain inside the groin indicates a possible bad hip joint. Pain on the outside of the thigh usually originates from bursitis, or it can come from L5 nerve root impingement. And all three can refer pain to the knee.

Which is why they are probably going to give a hip injection first.

Well.. either way.. you are going to have to take work off. Currently.. you could take work off because of the hip pain per FMLA. (family medical leave act)… if you haven't looked into that.. you need to .. because unless you have a lot of time stored up.. you will possibly need it after the total hip. Your HR person may have to have you jump through some hoops to have the documentation so your employer cannot fire you for being ill.

She wasn't taking any pain medication.

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I genuinely appreciate your input. Good stuff. I have a question for you: so I've been read ended 5, 6, or 7 times. I can't remember. My back took a beating and when I tried to get PT for it through insurance, I was denied. I have this extensive study and it shows a bunch of minor displacements, oddities, etc. but concludes nothing is wrong with my back (I had a 10K mri). That never made sense to me, would it be worth getting somebody to reinterpret the MRI?

It's definitely my hip joint. In my brain, there's a collection of doctors reacting to my x-ray. I'm sure it's due to age/severity and not merely severity, but almost every response is "I've never seen this before in somebody so young," or "when did this happen?" Nothing happened. I got my cortizone injection today and then I dropped my phone on my knee (that's like 3 days of extra pain for me) so I know the results will be murky for a few weeks, but they would be in any case. I filed for FMLA and am waiting for the paperwork. Last time I filed for FMLA I got denied because nobody thought to look at my knee. My boss said I can't come back to my current role because of my disability. He was nice enough to feign concern for me.

And yeah, it's totally possible that the woman wasn't taking any pain meds. I was just saying, Buster Keaton had a broken back for most of his career and didn't notice. People quit heroin and feel good the next day. But that's totally not normal. Those people should be studied and paid an enormous wage for it.

Mustachio said:

I genuinely appreciate your input. Good stuff. I have a question for you: so I've been read ended 5, 6, or 7 times. I can't remember. My back took a beating and when I tried to get PT for it through insurance, I was denied. I have this extensive study and it shows a bunch of minor displacements, oddities, etc. but concludes nothing is wrong with my back (I had a 10K mri). That never made sense to me, would it be worth getting somebody to reinterpret the MRI?

.

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Ahhh.. a good question.. I use it on my students. So.. you have a patient that comes in and has pain shooting down their right leg right down the s1 nerve root. They tell you that if they stand to long.. bend over, or sit to long.. the pain shoots down the leg all the way to the foot.
They tell you "man doc.. if I could stay in bed all day i'd be fine.. its the only place it doesn't hurt".

I ask my students.. "what do you think is going on?"... and they say.. " Herniated disc pressing on the S1 nerve root".

So then "what do you do?".

Student Answer "MRI".

I tell them"you do the MRI and its negative for a herniated disc" . So how is that possible?

Usually.. .they don't get it. The answer is... the MRI is done lying down. The patient is not moving. And what was the one position in which he did not have symptoms? Lying down!. So the reality is that the disc herniates out when he stands to long, or bends over, or sits to long.. and when he lies down.. it sucks back into place because the pressure is off.

So.. long story short.. there are multiple reasons that your MRI could show "nothing wrong".

The first is that you have problems that only are obvious with movement. Or with time..

The other reason the MRI could show nothing wrong.. is not that there is really "nothing wrong"... you may have herniated discs... spondylosis, osteophyte complexes etc. Its just that there is nothing seen on the MRI that can be fixed. Despite there being things that are "wrong".. back surgery may not be indicated for you because the risks of the surgery and the likely recover is simply not worth it. You could possibly hurt more after surgery.

Back surgery in particular is a "salvaging" procedure. In other words.. they are often removing things.. that should have been there.. or fixating things... in order to salvage some function. But the result is that in the process of salvaging.. they have also weakened things or had to fuse joints so now other joints will have to take more force.

The denial for PT has me interested. With your history.. you should not have gotten denied for PT. My first inclination is that the reason your insurance denied you was because you listed or the doctor listed MVA as the cause. Got that stinks.. but if your regular insurance got wind that it was an MVA.. they often deny because they say the person who hit you is liable.

I have a patient right now, that we are doing that dance because they fractured their C2 (that's a neck vertebrae).. and his insurance has denied the surgery and after care but that's because his car insurance was on the hook. But.. the car insurance was maxed out with the ER, hospital stay and in hospital surgery costs.. so our fees are denied because we are Johnny come lately and my office will have to get his car insurance to show that he was maxed out on benefit.. before his regular health insurance will pay.

I suspect you ran into such.

The other reason you could have gotten denied.. is because the diagnosis listed on your paperwork from the physician was not one that supported PT. For example.. if your diagnosis was "psoriatic arthritis".. it may not have been covered by PT because that diagnosis is a systemic issue that's not generally "fixed" by PT.

If the diagnosis had been "back pain unspecified".. or Some other diagnosis that WAS covered in the insurances computer program.. there might not have been an issue.

It's definitely my hip joint.

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You will know if the injection in the hip joint dramatically reduces your pain.

dropping your phone on your knee should have little effect if its your hip joint.

Good luck... When you file for FMLA.. you might want to see if you can get your doctor to state you need to be off work for x amount because of hip pain.

AS far as your boss and your current role. According to the American Disabilities Act.. your employer is required to make reasonable accommodations to your disability.

jaeger19 said:

dropping your phone on your knee should have little effect if its your hip joint.

Good luck... When you file for FMLA.. you might want to see if you can get your doctor to state you need to be off work for x amount because of hip pain.

AS far as your boss and your current role. According to the American Disabilities Act.. your employer is required to make reasonable accommodations to your disability.

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Progressive basically said "you're approved for 15K for medical care, no worries" after this really brutal rear ending, but flipped the script when they asked if I had any preexisting conditions. They did approve limited PT but I got human anaplasmosis from a dirty tick and after sleeping for 4-6 weeks Progressive had cut me off because they said I had enough time to heal. So they sent me to the independent medical examiner, and having an ex-girlfriend who used to schedule appointments for independent medical examinations, I expected the outcome.

I appreciate everything you've said, though. There are things I've noticed are definitely better now than before the injection, but I have this weird thing where my knee has become like glass. Everything hurts it. I got hurt getting out of bed today AND yesterday. I live a reasonable distance from the Mayo Clinic and there's a shot they'd take me on because my case is so unique. Some of your input is really interesting, some is helpful, some I've heard before. I definitely appreciate you taking the time to respond to me in as much detail as you have. Let me know if you have any openings

Mustachio said:

Progressive basically said "you're approved for 15K for medical care, no worries" after this really brutal rear ending, but flipped the script when they asked if I had any preexisting conditions. They did approve limited PT but I got human anaplasmosis from a dirty tick and after sleeping for 4-6 weeks Progressive had cut me off because they said I had enough time to heal. So they sent me to the independent medical examiner, and having an ex-girlfriend who used to schedule appointments for independent medical examinations, I expected the outcome.

I appreciate everything you've said, though. There are things I've noticed are definitely better now than before the injection, but I have this weird thing where my knee has become like glass. Everything hurts it. I got hurt getting out of bed today AND yesterday. I live a reasonable distance from the Mayo Clinic and there's a shot they'd take me on because my case is so unique. Some of your input is really interesting, some is helpful, some I've heard before. I definitely appreciate you taking the time to respond to me in as much detail as you have. Let me know if you have any openings

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No worries.. good luck.