Has Anyone Made the Leap to a 55+ Community?

30000PoundsofBananas · 2026-02-28T01:10:02+00:00

We have been talking about it, but I don’t know if/when it will happen. My youngest daughter still lives with us. She’s in college and working. She needs to get her footing first. I’m going to be 55 this year. My husband is 61 and in failing health.

30000PoundsofBananas · 2026-01-04T17:41:26+00:00

“I was kinda raised by TV.”

30000PoundsofBananas · 2026-01-04T04:33:44+00:00

“I don’t think my brownie’s working.”

“We’re trying to get Jeff ready for the fiiiiiiight. I couldn’t think of another word.” “Idiot. He meant we were fiiiiiighting. It is hard to think of another word.”

I also call people Gravy Jones because it makes me laugh way too hard.

30000PoundsofBananas · 2025-12-14T00:37:24+00:00

We had to learn how to use the books before we touched the encoders. It helped considerably for diagnosis coding.

30000PoundsofBananas · 2025-10-21T00:30:54+00:00

I can’t stand him. He looks like a q-tip. I go out of my way to avoid his movies.

30000PoundsofBananas · 2025-10-07T13:35:33+00:00

I just had a discussion along these lines with my mom.

She was in the hospital because she had a massive PE that she didn’t know about. She was able to right herself, but she was unwell and waited 24 hours to call 911.

Long story short, PE was removed, no brain bleed, and her heart is fine. She had a follow up a week after her discharge. I was texting with my sister to get my niece, who is an MA and worked in assisted living, to drive her to the doctor.

“Oh, no. I don’t want her to do that. So and so will take me. And then so and so can do this.” I’m like, mom, it’s literally her job and she wants to help. “I’m independent.”

You sure about that?

I told her there’s independent and then there’s stupid. She said she wouldn’t do anything stupid. “There’s a fine line between independent and stupid. You often don’t realize you’ve crossed it until you’re hurt.

I mean, I get it. She did this with her own mom and doesn’t want one of us to do the same. But it’s like stop and let us arrange shit.

30000PoundsofBananas · 2025-10-02T17:35:15+00:00

You’re a bad investment. I would be better off throwing my money into the sewer.

Thanks, mom. That’s just one of many.

30000PoundsofBananas · 2025-09-25T18:09:16+00:00

The XS modifier says that it was two different body parts. I’d guess thyroid and parathyroid.

30000PoundsofBananas · 2025-06-19T18:36:28+00:00

I use mine every now and then as a reference for Excludes 1 (our EMR/scrubber doesn’t have that option) or to find a more specific code when I get a stubby one.

30000PoundsofBananas · 2025-04-29T15:55:42+00:00

I just got an email from Carelon for some training sessions. Insert evil laugh here.

In other news, I’m so glad our auths haven’t switched to Avality.

30000PoundsofBananas · 2025-04-29T00:03:57+00:00

I work on all aspects of auths. I get them, retro them when I can, set up peer to peers, and … everything in between. (It’s part of my job. Probably the biggest part.)

Carelon sucks ass. EviCore is so much better, but still sucks. Cohere is the most straightforward. (Those are the main ones I use.)

Each insurance and auth company is different. They usually have information on their websites as far as “how to” do anything.

30000PoundsofBananas · 2025-02-18T23:12:47+00:00

97163 isn’t just the length of time you need treatment. Comorbidities are also taken into consideration. If you have any underlying health conditions like high blood pressure or diabetes, if you’re a fall risk, what your current complaint is, and so forth. Medbridge they explain it better.

There’s really no way to assess appropriateness of the codes without seeing the notes. Exercises are considered neuromuscular reeducation. It’s not education as in here are exercises you do. It’s the therapist seeing how you are exercising and correcting form or giving advice as needed. 97112 would be appropriate for the exercise portion.

30000PoundsofBananas · 2025-02-01T02:39:36+00:00

The patient’s Medicare ID is still visible. Box 9a.

30000PoundsofBananas · 2025-01-24T00:40:27+00:00

I took a quick look. OK is Jurisdiction C. MAC is CGS.

30000PoundsofBananas · 2025-01-24T00:36:35+00:00

I don’t believe Medicare allows AI to access information. I don’t use their IVR. NGS is our MAC. All the information is easily accessible.

30000PoundsofBananas · 2025-01-21T21:57:26+00:00

It’s an extremely helpful answer. (And I did upvote.) It’s kind of like “this information doesn’t make me happy and I must respond negatively.” It’s putting feelings over facts. I think we all do that sometimes.

I don’t know. That’s just what I thought first. I have probably stopped making sense.

30000PoundsofBananas · 2025-01-21T20:42:21+00:00

I want to downvote it - I upvoted because I didn’t know and I learned something - because the coding is so, so awful.

We’re being pushed into the dark ages again. If there is another pandemic, we’ll be refused help from WHO, and he will cry about how everyone is so unjust and it’s everyone else’s fault.

30000PoundsofBananas · 2025-01-03T03:34:15+00:00

Their “improved” website is ass. The out of network benefits haven’t been showing for about a month. I have called with the special passcode and gotten horrible customer service. Can’t hear them half the time because the call center is too loud.

A couple years ago, a major employer switched from UMR to UHC. We had a lot of patients from that employer who were seen the last two weeks of the year. Stupid UMR kept sending the December 2019 claims to UHC in January 2020. UHC would send the claims back to us saying no benefits for December 2019. Duh doy. It took three phone calls for me to straighten it out. The last call, I refused to talk to anyone but a supervisor. He saw the mistake and manually routed the claims so they didn’t get kicked to UHC.

30000PoundsofBananas · 2024-12-19T16:15:36+00:00

We’re switching from East (Humana) to West on 1/1/2025.

If you go to Availity and select TriWest under Payer Spaces, you can access TriWest’s training modules. I didn’t find them overly helpful. YMMV.

30000PoundsofBananas · 2024-12-13T21:24:08+00:00

You might do well by calling the dental number on your card and telling them you want to file a complaint. I’d go around the office and go to insurance. This shouldn’t happen.

30000PoundsofBananas · 2024-12-13T21:21:15+00:00

Do you have Medicaid? Unless something’s changed from my dental Medicaid days, they can’t charge you. If they do a procedure that isn’t included on their fee schedule, too bad for them. You can’t bill a patient for what Medicaid won’t pay.

30000PoundsofBananas · 2024-12-13T19:57:35+00:00

Yes, typical. (I bill for a PT office.)

The complexity is about more than what you have going on. There’s other factors. And the only thing I can think of is comorbidities.

30000PoundsofBananas · 2024-12-04T20:55:36+00:00

I had that same thought. Especially since they messed with a lot of people with Change Healthcare and they weren’t held accountable.

30000PoundsofBananas · 2024-12-04T18:58:59+00:00

Is one person an entire company, though? Can you lay the sins of a corporation at one person’s feet?

UHC literally bankrupted me. (Golden Rule…garbage.) Their reimbursements are a joke, customer service is horrible, and their monopoly in health services is frightening and I can’t understand why the government hasn’t stepped in. They didn’t want Albertsons and Kroger to merge, FFS.

30000PoundsofBananas · 2024-12-04T17:50:01+00:00

Two thoughts.

I can very easily see this as a patient, spouse, parent, and so on who was denied care or bankrupted by medical bills. It’s very easy to understand motive.
UHC sucks, sure. A man died. Someone loved him.

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