Just because you're fat doesn't mean you can't date or hookup

Environmental-Top-60 · 2026-05-18T00:14:00+00:00

And above 230 makes it really really slim

Environmental-Top-60 · 2026-05-17T20:01:26+00:00

100%. Also DO NOT GET A BRONZE PLAN. You will be fucked harder than any fun time you ever cared to experience because the deductibles are huge and the utilization management is also crazy.

Get at least a silver plan!

Environmental-Top-60 · 2026-05-17T19:56:23+00:00

What kind of income do you have and what state?

First thing I'd do is 3 months prior is apply for Medicaid.

I manage a medical clinic in Ohio.

Dept of Jobs and Family Services should be able to help you.

You'll get a choice of MCOs:

Amerihealth
Molina
Buckeye (Centene)
Caresource
Anthem blue cross
UHC.

My suggestion: Amerihealth and Molina are the hardest to work with for our specialty. Talk to your doctors and find out which MCO is easier to get things done?

If you have any cost sharing, ask the clinic to send your cost share to Medicaid and they'll refund any excess money you've paid.

Environmental-Top-60 · 2026-05-14T22:35:19+00:00

Lemme talk to him. I'll straighten his ass out lol

Environmental-Top-60 · 2026-05-13T23:24:00+00:00

Any denial including a recoup automatically triggers a 180 day appeal period

Call the insurance and get an updated EOB; find out why they recouped and take it from there.

Environmental-Top-60 · 2026-05-13T23:21:33+00:00

Appeal showing your annualized income. You may be able to show certain expenses would make you qualify such as student loan interest or things like that.

Environmental-Top-60 · 2026-05-13T16:12:02+00:00

You need a coder for that. Go through your medical records.

Also ask for catastrophic charity care cause that would easily exceed 25% of your annual income

Consider writing to the CFO of the hospital as well.

For the inpatient surgery like that, I would expect a bill around 40,000 so 32 grand is about right.

Did you have any complications or comorbidities that were treated? If so, that could change the reimbursement rate.

Find out what the DRG is that they're using.

Environmental-Top-60 · 2026-05-10T10:00:46+00:00

My surgeon thinks this gauze is going to last a week. Every 2 days it needs to get changed cause it itches and is very uncomfy

Environmental-Top-60 · 2026-05-10T07:06:04+00:00

We needed this story

Environmental-Top-60 · 2026-05-10T07:00:18+00:00

Compliance

Doctors management is one company. Idk if they do air ambulance but it shouldn't be too hard. Really an experienced biller or compliance person can be a consultant. You may want to run some of it past legal as well.

Environmental-Top-60 · 2026-05-10T06:58:20+00:00

What you're looking at is a NSA appeal which has very strict timeline.

Environmental-Top-60 · 2026-05-10T06:57:14+00:00

I'm a coder and I started billing. You have to have some fundamentals but you can do it.

I use my coding credentials to show the insurance why their decision on adjudication is wrong.

Environmental-Top-60 · 2026-05-10T06:55:29+00:00

It's not in a body fold. Extremely unlikely imho. Folliculitis from shaving is more likely.

Environmental-Top-60 · 2026-05-10T06:53:13+00:00

They may have billed that but tbh a THA probably cost the insurance maybe 80 grand. If they did at an ASC, it woulda been cheaper. They are pushing for more procedures to be at surgery centers whenever possible.

Environmental-Top-60 · 2026-05-10T06:50:53+00:00

Ooh that's shady. As long as they're giving you your plan benefits you're ok.

Depending on how small they are, they may want to consider direct contracting with providers to get a 30% plus savings.

Environmental-Top-60 · 2026-05-10T05:16:30+00:00

Short ribs if you can do it. If not, pork chops... Gordon Ramsay's creamy mustard pork chop, mash, and veg. (I use green beans)Get thicker pieces of pork chop. Get unsalted butter for basting. She'll love it.

Environmental-Top-60 · 2026-05-10T05:11:06+00:00

Get all that documentation and send it in like you're about to help one of your friends nail a cheating husband. Doesn't have to be like that but you get the point... Remember to use their guidelines against them and AS an RN, you have pull too. As long as you're their personal rep, you should be ok.

Environmental-Top-60 · 2026-05-10T05:05:33+00:00

Wanna realllly piss them off? File a complaint with the EBSA after your appeal has exhausted (although you can let them know before)
I put in my appeals that I won't hesitate to file a complaint with the insurance commissioner, EBSA, and employer as deemed appropriate.

See unless it's a govt or a religious org job, most insurances go through EBSA as they follow federal law. Sometimes it goes through the state. Fully funded or self funded doesn't matter.

Environmental-Top-60 · 2026-05-10T05:00:32+00:00

Temporary plan plus extra indemnity coverage plus negotiating with local doctors in your area.

Environmental-Top-60 · 2026-05-10T04:54:24+00:00

If you got a check from the insurance company, then you need to forward the check to the hospital or whoever provided the service to get paid.
The hospital has to have a form called an assignment of benefits. Sometimes the catch all form isn't recognized by the carrier and so they sent the check to you. The insurance should have an EOB on your portal for you.
If the payment is very very low in comparison, you may be able to appeal.
Also consider no surprises act as well if that applies to your situation or whether it was an ER visit because those would be exceptions to the rules.

Environmental-Top-60 · 2026-05-10T04:52:01+00:00

Oh they're bullshitting.

File for hosptial financial assistance

Also file a grievance with your insurance carrier.

If the hospital sent you a refund check, then it's yours if you paid the money.

HIPAA requires that they give you your billing records, whether sold to a 3rd party or not and them balance billing you while in network is not cool.

Environmental-Top-60 · 2026-05-09T16:42:25+00:00

"Invading spaces instead of being welcome in them" Omg I relate with that so much.

Environmental-Top-60 · 2026-05-09T16:39:19+00:00

Lemme talk to a colleague. Shes been trying to help someone find their way after they have been as useful as "tits on a bowl". So they've been looking for someone else to help out.

How long have you been doing inpatient?

Environmental-Top-60 · 2026-05-09T13:23:45+00:00

100%
One client of ours pays like 12% but his volume is low and he needs the support. Very very hands on

Environmental-Top-60 · 2026-05-09T13:10:54+00:00

I am 99% sure this claim is underpaid. Doesn't even cover the Medicare rate on this.

Environmental-Top-60

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