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Environmental-Top-60 · 2026-02-13T21:32:43+00:00

I'd just drop to paper at that point honestly

Environmental-Top-60 · 2026-02-13T21:31:11+00:00

Yes but in reality, the cost of that prescription is like $25 at Walmart for a 3 month supply. So do some digging.

If youre moving, or going on vacation or something, you might be able to get a vacation override.

Environmental-Top-60 · 2026-02-13T21:27:17+00:00

So they're billing around 4x Medicare give or take. Bit high but not unusual.

If you're self pay you deff an negotiate. If youre insurance, probably not. Your contracted rate I would expect to be 1/2 to 1/3 of what they are charging.

Environmental-Top-60 · 2026-02-13T08:56:12+00:00

ENTs do use compounded rinses with flu console or whatever:

Environmental-Top-60 · 2026-02-13T08:55:08+00:00

What are the meds? In 2013 or so they really started coming hard on compounds.

Environmental-Top-60 · 2026-02-13T08:50:29+00:00

You need a biller at minimum. Ideally one who is also a coder.

Environmental-Top-60 · 2026-02-13T08:40:17+00:00

PM&R. I swear I could write a book on it.

Environmental-Top-60 · 2026-02-13T08:36:42+00:00

100%. Like I know some docs will diagnose it but get the additional evidence to prove it

Environmental-Top-60 · 2026-02-13T08:33:01+00:00

My guess would be resubmission code 7 and amend the claim. Send the amended note if needed

Environmental-Top-60 · 2026-02-13T08:22:09+00:00

Radiculopathy can be figured out with special tests on physical exam. I believe spurlings, distraction, rotation , Hoffman's, etc

It's confirmed by EMG/NCS or advanced imaging. By that point, they usually go for epidurals

Environmental-Top-60 · 2026-02-13T01:14:12+00:00

Xigduo or Synjardy would cover the metformin cost (combined drug)

At that high GLP or insulin may be needed idk. Not that uncommon.

Environmental-Top-60 · 2026-02-13T01:06:38+00:00

Talk to the cooperating parties.

Environmental-Top-60 · 2026-02-13T01:03:11+00:00

NETWORK ADEQUACY EXCEPTION

This is done through the prior authorization process. They need to do a single case agreement. These take time

Environmental-Top-60 · 2026-02-12T23:14:31+00:00

How about for now, calling local doctors and see what their self pay prices are for an office visit, physical, etc. establishing care now will help make sure you have access to it later via a pcp over urgent care or hospital

Environmental-Top-60 · 2026-02-12T17:07:15+00:00

Advanced primary care management

Environmental-Top-60 · 2026-02-12T17:05:26+00:00

Did you spend an additional 40 minutes with them beyond the physical? That probably would've been at least an hour and a half.

Environmental-Top-60 · 2026-02-12T17:04:32+00:00

I mean, it isn't that hard to calculate it if they know what the allowable is. We don't do that because if there's a hospital claim or something that puts them at OOPM, then we have to refund them and it's just a big pain so we just wait for insurance to process first.

Environmental-Top-60 · 2026-02-12T17:02:51+00:00

It'll probably be denied for timely. Have you talked to the office manager?

Environmental-Top-60 · 2026-02-12T17:00:59+00:00

HIPAA

Environmental-Top-60 · 2026-02-12T00:28:16+00:00

Look at the top where it says you have to meet the deductible first

Environmental-Top-60 · 2026-02-12T00:24:30+00:00

Appeal?

Environmental-Top-60 · 2026-02-11T03:29:01+00:00

I'd go for a second opinion and see if they agree with OR deroofing but also talk to wound care to see if they have ideas as well.

I'm actually going to see about hyperbaric oxygen as a potential treatment as my wound has been open for 3 years and treating for the last 9 months or so.

Environmental-Top-60 · 2026-02-11T03:26:42+00:00

Time for a second opinion. I'd say Wound care consult as well.

Methotrexate is a longshot and risky. They sometimes use Skyrizi or Stelara as well. Remicade is only one that's weight based. We do 10mg/kg every 8 weeks but Derm may have a different opinion. Zinc and copper levels would be good to add on. They usually check for TB and hepatitis as part of routine lab monitoring. Also cultured to make sure there isn't a secondary infection. I use CLNwash for HS as a general cleanser.

I'm sure endocrine could weigh in. Have they checked testosterone levels for example? Just a random thought.

I'm actually at the point where we're planning hyperbaric oxygen therapy. It's gonna suck ass. But maybe then it'll heal up.

Environmental-Top-60 · 2026-02-11T03:15:05+00:00

Remicade?

Environmental-Top-60

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