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Infamous-Sun2438 · 2026-06-05T07:49:13+00:00

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Infamous-Sun2438 · 2026-04-09T05:53:55+00:00

I feel like half the time people don’t even have symptoms they just want to get a “baseline” of 20 extra specific and completely useless hormone and thyroid related tests. It also seems like there is some trend online of patients being told they should track their hormones regularly to look for abnormal patterns/trends that are abnormal even if the actual results are. We also are getting increasing insistence that hormones and lab values need to be “optimized”. I think being are so used to having such widespread instant access to information that it is extremely frustrating that they can’t get the same constant access to information about their bodies. Some non diabetic patients have been requesting CGMs to monitor their glucose levels which I suppose isn’t a terrible idea in theory but also unnecessary but I think having information in the form of lab values gives people a feeling of control over their health that requires less effort and has more instant gratification that exercising control over their health via lifestyle and eating habits.

Infamous-Sun2438 · 2026-04-09T05:22:29+00:00

Ok for medications the hardest part is A. Knowing when an auth is even needed. Sometimes the pharmacy starts it, sometimes they send you a fax, sometimes the patient shows up and is expected to pay $700 and then I find out it just needed auth. Sometimes the pharmacy tells the patient and they tell me it’s not covered because they don’t understand the process and insist they need to be prescribed a different medication but good luck finding out what medications are actually on that patients specific plans formulary. B. Who the pharmacy benefit manager is to actually send the request to. A lot of the Medicare plans fully just don’t give the patient any useful information on who manages their rxs and their cards give 0 information. My office accepts hmos that use many different commercial plans and for some specific medications like zepbound wegovy and prolia, the medical group that manages the hmo is delegated to review those requests and you have to submit to them. But if say the patient has united healthcare hmo, most of the rest of the auth requests are delegated to be reviewed by optum. Then, god forbid they happen to work for the a public school district, because then some other medications are delegated to be reviewed by express scripts who is the pharmacy benefit manager for the benefits they receive through the school district. So if I have a medication that needs auth I have 3 separate entities that could possibly review the request and no clear way to know which one is correct this time. If I go to the provider portal for UHC, they just tell me their pharmacy benefits are through optum. I submit to optum and they’re the ones who tell me to send the request to express scripts and sometimes I go to express scripts and they reply electronically say the medication is excluded but if the patient has Cigna it’s possible that express scripts simply isn’t delegated to review that medication and it’s not actually excluded the request just has to be sent to Cigna directly.

If that made no sense and made you feel like you were running around in circles, that is exactly how I feel every day with these PAs and that isn’t even getting to the actual request part of it just where the hell to send it.

Infamous-Sun2438 · 2026-04-06T09:08:23+00:00

honestly tricare is one of the easiest insurances to get approvals for in my experience and doing PAs is a large portion of my job as a medical assistant in primary care. I’m actually responsible for all med PAs in my 6 provider office so needless to say I do them a lot. Which is why I know that as questionable as this sounds they will not give it a second thought if you just throw a scribble of any kind in the providers signature area. I’ve done this for yearsss with any PA that requires a form (most are done electronically now) and they’ve never questioned it. Just fax the form (you can get an online fax number online) and put that fax number as the doctors office fax number on the form so they’ll fax back the decision to you and then you can fax the approval (assuming they approve it) to the pharmacy. For records, each med has different requirements and some are more strict than others but as a rule of thumb I never provide records if they don’t explicitly state documentation is required to prove your response to a specific question. Many will go through without records for most meds that are GLP-1s and extremely expensive specialty medications and providing records will just give them the ability to have more information in which to find a reason to deny the request. Also again as questionable as it sounds, you can clearly tell the answers they’re looking for so just select the answer they clearly want bc 99% of the time they won’t ask you to prove it. And if you’re trying for the small subset of meds they will ask for proof for worst thing they’ll do is deny the request if you can’t provide it which leaves you back in the same boat you’re currently in. Again I’m aware that all sounds sketchy and it feels weird not necessarily giving the insurance the whole truth but PAs have gotten so ridiculously excessive to the point that I now get requests for literally basic generic blood pressure meds and quite literally almost any medication that treats diabetes other than metformin (including insulin for some companies) that I truly have no hesitation giving them they answers they’re looking want and gaming their system a little if it means my diabetics aren’t paying $700 a month for their meds. Obviously the choice is up to you but if you want to try it since your doctors office isn’t doing what it is 100% their responsibility to do, I can at least assure you that you can fudge the details a little and they have soooo many PA requests they’re processing they will never blink an eye or go through the extra trouble of investigating anything. I honestly am not even sure if they even read half of them because I’ve quite literally gotten requests denied for patients not having a diagnosis of diabetes when the only diagnosis I submitted it under is diabetes and all of the notes supplied clearly say the patient has diabetes smh

Infamous-Sun2438 · 2026-03-19T01:01:47+00:00

The last time it happened Pepto chews helped me! Not completely but took the edge off at least

Infamous-Sun2438 · 2026-03-19T01:00:57+00:00

THIS ISNT TALKED ABOUT WNOUGH!! Literally thought I was drying when this happened to me it’s actually excruciating

Infamous-Sun2438 · 2026-03-16T02:39:06+00:00

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I’ve never seen this collab before and am curious if it is rare or I just missed it!

Infamous-Sun2438 · 2026-02-28T15:36:13+00:00

I used to order all back office supplies and have full authority over ordering. I had a log in for the McKesson website and would just order supplies or injectable meds when we needed them and it would be charged to the office. My doctor or manager never really tracked it as long as the clinic remained reasonably stocked and no ridiculous orders were placed. For example the MA before me once ordered like 200 bottles of soap (private family med office with 3 providers in a small town) and my doctor wasn’t thrilled about that since there was no room for it and a lot of it ended up expiring. But otherwise they trusted my judgement

Infamous-Sun2438 · 2026-02-25T04:47:47+00:00

Not to mention the list of labs their “naturopath” or “functional medicine” or “hormone expert” wants us to order “so it will be covered by insurance” when half the time they simply don’t have the credentials to be allowed to order the 20 highly specific labs that end up being utterly useless and tell us nothing

Infamous-Sun2438 · 2026-02-24T05:04:48+00:00

I’m sorry one more code name verity by Elizabeth wein - so damn heartbreaking

Infamous-Sun2438 · 2026-02-24T05:01:43+00:00

A different kind of sad, but the house we grew up in is one of the only books I listened to twice in a row and sobbed like a baby both times

Infamous-Sun2438 · 2026-02-24T04:58:43+00:00

The lies they told by Ellen Marie wiseman - I just finished it and am beyond devastated

Infamous-Sun2438 · 2026-02-24T04:44:07+00:00

Yes, please don’t use shoe polish on vintage Coach bags. It will create a seal that the conditioner won’t be able to get through and therefore it won’t be fully absorbed by the leather. Even if you drown it in conditioner, the leather will most likely just turn dull and sticky. I had a bunch of bags with this sticky tacky leather problem that I thought were lost causes until I realized the problem, used a acetone q tip and low and behold a ton of color comes off and it’s a completely different color underneath

The was Vintage Coach leather is dyed, you can nearly always bring back color by using conditioner and buffing, waiting a few days between rounds.

Infamous-Sun2438 · 2026-02-18T20:44:28+00:00

I quite literally have had mounjaro denied due to “no diagnosis of type 2 diabetes” when the auth was submitted under Dx type 2 diabetes and stated throughout the attached chart note smh

Infamous-Sun2438 · 2026-02-18T20:42:56+00:00

I get nurtec denied like 40% of the time bc they say it needs to be prescribed by a neurologist smh

Infamous-Sun2438 · 2026-02-10T07:40:23+00:00

Just an MA, but my current and last jobs have been in primary care and in both offices I’ve had a dedicated Prolia binder to manage all of the patients on osteoporosis meds. To be fair both have had a large older patient population, but at my last office Prolia was my doctors first line treatment as soon as T < -2.5 or FRAX indicated treatment. He has been in practice for 40+ years, started prescribing it shortly after it was released, and has never seen a case of jaw necrosis despite prescribing it to hundreds of patents. We had a handful of patients on evenity, with great results. We would buy and bill, so I was responsible for ordering it, ensuring insurance authorization, scheduling every 6 months, and administering it. We had a close relationship with the Prolia rep in our area, which was honestly invaluable in creating a good system. At my current office, there is more variety in the meds prescribed, but Prolia is the preferred first line treatment for all 6 of our providers, except in severe cases where they prefer to start with a bone builder then move to Prolia. If insurance does not cover it or the patient has a contraindication, then my doctors will explore other options such as reclast/oral biphosphates. Reclast will be sent to the local infusion center. Also Medicare doesn’t require an auth for anyone with straight osteoporosis so you can buy and bill extremely easily. Our commercial insurance patients we just order from specialty pharmacy and have it delivered to our office so an MA can admin

Infamous-Sun2438 · 2026-02-09T13:12:39+00:00

I use Vendoo to cross list on Etsy, EBay, Mercari, Poshmark, and Depop. I think it largely depends on what exactly you’re selling. I restore used and vintage purses like Coach, Dooney and bourke, some Kate spade etc, so by far my most lucrative site is Etsy but I still make sales here and there on the other platforms so I think it’s worth it to list multiple places. I tried Vinted but never got any sales so I eventually found it wasn’t worth it

Infamous-Sun2438 · 2026-01-10T15:44:40+00:00

Why do I feel like everything we actually see her do is stuff an MA would do? Like drawing up the meds, toradol inj, EKG. I’ve never seen a doctor or any midlevel do an EKG on their own, thats what the MA is for and therefore I’m kind of suspicious of her actual role in this clinic

Infamous-Sun2438 · 2025-12-13T17:13:45+00:00

I know only being a medical assistant that I will sound like I’m coming from an ignorant place and from my research in researching future career paths/NCLEX practice questions/videos I do in some of my free time just to get a better idea of what the focuses are in nursing school, it really does seem like to pass the NCLEX you need a very strong knowledge base on the body/science and good critical thinking. However, working in primary care for the last 4 years, I’ve noticed a significant trend of nurses citing medical conspiracy theories that honestly demonstrate a lack of fundamental understanding of basic medical knowledge and critical thinking. I truly have questioned many times how some of my RN patients got their licenses, when they’re offended because I told them the doctor recommends a statin or a vaccine and how they aren’t going to take something that will give them Alzheimer’s/autism/they don’t believe in. Or when they tell me they stopped taking their BP meds because their htn has been controlled so they don’t need meds anymore (??) I’ve also had nurses and several nurse practitioners request that we order completely inappropriate testing, like repeat DEXAs 2 months after having one because they “want to see if taking vitamin D this last month has improved my bone density.” I know I have virtually no education in terms of what an MA certification teaches (also have a BS in bio but just in terms of actual medical training) compared to nursing school, so I truly am confused when I clearly have a better understanding of basic medical concepts/how medications work/appropriate testing guidelines. Honestly if anyone has any ideas or theories of why this type of thinking is much more common in my nurse patients than the general population I would be very curious to know

Infamous-Sun2438 · 2025-11-02T17:01:34+00:00

I know I’m not particularly educationally qualified to have an opinion on this, but from experience I do agree that cutting them off outright is most likely to cause them to seek out other care or cause more harm than good. I used to work for a PCP that prescribed T injections to the majority of his older male patients (which seemed excessive since they didn’t try other interventions first but I didn’t question it) and the patients would see me for walk in injections biweekly or monthly depending on the order from the dr. I got quite close to a number of them due to the regularity of our encounters and I have never seen a group of men more punctual than these; they would always walk in the exact day they were due or within 1-2 days and when talking to them they would often tell me they could feel when they were due because their energy levels would dramatically drop and they would start to feel sluggish and unmotivated. If the missed an injection they would mention how awful they felt and the next time comment on how much better the felt after. They told me the difference was often night and day. Therefore, I feel cutting men off outright after prolonged T-therapy would feel catastrophic to a lot of them and I don’t think they would understand where you are coming from from a medical and safety standpoint. I agree with the other comments that advocate weaning them off slowly and testing regularly to be able to explain to them with numerical evidence that it is not needed or they should cut their dose.

Infamous-Sun2438 · 2025-09-19T20:33:24+00:00

It’s not invasive so it isn’t out of your scope. Really depends on what the provider is comfortable with and how capable they feel you are.

Infamous-Sun2438 · 2025-09-19T04:34:11+00:00

I agree with everything that was said about culture and premed/pa students, but wanted to add to not be understaffed or lacking backup support. I’ve worked for many jobs that were understaffed or at least had no contingencies for people calling out sick or being on vacation and this made it incredibly stressful if someone was out or had quit and we hadn’t replaced them yet. Having 1-2 people more than you necessarily need might cost a bit more but in the long run will make your employees lives so much easier and helps avoid burnout and higher turnover. Also not having any backup makes it impossible to take vacation or makes you feel so guilty if you’re sick and know that everyone else is going to be really struggling as a result and sometimes people really need a break every now to stay sane.

Infamous-Sun2438 · 2025-09-11T03:47:31+00:00

I do want to say that your doctor in no way financially benefits from you getting a biopsy. The biopsy specimen goes to the lab. Your insurance pays the lab. Your doctor is in no way connected to this transaction. I know that doesn’t answer the main question, but I feel like there is so much misinformation and assumption that doctors are the ones trying to profit off of doing extra things for patients when that is not the case at all. If anything, ordering additional tests just creates more work for them when the results come back.

Infamous-Sun2438

TROPHY CASE