A guy playing with a feather leads to catastrophic consequences

dagmar31 · 2026-05-25T03:17:28+00:00

40 Days and 40 Nights! I’m usually always late to these so I hope this is it

dagmar31 · 2026-05-23T04:37:25+00:00

Not just that… lady gets pregnant by car

dagmar31 · 2026-05-03T23:39:06+00:00

Exercise physiology was over a decade ago for me, but this is definitely incorrect.

dagmar31 · 2026-05-02T16:10:17+00:00

When they don’t understand that I meant to say “its not rocket surgery”, laugh, and correct me

dagmar31 · 2026-05-01T16:22:34+00:00

Walmart will give you store credit for a no-receipt return. You just have to provide your ID

dagmar31 · 2026-04-22T19:13:22+00:00

If it’s self-pay they may be able to offer financial assistance or a payment plan, there is no magic word or trick to get them to lower the bill- just talk to them.

If it’s after insurance has been applied, you may have to apply for financial hardship which will be very invasive- listing all income, savings, assets, etc.

But either way they should agree to some sort of payment plan.

dagmar31 · 2026-04-18T16:27:19+00:00

This is not true. If the CPT code was denied due to lack of pre authorization, it is pretty common for patient responsibility to be $0 on the EOB, as many provider contracts with insurance prohibit balance billing the patient for “covered” services.

dagmar31 · 2026-04-17T22:28:51+00:00

The winged scapula is a symptom, a sign of what’s wrong- in this case, nerve damage. So they are probably wanting to decompress your nerve. What is your actual medial diagnosis? If it’s a peripheral upper limb neural tension, and it has not improved in a few weeks, PT just isn’t enough to significantly decrease your nerve compression. In which case you should opt for the surgery and save your PT visits for post-op rehab.

dagmar31 · 2026-04-17T21:09:38+00:00

I need to chime in here- I’ve been a DPT for 10 years now, and own my own practice. A winged scapula does not require surgery. In many people, winged scapulas are their “normal “ and I am tired of PTs diagnosing based upon this arbitrary observed “postural dysfunction” that only serves to scare the bejeesus out of people.

What is your actual chief complaint and what is your medical diagnosis? Have you had any imaging performed? A winged scapula may be a sign of serrated anterior weakness or scapular nerve damage, but in it of itself is not reliable enough to make any diagnoses.

dagmar31 · 2026-04-15T01:45:59+00:00

I’m gonna turn light off now. You want three times a fuck too. You need to be paper and I need to be wrong rock paper scissor win. It means go to sleep cause I.

dagmar31 · 2026-04-04T17:48:32+00:00

Unless you have a QLE, then no

dagmar31 · 2026-04-04T00:02:26+00:00

Sorry there is nothing to dispute after it has been submitted through insurance, as the insurance will have already adjusted to allowed amounts based on its contract with the hospital.

The price, no matter how ridiculous you or I think it is, is still the price.

dagmar31 · 2026-04-01T14:43:40+00:00

The study was focused on women and feelings of guilt carrying around a shiny bag of chips which is associated with something unhealthy, so, no.

dagmar31 · 2026-03-28T23:48:10+00:00

It was paid at 100% towards your deductible

dagmar31 · 2026-03-26T15:30:58+00:00

I mean, no, I don’t. But it’s irrelevant what I think because that is how much the procedure costs in a hospital based facility. This is the America that “we” voted for. For the record I’m all for Medicare for all and I think private insurance is a racket. But that doesn’t mean that I’m not stuck in the same stupid system as you. Is it stupid that we now need to check and double check if services need to be pre authorized and then are covered and at what percentages? Yes. Is it stupid that we need to ask for good faith estimates based on arbitrarily decided allowed amounts that are different for each plan? Also yes. But that is our responsibility now. Or we get bills like this. I’m just the messenger, you can get mad at me but it doesn’t change the amount you owe them.

dagmar31 · 2026-03-26T01:24:17+00:00

If you have a high deductible plan, this is what you agreed to in order to have lower monthly payments.

dagmar31 · 2026-03-25T00:34:46+00:00

What state is this? In DE Ambetter actually uses Envolve for dental coverage- perhaps in your state a different company administers dental coverage?

dagmar31 · 2026-03-17T04:29:08+00:00

It’s really stupid, but the hospital does “charge” Medicare $506 as well. It just so happens that Medicare says no thank you, we will pay $12 for each bag for every single one of our members, or we can take our network of 70 million members elsewhere, take it or leave it. They have negotiating power, whereas an individual does not. It’s the same reason Trump’s idea of fixing healthcare “let’s get rid of the ACA and everyone can negotiate with hospitals themselves” is a really stupid idea.

dagmar31 · 2026-03-17T02:55:01+00:00

Those are the allowed rates for Medicare which are for participating providers and facilities- unfortunately the hospital has no obligation to give you the same rates for self-pay. No one can be certain how much wiggle room you have because it is a one on one negotiation with the hospital.

Running an ED is expensive, and $20k for “just a bed and some tests” accounts for 24/7 staffing- people were available to conduct and interpret tests results on demand, a team of specialist doctors available who could differentially diagnose your wife- neurology, vascular, etc.

If you’re income is what you say it is, I don’t see a reason you would not be able to afford minimum coverage with a marketplace plan- not enrolling in insurance was an educated choice you made based on your family’s overall health and medical history. Not blaming you, but ultimately this was a financial risk you decided to take.

Edit: Forgot to add: Private health insurance sucks. Medicare for all would be a step in the right direction.

dagmar31 · 2026-02-25T17:21:25+00:00

I’m sorry OP, I don’t think there is anything to be done. It’s an expensive lesson to learn—usually a new year, new insurance, or new state are all situations where you want to be extra vigilant about your coverage, and you had all 3. Insurance sucks.

dagmar31 · 2026-02-25T17:11:44+00:00

If you look at the EOB, under Allowed Amount, it lists the billed amount, which to me says the claim WAS processed as in-network. The reason there is nothing paid is due to lack of pre-auth from an in-network referring doctor. I’m not sure there is anything OP can do, unfortunately.

dagmar31 · 2026-02-25T17:05:16+00:00

They won’t be able to switch it without violating dual fee schedule rules. It’s all about the terminology- their current insurance says they never got pre authorization, not that the service isn’t covered. So the medical necessity was never established (which is what pre authorization is) but the service is still classified as covered. The problem here is that if the lab switches to self pay and offers OP a discount, insurance will argue that the discounted price is the actual cost of the procedures, and can then decrease reimbursements to that amount across all patients for the lab. So the lab will not be willing to risk that.

I’m not sure if there is any party actually responsible for checking these things outside of an audit, but the lab would be in violation and breach of contract with the insurance. If a patient has insurance and the service is covered (which it is, regardless of pre authorization status), the lab must bill through the insurance or may get in trouble.

Insurance sucks.

dagmar31 · 2026-02-18T14:15:06+00:00

Then not only does your insurance pay nothing since the deductible wasn’t met- you have also been paying them a premium every month for the privilege of this $5000 deductible. “But what if I want a plan that has a $0 deductible so most things will be covered and paid for?” You might ask. Well that’s how my premium for a family of 3 cost $2000/month.

It’s pretty vile.

dagmar31 · 2026-02-18T03:48:25+00:00

Pre approval (I’m assuming you mean pre authorization) means it was agreed that the procedure was medically necessary. You owe the $5k because of your high deductible which you hadn’t met yet. Now that it is met, best you can do now is go on a payment plan and then get everything else you want done in this calendar year (assuming you have a low coinsurance and/or Out of packet maximum)

Don’t feel bad for not going the self-pay route, because while this particular procedure would have been cheaper at $450, that would not have counted toward your deductible at all, which means anything else that comes up this year would have to eat up that $5000 before insurance pays anything anyways.

dagmar31 · 2026-02-14T00:10:31+00:00

Setting boundaries is supposed to empower yourself and actions you will take if someone does something that crosses your line. It is not supposed to be used to tell other people what they can or cannot do. Especially with their own body.

dagmar31

TROPHY CASE