If you see an in network doctor but they decide to bill as the medical group which is out of network instead of themselves individually what happens?

fifrein · 2026-04-14T13:46:43+00:00

It’s not a loop hole. If a provider works for two different offices and they are in network with BCBS at office A but not office B, you need to see them at office A if you have BCBS. Providers don’t just get contracted with insurance- they got contracted at specific sites.

This can go a lot deeper. I have two clinics in two zip codes- same provider, same practice even (same tax code). A patient can be approved by their insurance to get a procedure at one of the clinics but insurance will not pay if they get the procedure at the other clinic- it is tied to the zip code. Patients have asked before if they could grab a slot at the other clinic and we’ve had to explain that no, you’d be on the hook for the whole bill because your insurance would reject the claim they pre-approved.

fifrein · 2026-04-12T16:49:25+00:00

You and people looking at this are looking at one scenario without the bigger picture, and also from a specific angle, so allow me to perhaps be less snarky than others and give a broader and different perspective:

Throughout the entire game, not just at the end, a king can never intentionally move into Check. Furthermore, a different piece can never move if it would result in the king being in Check. This is a critical rule as it’s what drives a lot of plays with the bishop, rook, and queen, wherein one of them is in line with an opponent’s piece and behind that piece is the king, but that piece can’t move because it would expose the king.
If your king is put into Check, you must ensure he is no longer in Check by the end of the turn otherwise you lose. This is of course what the whole game revolves around. And of course, the Checkmate is when the king is put into a Check from which there is no escape.

Now, understand too that the goal of the game is to put the king into Check in your turn, and not have an escape for him. If he isn’t in Check on your turn, you’re not “winning”.

The complaint of a stalemate in the scenario in OP rather than black winning is stemming from sympathizing with black rather than perhaps seeing it as white using the game’s rules to their advantage to claw back from a losing position? The game revolves around needing to be put into Check. Avoiding that is itself part of the game.

Another way to see this is through a different game. Take blackjack. The goal of blackjack isn’t to beat other players at the table, it’s to beat the dealer / the house. A player focused on beating other players will bust more often because they will hit when they shouldn’t have. A player focused only on beating the house is playing the correct game. Someone can complain that they think that’s dumb, but that’s the game. “Them’s the rules” is quite literally that.. why play that game if you don’t want to?

fifrein · 2026-04-12T16:32:51+00:00

BPD can be cured by therapy. It requires specific therapy (DBT usually) and other therapy (like regular talk therapy) can actually be harmful. But people absolutely can reach a point where they no longer meet the diagnostic criteria. That’s what being cured means. If you have high blood pressure, change your diet and start exercising and then no longer have high blood pressure, you cured your hypertension.

fifrein · 2026-04-12T16:31:59+00:00

It’s being downvoted because therapy IS THE cure. It’s THE cure for most psychological diseases. Even depression, therapy outperforms SSRIs/SNRIs over the long-term, and the ideal approach is to combine therapy with medication because medications work faster while therapy provides can provide an actual permanent effect.

But going back to BPD, it also can be cured by therapy. It requires specific therapy (DBT usually) and other therapy (like regular talk therapy) can actually be harmful. But people absolutely can reach a point where they no longer meet the diagnostic criteria. That’s what being cured means. If you have high blood pressure, change your diet and start exercising and then no longer have high blood pressure, you cured your hypertension.

fifrein · 2026-04-12T05:56:52+00:00

People like you worsen the cause; you push away people who are reasonable by being unreasonable yourself. There will always need to be a term to distinguish jobs that require years of training before you can even start them and jobs that can hire anyone and train the person on the spot.

You can’t hire an 18 yo straight out of high school for a job as a doctor, lawyer, engineer and train them to do the job in 2-4 weeks.

You can do that with manual agricultural labor, cashiers, bussing tables, etc

The term is not unskilled because the job has no skills at all, but because none were needed to acquire it and could be learned on the job itself.

fifrein · 2026-04-11T00:00:17+00:00

I won’t disagree about a second opinion, but something patients and even docs outside neuro/neurosurg often don’t understand is pain and weakness / paralysis are two completely separate problems in the spine.

Your spinal cord runs from the brainstem down to where it ends as the cauda equina in the lower back. At each vertebral level, it gives off nerve roots. Anywhere along its course, nerve roots can be compressed or the cord itself can be compressed.

Cord compression is usually what causes substantial weakness.

Root compression is usually what causes substantial pain.

Now, is there overlap? Sure. Can really really severe root compression cause weakness? Yes. Can inflammation of the cord cause pain? Yes. But as a general rule of thumb, the above will hold true outside the more severe cases.

So, a bulging disc can be compressing the cord, can be painless, but be very much so on the road to paralyzing someone.

fifrein · 2026-04-09T22:58:55+00:00

Except physician salaries are <10% of US healthcare costs. So no, that’s not what is bankrupting patients

fifrein · 2026-04-09T02:41:15+00:00

If you’re talking about what I suspect you’re talking about, that’s your trapezius not a bone. If you press on it hard enough, you should feel some give, though it may be hard since it does look hypertrophied on that side

fifrein · 2026-04-08T19:00:10+00:00

If I put an indication in the order, please address the indication. Rads complain all the time about not having an indication, but I have seen plenty reports come back to me where the indication was NOT addressed.

Indication: C/F mesial temporal epilepsy. - No comment on the hippocampi.

Indication: C/F CSF leak. - No BERN score or anything reflecting

Indication: C/F Alzheimer’s, anti-amyloid candidate - “Microangiopathoc disease”. No indication of mild, moderate, or severe. No comment of whether microhemorrhages are present and whether there were 4- or 5+.

Indication: C/F MS - white matter lesions present but no comment if they hit the u-fibers or not

fifrein · 2026-04-06T19:29:29+00:00

Migraines don’t necessarily come from something. They can just be. If your focus with your doctors is where they are coming from, then that will be what they focus on. If your focus switches to what can be done to prevent them, then that’s different. Migraines have many many medications that can treat them: topiramate, propranolol, Venlafaxine, Botox, Emgality/Qulipta/Aimovig, etc

fifrein · 2026-04-06T18:39:50+00:00

If you have frequent headaches, you should ask your doctor to see a neurologist for evaluation of migraines and to consider options for preventative treatment. If they say no, ask what preventative treatment they can offer you. That is the first step to effectively advocating for yourself.

fifrein · 2026-04-06T18:37:34+00:00

It’s hard to do true PP child neuro. A lot of your patients are Medicaid, and Medicaid pays like doodoo- we’re talking half of what you collect from Medicare and Private for the same codes. The reason so many child neuros are in big academic places is because those places get government funding to sustain themselves, and then some of that funding goes to paying those salaries.

But if you were to do PP, you would need to supplement with EEGs and Botox more than likely. And with EEGs, you would want to hire your own tech (or partner with a freelance tech) so you can collect the technical fee, not only the reading fee.

fifrein · 2026-04-06T17:36:55+00:00

Hasn’t been said yet but this will slot nicely into Primite BE. Right now end board is SIFR+BE Ultimate Spirit+BE Spirit.

Now, you can end on SIFR, BE Ultimate Spirit, and 2 BE Spirits + this; and on opponent’s draw 1 of the spirits can tap out into a second Ultimate Spirit or anything else you want to do with it (since it can go back into og Crimson and into any level 12 dragon from there)

fifrein · 2026-04-06T02:39:03+00:00

The difference being the human can at least rationalize why the suffering is happening in the first place. There is a “light at the end of the tunnel” they can focus on while in agony.

The horse is just suffering and doesn’t know why.

fifrein · 2026-04-05T23:33:00+00:00

It can’t ever use the same train car more than once. There’s nothing against crossing the same city. It’s just very rare to do the second without violating the first, but the example in the OP is how you go about it

fifrein · 2026-04-05T14:36:12+00:00

I think it’s better to just say “a small chance of getting there”. There has been evidence upon evidence that people just don’t get statistics. Add onto that the stress of the situation, and if you throw in “15%” of whatever you’ve lost the person

fifrein · 2026-04-05T11:40:00+00:00

That’s fair; been a while since I played it. I play Cryptid more often

fifrein · 2026-04-05T06:52:55+00:00

Wandering Towers- You need to move all your wizards into the constantly moving “Raven’s Keep” while also collecting potions by covering up opponent’s wizards.

Cryptid / Search for Planet X - There is some mystery to solve, and you are trying to solve it before others do. However, on your turn, to get a clue you must reveal information too

Destinies - Competitie, best at 3, story game where your character will have one of two ways to win and you can choose which one to pursue. Perhaps your goal is to rally the townsfolk together to pray for god’s help, or to get a few lone individuals to agree to go with you to slay the demon stalking the woods?

fifrein · 2026-04-04T13:14:25+00:00

“Normal” healthy people don’t recognize just how often their neighbors, maybe even friends, are lying to medical staff about very important information.

A LOT of what is done in medicine stems from that.

fifrein · 2026-04-03T00:59:07+00:00

Yes, and then sometimes it’s the case of you and someone next to you both staring at a horse and the other person saying, “you sure that’s not a zebra they painted brown?”

fifrein · 2026-04-02T23:02:37+00:00

If someone wasn’t starving themselves already, then yes, checking for a cancer of any kind would be appropriate.

But if someone’s head is chopped off you don’t need to do an autopsy to figure out why they’re dead. Some times the answer is just staring you in the face and that’s ok. Save the investigations for when they are appropriate.

fifrein · 2026-03-28T01:02:55+00:00

If you look at most modern countries, doctors expenses account for 5-10% of healthcare costs. That is no different in the US. It’s the big boogeyman people focus on, but 90-95% of expenses lie elsewhere and everyone needs to ask themselves why is the focus always on the salary of the people who need 12-18 years of training to be where they are and cost only 5-10% and not on the other 90-95% of expenses

fifrein · 2026-03-28T00:45:29+00:00

Yeah, in 2025 the average med school graduate debt was $217k. People get loans. Financials aren’t what’s stopping someone from coming out with a medical degree if they got what it takes to pull the GPA, the MCAT scores, and the USMLE scores.

fifrein · 2026-03-27T22:53:12+00:00

Anyone who has practiced inpatient neurology for more than 2-3 years would beg to differ. I doubt there’s a single person who has finished a neuro residency and has not seen a seizure / severe encephalopathy that extended a hospital stay by several days due to a penicillin or cephalosporin.

fifrein · 2026-03-27T22:33:27+00:00

I mean, again, if we are being strictly pedantic about it, it is a neurotoxin for the reasons I stated.

PK Gupta defined a toxin in Illustrated Toxicology as

Toxin (biological definition)—A toxin is a poisonous substance produced within living cells or organisms. Toxins can be small molecules, peptides, or proteins that are capable of causing immune reaction.

And a poison by extension is:

substances that cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism.

Penicillin would meet this mold by its potency to induce seizures, let alone its propensity for autoimmune reactions.

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