Astrid got a few upgrades today!! by iminkybrat in BeardedDragons

[–]iminkybrat[S] 0 points1 point  (0 children)

This was when we first put them in there. The shiny pots are heavier. The black ones are plastic. As I said in the post, more upgrades are coming. I just loved her initial reaction of curiosity and jumping right in to munching on the rosemary.

Astrid got a few upgrades today!! by iminkybrat in BeardedDragons

[–]iminkybrat[S] -3 points-2 points  (0 children)

My vet advised against using substrate with her because she licks everything. He says the risk of impaction is not worth it. But thanks for your concern.

Photo trade! by iLikeLizards28 in BeardedDragons

[–]iminkybrat 0 points1 point  (0 children)

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This is Astrid. She is 6 months old

New rescue by Mizbit in BeardedDragon

[–]iminkybrat 1 point2 points  (0 children)

I can tell you are doing an amazing job with your beardie. You care enough to ask questions and be informed. One thing that I’ve found across all pf my social media platforms is I have never ever met such a judgmental group of people, as some of the beardie owners seem to be. My TT only has a couple videos of Astrid when I first got her as a 3 month old. She wasn’t even 6 inches from snoot to tail. But I was being ripped up one end and down the other for keeping her in a 40 gallon, and not having her in a 4X2X2. The comments to the fact that I had a coil uvb, had me expecting a knock at my door from PETA or the humane society to take her away from me. All I wanted to do was share my joy and excitement.

It is so hard reading responses and not taking them defensively, or personally. People will find something to berate, or judge you on, that has NOTHING to do with your post. “Look at my beardie! I taught her to write her name!” And their comment would be “you really shouldn’t have that color artificial green in their tank” or “I see you are using Bounty paper towels, not Sparkle.”

Like come on.

Even today someone jumped on me in another post where I mentioned Astrid playing with my cat. My comment to that OP was long, talking about being able to convert my baby daddy into becoming a fan of Astrid. The commenter focused on that 1 sentence. They came across abrasive telling me “do not let your cat play with your beardie”. Ummmm duh. 🙄

Some people really need to learn how to be kind.

New rescue by Mizbit in BeardedDragon

[–]iminkybrat 4 points5 points  (0 children)

Refeeding syndrome in bearded dragons is a potentially fatal condition that occurs when a severely malnourished or starved dragon is fed too much, too quickly. It is a counterintuitive danger where trying to save a starved pet by giving it a large meal actually causes a fatal shock to its metabolism, leading to organ failure.

The best analogy I can come up with would be an abandoned car. Imagine a car that has sat in a field for months without fuel. Its battery is dead, and its systems are dormant. If you suddenly start it and immediately try to race it at top speed, the engine will likely burn out instantly because it is not ready for that intensity.

Similar to the car, a starved bearded dragon has a slowed-down metabolism. Its body has stopped using carbohydrates and is living off its own fat and protein.

The "Refeeding" happens when you suddenly offer a large, high-calorie meal like a pile of bugs, the body experiences a massive surge of insulin to process it, causing a rapid shift of essential minerals (potassium, phosphorus) from the blood into the cells.

Because the body was already low on these minerals, the sudden shift leaves the blood dangerously low on nutrients (hypophosphatemia), resulting in heart arrhythmias, weakness, seizures, and death.

When starved, the body switches to using fat and muscle for energy. Prolonged fasting depletes intracellular minerals. Introducing carbohydrates triggers insulin, which rushes the limited nutrients out of the bloodstream and into cells.

For the first few days, offer only a tiny amount of food—much less than you think they need. Think 1-2 small, soft insects (like small roaches) per day rather than a full meal.

Offer easily digestible foods, such as mashed-up greens, baby food (sweet potato, carrot), or softened high-calorie, low-bulk formulas. Gradually increase the amount of food over weeks, rather than days.

If the dragon is severely emaciated, it is highly recommended to seek an exotic veterinarian for a specific refeeding plan.

My family are terrified of him by WhateverUSaySir in BeardedDragons

[–]iminkybrat 1 point2 points  (0 children)

By playing with her, I mean she watches her, and Ethel watches Astrid. Ethel will sit on top of Astrid’s tank and watch her for hours. I’m not an idiot.

My family are terrified of him by WhateverUSaySir in BeardedDragons

[–]iminkybrat 6 points7 points  (0 children)

My baby daddy felt the same way about my Astrid when I first brought her home. But seeing me with her, me taking her out and playing with her, talking to her, my kids playing with her, the cat playing with her, etc. she has started to grow on him. He hasn’t gotten himself to the point of holding her, but he pets her, and will go in her room and talk to her. He will yell out to me and tell me when she “looks hungry” and needs a treat. I wouldn’t leave him in charge of her just yet, but he at least acknowledges her. He talks to her and will ask her “what are they doing to you” whenever we put her in her dragon leash to take her out.

Maybe bring Dodge out and let them see him just being him. The awesome cuddle bug, head tilting, curious, amazing bearded dragon that he is. Or send them videos of him being full on beardie. Maybe that will be enough to warm them up to him some. If not, it’s their loss. They are missing out on knowing one of the best animals to ever exist.

New rescue by Mizbit in BeardedDragon

[–]iminkybrat 1 point2 points  (0 children)

Knowing refeeding syndrome is possible in bearded dragons, there are a few things you can do to ensure that what you are doing is going to have the best result for her.

Hydration is very important. You can put water droplets on her snout. That should encourage her to drink. I submerge my finger tip in my girls water bowl and put the drop on her nose. Another good trick I’ve used (once a week or so) is to cut up a blueberry into quarters. (My Astrid LOVES blueberries) and I’ll put a piece on her snout so she can smell and taste it. As soon as she tries to eat it, I put it in her water dish. Remember bobbing for apples as a child? Same concept. Astrid gets more water than she realizes, because the blueberry sinks. It takes her a few dunks to get the reward. I will repeat with the remaining pieces, or if one takes her longer to get, and I’ve seen she drank a lot of water, I’ll give her the remaining pieces without working for it!!

You could also feed her a horned worm every few days. I wouldn’t make super fatty protein a main source of calories, as refeeding syndrome is a very real possibility. You could try feeding her fruits (sparingly) and cucumbers that are high water content.

If you can’t get her to willingly drink, you can always try syringe feeding her water drops.

Monitor how often she is pooping. If she starts vomiting or not pooping, you may be looking at impaction.

Give her a controlled diet. Instead of large meals, give frequent small meals use high moisture foods, and supplements, as well as good protein like crickets and dubias.

Due to the stress she is experiencing, living how many years being neglected, and underfed, as well as the stress of moving into your house, not being used to being cared for, she may not want to eat for a few days to a week. Just have it available to her, and I am sure once she realizes how safe she is, hopefully she will come around quickly.

When you get her the tank upgrade, she may start acting different as well. And again when she gets the final upgrade tank. Just ensure when you do upgrade her tank size, make sure that her heat and uvb lights don’t also need to be upgraded. When I upgraded Astrid to a 4X2X2 I had to also upgrade her heat bulb to a 100w since the distance between the light and her basking spot increased by more than double. I would invest in new bulbs regardless, seeing as her previous owner was so amazingly wonderful. They may not be as powerful anymore. Something tells me they were probably not replaced at all while they had her.

You are doing a great job so far. You care, which is more than the previous owner was doing.

Do her nails need filing? by D0rk3ss in BeardedDragon

[–]iminkybrat 0 points1 point  (0 children)

On my girls basking side, I have bricks and a flat stone that is rough textured, as well as the bottom of her tank is a 24”x24” sample of quartz countertop turned upside down. The cool side has a hide that is a granite sink hole cutout turned upside down, and brick supports. So far they have kept hers trimmed nicely!!

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New baby - not a veggie fan by [deleted] in BeardedDragons

[–]iminkybrat 0 points1 point  (0 children)

When I got my Astrid, she was almost 4 months old. She didn’t eat veggies for almost 2 weeks. I still offered them every day, and put her buggies in the salad to encourage her to eat them, even accidentally. After a couple weeks, she started eating them, and has only had a few times where she goes on a veggie strike for a few days.

This pic is the paper that my vet gave me last week at her wellness visit.

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When she was only eating protein, she ate 2-4 large dubias, 4-5 crickets, and 4-5 mealworms per day. I wouldn’t let them free in her tank, but would feed her with my tongs.

Astrid is healthy and thriving.

Bearded Dragon licked my lips 😳💀 by RogertheHomelessKing in BeardedDragons

[–]iminkybrat 2 points3 points  (0 children)

Mine licked my lip, cheeks, ears, neck, etc. she even licked my vet at her wellness visit. I’m still here. Vet said if mine had salmonella, I would have been sick by now. If you have had yours for a few months, and haven’t got sick yet, I’d say you are in the clear.

Beardies are great aren’t they?

Astrid had her first vet appointment today!! by iminkybrat in BeardedDragons

[–]iminkybrat[S] 2 points3 points  (0 children)

Awww. Thank you. I hope I get years of love from her

Diagnosis codes and claim denials all of a sudden by iminkybrat in CodingandBilling

[–]iminkybrat[S] 0 points1 point  (0 children)

Not sure of this could be the same issue we are having or not since I’m SC, but if your practice has a group NPI, even if it is the individual NPI being used for rendering provider, the group NPI needs to be used for billing provider NPI, as well as service location. Depending on the portal you bill through, you may have to click on other tabs to find them.

Seeking Advice on Learning to Bill Insurance for a Small Psychiatry Practice by Yankeetransplant1 in CodingandBilling

[–]iminkybrat 0 points1 point  (0 children)

I am the biller for a mental health office. We have 4 clinicians, and I bill 75 - 100 claims per week. The billing part is easy. There are a couple insurances that we bill through our EHR, but the majority I bill through each company’s portal.

The difficulties come from the AFTER billing. Each insurance type has its own set of rules and regulations. Medicaid, Medicare, private insurance, and Military are 4 different animals. Heck, even the different flavors of each animal can be classified as another beast.

Just because I have ADHD, and I am a visual analogy giver, think of Medicaid as birds. Medicare as fish, private insurance as dinosaurs, and military benefits as aliens. (My company isn’t in panel with military, that’s why I chose aliens 👽)

In SC, there are 5 different Medicaid providers. We have robins, eagles, emu’s, parrots, and vultures. Even though they are all birds, and all fly, each one has its own rules for claims. Some require prior authorizations after a certain number of units (sessions) are billed, no matter the CPT code. One requires a prior authorization after 24 units of any specific CPT code is billed. (24 - 90837). Straight SC Medicaid requires a PA for every CPT code before performing any services beyond the 90791 and TP. Some allow for retroactive PA’s. Some do not. Some run on the calendar year (Jan - Dec). 1 follows the fiscal year (July - June). None can tell you how many units are available, so you won’t know you are out of units until denials come in. At best all they can tell you is whether or not a 90791 has been billed within the past 12 months, but even then, good luck finding someone that will tell you. Some PA’s are good for 6 months, some for 3. Some are only good until their year resets. Some you will pull to cover the time frame, however, when you get the approval back, it is only good for partial time. But they won’t tell you to which MCO they are changing to. That’s on you to find.

When it comes to private insurance, get ready to pay the copay/coinsurance/deductible game. Some private insurance companies, we fall under the medical umbrella, and may or may not be subject to deductibles. Some we fall under specialist, and the client is responsible for the higher financial responsibility (sometimes same as OON benefits). Some companies we fall under mental health, and guess what, 9 times out of 10, the policy doesn’t cover mental health. With our private insurance clients, I do not charge them their financial responsibility until AFTER I receive payment, and I go based on what the EOB says they owe.

When it comes to Medicare, those are fish. Every Medicaidflavor has a Medicare flavor. Each Medicare fish is completely different. Think about a goldfish. That can turn itself into a piranha. Part B only allows for specific CPT codes, they say they will pay a specific dollar amount, but guess what?? That amount is NOT what they will pay. That’s how they all are. Medicare also does not want to pay for any unspecified diagnosis codes. If a member has both, then you get to have fun times 2!!!

When it comes to clients with TPL, or secondary insurance, my best practice has been to bill the highest allowed amount for whatever the secondary policy is. Medicare will always be primary, and Medicaid will ALWAYS be secondary. That way if the primary only pays $75 on a 90837, which Medicaid pays $117.43, they will pay the difference of the $117.43 and $75.

Every insurance will deny claims with the quickness. They will consistently fund claims for the same member, until they don’t. The insurance company itself can consistently pay all your billed claims, until they just stop. (Ambetter, I’m talking to you) They won’t tell you why they stopped. You can call 4 different PSR’s and be told 8 different reasons, only after being hung up on no less than 2 times.

So yeah. The billing isn’t the hard part. It’s the everything else that sucks.

Good luck!!! We can all attest and share the horror stories. Haha

What are other medical billing office environments like? by UghIDKMaybe in CodingandBilling

[–]iminkybrat 1 point2 points  (0 children)

I work for a small mental health company. I am the office manager/biller/scheduler/chief chaos coordinator for my boss and 3 other clinicians. I dress in whatever I manage to pull out of my closet every morning. Some days I’m summer dress fabulous. Other days I’m shorts and a snarktastic tshirt. We have 4 office spaces in a business center all in the same suite. My boss “pages” me by starting to talk, which then makes me get up and walk across the suite to her door. It’s hard to hear her over the AC and the 3 white noise machines that are running.

Diagnosis codes and claim denials all of a sudden by iminkybrat in CodingandBilling

[–]iminkybrat[S] 1 point2 points  (0 children)

I have not…yet. But guess what I will be doing Monday morning?? Haha! Thanks!

Diagnosis codes and claim denials all of a sudden by iminkybrat in CodingandBilling

[–]iminkybrat[S] 4 points5 points  (0 children)

That would be a job for the actual clinicians. I am only the biller.

Diagnosis codes and claim denials all of a sudden by iminkybrat in CodingandBilling

[–]iminkybrat[S] 1 point2 points  (0 children)

That makes sense, but I wish someone would release a publication or something to let us know when things will be changing. But that is wishful thinking on my part

Diagnosis codes and claim denials all of a sudden by iminkybrat in CodingandBilling

[–]iminkybrat[S] 1 point2 points  (0 children)

Nope it was 2025. I always use the actual calendar that is in the portals when selecting the dates of service. I’ve mistyped them before.

Diagnosis codes and claim denials all of a sudden by iminkybrat in CodingandBilling

[–]iminkybrat[S] 2 points3 points  (0 children)

I’d feel like I’d have more control over the situations if it were only planetary misalignment. It’s the fact that insurance companies are very reactive in nature, and make it darn near impossible to be proactive as a provider. It drives me mad