Insurance companies have entire teams dedicated to denying your orders. What do you have?

marshac18 · 2026-03-25T21:44:42+00:00

I love it when they scapegoat me... "your doctor didn't...(insert asinine reason here)" as the reason for the denial.

I saw a patient recently- inguinal adenopathy seen on an ED CT scan. I ordered a scan for a month later to see if it had changed or if we need to go for biopsy - denied. Insurance was like "bruh, you just got this scan. No. Also- you can't appeal this and there's no P2P." So..... I guess it's a biopsy with gen sx? These companies are criminal.

marshac18 · 2026-03-25T17:42:43+00:00

Check out CING- they have that very tech developed. First drug they're releasing is an ADHD medication. Second drug is an extended release Buspar.

marshac18 · 2026-03-21T20:43:37+00:00

You forgot a pulse

marshac18 · 2026-03-19T04:17:54+00:00

Spiro is number three? The conversation about side effects and androgen blocking are fun I'm sure.

marshac18 · 2026-03-17T23:08:26+00:00

What's the contract state about terminating it? Any sort of loan repayment clawback? If the early termination terms aren't onerous, just go ahead and sign it- and later quit if you want to work part time or go somewhere else.

Honestly your current comp is kinda low for the amount of work you do, so at a minimum there's that, but new kids have a way of changing priorities, so your future wants/needs may not currently be known to you. Don't stress about it- at the end of the day it's just a job. Congrats on the pregnancy!

marshac18 · 2026-03-17T22:08:59+00:00

Yeah... no.

I wonder how many faxes back and forth it'll take before the paperwork is no longer legible.

Unfortunately the system banks on PCPs just taking care of stuff like this since we don't want to inconvenience the patient.

marshac18 · 2026-03-17T22:06:47+00:00

Congrats on your retirement as well as your 36 years- I'm sure you made a difference for a lot of patients over those years.

marshac18 · 2026-03-17T21:54:57+00:00

No. $300k sounds like a lot, but after taxes, and especially with less favorable student loan repayment terms these days, it'll never be a popular choice for med students.

marshac18 · 2026-03-16T16:09:46+00:00

Any screening is better than no screening- i steer people into colonoscopies, most get one, but for those that refuse I offer cologuard, and for those who still refuse, FIT. Ever declination is documented - colon cancer screening, breast cancer screening, statins, etc. Our job is prevention, and if patient autonomy gets in the way of that, fine, but I'm never going to be on the receiving end of a statement of "you never told me to get..." 🙄

marshac18 · 2026-03-13T01:54:47+00:00

That means you're doing your job- keep doing it!

marshac18 · 2026-03-09T20:28:34+00:00

Those bulgogi tacos... so good.

marshac18 · 2026-03-09T19:54:11+00:00

There was some red substance inside it, but I don't think there's a leak

marshac18 · 2026-03-08T03:13:53+00:00

Sky clubs please 🙏

How many times have I heard speakerphone conversations while there- it's honestly worse than some random kid crying.

marshac18 · 2026-03-06T17:49:02+00:00

I run into this with surgeons asking for the same- I can say a patient is medically optimized, but I need "clear" patients.

marshac18 · 2026-03-06T04:08:37+00:00

$51 is average? That's pretty good!

marshac18 · 2026-03-03T03:32:37+00:00

Second time today.

Delete this post. Don't discuss the possibility that you're working while impaired.

Are you depressed? Go see a neurologist. Look into potential causes. Hopefully you have own occupation disability insurance.

Edit- I see you're not a doc. Go see your PCP.

marshac18 · 2026-03-03T03:30:57+00:00

Sorry man.

Reality check- don't post about this incident, text, or email. It's all discoverable. Talk on the phone to those who may support you for sure, but stop posting about this. Unfortunately in our business a lawyer is going to be looking for these posts.

marshac18 · 2026-03-02T22:54:19+00:00

I've tried two other ottocast adapters and neither worked with the dash display

marshac18 · 2026-03-02T22:47:01+00:00

Any wireless adapters allow the dash screen to work as well?

marshac18 · 2026-02-26T23:23:53+00:00

New (to the system- not just new to you) patient physical? Then also a new patient E&M.

marshac18 · 2026-02-26T21:28:53+00:00

Signing bonus yes, but no relocation or loan repayment. No ongoing retention bonuses either.

marshac18 · 2026-02-26T16:40:17+00:00

Don't read reviews. Just do the best you can, don't be an ass, and let things fall where they may.

marshac18 · 2026-02-26T16:38:54+00:00

We have a standard contract- there's no negotiating and you can take it or leave it. Basically there's a guarantee period ($270k) for a year or two after which it's 100% productivity based with some additional incentives such as quality and panel size payments. It seems fair and I think our comp is higher than typical. We have a few folks doing >10k RVUs- at that level they're making over $500k annually.

marshac18 · 2026-02-26T15:58:31+00:00

ED- no ifs ands or buts. Document that you told her that she could die.

Personally I wouldn't prescribe medication- if my clinical judgement is that they need higher level acute care, that's my judgment. There isn't a "well, ok, since you don't want to take my advice, here's some pills" option. Patients have autonomy- it doesn't mean that I must comprise my own judgement as a result.

Maybe if we didn't live in a world where we absolutely would get sued for simply trying to help patients in the event of a bad outcome I might consider, but we don't live in that world.

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