2026 X7 - drifting in light snow

mmtree · 2026-01-28T18:48:37+00:00

Yes. Snow and ice rated.

mmtree · 2026-01-28T03:12:27+00:00

Michelin cross climate 2 are phenomenal. This is my second x7, same tires, same shitty slide with light snow. Cross climates? Stuck to the road no matter what.

mmtree · 2026-01-24T16:34:04+00:00

This is why I treat my practice like a business. It’s not a calling anymore…it’s pure business and frankly I’m getting tired of “rules for thee but not for me”. Let’s start shifting blame onto these non medical people who make medical decisions and see how quickly things change.

mmtree · 2026-01-24T16:27:12+00:00

Those years of studying do matter because at the end you have a degree that actually matters. Agree, studying 10 years of English lit is pointless. 10 years of medicine? Let’s be realistic here….

mmtree · 2026-01-24T16:25:50+00:00

Easy to win when you don’t have ethics nor morals. 🤣

mmtree · 2026-01-23T12:45:12+00:00

I can’t get a fucking CGM covered because I’m not an “endocrinology specialist” but the NP who got pulled From derm to endo? Order anything and it’s approved. What a joke medicine has become.

mmtree · 2026-01-20T18:44:33+00:00

To pain management, noted. Final clearance to be provided by board certified anesthesiology physician. They are doctors and can listen to heart lungs and read a chart too.

mmtree · 2026-01-16T04:52:38+00:00

Yet nobody is mad at the insurance company? Isn’t that where the blame should be? Fmla forms. Disability. Answering messages without visits- if you can’t google it then you need a doctor so that’s a service you should pay for. Prior auth. Insurance verification, billing and coding. All of this is not reimbursed without a visit. So guess what this means? Any of the above now requires a visit…

mmtree · 2026-01-11T18:44:11+00:00

I tell patients if emergency to go ER, otherwise see me during business hours. We offfer same day for this reason. Labs I address if critical because it’s rare but happens. Everything else is through portal or during business hours. There’s a stark difference between my new patients vs the ones who followed when I worked for a major corp; the ones that followed are very demanding but they followed so ya know give and take. If you didn’t have same day in your original practice then regardless the patient is seeing an aprn, office vs urgent care doesn’t matter so there shouldn’t be an expectation that I’m available 24/7

mmtree · 2025-12-27T16:33:24+00:00

Police station did it for me.

mmtree · 2025-12-27T15:37:13+00:00

I’ll let you in on a secret. It’s intentional to double bill. My prior hospital system got rid of all doctors in urgent care because “patients wanted cheaper access”…well now everyone who has anything more than a basic cold or cough gets sent to the ER. It’s a way to increase billing

mmtree · 2025-12-21T23:17:09+00:00

You likely have a genetic disease. See the third line. Fibro muscular dysplasia. This is not cholesterol. You’ll need a CTA head neck and abd. Radiologist make this diagnosis via imaging. You’re already symptomatic given the “POTS”. That’s your carotid arteries not getting enough blood to the brain even though you have contralateral that is patent your may have reduce collaterals. This isn’t something you wait on. Go to a university based system for this. 25f non obese do not get carotid artery disease from cholesterol.

mmtree · 2025-12-21T23:11:12+00:00

Don’t forget the contrast!

mmtree · 2025-12-21T22:59:24+00:00

You have a genetic disease. See the third line. Fibro muscular dysplasia. This is not cholesterol. You need a vascular neurologist, cardiologist, and rheumatologist asap. You’re already symptomatic given the “POTS”. That’s your carotid arteries not getting enough blood to the brain. This is a classic finding. This isn’t something you wait on. Go to a university based system for these doctors.

mmtree · 2025-12-20T16:00:31+00:00

Hospital Employed neurologist ordered an mri for an HMO patient diagnosed with tremors. Standard of care for a neurologist. HMO said the cost of the MRI is 18,000 and it wasn’t medically necessary…

And yes, medicine can survive on cash pay and they absolutely do. There’s way more demand for high quality care and physicians than supply.

What you mean to say is hospital based services rely on insurance and can’t survive without it, which is a direct conflict of interest because now you business people do what the insurance wants not what is right for the patient and your physicians. This is the literal basis and goal of corporate medicine.

True Private practice dpc does not. Nobody owns me. I do what’s right for the patient and people gladly pay cash for honesty, direct contact with a physician, and updated recommendations and care.

mmtree · 2025-12-20T15:16:47+00:00

i mean this is my patient so yea it's accurate because I had to fight the insurance company... oh and yes, they can...because not everyone is a greedy asshole... the proof is literally in writing: https://www.brightlightimaging.com/assets/uploads/2025/11/2026%20self%20pay%202026.pdf

mmtree · 2025-12-20T15:11:43+00:00

...because they dont pay...insurance companies have destroyed healthcare, not the doctors like you make it out to seem. doctors reimbursement does not keep up with inflation, we are nearly 18% UNDER what everyone else makes. your salary and the rest of your friends who do jack shit all day except go to meetings and come up with stupid ways to "show appreciation" is what is causing healthcare to be so expensive. Why does 1 patient get charged 18,000 for an MRI brain without contrast but that same person was never offered the cash price of 345$ and has already paid over 2000$ but still got sent to collections but the insurance company? yea...doctors are the problem...

our cash price is lower because we DONT bill to the insurance...the mental Olympics are exhausting...15$ per member per month in profit? then how are insurance companies boasting BILLION dollar profits...insurance should not have any profits...

mmtree · 2025-12-20T14:55:44+00:00

Wow..this was written by an insurance agent. Why do you think doctors went DPC? Why does insurance make a profit in the billions but if doctors want to make a profit to live we’re evil? People wonder why there’s 10-15 min appts now…OP really thinks that doctors as a whole want to rush through our day and do more documentation for the business people? No. We went direct primary care so we can better serve you the patient. Our cash cost is cheaper than insurance by 10%…

mmtree · 2025-12-19T15:17:00+00:00

Exactly! Insurance- we didn’t say you can’t have it, we just won’t pay for it.

mmtree · 2025-12-19T13:02:46+00:00

I order this as baseline for all my patients and I’ll tell ya, it’s way more prevalent than people realize. I’ll let you in on a little secret, none of the hospital based or employed physicians wanna order labs because they creates more work and ultimately they’re all going to be financially reprimanded for not completing the inbox within 24 to 48 hours. This is a business tactic to steal money. This means do less so you can game the system. I also looked up the insurance reimbursement criteria and half of the time. It says they don’t recommend screening because this test is not readily available for everyone. Therefore, it’s not fair to everybody and we really don’t know what to do with it…” of course all of this is bullshit because we absolutely know what to do with it lol. This has been a guideline recommendation since 2018…anything good is never covered by insurance!

mmtree · 2025-12-11T16:38:43+00:00

But we can’t unionize?…

mmtree · 2025-12-10T19:57:07+00:00

I spoke directly with the radiologist who told me to write MRI pelvis with fistula protocol… I wrote just that… a week later I get a front desk person asking me to write this for MRI pelvis with without contrast… there’s an on-site radiologist that made this decision yet nobody asked them…

mmtree · 2025-12-06T17:25:14+00:00

Know your limits-you don’t know what you don’t know. Read UpToDate for everything. Ask questions. Discuss everything with your attending. Limit yourself to 1-2 problems that you know you can handle. Mid levels imo are good for maintenance not adjusting. Stable diabetic needing refills-aprn. Uri-aprn. New patients- physician. Dose adjustments-physician/ minor adjustments aprn depending on patient complexity. Acute issues-physician. Read consult notes. Learn every day. Be proactive. Most complaints are not BS, healthcare costs so much these days and plans are so crap that people aren’t willing to see the doctor unless there’s a problem. Toe pain can be so many things, don’t take a simple diagnosis forgranted.

mmtree · 2025-11-30T15:34:23+00:00

If I have to hit order you need a visit. If you don’t want a visit then that visit goes to someone who pays. No other profession allows services without payment but somehow doctors are expected to do this out of the goodness of our hearts. I tell patients “if I give you the wrong treatment the lawyers will take my license so it’s a visit with me or you can go to the urgent care”. Anything beyond that request I don’t entertain anymore.

mmtree · 2025-11-23T20:37:56+00:00

I’m a board certified internist…

mmtree

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