Non-Emergent yet Frustrating Medical Conditions

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k9ophile

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Location
Middle TN
While my vote is still out on government funded health care*, something's gotta give.

My ears felt stopped up, so I tried to remove wax with a wax softener and irrigation. Four days later, the stopped feeling progressed to severe pain. This was also with a cold with the usual nasal complaints along with some dizziness. Apparently, the germs that caused my respiratory system, decided to stroll over to my ears. (Well, they all share a bit of common space, but still!)

I go to a walk-in clinic and get diagnosed with an ear infection. I'm prescribed an anti-biotic with the side effect of diarrhea. Dizziness gets worse to the point of the room is spinning when I roll over in bed and what I see feels like my head is really a bobble head doll. Eureka! I know what's bothering me: my ear crystals have gotten out of whack. I also know a simple 15-minute manipulation called the Edley maneuver will fix it like it has in the past. I call the audiologist that has treated me in the past. He doesn't do it anymore, so I'm referred to an ENT. They won't see them unless I have a proper referral from a doctor. I call my PCP and God knows how long it's going to take before I can get an appointment.

The next problem is that I'm out of thyroid. I knew I was running low, so I didn't request a refill because the endocrinologist that treats my osteoporosis drew thyroid labs. I have a history of several dosages based on labs. The results come in and my doctor calls in the Rx for my thyroid. The pharmacy doesn't have it in stock. Two weeks later, it's still not in. I take what I have left yet ran out a week ago. WTH? If I can't get something due to a shipping problem, I find a substitute or do without. But medicine? It's not like insulin or something else that is critical, but again WTF how can it take so long to get it?

Now intellectually, I know that referrals are often required. I also know many people make appointments based on what Dr. Google has told them. In the meantime, I'm sitting here with minor ear pain lingering from the infection and come close to losing my balance when I move my head. And the tinnitus seems to be louder.

*It's not lost on me that my insurance is Medicare, and my pharmacy plan is through Tricare military benefits. Both are government funded. I am grateful that between the two of them I paid nothing for all the care related to my hip fracture and somewhat recent kidney stones. And I'm still pissed. The Epley maneuver is so ridiculously easy, maybe 15-20 minutes at most. After it, I get my balance back and lose the nausea caused by the dizziness.

I don't expect any answers, just want to scream and DH is tired of my bitching. Rant over. Please resume what you were doing and thanks for listening.
 
ER?

They might know the Edley maneuver... if not.. they could be a referral to someone that does.
 
Thanks. If I don't hear anything tomorrow, I'll think about that. It's so frustrating that the first time I had it done by an audiologist is no longer offering it. I have a couple more options.

Mostly, I came here to vent. My poor husband really has been so good about my complaining.
 
Thanks. If I don't hear anything tomorrow, I'll think about that. It's so frustrating that the first time I had it done by an audiologist is no longer offering it. I have a couple more options.

Mostly, I came here to vent. My poor husband really has been so good about my complaining.
1–That’s his job. If mine has to listen to me, yours has to listen to you. Also, his 70th birthday was Saturday. I crashed on the couch, he went off to bed assuming I’d stay on the couch. An hour later, I joined him and he looked surprised. I screamed (because he STILL doesn’t have the hearing aids that he needed a year ago), “I had to join you. I’ve never been in bed with a guy in his 70s.” He laughed. (Because he heard me.)

2–Can your poor husband throw you into a car and drag you to an Urgent Care or VA Emer Dept for a referral?

3–This referral bs is why, even when it cost more than we should have budgeted for, we had a PPO and not an HMO. (You may have neither, but I’m chatty right now.). With a PPO, I don’t get treated like an imbecile quite as often. But NOW we have—not our choice, really…great plan but part of his retirement package, so it’s not like we shopped around—a MEDICARE ADVANTAGE PPO plan. Super good coverage. Office Visits $0 copay, Specialist copay $0, ER $25 but waived if admitted, most of my drugs $5, a few $10, and only his ultra costly psoriatic arthritis biologic drugs would cost a bunch (so he goes to the VA for that treatment, and he pays them $11).

Why did I start this rant? Hmmm. [Oh. I was going to mention that every time a clerk in a medical office sees the words “Medicare” and “Advantage” they insist we need a pre-auth, which we don’t.]. Anyway, I just found out that we probably qualify for “community care” via the VA. We are NOT rural, or FAR from a facility, but because we’re in LA, it takes forever* and THAT qualifies. But also having a WEIRD condition or one the local VA doesn’t treat (like in vitro fertilization) you also get approved for “community care.” Maybe after the current crisis, you could find a doctor that does this WEIRD procedure for a WEIRD condition (thanks for the education and sorry you’re dealing with this) for any future episode.

Meanwhile, if this causes whining to/grousing at a spouse, it kinda IS an emergency.


*It’s 29.5, 32.1 and 35.0 miles and 33, 35 or 38 minutes on the freeway or 24.9 miles and 52 minutes on surface streets. We once went to meet DianaCox and Charles for dinner, not even quite as far but the same route, it was TWO HOURS. To go maybe 20 miles.
 
After several phone calls, I am getting a referral after I've been seen by my PCP. Insurance rules and all that bullshit.
 
FWIIW.. re the referral necessity .. in broad strokes

Medicare advantage... need a referral
Medicare classic (includes Medicare supplemental) ... no referral needed

Now's the time of year to choose. You can always change to Medicare classic, though there may be some trouble ( read cost) to change to Medicare supplemental from Medicare advantage


What do folks do as their mental acuity starts to slip? When I first selected it took a while to figure out the gotchas and costs.

Good luck to all here
 
Medicare advantage... need a referral
Medicare classic (includes Medicare supplemental) ... no referral needed
Not always true. Some doctors require a referral regardless. Granted, if the doctor doesn’t require a referral, then classic Medicare doesn’t.
 
I'm sorry. You have my full support. Rant on. We're here for you!
I saw my PCP today. He's referring to the balance therapy place the hope I cat get ear crytals back in alignments we may not seeing the ENT DOC.
If the exercise doesn't help then we go plan B. The balance option sounds easier without 4/ 5 month waiting to get into the. ENT

Now I can't get my thyroid out of backorder Rx and into my hand.

ETA to correct spelling.
 
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FWIIW.. re the referral necessity .. in broad strokes

Medicare advantage... need a referral
Medicare classic (includes Medicare supplemental) ... no referral needed

Now's the time of year to choose. You can always change to Medicare classic, though there may be some trouble ( read cost) to change to Medicare supplemental from Medicare advantage


What do folks do as their mental acuity starts to slip? When I first selected it took a while to figure out the gotchas and costs.

Good luck to all here
EXCEPT “MEDICARE Advantage
PPO” referral NOT needed. It’s confusing to everyone, but that’s how the Advantage PPOs roll.

ETA…. southernlady Lady is right. Some specialists or services DO need a referral to TREAT. But insurance doesn’t require it to PAY.
 
The latest hitches...

After telling me my prescribed medication was out of stock, today I received noticed that it was canceled. Apparently the doc wrote to fill as prescribed and the brand name is unavailable. I'll call him and see if he'll order the generic. He has ordered the generic in the past, so maybe this can be resolved. I never thought supply chain issues would effect medications.

I got my referral from my PCP to see someone about my balance problems, I was told the earliest appointment was December 5th. I have been told that the treatment could be done at home. I didn't see any warnings about danger, just I might not do it correctly and could re-try after a suitable wait. I really don't want to wait a month for relief.
 
The latest hitches...

After telling me my prescribed medication was out of stock, today I received noticed that it was canceled. Apparently the doc wrote to fill as prescribed and the brand name is unavailable. I'll call him and see if he'll order the generic. He has ordered the generic in the past, so maybe this can be resolved. I never thought supply chain issues would effect medications.

I got my referral from my PCP to see someone about my balance problems, I was told the earliest appointment was December 5th. I have been told that the treatment could be done at home. I didn't see any warnings about danger, just I might not do it correctly and could re-try after a suitable wait. I really don't want to wait a month for relief.

Our Physical Therapist, whom we really like, comes from Luna Physical Therapy, which we don’t care for. But there’s a benefit:

Luna does not have physical facilities. Routine OUTPATIENT PT is billed as a routine PT visit, but delivered at your home. If you NEED more than they can deliver at home, they will refer you elsewhere.

This confuses both the doctors and their staff people who actually process the order, so DON’T MENTION the word “home.” If they call it “Home Health Care,” there are many hoops to jump through.

www.getluna.com
 
The latest up for y'all. The pharmacy called the explaining the out of stock status. Doctor okays generic.

Now the ears, I'm in hilly part of TN with lots of variance. My ears have been popping.

So who knows? It may just fluid causing the problem. My PCP said fluid gets and gets trapped. If my ear membrane reacts to the changes of attitude, I may feel human soon
 

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