I'm tasked with finding solutions towards this measure among many but as part of my process is targeting Medicaid HMO - they're particularly poor nationwide. 40.3 percent vs 21.9 Medicare. Straight from NCQA: https://www.ncqa.org/hedis/measures/hemoglobin-a1c-control-for-patients-with-diabetes/
What challenges are being met towards diabetes control and what in particular causes Medicaid to have such low numbers? I know ppo is still pretty bad but it's almost meeting the measure.
Hello all! I'm a rising junior at VCU pursuing my Bachelors in health services. I'm about to land an internship at VCU Health. It will be starting in few weeks and will run through the fall. I plan on going straight into an MHA program after getting my bachelor's, ideally at VCU. I see everywhere on the internet people say to get entry-level job experience before the MHA or else the MHA is kinda useless. My question is, do internships working for hospitals like I'm about to do count as that entry-level experience? I guess my main concern is going straight into an MHA and then graduating with many quality internships under my belt, but I still have to start at an entry-level position and work my way up the ladder.
I plan on getting 2-3 more internships before graduating with my Bachelors. But would it be a better idea to work an entry level job for a year or two instead of pursuing multiple internships if they don't really count as experience?
I have tried searching the old googles but I couldn’t quite find an answer I’m looking for. In a discussion between the two healthcare options, fraud was brought up as a reason to not use Medicare for all. My gut tells me a single payer system should make catching fraud easier. Is there any evidence that supports or refutes this? Also, is there any study on fraud in the private sector vs Medicare? Does Medicare invite more fraud than the private sector?
I hope this was an ok place to ask this question, and I appreciate any answers or assistance I get on this topic.
I live in the USA and I was surprised that we're not the only country to separate and honestly I'm confused why it varies from place to place
Regional insurance using Aetna signature ppo national network - can’t find care
Hi there, I am a remote worker from Oregon working in Miami Florida for the next year. I work for a large hospital who uses Moda health, a regional insurance company that covers Oregon, Washington, Idaho and Alaska.
When I moved to Florida I was told that I would be switched to the Aetna signature administrator ppo plan which has similar coverage. WHAT THEY DIDNT TELL ME is that my insurance is still MODA and that they utilize the Aetna network and providers, ie essentially subcontracting from them. Moda still handles the bills, and i still have a Moda card. There is a small emblem on the back of the card with the Aetna logo saying Aetna available outside Moda network for emergent care.
Finding care has been an absolute nightmare - I don’t have an Aetna number so the only way that anyone can verify my coverage is by calling the medical benefits line on my card. Getting people to do this is difficult because as far as they are concerned, I don’t have Aetna and Moda isn’t an option for their drop down billing departments. Many places have told me that while I have access to Aetna providers, they physically have no way to bill Moda(and fucking why would they, I’m 3000 miles away from the closest state that even know what Moda is). Many places just won’t even call.
I have an auto immune disorder and only have 2 months of medication remaining. I’m starting to get really nervous about how I will receive any care in this state. My job and Moda have both suggested I work with larger health organizations who will be “more familiar with interesting billing situations” but that has been far from the truth.
Is there a way for me to get my prescriptions sent by an Oregon doctor to a national mail in pharmacy? Has anyone experienced this regional subcontracting a national network bullshit, how have you navigated it?
Just really need some help and advice…thank you
I really need help finding a job as a phlebotomist but everywhere I look they require at least one year of experience and have crazy hours, I’m going to college in the fall and can’t work Monday through Friday. I’ve also never had a health care job and I’m not sure what steps I need to take to get one. I’m certified in cpr, first aid, patient care technician, and phlebotomy if that helps anything. Any help is much appreciated :)
Not sure if anyone else has experienced this but I saw a specialist in Irvine CA through UC Irvine and got an extra charge for a “facility fee” of almost 200 dollars. Apparently this is separate from insurance and may or may not go towards your deductible depending on your plan. I guess when I signed the intake documents I agreed to this absurd extra charge for using their facilities. Of course the exam itself gets billed through insurance and I pay my copay but this extra charge just seems outrageous. It’s not like I can see the doctor at my own rented out exam room lol. What’s weird is I’ve been to other UC specialists and never gotten charged this fee. I have no idea if it’s based on time or what room you use. There were no procedures done at all just a standard appointment to go over test results. Is this becoming a common practice? Has anybody had this before and has anybody had any luck fighting it? Just when I thought US healthcare couldn’t get any worse.
I went in to the doctor to talk about some issues I’ve been having sometime last week. During the visit it was suggested that I have some blood drawn to get some work done and so I went ahead with it. The doctor told me he was going to start me on some medication for something after the bloodwork and that I was set for the day so I went home. After waiting a few days for a call I realized I haven’t had blood drawn in quite some time so I called the office just to ask when I should be expecting a call so I’m not in the dark and worried about receiving a call, the nurse told me they actually would be receiving the results in a couple hours that day and that I should be expecting a call that day. I never received a call and I have called for five days now and each time the nurse says that the doctor will call me right after he gets done with his current patient and yet I still have not gotten a call. (I understand that this can take some time and I know doctors are very busy and have tons of patients. The only reason I’ve been calling so frequently is because of my first conversation with the woman who told me they had the results and to expect a call that day. If they had told me 2 weeks I honestly wouldn’t have even thought about it until then.) Should I start making appointments with other doctors or just keep trying to get someone to call me? I really appreciate any direction and I appreciate your help because I have little to no experience with doctors for the most part.
I went to a birth control clinic today. I asked for Slynd, but found out Tricare doesn't cover it. Apparently I am not a good candidate for combined pills because of my history of migraines. The only pill I was able to get was a mini pill, but I was told by the NP that this can cause irregular bleeding. I already had irregular bleeding on a combined pill (I got it prescribed earlier despite my history of migraines) which was the reason I got prescribed Slynd in the end and I was doing great on it. I also have a suspicion of endometriosis but it's not confirmed and I don't wanna get a laparoscopy yet. Is there any way I can try to get Slynd covered by Tricare? This pill worked great for me. So if it turns out the mini pill I just got prescribed doesn't work good for me, I'll be out of options (can't have an IUD either because my body has rejected it twice in the past).
I have health insurance through Medicare from my mom. I have tried asking her several times what my health insurance provider is and she never gets back to me.
I tried calling my old doctors office, and they told me what was on file, but the last time I recieved care was 3 years ago and I am unsure if that insurance is still currently what I have
So how can I find out what health insurance I have? Am I able to just walk into a random office and ask?
I am unable to go to my old doctor's office because I live 3 hours away from home now.
It is Illinois Medicaid.
I'm a recent High School Graduate going to community college for nursing this fall. I'm currently out of a job and the search has been hard and unfruitful. I'm still searching for any type of job, but what I really want is a more "professional" job, maybe something in a hospital or clinic. I'm tired of staying stagnant at restaurant and retail and I would want a job that brings my closer to my future in nursing. I have no experience in healthcare, but my mom is a nurse. Are there any entry-level jobs that would be fine?
Hi! Im typically covered by an academic health care plan but will be taking a semester off for an internship. I might get continuance insurance till end of November. From January, i’ll be covered again.
I will need insurance - i get meds + need therapy.
Does anyone know of any good options?
My parents plan can be a bit expensive, but thats def an option.
Hello, I’m interested in healthcare like sonography, nursing, and dental hygiene. I’m currently going to be a freshmen in college and I was wondering if I could shadow people. Called some clinics and programs to see if they do that and turns out they don’t. It’s a liability/insurance thing or only for students. It makes sense yet I’m bummed out. I hear so many stories of students in high school having those programs to see medical fields yet my school never had one. I don’t think I can even do that anymore cause I’m already graduated. It seems the only way to see if I like being in the field is by studying for that career or actually working one part of it. Any way you guys can help?
I've recently been very interested in how automated patient referral software works and the benefits. I've done a lot of research and I'm trying to get a better understanding of what these programs are lacking and how they can be improved. I'd appreciate any commentary on your experience with these programs.
I’m starting college soon and I don’t know what I want to be. I’m thinking about medical field since it’s always there but would like to see if I truly like it. What’s the best way to dip my feet in the medical field before become anything?
Hello! I've only ever had health insurance from my parents or a job so I don't know the answer to this. I have an older relative who is a US citizen but lives in the Philippines full-time. They're visiting California for a month and we'd like to get health insurance for them, is that possible? They've never worked in the US too. I'm assuming some sort of travel insurance is what we should get them? Thanks!
Do you think there is a lot of misinformation about ozempic and do you think people are misusing the drug?
well, if there’s a first for everything, today was mine with getting fired. it still feels weird to type/say out loud… my entire adult life i’ve had horrible issues with tardiness (shoutout late diagnosis ADD at 24🥴) medication/treatment has helped me understand why i feel like such a screw up and i’ve made baby steps but i’m still far from perfect.
this was my first nursing job, inpatient hospital unit 7a-7:30p. i worked on this unit for 3.5 years and started in a new grad residency program. i can’t help but feel like a failure. the unit has rapidly deteriorated and it’s heavily run by favoritism from management, i was planning on getting out soon anyways, yearning for it even. now that it’s over i feel so torn. i didn’t know anything when i started there… i was a new grad who did half of her nursing school online because of the pandemic and i went from a terrified student to a confident nurse, only for my downfall to be myself and my poor time management.
even my higher ups said i was an amazing nurse in my exit interview and they hated to do this, that’s a relief that stings. they said your patients love you, we love you, your care is perfect, we just can’t overlook the tardies any longer. i can’t put into words how it felt to have to be watched on my unit, my HOME unit, while i gathered my things from my charting station, painstakingly peeled the stickers off my locker… took apart my badge to return to them and leaving with nothing but an empty reel… fuck.
i’m trying to see this as a blessing in disguise, i know things went sour there and i wouldn’t have taken the initiative to find something better on my own. i’m sure i will, but how do i explain why my status is terminated? because i’m chronically late?
i’m so burnt out and my nerves are so fried i’m thinking about taking a few weeks for myself before finding my next chapter… not to mention my city is monopolized by one healthcare system so the hospital setting is out of the picture for at least 18 months… i know deep down i’m not a piece of garbage but it wouldn’t hurt to hear. anyone fired from their nursing/first nursing job and ended up way better? anyone have advice how to stop ADD from sabotaging my life? also in my exit interview they said ADD was “no excuse and i need to pocket that one for awhile”. that hurt too. i’m hurt and looking for hope. 💔
My background is EHR software. I’m somewhat familiar with quality measures, but I’m struggling to understand the overall organization of it and the alphabet soup of acronyms isn’t helping. Is QPP the same as MIPS? How is a Clinical Quality Measure different from an eCQM?
I need to be familiar enough with the basics so I don’t sound like an idiot with clients. I’ve searched online but CMS resources are a far cry from an easy read.
If there’s a better community for this question, please let me know.
Looking for ideas on jobs in Healthcare that has little to no patient interaction. Or if there is patient interaction, isn't typically sick people.
A couple examples
One job i've come across thats in the realm of what i'm looking for is- biomedical equipment technician. The people that fix hospital equipment. I like that it's an important role but I wouldn't be touching people, just machines.
Another job I've come across is hearing practitioner. I like that even though I'd have to deal with patients ears, it's the kind of medical work where you're not dealing with super sick people.
I have an odd situation:
Was setting up a payment plan for my most recent bill on the epic EHR system, and this is the first time I've ever used the financial/billing section and decided to peek around at everything.
Long story short- you can look up visits that were billed for just over the past 10 years at the health system I go to. It stops at around the time they switched to a different type of EHR.
Took a scroll down memory lane, and also just to see how certain things get billed, etc. Also to compare the rates of services that I still receive now vs 10 years ago. What I did notice, was that a physician that I saw 10 years ago a few times billed my insurance for a service that was not provided. I know for a fact it was not provided because I even asked him about this the first time I met him. He took over a type of medical service clinic a doctor I had been seeing had left. His comment to me was some doctor's need to use it, he did not. This is partially why I left that location.
I know it's been so long there's nothing to be done about the charges, but my main concern was how many other patients did this happen to?
I contacted billing, to say something, I explained I wasn't expecting the charges to be reimbursed or anything but wanted to say something due to the "other" patients factor. The lady was aggravated and she looked at the notes (this is before you had access to what they wrote w/out making a special request), and said "well his notes said he did this using (the machine I was billed for that wasn't used)".
Admittedly I wasn't really good at understanding bills back then, plus a lot of times the hospital bill would come without an explanation of charges, and the EOB from insurance may say one thing one month, then say something different the next month. I'm on this shit like a hawk now due to being on medicare and on SSDI, so I have limited income and have learned I need to watch things.
Even though this is 10 years ago and that physician no longer works there, is it worth requesting an amendment of the 3 medical records from his visits, because he lied and said he used something he did not use? Perhaps they may look into other patients files? I just think that's a shitty thing to do, and maybe he did it because most patients would not go through the trouble to request a copy of their medical records.
I've been on cosyntyxfor my psoriasis for about 4 years now and pay every other month for 2 injections. I recently changed jobs but got the same plan under Kaiser and they're trying to make me pay my deductible of $1600 all at once just to get my meds. I imagine this is just how the shitty system works and there's no way around me paying $1600 for 2 injections?
Any one have experience getting out of something like this? If I didn't have to pay it all at once for a 2 month dosage I wouldn't be as upset but this is just too much at once for something I need.
Hello all,
As the title says I am somewhat confused about the process to get seen by a doctor.
I am trying to apply for VA Disability and would like to gather evidence with doctors notes to show I have what I claim to have.
Is there a website I can go to to get seen by somebody or how does it work?
Thank you so much for reading.
I'm really frustrated and confused about my dental insurance claim denial. I'm hoping someone here might have some insight or advice. Here’s the situation:
CHART, CLAIM FORM, AND DENIAL LETTER HERE
Background:
Attachments:
THE FOLLOWING IS INCLUDED HERE
Details:
Current Status:
Questions:
Earlier this week (Tuesday) my 3 y/o had a bad fall where he fell off my office chair and hit the back of his head on my floor tile. He fell straight back hitting the back part of his head. The impact was hard and I wasn’t able to grab or catch him in time. He cried for approximately 10-15 mins and we took him to the our local Children’s Hospital (Phoenix Children’s Hospital). We were seen by a Nurse Practitioner upon initial physical assessment. However, my Toddler’s head injury although he struck the back of his head me (dad) and mom noticed that there was swelling on the side of the left side of his head. That was concerning for us so we made the NP aware and she said that she was going to have the Doctor come in and check him out as well. He initially assessment she said that he didn’t seem concussed, he wasn’t dizzy or having trouble walking. He never vomitted, he never lost consciousness. And by this time (4 hours had gone by while waiting for the Doctor after the NP’s first assessment. She said she didn’t think anything serious. But they wanted us to stay there 2 more hours (total of 6) to make sure. A short while after the Doctor came in and she pretty much said the same thing as the NP. The only thing that she said additionally was that she thought about doing a CT scan but because my son at this point looked fine. He was being his normal self, she didn’t suggest because of the radiation exposure. Also, if the spots where the impact was and the side swelling. Got “smushy” or he started to develop signs like throwing up, trouble walking, dizzy, etc to bring him back right away. Three days pass by and my son seems fine. However that spots on his back of the head has virtually gone down and is barely noticeable. Now the spot on the side of his head has gone down some but it’s still pretty noticeable. And it feels “smushy”. So my wife (mom) talks to her friend which is a Peds RN and she said we should take him back and demand a CT scan and or X-Ray. That she was shocked they didn’t do any imaging to rule anything out. She has seen times where unfortunately a child’s parents have been told similar to us and unfortunately they don’t wake up. Now she’s an RN in CA and we’re in AZ. Not that that should matter all children/people should receive the same standard and high quality of care as possible. So we took him back yesterday (3 days after the first hospital visit) and to make a long story short. My son had a CT scan and the results showed he has a hairline fracture and a minir superficial brain bleed. My wife’s RN friend said that we should seek an attorney for malpractice and negligence, because god forbid what if our son didn’t wake up. She emphasized how they didn’t do any imaging and said they don’t have x-ray vision to have just sent our son home with a CT/X-Ray. So her comments made me start to think. So I did some digging on the internet and found cases of children where they suffered a head injury, they had a physical assessment done by a medical provider, ruled okay to go home only to never wake up again. This really scared the crap out of me. Me and my Wife aren’t medical professionals we put our trust and hope into the healthcare professionals and trust they will do their absolute best. My wife’s RN friend said even if you don’t win the case it makes that Doctor and NP (Hospital) approach this situation differently in the future and can potentially save a child’s life. Sorry for the long post. Thank you in advance for any feedback and advise. Me and my wife have been through all sorts of emotions this week. Scared, sad and now honestly upset and mad. Thank you all for your valuable help! Do we have a case? TIA
I am managing the Leapfrog Survey submission for my hospital right now. It’s my first time working on Leapfrog and I feel like I’m going to loose my damn mind. I’m here working on a Saturday and wondering if anyone is in the same boat?
Hi! I hope this is the right place to ask this!
I'm turning 17 next month and I'm heading to the 11th grade, I recently started to think about what I wanted to do in the future and I've allways had an interest in the medical field.
I want to know how to get a head start, what to do and what collages I should strive for. I want to be a general surgeon in the future, that's honestly my dream job.
So if anybody has any tips or advice I'd love to hear it!
(Reposted cause I accidentally posted in the wrong place 😅)
Sometimes, when I search up potential doctors, I look up rateMD reviews online
The rateMD reviews might be 4.9/5, but when I go there , the experience is the complete opposite and completely horrible
Is RateMDs reliable source from which to choose doctors?
The other day I got a prescription for medication via telehealth. The prescription was sent to the pharmacy and that was that. Today I went to the pharmacy to pick it up—the pharmacy is in network with my insurance and the medicine is also covered by my insurance so I assumed there would be no issues. Turns out, my medication got put on hold because the DOCTER who wrote my prescription, not the medication or pharmacy itself, is out of network (and is out of state as well. Read: telehealth). This is the first time this has happened to me. If the prescription was already written and approved and sent, does the docter who wrote it have to be in network as well? I’m in NY, does this sort of thing vary by state?
I called 911 for an ambulance to the ER because my asthma was flairing and my nebulizer and inhalers weren’t helping. I told them I used albuterol, they gave me more in the ambulance, then I got more in the ER. When the doctor went to discharge me she became upset when I told her I was still wheezing and couldn’t breathe well. She gave me a spacer for my inhaler, ANOTHER prescription for the same albuterol, and told me “go home, lay down, and breathe.”
I made it home then couldn’t breath. 10 minutes later I was back via ambulance. I collapsed at home, was rushed into the ICU; intubated and sedated for 2 days. I almost went into cardiac arrest, my oxygen levels dropped to ~70%, and I had damn near a liter of fluid in my lungs. I ended up in the hospital for a full week and I’m lucky to be alive.
Is this lawsuit worthy? Can I dispute it with insurance? What should I do from here to get the ER doctor that failed at her job?
I called both the United Healthcare people and the Urgent Care where I visited each about 2-3 times. I'm new to being independently insured, and I have a crappy short-term health insurance plan through United Healthcare where I pay monthly (not insured through my employer at all). On the explanation of benefits, it looks like I have a discount for the urgent care (I checked, the urgent care is in network), although that discount was not applied to my bill from the urgent care at all. At the bottom of the explanation of benefits from United Healthcare, they say I owe $353.11, and that they'll be paying $0, but that doesn't make sense to me if my original bill was $600.90. I understand that there are reason codes for why things aren't covered, but that's talking about the after-discount amount, right? When I called, the customer service lady from United Healthcare told me I had to pay the full $600 and kept reading a canned explanation over and over to me when I didn't understand. Am I an idiot? I'm really confused about why it says I owe $353.11 on the EoB but $600.90 on the bill.
I make $200 over the threshold for Medicaid so I’m losing it in 2 weeks…
I’m self employed & barely make above the poverty limits… so fun.
I went to Healthcare gov site - filled out the form with my info …and was directed to Medicaid. Knowing I’m being booted from Medicaid; what now?!
Too poor for ACA. Too “rich” for Medicaid.
What do I do??
I’m not sure if this is the right place to ask. I’ve been toying with the idea of opening my own homecare agency. I’ve been in the industry roughly 15 years. And have yet to find a company that does it “right.” I constantly see great caregivers, with management that sees their clients as dollar signs and brush off concerns caregivers bring up and treat their clients like crap when they call with a concern or question. I’ve thought of starting my own, but don’t know where to start. I know how and where to advertise to get clients. I’ve known enough people over the years that I feel like I could get good staff pretty quick and easy. I’ve run a couple of assisted livings in the past and kept in touch with my contacts from then. But the business aspect of it all…I have no clue where to start or what I need. Obviously a lot of overhead cash. LLC and other basic licensing. Probably a good attorney. But I’d love like a step by step if anyone knows where to find that, or has done this before.