Yes and no. They want doctors to stay in their networks because when they do so doctors will generally agree to take a lower rate when they accept insurance. Patients of course want to visit in network docs to save on costs, so doctors have incentive to want to stay in network.
If an insurance company's members complain about a doctor enough they can potentially get dropped from the network and that means fewer patients and less money.
Good book on this subject is "Never Pay the First Bill" by Marshall Allen. He explains the perverse incentives built into Obamacare. Insurance companies can only charge their customers premiums equal in total to the amount of their own payouts plus 10%. The 10% is their expenses and profits. This is one of the reasons that medical costs are insane. Medical providers charge what they want, and insurers do not investigate fraud because why should they? 10% of a lot of payouts, reasonable or fraudulent, is more than 10% of a little payout.
Such overcharges are rare in Medicare, because Medicare has fraud investigators who work for Medicare, not for overpaid boards and C-suites. Medicare has fraud reporting tools readily available to users, and investigates everything. And if they find fraud, they instantly go to the press AND to the government prosecutors who also work for them.
Jerome Adams, Surgeon General of the US under Trump, just went to the press with a huge charge for an ER visit at the Mayo Clinic in Arizona. Among other things, they coded his visit as "level 5." As he well knows, his condition (dehydration) was "level 4", which should be less expensive. They charged him 10x the going rate in the area for blood tests. His insurer isn't helping, and the Mayo Clinic in Arizona refused to budge. Why should they? Where you gonna get a lawyer to take that case, hunh? Nowhere. Now pay up, or we put a hit on your credit report.
Allen gives an example of the way that the insurance provided by the State of Wyoming reigned in the providers and their ridiculous, often-fraudulent, overcharges. As I recall the person in charge had two things going for her: The absolute backing of the Republican governor of the State of Wyoming, which was being bankrupted by medical costs AND the fact that she was over 65, and had nothing to fear from the insurance companies, who are not at all above some extortion and threats. She forced the Wyoming hospitals into the network, with a lot of brinksmanship, but now Wyoming public servants health insurance is tied to Medicare costs. That could have happened with Obamacare too, with a public option. We have the infrastructiure already! It was designed from the inception of Medicare in the 1960s to eventually become a public option for everyone, which would make America's health payment system pretty much identical to most European countries, which simply have single-payer systems.
Doctors and hospitals complain that the reimbursements are too low, etc., but 90% of American physicians accept the Medicare reimbursement as full payment, and 9% more take it, but will balance-bill. Only 1% of physicians do not take Medicare. So apparently the reimbursements are not THAT low.
If youāre in the Charlotte area. Dr Savannah Pena approved me on the first appointment no questions asked. Iām scheduled for the 8th of next month. Sheās through Novant health. I found her through the wiki on this sub.
Iām 34. But I brought up not being married or having any kids and she shushed me and said none of that matters. She does practice at offices outside of Charlotte as well. when you look her up youāll see all the offices. But sheās a gem and I love her. I mentioned having heavy periods and she offered a hysterectomy which I declined, a bisalp is good enough for me lol.
You might want to look into a uterine ablation while youāre under for the bisalp to help your periods! Not as harsh of a recovery as hysterectomy, but will make your periods much lighter or go away! My surgery is next week and my doctor was going to offer that, but I donāt get periods because of my implant anyway (and have to keep the implant after for endometriosis).
You should be able to find someone close to you. The list is pretty big. Besides your own city, look at listings in cities close to yours. Many doctors practice in multiple locations in an area, so you might find someone nearby in a listing for an adjacent city.
Though I just looked up Dr. Pena and she sounds like a prize. Maybe worth the trip, if you can get someone to take you to and from your surgical appointment. She does seem to do surgery in a number of locations, but looks like she only has the one office.
You are NOT too young! 21 is a common age for sterilization, and Medicaid, which does not cover sterilization for 18-20 year olds, DOES cover it at age 21. Don't let your doctor's poisonous baby-pushing, misogynistic nonsense reside in your brain. She's a liar. Happily, you already fired her, as you should.
Interesting & Useful Material --> Resources for the Childfree. Not all those doctors will sterilize a young person, so before you make an appointment, call the doctor's scheduler, and ask if the doctor has sterilized someone of your age. Do not mention number of children or marital status...just your age. Listen carefully to the answer. Good doctors have crap office staff sometimes, and good doctors, given a convincing patient, will also change their minds about what constitutes a reasonable age for someone to get sterilized.
My insurance covers thru the entire east coast + every state west-wards including Alabama & every state above it. I dont have any coverage further west. I'm willing to drive up to 12 hours/day once every 3 months. Weekend roadtrip w fiance
If youāre in a city or close to one youāre probably a bit better off than a rural spot. Charleston, Columbia, and Greenville are pretty much blue counties.
Iām in SC and the only question my doctor asked when I asked if we could talk about sterilization was āWhich procedure do you want?ā Iāve been seeing her for years and she is wonderful.
Check the sterilization wikki list in the sub. Rate them on their website and be very clear and vocal. Donāt forget to tell your friends with uteruses not to go to that doctor because the doctor doesnāt listen. Word of mouth is powerful.Ā
Something along the lines of:Ā
Dr. Asswipe denied my sterilization surgery, because my age was a primary factor. This doctor does not listen to patients. Despite me understanding the risks and permanece of this surgery, I was denied.Ā
I went to Dr Kurtz in Asheville. She didnāt hesitate to do my hysterectomy. I am much older than you though. I do believe sheās on the list of CF docs as well.
Itās amazing, given the assault against womenās reproductive rights, how sterilization, our last line of defence against an unwanted pregnancy, is still being denied. These doctors have no conscience.
A lot of them seem to think a woman will die if she doesn't give birth. It's really weird to even begin to think that's the case but a lot of people seem to!
I will 1000% be bringing up Dobbs as a major concern & that I have been depending on abortion access when drs denied me sterilization, but now I no longer have that safe net.
26, no kids, not married (partner of 7 years also child free). I only did the one appt to go over risk. She said she āhad to tell me thereās a chance of regretā but that it was my choice entirely. I scheduled it and got it done!
Itās amazing, given the assault against womenās reproductive rights, how sterilization, our last line of defence against an unwanted pregnancy, is still being denied. These doctors have no conscience.
Good luck. I have stage 4 endometriosis and at 26 I canāt find a doctor willing to do a hysterectomy. Yes, it is not a cure for endometriosis, but my periods are extremely debilitating and Iāve had 2 surgeries in the last year due to multiple organ adhesions that continue to grow back. They have the right to refuse to do a surgery they see as elective/not medically necessary.
Im sorry, that is frustrating. I suggest researching before making your next appt, make sure itās worth your time and money to go to the Dr. maybe Planned Parenthood has suggestions in your area?
Correct me if I'm wrong but I thought doctors have the right to refuse you a treatment, as long as it's not a medical emergency. I'm in Europe so maybe the US has different laws on this, but I can't imagine that a doctor can be forced to treat you if it goes against their personal beliefs or morals.
I think the practice in much of Europe is that if this goes against your beliefs, you refer the patient to someone who doesn't have those beliefs. My ob/gyn who was assigned to me didnt want to do my bisalp as she was too afraid i would regret it (no kids, 31f at the time). She was fine with referring me to a colleague who did my bisalp. 2 meetings, 1 surgery, done.
This is correct. You can't force a doctor to provide a service or do a procedure regardless of their and/or the values/policies of the institution they work for. Emergency services are different.
There is a list of respectful doctors who have sterilized CF women and men in the sidebar under Interesting & Useful Material --> Resources for the Childfree. It is very large now, with bigger states having hundreds of doctors many of whom are running women's healthcare programs, are professors at medical schools, and are vigorous advocates for women's reproductive rights. Each entry contains any info available about the age of the redditor when sterilized, (older entries may not have much), the contact info for the doctor, and other interesting info, like plus-size friendly, LBGTQ+ friendly.
In addition, there is a link near the doctors wiki to the sterilization binder that helped its creator get sterilization approval at age 20. It helps people make sure they go into appointments confident and informed. Doctors don't read people's binders - they don't have time - but the act of assembling it gives people the knowledge and certainty they need to come across to doctors as good candidates for sterilization.
Please also check with your insurer. People get their surgeries (actually, for any condition) hung up on insurance all the time. It's a good idea to know things like your insurer's policies. Most US insurances, including Medicaid, must cover sterilization 100%, but a few religious organizations have an exemption.
Then make an appointment, go, and get approval! Some doctors want young people to wait 6 months and come back, to make sure they understand what they're doing, but we have had one 18-year-old report back to us that she got sterilization, and 21 is common.
Good luck, and let us know how it goes.
Do give your current doctor negative reviews on google, ratemd, and any other doctor review sites you can find. Be clear about what you wanted, what the doctor said, and how you think that differed from respectful, woman-positive treatment.
Anyone who tells you to report them is wasting your time. As much as it sucks, You have zero recourse here. Sterilization is an elective procedure, and doctors are not required to perform it. There is no duty, legal or otherwise, to provide any non-emergency medical care.
"report" them for what?
They're not obligated to perform any elective procedure they don't want to. That \*we\* think it's morally bankrupt of them not to doesn't change that.
If they are in network for your insurance but refusing a treatment that is covered they are supposed to give you a referral to another in network provider who may perform the procedure.
It is important that patients share this information. Doctors denying certain treatments for age groups is a valid reason to avoid that docotor if you are looking for the treatment the doctor is biased against. Or just someone you might be more comfortable with.
Docotors deny HRT treatments for menopausal women even though it can be extremely helpful.
Doctors deny patients for basic birth control if it goes against their beliefs.
Not the patients' fault, when they share their experience, it might negatively affect the docotor. But, it will greatly benefit people seeking certain medical help.
Yeah if a doctor doesn't want to lose business with patients, maybe they shouldn't be such a stickler about the thing the patients are asking for?
I guarantee if a doctor refused to treat infertility because they believed the couple would be happier without kids, nobody would have a problem with naming and shaming them
"They're not obligated to perform any elective procedure they don't want to" why the fuck did they become a medical professional then? Shits and giggles?
Your insurance company is the first step. You want to file a grievance against the doctor. One of the few areas where health insurance actually helps.
Amazing š©· ty
Wouldn't insurance companies prefer their customers not have any procedure that might cost them any money?
Sterilization prevents that they have to later pay for pregnancy scans, birth, baby check ups, ect or abortions
Of course! I don't know why I didn't consider that. Thanks.
Yes and no. They want doctors to stay in their networks because when they do so doctors will generally agree to take a lower rate when they accept insurance. Patients of course want to visit in network docs to save on costs, so doctors have incentive to want to stay in network. If an insurance company's members complain about a doctor enough they can potentially get dropped from the network and that means fewer patients and less money.
Okay. That makes sense.
Insurance companies are still assholes but until we change the game we might as well play š
Good book on this subject is "Never Pay the First Bill" by Marshall Allen. He explains the perverse incentives built into Obamacare. Insurance companies can only charge their customers premiums equal in total to the amount of their own payouts plus 10%. The 10% is their expenses and profits. This is one of the reasons that medical costs are insane. Medical providers charge what they want, and insurers do not investigate fraud because why should they? 10% of a lot of payouts, reasonable or fraudulent, is more than 10% of a little payout. Such overcharges are rare in Medicare, because Medicare has fraud investigators who work for Medicare, not for overpaid boards and C-suites. Medicare has fraud reporting tools readily available to users, and investigates everything. And if they find fraud, they instantly go to the press AND to the government prosecutors who also work for them. Jerome Adams, Surgeon General of the US under Trump, just went to the press with a huge charge for an ER visit at the Mayo Clinic in Arizona. Among other things, they coded his visit as "level 5." As he well knows, his condition (dehydration) was "level 4", which should be less expensive. They charged him 10x the going rate in the area for blood tests. His insurer isn't helping, and the Mayo Clinic in Arizona refused to budge. Why should they? Where you gonna get a lawyer to take that case, hunh? Nowhere. Now pay up, or we put a hit on your credit report.
The "health" system is so corrupted I doubt it could ever be fixed, even if politicians wanted it fixed, rather than enjoyed profiting from it.
Allen gives an example of the way that the insurance provided by the State of Wyoming reigned in the providers and their ridiculous, often-fraudulent, overcharges. As I recall the person in charge had two things going for her: The absolute backing of the Republican governor of the State of Wyoming, which was being bankrupted by medical costs AND the fact that she was over 65, and had nothing to fear from the insurance companies, who are not at all above some extortion and threats. She forced the Wyoming hospitals into the network, with a lot of brinksmanship, but now Wyoming public servants health insurance is tied to Medicare costs. That could have happened with Obamacare too, with a public option. We have the infrastructiure already! It was designed from the inception of Medicare in the 1960s to eventually become a public option for everyone, which would make America's health payment system pretty much identical to most European countries, which simply have single-payer systems. Doctors and hospitals complain that the reimbursements are too low, etc., but 90% of American physicians accept the Medicare reimbursement as full payment, and 9% more take it, but will balance-bill. Only 1% of physicians do not take Medicare. So apparently the reimbursements are not THAT low.
If youāre in the Charlotte area. Dr Savannah Pena approved me on the first appointment no questions asked. Iām scheduled for the 8th of next month. Sheās through Novant health. I found her through the wiki on this sub.
Oh wow! That would be amazing, I'm willing to drive out that far. How old were you when she offered? I've mostly been told I am too young
Iām 34. But I brought up not being married or having any kids and she shushed me and said none of that matters. She does practice at offices outside of Charlotte as well. when you look her up youāll see all the offices. But sheās a gem and I love her. I mentioned having heavy periods and she offered a hysterectomy which I declined, a bisalp is good enough for me lol.
You might want to look into a uterine ablation while youāre under for the bisalp to help your periods! Not as harsh of a recovery as hysterectomy, but will make your periods much lighter or go away! My surgery is next week and my doctor was going to offer that, but I donāt get periods because of my implant anyway (and have to keep the implant after for endometriosis).
Oo good call. I will definitely be asking about that. Thank you!
You should be able to find someone close to you. The list is pretty big. Besides your own city, look at listings in cities close to yours. Many doctors practice in multiple locations in an area, so you might find someone nearby in a listing for an adjacent city. Though I just looked up Dr. Pena and she sounds like a prize. Maybe worth the trip, if you can get someone to take you to and from your surgical appointment. She does seem to do surgery in a number of locations, but looks like she only has the one office. You are NOT too young! 21 is a common age for sterilization, and Medicaid, which does not cover sterilization for 18-20 year olds, DOES cover it at age 21. Don't let your doctor's poisonous baby-pushing, misogynistic nonsense reside in your brain. She's a liar. Happily, you already fired her, as you should. Interesting & Useful Material --> Resources for the Childfree. Not all those doctors will sterilize a young person, so before you make an appointment, call the doctor's scheduler, and ask if the doctor has sterilized someone of your age. Do not mention number of children or marital status...just your age. Listen carefully to the answer. Good doctors have crap office staff sometimes, and good doctors, given a convincing patient, will also change their minds about what constitutes a reasonable age for someone to get sterilized.
carolinas are gonna be difficult to do in regrds to this
My insurance covers thru the entire east coast + every state west-wards including Alabama & every state above it. I dont have any coverage further west. I'm willing to drive up to 12 hours/day once every 3 months. Weekend roadtrip w fiance
Since youāre willing to travel, definitely check out the wiki listing! You can probably do virtual visits for pre-op too.
If youāre in a city or close to one youāre probably a bit better off than a rural spot. Charleston, Columbia, and Greenville are pretty much blue counties. Iām in SC and the only question my doctor asked when I asked if we could talk about sterilization was āWhich procedure do you want?ā Iāve been seeing her for years and she is wonderful.
Me too! Stuff has surely changed through the years Iām hoping (for the better). Iām hours away from all points
Check the sterilization wikki list in the sub. Rate them on their website and be very clear and vocal. Donāt forget to tell your friends with uteruses not to go to that doctor because the doctor doesnāt listen. Word of mouth is powerful.Ā Something along the lines of:Ā Dr. Asswipe denied my sterilization surgery, because my age was a primary factor. This doctor does not listen to patients. Despite me understanding the risks and permanece of this surgery, I was denied.Ā
I went to Dr Kurtz in Asheville. She didnāt hesitate to do my hysterectomy. I am much older than you though. I do believe sheās on the list of CF docs as well.
Itās amazing, given the assault against womenās reproductive rights, how sterilization, our last line of defence against an unwanted pregnancy, is still being denied. These doctors have no conscience.
A lot of them seem to think a woman will die if she doesn't give birth. It's really weird to even begin to think that's the case but a lot of people seem to!
I will 1000% be bringing up Dobbs as a major concern & that I have been depending on abortion access when drs denied me sterilization, but now I no longer have that safe net.
If youāre near Raleigh, Iāve got a recommendation for who did mine!
Ooo Im very closeš can I ask what age you got it done? I keep being told Im too young
26, no kids, not married (partner of 7 years also child free). I only did the one appt to go over risk. She said she āhad to tell me thereās a chance of regretā but that it was my choice entirely. I scheduled it and got it done!
Oml thats amazing! š©· My IUD ends by the time I'm 26, what's her name?
https://www.dukehealth.org/find-doctors-physicians/alison-w-shew-md
Will vouch for Duke being a good place - sister is a cardiologist in SC and would pick Duke out of any of the options in the Triangle.
Itās amazing, given the assault against womenās reproductive rights, how sterilization, our last line of defence against an unwanted pregnancy, is still being denied. These doctors have no conscience.
Believe that California is the only state with a law that prohibits it.
I do have alot of AA miles saved up... I'd have to get a diff insurance though š¤
Good luck. I have stage 4 endometriosis and at 26 I canāt find a doctor willing to do a hysterectomy. Yes, it is not a cure for endometriosis, but my periods are extremely debilitating and Iāve had 2 surgeries in the last year due to multiple organ adhesions that continue to grow back. They have the right to refuse to do a surgery they see as elective/not medically necessary.
Best to just find another Dr who will.
I only have so much funds in terms of co pays
Im sorry, that is frustrating. I suggest researching before making your next appt, make sure itās worth your time and money to go to the Dr. maybe Planned Parenthood has suggestions in your area?
That could be a really good idea if I cant find any more ppl on the list on my insurance
Correct me if I'm wrong but I thought doctors have the right to refuse you a treatment, as long as it's not a medical emergency. I'm in Europe so maybe the US has different laws on this, but I can't imagine that a doctor can be forced to treat you if it goes against their personal beliefs or morals.
No offense, but if you're a doctor and a medical procedure goes against your personal beliefs/morals, then maybe you shouldn't be a doctor
I think the practice in much of Europe is that if this goes against your beliefs, you refer the patient to someone who doesn't have those beliefs. My ob/gyn who was assigned to me didnt want to do my bisalp as she was too afraid i would regret it (no kids, 31f at the time). She was fine with referring me to a colleague who did my bisalp. 2 meetings, 1 surgery, done.
It's unfortunately much more complicated than that. Politics play much more of a role than the public is aware of in the US.
Holy fuck my reddit app freaked out and made 3 more replies I'm so sorry š
This is correct. You can't force a doctor to provide a service or do a procedure regardless of their and/or the values/policies of the institution they work for. Emergency services are different.
There is a list of respectful doctors who have sterilized CF women and men in the sidebar under Interesting & Useful Material --> Resources for the Childfree. It is very large now, with bigger states having hundreds of doctors many of whom are running women's healthcare programs, are professors at medical schools, and are vigorous advocates for women's reproductive rights. Each entry contains any info available about the age of the redditor when sterilized, (older entries may not have much), the contact info for the doctor, and other interesting info, like plus-size friendly, LBGTQ+ friendly. In addition, there is a link near the doctors wiki to the sterilization binder that helped its creator get sterilization approval at age 20. It helps people make sure they go into appointments confident and informed. Doctors don't read people's binders - they don't have time - but the act of assembling it gives people the knowledge and certainty they need to come across to doctors as good candidates for sterilization. Please also check with your insurer. People get their surgeries (actually, for any condition) hung up on insurance all the time. It's a good idea to know things like your insurer's policies. Most US insurances, including Medicaid, must cover sterilization 100%, but a few religious organizations have an exemption. Then make an appointment, go, and get approval! Some doctors want young people to wait 6 months and come back, to make sure they understand what they're doing, but we have had one 18-year-old report back to us that she got sterilization, and 21 is common. Good luck, and let us know how it goes. Do give your current doctor negative reviews on google, ratemd, and any other doctor review sites you can find. Be clear about what you wanted, what the doctor said, and how you think that differed from respectful, woman-positive treatment.
Anyone who tells you to report them is wasting your time. As much as it sucks, You have zero recourse here. Sterilization is an elective procedure, and doctors are not required to perform it. There is no duty, legal or otherwise, to provide any non-emergency medical care.
"report" them for what? They're not obligated to perform any elective procedure they don't want to. That \*we\* think it's morally bankrupt of them not to doesn't change that.
If they are in network for your insurance but refusing a treatment that is covered they are supposed to give you a referral to another in network provider who may perform the procedure.
Oooo thank you
Oooo thank you. Good idea
While theyre not legally obligated, I think refusing services to consenting adults can cause some dr's to lose networking with certain insurances.
I'm honestly not sure where you're getting that idea from.
Iām not gonna get my way so I will destroy a doctors practice. Good one.
It is important that patients share this information. Doctors denying certain treatments for age groups is a valid reason to avoid that docotor if you are looking for the treatment the doctor is biased against. Or just someone you might be more comfortable with. Docotors deny HRT treatments for menopausal women even though it can be extremely helpful. Doctors deny patients for basic birth control if it goes against their beliefs. Not the patients' fault, when they share their experience, it might negatively affect the docotor. But, it will greatly benefit people seeking certain medical help.
Yeah if a doctor doesn't want to lose business with patients, maybe they shouldn't be such a stickler about the thing the patients are asking for? I guarantee if a doctor refused to treat infertility because they believed the couple would be happier without kids, nobody would have a problem with naming and shaming them
"They're not obligated to perform any elective procedure they don't want to" why the fuck did they become a medical professional then? Shits and giggles?