#fuck the medical community and insurance companies

[serpentinegraphite]

While there are varying factors behind EFT in general and as a recent trend, i can at least highlight one factor in why it's so fucking prevalent in American healthcare (and presumably other industries): outsourcing.

A lot of healthcare facilities don't really do their own billing anymore? They go through a billing company. Sometimes multiple billing companies.

A small private practice has the staff to offer various health-related and perhaps even specialty services. But instead of keeping on regular staff for billing or whatever, they outsource to a company that specializes in medical billing, ostensibly to streamline the process (so that doctors aren't having to train billing staff; billing staff can confer with fellow billing specialists at the big Medical Billing Company and they can all be better at their jobs).

However, several things often happen with outsourcing:

• there's little to no direct communication between the providers and the billing staff. They're not in the same building. They're not at the same company. The billing staff probably don't ever talk to the doctors, possibly even the office manager directly. That's for the Medical Billing Company management to deal with.

• internal communication isn't much better. Billing companies don't like to escalate things to managers. And they don't like when someone doesn't know how to fix a problem. And it's not efficient to take the appropriate amount of time to solve every issue, especially when the employees aren't trained in medical billing or coding or perhaps even in the basics of American healthcare.

• underpaid employees are encouraged (okay, often required) to send the bill to the patient rather than solve the problem. Patients HATE bills. They'll call back and solve the problem.

• internal communication is REALLY bad actually. I was trying to soften the blow before. Sorry. Even when i worked at a comprehensive billing company, they had separate departments for patient calls and back office billing and front office minutiae. We weren't just discouraged from speaking with other departments about a particular issue, it was nigh impossible.

• many aspects of healthcare billing are actually outsourced to different companies! These days in the US, a practice will often outsource the labs to a lab company which may be or have an office in the healthcare facility. (The lab also, separately, outsources their billing.) Coding, billing, and patient calls are often outsourced to separate companies.

• that's already four different departments or even companies (plus the healthcare facility) for tasks that used to take place in the same building.

• those billing companies? Might also be subtly or overtly outsourcing some of their work too.

So, to recap: the front desk books your appointment. You get, let's say, uh some kind of blood test done (separate bill, separate company). The doctor checks you over. Then jots down some notes on your chart and maybe some basic deets for billing purposes.

Someone else, perhaps a doctor or nurse or certified coder (perhaps outsourced! though there is more liability in this step so that's less common) has to put in the billing information and the relevant medical codes.

That information goes to your insurance company (which definitely outsources everything they can't automate).

Then, it doesn't go back to your doctor. It goes to the billing department (outsourced), which isn't paid well enough to spend more than 5 minutes on your issue. They bill the patient because they're being timed down to the click on every claim.

You, the patient, now have to figure out a) which billing department you need (labs or surgery or just the doctor's visit), b) what the issue is (no one in the chain will give you more information than the automated denial), c) how to fix the issue (what's a prior authorization and since when is the patient responsible for it?), and d) who else to call because the first number you try is never right. Even if you do everything right, sometimes the phone tree will misdirect you. Sometimes you get a disgruntled employee on the first try.

This is both cheaper and more efficient. :) allegedly. :)

I think this is just a trend everywhere but I've been very frustrated this week by how much admin work is being outsourced to me as the patient/customer.

My orthodontist tells me I can make an appointment with the surgeon. I call the surgeon. They tell me I need a new referral. I call the orthodontist. They do a referral. I call the surgeon. Referral didn't come through. They tell me about their special unique system we have to use. I call the ortho again and walk them through the referral. I call the surgeon. They say the referral was missing some details so they have to do it again. I call the ortho.

The insurance company calls me about repair shops. I give them the name of the repair shop which I already gave them yesterday. They say they're not in their system but I can use them, but I have to call the repair shop to ask them to contact the insurance company. I call the repair shop and they say the insurance company is supposed to email them.

I feel like at a certain point these constant fetch quests become unreasonable?? Is it too much to expect these groups to communicate with each other instead of making me run back and forth between them???

[emiliosandozsequence]

as someone who literally has had to fight tooth and nail for a diagnosis to get treatment for a disease i've had all my life because the healthcare system in this country is fucked, i want to send the insurance shooter flowers

[benjaminallhope-fulltimemind]

Wow shocking things might be getting out of control, how could anyone have seen this coming?

[punk-pins]

american health insurance industry. not great!

[pandavalkyrie]

If it isn't already obvious, I work in utilization management. For those that don't know, it's a department that exists in most hospitals with the single minded purpose of getting health insurance companies to pay their due.

It's usually staffed by a lot of overworked nurses and one or two physicians, usually doing UM alongside actual clinical practice.

The nurses use whats in the patient's chart to justify the diagnostic code. They then upload those clinicals to the insurance company's portal, or fax them over.

Then, if we're lucky, a human being compares the clinicals with the MCG or other clinical standard guidelines and decides whether or not the chart justifies the diagnosis and treatment.

If we're not lucky, it's UHC which uses an automated system with a 90% error rate that denies 1/3 of the claims they receive.

In that case our nurses, who have to do this and so much more for about 90 patients a day *each*, have to go back in and highlight the criteria and hope it escalates to a human being.

The denial will usually be upheld.

So the case is forwarded to a contracted consultant company that staffs physician advisors. Their job is to narrow down exactly what needs to be done to beat the insurance company at their own game. The hospital pays for this service. Sometimes it works.

Often it doesn't, and the denial is still upheld.

So it goes to peer to peer. This means one of our doctors will have a phone call with a doctor on staff at the insurance company. There is no guarantee their doc will know anything about the specialty involved. I've seen OBGYNs make final calls on psych cases. This is the last chance.

Sometimes the physician on staff at the insurance company has a heart, and remembers what they got into medical school for. But often they have only a few minutes to make a judgement before the next peer to peer, and they have a quota of denials to maintain to keep their jobs.

So usually it's denied, and that's it. There's nothing else to do. The insurance company smugly gloats about protecting consumers from overuse of healthcare resources, the hospital bills the patient directly hoping to recoup something from it (even giving the patient services to help reduce their bill) and the patient is fucked at best, forgoes life saving care at worst.

All of that for such a shit ending. All of that money, time, administrative resources, look at it. Look at how many people are employed in the attempt to get insurance companies to pay and how many are employed to prevent it. There is so much bloat in the industry around this one thing, this one process, and it all goes back into the already inflated bill.

I go through insurance communications, I open the medical record with a photo of a child undergoing chemo. She's so small and so brave, smiling for the camera. Weeks of fighting back and forth to guarantee her care until one day I open it to forward yet another denial, and see the big gray 'deceased' tag under her now black and white photo. And I take a minute, I cry, I forward the fax, and I continue on. And this exact scenario repeats at least twice month.

We don't have to live this way. We don't have to.

[genderqueerpositivity]

TW: medical/surgery talk and dysphoria

I am officially one step closer to my hysterectomy.

After nearly 10 months of effort, I have the support of my primary care doctor, my therapist, my psychiatrist, and the doctor who will be doing the procedure.

I've also gone through the pelvic exam and the transvaginal ultrasound that my doctor requires of patients seeking a hysterectomy; and to be absolutely clear, I would not have agreed to the ultrasound if it weren't a requirement for the surgery.

In spite of all of this, of course, there is still my health insurance company to convince of the necessity of the surgery. I should hopefully know more in the next week or two.

Every step of my medical transition has been blocked by some barrier at one time or another. I'm lucky to have even made it as far as I have.

This is why I want to laugh and cry when certain folks try to claim that it is too easy to medically transition. Every single step of my medical transition has been undertaken as an adult well over the age of 25, paid for with my own insurance or out of my own pocket, with the support of multiple mental health professionals along the way. And still, each step has been difficult.

I've been required to do everything from talk explicitly about my sexual experiences and physical dysphoria for my initial GID diagnosis to having a cold ultrasound wand poked and shoved around inside of my body until I bled. And still I have to do more, still it is not enough.

I want to be excited right now. And on some levels I am! I've been hoping for and looking forward to this for so long! But I am also so fucking tired, I've been so afraid all year of hitting some unnecessary roadblock and having to start this process over. And I am still so so so afraid, because I know now that this probably isn't going to get done before January 20th, and after that who knows if I'll be able to have it done at all.

Also, also? We do a massive fucking disservice to part of our community by not highlighting how difficult it is to medically transition as an AFAB person.

My hormone therapy is a controlled substance that I cannot legally stockpile in anticipation of gender affirming care bans. I was only able to begin hormone therapy in the first place because the requirement of an in person appointment for an initial prescription of a controlled substance was still waived in 2021 due to the pandemic, so I was able to see a telehealth provider. Only this year have I able to begin seeing a primary care doctor willing to take over managing my HRT.

My barriers to a hysterectomy exist both because the procedure is gender affirming care AND because of my sex assigned at birth. Having to repeatedly reassure everyone else involved in this process that I am certain that I do not want to ever experience pregnancy or childbirth is exhausting.

I think I'll be excited and extremely relieved when this is finally done. And then, then, I can finally start thinking about next steps, potentially top surgery...but that will be next, in whatever reality I find myself living in after January 20th.

It's ironically fitting that today is New Year's Eve; it's been a long year and all of this has been a long time in the works. I can only hope that I'll get to start next year off by finally getting this hysterectomy done.

[lazyscience]

So for my followers who come with a factory-installed uterus I know you're concerned about your health and autonomy. And you well should be

But here's something all of you should be thinking about and planning for no matter what your plumbing - if Trump goes through with putting RFK Jr. in a position of power as far as the Department of Health and Human Services, he could do a LOT of damage as far as vaccines. Vaccines are not super profitable for pharma companies, despite what cranks think; they take a LOT of development for only a few uses. Vaccines are driven by public health requirements and a lot of places would shrug and say "ok, bet" if there isn't a guaranteed market for them.

The professional medical community will still have recommendations about when and how to vaccinate, but they won't have the force of law, and insurance will probably smell blood in the water and start kicking up a fuss about covering vaccines when they're not required. So then when doctors recommend them there'll be suspicion and pushback that they're just doing it for "kickbacks" even though the only doctor who would have gotten paid for vaccine is ironically Andrew Wakefield, the lying fuckshit, because his whole "vaccines cause autism" lie was to push his OWN, SPECIAL proprietary vaccines that wouldn't cause his made-up syndrome, because NO vaccines were causing it. May he roast somewhere warm when the devil comes for him.

This will not happen immediately, but. Because there will no doubt be anticipatory compliance on the part of drug companies and healthcare systems. I HIGHLY advise you get the fuck out there and get your Tdap updated (tetanus, diptheria and pertussis). Whooping cough is out there, and it is horrible for babies. If you are eligible for shingles vaccine and haven't done it, get that. Get your COVID vax if you haven't, there might not BE another one, at least not that's available in the US.

If you have kids, especially make sure THEY'RE up to date because their classmates might very well not be mandated to get them any more - state regulations will undoubtedly vary, but with the current composition of the Court, it will rule in favor of every possible exemption for antivaxxers as possible because the conservatives are all "fuck the weakest of us, I got mine fuck you." And expect idiocy like "pox parties" to spread (not like the average suburban parent can tell measles from rubella from chicken pox from hand foot and mouth by fuckin' looking at it, who knows what the christ they're going to be passing around). Measles is NOT just a "bit of a rash." Rubella is the world's leading preventable cause of birth defects. Chickenpox can result in scarring, encephalitis causing blindness or even death, and the risk of shingles later in life. I have a cousin who would be 57 this year who died as a toddler from hemophilus influenzae strain B meningitis, one of those "too many" childhood vaccines that were invented in the 1990s. Tell my aunt that's too many vaccines -oh, wait, you can't, she fucking killed herself out of grief her baby died.

tweens? get them the HPV vaccine if they haven't gotten it (given its associations with sex it'll probably be one of the first to go, but it prevents CANCER. who wants their child to get cervical cancer, or penile cancer, or throat cancer, or rectal cancer? IT PREVENTS CANCER. JUST DO IT.)

Similarly, if you have a child with any kind of immune issue that precludes vaccination, I would very much look into homeschooling, because bye-bye herd immunity.

If you have teenage kids, encourage them to update their Tdap and get the meningiococcal meningitis vaccine if they haven't been mandated to already by campus policy. Tetanus and meningitis aren't common, but they are frequently permanently life-altering when they're not fatal. We're talking months in the hospital. I'm old enough that I remember people fucking dying in college, and the panic that went around campus every time one of those breakouts happened in the state wondering if it would make its way to our campus.

Stay safe out there. I have no idea what this will do to our already teetering healthcare system but I don't think it'll be pretty. Everybody pray Trump pulls his usual scam and hangs RFK Jr. out to dry, because while the plutocrats consider regulations an unnecessary burden, they don't have a stake in creating a public health state of emergency when we already have a workforce not keeping up with demand, unlike Captain Convenient Brain Worm.

[cirie-won-thirty-four]

I’m gonna need commies to hijack the democratic party like the fascists did the republican party! The antithesis of trump isn’t just another democrat who’s unhinged (Like Gavin Newsom who everyone keeps suggesting), Its a borderline ‘terrorist’ with antifa allegations that’s just like

���yeah fuck cops and the MIC, if Im president, my goal is to abolishing the whole institution’ or

‘my eventual goal is a moneyless stateless America and to start, I’m implementing a wealth cap of $999,999,999.’ Or

‘i’ll imposing STEEP fines for heavy dirty energy usage, infact every company has a national mandate to come up with a clean energy transition plan for the next 5 years, and if you don’t achieve that, you are shut down NO LOOPHOLE. The department of energy had the same mandate, sparing no expense, to switch to clean energy! Whatever we need to build or buy, we are doing it!’ or

‘Healthcare is free now, we’ll find the money! Private hospitals no longer exist and medical insurance companies are abolished’, or

‘No more landlords! If you already own a home, the government will give you the money you paid for it back, If you have a morgage? No you don’t! In fact we’ll give you back the money you already spent and then give you the title! and for all other properties that are not primary residences, the government will buy them all and distribute them to everyone so that everyone has a place to live!…If you want to hold on to a non-primary residence, then the taxes you pay for it will be steep as fuck and the more non-primary residences you have the higher the tax!’

‘human rights are not up for debate like don’t fucking play in my face. Protections for all who need it! I don’t care SHUT UP’

Like just some ABSOLUTELY balls to the wall charismatic psycho. …. ‘That will never take hold’ lmaooo well 10 years ago Americans didn’t think fascism would become a thing in their country and look at it now! Why not communism?

[ooooshetriesss]

Announcement/Update Cat parents of MALE CATS SPECIFICALLY! If their under 8 &/or u’ve yet to learn about ‘the possibility of obstruction (something that CAN & WILL happen to certain genetically predisposed cats; swap them to wet food for their safety & PLEASE READ)

Hey guys💔 Todays rope had to be canceled. I had to rush one of my boys to ER. It was pretty serious, pretty scary & after 2 days I was finally able to bring him home but, I’m gonna have to keep an eye on him.Because of his size & the meds he needed; they hit him heavy so, he needs help going to the bathroom & using the water bowl.

Thank you to everyone whose reached out via IG as this was going down; if I didn’t get back to you, my apologies; it’s been a bit hectic but Im sincerely grateful for everyone’s concern.

IF U HAVE MALE CATS; SWAP THEM TO WET FOOD FOR THEIR SAFETY if u wanna spare a 1k vet bill,

(I was so shocked to hear both the vet & a lot of my fellow cat owners say “yeah it’s common, most ppl just don’t find out their cats intolerant till the worst happens; & because cats mask so well; at that point, it can truly be serious…)

I know Miami is densely populated but not everyone is 10 mins away from a vet. Also times are tough; I cannot stomach the idea of someone losing their cat cause they didn’t have 1000$ on standby (which who the fk has that these days)

I want to make this last part exceptionally clear..,

I am someone who has had a job since before I was legally allowed to obtain one… I’m one of millions of Americans who couldn’t afford college nor qualify for financial aid… I have worked to the BONE In everything from service industry, to blue collar, to maintenance(both in terms of house keeping & even assembling & maintenance of salt water aquariums..was even a groutsmith) like most Americans, I’ve never had insurance & lived paycheck to paycheck + have made just enough to get by since I was 15.

I didn’t have ‘luxurious purchases’ I had medical bills I couldn’t even afford a regular minimum payment on… I didn’t save for ‘exuberant trips’ … I saved to get a weeks worth of groceries…

I never bought a car..: but some days I spent just as much as I made just to get to work ..(& while the men were praised for riding their bikes & showing “that type of initiative…” I was berated for showing up to work “in such a condition” “It doesn’t matter u come in early /before we open to “fix urself up”

When YOU WALK IN THRU THAT DOOR, U WALK/TALK/COME IN LIKE UR ALREADY ON THE CLOCK… U SHOULD BE COMING IN EARLY ANYWAY (just for them to yell at u for actually coming in early)

The ONLY REASON, I (someone who would literally run into a burning building & d*e for their animals; for animals who weren’t even mine) someone who would miss meals so they could eat THE best food…someone who LOVES & is DEDICATED to their creatures, who would do ANYTHING for them, & MOST importantly..

Someone who was DUMB/NAIVE ENOUGH to be ‘the hardest worker in the room for souless companies/selfish ppl for 30+ yrs was ONLY CAPABLE of getting my baby THAT care NOT because of a “traditional (what yall call ‘honest days work’) IT WAS BECAUSE OF WHAT IS CONSIDERED SW. full fucking stop.

& because I had a women who had both a virtually non interest credit card AND my back♥️ (I’ve told u once, I’ll say it again; Grandmas a gangster)

I know SM likes to frame SW as an option for women who “don’t feel like working/ want expensive luxuries things & are looking for a free ride..”

What we’re lookin for is a career that allows us to still man the ship the way we need to, we’ve been expected to..

It allows us not just means for survival, but the capacity to do so WHILE we continue to be the caretakers of our family & (for some particularly exceptional women) the caretakers of our community…

I wanna make it SO clear this is NOT A DIG to ANYONE, ESPECIALLY the vet& staff that helped us & are appreciated SOOO DEEPLY. These are ppl who are overwhelmed, burnt out like the rest of us, expect unlike nurses, they usually aren’t given a 1/4 of the respect other medical professionals are. PLEASE be kind to them. (I know it’s difficult when emotions are high)

But while this was not my regular content, I know ALOT animal lovers on here… times are tough, there only gonnna get tougher… information is invaluable..

1 week before this happened; 1 woman made a video sharing how she JUST lost her MALE CAT (due to this)

Because of THAT video, I was aware this could even happen…

Because of a incredible vet & her team who TRUSTED me when I said “I will figure out the money, u have my WORD” my boy is safe & while expensive; they made it as affordable as possible…

And because of another woman who had my back w/a piece of plastic at the drop of a hat, I was able to bring him home.

And because of some incredible supporters & community like yall who like my content & share it, push it into the algo, find me on other platforms s & interact, even if they can’t financially contribute.. because of being lucky enough to be supported; I was able to make that happen for my boy. Every single variable is what came together to keep him here today & my heart… can’t even think of how to properly thank you all.

The community looked out for me.. & while this post may be all I have to give back ATM.. it’s what I got..

MALE CATS=WET FOOD TO BE SAFE!!!

(Also, CONSTANT FRESH WATER SOURCE BOTH BY & away from their food ; by their food so they have some to access while eating & some away so it stays fresh & can help them pass more easily.)

Love u guys xoxoxo.

We’ll be resuming to our regular scheduled content next week lol

Till then, xoxoox - hummingbird + ‘Fil’ @ooooshetriesss

[lavendercrow136]

I am so sick of living in the United States.

I am saving to move to be with my fiancee, but I work a part time in job in retail, working for basically pennies and work basically paycheck to paycheck.

The economic climate of the us, is atrocious, companies don't pay people what they are worth. And raise the taxes on everything so people are constantly financially struggling.

Health care system is outrageously expensive for most Americans even with insurance. And most insurance companies don't cover mental health services, and then we wonder why the suicide rate in young people is so high.

People seek joy in social media and the little silly videos and things on apps like tik tok and our government officials find false problems, instead of solving real issues like gun control regulation, or trying to repair the economy and make it so american people can afford to live. Or even ensuring people have the right to bodily autonomy.

You can be broke bordering on homeless,

You can encrue debt in a hospital if your sick and dieing- without help or assistance.

Your children can be violently murdered in the safety of their schools, because drag queens and the gay community are percieved as more of a threat to public safety, then violent individuals, that gain access to guns do to improper regulation.

You can battle for a life time with your mental health before you can't take anymore because you can't afford to get the help you need anymore.

Young trans individuals are left with no choice other then to end it, or suffer in a body they don't belong in because the government deems the gender affirming and life saving care they need unnnecessary.

That young woman who was violently raped and impregnated, is forced to carey a baby because she can't get an abortion.

That woman whose suffering a miscarriage can risk bleeding out and dieing because doctors risk losing their licenses if they help treat her medically.

People are dieing, people the us could help both in and out of our country, but No, our elected officials worry about a fucking app.

I am so blessed to have people in my life that make life worth living and make me want to continue to fight my own mental battles.

I am lucky to have something to work towards and strive for to get the fuck out of here, someone I love that loves me and wants to build a life with me and a future, outside of the dystopian hellscape myself and other fellow americans lives in. Because if I did not have her, I don't think I would be here.

This is so much more then an app being banned, its about the government controlling people, and making life so much harder.

[hyperlexichypatia]

Y'know, one thing I honestly struggle a lot with as a disabled person is like... with certain things I experience, where do I draw the line between "there is a very literal physical set of phenomena occurring in my neurological and related bodily systems that is responsible for my experience of these physical and emotional/mental events" and "these events are being influenced or caused by external stimuli, often related to class dynamics and oppression" and even "said class dynamics and oppression are responsible for much of said physical phenonena within my bodily systems, as they are simply an interaction/reaction to said external stimuli".

To me, it's like the nuance between how "choice feminism" is used to shut down very genuine real critiques of misogyny and patriarchal beauty standards (which are so deeply rooted in racism and white supremacism), but have also been misused to ironically deny women any autonomy whatsoever, rather than striking a balance with "these systems are fucked, much of this stems from a place of coercion and misogyny, and not acknowledging that can feed into it, but as a marginalized class within that system women (and gender minorities in general) do still have the right to decide how they want to respond to that and informed consent still does matter" if that makes sense?

I feel like I'm not able to exactly address the root of the issue for myself with disability but I think it has some to do with the social model of disability, some to do with the way cartesian dualism has been used to divide the disabled community, and some to do with how I am both anti-psych and anti-phys (the institutions including the biased science as it currently exists, not say, medication or treatment).

It's like... okay I tend to look at my own disability through a mixed medical-social lens. In a "perfect" world, neither medical knowledge nor treatment would be gatekept. I'd be able to get medication for things like what are now labeled ADHD, POTS, and MCAS, including getting compounded medication without having to have an official diagnosis of MCAS (seriously, who does it hurt other than insurance company bottom lines to just make a med without corn or milk sugars/proteins or dyes as filler ingredients -_-).

I would still, however, be disabled. I do understand that that is covered under the social model's definition of "impairment", but I also take issue with the relabeling of disability. It seems oddly euphemistic in the same way that "differently abled" does - defining disability itself as only the social access barriers that cause people to be unable to live a satisfying, fulfilling life including with "impairments", to me ignores the reality of those of us with more severe symptoms and higher support needs.

As I saw someone say so well, "chronic pain is still gonna hurt." But it's also that the pain itself is still going to significantly impact my quality of life, even with full access to treatment and meds. My symptoms are still a physical reality within my body, causing distress and dysfunction, and disabling my ability to engage in certain activities - not just "impairing" said ability. It still would have a significant negative affect in my quality of life, outside of my control. And here I am referring to activities in again, a "perfect" world, where the only reason to do them is out of pure, uncoerced and uninfluenced desire.

There's also the way that rather than actually depathologizing what we label as mental illness, its ability to be profoundly disabling and its very nature as occurring physically for whatever reason has been ignored in order to be neuroableist and sanist against neurodisabled people.

I am firmly for self-labeling, and firmly against the forced labeling of any trait as "abnormal" and "unhealthy". I do think even for self-labeling, it's important to question the premise behind many labels and explore more deeply what you are actually using said labels to mean.

I have talked at length about what "demedicalizing DID", as an example, actually entails, and how it actually increases access to resources and treatment for those that want to pursue those things.

The labels themselves are social, even if they are categorizations for material experiences in many cases. The line gets blurrier with psychiatric labels, as the experience is essentially an internal abstraction of physical phenomena, and the categories themselves are significantly more arbitrary without that solidly material basis.

"Trauma" is used as a label to essentially put the onus of class oppression on marginalized people. Things like "dopamine" and "seratonin" at this point are little more than neurochemically-named horoscopes, in a discipline I already refer to as "the astrology to neurology's astronomy" - and noting here, that neurology and medicine in general are still themselves more partially social than the significantly more mathematical discipline of physics I compare them to.

I also have a reactivity to things that I perceive (or misperceive) as divorcing "mental illness" or "neurodivergence" from any kind of physical basis. It's why I think I was initially confused about your use of "pathologization" - my own bias causing me to struggle to see the difference between what ultimately are very clearly different understandings.

It was, "We should question the categorization of certain experiences as innately pathological, meaning abnormal, unhealthy, and to be suppressed," versus "Mental illnesses are diseases of an abstracted mindsoul, with no physical basis, and can therefore be 'overcome' with a minimum of effort and can never be profoundly or physically disabling".

Which, to be clear, I didn't at all think you were saying the latter. More that I struggled to recognize the former because I had not yet divorced "physical experience" from "specific pathologizing label" in my head, and ironically seeing it laid out so clearly threw such a wrench in that existing perception that I had to go in and decouple/detangle the two to get things going again.

Really, though, it seems it's once again about informed consent in a society where "choice" is so deeply and insidiously influenced by prevailing hegemonic attitudes. It's "if you're going to label yourself disordered, it is still good to question the very premise of that label".

In a world with no access barriers and oppression, I would still have some of the same physical experiences I have now. With unrestricted access to medical treatments that directly interface and alter my biochemical processes, I would still likely not be without what we now label as "symptoms". Certainly, assuming I grew up in that world, "trauma" might very well be an unrecognizable concept as to what it is considered in our reality - assuming it even existed in any meaningful way at all.

I guess it's just - where is that balance between acknowledging the extreme influence of current societal norms and ideas about disability, the way the very language we use to talk about them is steeped in those biases, misconceptions, and assumptions, and the way that a physical result is treated as the cause itself; with the existence of varied experiences of abstracted neurological phenomena, having/creating language some need to help define and understand ourselves, and those societal causes still engendering a physical result?

Is it in the connotation? Is destigmatizing the concept of disability and "disorder" (as meaning "causing distress and/or dysfunction as defined by the person experiencing it") and stopping their misapplication enough? I admit, when my disabled identity has been repeatedly denied by ableists, my instinct is to cling to the labels that say "yes, this is an experience that makes me not able to achieve my own personal desires and goals and causes me distress".

While the concept of "ab/normalcy" is deeply unhelpful and often harmful, there are times when I at least want to say "my material experience is not the same as yours despite your insistence that it is" to people who identify as abled, who have described their perception of my experience as something oppositional to my actual experience. Not abnormal, but not identical, either.

Maybe that's getting off in the weeds. I guess just... at what point does acknowledging my own experiences as a significantly overlapped venn diagram of innate physical and purely societal causes meeting at mixed causes and societal causes of physical results, cross the line into mislabeling societal forces as innate physical events.

Is it just divorcing them from the greater context of society? It is the reversal of causality? Is it the lack of acknowledgement that the way we label these experiences is inherently tied up in the social environment surrounding them? If I view some of my experiences as entirely unrelated to and uninfluenced by that social environment (at least to the extent that is possible), while still being a natural variation in neurology (or physiology) that is itself neutral overall regardless of how I experience it, is that enough?

Is viewing the things labeled as ongoing "trauma" and "mental illness" as a natural and rational response to class oppression a factor in depathologization, as long as we also acknowledge that the labels of "trauma" and "mental health" themselves carry meaning and bias and connotations that don't uphold or even contradict that belief?

I dunno. Maybe I'm just stuck in stubbornly not wanting to give up labels I've been forced to fight for because I'm scared to admit that I could have been fighting for not having them at all while still having my needs met in the first place. Maybe I am just struggling as someone who can't actually process or understand their own experiences without language to integrate a new understanding of that language into my paradigm. Maybe some parts of us are still reactively misinterpreting "question and examine how the language we use is a social construct and how that has been wielded against marginalized identities, including your own" as some sort of threat to our autonomy and in particular self-determination.

I may very well be afraid of and biased by those things, but the one thing I'm not scared of is examining that and admitting it's a possibility.

I guess I'm sending you this ask in particular precisely because you've articulated precise analyses of these subjects so clearly. I'd love to hear your thoughts, if you're willing.

Oh, this is the ask I thought I'd lost!

So, before I start, my own bodymindbrain is VERY compromised by COVID right now. I am living that physical illness affecting cognition life.

This is a great question and I'm really struggling to come up with a thoughtful response, because so much of it, I just don't know. I have no idea "how disabling" any of my disabilities would be if I lived in a society that accepted and accommodated differences, because I've never lived in a society like that and I can only vaguely imagine it. I know that part of that goal is making it so that the supports we receive (medical, social, or otherwise) aren't contingent on any particular label or any particular concept of "disorder." And also that they're never an excuse to infringe on someone's autonomy.

On the language of it all, I'm always struggling to refine my own use of language, but it's especially frustrating because any potentially radical/liberatory use of language gets co-opted and appropriated by pathologization (like "neurodiversity," "Mad," or "anti-psychiatry"). I've left so many groups that I thought were about rejecting pathologization that turned out to be about "recovery" or "healing" (which is fine for people who are interested in those things! I'm just not one of them!).

I also struggle with my own... parts of my mind/emotions that are distressing to me... and I struggle to find words for that that aren't part of the pathology paradigm like "mental health," and also aren't spiritual because that's not what I believe. I just don't know the words. I know that I have anxiety attacks and it sucks and I hate it, but I don't know good overarching terms for "The experience of having profoundly unpleasant unwanted emotional states" or "The attempt by various means to mitigate or remediate profoundly unpleasant unwanted emotional states."

Your question is better than my answer, and I'm sorry for that, but I'm glad you asked!

[larnax]

real meaningful problems to postop transmascs/transmascs seeking bottom surgery

bottom surgery too much money call that shit expensive

lack of education about bottom surgery to people who don't actively look for it so allies and enemies alike dont know shit about bottom surgery and people who would benefit from it dont even know what their options are

medical gatekeeping forcing people to jump through absurd hoops only to have coverage denied for anesthesia

good fucking luck finding a urologist who has any experience with post-op patients, idiot

difficult to find clinics outside of the USA and Thailand bc while they do exist most resources assume you either live in the US or have the resources to travel to Thailand

postop/seeking op people having the topic treated like its a very serious tragic discussion so we're not included in any conversations unless people are sharing articles about gender clinics being bombed or reminding trans people that bottom surgery sucks

postop people being seen as incapable of sex or having lost their transgender sex appeal so people feel pressured not to get bottom surgery lest they lose their boypussy which theyre acutely aware is seen by many people as the only reason you would fuck a transmasc person

again bottom surgery being seen as this worldending tragedy only the most selfhating transgendereds resort to is like The biggest problem for postop people and contributes to the isolation/alienation a lot of postop people feel. making jokes about bottom surgery and bringing it up in casual conversation is Good Actually and i wish more nonop people did it so i didnt feel like i only exist when its time for people to talk about how glad they are that they arent like me

transmisogyny in the transmasc community leading people to lash out at transfems for having "too much visibility" which prevents us from working together to strike back against the real enemy, healthcare providers forcing me to get updated mental health letters to prove im sound of mind for seeking phallo stage 2 as if im going to regret Just the tip

not real meaningful problems

random trans women making posts on their personal blogs about being trans women including posts about vaginoplasty

people making jokes about bottom surgery

postop people identifying with a variety of labels or having their identity change throughout the course of getting bottom surgery, yeah even people who end up not iding as trans anymore. not my business and not yours either

non-transmasc people seeking phallo/metoidio. aside from the extremely legitimate reasons intersex people who had surgeries performed on them without their consent/ppl with natal penises who have been in a Penis Accident would get it, or nonbinary people seeking it for the same reasons i am, who am i to judge if a cis woman wants to piss standing up. again why would i waste any energy on this when insurance companies exist

[stupidbeecandle]

who are you????????? you're like so cool and you follow me on tumblr????

you had a massage job with a flirty muscle lady and now you're asking your adviser to do some work within the bdsm community and I have no idea what you even do??

you're like a cool person how is that possible on tumblr dot com

Aww, thanks. Despite all the people saying Id eventually grow out of wanting to be cool, that was a lie and the while world runs on flattery! I think im cool too, but im supposed to politely say thanks instead of hamming it up.

Im kind of a jack of dropped trades. Wanted to be a fieldresearch wildlife biologist for awhile but then dropped out to dissapoint my family and move in with my partner 4 states over. Loved being a massage therapist but got frustrated with my level of power in the medical system. (Not from clients but from insurance companies and other healthcare providers, it was so frustrating advocating my clients get their sessions paid for when they had "legitimate" pain (all pain is legit)).

So now Im working to get my doctorate in occupational therapy which is kind of like applied pt and psychology. We ask clients what they want to do, find what is preventing that task from being done, and address that prevention either by removing it, finding substitutions, or ways to help reduce the problem. Lots of OTs work in schools with kiddos who have barriers to doing homework. Some with adults who want to get back into crochet or cooking after a hand injury and we need to practice how thatl work.

Specifically I want to work with people who want to have sex, but have access issues due to health and safety. Maybe they have spinal cord injuries, maybe they have RA, maybe their bp medication makes their skin tear dangerously easily in unsexy and life threatening ways. Who better to address these concerns than the bdsm community who work so hard to design toys, buildings, furniture and mpre to support boring sex, weird sex, almost sex, not sex, wild sex, and competitive ranked sex. (Also everyone who has any awareness of the culture can clock me and my partner from blocks away even in a plainclothes setting just by posture alone)

I have to spend an entire year (at least) doing a big project for the school and then present it to people who will try to make me speak for and defend the research (this is tradition in america). I might just end up lurking at a sexual health clinic like planned parenthood but I dont want to just cover sexual health yknow? I want to help people fuck however they want! Best of all my school SEEMS to support my ideas sofar because sexual health and family planning are deeply important and very poorly addressed in our society. but we shall see how things continue to go. Love my school, they let me cosplay on a clinical gradschool campus and take my commentary on subcultures and nontraditional lifestyles very seriously.

Glad I could make someone happy by doin my thing. Thats a little about who i am

[williamhartnell]

i think i’m over tired from being in so much pain these last few weeks but i’m honestly on the verge of tears rn thinking about how i haven’t been able to get humira because of some dumb fucking technicality and a lack of communication somewhere between my derm, my insurance company and the specialty pharmacy and no matter how many times i call any of those places none of them are listening to me i am IN PAIN AND DEALING WITH MULTIPLE INFECTIONS why does it have to be this hard to get a medication

[bellshazes]

got a call from a dear friend about a bad ER experience and she's not with my health plan but i am literally going to message our provider person tomorrow about PQOC options. i am so fucking livid, enough that i will seriously drive down to lexington next time she goes to the dr's if she wants me despite my phobia bc this is not okay!

for the record medical facilities like hospitals are typically (in the US, i would expect this to be universal but states can vary widely) under the oversight of organizations like the state Office of the Inspector General (OIG or equivalent) and the Joint Commission, where you can report Quality of Care concerns. in my professional these are taken quite seriously, and although there is often a lot of bureaucracy or poor communication back when govt gets involved, if you have the capacity or can assist someone in filing a QOC complaint or escalating to larger oversight organizations, it's not a bad thing to try.

if you have healthcare (esp. government-funded plans like Medicare or Medicaid) your health insurance company may employ an Ombudsman or Inquiry Coordinator, whose information you can probably get by asking for their contact via the standard Member Services line on the back of your insurance card. ombudsmans can help you decide if you need to file a QOC complaint or go through the Grievances & Appeals (or equivalent name) formal process, or if they can work directly with the offending parties to improve the situation or ensure better future outcomes. there's a strict code of conduct & ethics for these roles, including confidentiality; if there is anyone i might take a chance on explaining something that went wrong to in an insurance company, it'd be the ombudsperson.

[axolotlsdreams]

Thissssss!!! The corporate media and CEOs are absolutely BANKING on us to be divided over the ONE thing that has united us against them in years. If you don't like his politics, that doesn't fucking matter! They will try to split us up, jingle culture war keys in front of us like toddlers! Stay focused on his message instead. That WE HAVE HAD ENOUGH, we DEMAND better. AS HUMAN BEINGS. If you claim to be a good "leftist", who cares about marginalized and underserved communities, then focus on helping them actually afford healthcare, and not ancient potentially problematic Tweets of a tech bro. Some guy online doesn't have the power to deny Trans people help by making a phobic comment online. Insurance companies can deny help in covering HRT, estrogen, top/bottom surgeries. Some dude online doesn't have the power to deny AFAB people help by making a sexist remark on Twitter. Insurance companies can deny help in covering hysterectomies, abortions, and can even in some cases refuse to cover contraceptives. Then you have medications, surgeries and treatments enyone can need which they can deny on a whim. KEEP THIS IN MIND if anything "sus" comes out about him.

P.S. :ACA is responsible for preventing MOST insurance companies from discriminatory practices and requiring them to help cover gender-affirming and reproductive care. However, there are still companies out there who can abstain due to "moral objections". Companies are also not required to necessarily accept ALL claims under these categories, just that they can be accepted and denied like any other claim (which given some companies records doesn't look too good).

(Also I am not advocating violence, so don't freak out at me over that)

Things we already know about the UHC shooter, mostly from his social media:

- He has a bachelor’s and Master’s in computer science from an Ivy League school.

- He has read several books on chronic back pain.

- His profile banner includes a photo of an x-ray for back surgery. (Spinal fusion I believe.)

- Based on messages from his family, he dropped off the map a few months ago and they’ve been worried about him.

- His political beliefs are a bit all over the map; without doing a deep-dive my take is a pretty average centrist tech bro who’s read too much evopsych.

I’m a bit worried that, as the left is so fond of doing, people will turn on him immediately for that last part. Let’s not do that! Can we agree not to do that? Because here’s the important thing:

He’s a victim of the system, just like we all are. The system pushed him past his limits, and he lashed out at it. The details of his political leanings don’t actually matter - what matters is that you don’t have to be a radical leftist to lash out at a health insurance company. That’s shows how bad things are broken, that a guy who seems fairly privileged in most respects, with no strong political motive, could be beaten down and broken to the point of doing this. He has two Ivy League computer science degrees and yet had nothing left to lose.

This is a class war that doesn’t differentiate between the working class, middle class, even upper middle class. We’re all dog food for the 1% to chew up and spit out. Even if he turned out to be hardcore right wing, in this one single issue we’re united with him.

Everyone’s been talking about how this guy has seen insane levels of support across the political spectrum - which means nobody should be shocked that he could have come from any spot on that spectrum. I’m hoping the fact that he doesn’t seem super far left or right politically will make it easier to keep that unity, but the left just looooves our purity tests. Let’s maybe not this time.