#pain management medical billing company

[mososimos]

4 Common Overuse Knee Injuries and Their ICD-10 Codes

Knee overuse injuries occur when a person engages in repetitive tasks. Read about four common knee overuse injuries and their ICD-10 codes. Outsourced othopedic medical billing and coding services are a practical option to ensure accurate and appropriate coding based on the clinical documentation.  https://www.outsourcestrategies.com/blog/four-common-overuse-knee-injuries-and-icd-10-codes/

[cobaltperun]

Lost (24) - Landing in London

Tara Carpenter x female Reader

Summary: To anyone on the outside, and to Tara’s friends, you were Tara’s fierce protector, the MMA fighter who’d take anyone on for Tara. The Guard Dog, as Amber called you. You had no idea you’d have to protect her from people who claimed they loved her. It didn’t matter. As long as you and Tara had one another there was nothing you wouldn’t be able to survive.

Story warnings: Scream violence, family issues, trauma, angst, certain sensitive topics

Word count: 3.7k

Story masterlist / First part / Previous part / Next part

-And when the night falls in around me, I don't think I'll make it through, I'll use your light to guide the way, 'Cause all I think about is you-

She used to be lonely as a child. Woodsboro was a small place, children often met through parents, and her mother had her when she was young. Meaning while her parents were raising her their classmates and friends went out to party or went to college, meaning they had no kids Sam could hang out with when she was really young. So, Sam was lonely, Sam was alone, quickly learning that she couldn’t really go to anyone for company. Kids at kindergarten talked about watching cartoons with their parents, but Sam never had that. Her father, the only father she ever knew, even if she wasn’t his biological daughter, did his best, gave up on his dreams so he could take care of her. Her mother did the same thing, working, coming back home, taking care of Sam. They didn’t really struggle, they weren’t rich, but they had plenty, but Sam was lonely. All she ever wanted was to have someone to spend time with, to share moments and memories with.

And then the greatest gift Sam ever received in her life made the loneliness go away. Tara was born, a month earlier than she was supposed to be, and sickly, soon to be diagnosed with asthma, but she always, always looked at Sam with those expressive brown eyes and a happy smile that made Sam promise she would always protect her little sister. It broke Sam’s heart when Tara would spend another sleepless night, sick, sometimes just barely breathing, and still managed to smile at Sam.

Her strong, resilient little sister. Tara’s always been the strongest person Sam knew, enduring everything happening to her before she could even walk. Tara knew pain before she knew love, she knew sickness, and hospitals, and medicine before she knew playgrounds, parks, toys, playing, anything a child her age should know.

Sam loved Tara, more than anything in the world, but her love couldn’t replace the love of her parents. Unlike Sam, Tara never truly had that. Because Sam was loved as a child, her mother loved her, her father adored her, their family worked the way it was. Sam didn’t need much, so Sam was loved.

Her parents didn’t count on a sick child though, they didn’t count on all the medical bills, on all the time they’d need to spend taking care of Tara and taking her from one doctor to another. Looking back, perhaps finding out Sam wasn’t his daughter was only the excuse her father needed to leave them, because he could no longer handle having a sick child and now that the other one wasn’t his, well, it just gave him another excuse. Not to mention Christina was starting to drink some time before he left. He ran away, never to be heard from again, and Sam hated him for leaving Tara like that.

So, with him gone, money became a bit of an issue, and the only reason people didn’t really notice was Christina’s inherited house. Hell, Sam had no idea until several years later that Christina took money for Sam babysitting Chad, Mindy, and Wes. Sam didn’t say anything, because that money was used to pay for Tara’s medicine, and Sam would always protect Tara.

That was how she, now an angry teenager swung first before asking any questions when she saw an unfamiliar kid talking to Tara. That kid turned out to be you, trying to help Tara, but Sam didn’t know that at the time. She wouldn’t have even remembered your first meeting if Tara wasn’t angry at her for attacking you like that.

It was almost funny how the two of you were so drawn together, how Tara, without even knowing your name got angry at Sam. Tara was shy though, but she kept seeing you every now and then, and even though she never approached you, she’d tell Sam she saw the ‘cool girl’ in the hall between classes. So, Sam asked around as subtly as she could, finding out you were the only child of a rich family that recently moved to Woodsboro, but other than that she couldn’t find out anything about your family. She did learn you had an interest in martial arts, which explained the quick reaction when Sam attacked you.

Sam still remembered her anger when Tara, near the end of that year, and sicker than she was in a long time, told her how their mom didn’t pick her up from school and how she stood in the rain for an hour and a half. Yet, despite the temperature that was too high for home-made medicine, despite the cough and runny nose and all the other symptoms, Tara still looked happy, because she properly met you, and you carried her home in that rain. And when you dropped by the next day to check on Tara because she didn’t show up in school Sam saw the admiration in Tara’s eyes and somehow, without an explanation, she felt at peace.

And then you became a constant in Tara’s life, acting as her shield from the world. Sam remembered it as if it happened yesterday, the scene she walked into a few months before she left.

~X~

Tara hadn’t been this sick in a couple of years, probably since that time in the rain when you first carried her home. You kind of made sure of that, you skipped after-school activities when it was raining so you could make sure Tara got home as dry and warm as possible. You couldn’t protect Tara from everything, so when Christina’s neglect made Tara wait in front of the front doors for hours in cold weather, she got severely sick. She couldn’t even lie down without having a coughing fit, but Sam couldn’t panic. She couldn’t do much more than pick up medicine or make Tara some tea. She had to put faith in her mother to take care of Tara, even if every sign pointed toward the realization that Christina wouldn’t do that. Still, Sam had to hope because sooner rather than later Sam would leave and Tara would be left only with their mother.

She had to leave, she wasn’t safe for Tara, she was starting to hallucinate, waking up in the middle of the night and seeing her biological father. It took her several minutes to figure out what was real and what was her mind fucking with her, and she couldn’t let Tara see her like that. More importantly, she couldn’t risk hurting Tara in that state of confusion.

She still called her mother, just to ask how Tara was.

“W-what is it,” her mother answered and hiccupped, drunk, and Sam’s blood ran cold.

“Where are you? What about Tara?!” Sam demanded, for a moment wondering if she really could kill her mother, because she wanted nothing more than to do that, and that desire frightened her, strengthened her need to get away from Tara to protect her.

“At home, she’s fine~,” her mother drawled, and Sam wanted to crush her phone, to let her rage out, instead, she just ran home, barging in and running upstairs to Tara’s room. She didn’t hear coughing, she didn’t hear anything as she ran down the hallway, and she was frightened of what she would find when she opened the doors, but instead of Tara in pain or not breathing at all, she found Tara with you.

You were sitting in a not so comfortable position, leaning back against the rather uncomfortable headboard. You held a pillow to your chest, and Tara was right there, leaning on it and sleeping peacefully, half lying down, half sitting, but not coughing. She had the yellow teddy bear Sam bought her years ago next to her, and she was holding your hand, making you hug her from behind. From the corner of her eyes Sam noticed an almost eaten plate of soup, one that her mother definitely didn’t make. It was from a local restaurant, so you must have bought it for Tara.

Sam’s knees nearly buckled from relief, but the look in your eyes made her freeze, you were angry, but you couldn’t move, not without disturbing Tara’s peaceful slumber, and even as pissed as you were you wouldn’t do that. Sam saw you wanted nothing more than to get into a fight with Sam for leaving Tara alone when she was this sick, and Sam would have let you hit her as hard as you could, because she felt like she deserved it. Yet, you didn’t. Not because you cared about Sam, no, you talked every now and then and you were civil with one another, so no, it wasn’t because of Sam. It was because Tara would be sad if you and Sam fought, and you wouldn’t allow that.

“Y/N,” Tara mumbled weakly, and Sam noticed she held your hand a bit tighter now.

“I’m right here,” you soothed her, your thumb brushing against her hand as Tara settled down once more.

It was you. When Tara was sick and left alone by her mother, she didn’t call Sam, she called you, and you came, dropping who knows what just to take care of Tara. With how sick Tara was, she barely remembered calling you, she vaguely remembered you were there, but she most certainly didn’t remember sleeping while leaning back on you. Or if she did remember she definitely wasn’t sharing that with Sam.

~X~

The next time Sam saw you and Tara like that was after Tara was attacked, only there wasn’t a pillow between you two this time. Sam could never repay you for how much you cared for Tara while she was gone, because she was sure you’ve spent countless sleepless nights taking care of sick Tara, or simply keeping her company when she felt alone, abandoned by everyone else. Later, while you were training for your last two matches Tara told Sam about those times, about how she would always worry that you’d get sick taking care of her, yet you somehow remained resilient, not once getting sick. Tara also told her about all the times she had you watch The Babadook with her, or the times she just called you over so you could just hang out, do homework together or research random things.

Tara was always the happiest when you were with her, and Sam would forever cherish the memory of Tara laughing while the two of you danced at your wedding.

It was, naturally, a small wedding, the two of you, her and Danny, Chad with his girlfriend at the time, Mindy, Anika, Gale, Sidney with her family, and Kirby. And Tara looked more beautiful than ever, laughing, unable to keep the smile off her face for a moment, and her happiness was contagious.

Sam would have given everything she had to go back to those times, to the time when Ghostface was a thing of the past, and not a threat she once again had to deal with. To sit at the dinner table with Tara and you, making plans for whatever you wanted to do this week, instead of sitting at her computer, yet again realizing that the cult dedicated to Ghostface actually existed.

She should have known it was only a matter of time before he came back, and in the darkness of the night she looked at her window, seeing him there. Her real father, taunting her, putting the mask on her reflection, his mask, the same mask she put on when she killed Bailey.

“I like the design,” the monster told her, and she knew exactly what he was talking about, the dog painted on the mask, proving the belonging to the cult.

Sam got up abruptly, her chair scrapping against the floor. She needed to tell Tara and you, she needed to make sure you were ready and careful. She found you and Tara in the living room, on the sofa, with Tara sitting on your lap and flipping through a magazine while you hugged her from behind and rested your chin on her shoulder, occasionally kissing Tara on the cheek or the side of her neck.

“Sam? What’s wrong? You look worried,” Tara noticed, of course Tara noticed.

Sam should have told her right then and there, she should have told Tara everything. How she’s been lurking online, looking for any signs of Ghostface coming back, how she saw her father more and more often and the medicine was no longer working as well as it used to. Instead, seeing how happy you two were, she shook her head, staying quiet. “Just something at my job. What got you two so excited?” she tried to put on a smile.

Tara and you remained silent, as if exchanging a silent conversation by just briefly glancing at one another. “We’re having a baby!” Tara’s words shattered what little sense of relaxation Sam had left.

Tara would more than likely be the one getting pregnant. She’d be in even more danger than usual, and the child would be in the constant danger from Ghostface, no matter where Tara and you moved to. And in that cold September night that one thing that made Sam’s body tremble wasn’t the temperature, it was the fear for her sister and the life Tara was trying to build with you.

“Sam?” you spoke up when Sam didn’t respond.

“Oh! Sorry! That’s great! Congratulations!” she put on a fake smile, but her mind was already creating plans to infiltrate the cult. She’d just take the place of the one with the dog on the mask. She just needed to find him or her first.

~X~

It was the middle of the October, in the early morning, and Sam was watching a building from a busy coffee shop, with nothing but newspapers and a cup of coffee that had long since stopped steaming. She barely touched the coffee, frankly, she just needed some kind of cover. The unassuming blonde woman, no older than twenty-three left the building in a densely populated block. It was just at the edge of an area with high crime-rate, more importantly it was an area where one could easily rent an apartment without having to answer too many questions, so perfect to hide, or use as a base of operation for following someone. Sam narrowed her eyes and waited to make sure the woman wouldn’t come back right away before slipping into the building.

She had followed the woman enough times already to know which apartment was hers, so, when she got on the fourth floor she looked around and dropped to her knee to pick the lock, only to realize the apartment was unlocked.

Did the woman notice her and was setting up a trap? Or was she just that carefree? It didn’t matter, the girl was slightly smaller than her, looked slower and weaker than Sam as well. Worst case scenario Sam would get injured, but she’d come out on top, no matter what. It wasn’t this girl Sam was worried about, even if she left her alone she wouldn’t be able to beat you, it was the rest of the cult that worried her.

So, she stepped inside, on edge and ready to strike at any sign of movement, but the apartment was empty. No one was inside and she even checked to make sure there wasn’t a hidden room behind the mirror. So, she went and searched the place for clues about the cult. The notebooks gave her very little, and she’d have to deal with the girl’s laptop when she was alone. Still, hoping she’d find something in the laptop she stashed it away in her bag and hid in the girl’s bedroom. All she had to do now was wait for the woman to come back.

And sure enough, about an hour later she heard the doors opening. The blonde had no reason to suspect anyone was in her apartment, and she actually whistled happily when she stepped into the bedroom. As for Sam, she just sneaked up on the girl and grabbed her from behind, slitting her throat before the girl could even figure out what was happening.

She did it, she easily killed the woman that had the mask with the dog, but it also frightened her, because the woman was only a few miles away from where Tara and you lived. She moved there two weeks ago, and Sam was willing to bet she was going to attack Tara and you, or Sam herself, soon.

After that Sam got lucky, the cult meetings required the mask to be on at all times, and that they would use a voice changer, which meant no one really knew who the other Ghostfaces were. But she got into the cult, and though she wanted to start slaughtering them, she couldn’t get close to anyone without raising suspicions.

And then an opportunity that she couldn’t pass up on came up. The leader wanted to kill your father, and then get your mother to give him as much money as she could in return for her life. That would fund the next step of the leader’s plan.

Sam volunteered, killing your father in an apartment falsely rented in your name, in cold blood, stabbing him multiple times, taking her revenge for everything he and your mother did to you. Taking her revenge for them hiring Thomas and making Tara cry while you were in a coma, for making her cry for you, for nearly successfully arranging your murder… She may have stabbed him a few times too many in her fury.

“That’s enough, Ghost-Dog,” Ghostface pulled her away from the body and she shook him off, wiping the knife clean of blood and breathing heavily as she stepped away.

“Still, this will look convincing. Now, I’ll go deal with the Mrs. L/N, you need to get Y/N L/N to come here,” his words made her heart stop for a moment.

Why did he want you there? What did he plan to do? If he wanted to attack you that would be the perfect opportunity to end the biggest threat. The two of you could end the leader of the cult, you could take his mask and the two of you could then take care of the rest of the cult members.

“Ghost-Dog? Call Y/N and get out of here, let the police do the rest,” she could hear the confusion in his voice even through the voice changer-

They weren’t attacking you? They were framing you? They were making sure you were locked up? But Tara was pregnant! You couldn’t protect her from jail!

Still, if she didn’t follow the orders, she’d lose her chance and Tara would be in an even greater danger.

So, Sam nodded. “Yes, sir,” she spoke evenly, once again seeing her father tauntingly smirking at her. She was making things even worse. She was taking Tara’s greatest protection away from her. She was betraying you. She was betraying her sister. But maybe this would protect Tara in the long run. Maybe with you gone she’d go into hiding?

When the leader left, and Sam was sure she was left alone she turned off the voice changer and called you.

“Sam?” you sounded relieved to hear her. “Do you have any idea how worried Tara is, you asshole. Come back home!” you still scolded her, and despite blood dripping from her hand Sam still smiled a bit. If she could protect Tara, if she could only protect Tara…

“I don’t have time to talk, I need you to come and meet me somewhere, right now,” she didn’t need to fake urgency, she knew exactly what she was doing, she knew it would be unforgivable, that you would never trust her again, but she still set up the trap for you. And you walked into it, like a fool that trusted her.

~X~ March 24th, 2027 ~X~

Sam sat at a bar, drowning her sorrow in whiskey. Funny how things turned out. She despised her mother for drinking, she scolded Tara for drinking, yet here she was, drinking her problems away. She spent five months in the cult and had nothing to show for it but one dead Ghostface and blood on her hands. Danny was dead, Tara was captured, and she had no idea where she was. After getting you framed, she became somewhat of a second in command, seeing as she basically took care of the greatest threat, so she wasn’t assigned to whatever location they were holding Tara in.

She tried to keep Tara safe, and all it accomplished was the death of her boyfriend and her beloved, pregnant, sister, now being in more danger than ever before. Everything she touched she ruined, that was the summary of her life and she felt awful, she felt cursed, she felt like she had no right to ever hold her sister again.

“Your tip saved Sidney’s life,” she heard Kirby’s voice coming from the side and just barely lifted her head to look at the FBI agent. She didn’t care how Kirby managed to find her, Kirby somehow ended up finding her a couple of times over the past half a year, at this point Sam didn’t really question it. Maybe she was just that predictable.

“And Gale?” she asked, even though she felt the answer in her bones.

“Dead. It took too long for my mole, Ghost-Wolf, to take the snake mask and go after them,” Kirby sat down in front of her and slumped back against the chair. “Things aren’t so bleak though. Our newest ally found Y/N,” she managed to smile a bit, despite the circumstances.

Sam nodded. She failed to protect Tara, but you would be able to do it. You’d keep Tara and your child safe. “Good, I’ll finish this, three nights from now,” she decided right then and there, she’d put an end to the cult, or die trying.

Story masterlist / First part / Previous part / Next part

Taglist: @alexkolax

[xx3bvvx]

Based in chapter 283

___________________________

The mission had been a disaster. Kim Rok Soo and Lee Soo Hyuk lay on the ground, bruised and battered, their defeat evident in the air around them. The mission they had undertaken was supposed to be straightforward, but they had underestimated their opponents' strength and coordination.

"Team leader," Kim Rok Soo called out, his voice strained.

Soo Hyuk groaned, barely able to turn his head to look at him. "Ah, listen to that tone of yours, you bastard. What is it?"

"When do you think we will be able to fight using overwhelming strength? Do you think it is possible?"

"I don’t know. Don’t talk about the impossible," Soo Hyuk replied, his voice filled with fatigue and a hint of resignation.

"That’s too bad," Rok Soo said softly, more to himself than to his leader.

"What is?" Soo Hyuk asked, curious despite the pain.

Kim Rok Soo sighed. "Our company is always lacking manpower. We always have to fight against large organizations or strong individuals even though we’re weak. We never have enough strength."

It was a harsh truth that weighed heavily on Rok Soo's mind. Throughout his time with the company, he had always been on the back foot, struggling to keep up with the challenges they faced. They were constantly outnumbered and outmatched, forced to rely on tactics and strategy rather than raw power.

Kim Rok Soo had never known what it was like to fight an enemy from a position of overwhelming strength. The idea seemed almost foreign to him. But it was something he yearned for—a chance to turn the tables, to be the one with the upper hand.

"My style is to cause a damn ruckus with overwhelming strength," he said, his voice firm despite his injuries.

Soo Hyuk managed a weak chuckle. "You crazy bastard."

Rok Soo smiled slightly, the pain momentarily forgotten. "Yeah, maybe I am. But it's something to aim for, right? To be strong enough that we don’t have to scrape by every time."

"Maybe," Soo Hyuk conceded, though his tone remained skeptical. "But until then, we keep fighting smart. We use what we have."

"Right," Rok Soo agreed. "But one day, we’ll have that strength. We’ll be the ones they’re afraid of."

Soo Hyuk closed his eyes, letting the thought linger. "One day," he murmured, as the promise of a future where they could fight without fear and hesitation remained a distant but hopeful dream.

As they lay on the ground, bruised and battered, Kim Rok Soo's mind was already churning with thoughts of recovery and regrouping. He glanced over at Lee Soo Hyuk, who was closing his eyes, likely lost in his own thoughts of their defeat.

"Team leader," Rok Soo called out again, his voice carrying a hint of amusement this time.

"What now, you crazy bastard?" Soo Hyuk replied, his eyes still closed.

"You owe me a dinner."

Soo Hyuk's eyes shot open, and he turned his head to glare at Rok Soo. "What are you talking about?"

Rok Soo smirked. "You heard me. You owe me a dinner. And you’re paying my medical bills."

Soo Hyuk scoffed, a mix of annoyance and reluctant amusement in his expression. "Why the hell would I do that?"

Rok Soo's smirk widened. "Because I saved your ass back there. Twice, if I remember correctly."

Soo Hyuk rolled his eyes. "You saved me, huh? Pretty sure we both got our asses handed to us."

"Details," Rok Soo said, waving a hand dismissively. "The point is, you owe me."

Soo Hyuk sighed heavily, but there was a faint smile tugging at the corners of his mouth. "Fine. Dinner’s on me. And I’ll cover the medical bills. But don’t expect this to become a habit."

"I wouldn’t dream of it," Rok Soo replied. His smirk widened even more.

Soo Hyuk shook his head, still smiling despite himself. "You’re something else, Rok Soo. You know that?"

"I aim to please," Rok Soo said with a mock bow, which turned into a wince as his bruised ribs protested the movement.

"Let’s get out of here," Soo Hyuk said, pushing himself up with a groan. "We need to regroup and figure out what went wrong."

Rok Soo nodded, following his leader's example and slowly getting to his feet. "Agreed. But remember, dinner first. I’m starving."

Soo Hyuk chuckled, a sound that was more relieved than anything else. "Fine. Dinner first. But then we’re getting back to work."

Rok Soo nodded, already thinking ahead to their next mission. They had a lot to learn from this defeat, but he was determined to turn it into a stepping stone for future success, he knew they would eventually find a way to fight with the overwhelming strength they both dreamed of.

As they limped away from the battlefield, Rok Soo couldn’t help but feel a sense of hope. They might have been beaten today, but they were far from defeated. One day, they would be the ones dishing out the beatings, with overwhelming strength on their side.

[consolecadet]

big complaining. please do not give me advice on any of this unless 1) we already talk AND 2) you get my consent first

Virtually everything for me right now is in some state of "it is terrible rn but I just need to hold on for a few more weeks/months" and it just. I don't have a lot of grip strength with which to hold on rn.

My tennis elbow hurts more since I started OT, or perhaps I am just more aware of it. Either way it's really bothering me and making me sad

I recently developed eczema or something like that, because of course I did, and the second I stopped steroid cream it came back just as itchy and weepy, despite aggressive moisturizing. I cannot see a dermatologist until November but I have vague hope in the form of a different steroid cream I may try in one week

The three-day low-residue diet my dietician had me try backfired horribly after I stopped it and now I'm even more scared to eat, like, beans and/or onions

I have been having trouble accessing medical supplies that I can technically get by without but really shouldn't. Dealing with it requires making tons of phone calls and/or driving to a bunch of different pharmacies, something I have no time or energy to do rn

I'm in a BMW situation and cannot resume trying to sell it until it is resolved, though it's not a big deal because I am borrowing my sister's car and will buy it from her once I have sold the BMW

Reviewing KC's edits to Latent Defects is tiring and emotionally challenging (though I'm way less upset and dramatic about it than I thought it would be)

I keep spiraling about things like the election, genocide, and the climate

Covid cases have once again risen in my area and I am nervous about that because I've socialized a lot IRL recently and don't know if I was careful enough

I agreed to do an art project with a friend that I think will be really cool, but am worried will hurt my forearm too much and/or cause extra stress which I have little capacity for rn

I am having trouble keeping in touch with friends bc the first thing to go when I get stressed is The Ability to Message People. I also have a newish local friend who messages me a lot more than I am used to and I'm worried I'm making him feel sad and uncared for bc I am so slow to respond and don't message him first very often

KC's summer break is about to end, which means I am about to start having to get up earlier, which realistically means I am going to lose a lot of sleep while I once again struggle to adjust. Also means I'm gonna spend a lot more time driving again

The project I am managing is a MESS, we pushed the launch back, and I feel like it's my fault for 1) not knowing how to manage a project, 2) not asking for nearly enough help, and 3) being kind of mentally absent due to being itchy, in pain, and very cranky for basically the whole project. Though tbf multiple of my coworkers have been sick for chunks of it and also not able to pitch in as much as we expected. Also once we launch, then I have to help manage an online community, which, yikes

I would like a raise to offset the gigantic medical bills I seem to get stuck with every year, but I also fucked up something else at work recently, the one account I managed fired us, and worse yet I absolutely know that the company I work for is barely scraping by and cannot afford to give me a raise regardless of whether my boss wants to. I should probably look for another job but 1) I like these people 2) I have no energy or time rn and 3) much fewer companies are fully remote these days and I cannot physically handle commuting and working in an office

yeah

[lololollywrites]

STEWING in anger today. My younger sister - she's 33 - was diagnosed with multiple sclerosis (MS) 16 months ago, which obviously has been devastating. She is no longer able to work as a nurse, which has been a huge adjustment mentally for her (she LOVED her job in post-labor maternal care). She and her husband had only recently bought a house, but now they can barely pay their bills; he has to work extra hours, and she's home with both of my nieces, one of whom (at 8 years old) has severe behavioral issues stemming from ADHD and OCD. They've already had to file for bankruptcy. She's a wonderful mother, but the stress of it all certainly doesn't help her MS symptoms, and it all piles up (she isn't always physically able to clean the house, etc.). I live about five hours from her and come down when I can to help, but I can't do that as often as I'd like.

She's been hospitalized five times in the past year (unable to walk, with spasms and pain) and received planned infusions even more often, though has thus far only received steroid treatments because HER INSURANCE COMPANY DIDN'T COVER THE INITIAL MEDICATION SUGGESTED BY HER NEUROLOGIST, then REFUSED TO COVER THE SECOND RECOMMENDATION (after the first one was ineffective) despite it being the one they argued should have been chosen in the first place. That's meant she's only had treatment to **manage** her symptoms rather than **treat** them. For over a year. FOR A PROGRESSIVE DISEASE. After more than five years of being misdiagnosed with POTS despite clearly having more going on (and a doctor's office "misplacing" an MRI from years ago that could have showed early signs). Fortunately, she recently got approval from her insurance and will begin treatments next month that will hopefully help.

But this post isn't even about that. This post is about the fact that, as she can no longer work (and briefly tried another desk job at the hospital that was also impossible due to her MS brain fog), she applied for disability. 15 MONTHS AGO. They've made her jump through SO MANY HOOPS - so much paperwork and waiting with no updates that she's been in tears more than once. My mother even contacted her state's Congress representative, who's reached out directly to the disability office to inquire as to why it's all taking so long. Without disability, she and her husband will barely be able to cover their bills, let alone save to repair the many things that need repaired in their new home or to support their children. Or even to just, you know, take a vacation for the first time in ten years to ensure their marriage is salvaged. We started a GoFundMe at the beginning, right after she was diagnosed, which was wonderful, but she doesn't want to do that again now; it feels like begging to her.

Yesterday, her disability request was denied. Who the hell knows why. It was just an instant updated status; we don't yet have the letter. She's devastated, as are all of us. It just seems incomprehensible, though apparently up to 77% of disability applicants are denied in the hope that no one appeals (about 50% do). She now has to get a lawyer and fight for what she deserves. More stress (making her symptoms worse) and more money. And more waiting.

This whole experience has just further radicalized me. I have no idea what to do. I'm just SO ANGRY.

[dollsonmain]

An I Have a Job Now ramble that is less about the job than about other things.

So the job is basically Do All the Things including some management activities like ordering goods at a small, family owned gas station/convenience mart at the edge of my housing complex which makes it convenient to get to, other than the part where I live in the far-middle of the complex so it's a bit of a slog. I could live farther away from it, but not by a lot. It's about a 20 minute walk.

It's going to suck when it's hot, and it's going to suck when it's cold.

It's also going to suck because the only reason my chronic hip and back pain has been even marginally manageable the past decade or so is because I haven't been moving or standing on my feet much, and now I'm going to be suddenly walking 40 minutes a day and on my feet working for hours between walks.

I'm also going to go from basically no UV exposure to 40 minutes/day so will probably start aging pretty fast. I look a good bit younger than I am due to that lack of UV exposure and being plump. I did order some lighter sunscreen as suggested, and hopefully that will at least take some discomfort out of those walks (and work) if I don't have to be super greased up.

It's $10/hr which is nothing and I likely won't get full time because then they have to provide insurance and I have no idea if their company is big enough to do that. Normally I would be annoyed by that but I've put in hundreds of applications and need a current job on my resume. It won't hurt just to get used to being At Work again, either, and it's both more than no money and so little money that leaving when something better comes up won't be too difficult.

Have to remember to manage my potty mouth, belching, and poots, though. That's not something I've had to care about other than when I was at the store for the past 17 years.

Also have to change my routine to hopping in the shower as soon as That Guy leaves instead of sitting at the computer because my hair takes forever to dry. This will suck more when it's cold.

They hired me despite my very poorly filled out application, which is a big red flag, or could mean no one else applied for early mornings which wouldn't surprise me considering how low the pay they're offering is. Will find out today when I get my schedule, I guess.

I will also find out what I'm expected to wear, then as soon as That Guy gets home with the car have to run out and buy work clothes, then come home and wash them because I start work TOMORROW. I'm hoping they'll either let me wear soft lounge pants or basic men's cargo work pants because Walmart has lots of those, and even had some softer ones yesterday which are better for me because of how hard it is for me to find pants that fit.

No idea what hours, yet, or if I need to bring a lunch/get a lunch break, or anything.

That Guy, after I had those kidney problems, he nearly let me die from them, and then the medical bills came in demanded I get a job and health insurance while being completely in the way of me getting either, and then also told me to get out when Son turns 18 and blah blah blah, and now that I've gotten hired somewhere, especially somewhere I don't need him to drive me, he's moping. He does not like not being in control, and he does not like me having my own money. He grills me on where every dollar I've come up with has come from and tries to monitor what I buy etc. Me having money makes him nervous.

He tried to demand information yesterday "how are we going to manage logistics" without being specific and when I finally got him to be specific, I didn't have any answers for him because I don't know, yet. He also whined "I just want you to talk to me... No one talks to me....." and yep, no one talks to him because he's consistently, distressingly unpleasant to talk to.

-

Then, to add stress to the stress, before I went to bed I got an incoming package email from USPS Informed Delivery stating that another big box of ponies for the salon is on the way, then another which is a doll hair plus chemicals experiment subject, and then a THIRD which is from Scott.

He sent me his old android phone so I can use the camera because the camera on the iPhone6s is kind of not great. Explaining the extra, unfamiliar phone to That Guy is going to be... Fun... It doesn't even have a SIM card.

I have no idea how I'm going to manage the salon now with a job, especially a job that WILL hurt, and have two boxes incoming.... Outgoing boxes will likely have to be taken to the post office because I can't sit and watch them to be sure they're not stolen anymore, unless I schedule pick ups on Saturdays. I guess I can do that.

It's going to be even slower than before, and I will not be able to work on personal projects at all for lack of spoons after working on commissions.

[feminist-space]

How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them

by Patrick Rucker, Maya Miller and David Armstrong for ProPublica

March 25, 5 a.m. EDT

Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files. “We literally click and submit,” one former company doctor said.

When a stubborn pain in Nick van Terheyden’s bones would not subside, his doctor had a hunch what was wrong.

Without enough vitamin D in the blood, the body will pull that vital nutrient from the bones. Left untreated, a vitamin D deficiency can lead to osteoporosis.

A blood test in the fall of 2021 confirmed the doctor’s diagnosis, and van Terheyden expected his company’s insurance plan, managed by Cigna, to cover the cost of the bloodwork. Instead, Cigna sent van Terheyden a letter explaining that it would not pay for the $350 test because it was not “medically necessary.”

The letter was signed by one of Cigna’s medical directors, a doctor employed by the company to review insurance claims.

Something about the denial letter did not sit well with van Terheyden, a 58-year-old Maryland resident. “This was a clinical decision being second-guessed by someone with no knowledge of me,” said van Terheyden, a physician himself and a specialist who had worked in emergency care in the United Kingdom.

The vague wording made van Terheyden suspect that Dr. Cheryl Dopke, the medical director who signed it, had not taken much care with his case.

Van Terheyden was right to be suspicious. His claim was just one of roughly 60,000 that Dopke denied in a single month last year, according to internal Cigna records reviewed by ProPublica and The Capitol Forum.

The rejection of van Terheyden’s claim was typical for Cigna, one of the country’s largest insurers. The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. The company has reported it covers or administers health care plans for 18 million people.

Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials.

But the Cigna review system that blocked van Terheyden’s claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.

“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”

Not all claims are processed through this review system. For those that are, it is unclear how many are approved and how many are funneled to doctors for automatic denial.

Insurance experts questioned Cigna’s review system.

Patients expect insurers to treat them fairly and meaningfully review each claim, said Dave Jones, California’s former insurance commissioner. Under California regulations, insurers must consider patient claims using a “thorough, fair and objective investigation.”

“It’s hard to imagine that spending only seconds to review medical records complies with the California law,” said Jones. “At a minimum, I believe it warrants an investigation.”

Within Cigna, some executives questioned whether rendering such speedy denials satisfied the law, according to one former executive who spoke on condition of anonymity because he still works with insurers.

“We thought it might fall into a legal gray zone,” said the former Cigna official, who helped conceive the program. “We sent the idea to legal, and they sent it back saying it was OK.”

Cigna adopted its review system more than a decade ago, but insurance executives say similar systems have existed in various forms throughout the industry.

In a written response, Cigna said the reporting by ProPublica and The Capitol Forum was “biased and incomplete.”

Cigna said its review system was created to “accelerate payment of claims for certain routine screenings,” Cigna wrote. “This allows us to automatically approve claims when they are submitted with correct diagnosis codes.”

When asked if its review process, known as PXDX, lets Cigna doctors reject claims without examining them, the company said that description was “incorrect.” It repeatedly declined to answer further questions or provide additional details. (ProPublica employees’ health insurance is provided by Cigna.)

Former Cigna doctors confirmed that the review system was used to quickly reject claims. An internal corporate spreadsheet, viewed by the news organizations, lists names of Cigna’s medical directors and the number of cases each handled in a column headlined “PxDx.” The former doctors said the figures represent total denials. Cigna did not respond to detailed questions about the numbers.

Cigna's explanation that its review system was designed to approve claims didn’t make sense to one former company executive. “They were paying all these claims before. Then they weren’t,” said Ron Howrigon, who now runs a company that helps private doctors in disputes with insurance companies. “You’re talking about a system built to deny claims.”

Cigna emphasized that its system does not prevent a patient from receiving care — it only decides when the insurer won’t pay. “Reviews occur after the service has been provided to the patient and does not result in any denials of care,” the statement said.

"Our company is committed to improving health outcomes, driving value for our clients and customers, and supporting our team of highly-skilled Medical Directors,” the company said.

PXDX

Cigna’s review system was developed more than a decade ago by a former pediatrician.

After leaving his practice, Dr. Alan Muney spent the next several decades advising insurers and private equity firms on how to wring savings out of health plans.

In 2010, Muney was managing health insurance for companies owned by Blackstone, the private equity firm, when Cigna tapped him to help spot savings in its operation, he said.

Insurers have wide authority to reject claims for care, but processing those denials can cost a few hundred dollars each, former executives said. Typically, claims are entered into the insurance system, screened by a nurse and reviewed by a medical director.

For lower-dollar claims, it was cheaper for Cigna to simply pay the bill, Muney said.

“They don’t want to spend money to review a whole bunch of stuff that costs more to review than it does to just pay for it,” Muney said.

Muney and his team had solved the problem once before. At UnitedHealthcare, where Muney was an executive, he said his group built a similar system to let its doctors quickly deny claims in bulk.

In response to questions, UnitedHealthcare said it uses technology that allows it to make “fast, efficient and streamlined coverage decisions based on members benefit plans and clinical criteria in compliance with state and federal laws.” The company did not directly address whether it uses a system similar to Cigna.

At Cigna, Muney and his team created a list of tests and procedures approved for use with certain illnesses. The system would automatically turn down payment for a treatment that didn’t match one of the conditions on the list. Denials were then sent to medical directors, who would reject these claims with no review of the patient file.

Cigna eventually designated the list “PXDX” — corporate shorthand for procedure-to-diagnosis. The list saved money in two ways. It allowed Cigna to begin turning down claims that it had once paid. And it made it cheaper to turn down claims, because the company’s doctors never had to open a file or conduct any in-depth review. They simply denied the claims in bulk with an electronic signature.

“The PXDX stuff is not reviewed by a doc or nurse or anything like that,” Muney said.

The review system was designed to prevent claims for care that Cigna considered unneeded or even harmful to the patient, Muney said. The policy simply allowed Cigna to cheaply identify claims that it had a right to deny.

Muney said that it would be an “administrative hassle” to require company doctors to manually review each claim rejection. And it would mean hiring many more medical directors.

“That adds administrative expense to medicine,” he said. “It’s not efficient.”

But two former Cigna doctors, who did not want to be identified by name for fear of breaking confidentiality agreements with Cigna, said the system was unfair to patients. They said the claims automatically routed for denial lacked such basic information as race and gender.

“It was very frustrating,” one doctor said.

Some state regulators questioned Cigna’s PXDX system.

In Maryland, where van Terheyden lives, state insurance officials said the PXDX system as described by a reporter raises “some red flags.”

The state’s law regulating group health plans purchased by employers requires that insurance company doctors be objective and flexible when they sit down to evaluate each case.

If Cigna medical directors are “truly rubber-stamping the output of the matching software without any additional review, it would be difficult for the medical director to comply with these requirements,” the Maryland Insurance Administration wrote in response to questions.

Medicare and Medicaid have a system that automatically prevents improper payment of claims that are wrongly coded. It does not reject payment on medical grounds.

Within the world of private insurance, Muney is certain that the PXDX formula has boosted the corporate bottom line. “It has undoubtedly saved billions of dollars,” he said.

Insurers benefit from the savings, but everyone stands to gain when health care costs are lowered and unneeded care is denied, he said.

Speedy Reviews

Cigna carefully tracks how many patient claims its medical directors handle each month. Twelve times a year, medical directors receive a scorecard in the form of a spreadsheet that shows just how fast they have cleared PXDX cases.

Dopke, the doctor who turned down van Terheyden, rejected 121,000 claims in the first two months of 2022, according to the scorecard.

Dr. Richard Capek, another Cigna medical director, handled more than 80,000 instant denials in the same time span, the spreadsheet showed.

Dr. Paul Rossi has been a medical director at Cigna for over 30 years. Early last year, the physician denied more than 63,000 PXDX claims in two months.

Rossi, Dopke and Capek did not respond to attempts to contact them.

Howrigon, the former Cigna executive, said that although he was not involved in developing PXDX, he can understand the economics behind it.

“Put yourself in the shoes of the insurer,” Howrigon said. “Why not just deny them all and see which ones come back on appeal? From a cost perspective, it makes sense.”

Cigna knows that many patients will pay such bills rather than deal with the hassle of appealing a rejection, according to Howrigon and other former employees of the company. The PXDX list is focused on tests and treatments that typically cost a few hundred dollars each, said former Cigna employees.

“Insurers are very good at knowing when they can deny a claim and patients will grumble but still write a check,” Howrigon said.

Muney and other former Cigna executives emphasized that the PXDX system does leave room for the patient and their doctor to appeal a medical director’s decision to deny a claim.

But Cigna does not expect many appeals. In one corporate document, Cigna estimated that only 5% of people would appeal a denial resulting from a PXDX review.

“A Negative Customer Experience”

In 2014, Cigna considered adding a new procedure to the PXDX list to be flagged for automatic denials.

Autonomic nervous system testing can help tell if an ailing patient is suffering from nerve damage caused by diabetes or a variety of autoimmune diseases. It’s not a very involved procedure — taking about an hour — and it costs a few hundred dollars per test.

The test is versatile and noninvasive, requiring no needles. The patient goes through a handful of checks of heart rate, sweat response, equilibrium and other basic body functions.

At the time, Cigna was paying for every claim for the nerve test without bothering to look at the patient file, according to a corporate presentation. Cigna officials were weighing the cost and benefits of adding the procedure to the list. “What is happening now?” the presentation asked. “Pay for all conditions without review.”

By adding the nerve test to the PXDX list, Cigna officials estimated, the insurer would turn down more than 17,800 claims a year that it had once covered. It would pay for the test for certain conditions, but deny payment for others.

These denials would “create a negative customer experience” and a “potential for increased out of pocket costs," the company presentation acknowledged.

But they would save roughly $2.4 million a year in medical costs, the presentation said.

Cigna added the test to the list.

“It’s Not Good Medicine”

By the time van Terheyden received his first denial notice from Cigna early last year, he had some answers about his diagnosis. The blood test that Cigna had deemed “not medically necessary” had confirmed a vitamin D deficiency. His doctor had been right, and recommended supplements to boost van Terheyden’s vitamin level.

Still, van Terheyden kept pushing his appeal with Cigna in a process that grew more baffling. First, a different Cigna doctor reviewed the case and stood by the original denial. The blood test was unnecessary, Cigna insisted, because van Terheyden had never before been found to lack sufficient vitamin D.

“Records did not show you had a previously documented Vitamin D deficiency,” stated a denial letter issued by Cigna in April. How was van Terheyden supposed to document a vitamin D deficiency without a test? The letter was signed by a Cigna medical director named Barry Brenner.

Brenner did not respond to requests for comment.

Then, as allowed by his plan, van Terheyden took Cigna’s rejection to an external review by an independent reviewer.

In late June — seven months after the blood test — an outside doctor not working for Cigna reviewed van Terheyden’s medical record and determined the test was justified.

The blood test in question “confirms the diagnosis of Vit-D deficiency,” read the report from MCMC, a company that provides independent medical reviews. Cigna eventually paid van Terheyden’s bill. “This patient is at risk of bone fracture without proper supplementations,” MCMC’s reviewer wrote. “Testing was medically necessary and appropriate.”

Van Terheyden had known nothing about the vagaries of the PXDX denial system before he received the $350 bill. But he did sense that very few patients pushed as hard as he had done in his appeals.

As a physician, van Terheyden said, he’s dumbfounded by the company’s policies.

“It’s not good medicine. It’s not caring for patients. You end up asking yourself: Why would they do this if their ultimate goal is to care for the patient?” he said.

“Intellectually, I can understand it. As a physician, I can’t. To me, it feels wrong.”

[alynnl]

I went to the doctor about two weeks ago for worsening flare ups of my chronic illness symptoms and... (Personal rant, talk of finances and health issues ahead)

I was prescribed medicine for my IBS symptoms that made them noticeably worse

Technically against medical advice (the 24/7 nurse hotline) I stopped taking these meds because I can't be laid up with diarrhea and abdominal pain.

If I don't work, I don't get paid and I am terrified of falling behind on utilities because these companies don't cut anybody slack (I was threatened with an electric shut-off in 2019. The threat is real. They took every penny in my bank account back then. It feels like nothing short of extortion)

I had a complete abdomen ultrasound and it came back that all my organs (kidneys, liver, spleen, appendix, gallbladder etc) were normal

I just got billed for this ultrasound today and running the numbers in my head, I've been billed enough for half a day's wages

This is despite the receptionist at the front desk saying "Don't worry, your insurance will cover all of it! :)"

This is making me hesitant to get any more medical attention for my chronic illness at all because I'll definitely pay for it later

That feel when I still have to take matters into my own hands with Food Trial and Error and so many White Rice and Ginger Ale Days

I'm doing (relatively?) fine now only because of my own management of my illness and not the doctors'

What exactly was the point of it all?

[seraphsfire]

Haha. please help me, opening emergency commissions, etc. i am Afraid lol

Hey y’all please cast a spell or pray or do a magic dance bc my life is the biggest mess r n, i have 1 month’s rent left (885.00) and then i’m fcked , i WOULD LOVE TO DO COMMISSIONS! PLEASE DM ME! let me know your price range and i’ll tell you what I can do!  if you want to help out bu t don’t want a commission you can donate here on paypal or here (for other apps) I’ll go a little bit into it just to sort of let u know what the situation is currently since i know some of you have known me for a long time and still follow what’s going on in my life:

i’ll try to keep this short(er)since it’s on my main

I was dealing with a job where I was subjected to constant belittling, microagressions, mismanagement of the schedule, ableism resulting in having to do my job in a way that injured me and caused me excruciating pain, insults, retaliation, threats, and dismissal of hazardous work conditions contributing to serious, textbook heat stroke which they then told me I had to just “deal with”; my choices were to go home and try to recover by myself or go back to work and probably have to go to urgent care and be stuck with a huge medical bill. They had not taken any other precautions to protect their employees; we were required to work outdoors when with very little effort, the stations we were posted at could have been moved to inside areas. I couldn’t go the next week to work either because it was going to be even hotter, and I’d already had my first write-up and knew that I would be fired anyway, so I decided to cut my losses and put my health first, and I walked off. It was a temporary job too, but of course they had drastically overstated how much it paid, and had also given us no transparency about the large amount taken out of our paychecks. I could go on about the specifics but let me just say i was absolutely floored that a company that mismanaged, who treated their employees openly with contempt, with so many workplace violations, could function *at all* 

I was treated with more day-to-day respect by management during my covid job when they wanted us to keep working before a vaccine or masks which literally put our lives in danger. 

Anyway. I have enough money saved up for internet, household goods, and xeno’s food and medicine as long as I eat as little as possible for this month. After I pay my rent on August first i will be dollars away from bankruptcy so yeah. Trash pile Year 2022 has turned into trash pile 2023 for me sadly. 

thanks, love y’all. A boost would b appreciated if you’re able!

[acquariusgb]

Billary Fic Drabble Advent Calendar- Day 22

Day 22: Sick/injury

The winter of 1984 Governor Clinton decided to take his family to Sun Valley in Idaho. He knew his wife loved skiing and since Chelsea was about to turn four, it was the right time to start getting used to the snow. Bill, on the other hand, wasn’t really comfortable on skis, but he tried for HIllary’s sake. That was how he ended up on the top of the mountain, in a thick winter jacket about to follow his wife down the slope.

“Are you sure you want to do this?” Hillary asked him one last time.

“Honey, it’s not my first time skiing. I think I can manage. It’s an easy slope.” 

Chelsea was waiting for them by the chalet where she was taking a lesson for small children with a ski instructor. 

“Okay.” Hillary lowered her snow goggles and pushed herself forwards with the ski poles. 

Bill soon followed her. HIs descent was going well until he lost his balance. He tried to stop but he still fell just as he reached the bottom and he cursed in pain.

Hillary soon heard it and skied towards him. “Bill!” she shouted, worried. She stepped out of her skis and knelt beside him. “Does anything hurt?”

“Besides my pride?” He said with gritted teeth. “I think I hurt my knee.”

Soon they were surrounded by people including medical mountain rescue staff.

“Governor, we’re going to take these skis off and check for injuries.” they informed him.

Bill nodded and hissed in pain when they moved his leg. 

They decided it was better to have it checked in a hospital so they laid him on a gurney and loaded him in an ambulance. Hillary held his hand in support.

“I’m going to get Chelsea then meet you at the hospital, okay?” Hillary said before they closed the doors.

When she arrived at the hospital, Bill was on a bed in the ER. His leg was elevated on a cushion.

“Daddy!” Chelsea exclaimed as soon as she saw him and ran towards him.

“Chelsea, be careful.” Hillary warned her.

“Did you get hurt, Daddy?” She laid her chin on the edge of the bed and looked at him with puppy’s eyes.

“Yeah.” He laid his hand on her head. “Your Daddy fell while skiing.”

“I’m sorry.”

“Oh, sweetheart… it’s going to be okay.”

“Any news?” Hillary asked him as she put a hand on his shoulder. 

He immediately took it in his. “No. They did some tests. Just here waiting.”

Soon, the doctor arrived. “Well, Governor Clinton, good news. Nothing is broken, but I’m afraid you will have to cut your skiing holiday short. You’ve slightly sprained your knee. You should avoid putting weight on it, use crutches and put some ice on it. I’m also going to prescribe you some pain killers.” He looked up from his chart. “We’re ready to discharge you.”

“Okay, thanks doctor.” Bill sighed. Once they were alone Bill turned towards Hillary with a pout. “I’m sorry I’ve ruined our holiday.”  

Hillary chuckled. “It’s okay, honey.” She kissed his forehead. “It was an accident. All we want is for you to get better.”

“We can still stay in the cabin for a few days. You can go skiing a bit more and I will rest with Chelsea.” He looked at his daughter. “What do you say, honey? Do you want to keep Daddy company?”

The little girl nodded. “I’ll help Daddy get better.”

“We’ll see.” She smiled. “For now let’s see how the night goes.”

And Bill also realized something else. “Oh no, this will also put a stop on…” he looked down at Chelsea who was listening to them “... you know what.” He wiggled his eyebrows. One of the reasons they took that holiday was to try for a baby again.

“I know… it will be for another time. The important thing is that we spend time together.”

“I love you.” He kissed her hand.

“Love you too.”

“I love you too, Daddy!” 

Bill and Hillary laughed. 

[mososimos]

ICD-10 Codes for Hyperlipidemia

The specific ICD-10 code to report for hyperlipidemia depends on the type and severity of the condition.  If the clinical documentation is unclear or lacks specific details, coding specialists in medical billing outsourcing companies will seek clarification or additional information that may be necessary for accurate coding. These professionals stay updated with ICD-10 codes and guidelines to ensure accurate and up-to-date coding practices.https://www.outsourcestrategies.com/blog/what-are-the-icd-10-codes-for-hyperlipidemia/

[dwarf-vader-of-middle-earth]

I fucking hate the USA. So much.

My mother sent in paperwork weeks ago to the insurance company, stating that they had agreed to keep her covered while she was recovering and laid up from work.

Yesterday, our insurance company suddenly said they never received the paperwork that was faxed directly to them despite the fact that I had witnessed it being done so, and that the insurance was cancelled indefinitely.

Today, my tooth broke horribly and is super sharp and painful, it's scraping my cheek inside until I can't even talk without feeling pain, and I have a bad taste in my mouth from it. I am mid lupus flare, and my migraines are returning as a result. And the most agonizing thing of all is I have suddenly developed a fissure in my lower body and I am in such horrible agony that I cannot use the bathroom without screaming and crying.

And I can get help with none of this. All because the fucking insurance company probably threw aside the faxed documents and ignored them completely, and they're just sitting there in a pile or on a computer and will never be seen.

I am suffering. I am in severe pain in multiple places and it is actually making my life unliveable. I cannot do basic functions (use the bathroom, walk, eat). And there's not a damn thing I can do for this until the insurance company agrees to sign us back on, and there is legit no telling how long it'll be. Last time this happened, it was a full month we had to go without insurance. And apparently that's a short time.

Doctors will not and cannot see me because I am not covered by insurance, and therefore I am not permitted by their practices to be treated since having no insurance is a liability issue. If I managed to find a private practice primary care doctor, and oral surgeon, and rheumatologist, which is basically impossible on all accounts, my family would be shelling out literally hundreds of dollars for just one visit to each one where I'd have to go for even more expensive testing that would be tens of thousands of dollars, and none of it would even including the far more expensive meds that would be thousands of dollars each and I'd need at least 6 prescriptions covered. And my mom currently has to pay off the insane hospital bills and surgery bills and helicopter medivac ride bills, the last of which isn't even covered by insurance despite the fact that it was necessary for her life to be saved. So there is no money for uninsured doctor visits.

American healthcare is a Godsforsaken scam that fucking kills people. I'm not even making that up. Doctors here admit insurance companies exist to scam you out of your money. And it's illegal to not have health insurance. And having no health insurance means no care which means death. If you do have health insurance then it means you're denied care and coverage and limited on where you can go for any appointments and what steps you must take to get an appointment, the steps of which each require increasing copays just to be told you have to find another type of doctor, and pay them a copay for them to say the same thing, and it keeps going until the issue is so bad you wind up in the hospital. If you don't know what you're doing when finding doctors and filling out paperwork and signing documents for things regarding health and treatment, you're scammed out of literally hundreds of thousands of dollars.

Insurance companies are bullshit. They will profit off you, then refuse to benefit you in any way, and then take away all medical resources for stupid reasons without notice, literally leaving you to suffer and die without care.

Fuck the USA.

[beardedmrbean]

Texas veterans have pledged to come out in force at the Capitol in the coming months to vouch for delta-8, the hemp derivative that provides a soothing effect similar to marijuana, as state officials argue it’s illegal in court and lawmakers consider banning it.

“If eating a delta-8 gummy helps you manage your life, helps you function, helps you avoid a pharmaceutical fog, helps keep you gainfully employed, what is the harm in that?” said Mitch Fuller, national and state legislative chairman for the Texas Veterans of Foreign Wars, adding that addictive opioids are often much more detrimental.

“This is not an overly dramatic statement: Access to hemp-derived delta-8 saves lives, period.”

Delta-8 has become so sought-after by veterans that the products are now readily available in vending machines at six VFW posts across the state, through a partnership formed a couple years ago with Austin-based hemp company Hometown Hero CBD.

The VFW is also advocating for an expansion of the state’s limited medical marijuana program to include patients with chronic pain, but Fuller said the regulated products tend to be more expensive and less convenient to buy, and veterans deserve to have a choice.

Delta-8, typically found in the form of edibles or vape cartridges, has exploded in popularity since 2019 when Texas, along with many other states, legalized hemp production following the passage of a federal law that reclassified the plant from an illegal drug to an agricultural commodity. 

It rose to prominence due to a loophole in those laws: For hemp products, they set a 0.3 percent limit on the concentration of delta-9 tetrahydrocannabinol, or THC, which induces the high associated with marijuana. However, the laws did not touch on another less common compound found in the plant, delta-8 THC, which can cause a similar feeling, especially at high dosages.

Delta-8 products grossed over $2 billion in sales in the last two years, according to a report by the Chicago-based Brightfield Group, a market research firm that studies the cannabis industry.

The Texas Department of State Health Services is engaged in an ongoing legal battle over the legality of delta-8, but in the meantime, the courts have allowed it to remain on shelves.

State Sen. Charles Perry is looking to put the issue to rest. Perry authored the bill that veterans like Fuller say they’re committed to fighting, Senate Bill 264. The Lubbock Republican has said that the Legislature never intended to legalize products that make people high.

This is not the first time Perry has attempted to curb the production of delta-8. 

Perry offered up legislation in 2021 to restrict delta-8 products, telling his fellow lawmakers that chemists had figured out how to synthesize hemp to go above the 0.3 percent THC content, “making it illegal in Texas, but also making it an unregulated, possibly unsafe product in the market.”

The House rejected the measure.

Red tape stunts state program 

Since 2019, lawmakers have broadened the medical marijuana program to add more than half a dozen qualifying conditions, and the number of patients enrolled has grown to 45,440. But leaders of the state’s licensed dispensaries say the proliferation of delta-8 has made a noticeable dent in their customer base.

Nico Richardson, interim CEO of Texas Original Compassionate Cultivation, one of three medical cannabis companies licensed in Texas, said the number of active patients in the program — those who have filled at least one prescription in the last six months — has dipped by from 47 percent to 38 percent over the last year, a loss of about 3,000 patients, which he attributes at least in part to the availability of delta-8.

The medical dispensaries and some consumer advocates warn that delta-8 products come with some risk, as they aren’t subject to the same rigorous testing requirements and other regulations.

“We just don’t know what the safety profile is,” Richardson said about delta-8, whereas “our medicine is very highly regulated, and a high level of scrutiny goes into testing.”

[xsurvivalistx]

Claudio Rivera. The Tinker. Survivalist through and through. 

001.  GENERAL

name  Claudio Rivera

nicknames  hard-ass

age  forty-three

date of birth  January 8th 1977.

zodiac  capricorn

place of birth  new york

current residence  new york

gender  male

pronouns  he/him

sexuality  homosexual

occupation  ceo of Rivera corperations.

faceclaim  mark consuelos

height  5'8

tattoos  none

piercings  none

distinguishing features  the ever present cocky smirk on his lips.

positive traits  resourceful, witty

negative traits  rough, high-maintence

labels / tropes  the hbic

likes  when people do what he says, when he says it.

dislikes  when people don't listen to him.

fears  not being successful. being broke.

hobbies  reading, negotiating.

habits  smoking, drinking.

002.  EXTRA ORDINARY

the questions here for each section are suggestions to get you thinking. as long as the section is appropriately elaborated upon, you’re fine!

near death experience…  one of the few times that Claudio agreed to team up with a coworker on a project, and they explode the building. Claudio found himself close to death. he tried her best to claw his way out of the rubble and inventions that he had made...but it was no use. thankfully, the rescue services managed to find him. otherwise he’s afraid he may not have ever gotten the chance to become as successful as she was.

power…  he can create anything he sets his mind to. he just needs access to the resources and equipment. 

drawbacks / vulnerabilities…  he can't just magically make the thing appear. he has to get the supplies and actually create it. He doesn’t have telekinesis or anything like that to help him out unfortunately!

(if applicable)  cerberus corp…  after hearing of his company, they recruited his coorperation to help them with testing. the company has a great track record in both inventing and science, and he doesn't plan on stopping now.

codename… tinker. it's what the news gave him when they caught the man playing with some electral wiring while trying to steal some supplies. Personally? he hates the name, but he's not going to waste precious time trying to think of some silly name.

003.  EXTRA

an optional section where you can give a bio / stats / pinterest / spotify / connections you’re looking for.

Bio: 

Even at a young age, if you asked Claudio Rivera what his biggest fear was? The young boy would say that it was to be unsuccessful. Poor. His parents struggled to keep a job. And he saw the struggles they put up with, especially his mother. Granted, the alcohol and drugs definitely didn't help. His mother was a stripper while her husband bummed off of her. Sometimes he would try to keep a job, although most of the time? He didn't. But Claudio’s mother loved him regardless, which Claudio thought she was crazy for doing so. He wasn't contributing around the house...He wasn't making money...He was useless. And as they got behind on bills more and more? He got more unbearable as the stress mounted. It wasn’t exactly uncommon to hear a cry of pain from either a young Claudio or his mother around the house.

Which is why Claudio couldn't wait to leave. He had been saving up for years. Money that he’s hid most of his life. And while his father had taken some of it here and there when he came across it? He’s been better at hiding it. And when he finally had enough money? Claudio decided to go to college. He wanted to be a inventor. So he got a degree in engineering and a science degree. Although he focused on the engineering, and his partner focused more on the science and medical. The two worked hard. And sure...Some of the stuff they did? Wasn't exactly legal. 

He created stuff for companies. Great inventions that anyone would be happy to have. Although his favorite things to create was definitely weaponry. His partner and himself also dabbled in medical studies as well. One day, his partner had taken it a step too far. Testing on a human when they clearly weren't ready. It caused a series of events, and led to the entire building blowing up while Claudio had been working on one of his inventions. He ended up burried underneath. He pushed, clawed, squirmed...Even while impaled. He wasn't going to die here...Claudio COULDN'T die here. There was still so much shit he had left to do. And he wasn't going to let his partner's mistake cost him his life. 

And it didn't. What it did do, however? Was open another door to him. Omnifabrication. He could think of what he wanted to build, and know just how exactly to do it. What materials Claudio would need. And sure, some of those things take time to acquire and what not. But now that he could craft things that were breakthroughs and thought to be merely fictional before? He was a resource that many people clamored for. And his company? Absolutely flourished. Claudio quickly became rich, and one of the most powerful men in the world. And he acted like it. He took care of his mother, although made sure his father didn't get a penny after he left Claudio’s mother for some other woman. 

Cerberus approached him and made Claudio a deal though. All of this money for some inventions. And how could he say no? At first, he just created weapons and other items for them. But then he began testing things for them and allowing them to test at a safe place in his building. And then Claudio began dabbling in researching their people for them. All in all? He may not be a agent. But he definitely has agency within cerberus. And that's perfectly okay with him.

Claudio became a anti-hero over time. At first? He was simply a villain. Stealing supplies when he needed them before his business went off and became as successful and powerful as it did. Hell, he even stole from Cerberus a time or two and was never caught. However, now? He’s a anti-hero. Using his inventions and his skills to protect people through his rough way. Although he’s definitely not a full fledged hero. He still uses his powers selfishly and isn’t afraid to work against some heroes to put himself in a better position, or even to work with some villains if he thinks it’s best. He’s trained in many forms of combat, and he is a perfect shot. Often times using guns, knives, and staffs more than actual hand to hand combat. He goes by the name Tinker, although personally? He despises the name. But he has things to do, and making some silly alias? Wasn't anywhere near the top of his list.

[wickedsrest-rp]

Name: Quinlan Delgado Species: Vampire Occupation: Accountant Age: 26 Years Old Played By: Red Face Claim: Alba Baptista

"Quick to words but not necessarily quick to wit, but would you like a cookie."

TW: Abortion (mention), medical blood (piercing)

Being an only child to parents who never intended to be anything more than a one night stand let alone married, gave way to an…interesting upbringing for Quin. Her father named her for his best friend through his youth, and her mother named her after herself. From early on Maria Iolanda Delgado shuttled her daughter around the state of North Carolina chasing every pageant she could wriggle her daughter into, all while Quin’s father worked job after job to keep up with his wife’s spending. 

By Quin’s teenage years her father had managed to work his way into a CFO position for a local company. Nothing to gawk at, but it meant he was home for dinner and was able to tag along on road trips without risking financial ruin for the family. Those pageants were the only one’s Quin really enjoyed. Playing car games with her dad instead of being drilled by her mother about potential questions and answers or critiques on her posture or figure. Where her dad was warmth and comfort and security, her mother was just…scary. When she was sixteen Quin went into a tattoo parlor with her father for her first ever piercing, a sparkly monroe that she had been aching for for months. Every time Mama Delgado caught Quin gazing wistfully at ear or body jewelry there was at minimum a twenty minute lecture about the beauty of flawless skin, unmarred by alterations. A load of crap on a cracker from a woman who got weekly botox as soon as her husband could foot the bill. 

The piercer referred to her as “a bleeder” as the needle broke through the layers of tissue in her face so the jewelry could be anchored in. Their tone was light, there was no alarm in their eyes, nor in the eyes of Quin’s father. Yet as the adults chatted about aftercare and healing time all Quin could focus on was the blood they hadn’t seen, the very stuff that was coating her mouth and trickling down her throat. How long had gone by, she wasn't sure, but one thing she did know was that she was going to puke then and there. So she did. And upon seeing the blood she had almost consumed, Quin passed the hell out. 

That was the most exciting part of her adolescence. Maybe even her life. Aside from her mother’s reaction hours later to her daughter’s marred flesh. All in all, it felt like a triumph. Starting then, Quin made small changes to irritate and get back at her mother. Though all further “body modifications” were extremely temporary in that no skin was broken to achieve them. And by small, they were very spaced out and gradual as, again, Mama Delgado was scary. It wasn’t until Quin’s twenty sixth birthday when she announced that she was moving to Maine, that she was finally brave enough to fully be her own person. 

Nine days she had been in Wicked’s Rest, mostly just moving into her new apartment and googling absolutely everything, when her dad called asking her to meet him in Boston. The roads weren’t bad, she could technically make it there and back again in time to start her new job. So she packed an overnight bag and made her way down the winding road. Damn it sure was pretty in Maine. All of the trees and wildlife…WILDLIFE! Before Quin could mentally process the moose staring her down in the road she swerved. Unfortunately for her that swerve took her off of the road and down the mountainside. After that was excruciating pain, the smell of gas, some lovely red eyes, the taste of blood, and then, nothing.

Character Facts:

Personality: Organized, kind, reserved, anxious, romantic, sympathetic, gullible, cowardly, sharp-tongued

A sucker for bodice ripper romance novels but more partial to the fluffy stuff for other forms of media.

Depending on the amount of blood she will either gag, puke, or pass out. 

Yes that applies to movies and television. Even the piercings on her earlobes are clip-ons.

Moved to town for a CPA position.

Refuses to start puzzles with the edges.

Is particularly ruthless in a game of spoons.

Has a pale yellow comfort cardigan that is about 3x too big that she wraps herself up in after a bad day.

Has a crystal collection that started off as a way to piss off her mom but just kind of became a hobby after a while.

[agimamedical]

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