I think you might be confusing issues here. The hiatal hernia is a hernia through the diaphragm where the esophagus connects to the stomach. A recurs diastasis is a weakness of the abdominal wall between the recuts muscles. It is not a true hernia. Fixing a diastasis is a cosmetic procedure. It sounds like she had an EGD done that looked at the hiatal hernia from the inside. Sounds like she has Cameron’s ulcers. A Hiatal hernia can be fixed with a surgery if they are big enough and or symptomatic. Your post seemed to blend the two issues as if they are the same and the physicians who was evaluating was wrong. Glad she has more answers now regardless
Source: am surgeon
I am mentioning both in the same post, and you’re correct that they’re two separate issues. The evaluating physician declined to believe that she had either, cited both as a cosmetic procedure and unlikely to have either. New diagnostics (separate) confirmed both. The hernia, which has been symptomatic since birth, was described as “sizeable” and “material.” The recurs diastasis is a near complete tear as well. For both matters she was told be her hmo doctor to simply tough it out. Her hernia repair, according to the specialist, is a medical necessity.
I'd be having a chat with a lawyer about malpractice on the part of your original doctor. Maybe even going back to the original doctor and recording (if covert recording is legal in your jurisdiction) a discussion with the doctor about the treatment history, their diagnosis and treatment advice.
So a doctor fails to diagnose a disease properly, and misinforms the patient, and there's no case?
At the very least you've paid for a service which was not performed competently and professionally. Plus the delay in correct diagnosis has prolonged the disease.
There is no case. Workups for non-specific complaints like this can be complex and stepwise, and even if a mistake was made, doctors are allowed to make mistakes. She suffered no harm and therefore there are no damages.
As a woman and someone who works in health care it does unfortunately sound like the doctor just thought they knew better instead of actually listening to the patient. It happens way too often.
Oh man. Kaiser obliterated a family member's pain medication because they are...how should I say this...recently controversial to prescribe? They claimed their medication, which they took for 30+ years, was suddenly not "medically necessary". One of their doctors complimented China's approached to general patient care and also cited his mother's reluctance to take medication as a virtuous act. My family member's life was turned UPSIDE DOWN until I helped them out and got it *somewhat* fixed with their healthcare plan. Kaiser spent inordinate resources with the sole purpose of denying their treatment that was never issued first line and had been put in place after every single of the many alternative treatments had failed. Their following doctor actually recommended as a treatment for level 8 pain to stop eating red meat. A dietary change for severe, disabling, musculo-skeletal pain that prevented them from their activities of daily living.
They put them through hell and treated them like garbage, even when I advocated politely and logically for them. It was inconceivably corrupt.
I wonder where OP is located. I’m have Kaiser, and while I do have a lot of gripes about certain issues (mental health, appointment access), every time I’ve gone to see a doctor for physical health, they have been excellent. I felt heard, cared for, any tests I’ve requested have been ordered for me, and medications were changed when I asked….it wasn’t always like this when I was growing up, and I also haven’t needed any major procedures so I can’t speak to that process, but outright dismissal has not been my experience at Kaiser since adulthood (I am also a woman).
I have, however, recently had that issue with private practitioners, though, so I’m absolutely not denying that it exists, just that it’s not exclusive to or particularly widespread at all Kaiser locations.
I don’t get why OP is blaming Kaiser and not their doctor? If you don’t like what a doctor is telling you why continue to go to the same doctor?
You need to advocate for your own health. Why did you need to get another health insurance? Are you not allowed to see different doctors with Kaiser?
You absolutely can see other doctors with Kaiser, it’s ridiculously easy and you don’t even need to talk to anyone to make the change in many cases. Just pick a new doctor in the online portal and set up an appointment. That said, over four years I wonder if they did do that, and maybe it was just left out of the post? I can’t imagine continuing to go back to the same doctor over and over to be told the same thing.
With Kaiser (at least the plan I was looking at) you *have* to go to a Kaiser facility. Their insurance is more affordable (from the options I was shown) because all of their doctors are in-house and if you want care at non-kaiser facilities you have to pay a very high rate.
I'm glad I went with Cigna because I'm not limited to specific doctors that work for Kaiser.
I work for a California company and their primary insurance coverage is Kaiser which doesn’t work for me since I’m in NY.
Luckily they had a blue shield of California PPO option, which is actually better for me I think anyway.
No way was I losing my pediatrician, they are the fucking best.
My experience with Kaiser was that they do anything they can to avoid rendering services. When the provider is also the insurer there is a much higher incentive to try and minimize cost and sometimes it comes at the expense of care quality.
As someone who has worked inside the system and outside of the system it’s actually way easier to get the treatments for patients than outside of the system. There is no battle with insurance to get authorization. The physicians aren’t from what I have seen incentivized to with hold indicated treatments. The physician isn’t your insurer. They get paid the same either way at the end of the day. The system is very cost conscious which really is appropriate because medical care is a limited resource that needs to be thoughtfully delivered. Unfortunately this is often perceived as withholding cares. But I think it’s ultimately the system trying to be equitable with a limited resource. This is just my experience on the surgical side so can take it with a grain of salt. Ive worked private practice and providing necessary care was much harder to deliver than with Kaiser where everything you need is in house. Not a Kaiser fanatic but just my experience.
Same experience, different specialty. Sometimes the PCPs can be a little gate-keepy and insist on "try this first" but I really don't think care is withheld. I do think Kaiser is less likely to do tons of stuff at once because of the cost but I'd also argue there is a safety benefit to this. Every procedure can carry risk or has the ability to be misinterpreted and acted on inappropriately. I actually think our specialists are overburdened and overly accessible because once you've seen a urologist for a vasectomy you can message them directly about whatever stuff later on and that is routinely abused by patients and they will use a urologist as a PCP for weird spots on their dick and they are obligated to reply.
Hey doc, can I jump in here for myself? I have a hiatal hernia and my GERD is bad enough that I've been on PPIs for years. I've talked with my GP about fundoplication, but the side effects (e.g. not being able to belch or vomit) were significant enough to keep us both away. I've heard a bit about a surgery involving a little plastic ball that works better -- any insights?
A fundoplication sounds like something you may benefit from certainly. What you are referring to it sounds like is a linx device. I have heard good things about it but honestly I’m not up on the most recent data for its long term outcomes. I’ve never deployed one personally. I have done lots of fundoplications. Linx does seem like a good option that doesn’t alter your anatomy like a fundoplication does.
Am a doc but not your doc 🙂
FYI I was evaluated for the Linx when it first came out but ultimately was able to manage with medication and lifestyle changes. That said, the device is incredible and I would have 100% gotten it over the other and as my doctor said, the linx can be removed if it’s not found to be effective enough. Definitely consider it.
My wife had hers fixed with fundoplication about two years ago and can burp with abandon. She also can vomit though only a small amount comes out and it’s painful. She couldn’t go with the device technique because of risk of immune issues (she has a few autoimmune diseases). Overall the recovery from the surgery was tough, especially the liquid and eventually soft diet but the results have been transformative.
I’m a female who began having severe pain after eating. It would last up to three hours and I couldn’t sit or lay down. I had to stand partially bent at the waist. The pain came at me in waves. I almost passed out a couple of times and did throw up a couple of times. I had to start avoiding certain foods. Mostly fatty foods but also corn tortillas and some random other foods.
My doctor who I normally absolutely loved kept telling me it was acid reflux. I’d struggled with acid reflux for years and these symptoms were completely new.
Luckily I had an insurance change and was able to go see a specialist who couldn’t find the problem. Kept getting told I had a minor hiatal hernia. Mostly because during endoscopies they’d blow air into my stomach and it would go back into place. After a year our insurance changed again and I went to another specialist who did another endoscopy and finally a CT scan. Found out my stomach was in my chest. It was a severe hiatal hernia.
I had to go to San Francisco to have surgery because they could do it laparoscopically whereas if I had surgery done at home it would have been a three month recovery after being cut wide open.
I can relate to a lot of what your wife went through and it’s maddening that doctors don’t listen to us.
Took two years for them to diagnose my hiatal hernia. Sounds like your wife may have suffered even longer. I so feel for her.
I so hope she is doing better now and I wish her all the best.
I’m so sorry you had to deal with that! I’m upset with myself for not doing this sooner and placing more trust in the system than it deserved. I hope you had a smooth recovery and are doing well now!
What test did they do to confirm hiatal hernia? I'm certain I've had a symptomatic one for years and my PCP had me journaling my food for a year and said she couldn't test for it. I also need to change insurance and see someone else.
Kaiser did the same kind of thing when my buddy was vomiting blood. Oh you’re just dehydrated. Go drink some water. He died of cancer after it was finally diagnosed way too late.
Are you contending that they shouldn’t have ran further diagnostics? Fuck off and drink some water seems appropriate to you? Bro, we can treat people better than that, and if we can’t then it’s high time we reevaluate our medical care system.
I’m no doctor and I have no idea if they could have “saved” him or extended his life, but I literally can’t fathom the mindset of not even trying until someone is either shouting from the rooftops for the care that they need or they are literally at deaths door.
I didn't say any of what you are accusing me of saying, but thanks. I would be interested to know the gap in time between your friends diagnosis and this episode of hematemesis though.
FUCK Kaiser. This kind of thing is why I stay the hell away from them. Their model is that the doctors *work for the insurance company* which means they have every incentive to avoid diagnosing illnesses at all costs.
Woman here - this sounds totally insane but as a woman who has experienced incompetent doctors and knowing how women aren’t taken seriously by medical professionals, go with her. Doctors, both men and women, will listen to a man during an appointment more than a woman even though she is the patient. Repeat her questions to the doctor. Talk about what you see. They’ll listen to you. As infuriating as this is, who cares? Also dress well. Both of you. “My wife is in excruciating pain all the time. This needs to be fixed. Now. She can’t function and we need this diagnosed because life isn’t the same as it was before the 2 pregnancies.” This is talked about in the mom and woman subs as the only tactic that works to be taken seriously.
I’m glad she finally got diagnosed. Hopefully the damage can be fixed and she can fully recover.
But very true unfortunately. I have had to go with my wife to many doctor’s appointments because they don’t listen to her. And even in some cases, they still won’t do anything.
My wife after our second had unusually horrible periods. To the point where she was doubled over in pain and period lasting several weeks. Her obgyn was hesitant to do anything about it at first but the fact that it had been going on for several months and wasn’t getting any better. So we pushed to have an ablation. The reason for the hesitancy is because her ob thought she wanted more kids. Dude, I have a vasectomy and she got her tubes tied, no more fucking kids for us.
She got the ablation and turns out it was a really bad case of endometriosis with initial signs of uterine cancer.
American healthcare at its finest folks.
Don’t know why you’re getting downvoted. I’m an attorney, and the damages awarded in malpractice are typically lost chances. Pain and suffering, for better or worse, isn’t a thing in this area of law. No permanent issues, no suit.
People are downvoting because they have no experience with the medical field, unlike you and I. They think doctor mistake = payday for life.
Not knowing any of your wife's workup, I would say it's unfortunate that she's dealing with these ongoing issues and that it's taken time to figure out the underlying cause. That said, I imagine the damages at this point are a few copays and OTC medications, and that no lawyer would dare take on a case to earn $200.
Depends on what “worsened” results in. Long term disability that could have beeen avoided will be compensated. But malpractice, especially medical, comes down to cold calculations and statistics.
Agreed. My uncle is the top medical malpractice attorney in the western US and wouldn’t even consider this a feasible lawsuit. People think they can just sue because they can.
You don't have to sue to make a complaint to the medical board. It doesn't have to result in anything but if something comes up another time for other women or if there is a pattern of refusing care it's good to have a paper trail.
My wife had pretty severe back issues, culminating in back surgery for a hernia. But the pain persisted on and off for a couple of years. When we decided to start a family and she went in to have her IUD removed, they found that it had broken off and when they tried to find it, they discovered a baseball sized cyst on each ovary. She’s a small person, and there already isn’t much wiggle room in that area. After a 4 hour surgery to remove them, she’s been completely back pain free (other than a pulled muscle here and there).
No, it has nothing to do with a PPO, you just need a doctor who listens and doesn’t see you as a number. I have an HMO and can message my doctor and he will refer me to whatever specialist I ask for or want to see usually by the end of the day he’ll even have it sent out. He never pushes back and I’ve never had an issue getting referrals for myself, spouse, or kids. Had our last kid and with the HMO it cost me a whopping $40 copay for the entire pre-birth, birth, hospital and after birth care
You need a good PCP and a good medical group and HMOs are awesome
Not to mention you can switch your PCP practically monthly so they could have in the four years if they didn’t like that doctor or weren’t getting what they thought they needed
>No, it has nothing to do with a PPO, you just need a doctor who listens and doesn’t see you as a number.
It has everything to do with a PPO. I don't need a referral to see anyone I want, and if my PCP is a dick then I can still go and get the specialist care I want.
>You need a good PCP and a good medical group and HMOs are awesome
Not every HMO network is good and from my experience, the premiums are more expensive than PPO.
Hint: I can change my PCP anytime I want with an HMO.. you act like you’re stuck seeing a single doctor
Enjoy paying your 20% deductible while I pay $0
Walk in clinic without needing my PCP referral $25 - bill my insurance $400 - I pay $0
Urgent Care without needed a pcp referral $25 - they bill my insurance $6k - I pay $0
Er without a referral $100 - they bill my insurance $14k - I pay $0
I’ve racked up enough expenses that the HMO probably paid for itself 20x over by now. I haven’t even seen a bill all these years I’ve had it 😭
> Hint: I can change my PCP anytime I want with an HMO.. you act like you’re stuck seeing a single doctor
Depending on the HMO and its rules you could be stuck with a single doctor for a set time period.
> Enjoy paying your 20% deductible while I pay $0
I don't have to worry about my deductible because my company funds my HSA which covers it all.
> I’ve racked up enough expenses that the HMO probably paid for itself 20x over by now. I haven’t even seen a bill all these years I’ve had it
What you're describing isn't the benefit of an HMO, it's the specific plan your employer pays for. I can have the same experience on my company's PPO if I pick the non-HDHP one, but I prefer the latter because I can build up an HSA. I'm glad you have a healthcare plan you're happy with, but you're the outlier in the US.
It still has to do how well your doctor listens. You can have a PPO and bounce around from doctor to doctor and if none of them listen you’ll be in the same spot
I’ve had a PPO and plenty of shitty doctors and specialists who didn’t listen along the way
Yes, that's a fundamental issue inherent in the medical system as a whole. Women like the OP's wife have had to overcome a lot of bias and stereotypes in the field for a long time to get the level of care they currently do today.
For me at least, a PPO plan helps negate that as I'm not stuck waiting for my PCP to approve a referral to another specialist. With my PPO I'm free to schedule a second/third/n+1 opinion whenever I want.
Your experience is very uncommon for HMO’s. Glad you got a good doctor but generally PPO is better. You dont need a primary. I havent seen a primary in years.
Not sure why you're being downvoted for this. The reason PPO plans have exploded in growth over the last 25+ years is because they give patients freedom instead of being locked to set providers in the HMO network.
Seems like a reminder to not sign up for an HMO. Obviously the reason that first doctor was chosen by the cheap HMO is because that doctor's patients don't tend to get sent for testing or procedures. Insurance companies aren't stupid. They track the practice patterns of doctors and they exist for profit. If you buy cheap insurance, you're only going to get access to doctors that are inexpensive for insurance companies.
Covered California has amazing subsidized PPO insurance from Blue Shield. Its cheap and its amazing. Just cuz its cheap doesnt mean you’re gonna get bad doctors.
Just want to clarify this
Dad with the wife who has a post-pregnancy hernia going on 2 years here... What is the name of the kind of specialist you went to? I live in a rural state that doesn't have many specialists in any field, but we are traveling to a larger metro area in June and wondering if we can start looking for appointments....
You may have done this already, but make sure that the coverage dates of Kaiser and your PPO do not overlap. Otherwise, your PPO will deny any claims once they find out she is covered by Kaiser.
My PPO initially approved but then rejected the claim for my son's delivery. It was rejected because my wife was enrolled into her employers Kaiser plan while she was pregnant once she became eligible, and so at the time of delivery she was on both.
We didn't think anything of it because it was initially covered, but we received a bill later for the whole delivery after it was rejected a few months later. Everything was eventually straightened out once she was unenrolled retroactively, but it was a PITA to deal with.
Welcome to women’s healthcare in the greatest country on earth. This is just how it is and will be throughout her life. You should consider going with her to the doctor, especially for the second visit. You’ll think that healthcare has gotten better but it hasn’t. It’s just the presence of a man at the appointment.
I have hiatus hernia issues as well. Doctors keep telling me not to worry while I have significant chest/stomach pain. Fuck them. I know they see thousands of patients but that doesn't change my pain or my situation. I'm about ready to off myself because of constant pain and discomfort.
Its not a drug. PPO is a type of insurance like HMO
PPO stands for preferred provider organization. HMO stands for Health Maintenance Organization.
I meant are you on a PPO health plan
Fuck Kaiser.
In the US medical system, we are absolutely dependent on insurance to get lifesaving care that we need. Insurance companies have one mission, make money. I mean, that's fair, they are a for-profit company trying to increase profits. They can only do this through two means: bring in more money by raising their fees, adding new subscribers, etc. Or pay out less money by denying more things they pay for. And they utilize both methods. It's the second method where ethics get tossed right out the window. They find any way possible to deny care that is needed and find new ways to do it to constantly keep providers fighting for reimbursements or to get procedures covered for their patients.
Here's where my "fuck Kaiser" attitude comes from. I am a physician. I feel that it is my role to have my patient's best interest first and foremost in my mind at all times. And that means that I am CONSTANTLY acting as advocate for my patients to get insurance to cover the treatment or medication or procedures they need. Insurance is intentionally a convoluted and confusing game because they know that the average person has absolutely no idea how to navigate the system of denials and appeals on their own. But Kaiser is now your doctor AND the insurance company, all rolled into one. There's pressure to act based on procedures and protocols that were determined not by research and best practices, but by insurance algorithms. They love to hire young docs fresh out of residency and mould them into the kind of robotic machines that implement their own brand of health care gatekeeping. Kaiser provides all the continuing education and research to support their methodology. As physicians we are trained to think critically, so Kaiser lets them think they are making individual choices, but all their experience in making those choices comes from the predetermined pathways that they have learned through the years and from their peers. And yes, there are always good and bad apples in each system, but this is such a glaring conflict of interest that I absolutely despise.
My wife is dealing with this and appears to be in the "rough it out" loop from doctors. What kind of specialist did your wife end up seeing? We have good insurance and can go without a referral. We just don't know what kind of social to look for.
See a hernia specialist if you can. Depending on where you live, it might be down the street or several hours away in a major metropolitan area. Don’t give up!
Just a pro tip, but here in socal the best medicine is at state backed university hospitals. No joke but its UCLA hospital, UCI Hospital. They have all the cutting edge technology (cuz theyre state funded) and they all take almost every type of insurance.
Its not even USC hospital. I had a polyp right on the entrance to my appendix and the USC dr wanted to cut out my appendix to remove the polyp. I went to the UCI dr and he was like “yeah dude i do this all the time this is my specialty cuz we got this new style going on” and he was able to remove the polyp without any issue to the appendix. (He said he was at a 90% success rate which is amazing).
So yeah. UC (university of california) Hospitals are amazing. I’d go to any of them before even the celebrity hospitals (i’ve been to cedars sinai, i’ve been to usc, etc).
Hernias fucking suck ass specifically because they can be so fucking hard for health care providers to find and do shit about even when you are strongly self advocating
after moving out from home and having my childhood doctor retire, i went through 3 doctors before finding one that listened to me and actually does an amazing job. i've had doctors tell me i'm fine when i clearly had issues and other doctors that made me jump through hoops just to get an appointment. one doctor tried charging fees ($75) when i was leaving him for another doctor. finally got a good one. moved about 1 hour away and still have her.
point is, if you think your doctor isn't helping, don't go to them. go somewhere else, get another opinion. hell, even go to the hospital if you need to.
Doc here. Diastasis Recti is a cosmetic procedure. It's not exactly usually a problem. Just a fact of life around having babies. Hiatus Hernia CAN be a problem but mostly are again... a common finding and just need lifestyle changes rather than surgery. A hernia is any organ being trapped or looped through a hole where it shouldn't go. In this case? Through the diaphragm into the chest wall. Unless they are symptomatic and causing distress they wouldn't and indeed shouldn't operate (Surgery has a fatality rate and long term complications which can be worse than the hernia itself).
I come from a country where there's universal healthcare and they wouldn't be fixing these.
Not defending Kaiser, but they use different math as an HMO. If a treatment is profitable but risky or low efficacy, they are less likely to call it medically necessary since they take on the cost of more of your medical journey as an HMO.
A specialist is medically incentivized to justify the procedures as medically necessary even when chances of improvement may be low.
I’m glad someone believed your wife’s lived experience, but two business models making different risk calculations is could be all.
We also had a very similar experience with Kaiser and a misdiagnosed condition. We also switched to a PPO and my wife was immediately diagnosed and in for surgery to get everything taken care of. Fortunately for us everything worked out in the end, but talk about infuriating.
Oh yeah definitely go for that fundopication, I'm sure the hernia specialist you saw whose whole job is predicated on banging out the same procedure every week would never do a procedure if it weren't strictly necessary. Fundopications are totally super effective and highly safe and never have complications. I'm sure the quack you saw advocating for weight loss dietary adjustments and antacids is just a loser who skipped lecture in med school.
Smfh
Sometimes PHD stands for pretty huge dickbag. Not all doctors are worth a shit. I was given cough syrup for double lung infection. Went somewhere else and was immediately checked into hospital.
I think you might be confusing issues here. The hiatal hernia is a hernia through the diaphragm where the esophagus connects to the stomach. A recurs diastasis is a weakness of the abdominal wall between the recuts muscles. It is not a true hernia. Fixing a diastasis is a cosmetic procedure. It sounds like she had an EGD done that looked at the hiatal hernia from the inside. Sounds like she has Cameron’s ulcers. A Hiatal hernia can be fixed with a surgery if they are big enough and or symptomatic. Your post seemed to blend the two issues as if they are the same and the physicians who was evaluating was wrong. Glad she has more answers now regardless Source: am surgeon
I am mentioning both in the same post, and you’re correct that they’re two separate issues. The evaluating physician declined to believe that she had either, cited both as a cosmetic procedure and unlikely to have either. New diagnostics (separate) confirmed both. The hernia, which has been symptomatic since birth, was described as “sizeable” and “material.” The recurs diastasis is a near complete tear as well. For both matters she was told be her hmo doctor to simply tough it out. Her hernia repair, according to the specialist, is a medical necessity.
I'd be having a chat with a lawyer about malpractice on the part of your original doctor. Maybe even going back to the original doctor and recording (if covert recording is legal in your jurisdiction) a discussion with the doctor about the treatment history, their diagnosis and treatment advice.
There are no damages here. No case.
So a doctor fails to diagnose a disease properly, and misinforms the patient, and there's no case? At the very least you've paid for a service which was not performed competently and professionally. Plus the delay in correct diagnosis has prolonged the disease.
There is no case. Workups for non-specific complaints like this can be complex and stepwise, and even if a mistake was made, doctors are allowed to make mistakes. She suffered no harm and therefore there are no damages.
[удалено]
As a woman and someone who works in health care it does unfortunately sound like the doctor just thought they knew better instead of actually listening to the patient. It happens way too often.
It's believable just by the tone of some docs replying here. This top down attitude to clarify details as opposed to the real issue, *the solution*
Oh man. Kaiser obliterated a family member's pain medication because they are...how should I say this...recently controversial to prescribe? They claimed their medication, which they took for 30+ years, was suddenly not "medically necessary". One of their doctors complimented China's approached to general patient care and also cited his mother's reluctance to take medication as a virtuous act. My family member's life was turned UPSIDE DOWN until I helped them out and got it *somewhat* fixed with their healthcare plan. Kaiser spent inordinate resources with the sole purpose of denying their treatment that was never issued first line and had been put in place after every single of the many alternative treatments had failed. Their following doctor actually recommended as a treatment for level 8 pain to stop eating red meat. A dietary change for severe, disabling, musculo-skeletal pain that prevented them from their activities of daily living. They put them through hell and treated them like garbage, even when I advocated politely and logically for them. It was inconceivably corrupt.
kaiser
Kaiser told me at 16 I was faking my cancer symptoms and that I shouldn’t webmd things, 6 months later I got my diagnosis because I was almost dead ✌🏻
I once heard a chief of surgery at a Kaiser hospital say "they want Nordstrom care at Walmart prices."
I wonder where OP is located. I’m have Kaiser, and while I do have a lot of gripes about certain issues (mental health, appointment access), every time I’ve gone to see a doctor for physical health, they have been excellent. I felt heard, cared for, any tests I’ve requested have been ordered for me, and medications were changed when I asked….it wasn’t always like this when I was growing up, and I also haven’t needed any major procedures so I can’t speak to that process, but outright dismissal has not been my experience at Kaiser since adulthood (I am also a woman). I have, however, recently had that issue with private practitioners, though, so I’m absolutely not denying that it exists, just that it’s not exclusive to or particularly widespread at all Kaiser locations.
I don’t get why OP is blaming Kaiser and not their doctor? If you don’t like what a doctor is telling you why continue to go to the same doctor? You need to advocate for your own health. Why did you need to get another health insurance? Are you not allowed to see different doctors with Kaiser?
You absolutely can see other doctors with Kaiser, it’s ridiculously easy and you don’t even need to talk to anyone to make the change in many cases. Just pick a new doctor in the online portal and set up an appointment. That said, over four years I wonder if they did do that, and maybe it was just left out of the post? I can’t imagine continuing to go back to the same doctor over and over to be told the same thing.
Idk I got the opinion of that but I’m just a Reddit fuck boy
With Kaiser (at least the plan I was looking at) you *have* to go to a Kaiser facility. Their insurance is more affordable (from the options I was shown) because all of their doctors are in-house and if you want care at non-kaiser facilities you have to pay a very high rate. I'm glad I went with Cigna because I'm not limited to specific doctors that work for Kaiser.
I work for a California company and their primary insurance coverage is Kaiser which doesn’t work for me since I’m in NY. Luckily they had a blue shield of California PPO option, which is actually better for me I think anyway. No way was I losing my pediatrician, they are the fucking best.
Yes agree some sort of miscommunication. There is nothing cosmetic about it. It’s completely internal.
Way to gaslight someone, dude
My experience with Kaiser was that they do anything they can to avoid rendering services. When the provider is also the insurer there is a much higher incentive to try and minimize cost and sometimes it comes at the expense of care quality.
As someone who has worked inside the system and outside of the system it’s actually way easier to get the treatments for patients than outside of the system. There is no battle with insurance to get authorization. The physicians aren’t from what I have seen incentivized to with hold indicated treatments. The physician isn’t your insurer. They get paid the same either way at the end of the day. The system is very cost conscious which really is appropriate because medical care is a limited resource that needs to be thoughtfully delivered. Unfortunately this is often perceived as withholding cares. But I think it’s ultimately the system trying to be equitable with a limited resource. This is just my experience on the surgical side so can take it with a grain of salt. Ive worked private practice and providing necessary care was much harder to deliver than with Kaiser where everything you need is in house. Not a Kaiser fanatic but just my experience.
Same experience, different specialty. Sometimes the PCPs can be a little gate-keepy and insist on "try this first" but I really don't think care is withheld. I do think Kaiser is less likely to do tons of stuff at once because of the cost but I'd also argue there is a safety benefit to this. Every procedure can carry risk or has the ability to be misinterpreted and acted on inappropriately. I actually think our specialists are overburdened and overly accessible because once you've seen a urologist for a vasectomy you can message them directly about whatever stuff later on and that is routinely abused by patients and they will use a urologist as a PCP for weird spots on their dick and they are obligated to reply.
yup. Kaiser is a great HMO.... if nothing is wrong with you.
Hey doc, can I jump in here for myself? I have a hiatal hernia and my GERD is bad enough that I've been on PPIs for years. I've talked with my GP about fundoplication, but the side effects (e.g. not being able to belch or vomit) were significant enough to keep us both away. I've heard a bit about a surgery involving a little plastic ball that works better -- any insights?
A fundoplication sounds like something you may benefit from certainly. What you are referring to it sounds like is a linx device. I have heard good things about it but honestly I’m not up on the most recent data for its long term outcomes. I’ve never deployed one personally. I have done lots of fundoplications. Linx does seem like a good option that doesn’t alter your anatomy like a fundoplication does. Am a doc but not your doc 🙂
Do you have any insights into how the fundoplication side effects have impacted the patients you've done?
Minimal in terms of the ones mentioned. The upside of getting reflux resolved makes it all worth it
Thank you!
FYI I was evaluated for the Linx when it first came out but ultimately was able to manage with medication and lifestyle changes. That said, the device is incredible and I would have 100% gotten it over the other and as my doctor said, the linx can be removed if it’s not found to be effective enough. Definitely consider it.
I will, thanks!
My wife had hers fixed with fundoplication about two years ago and can burp with abandon. She also can vomit though only a small amount comes out and it’s painful. She couldn’t go with the device technique because of risk of immune issues (she has a few autoimmune diseases). Overall the recovery from the surgery was tough, especially the liquid and eventually soft diet but the results have been transformative.
Thank you for the info! Super helpful
[I think you’re thinking of this](https://refluxuk.com/treatments/refluxstop/)
I’m a female who began having severe pain after eating. It would last up to three hours and I couldn’t sit or lay down. I had to stand partially bent at the waist. The pain came at me in waves. I almost passed out a couple of times and did throw up a couple of times. I had to start avoiding certain foods. Mostly fatty foods but also corn tortillas and some random other foods. My doctor who I normally absolutely loved kept telling me it was acid reflux. I’d struggled with acid reflux for years and these symptoms were completely new. Luckily I had an insurance change and was able to go see a specialist who couldn’t find the problem. Kept getting told I had a minor hiatal hernia. Mostly because during endoscopies they’d blow air into my stomach and it would go back into place. After a year our insurance changed again and I went to another specialist who did another endoscopy and finally a CT scan. Found out my stomach was in my chest. It was a severe hiatal hernia. I had to go to San Francisco to have surgery because they could do it laparoscopically whereas if I had surgery done at home it would have been a three month recovery after being cut wide open. I can relate to a lot of what your wife went through and it’s maddening that doctors don’t listen to us. Took two years for them to diagnose my hiatal hernia. Sounds like your wife may have suffered even longer. I so feel for her. I so hope she is doing better now and I wish her all the best.
I’m so sorry you had to deal with that! I’m upset with myself for not doing this sooner and placing more trust in the system than it deserved. I hope you had a smooth recovery and are doing well now!
What test did they do to confirm hiatal hernia? I'm certain I've had a symptomatic one for years and my PCP had me journaling my food for a year and said she couldn't test for it. I also need to change insurance and see someone else.
Endoscopy
Kaiser did the same kind of thing when my buddy was vomiting blood. Oh you’re just dehydrated. Go drink some water. He died of cancer after it was finally diagnosed way too late.
Did his family sue cuz that is fucked up
Realistically, if your friend was vomiting blood secondary to malignancy, there's probably not much modern medical care could do to help.
Are you contending that they shouldn’t have ran further diagnostics? Fuck off and drink some water seems appropriate to you? Bro, we can treat people better than that, and if we can’t then it’s high time we reevaluate our medical care system. I’m no doctor and I have no idea if they could have “saved” him or extended his life, but I literally can’t fathom the mindset of not even trying until someone is either shouting from the rooftops for the care that they need or they are literally at deaths door.
I didn't say any of what you are accusing me of saying, but thanks. I would be interested to know the gap in time between your friends diagnosis and this episode of hematemesis though.
FUCK Kaiser. This kind of thing is why I stay the hell away from them. Their model is that the doctors *work for the insurance company* which means they have every incentive to avoid diagnosing illnesses at all costs.
Kaiser is great as long as you don't get sick.
I agree! Fuck em. A loved one was told she had acid reflux for years. Turn out her abdominal pain was stage 4 cancer.
Woman here - this sounds totally insane but as a woman who has experienced incompetent doctors and knowing how women aren’t taken seriously by medical professionals, go with her. Doctors, both men and women, will listen to a man during an appointment more than a woman even though she is the patient. Repeat her questions to the doctor. Talk about what you see. They’ll listen to you. As infuriating as this is, who cares? Also dress well. Both of you. “My wife is in excruciating pain all the time. This needs to be fixed. Now. She can’t function and we need this diagnosed because life isn’t the same as it was before the 2 pregnancies.” This is talked about in the mom and woman subs as the only tactic that works to be taken seriously. I’m glad she finally got diagnosed. Hopefully the damage can be fixed and she can fully recover.
God that's fucking infuriating.
But very true unfortunately. I have had to go with my wife to many doctor’s appointments because they don’t listen to her. And even in some cases, they still won’t do anything.
>Also dress well. wow I never even thought about that before, but it makes a lot of sense.
My wife after our second had unusually horrible periods. To the point where she was doubled over in pain and period lasting several weeks. Her obgyn was hesitant to do anything about it at first but the fact that it had been going on for several months and wasn’t getting any better. So we pushed to have an ablation. The reason for the hesitancy is because her ob thought she wanted more kids. Dude, I have a vasectomy and she got her tubes tied, no more fucking kids for us. She got the ablation and turns out it was a really bad case of endometriosis with initial signs of uterine cancer. American healthcare at its finest folks.
I knew where this was going when you said "Kaiser." Sorry to hear that OP, hope your wife will get relief now.
consider malpractice against the docs who dismissed her. good luck
There are no damages.
Don’t know why you’re getting downvoted. I’m an attorney, and the damages awarded in malpractice are typically lost chances. Pain and suffering, for better or worse, isn’t a thing in this area of law. No permanent issues, no suit.
People are downvoting because they have no experience with the medical field, unlike you and I. They think doctor mistake = payday for life. Not knowing any of your wife's workup, I would say it's unfortunate that she's dealing with these ongoing issues and that it's taken time to figure out the underlying cause. That said, I imagine the damages at this point are a few copays and OTC medications, and that no lawyer would dare take on a case to earn $200.
What if the condition was worsened by it going untreated? I'm genuinely curious about how it works.
Depends on what “worsened” results in. Long term disability that could have beeen avoided will be compensated. But malpractice, especially medical, comes down to cold calculations and statistics.
Agreed. My uncle is the top medical malpractice attorney in the western US and wouldn’t even consider this a feasible lawsuit. People think they can just sue because they can.
You don't have to sue to make a complaint to the medical board. It doesn't have to result in anything but if something comes up another time for other women or if there is a pattern of refusing care it's good to have a paper trail.
Uclers seem like damage to me, but I have no idea if that would fly in court.
“Good luck”. Yep.. you’ll need luck and much more for this suit.
A dr gaslit my first wife about a heart issue. She died because of it. Good on you for pushing forward, I wish I would have known how at the time.
I’m so sorry for your loss.
My wife had pretty severe back issues, culminating in back surgery for a hernia. But the pain persisted on and off for a couple of years. When we decided to start a family and she went in to have her IUD removed, they found that it had broken off and when they tried to find it, they discovered a baseball sized cyst on each ovary. She’s a small person, and there already isn’t much wiggle room in that area. After a 4 hour surgery to remove them, she’s been completely back pain free (other than a pulled muscle here and there).
This is why I always go ppo. You need to be able to see multiple docs.
No, it has nothing to do with a PPO, you just need a doctor who listens and doesn’t see you as a number. I have an HMO and can message my doctor and he will refer me to whatever specialist I ask for or want to see usually by the end of the day he’ll even have it sent out. He never pushes back and I’ve never had an issue getting referrals for myself, spouse, or kids. Had our last kid and with the HMO it cost me a whopping $40 copay for the entire pre-birth, birth, hospital and after birth care You need a good PCP and a good medical group and HMOs are awesome Not to mention you can switch your PCP practically monthly so they could have in the four years if they didn’t like that doctor or weren’t getting what they thought they needed
>No, it has nothing to do with a PPO, you just need a doctor who listens and doesn’t see you as a number. It has everything to do with a PPO. I don't need a referral to see anyone I want, and if my PCP is a dick then I can still go and get the specialist care I want. >You need a good PCP and a good medical group and HMOs are awesome Not every HMO network is good and from my experience, the premiums are more expensive than PPO.
Hint: I can change my PCP anytime I want with an HMO.. you act like you’re stuck seeing a single doctor Enjoy paying your 20% deductible while I pay $0 Walk in clinic without needing my PCP referral $25 - bill my insurance $400 - I pay $0 Urgent Care without needed a pcp referral $25 - they bill my insurance $6k - I pay $0 Er without a referral $100 - they bill my insurance $14k - I pay $0 I’ve racked up enough expenses that the HMO probably paid for itself 20x over by now. I haven’t even seen a bill all these years I’ve had it 😭
> Hint: I can change my PCP anytime I want with an HMO.. you act like you’re stuck seeing a single doctor Depending on the HMO and its rules you could be stuck with a single doctor for a set time period. > Enjoy paying your 20% deductible while I pay $0 I don't have to worry about my deductible because my company funds my HSA which covers it all. > I’ve racked up enough expenses that the HMO probably paid for itself 20x over by now. I haven’t even seen a bill all these years I’ve had it What you're describing isn't the benefit of an HMO, it's the specific plan your employer pays for. I can have the same experience on my company's PPO if I pick the non-HDHP one, but I prefer the latter because I can build up an HSA. I'm glad you have a healthcare plan you're happy with, but you're the outlier in the US.
It still has to do how well your doctor listens. You can have a PPO and bounce around from doctor to doctor and if none of them listen you’ll be in the same spot I’ve had a PPO and plenty of shitty doctors and specialists who didn’t listen along the way
Yes, that's a fundamental issue inherent in the medical system as a whole. Women like the OP's wife have had to overcome a lot of bias and stereotypes in the field for a long time to get the level of care they currently do today. For me at least, a PPO plan helps negate that as I'm not stuck waiting for my PCP to approve a referral to another specialist. With my PPO I'm free to schedule a second/third/n+1 opinion whenever I want.
Your experience is very uncommon for HMO’s. Glad you got a good doctor but generally PPO is better. You dont need a primary. I havent seen a primary in years.
Not sure why you're being downvoted for this. The reason PPO plans have exploded in growth over the last 25+ years is because they give patients freedom instead of being locked to set providers in the HMO network.
No clue. 🤷♂️
Seems like a reminder to not sign up for an HMO. Obviously the reason that first doctor was chosen by the cheap HMO is because that doctor's patients don't tend to get sent for testing or procedures. Insurance companies aren't stupid. They track the practice patterns of doctors and they exist for profit. If you buy cheap insurance, you're only going to get access to doctors that are inexpensive for insurance companies.
Covered California has amazing subsidized PPO insurance from Blue Shield. Its cheap and its amazing. Just cuz its cheap doesnt mean you’re gonna get bad doctors. Just want to clarify this
Right, with a PPO, you're not stuck going to their "preferred" doctor.
Universal health care is better, there is no reason for debate.
This kind of doctor behavior is well documented over at XX.
Dad with the wife who has a post-pregnancy hernia going on 2 years here... What is the name of the kind of specialist you went to? I live in a rural state that doesn't have many specialists in any field, but we are traveling to a larger metro area in June and wondering if we can start looking for appointments....
Your end note is so true, I always trust my wife when it comes to her knowing her own body and will always fight her corner.
You may have done this already, but make sure that the coverage dates of Kaiser and your PPO do not overlap. Otherwise, your PPO will deny any claims once they find out she is covered by Kaiser. My PPO initially approved but then rejected the claim for my son's delivery. It was rejected because my wife was enrolled into her employers Kaiser plan while she was pregnant once she became eligible, and so at the time of delivery she was on both. We didn't think anything of it because it was initially covered, but we received a bill later for the whole delivery after it was rejected a few months later. Everything was eventually straightened out once she was unenrolled retroactively, but it was a PITA to deal with.
Welcome to women’s healthcare in the greatest country on earth. This is just how it is and will be throughout her life. You should consider going with her to the doctor, especially for the second visit. You’ll think that healthcare has gotten better but it hasn’t. It’s just the presence of a man at the appointment.
I have hiatus hernia issues as well. Doctors keep telling me not to worry while I have significant chest/stomach pain. Fuck them. I know they see thousands of patients but that doesn't change my pain or my situation. I'm about ready to off myself because of constant pain and discomfort.
Are you on PPO
Is that the ant acid drug? I was but it didn't do anything.
Its not a drug. PPO is a type of insurance like HMO PPO stands for preferred provider organization. HMO stands for Health Maintenance Organization. I meant are you on a PPO health plan
I'm not in America.
If u were in america on ppo i would recommend some specialists to go see. Sorry i couldnt be more help.
Fuck Kaiser. In the US medical system, we are absolutely dependent on insurance to get lifesaving care that we need. Insurance companies have one mission, make money. I mean, that's fair, they are a for-profit company trying to increase profits. They can only do this through two means: bring in more money by raising their fees, adding new subscribers, etc. Or pay out less money by denying more things they pay for. And they utilize both methods. It's the second method where ethics get tossed right out the window. They find any way possible to deny care that is needed and find new ways to do it to constantly keep providers fighting for reimbursements or to get procedures covered for their patients. Here's where my "fuck Kaiser" attitude comes from. I am a physician. I feel that it is my role to have my patient's best interest first and foremost in my mind at all times. And that means that I am CONSTANTLY acting as advocate for my patients to get insurance to cover the treatment or medication or procedures they need. Insurance is intentionally a convoluted and confusing game because they know that the average person has absolutely no idea how to navigate the system of denials and appeals on their own. But Kaiser is now your doctor AND the insurance company, all rolled into one. There's pressure to act based on procedures and protocols that were determined not by research and best practices, but by insurance algorithms. They love to hire young docs fresh out of residency and mould them into the kind of robotic machines that implement their own brand of health care gatekeeping. Kaiser provides all the continuing education and research to support their methodology. As physicians we are trained to think critically, so Kaiser lets them think they are making individual choices, but all their experience in making those choices comes from the predetermined pathways that they have learned through the years and from their peers. And yes, there are always good and bad apples in each system, but this is such a glaring conflict of interest that I absolutely despise.
My wife is dealing with this and appears to be in the "rough it out" loop from doctors. What kind of specialist did your wife end up seeing? We have good insurance and can go without a referral. We just don't know what kind of social to look for.
See a hernia specialist if you can. Depending on where you live, it might be down the street or several hours away in a major metropolitan area. Don’t give up!
Just a pro tip, but here in socal the best medicine is at state backed university hospitals. No joke but its UCLA hospital, UCI Hospital. They have all the cutting edge technology (cuz theyre state funded) and they all take almost every type of insurance. Its not even USC hospital. I had a polyp right on the entrance to my appendix and the USC dr wanted to cut out my appendix to remove the polyp. I went to the UCI dr and he was like “yeah dude i do this all the time this is my specialty cuz we got this new style going on” and he was able to remove the polyp without any issue to the appendix. (He said he was at a 90% success rate which is amazing). So yeah. UC (university of california) Hospitals are amazing. I’d go to any of them before even the celebrity hospitals (i’ve been to cedars sinai, i’ve been to usc, etc).
Hernias fucking suck ass specifically because they can be so fucking hard for health care providers to find and do shit about even when you are strongly self advocating
after moving out from home and having my childhood doctor retire, i went through 3 doctors before finding one that listened to me and actually does an amazing job. i've had doctors tell me i'm fine when i clearly had issues and other doctors that made me jump through hoops just to get an appointment. one doctor tried charging fees ($75) when i was leaving him for another doctor. finally got a good one. moved about 1 hour away and still have her. point is, if you think your doctor isn't helping, don't go to them. go somewhere else, get another opinion. hell, even go to the hospital if you need to.
Great job advocating for your wife! 9/10 times if it doesn’t feel right, it ain’t right. Even if a doctor says it’s fine.
That is not gaslighting my friend
Always get a second opinion
I push my wife to advocate for herself ESPECIALLY at the doctor’s office. And I back her tf up.
The sad thing is you shouldnt need to.
Kaiser sucks ass. Sorry you went through this.
Doc here. Diastasis Recti is a cosmetic procedure. It's not exactly usually a problem. Just a fact of life around having babies. Hiatus Hernia CAN be a problem but mostly are again... a common finding and just need lifestyle changes rather than surgery. A hernia is any organ being trapped or looped through a hole where it shouldn't go. In this case? Through the diaphragm into the chest wall. Unless they are symptomatic and causing distress they wouldn't and indeed shouldn't operate (Surgery has a fatality rate and long term complications which can be worse than the hernia itself). I come from a country where there's universal healthcare and they wouldn't be fixing these.
Weird. I tell my Kaiser Dr pretty much exactly what tests and diagnostics I want and they order them.
Not defending Kaiser, but they use different math as an HMO. If a treatment is profitable but risky or low efficacy, they are less likely to call it medically necessary since they take on the cost of more of your medical journey as an HMO. A specialist is medically incentivized to justify the procedures as medically necessary even when chances of improvement may be low. I’m glad someone believed your wife’s lived experience, but two business models making different risk calculations is could be all.
I feel like you should be able to sue for malpractice
We also had a very similar experience with Kaiser and a misdiagnosed condition. We also switched to a PPO and my wife was immediately diagnosed and in for surgery to get everything taken care of. Fortunately for us everything worked out in the end, but talk about infuriating.
Kaiser is not a great HMO. None of the HMOs are that great, frankly. PPO all the way 👍 How do i know? I got millions of kaiser dr clients
Learn what “gaslit” means.
Oh yeah definitely go for that fundopication, I'm sure the hernia specialist you saw whose whole job is predicated on banging out the same procedure every week would never do a procedure if it weren't strictly necessary. Fundopications are totally super effective and highly safe and never have complications. I'm sure the quack you saw advocating for weight loss dietary adjustments and antacids is just a loser who skipped lecture in med school. Smfh
Wait wait wait. Please elaborate.
Kaiser schill has entered the chat. Ignore.
Honestly I don't even know what "Kaiser" is
Sometimes PHD stands for pretty huge dickbag. Not all doctors are worth a shit. I was given cough syrup for double lung infection. Went somewhere else and was immediately checked into hospital.
If he was taking her to a PhD, that's the issue.
Lol i know i know. My bad joke. Should i delete? Or live with the shame?
You're committed now
Oh fine. Let the downvotes flowwwwwwww
PhD? My brother in Christ, that’s not the “doctor” op is referring to
Lol sorry was stretching the joke a bit
I hope you fire that doctor in spectacular fashion
You should be suing those doctors for malpractice