Sample appeal letters for assistant in surgery

Hello, I am wondering how this sounds for my Sap appeal. I am in good standing and above a 2.0, as of right now, I am kit eligible for fafsa, which is the reason why for my appeal. I would love any and all feedback. Thank you!
I am writing to appeal against the loss of my federal financial aid eligibility due to not meeting Satisfactory Academic Progress. (SAP) requirements and ask you to please restore my eligibility to receive all forms of federal aid. I regret that I have not been able to meet the Satisfactory Academic Progress ( SAP ) requirements. Should I not receive aid, I will not be able to continue my wonderful path here at the University of Texas at San Antonio. During my time of enrollment in a university at Texas A&M Corpus Christi, I had faced numerous challenges that put a delay on my growth and hindered me from reaching my goals of being an academically successful student. After taking a year off to be more proactive about my situation I am writing this letter in hopes of appealing my aid for SAP, which was revoked due to a failure to meet the completion rate. I understand the reason for the stopping of my aid, and I take full accountabilities for all events leading up to that point. I am writing this letter to express the importance in which I hold my education, as well as to outline the steps I plan on taking to ensure that I remain on the road to academic success and completion at University of Texas at San Antonio.
I went back to school in 2017 as an independent student. I faced many obstacles, and being the only person in my family that was able to enroll in college, I was determined to make something of myself and be successful by excelling in my studies, but I came into that college experience with a blind eye and did not utilize the campus resources to be a scholar, like I should had done. During my following semester in 2019, I had recently become pregnant with my son, and that was around the time that COVID-19 had happened. During that time, I was let go from my job due to the lockdown, which left me in a finical crisis, so I was unable to pay for my semester at the time. During the fall of 2020, I had just given birth to my son, so I was finding new self, and my new lifestyle, which had me switched my major multiple times, because I did not have passion for the previous majors that I had selected, so I dropped many courses as well. During the terms for the year 2022, I was still attending the Alamo Colleges out here, but I had recently found my passion in the tech field, I started to be on top of my courses and class work and was able to successfully 2 / 3 succeed during the following years. Once I got transferred to the University of Texas at San Antonio, I knew exactly what my passion was, and I was more than excited to start my growth academically and soar. In the begging of the spring semester, I had just recently bought my first house, so I was preoccupied with packing, and the whole process of buying your first home. I was overly overwhelmed with the moving process, raising my 3-year-old son, and working full time that I lost focused on one of my courses for the term. Since not passing that class, my life has done a complete 360, I decided to take the summer off to organize my house and get everything in order. Now that I have finished moving into my new house, I can fully stay focused and determined not to lose sight of my academics. Now that I am fully moved into my house, My parents help out with my son so that I can take 3 hours every day to study each of my courses, I organized my time to make sure that I will be attending at least 2 tutoring sessions a week, as well as utilizing the university resources to help gain more of an advance on my academics and make sure to meet with my professors and advisor at least twice each semester so I can make sure that I can stay caught up on my course work, and getting more assistance if I do feel lost. If I knew then what I know now, I would have taken a break after my first failed semester, as well truly knowing where my interest lies, so that I didn’t switch my major multiple times. I did not understand the impact of changing majors, and dropping courses that would influence not only my GPA, but also my completion rate for SAP. I also realize that I should’ve taken more of advantage of the student resources provided to me, by the colleges and universities. I also take full responsibility and accountability for the consequences of my actions.
What will be different if given the chance to receive aid again is that I am in a much better place than I have been in the past 5 years, and I will continue to always improve myself and never let my studies go. I will always stay focused during each term of the school year and will never let myself get lost or behind again. I will also commit to routine/ scheduled meetings with my academic advisor as well as professors, and tutoring aids that are available to help with each course. I have a tremendous amount of support from my loved ones who want to see me succeed and be the first one in my family to graduate from college / university. I am not only determined to make something better of myself for myself, but for my son. If I am given this extra chance at this opportunity, I can show my son how successful one can be with life going on, but also that if you don’t give up on your dreams, you can do anything you set your mind to. I am very disappointed in the person who I was in the past, but I am more than happy to say that that person is not me anymore. I have grown so much, and the old me would be so shocked that I even made it this far in life. I know that in life, things are always going to come up and hit you out of nowhere, but I have now realized that no matter what life throws at you, you just got to push through it and keep going, no matter how hard it is. I understand that this chance does not come around often but if you take this amazing chance on me, not only will I succeed and go far in life, but I will provide my son with a better life than I could ever imagine. If awarded this opportunity, I will do everything It takes to become successful and remain successful throughout the remainder of my academic career the University of Texas at San Antonio.
3 / 3 I plan on taking on more tutoring sessions at least twice a week with my professors. I will also take up more of the student resources that the university has to offer, as well as scheduling more appointments with my tutor. I will never drop any of the courses that I am registered for and going to take in the future. I will also never let myself not pass any of these courses. I am going to do everything in my power to make sure that not only will I pass every course that I am taking / and or will take, but I will also make sure that I stay determined and focused and seek out any help from my scholars with my academics.

Looking for assistance on why my general anesthesia experience went so well and when it’s appropriate to request for future procedures.
BACKGROUND: 40F / living in US
Diagnoses: CRPS, MCAS, POTS, OSA using CPAP, HSD/hypermobility spectrum disorder, morbid obesity BMI ~55
Extensive documented history of medical trauma and miserable pain following procedures
DESCRIPTION: This month I had an IR procedure that went 1000% smoother than anything I’ve had before and I think it was due to the anesthesia/anesthesiologist.
I had a port removed and a tunneled line placed.
The procedure was ordered “with anesthesia” and the assumption was MAC as that’s generally what I get. My understanding is most people get sedation with fentanyl and versed or MAC.
The anesthesiologist listened to my concerns about past procedures and how I abruptly emerge with severe pain. They mentioned reading my chart and seeing significant pain post-procedure and they thought general anesthesia would be the best option from safety and pain control.
I thought they were pushing for higher reimbursement and just suggesting better pain control as a way to get me to agree.
I received two doses of pain meds and Benadryl in PACU and my pain was incredibly well managed. I didn’t get yelled at to take slow deep breaths or told my pain wasn’t that bad, my BP/HR were in range
some of the reasons I was given that resulted in agreement for general:

• minimize risk of injury if my airway needs to be secured in an emergency
  
• greater flexibility with meds for pain control during procedure because my stats are monitored (differently?)
  
• possibility of less emergence pain because of better control during procedure
  
• concerns over my ability to breathe the duration of the procedure 90-120 minutes while flat on my back… specifically because of the weight of my chest tissue compressing my lungs
  

To be honest, I was sold on “better pain control”… but the anesthesia team (MD/NP) both seemed encouraged that this was a great option for me given my chart and weren’t pushy and took the time to answer my questions.
QUESTIONS FOR REDDIT:

• was GA a higher or lower risk option given morbid obesity, OSA, and chronic pain?
  
• is what I recall as rationale accurate or are there risks I might not have recalled or understood?
  
• is the reason my pain was SO well controlled because of better management during procedure due to general anesthesia?
  
• did I just get lucky with a great team, or was the pleasant surprise of less pain than anticipated directly related to pain control during procedure?
  
• will I get looked at funny if I ask about this for future procedures (IR, interventional cardiology, surgical, etc)? … how is it decided if this is appropriate or excessive/unnecessary?
  
• how much of the “success” of the procedure the result of a great IR? … I’ve had many IR procedures and this just was incredible compared to the others
  
• Most importantly… what’s the best way to thank the anesthesiology providers for doing such an incredible job for me?
  

THANK YOU!
—— ADDITIONAL BACKGROUND;
Versed/Fentanyl: 1st port placement…was extremely traumatic during and struggled with severe pain for roughly 6 weeks post-procedure with oral pain meds MAC - sympathetic blocks - removal of 1st port / placement of 2nd port…less traumatic, but another 6 weeks of severe pain requiring temporary increase in oral pain meds - colonoscopy - GJ placement
General Anesthesia (breathing tube placement): - cardiac cath lab…turns out my nuclear stress test was a false positive and I didn’t end up needing stents - removal of 2nd port/placement of tunneled line “emergency” laparoscopic gallbladder removal 20ish years ago… got admitted Saturday/surgery on a Sunday morning, discharge Monday
To save folks from asking: … I’ve had a line of some sort for several years for IV fluids and Infuvite, 2-3 rounds of potassium and magnesium a few times a year, and upcoming iron infusions.

I have been taking dupixent for over a year. It is very expensive, but it is the only thing that works for my eczema. I have been on Medicaid for many years and they have paid for it. I recently also got medicare and I'm having to use signa for my part D coverage.
Signa does not want to pay for it. They paid for a temporary 30 day prescription when I first started using them in March. At that same time they told me they would not pay for it anymore and I needed to apeal. I asked them how the appeal process works. The faxed a prior authorization application to my Dermatologist. The next day they called me with a voicemail saying the appeal was denied. I immediately emailed my Dr, I told her about the denial and asked if she even turned in the application yet. A couple days later my Drs assistant called me saying the application was on her desk, and that she will be in tomorrow to fill it out and send it in. So they Dennied the application before they got it from my Dr.
I called them several times trying to figure out what I need to do. They told me I need to mail in a written apeal. Or I can file one online. The website they gave me didn't work. I assumed it was a typo on my part due to language barrier between me and customer service. They recommend I file a grievance due to them denying the appeal. I did that.
I got a message from my pharmacy on may 9th saying the meds were ready. 2 weeks after I was due to take them. I thought they approved the appeal so I thought that was the end of my troubles.
Today I get a letter in the mail saying the grevience was denied and that I need to send in a written apeal. The meds I got in the 9th was a temporary supply. The appeal instructions are confusing. There is a website that is the same non functioning broken link as before, and a mailing address to send in a written apeal.
They are making this nearly impossible to apeal. There are no instructions on how to send in an appeal or what needs to be on it or anything. I asked them today how I'm supposed to do that and eventually they told me I needed to send in an application for the written apeal. This is when I lost it. I asked them why they didn't tell me this months ago.
This has caused me intense anxiety and depression due to all of the uncertainty. Do I have any type of a case against them for the pain from not receiving my medication for the 2 weeks and the emotional suffering I have been going through?
TLDR- my new insurance won't cover a medication, that my old insurance was paying for. The new company is making it difficult to appeal the denial, that they Dennied before receiving my Drs prior authorization.

Child Support and paternity fraud plz help
Where do I begin. For the purpose of this post, I will use fictious names and locations as it is ongoing, and out of respect (even though she doesn't deserve any)
My name is Daniel. I am 35 years old, and i am dying. I have a disease called systemic sclerosis. I am currently on a supplemental disability plan, until I get approved for SSI (social Security). Until then, my income is about 4K a month. I own a home but after child support and bills, NOT INCLUDING gas, food, haircuts, medical appointments, and or emergencies like my fridge just broke. (which i never go out) I am left with $260 that has to last me a month. I also have three children who I have to take care of half the time per the 50/50 agreement.
Recently, I found out my oldest, (who is 13) is not biologically mine. I decided to look into it as I had concerns for a while since my divorce as her cheating was very rampant. I also had caught her in 2017 with a man in my house, which is what prompted the divorce. But FL being a no fault state, doesn't matter. I also had to pay child support since the beginning and WHILE LEGALLY Married since 2010 because she had applied for financial support like food stamps and government assistance then. I know what your thinking. Why didnt you stop it then? I tried. You cant take yourself off child support. I also never grew up with a father and wanted that two-parent household. I don't run from responsibilities, like he did. Its how I was raised. Anyways, I married her, tried to do the right thing, she lied numerous times. she never worked, and I worked 90 plus hours a week. To look into her cheating, was impossible at the time as I was never home. and to busy providing for my family.
fast forward to now. My disease started to become worse and over three years; it didn't reveal itself until last year fully to actually pinpoint what this was. for instance, I had in 2019 pain behind my eyes and horrible headaches to the point that I thought I had MS. following year, I had trouble swallowing for 3 months. next year itching in the skin for three months. But prior, I had visited various doctors to see what was going on, each time a flare up then would last 3 to four months, which again, when you don't understand what's going on, you need to take time off to go see doctors, run tests, but this illness was and still is very elusive. with that being said I had 5 jobs since its first flare up till last year to continue to support my family and to pay child support. as of last year. I'm having trouble moving on certain days, breathing and acid reflux and muscle atrophy. (disease progression) especially when this is going on, it worsens everything as this is flared up. I was working under the table to try and make ends meet as I was paying child support still. I should add that the child support with 50/50 custody was $1029 for three kids cause I was making six figures at the time of divorce in 2018. Last year however, I couldn't work anymore, and filed for disability.
In june of last year, I had asked Susan, to get the children school supplies, (which she never does) as I was still paying at the time $1029 in child support. She said she didnt have the money despite now making 70k and her new BF living with her and is working whom she cheated on me with. With me working under the table, I bought them clothes, haircuts, school supplies (ive done every year) but then, I noticed she went on vacation to puerto rico and got a giant leg tattoo. At the time, I had already known what I had, and I asked myself why the heck am I doing this? So i turned to an attorney to get it modified. Again, this is June 20th to be exact of last year. My lawyer, stated that this was only going to be a 90 day turn around for the temporary modification then we will go for the final.
Since then, I have gone for a DNA test. I had to know. I am dying. I wanted to know. And you may judge me for this. but i have filed for disablement for paternity, meaning I am removing myself from the birth certificate. However, in the state of Florida, a mother can deny this and so can the courts. before you judge me, I have many reasons none of which have to do with him other then his mental disability (Aspergers) This illness, as days go by takes more and more from me. As previously aforementioned, I am left with 250 a month. I cannot go get a drs appointment pay for groceries or start planning my funeral which I will start making payments on soon. He also eats three times the amount that we all collectively do (Not his fault) but I have paid enough both mentally and financially. He also has trouble communicating as my suspicions is, that he was born of incest (gross) which is why I was 'chosen' to be his father at the time. Before you ask how do you know? Lets just say she had an uncle 'leave' during that time.
anyways, in February, I had the temporary modification hearing for child support and needless to say it was a circus. My doctor was subpoenaed to be there by my attorneys request to better my argument, even though I felt we didn't need her, she advised me to have my doctor there. Well, he attorney attacked my doctor and me for an hour and 40 mins when the court case was only supposed to go for an hour. He said "you saw another dr Max so and so and they said it was all in your head" (again I had flare ups on a illness that hadnt revealed itself correctly since last year). So there argument was that I was doctor seeking to avoid child support. After I have paid for 13 years never missing a payment. Her lawyer also targeted people who are living with me. Now I'll admit that I said they were friends which is true but how else can I pay for my attorney? Cant work, cant sell drugs, cant rob a bank? So they want to take there income into consideration. BS. She also hired a private investigator to watch me exercise outside and stated that because I can exercise, I can work..... Ok. Where's the 23 hours of the rest of the day watching me in pain. or when do you have me on video of a flare up from this terminal illness? (that's what I wanted to say)
Although I was granted the temporary modification, of $209, I left the court thinking wow, this woman can cheat, commit paternity fraud, not give two craps about our children, live with her mom in a section 8 home, and here I am doing whatever I can and I've done nothing wrong but be lied to and this is how my government, my country treats me? No wonder men my age dont have children this is insane. The paternity issue wasn't even brought up they said that this isnt the place for this and that the disestablishment will be another trial for those wondering. My lawyer only spoke for 5 mins. Asking her about her income cause thats the only thing that has changed since 2018 since she didnt work at the time. Other than that, it was an attack on me and my disease arguing my ability to work.
after leaving that, I didnt eat for 96 hours. I have since been crying nonstop. Compilating suicide. I am already heart broken about my son not being mine. Sure does a terminal illness make me said, no question everyday. But a life wasted on another? Cause I decided to be a man and take up responsibility? thats soul crushing. And to say "well, there is a big chance the courts will deny your request' thats BS. If i go to prison because I was accused of a robbery for 13 years, and DNA evidence proves I wasnt there, I get out of jail and can sue. This is no different. If anything, DNA evidence needs to be more of a factor in family law than in almost every court of law if not as equally important. My bad for not investigating her infidelity not only in the beginning but also in the end. How about not being a POS. sorry rant over
gets better. Her mom and dad smoke in the section 8 house, kids reek of cigarette smoke and marijuana, all day. they dont take showers there, they were hand me down clothes, they live in the garage shared with there mother, that isn't air conditioned. and he makes only a few thousand less than I do a month. She stated in court that she pays her mom $500 in rent which is BS, she is only doing that now so that she makes herself look bad. I know she is doing pills, like oxy and what not. Id love to prove it.
after the temp hearing, in april, I had to go to court to contest my drivers license suspension as I hadn't paid child support since, august of last year. again, there is no way, I can pay my bills, feed my children, go to the doctor, pay my lawyer to end all of this BS and pay the current child support amount. and again, this final hearing is still not set yet. So they intercepted my tax return, even though the temporary modification was approved, the final is what gets it retro backed to the date of filing, so they took, a much needed 5500 tax return from me. I needed that cause one of the issues I failed to mention as well, hurricane Ian has destroyed my home and I'm still going through that process too. not to mention I am on payment plans with Mayo clinic and other various medical facilities. (no one cares) but the interest that accrues, makes it impossible to catch up. also, Florida department of rev is overstepping I feel, and asking for medical info to be sent to them as well as updated doctors letters to be sent saying that I am still on disability.
a few weeks ago, I got an email from my lawyer having a withdrawal notice from her lawyer. in the withdrawal, he stated that he cannot represent her, due to something she may have withheld or lied about (more or less wasn't worded like that but you can tell). In feb court appearance they never produced the PI report, or videos, they had medical info they shouldn't have had, and they had very outlandish comments about my lifestyle. So my lawyer filed immediately a motion to compel. meaning, we want to see everything you have on my client. this was filed almost immediately after court appearance on feb 20th. Susan has failed to provide any updated info requested by my attorney so on june 18th, we have that upcoming hearing.
in the mean time, I have sent my lawyer, a very heavily requested topics, such as "where did they get my medical records, if those were lies, what are the consequences if any"? What did exercising have to do with any of this despite various drs saying he has to or he will get worse.
I know wat you must be thinking, what about your oldest, how can you do that to him. Please listen. This woman has taken everything from me. And i mean everything but the roof over my head. I am seeing a therapist to help with the suicidal thoughts. it isnt enough. the reality of it is, I chose to be loyal and it bit me in the butt. This disease will rob me of everything, my teeth will fall out ( I had 5 cavities last time I went to the dentist) I haven't had a cavity since I was 30 and even then I was suspicious. And I am brushing 5 time s a day to save them. My skin is tightening, and my arms and muscles are wasting. I will literally be left with nothing. My organs will also start to harden, and I will have to start getting around the clock care.
I forgot to mention they (child support) recently, sent a letter to SSI (social security) saying that they would garnish my SSI before I even got it, totaling $1029. the incorrect amount. I sent this to my lawyer and she is looking into it. But it shows that child support will overstep and breaks every law or freedom you may think you have. I DO take care of my children. if they need a haircut i do it, school supplies clothes, anything I do it. And I do it, cause she wont. What I want to leave you with, is that woman can be dead beats too. Child support was designed to have woman off of government subsidized programs like section 8 food stamps and what not. Also to make the man pay for their children man or woman I should say, I know this. I am not running from my obligation. I just want Susan, to have to pay for what's she's done to me and the kids.
I would like to hear your thoughts on this, please comment and share, all names are fake, but everything else is unfortunately real. I know it was wordy, but I wanted to provide as much backstory as possible. And please. Respect my descions. When you are end of life, I hope someone would be kind enough to respect yours. You may not agree and that's ok, but I am asking you to respect them. Thank you for reading.

Plot Summary:
In the bustling city of Brisbane, the Glasshouse Primary School is a beloved institution at the heart of the community. It's a place where children learn, play, and make lifelong memories. However, the school's future is threatened when plans are announced to demolish it and replace it with a modern townhome complex. This news sends shockwaves through the neighborhood, prompting the locals to rally in protest.
Bluey, her younger sister Bingo, and their close-knit group of friends are among the concerned residents. Determined to save their school, the children take matters into their own hands. With the guidance of their parents and teachers, they come up with a plan to show just how important Glasshouse Primary is to the community.
The story's antagonist is Mr. Victor Sterling, a wealthy and influential developer with a sharp suit and an even sharper mind. Sterling is the driving force behind the townhome complex project. He sees the school as nothing more than an obstacle in the way of his grand vision for modernizing the neighborhood. Sterling is charismatic but ruthless, willing to do whatever it takes to see his project succeed.
Sterling's main argument is that the new townhomes will bring economic growth and modern amenities to the area. He uses slick marketing campaigns and even underhanded tactics to sway public opinion. He tries to bribe officials, spreads misinformation about the school's supposed disrepair, and dismisses the children’s efforts as naive and insignificant.
Bluey and Bingo spearhead the campaign to save their school, organizing a series of fun and creative events to raise awareness and gather support. They hold a school fair, complete with games, performances, and a showcase of student talents. Through these activities, they highlight the unique spirit and educational value of their school.
Sterling, seeing the growing support for the school, tries to sabotage their efforts. He sends his assistant, Ms. Grindle, to disrupt the fair, and spreads false rumors about safety issues at the school. Despite these setbacks, Bluey, Bingo, and their friends remain undeterred. They double down on their efforts, involving their parents and neighbors more deeply in their cause.
In the movie's climax, the children present their case to the city council in a heartfelt and passionate plea. They share stories, present petitions, and showcase the support they've garnered from across the city. Sterling tries to counter their presentation with a slick, professional pitch full of promises and high-tech visuals. However, the authenticity and emotional appeal of the children's presentation won the day.
In a dramatic twist, Alfie, a former student of Glasshouse Primary, now a respected community leader, steps forward to support the children’s cause, tipping the scales in their favor. The city council votes to preserve Glasshouse Primary School, recognizing its irreplaceable role in the community.
The movie concludes with a celebratory scene at the school, where children and adults alike come together to enjoy a day of festivities, grateful for the preservation of their cherished school. Sterling, realizing the strength of the community’s spirit, begrudgingly respects their victory and backs down from his plans.
~Voices~
Dave McCormack as Bandit
Melanie Zanetti as Chilli
Hugh Jackman as Victor Sterling
Jacki Weaver as Ms. Grindle
Megan Washington as Calypso
Emma Watson as Venus Sterling
Dan Brumm as Uncle Stripe
Myf Warhurst as Aunt Trixie
Patrick Brammall as Uncle Rad
Claudia O'Doherty as Frisky
Rose Byrne as Brandy
Robert Irwin as Alfie
Lin-Manuel Miranda as Major Tom
(Note: The voice actors of Bluey, Bingo, and their friends are children of the Ludo crew and haven't been credited in Bluey due to privacy reasons. However, the child actors' names would be revealed in the movie's end credits.)

Good evening Healthcare_anon members
I believe we are at the midpoint of the multi series DD on the paper:
Rooke-Ley H, Brown E, Grumbach K, Hoffman A, Ryan A, Roy V, Grogan C, Appelbaum E, Lipschutz D. Medicare Advantage and Vertical Consolidation in Health Care. American Economic Liberties Project, April 2024. Available: https://www.economicliberties.us/our-work/medicare-advantage-and-vertical-consolidation-in-health-care/#, accessed 05/19/24 (for this subreddit post).
Today's discussion will be centered around page 23-31. I will be collaborating with u/ Fabulous-airport-273 on the remainder of the paper, as I believe we should address the topic in a collaborative fashion after this midpoint. If you like, you may review the previous DD in the following links:
https://new.reddit.com/Healthcare_Anon/comments/1culz57/medicare_advantage_capitation_model_prio
https://new.reddit.com/Healthcare_Anon/comments/1cw50xp/vertical_integration_of_the_healthcare_insurance/
https://new.reddit.com/Healthcare_Anon/comments/1cwsavi/vertical_integration_of_the_healthcare_insurance/
I was thinking on also discussing Aetna and Humana within the model as well, however in the interest of time and effort, I may have to revisit those 2 creatures at a later time - not because they are particularly difficult, but that it would be a similar rehash of UNH and BHG. The minutiae of improper population model care and investment made by CVS/Aetna and Humana is in my personal belief the reason why their MCR exploded, and perhaps inadequate preparation for CMS V28 blend adjustment also played a role. Even though CVS/Aetna has an adequate service sector, Humana does not, and we may see further margin divergence of these 2 behemoths.
Without further digression, let us begin:
Vertical consolidation - what is currently happening
"Consolidation allows these vertical conglomerates to use capitated payment structures in ways that drive profits without creating value. As noted above, corporate consolidation in health care has existed for decades, largely driven by hospitals. The primary result: hospitals can negotiate higher prices in the commercial market, cut labor costs and demand more of clinicians, and exploit various loopholes in the fee-for-service Medicare system. In addition, private equity (PE) rollups in health care have risen dramatically over the decades, also exploiting fee-for-service reimbursement and threatening patient care."
We have certainly seen the damage from PE acquisition on practices, especially in emergency medicine, which I previously alluded to in: https://new.reddit.com/Healthcare_Anon/comments/1c0bi4u/the_healthcare_workforce_staffing_crisis_a/. The damage to physician morale is especially acute during this consolidation process.
We are also seeing widespread practice buyouts in the PCP arena now:
https://www.nytimes.com/2023/05/08/health/primary-care-doctors-consolidation.html
https://www.beckersasc.com/asc-transactions-and-valuation-issues/optum-s-multibillion-dollar-acquisition-spree-3-deals-to-know.html
https://www.hcinnovationgroup.com/finance-revenue-cycle/mergers-acquisitions/news/55000097/steward-health-care-plans-to-sell-physician-network-to-optum
https://radiologybusiness.com/topics/healthcare-management/healthcare-economics/unitedhealth-earns-emergency-order-buy-radiology-provider-placed-crisis-due-change-cyberattack
The last one from Corvallis is a particularly spicy acquisition - the change healthcare cyberattack created a cash flow crunch within Corvallis, creating the impetus for Corvallis to then sell itself to Optum. If I were to use cruder terminology, the analogy is this: Optum/Change groomed Corvallis to be dependent on its "service", and once Corvallis is dependent on Optum/Change, Optum/Change then "convinced" Corvallis that Corvallis needs to sell its body (clinics) to Optum for the couple to stay together after Optum/Change failed in its basic "pimp" duty on protecting the groomed subject. Absolutely disgusting analogy, and I hope it brings the message across - what Optum did was absolutely abhorrent and should have paid Corvallis interest and damages, but instead gets to steal the Damsel-in-distress. Who said pimping doesn't pay?
"Today, as policy moves away from fee-for-service, analogous patterns of corporate consolidation are emerging under capitation-based financing. While vertical conglomerates promise clinical integration, familiar harms are emerging, such as the push toward “productivity” medicine and the replacement or supplementation of physicians with less expensive advanced practice providers."
Ok, I am not sure if that last part was absolutely necessary. Advanced Practice Providers (APP) are Physician Assistants (PA), Advanced Nurse Practitioners (APRN), or in the case of Anesthesia, CRNA (Certified Nurse Anesthetist) who work under a supervision of an overall Medical Doctor (MD) for the practice. In the current labor shortage, there are not enough physicians to make up for lack of physician help. I would rather work with our APP colleagues on creating a more equitable platform, and this paper is not helping the cause in this manner. Vertical integration can bring plenty of harm, but having APP being part of the Team is NOT a problem. In fact, I have worked with many APP who are wonderful healthcare colleagues and we all want the same thing: equitable treatment of our patients in the most humane, effective, and medically appropriate way possible.
I. Gaming capitated benchmarks:
"Vertical conglomerates in capitation-based models are keen on controlling primary care physicians, who are essential for inflating risk-adjustment payments and quality bonuses. In MA alone, gaming of risk adjustment is responsible for at least $23 billion in annual overpayments to insurers, while quality payments amount to another $10 billion in subsidization without demonstrated value. In addition to increasing costs, the preoccupation with risk-coding and box-checking wastes scarce time with patients and contributes to dissatisfaction among clinicians."
Remember my CMS DD a month ago? If not, I will submit those links again:
https://new.reddit.com/Healthcare_Anon/comments/1c1n3tf/cms_finalizes_payment_updates_for_2025_medicare/
https://new.reddit.com/Healthcare_Anon/comments/1c1yg8q/cms_finalizes_payment_updates_for_2025_medicare/
We on the field AND CMS knows this is happening. In fact, CMS is attempting to stop this practice by the rollout of CMS V28 AND the April 1 2024 Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F). What CMS is attempting to do is to decrease the capitated payments on risk adjustment and quality bonus payments to elongate the Medicare Trust Fund depletion runway, which hopefully also will force the MA companies to take care of patients. As was seen in our 24Q1 DD, companies will instead retrench, retreat, and cut benefits instead. this indicate a potential market failure of the capitated model payment. We should readdress this point in a future post.
***"***The centrality of data in diagnosis coding puts vertical conglomerates in the driver’s seat. It helps contextualize UnitedHealth’s recent $13 billion acquisition of Change Healthcare, the nation’s largest billing clearinghouse, which, according to the Department of Justice, would give UnitedHealth a near monopoly (94% market share) over the clearinghouse market. Through the prism of risk coding, as well as other financial strategies discussed below, the business case was obvious: acquiring Change gives UnitedHealth visibility into the claims, diagnosis codes, and provider IDs of tens of millions of patients"
With the Change Cyberattack in February 2024, UNH unleashed the biggest cybersecurity threat on our patients' medical history in this nation's history, all because someone forgot 2 factor authentication on a whole server worth of data. Good job United. We thank you for proving the ineptitude of private enterprises. We no longer get to just make fun of the National Health System in UK for ineptitude, or that only government agencies suck, but a private enterprise that is a small nation state with a profit margin higher than the NSA's yearly budget can't figure out 2FA.
***"***As with risk adjustment, vertical conglomerates can inflate quality scores with greater control of clinicians. They can, for example, game medication adherence quality measures by pushing providers to put their patients on 90-day refills, mail-order prescriptions, and automatic refills, even if patients never take the medications. Similarly, they can discourage or prohibit clinicians from giving samples to patients and allowing them to use lower- cost alternatives. Further, Star Ratings and other quality programs require significant administrative efforts, placing small practices at a disadvantage."
I do take exception to the samples argument. Look, we just got out of the VERY SHADY stuff happening in the 90s with MD offices taking a HUGE backhand deal when giving out samples, I don't really want to see that stuff back in vogue again. Do you know how frustrating it was for a patient to say they are on a med that is from their doctor's office, they got it for free, and they must have it as an inpatient, when they don't even have it on the medication fill list or on the electronic medical record database? Who do I trust?
II. PATIENT STEERING AND “CAPTIVE” REVENUE:
This section is the reason why I did UNH and BHG as a DD - to pave the way for the discussion on this section. If you haven't read it, please see:
https://new.reddit.com/Healthcare_Anon/comments/1cw50xp/vertical_integration_of_the_healthcare_insurance/
https://new.reddit.com/Healthcare_Anon/comments/1cwsavi/vertical_integration_of_the_healthcare_insurance/
"UnitedHealth is increasingly relying on this captive revenue—or “intercompany eliminations”—with its growth of its provider subsidiary, Optum. UnitedHealth has increased intercompany eliminations by over 80% in five years, reaching $108 billion in 2022. It now sends over 25% of its medical claim revenue to its own subsidiaries. Its market presence shows why: UnitedHealth exists in 87% of insurance markets, only rivaled by Humana at 90%. 130 Further, UnitedHealth has over 50% share in more than 140 MA markets."
OK even though this paper is quoting another paper, my 10K/10Q analysis does match what this paper said, except it isn't 25%. Its 37.7% now. WHOA!
"These captive revenue strategies enable regulatory arbitrage. Medical Loss Ratios (MLRs) were established in the Affordable Care Act to cap insurance administrative costs and profits and to ensure that a minimum percentage of capitation payments and private insurance premiums were spent on medical care. However, insurance companies can circumvent this regulation by paying themselves, directing above-market payments and end-of-year bonuses to their own sister subsidiaries. This is referred to as “transfer pricing” and has been best documented with PBMs. For example, UnitedHealth can evade the MLR requirement by paying higher-than-cost fees to its Optum PBM, booking that fee as a medical cost. The same is possible with medical providers: insurers can increase fees to their sister primary care or post-acute providers to conceal profits as costs and to therefore evade the MLR constraint."
Is this how UNH continues to have high profits, and how the impact of CMS V28 somehow did not threaten UNH and Elevance the same way as Humana and CVS/Aetna? I think they may be onto something...
"In addition to increasing profits, steering squeezes independent providers and other competitors. In the prescription drug space, the gaming of medication adherence, explained above, diverts business away from unaffiliated pharmacies while gaming quality metrics. As another example, vertical conglomerates that own PBMs can devise formularies and copays that funnel patients to their own pharmacies, squeezing independent pharmacies. The proliferation of “specialty” pharmacies embeds these anti-competitive practices.".
Personal anecdote: I know of independent pharmacies who CANNOT compete anymore due to high PBM requirements, "clawback" penalties, quality metrics that is impossible to achieve, and "out of network" processing fees, that these pharmacies either have to be shut down, or acquired. "Specialty Pharmacies" are basically pharmacies who carry high dollar cost items that may have more stringent FDA counseling requirements, but because now the Marketplace is littered with PBM funnels, most independent pharmacies cannot "enter the foot in the door" of the PBM requirements. Guess who does though? Optum Rx!
"Vertical consolidation in the post-acute setting presents similar steering risks. MA insurers have increasingly been under scrutiny for limiting or denying care through narrow networks, “ghost networks,” and onerous prior authorization. Recent reporting revealed that UnitedHealth and Humana are using artificial intelligence with their conveners, specifically NaviHealth, to drive “clinical” prior authorization decisions and override clinical judgment."
I think I've beaten this dead horse many times already.
"Another way to steer patients in post-acute care is to effectively bring the prior authorization function “in house.” By directly employing physicians, the risk-bearing entity can cut costs by prohibiting or discouraging clinicians from authorizing expensive care. In a 2020 whistleblower lawsuit reported by The Prospect, Maxwell Ollivant, a UnitedHealth-employed nurse practitioner in a nursing home, alleged that his supervisor denied requests to transfer UnitedHealth-MA patients with exacerbations to the hospital. This, Ollivant alleged, was consistent with UnitedHealth’s compensation structure, which gave bonuses to their clinicians who kept patients in the nursing home and out of the hospitals."
Well holy shit Batman, that is more degenerate than a WSB 0-5DTE put taken on a Thursday afternoon.
III. PATIENT “FLIPPING” AND ENROLLMENT ARBITRAGE
" In MA, favorable selection is responsible for another 11%-14% of overspending, or as much as $56 billion annually. Selecting enrollees also allows insurers in MA to game county benchmark bonuses, which excessively rewards insurers with patients in areas of low Medicare spending, to the tune of another roughly $10 billion in excess MA payments. As vertical conglomerates increasingly own physicians and operate in ACOs, similar risks of selection may arise."
CMS is acutely aware of this gaming, however their model hasn't exactly been able to pinpoint how to address this yet. This was discussed in the CMS Final rule comments section.
"More direct than marketing, provider acquisitions allow conglomerates to “flip” patients into MA plans or ACOs by coordinating efforts with sister provider subsidiaries. Conglomerates can initiate the flipping strategy by using some of the steering tactics discussed above. In a recent lawsuit, UnitedHealth was accused of terminating contracts with unaffiliated physicians in order to force the patients to establish care at nearby Optum practices. In another suit, UnitedHealth, with 50% of the MA and commercial insurance markets, allegedly attempted to force the sale of local practices to Optum. UnitedHealth was accused of cutting insurance reimbursement and steering members away from the target practice, and as a condition of insurance contracting, forcing the target practice to give UnitedHealth the first right of refusal upon sale.
I inivite our physician colleagues to comment on this section. I have personally heard of such anecdotes, but further validation is always helpful and will also increase our membership engagement on such complicated subjects
And we now reach the end of page 31. This paper is extremely dense, and required basically a multi-layer DD on top of it to corroborate and create discussion points on the topic discussion.
We hope you enjoyed this half of the mini-series, and we hope to bring you the 2nd part of the mini-series soon as a collaborative post.
Thank you for taking the time to read through this. I hope this provides you with a better perspective on a glimpse of the landscape that I am personally aware. Please submit your comments below on your thoughts
Sincerely
Moocao
​

We just got a court notice for unsecured debt from BDC of $40000 for which their lawyer has filed a claim in The king's bench. I have another 4 days before 20 days time complete to respond and the letter says their lawyer can then seek default judgement. I do not own any assets or have no savings in my bank. But me & partner have no bad intentions and still wanting to settle it down somehow without going through bankruptcy or consumer proposal route. We both are currently no making any money but working hard day and night to set up our small business anticipating it should work out for us.
This is an old debt & my last communication with the bank was in July 2023. This was a business start up loan with personal guarantee.
I couldn't pay back the loan due to financial hardship due to family & stressful time & now I am wanting to settle it down with a Lum sum payment with the help of my parents from their pension They promised upto 4-5 k savings they can do if we wait 4 months. I am working on setting up my small owner operator business; however, currently making no money since last 2 years) and I am hoping if I can save some in 3-4 months. So looking to buy some time from BDC & . However, I am not sure what is the best way to go about it at the moment & looking to take assistance from you with dealing with this situation. We are very stressed out at this time and this is effecting our young kids as well. Any suggestion is appreciated.

Four years ago I was doing well at a new job and making enough money to consider taking ownership of my grandparents house that was currently being rented to a family. My good friend was living in a one bedroom apartment with her two children. She was having issues paying her rent which was $1800. I decided to use around $25k to renovate my grandparents house so that I could have a tenant living upstairs and me living downstairs. I planned to let my friend be that tenant living upstairs. I really cared about her and her children and wanted to help her get out of a bad situation. For context we live in NY.
Since I know she couldn’t afford her current apartment at $1800 I made the rent $1500 with all utilities included, water, heat, Wi-Fi, and electric. The apartment is a two bedroom apartment on the second floor of the house. It has a big room for a kitchen/dining area/living room space along with a big bathroom, two big walk-in closets and a lot of extra hallway room in the foyer. She has a parking spot in the driveway and the house also has a big backyard where the kids can play. At that time the apartment could have gone for at least $2100, it was severely under the market price for apartments in the area. When I gave her that price I did not expect to keep it at that price for long. I had hoped it would help her afford another place. Because with the price I gave her I was not going to make a penny back on what I spent in renovations and I would still need to put in money every month to pay the bills to live there as well.
When I was creating the lease I referenced a lot of different lease agreements I saw that it was common to charge $50/day till rent was paid if rent was late. These seemed like harsh terms but I have never been a landlord before and I hoped it would never affect her since I thought she would pay on time. I gave her the contract, she looked it over, she never questioned it and signed. She moved in and so began our journey of living together in the same house.
Over the course of 4 years she continued to struggle to pay rent. All spread out by several months in between, she had a series of unfortunate events.
When Covid hit, she wasn’t working, so they weren’t paying her. When she started working again she got Covid and was out of work for weeks. She almost lost her eyesight and needed to get a surgery which successfully saved her eyesight. Her car broke down and needed to get a new/used car. She lost her job and struggled to find a new one. Most recently her kid was in the hospital for 6 months and is now home but she can’t work a full-time job because she has to be home to take care of her kid.
To get through these times she used a lot of government assistance programs and borrowed money from friends and family. Unfortunately she was late often. I was always very understanding and patient with her about rent. I have never mentioned late fees or asked for late fees. She was always the one to bring it up and say that she will get the late fees to me. I even decided to waive the late fees several times. Every time I had a chance to raise the rent I decided not to because I knew she could barely afford what I was charging her and was still continuing to struggle.
Recently she wanted a meeting with her boyfriend and I, to talk about her boyfriend moving in with her. At least that’s what I assumed. I was startled when we met and her boyfriend aggressively dug into me about how my late fees are unlawful and that they must be rectified as soon as possible. Going on and on about how he has lawyer friends and if he took this to court it wouldn’t go well. I kept my cool and just said I need to look into this on my own and we can reconvene for another meeting.
This is not a legal apartment. So if they were to go to court about this then she would lose the apartment. If I were to have made it legal, I wouldn’t have been able to charge her so little for rent because taxes would be a lot higher.
After a lot of research, I’ve come to terms that my late fees are no longer legal. I did not realize but after Covid the laws had changed for apartment rentals in our area. Which changes it to a $50 flat fee if late on rent. After recognizing that I had made a mistake, I decided to look over how much I owe her in whatever late fees she paid over the years MINUS a $50 flat fee for every time she paid late. After doing a quick analysis I owe her $800 minus the 10 times she’s been late on rent which is $500 so I owe her $300.
I’ve then look at all the renovations I’ve done on her apartment over the years that I never charged her for. I fixed four blinds that she broke and bought her new ones for the bathroom since she didn’t like the curtain I put there. I repainted her children’s bedroom plain white since they had grown up and no longer liked the bright pink and blue that we originally painted in their room. I painted the floor in the bathroom because she said it was dirty looking and embarrassing to the kids when they had company. I fixed a door that she broke and installed a new door knob she also broke. I changed the light fixture in the kitchen twice because she had issues seeing. These are all renovations that my dad and I had done. I am very handy so a lot of it was done by me.
With this in mind the $300 that I owe her doesn’t seem necessary. I am currently gathering up the prices for all the materials and items I have bought to do these renovations. Not to mention I never charged her for my labor. I could have gotten someone professional do the labor but then neither of us would be able to afford that.
Currently we are both gathering our bank statements to get a full understanding of the situation. She does not know that I kept the terms by mistake. I tried to set up a meeting with her again to talk more and she treated me like a villain. She does not wanna talk without her boyfriend present. Saying that I should say sorry to her and that she is going to look into what she is due.
I’ve been feeling pretty mad about this, she has not given me the benefit of doubt and even after all these years of doing so much for her. I am in the process of writing a new lease with a rent increase. I am sad to think that this might be an end to our relationship. I have been trying to think of tactful ways to have her move out, so I can finally rent the apartment for what it’s worth which is now around $2500-$3000. I am also no longer making the money I used to. I had also lost my job twice during and after Covid so times have been hard on me as well.
Any legal or other advice is appreciated. Thanks for listening to my story.

First a couple legal acronym meanings for those unaware of what these stand forTRO-Temporary Restraining order EPO-Emergency Protective Order.
I 38f reside in Rverside County, CA. I’m wondering how to go about filing a lawsuit against my former landlord for his illegal self-help eviction as well as him knowingly allowing me to live in uninhabitable conditions. When I attempted to withhold rent and make him aware of my decision to do so, He violently assaulted me, harassed me in many other ways, and retaliated against me in the most unbelievable ways (ie. shutting off my electricity, water and plumbing, witholding my mail, and keeping me from my patients as the house on the property that he owns but doeNOT live in was my place of employment at the time.) He also caused my great financial ruin in one of his attempts to have me removed from the property by filing a false TRO and EPO against me forcing me to have to leave for 6 weeks. I had to shell out thousands of dollars in air bnb fees due to that little stunt. He also never allowed me to gather the remainder of my things as when I arrived to do so, he had random people moving my things out of the unit that I was still in lawful possession of. He not only violated my tenancy rights, but also basic human rights and continues to do so with the tenants that still reside there. I want to stop him from continuing to do so. EVERY single government entity I’ve attempted to get help from (ie. Sheriffs dept, code enforcement, fair housing counsel, adult protective services, but especially the RCSD) has failed me greatly as I attempted to reach out to them numerous times and was told by every one of them that “there’s not much I can do for you”. My landlord violated the restraining order I had in place against him the very day he was served with it and when I called the sheriff about it, they did nothing! He has violated the restraining order more than once and neither time was he held accountable for doing so. The RCSD has been MORE than negligent. I even attempted a call to the watch commander whom pretty much gave me the same crap all the officers did. They keep telling me that they can’t get involved in civil matters when I know for a fact that this is not merely a civil matter but a criminal matter finable up to $100per day he stays in violation of my civil rights. It’s even stated in their penal code. So any attempt to hold him responsible for his blatant violations of my rights have been met to no avail So here I am doing everything to the letter of the law and going about this the legal way, while he’s basically being rewarded for being an abusive slumlord who sees my attempts at legal action as nothing but a game. I’ve got mountains of evidence to back up ALL of these accusations and need help persuing a lawsuit… the problem is…all of my savings were squandered when I had to pay thousands for an Air BnB when I was forced off of the property due to his false claims against me which prompted the approval of his EPO. At the hearing for that TRO, his claims were found by the judge to have no merit and so it was not extended. I attempted to seek payment from him for such expenses at that hearing, but the judge wouldn’t grant it to me bc I had not served him with my answer to the TRO prior to the hearing. I truly feel like I have a solid case here against my landlord and possibly even against the RCSD as I feel they pretty much assisted him in illegally attempting to remove me by cutting my utilities. Like I said though, since I accrued astronomical costs not only on temporary housing, but moving costs as well, my funds have been exhausted. Are there any lawyers that would possibly take my case on a winning contingency? I’ve tried to find one, but keep running into dead ends or just being referred to legal aid services which I always feel are kind of scammy. Any advice as far as what I can do to move forward with this matter even though I don’t have the finances to cover upfront costs?

Could I get my query letter critiqued please?
I'm trying to make it more appealing and attractive for agents
Dear XXX,
I’m seeking representation for my debut YA fantasy novel of 80,000 words, THE WARLOCK’S SHADOW. In a mystical world where magic and modern life seamlessly coexist, fifteen-year-old Alex is an ordinary teenager with huge dreams of following in his late father’s footsteps to become a Knight; an elite dragon-riding, magic-wielding, protector of the world. There’s only one problem: he sucks at magic. While attending school he undergoes an affinity ritual to discover that he aligns with the mysterious element of darkness, something extremely rare and associated with black magic users called Warlocks. The only Warlock Alex knew of is Blight, the same man who tried to enslave all dragons in pursuit of world domination--as well as his father’s murderer. Disheartened when no domesticated dragon egg bonds with him as it does for classmates, Alex stumbles across a wild dragon egg in the nearby woods. It immediately hatches for him alone, unleashing his previously untapped magical gifts. Intrigue mounts when his mother passes down a cryptic amulet, a gift from his late father later that evening. Meanwhile, black magic cults are on the rise and Alex’s amulet begins to pulse with energy and his own magic starts to go haywire. Curious about the amulet’s behavior Alex finds his father’s journal while researching and discovers an upcoming cosmic event called the Celestial Shadow. The event in question would weaken the boundary between their world and the Void which is imprisoning the Warlock Blight. Cults worshiping Blight plan on using this event to free him. Alex and his friends vow to stop whoever is behind the plot to bring back Blight. Should they fail, life as they know it will be turned upside down. THE WARLOCK’S SHADOW is a unique combination of “How to Train Your Dragon 2” and “Harry Potter”. This work is aimed at a young adult audience seeking an immersive escape into a world where magic is not just a part of life but a force that shapes destinies.
Enclosed, please find the first xx pages/chapters for your consideration. Thank you for your time.
Sincerely, (Me)

Hey everyone, I’m sitting around bored 12 days post-op and thought I’d write about my injury and experience up to this point just in case it’d be helpful to anyone. I’m also a physical therapist, so I have experience on the other end assisting with the recovery process - but this is my first major injury for myself. Apologies in advance for the length!
My injury first occurred on March 16th, pushing off with my right foot to return a serve in a game of racquetball. It was the typical feeling of getting kicked in the back of the leg - to the point that I thought someone had dropped something from the spectator gallery (it was a tournament with an audience) and looked back expecting to see something on the court. Following that was the immediate realization that I had torn the Achilles. No significant pain, but a complete inability to actively plantar flex my right foot and a visible/palpable defect.
The ER visit started with two PAs agreeing with me that it’s a clear Achilles tear, and using my leg as a teaching tool for a new nurse. That confidence in the diagnosis was shaken though when the MRI came back negative. I was splinted in plantarflexion (PF) and anxiously awaited a visit with a podiatrist on Monday (injury was on Saturday). I also had a visit with an orthopedist (foot/ankle specialist) for that Friday just in case.
The podiatrist agreed that clinically everything lined up with an Achilles tear, but wanted to put me in a boot in neutral given the negative MRI. I was uncomfortable with that approach and rigged up my own heel lifts to stay in PF until I saw the ortho that Friday. The ortho was also a bit stumped, suspected a possible plantaris tear (maaaaybe showing on the MRI) and partial Achilles tear, and put me in a cast for 4 weeks. This was uneventful, just a boring month, so I’ll skip forward to my “big mistake”.
After a month in the cast I was put in a boot with heel lifts, planning to continue with a conservative approach and some physical therapy. I scheduled my first PT appointment for a week after getting out of the cast (6 weeks post-injury) and started my own PT at home with some light IER AROM, NMES for my calf, and other basic exercises. That Wednesday (April 24th) I was home with my 4 y/o daughter, using my knee scooter to get around. I was typically quite diligent in keeping my boot on, only taking it off to let my foot breathe when lying in bed or on the couch. In a moment that still lives rent free in my head, my daughter asked me for some strawberries and I decided that it was just a quick roll on the scooter to the kitchen and back. Somewhere between shutting the refrigerator door and turning my body to grab the strawberries off the counter the scooter tipped over. To my right side. And I came down with most of my weight on my right leg, without my boot on, forcing my foot into dorsiflexion. I felt a pop, immediate pain, and laid on the kitchen floor while my daughter helped me grab my phone so that I could call my wife.
What followed was a week of shame (beating myself up as I absolutely knew better than to move around without the boot), pain, and the awful realization that surgery was the next step. Diagnostic ultrasound showed a rupture with 2.7cm gap, and surgery was scheduled for Thursday, May 9th. The surgery itself went well, although the surgeon expressed to my wife that the tendon was “more shredded” than he expected. I was splinted with bandaging/ACE wrap holding it together. Showering has continued to be a pain, although two months into all of this I’m getting used to sitting down. I get the splint off tomorrow during my first post-op visit, likely moving to the boot next. Pain is fairly well managed, although I’m currently getting a fairly constant rotation of burning, aching, and spasms as my leg goes slowly through the healing process.
I’m nervous about the upcoming rehab process, likely the result of “knowing too much” and fearing the worst as I hope to get back to my prior level of function. I’m comforted knowing I have the tools at my disposal to maximize my rehab. It’s been great to read through other peoples’ posts on this forum, particularly getting some perspective on different experiences. For those that read this, I’m happy to answer any questions or update as I progress through my last weeks of lying around at home and finally start PT (in a few weeks).

Has anyone else received one of these? I picked up my SO from the airport, use the cell phone lot, and came around when she was at the curb. We were there for maybe 60 seconds while we loaded luggage, so am monumentally confused at getting a $60 ticket in the mail for this that also tells me I've exhausted my opportunity to appeal.. What opportunity to appeal?? This letter is the first I'm hearing of it. Trying to understand if this is some new rule we violated so I can avoid having this happen again...

I feel like fixing my financial health is one of the last big hurdles I need to accomplish before I will start feeling like I am okay with the setbacks and limitations of living with bipolar disorder for the first 12 years of my adult life prior to achieving medical success. I have so much shame. There was financial control and abuse between my parents and one of my traits from growing up in an abusive home is an extreme need for independence regarding survival essentials. Money. Living away from them. Perfectionism and overworking.
I make a good salary in the low 6 figures. My boyfriend wants to move in together. He makes a little more than me but he’s been making this type of a salary the entire time and is in a really good spot financially. I need to talk with him and I just don’t know how to do it right now.
There’s so much shame tied to my debt. I was in law school when I had my first debilitating manic episode and then it all made sense. I was at the part of law school where you finally have enough time and knowledge to start making money part time during school. My plan for the entirety of law school was to work as much as I could to put myself in a good position to graduate on good footing. I was completely unable to work for the entire time from the manic episode a month before my second to last year through the time until I took the bar exam.
At the time, I had a mild amount of credit card debt. A few thousand dollars. I did what I felt I needed to do to get by without needing to rely on my father to get by.
Instead of working that year I started almost 3 years of medication trials and instability. Even hypomania is debilitating as an attorney because it destroys my ability to concentrate and keep an even keel.
But most of all, antipsychotics were continually pushed on me and the physical side effects were debilitating. I slept for 12 hours a day and gained 40 pounds. I couldn’t regulate my body temperature on some of them. Once my beach umbrella blew away and I was literally too slow to grab it and stop it from hitting another persons tent.
I relied on student loans and on credit cards for my third year and it got bad. My first job paid low but was worth the career experience for a year. My brother was sick with cancer, I was studying for the bar, I paid for bar prep, I was in an abusive relationship where I was pressured into paying for everything and where he got me to even pay for his laptop repair claiming that my car stepped on it and broke it. I was so broken down from the med side effects that life was just happening and I tired to get through each day with minimal damage. My parents didn’t believe I was sick and this guy took care of me literally when I was disabled. Except that it was in a manipulative way way. He accidentally exposed my cat to lily toxins and I had to pay $2500 at the vet, he didn’t help with a penny. I couldn’t let the cat go, he saved my life more than once.
My debt got worse. I consolidated and my parents helped me with a loan, but it still got worse when my pay was low. I had a lot of medial expenses. Therapy. Psychologist. IOP. Prescriptions @latuda $86 to poison myself. I also had a nasty colorectal condition that was very upsetting and painful and required surgery.
I was struggling daily with wanting to be alive and debt was a minimal concern. I said ok it won’t be so bad when I make $150K this is temporary. I was still trying to work at a mental capacity that had changed after having a severe manic episode and realizing I can’t just grind my way into success because I’m limited.
I moved away and got a job with better pay. I’m trying, but this is so hard. I still owe my parents money and they can’t forgive it for me because they have their own debt. My mom took it in for me on a 0% card.
My credit score says it’s about a 665-675. I have a lot of debt but a good payment history. I just need help. I need advice to talk to him. I need encouragement.
I’m having such a bad day. My city’s local university is hosting an encampment protest demanding the school “terminate” their Jewish student center because the organization is affiliated with Israel and incorporating “there is only one solution” into marches that have come past my office window at a volume that could be heard anywhere in my office suite.
I am heartbroken and so triggered over this. Apart from the Jewish stuff, the Hitler reference is very triggering for me as a person with a mental health disability because I’m really freaked outabout the recent embrace of physician assisted suicide for mental health. I don’t trust psychiatrists to have my best interest in mind nor do I trust us when we are sick to be rational about a choice like that.
I have an assignment due to a partner who has all but said he thinks I am incompetent and am in anxiety paralysis about it. I’m in doom panic mode thinking about everything that is wrong.
I feel like I want my finances to be private but I don’t want to keep secrets from my boyfriend. I would save $1000/month if I moved in with him. He would save $750. I’m ready for that commitment and he is too but I feel like I need to be transparent before we make such a big step.
Pls help pls advise. Crying in the tub rn 🛀

I have a family friend serving a federal prison sentence. They hired a lawyer to file an appeal on a constitutional issue as well as ineffective assistance of council. Unfortunately, they lost the appeal but always planned on appealing to their circuit court in the event they lost. Their lawyer never let them know about any deadlines and didn't send the district court's decision until after the deadline for filing in their circuit expired. I don't know the exact amount but they spent quite a bit of money on this appeal only to have it die because their lawyer didn't keep up with the deadlines.
Is there anything they can do? We've been looking around for legal malpractice attorneys but they all seem to be more geared towards civil cases where there are financial damages.

recently, my application for group insurance through my employer (including life, single health, and single dental) was declined due to my medical history. i have a sleep disorder, and I'm currently on medication for anxiety and depression. the insurance company noted that due to this and the fact i haven't consulted a doctor for lightheadedness/brain fog issues, which they see as increasing the risk of a life and/or health claim.
i have the option to appeal the decision by providing additional medical details from my doctor.
has anyone successfully appealed a similar insurance denial? what kind of information or documentation did you provide?
what specific details should I ask my doctor to include in the appeal letter to strengthen my case?
any advice or personal experiences would be greatly appreciated. i'm feeling a bit overwhelmed. i don't need anything medical related immediately which is the only upside :/

I just completed my first semester at UMD as a transfer. I was an engineering major at my previous university but decided to transfer into UMD undecided since I still needed to complete some prereqs before applying for the engr school here. I already took Chem at my previous college and got a B but unfortunately took my first attempt of physics there but withdrew because I was taking too many classes at that time. This semester at Umd I took Math141 (Calc 2) and Phys161 and got an A in Calc but sadly a C in physics. The engr school requires atleast a B- in Calc 2, a B- in physics, and a C+ in Chem. You’re also only allowed to retake one of those 3 classes and a W counts as an attempt. This means I already used the max amount of retakes but it’s unfair that a W still counts as an attempt. I don’t really know what to do at this point because I was hoping to apply for the Engr school for next sem but I think my chances of getting in are slim to none now. Should I take Physics over the summer and apply after those grades come out? Could I write a good appeal letter about my situation and get in maybe? Anything helps. Thanks.

I hope this letter finds you well. To begin, I was drawn to this topic through social media posts that shared dozens of records detailing the abuse and deaths of hundreds of children in these therapy programs. I have often wondered, how can these programs be allowed to cause this amount of trauma to teens and children? This inspired me to look deeper into the troubled teen industry and understand why paid “caregivers” have put so many in danger. If we want to protect the wellbeing of these teens, we must find a solution to regulating these industries. Without increased laws and regulations we continue to place America’s children into potential death traps. Now what is a wilderness therapy program? Wilderness therapy programs, on the surface, seem like a promising solution for troubled teens, offering a blend of nature immersion and psychiatric support. However, the roots of the troubled teen industry date back to the 1970s, with reports of abuse surfacing early on. Shockingly, despite decades of outcry and documentation of fatalities, political inertia persists, and federal oversight remains lacking. It is understandable that parents want their children to be happy, respectful, and well-mannered. However, in an attempt to do what is right for their struggling child, parents may turn to the troubled teen industry. Currently, according to the American Bar Association, there are thousands of teenagers in these programs within the U.S, programs that often induce trauma and abuse, even causing the deaths of their children. So, why do parents continue to put their children into these programs? Is the fear of losing the “perfect” family leading parents to enrolling their children into these troubled teens’ wilderness programs? So why do parents enroll their children in these awful facilities? Simple answer: manipulation. The troubled teen industry (TTI) often manipulates parents through a series of insidious tactics. For instance, leveraging fear by exaggerating the risks associated with a child's behavior and creating a sense of imminent danger. Isolation tactics further reinforce this urgency, convincing parents that the facility is their sole recourse. These industries hire workers framed as “education consultants” that utilize high-pressure sales strategies to exploit parental anxiety, and present their TTI program as the only viable option. In an article by USAtoday, reporters held interviews of parents and teens who experienced a TTI program at Evoke, a Utah facility. "I was just an anxious mom. I loved (Katelyn) to death," Tessie, Katelyn’s mom, says, "I was so desperate and desperately wanting to save my child from herself" (USAtoday). Programs offer promises of rapid transformation and they prey on parental desperation for quick, easy fixes. Emotional manipulation adds another layer, playing on a parents guilt and insecurity. By showcasing selective success stories and controlling information flow, they obscure potential risks and alternatives. Stigmatizing the child's behavior further pressures parents into compliance, painting their facility as the sole refuge from societal judgment. "’[Evoke] just made it seem like (she was) such a rotten kid and that she couldn't come home after the wilderness program,’ Tessie says, instead [Evoke suggested] Katelyn go to an aftercare program” (USAtoday). In this web of manipulation, parents often find themselves coerced into decisions they later regret, unaware of the nuanced realities obscured by these tactics. In an article from the “Cafemoms” blog titled My Daughter Was a Victim of the 'Troubled Teen' Industry & It Haunts Me to This Day, a mother recounts her perspective of the tactics used by Island View (IV) treatment center to send her sixteen year old daughter to their facilities. “We trusted the [education consultant] when he said IV was the best program in the country and the best fit for Colleen. What the [education consultant] didn’t tell us was that the reason so many IV grads did so well after graduation is because nearly all of them went straight from IV to another residential treatment”(Cafemoms). Despite this, there is still hope for change. Imprint News wrote an article that focused on recent protests and youth advocates who were pushing congress to introduce new laws. Specifically, they discussed the Stop Institutional Child Abuse Act. A main advocacy group aiming at these lawmakers is Breaking Code Silence, a group dedicated to advocating for young people who had experienced harm in a youth treatment center (Imprint News). Their main goal is to pass a Bill of Rights for all children in youth treatment centers (Imprint News). The article also mentions that Breaking Code Silence wants children to have guaranteed protection from physical restraint and monitored phone calls. They further require that children are provided with all the basic necessities (Imprint News). Paris Hilton, a well-known celebrity, discussed in a Washington post article when she was 16 years old when she was taken from her home by two men. This was a result of her parents signing her up for a teen wilderness program (Hilton). Hilton describes that she was beaten and malnourished throughout her time at a Utah Facility. In October 2021, she partnered with Breaking Code Silence and pushed for a reform that was signed into law last April (Hilton). In Utah, it is now mandatory for treatment centers to document any time that staff used physical restraint (Hilton). Immediately following they have to submit these reports to the Utah Office of Licensing (Hilton). It also prohibits programs from sedating residents or using mechanical restraints, such as handcuffs and chains (Hilton). Therefore, this proves that reforms can be implemented and that it is important to continue the fight for more. Without regulations these programs can run rampant and place hundreds of children in danger. Continuing to protest, collaborate with government officials, and raise awareness can, and will, eventually stop the persistence of these programs. Enforcing reports and proper care through the law is the only way to give teens struggling with mental illnesses in these programs a fighting chance to recover. On the other hand, supporters of the troubled teen industry have used studies and research to prove the effectiveness of these programs, one example being RedCliff Ascent. RedCliff Ascent is a wilderness therapy program that claims the effectiveness of wilderness therapy. In 2005, this company hired a researcher to study families and adolescents 2 years after the program. The results found that over 90% of adolescents found wilderness therapy as effective and 83% of adolescents were doing better. In another study by Dr. Steve Aldana, it was found that 91.4% of children experienced clinically significant improvement six months post program. The counter argument presented by RedCliff Ascent is not only biased as the research was initiated from a wilderness therapy company, but they do not provide a sample size. This is important because when making conclusive statements such as “Over 90% of adolescents contacted perceived wilderness therapy as effective” they could be talking about six out of seven children or two hundred out of two hundred twenty (RedCliff Ascent). Through further research, the same results can be presented without the use of wilderness therapy. An article by the American Psychology Association (APA) titled “Better options for troubled teens” presents a series of studies and programs that was created to help adolescents. These programs focus on community-based activities, activities to help connect teenagers with their parents, and activities that align with the teens interests. This includes computer labs, dance studios, and machine shops. These programs have found significant success in decreasing the amount of juvenile offenders from 50% to 4% in an area of Connecticut (APA). It did this by helping teens take accountability and understand their actions. It utilized role play, writing assignments, and guided discussions between the teens. Overall, the troubled teen industry has caused abuse, trauma, and death to many children across the United States. It is a trap for children and a trick for desperate parents. Through the personal stories from teens and parents, reports of mistreatment, and protests it can easily be seen the impact and the importance of preventing this industry from expanding, instead increasing regulations and transparency to protect America’s children. To keep these children safe it is imperative that everyone works together to enact legislation. Your support matters to keep America’s children protected.
Sincerely, A high school student trying to make positive change
Works Cited Brennan, Caleb, et al. “Youth Advocates Again Push Congress to Crack Down on ‘Troubled Teen’ Industry.” The Imprint, 19 Aug. 2022, Date Accessed Mar. 2 imprintnews.org/top-stories/youth-advocates-congress-troubled-teen-industry/67243.
DeAngelis, Tori. “Better Options for Troubled Teens.” https://www.apa.org, www.apa.org/monito2011/12/troubled-teens. Accessed Feb. 19
Hilton, Paris. “America’s ‘Troubled Teen Industry’ Needs Reform so Kids Can Avoid the Abuse I Endured.” Washington Post, 22 Oct. 2021, Date Accessed Feb. 5 www.washingtonpost.com/opinions/2021/10/18/paris-hilton-child-care-facilities-a Buse-reform.
Krebs, Catherine E. Five Facts About the Troubled Teen Industry. 22 Oct. 2021 Date Accessed Apr. 23 www.americanbar.org/groups/litigation/resources/newsletters/childrens-rights/five-facts-about-troubled-teen-industry.
Moniuszko, Sara M. “Wilderness therapy was supposed to help these ‘troubled teens.’ It traumatized them instead.” UsaToday, 8 Dec. 2022, Date Accessed Apr. 15 www.usatoday.com/in-depth/life/health-wellness/2022/12/08/wilderness-therapy-troubled-teen-industry/9890694002.
Parenting, baby names, celebrities, and royal news CafeMom.com. 14 Oct. 2022, Date Accessed Apr. 19 https://cafemom.com/parenting/troubled-teen-industry-island-view
RedCliff Ascent. “Does Wilderness Therapy Work?” Wilderness Therapy for Teens Needing Mental Health Treatment RedCliff Ascent, 10 Jan. 2023, Date Acessed Feb. 21 www.redcliffascent.com/wilderness-therapy-program/does-wilderness-therapy-work

Demographics
White dude
Iowa resident
First gen, rural (population of 700), and underserved background. Likely low income as well, not entirely sure.
Academics
cGPA (with dual enrollment included): 3.3
cGPA (only undergrad): 3.47, upward trend, 3.6-3.7 GPA in last 3 semesters with REALLY rigorous course load
sGPA (everything included): 3.32
MCAT: 508, even distribution, nothing below 126
Registered for Preview, will do casper as well
1 gap year, starting a 1 year master's program at my state school in the fall that is basically the first year of medical school. That is why this is kind of a fuck it we ball cycle, if I dont get accepted this year and dont fuck up, my chances at my state school are genuinely REALLY good next year.
Extracurriculars:
Hours are approximate but very close, I havent gotten to doing the exact math yet, but I did track hours for most things.
Research: 1500+hrs, 1000 in organic chem and 500 in Orthopedic surgery. One first author pub submitted for the ortho research
Clinical Volunteering: ~350hrs as coordinator for free mobile clinic for unserved communities, managed all of the supplies and lab equipment, trained over 300 student volunteers in lab tests and vitals. Clinics legit could not run without me, and that will be included in a rec letter
Leadership: ~100 hours as a fraternity VP and standards chair
Work experience:
2000+ total in a bunch of stuff
~500 hours as a peer mentor for first-generation college students
~100 hours as a private tutor, biology and chem at all levels
Other weird jobs I have had, mostly manual labor: Farm Hand, DNR State Park groundskeeper, tour guide for local architecture attraction, and working in warehouses.
About to get a patient care tech position
Other Misc ECs:
SHPEP Scholar
~30hrs working with a physician on a men's health initiative, targeted school's frats and athletic teams to educate young men on men's health
~30hrs social media manager for a Instagram page educating HS and younger prehealth students on the realities of healthcare and the opportunities at all levels
Hobbies: backpacking, photography, cooking and baking, computers, fitness, and reading
Other relevant info:

• Most of my extracurriculars, personal statement, etc., revolve around my rural, first-generation, and blue-collar background
• Really trying to leverage the fact that I am from a rural area, and would probably do rural health
• My lower GPA can also be explained by my extreme over-involvement in my earlier years and slower-than-average adaptation to college.
• My rec letters are pretty solid

School list so far:
Note: You're gonna notice I'm not applying DO. I know everyone's gonna lose their shit over this. 3 reasons why:

1. Im broke, I can't afford 30+ schools.
2. DO schools financially exploit the fuck out applicants even more so than AAMC already does, and I just don't wanna deal with that.
3. Like I said, I'm getting a master's; if I get straight rejected this cycle, I'll be in a much better position to apply across the board in the next one and will apply for DO then.

In no particular order

1. Iowa Carver (please god just let me in)
2. Nebraska (where I did SHPEP)
3. U of Minnesota
4. UW Madison
5. Michigan State
6. Mayo Alix (No shot but I'm still a strong mission fit)
7. Medical College of Wisconsin
8. Yale (my one absolutely fuck it why not app, I really like new haven and pizza)
9. Ohio State (considering removing, outside 10th percentile)
10. U of Cincinnati (considering removing, outside 10th percentile)
11. U of Miami Leonard (Consitering removing, outside 10th percentile)
12. Oregon health and science
13. Indiana (considering removing, regional bias and outside 10th percentile)
14. Rutgers, Robert wood johnson (SHPEP is RWJ sponsored, again just trying to leverage anything I can)
15. Geisel at Dartmouth
16. Robert Larner at Vermont
17. University of Missouri - Kansas City
18. Virgina Tech
19. West Virginia
20. University of South Carolina Columbia
21. Toledo

I really did try to pick schools where my stats were at least on the bell curve and OOS acceptance was above 25%. My concerns overall are that I generally have no idea how to put a school list together and that many of these schools might be super low-yield for OOS. I am also worried that I might have skipped over a lot of schools that I'd be a good mission fit at.
I have had pretty much zero guidance on applying outside of this subreddit, so I really appreciate any and all advice. Be harsh if you have to, I get it.

Hi all,
My husband applied for citizenship. When he went to the interview, the officer would not allow him to explain his posture as a conscientious objector based on religious beliefs. She would only allow him to say yes or no to her questions. She then says:"You did your military service in your country of origin, but you won't bear arms on behalf of the US. Is that right?". He tried to explain that his military service was 30 years ago and before he studied the Bible, but she cut him off and said: "Just answer yes or no."
We got his denial letter this morning. What can we do? Should we file an appeal?
Thanks!
P.S. This was the USCIS office in Baltimore.

I'm in a state of rebuilding financially after some serious health issues over these past few years. I had surgery a few years ago (out-of-state and out-of-network) and my post-op surgical bill was massive-- like, $300k massive, despite everything having been approved and green-stamped by my health insurance company beforehand. I got boned by my health insurance in like 8 different ways, but most notably by the Maximum Allowable Fee-- so instead of owing $10,000 (my OON out-of-pocket max) I was billed $300,000 while my insurance only paid a few thousand toward the debt. I was billed $300,000 by my doctors while my insurance's out-of-network out-of-pocket max was not even considered "met" yet. :/ And I did everything I knew to do at the time to make sure everything was cleared with my insurance beforehand (hours on the phone making sure the hospital was in-network, making sure all the surgical codes were approved, getting estimates, etc etc), so now I feel a little ill-equipped in my ability to protect myself against future debt.
Anyway.
After the surgery, I was profoundly disabled for a couple years, stopped paying on any medical bills, totally destroyed my finances, and lost track of the status of the various insurance appeals I had submitted at that time. So I have no idea what I currently owe my former medical providers (vs the $300K I was billed 4 years ago), and I would like to know the best way to find out what I actually owe them without potentially resetting any debt clocks or putting new activity on an account that might otherwise be written off by my doctor-- the debt is nearly 5 years old now, so it's possible it might be getting close to that point.
Has anyone ever dealt with anything like this before, or have any resources they can point me to on how to protect myself? Without knowing how much I actually owe my surgeon and his team, the decision of medical bankruptcy vs negotiating the debt down (settling for less) is kind of an impossible one.
Many thanks!