Letter of proof of medical insurance

Proof
https://imgur.com/a/whTJpK9
Canada coins:
1976 complete set of Canada Olympics. 28 silver coins. 30.24 total ozs. $1035
Canada coins sold as a lot:
20 coins for $67 1961 25 cents 1968 25 cents (x3) 1967 10 cents 1911 5 cents 1936 one cent 1943 one cent 1932 one cent 1943 25 cents 1965 25 cents 1947 maple leaf 10 cents 1928 5 cents 1928 one cent 1947 10 cents 1751–1951 5 cents 1904 one cent 1955 25 cents 1968 10 cents
https://imgur.com/a/F8V3Crs
Silver bullion
US Silver Corp 1974 world trade 1oz- $32
https://imgur.com/a/WsAGl7t
https://imgur.com/a/Nf1YWWi
Canada Silver stamp- Nonsuch 1968 Very rare $48
https://imgur.com/a/EJxzHXx
Astrology bullion Two, 1/2 oz each $33 for the pair
https://imgur.com/a/lffQIrM
Andrew Jackson liberty lobby 1991 240 grains silver $15
https://imgur.com/a/4vFj87v
2017 Canada big horn sheep 3/4oz proof69 2018 Canada wolverine 3/4oz proof69 https://imgur.com/a/d2UZJoG Both for $67
2023 silver Krugerrand MS69 $35
https://imgur.com/a/CuKTEfA
2021S silver eagle $40 emergency production MS69
https://imgur.com/a/vY8caDp
Silver round Eisenhower addresses troops at Normandy $33 1oz
https://imgur.com/a/JQUKy3K
https://imgur.com/a/k9YVYMy
George bush 1oz silver gold plated 24k $33
https://imgur.com/a/DlxvepK
Gold
1992 Cook Island $50 coin Proof Panda 14k, .25oz $371
https://imgur.com/a/da0ep0y
https://imgur.com/a/TtofpBu
2000 Jahre Christnetum Austrian Gold Coin 500 Schilling 10g, .986 fine $742
https://imgur.com/a/ANFIViv
https://imgur.com/a/lZLZRiA
1904 Russia gold coin 5 Rubles $385
https://imgur.com/a/p9oWKOd
https://imgur.com/a/S9ZaUqw
https://imgur.com/a/lVM62Fu
Gouden Dukaat 1989 proof 3.494g plus numismatic value $260
https://imgur.com/a/xjmfaSX
https://imgur.com/a/SMIHQUg
1909 20F gold coin, 6.46g $455
https://imgur.com/a/c6LqbxB
https://imgur.com/a/10A2Qb4
Silver coins
Lot of 3 coins-$21 George Washington 1982 half dollar 90% Two 1976 Washington quarter proof 90%
Statue of Liberty Centennial 1986 Statue Of Liberty Washington Crossing Delaware 28.6 Grams Sterling Silver .925 collector coin $42
One Peso Filipinas 1908S $55
https://imgur.com/a/6aTy3EA
1970 Egypt nasser commemorative $32
WWII 50th anniversary silver coin D-Day $34 1991-1995 26g .9 highly collectible low mintage
https://imgur.com/a/xzkxVPw
Eisenhower Liberia $20 silver coin 20g .999 Low mintage $26 proof
https://imgur.com/a/Jq95ugr
Douglas Arthur Philippines one Peso $50
https://imgur.com/a/1y1G1Fp
1960 South Africa 5 shillings silver coin $30
https://imgur.com/a/twGBcLo
$6 for <6ozs $10 >6ozs Gold coins $10 each or all, shipped priority
Shipping is USPS from NJ I will email a picture of the tracking receipt. Once tracking sent , assumed delivered.
I can take more pictures just ask.
Insurance is optional paid by the buyer I accept Venmo, Zelle and PayPal friends and family only. If you want to use goods and services please pay the ~2% extra that they charge me. I used Internet and online auctions to determine prices. Make offer if you think they are unfair. Thank you for looking.

I have had TMJ for several years, but it was limited to some clicking in my jaw until recently, where it has been getting progressively worse over the past two months. I have severe popping and pain in my jaw and cannot open it more than a few inches without pain, cannot eat properly, cannot sleep, suffer from migraines due to this issue. I visited a dentist in-network with my dental plan (MetLife Choice Plus) and they took a panel X-ray showing signs of damage from TMJ.
My dentist recommended a CT scan to get a much clearer view of the entire area, damage that’s been sustained by the joint, position my mandible is in, etc. in order to formulate a plan of care; however, my dental plan will not cover CT scans as they say that is a medical procedure that needs to be handled with health insurance. If I want to do the CT at my dentists office it will cost ~$570 out of pocket (30% coinsurance) which I really can’t afford.
I then contacted my health insurance (UnitedHealthCare PPO) about where I can find a TMJ specialist who can hopefully help me get a CT (only $20 copay when in-network) and treatment, and they tell me that TMJ is not covered under my plan because it’s a dental issue not a health one. My dentist wrote me a referral for the CT scan to an imaging center in-network (UHC) but every imaging center I’ve contacted says they do not take referrals for CT’s from dentists.
So I’m trying to figure out what the heck to do. I need a CT scan (medical procedure) for TMJ (dental issue) and none of my insurances are cooperating because CT’s are not dental procedures and TMJ is apparently not considered a medical issue. I have an idea, but not sure if it makes sense:
Go to an in-network (UHC) family doctor for my yearly physical, which I am due for, and mention to them that I’m having severe jaw pain, headaches, migraines, etc. due to this issue, explain my story so far with my dentist’s recommendation, and request they write me a referral for a CT scan. Even though TMJ treatment isn’t covered under my health plan, maybe the CT would be coded as part of the physical?
I would really appreciate any advice or insight on this issue. For context I am 26m and live in Southern California.

I'm (27) an only child with older parents and am completely loss on how to navigate transitioning my mom into a nursing home facility for long-term care.
My mom (66) is currently home bound (for the most part). To put a long story short, she has had several medical issues within the last several years; it's gotten to the point that she's completely dependent on my dad (67) for everything. My dad is currently her full-time caretaker and with his own declining health, it's getting to be too much for him. Physically, it's simply unsafe for both of them to live as they have been for the past year or so.
I'm aware of several local nursing homes that are in-network through her insurance. However, I have yet to reach out to any as I'm concerned about the monthly expenses. I'm not sure exactly the role of insurance and what my mom's out-of-pocket-copays would be.
My major concern is my parents' savings. It's not much, but it's literally all they have. Together, they have roughly $11k in the bank between the two of them, and I'm aware that some people end up going on State insurance, but they basically take most of your money to pay for SNF expenses. Also, they look at a grace period of five years or something like that. Again, I'm unfamiliar with all of this process.
Any guidance or resources would be greatly appreciated.

Hi, just looking for some advice on what to expect here. Or to hear experiences from people who had a similar situation.
I’m 30 years old and have zero record. I never once have even been pulled over, and never faulted for an accident. Last Friday I was stopped (Clermont county) for speeding around 2:40am, 78 in a 65. The officer immediately said he smelled marijuana and asked me to step out of the car. He never asked to search my car, or found any marijuana. Because I have back issues and see a chiropractor weekly for sciatica I refused to walk a straight line or stand on one leg. When the officer said he smelled alcohol I informed him I was on my way home from a hookup where I performed oral sex and used an antiseptic mouth rinse right before leaving. I was arrested and taken to the station where I refused a breathalyzer, stating I was worried of the effects of the mouthwash since he said he could smell it. By this point it had already been established I have a severe anxiety disorder for which I take medication daily and was on the verge of a panic attack. Honestly looking back I wish I had blown, but I was so anxious, especially never having had any sort of contact like this with police. I just sort of shut down. After the officer finished his paperwork he even gave me a ride home.
I have an arraignment in 3 days. I can not afford an attorney. I make about $30k a year, but after rent/bills I basically live hand to mouth. I don’t know if I make too much for a public defender. As of right now my license is suspended for a year because I refused to blow. What do I expect at the arraignment? Do I just go plead not guilty, and then the court will start the process of assigning an attorney? Any chance this could be dropped since there’s very little proof (aside from the officer saying there was an odor and my eyes were watery and bloodshot- at this point I had been awake nearly 20 hours)? What about privileges to drive to work? Is that something that can be discussed Friday, or do you have to wait a certain amount of time? Really any info is welcome. I have all the questions 😞

Hello everyone!
Like many of you, I struggle with an eating disorder. I can only feel full on a physical level, not a mental one, and that only happens when I start to feel discomfort. This has been going on for many years. My weight constantly fluctuates. I diet for six months, then binge for three. Because of these cycles, I've lost a significant amount of muscle mass. It's now very difficult for me to lose weight through regular diets, and I'm experiencing more frequent relapses. I'm considering taking medications to help manage my hunger—specifically, mental hunger. However, with a weight of 95 kg and a height of 186 cm, I don't always fall into the range for a formal obesity diagnosis. But looking at my body, it's clear I have a "skinny fat" physique.
At the moment, I have the Essential Plan 200-250 insurance. I'm not sure if it covers Ozempic. Perhaps you could advise me on the best course of action and where I can seek help with my insurance plan.

Proof
https://imgur.com/a/whTJpK9
1976 complete set of Canada Olympics. 28 silver coins. 30.24 total ozs. $1035
https://imgur.com/a/bGrucHu
Silver bullion
US Silver Corp 1974 world trade 1oz- $32
https://imgur.com/a/WsAGl7t
https://imgur.com/a/Nf1YWWi
Canada Silver stamp- Nonsuch 1968 $45
https://imgur.com/a/EJxzHXx
Astrology bullion Two, 1/2 oz each $33 for the pair
https://imgur.com/a/lffQIrM
Andrew Jackson liberty lobby 1991 240 grains silver $15
https://imgur.com/a/4vFj87v
2017 Canada big horn sheep 3/4oz proof69 2018 Canada wolverine 3/4oz proof69 https://imgur.com/a/d2UZJoG Both for $66 or $35 each
2023 silver Krugerrand MS69 $35
https://imgur.com/a/CuKTEfA
2021S silver eagle $40 emergency production MS69
https://imgur.com/a/vY8caDp
Silver round Eisenhower addresses troops at Normandy $33 1oz
https://imgur.com/a/JQUKy3K
https://imgur.com/a/k9YVYMy
George bush 1oz silver gold plated 24k $33
https://imgur.com/a/DlxvepK
Gold
1992 Cook Island $50 coin Proof Panda 14k, .25oz $373
https://imgur.com/a/da0ep0y
https://imgur.com/a/TtofpBu
2000 Jahre Christnetum Austrian Gold Coin 500 Schilling 10g, .986 fine $742
https://imgur.com/a/ANFIViv
https://imgur.com/a/lZLZRiA
1904 Russia gold coin 5 Rubles $385
https://imgur.com/a/p9oWKOd
https://imgur.com/a/S9ZaUqw
https://imgur.com/a/lVM62Fu
Gouden Dukaat 1989 proof 3.494g plus numismatic value $260
https://imgur.com/a/xjmfaSX
https://imgur.com/a/SMIHQUg
1909 20F gold coin, 6.46g $455
https://imgur.com/a/c6LqbxB
https://imgur.com/a/10A2Qb4
Silver coins
Lot of 3 coins-$21 George Washington 1982 half dollar 90% Two 1976 Washington quarter proof 90%
Statue of Liberty Centennial 1986 Statue Of Liberty Washington Crossing Delaware 28.6 Grams Sterling Silver .925 collector coin $42
One Peso Filipinas 1908S $55
https://imgur.com/a/6aTy3EA
1970 Egypt nasser commemorative $32
WWII 50th anniversary silver coin D-Day $34 1991-1995 26g .9 highly collectible low mintage
https://imgur.com/a/xzkxVPw
Eisenhower Liberia $20 silver coin 20g .999 Low mintage $26 proof
https://imgur.com/a/Jq95ugr
Douglas Arthur Philippines one Peso $50
https://imgur.com/a/1y1G1Fp
1960 South Africa 5 shillings silver coin $30
https://imgur.com/a/twGBcLo
$6 for <6ozs $10 >6ozs SFRB Gold coins $10 each or all, shipped priority
Shipping is USPS from NJ I will email a picture of the tracking receipt. Once tracking sent, assumed delivered.
I can take more pictures just ask.
Insurance is optional paid by the buyer I accept Venmo, Zelle and PayPal friends and family only. If you want to use goods and services please pay the ~2% extra that they charge me. I used Internet and online auctions to determine prices. Make offer if you think they are unfair. Thank you for looking.
Cross listed in CoinSales with some non-PM that are in the proof picture (Mexican coins and Canadian coins)

I & husband are in mid 30s & have an 8yr old child. Hubby is only child kaya yung mom nya would always tell us na give her another apo esp SAHM din lang ako at nasa bahay lang naman daw,she's a maalaga Lola naman which we are thankful for. Yun nga lang kasi our inlaws still depend on us for their mortgage & bills payment & other financial needs like allowance at medical expenses, they got a house near us lang din. I just told them na di namin kaya ang gastos ng another child,my husband is the only one supporting us,his family & his parents. Ang bigat din ng adulting responsibilities like mortgage of 2 houses,bills of 2 households,private school fees,insurance,HMO,etc. My inlaws wouldn't just understand my financial frustration with having another kid & minsan sasabihin pang "Masarap mag alaga ng apo,kanin lang at toyo ayos na sa bata,tapos si Nanay(ako) bahay lang naman din. Alam ko I shouldn't take this personally pero I feel affected lately to the point na nararamdaman kong I'm not enough as a Nanay ng anak ko & as an asawa na SAH lang. Am I too selfish with my worries?

Hi I’m 25 and for context I currently live in Maryland for 7 months now and have made no progress in my life here at all, I am debating going back to college for a medical career which is so funny for me to even think because I went to college for nursing and didn’t finish to become an esthetician and because of covid I left that field as well and haven’t been back until literally 2 weeks ago when I got a job to do lash extensions and have been disappointed since.
I honestly never thought that I wouldn’t be the person to not go to college and I think that because I got a license as an esthetician I didn’t really process how I really didn’t go to college I did a vocational education basically and lost my job because of covid and was so depressed about it I didn’t go back to it which was useless.
I still had hopes of becoming an esthetician again when I got this job as a lash tech to realize I have been out of the game in a long time and definitely draining on my body specially all the back pain, all that for not much reward since the other techs have told me that honestly they get paid very little specially when I told them where I used to live some lash techs could make up to 1,200-1,400 a week and here they were making half that I felt more discouraged because I already felt this wasn’t what I wanted to do anymore for a career.
I got desperate recently since the past couple of months I’ve been walking on a tight rope verging being fully broke every month and feeling like a bag of waste and that I wasted so much time of my life in a delusion that I was okay and in fact I am not which brought me to 2 hours ago scrolling career paths online and I found a posting for travel health agencies and the pay definitely caught my attention first but also the position, to think if I have continued my college degree and had been a nurse I could be in a different place that I am right now.
But not to dwell in the what if’s that I cannot change since I don’t currently life in a Si-fi movie with a best friend scientist that will create a time machine for me, I want good advice on what are my options and realistically what would be most beneficial for my future.
The path I was thinking of choosing is not very clear but I was very interested in some of the positions in the traveling agency’s I saw and looked into and some of them where physical therapy, Cath tech, and a CT technician where the only ones I had enough time to do research on but there seemed to be several others but they all still mean going back to school for probably at least 4 years.
I guess my biggest worry is not really going back to school but the financial, I currently tip toe the lines of having a 0 balance in by bank every month and some credit card debt that I used to pay for the vocational school (about 5k, I feel like when I say cc debt some people always think it’s over 10k so maybe not that bad), but I’m scared of doing school and working, rent, car, insurance, I already try to work a lot now even babysitting on my off time to make sure I’m always bringing some money in every day and I’m just scared of making a mistake and it costing me what I already don’t have.
I also don’t know if this is important but a reason that kept me from going back to school before is that I am married we are separated but not yet divorced and I couldn’t get financial aid anymore since I basically made too much money bc he was on the tax return.
That’s honestly all the information I could think of right now but can always say more for clarity and I’m just hoping for some guidance or advice on what to do, since I’m literally writing this after having a small mental breakdown and considering being a sugar baby (although I’m not sexy enough of that the idea went away really quickly lol). Any advice is greatly appreciated, thank you.

Read this article from Vancouver Sun. I hope nobody ever gets into a car accident in BC. No Fault Insurance is not going to help you. Imagine if you were college athlete or Medical Student. You would be SOL under this insurance plan. Time for a change.
https://vancouversun.com/news/local-news/cyclist-left-quadraplegic-icbc-savings-backs-of-crash-victims

Hi, just looking for some advice on what to expect here. Or to hear experiences from people who had a similar situation.
I’m 30 years old and have zero record. I never once have even been pulled over, and never faulted for an accident. Last Friday I was stopped (Clermont county) for speeding around 2:40am, 78 in a 65. The officer immediately said he smelled marijuana and asked me to step out of the car. He never asked to search my car, or found any marijuana. Because I have back issues and see a chiropractor weekly for sciatica I refused to walk a straight line or stand on one leg. When the officer said he smelled alcohol I informed him I was on my way home from a hookup where I performed oral sex and used an antiseptic mouth rinse right before leaving. I was arrested and taken to the station where I refused a breathalyzer, stating I was worried of the effects of the mouthwash since he said he could smell it. By this point it had already been established I have a severe anxiety disorder for which I take medication daily and was on the verge of a panic attack. Honestly looking back I wish I had blown, but I was so anxious, especially never having had any sort of contact like this with police. I just sort of shut down. After the officer finished his paperwork he even gave me a ride home.
I have an arraignment in 3 days. I can not afford an attorney. I make about $30k a year, but after rent/bills I basically live hand to mouth. I don’t know if I make too much for a public defender. As of right now my license is suspended for a year because I refused to blow. What do I expect at the arraignment? Do I just go plead not guilty, and then the court will start the process of assigning an attorney? Any chance this could be dropped since there’s very little proof (aside from the officer saying there was an odor and my eyes were watery and bloodshot- at this point I had been awake nearly 20 hours)? What about privileges to drive to work? Is that something that can be discussed Friday, or do you have to wait a certain amount of time? Really any info is welcome. I have all the questions 😞

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.

The closest Dr for me is Orourke in South Carolina. It looks like she is in network with my insurance. 3 hour drive. Not horrible.
My question is, what all needs done for this to be approved by my insurance and for the doc to want to do the procedure? For those who have had it done, did you have to "jump through hoops" before your doc approved the procedure / get insurance approval?
I imagine a consult at the very least, did your doc do it same day? And did they require you to try medication / endoscopy / therapy /multiple visits to confirm the diagnosis? Or is my lack of being able to burp and the fact it disrupts my daily life enough?
I know I will of course be paying my deductible if I get this covered. I'm just worried that the Dr will want me to drive up there for multiple visits when I really don't have that kind of time. I know it would be worth it, but I only have so much PTO.
And I also know for fact that if I'm rejected for the procedure I will spend every second of that three hours drive back home crying lol. So just trying to mentally prepare myself for the steps.

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.

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
​

hi all! for reference, im 26. i’ve been decided on not having kids for a while now, and i would like to be sterilized. im struggling with an insurance issue atm so anything medical is kinda being put to the side unfortunately. but i was wondering how everyone that’s gotten the procedure done, how did you bring it up to your doctohow did you get in contact with a doctor who would do it? i know about the list but do you just contact them or do you need a referral? i have a male doctor so im kind of expecting the typical “you’re too young to decide” and “you should wait” but with how other states (im in cali) are banning abortion and birth control, id really like the comfort of knowing that i wouldn’t be effected if any of those laws came into place here in california. thank you in advance!!

Please not, I'm, not depressed or thinking about hurting myself, I genuinely am looking for help or information on what I can do. Now onto what is going on.
Ten months ago I got sick and lost the full use of my eye which cost me my Job as a trucker. Over the last ten months I have struggled with the discovery that I have a large Benign Mastoid Tumor on my right orbital outer sinus which has been pressing on the nerves in my eye. Several inpatient attempts at draining the mass have failed with the most recent on causing a massive infection that almost put me in intensive care. (I have posted about this in the past but I've minimized what has been going on) Not having income, health insurance, or any real means, I panicked and did something equally stupid and ended up getting involved in what tuned out to be a real-estate scam where I posted properties on FB Marketplace for a guy. At the time, hell I don't know what I was thinking, but in my panic, It sounded like the answer to my prayers. I make no excuses and am working with the authorities to make things right.
Now, it's not all bad news. I finally was able to find a job working as a Lifeguard at a local theme park a hour and change from my house. (Aside from the tumor, I'm in good shape respectively) The problem is, My first full paycheck (not including the paid training) is in June and today I came home to find my car will be repossessed if I can't somehow find $500 by Thursday at 5PM. I have been making payments when I could since loosing my job and have attempted to get on a payment schedule going forward that will allow me to make up the missed payments, but the company is playing hardball at this point. No matter who I talk to on the phone, the letters threatening reposition, default, and the like make it sound like I'm too far gone. I'm not sure where to turn, and I can't work without my car.
I really don't know what my rights are here or how I can navigate out of this hole I find myself in. Any advice or help will be appreciated. I work a full shift tomorrow but will respond after I get off the chair for the day.

I had updated my marital status and IRCC has requested some docs. My spouse is already PR( e-COPR inside Canada, awaiting PR card). I am pretty sure that I don't need to send docs or not apart from Marriage certificate, birth certificate and PR card
First Para of letter says, you only need to submit PR card, marriage certificate and Birth Cert if spouse is P Citizen
"Thank you for informing us of your change in marital status. If your spouse or common-law partner (CLP) is a Canadian citizen or if they have obtained permanent residence status in Canada, he or she does not need to be added to your application for Permanent Residence. However, you must provide our office with a proof of his/her status such as a copy of birth certificate, proof of citizenship or permanent residence card. If your spouse or common-law partner (CLP) is NOT a Canadian citizen or has NOT obtained Permanent Residence status in Canada, you will need to complete each of the following steps in order to have them added to your existing application and examined for compliance with admissibility requirements (medical, criminality and security). Unless otherwise stated, the following is mandatory, whether or not your spouse or CLP decides to accompany you to Canada. The following information/documents must be received within 30 days from the date of this correspondence. If this deadline is not met, your application will be assessed based on the information available and could be refused."
Also there is list of docs with a questionnaire. I am confused whether that questionnaire is required or not.
INCLUSION OF A SPOUSE/COMMON-LAW PARTNER ON AN ECONOMIC CLASS APPLICATION

QUESTIONS FOR THE PRINCIPAL APPLICANT << Provide a complete and precise response to each question in your own words. Failure to provide the information requested below will delay processing and could result in a refusal of your application. Make sure you have indicated your name, application number, the questionnaire title and the number or letter of the question you are answering. Please answer the following questions on a separate page and include the question number with your answer. DEVELOPMENT OF YOUR RELATIONSHIP 1. Describe the development of your relationship, including the following details: a. First contact with your spouse/common-law partner (i.e., when and where) b. Provide timeline of dates, photos, and documentation of events in which you both participated in, such as trips and outings. c. Have you visited each other during your relationship? (i.e., when and where) d. How do you communicate when not together? (e.g., phone, email, online chats) e. Please provide dates of cohabitation, if applicable. 2. Was your relationship known to your close friends and family members? Yes/No If in common-law relationship skip to question #8 3. Was your marriage arranged? Please provide details on who arranged the marriage and when it was arranged. 4. Was there a formal ceremony to recognize/celebrate the engagement? Please provide details such as when, where, and who attended. 5. Was there a formal ceremony to recognize/celebrate the marriage? Please provide details such as when, where, who attended, and the religion in which the marriage was performed, if applicable. 6. Provide information regarding your religious beliefs. 7. Was there a reception? If so please provide details such as when, where, and who attended. 8. Did you have a honeymoon (a holiday or trip taken by you and your spouse after the marriage)? Provide details such as when and where. 9. If in a common-law relationship, was there a commitment ceremony? Please provide details such as when, where, and who attended. Applicant Signature: ___________________________________ Date: __________________________

INCLUSION OF A SPOUSE/COMMON-LAW PARTNER ON AN ECONOMIC CLASS APPLICATION

QUESTIONS FOR THE PRINCIPAL APPLICANT << Provide a complete and precise response to each question in your own words. Failure to provide the information requested below will delay processing and could result in a refusal of your application. Make sure you have indicated your name, application number, the questionnaire title and the number or letter of the question you are answering. Please answer the following questions on a separate page and include the question number with your answer. DEVELOPMENT OF YOUR RELATIONSHIP 1. Describe the development of your relationship, including the following details: a. First contact with your spouse/common-law partner (i.e., when and where) b. Provide timeline of dates, photos, and documentation of events in which you both participated in, such as trips and outings. c. Have you visited each other during your relationship? (i.e., when and where) d. How do you communicate when not together? (e.g., phone, email, online chats) e. Please provide dates of cohabitation, if applicable. 2. Was your relationship known to your close friends and family members? Yes/No If in common-law relationship skip to question #8 3. Was your marriage arranged? Please provide details on who arranged the marriage and when it was arranged. 4. Was there a formal ceremony to recognize/celebrate the engagement? Please provide details such as when, where, and who attended. 5. Was there a formal ceremony to recognize/celebrate the marriage? Please provide details such as when, where, who attended, and the religion in which the marriage was performed, if applicable. 6. Provide information regarding your religious beliefs. 7. Was there a reception? If so please provide details such as when, where, and who attended. 8. Did you have a honeymoon (a holiday or trip taken by you and your spouse after the marriage)? Provide details such as when and where. 9. If in a common-law relationship, was there a commitment ceremony? Please provide details such as when, where, and who attended. Applicant Signature: ___________________________________ Date: __________________________

I had updated my marital status and IRCC has requested some docs. My spouse is already PR( e-COPR inside Canada, awaiting PR card). I am pretty sure that I don't need to send docs or not apart from Marriage certificate, birth certificate and PR card
First Para of letter says, you only need to submit PR card, marriage certificate and Birth Cert if spouse is P Citizen
"Thank you for informing us of your change in marital status. If your spouse or common-law partner (CLP) is a Canadian citizen or if they have obtained permanent residence status in Canada, he or she does not need to be added to your application for Permanent Residence. However, you must provide our office with a proof of his/her status such as a copy of birth certificate, proof of citizenship or permanent residence card. If your spouse or common-law partner (CLP) is NOT a Canadian citizen or has NOT obtained Permanent Residence status in Canada, you will need to complete each of the following steps in order to have them added to your existing application and examined for compliance with admissibility requirements (medical, criminality and security). Unless otherwise stated, the following is mandatory, whether or not your spouse or CLP decides to accompany you to Canada. The following information/documents must be received within 30 days from the date of this correspondence. If this deadline is not met, your application will be assessed based on the information available and could be refused."
Also there is list of docs with a questionnaire. I am confused whether that questionnaire is required or not.
INCLUSION OF A SPOUSE/COMMON-LAW PARTNER ON AN ECONOMIC CLASS APPLICATION

QUESTIONS FOR THE PRINCIPAL APPLICANT << Provide a complete and precise response to each question in your own words. Failure to provide the information requested below will delay processing and could result in a refusal of your application. Make sure you have indicated your name, application number, the questionnaire title and the number or letter of the question you are answering. Please answer the following questions on a separate page and include the question number with your answer. DEVELOPMENT OF YOUR RELATIONSHIP 1. Describe the development of your relationship, including the following details: a. First contact with your spouse/common-law partner (i.e., when and where) b. Provide timeline of dates, photos, and documentation of events in which you both participated in, such as trips and outings. c. Have you visited each other during your relationship? (i.e., when and where) d. How do you communicate when not together? (e.g., phone, email, online chats) e. Please provide dates of cohabitation, if applicable. 2. Was your relationship known to your close friends and family members? Yes/No If in common-law relationship skip to question #8 3. Was your marriage arranged? Please provide details on who arranged the marriage and when it was arranged. 4. Was there a formal ceremony to recognize/celebrate the engagement? Please provide details such as when, where, and who attended. 5. Was there a formal ceremony to recognize/celebrate the marriage? Please provide details such as when, where, who attended, and the religion in which the marriage was performed, if applicable. 6. Provide information regarding your religious beliefs. 7. Was there a reception? If so please provide details such as when, where, and who attended. 8. Did you have a honeymoon (a holiday or trip taken by you and your spouse after the marriage)? Provide details such as when and where. 9. If in a common-law relationship, was there a commitment ceremony? Please provide details such as when, where, and who attended. Applicant Signature: ___________________________________ Date: __________________________

INCLUSION OF A SPOUSE/COMMON-LAW PARTNER ON AN ECONOMIC CLASS APPLICATION

QUESTIONS FOR THE PRINCIPAL APPLICANT << Provide a complete and precise response to each question in your own words. Failure to provide the information requested below will delay processing and could result in a refusal of your application. Make sure you have indicated your name, application number, the questionnaire title and the number or letter of the question you are answering. Please answer the following questions on a separate page and include the question number with your answer. DEVELOPMENT OF YOUR RELATIONSHIP 1. Describe the development of your relationship, including the following details: a. First contact with your spouse/common-law partner (i.e., when and where) b. Provide timeline of dates, photos, and documentation of events in which you both participated in, such as trips and outings. c. Have you visited each other during your relationship? (i.e., when and where) d. How do you communicate when not together? (e.g., phone, email, online chats) e. Please provide dates of cohabitation, if applicable. 2. Was your relationship known to your close friends and family members? Yes/No If in common-law relationship skip to question #8 3. Was your marriage arranged? Please provide details on who arranged the marriage and when it was arranged. 4. Was there a formal ceremony to recognize/celebrate the engagement? Please provide details such as when, where, and who attended. 5. Was there a formal ceremony to recognize/celebrate the marriage? Please provide details such as when, where, who attended, and the religion in which the marriage was performed, if applicable. 6. Provide information regarding your religious beliefs. 7. Was there a reception? If so please provide details such as when, where, and who attended. 8. Did you have a honeymoon (a holiday or trip taken by you and your spouse after the marriage)? Provide details such as when and where. 9. If in a common-law relationship, was there a commitment ceremony? Please provide details such as when, where, and who attended. Applicant Signature: ___________________________________ Date: __________________________

I'm not totally sure if this is medical malpractice or not so I am here to seek advice
Background: I started getting sick when I was about 18 and I was diagnosed a few months after I turned 19. It took a long time to get testing done. My first specialist did not do a great job at taking care of me. Because it took so long to dignose me I ended up in the hospital. My first specialist didn't respond back for days while I was in the hospital and I was very frustrated with their care. It didn't feel like they were taking it seriously. While I was at the hospital I met my current specialist (who this post is about) they suggest their clinic which was a bit closer to me so I decided to switch specialist. It went by smoothly the first 3 months. They got me on treatment right away and I was satisfied with how quick things went.
After a few months on the treatment I can tell it wasn't working and my appointment was coming up so I thought I'd let them know during the appointment, it was canceled. No biggie. I made another one, which was 2 months out. Every single one of their appointments is about 2 months out. The day comes, it was canceled. At this point my body was shutting down and I was already not going to work. Made another one, canceled. They explained to me because I was 19, that I was still being seen through child services or something? I was so confused but that was because I use to me on my mother's health insurance plan (we have medical) and then I got my own and had to made a big switch to an adult doctor and get removed from this so call child services, still no idea what that was about. Now, 2 months later after I finally fix the child services issue and insurance. My body gives up and I end up being hospitalized. Where I saw my specialist there. They do a small procedure to check how worse I've gotten and my mayo score increased. They give me steroids and I feel a bit better, I get sent home and told to call to make an appointment with their office again I call and they are able to finally see me. I go to the office. They cancel because my insurance doesn't approve it on time. I literally break down in their office, in tears that one of the other patients their tell something to the front desk and they are able to see me. I think one more apartment was canceled after this instance and I call my insurance and they fix things for me because after that I had not one missed appointment. I had to always call them and make sure they request an authorization to see me because they neve did it on time. I basically went a whole year without seeing my specialist and wasn't on any working treatment and that's why I ended up in the hospital. Now this year, I haven't had any canceled appointments but none of the medication worked whatsoever. It seems the only thing keeping me from getting as bad as I did last year are the steroids, but I can't be on these for long. It's not a viable solution. I've been on several medication, none have worked, at least not the way they would like it to work. So now i have to do surgery. I can't help but feel that this is their fault for not seeing me for almost a year without proper treatment.
Recent issue: I was referred a surgeon this month, I called and they said they can see me for a consultation until the end of June??? But my specialist said this was urgent and I needed surgery soon or I can be at risk getting MUCH worse. So I called my specialist office again, they said we don't understand why it will take so long and they will fix it. They even noted that they give me the wrong surgeon they requested. They said they will fix it as soon as possible. I get a text from my specialist office, they said the surgeon herself would reach out to me. This was Thursday. I wait for a call Friday, nothing. This Monday I call and no one gets back to me. I finally send a text today and they finally tell me. "Oh it looks like we made a mistake". They appointment filled out the form wrong and give me wrong physician to do my surgery. Is that even possible? I imagine those forms are very detailed, how do you make a mistake so bad they give you a different doctor. The two surgeons have different names and are different sex. I'm so confused. They also asked me to stop taking all the medication, even the steroids. They told me to stop taking them 2 weeks ago because I will need surgery soon and I can't be on any medication like that before surgery. I am slowly getting worse. I am lost and completely in the dark. They send they sent in a corrected form today and it should be resolved within 72 hours. But even then, how long will it take to get seen for consultation? When will I get surgery? They told me to stop taking medication so I don't even know if I will make it until then.
Here is where i don't know if I can sue. The doctor himself never made a mistake, I feel like my specialist gave me proper care. But his staff, canceling so many appointments, not giving me any clue as to why they are being canceling, messing up important documentation, causing me to delay needed surgery. His staff are the problem, so do I have grounds to sue and should I?
Important notes: I have ulcerative colitis. When I mean I was in a horrible state last year. I mean I was using the bathroom 30 times a day. Eating once a day. Throwing up bile because I was throwing up on a empty stomach. Blood in my stool every single time I used the bathroom so i lost so much blood. I went through literal shit.
Current: I don't throw up, I am using the bathroom 8 times a day. Slowly increasing back to 10 and still blood. I know it may seem bad and according to my specialist this is still not liveable. But this is so much better then the hell I went through last year. I don't want surgery, I don't know why it had to come to surgery. I am getting a total colectomy, my whole colon is being removed. I hope this bit of information helps. Any advice is appreciated.

Ok this might be a bit long... I'm in the state of Massachusetts and been on workers comp since October of 2021. The limit here is 3 years and this October makes it the 3. Everything's was going good and adjuster always paid my checks bi weekly and most my meds. I temp at my job went crazy and attacked me with an almost 2 foot pipe wrench that weighed at least 20 lbs. I was in my car and he destroyed it along with my face head and shoulder. I was knocked out for I really don't know how long but was pouring blood everywhere. Me and this man never had an issue or words at all. So I was sitting in my car eating lunch and was dark since I worked 2nd shift and there was basically no supervisors on my shift. I don't really eant to get more into the assault but will say I had eye damage esp. from the glass from the first strike through my window that knocked me out. My shoulder was injured and motion is back but couldn't finish PT due to my migraines which got better but with quilipta and zavzperat spray and Botox injections from a nuero. I still get them and triggered by certain things but did improve a bit since 2021.this man was not even clocked him my boss invited him to live there and sleep at the warehouse whenever the office went home and he would come since he was homeless and sleep wake up drink and just very odd guy which me and a co worker complained many times about his drinking and making us uncomfortable and my boss would just laugh. So they knew there was negligence and co operated fully and so did workers comp up until few months ago started sending me to imes which is when I finally got an attorney.my state can't use for apin and suffering when it comes to workers comp. The thing I face know which I did have anxiety and depression a bit in the past and was in and out of therapy through the years with self medicating before that around 2008 off and on also due to my brother's death. Since this assault though wow I panic daily about little things. Extremely scared to drive or leave the house. My family does almost everything for me and I'm a 37 yr old male. I'm on about 12 meds total and 9 is for mental health. I am diagnosed with post concussion syndrome, agoraphobia, depression, anxiety and insomnia. Of course the imes the insurance sent me to treated me so bad the first was a neurologist and tried to treat me as a psych patient the second wasn't rude and was actually a psychiatrist but could tell was not listening at all to me and wrote I have no issues and I am all good just like the first time. My attorney sent me to his own ime that will say just based on my pictures and medical records that I am disabled for life. My neurologist therapist and psychiatrist all wrote great letters but said they don't know if or when I will get better but also didn't say I am disabled for life and that's what my attorney is looking for but said the letters will help and are greatly written esp. how it goes against the imes. He said the judge knows how it goes insurance gets there guys they pay 900 to to make a report and my attorney gets his guy and plus treating Dr s that the hospital recommended through occupational therapy. My memory is very bad and sorry if I'm all over the place. My question is I have court on June 4. Saw my attorney Dr. Yesterday. Today attorney called me to talk about the case. He said you're payments stop October anyway and I'm sure I can get it to that but October comes the judge can cut off all money or extend it 4 years of checks but cut in half which is like 43000 in them years he said he would like to fight for full life long disability but due to my age being 37 it's an uphill battle but doesn't mean he can't get it but if I was in my mind 40s he said he'd have full confidence getting it. That's one my questions about the age thing also he told me they said well we would offer about 45000 to settle and a little more to settle the mental part of it he laughed at them he said. He said I can get you 100,000 but probably and this is all jus predicted but about 75,000 before I pay him his 20%. I really don't know what to do. I'm afraid it's such a low amount for head I jury and sever mental trauma where I don't have friends anymore and don't leave the house and pa ic non stop. Also want to be done with this and try and move on like my dr.s said maybe you'll start healing once this is behind you. I do have mass health insurance and they fill a lot scripts no problem when workers comp should be. So my attorney thinks it's fully up to me and court is less then 2 weeks and it takes him about a week to put together a settlement amount request hes cobfident about 75,000 i said i need to think hes said of course. I'm thinking I should ask him I won't take less than 80,000 but look more for 85,000 or little more. More I get he gets I know. I just don't want to piss him off he's very intimidating blunt straight forward guy. Any similar stories and advice should I say ok go for 75 or should I say try for 80 or85,000. I feel like if he thought he could get it he would since he gets a percentage. Sorry for the long rant guys. Any advice is helpful,tia.