Gender enlightenment

My granddaughter-in-law, a newly-minted doctor, was awarded a fellowship in adolescent medicine. Some of her patients are dealing with issues having to do with gender identity and sexual orientation, topics that have only recently received the attention they deserve. She shared with me a graphic that helps explain the wide range of possible variations. For example, for transgender people, the sex they are assigned at birth and their own sense of gender identity are not the same. Some people consider themselves gender neutral. (Use the pronoun "they," when referring to them.)

Here’s the graphic that shows all the ways you can mix and match these identities. Note that this graphic is filled-out example of how someone rated his or herself on the scales (look at the black spots on the arrows).

Female/Male/Other

Feminine/Masculine/Other

Female/Male/Other

Women/Men/Other

Women/Men/Other



Some definitions:
Gender Identity: Your internal sense of being male, female, neither of these, both, or another gender(s).

Gender Expression/Presentation: The physical manifestation of your gender identity through clothing, hairstyle, voice, body shape, etc.

Sex Assigned at Birth: The assignment of people as male, female, intersex, or another sex based on a combination of anatomy, hormones, chromosomes.

I identify as a female, but not as feminine. My gender expression is somewhat manly. I prefer pants to skirts and low heels to high. I have no interest in jewelry or makeup. I sometimes buy men's shoes because they're more comfortable. A boy I once dated in college told classmates, "she's the kind of girl you take bowling."

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An outrageous clinic bill foiled—sort of

In response to my posts about hospital fraud, a friend of a friend tells this story:

“When we were camping about seven years ago, I became ill (I think it was the beginning of COPD). I went to an emergency clinic in Nevada—the closest place around. I was there for less than 24 hours. During that period every doctor who was involved in that clinic must have come and done ‘something’ (they knew I had Kaiser Medical coverage). The bill was $38,000.00. GASP! 

Of course, I was stunned and took the bill to Kaiser and asked them to translate it for me. Evidently this was nothing new for them. They took the bill, knocked it down to $18,000.00, paid the clinic and I paid $50.00.  What a scam! Moral to this story: NEVER GO TO A CLINIC OUT OF STATE UNLESS YOU ARE GOING TO DIE!”

So, let me see if I got this right: Kaiser gets outrageous $38,000 bill from clinic in Nevada. “Whoa,” says Kaiser, “$38,000 is too much! We’ll knock off $20,000 and pay you $18,000.” Clinic says, “OK. Whatever." 

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Fraudulent hospital charges V: The enforced upgrade

This is the last post on the topic of Elisabeth Rosenthal’s complaints about hospital charges following her husband’s motorcycle accident (see previous posts for the first four). After he’d been released, but was in pain and out of pills, her husband called his trauma doctor who suggested they meet in the emergency room because the trauma clinic was open only from 8 to 10:45 on Wednesdays and Thursdays. Even though this meeting could have happened in the lobby, her husband received a bill of $1,330 for the emergency room.

Similarly, the plastic splint on his broken finger pressed on the fracture and caused him pain. At a follow-up visit, someone took a pair of scissors and cut off the upper half of the splint and taped the lower half back in place. The bill for this visit included $481 for a “surgery,” $375 for the office visit, and a $103 “facility fee.” Rosenthal asks, “Doesn’t surgery, by definition, involve cutting into flesh or an animate object—not a piece of plastic?”

What to do about all of this fraudulent billing? On a “Fixing Healthcare” podcast Rosenthal suggests “Ask for an itemized bill. See what you’re being charged for. Protest any charge that seems outrageous or unreasonable. I do tell people, also, and this sometimes works, go find out what the Medicare DRG rate is for that same hospitalization and go in armed to the patient ombudsman and say, ‘You are charging four times what the Medicare approved rate is and I’m not going to pay it. Let’s see if we can do a deal.’” (The Medicare DRG rate is a “diagnostic related grouping” which they use to determine how much to pay.) I must admit that my husband and I have never done any of this, but we should. Next time!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Fraudulent hospital charges IV: The drive-by

This is the fourth of Elisabeth Rosenthal’s complaints about hospital charges following her husband’s motorcycle accident (see previous posts for the first three). Before Rosenthal’s husband left the hospital, a physical therapist came by and asked a few questions. On his report, the therapist noted “ambulation deficits, balance deficits, endurance deficits, pain-limiting function, transfer deficits”—boxes he’d checked. The report also stated that he was there for 30 minutes (it was just 10), and that he’d walked her husband up 10 steps with a stabilizing belt. He had not. In fact, he’d given no significant health service. All he’d done was check some boxes. The bill for this ten-minute “drive-by” visit, was $646.15.

Rosenthal also notes that the drive-bys continued at their home. The day after he was discharged a physical therapist from a private company called her husband’s cell phone and wanted to visit him for at-home therapy. The therapist came (not knowing which body part had been injured) and concluded he was in too much pain to participate. This occurred two more times—with her husband not receiving therapy. Nevertheless, the insurer paid for three visits.

Rosenthal asks, “why do insurers pay for all of these questionable charges?” It’s partly because they have no way to know whether you got a particular item or service. But it’s also not worth their time to investigate the millions of medical interactions they write checks for each day. As one benefits manager told Rosenthal, “they’re too big to care about you.” Moreover, electronic records, which have auto-fill billing boxes, have probably made things worse. For example, the birth of a baby boy may automatically prompt a bill for a circumcision.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.