Anal Sphincter Muscle & MS

[yorkieville]

Hi, Everyone.

   I am undergoing evaluation for MS. One problem I have is loss of bowel function. A proctography revealed I have no function, at all. My GI doc says I have a tight anal sphincter muscle and feels it is nerve related, and to finish my evaluation.
  Does anyone know how MS affects the anal sphincter muscle?
  I attempted to do some rectal kegel exercises, but they only make the nerves in my spine sting more.
  Thanks in advance.

[yorkieville]

Hi, Zilla.

    "Funned out" is a good thing sometimes. :) Enjoy your boys...as you know, they grow up way too fast. This, from a mom of a 33 year old...but it seems like only yesterday......he was a little guy.

    This is confusing. The services took place at The Center for Advanced Medicine, which I 'think' is considered part of the hospital. And the docs office is there.  The nurse requested a urine sample from me. The only other procedure I had was in the exam room, where the gyne did a pelvic & rectal exam, then she said "Lets go to my office & talk". Her office was a tiny little room right down the hall from the exam room.

    This is what they billed me on that date:
    Service Code 1640414 GYNU-EVALUATION & Management 124 99214  $719.00

                        68445    FAOB-UA DIP STICK; NON-AUTO WO MICRO81002  $51.00  

    They submitted it as 3 separate things though. And one of the reps at BCBS told my DH that $210.00 was "use of the office", and $509.00 was the doctors fee. BCBS "allowed" $21.58 for the FAOB-DIP STICK, and and the provider agreed to accept the allowance as payment in full.

    Regarding the claim for the $210.00 it says "This service is not a covered benefit at this place of service."

    Regarding the claim for the $509.00 it says, "This service is not a contract benefit when performed in this setting. You are responsible for the provider's charge."

    So, I am not sure how this Gyne is in our PPO.

    Zilla, thanks for taking the time to sort through this with me. Even if you cannot help me with it, I am so touched by your willingness to try. That alone, means more to me than if I have to pay the bill.

    Sheila

[grannyhotwheels]

Thanks Sheila, I will try them.  We are the exact same with our problem.  Not having any feeling.  I too only feel the pressure but I don't know when it passes.

I'll tell you a funny story:  I also have a really bad gas problem.  That's another thing that I just don't know is happening until it happens.  One day my 23 year old son and his wife where walking in walmart and every step I took I farted.  We laughed so hard.  I was using my walker and I finally set down.  When I got back up it was the same thing.  A true case of the walking farts.lol

Come on guys, you gotta laugh at that!! hahahaha

Zilla,  Your right, the only thing that keeps me going is the fact that I do have the sexiest legs on earth.  Now that I'm walking again I'm thinking about getting me some of those real short shorts with the real low waist. What do you think?

Have a great night all,
Carol

[Momzilla]

Hi, Sheila~  Oktoberfest was great fun!  I'm funned out, tho!  My boys were so cute, if I do say so myself...

Where did the services take place?  At the hospital or doc's office?  This is so confusing.  But for me confusing happens all the time.  It's true, the doctor is ultimately responsible for coding.  He/she has a biller who should know exactly what to bill for.  Blue Cross is NOT going to tell you what it will pay for.  Ever.  "Use of office" sounds hokey.   It sounds like "double dipping," almost.  That's not allowed.  I work for a surgeon, and we use a different section of the coding book, but I don't think there's anything comparable to that.  Coding always surprises me, though!

If something's not a covered benefit, and the doc is in your PPO, they shouldn't charge it.  They know not to bill your company for it.  They should have gotten pre-approval before doing the procedure.  "Use of office?"  What does that mean?  It sounds fraudulent, kind of.  That's why it's not a covered benefit.  DO NOT pay it yet until they explain what it is.  

Get back to me about where the procedure was done, OK?  What exactly was done?  What did they do and what ALL did they bill for on that date?  Interesting as the plot thickens.....

Later, Sheila,

Zilla*

[yorkieville]

Hi, Carol.

    Thank you for the welcome. This is a very nice place. Such kind, caring people here. I don't feel so alone anymore. But I am sorry so many others are going through it.

    Carol, I have no feeling either. I feel the pressure of stool. I do not feel it when I pass stool. If I don't use vitamins and minerals to go, then, nothing happens. No urge.

    Have you tried the Poise Ultimate Coverage Protection Supreme pads? I bought some for after my proctography, was afraid I might have problems after, on the long drive home from Chicago, IL to NW IN  Joke was on me, nothing came out. Not even during the test when it was supposed to.

   I'm sorry this is happening to you, too. Yes, you are much too young to have this problem.

    Carol, God Bless you, too. I'll keep you in my prayers, as well.

    Chris is right, you do have a wonderful attitude.

    (((BIG gentle HUG)))

    Sheila

[yorkieville]

Hi, Zilla.

    Oktoberfest, what fun! My goodness, we don't live that far away from each other...I'm in NW IN.

    I agree, this forum is wonderful To find people that actually understand.

    Interrupting? My goodness, you are not interrupting! I believe it's called 'chatting' :) I appreciate the advice about the bill. Would it be an imposition to ask you how I can get the doctor to submit the bill with the code the insurance company requires? The office call with the Gyne was at University of Chicago Hospital, Center for Advanced Medicine, this past July 18th. When we received the Explanation of Benefits from our insurance company, Blue Cross Blue Shield of Michigan, the claim was submitted as two things; $210.00 for hospital services and $509.00 for Medical Care. My DH went round and round with phone calls to BCBS who kept insisting the claim was denied because of the way it was submitted, and the billing dept. at U of C kept insisting they couldn't submit it any other way.  We've since found out that $210.00 was a charge for "use of the office" and the $509.00 was the doctors fee. (the actual bill we received says GYNU-EVALUATION & Management 124 99214 719.00) We've never heard of a charge for use of the office, and apparently it's not a covered benefit. Our plan does not pay office calls, but if we use a doctor in our PPO, they have an "amount allowed' so we pay a reduced amount. This Gyne is in our PPO. We are not sure how she is allowed to get around that fact. Last week, I told my GI doc about the bill and he said it was ridiculous and said DH should go see the Benefits Rep at the plant. Well, the Rep agreed, called the BCBS hotline number and they wouldn't even discuss it with him. The Rep said the doctor is responsible for the codes and suggested DH call the doctors head nurse and ask her to discuss it with the doctor. DH called and left a message on the voice-mail. He also called the Gynes finance person when we first got the bill and left a voice-mail but she didn't return his call either. We wrote to the Physicians Board, no response. We sent a written letter to BCBS last week. DH spoke to billing when we got the bill and said he would pay what he could on it each month, and explained that he is retired and we live on a fixed income. (we made a payment when the 1st statement arrived, and on the 2nd statement, they said the bill is over-due.)

    I apologize this is so long. It may end up we have to bite the bullet and pay the bill, but the thing that really worries me, is, if this Gyne can avoid submitting the bill in a manner that we get the "amount allowed", how do I know what doctor in my PPO is safe to go to? I have not run into this problem before.

    Back on track, yes, my DH is great, and I don't know how I would manage being sick without him. When I give in to tears of frustration and hopelessness, and I admit that I do, (today was a teary day) he reassures me that I will be diagnosed and back on my feet.

   You are so blessed to have 5 boys! Just imagine how many grandchildren they will give you someday......:)

    I pray we all find some answers oon....

    XXX
    Sheila

[Momzilla]

Oh, Carol,

Does it ever stop with you?  I just want to reach through the computer and hug you!  You have been through SO much, and you have the absolute BEST attitude.  It' is just such a dagnab good thing you have such HOT legs, or I don't know where you'd be, Girlfriend, really and truthfully.

'Zilla Twinkle Toes*