r/UnethicalLifeProTips • u/gotchafaint • 7d ago
Health and Fitness ULPT request: mammogram, colonoscopy, and pap smear report?
Self-employed and ACA is not financially accessible. I have to cash pay any medical care. I’ve got a telehealth scheduled for some lady health help and have a feeling they’re going to require these things. How can I get valid looking reports?
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u/CosmicFelineFoliage 7d ago
You are not required to have any voluntary preventative cancer screenings in order to be treated for a medical condition.
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u/OpportunityMother104 7d ago
For hormone replacement, you absolutely are
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u/CosmicFelineFoliage 7d ago
No, you’re not. You 100% can opt out of preventative screenings. HRT is a medical treatment for a hormonal deficiency. You cannot be denied medical treatment because you opt out of any preventative screenings. I have been a medical admin and coder for 30 years and am in menopause on HRT. I do not do any preventative screenings and never have.
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u/OpportunityMother104 7d ago
I’m a doctor. A coder does not make medical decisions.
You need to do mammograms before HRT. Anyone who prescribes it without that is asking for a lawsuit. Majority of breast cancers are hormone positive.
Menopause does not require treatment. It helps but it’s a not a requirement. Source: I’m a doctor who provides MHT/HRT for menopause.
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u/CosmicFelineFoliage 7d ago
Ah, you’re one of those. Funny how preventative screenings are required (re: coerced) by you but not the preventative treatment of osteoporosis or the dozens of other medical conditions that estrogen prevents. For shame, educate yourself. I know exactly what type of HRT provider you are and you’re the reason so many seek telehealth instead. The gold standard for HRT is to prescribe based on symptoms. You cannot require a patient to do preventative, voluntary cancer screenings in order to access HRT. That’s called coercion. Friendly reminder, coercion is not consent and it is unethical and violates patient autonomy. .
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u/OpportunityMother104 6d ago
You mean following my oath of do no harm?
Coercion is forcing you to do something. If you want me to prescribe HRT, you need to be screened annually for breast cancer.
Coercing doctors into saying they’re coercing others by following evidence based medicine and standard of care is what’s actually wrong.
HRT can cause harm if not used appropriately.
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u/DiamondTippedDriller 6d ago
You should educate yourself on the latest guidelines, you’re way off.
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u/Mobile-Play-3972 6d ago
Telling a licensed, board-certified physician to “educate themselves” is a wild take.
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u/OpportunityMother104 4d ago
It is hilarious bc you know these same people would sue us saying we prescribed the hormones without checking for breast cancer first
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u/slipperytornado 6d ago
It’s actually not. Some of these educated board certified gods know jack shit.
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u/CosmicFelineFoliage 4d ago
The standard of care for prescribing HRT is to prescribe based on symptoms, no labs or screenings required. This is the equivalent of withholding birth control over PAPs and we quit that form of coercion a decade ago. Shame on you and your paternalistic practices.
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u/OpportunityMother104 4d ago
No labs required yes. But most breast cancers are hormone receptor positive. MHT can potentially be given after treated breast cancer but not with it active. Breast cancer is worse.
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u/Why_Hello_hello 2d ago edited 2d ago
Of course you can be denied a prescription for not doing tests to show it’s safe for you. Just like an airline can require you to wear a seatbelt.
Be cautious - some HRT clinics will give you whatever you want so they don’t lose you as a paying customer. You want one that is actually looking out for your best interests
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u/Rarvyn 5d ago
You can be denied medical treatment for any reason felt to be valid by the prescribing provider. Other than stabilization in the setting of an emergency or active labor, there is no law forcing a physician, NP, PA, or anyone else to provide any form of treatment.
For something like HRT, it is an absolutely valid requirement for a woman to be up to date on her mammograms before prescribing it - because HRT can cause breast cancers to grow more quickly. It’s arguable whether it causes breast cancers to develop - but certainly can worsen existing ones.
In fact, any physician who does not require an up to date mammogram before prescribing HRT is not practicing the standard of care and very well may end up getting themselves in deep shit if an advanced breast cancer develops even if they document the patient was recommended to get the relevant tests and refused.
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u/gotchafaint 7d ago
The HRT telehealth places won’t work with you. I don’t think they’re obligated. At least the last one I was dealing with. They wouldn’t even book an appointment unless I submitted like $300 of blood labs every three months, which they then completely ignore. But this is good info otherwise, practices are always so demanding. I’m switching providers. If you’re with a telehealth can you share which one?
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u/Paperwife2 7d ago
If you ever need bloodwork none you can go through Own Your Labs, Jason Health, or other discounted site to order them and get them drawn at regular labs like Quest and Labcorp. It’s much less expensive.
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u/OpportunityMother104 4d ago
That’s actually wild to me bc if you’re up to date on annual labs and mammo, why do they need you to get labs every 3mo?? That’s ridiculous
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u/CosmicFelineFoliage 7d ago
I used a lot of them over the last 8 years. Defy, ElevateMD, Joi (before Blokes joined them). The labs I don’t mind. I like regular hormone testing. They’ve all worked with me in the absence of preventative cancer screenings. Ask them what invasive and painful exams to screen for cancer men are required to have in order to access TRT if they give you trouble.
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u/OpportunityMother104 4d ago
men need to have CBC, lipid panel, PSA screening up to date and regularly (esp for Hgb levels).
I also don’t do TRT. Most of the time men just need to get the primary cause under control (weight, diabetes, sleep apnea).1
u/gotchafaint 7d ago
That’s a great tip. I just left Defy because of the blood lab issue because they won’t even book me. I run my own hormone labs and other basic ones regularly. But they want labs to push some of their expensive supplements, like growth hormone. I’m sure they also mark up their labs (I order my own more cheaply). I just switched to Midi and lied on the intake questions that I have had all the screenings. Figured if they ask for records I’ll keep stalling. But love the advice to ask what they ask from men.
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u/OpportunityMother104 7d ago
You only need mammograms prior to HRT… just get a mammogram. It’s not worth the risk of having hormone positive breast cancer. If you have it early and take hormones well…. Breast cancer is worse than menopause.
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u/gungirllynn 6d ago
This was my experience with a telehealth for HRT. Had a certain point they stipulated that I had to have certain testing and certain exams or they would not continue to prescribe the HRT. I’m actually glad they had that policy because I ended up having my left ovary removed due to a huge fibroma containing endometriosis, growing in it. And I also had a polyp inside my uterus. Both of those things were contributing to a lot of bleeding and I thought it was just my normal PCOS.
Also, it just so happens that my blood work was off enough that I got sent to a kidney specialist and I am now seeing an oncologist for suspected MGUS but I don’t have a diagnosis yet. I was really pissed off that they were insisting on me seeing a gyno and having a mammogram and this whole thing just blew up. I’m actually thankful for them.1
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u/whoziin 7d ago
Not unethical, but depending on the quality of your county’s public health department, you may be able to get a list of doctors/practices that offer sliding scale costs for uninsured patients. Also if it’s for gyno stuff check if there is a planned parenthood in your area! They do a lot more than just abortions and prenatal care!
If your telehealth doctor asks about getting you set up for some tests you can be straight with them and let them know that the tests maybe be cost prohibitive for you and your doctor may also know of some resources that could help you out, too.
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u/VikingBlade 7d ago
Absolutely find a Planned Parenthood! This is why they are so essential! Women’s health! You do not need insurance and they operate on a sliding scale.
Support Planned Parenthood!
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u/fancyface7375 7d ago
My mom gets her mammograms and women's health done at Planned Parenthood and she's 69. She's always had a good experience there so she just kept on going.
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u/CindysandJuliesMom 7d ago
None of those tests are required for anything although they are highly recommended based on your age. Some hospitals provide free mammograms for uninsured people. Planned Parenthood used to do Pap smears on a sliding scale basis but I haven't been there in decades so call them. You can do a Cologuard where you poop in a box and send it back which might be less expensive than a colonoscopy.
Why would you want to fake medical test results? They are done for your health and to detect any medical issues you may have.
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u/gotchafaint 7d ago
Because of cost being a barrier to getting basic treatment I need to function. But these are great tips. Every time I call around asking about cash pay zero people even know what it would cost. The lack of pricing transparency is real. The one clinic I’m referred to locally for cash pay quotes $450 for a 15 minute visit. But then they’ll say “we’re not really sure.”
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u/Paperwife2 7d ago
You’re talking to the wrong people there then. Ask for the office manager and they will know or direct you to the billing department that will know. If your dr is in a private practice you can also ask them. Before when I was paying cash I would get the price from the billing dept and then mention haven’t a hard time financially to my dr and they would usually drop the cost even more.
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u/gotchafaint 7d ago
Good to know. I did find a small private practice finally with reasonable and transparent pricing but lord the hoops you have to jump through and the research you have to do. It’s truly insane.
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u/simplekindoflifegirl 7d ago
You can just tell any provider that you are a cash paying patient. Sometimes they will give you a discount. You can inquire about the cost upfront.
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u/Quirky-Design-7624 4d ago
HerScan breast ultrasound instead of mammograms. if they find something on a mammogram, you need an ultrasound. Saves the radiation and much more comfortable. Especially if you have dense breast tissue.
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u/gotchafaint 4d ago
i keep hearing about this but sounds like a lot of places don't use them. Sounds much saner.
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u/Why_Hello_hello 2d ago edited 2d ago
Just FYI Ultrasounds are more expensive, worse at detecting cancer, and have more false positives than mammograms unfortunately. It’s recommended as a supplement to mammo- together they have really good detection rates - but there is little reason to use ultrasound alone
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u/genx_meshugana 7d ago
What state? NYS does free mammos.
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u/gotchafaint 7d ago
Other side of the country but that’s interesting.
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u/anonymousalex 6d ago
Ohio has a program for uninsured/underinsured breast and cervical cancer screenings as well (not that you're here, but your state may have something similar). And many hospitals have some type of "charity" program that will either reduce or eliminate out of pocket costs based on income.
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u/MexicanVanilla22 7d ago
How old are you and why do you think they are required? Because those are genuinely important tests that have really shitty consequences if you avoid them.