As I prepare for a brief escape from the clutches of healthcare hell, I thought it only fitting to offer a special mid-week installment—because when the bureaucratic gods rain flaming prior authorizations, you don’t wait until Monday to light your readers’ hair on fire.
This week’s saga includes a miraculous conversion: Dr. DeLorean, once a scoffer of silicon sages, now openly embraces ChatGPT—even for his own care. Meanwhile, over at the House of Rehabilitative Horrors (a.k.a. Advent Sports Med & Rehab), the Medicare billing machine keeps spewing smoke and CPT codes with the precision of a North Korean missile parade. All of which feeds directly into my souring opinion of Dr. Speedy McNeedle and her chat-averse PA, who ignored my MRI, pushed hyaluronic snake oil, and tried to shove me back into the same Advent rehab that already failed me once. Wash, rinse, overbill, repeat.
But there’s hope on the horizon. I’ve enrolled in SOMMA2, a research study on muscle loss and aging. Finally, someone wants to study my sarcopenia rather than shrug at it! And in a thrilling third-act twist, Poona—yes, our favorite dartboard calendar enthusiast at EnGuide Pharmacy—actually delivered my Mounjaro shipment just in time for my upcoming road trip.
Buckle up. We’re cruising through incompetence, insurance, and institutional indifference at 80 mph—with the windows down and a middle finger extended toward the healthcare-industrial complex.
DeLorean, the Cyber Convert
Last week, Dr. DeLorean was the poster child for the “I’m not ChatGPT” crowd. Now? He’s browsing Amazon for wrist braces and quoting ChatGPT like it’s the Merck Manual. I’ll take partial credit—I keep showing up to appointments pre-briefed by my AI sidekick and it’s finally worn him down.
This week’s visit was prompted by bilateral hand and wrist pain. I feared something more exotic than osteoarthritis—maybe lupus, RA, or an obscure curse from a jealous voodoo priest. But after ruling out everything short of alien abduction (CRP, ESR, RF, ANA—all normal), we landed back at OA.
The presentation was classic: nighttime pain, relief with movement, improved grip with deadlifts. No swelling, no deformity, no neuropathy to speak of. DeLorean prescribed Voltaren Gel—blessed by ChatGPT, no less, for his own runner’s aches and pains—and helped me pick out wrist wraps online. He even complimented my veins and biceps, which, for a 78-year-old diabetic on Mounjaro, I’ll accept as currency. (And I need currency aplenty to pay DeLorean’s exorbitant concierge fee).
We also discussed dialing back my losartan yet again (25mg, down from 50, and experimenting reducing further to alternating days), and I briefed him on my disappointing orthopedic escapades, which segues nicely to…
McNeedle Disappointment
Oh, how quickly the halo tarnishes.
Dr. McNeedle, initially promising and attentive, now seems content to ignore actual imaging and outsource care to her PA, who decided I needed more PT at the same damn Advent facility that already failed me. The MRI clearly showed a worsening quadriceps tendon tear—something I had already suspected and already said. But instead of a focused, tendon-specific therapy referral, they issued a generic PT order and defaulted to the same failed vendor who flew a holding pattern for six weeks. As if I’m some forgetful octogenarian who won’t notice.
Of course, McNeedle is an employee of Rothman Orthopedic, an outfit that has cut a sweetheart deal with Advent (see sidebar). So, of course, the one-hand-washes-the-other pipeline must be fed with fresh patients and fresh billing codes.
They also proposed that I go ahead with hyaluronic acid (HA) injections—not because they’re indicated, but to “differentiate the pain source.” Translation: “Let’s play medical darts with your knee until something sticks… or bills.”
I declined, asked them to withdraw the Advent referral, and requested actual communication and reasoning before proceeding. Radio silence since Friday, although they unceremoniously complied with my request to replace the Advent referral with a generic one. I’ve cancelled all future appointments, sending the message stating: “Don’t call me; I’ll call you.” In other words, sayonara.
Billing Like Bandits: The Advent Rehab Episode
After the ineffective PT ended, I did a little digging into the Medicare billing. Thanks to ChatGPT and a well-trained eye for bullshit, I discovered that my rehab bills were padded with fiction worthy of a Netflix drama.
- Manual therapy (97140): Billed 6 times, performed 2. The rest was ice packs from an aide.
- Group therapy (97150): Never happened, billed anyway. Maybe they count “being near other people” as a therapeutic modality now.
- Neuromuscular re-ed (97112): Tossed a ball on Day 1. Still billed twice.
- Therapeutic exercise (97110): Probably valid… except that most sessions involved me working out alone while the therapist scrolled Instagram.
Yes, they billed everything under the sun while I stretched bands in solitude. Medicare may be footing the bill, but I’m footing the outrage. If we don’t call this out, we all pay—one bland billing code at a time.
I want real sports med PT: progressive tendon loading, one-on-one supervision, continual progress monitoring, and zero billing fiction. What I got was one-size-fits-all, half-assed, generalized senior knee pain protocol. Going back for more of the same, as McNeedle’s PA feels is appropriate, validates Einstein’s definition of insanity.
SIDEBAR: The Rothman–Advent Health Bait & Switch
Rothman Orthopedic, long a fixture in Philadelphia and a marquee name in the world of joints, bones, and billables, made its Florida debut by cozying up to none other than Advent Health—Central Florida’s biggest church-affiliated billing machine. This unholy alliance is textbook corporate symbiosis: Rothman gets Florida market share, Advent gets a gleaming sports-med halo, and patients… get misled.
How? Simple. Rothman markets itself as the orthopedic group trusted by professional athletes. They’re proudly affiliated with teams like the Orlando Magic (NBA) and the Orlando Solar Bears (AHL), which makes it sound like your average Medicare enrollee might receive the same cutting-edge treatment as a starting power forward nursing a torn meniscus. Spoiler alert: you won’t.
This is the classic bait and switch. The pro team branding lures you in, but unless you’ve got a multi-million-dollar contract and a postgame press conference to make, you’re probably not seeing the surgeon who keeps the Magic limping through the playoffs. Instead, you’re getting the Rothman-to-Advent shuffle—redirected to a non-surgical doc and ultimately dumped at Advent Sports Med & Rehab, where therapy plans are generic, progress is optional, and billing is… robust.
So while Rothman claims to bring “pro sports medicine to everyone,” what they actually deliver to us mere mortals is the low-touch, high-volume, template-driven care designed for maximum CPT harvesting—not maximum recovery.
Think you’ll get what the Magic players get? Not unless you’re wearing a jersey and generating ticket sales. Otherwise, you’re just another aging knee with a deductible and a prayer.
SOMMA2 Study: Old Farts, New Science
I’ve officially joined the SOMMA2 study—an NIH-funded exploration of muscle loss in aging. Sponsored by Wake Forest, Pitt, and yes… Advent Health. (Cue nervous laughter.)
The study will involve MRIs, muscle biopsies, GPS-tracked activity, and a VO2 max treadmill torture session. In return, I’ll learn how my muscle mass stacks up against my septuagenarian peers and get a modest $450 in “we appreciate your flesh” compensation. That compensation comes in dribs and drabs at various checkpoints. I will earn the full amount only if I stick around to the conclusion of the study three years from now.
They will give me a GPS tracker for a week to measure my moving time and distance, with the assurance that they won’t be logging my visits to the supermarket or the local sex toy shoppe. Plus, the study coordinator pointedly added that the tracker cannot be mistaken for an ankle monitor. I imagine several of my aged peers already wear one of those, courtesy of the court mandated sex offender list. (Just kidding, of course. I know only one such geriatric offender, a ham radio operator in fact, who won’t be getting out of his Iowa cell in time to join us at the event we’re attending next week. So, he won’t be involved in the study, either. But I digress.)
I confirmed with the lead researcher that my current creatine regimen won’t interfere much with the study’s deuterium-labeled creatine testing, and when he asked if it helps, I flexed like a jackass. He smiled and said bodybuilders were welcome. Damn right! I’ll call my friend Arnold in Collie-FORNya to see if he’s interested.
Time Out for a Dr. Ferrari Story
I couldn’t resist sharing this encore: Dr. Ferrari, the hotdog, hot-shit knee surgeon who once told me I had “end-stage arthritis” (see my August 19, 2024 blog post) and needed double knee replacements yesterday, made a surprise cameo. Dr. DeLorean ran into him at a cycling event, where Enzo—yes, I’m calling him that—proceeded to mansplain basic knee anatomy to a fellow physician.
Apparently Ferrari was shocked that DeLorean had injected his own knee. “You can’t do that!” he cried. This, from a D.O. who thinks every patient is a surgical candidate and every knee is a revenue stream.
I mentioned the D.O. thing to DeLorean, playing the straight man set-up angle to amuse myself. “Isn’t that considered a lesser tier of humanity by you M.D.s?” He nodded an assent. Then, I reminded DeLorean that Enzo graduated from Michigan State (a.k.a. Moo U.), and his Big Ten-trained M.D. pride lit up. “Yeah,” he chuckled. “Not even University of Michigan!”
Chef’s kiss.
Poona Delivers!
At long last, our heroine of Hyderabad came through. After yet another cryptic delay notification from EnGuide, I called to light a fire under someone. Enter: Angel (yes, that was her name), who assured me the shipping label was printed and the shipment imminent.
Sure enough, on Monday, UPS confirmed the package was en route. And at exactly 5:36 PM on Tuesday, the styrofoam sarcophagus arrived, full of precious peptide payload. I now have three months’ worth of Mounjaro chilling in my fridge, safe from bureaucratic bungling… for now.
In three months, I expect to rinse and repeat this entire Kafkaesque dance with Poona, Yanna, or perhaps a new cast member named Lakshmi or Meena. But for now, I raise my GLP-1 pen in triumph.
And Now, a Brief Intermission
And with that, dear readers, I shall vanish into the late-summer haze for a brief, hopefully medication-free (hah!) reprieve. By the time you hear from me again—sometime around Labor Day—I’ll have survived a ham radio gathering in Oklahoma, potentially endured in-law small talk and Kauffman’s Deli carbs in Chicago, and quite possibly left a few non-essential body parts scattered along the way.
Rest assured, I’ll return with tales from the opening salvo of the SOMMA2 study, a six-hour blend of biopsies, bloodletting, and bionic treadmill torment that promises to leave me informed, exhausted, and maybe down a quadriceps fiber or two. If the VO2 Max test doesn’t kill me, I’ll tell you all about it.
As for my now confirmed quadriceps tendinopathy, I’ll keep you in the loop during my quest for a competent rehab facility, where functional improvement eclipses billing codes. We’ll see whether Dr. McNeedle will stick around for the ride. Hint: she may already be history.
Also expect updates on whether Poona makes good on her next shipping cycle, whether Dr. Ferrari’s ego has eclipsed the moon, and whether my Tesla—armed with its not-quite-full-self-driving—manages to find its way through the backroads of the Midwest without me having to take the wheel and scream, “No, dammit, we don’t need a scenic detour through Tulsa, you idiot!”
Until then, keep your syringes cold, your PT referrals unforwarded, and your bullshit detectors fully charged.
See you in September. Maybe with both knees still intact.
For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.
