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Gavinmad

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tomorrow, have appointment with general surgery at local hospital. had to call them to ask what it was for, turns out they setup colonoscopies.
Well you're gonna have to reschedule/cancel that unless you really wanna try and do the big laxative blowout today without having had a couple days to adjust your diet first.
 

Goatface

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Yeah the colonoscopy is on hold, Thursday I have a laser snake again. New Urologist said where the 5.5mm stone is would only have 60% chance of working. He said unless something unforeseen happens they will be able to do both the 5.5 and the 7mm Stones the same time.
Also said there is at least 1 stone under 2mm in the left kidney.
He also said after this is done, will start running tests to see why I am making these stones and work on fixing that.
I have seen 3 urologista and 5 doctors about stones and he is the first to say anything about that.
 
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Ossoi

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I chipped a front tooth recently and went to see a new Dentist. He told me I should consider getting braces because my back teeth don't meet when I bite and that is what might have caused the chip on the front.

I knew my teeth weren't amazing cosmetically but they weren't terrible either. I probably should have had braces as a teenager but my mother wouldn't pay for them. One front tooth grew through crooked as the baby tooth in that position was damaged when I tried to fly.

He said invisalign wasn't sufficient and referred me to an actual orthodontist. His quote based on some photos referred to "lateral open bite" which is a form of malocclusion.

He's quoted £6000 for the full treatment.

Just wondering what peoples experiences with braces as an adult have been? I've got to 40+ with my molars not meeting. Now that he pointed it out I can feel my front teeth meeting when I bite. It would be nice to get them fixed cosmetically too but again I've got this far.
 

Goatface

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Just wondering what peoples experiences with braces as an adult have been? I've got to 40+ with my molars not meeting.
are you getting just braces, or the hardware that pushes all the molars? a youtuber had that and it took him a couple months to be able to speak correctly. don't know personally, but he talked about it saying the cost wasn't fixed as they can only give a rough estimate of how long it would take. his estimate was around $8k, something like $1k to start and $500 per month.
 

Gavinmad

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lol I guess pump the brakes on the 'it definitely isnt a bone infection' train because my primary today told me the CT I got Saturday was just of my chest, the ER doc didnt look at my shoulder at all.
 
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Kajiimagi

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Wasn't sure where to post this, going here due to who called and why I was asleep at 10am on my couch.

Disclaimer: This really happened to me today and this is supposed to be funny

Little bit of back story, chemo is still kicking my ass even though I've been off it for 2 weeks. Back/joints are all on fire and sleep is next to impossible. So last night I finally passed out around 2AM. I woke up with my wife at 5AM to get her off to work then went back to sleep on the couch.

Below is a call log from this morning. I was still asleep when it rang.

I see 'Private Number' and didn't answer it figuring it would be spam.

Then they immediately called right back. This time I answered, It's some Urology place looking for someone with a Spanish name. I tell them it's the wrong number and hang up.

Then they immediately call back?! This time I say 'This is still not who you are looking for, you STUPID CUNT and stop calling me'. The woman on the line says 'fine we will cancel the consultation' and I say 'Great you STUPID CUNT, cuz this is the wrong number' and hang up.

Then....you got it , they immediately call back. So this time I decided to sing them a song. I answered the phone and sang:

CUNT
CUNT
CUNT
YOU'RE A STUPID CUNT
CUNT
CUNT
CUNT
YOU'RE A STUPID CUNT

over and over until they finally got the message and hung up. Now if you look at the log, that took them 1 minute , 6 seconds

That'll teach them to mess with someone with too much free time!
Screenshot_20240213_132324_Phone.jpg
 

Koushirou

Log Wizard
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Wasn't sure where to post this, going here due to who called and why I was asleep at 10am on my couch.

Disclaimer: This really happened to me today and this is supposed to be funny

Little bit of back story, chemo is still kicking my ass even though I've been off it for 2 weeks. Back/joints are all on fire and sleep is next to impossible. So last night I finally passed out around 2AM. I woke up with my wife at 5AM to get her off to work then went back to sleep on the couch.

Below is a call log from this morning. I was still asleep when it rang.

I see 'Private Number' and didn't answer it figuring it would be spam.

Then they immediately called right back. This time I answered, It's some Urology place looking for someone with a Spanish name. I tell them it's the wrong number and hang up.

Then they immediately call back?! This time I say 'This is still not who you are looking for, you STUPID CUNT and stop calling me'. The woman on the line says 'fine we will cancel the consultation' and I say 'Great you STUPID CUNT, cuz this is the wrong number' and hang up.

Then....you got it , they immediately call back. So this time I decided to sing them a song. I answered the phone and sang:

CUNT
CUNT
CUNT
YOU'RE A STUPID CUNT
CUNT
CUNT
CUNT
YOU'RE A STUPID CUNT

over and over until they finally got the message and hung up. Now if you look at the log, that took them 1 minute , 6 seconds

That'll teach them to mess with someone with too much free time! View attachment 514266

Heh, I'm hoping in a few days you find out this was some appointment you were getting scheduled and in your sleepy stupor just misheard the name or something for maximum lols. In a similar story, my dad's been having some back and sciatica problems lately. He brought it up to one of the neighbors he's been hanging out with. Guy is apparently a chiropractor and working on setting up a practice down there, but since he hasn't gotten insurance, etc. set up, he'll give my dad an appointment for like $40 and will call him soon to schedule it. Some days later, dad's on the golf course and he's having a pretty shit game so far. Just as he's about to take a swing, his phone rings. He's already pissed off, but the phone just puts him over the edge for some reason. He doesn't recognize the phone number, so assumes it's just spam, but instead of just silencing it and ignoring it, he answers it. No "hello," no "who's this?," just yells "SHUT! The FUUUUUCK! UP!" A meek voice comes on the other line of "uh...is this <dad's name>?" It's the nice chiropractor neighbor calling to schedule him, lol. He had a fun time explaining that one.
 

Kajiimagi

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Heh, I'm hoping in a few days you find out this was some appointment you were getting scheduled and in your sleepy stupor just misheard the name or something for maximum lols. In a similar story, my dad's been having some back and sciatica problems lately. He brought it up to one of the neighbors he's been hanging out with. Guy is apparently a chiropractor and working on setting up a practice down there, but since he hasn't gotten insurance, etc. set up, he'll give my dad an appointment for like $40 and will call him soon to schedule it. Some days later, dad's on the golf course and he's having a pretty shit game so far. Just as he's about to take a swing, his phone rings. He's already pissed off, but the phone just puts him over the edge for some reason. He doesn't recognize the phone number, so assumes it's just spam, but instead of just silencing it and ignoring it, he answers it. No "hello," no "who's this?," just yells "SHUT! The FUUUUUCK! UP!" A meek voice comes on the other line of "uh...is this <dad's name>?" It's the nice chiropractor neighbor calling to schedule him, lol. He had a fun time explaining that one.
Any legitimate ones call my wife as the Cancer Center knows I'm out of it most of the time.

Honestly I wish the offices at my docs did care this much. 4 fucking times in a row, wow.
 
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Goatface

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so the kidney stone removable x2 happens tomorrow around 8am. last time, the stent, which hurt like hell, was only in for 2 days. in tuesday out thursday. doctor told me that before going in and already had an appointment time.
this time, doc didn't say anything, nor is there an appointment. had a tiny bit of hope wouldn't going to have a stent, but i called the nurse. with it being on a thursday, earliest to get it out would be monday, but doctor is going to wait and see. it could be in 7 to 14 days.
 
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lurkingdirk

AssHat Taint
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so the kidney stone removable x2 happens tomorrow around 8am. last time, the stent, which hurt like hell, was only in for 2 days. in tuesday out thursday. doctor told me that before going in and already had an appointment time.
this time, doc didn't say anything, nor is there an appointment. had a tiny bit of hope wouldn't going to have a stent, but i called the nurse. with it being on a thursday, earliest to get it out would be monday, but doctor is going to wait and see. it could be in 7 to 14 days.

That's both good and horrible. Really glad to hear it's getting taken care of.
 
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Sludig

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Where's our billers at again?

Trying to sort through the bills from decembers back surgery. So far havn't had many issues, but hit where I know where I'm going to be over my max out of pocket and the bills from providers exceeds that, so was painfull downloading all my eob's to sort it out. Fucking sucks anthem had a nice graph that broke it down nicely in the app only but it will only show current yet, so sucks that this was all 2023.



But I need to know how it might work going forward, the co-surgeon who i had a pre surgery appointment with all those things, should have been cleared by insurance. Well now I have a 3k bill theyve sent me a couple times, and I can see 2 claims submitted in my eob, one was immediately denied and one that is still pending for some time now.

Not sure if I call them and tell them hey, call me back when your done fucking with insurance or just ignore them for now. Worst case it's all denied and they try to come after me for it, what recourse do I have on them fucking up coverage questions? If I end up having to pay them anything, can't I submit any of that as user submitted claims and possible hit my max out of pocket that way and either not pay some other of the bills and have ins do it, or i doubt i'd get a refund somehow.
 

sleevedraw

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But I need to know how it might work going forward, the co-surgeon who i had a pre surgery appointment with all those things, should have been cleared by insurance.

What do you mean by "should have been cleared by insurance?"
You are under an HMO and you saw a surgeon without a referral from a PCP?
Your surgeon ordered a bunch of tests and didn't bother to obtain prior authorization for what he ordered before you had them performed? Something else?
I'm having some trouble parsing this situation and understanding what's going on here.

Well now I have a 3k bill theyve sent me a couple times, and I can see 2 claims submitted in my eob, one was immediately denied and one that is still pending for some time now.

Not sure if I call them and tell them hey, call me back when your done fucking with insurance or just ignore them for now.

If the co-surgeon was in-network, they shouldn't be trying to balance bill you until the claims are settled and the insurance company agrees that you either owe deductible or coinsurance money per the EOB. If that's the case, I would probably call up the co-surgeon's billing company and put the bill in "suspend", explaining that the claims are still pending. I had to appeal a claim once, and they were willing to suspend while it was working its way through appeal. You could also call up Anthem and ask them what the hold-up is regarding the claim.

If your main surgeon was in-network, any assistant surgeon should still be considered in-network per the No Surprises Act.

If the main surgeon the co-surgeon are both OON, you're fucked, and they can balance bill/come after you for whatever they were unable to collect from insurance. Will be 100% on you to either pay or attempt to negotiate the bill amount down with the provider.

Worst case it's all denied and they try to come after me for it, what recourse do I have on them fucking up coverage questions? If I end up having to pay them anything, can't I submit any of that as user submitted claims and possible hit my max out of pocket that way and either not pay some other of the bills and have ins do it, or i doubt i'd get a refund somehow.

The first recourse you have is calling up the doctor/their biller and trying to bitch at them for not looking properly at the insurance. A good doctor might write off the bill, an asshole doctor will say "Your insurance is a contract between you and the insurer" and tell you to pound sand. If they tell you to pound sand and they are in-network, you can get your insurance company to hold the doctor's feet to the fire (i.e. file a grievance, which usually gets a doctor's attention, because they don't want a black mark on their record). Decent stepwise guide to disputes here.

To my knowledge, the date of service determines payment. So if the services were rendered in 2023, and you already hit your out of pocket max in 2023, theoretically you would be reimbursed for 100% of whatever the allowable expenses are under your health plan. Anything your health plan specifically excludes would not be paid. There might be a time limit on how long you have to submit claims after a service is rendered, however. That would probably be dictated by your individual policy/contract.
 
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Sludig

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What do you mean by "should have been cleared by insurance?"
You are under an HMO and you saw a surgeon without a referral from a PCP?
Your surgeon ordered a bunch of tests and didn't bother to obtain prior authorization for what he ordered before you had them performed? Something else?
I'm having some trouble parsing this situation and understanding what's going on here.



If the co-surgeon was in-network, they shouldn't be trying to balance bill you until the claims are settled and the insurance company agrees that you either owe deductible or coinsurance money per the EOB. If that's the case, I would probably call up the co-surgeon's billing company and put the bill in "suspend", explaining that the claims are still pending. I had to appeal a claim once, and they were willing to suspend while it was working its way through appeal. You could also call up Anthem and ask them what the hold-up is regarding the claim.

If your main surgeon was in-network, any assistant surgeon should still be considered in-network per the No Surprises Act.

If the main surgeon was OON, you're fucked, and they can balance bill/come after you for whatever they were unable to collect from insurance. Will be 100% on you to either pay or attempt to negotiate the bill amount down with the provider.



The first recourse you have is calling up the doctor/their biller and trying to bitch at them for not looking properly at the insurance. A good doctor might write off the bill, an asshole doctor will say "Your insurance is a contract between you and the insurer" and tell you to pound sand. If they tell you to pound sand and they are in-network, you can get your insurance company to hold the doctor's feet to the fire (i.e. file a grievance, which usually gets a doctor's attention, because they don't want a black mark on their record). Decent stepwise guide to disputes here.

To my knowledge, the date of service determines payment. So if the services were rendered in 2023, and you already hit your out of pocket max in 2023, theoretically you would be reimbursed for 100% of whatever the allowable expenses are under your health plan. Anything your health plan specifically excludes would not be paid.
I'm on a high deductible w/ HSA plan. My surgeon for a total disc replacement (older talk on this in the thread think you even commented on but maybe that was all wifes mega brown recluse bite), at the specialty inpatient hospital used a co-surgeon who essentially went in through my front to provide access to my spine for doing that work. (The surgery center being seperate from either dr, but had the most outrageous bill, 72k billed for my room it says, they paid 33k and I pay 1k)

Numerous times I had asked about making sure my insurance is cleared etc and folks are in network. It even held me up because for a bit Anthem was trying to say they wouldn't give a approve or deny, no preapproval for the surgery through my primary surgeon that is the one that took me thru MRI to doing the surgery.

On my eobs etc, the first visit with the dude is interesting because it was under one hospital group, ascension st john and was approved and I paid whatever. But now the surgery bill is the one in question, and it's through Utica/Hillcrest and bill actually shows a 3rd heart group branch (All various sub groups of the same mega health system here in OK) On my EOB's it shows 2 claims, one seemingly same day denied, and another that's been showing processing for the last month and a half I guess.

No matter how it shakes out, i should be at out of pocket max pretty much or within $100. Good to know about no surprises act, but if they are stupid not sure how I throw that at them. But to reiterate yes, my main surgeon and all his bills pre and post surgery have been approved in network.



Re that out of pocket though, I wasn't sure if they would reimburse, if it's money I spent on something they denied as out of network. (Seperate from not being covered like at all I imagine like having a 3rd arm grafted on etc odd stuff)
 

sleevedraw

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I'm on a high deductible w/ HSA plan. My surgeon for a total disc replacement (older talk on this in the thread think you even commented on but maybe that was all wifes mega brown recluse bite), at the specialty inpatient hospital used a co-surgeon who essentially went in through my front to provide access to my spine for doing that work. (The surgery center being seperate from either dr, but had the most outrageous bill, 72k billed for my room it says, they paid 33k and I pay 1k)

Numerous times I had asked about making sure my insurance is cleared etc and folks are in network. It even held me up because for a bit Anthem was trying to say they wouldn't give a approve or deny, no preapproval for the surgery through my primary surgeon that is the one that took me thru MRI to doing the surgery.

On my eobs etc, the first visit with the dude is interesting because it was under one hospital group, ascension st john and was approved and I paid whatever. But now the surgery bill is the one in question, and it's through Utica/Hillcrest and bill actually shows a 3rd heart group branch (All various sub groups of the same mega health system here in OK) On my EOB's it shows 2 claims, one seemingly same day denied, and another that's been showing processing for the last month and a half I guess.

No matter how it shakes out, i should be at out of pocket max pretty much or within $100. Good to know about no surprises act, but if they are stupid not sure how I throw that at them. But to reiterate yes, my main surgeon and all his bills pre and post surgery have been approved in network.



Re that out of pocket though, I wasn't sure if they would reimburse, if it's money I spent on something they denied as out of network. (Seperate from not being covered like at all I imagine like having a 3rd arm grafted on etc odd stuff)

OK, HDHPs are normally basically just high deductible equivalents of EPOs or PPOs, so no referral should be required.

Anthem stating that they wouldn't give an approval or denial for the procedure may be normal; somedo not require preauthorization. What procedures do and do not are dictated by the individual health plan, and sometimes they are switched out year over year (we monitor claims data and see what services tend to be abused, and those usually get added to prior auth lists.) The big companies (and Anthem is huge) are largely scaling back their manual prior auth processes now because it causes a lot of abrasion with doctors. They are trying to replace manual prior auth with AI, which is causing its own set of headaches.

If your main surgeon is in-network, you should be good unless you signed a form called a Notice and Consent (N&C as we call it in the biz). They look like this, they are supposed to be included separately from all other paperwork (not buried in a stack so that a provider can hide it), and they are supposed to be thoroughly explained if a facility/provider wants to issue one.

1707977001259.png


Regarding denied claims, there are many different reasons/codes that can be used to deny something. Some of them shift financial responsibility to the patient (like out of network, no prior authorization received, experimental/investigational services, etc.). For others, we basically tell the doctor "We're not paying, and the patient doesn't need to pay either". On the EOB, it should explain your financial responsibility. If the EOB says "0" under the "patient responsibility" column, you do not owe them anything.

If the insurance company is specifically trying to deny the claim on the basis that the co-surgeon is out of network, I would call them up and explain that the surgeon is a co-surgeon, your main surgeon and the surgery center were both INN, you did not sign a N&C, and thus the co-surgeon should also be treated as in-network per the No Surprises Act.

Co-surgeons always make insurance claims a fucking nightmare. When I was working at a different Blue Cross company back in the day, we basically told the co-surgeons that one of them needed to be listed as the primary surgeon, that was the one that would get paid, and they would need to privately duke it out amongst themselves regarding how much the co-surgeon would get paid, because we didn't want to get caught in the middle of all the bullshit.
 
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Goatface

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hope to never have to post about this again
both stones got removed this morning, all went well
doctor didn't talk to me afterwards, so little unclear on a couple of things.
woke up pretty quick, made sure to pound 3-4 cups of water and get ice pack on my dick, it made the 1st pee 100x better.
for some reason they wrote me couple of paper scripts, 1st time gotten them in like 2 years from any provider, everyone just sends them to cvs. we dropped them off at cvs. about 20 mins later cvs calls, "can't fill your scripts, they left his info off the lortab and insurance info off the antibiotics." this was preformed at the hospital and had to give cvs doctor's office info. guess he can update the antibiotic, but said he can't add anything to schedule 2 scripts. hope they can get the worked out, but if not still have 11 left from last weeks er visit.

chatting with one of the ladies at the hospital, she said once the figure out the makeup the stone they can do stuff to prevent them. she said, she was having stones taken care of almost every 6 months. they put her on pill that flushes the kidneys to prevent build up.

i just passed this.
1708026135229.png
 
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Chris

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Wasn't sure where to post this, going here due to who called and why I was asleep at 10am on my couch.

Disclaimer: This really happened to me today and this is supposed to be funny

Little bit of back story, chemo is still kicking my ass even though I've been off it for 2 weeks. Back/joints are all on fire and sleep is next to impossible. So last night I finally passed out around 2AM. I woke up with my wife at 5AM to get her off to work then went back to sleep on the couch.

Below is a call log from this morning. I was still asleep when it rang.

I see 'Private Number' and didn't answer it figuring it would be spam.

Then they immediately called right back. This time I answered, It's some Urology place looking for someone with a Spanish name. I tell them it's the wrong number and hang up.

Then they immediately call back?! This time I say 'This is still not who you are looking for, you STUPID CUNT and stop calling me'. The woman on the line says 'fine we will cancel the consultation' and I say 'Great you STUPID CUNT, cuz this is the wrong number' and hang up.

Then....you got it , they immediately call back. So this time I decided to sing them a song. I answered the phone and sang:

CUNT
CUNT
CUNT
YOU'RE A STUPID CUNT
CUNT
CUNT
CUNT
YOU'RE A STUPID CUNT

over and over until they finally got the message and hung up. Now if you look at the log, that took them 1 minute , 6 seconds

That'll teach them to mess with someone with too much free time! View attachment 514266
Call 1:
"That's weird, my name is XYZ. I'm having cancer treatment at ABC is there any chance you have the names or numbers mixed up? Otherwise can you please remove my number from your system? Thanks"

Call 2:
"Yeah still me, please delete the number"

Call 3:
"I'm in a lot of pain from chemo and you woke me up, stop dialing the same number and fuck off"

I don't think there's a reason to escalate the conversation to "cunt" so quickly, nevermind singing that song. Karma says that you have dick cancer and they were trying to help you.
 

Sludig

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Call 1:
"That's weird, my name is XYZ. I'm having cancer treatment at ABC is there any chance you have the names or numbers mixed up? Otherwise can you please remove my number from your system? Thanks"

Call 2:
"Yeah still me, please delete the number"

Call 3:
"I'm in a lot of pain from chemo and you woke me up, stop dialing the same number and fuck off"

I don't think there's a reason to escalate the conversation to "cunt" so quickly, nevermind singing that song. Karma says that you have dick cancer and they were trying to help you.
Stfu cunt
 
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Gavinmad

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I had thoughts in the same general direction but I was thinking maybe just tone it down slightly instead of going full pansy. Decided I didn't care enough to want to tell the guy with cancer he should be nicer.


MRI this morning firmly ruled out osteomyelitis so the pain is almost certainly from ac arthrosis that decided to be a dick and flare up for the first time ever right when it would justifiably spark fears that it was something far more serious. Of course it can't all be good news and I'm the proud owner of yet another rare medical condition, an intramuscular lipoma (in the subscapularis). It will undoubtedly require a biopsy but it's unlikely to need removal.

The follow up appts with surgery and ID were quick and uneventful and really could have been video calls except there was no way of knowing that I would be getting a CT in the ER on Saturday that would have made the chest x-ray that surgery wanted kind of redundant. Would have been nice to not spend 6+ hours on the road today but whatever.

Mrs. Gravy Mrs. Gravy We actually were gonna go kill a little time at the science center before my second appt but the map app took us right to the construction work under the walkway into the flagship Barnes building and there was no room to turn around and the only thing we could do was pull into the underground parking garage so we just said fuck it, parked there, and walked the half mile back over to where my ID appt was.
 
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Kajiimagi

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Call 1:
"That's weird, my name is XYZ. I'm having cancer treatment at ABC is there any chance you have the names or numbers mixed up? Otherwise can you please remove my number from your system? Thanks"

Call 2:
"Yeah still me, please delete the number"

Call 3:
"I'm in a lot of pain from chemo and you woke me up, stop dialing the same number and fuck off"

I don't think there's a reason to escalate the conversation to "cunt" so quickly, nevermind singing that song. Karma says that you have dick cancer and they were trying to help you.
STFU cunt
 
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Goatface

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got stent out today, feels almost normal now :) ultrasounds in 5 weeks and see doctor. they are running test on stone to see what type it is.

hope no one ever has to go through this, but if anyone has questions, can going into terrible details.
 
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