(Snippets from the frontline)
Insurance company denial is your risk
My patient was admitted to the ICU with a heart attack. At that time we did not have coronary angiograms with stent placement, so we modulated his medication. On the third hospital day, his wife brought a letter from the insurance company denying his admission stating he would have to pay out-of-pocket.
His response was emotional, extending the myocardial infarct…and he died.
Another patient had symptoms of a stroke known as a TIA (transient ischemic attack) with a carotid doppler indicating significant blockage. The insurance company denied surgery, and within a month the patient became permanently paralyzed on one side.
This year, a patient was admitted with the insurance letter denying “the need for an acute inpatient level of care” insisting the patient be discharged. Their basis was:
- No fever.
- Ability to tolerate a diet by mouth.
- McKesson InterQual Acute Adult, Extended Stay, General criteria were not met.
Yet he had a documented threatening aortic arch aneurysm which could be fatal if not repaired.
Is this the way to save healthcare system money by risking the lives of our patients?
Where is the outcry?
Gene Uzawa Dorio, M.D.
Don’t paint us all with the same brush! All doctors are not the same and all insurance companies and HMO’s are not the same either. I am a retired specialist and along with another retired specialist do the authorizations for our Healthplan, and all of the cases mentioned would have been approved without question. Before joining HMOs, patients should ask who does the authorizations for consults or specialty care. If a licensed physician is not doing it, the patient should look elsewhere.
As a physician I have seen similar insurance overlords dictate who dies or who lives. The overlords are preventing medical miracles such as a person in a coma for years wakes up and remembers everything or patient at home has a heart attack and is shocked back into normal rhythm but when arrives to hospital is greeted by a hospital employee stating the patient does not meet the criteria for admit since now heart is looking ok on the cardiogram. The medical personnel denying admission and treatments that had sworn an oath to do the best for mankind are now acting like the Vichy in France during WWII.
When people tell me that we need a free health care system, I know that free is never free. Coming from France, I always have paid my dues for health in America. The health insurance denied my rights once, denied the rights of one of my children once, and that’s the problem we face here; That’s what we have to work on. We all need to be clear with those private entities.