The Widdershins

Archive for February 6th, 2018

Who pays the bill?

Good Day Widdershins!

MB has had some real life issues come up
so I’m subbing for her today.

Welp, the Super Bowl is over and as chat and I used to say, we’ve entered the Dark Times now as far as football is concerned.  However, we survive.

What we may not survive is how insurance companies treat us when we may have to use the services of the emergency room.  Basically they now have decided that unless you have diagnosed yourself, performed an M.R.I. on yourself with your own imaging machine that you keep out in the garage and truly have an emergent condition under their own list of diagnostic codes rules and, in the case of Anthem, they probably won’t cover your claim for an E.R. visit.

A list of codes from Missouri is significantly longer, with more than 1,900 diagnostic codes that could indicate non-emergency visits. The list includes multiple types of “unspecified injuries” and “chest pain on breathing.”

(snip)

In other states, the list of diagnosis codes remains confidential. Georgia insurance regulators have asked Anthem to provide a copy of that state’s list, but so far, that hasn’t happened.

The link above is a link to a Vox article describing what happened to one woman in Kentucky Who had Anthem Blue Cross.

Brittany Cloyd was doubled over in pain when she arrived at Frankfort Regional Medical Center’s emergency room on July 21, 2017.

“They got me a wheelchair and wheeled me back to a room immediately,” said Cloyd, 27, who lives in Kentucky.

Cloyd came in after a night of worsening fever and a increasing pain on the right side of her stomach. She called her mother, a former nurse, who thought it sounded like appendicitis and told Cloyd to go to the hospital immediately.

Hell, if my mom was a former nurse and told me that I would be heading to the E.R. too!

At the E.R. the doctor and staff did a CT scan and ultrasound.  They determined that Cloyd had a case of ovarian cysts.  They gave her a prescription for pain meds and an order to followup with her gynecologist.  And ya know…most of us don’t have that CT machine and ultrasound to do our own tests before heading to the E.R.

However that wasn’t good enough for Anthem Blue Cross and they denied Cloyd’s claim leaving her to pay a $12,000 bill.

What Anthem suggests other than a visit to the E.R.

Anthem discovered a really neat way to start denying E.R. claims when they received them.

Anthem has begun denying coverage for emergency room visits that it deems “inappropriate” because they aren’t, in the insurance plan’s view, true emergencies.

The problem: These denials are made after patients visit the ER, sometimes based on the diagnosis after seeing a doctor, not on the symptoms that sent them, like in Cloyd’s case.

Now, I’m not a doctor nor a nurse but I do believe when you present to the E.R. the docs and nurses will get the symptoms you are having and then start the process of ruling out or ruling in what the problem or issue is.  However, it’s much easier and cheaper (!) to go by what the discharge diagnosis turned out to be.

Vox wanted to interview someone from Anthem but after initially agreeing to an interview Anthem backed out and just gave them a written statement.  (which is bullshit btw)

Renee Hsia, a professor of health policy studies at the University of California San Francisco and practicing emergency physician said:

“If you look at insurance claims data, you have diagnoses but you don’t have what the patient came in with,” Hsia said. “It’s not fair to expect the patient [to come] in knowing their diagnosis. If they did, they wouldn’t come in and wait for ours.”

Oh and that little flyer thing above that Anthem included in some folks’ bills?  It a crock.  In my local area, urgent care places close at 6:00 p.m., they aren’t open “nights”.  So if I have chest pains after 6, do I wait until the next day when they are open or do I call 911 and go to an E.R.?  And pardon me, but the Teledoc?  I’m having chest pains and I’m going to video conference with a doc?  Uh no and besides they charge either $40 or $45 bucks and then they would say “go to the E.R.”.

At least Brittany got satisfaction on her claim.  It only took two appeals and then Vox getting into the situation.

John Rogers, president-elect of the American College of Emergency Physicians said “Hospitals are starting to talk to patient advocacy groups, asking whether they’re aware of the situation,” he said. “We’re starting to sit down with legislators to say, ‘This is happening, we don’t think it’s a good idea, and these are other, better solutions.’”

Good luck Dr. Rogers.  Going up against the big health insurance companies will be a long, difficult slog.

Open thread of course.

I couldn’t bring myself to write about tRump and his calling the Democrats “treasonous” because they refused to kiss his ass applaud his S.O.T.U. address.  You’ll find out about real treason very soon Donald.

 

 

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