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goda90 a day ago

>Randy needed immediate psychiatric care, and as an emergency physician I knew the options. We put our trust in the mental health team at a local crisis receiving unit, and they kept Randy overnight in temporary safe housing where he could be observed. By morning they had devised a plan to transfer Randy to a retreat-like inpatient psychiatric facility that was in-network with our insurance. The psychiatrist felt Randy was very high risk, but that he could heal with eight weeks of inpatient treatment. We were told our insurance would cover it.

>But six days into Randy’s eight-week hospital stay, our health insurance company denied any further inpatient care.

>The facility appealed Randy’s case, providing psychiatrist’s notes that clearly outlined his need, but the outcome did not change. Because Randy had no prior history of mental illness, the insurance company determined he shouldn’t need to be hospitalized and stopped paying for his care. A day later Randy was forcibly discharged.

This is definitely a case where the insurance company holds the majority of the blame.

rayiner a day ago | parent [-]

> This is definitely a case where the insurance company holds the majority of the blame.

What facts are the basis of your conclusion? There is no health system in the developed world where a doctor's recommendation will guarantee expensive inpatient treatment without a layer of bureaucratic review.

ryandrake a day ago | parent | next [-]

You are right--Doctors absolutely share blame. Take my dentist's behavior, for example. When the oral hygienist is done doing all the real work, my dentist sits down for 10 minutes to count my teeth and say the words "You should floss more." She bills $85 for that sentence and calls it "Oral hygiene instructions". My insurance company (IMO rightly) denies paying for this. It's ridiculous and the dentist knows they're going to call bullshit on it, but they bill it anyway, and then I'm technically on the hook to pay for it. So far, the dentist has not yet attempted to balance bill that charge, and I will drop them like a bad habit if they ever do.

foco_tubi 21 hours ago | parent [-]

Doctors and dentists in the US are not bound by the same regulations (or even a similar stringency of regulation) involving billing practices and procedure codes.

foco_tubi a day ago | parent | prev | next [-]

I'd imagine you'd struggle to find a healthcare system in which a doctor's prescribed care is assuredly covered by insurance, by the insurance provider, and then later rescinded after care has already started.

EvanAnderson 17 hours ago | parent [-]

The ACA made rescission of health insurance more difficult for insurers, but it absolutely happens. There are people at insurers tasked with looking for fraudulent omissions in policy applications for high loss ratio individual policyholders to target for rescission.

This one is pre-ACA but the insurer focused on an "omission" to justify the rescission: https://www.cnn.com/2009/POLITICS/06/16/health.care.hearing/...

SpicyLemonZest a day ago | parent | prev | next [-]

There are many health systems in the developed world, though, where the system doesn't make this the patient's problem. It shouldn't be possible to have a scenario where the provider believes eight weeks of treatment will be covered, the patient moves to an inpatient facility based on this understanding, and then the bureaucratic review layer decides six days layer that the provider was wrong.

goda90 a day ago | parent | prev [-]

The goal should be to provide every human being with the best care possible. If a system can't handle that, then we need to assess why and make changes.

rayiner a day ago | parent [-]

Show me a country where that's the goal. Every other developed country has a goal that's something like: "provide the best outcomes for the population as a whole, at a cost the public is willing to pay."

goda90 a day ago | parent [-]

We should make it the goal as a species. We have the resources and technology. We decide to be limited by economics.

rayiner a day ago | parent | next [-]

No, economics is just how we describe resource limits and tradeoffs in a methodical way.

hollerith 16 hours ago | parent | prev [-]

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