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Look, this is prima facie a scandal, but I can assure you that the insurance carrier is dealing with a real issue. Basically the road to hospitalization is pav
by AStonesThrow 1y ago
Look, this is prima facie a scandal, but I can assure you that the insurance carrier is dealing with a real issue.
Basically the road to hospitalization is paved with Vaseline and gingerbread cookies. In my experience, every effort is made at every level to unfailingly recommend a hospital visit at every opportune moment, regardless of the underlying medical necessities.
Surprisingly some of the most neutral situations I've encountered are 9-1-1 calls to my home. Being conscious and responsive, the EMTs will determine I'm stable, and then the $64,000 question: "Do You Want To Go To The Hospital?" and all you need to say is "no".
Once I visited a mini-clinic in a pharmacy. Not Urgent Care, no emergent condition, just a clinic visit with a nurse to check my BP. After reading my BP the nurse informed me she was duty-bound to contact 9-1-1. No fewer than seven extremely buff and very male EMTs poured into the tiny exam room and very insistently tried to induce me to go to the hospital with them. I became obstinate and told them that they were the only cause of my stress at that point. They finally dialed the attending physician and made me listen to him read off all my risk factors before they relented.
I've been at Urgent Care telemedicine visits and if I admit to the wrong symptom they will immediately shut down the call and refer me directly to E.R.
I was once signing admission papers to a BH hospital. I was conscious and responsive and arguably quite sane. The papers had a series of agreements which included one blanket consent to transfer me to any other facility they pleased. The ensuing argument and the occurrences within the BH facility led me to believe that this is a cash-cow kickback arrangement for them to funnel mentally ill patients into the "real" physical hospital with flimsy pretenses. Every medical-based exam I received seemed oriented to finding a reason to send me out there, but they would've discovered that I never granted them the consent to do so.
Often, I would say that LTC and palliative care facilities may not have staff equipped to determine necessity for going to the hospital. If they have an issue with a resident and they don't know what it is, or they're feeling over their head, they're going to just punt to 9-1-1 and let the hospital figure it out on their end, and you can be sure the hospital can find stuff in a patient population like that.
Every time I read about someone lamenting how medical "care" was denied by insurance, I simply consider how many medically unnecessary propositions have been placed before me, and I needed to be the voice of reason, to shut those down, before I was exploited and viewed as a cash cow to slip claims past the insurance company.
- maest 1y agoIs this in the US? There are plenty of scandals here in the UK, but nothing so systemic as what you are describing.
- QuarterReptile 1y agoGrowing up in the 90s and 2000s, my mom trained by brothers and me to forcefully demand to call her if we thought 911 had been called so she could race down to intercept and send them packing, lest we get a crazy ambulance ride bill. The calls ranged from total non-issues to things that in no way required ambulance transport, though a hospital visit be necessary.
- AStonesThrow 1y agoOh, indeed. It is ridiculous to rely on ambulances just to get to the hospital. In so many situations. What happens out on the streets here is that someone has an oopsie, maybe they go unresponsive, or have massive pains or something, and some well-meaning dope contacts 9-1-1. Then the EMTs show up and the circus begins, and inevitably the ambulance transports the patient and gets them to the E.R., post-haste dispatch. When I broke my leg while roller skating, I was firmly expecting an ambulance ride. Thankfully I was in a large group of very sane and pragmatic individuals who said "just call a taxi!" It's not like I would die of a broken leg if the taxi took an extra 30 minutes! [Unfortunately, taxis do not like bodily fluids that soil their interiors.] I once dipped into the hot tub where I live. Due to the pandemic, all our pool furniture had been disappeared, and so when I exited the hot tub, I just lay on the ground to bliss out and enjoy the relaxation. A neighbor immediately began shouting at me and brandished her phone to call 9-1-1. I told her to please cease and desist. Well-meaning citizens have a hair trigger on emergency services and it's exceedingly unnecessary. But your insurance doesn't need to pre-auth an EMT/ED circus. Conversely, I had an urgent visit with my PCP once, and feebly attempted to describe symptoms. He shrugged. No testing, no diagnosis, no speculation. I can't do nothin' for ya, man. Two days later I was ambulanced to the E.R. with a kidney stone. And yet, no hospital was necessary. Nothing my PCP could've done for a kidney stone. 6 hours, let it pass. It was painful but it passed. All that medical care? Unnecessary. PCP? No reason to sue -- he did nothing wrong. He could've referred me to a CT scan -- for what reason? Let it pass. No lawsuits. Karen Ann Quinlan's case had a poignancy that touched my heart. I had heard of Terri Schiavo, but Karen Q was before my time. Karen's parents weren't malicious -- they didn't want her to die -- they simply wanted to take away her pain. Physicians insisted that "pulling the plug" would be tantamount to murder! Her parents fought the state and the medical establishment, and ultimately, won for her nine years of life and peace. https://en.wikipedia.org/wiki/Karen_Ann_Quinlan https://en.wikipedia.org/wiki/Karen_Ann_Quinlan