Wednesday, May 13, 2009

Insurance stupidity

I really wish I was better able to put my rants into eloquent words. I just always feel like I'm ranting aimlessly, not doing much to effectively put my thoughts into words. But whatever....I'm still doing it.

SO the other day we got a call to take a patient from the hospital to his house. I wasn't sure about this one as soon as I walked on the unit, and checked on the patient's room. I could hear him breathing from where I was in the doorway. Even the nurse's were saying that the man needed to stay in the hospital. No home health care, no home O2, no home suction....and only his equally elderly wife to care for him. The patient was bed-bound, and pretty much awake, but un-responsive. The nurse had taken off the O2, and the patient had developed what I call the 'fish-eye stare;' the stare of someone who doesn't have enough O2, and whose brain is shutting down due to lack of oxygen.

So why was this man, who so obviously needed to still be in the hospital, being sent home, especially to a home that was not equipped to care for him? Because his insurance had decided that they were no longer going to pay for his hospitalization, and had cut off payment at noon that day. Therefore, the hospital was sending him home. Our company would take him home, and charge the insurance company for it.

We managed to finally get him home (see previous post rant on nurse's not having the patient ready to go when we get there), to a house that was supremely unfit for a person who is constantly ill. His wife, a tiny woman who 'had a cold' apologized for the state of the house and how it had been built years ago, before anyone thought of disabilities. I had put the man on O2 on the way over, just to give him a chance at staying home a little longer, but I would bet my next paycheck, his wife called 911 not an hour after we left.

So, let's add things up. Insurance company pays for X number of days in hospital, and won't pay any more. Patient requires more hospitalization, but is sent home because insurance won't pay for more hospital time. Private ambulance company take patient home, and charges insurance company. Patient needs more time in hospital, so 911 is called, who comes to take patient to hospital and (most likely) charges insurance company again. Patient is taken to ER, who charges insurance more money to see the patient, and treat him, and bed him until another bed opens up on the floor. Patient goes up on the floor, and stays until insurance stops payment again. Or until the patient is healthy.

Or until the patient dies.

Rinse and repeat, ad nauseum.

So you can see my irritation here. I've ranted about insurance companies before, though not here, and their ridiculous policies that have no relation to reality. One example is my old insurance company's policy that physical therapy is limited to 30 visits, regardless of medical need. So, you know, don't have a stroke, or any other serious medical issue that may require extensive therapy to recover from.

It is my firm belief that anyone who works in the policy making department of an insurance company should be made to spend time with EMS crews (both public and private), and on the floors in hospitals and in ER's, so they can see what happens in the real world, as opposed to some mythical virtual world where everyone is magically healed after X days, and there are never complications.


Epijunky said...

Can I get an "Amen"?

Seriously. I know exactly what you're talking about. It's infuriating.

EMS Chick said...

I agree with you 100%. And the sad part is every year they raise that man's rates (along with all of ours) and yet no one is getting better care.