Behind the scenes in the practice of medicine (#1)
By dopa345 05-18-2011 02:48 PM
This will be a first of a series of blog posts geared toward shedding some light about the red tape that doctors and other health care providers have to deal with that most patients may be unaware. It's also the mundane reality of medicine that they don't teach you in medical school. These will be drawn from my day-to-day experience as they happen. Comments are certainly welcome but if I am just rambling to myself, so be it.
This is one of those "how many things are wrong in this picture?" type of exercises, if you are willing to play this game with me.
Today, I received notification from our hospital's financial department that an insurance company denied payment for a patient that was under my care in February of this year. The patient was a transfer to our hospital after presenting to another hospital's emergency room with a question of multiple seizures and was admitted to my service for a brief 2 day stay before being discharged. The evaluation included an MRI of the brain and EEG monitoring (a test that records brainwaves that can confirm the presence of seizures). It did turn out that the "seizures" were probably not real and were induced by a combination of stress and depression. In their own words, "after reviewing the medical record and the resulting diagnosis, we feel that the patient's care could have been managed as an outpatient and did not require hospitalization and therefore we are withholding payment for these services." The hospital stands to lose over $8,000 in reimbursement. I was asked to write a letter to appeal the decision to the insurer. The deadline for this letter is two weeks.
Any thoughts? I will post a follow-up tomorrow.
|Comments (Total Comments: 19)|
|Hobotalk - 05-18-2011, 03:13 PM|
|antlp89 - 05-18-2011, 04:04 PM|
|mtxbass1 - 05-18-2011, 04:05 PM|
|Pck21 - 05-18-2011, 05:20 PM|
|UrAllVirgins - 05-18-2011, 07:09 PM|
|AvidWriter - 05-18-2011, 10:56 PM|
|dopa345 - 05-18-2011, 11:06 PM|
|willardhaven - 05-18-2011, 11:47 PM|
|BlueWingX - 05-19-2011, 12:10 AM|
|twiceborn - 05-19-2011, 01:38 AM|
|Spanky - 05-19-2011, 03:06 AM|
|dv8mad - 05-19-2011, 09:25 AM|
|zshipp - 05-19-2011, 02:33 PM|
|ZeroFactorial - 05-19-2011, 02:42 PM|
|zshipp - 05-19-2011, 02:52 PM|
|E*Master - 05-19-2011, 06:00 PM|
|4nik8tor - 05-19-2011, 06:07 PM|
|zshipp - 05-19-2011, 07:39 PM|
|dopa345 - 05-19-2011, 09:58 PM|
|Recent Blog Entries by dopa345|