Another reason why we need Universal Health Insurance (or at least a robust Public Option)

[WI_DEM]

I work in an ER and one of the things I do is handle insurance questions. Yesterday a patient was admitted to the ER and needed an MRI. Well, his Blue Cross plan requires that this be precertified. Now I can understand a precertification if it was an out patient procedure that was planned in advance but an ER is immediate and most people who come here need the treatment because it is, well, an EMERGENCY. So I call his Blue Cross plan and after maneuvering through four or five telephone prompts which took several minutes (Insurance companies, btw, do this on purpose they hope to exasperate their insured or providers so that we give up and then they can say--Why weren't we notified?)I got a message saying "Sorry our office is closed. Try again tomorrow our hours are 8:00-4:30 Eastern Standard Time." (I live in Central Standard Time).

So I try calling our local BX just so we can show that we have made contact. The first guy says "Well, we aren't in his plan." Then I'm transferred supposedly to an emergency precertification line but the silly ass on this line keeps telling me, "Well you know this is supposed to be preauthorized in advance."

"I know, but he is in the ER and didn't know.."

"This really should be done at least a week in advance."

(I think isn't this person listening?)

I finally ask for a supervisor. I'm transferred to the supervisor.

"The patient is concerned because he says MRI's need to be preauthorized and can't afford to pay for it..."

Supervisor: Well, he is right. MRI's should be authorized at least 48 hours in advance.

Me: But this is an emergency visit.

Supervisor: Ok...I will note that BUT there is no guarantee of payment--we will have to review and make sure this was needed medically. There are also pre-existing conditions which may come into play.

Long story short the man had MRI and may have a brain tumor. Bottom line Insuance companies are more interested in profits than people.

[Echo In Light]

1. K&R

[Aragorn]

2. BCBS

My reason for quitting BCBS as a doctor in their plan was so similar. I got a call directly from BCBS. "Patient is in ICU after OD. Will you see her - we think you could help her avoid inpatient psych care which she does not want anyway."

Long story short I did, she did OK as outpatient. BCBS saves thousands on her care, patient is happy, etc.

6 weeks later when I sent the claim BCBS denied it - "it was not pre-authorized".

[John Q. Citizen]

3. Insurance companies are ongoing criminal enterprises and the "public option" will just allow them to

continue to rape people.

The public option is a scam to divide the American public and to confuse us.

We need single payer, and we need it now.

[peacetalksforall]

4. Don't get sick. If you get sick, die quickly - or we will help you to die faster..

Republicans were not accurate about death panels, but they stand behind the corporations who create communication and rule 'death walls'.

[spinbaby]

5. No one, but no one, thinks it works well

Weirdly, some of the people I know who complain the loudest about the sytem are the ones most against a public option in health insurance. Somehow they think it'll get ever worse than it is, as if that were possible.

I know a woman who recently went to the ER with symptoms of a stroke--they had to transfer her to another hospital so her insurance would pay for the tests. Fortunately, she had something else--if she had had a stroke, the delay could have killed her or left her seriously impaired. They only way the the system could get worse than that is if they shot patients coming in the door.

[lapislzi]

6. And the bullets would have to be pre-authorized

If you paint a target on your forehead, that's a pre-existing condition.

[WeCanWorkItOut]

7. BC responded badly. But we do overuse imaging.

This is more of an issue with CT scans and nuclear imaging.
A mammogram should be 0.04 millisieverts of radiation.
But an angiogram of the neck can be 15 mSv
and now we have a small percent of nonelderly people undergoing
over 50 mSv a year, a "very high" dose, according to NEJM.

NEJM is concerned because this is a problem.
The story told here is of the insurance company being stupid, and also
(with those "pre-existing conditions that may come into play")
apparently looking for a cheap out.
But we also have the problem of doctors using too much.
NEJM noted that "only 9% of emergency department physicians reported
even being ware that CT was associated with an increased risk of cancer."
So they were overusing, partly because of ignorance,
but partly because neither they nor the patient paid.

MRI does not use ionizing radiation, of course.
But it's very expensive. And in a nation where people
do without adequate food and other basics of health,
like decent amounts of vacation time, just to pay
for ever-increasing health premiums, we need to worry about
giving doctors a blank check.

Which is not to say that idiot insurance companies are the answer.
But it's not clear that Medicare is either.

(Spellchecker doesn't know about millisieverts or angiograms. Sigh.)

[Ruby the Liberal]

8. What is a BX?

How does that protect the patient?