After the killing of the UnitedHealthcare CEO, many individuals have shared stories of being denied coverage by medical insurance companies, highlighting a problem that working-class People are battling on daily basis.
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After studying tales from the sufferers’ views, we determined to ask medical professionals to share the instances they’ve witnessed insurance coverage firms fail their sufferers. One line from the responses we obtained stood out: “Till insurance coverage firms are not-for-profit non-public organizations, the underside line will at all times trump affected person care.”
This is what 19 medical professionals needed to say:
1.There’s the surgeon whose diabetic affected person’s insurance coverage refused to pay for a prosthesis or wheelchair after his leg was amputated:
“I have been an orthopedic surgeon for 32 years. I had a affected person with diabetes and peripheral vascular illness who ended up needing an amputation of certainly one of his legs to save lots of his life. The insurance coverage paid for the amputation however wouldn’t pay for a prosthesis or wheelchair! Actually?!”
—Nameless
2.There’s the nurse whose affected person suffered a coronary heart assault and died ready for medical insurance coverage approval:
“As a nurse, I’ve seen loads of conditions the place a better take a look at or process was denied, resulting in the affected person having extra severe well being points that might have been prevented. One which I’ll always remember is a affected person whose insurance coverage denied a cardiac catheterization. The hospital employees spent half the day making an attempt to get it permitted; the physician even talked to a different physician on the insurance coverage firm. The affected person had a coronary heart assault and died earlier than they may get the approval. It was heartbreaking.”
—Nameless
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3.There’s the affected person whose insurance coverage firm left him bedridden for 5 days after not sending a house well being nurse:
“I used to be a nurse discharge planner in a hospital and had an aged diabetic affected person who had a big, open wound on certainly one of his legs. After he underwent surgical procedure, he improved and was capable of be discharged house, however he wanted a nurse to return out day by day to do his dressing modifications in addition to a bodily therapist to assist him together with his mobility. He lived alone and had nobody to assist him. Usually, I’d make a referral to a house well being company, however this affected person’s insurance coverage firm required me to name them. They refused to let me make the referral and stated they’d do it and inform the affected person. I wasn’t pleased with this, however my fingers have been tied. I heard later the affected person was not seen for 5 days and ended up being admitted to a different hospital. So, they needed to pay for 2 admissions, and the affected person suffered. I want the paper pushers would let the medical professionals do their job; we all know what we’re doing.”
—Nameless
4.There’s the hospital employee who is consistently writing medical insurance coverage enchantment letters:
“I work within the hospital income cycle, and a part of my job is to put in writing enchantment letters to the insurance coverage firms as a result of they denied a affected person who had a prognosis that was truly handled and monitored. Due to this fact, the hospital owes a ‘refund’ to the insurance coverage firm.”
—Nameless
5.There’s the physician’s workplace worker who witnessed a medical insurance coverage firm deny new child infants procedures to permit them to eat correctly:
“I work in a health care provider’s workplace. Periodically, we see new child infants which are tongue-tied and can’t latch to feed. The newborn can’t eat. The insurance coverage firm denied the straightforward process to appropriate the situation, saying it was ‘pre-existing’ as a result of the newborn was born that means.”
—Nameless
6.There’s the physician whose severely diabetic affected person died from their insurance coverage not protecting insulin:
“I had a extreme diabetic affected person who labored however had unhealthy insurance coverage. They’d not cowl his insulin. His diabetes was very poorly managed for years. I used to just accept donations of unopened sterile insulin, and once I acquired a donation, I’d drive it to his office and drop it off to him with directions. It wasn’t sufficient, and his glucose was normally very excessive. He died on the age of 62 of extreme issues of poorly managed diabetes.”
—Nameless
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7.There’s the ER physician who witnessed a girl obtain lifesaving coronary heart surgical procedure that her insurance coverage refused to cowl:
“We had a 27-year-old girl come to the ER having a coronary heart assault. The on-call heart specialist carried out a lifesaving surgical procedure and positioned a stent. Her insurance coverage denied protecting the surgical procedure time and again due to a lately printed research stating a medicine had been proven to be as efficient for long-term care and deemed the surgical procedure ‘medically pointless.’ The medicine the insurance coverage determined was a greater answer just isn’t really helpful for girls of childbearing years. The insurance coverage firm then stated she was now not thought of to be in childbearing years. They left her owing over $60k in medical payments. Till insurance coverage firms are not-for-profit non-public organizations, the underside line will at all times trump affected person care.”
—Nameless
8.There’s the resident who argued with a medical insurance coverage agent for his or her affected person’s breast most cancers remedy:
“So many tales, however this occurred throughout residency and made me understand what I used to be in for. A affected person had biopsy-proven breast most cancers. I needed to get pre-authorization for a mastectomy and lymph node dissection. After a protracted argument with a man who sounded historical, he stated, ‘I’ll approve the mastectomy however not the lymph node dissection because it’s only for staging and never a remedy!’ In fact, the remedy will depend on the staging.”
9.There’s the medical insurance coverage firm that solely agreed to approve the declare if the affected person wanted emergency surgical procedure however refused to approve the scan to judge the aneurysm:
“I’m a nurse. I used to work at a major care workplace. I used to be making an attempt to get a surveillance CT scan permitted for a affected person with a identified AAA (stomach aortic aneurysm) to see if the aneurysm was secure or getting larger. The insurance coverage firm advised me they may solely approve it if we thought it was dissecting. That will imply the aorta was splitting open, which is a surgical emergency. I actually stated to the particular person on the cellphone, ‘If we thought it was dissecting, he’d be within the hospital dying, and we wouldn’t be having this dialog.’ Fairly certain in the event you’re having a dissecting aneurysm, you don’t cease and name the insurance coverage first, however what do I do know? I’m only a nurse.”
10.There’s the British medical scholar who witnessed a homeless affected person be escorted from the hospital as a result of he did not have insurance coverage:
“I’m British. As a scholar I did a secondment in New York Metropolis. There was a affected person who introduced to the emergency division with rectal bleeding. He was 23 and homeless. With out insurance coverage, funds, or anybody to cowl his remedy, he was escorted by safety from the hospital in December. I used to be livid! We have now a tax-payer-funded, free level service nonetheless within the UK. He would have survived right here however was left to die within the States.”
—Nameless
11.There’s the medical insurance coverage firm that attempted to disclaim a CAT scan to a person with kidney most cancers:
“A affected person got here to see me Monday afternoon late with left-sided stomach ache. It was too late within the afternoon to get an emergency CAT scan as a result of every part was closed, so I gave him medication for a attainable an infection referred to as diverticulitis and advised him we might get a CAT scan within the morning; we acquired approval for a CAT scan. His insurance coverage firm stated no. I referred to as him and advised him he needed to go to the hospital to get a scan. He stated I’ll name you proper again, and he referred to as and yelled at an insurance coverage firm, and so they gave in. The next day, we ordered a CAT scan of his stomach; he had the most important kidney most cancers I’ve ever seen.”
—Nameless
12.There’s the employee’s compensation denial that brought on a affected person to develop a disc hernia in his neck that wanted surgical procedure:
“I used to be an NP for a employees compensation program. I had a big, highly effective, lovely Black man with psychological slowness who was crushed between a loading dock and a truck. He had extreme nerve harm to his arms and ache within the neck space. I ordered an MRI of the neck and higher backbone to judge disc bulges or herniations, which might completely paralyze the affected person from the neck down. The employee comp adjuster denied the MRI till he had accomplished weeks of bodily remedy. I used to be involved the PT might paralyze him as we didn’t understand how unhealthy his backbone was. I needed to primarily waste PT visits by consulting with the MD whom I labored for and the PT employees to solely do light, secure remedy. He ended up with an enormous disc hernia in his neck that wanted surgical restore or threat paralysis from the neck down. Employee comp denials are profound and so frequent.”
13.There’s the bodily therapist assistant whose affected person’s insurance coverage denied her PT despite the fact that she could not elevate her arm above her head:
“Bodily therapist assistant. Simply final week, we had insurance coverage deny a affected person who had shoulder manipulation beneath anesthesia to deal with a frozen shoulder. These sufferers want intense PT afterward. After 15 visits, we submitted for approval for extra visits as a result of she nonetheless lacked the power to lift her arm over her head. Her job is bodily, and she or he didn’t have the vary of movement, power, or endurance to adequately do her work. Insurance coverage denied as a result of it wasn’t ‘medically obligatory’ when she is actually unable to work.”
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14.There’s the medical insurance coverage firm that insisted a affected person who obtained blood transfusions for postpartum hemorrhage go house that very same day:
“Years in the past, a affected person had a child, then acquired handled and had blood transfusions for postpartum hemorrhage. The insurance coverage particular person nonetheless insisted that the affected person go house that day by midnight ‘trigger they weren’t going to pay one other day. The physician even referred to as the insurance coverage firm. No change. All of us advised the affected person and household that it was safer to remain on the hospital one other day, and the hospital might work one thing out. They nonetheless left by midnight.”
15.There’s the medical insurance coverage firm that attempted to disclaim a affected person’s declare for the medicine their physician really helpful:
“I labored on the final medical ground in my hospital on the time. My former mother-in-law had small cell lung most cancers and was admitted three separate instances for low sodium ranges, a typical complication of small cell lung most cancers. On her first admission, that they had a kidney physician come to see her, and he needed to place her on a medicine that will repair the low sodium for good. Her insurance coverage firm denied the declare for this medicine, claiming it was too costly. Her subsequent hospital admissions price far more than that medicine. The medical doctors and her husband needed to battle tooth and nail to get the insurance coverage firm to lastly approve the medicine. In any other case, she would have continued to be hospitalized for low sodium for the rest of her final yr of life.”
16.There’s the Residential Dependancy Counselor who needed to persuade a medical insurance coverage agent why their affected person wanted residential care, NOT conferences:
“Residential Dependancy Counselor right here. We have now battles CONSTANTLY with insurance coverage firms who do not suppose our shoppers want care. A number of years in the past, I had a consumer who was utilizing meth, IV, day by day, and her insurance coverage firm got here again with, ‘We do not see the necessity for residential. She will most likely simply go to a couple conferences, and she or he’ll be advantageous!’ I needed to do a peer-to-peer evaluation with certainly one of their representatives and virtually plead my case. After virtually an hour, they lastly, ‘graciously’ gave me seven days of residential look after her. Which does completely nothing. When these seven days have been up, I had to return by the entire course of once more to get her permitted for an additional seven. Some insurances are higher than others, however you positively know those that getting days permitted might be an uphill battle. I’ll say that a type of insurance coverage firms that’s almost not possible to get approval for is UnitedHealthcare.”
17.There’s the nurse whose affected person died of contaminated bedsores as a result of he could not afford the copay:
“Affected person dying of contaminated bedsore wants a hospital mattress with a particular mattress. He can’t afford the copay for the mattress and the mattress so he elected to simply go house and die.”
—Nameless
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18.There’s the wound care nurse who’s appalled on the lack of protection for preventative care:
“I work in wound care, and it’s the shortage of preventative protection that blows my thoughts. To stop venous leg ulcers (blood stream going again to coronary heart is compromised) for folks with venous insufficiency, or leg swelling we suggest compression stockings which are typically $60-ish a pair. Insurance coverage received’t cowl them except they’ve an lively open wound. One other one is for sufferers with peripheral neuropathy (numbness, lack of protecting sensation) of their ft. They received’t cowl customized shoe orthotics and sneakers which is round $300–$500 in any respect if they don’t seem to be diabetic. Once more, one thing that may forestall them from getting wounds, emergency amputations, lack of the flexibility to stroll, and threat of life-threatening infections. Common price to heal a venous leg ulcer with every prevalence is $10,000 from 2021 information vs. $60 preventative stocking. Common price to heal a neuropathic ulcer is $8,000 and if issues come up can simply attain $45,000 in 2021 vs. $300–$500. It’s not simply the healing remedies which are an issue with being denied. It is usually the preventative ones.”
And eventually…
19.There’s the admissions employee who tried to clarify to insurance coverage that they wanted stair coaching for his or her 80-year-old affected person:
“I work in admissions for a talented nursing facility (inpatient rehab for seniors). I as soon as submitted an authorization for a girl in her mid-80s who had a knee alternative for per week of rehab to get her again to her independence. She wanted to have the ability to navigate 5 steps to get into her house. On the time she couldn’t do any. Her insurance coverage denied her as a result of she might stroll 50 ft (the common size of a home) with a walker. I attempted to clarify that she wanted to have the ability to do stairs, and so they mainly stated they do not pay for stair coaching, and she or he might sit on her butt and scoot up the steps.”
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