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Tuesday, July 29, 2008

Dr vs Insurance - Who is Really in Charge?

I want to thank everyone that has been praying for my mom and our family. She has been having problems for quite some time and this past Sunday it lead us to the ER at ARMC. What great care she received. The doctor, PA and nurses were fantastic. They were truly concerned for her care and comfort.

What is sad is they were not in control of the actual treatment she received. Her insurance company was! That is terrifying to me! They are telling her she needs to be admitted so they can give her the proper care she needs, but yet, they can't because they can't actually put on paper what is wrong with her! ARGH!!

I don't mean to be long winded, and I don't want to give a lot of gory details, but it does need some explaining.

She has a primary care physician (pcp) that she really likes and is on her insurance. Last year when she started having problems, he sent her to a gastroentologist that is also on her insurance. However, the gastroentologist does not/can not practice at the hospital that is covered by her insurance. That is where the problem occurs. She last saw her pcp in the spring for a different reason. He did labs that were not related to her problem so he could not show she needed to be admitted.

She has been seeing the gastroentologist just about every week for the past year (or should I say his PA) and they have been working to get her fixed up. But when she became so sick this weekend and was getting sicker by the minute, she had no choice to go to ARMC. As I stated earlier, they were fantastic. They immediately got her through triage and to a room and she waited no more than three minutes before the ER dr. himself was in there visiting with us and making his preliminary diagnosis.

She had a CT and the dr. could tell she needed to be admitted. But had to contact her pcp. He could not approve her being admitted because her labs from the spring have nothing to do with the problem she is having now. And they could not even call her gastroentologist because he doesn't practice there. They kept her as long as the could and administered fluids and antibiotics, but eventually had to release her. Each of those caring for her at different times did tell us if she wasn't better to come back and they would have no choice but to admit her. The medical staff has figured out a way to buck the insurance system and have to slyly pass that info on to their patients! That is crazy!

Frank and I took her home and got her settled in. By this time she had already shown major improvement. She is improving daily and planning on going to work for a little bit tomorrow. But in the mean time she has had to call all her doctors and try to work this mess out and will probably end up having to find another gastroentologist that she might not like as well as the one she has.

It is just so frustrating that those attending to you are not the ones that choose your care. Be sure to read all of your insurance information carefully so you don't end up in the same situation that she did!

Please keep mom on your prayer list as she is not well. She is good for now but we still need to find out what is causing all of these problems!

2 comments:

Shellmo said...

Sending a lot of prayers for your mom. Navigating the insurance company can be so frustrating!

Trina said...

God was probably in charge more than we know. It is just like teaching....sometimes a different teacher can teach my class the same lesson I did and the one kid who didn't get it when I taught the lesson gets it with a different teacher. Maybe this doctor will be very aggressive and get the ball rolling to recovery!