Monday, November 24, 2008
Looking at my medical insurance. Visits to the emergency room are covered "only if it's a true emergency".
Definition of a true emergency: "You are admitted to the hospital."
So I guess we're supposed to be very good at self-diagnosis. You'd better not mistake that stiff neck muscle and headache and beginnings of a cold for meningitis, or vice-versa. And you'd better be very good at keeping two days-worth of pressure on that deep cut in your leg that needs stitches, until your doctor's office opens on Monday.
There are lots of "true emergencies" that require immediate diagnosis or treatment, but do not require hospitalization.
Sheesh. Bureaucrats!
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We did once experience something like this. Jay'd had a port implanted in an artery in his chest one afternoon in Albany. They covered it with gauze and that thin plastic stuff that seals all around the edges. They said if it bled, I should call.
I woke up during the night to check on him, and found the plastic bulging, filled with almost a cup of bright red blood. I called Albany. They said to take him to the ER, but not our local hospital. I had to take him to the one about a half hour away, because the smaller local hospital wouldn't be able to handle it if it was a serious problem, and there was a 50-50 chance it was serious.
I threw him in the car, and made it to the further hospital in 13 minutes, with visions of an open spurting hole in his aorta and his chest filling with blood.
They somehow determined that it was the incision bleeding, not the artery, and they got it to stop, and sent us home.
The insurance company did squawk, but I was able to prevail, since Albany Medical Center had told us to go, but if we hadn't had a case manager who agreed it could have gone either way.
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4 comments:
A friend of mine broke her knee at work. She fell against a desk and split her knee cap in half. She called the insurance company and begged to go to the emergency room but they told her no, it wasn't really an emergency.
Her daughter and son talked her into going. By that time, her leg was so swollen, her trousers had to be cut off her.
I hate insurance companies.
That's a horrible definition by your insurance carrier. A lot of things can be stabilized and sent home, and that doesn't necessarily mean that they weren't emergent.
The people writing the insurance policies should be the ones having a non-emergency emergency! I have wanted to amend the portion of the papers you sign saying you will be responsible for what your insurance does not pay.
Insurance companies make me sick. I'm very angry just reading about them. My manager at work who just found out she's pregnant got HUNG UP ON by three insurance companies yesterday once they found out she was pregnant.
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