(Another of David's rants about insurance companies)
I've written many times about the absurdities I've encountered dealing with insurance companies. I've had another experience that I'd like to share.
The patient came into clinic for chemotherapy. The PA examined him and heard an irregular heartbeat. Neither of us know the patient well, so we looked through his chart to see if anyone has ever noticed an irregular heartbeat before. No one had. We ordered an EKG, and it showed an abnormal rhythm. The patient has had several EKGs in the past, and this rhythm was a new finding. One possible explanation for the new abnormal rhythm would be if the patient's central line had moved a bit and was irritating the right ventricle of his heart. The best way to figure out if that could be happening is to get a chest x-ray to see where the catheter tip is.
We ordered a chest x-ray, only to learn that the patient's insurance company doesn't cover radiology procedures at Johns Hopkins. Since an abnormal heart rhythm can cause sudden death, diagnosing a cause is an emergency, so we called the insurance company for "permission" to order the x-ray.
You may think this is a "no brainer." After all, a chest x-ray is cheap, and we could discover the cause of the patient's abnormal heart rhythm and fix it relatively easily. The insurance company, however, needed to authorize the x-ray. So I was told the nurse would review the case and get back to us.
Once again, I find my judgment about a case under review by someone with a financial stake in the decision. In this case, a nurse, sitting in an office in another state, not able to see my patient, was going to decide if my decision to order a chest x-ray was justified.
No. I'm not kidding.
But if you ask, insurance companies don't make medical decisions, they make coverage decisions.
Why David Hates Insurance Companies
Not Medically Necessary