Quote from mlos
from my er perspective, insurance comes into play after eval & treatment in the following 3 ways:
1) if the pt. is to be admitted, our 6 groups of admitting docs rotate daily to take self-pay pts. if it's tuesday, then it's group a ...
2) pts. without prescription coverage, if they intend to fill prescriptions, often ask about the cost of meds and whether there is a less expensive alternative.
3) if the pt. has been involved in an mva they will be asked about auto insurance and about any info they may have gathered at the scene re: the auto insurance of the other party.
mlos, i completely agree with both of your posts on this thread. (i'm only quoting the above one because i can't quite figure out the multiple-quote function :spin: )
it really bothers me that every time someone gets substandard care, they assume it is becasue of the type of insurance they have, or that they don't have any. quite simply, there are bad physicians out there. they practice. they will be bad no matter what type of insurance one has.
i almost started a thread along these lines after reading the thread from the poster whose mother felt she had a bad experience in the er when seen for vaginal bleeding.
to say that we don't know anything about pt's insurance coverage isn't true -- i often know what kind of insurance my patients have, and so do the doctors. that wasn't true when i worked in icu -- then i never cared, never bothered to look. but it does matter in the er at times
the first reason i check insuranceis that i work in a state that has hmo-type medicaid. so, if you have our version of medicaid, then you are restricted as to what type of hospital you can be admitted to depending on who is administering the medicaid. that means that if a patient needs to be admitted, but is "out of network," then we have to find a bed at the appropriate hospital, just like with any patient with commercial insurance. the biggest difference that i find, is that patients with commerical insuance are more likely to go to the appropriate hospital to begin with, rather than the closest one. i work in a hospital that is dead center in a very poor part of town. many of the patients walk, or take the bus (if one is running), or are dropped off. they tend to come to the closest facility. i've also notice that they are often clueless as to what hospital they should be going to. we try to educate them about this, but education doesn't help if transportation is an issue.
so that is one reason why we tend to know about insurance coverage. a second is rx drug coverage. we don't dispense meds -- have no outpatient pharmacy. but, our docs do try to write for drugs the patient can afford. if they are self-pay and low income, there isn't any point in giving them a script for a zpack. they won't fill it, they can't. then they will just be back the next week, only maybe sicker. tussinex is another example. i don't know what the stuff costs, but i field more pharmacy calls related to tussinex than any other drug. insuance (at least tenncare) doesn't cover it, and no one can ever afford it. some of our "usual" docs will write for lortab and robitussin instead, knowing what the problem will be.
a couple of docs even use insurance/lack of insurance to decide whether or not to admit someone -- but not for the reasons traditionally thought. if the doc isn't sure if the pt needs admitted or not -- say the patient will be ok to go home if they get follow up care, but will get sicker if not attended to -- some of them will elect to admit the patient if the doc thinks the patient will have a hard time getting an appointment because of their lack of insurance. i had a doc admit at 20-something guy with abd pain/crohns disease one night, and i was really surprised, and said something like "your admitting him? really?" the doc just looked at me and said "he has no insurance. he'll never get seen by a gi doc if we don't admit him."
many of the horror stories i've read that talk about mistreatment in the er were before the time of emtala. so, as many of the hoops i jump through because of that "silly" law, i guess it wasn't so silly after all. and i'm not naive enough to think that there still arn't some instances where a patient gets substandard care due to insurance issues. but i just can't believe it is the norm, or even a little bit common. i do realize that my view is skewed since i work in a predomintaly uninsured/medicaid area, and we are used to dealing with it. and if we give substandard care to them today, they will be back next week, only sicker.