Insurance: The Urban Legend.

  1. Once you're in a facility you'll be treated the same as everybody else.

    It's laughible to imagine that staff look at somebodies insurance and treat them any differently. I mean it's hard enough to get them to even know the patients name, let alone know what insurance the person is using.

    Of course you might not actually get into a LONG TERM facility unless you have the correct insurance.

    And sure I guess you might be diverted to some place else for ER treatment if you don't have any insurance. But that would stand to reason, even if it's just a matter of geography.

    I wouldn't expect to receive the same type of health care in a developing country as I might in say a European country or within the USA.
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  2. 26 Comments

  3. by   outcomesfirst
    I think it is naive and unworthy to believe that people are not treated differently based on insurance. It is not an urban legend. Look at your patients. Why is that CABG staying 10 days instead of 5? Why did that LOL NAD with possible dehydration in the ED get admitted and the 45 year old CP get discharged? How about the LOL NAD with guiac positive stool went home? How come some femur fractures get a three day hospital stay after pinning? How come some femur fractures get stabalized and then sent home to the hospital of their choice? How come some pneumonia patients get admitted and some do not? How come almost every hospital I have ever worked in has a suite for VIPs? How come cardiac ablation has a 2 week wait list, but the mayor got his done on a Saturday.
    You serve no one if your eyes are not open. This is the real world. Learn about it and determine how to make it work for your patients!
  4. by   Tweety
    In my hospital it's the one with the insurance that gets the lowest length of stays because the insurance RN comes in and deems the patient stable and "we will no longer pay for any further stay, does not meet inpatient criteria", so the insured gets thrown out quicker.

    Still it's better to be insured. You get better aftercare, home health if you need it. LTC if you need it, rehab, etc.

    I can say with certainty in our facility indigent patients are receiving the same quality care from the staff and doctors as the insured. No distinction is made.
    Last edit by Tweety on Dec 27, '06
  5. by   NoMoreStudying
    Quote from Zizka
    And sure I guess you might be diverted to some place else for ER treatment if you don't have any insurance. But that would stand to reason, even if it's just a matter of geography.
    EMTALA requires that all patients who come to an ER must receive an MSE. We can't send them elsewhere b/c of their insurance status. A doc has to see them. And as far as coming in by EMS, unless we're on reroute, they come in regardless of insurance.

    In general, I think the difference in care has more to do with socioeconomic status and the image put forth, than insurance. Plenty of young professionals are w/o insurance anymore. But people who come in a certain dress, act a certain way, frequent flyer, etc , can be brushed off by the unethical, and no one knows if they have insuance (it's an assumption.) Our docs don't even pick up the registration folder that lists it.

    I do see on call docs trying to tell us "I don't take uninsured patients or patients with xxyy." Well, you're taking the money to be on call, so you take this patient. Of course, we complain and some of them are still around. It really pisses me off. "Don't call me at 3 am, i don't take uninsured patients!" Let us go over the definition of 'on call' again, at 3 am.
  6. by   Altra
    Quote from Tweety
    In my hospital it's the one with the insurance that gets the lowest length of stays because the insurance RN comes in and deems the patient stabled and "we will no longer pay for any further stay, does not meet inpatient criteria", so the insured gets thrown out quicker.

    Still it's better to be insured. You get better aftercare, home health if you need it. LTC if you need it, rehab, etc.

    I can say with certainty in our facility indigent patients are receiving the same quality care from the staff and doctors as the insured. No distinction is made.
    ITA.

    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.
    Last edit by Altra on Dec 27, '06 : Reason: deleted info pertained to other thread
  7. by   HappyNurse2005
    I had a patient a while back, in for labor, ended up with chorio and got a c/sec. she told me after i had her in her room and comfy after the c/sec that she was surprised everyone was so nice to her, since she had Medicaid. I told her no one should ever treat you differently....
  8. by   MsLady06
    This thread is so true. I notice it when I got my gyn. my doc was supposed to do a full exam..he didnt because I guess the insurance I was on. My primary Dr. does a poor job too, but I assume my ins is not good enough. I seen this mentioned on a movie once and ever since then I notice how Dr's will treat your situation. I thought the health field was to help others...but I guess its all about who you are and what benefits you have.
  9. by   SmilingBluEyes
    NO difference in care or accomodations where I am. Actually I think a huge proportion are on either uninsured or using public assistance or of some sort in both hospitals in which I am employed. But I really don't know who, for sure, most of the time. And I do not want to, really. I do not go out of my way to find out, either.
  10. by   Altra
    Quote from MsLady06
    This thread is so true. I notice it when I got my gyn. my doc was supposed to do a full exam..he didnt because I guess the insurance I was on. My primary Dr. does a poor job too, but I assume my ins is not good enough. I seen this mentioned on a movie once and ever since then I notice how Dr's will treat your situation. I thought the health field was to help others...but I guess its all about who you are and what benefits you have.
    Did you ask your gyne why he didn't do a full exam?

    Have you discussed your concerns with your primary doc? Or do you make the assumption that you're getting second-rate care because of insurance issues and continue to accept what you view as poor care?
  11. by   cardiacRN2006
    Quote from outcomesfirst
    I think it is naive and unworthy to believe that people are not treated differently based on insurance. It is not an urban legend. Look at your patients. Why is that CABG staying 10 days instead of 5?
    You serve no one if your eyes are not open. This is the real world. Learn about it and determine how to make it work for your patients!

    When I worked in a CVICU, the only reason you stayed past 5 days after your CABG was if you had complications. Otherwise, once you were better, you were gone-period.
    Insurance is sooooooo last thing I look at (actually, I don't look at it at all). That's someone else's job. I can't even imagine someone looking at a pts insurance and then treating the pt differently. How silly! Makes no sense...

    No VIP suits in any hospital I've worked in during the last 11 years.

    I can't control the LOS of a pt (other than prevention and good care). I also can't control the insurance company and what they charge/bill/etc... But to say that pts are treated differently-as in, by nursing staff-due to insurance or lack thereof is rare.
  12. by   banditrn
    I sometimes wonder if people accept poor doctoring because they think they have no choice. A few years ago we were part of an HMO - I went thru two doctors before I found one that I liked. Of the other two, the first one was careless, and the second was arrogant and nasty about the HMO - which he had agreed to be a part of. I reported my concerns about both of them to the HMO.
  13. by   TheCommuter
    I work at an upscale nursing home where the payors include a mixture of Medicaid, private insurance, and cash. Private rooms cost $6,900 monthly. Semiprivate rooms cost $4,600 monthly.

    I can state confidently that management and the administrators bend over backwards for the cash patients while not providing the same service for the Medicaid patients. In addition, all of the nurses stations have updated census sheets that indicate the patient's form of payment.
  14. by   CritterLover
    Quote from mlos
    ita.

    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.

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