Patient care and insurance, a little vent.

[Tait, MSN, RN]

I just have to get something off my chest. Forgive me.

Recently I switched to day shift, which for someone who loved nights, this has been an interesting transition. While I love having more ability to help my patients by talking to them and discussing cases with other practitioners, I am having a hard time with some of the drama of my uninsured patients.

Without violating my patients privacy, I have a case of an uninsured person who I think is getting an opinionated short end of the stick from a case manager.

I understand that when you deal with case management, doctor's and all the ins and outs of insurance/Medicare management it gets frustrating. It is hard to watch case after case come in and get care, be non-compliant and leave without being able to help hospitals already strapped with cut backs and losses. However I hate it when insurance (or lack there of) becomes something a case manager feels should impact MY care.

Sometimes I just don't know what to say to someone who has such hatred of the system, and seems to believe that I should feel this way as well! Towards my sweet, cancered patient! The kicker is I got a lecture on my patient yesterday about being non-compliant with previous care and that he didn't "deserve" to be treated! I talked with him and realized he isn't non-compliant, he just doesn't understand all the details of how to manage his care. (There is so much more to this, but unfortunately I don't want to get myself in a HIPPA nightmare over it, but trust me, the patient does not deserve this stigma.)

I guess this is just something I need to learn to navigate with grace, but it is difficult when half your team each day doesn't have insurance, and your case manager giggles with delight when an un-insured patient leaves AMA.

*sigh*

I don't know.

Just had to vent it somewhere,

Tait

[GHGoonette, BSN, RN]

I can see how this would make you furious.

In my country, the managed health care system has become so ridiculous, that even with insurance, you can't afford proper care. I have insurance that gives me 100% cover if I should be admitted to hospital, but places limitations on what items and medications may be charged for. As for the day-to-day limits, it's so minimal, I can see me running out of funds halfway through the year.... And my insurance is not cheap; my employer pays 50% of the premiums, so it works out to ZAR2800 per month. My day-to-day limit is ZAR6000 PER YEAR! That must not only cover doctors and specialist visits, but also meds, pathology, radiology, physiotherapy etc etc etc.

I feel so sorry for those people who can't afford decent insurance; it's beyond frustrating when you need to use some item for the good of your patient, only to be told sorry, the medical aid doesn't cover it....

[WildcatFanRN, BSN, RN]

There is a huge difference IMHO between noncompliance and not truely understanding all the details about managing their own care. If this person doesn't understand then it should be explain in a way he/she can understand and the person doing the teaching should make sure he/she does understand. a lot of things could be cleared up with noncompliance we proper patient teaching. Don't get me wrong I KNOW there are those that even though the DO understand just don't give a hoot. But I do believe there are those, even uninsured who care a great deal, but are frustrated because they are labled as noncompliant when they truely aren't.

And a Case Manager who has that attitude IMHO should find another line of work. When I was on medicaid one of the case managers that came in when I got sick really talked down to me. I guess she assumed that because I'm poor I'm stupid.

[nursel56]

I hate that attitude, too. On some units it's so toxic it poisons the air. One place made a point of telling oncoming nurses what kind of insurance a pt had while giving report, accompanied by a dismissive tone at best, often an outright sneer.

Like you pointed out, I do get upset by the entitled attitudes people give us, but I would rather have that than treat a sick, uninsured person with less than I would give any other patient, it's awful to see that, because people like that CM broadcast their disdain loud and clear without saying a word.

[itsmejuli]

Don't even get me going on the topic of medical insurance.

How ironic that I am a nurse without medical insurance.

I don't want to know what insurance a patient may have, they will all get treated equally by me.

[KaroSnowQueen, RN]

Speaking of ironically being a nurse without healthcare, I have been a nurse 26 years and only for the last six years have I had employer provided insurance that was both A. Worth the money it cost and B. actually paid on my health bills. When I first started nursing, the doctors would treat us at work, write Rxs for free and the lab did our labs for free. By the late 80's that was over. Now its pay up or do without.:uhoh21:

And the fact that CMs and/or nurses even bring up the patient's financial status is horrible. The only time that should come into play is when there are expensive treatments that the patient cannot afford, and they look into resources for them.

"Giggling with delight" when a self-pay (or unable - to - pay) patient leaves AMA makes me feel ill. "Yeah, boy!!! There you go!!! She ticked him off and out he goes, maybe home to die, but man she saved the hospital X amount of money by getting rid of him!! " (Dripping sarcasm.) :smackingf

[Mommy&RN, BSN, RN]

I honestly have no idea what types of insurance my pts have. I don't care what kind of insurance they have (or don't have). It is easy enough to find out, but it is simply something I don't need to know to do MY job.

I had a pt that was out of control one day tell me "You are only treating me like this, because I am uninsured." I told her I didn't know that until you just told me." Her son was at the bedside trying to help getting her to settle down, and told her that we were not treating her badly anyway. Not o mention she wasn't assigned to me, I was getting her IV started so she could get her meds.

[retiredlady]

Sometimes it looks like someone is non-compliant when in fact they haven't been taught or they don't have the money to get special foods or medicine. It really upsets me because I know when I had a relative they thought he was non-compliant when he didn't have money to go to the doctor or get medicine. He would get these looks, mainly from the doctors. Of course, there are those who are and who don't care.

[classicdame, MSN, EdD]

most nurses I have worked with have no idea what type insurance the patient has or does not have. Should not be an issue, IMHO