Look, this is
prima facie a scandal, but I can assure you that the insurance carrier is dealing with a real issue.
Basically the road to hospitalization is paved with Vaseline and gingerbread cookies. In my experience, every effort is made at every level to unfailingly recommend a hospital visit at every opportune moment, regardless of the underlying medical necessities.
Surprisingly some of the most neutral situations I've encountered are 9-1-1 calls to my home. Being conscious and responsive, the EMTs will determine I'm stable, and then the $64,000 question: "Do You Want To Go To The Hospital?" and all you need to say is "no".
Once I visited a mini-clinic in a pharmacy. Not Urgent Care, no emergent condition, just a clinic visit with a nurse to check my BP. After reading my BP the nurse informed me she was duty-bound to contact 9-1-1. No fewer than seven extremely buff and very male EMTs poured into the tiny exam room and very insistently tried to induce me to go to the hospital with them. I became obstinate and told them that they were the only cause of my stress at that point. They finally dialed the attending physician and made me listen to him read off all my risk factors before they relented.
I've been at Urgent Care telemedicine visits and if I admit to the wrong symptom they will immediately shut down the call and refer me directly to E.R.
I was once signing admission papers to a BH hospital. I was conscious and responsive and arguably quite sane. The papers had a series of agreements which included one blanket consent to transfer me to any other facility they pleased. The ensuing argument and the occurrences within the BH facility led me to believe that this is a cash-cow kickback arrangement for them to funnel mentally ill patients into the "real" physical hospital with flimsy pretenses. Every medical-based exam I received seemed oriented to finding a reason to send me out there, but they would've discovered that I never granted them the consent to do so.
Often, I would say that LTC and palliative care facilities may not have staff equipped to determine necessity for going to the hospital. If they have an issue with a resident and they don't know what it is, or they're feeling over their head, they're going to just punt to 9-1-1 and let the hospital figure it out on their end, and you can be sure the hospital can find stuff in a patient population like that.
Every time I read about someone lamenting how medical "care" was denied by insurance, I simply consider how many medically unnecessary propositions have been placed before me, and I needed to be the voice of reason, to shut those down, before I was exploited and viewed as a cash cow to slip claims past the insurance company.
Basically the road to hospitalization is paved with Vaseline and gingerbread cookies. In my experience, every effort is made at every level to unfailingly recommend a hospital visit at every opportune moment, regardless of the underlying medical necessities.
Surprisingly some of the most neutral situations I've encountered are 9-1-1 calls to my home. Being conscious and responsive, the EMTs will determine I'm stable, and then the $64,000 question: "Do You Want To Go To The Hospital?" and all you need to say is "no".
Once I visited a mini-clinic in a pharmacy. Not Urgent Care, no emergent condition, just a clinic visit with a nurse to check my BP. After reading my BP the nurse informed me she was duty-bound to contact 9-1-1. No fewer than seven extremely buff and very male EMTs poured into the tiny exam room and very insistently tried to induce me to go to the hospital with them. I became obstinate and told them that they were the only cause of my stress at that point. They finally dialed the attending physician and made me listen to him read off all my risk factors before they relented.
I've been at Urgent Care telemedicine visits and if I admit to the wrong symptom they will immediately shut down the call and refer me directly to E.R.
I was once signing admission papers to a BH hospital. I was conscious and responsive and arguably quite sane. The papers had a series of agreements which included one blanket consent to transfer me to any other facility they pleased. The ensuing argument and the occurrences within the BH facility led me to believe that this is a cash-cow kickback arrangement for them to funnel mentally ill patients into the "real" physical hospital with flimsy pretenses. Every medical-based exam I received seemed oriented to finding a reason to send me out there, but they would've discovered that I never granted them the consent to do so.
Often, I would say that LTC and palliative care facilities may not have staff equipped to determine necessity for going to the hospital. If they have an issue with a resident and they don't know what it is, or they're feeling over their head, they're going to just punt to 9-1-1 and let the hospital figure it out on their end, and you can be sure the hospital can find stuff in a patient population like that.
Every time I read about someone lamenting how medical "care" was denied by insurance, I simply consider how many medically unnecessary propositions have been placed before me, and I needed to be the voice of reason, to shut those down, before I was exploited and viewed as a cash cow to slip claims past the insurance company.