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American Health Care – Whatever You do, don’t get Sick!

The Executive Director (ExD) of an organization that I volunteer for had a health emergency at his home.  The symptoms indicated that it might have been a stroke.  Paramedics were called and he was taken to the nearest hospital — as prudence would call for.

He was checked in and taken immediately to one of the beds in the emergency room.  Apparently the triage nurse felt that immediate care was necessary.  No waiting room time, he was checked right in.  The receptionist took down the usual information (Name, Insurance, etc.).  The ExD had Kaiser-Permanente as his primary health insurance.  While he was being examined with, possibly, a life threatening condition, Kaiser was called by the receptionist to verify coverage.  Kaiser said that they will not pay!  It turns out that the closest hospital to our Executive Director, the only hospital in the county, and part of Johns Hopkins, is not approved for coverageIsn’t that special?

The ExD first learned that there was a problem when an ambulance driver walked into the emergency room looking for him.  Kaiser actually had the nerve to send an ambulance and get a man, with a potentially life-threatening condition, and try to take him to another hospital.  The attending doctor told our director that, “We will take care of you”, and asked the ambulance crew to leave.  Well, at least Kaiser gets points for not sending a taxicab!

Kaiser then tried to get the ExD on the phone and asked him to state that he was “Refusing Coverage”  so that they could record it.  He replied that he wasn’t refusing coverage but he was too ill to be moved.  They kept insisting that he had to say that he was refusing.  There were a total of six calls.  On the 6th time that this happened, the attending physician took the phone and told the person at the Kaiser that if they kept harassing the patient, legal action would be considered.  The harassment stopped.

Now, lots of us have all sorts of hopes for “Obamacare”.  Hopefully what the President was able to push through congress is only a first step.  It appears that roughly half of our elected officials feel that the only people they represent are the large insurance companies.  They made sure that Obamacare did not put an end to the type of callous disregard for the patient and human life that Kaiser displayed.  I would think that only a single payer system, or a very tightly monitored “for profit”, system would do that.  And congress made sure that we didn’t get what we really needed   Obamacare is a start, but we are still far behind most of the civilized world.

The Executive Director got the care that he needed.  The bill that his insurance company should be paying came to $10,000.  At his most vulnerable time, he had to fight for his life, and fight his insurance company.  This nonsense was done to a middle class family who THOUGHT that they had good health coverage.  That is exactly why we need some serious changes!

But, OK, let’s look at this:  I guess that if I were to take the side of the insurance company I would say that the contract spelled out exactly what Mr. ExD was getting. Maybe so, but I just wonder how many people read all their insurance contracts.  I wonder how many people in my county would knowingly be buying the Kaiser policy if they understood that they were effectively shutting themselves out of emergency medical care.  

Kaiser could argue that there are lots of hospitals in the area in which they WOULD be paying for emergency care.  Indeed, but the problem with that is that the ambulance crew is not composed of doctors.  If you have an emergency, the crew has to take you to the closest hospital that can handle the emergency.  The closest hospital for anyone in my area is the Johns Hopkins Hospital — and there aren’t many medical emergencies that it can’t handle!

Kaiser probably employs lots of high priced lawyers.  I am sure that the Health Care Policy is totally within the law.  I wonder if the management has a clear conscience regarding this policy.  Do they have a conscience.


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One comment on “American Health Care – Whatever You do, don’t get Sick!

  1. Of course it is unconscionable that an insurance company will get in the way of what is best for the patient, but that is what is wrong with the U.S. health care system. Having insurance companies run the health care system in the name of free enterprise makes as much sense as having the fox guarding the chickens because insurance companies are not in the business of taking care of the sick. They are in the business of making a profit by collecting hefty premiums from people who are healthy and in no need of a doctor.

    And what was probably the insurance company’s objection to the use of this particular hospital? Well., in the industry this hospital is labelled “gold plated” and therefore expensive. Good, bad or indifferent, insurance companies bulk at the use of these type of hospitals because it makes no business sense from their perspective. They rather used “approved” less expensive hospitals even though it may not be what is best for the patient.

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