A few days ago, while getting rid of some "old stuff" in my office, I found an interesting denial letter sent to a patient of mine in 1986 (yes, 23 years ago) from a major health insurance carrier in Connecticut. The letter states that:
"Your contract defines a medical emergency as the sudden and unexpected onset of a condition requiring medical care which the patient obtains immediately after the onset. Heart attacks, cardiovascular accidents, loss of consciousness and convulsions are examples of medical emergencies.
"The information received from the hospital does not indicate that a similarly acute condition existed when services were rendered for ... Therefore, we are unable to provide benefits."
In reality, the patient had acute appendicitis, was admitted to the hospital at 2 AM, and had surgery within an hour. The appendix was about to burst. I guess that's not an emergency. Can you imagine how much energy it took to reverse this denial?
Do you think that things got better in the 23 years since this episode? Unfortunately, things only got worse, and it's going to take a lot of sincere effort and energy to fix them.
Do you have any war stories?
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