This husband chronicles the high cost of chest pain
His wife went to the ER for chest pain. She ruled out and had an inpatient stress test. The insurance company denied the claim:
“Just three days later, we received a letter from Empire thanking us for our “medical service authorization request.” It was denied. The stated reason: “Not medically necessary.” The letter, signed by a doctor, elaborated that “using evidence-based criteria,” the company was “unable to approve the requested coverage for acute inpatient hospital stay for evaluation of chest pain.” The letter continued:
“Information received indicates stable vital signs, negative cardiac enzymes and that that patient was discharged to home the next day after a negative stress test. There is no indication of abnormal EKG, previous history of unstable angina or heart attack. As such, the evaluation of this patient, including stress test, could have occurred in a setting other than acute inpatient.”
As defensive medicine becomes more frequent, cases like this will become the norm. What happened here (i.e. stressing the patient prior to discharge) is not uncommon. If the patient had a heart attack while waiting for the outpatient stress testing, the physician would have been sued for not doing it sooner. Pick your poison.