CJD.

Now here’s an expert in the law!

I think most states (maybe it is federal standard) have a prudent layperson standard for ER visits. That is if a patient thinks a symptom could be serious the insurance is obligated whether it turns out to be something trivial. However the insurance companies are ALWAYS trying to stiff us on this one. The insurance company will say we are not contracted with them (the ER) and say they will pay whatever they want to pay (which is often a ridiculous pittance). It is quite commonplace for the insurance company to downgrade the payment, even though it often takes extensive testing, contemplation, increased medical-legal risk to arrive at the conclusion that a patients symptom is not serious. It is often much more taxing (especially in todays legal environment) to arrive at a diagnosis of “bronchitis” or “costochondritis” than it is to see, treat, and admit the obvious MI or pulmonary embolus.

I am a patient, and I’d never dream of waking a doctor in the middle of the night except in cases when I just had an outpatient procedure and the doctor specifically instructed me to call him/her anytime if I have specific problems such as serious bleeding that doesn’t stop (my periodontist gives his home number after surgeries, although thankfully I haven’t had to use it – it would be a difficult thing for me to do since I don’t like to bother people). If I think I have a real emergency, I’d call an ambulance or drive to the ER. To be honest, until I read this post, I haven’t even known calling a doctor off-hours is a possibility. With the exception of my periodontist, I’ve never had a doctor’s home number. Medical groups don’t usually give it.

Years ago when I had a chicken pox, I called an office on Saturday. The doctor specifically told me the day before to call the office if it starts hurting (my symptoms just started at that time – I just knew what it was because I knew I was exposed, so I wasn’t yet uncomfortable and she didn’t recommend anything). She suggested I use Aveeno bath. If she had told me during the visit “if you become uncomfortable, do this…”, I wouldn’t have needed to call the office.

I was always wondering about those “if it turns out to be non-emergency, you will not be reimbursed”. How can I know in advance if my chest/stomache/whatever pain is serious? Although most insurance policies I had, only specified certain small amount I’d have to pay that will be waived if I am admitted. Still, it is ridiculous to bother anybody in the middle of the night to save $100.

If you are sending your patient to the ER don’t give them the impression that we are waiting for them and that they will get preferential treatment just because they are your patient. If the triage nurse sees that they have a sniffle or a hangnail they will wait for 4+ hours with the rest of the coughing, vomiting, homeless, drunken humanity.