Does anyone here not see the difficulty here, (or outrage, if you will) is an insurer with the power to ovveride your medical opinion that this man needed an urgent MRI?

Why should he be processed through an ER for this reason? Is it not an uncessary delay involving addition wait and expenditure, dragging in a new set of physicians to to a redundant exam, to re-evaluate the same medical issue, review of signs and symptoms that has already convinced a treating physician that urgent MRI is necessary?

Why is there no mechanism for a treating physician in any office to order an urgent MRI, that doesn't automatically excuse the insurer from paying?

The ER should but wont understand the urgency of the situation or the frustration and fear of the patient. So they screw up, in the way that a vacuum of information promotes. They don't know that he's already been where he should have gotten the MRI order, that he's being jumped through hoops while terrified and in misery.

That patient did NOT belong in that ER. He belonged in a scanner ASAP, and the insurer's demands delayed his care to protect the HERD, not that patient.

If an insurer does not respond without delay, with pre-auth, when any treating physician requests an urgent test, they should be estopped from claiming pre-auth was not obtained. It's no one's fault but their own if half the staff is on vacation.

At minimum they should be required to evaluate it on the basis of what they would pay for in an ED setting.

Or, just admit the patient directly from office. If a life threatening spinal abscess was at the top of this MD's DDX, why mess with the outpatient work-up? Would have saved a lot of time and hassle.

A good reason to be selective about what plans, if you any, you sign on to.

The answer to "why" is too long for a blog--no one would read it--and involves a long series of court cases and legislation.

Bottom line, the medical care is the physician's responsibility-period. No matter who else isn't doing their job, or who in doing their job is obstructing things, it is the physicians ultimate responsibility to move them, run over them, or go around them..

Believe us when we tell you, that is the way it is. Frustrating it is, but all patients will rue the day when no one has the final responsibility for the outcome, when physicians, like everyone else, is responsible only for process and not outcome.

Do the attorneys have their own website? Because anon 3:11 needs to stick to them. The point of the matter is that the patient wanted to sue THE DENTIST and not to sue the doctor, yet the atty's basically told the patient that he had to sue all. So exactly what is misleading? This patient/client wanted "justice" (as he saw it) from the dentist, and was "forced" by the atty's to seek a suit against the doctor, against the client's obvious wishes. Yes the client had to give permission, but with those conditions,the client had little choice. And please don't argue the point that there is no case without filing against the doctor, because if that is the case then the atty's should have just told the pt./client he had no case!

While I am familiar with the likely insurer in this case, and have absolutely ZERO good to say about them, I'd also toss out that this patient does have some responsibility here:

doc (with worried voice): "You need to go to the ER right now to get an MRI, you could die or be paralyzed if you don't! You could have a life threatening infection or fast-growing cancer!"
pt: "No, if I go to the ER, I'm going to have to wait for five hours and I don't want to do that."
doc: "....?"

All this from a patient who came in demanding an immediate angiogram? Where did he think he was going to get *that* procedure, other than through the emergency department?

That moment of refusal to go to the ED was the moment where, in a fairer legal system, "loser pays" damages would have been triggered if this patient then brought a suit.