Blog | Monday, March 26, 2012

Bewildering insurance policies and how they play out in reality

A woman goes to her urologist. She has a known stone that was partially removed through a cystoscopy a month ago. She has been having residual colicky pain for the past month that has been getting increasingly worse. Her urologist recommends a CT scan to see if there is evidence of obstruction. Her insurance denies the scan.

Now from a health economics perspective, this is where it gets interesting. She is so disgruntled that she goes to the local emergency room where she racks up a hefty ED bill, has the scan done, and gets admitted. They don't have a hospital bed for her at this particular hospital but they do at the sister hospital across town, so they send her over by ambulance and she is admitted to a medical floor for two days.

If you were the insurance company wouldn't you be kicking yourself right about now for not just getting a CT scan from her urologist's office. Maybe the outcome would have been the same, but then again maybe it wouldn't. Waste anyone?


Justin Penn, MD, ACP Associate Member, attended medical school at the University of Washington School of Medicine and trained in internal medicine at the University of Rochester, where he is serving as Chief Resident. This post originally appeared at his blog, Musings of an Internist.