I know in the 10 years ive worked in a hospital ive never had a patient denied care in ICU unless the reason listed above. I also know A LOT about insurance, much more than most healthcare professionals. I also connect my doctors to insurance when we do need to appeal decisions and ask for a peer to peer.
Im not saying insurance never denies care. They do. Anecdotally though, never had incorrect denial with ICU. Its too easy to prove insurance definition of "medical necessity’ there. I am still very doubtful of this specific example. Downvote all you want but the scanario I gave above is almost 100% probably what happened. I’m just explaining the process and likely what happened. Its okay if I’m not believed. I know what’s true and how healthcare works. Its bittersweet that I have my job because I know how to navigate the healthcare system and get my patients what they need for their healthcare goals.
Edit: Also, with the scanario above, almost 100% of ICU professionals would agree with insurance for the reasons listed above. We know how it feels to want to bring someone up from the ED but can’t because we have beds already full… There are a very few select patients occasionally that want to live in the hospital. I’m aware we are encountering some people at their most vulnerable, traumatic times. It sucks. But they can’t live there.
The only other reason I can think for denial is if treatment is experimental. Otherwise, its really easy to appeal and get the care approved in ICU.
I know in the 10 years ive worked in a hospital ive never had a patient denied care in ICU unless the reason listed above. I also know A LOT about insurance, much more than most healthcare professionals. I also connect my doctors to insurance when we do need to appeal decisions and ask for a peer to peer.
Im not saying insurance never denies care. They do. Anecdotally though, never had incorrect denial with ICU. Its too easy to prove insurance definition of "medical necessity’ there. I am still very doubtful of this specific example. Downvote all you want but the scanario I gave above is almost 100% probably what happened. I’m just explaining the process and likely what happened. Its okay if I’m not believed. I know what’s true and how healthcare works. Its bittersweet that I have my job because I know how to navigate the healthcare system and get my patients what they need for their healthcare goals.
Edit: Also, with the scanario above, almost 100% of ICU professionals would agree with insurance for the reasons listed above. We know how it feels to want to bring someone up from the ED but can’t because we have beds already full… There are a very few select patients occasionally that want to live in the hospital. I’m aware we are encountering some people at their most vulnerable, traumatic times. It sucks. But they can’t live there.
The only other reason I can think for denial is if treatment is experimental. Otherwise, its really easy to appeal and get the care approved in ICU.