Why insurance companies should not make treatment decisions

“Get the crash cart!”

“She’s going to code!”

“Hang in there, honey, look into my eyes.”

“Her pressure is 40 over 20 … and falling!”

Yesterday morning, I went to my primary care doctor for a followup.  A simple office visit, nothing too exotic.  But as I was leaving the office, the physician’s assistant stopped me.  “How long have you been breathing like that?” she asked.  Since yesterday, I replied, thinking, haven’t we been over this?  I told you my symptoms at the start of the visit, and this was deemed to be no big deal.  “But you weren’t breathing like that before,” she said.  That’s right.  I was sitting still before, or lying down when I was waiting to be seen (why not?).  The breathing is only bad when I sit up for a while, or walk around.  “Don’t leave,” she said, “I’ll be right back.”

And she was.  With bad news.

“I don’t like the way you’re breathing,” she said, “With your history, I don’t want to take any chances.  I know you’re scheduled for a PET/CT scan later in the week, but I want to move it up, to check your lungs for a pulmonary embolism.”  Okaaaaaaaay.  “The doctor’s assistant tried to get you in for a CT today, but your insurance company said, no, they have three days to approve a CT.  You can’t get in until Monday.  But if it’s a PE, then it has to be caught today.”

“I’m sorry, but you need to go to the ER.”

The ER?  Really?  But it’s just a little labored breathing, and general weakness.  Couldn’t I just be fighting something off?  Like, say, H1N1, or a simple infection?

“You need to go to the ER, and you need to go now.  Do you have someone to drive you?”

I’ll drive myself, I said.  It’s only a couple of miles away, and I’ll call my husband to meet me there.  Of course, I was supposed to host playdate in a few minutes, but perhaps my friend Lisa will pinch-hit for me.  Yes, that will work.  I’ll leave now, I told her.  And I did.  I made arrangements for the kids, asked my husband to meet me at the hospital, and drove myself over to the ER.

Because my insurance company’s policy was to not approve CT scans for 3 days, I ended up in the ER, 2 hours in the waiting room with H1N1 patients and all kinds of infection floating through the air, waiting for the ER doc to take a look and say, “Why yes, she does need a CT.”  But, in just a few hours, I figured, I would have the CT, have it read, and be cleared to go home.  I’d even be checked for metastatis while we were at it (since a CT scan can do double duty, checking lung health in general and in specific, and cancer is most likely to move to the lungs, bones, and liver first, when it makes its jump to a level IV cancer).  So while this was going to be an annoyance, at the end of the day, it would be a net positive, right?

Well, that was before I was ushered back to the ER, behind the curtain.

to be continued….


16 Responses to Why insurance companies should not make treatment decisions

  1. kgirl says:

    Oh god. This is already not a good story. Hoping your part two is more favorable. (I spelled it that way for you.)

  2. *m* says:

    Yikes. Cliffhanging…

  3. Susan K says:

    Pulmonary Embolisms are not to be messed around with. One killed a friend of mine at NASA years ago – she was not old and fit and talking left her out of breath. And the doctors told her not to worry and she got on a airplane and died in a hotel in Pasadena…. Not how you expected to spend your day. But good for that PA. I wait for part 2 and hope for a totally, completely false alarm.

  4. liz says:

    oh for chrissakes, hope part two is GOOD NEWS.

  5. slouchy says:

    Oh, no! Don’t leave us hanging!


  6. Anta says:

    Oh Whymommy. Thank God for the physician’s assistant. Holding my breath until your next post. Praying for good news.

  7. FishyGirl says:

    Wow. Waiting with bated breath for the rest. Unfortunately I’ve had my own scare where I thought I was going to the doctor’s office to get something checked and ended up in the back of an ambulance as a P1 patient. Scary. Hoping against hope that it was a big false alarm.

  8. Nicole says:

    So sorry, I too hope part 2 is better. I’m all for saving $, but you are so right, insurance should not determine treatment. Hate that there is “good” & “bad” insurance.

  9. upsidebackwards says:

    I’m already furious on your behalf (and terrified). And I live too darn far away to help with the play date or come hold your hand or bring a meal or even give a hug!

  10. Stella says:

    Is it National Build Suspense Day? Holy Cow!

  11. Spacemom says:

    Oh Man, my mom was just released last month from ICU with more PE… She still has a clot in her leg. Please please tell me this is not happening to you!!!

  12. Carolyn says:

    Wowsers! I’m assuming you’re OK since you could write this story… but this is not the kind of thing that ANYONE wants to live through. Or worse, what if you just went home to wait your 3 days and died in the meantime? It’s shocking!!

    Just more reasons why I am SO glad to be in Germany, covered by rational, government mandated and regulated insurance. The doctor decides what is best for me. I’ve never had to call my insurance company for any reason. I never even SEE a medical bill. That is definitely a quality of life issue. It is definitely worth making changes in the US system to make it more humanitarian, because your experience is simply inhumane. The US insurance situation is capitalism gone wrong. It is just plain scary.

    Sending good karma your way!!

  13. Spruce Hill says:

    That is just wrong. I hope it ended well

  14. Oh horrible. I’ve been seeing your tweets. Can’t wait to read the rest and hope you are feeling better.

    Anyone who says our health care system isn’t broken doesn’t have any health problems.

  15. Stimey says:

    I’m obviously reading in the wrong order, but this whole episode is absolutely appalling. I am so sorry you had to go through it because of stupid rules and incompetent nurses and people who just don’t listen.


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