topic Re: An Unusual Medical Insurance Incident in Community Chat

An Unusual Medical Insurance Incident

PickyPicky3 — Fri, 30 Sep 2022 23:13:22 GMT

Kaiser Health News is reporting the experience of a high school girl who was in a car accident. The car had skidded on some standing water and rolled over. But the low speed, seatbelt and airbag deployment all kept her safe. She reported only a slight headache.

Her father decided to take her to an urgent care to have her checked out. In spite of having full coverage health insurance, the girl was denied treatment because injuries due to car accidents are often covered by auto insurance or homeowners insurance, which the UC didn't accept. The UC referred her to the nearby hospital which actually owned the urgent care.

The ER declared her fine.

Live and learn.

Re: An Unusual Medical Insurance Incident

conlt — Fri, 30 Sep 2022 23:19:36 GMT

The auto insurance comes first until the benefits are exhausted. After that the regular medical insurance kicks in.

Re: An Unusual Medical Insurance Incident

sann — Fri, 30 Sep 2022 23:30:34 GMT

I have never heard of any Medical Facility refusing treatment to anyone...if it's life threatening certainly you should go to the Hospital ER....something about this story doesn't sound right

Re: An Unusual Medical Insurance Incident

icezeus — Fri, 30 Sep 2022 23:44:49 GMT

It sounds very odd to me. What if she had a brain bleed, and they had denied her coverage. It just seems as if they could be opening themselves up to a serious lawsuit.

Re: An Unusual Medical Insurance Incident

PickyPicky3 — Fri, 30 Sep 2022 23:45:07 GMT

@sann You are correct. The father could have paid the UC with cash or credit card and then submit the bills to his insurers. But the hospital was close by.

Re: An Unusual Medical Insurance Incident

Zhills — Fri, 30 Sep 2022 23:51:58 GMT

They didn't refuse her treatment, they referred her to the ER!

They are usually close to each other!

This happened to me with Diverticulitis because, "I needed tests they couldn't do!?"

Not uncommon.

Re: An Unusual Medical Insurance Incident

Trailrun23 — Fri, 30 Sep 2022 23:51:17 GMT

This whole scenario is rdiculous , but it doesn't sound surprising given how insurance companies are. Sounds like the "urgent care" clinic should change its name.

Re: An Unusual Medical Insurance Incident

Trailrun23 — Fri, 30 Sep 2022 23:52:46 GMT

If he had taken her to an ER first, they would probably still be sitting there waiting for her to be seen by a dr.

Re: An Unusual Medical Insurance Incident

PickyPicky3 — Fri, 30 Sep 2022 23:56:37 GMT

@Zhills It said in the article the UC had all services needed to treat the girl. It was entirely about insurance, not any clinical issues.

Re: An Unusual Medical Insurance Incident

cjm61 — Sat, 01 Oct 2022 01:37:52 GMT

I agree with @Zhills , something is missing here. From what the OP states, the daughter had a headache or slight head injury? I worked at Kaiser, they would definitely want the patient to be seen in the ER due to the available testing and treatments at the ER. Urgent Care's do not have the facility to handle any serious injury, should the head injury require extensive tests, etc.

As a parent, I would be taking my child to the ER with any car accident like this, a roll over? And, complaints about a headache, I would be very concerned and would not rely on the UC.

Kaiser will cover the cost at any hospital for a serious illness/accident. Now, it's been a few years since I worked at Kaiser so not sure if this policy is still in affect but I believe it is.

Re: An Unusual Medical Insurance Incident

Tinkrbl44 — Sat, 01 Oct 2022 01:59:06 GMT

@PickyPicky3

What state was this in?

Re: An Unusual Medical Insurance Incident

PickyPicky3 — Sat, 01 Oct 2022 02:08:39 GMT

@cjm61 The article is the Kaiser Health News "Bill of the Month." The incident did not happen at a Kaiser facility.

Easy to find at the Kaiser Health News website, where you always learn something new and interesting.

If it were my daughter, I also would have taken her directly to an ER. But the article is about insurance coverage and medical billing.

Re: An Unusual Medical Insurance Incident

PickyPicky3 — Sat, 01 Oct 2022 02:16:50 GMT

@Tinkrbl44 Georgia Good question!

Re: An Unusual Medical Insurance Incident

sann — Sat, 01 Oct 2022 10:44:05 GMT

@Zhills wrote:
They didn't refuse her treatment, they referred her to the ER!

They are usually close to each other!

This happened to me with Diverticulitis because, "I needed tests they couldn't do!?"

Not uncommon.

If they didn't give her treatment then she was refused....

Re: An Unusual Medical Insurance Incident

Imaoldhippie — Sat, 01 Oct 2022 11:27:36 GMT

There is something odd about this story. If the accident occurred as described the police and emergency squad would have been there and she would have been transported to the ER, especially with the complaint of a headache.

Re: An Unusual Medical Insurance Incident

Spurt — Sat, 01 Oct 2022 12:30:37 GMT

@sann wrote:
I have never heard of any Medical Facility refusing treatment to anyone...if it's life threatening certainly you should go to the Hospital ER....something about this story doesn't sound right

@sann

It sounds like a nice scenario for a lawsuit since she was refused treatment and what if something came up that they discovered that had required immediate attention!!! .

Re: An Unusual Medical Insurance Incident

Starpolisher — Sat, 01 Oct 2022 12:49:47 GMT

@Trailrun23 @PickyPicky3

I agree with you both. Bottom line, The whole thing is about money! Unfortunate, but true!

Re: An Unusual Medical Insurance Incident

CelticCrafter — Sat, 01 Oct 2022 13:20:53 GMT

I one time went to the CVS Minute Clinic for a cat scratch that became infected.

I signed myself in on the iPad, personal info and why I was there, sat and waited my turn.

It wasn't until AFTER she did vitals and all that stuff did she tell me that they don't treat animal bites/scratches there and I had to go to a regular urgent care.

I was really po'd. She knew why I was there, I should have been told before she took me in.

Re: An Unusual Medical Insurance Incident

Nonametoday — Sat, 01 Oct 2022 13:27:01 GMT

@PickyPicky3 wrote:
Kaiser Health News is reporting the experience of a high school girl who was in a car accident. The car had skidded on some standing water and rolled over. But the low speed, seatbelt and airbag deployment all kept her safe. She reported only a slight headache.

Her father decided to take her to an urgent care to have her checked out. In spite of having full coverage health insurance, the girl was denied treatment because injuries due to car accidents are often covered by auto insurance or homeowners insurance, which the UC didn't accept. The UC referred her to the nearby hospital which actually owned the urgent care.

The ER declared her fine.

Live and learn.

@PickyPicky3

As someone who worked in the medical industry for years, that was appropriate. Doctors' offices and urgent care cannot accept this insurance. They are not qualified and feel that should something happen, they could be sued. It is always this way with these kinds of accidents. No doctors' offices should ever accept a patient who has been in an MVA or some kind of potentially severe accident as they cannot cover it and most do not even stock Tetanus for that reason as well as frequently not having an MD in the house, only a nurse practitioner or PA.

Re: An Unusual Medical Insurance Incident

reiki604 — Sat, 01 Oct 2022 13:27:57 GMT

This is the result of our for profit healthcare system. The US ranks last out of the top 11 weathiest nations in health care outcomes.