Insurance Company Taking Over Care

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Insurance Company Taking Over Care

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Old 12-14-2012, 03:31   #1
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Exclamation Insurance Company Taking Over Care

Has anyone ever heard of this? I've been hospitalized 4 times in the past few weeks. My blood sugars have been in the 600s, symptomatic, with ketones and abnormal heart rhythm. This morning, I received a call from my insurance company's nurse who said they are switching me to internal medicine at a major hospital, and not to go back to my doctor. They said I may have to spend time in the ICU til I can get stablized. I am writing this post from home by the way. Luckily they are giving me time to prepare for hospitalization (I am a single mom). But I am concerned that my insurance company feels they have to make medical decisions for me. Can they even do that? If I don't agree with something they say, can they refuse to pay for my care? Anyone have any insight?

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Old 12-14-2012, 03:52   #2
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I know some insurance companies like to have a case manager, who synchronizes all the care for patients with complicated diseases. The fact that you have been in the hospital 4 times in the past few weeks, with out of control blood sugars, abnormal heart rhythm and ketones (meaning you were in ketacidosis) -- well I agree with the insurance company, they want you to be taken care of by someone that they feel has more experience in cases like yours. Clearly they feel your current doctor is "out of his depth".

I think it is really quite rare for an insurance company to step in and ask you to change doctors. But as seriously ill as you are, I would go along with what they suggest. That is just my own gut opinion. Others here may feel differently.

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~~~ Gretchen ~~~
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Old 12-14-2012, 17:23   #3
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I agree with Gretchen.

I am surprised they are stepping in like that. I, personally, find it reassuring that there could be someone on their side looking over treatment and advising on a better route when something doesn't seem to be working. The fact that you are so ill is probably why. I would be perfectly fine with my insurance stepping up to help me get better care.

I would definitely follow their advice considering how sick you are. What your doctor is doing now just isn't working.

I really hope this helps and you get to feeling better soon.

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Old 12-15-2012, 10:59   #4
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Originally Posted by clark1341 View Post
I am concerned that my insurance company feels they have to make medical decisions for me.
This is just speculation on my part, but because you were hospitalized 4 times within a few weeks for the same thing, this is costing your insurance company some big bucks, so they might have decided to intervene and determined that you should go into ICU this time to make sure things are as they should be before you are released.

My guess is they deep 6'd your doc because he is the one who made the decisions to release you from the hospital before everything was under control.

I do know that it is in the hospital's best interest to make sure all is well before you are released because under the new health care law, as of October 1st of this year, if anyone is readmitted to a hospital within 30 days for the same condition, the hospital has to pay a fine. I have no idea how they are going to work that since it is the doctor, not the hospital, who decides when a patient is ready to be released.

I hope you are well on your way to recovery. Be sure to let us know when you are back home because we can help you get your blood sugar where it should be.

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