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1996-01-01
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3KB
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77 lines
MCL Extra
ER, Sorry 'Bout That
We have been featuring a NewsCenter 5 series on managed care.
One thread was entitled "HMO's: Prescription for Concern" by
the Boston TV channel. A second was simply called "HMO's and
Emergency Room Care." Here is Part I:
You're hurt, you're scared and you do what you've always done: Go to
the hospital emergency room.
But a recent poll shows about one out of every five people who do,
say their insurance company DENIES them access to the ER, or doesn't
pay their bill after the fact.
NewsCenter 5's Heather Kahn reports...it's part of the move towards
Managed Care.
It's after 5pm and Boston emergency rooms are getting busy . . .
"Has she ever been here before?"
This little girl is evaluated after swallowing some bleach . . .
there are asthma attacks, and chest pains. For Betty Sienczyk it was
a mugging on her way home from a Dorchester T station.
"I saw a fella jump out of the car and that's when I started
running."
Betty was knocked to the ground . . . she hit her head on a fire
hydrant and lost consciousness.
At the Hospital, The staff called her primary care physician who
gave approval for the ER visit. She was treated for a concussion and
X-rays showed nerve damage to her spine.
"It was a nightmare in itself to have something like that happen
to you, but it was even a bigger nightmare to get a letter like
that from the insurance company."
The letter, from Bay State said she was denied reimbursement,
because her injury was not an emergency. Bay State says what
happened to Betty happened before Blue Cross took over the company .
. . and they say Betty would not have a problem filing the same
claim today.
But emergency room reimbursement is a problem for some HMO patients.
An exclusive NewsCenter 5-Boston Herald poll found 19% percent of
HMO patients have been discouraged from going or denied
reimbursement for emergency room care. Compare that to just 4
percent of those in fee for service insurance.
Blue Cross/Bay State spokesman:
"Anything that is a significant emergency we pay for that."
But an experienced Emergency Room Physician says too often they
don't make that decision until after the patient has been treated .
. . and the bill has been sent.
Dr. Charlotte Yeh (New England Medical Center):
"Clearly there are real true emergencies, somebody with a heart
attack. But there is a middle of the road group where there are
symptoms but you don't know until after the evaluation if it is
a true emergency."
The question is . . . just what is an emergency . . . something
hospitals and insurers are examining as the debate continues.
[This report from medical reporter Heather Kahn aired 14-Nov-1995.]
...For further information, contact CURE, 812 Stephen St., Berkeley
Springs, WV 25411. 304-258-LIFE/258-5433 (CUREltd@ix.netcom.com)