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American doctor days she has multiple elderly patients that need to be admitted into nursing homes She says insurance companies are now giving no notice for peer-2-peer calls to approve them. The latest one gives her 3 hours, if she can’t drop everything “he doesn’t get to go” “So...

89,439 views • 1 year ago •via X (Twitter)

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INSANE 🚨 This surgeon has a patient who needs a “deep flap” surgery. Insurance denied it To appeal she had to speak to her patients insurance. “I actually asked, do you know what a deep flap is? THE DOCTOR SAID NO.” The insurance companies deciding if Americans get their procedures DONT EVEN KNOW what the procedures are. How is this okay?! THIS is the state of American healthcare… “You may remember I had a patient who needs a deep flap, and the insurance company denied an inpatient stay for her. So I had to schedule a peer to peer call and schedule time out of my day to ask for a conversation directly with someone who is my peer to discuss deep flap surgery and why that patient needed to be overnight. That call was scheduled for 11AM, and eleven came around 11: 30, 11: 45 and no call still. And then we emailed the insurance company because, of course, they don't give me the call number. They only let me receive the call. So finally at 12: 15, I received the call that was initially scheduled for 11. And the doctor who called me was not a surgeon. And I actually asked the doctor, do you know what a deep flap is? And the doctor said no. So that's where we are. My patient has insurance. She's seeing someone who's fellowship trained in microsurgery, me, to do her breast reconstruction, and I'm having to teach another doctor what a deep flap is in order to justify her overnight stay to navigate her insurance. This is completely ridiculous.”

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1,292,441 views • 1 year ago

American Surgeon shows the actual letter from UnitedHealthcare DENYING a patient in emergency condition from receiving care “This is a woman who was in the emergency room with pulmonary embolisms” “I think we all knew this would happen. I had another patient come in and share with me that UnitedHealthcare denied her inpatient's day. So this is a patient who had shortness of breath and some chest pain, and she just knew that something wasn't right in her body. She had a family history of blood clots and she'd had a deep flap surgery a couple of weeks ago. She went to the hospital and they saw her and they found that she had a life threatening condition known as pulmonary embolisms. So she was admitted to the hospital and taken care of really well by the doctors there. And they ordered all the right things. After a couple of days, she was discharged. She got a letter from UnitedHealthcare explaining that they didn't agree with the level of her care and that they would not cover it. So I'm gonna share some of the language of that letter with you, and I want you to know that my patient that we talked about previously who had her surgery denied had almost exactly the same letter shared. So there's some troubling things in this letter. I think this term is really interesting. United is saying they reviewed the request for inpatient admission. So let's all just pause and consider that. This is a woman who was in the emergency room with pulmonary embolisms, and the doctor wasn't really requesting anything. They were saying this patient needs to be in the hospital. But an insurance company sees this as a request, and that's part of this prior auth environment that we're living in. So I think it's important as patients and as physicians to just acknowledge that this is our reality now. Someone can think that there's a good medical decision for you and can write orders and wanna do the right thing for you, but your insurance company is seeing that as a request and deciding whether or not they wanna do it. One of the criteria that this insurance company used to decide whether or not to accept or deny this request was whether it's medically necessary. And it's so interesting that we're letting insurance companies and the doctors who work for insurance companies determine what's medically necessary and not just the doctor in front of the patient in the emergency room. So this is a really bold statement from UnitedHealthcare for my patient. They say you did not have to be admitted as an inpatient to the hospital for this care. I think we all need to just reflect on that. An insurance company is telling a patient and her doctor that they disagree with the plan of care to keep that patient safe. I know that this is boiling down to whether it's an inpatient admission or an observation admission, and that's really about money. But what I wanna point out to you is they're making medical decisions. This insurance company is actually weighing in and disagreeing with a doctor who made a medical decision to admit this patient for her safety. So this specific sentence, when a doctor or facility treats a patient above the recommended level of care, we cannot cover it. What the heck? That's what we do. We go above and beyond as physicians. It's clear that insurance companies don't, and they're actually saying it here.”

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115,712 views • 1 year ago

EVERYONE NEEDS TO SEE THIS 🚨 American doctor exposes new internal change to Blue Cross prior authorization process to deny coverage for Americans - They’ll only speak to the doctor who put in request - They WONT SAY WHAT NUMBER THEY’RE CALLING FROM - They’ll ONLY CALL ONCE - If they miss the call, the patient will be denied coverage for treatment “Now Blue Cross is saying that they will only do their peer to peer reviews by calling the doctor who is asking for the treatment to be authorized. And they will only call once, and they won't tell you when they're calling, and they won't tell you what number they're calling from.” “So if you're a doctor seeing patients and you have your phone on do not disturb because you're seeing patients or you just don't answer numbers that you don't recognize, and you're seeing patients and you don't wanna interrupt a a patient visit, you're gonna miss the call. And guess what? The treatment will not be authorized” “They're getting more creative about how to deny your claims or just not authorize your treatment at all. I'm going on information given to me by Blue Cross. I am a physician. When we physicians ask for a treatment to be authorized by an insurance company and they deny authorization, what happens at that point is that we are asked to do a peer to peer review, meaning that we, the doctor asking for the treatment, have to speak with the doctor who is employed by the insurance company, who is there only to say no.” THIS IS INSANE

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1,465,586 views • 1 year ago