When did a newly diagnosed creatinine of 4.5 not become an indication for admission to the hospital? Why did I just have to spend 20 minutes arguing with the medical director of an insurance company that payment for my patient's admission should not have been denied? ("The patient did not need to be admitted. The creatinine was not greater than 5, which is our guideline for hospital admission. You are welcome to appeal our decision.")
Why did I have to convince him that the increased creatinine was truly acute, likely due to interstitial nephritis from an antibiotic, and we had no way of knowing whether he would get worse, need a kidney biopsy, and require high dose steroids?
Eventually, payment for the admission was granted, which is the only reason I'm not naming names.
And the patient did fine and the renal failure resolved.
But am I pissed off.
3 comments:
And well you should be. Insurance companies should never have been allowed to put themselves in a position to force physicians to argue medicine with them.
How did we let it get this way???
I do not mean to sound spiteful, but I feel some relief that nephrologists have to deal with this crap, too.
From a psychiatric perspective, sometimes it seems like people have to had attempted to kill themselves (particularly inadvertently) or someone else first before we can get hospital authorization.
It's reassuring to know that insurance company administrators are at the vanguard of patient advocacy.
I on the other hand would have certainly let this patient down. This is because I would have missed the peer-reviewed research data demonstrating that a new creatinine of 4.5 is appropriately treated as an outpatient but 5.0 requires admission.
As I hospitalist, I'm ashamed to have permitted this obvious hole in my knowledge base. Funny thing though...I still can't seem to find the articles this insurance person was obviously alluding to.
I wonder if this "rule of thumb" is regardless of the potassium or bicarb?
John
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