About a year ago the seventeen year old daughter of one of my employees was found to have a brain tumor, a few months later she had a stroke and has been in the hospital ever since. Now the hospital, the health plan and the treating doctor believe the child needs to leave the hospital and enter a rehab situation with less intensive care. There is nothing more they can do in the hospital setting. The parents are understandably upset and want the child to stay in the hospital, the mother is beside herself with worry and yet from all indications moving the child is the right thing to do.
However, the mother is seeking help from me and our management to force the health plan to allow the child to stay in the hospital. I cannot do that, there is no medical necessity to do so and in addition, there is a tremendous cost difference between the two types of facilities.
The parents don’t want to hear any of this logic they just want the best (in their minds) for the child. They want 24-hour care by doctors and nurses. This is the perfect big bad insurance company horror story, but you know all the issues behind what you may read in the newspaper about a sick child being “kicked out of the hospital.
So, what would you do? Should a health plan give unlimited care and meet all the demands of patients and their families?
