Hospital Transfer Help
December 22, 2010 3:11 PM Subscribe
How to get a hospital transfer approved and done *fast*?
(Asking on behalf of a friend, and I am not up on all of the specifics, but giving it my best shot.)
My friend's father was hospitalized in Little Rock, Arkansas. Since then, events have spun horribly out of control.
They all live in Texas, and would prefer him to be transferred closer to home, for several reasons. Not the least of these is that she and her family are living out of a hotel room and running out of money fast -- but also, the quality of care her father is receiving is absolutely abysmal, from all reports.
Apparently the request to transfer is under review by the insurer (I believe United Healthcare) and will reportedly take several weeks. They cannot afford several weeks, in many senses.
There is a caseworker assigned to them, I believe from the hospital, who has been alternately incommunicado and ineffective.
So... how can she push the insurance company to approve a transfer faster? What avenues of help are available to families in her position? Anything else you can think of that might result in immediate and effective assistance? This whole situation is just so awful and ugly, there has to be SOMETHING that would get the gears running smoothly.
(Asking on behalf of a friend, and I am not up on all of the specifics, but giving it my best shot.)
My friend's father was hospitalized in Little Rock, Arkansas. Since then, events have spun horribly out of control.
They all live in Texas, and would prefer him to be transferred closer to home, for several reasons. Not the least of these is that she and her family are living out of a hotel room and running out of money fast -- but also, the quality of care her father is receiving is absolutely abysmal, from all reports.
Apparently the request to transfer is under review by the insurer (I believe United Healthcare) and will reportedly take several weeks. They cannot afford several weeks, in many senses.
There is a caseworker assigned to them, I believe from the hospital, who has been alternately incommunicado and ineffective.
So... how can she push the insurance company to approve a transfer faster? What avenues of help are available to families in her position? Anything else you can think of that might result in immediate and effective assistance? This whole situation is just so awful and ugly, there has to be SOMETHING that would get the gears running smoothly.
The fastest thing, assuming that the father can be transported safely by private vehicle, is to check out against medical advice, go to the hospital you want to receive care at, and check into the emergency room there.
Don't take that as advice to do so-- I have no idea what sort of problems the man has. If it is only somewhat safe to transport him, you could look into the cost of hiring an ambulance privately.
I don't know how that would affect insurance. It would be worth asking an insurance representative how billing would work, should you choose to do that.
If there is more than one case worker, it's worth asking if your friend's father could be represented by another one.
If the abysmal care is just bad luck, and there are some people in the hospital capable of good care, you could document your grievances and bring them to a hospital representative. Many hospitals have patient advocates on-staff, who have the power to get some strings pulled-- maybe just getting a bed on a different floor would improve the care he's receiving. Maybe the patient advocate could get the man a private room, where a cot could be installed for a member of his family, so that his family doesn't have to stay in a hotel room.
posted by nathan v at 3:40 PM on December 22, 2010
Don't take that as advice to do so-- I have no idea what sort of problems the man has. If it is only somewhat safe to transport him, you could look into the cost of hiring an ambulance privately.
I don't know how that would affect insurance. It would be worth asking an insurance representative how billing would work, should you choose to do that.
If there is more than one case worker, it's worth asking if your friend's father could be represented by another one.
If the abysmal care is just bad luck, and there are some people in the hospital capable of good care, you could document your grievances and bring them to a hospital representative. Many hospitals have patient advocates on-staff, who have the power to get some strings pulled-- maybe just getting a bed on a different floor would improve the care he's receiving. Maybe the patient advocate could get the man a private room, where a cot could be installed for a member of his family, so that his family doesn't have to stay in a hotel room.
posted by nathan v at 3:40 PM on December 22, 2010
I have acted as a medical advocate for various family members over the years. I have some medical training, but I am not a medical professional. Still, I have been very effective at getting high quality care and responsive carers. I'd suggest keeping in mind three strategies.
Be persistant.
Be present.
Be proactive.
1- Identify one person as the go-to person who will be acting as the patient's advocate. Carry around a notebook. Take notes on all provider conversations, next steps they discuss, etc. Ask questions. Ask for their name and contact details if they don't provide it and write it down in the record you're making.
2- Be present as much as possible for all caregiver appointments. Befriend the nursing staff (you can easily do this by not complaining, being friendly, and not yelling at them, they get a lot of people who are simply not polite to them due to their circumstances, so if you treat them as a human being your stock will immediately go up). Once you're friends, you can ask them to call you if the dr or other caregivers arrive. Still, it is wise not to go too far away from the room so you can be there for all elements of patient care.
3- Act as if you are the spokesman for the patient. It is your job to make sure he is seeing the right specialists/getting through to the right people. Be kind, friendly, but very persistent.
In a hospital setting, getting things done can be more difficult because there are so many people who are possibly responsible for agreeing to/facilitating various things. It is more important than in any other health care situation to have a person identified to act as a patient advocate and actively work on their behalf. Good luck.
posted by arnicae at 3:51 PM on December 22, 2010 [2 favorites]
Be persistant.
Be present.
Be proactive.
1- Identify one person as the go-to person who will be acting as the patient's advocate. Carry around a notebook. Take notes on all provider conversations, next steps they discuss, etc. Ask questions. Ask for their name and contact details if they don't provide it and write it down in the record you're making.
2- Be present as much as possible for all caregiver appointments. Befriend the nursing staff (you can easily do this by not complaining, being friendly, and not yelling at them, they get a lot of people who are simply not polite to them due to their circumstances, so if you treat them as a human being your stock will immediately go up). Once you're friends, you can ask them to call you if the dr or other caregivers arrive. Still, it is wise not to go too far away from the room so you can be there for all elements of patient care.
3- Act as if you are the spokesman for the patient. It is your job to make sure he is seeing the right specialists/getting through to the right people. Be kind, friendly, but very persistent.
In a hospital setting, getting things done can be more difficult because there are so many people who are possibly responsible for agreeing to/facilitating various things. It is more important than in any other health care situation to have a person identified to act as a patient advocate and actively work on their behalf. Good luck.
posted by arnicae at 3:51 PM on December 22, 2010 [2 favorites]
Response by poster: A few more details on the emerging catch-22: Both hospitals are willing to do a transfer, it's the insurance company that is the hangup. The insurance company now says they will refuse to pay for care at the local home hospital if the family pays for the actual transportation out of pocket; and as above, it will take them weeks to decide whether to approve that transfer and pay for it themselves or not. Crazypants.
Assume that the patient is well enough to travel; that hasn't seemed to be the hangup at all, it's seems to be entirely a matter of timing, coverage, and slow-as-treacle approvals.
posted by Andrhia at 4:00 PM on December 22, 2010
Assume that the patient is well enough to travel; that hasn't seemed to be the hangup at all, it's seems to be entirely a matter of timing, coverage, and slow-as-treacle approvals.
posted by Andrhia at 4:00 PM on December 22, 2010
I have no experience with this personally, but I do make a lot of phone calls to large companies. If I were you, I'd start working my way up the insurance company org chart by phone. Be polite. Be insistent. Calmly state how ridiculous the situation is, and (if true) the reasons why this is not saving them any money. Ask them to help you brainstorm alternative solutions that meet the timeliness needs of the situation, or to direct you to someone who can. Don't stop calling until you have a better resolution.
Contact phone numbers can be found by calling the company main line and asking to be directed to the office of a senior management name from the insurance co's website (look for "about us"), or sometimes you can find direct lines on a site like Jigsaw.com if you can "swap" some alternate business contact info for them. Try the operator first.
You've got to be the squeaky wheel. Make it cost them more in time and effort to not resolve the situation.
posted by deludingmyself at 4:28 PM on December 22, 2010
Contact phone numbers can be found by calling the company main line and asking to be directed to the office of a senior management name from the insurance co's website (look for "about us"), or sometimes you can find direct lines on a site like Jigsaw.com if you can "swap" some alternate business contact info for them. Try the operator first.
You've got to be the squeaky wheel. Make it cost them more in time and effort to not resolve the situation.
posted by deludingmyself at 4:28 PM on December 22, 2010
Response by poster: Just confirming: The patient in question is on a ventilator but stable and his doctors have approved him for transport.
And thank you, everyone, for your advice so far -- please keep it coming!
posted by Andrhia at 5:03 PM on December 22, 2010
And thank you, everyone, for your advice so far -- please keep it coming!
posted by Andrhia at 5:03 PM on December 22, 2010
I do work in the medical field and, unfortunately, the vast majority of health insurance companies will refuse to pay for a patient to be transferred unless specific criteria is met, namely that of medical necessity. For instance, if a patient needs an organ transplant and the current hospital isn't capable of doing them, most insurance companies will pay for the patient to be transferred to one that can because organ transplants are medically necessary.... I know, call me Captain Obvious.
From my experience, most insurance companies will not pay for the patient to be transferred to another facility for the convenience of the patient, family or even the patient's physician. I know this seems counterintuitive because you would think they wouldn't want the patient stressing out unnecessarily about this kind of thing.... but they don't care about the best interest of the patient. They care about whatever saves them money.
I am not an insurance expert so I can't say with 100% certainty that this is how it will play out. I really hope I am wrong. Like others have suggested, if they refuse to pay there is an appeals process.
Good luck.
posted by cdg7707 at 5:33 PM on December 22, 2010 [1 favorite]
From my experience, most insurance companies will not pay for the patient to be transferred to another facility for the convenience of the patient, family or even the patient's physician. I know this seems counterintuitive because you would think they wouldn't want the patient stressing out unnecessarily about this kind of thing.... but they don't care about the best interest of the patient. They care about whatever saves them money.
I am not an insurance expert so I can't say with 100% certainty that this is how it will play out. I really hope I am wrong. Like others have suggested, if they refuse to pay there is an appeals process.
Good luck.
posted by cdg7707 at 5:33 PM on December 22, 2010 [1 favorite]
Is the insurance through the patient's employer? In some places where I've worked, there was an advocate for employees that helped them deal with insurance issues. Ask the patient's employer's HR department about it.
posted by ShooBoo at 5:42 PM on December 22, 2010 [2 favorites]
posted by ShooBoo at 5:42 PM on December 22, 2010 [2 favorites]
Another thing I thought of..... have they checked with the hospital to see if there is some sort of hospitality house they can stay at? I've also heard that some hotels will discount rooms in circumstances such as these. Might be worth checking into.
posted by cdg7707 at 8:14 PM on December 22, 2010
posted by cdg7707 at 8:14 PM on December 22, 2010
I'm no expert here, but - perhaps this something that the Patient Advocate Foundation could help with? It's worth a phone call, at the very least.
posted by chez shoes at 8:26 PM on December 22, 2010
posted by chez shoes at 8:26 PM on December 22, 2010
UHC makes stupid decisions like that all the time (used to deal with them at the psych hospital). What you need to do is escalate up their chain of command. Get the employer to call their rep, get the family to work up the chain ( and ask for the names of everyone you talk to, with date and time and notes from each convo), and find the person at the hospital who is calling UHC and be very friendly with them bask them if they have escalated the matter. When a cert is denied with the usual people who answer the phone it can go to a "Doc to Doc" review, where the treating doc gets on the phone with the insurance doc and they fight it out. The family needs to talk really nicely to the doctor and ask him/her to go to bat for them with UHC.
I am in Little Rock so you can memail me the hospital involved if you want. I know we have a Ronald McDonald House for Childrens and I believe UAMS has a house as well. I might be able to dig up some info tomorrow. Just keep bugging UHC. It might also be good to read the actual policy to see if they cover housing for out of state medical care. Or call the insurance commissioner in Texas and see if there is some legal expectations in a situation like this.
posted by MultiFaceted at 9:48 PM on December 22, 2010
I am in Little Rock so you can memail me the hospital involved if you want. I know we have a Ronald McDonald House for Childrens and I believe UAMS has a house as well. I might be able to dig up some info tomorrow. Just keep bugging UHC. It might also be good to read the actual policy to see if they cover housing for out of state medical care. Or call the insurance commissioner in Texas and see if there is some legal expectations in a situation like this.
posted by MultiFaceted at 9:48 PM on December 22, 2010
If the patient's vented, i'm not at all surprised. The cost of transporting him from AK to TX is seriously astronomical-- way more than the cost of his family staying in a motel for months.
And he's probably in an ICU, so there's not really any chance of a transfer for better care.
I would be surprised if the insurer had any legal obligation (would depend on plan details) to transfer him. I would also be surprised if his family, who are apparently burdened by motel costs, had the ability to pay for safe transport. It's no simple matter to get a guy on a vent across state lines.
If this is an important end-of-life issue, where the father wants to die at home, then at this point I would start making arrangements outside of insurance, accepting that the cost would be astronomical.
Otherwise, I would focus on the important reason for wanting the transfer-- the crappy care he's receiving. (I don't count motel costs as a reason, because they're nothing compared to the cost of transport.). There are ways to improve the quality of care that he's receiving, some nice, some not-so-nice. A good start would be to document problems meticulously, and to seek the services of a patient advocate/rep. With more details,I could maybe recommend more.
posted by nathan v at 1:27 AM on December 23, 2010 [1 favorite]
And he's probably in an ICU, so there's not really any chance of a transfer for better care.
I would be surprised if the insurer had any legal obligation (would depend on plan details) to transfer him. I would also be surprised if his family, who are apparently burdened by motel costs, had the ability to pay for safe transport. It's no simple matter to get a guy on a vent across state lines.
If this is an important end-of-life issue, where the father wants to die at home, then at this point I would start making arrangements outside of insurance, accepting that the cost would be astronomical.
Otherwise, I would focus on the important reason for wanting the transfer-- the crappy care he's receiving. (I don't count motel costs as a reason, because they're nothing compared to the cost of transport.). There are ways to improve the quality of care that he's receiving, some nice, some not-so-nice. A good start would be to document problems meticulously, and to seek the services of a patient advocate/rep. With more details,I could maybe recommend more.
posted by nathan v at 1:27 AM on December 23, 2010 [1 favorite]
Response by poster: An update: I'm not sure what advice my friend used, if any, but the patient is currently on route to a plane right now. This thing is happening. What a huge relief!
Thanks to everyone for your help. It meant a lot.
posted by Andrhia at 3:51 PM on December 23, 2010
Thanks to everyone for your help. It meant a lot.
posted by Andrhia at 3:51 PM on December 23, 2010
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posted by bookrach at 3:37 PM on December 22, 2010