Those of us who have been immersed in advocacy work for a long time often think that no healthcare horror story can shock us any more. Wrong! This is the story of a patient fortunate to again be employed and insured through work, but who, like most Americans, is living only a few paychecks away from potential disaster.
This is what happened. After contacting his primary care physician due to increasingly severe abdominal pain, he was instructed to go to the ER , as it was a Saturday evening. The emergency room physician subsequently sent the patient for surgery, to repair a strangulated hernia. After surgery, he was transferred from the recovery room to the inpatient surgery floor, where he was kept overnight.
A week later, the patient received a form letter in the mail from his insurance company, stating that hernia repair was not a procedure for which hospitalization was authorized and therefore the night in the hospital would not be covered. On the next work day, a Monday, the patient called his supervisor (who had been informed the previous Monday why he would not be at work) and asked who to contact about the insurance matter. He was directed to the employer’s HR office to ask for troubleshooting help . However, before the insurance snafu could even be discussed, the HR clerk informed him that he was AWOL with the company! She said that since a request for sick leave had not been submitted in advance of the absence, his leave would be without pay, with a reprimand note put in his record.
Fortunately, this case has a happy ending because there are still doctors who believe in the core values of the medical profession. The surgeon’s office quickly cleared up the “confusion” with both the insurance company and the employer.
Any wonder why we are struggling here in the US to get even the most basic of humane healthcare reforms and employment protections?