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When insurance cures

Posted Mar 23 2013 7:50pm

She was taken to the hospital by the ambulance.  She had miscalculated and the pills she had taken were not going to be enough to kill her.  It was little comfort to her family.  It was her 3rd attempt in a very few months.  Her husband and kids just cried. They were not mental health wise, but they were losing someone they loved and they knew it. The news for today just left them with their fears for tomorrow.

She went into the hospital as she had before. As before she got the same news. Her mood had brightened. She seemed like she was doing okay and after the fifth day her insurance wasnt going to pay for any more days. She was “cured” by insurance. Her insurance didnt believe much in people, but they sure believed in pills. She had medication and more medication and finally medication to medicate her medication. She told me once what she had learned from the hospital was that things were never going to get better. She had heard them say she was a “frequent flyer.” She wasnt real sure what that was but knew by their tone it wasnt good. They would tell her she was ready to go home but by now she didnt really think so. No matter what they said, how much they assured her, or what they promised nothing really got better. She didnt have the best of insurance and it didnt pay for very much and that not very much never seemed to help.

She never got a chance to be cured by insurance again. The next time she took enough pills. After 3 days in intensive care her organ systems had shut down. They turned off the life support systems and she died. She was 34 years old. Her name was Betty. She was a quiet and gentle person. In the end I really think she just lost herself and didnt know where to look. She was my sister in law. She was mine and my wife’s good friend. To this day I still question rather the disease killed her or she was a victim of the cure.

She is not the only person I have known that was “cured” by insurance. Ask any patient in a psych hospital how long they will be there and they all know. “…until my insurance company pulls the plug.” I have seen people one day be told they were just starting to make progress being congratulated the next day when the insurance company pulls the plug on being ready to go  home. I have seen others who think they are going home be told they get to stay a few more days. Their insurance company has been unexpectedly kind to the hospital. These are not rare occasions. They are everyday reality.

Hospitals do not admit people because they can help them. It is great if they can. Everybody wants that. It is just not necessary. Hospitals admit people because they can get paid for them. When they are admitted they have a pretty good idea how long they can keep someone. They have a pretty good idea rather or not what they can do is likely to be helpful in the time given. None of that is normally shared with the patient and often not with the staff. Consequently many people relapse. I worked in one program seen by almost all as a good program whose population at any point in time was 30-40% people who had been there before. Without the relapses they could never financially have made it. If you were cynical you would call it a match made in heaven and wonder why anyone would try to change it. The insurance companies profit from reducing length of stay. The hospitals profit from the never ending supply of relapses to keep their beds full. It doesnt mean there is some kind of conspiracy or anything like that. Most people mean well. It is just the ways people make money tend, as long as everyone profits, to be very resistant to change.

Inpatient care is as much a series of transactions with an insurance company as it about interactions with patients. I know one lady who has has gotten the insurance cure 23 times in the last 6 years. There is a lot of naivete about inpatient care. Many people talk a lot about techniques, theories, and interventions. Many people really do want to help. But it is a business, maybe regretfully so. Closing eyes doesnt help. If you dont look the real danger is that in the end it will be nothing but a business.

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