Since I’ve been a resident, insurance has denied: 1- an MRI for a developmentally disabled patient who was gradually + dramatically losing motor function / developing contractures 2- fidaxomicin for our patient w/ recurrent severe c diff who didn’t show improvement with PO vanc for several days 3- a biopsy for a patient with a suspicious neck mass 4- an absurd number of medications that have strong evidence behind them 5- rehab for elderly patients bc they didn’t meet inpatient criteria for two months. 6- DOACs for eligible patients (in favor of warfarin, which is a huge hassle) After a while, one gets used to Coverage Cobra dictating care plans. I work for an underserved population, and am routinely struck by the barriers that Coverage Cobra puts in place explicitly to prevent people from accessing care. For example, physical paperwork that requires a doctor’s signature to verify orders that were placed via the EHR seem to have no purpose but to overwhelm doctors and prevent patients from accessing care (while shifting blame onto PCPs.) as they say- the cruelty seems to be the point.
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