Patients' handling called 'criminal'

January 14, 1998

Patients' handling called 'criminal'


Staff Writer

Patrice Kifer came down with bronchitis in October. Then she had problems with asthma. On Nov. 7, she was rushed to Washington County Hospital's emergency department when her tongue swelled so much she couldn't speak.

A specialist at Johns Hopkins Medical Center knows what it isn't: Cancer, lupus, leukemia. But what ails Kifer, 33, of Hagerstown, remains a mystery.

Her allergist wanted to admit her to the hospital again to run more tests, but her insurance company - Blue Cross/Blue Shield - denied the stay, saying it wasn't medically necessary and she wasn't suffering from a life-threatening injury.


She was shocked.

"I really didn't know what to do," Kifer told a room full of health care professionals Tuesday during a public hearing about persistent problems with health care insurers. "It's just very frustrating."

Del. John P. Donoghue, D-Washington County, hopes to lessen the burden on patients and providers with legislation expected to be introduced in the House of Delegates this week or next.

If passed, Donoghue's bill would require health care insurers and HMOs to establish internal grievance processes for members and would authorize the Insurance Administration to investigate complaints if a carrier refuses to pay for treatment.

The administration could then make decisions on a question of medical necessity after consulting health care professionals.

Health care practitioners at Donoghue's health care summit Tuesday at the Robinwood Conference Center in Hagerstown supported the bill, saying insurers are focusing more on the business aspects of medicine and that patient care is suffering.

Many are being denied medical treatment retroactively, which sticks the hospital or physician with the bill, or are denied before the treatment is performed.

"This makes my blood pressure go up," said Dr. Edward Ditto, a Hagerstown physician.

"I had this lady who was brought in the backseat of an automobile. The lady had two previous strokes that left her with a permanent speech defect. Her blood sugar was critical," Ditto said.

"We got it under control in four days, she went home and was denied by Blue Cross/Blue Shield. In my opinion, this is criminal. She was ill and yet they kept denying her," Ditto said.

Providers said they know their patients and know what they need, and that the second-guessing is ridiculous.

"I'm just a regular old family doctor and I anticipate three or four life or death decisions (on any given day,)" said Dr. Allen Ditto, with Potomac Family Medicine in Hagerstown. "I don't need this to occupy my mind."

Donoghue said meeting with health care professionals brought the issue home.

"This was just a microcosm," Donoghue said. "This is a very clear example of what's going on statewide."

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