In a message dated 2/21/00 11:05:02 PM Eastern Standard Time,
[log in to unmask] writes:

<<
 What is the situation in other countries - and please enlighten me
 regarding the States, too.
 Thanks
 Denise >>

In the States, we have people employed by the hospital reviewing charts, on a
daily basis,  who will contact the doctor and/or insurance company regarding
the patient's diagnosis & length of stay. Most insurance companies will only
pay the hospital a certain dollar amount for a certain diagnosis. Therefore,
the hospital may lose money on a patient who stays beyond the "normal" period
of time unless there is a "recognized" diagnosis (that is authorized by the
insuror) & proper documentation in the chart to support it.

There are also some insurance companies that employ individuals who travel to
the various hospitals to review charts while patients are still inpatients.
If some treatments can be done at home, the company may require the patient
to be discharged & be treated at home by a HCP. You would not believe how
nit-picky some of them can be.

Many of us in the States are not happy with our insurance system at this
time. It is restrictive & complicated for both the health care provider and
the patient. These insurance companies also get hospital & doctors to sign
contracts to agree to accept certain fees for specific services. Therefore,
the hospital/doctor may receive 8 different payments from 8 different
insurance providers for exactly the same service.

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