insurance question - what would you do?

[corona 247]

Had this situation happen to a friend of mine:

Pt comes in need of bypass heart sx. Pt is switching health insurance. His old insurance company refueses to pay, and the new insurance company will not pay until the 1st of the new year. Without this sx, the pt will die..
what would you do?

Thanks!

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[InductionAgent]

Do the surgery, then let the billing people/lawyers sort out getting paid. If it looked liked absolutely no insurance coverage is possible, bill the patient directly, for a lesser amount than one would seek from insurance.

If the patient presents very close to Dec. 31, consider admitting the patient to the hospital so he can be monitored, with surgery scheduled for Jan. 1. Do the paperwork of D/C and re-admit as necessary to get the new insurance company to pay.

Ultimately, the decision is up to the patient, unless you outright refuse to do the surgery without guaranteed compensation.

 

[16846]

Can the patient make it until the 1st of the year?

 

[beriberi]

It is medicare fraud to bill a patient less than you would bill medicare (doesn't matter if the patient doesn't have medicare).

Ummm..I assume this is for an ethics class, because there are few patients who have such well planned out insurance program changes and because few patients understand the possible financial burden of bypass surgery (and would say anything other than "do what you think is best dr.). Also, there are few insurance companies that do no cover life-saving bypass surgery