My 23 year old daughter had to undergo a colonoscopy that never should have happened because of a misdiagnosis by a gastroenterologist.
Mr. Blau, who is a utilization reviewer for the insurance company, denied reimbursement for the anesthesia that was used to put her under--a decision that was made by the physician and one that my daughter had absolutely no control over.
This strategy by insurance companies to avoid paying claims is being used more frequently, requiring consumers to jump through hoops in order to get legitimate claims reimbursed. I know in the end, after I make a big enough stink about it, this claim will be reimbursed. But I am so angry that some irresponsible person in Encino (who must get paid extra for each claim he rejects) has no idea what the circumstances were that led to the physician ordering the anesthesia.
I was not the least bit surprised to see a Yelp complaint against you, Mr. Blau, by one of your own patients (or former patients) for forcing him to undergo a colonoscopy with weak sedation. "During my colonoscopy - the drugs he gave me were weak and I felt a lot of pain," your patient wrote on Yelp. Incredible! Take better care of your own patients before you interfere with those who are seeing other physicians.
Mr. Blau, I hope someone close to you who has anxiety and physical pain has to undergo a painful procedure and gets her claim rejected so you can have a slight understanding of how angry I am right now.
Obviously, you don't get it. Responsible physicians know that patients who opt to undergo a colonoscopy with weak or no sedation typically have low levels of anxiety, usually have no abdominal pain before the procedure and are MEN. Because of anatomic factors, men are better candidates for trying colonoscopy unsedated or with weak sedation. It's time to go back to medical school, Mr. Blau. You are wasting everyone's time: the insurance company's, the physician's office, and mine.
Watch out, Mr. Blau: Outside entities that deny care can be liable for negligence in reviewing medical records. There is a growing concern that procedures to contain costs are interfering with decisions doctors make for their patients. read more