[legitster]

If anything, the doctor is admitting to a potential crime! Medical providers aren't supposed to deny procedures based on insurance coverage. Even if UHC called during surgery to say the claim was denied, it's the doctor's choice to do the surgery of not.

[mlyle]

> Medical providers aren't supposed to deny procedures based on insurance coverage.

This is false. There's EMTALA, which requires that emergency services will be provided until a patient can be transferred. But doctors absolutely refuse to provide services based on ability to pay all the time.

[legitster]

Good point. But as the original story made the rounds on social media, it got exaggerated to make it sound like this was a life-threatening surgery. Knowing that it was a routine call and it was a plastic surgery procedure definitely deflates the scandal of the whole thing.

[ceejayoz]

Removing a brain tumor is "life-threatening surgery", but it won't be subject to EMTALA requirements.

[nradov]

Well that would depend on the facts of a particular case. If a patient presents at the ER with a brain tumor which is causing severe symptoms such as unstable vital signs then under EMTALA the hospital might be legally required to remove the tumor regardless of the patient's ability to pay.

[ceejayoz]

No; the tumor itself would be non-emergent. The symptoms it causes - pain, for example - would be treated, then the patient would be discharged with a suggestion of a follow up with oncology.

[nradov]

Are you certain about that? I think it would really depend on the severity of symptoms. Cases like Munoz v. Watsonville Community Hospital et al indicate that courts have interpreted the legal requirement to stabilize the patient rather more broadly. Just discharging the patient with painkillers and a referral isn't necessarily sufficient to avoid liability.

[ceejayoz]

> Medical providers aren't supposed to deny procedures based on insurance coverage.

Only in a very specific, narrow set of circumstances.

https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...

It only applies to emergency assessment and stabilizing care, and only if the facility accepts Medicare patients.