Elective+surgery+advice+for+the+uninsured+or+pending+patient

Elective surgery advice, for the uninsured/pending patient
This advice was submitted by Kim Haglund, surgical registrar, September 2008.

If you have a patient you believe needs an //elective// hernia repair, lap chole, colostomy takedown, vein stripping, lipoma removal, breast reduction, etc, you can save your patient time and effort if you do the following before filling out the MR191: 1. Check patient’s insurance status. 2. Review with patient what they should do if their condition changes and their need for elective surgery evolves into a need for urgent or emergent surgery
 * Anyone who is //pending// anything (BAC, MediCal, CCHP) with no current active insurance cannot be scheduled for surgery in the OR or in minor procedures until their forms are completed, turned in, and patient’s status is updated in our computer system (although it seems they //can// be scheduled in surgery clinic for at least 1 visit).
 * Thus, it is usually a waste of time for the AZ, TZ, PO patient to come to surgery clinic until they become AO, TO, or other active insurance, since we usually just tell them to get their insurance in order, and come back once it is, for scheduling of their intended surgery.
 * If the patient is uninsured or pending insurance, make sure they understand that their forms must be completed and submitted, and insurance activated, for them to get the surgery they want/need.
 * Refer to financial counselor if the process has not yet been started.
 * If you do not think the patient needs surgery but just want the opinion of a surgeon on management, or have some question for the surgeon to address, the AZ/TZ/PO population can be seen in clinic, but again, no surgery will be scheduled so you might be better off just calling for a phone consult (especially since the PO patients will get billed for a clinic visit).
 * For uninsured/pending insurance patients, this means telling them to go straight to the emergency room at CCRMC if at all possible.
 * The reason for this is that we in the surgery department are generally happy to take care of uninsured patients in the most efficient way possible. Rather than have the uninsured, undocumented patient bounce in and out of ERs across the county with multiple episodes of biliary colic, we will typically admit the patient, do the surgery the same or next day and fix the problem, saving the system the cost of multiple visits.
 * However, patients in East or West County sometimes present to Doctor’s or Sutter-Delta multiple times with the same complaint and because they do not have a surgical emergency they are either discharged with instructions to “f/u at County” or they are transferred from the outside hospital to us. Either way, the patient has more time wasted and more resources used.
 * We still send some uninsured patients home from our ER, but usually only the ones who are really completely asymptomatic and who can get insurance to cover their problem if only they fill out the paperwork.