When Insurance Companies Engage in Medical Bad Practice

On Tuesday morning I received a call from a former colleague of mine that a young man was caught drinking on the job. My colleague knew that the young man, George*, was a former student of mine and that he had once been sober for about two years.

I was able to get in touch with George and explain to him that the jig was up. “Everyone at your job knows that you have a drinking problem,” I told him. I explained that he should go to treatment and that he could keep his job and that I would help him through this. He agreed to call several detoxes. Within 15 minutes, he had an appointment at a quality program in Central New Jersey for Wednesday morning.

The medical staff at the detox unit took his vital signs. His resting pulse was 101 and his blood pressure was 140/100 (he is 25 years old). He admitted to drinking for the last 72 hours and that he usually drinks 13 out of 14 days (his pattern for the last several months). The medical professionals and the substance abuse counselors all agreed that he needed to be admitted to the detox.

Here is a word by word copy of our text conversation from Wednesday morning (reprinted here with his permission):

George: I’ve been admitted.

Me: Great. Keep me posted on your progress and let me know when they begin discharge planning.

George: Correction. I was denied. I’m under “doc” review from my insurance company.

Me: WHAT?!? If they don’t pay for it make sure that doctor gives you written reasons why and a referral/rec for other treatment.

George: Okay..like, I’ve drank for 72 hours straight, my pulse is 101, BP is 140/100 and they fuckin deny it. How is that possible? Alcohol is one of two detoxes that you can die from.

Me: Let’s try Sunrise detox or Bergen Pines.

George: It’s my insurance saying no.

Me: Ah…it’s the insurance. Right. Of course.

George: Yessir. The clinician is really pushing for me to be accepted.

Me: Who is your insurance company and what kind of insurance is it?

George: HBCBS and advantage EPO. I’m being referred to an ambulatory detox.

Me: Are you going to go there?

George: Probably not. I don’t see how I’m not going to drink at night. My pulse is 116 now. The doctor told me to go to a GP and have him prescribe me a benzo and detox at home.

Me: That is outrageous. Who is the doctor reviewing your file for the insurance company.

George: Dr. Pigvomit**.

Me: Ok. We are going after him and that company. Fill out this form when you get a chance – NJ State Insurance Complaint Form

George: Will do. This detox is admitting me.

Me: Ah, great news.

George: They said irrelevant to what the insurance doctor says, I’m in and not responsible for all payment if the insurance company says no.

Me: Wow. Great great news. I’ll have to contact them and thank them.

My student has been there for 36 hours now and is doing fine. We are going to file a complaint against the insurance company and I’ll take this story to the press. Sadly, this is all too common. If you have a story like this or know someone who does, please fill out this form: NJ Insurance Complaint Form and please tell your story to the press.


* George is not his real name. I’ve changed it for this article.

** Pigvomit is not the Dr.’s real name.