When Diagnosis is not CoveredCreated by:
Healthcare insurance protect their business by putting a limit on the services that they provide for their clients. In most insurances that I've encountered, common conditions that are not covered are traumatic injuries, patients who are under the influence of prohibited drugs or alcohol, psychiatric conditions, congenital diseases and sometimes even pregnancy. In my experience as a resident, I frequently encounter patients who present with headache and after an extensive work up, it turns out they have an aneurysm. Unfortunately, an aneurysm is classified under congenital diseases (in HMO diagnostic standards). After this, the HMO liaison officer usually inform the patient that his hospitalization will not be covered. Sometimes patients would go to the extent of requesting physicians to give a different diagnosis so that they will be medically covered.
What is your experience on this? Have you encountered physicians who agree to putting a different diagnosis so that their patients will be medically covered?