Page 69 - OB Risks - Delivering the Goods (Part One)

SVMIC Obstetrics Risks: Delivering the Goods

two days for recheck of the cardiac symptoms, to have

another non-stress test, and to determine whether or not
an induction was warranted.

When the expectant mother arrived at the appointment

two days later, the front desk staff was unable to verify the
patient’s insurance information. According to the patient,

she had changed insurance recently, and the new
insurance company did not have her information in the

system. The receptionist told the patient she could not be
seen until they had confirmation that her insurance was

valid. Because the office had to wait for the insurance
company to confirm coverage, and they were uncertain

of when they would receive the notification, they suggested
to the patient that she call the office every day to check

on insurance status and they would let her know when
she could be seen. As instructed, the patient called the

next day to reschedule the follow-up appointment, but
her request was denied because of the unconfirmed

insurance status. She returned to the office in person
three days later and was turned away again. The following

day, four days after the initial appointment was scheduled,
she was seen in the office and diagnosed with fetal

demise.

This case is very similar to the one we earlier discussed

regarding communication. Again, the front office staff was used
as a “gatekeeper”. Unfortunately, the office staff did not have

a protocol to use when faced with an insurance problem for a
third-trimester patient requesting an appointment. There was

also no protocol for phone staff to use when faced with a patient

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