I hope appropriate precautions have been put in place to prevent unintended adverse consequences for the responders to your survey. The insurance company claimed that the patient was not ill enough to require hospitalization, but could have been adequately treated as an outpatient. When an envelope from the insurance company did arrive, it was not from the 'utilization' department, but from 'quality assurance. They were citing me with a potential violation because they felt that the patient was too ill to have been released from the hospital after the 4th day, and should have been kept longer. The approval was finally granted for his 'equipment request'.
Many insurance companies refuse to credential NPs as providers.
The diagnosis was 427.5 which is cardiopulmonary arrest. The claim was paid 8 days later. He looked at the final diagnosis, not the presenting complaint, and couldn't have cared less about the prudent layperson definitions of emergent conditions. After this, he had a fit and couldn't figure out why our report card scores were so low due to the high number of grievances and appeals which brought overturns by the HMO's. They said that going to an urgent care center wasn't necessary.