Frustration with the Medical System

I don't share much about medical issues because they are so intensely private.  I hope to be able to nibble around the edges enough to give you guys a feel for what is going on.  It is my hope that I can leave enough unsaid to protect the privacy of the individuals involved.

A few weeks back...

One of our family members had a minor change made to the meds they are taking.  It seemed like a good idea at the time.  All the arrows were pointing in the direction that this was a good adjustment.

It turned into a slow moving train wreck.

A call was made to our Doctor at 10:30 at night.  She directed us to admit the patient to the hospital via the Emergency Room.  She went to medical school.  I did not.  She prescribed the various medicines and knows the side effects and the various "acceptable" signs of an effective up-titer or down-titer.  She said "Go!"

We went.

That trip to the E-Room resulted in a four day hospital stay as medicines were adjusted and monitored via blood and urine tests and other symptoms exhibited by the patient.

The Insurance Company

The health insurance company is pushing back. 

Based on the information they have at this time, their artificial intelligence program indicates that there was a "reasonable" chance that the med adjustments could have been handled on an out-patient basis.

Pending investigation, they are withholding payment.

In a perfect world I would be able to bill the insurance company for tmy time they are obliging me to commit to chasing down the documentation and details.