Sarah Beth Cowherd

craft coffee and world change

[Sarah Beth Cowherd @SarahBethRN]

America

[Kevin Pho, M.D. @kevinmd]

A 47-year-old woman asked for an MRI. By the time her insurance company let her have one, the cancer in her hip was too far gone to save her leg.

Her doctor had done the X-ray. Examined her. Sent her for physical therapy, the six weeks the insurer's own published criteria said she needed to complete before an MRI was on the table. No improvement. He told her she needed the scan.

The insurance company said it was not medically necessary, until she finished six weeks of physical therapy. She had finished it. They had paid for it. He appealed.

38 days later, they reversed.

The MRI showed sarcoma. The hospital told her that one month earlier, they could have treated it with chemotherapy alone. Instead, they amputated her leg, her hip, and her pelvis. She died two years later.

Her family sued. The federal judge called it tragic, then threw the case out. Why? Because no law in New York holds an insurance company accountable when it gives bad medical advice. Doctors are accountable. Nurses are accountable. Hospitals are accountable. Insurance companies are not.

That is the contrarian thesis worth holding onto. Prior authorization is not a billing decision. It is a medical decision being made by someone who, by law, is supposed to be a specialist in the relevant field, and who, by the federal HHS inspector general's own findings, often is not. When an insurer overrides a treating physician based on criteria the insurer itself does not follow, that is medical advice. When that advice causes harm, the law treats the insurer as untouchable. Every other party to the patient's care is held to a standard. The decision-maker with the most leverage is held to none.

The framework worth saving:
1. By law, the reviewer denying a prior authorization is supposed to be a doctor in the relevant specialty.
2. The federal HHS inspector general has confirmed that often, they are not.
3. The published criteria insurers cite to defend denials are not always the criteria they actually follow.
4. Most insurance plans fall under ERISA, a federal statute that makes negligence cases against insurers nearly impossible. This case is in state court because the plan is for public employees, outside ERISA.
5. The AMA, the New York State medical society, and the Vermont and Connecticut medical societies have all filed amicus briefs supporting the family.

Attorney Steve Cohen argued the case before the Second Circuit. Doctors who fight these denials should know what is at stake and who fought alongside them.

Listen to the full conversation on The Podcast by KevinMD. Link in the replies.

What is the longest a prior authorization denial has ever delayed care for one of your patients?

#PriorAuth #ThePodcastbyKevinMD

[Sarah Beth Cowherd @SarahBethRN]

What company wouldn’t kill to be Nutella right now?

[Nutella @NutellaUSA]

Honored to have traveled further than any spread in history 🚀 Taking spreading smiles to new heights ❤️

[Sarah Beth Cowherd @SarahBethRN]

Happy Easter from the Christian president.

[Aaron Rupar @atrupar]

"Open the Fuckin’ Strait, you crazy bastards, or you’ll be living in Hell" -- Jake Tapper reads Trump's Truth Social post on air

[Sarah Beth Cowherd @SarahBethRN]

Beautiful 🌏

[Sarah Beth Cowherd @SarahBethRN]

Wild

[Michael Antonelli @BullandBaird]

Imagine the math required to make this guess and aim 4 people at a point in space

[Sarah Beth Cowherd @SarahBethRN]

We are going to the frickin moon!

[Curiosity @CuriosityonX]

I'm honestly SHOCKED at how the general public still has NO IDEA Artemis II is, right this minute, taking humans to the moon and will be the furthest humans have ever flown. Every non-space nerd I've talked to has no idea. WE MUST GET PEOPLE STOKED!!!!

THESE FOUR HUMANS ARE FLYING TO THE MOON!!!

[Sarah Beth Cowherd @SarahBethRN]

To infinity and beyond! Let’s go!

[Barack Obama @BarackObama]

It was inspiring to watch the Artemis II launch yesterday — @NASA’s first crewed mission around the moon since 1972. Our space program has always captured an essential part of what it means to reach beyond what we thought was possible, and I hope the four brave astronauts on this mission will inspire a new generation to follow in their footsteps.

[Sarah Beth Cowherd @SarahBethRN]

This is literally the most obvious outcome. I’m actually shocked that these people are shocked.

[Tanning Salon Don @TheSalonDon]

Strait closed means $200 oil

There’s nothing Trump can do to open the strait

This will cause Covid level lockdowns and hyper inflation at 30% +

I voted for Trump but

Attacking Iran will go down as the worst decision a president ever made

[Sarah Beth Cowherd @SarahBethRN]

@mericafirst25 @agraybee America first 25 believes you are embarrassing yourself. We live in the dumbest timeline.

[Sarah Beth Cowherd @SarahBethRN]

I’ll never forget when I saw hydrophobia in person. It is hard to believe, and terribly tragic, as it is a death sentence.

[Morbid Knowledge @MorbidKnowledge]

Footage of a boy with rabies exhibiting hydrophobia when his mother tries giving him water.

[Sarah Beth Cowherd @SarahBethRN]

@BananaScientist @mattyglesias @jonfavs @lolimjavier *he’s too tall

[Sarah Beth Cowherd @SarahBethRN]

Irony is dead

[Phil Stewart @phildstewart]

TRUMP: NO EVACUATION PLAN FOR EMBASSIES BECAUSE IT HAPPENED VERY QUICKLY

[Sarah Beth Cowherd @SarahBethRN]

Wild

[L. Louise Lucas @SenLouiseLucas]

We are now a week into this fight over the data center tax break and I have yet to hear any coherent answer on why every small business in Virginia has to pay our sales and use tax but data centers should be excempt.

[Sarah Beth Cowherd @SarahBethRN]

Also, the sky is blue.

[Aaron Rupar @atrupar]

Lisa Rubin explains how journalists have figured out the DOJ has withheld documents containing accusations of sexual assault against Donald Trump from their Epstein files releases

[Sarah Beth Cowherd @SarahBethRN]

Seriously though, what kind of blanket was it?

[Meghan McCain @MeghanMcCain]

How does Kristi Noem still have a job?!

[Sarah Beth Cowherd @SarahBethRN]

Irony is dead.

[WarMonitor @TheWarMonitor]

A Navajo man says ICE detained him in Peoria despite showing tribal ID and a birth certificate, then threatened that his children could be taken if he didn’t comply. Tribal leaders warn Native Americans are being targeted despite legal status. (ABC15)

[Benjy Sarlin @BenjySarlin]

Wow, it says here Bovino is to guard the border wall, and also take no wife, hold no lands, father no children, wear no crowns and win no glory.

[Sarah Beth Cowherd @SarahBethRN]

Nurses demand action 🔥

[American Nurses Association @ANANursingWorld]

Alex Pretti, a registered nurse, was killed in a horrifying shooting at the hands of federal law enforcement. We ask all nurses to visit https://t.co/brSe939K7j to send a letter to your members of Congress. Let them know that nurses demand immediate action.

[Sarah Beth Cowherd @SarahBethRN]

2k26. So far they’ve taken healthcare funding and shot a nurse.

[Sarah Beth Cowherd @SarahBethRN]

Nazi shit

[Covie @covie_93]

They murdered a VA nurse, lied about it then went to a movie.