Question for the group.  

I had a discussion today with hospital executives about a case in which one of our providers transferred a patient to another hospital in town on account of the patient's insurance not being contracted.  The transfer was lateral with regards to the medical capacity of the facilities involved.  
Clinically, the patient was hemodynamically stable but had anemia requiring transfusion(s) and if admitted to our facility would have gone the the general pediatrics unit.  The anemia was not due to acute blood loss or acute hemolysis/consumption.  
Our provider arranged for our pediatric critical care transfer team since the PRBC transfusion was already infusing.  The insurance is now arguing that the patient should have been transferred by a lower cost transport option, BLS or ALS.  

The question arises was the child even "stable" for transfer?    

Should (could) the provider deem the patient "unstable for transfer" given the need for PRBC and admit for transfusions at our hospital?  

Should (could) the provider delay the transfusion, which the child needed, in order to accommodate a BLS/ALS transfer to an insurance contracted facility?

Should (could) the provider just move to the Netherlands and not worry about any of this ever again?  

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