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Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 12:09 pm
by dm200
http://www.wusa9.com/entertainment/buzz ... /499665429

or, perhaps a prompt service Taxi?

it is not just "cost", either, in my view. In our case, for example, if either DW or I had need for transportation (we or both for some reason could not drive) for an "urgent care" situation, we would want to go (or be taken) to the Kaiser 24 x 7 urgent care facility - for BOTH health/medical and financial reasons. I don't think an ambulance would or could take us there. Uber or taxi would not help, either, if there were an issue of having to be carried or lifted (even if a 100% non life threatening situation).

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 12:20 pm
by livesoft
If I have a heart attack, I want an ambulance from the very nearby firestation to take me to the hospital. The EMT's should stabilize me and already inform the OR at the hospital that I am coming in, so I get to bypass the ER.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 12:34 pm
by Chuck
Likewise, if I have a broken arm and can't drive, I'd call Uber, not an ambulance.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 12:43 pm
by harrington
My Parents are both 90 plus years old and live 5 houses from the hospital. We have had to call the ambulance many times through the years and the cost was $1200-$1600 each time. Luckily they have excellent secondary insurance and they paid nothing out of pocket.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 1:03 pm
by PVW
In related news, Bogleheads have reduced the net income of Financial Advisors.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 1:04 pm
by whiteprius
This is smart. I recommend everyone read their byzantine medical insurance policy to see exactly how much a trip to the ER costs for anticipated emergencies. You'd be surprised that two ER's right next to each other can result in a hugely different cost depending on your insurer's network. One night I went to the ER for something stupid and I (a) drove myself and (b) went to the ER about 1.2 miles away from the closest one (because that had a discount for my policy). Wound up paying only $250. Had I taken an ambulance to the other ER I would have paid $6,000.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 1:11 pm
by dm200
whiteprius wrote:
Fri Dec 15, 2017 1:04 pm
This is smart. I recommend everyone read their byzantine medical insurance policy to see exactly how much a trip to the ER costs for anticipated emergencies. You'd be surprised that two ER's right next to each other can result in a hugely different cost depending on your insurer's network. One night I went to the ER for something stupid and I (a) drove myself and (b) went to the ER about 1.2 miles away from the closest one (because that had a discount for my policy). Wound up paying only $250. Had I taken an ambulance to the other ER I would have paid $6,000.
DW and I now both are on the same Kaiser Medicare plan - and there is not a huge difference between the costs of a Hospital ER and Kaiser urgent care. However, when DW was on an Obamacare kaiser policy before being eligible for Medicare - the hospital ER was MUCH more expensive.

There are both health and financial risks and tradeoffs. Based on multiple experiences, I believe the Kaiser (24x7) ungent care facility is very capable of dealing with almost any medical situation, and at a lower cost. It also has online access to all records and physicians. If needed, specialists are called in - happened to us.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 1:15 pm
by mouses
Urgent care places cannot always deal with serious situations. A local hospital has several urgent care facilities in my state and they specifically say they are not for things like heart attacks, etc. They're basically "doctor's office" places without the supporting facilities or specialists for emergencies. Their advantage is they're open outside of normal business hours, but even then not necessarily 24/7.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 1:49 pm
by EngCapt1
"Uber vs Ambulance - HUGE cost difference"

And also a HUGE difference in emergency prehospital care. Is this a comparison because they both offer transport services? Should I call a plumber to my house instead of a cardiologist if I need a cardiac catheterization? They both clean pipes, right? Is there a difference? Training and education maybe?

:D

EDIT: Not meaning to offend any plumbers.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 1:59 pm
by nisiprius
A couple of years ago... I can't prove that the EMTs who started IV fluid and had it running during the ten minutes it took to get me to the ER saved my life. But even if it didn't, it might have contributed to a good outcome. (Like, my arriving at the ER conscious and being able to talk to them...)

On the other hand, there was the time I walked 3/4 of a mile to the ER because I'd cut my finger in the kitchen, my wife had the car and was out of town, and I just... could... not... get the cut to stop bleeding... and the ER was 3/4 mile away and the Urgent Care was three miles away... yeah, it would probably have been smarter to call Uber. If they weren't worried about getting blood on the car upholstery.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 2:09 pm
by NCPE
Speaking from 40 years experience as a Firefighter / EMT - "You get what you pay for"

No offense to Uber but if I have a life threatening emergency I want the best possible pre hospital care I can get. For a non life threatening issue Uber is probably fine, but a wrong decision could mean the difference between life and death. The modern day ambulance truly brings the Emergency Room to you and it is indeed costly to equip and staff an ambulance with Paramedics.

As far as the "Doc in a Box" they do an excellent job providing non urgent and follow up care. In our area If you walk in with any potential life threatening symptoms (Chest Pain, Breathing difficulty, signs of stroke, etc) they pick up the phone and call 9-1-1 for an ambulance.

<edit> - As I soon as I hit the submit button one of the adjacent departments was dispatched to a local urgent care for patient with breathing difficulties. :(

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 2:38 pm
by EngCapt1
NCPE wrote:
Fri Dec 15, 2017 2:09 pm
The modern day ambulance truly brings the Emergency Room to you and it is indeed costly to equip and staff an ambulance with Paramedics.
You mean they're not just "ambulance drivers"? :D

On a serious note: If you've stubbed your toe, or had a headache for 3 weeks and decide at 3 a.m. you need to go to the ER for it, or you need to have your cold symptoms checked, or you've cut your finger- then by all means call an Uber.

If you're having chest pains, abdominal pains, breathing problems, etc-- then don't let costs dictate whether you call an ambulance or not.

An Ambulance is equipped with diagnostic tools/equipment and staffed by well-trained professionals that will provide life-saving interventions when needed-- it's not just a means of transport from one place to another. An Uber is just a means of transport. There can be no comparison between the two as they are totally different.

Regards

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 2:43 pm
by nickjoy
If it makes a difference, I know in the county where I grew up, you only had to pay the city ambulance bills.

The non-city ambulances would still send you a bill, but if you didn't pay it after the 3 bills came in the mail, they just wrote it off.

The city ambulances would go to collections.

Frederick County, MD. Everything within Frederick is considered city, everything else is considered county. So 85% of the county is just county.

I would take an ambulance either way though. Ubers are just random people who don't want a person dying in their back seat or getting blood everywhere. How pissed would you be if you called an uber, and the uber wouldn't let you in his car because you were bleeding profusely, you argue, then he drives away, now you have to wait even longer for an ambulance.

If it's serious enough for an ambulance, everything else stops, including financial worries.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 2:50 pm
by Shallowpockets
ER RN 25 years here.
Ambulances come in all the time with people who could have come by POV, privately owned vehicle. Or an Uber. So I believe it could be an option for some. But, they are not the same, nor for the same thing.
In most cases an ambulance will get you in to a bed in the ER. No waiting. Due to the burden on ERs many will just triage you out to the acting room for a condition that can wait. I have worked at hospitals in downtown areas where people took ambulances to the ER for minor complaints and were then triaged to wait room and just left. They just wanted a ride downtown. Then they went shopping. I know this because it was repeat business. Heck, there are frquent flyers for whom the ambulance pulls up and honks and the patient comes out and gets in. This was back in the old days when I was an EMT.
It is not unusual for an ambulance to get a 911 call from an ER waiting room from someone who just does not want to wait.
Also many many people (and families) think that the ambulance can take them back home after discharge, from the ER or from the hospital. This is not usually the case. You might have to pay up front, or thinking that it was free you may get a bill later.
Most people think their insurance covers ambulance transport. They should check their policy. Maybe not covered. In which case the bill could be substantial.
I think for the above Uber may be a good alternative. However, even Uber costs money and many do not want to pay anything for a ride to or from the hospital.
I think they both have their places for transport to a medical facility. However if going to an ER for something you think is life threatening, it is best for an ambulance to take you. An ambulance is not just a ride, it is care enroute, notification you are arriving and in what condition. Care is quicker. The poster who stated he could just bypass the ER and go to the OR - well, I have never sent that happen. The best that can be said of that sort of scenario would be the use of the cath lab if it is determined you meet certain criteria, and the system is set up to recognize and plan and execute that scenario.
Uber is same as a taxi and there are many people who arrive or depart the hospital by taxis.
The Uber verses an ambulance title of this post is correct in that there is a huge differemce in cost. But it has no context beyond that.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:02 pm
by miamivice
Chuck wrote:
Fri Dec 15, 2017 12:34 pm
Likewise, if I have a broken arm and can't drive, I'd call Uber, not an ambulance.
If I was an Uber driver I'd refuse any rider who was injured and wanted me to drive them to the hospital. I wouldn't want the liability of making their injury worse, or the responsibility to try to monitor them to ensure that their condition didn't degrade while I was driving them.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:11 pm
by Doom&Gloom
Seems like a strange topic. Of course there is a huge cost difference.

However, if I think I need to go to the ER and can't drive myself there, cost is likely to be the least of my concerns.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:12 pm
by dm200
mouses wrote:
Fri Dec 15, 2017 1:15 pm
Urgent care places cannot always deal with serious situations. A local hospital has several urgent care facilities in my state and they specifically say they are not for things like heart attacks, etc. They're basically "doctor's office" places without the supporting facilities or specialists for emergencies. Their advantage is they're open outside of normal business hours, but even then not necessarily 24/7.
There are differences in "Urgent Care" facilities.

I know (from several experiences of mine and my wife's) that the Kaiser (24x7) Ungent care and Clinical decision unit have several type of physicians there in person, can call in appropriate specialists, have lab, CT, Xray, MRI, etc. - and can keep you up to 24 hours. Very extensive supporting facilities. So far, every time we have needed to go there - one of us has driven. I certainly, though, can think of some circumstances where one of us driving would not be prudent, but taking Uber or a cab would work out well.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:15 pm
by White Coat Investor
dm200 wrote:
Fri Dec 15, 2017 12:09 pm
http://www.wusa9.com/entertainment/buzz ... /499665429

or, perhaps a prompt service Taxi?

it is not just "cost", either, in my view. In our case, for example, if either DW or I had need for transportation (we or both for some reason could not drive) for an "urgent care" situation, we would want to go (or be taken) to the Kaiser 24 x 7 urgent care facility - for BOTH health/medical and financial reasons. I don't think an ambulance would or could take us there. Uber or taxi would not help, either, if there were an issue of having to be carried or lifted (even if a 100% non life threatening situation).
One thing I've never seen an Uber driver do is load you into the car and pull you out. If you need that service, call an ambulance.

I actually find it problematic when people pull up in front of the ER and expect the ER staff to get their loved one out of the car and into the ER. Look, if you can't get them out of the car and into the ER, then call the medics. They specialize in doing that. I can't figure out why they could get into the car, but can't get out. I haven't quite called the medics yet to get someone out of the car in front of the ED door, but I think about it every time.

But when it is me and two 120 lb nurses, we can't get your 400 lb wife out of the car safely.

But this whole uber ambulance thing...this has real merit. Uber response times are lower than ambulance response times in many parts of America. But an ambulance isn't just a ride...

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:20 pm
by White Coat Investor
livesoft wrote:
Fri Dec 15, 2017 12:20 pm
If I have a heart attack, I want an ambulance from the very nearby firestation to take me to the hospital. The EMT's should stabilize me and already inform the OR at the hospital that I am coming in, so I get to bypass the ER.
Ha ha. What kind of OR are you planning to go to for your heart attack? You think the CT surgeon is waiting in there ready to do your CABG? I thought you worked in health care?

Your point, however, is right. If medics take you to the hospital for a heart attack and you've actually got a STEMI, it will reduce your door to balloon time compared to Uber transport as we'll activate the cath lab with a medic report of STEMI and the cath lab crew will start driving in. But skipping the ER...haven't seen it happen yet.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:20 pm
by Adam11
A few months ago I drove a VERY pregnant woman and her husband in an uberX to the ER. I've had way crazier rides in the past and this one was going to be very short and quick, so it never really even crossed my mind to suggest an ambulance instead. She wasn't in full-on labor and was able to walk, but definitely uncomfortable and had a couple of groans/moans on a mile-long ride. Her husband said the due date was in a week so she was close, but the reason they called an uberX was because they had a false-alarm a week prior and it took almost an hour for an ambulance to arrive (in the heart of D.C.). I took them door-to-door for $10 in less than ten minutes. And I got tipped a dollar...I'll always wonder if they named their baby after me, lol.
Image

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:22 pm
by Chuck
miamivice wrote:
Fri Dec 15, 2017 3:02 pm
If I was an Uber driver I'd refuse any rider who was injured and wanted me to drive them to the hospital. I wouldn't want the liability of making their injury worse, or the responsibility to try to monitor them to ensure that their condition didn't degrade while I was driving them.
Luckily, I think most other people's first reaction wouldn't be to refuse to help.

There are a lot of absurd reactions in this thread. Your situation is either life-threatening or it's not. If it is life-threatening, you take an ambulance. I don't think anyone suggested otherwise.

There are many many people who consider ambulances to be hospital taxis. This is a good example of what happens to activities that are subsidized. It's better for everyone if ambulances are available for real emergencies.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:26 pm
by letsgobobby
I have begun seeing patients at the hospital who present for SI (suicidal ideation) and arrive by Uber.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:33 pm
by 9liner
As a career firefighter and paramedic for almost 18 years now, I can honestly say there has been a sea change over the last decade. The wholesale abuse of emergency services (ambulances and emergency room visits) is rampant. The stress it puts on many systems leads to increased response times, overburdened ERs, and significant provider burnout. 911 has been the de-facto go-to for even the most minor of problems. The strain on the systems often leads to unavailability of resources to those who truly need it. I can anecdotally say that 75% of the patients I transport to the hospital would have been just as well served going in a private vehicle to an urgent care center. Most large-scale EMS systems are on the verge of collapse and are scrambling to cope with this increased demand. EMS has turned into a glorified taxi service.

The system I work for has begun investing large sums of time and money in pilot programs such as nurse triage lines for low acuity callers in order to re-direct them away from the 911 system. While some progress is being made, the question remains as to how long the system can cope at this rate.

Bottom line: Life, limb, or eyesight: Call an ambulance. For maladies that do not rise to that threshold, your personal physician or urgent care center will suffice.

CNBC article on Uber -->> fewer ambulance rides /Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 3:50 pm
by ResearchMed
Timely... an article about how ambulance service drops when Uber is available:

https://www.cnbc.com/2017/12/15/when-ub ... rides.html

We had to call an ambulance twice in the past 2 years, and there isn't a chance we'd have done anything other than call 911.
In both cases, immediate care was started in the ambulance.
It was pretty impressive. Those people knew what they were doing.
They also had a lot of information ready for the ER staff upon arrival, making everything faster.

We owe them a lot, as we do many others who serve in a variety of ways.

RM

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 4:47 pm
by dm200
9liner wrote:
Fri Dec 15, 2017 3:33 pm
As a career firefighter and paramedic for almost 18 years now, I can honestly say there has been a sea change over the last decade. The wholesale abuse of emergency services (ambulances and emergency room visits) is rampant. The stress it puts on many systems leads to increased response times, overburdened ERs, and significant provider burnout. 911 has been the de-facto go-to for even the most minor of problems. The strain on the systems often leads to unavailability of resources to those who truly need it. I can anecdotally say that 75% of the patients I transport to the hospital would have been just as well served going in a private vehicle to an urgent care center. Most large-scale EMS systems are on the verge of collapse and are scrambling to cope with this increased demand. EMS has turned into a glorified taxi service.
The system I work for has begun investing large sums of time and money in pilot programs such as nurse triage lines for low acuity callers in order to re-direct them away from the 911 system. While some progress is being made, the question remains as to how long the system can cope at this rate.
Bottom line: Life, limb, or eyesight: Call an ambulance. For maladies that do not rise to that threshold, your personal physician or urgent care center will suffice.
Exactly ...

BUT - I am not sure I agree 100% with your conclusions.

1. Prior to our returning to Kaiser, which has extensive after hours care, urgent and (to a considerable degree) emergency services in this area, our Physicians provided no after hours services at all. A hospital ER was the recommendation.

2. When someone at various kinds of organizations, places of worship, employment, etc. has almost any kind of medical need - however trivial - those organizations seem to insist on calling 911 - and invoking all of the steps you decry.

3. A few years ago, before returning to Kaiser - I noticed a number of these urgent care centers popping up. I called our helth insurance provider to ask about which ones would be covered under our plan, since I did not see any of them in the provider book. The insurance person who staffed the hotline, would not answer the question - fully. He acted like this was a "secret". He said that if I gave him the details (name of place, name of Physician, etc. - then he could tell me if it would be covered. Obviously, since I was not "there" with a need - I could not give him the information. In addition, if I went there in the evening or weekend, the insurance place would not have the hotline staffed. I tried to be a wise consumer -- but was stifled by the insurance company.

I regard going to a Hospital ER as a tortuous experience for anything other than life or death situations. Why anyone would go there when other choices are available is completely beyond my comprehension.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 4:48 pm
by livesoft
White Coat Investor wrote:
Fri Dec 15, 2017 3:20 pm
Ha ha. What kind of OR are you planning to go to for your heart attack? You think the CT surgeon is waiting in there ready to do your CABG? I thought you worked in health care?

Your point, however, is right. If medics take you to the hospital for a heart attack and you've actually got a STEMI, it will reduce your door to balloon time compared to Uber transport as we'll activate the cath lab with a medic report of STEMI and the cath lab crew will start driving in. But skipping the ER...haven't seen it happen yet.
Happened to a friend of mine. Right into cath lab. Lots of good hospitals and physicians around me. Of course, his incident was at a convenient time during a weekday. :)

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 4:52 pm
by jebmke
No uber in rural areas; no medical care either so I'm still dependent on duct tape for trauma and jumper cables for cardiac care to get me to civilization. Our local hospital can't handle either so I'll likely have to drive myself.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 5:34 pm
by Sandtrap
Drive in to the ER and wait.
911 Ambulance gets you farther up the waiting line and into the ER and onto a bed.
There is no cost to be considered when a fatality is on the line. Of course you may grumble about the bills later as they come in, but when you're on the floor and seeing the tunnel and the bright warm light. . . 911 brings the entire medical system to bear. . . . And, it's worth every single dime.
j :D

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 5:53 pm
by Jack FFR1846
Son had some kind of reaction while at college. Campus police called ambulance. While en route, his throat started closing and they used an epi pen. Throat cleared up. I'm fine paying the bill because an Uber would have likely resulted in dead son.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 5:57 pm
by bostondan
livesoft wrote:
Fri Dec 15, 2017 4:48 pm
White Coat Investor wrote:
Fri Dec 15, 2017 3:20 pm
Ha ha. What kind of OR are you planning to go to for your heart attack? You think the CT surgeon is waiting in there ready to do your CABG? I thought you worked in health care?

Your point, however, is right. If medics take you to the hospital for a heart attack and you've actually got a STEMI, it will reduce your door to balloon time compared to Uber transport as we'll activate the cath lab with a medic report of STEMI and the cath lab crew will start driving in. But skipping the ER...haven't seen it happen yet.
Happened to a friend of mine. Right into cath lab. Lots of good hospitals and physicians around me. Of course, his incident was at a convenient time during a weekday. :)
I am a cardiology fellow at a major academic medical center. When it is a clear STEMI, patients go right to the cath lab and skip the OR. We do this to reduce door-to-balloon time, as you mentioned.

Ed is right though, most patients do go through the ER no matter what. The STEMI situation is unique.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 6:48 pm
by jmw
This is a really odd topic. So let's limit this to the emergency conditions where you can't drive yourself to the ER due to danger of passing out or something similar and a family member/friend can't drive you there immediately. Uber is just a substitute for driving yourself to the ER. Also very important: the Uber or taxi driver is not going to help you get in or out of the vehicle because you're feeling weak. If you can't drive yourself there and walk in, Uber is not an option. ER personnel are not going to be ready to help you if you pass out at the front door. Your head will just make contact with the hard floor when you pass out.

I think this is a thinly veiled query about avoiding the high cost of an ambulance copay under many Medicare Advantage plans and other HMO plans that can cost around $200 per ambulance ride vs. using Uber. First of all, you could have avoided this cost discussion and rationing of medical care with traditional Medicare with a supplement. But since you made the "disadvantage" choice and don't have a driver handy to take you to the ER immediately, just eat the ambulance copay, pay the bill, and move on while others pay nothing for their ambulance ride since they chose the more expensive and higher benefit plans. This thread could have came up in many other different forms due to the many ways Medicare HMO plans jack up the copay like $200 copay MRIs, CTscans, days in a SNF, etc.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 7:27 pm
by 9liner
Sandtrap wrote:
Fri Dec 15, 2017 5:34 pm
Drive in to the ER and wait.
911 Ambulance gets you farther up the waiting line and into the ER and onto a bed.
There is no cost to be considered when a fatality is on the line. Of course you may grumble about the bills later as they come in, but when you're on the floor and seeing the tunnel and the bright warm light. . . 911 brings the entire medical system to bear. . . . And, it's worth every single dime.
j :D
Not true. EVERYONE regardless of the mode of arrival gets triaged. I bring plenty of patients straight from my stretcher to the waiting room. If you show up in a privately owned vehicle suffering from a serious condition you will be triaged as such.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 7:29 pm
by 9liner
Jack FFR1846 wrote:
Fri Dec 15, 2017 5:53 pm
Son had some kind of reaction while at college. Campus police called ambulance. While en route, his throat started closing and they used an epi pen. Throat cleared up. I'm fine paying the bill because an Uber would have likely resulted in dead son.

I don’t think ANYBODY has advocated Uber for a serious condition such as an allergic reaction.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 7:41 pm
by Thesaints
A bus, or the underground, are even cheaper...

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 7:51 pm
by junior
miamivice wrote:
Fri Dec 15, 2017 3:02 pm
Chuck wrote:
Fri Dec 15, 2017 12:34 pm
Likewise, if I have a broken arm and can't drive, I'd call Uber, not an ambulance.
If I was an Uber driver I'd refuse any rider who was injured and wanted me to drive them to the hospital. I wouldn't want the liability of making their injury worse, or the responsibility to try to monitor them to ensure that their condition didn't degrade while I was driving them.
I don't know how this would play out legally, but the idea that leaving the injured person who had been waiting for your car to fend for themselves gives you less liability is an odd conclusion.

edit: Seems like they could sue you for breach of contract, for example.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 7:53 pm
by livesoft
Check out what Good Samaritan laws are in your state.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 8:37 pm
by dm200
jmw wrote:
Fri Dec 15, 2017 6:48 pm
This is a really odd topic. So let's limit this to the emergency conditions where you can't drive yourself to the ER due to danger of passing out or something similar and a family member/friend can't drive you there immediately. Uber is just a substitute for driving yourself to the ER. Also very important: the Uber or taxi driver is not going to help you get in or out of the vehicle because you're feeling weak. If you can't drive yourself there and walk in, Uber is not an option. ER personnel are not going to be ready to help you if you pass out at the front door. Your head will just make contact with the hard floor when you pass out.

I think this is a thinly veiled query about avoiding the high cost of an ambulance copay under many Medicare Advantage plans and other HMO plans that can cost around $200 per ambulance ride vs. using Uber.
First of all, you could have avoided this cost discussion and rationing of medical care with traditional Medicare with a supplement. But since you made the "disadvantage" choice and don't have a driver handy to take you to the ER immediately, just eat the ambulance copay, pay the bill, and move on while others pay nothing for their ambulance ride since they chose the more expensive and higher benefit plans. This thread could have came up in many other different forms due to the many ways Medicare HMO plans jack up the copay like $200 copay MRIs, CTscans, days in a SNF, etc.
No, it is more than that. In my jurisdiction, and probably most jurisdictions, when you call 911 and an ambulance is sent - I believe the ambulance will only tansport you to the nearest (or assigned) Hospital ER. In a great many cases, that is not meedically necessary or even wise. It is often best to go to (or be taken to) some kind of Urgent care facility. In our cases, I believe that in, perhaps, 95% or so of such medical needs - we would best go to, or be taken to, our Kaiser Urgent care facility.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 9:28 pm
by Sandtrap
9liner wrote:
Fri Dec 15, 2017 7:27 pm
Sandtrap wrote:
Fri Dec 15, 2017 5:34 pm
Drive in to the ER and wait.
911 Ambulance gets you farther up the waiting line and into the ER and onto a bed.
There is no cost to be considered when a fatality is on the line. Of course you may grumble about the bills later as they come in, but when you're on the floor and seeing the tunnel and the bright warm light. . . 911 brings the entire medical system to bear. . . . And, it's worth every single dime.
j :D
Not true. EVERYONE regardless of the mode of arrival gets triaged. I bring plenty of patients straight from my stretcher to the waiting room. If you show up in a privately owned vehicle suffering from a serious condition you will be triaged as such.
You are Absolutely Correct and very wise.
I may have been vague in my description. Unfortunately, I've been in both situations far too often and am thankful to have devoted medical professionals like yourself give me their fullest attention. If not, I would not be typing this right now.
Mahalo,
j

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 9:41 pm
by motorcyclesarecool
1. Our local §501(c)(3) nonprofit ambulance service has an annual “subscription”. For $50 per year per household, they’ll waive any bill beyond what your insurance pays them. They do a mail campaign each December.

2. I have a kid with severe allergies. I’ve driven her in each time she's needed a trip to the ED. I’d just rather not wait for the ambulance to arrive. When they see a little kid completely covered in hives (the last time she even started to wheeze) in triage, they get you in fairly quickly.

3. DW had a miscarriage while we were on vacation. Nothing they could do = long wait first at urgent care then ED. Frustrating but perfectly understandable.

4. I could totally see using Uber to get myself to hospital if I were ambulatory.

All in all, I feel like the ED system tends to work. Also I’m glad the ambulance is there.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 11:25 pm
by White Coat Investor
bostondan wrote:
Fri Dec 15, 2017 5:57 pm
livesoft wrote:
Fri Dec 15, 2017 4:48 pm
White Coat Investor wrote:
Fri Dec 15, 2017 3:20 pm
Ha ha. What kind of OR are you planning to go to for your heart attack? You think the CT surgeon is waiting in there ready to do your CABG? I thought you worked in health care?

Your point, however, is right. If medics take you to the hospital for a heart attack and you've actually got a STEMI, it will reduce your door to balloon time compared to Uber transport as we'll activate the cath lab with a medic report of STEMI and the cath lab crew will start driving in. But skipping the ER...haven't seen it happen yet.
Happened to a friend of mine. Right into cath lab. Lots of good hospitals and physicians around me. Of course, his incident was at a convenient time during a weekday. :)
I am a cardiology fellow at a major academic medical center. When it is a clear STEMI, patients go right to the cath lab and skip the OR. We do this to reduce door-to-balloon time, as you mentioned.

Ed is right though, most patients do go through the ER no matter what. The STEMI situation is unique.
If patients went straight to the cath lab they'd be in there all alone at my hospital 90% of the time. Our cath teams certainly don't sleep in there. But somewhere big enough to have in-house fellows, sure, why not?

And I assume you mean ER, not OR.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Fri Dec 15, 2017 11:47 pm
by ccieemeritus
I dislocated my shoulder a few years ago. The circulation in my arm was not impaired. A friend was nearby and drove me to the hospital. Had he not been available, lyft would have been a less expensive choice than an ambulance. Driving myself with that injury was not recommended.

If my circulation was impaired, I'd call 911.

+1 to the comment that bringing yourself to the ER results in a wait in the waiting room. You'll get faster medical care arriving in an ambulance, but you'll pay for it.

lyft would also have been useful for my Mom. She had difficulty driving herself at night and on highways. But I was never able to get her to use a smartphone. She did use taxi (from her flip phone) but its more expensive and more trouble to call (although some taxi companies now have smartphone apps).

Re: Uber vs Ambulance - HUGE cost difference

Posted: Sat Dec 16, 2017 12:13 am
by Watty
The Uber part of this question is a bit of a red herring except that they might rightfully refuse to take you and call 911.

You could just as well ask when you should have a friend or family member take you to the ER or urgent care center.

Here is a general PDF on that.

http://www.in.gov/dhs/files/When_to_cal ... eet(1).pdf

I have no specific medical background but I have seen the "FAST" acronym a number of times to help people remember how it identify a possible stroke which will apparently respond to some treatments only within the first three hours. If you wait four hours to see if the symptoms go away then then could be a huge mistake.

Face: Smile and see if one side of the face droops.

Arms: Raise both arms. Does one arm drop down?

Speech: Say a short phrase and check for slurred or strange speech.

Time: If the answer to any of these is yes, call 911 right away and write down the time when symptoms started.

https://www.webmd.com/stroke/guide/signs-of-stroke

Re: Uber vs Ambulance - HUGE cost difference

Posted: Sat Dec 16, 2017 1:22 am
by 2comma
On my favorite science and critical thinking podcast they have a science of fiction quiz for the panel every week. Two of the statements are science (true) and one is fake. One questions was is it always better to take and ambulance if have an emergency. Turns out in the study he was quoting, for puncture type wounds (severe stabbings and gunshot wounds) the mortality rate was actually higher if you called an ambulance. Apparently time was so critical having someone throw you into a car and get you to the ER overcame the ability of the EMTs to prevent you from bleeding out. Something to think about after you next knife or gun fight goes badly. The host of the show is a practicing academic neurologist and I'm sure the study accounted for things like the higher number of incidents in areas where ambulance service might also be slower.

Small rural hospitals in my area have a reputation for not being where you want to go if it's an emergency. I had a friend who's father, who was obviously having a heart attack, chose to have his cousin try to rush him to a hospital an hour away in the big city. That decision may have cost him his life.

My wife had a sever asthma attack and I called the health insurance company's 24 hour nurse to ask what to do - ok, I'm not the smartest... She said call 911 and get her to ER now and an ambulance will get her admitted quicker. Well the hospital is 5 minutes away, ambulance takes about 8 minutest to get here so I knew I could get here to ER before they could even arrive. They saw her immediately. I asked my friend the EMT, works as volunteer for a city FD, if the ambulance ride gives you any priority at ER and he said no, they all do triage and it's worst in first in.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Sat Dec 16, 2017 4:42 am
by madbrain
Had to go to the ER a month ago . My husband was out of the country. I was supposed to fly soon after. There was no one to drive me. I did not have uber setup. I was short of breath. Called 911 and got an ambulance. Was driven by EMT to the nearest Kaiser in-network hospital, which happens 15 miles away. Had zero wait. The ER did not keep me long, gave me some quick breathing treatment, cleared me to go home and travel, and basically kicked me out. I got an ambulance bill in the mail upon my return from Asia for ... $2,758.45 . Covered 100% by my insurer. And yes, this is only for transportation, not for the ER stay. I haven't gotten the EOB for that yet. I paid my $35 flat ER copay and may never see that EOB.

During my Asia trip, I suffered from food poisoning in Bangkok. After ruining an Uber driver's car due to vomiting, I had to be hospitalized for 2 nights with explosive diarrhea. One of the best hospitals I have ever seen. My husband was joking we should book that instead of the 5-star Conrad we were staying in (in which I spent only 3 nights instead of 5 due to hospital stay...). It is the 3rd time I get food poisoning in asia and the second time it brought me to the hospital. The bill for the 2 nights came to 60,913 Thai bhat, or $1873 as of today. Less than the ambulance ride in the US ! The nurses were very nice even though they had to change my adult diapers a number of times (finished one box). If you have to be get sick somewhere, Thailand is it. Much better service than at the Hanoi French hospital in Vietnam, for the same price per night. Still 5 times the price of the Conrad/night. But hey, I earned reward points on my Sapphire Reserve for those hospital bills. Now I just need to get Kaiser to reimburse, and that will take a few months to get paid back. Not my first time submitting foreign medical bills to them ! This time I also have another doctor bill for $265 in Ho Chi Minh as well the week before.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Sat Dec 16, 2017 5:58 am
by palaheel
In our area, an ambulance will get you into a bed in the ER immediately. If Urgent Care is closed, our discussion is "do we want to call for an ambulance, or sit in the waiting room for 3 hours?"

Re: Uber vs Ambulance - HUGE cost difference

Posted: Sat Dec 16, 2017 7:59 am
by westie
My local town fire department has a program whereby if you pay $75 a year they will cover the cost of ambulance services that your insurance won't pay.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Sat Dec 16, 2017 8:41 am
by annielouise
If I were having a heart attack, I would accept that dying is part of life, stay with my family, and save them the cost of both the ambulance and outrageous hospital expenses. Everybody dies.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Sat Dec 16, 2017 9:12 am
by whomever
when you call 911 and an ambulance is sent - I believe the ambulance will only tansport you to the nearest (or assigned) Hospital ER.
From reading this thread, I think there must be a lot of local variations. We had an elderly neighbor who took a number of ambulance rides (legit ones, e.g. for one we called her oncologist and gave him her vitals and the oncologist said 'call 911'). The EMTs always asked which hospital she preferred. FWIW, this was an urban area with several hospitals withing a few miles.

Given that insurance varies so much, some reasonable accommodation of the patient's preference seems reasonable, assuming all the options are equipped to treat whatever malady the patient has. My sense was that only a couple of those hospitals were set up for e.g. severe trauma, so you might be offered fewer reasonable options for that..

Re: Uber vs Ambulance - HUGE cost difference

Posted: Sat Dec 16, 2017 11:05 am
by nisiprius
miamivice wrote:
Fri Dec 15, 2017 3:02 pm
Chuck wrote:
Fri Dec 15, 2017 12:34 pm
Likewise, if I have a broken arm and can't drive, I'd call Uber, not an ambulance.
If I was an Uber driver I'd refuse any rider who was injured and wanted me to drive them to the hospital. I wouldn't want the liability of making their injury worse, or the responsibility to try to monitor them to ensure that their condition didn't degrade while I was driving them.
Or even the possibility of the vehicle needing to be cleaned afterwards.

Re: Uber vs Ambulance - HUGE cost difference

Posted: Sat Dec 16, 2017 11:33 am
by dm200
annielouise wrote:
Sat Dec 16, 2017 8:41 am
If I were having a heart attack, I would accept that dying is part of life, stay with my family, and save them the cost of both the ambulance and outrageous hospital expenses. Everybody dies.
Versus the real possibility/probability that your life cound be saved and live a normal lifespan? One thing if you are elderly and have other health issues - yet another if you are, say, 35 and in otherwise good health...