How to Minimize Your Emergency Care Expenses

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White Coat Investor
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Sat Feb 03, 2018 9:34 pm

dm200 wrote:
Sun Jan 28, 2018 12:07 pm


A few years ago, I fell very hard on my side after tripping while doing brisk walking around the neighborhood. I really had the wind knocked out of me - and had no continuing pain - except for when I first would get out of bed. My wife gave me a hard time that I might have broken rib(s) and should see the doctor. I said that even if I had broken a rib, what would they do? Normally nothing. Several years later, a heart CT scan just happened to show several healed ribs - so I had broken them. No regrets.
You'd regret it even less if you knew the treatment for broken ribs.
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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun Feb 04, 2018 9:36 am

If you want to spend less on health care, consume less health care, including emergency care. Is there some risk there? Sure. The world is a risky place to live and none of us get out alive. How much of your income are you willing to spend to reduce that risk by a small amount?
Right... I am reading (from what I believe are very credible, medical sources) that so many expensive tests, scans, etc. do nothing to decrease death rates from various conditions - and, sometimes, increase death rates. It is very challenging, though, as a patient to know when to "just say no"

A few years ago, my previous Primary Care Physician pressed me for a Thallium stress test (on a treadmill). I thought it was nonsense and resisted. However before I could have some very minor eyelid surgery, I had to get her signoff - and she would not do it without this stress test. I had it (with the risks of getting injected with radioactive thalium). The Cardiologist tells me there is a slight lack of blood flow to the tip of my heart. Could tell me nothing else "We don't know" was the universal answer. Repeat a year later - I changed NOTHING that I know. Same cardiologist. Blood flow ok. "We don't know". My insurance paid what was, I am sure, a lot. I tried to "just say no" - but was not able to do so.

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Re: How to Minimize Your Emergency Care Expenses

Post by dodecahedron » Sun Feb 04, 2018 10:00 am

dm200 wrote:
Sun Feb 04, 2018 9:36 am
A few years ago, my previous Primary Care Physician pressed me for a Thallium stress test (on a treadmill). I thought it was nonsense and resisted. However before I could have some very minor eyelid surgery, I had to get her signoff - and she would not do it without this stress test. I had it (with the risks of getting injected with radioactive thalium). The Cardiologist tells me there is a slight lack of blood flow to the tip of my heart. Could tell me nothing else "We don't know" was the universal answer. Repeat a year later - I changed NOTHING that I know. Same cardiologist. Blood flow ok. "We don't know". My insurance paid what was, I am sure, a lot. I tried to "just say no" - but was not able to do so.
Curious--were you covered by Kaiser at the time? (I was under the impression that they had reasonably rational guidelines about such decisions.)

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun Feb 04, 2018 10:34 am

dodecahedron wrote:
Sun Feb 04, 2018 10:00 am
dm200 wrote:
Sun Feb 04, 2018 9:36 am
A few years ago, my previous Primary Care Physician pressed me for a Thallium stress test (on a treadmill). I thought it was nonsense and resisted. However before I could have some very minor eyelid surgery, I had to get her signoff - and she would not do it without this stress test. I had it (with the risks of getting injected with radioactive thalium). The Cardiologist tells me there is a slight lack of blood flow to the tip of my heart. Could tell me nothing else "We don't know" was the universal answer. Repeat a year later - I changed NOTHING that I know. Same cardiologist. Blood flow ok. "We don't know". My insurance paid what was, I am sure, a lot. I tried to "just say no" - but was not able to do so.
Curious--were you covered by Kaiser at the time? (I was under the impression that they had reasonably rational guidelines about such decisions.)
No, this was a period between Kaiser coverage (employer plan - Kaiser not available). Based on my current Kaiser experience, Kaiser would not have required or even recommended this.

Since this, certainly expensive, test was fully covered by insurance - there was zero financial incentive for not doing the tests. In fact, large financial incentive to do them.

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Re: How to Minimize Your Emergency Care Expenses

Post by MrsBDG » Thu Feb 08, 2018 1:56 am

Regarding the earlier story of surgery & signing forms and doctors nowt being in network, if that happens you should appeal. If you have done your due diligence and are using an in network facility and in network main physician, and you have no control over the other guys- assistants, anesthesiologist, etc., the insurance company should pay those fees, in full. But you have to appeal and in writing.

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Re: How to Minimize Your Emergency Care Expenses

Post by keystone » Thu Feb 08, 2018 1:33 pm

White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
If you realize you screwed up and went to the ED when you shouldn't have, chalk it up to life experience and don't make that mistake again. Most of us (including me) have made that mistake.
Great post!

This is exactly what I got out of my expensive and unpleasant ER experience for pneumonia last year. I was stuck in an endless loop of medical testing and follow-up testing and I was basically held hostage for a few days in the hospital until my fever subsided. Had I just gone to an urgent care facility, I would have gotten the antibiotics that I needed and could have been miserable at home instead of miserable at a hospital at a fraction of the cost and without all of the massive billing issues.

After my experience, I tell everyone I know your rule #3 "Don't go to the Emergency Department if you don't have to"

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Thu Feb 08, 2018 1:41 pm

keystone wrote:
Thu Feb 08, 2018 1:33 pm
White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
If you realize you screwed up and went to the ED when you shouldn't have, chalk it up to life experience and don't make that mistake again. Most of us (including me) have made that mistake.
Great post!
This is exactly what I got out of my expensive and unpleasant ER experience for pneumonia last year. I was stuck in an endless loop of medical testing and follow-up testing and I was basically held hostage for a few days in the hospital until my fever subsided. Had I just gone to an urgent care facility, I would have gotten the antibiotics that I needed and could have been miserable at home instead of miserable at a hospital at a fraction of the cost and without all of the massive billing issues.
After my experience, I tell everyone I know your rule #3 "Don't go to the Emergency Department if you don't have to"
I agree. The problem/challenge is to find acceptable (financial/insurance/health risk) alternatives for situations that are not immediately life threatening but need quick attention (Urgent).

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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Thu Feb 08, 2018 9:40 pm

keystone wrote:
Thu Feb 08, 2018 1:33 pm
White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
If you realize you screwed up and went to the ED when you shouldn't have, chalk it up to life experience and don't make that mistake again. Most of us (including me) have made that mistake.
Great post!

This is exactly what I got out of my expensive and unpleasant ER experience for pneumonia last year. I was stuck in an endless loop of medical testing and follow-up testing and I was basically held hostage for a few days in the hospital until my fever subsided. Had I just gone to an urgent care facility, I would have gotten the antibiotics that I needed and could have been miserable at home instead of miserable at a hospital at a fraction of the cost and without all of the massive billing issues.

After my experience, I tell everyone I know your rule #3 "Don't go to the Emergency Department if you don't have to"
If you were admitted from the ED, it is likely the urgent care would have referred you to the ED to be admitted rather than send you home with oral antibiotics. Pneumonia patients are admitted for increased work of breathing (i.e. severe shortness of breath), low oxygen, and co-morbid conditions raising the risk of death, not because they came to the ED instead of clinic or an urgent care.
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Re: How to Minimize Your Emergency Care Expenses

Post by inbox788 » Sat Feb 10, 2018 7:13 pm

White Coat Investor wrote:
Thu Feb 08, 2018 9:40 pm
keystone wrote:
Thu Feb 08, 2018 1:33 pm
White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
If you realize you screwed up and went to the ED when you shouldn't have, chalk it up to life experience and don't make that mistake again. Most of us (including me) have made that mistake.
Great post!

This is exactly what I got out of my expensive and unpleasant ER experience for pneumonia last year. I was stuck in an endless loop of medical testing and follow-up testing and I was basically held hostage for a few days in the hospital until my fever subsided. Had I just gone to an urgent care facility, I would have gotten the antibiotics that I needed and could have been miserable at home instead of miserable at a hospital at a fraction of the cost and without all of the massive billing issues.

After my experience, I tell everyone I know your rule #3 "Don't go to the Emergency Department if you don't have to"
If you were admitted from the ED, it is likely the urgent care would have referred you to the ED to be admitted rather than send you home with oral antibiotics. Pneumonia patients are admitted for increased work of breathing (i.e. severe shortness of breath), low oxygen, and co-morbid conditions raising the risk of death, not because they came to the ED instead of clinic or an urgent care.
If there was only a simple way to decide "if you have to". Usually flu isn't life threatening, but this year, it's been hitting especially hard, including less vulnerable healthy populations. It's very sad to hear about deaths, but it's especially sad to hear about people that have been hospitalized, getting better and released only to suddenly get worse and not make it.

The rule #3 is actually the corollary to the rule, "If you have an emergency, go to the ER", and the threshold for "if you have to" should be lower.

https://www.usatoday.com/story/news/201 ... 322928002/

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Re: How to Minimize Your Emergency Care Expenses

Post by tarnation » Sat Feb 10, 2018 7:32 pm

White Coat Investor wrote:
Sat Feb 03, 2018 9:33 pm
tarnation wrote:
Sun Jan 28, 2018 11:41 pm
I think the info on billing and insurance and all that is informative. However, in my opinion, reducing costs by not receiving or declining emergency medical care has to be some of the worst advice I have seen on this forum (or anywhere maybe). The OP may feel confident second guessing medical experts, but to encourage lay persons to do so is questionable at best, reckless at worst.

Personally, one reason I have a job, insurance, and savings is to afford emergency care for myself and my family. That's a high priority; it ranks at the top of the list. I hope some poor soul doesn't read this and die in an Uber trying to transport themselves to another hospital.
Yes, please keep coming in. :) I'm sending my kids to college using fees collected from people who feel the same way you do about emergency care.

As I explain to my nurses, anxiety pays about 1/3 of our salaries so don't get too upset with the nervous nellies coming in worried their 15 second episode of chest pain could be something serious.

If you want to spend less on health care, consume less health care, including emergency care. Is there some risk there? Sure. The world is a risky place to live and none of us get out alive. How much of your income are you willing to spend to reduce that risk by a small amount?
The previous post about pneumonia I think supports my point. As an MD, you are far better equipped to second guess medical advice, the rest of us not so much. I had a old high school friend with a mole on his chest, no biggie, until a year later he found out it was some form of melanoma that doesn't produce melanin ([removed --admin LadyGeek]). When he died, he left behind a Wife and six year old son. Saving money by skimping on medical care makes no sense to me. I know there are some cheap folks on here, but valuing money over survival is pathological. Lastly, I found your tone to be condescending/mocking e.g. nervous nellies and also reinforces my stereotypical opinion of MDs.
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Sat Feb 10, 2018 8:48 pm

inbox788 wrote:
Sat Feb 10, 2018 7:13 pm
White Coat Investor wrote:
Thu Feb 08, 2018 9:40 pm
keystone wrote:
Thu Feb 08, 2018 1:33 pm
White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
If you realize you screwed up and went to the ED when you shouldn't have, chalk it up to life experience and don't make that mistake again. Most of us (including me) have made that mistake.
Great post!

This is exactly what I got out of my expensive and unpleasant ER experience for pneumonia last year. I was stuck in an endless loop of medical testing and follow-up testing and I was basically held hostage for a few days in the hospital until my fever subsided. Had I just gone to an urgent care facility, I would have gotten the antibiotics that I needed and could have been miserable at home instead of miserable at a hospital at a fraction of the cost and without all of the massive billing issues.

After my experience, I tell everyone I know your rule #3 "Don't go to the Emergency Department if you don't have to"
If you were admitted from the ED, it is likely the urgent care would have referred you to the ED to be admitted rather than send you home with oral antibiotics. Pneumonia patients are admitted for increased work of breathing (i.e. severe shortness of breath), low oxygen, and co-morbid conditions raising the risk of death, not because they came to the ED instead of clinic or an urgent care.
If there was only a simple way to decide "if you have to". Usually flu isn't life threatening, but this year, it's been hitting especially hard, including less vulnerable healthy populations. It's very sad to hear about deaths, but it's especially sad to hear about people that have been hospitalized, getting better and released only to suddenly get worse and not make it.

The rule #3 is actually the corollary to the rule, "If you have an emergency, go to the ER", and the threshold for "if you have to" should be lower.

https://www.usatoday.com/story/news/201 ... 322928002/
That's why they have the "prudent layman" rule and why stuff like Anthem's latest antics can't be the method. As I mentioned to Tarnation (and apparently offended him/her doing so) come on in! We won't object. But we will send you a bill.

If you are worried you are having an emergency, come to the emergency department. If you think it is really bad, call 911. But don't be surprised if you end up spending a significant chunk of money on emergency care. It's your call and your money. Your choice and your consequences. But if you want to spend less on medical care, consume less medical care and what you do consume, consume in the least expensive setting possible.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun Feb 11, 2018 9:53 am

The previous post about pneumonia I think supports my point. As an MD, you are far better equipped to second guess medical advice, the rest of us not so much. I had a old high school friend with a mole on his chest, no biggie, until a year later he found out it was some form of melanoma that doesn't produce melanin ([removed --admin LadyGeek]). When he died, he left behind a Wife and six year old son. Saving money by skimping on medical care makes no sense to me. I know there are some cheap folks on here, but valuing money over survival is pathological. Lastly, I found your tone to be condescending/mocking e.g. nervous nellies and also reinforces my stereotypical opinion of MDs.
A continuing dilemma - let small (or appearing small) things go - and serious conditions are not diagnosed early - BUT I see many, credible reports and studies showing the real risks and dangers of the risks of too many tests.

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Re: How to Minimize Your Emergency Care Expenses

Post by chessknt » Sun Feb 11, 2018 11:43 am

CppCoder wrote:
Sat Jan 20, 2018 4:48 pm
I didn't say unionize. I said organize. As one of the largest lobbying groups in the U.S. (according to Wikipedia, anyway), what exactly does the AMA do? I'm an engineer in oil and gas. I'm proud that I help power the world, provide electricity, and provide transportation. My job has a positive effect on humanity, just like yours. I don't think I'm ethically obligated to work, though. OK, maybe you do.
I would like to point out that the ama does not represent physicians despite its deceptive name. It is a business group that exists to monopolize cpt coding and ensure it remains the only official language of cms. The majority of physicians do not belong to this group given its emphasis on prioritizing this at the great profit to its advisory board. True physician lobbying occurs through board specialty groups and, as such, is highly fragmented and ineffective (and at times contradictory).

Also the idea of striking to produce change doesn't translate in to health care where people are on ventilators. If we all take the day off work we guarantee that people will die.

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Re: How to Minimize Your Emergency Care Expenses

Post by PlayingLife » Wed Feb 21, 2018 7:34 am

Bookmarked, quality BH post right here thank you. Two years ago we had our first child, I remember an incredible YouTube video in which a "soon to be" parent did hours and hours of research to figure out the cost in advance. He interviewed the hospital, OBGYN's office, all related parties. He low balled it by I think $5-10K once it was all said and done.

TravelforFun
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Re: How to Minimize Your Emergency Care Expenses

Post by TravelforFun » Thu Mar 01, 2018 7:53 pm

 "I'm willing to share this risk with you if it can save me substantial amounts of money" 

I'm not sure if the emergecy doctor would want to take the patient's words for it. Great summary though. I appreciate it.
TravelforFun

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Re: How to Minimize Your Emergency Care Expenses

Post by climber2020 » Thu Mar 01, 2018 8:22 pm

naturaforver wrote:
Thu Mar 01, 2018 7:25 pm
dm200 wrote:
Thu Mar 01, 2018 7:11 pm
naturaforver wrote:
Thu Mar 01, 2018 6:28 pm
I would also add that use natural medicines where possible.
We are big believers in homeopathy and it works beautifully for flu, fever, stomach and other areas that lead you to emergency.
Ofcourse if its a true emergency, then again you should just get good care first.
Homeopathy is actually nothing and has been completely discredited by science. I hope nobody here believes you.
Thank you, appreciate your update. It has worked for me and worked for many across the world(am not associated with them).. again am not here to debate my opinion nor disagree with yours.
No need for opinion. Properly designed randomized clinical trials on the medicines and techniques will show whether something either works or is a bunch of nonsense. It's unfortunate - but not surprising at all - that such studies are lacking in the subject of homeopathy.

A more cynical way to look at it: if something works well, you can bet that a pharmaceutical company will isolate it, put it in a pill, patent it, and sell it for $5000.

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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Thu Mar 01, 2018 9:41 pm

White Coat Investor wrote:
Fri Jan 26, 2018 12:19 am
sawhorse wrote:
Thu Jan 25, 2018 11:56 pm
White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
An ambulance ride costs $1500-2000. An Uber costs $20. If you need the ambulance, for heaven's sake call it. But if not, call an Uber. This also applies to interhospital transfers. "Doc, I don't want to go by ambulance because it's so expensive. I know there is the liability thing, but I'd be willing to sign all that Against Medical Advice paperwork if you think the chances of something happening to me en route are less than 10%."
How many hospitals allow this? I asked to take a taxi once instead of a ambulance, and they said no. It wasn't due to medical necessity. According to the nurse they just don't allow it. They even insist on transferring someone to another building of the hospital complex by ambulance, no doubt at a pretty hefty price.
It's a hospital, not a prison. It doesn't matter what they "allow." You say, "Nope, my son is driving me, where's the AMA paperwork for me to sign?"

Our policy is to transfer every one by ambulance, but the only ones I can force to do that are the suicidal ones.
My hospital would not discharge me after a colonoscopy unless there is someone to pick me up. They would not agree for me taking a taxi. Is there a way for me to assert that it's a hospital, not a prison?

Victoria
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Re: How to Minimize Your Emergency Care Expenses

Post by Lynette » Thu Mar 01, 2018 9:51 pm

Some hospitals will not start surgery until they personally meet the person who is going to take you home.

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Re: How to Minimize Your Emergency Care Expenses

Post by jalbert » Thu Mar 01, 2018 9:56 pm

If you can't afford health insurance, apply for Medicaid. If you don't qualify, try to buy through a PPACA exchange. If you have a very low income, the subsidies are typically quite large and most of the middle class qualifies for a subsidy of some type. Even a family of 4 making $80K might be able to buy health insurance at a 50% discount after the tax subsidy.
In states that did not expand medicaid, people who do not earn enough to qualify for a premium tax credit would find the full premium on the cheapest plan quite burdensome, but are unlikely to qualify for medicaid. This is a very serious problem in those states.

The ACA individual plans seem to be moving in the direction of EPOs with narrow networks. Under ACA emergency care is always in network but otherwise, EPOs do not provide coverage for any out of network care. Be sure to follow insurance provider procedures so that you do not have major out of network care causing out of pocket costs that will greatly exceed the out of pocket max for the policy. (I assume the hospital has an interest in making that happen as well, e.g. transfering to an in-network hospital, as they want to be paid if they provide the care, but it is ridiculous that, ultimately, the onus is on a patient having a life threatening emergency to be sure procedures are followed if the hospital makes a mistake in evaluating the insurance).

With an EPO, balance billing for out of network doctors or services will be 100% of the bill. Would another motive for unnegotiated fees being set very high be that when bills for uninsured care is written off and sold for pennies on the dollar, the final number is closer to what the provider normally charges in-network?
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Fri Mar 02, 2018 10:19 am

VictoriaF wrote:
Thu Mar 01, 2018 9:41 pm
White Coat Investor wrote:
Fri Jan 26, 2018 12:19 am
sawhorse wrote:
Thu Jan 25, 2018 11:56 pm
White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
An ambulance ride costs $1500-2000. An Uber costs $20. If you need the ambulance, for heaven's sake call it. But if not, call an Uber. This also applies to interhospital transfers. "Doc, I don't want to go by ambulance because it's so expensive. I know there is the liability thing, but I'd be willing to sign all that Against Medical Advice paperwork if you think the chances of something happening to me en route are less than 10%."
How many hospitals allow this? I asked to take a taxi once instead of a ambulance, and they said no. It wasn't due to medical necessity. According to the nurse they just don't allow it. They even insist on transferring someone to another building of the hospital complex by ambulance, no doubt at a pretty hefty price.
It's a hospital, not a prison. It doesn't matter what they "allow." You say, "Nope, my son is driving me, where's the AMA paperwork for me to sign?"
Our policy is to transfer every one by ambulance, but the only ones I can force to do that are the suicidal ones.
My hospital would not discharge me after a colonoscopy unless there is someone to pick me up. They would not agree for me taking a taxi. Is there a way for me to assert that it's a hospital, not a prison?
Victoria
I/we have the same requirements (Kaiser - Wash DC area) for outpatient surgery, colonoscopies, etc. Fortunately, in our case, I can be with my wife and my wife with me. In looking at the "fine print" of this requirement, it turns out that we could take a taxi home, BUT another responsible adult must also be with the patient. So, for example, if my wife did not feel comfortable actually driving me home after a colonoscopy or outpatient surgery, we could (both) take a taxi home.

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Re: How to Minimize Your Emergency Care Expenses

Post by Diogenes » Fri Mar 02, 2018 10:45 am

Interesting and detailed post. A 1-2 paragraph executive summary might be useful to stick on the refrigerator.
A couple of questions:

1. Why is a Morphine shot in the ER so much more? Why should it be?
2. Why are the ER visits in the U.S. so much more than in most other first-world countries?
3. How many patients in the ER actually pay these amounts? For example, if an illegal alien shows up with no medical coverage, what do they pay? Who pays the rest?

Discouraging someone who needs urgent care is not the answer, as you noted. Having a person triage themselves at a stressful time likewise is not workable. So what's the best solution?

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Fri Mar 02, 2018 10:56 am

Diogenes wrote:
Fri Mar 02, 2018 10:45 am
Interesting and detailed post. A 1-2 paragraph executive summary might be useful to stick on the refrigerator.
A couple of questions:
1. Why is a Morphine shot in the ER so much more? Why should it be?
2. Why are the ER visits in the U.S. so much more than in most other first-world countries?
3. How many patients in the ER actually pay these amounts? For example, if an illegal alien shows up with no medical coverage, what do they pay? Who pays the rest?
Discouraging someone who needs urgent care is not the answer, as you noted. Having a person triage themselves at a stressful time likewise is not workable. So what's the best solution?
Very good questions.

I believe there may be statistics on this, but I suspect that a great many services at a hospital ER are not paid for by patients or their insurance (many have none). I suspect, therefore, that those who do pay (or have insurance) pay a lot more as a result. I wonder if having more folks insured (ACA and/or Medicaid expansion) has changed that?

With previous physician(s), we had no access to after hours urgent or emergency medical services. Being a "responsible" patient and not wanting to use a Hospital ER, I noticed several urgent care centers nearby. I could not see any of these centers in our insurance book, so I called the insurance company to ask which ones we could use under our plan. They refused to tell me. What? OK, they said, if I gave them specifics - then they could answer whether it would be covered. They acted like this was some sort of national secret. Wotrhless...

I am so glad, now, that we have Kaiser urgent care 24x7 - that we would use 99% of the time for almost any after hours urgent or emergency needs.

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Re: How to Minimize Your Emergency Care Expenses

Post by LadyGeek » Sat Mar 03, 2018 4:47 pm

I moved a suggestion on reducing the cost of a colonoscopy into a new thread. The discussion was getting derailed. See: [Minimizing costs of a medical procedure (Colonoscopy)]
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Re: How to Minimize Your Emergency Care Expenses

Post by Sunflower » Sat Mar 03, 2018 9:57 pm

VictoriaF wrote:
Thu Mar 01, 2018 9:41 pm
White Coat Investor wrote:
Fri Jan 26, 2018 12:19 am
sawhorse wrote:
Thu Jan 25, 2018 11:56 pm
White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
An ambulance ride costs $1500-2000. An Uber costs $20. If you need the ambulance, for heaven's sake call it. But if not, call an Uber. This also applies to interhospital transfers. "Doc, I don't want to go by ambulance because it's so expensive. I know there is the liability thing, but I'd be willing to sign all that Against Medical Advice paperwork if you think the chances of something happening to me en route are less than 10%."
How many hospitals allow this? I asked to take a taxi once instead of a ambulance, and they said no. It wasn't due to medical necessity. According to the nurse they just don't allow it. They even insist on transferring someone to another building of the hospital complex by ambulance, no doubt at a pretty hefty price.
It's a hospital, not a prison. It doesn't matter what they "allow." You say, "Nope, my son is driving me, where's the AMA paperwork for me to sign?"

Our policy is to transfer every one by ambulance, but the only ones I can force to do that are the suicidal ones.
My hospital would not discharge me after a colonoscopy unless there is someone to pick me up. They would not agree for me taking a taxi. Is there a way for me to assert that it's a hospital, not a prison?

Victoria
I was told this too. So does this mean a person living alone without family/friends will be refused treatment? Is this why single people have a shorter life? :shock:

When I said there was no one to escort me, so what does one do in these instances, I was given the names of medical transport services. These are not only ambulances or van transport. This was a small car and a guy who carried a clipboard. Lol Seriously, the difference between him and a taxi was he walked into the medical building, into the office, and walked with me to his car. I didn't need physical assistance at all. Also, the other difference from a taxi is the more expensive cost. But look into medical transport companies - they're not just ambulances or wheelchair transport.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun Mar 04, 2018 9:23 am

I was told this too. So does this mean a person living alone without family/friends will be refused treatment? Is this why single people have a shorter life? :shock:

When I said there was no one to escort me, so what does one do in these instances, I was given the names of medical transport services. These are not only ambulances or van transport. This was a small car and a guy who carried a clipboard. Lol Seriously, the difference between him and a taxi was he walked into the medical building, into the office, and walked with me to his car. I didn't need physical assistance at all. Also, the other difference from a taxi is the more expensive cost. But look into medical transport companies - they're not just ambulances or wheelchair transport.
Fortunately, my wife and I can do this for each other (now). I also did this for a single friend who had a colonscopy. In many (probably most) such cases, the "companion" would need no medical credentials at all.

Is there an opportunity for being paid to do this?

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Sun Mar 04, 2018 6:35 pm

dm200 wrote:
Sun Mar 04, 2018 9:23 am
I was told this too. So does this mean a person living alone without family/friends will be refused treatment? Is this why single people have a shorter life? :shock:

When I said there was no one to escort me, so what does one do in these instances, I was given the names of medical transport services. These are not only ambulances or van transport. This was a small car and a guy who carried a clipboard. Lol Seriously, the difference between him and a taxi was he walked into the medical building, into the office, and walked with me to his car. I didn't need physical assistance at all. Also, the other difference from a taxi is the more expensive cost. But look into medical transport companies - they're not just ambulances or wheelchair transport.
Fortunately, my wife and I can do this for each other (now). I also did this for a single friend who had a colonscopy. In many (probably most) such cases, the "companion" would need no medical credentials at all.

Is there an opportunity for being paid to do this?
Yes, there are nursing services that provide people to take you to and from appointments. I've used them myself on occasion.

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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Sun Mar 04, 2018 6:37 pm

dm200 wrote:
Sun Mar 04, 2018 9:23 am
I was told this too. So does this mean a person living alone without family/friends will be refused treatment? Is this why single people have a shorter life? :shock:

When I said there was no one to escort me, so what does one do in these instances, I was given the names of medical transport services. These are not only ambulances or van transport. This was a small car and a guy who carried a clipboard. Lol Seriously, the difference between him and a taxi was he walked into the medical building, into the office, and walked with me to his car. I didn't need physical assistance at all. Also, the other difference from a taxi is the more expensive cost. But look into medical transport companies - they're not just ambulances or wheelchair transport.
Fortunately, my wife and I can do this for each other (now). I also did this for a single friend who had a colonscopy. In many (probably most) such cases, the "companion" would need no medical credentials at all.

Is there an opportunity for being paid to do this?
There are home health agencies that will drive people to medical appointments, wait, and take them home, not just provide services *in* the home. We've used this type of service when MIL needed to get to medical appointments and we were out of town. In this case, we were able to request one of the same three people who had helped with in home (in assisted living, that is) after she was discharged from rehab.

These people do have some medical training (different types for different level assistants), so it's probably better than "a guy with a clipboard" :confused

And if someone is "woozy" after anesthesia, it wouldn't be a bad idea to have the person stay with you for a few hours (or however much time needed) so that you weren't at risk of falling once home, etc.

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Re: How to Minimize Your Emergency Care Expenses

Post by eye.surgeon » Sun Mar 04, 2018 6:42 pm

Excellent advise and summary.

As a physician that frequently gets called to the ER I'm frequently dismayed at how many of the problems I see could have been easily seen in my office. Unfortunately as a general rule the less you actually contribute to your healthcare costs the more egregious the abuse.
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Mon Mar 05, 2018 2:01 am

VictoriaF wrote:
Thu Mar 01, 2018 9:41 pm
My hospital would not discharge me after a colonoscopy unless there is someone to pick me up. They would not agree for me taking a taxi. Is there a way for me to assert that it's a hospital, not a prison?

Victoria
"Goodbye, I'm leaving now. If you want to keep my paperwork, knock yourself out, but you can't keep me."

This assumes you're actually awake, of course. If you truly aren't in your right mind, they do have the right to hold you. Our nurses often don't give you your percocet prescription until they see the face of the person taking you home, but they won't tackle you if you walk out without said prescription and discharge paperwork.

You can always sit there and stare at them until they let you go, asking every 10 minutes "can I go yet?" Eventually, you win. Or just get a ride home from a friend, which is probably the best choice.
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Mon Mar 05, 2018 2:05 am

dm200 wrote:
Fri Mar 02, 2018 10:56 am
Diogenes wrote:
Fri Mar 02, 2018 10:45 am
Interesting and detailed post. A 1-2 paragraph executive summary might be useful to stick on the refrigerator.
A couple of questions:
1. Why is a Morphine shot in the ER so much more? Why should it be?
2. Why are the ER visits in the U.S. so much more than in most other first-world countries?
3. How many patients in the ER actually pay these amounts? For example, if an illegal alien shows up with no medical coverage, what do they pay? Who pays the rest?
Discouraging someone who needs urgent care is not the answer, as you noted. Having a person triage themselves at a stressful time likewise is not workable. So what's the best solution?
Very good questions.

I believe there may be statistics on this, but I suspect that a great many services at a hospital ER are not paid for by patients or their insurance (many have none). I suspect, therefore, that those who do pay (or have insurance) pay a lot more as a result. I wonder if having more folks insured (ACA and/or Medicaid expansion) has changed that?

With previous physician(s), we had no access to after hours urgent or emergency medical services. Being a "responsible" patient and not wanting to use a Hospital ER, I noticed several urgent care centers nearby. I could not see any of these centers in our insurance book, so I called the insurance company to ask which ones we could use under our plan. They refused to tell me. What? OK, they said, if I gave them specifics - then they could answer whether it would be covered. They acted like this was some sort of national secret. Wotrhless...

I am so glad, now, that we have Kaiser urgent care 24x7 - that we would use 99% of the time for almost any after hours urgent or emergency needs.
This idea that "those with insurance pay more" is widely believed, but probably not true. If you have insurance, I try to get as much from you and your insurance company as I can for my services. If you don't have insurance, I try to get as much from you as I can, but probably get nothing. But there's no way I know of to shift the costs from those who don't pay me to those who do. I just eat the losses from those who don't pay me. An insurance company doesn't contract with me for more money because they know 20% of my patients don't pay me. Why would they do that? And the government certainly doesn't give me anything for EMTALA-mandated care. Seriously- the docs and hospitals just eat it. Now if they weren't doing well from the 50-80% that do pay, they'd obviously go out of business, but that's not the same thing.
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Mon Mar 05, 2018 2:09 am

Diogenes wrote:
Fri Mar 02, 2018 10:45 am
Interesting and detailed post. A 1-2 paragraph executive summary might be useful to stick on the refrigerator.
A couple of questions:

1. Why is a Morphine shot in the ER so much more? Why should it be?
2. Why are the ER visits in the U.S. so much more than in most other first-world countries?
3. How many patients in the ER actually pay these amounts? For example, if an illegal alien shows up with no medical coverage, what do they pay? Who pays the rest?

Discouraging someone who needs urgent care is not the answer, as you noted. Having a person triage themselves at a stressful time likewise is not workable. So what's the best solution?
1. Because we can. Business isn't about "what should be," it's about charging what you can. Why should a MLB ticket cost more than a college football ticket or vice versa? Pricing isn't based on someone's value system, it's based on the market. Two willing parties making an exchange. The problem with healthcare is there isn't a functioning market. That's why the pricing is so nonsensical. BTW, where else do you get a morphine shot? I don't know of any clinics or urgent cares that give morphine shots. Do you?
2. System broken. See OP.
3. Nobody pays. I eat the opportunity cost of my time, the hospital eats the cost of its employees and materials.

Best solution is increase transparency of pricing, increase transparency of effectiveness, and increase "skin in the game" and go with a market based system. The only other alternative is avoid a market based system and go with "death panels" that decide what care is given and when, or some combination of the two approaches.
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Re: How to Minimize Your Emergency Care Expenses

Post by LadyGeek » Mon Mar 05, 2018 5:01 pm

Let's keep the discussion focused on Emergency Care Expenses.
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Mon Mar 05, 2018 5:46 pm

I just had a conversation with an acqaintence - who has the same health plan we DW and I. Our local jurisdiction has a very competent and responsive "ambulance" service based at all the firehouses around the jurisdiction. However, that service will only transport you to the Emergency Room at the nearby hospital. [and if they transport you, your insuarance company and/or you will receive a hefty bill]. Especially as we age, mobility issues/problems can require their services, even though the condition may not require a visit to the ER (urgent not "emergency").

Apparently (I plan to investigate further), if they assist you (let's say you fall upstairs and need assistance to get up and down the stairs) - you can then decline (no charge) transportation. For various reasons, I can see that my wife is likely to encounter such a situation where I cannot do the required assistance, but if she were downstairs - it would be ok for me to drive her to the Urgent care facility of our health plan. There would then be NO ambulalce expense AND the required payment would be much less than the hospital ER. Based on our experiences with that 24x7 Urgent care facility - the care would be quicker and better than at the hospital ER.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Mon Mar 05, 2018 6:28 pm

Again, depending on the nature of the condition, some (mine does) health plans/providers have "hot lines" or advice lines to consult for various conditions that can help a lay person decide how urgent a condiiton might be. DW and I found this especially helpful when child(ren) were small. Maybe a phone conversation could mean you can very safely wait to see your regular physician.

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Re: How to Minimize Your Emergency Care Expenses

Post by Diogenes » Tue Mar 06, 2018 10:14 am

White Coat Investor wrote:
Mon Mar 05, 2018 2:09 am
Diogenes wrote:
Fri Mar 02, 2018 10:45 am
Interesting and detailed post. A 1-2 paragraph executive summary might be useful to stick on the refrigerator.
A couple of questions:

1. Why is a Morphine shot in the ER so much more? Why should it be?
2. Why are the ER visits in the U.S. so much more than in most other first-world countries?
3. How many patients in the ER actually pay these amounts? For example, if an illegal alien shows up with no medical coverage, what do they pay? Who pays the rest?

Discouraging someone who needs urgent care is not the answer, as you noted. Having a person triage themselves at a stressful time likewise is not workable. So what's the best solution?
1. Because we can. Business isn't about "what should be," it's about charging what you can. Why should a MLB ticket cost more than a college football ticket or vice versa? Pricing isn't based on someone's value system, it's based on the market. Two willing parties making an exchange. The problem with healthcare is there isn't a functioning market. That's why the pricing is so nonsensical. BTW, where else do you get a morphine shot? I don't know of any clinics or urgent cares that give morphine shots. Do you?
2. System broken. See OP.
3. Nobody pays. I eat the opportunity cost of my time, the hospital eats the cost of its employees and materials.

Best solution is increase transparency of pricing, increase transparency of effectiveness, and increase "skin in the game" and go with a market based system. The only other alternative is avoid a market based system and go with "death panels" that decide what care is given and when, or some combination of the two approaches.
'Business' is a negotiation. Quite a bit of difference in the negotiation if you're buying a ticket to an MLB game versus when you are laying on a table in the ER. If you don't like the price of the ticket for the game, you ask for a cheaper one or hang up the phone. If the ticket office says "I don't know" when asked the price of the ticket, you hang up the phone. That's what makes it very different than simply 'business' in an ER.

I doubt that the hospital eats the costs of folks that don't pay overall, even though an individual physician frequently may. Logic dictates that everyone else (who pays) is charged more in the end, one way or another. Capitalism 101. If that's not the case, I would sure like to see some proof, as that 's not the way any business survives.

It's fine if prices in the ER are much higher for the same treatment or medication to discourage overuse, or to cover 24/7 availability for a variety of situations, etc. 'Skin in the game' is great if the customer knows what the 'game' is. It must be transparent, as you said. The USA has top quality medical care and is most-frequently on the cutting edge. Amazing really. But it's these issues that cause it to appear otherwise.

A first step to making a system more transparent and actually market driven may be for those providing the service to actually know the prices that will be charged and tell the customer upfront as a matter of routine, which they don't as you said. The second may be to admit the real reasons the prices are so high. The third probably is serious tort reform, which is another topic...

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Mar 06, 2018 11:38 am

There are many things about US medical care that are puzzling/confusing.

In this area (Washington DC and Virginia/Maryland suburbs), Kaiser is big and growing. What Kaiser did here is establish and expand its own dedicated Urgent Care (24x7) facilities and have several be able to keep patients (some very sick) up to 24 hours. The costs to Kaiser patients are much lower than a hospital ER and, I am sure, even much lower to Kaiser.

I would have thought that with the large patient base, Kaiser could have made arrangements with the various hospitals to share resources and reduce costs for all concerned. Guess, though, it could not be done.

For a few years over the last decade or two, there was also a rapid growth of small standalone urgent care centers (two within a few blocks of my house). Then, in more recent years, a big hospital conglomerate has been buying them up - and now part of the big complex. I suppose those Physicians that started them may have done well financially in such sales.


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Re: How to Minimize Your Emergency Care Expenses

Post by boogle » Sat Mar 31, 2018 12:24 pm

White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
Problems that can be solved with money aren't problems when you have money.
This is inspired writing. Thanks for sharing.

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Re: How to Minimize Your Emergency Care Expenses

Post by sschullo » Wed Apr 04, 2018 7:53 pm

I am extremely lucky to have two health care plans, the VA and from work in retirement for life. I skipped over your post realizing once again, how lucky I do not have to use the complicated information you provide and take two or three hours of my time trying to understand it:
Plus
1. I live in Rancho Mirage, CA, a city that will pay for ambulance service for all citizens. But I don't need them because my HMO covers it as well.
2. I am a veteran and get low-cost medications and free service, and have a new clinic in my neighborhood. Lucky for me at age 70, I take no daily medications.
3. I also have an HMO, Kaiser, so all I have to pay is a $5.00 copay for anything, check-ups, surgery, flu shots are free. I had hernia surgery with a $5.00 copay and had to pay for the painkiller Vicodin. That's it.
Bonus, I even have some dental and some vision coverage.
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Thu Apr 05, 2018 12:53 am

sschullo wrote:
Wed Apr 04, 2018 7:53 pm
I am extremely lucky to have two health care plans, the VA and from work in retirement for life. I skipped over your post realizing once again, how lucky I do not have to use the complicated information you provide and take two or three hours of my time trying to understand it:
Plus
1. I live in Rancho Mirage, CA, a city that will pay for ambulance service for all citizens. But I don't need them because my HMO covers it as well.
2. I am a veteran and get low-cost medications and free service, and have a new clinic in my neighborhood. Lucky for me at age 70, I take no daily medications.
3. I also have an HMO, Kaiser, so all I have to pay is a $5.00 copay for anything, check-ups, surgery, flu shots are free. I had hernia surgery with a $5.00 copay and had to pay for the painkiller Vicodin. That's it.
Bonus, I even have some dental and some vision coverage.
Unfortunately for the people, your situation is becoming more and more rare all the time. Unfortunately for the system, it's all very expensive stuff even if the charge to you isn't very high.
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Re: How to Minimize Your Emergency Care Expenses

Post by denovo » Thu Apr 05, 2018 12:57 am

kjvmartin wrote:
Mon Mar 05, 2018 11:58 am
dm200 wrote:
Mon Mar 05, 2018 9:19 am

Neither are we (as a society, or government, etc.) generally willing to "force" folks to do healthful/lower risk things, sich as getting all relevant immunizations and make "lifestyle" changes.

Would we give out cigaretttes if they were free and folks like it? Not today, but that was done 50-60 years ago by some.
It's interesting how some things were considered healthy many decades ago. There are advertisements from the 1930s through the 1950s where doctors recommended cigarettes! My late grandmother was encouraged to smoke by her doctor. Doctors often seem to "tow the party line" on issues. Our first child received recommended vaccinations, to a point. We started seeing the signs of autism. Research is always advancing and what's common sense right now might very well be looked back on like smoking in the 1930s

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Re: How to Minimize Your Emergency Care Expenses

Post by sschullo » Thu Apr 05, 2018 6:53 am

White Coat Investor wrote:
Thu Apr 05, 2018 12:53 am
sschullo wrote:
Wed Apr 04, 2018 7:53 pm
I am extremely lucky to have two health care plans, the VA and from work in retirement for life. I skipped over your post realizing once again, how lucky I do not have to use the complicated information you provide and take two or three hours of my time trying to understand it:
Plus
1. I live in Rancho Mirage, CA, a city that will pay for ambulance service for all citizens. But I don't need them because my HMO covers it as well.
2. I am a veteran and get low-cost medications and free service, and have a new clinic in my neighborhood. Lucky for me at age 70, I take no daily medications.
3. I also have an HMO, Kaiser, so all I have to pay is a $5.00 copay for anything, check-ups, surgery, flu shots are free. I had hernia surgery with a $5.00 copay and had to pay for the painkiller Vicodin. That's it.
Bonus, I even have some dental and some vision coverage.
Unfortunately for the people, your situation is becoming more and more rare all the time. Unfortunately for the system, it's all very expensive stuff even if the charge to you isn't very high.
Yeah. My medical service professionals are getting paid by a system that has to get paid either from insurance companies, other patients, and/or the government, since and I am not paying out of pocket. In my situation, I got wounded in one of our country's numerous wars, so the federal entitlement program is paying for my VA services for the rest of my life. I also was extremely lucky that I selected a profession that didn't pay much in salary, but had a strong union, and provided both a pension plan and health benefits for life (and I saved in my 403(b).

As you said, that my situation is rare for more and more people. But we know the past. My mother also had a strong union and a defined pension with a rare benefit--prescription drug coverage back in the 70s, 80s and 90s! 3M was way ahead of its time! She worked for 3M as an assembly line worker earning 50 cents an hour back in the early 1950s. 3M continues to be a powerful and huge multinational corporation but all of the unions, pension and of course the prescription drug coverage are all gone now.

This is one reason why people are angry and afraid. Why have so many in the private sector made the conscious decision to drop defined pension plans and medical coverage, EVEN DURING EMPLOYMENT (not talking about in retirement)? Anyway, heading into politics and our lovely ladygeek will close down this discussion, as she should. The problem with our medical delivery system, unfortunately, will not be solved anytime soon.

There is one small light of hope, as I mentioned my city pays for ambulance services. It also has a mission to provide low-income housing which is rare in a wealthy, country club culture conservative population.
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Re: How to Minimize Your Emergency Care Expenses

Post by boglegirl » Fri Apr 13, 2018 4:15 pm

sschullo wrote:
Wed Apr 04, 2018 7:53 pm
...
1. I live in Rancho Mirage, CA, a city that will pay for ambulance service for all citizens. But I don't need them because my HMO covers it as well.
...
The bolded is not exactly correct. According to the city's website, they bill your insurance ("Medicare and other health-care insurance providers") and accept their payment as payment in full, with no balance billing to city residents if it's not covered at 100%. So the city isn't paying for this benefit (except for the balance waiver) - Medicare and private insurers are paying for it.

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Re: How to Minimize Your Emergency Care Expenses

Post by sschullo » Tue Apr 17, 2018 2:00 pm

boglegirl wrote:
Fri Apr 13, 2018 4:15 pm
sschullo wrote:
Wed Apr 04, 2018 7:53 pm
...
1. I live in Rancho Mirage, CA, a city that will pay for ambulance service for all citizens. But I don't need them because my HMO covers it as well.
...
The bolded is not exactly correct. According to the city's website, they bill your insurance ("Medicare and other health-care insurance providers") and accept their payment as payment in full, with no balance billing to city residents if it's not covered at 100%. So the city isn't paying for this benefit (except for the balance waiver) - Medicare and private insurers are paying for it.
My wording is not correct but the concept of no ambulance service bill for all citizens in the city is correct.
I called the city manager in charge of this benefit. He said what you said Medicare and private insurers are paying for it, but if I were to live in a neighboring city, I would have to pay the difference of what my insurance covered and what the ambulance actually charged. Rancho Mirage made a deal with all of the insurance companies that the ambulance service will only collect the insurance payment and the excess will be waived to us citizens. All citizens are covered. Rancho Mirage does not "punish" people for not having insurance.
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Re: How to Minimize Your Emergency Care Expenses

Post by ShabonScribe » Sun Apr 22, 2018 6:13 pm

sschullo wrote:
Tue Apr 17, 2018 2:00 pm
boglegirl wrote:
Fri Apr 13, 2018 4:15 pm
sschullo wrote:
Wed Apr 04, 2018 7:53 pm
...
1. I live in Rancho Mirage, CA, a city that will pay for ambulance service for all citizens. But I don't need them because my HMO covers it as well.
...
The bolded is not exactly correct. According to the city's website, they bill your insurance ("Medicare and other health-care insurance providers") and accept their payment as payment in full, with no balance billing to city residents if it's not covered at 100%. So the city isn't paying for this benefit (except for the balance waiver) - Medicare and private insurers are paying for it.
My wording is not correct but the concept of no ambulance service bill for all citizens in the city is correct.
I called the city manager in charge of this benefit. He said what you said Medicare and private insurers are paying for it, but if I were to live in a neighboring city, I would have to pay the difference of what my insurance covered and what the ambulance actually charged. Rancho Mirage made a deal with all of the insurance companies that the ambulance service will only collect the insurance payment and the excess will be waived to us citizens. All citizens are covered. Rancho Mirage does not "punish" people for not having insurance.
Apropos of absolutely nothing, were you interviewed on Frontline some years back? I have the specific episode in mind but I'm being deliberately for privacy reasons. The ep I have in mind was very informative and, as a former schoolteacher myself, I was very mindful of some of the stuff you mentioned.

If that's you, my thanks for your words.

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Re: How to Minimize Your Emergency Care Expenses

Post by sschullo » Mon Apr 23, 2018 6:47 pm

ShabonScribe wrote:
Sun Apr 22, 2018 6:13 pm
sschullo wrote:
Tue Apr 17, 2018 2:00 pm
boglegirl wrote:
Fri Apr 13, 2018 4:15 pm
sschullo wrote:
Wed Apr 04, 2018 7:53 pm
...
1. I live in Rancho Mirage, CA, a city that will pay for ambulance service for all citizens. But I don't need them because my HMO covers it as well.
...
The bolded is not exactly correct. According to the city's website, they bill your insurance ("Medicare and other health-care insurance providers") and accept their payment as payment in full, with no balance billing to city residents if it's not covered at 100%. So the city isn't paying for this benefit (except for the balance waiver) - Medicare and private insurers are paying for it.
My wording is not correct but the concept of no ambulance service bill for all citizens in the city is correct.
I called the city manager in charge of this benefit. He said what you said Medicare and private insurers are paying for it, but if I were to live in a neighboring city, I would have to pay the difference of what my insurance covered and what the ambulance actually charged. Rancho Mirage made a deal with all of the insurance companies that the ambulance service will only collect the insurance payment and the excess will be waived to us citizens. All citizens are covered. Rancho Mirage does not "punish" people for not having insurance.
Apropos of absolutely nothing, were you interviewed on Frontline some years back? I have the specific episode in mind but I'm being deliberately for privacy reasons. The ep I have in mind was very informative and, as a former schoolteacher myself, I was very mindful of some of the stuff you mentioned.

If that's you, my thanks for your words.
Thanks for the kind words.
Here is the 5-year-old thread on the "Retirement Gamble" viewtopic.php?t=115019
Public School K-12 Educators: "Ask NOT what your annuity sales person can do for you, ask what you can do to be a Do-It-Yourselfer (DIY)."

dknightd
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Re: How to Minimize Your Emergency Care Expenses

Post by dknightd » Sat May 05, 2018 5:20 pm

VictoriaF wrote:
Thu Mar 01, 2018 9:41 pm

My hospital would not discharge me after a colonoscopy unless there is someone to pick me up. They would not agree for me taking a taxi. Is there a way for me to assert that it's a hospital, not a prison?

Victoria
I consider a colonoscopy an elective procedure. Not an emergency

dknightd
Posts: 701
Joined: Wed Mar 07, 2018 11:57 am

Re: How to Minimize Your Emergency Care Expenses

Post by dknightd » Sat May 05, 2018 5:33 pm

I think the underlying problem is people not judging what is an emergency properly.
Wife has a stroke - emergency
I slip and fall, bonk my head, pass out for a few minutes - emergency
Almost cut off my fingers with a table saw - emergency
I have problems breathing when working too hard - urgent care
I get a horrible looking rash, with infection - urgent care
Flu like symptoms - primary care
Emergency care is expensive. It should be used for emergencies.
I've yet to leave emergency room and been asked to pay more than deductible Maybe I'm lucky?

I think the heath care system in USA is broken. But I will not comment on that. And I could be wrong.

dknightd
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Re: How to Minimize Your Emergency Care Expenses

Post by dknightd » Sat May 05, 2018 5:55 pm

White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
"What would you do if it was your wife or child?"
This.

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dm200
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Location: Washington DC area

Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun May 06, 2018 8:14 am

dknightd wrote:
Sat May 05, 2018 5:20 pm
VictoriaF wrote:
Thu Mar 01, 2018 9:41 pm
My hospital would not discharge me after a colonoscopy unless there is someone to pick me up. They would not agree for me taking a taxi. Is there a way for me to assert that it's a hospital, not a prison?
Victoria
I consider a colonoscopy an elective procedure. Not an emergency
Right - but the discussion issue is the requirement for someone to be with you on discharge when having anesthesia/sedation for the procedure.

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