How to Minimize Your Emergency Care Expenses

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jul 24, 2018 9:42 am

That must have someone to accompany you thing makes it difficult for people with no family. However, as annoying as it is in terms of a colonoscopy, you put not only yourself but others at risk due to the lingering effects of Versed. etc. I don't want someone with no long term memory out there driving or depending on a taxi driver who may be a criminal.
Yes - the other colonoscopy issue/risk (happened to a friend of mine) is that a puncture of the colon may have happened and it is not noticed until after the person gets home. If not dealt with immediately, death could result. Death is also possible even if dealt with quickly.

Fortunately, the friend was OK - but needed emergency surgery (full incision) to repair the puncture and he had an "uncomfortable" recovery.

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Re: How to Minimize Your Emergency Care Expenses

Post by 123 » Tue Jul 24, 2018 11:51 am

I may get a bunch of slings and arrows for this but an easy way to minimize emergency care expenses is to belong to an HMO (like Kaiser that operates their own hospitals and other facilities) and to use Kaiser facilities. Some parts of the country have a strong Kaiser presence, others don't have any. The Emergency Care Expense narrative is still important and helpful because we can't know when we will have an emergency or where we will be taken (regardless of whether we participate in an HMO like Kaiser).
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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jul 24, 2018 11:54 am

123 wrote:
Tue Jul 24, 2018 11:51 am
I may get a bunch of slings and arrows for this but an easy way to minimize emergency care expenses is to belong to an HMO (like Kaiser that operates their own hospitals and other facilities) and to use Kaiser facilities. Some parts of the country have a strong Kaiser presence, others don't have any. The Emergency Care Expense narrative is still important and helpful because we can't know when we will have an emergency or where we will be taken (regardless of whether we participate in an HMO like Kaiser).
Yes - I agree 100%!! In this area, Kaiser does not own/operate its own hospitals - but has agreements and Physician presence at such hospitals. However, for perhaps 99% of what we might go to n emergency room for, Kaiser has 24x7 Urgent care facilities that seem just like a hospital - and can keep you up to 24 hours.

You are correct, though, that most areas of the country do not have this capacity.

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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Tue Jul 24, 2018 2:52 pm

mouses wrote:
Mon Jul 23, 2018 10:58 pm
VictoriaF wrote:
Thu May 10, 2018 10:49 am

Yes, of course.

My cited comment was not about the nature of colonoscopy but about the limits of patients' control over our own healthcare. I wrote that in response to White Coat Investor's statement about patients' power that we give up. I was not arguing with WCI--I agree with his general premise and I value his contributions--I was giving an example of how in many circumstances patients' power is curtailed.

Victoria
That must have someone to accompany you thing makes it difficult for people with no family. However, as annoying as it is in terms of a colonoscopy, you put not only yourself but others at risk due to the lingering effects of Versed. etc. I don't want someone with no long term memory out there driving or depending on a taxi driver who may be a criminal.
Not driving under the influence of Versed and endangering others is different from deciding to take my chances with a taxi driver. I have traveled solo in developing countries, walked past midnight in major cities, and took unmarked detours on el Camino de Santiago. I want to believe that I have agency over taking risks as I find appropriate.

Victoria
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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jul 24, 2018 2:57 pm

Not driving under the influence of Versed and endangering others is different from deciding to take my chances with a taxi driver. I have traveled solo in developing countries, walked past midnight in major cities, and took unmarked detours on el Camino de Santiago. I want to believe that I have agency over taking risks as I find appropriate.

As I understand, the prohibition of just a taxi driver after colonoscopy or some other medical procedures is not "danger" from such a driver - but that the driver has no connection (other than just ransportation0 with the patient.

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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Tue Jul 24, 2018 3:03 pm

dm200 wrote:
Tue Jul 24, 2018 2:57 pm
Not driving under the influence of Versed and endangering others is different from deciding to take my chances with a taxi driver. I have traveled solo in developing countries, walked past midnight in major cities, and took unmarked detours on el Camino de Santiago. I want to believe that I have agency over taking risks as I find appropriate.

As I understand, the prohibition of just a taxi driver after colonoscopy or some other medical procedures is not "danger" from such a driver - but that the driver has no connection (other than just transportation) with the patient.
This is what they tell me but the reason is bogus. They don't try to protect me from disobeying other medical directions that could have worse consequences than fainting after anesthesia. I should be able to sign a disclaimer releasing the hospital from any responsibility and do whatever I find appropriate.

Victoria
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Re: How to Minimize Your Emergency Care Expenses

Post by ImaBeginner » Tue Jul 24, 2018 3:10 pm

Hug401k wrote:
Sat Jan 20, 2018 2:45 pm
I also maintain a list of health care items I plan to attend to after I hit my out of pocket. Nothing urgent, but a few aches and pains I'll only get taken care of once we see if we hit the deductible. I wonder if hospitals start to see a rush towards the end of the financial year with so many high deductible plans.

One other thing I learned.. if you have a specialized issue like an eye and you are headed to the ER, call ahead. We were on our way, leaving the house, my husband called the ER to tell them he would need an eye specialist. The eye specialist called us back and directed us to his office instead, where he had all the proper equipment (and no ER rates). We were in and out in 45 minutes.
We do 35% more surgeries in the 4th quarter than we do in any of the other quarters. It makes for long days, cranky staff, and missed family time. I wish deductibles reset in patient birth months or something so everyone wasn’t trying to cram cases in at the end of the year.

Seasonally staffing is hard because most places experience a similar rush, so you end up just having your staff work longer hours, or being overstaffed the rest of the year.

However, it is mostly elective stuff and generally only the people who actually have insurance put stuff off until the deductible is met, so the reimbursement per charge is better than other times of year.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jul 24, 2018 3:13 pm

We do 35% more surgeries in the 4th quarter than we do in any of the other quarters. It makes for long days, cranky staff, and missed family time. I wish deductibles reset in patient birth months or something so everyone wasn’t trying to cram cases in at the end of the year.
Seasonally staffing is hard because most places experience a similar rush, so you end up just having your staff work longer hours, or being overstaffed the rest of the year.
However, it is mostly elective stuff and generally only the people who actually have insurance put stuff off until the deductible is met, so the reimbursement per charge is better than other times of year.
I will remember that if/when I need surgery. ;)

Thanks.

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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Tue Jul 24, 2018 3:16 pm

ImaBeginner wrote:
Tue Jul 24, 2018 3:10 pm

We do 35% more surgeries in the 4th quarter than we do in any of the other quarters. It makes for long days, cranky staff, and missed family time. I wish deductibles reset in patient birth months or something so everyone wasn’t trying to cram cases in at the end of the year.

Seasonally staffing is hard because most places experience a similar rush, so you end up just having your staff work longer hours, or being overstaffed the rest of the year.

However, it is mostly elective stuff and generally only the people who actually have insurance put stuff off until the deductible is met, so the reimbursement per charge is better than other times of year.
The Bogleheads routinely recommend to aggregate expenses during years of high expenses, whether it's for tax reasons or for insurance deductible reasons. We prudently minimize our out-of-pocket payments, wherever we can.

Medical service providers should plan for more work in the 4th quarter just as accountants plan for more work in the 1st quarter.

Victoria
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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jul 24, 2018 3:20 pm

Medical service providers should plan for more work in the 4th quarter just as accountants plan for more work in the 1st quarter.
I suspect it is much easier to fix an arithmetic mistake a tired accountant made - than many of the kinds of mistakes a tired surgeon might make.

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Re: How to Minimize Your Emergency Care Expenses

Post by 2015 » Tue Jul 24, 2018 3:34 pm

willthrill81 wrote:
Sun Jul 22, 2018 6:45 pm
dm200 wrote:
Mon May 14, 2018 12:34 pm
The other risk (happened to a friend of mine) is that the colonoscopy might have punctured something (like a blood vessel) and it might not be noticed right away. Without immediate emergency surgery, you could die.
The same goes for a strangulated hernia. I had one when I was eight, and it was some of the worst pain I've ever experienced. They had me under the knife within a couple of hours from the onset of symptoms. With having both parents work in the medical field, they pretty much knew what it was immediately.

That being said, I think that poor education in the general populace as to what actually constitutes a medical emergency. But Google may be your friend in this area.
A strangulated hernia and searing pain at just 8 years old. Wow. I think that experience would stay with me.

I agree with your last paragraph. When I was still working, we were always looking for ways to reduce or at least minimize unnecessary costly health care utilization.

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Re: How to Minimize Your Emergency Care Expenses

Post by ImaBeginner » Tue Jul 24, 2018 11:18 pm

VictoriaF wrote:
Tue Jul 24, 2018 3:16 pm
ImaBeginner wrote:
Tue Jul 24, 2018 3:10 pm

We do 35% more surgeries in the 4th quarter than we do in any of the other quarters. It makes for long days, cranky staff, and missed family time. I wish deductibles reset in patient birth months or something so everyone wasn’t trying to cram cases in at the end of the year.

Seasonally staffing is hard because most places experience a similar rush, so you end up just having your staff work longer hours, or being overstaffed the rest of the year.

However, it is mostly elective stuff and generally only the people who actually have insurance put stuff off until the deductible is met, so the reimbursement per charge is better than other times of year.
The Bogleheads routinely recommend to aggregate expenses during years of high expenses, whether it's for tax reasons or for insurance deductible reasons. We prudently minimize our out-of-pocket payments, wherever we can.

Medical service providers should plan for more work in the 4th quarter just as accountants plan for more work in the 1st quarter.

Victoria
True. And we do. The last paragraph was supposed to say how much I enjoy the benefits of fourth quarter.

I would advise people to consider whether or not to plan surgery in January and have free care all of the next year if they are not at their deductible. Or, if you have hit your deductible every year for the past 5 to just go whenever and not put things off until you hit it for sure.

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Re: How to Minimize Your Emergency Care Expenses

Post by Rexindex » Wed Jul 25, 2018 2:47 am

WCI:

I am curious, it seems the overwhelming number of ER visits could likely be performed at a much cheaper cost per incident at an urgent care. If so, how much of it is because of overhead? I see much, but not all of the same equipment at an urgent care I do at an ER.


A friend of mine is an ER doc who specifically told me he does not work in urgent care because the pay is significantly less than in a hospital setting. Any commment ?

By the way, nice article/post!
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Jul 25, 2018 10:29 am

Rexindex wrote:
Wed Jul 25, 2018 2:47 am
WCI:
I am curious, it seems the overwhelming number of ER visits could likely be performed at a much cheaper cost per incident at an urgent care. If so, how much of it is because of overhead? I see much, but not all of the same equipment at an urgent care I do at an ER.
A friend of mine is an ER doc who specifically told me he does not work in urgent care because the pay is significantly less than in a hospital setting. Any commment ?
By the way, nice article/post!
"Urgent Care" facilities seem to have popped up all over the place in our area over the last 10-20 years - so there must be an expectation of profitability. Some even advertise as "Primary Care". The latest trend is that a large hospital complex is buying them up and branding as part of their health care "system".

When my wife was on an Obamacare Kaiser plan, the cost difference between an ER and the Kaiser urgent care was 2-3 times more expensive for the ER. Now, on our Medicare plan, the difference is not that much - but for 99% of cases, we would go to the Kaiser urgent care facility because we believe the quality if better.

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Re: How to Minimize Your Emergency Care Expenses

Post by mouses » Thu Jul 26, 2018 10:58 am

VictoriaF wrote:
Tue Jul 24, 2018 2:52 pm
mouses wrote:
Mon Jul 23, 2018 10:58 pm
VictoriaF wrote:
Thu May 10, 2018 10:49 am

Yes, of course.

My cited comment was not about the nature of colonoscopy but about the limits of patients' control over our own healthcare. I wrote that in response to White Coat Investor's statement about patients' power that we give up. I was not arguing with WCI--I agree with his general premise and I value his contributions--I was giving an example of how in many circumstances patients' power is curtailed.

Victoria
That must have someone to accompany you thing makes it difficult for people with no family. However, as annoying as it is in terms of a colonoscopy, you put not only yourself but others at risk due to the lingering effects of Versed. etc. I don't want someone with no long term memory out there driving or depending on a taxi driver who may be a criminal.
Not driving under the influence of Versed and endangering others is different from deciding to take my chances with a taxi driver. I have traveled solo in developing countries, walked past midnight in major cities, and took unmarked detours on el Camino de Santiago. I want to believe that I have agency over taking risks as I find appropriate.

Victoria
Have you traveled solo in developing countries knowing that a few hours later you would have no memory of what happened previously?

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Re: How to Minimize Your Emergency Care Expenses

Post by OffGridder » Thu Jul 26, 2018 12:09 pm

123 wrote:
Tue Jul 24, 2018 11:51 am
I may get a bunch of slings and arrows for this but an easy way to minimize emergency care expenses is to belong to an HMO (like Kaiser that operates their own hospitals and other facilities) and to use Kaiser facilities. Some parts of the country have a strong Kaiser presence, others don't have any. The Emergency Care Expense narrative is still important and helpful because we can't know when we will have an emergency or where we will be taken (regardless of whether we participate in an HMO like Kaiser).
We have Kaiser too, and are very happy with the service and care we have recieved, including one major emergency. Kaiser does provide coverage for emergencies while traveling including internationally. I am just not sure what the reimbursement rate will be when the bill comes from a non-Kaiser facility. What Kaiser considers reasonable and what the non-Kaiser facility bills maybe quite different, leaving me on the hook to pay the difference.
"Goodness is the only investment that never fails." | H.D. Thoreau

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Thu Jul 26, 2018 12:13 pm

OffGridder wrote:
Thu Jul 26, 2018 12:09 pm
123 wrote:
Tue Jul 24, 2018 11:51 am
I may get a bunch of slings and arrows for this but an easy way to minimize emergency care expenses is to belong to an HMO (like Kaiser that operates their own hospitals and other facilities) and to use Kaiser facilities. Some parts of the country have a strong Kaiser presence, others don't have any. The Emergency Care Expense narrative is still important and helpful because we can't know when we will have an emergency or where we will be taken (regardless of whether we participate in an HMO like Kaiser).
We have Kaiser too, and are very happy with the service and care we have recieved, including one major emergency. Kaiser does provide coverage for emergencies while traveling including internationally. I am just not sure what the reimbursement rate will be when the bill comes from a non-Kaiser facility. What Kaiser considers reasonable and what the non-Kaiser facility bills maybe quite different, leaving me on the hook to pay the difference.
An acquaintance of mine (on Kaiser) had medical expenses in Canada. he was well taken care of. It took a while, but there was a lot of back and forth between Kaiser and Canadian medical providers. Fortunately for him, he was ok - just between Kaiser and the Canadians. His care both places was topnotch.

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Re: How to Minimize Your Emergency Care Expenses

Post by OffGridder » Thu Jul 26, 2018 2:16 pm

dm200 wrote:
Thu Jul 26, 2018 12:13 pm
OffGridder wrote:
Thu Jul 26, 2018 12:09 pm
[quote=123 post_id=4034597 time=1532451068 user_id=4

We have Kaiser too, and are very happy with the service and care we have recieved, including one major emergency. Kaiser does provide coverage for emergencies while traveling including internationally. I am just not sure what the reimbursement rate will be when the bill comes from a non-Kaiser facility. What Kaiser considers reasonable and what the non-Kaiser facility bills maybe quite different, leaving me on the hook to pay the difference.
An acquaintance of mine (on Kaiser) had medical expenses in Canada. he was well taken care of. It took a while, but there was a lot of back and forth between Kaiser and Canadian medical providers. Fortunately for him, he was ok - just between Kaiser and the Canadians. His care both places was topnotch.
Great to hear. We are leaving in a few days for a one month trip to Newfoundland.
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Re: How to Minimize Your Emergency Care Expenses

Post by cs412a » Thu Aug 02, 2018 11:29 am

VictoriaF wrote:
Tue Jul 24, 2018 3:03 pm
dm200 wrote:
Tue Jul 24, 2018 2:57 pm
Not driving under the influence of Versed and endangering others is different from deciding to take my chances with a taxi driver. I have traveled solo in developing countries, walked past midnight in major cities, and took unmarked detours on el Camino de Santiago. I want to believe that I have agency over taking risks as I find appropriate.
As I understand, the prohibition of just a taxi driver after colonoscopy or some other medical procedures is not "danger" from such a driver - but that the driver has no connection (other than just transportation) with the patient.
This is what they tell me but the reason is bogus. They don't try to protect me from disobeying other medical directions that could have worse consequences than fainting after anesthesia. I should be able to sign a disclaimer releasing the hospital from any responsibility and do whatever I find appropriate.

Victoria
Until recently, I would have agreed with you. However, about a month ago I had outpatient surgery with general anesthesia at a local hospital. I would have preferred local anesthesia, but the surgeon provided convincing reasons for general anesthesia. Major snag: they would not perform the surgery unless I could bring someone with me (a friend or relative) who would accompany me to the surgery and accompany me home after the surgery.

This really bugged me. My sisters offered to help out, but I didn’t want them to have to have to take a few days off work (most of which would involve spending half a day driving to and from River City). Ditto for my friends, who work and have families and have better things to do than schlep me around. I knew I’d be in no shape to drive home, but saw no reason why I couldn’t just take a cab to and from surgery. It was outpatient surgery, and the surgery itself would take less than half an hour. What was the big deal?

What I ended up doing was hiring a nursing assistant from a local nursing agency. It turned out to be fortunate that I did this. I had no problem with the general anesthesia during the surgery. However, when I was in recovery, I had a bad reaction to one of the painkillers they gave me. Essentially, the drug lowered my heart rate quite a bit, which decreased the oxygen going to my brain. Not good. Moreover, because of this, I wasn’t able to be my usual “take-charge” self. I knew I felt awful, but I wasn’t able to do much more than repeat “I really don’t feel good”. I was pretty out of it, and the recovery room nurses seemed pretty oblivious to what was going on. Luckily, my CNA not only immediately realized that I was in bad shape but also knew exactly what was happening and why. She was able to calmly and courteously but firmly persuade the nurse that something bad was happening and that she needed to get the anesthesiologist. When he came into the recovery room he quickly prescribed Narcan to block the action of the painkiller I had been given. If I had been on my own during this period, I might well have been SOL because the nurses seemed to be focused on sending me home regardless of how I felt.

My CNA later told me that they routinely give patients the painkiller I got in recovery so that they are more comfortable on the ride home. Most people don’t have a problem, but she said she could tell I didn’t use painkillers often, which might have been why I had such a strong reaction to the drug. She drove me home, then stayed with me for several hours while I napped. I felt a lot better after I woke up, so I told her I thought she could head for home but she made sure I had a little dinner before she left. I can’t say enough good things about her.

Frankly, I don’t think a friend or family member would have been able to be as much help. I know I wouldn’t have been as helpful in that sort of situation. Most likely, I would just have ended up getting upset and antagonizing everyone.

If I have to have any surgery in the future, I plan to have a CNA accompany me, even if I have a family member as well. Hopefully, nothing would go wrong - but I’ve found that you just can’t count on that.

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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Wed Aug 15, 2018 11:55 am

cs412a wrote:
Thu Aug 02, 2018 11:29 am
VictoriaF wrote:
Tue Jul 24, 2018 3:03 pm
dm200 wrote:
Tue Jul 24, 2018 2:57 pm
Not driving under the influence of Versed and endangering others is different from deciding to take my chances with a taxi driver. I have traveled solo in developing countries, walked past midnight in major cities, and took unmarked detours on el Camino de Santiago. I want to believe that I have agency over taking risks as I find appropriate.
As I understand, the prohibition of just a taxi driver after colonoscopy or some other medical procedures is not "danger" from such a driver - but that the driver has no connection (other than just transportation) with the patient.
This is what they tell me but the reason is bogus. They don't try to protect me from disobeying other medical directions that could have worse consequences than fainting after anesthesia. I should be able to sign a disclaimer releasing the hospital from any responsibility and do whatever I find appropriate.

Victoria
Until recently, I would have agreed with you. However, about a month ago I had outpatient surgery with general anesthesia at a local hospital. I would have preferred local anesthesia, but the surgeon provided convincing reasons for general anesthesia. Major snag: they would not perform the surgery unless I could bring someone with me (a friend or relative) who would accompany me to the surgery and accompany me home after the surgery.

This really bugged me. My sisters offered to help out, but I didn’t want them to have to have to take a few days off work (most of which would involve spending half a day driving to and from River City). Ditto for my friends, who work and have families and have better things to do than schlep me around. I knew I’d be in no shape to drive home, but saw no reason why I couldn’t just take a cab to and from surgery. It was outpatient surgery, and the surgery itself would take less than half an hour. What was the big deal?

What I ended up doing was hiring a nursing assistant from a local nursing agency. It turned out to be fortunate that I did this. I had no problem with the general anesthesia during the surgery. However, when I was in recovery, I had a bad reaction to one of the painkillers they gave me. Essentially, the drug lowered my heart rate quite a bit, which decreased the oxygen going to my brain. Not good. Moreover, because of this, I wasn’t able to be my usual “take-charge” self. I knew I felt awful, but I wasn’t able to do much more than repeat “I really don’t feel good”. I was pretty out of it, and the recovery room nurses seemed pretty oblivious to what was going on. Luckily, my CNA not only immediately realized that I was in bad shape but also knew exactly what was happening and why. She was able to calmly and courteously but firmly persuade the nurse that something bad was happening and that she needed to get the anesthesiologist. When he came into the recovery room he quickly prescribed Narcan to block the action of the painkiller I had been given. If I had been on my own during this period, I might well have been SOL because the nurses seemed to be focused on sending me home regardless of how I felt.

My CNA later told me that they routinely give patients the painkiller I got in recovery so that they are more comfortable on the ride home. Most people don’t have a problem, but she said she could tell I didn’t use painkillers often, which might have been why I had such a strong reaction to the drug. She drove me home, then stayed with me for several hours while I napped. I felt a lot better after I woke up, so I told her I thought she could head for home but she made sure I had a little dinner before she left. I can’t say enough good things about her.

Frankly, I don’t think a friend or family member would have been able to be as much help. I know I wouldn’t have been as helpful in that sort of situation. Most likely, I would just have ended up getting upset and antagonizing everyone.

If I have to have any surgery in the future, I plan to have a CNA accompany me, even if I have a family member as well. Hopefully, nothing would go wrong - but I’ve found that you just can’t count on that.
Thank you for the story, cs412a,

If I were in your situation, and if I were asked whether I wanted painkillers, I would have declined them. But of course, medical professionals customarily give us stuff we have not asked for.

Your story is instructional. I'll continue declining anesthesia whenever I can and will find someone to escort me when I can't.

Victoria
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Re: How to Minimize Your Emergency Care Expenses

Post by Kimbowen » Wed Aug 22, 2018 7:34 am

Thank you very much for taking the time to write this.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Aug 22, 2018 11:37 am

While I don't know all of the details, from my understanding and experience - there are many types and degrees of "anesthesia".

I suppose most patients would not pay much attention, but for a neck surgery I had, obviously I would be "out" the whole time, but for most patients with that surgery - they would not do "General Anesthesia", but in my case (when the surgeon and anesthesiologist discussed it in my presence before the surgery) there were reason(s) that they decided to do "General Anesthesia".

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Re: How to Minimize Your Emergency Care Expenses

Post by AlphaLess » Sun Sep 09, 2018 5:51 pm

OP: thanks for the time and effort to type up this post.

I have been to ED twice, but it was not expensive either time.
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OkieIndexer
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Re: How to Minimize Your Emergency Care Expenses

Post by OkieIndexer » Fri Jan 11, 2019 11:51 am

In my health insurance policy I see some procedures require "pre approval" to be covered. They aren't just elective things either. Does the hospital usually check your insurance and get pre approval when necessary without you asking? What if you're not in a condition to ask for pre approval, e.g.unconscious? Does insurance usually pay for it anyway even if the hospital didn't get pre approval? Maybe as out of network at least?
Lynette wrote:
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.
Is this really true for life threatening situations (e.g. heart attacks)? Or just types of surgeries where you can postpone it until you can get someone to come to the hospital with you?

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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Fri Jan 11, 2019 12:16 pm

OkieIndexer wrote:
Fri Jan 11, 2019 11:51 am
In my health insurance policy I see some procedures require "pre approval" to be covered. They aren't just elective things either. Does the hospital usually check your insurance and get pre approval when necessary without you asking? What if you're not in a condition to ask for pre approval, e.g.unconscious? Does insurance usually pay for it anyway even if the hospital didn't get pre approval? Maybe as out of network at least?
Lynette wrote:
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.
Is this really true for life threatening situations (e.g. heart attacks)? Or just types of surgeries where you can postpone it until you can get someone to come to the hospital with you?
The "must have an adult with you" is most often for "same day" procedures, which are often elective at least in timing, such as colonoscopies, where the expectation is that you would not become an overnight patient.
Same with a tooth extraction under anesthesia or such.

And no, at least in the USA, no hospital will (or they shouldn't, absent some peculiar circumstances) withhold emergency, life-saving care until you have "someone with you" or have proof of insurance.

Some insurance policies will apply "in network" coverage for emergency treatment.

But note: There can still be those pesky balance billing problems... which is especially absurd when the patient was unconscious and had no say in "which hospital is in or out of network".

RM
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Re: How to Minimize Your Emergency Care Expenses

Post by AlbertEinstein » Sun Jan 13, 2019 3:55 pm

One of the best benefits of having an insurance policy, even if your deductible is so high you basically pay everything, is getting the benefit of the insurance company's negotiations with hospitals and doctors.
This is just half of the equation. As you noted, hospitals typically charge prices that even they would admit are outrageous and which they never expect to collect in full. The hospital and the insurance company know that THE big benefit for patients - financially and psychologically - of having insurance is getting the negotiated rate. The hospital wants you to have insurance because it's easier for them to get paid (and to get paid at the negotiated rate). The insurance company wants you to have insurance because your premiums are how they make money.

Does anybody think that the hospital or the insurance company doesn't recognize this game? The insurance company knows that the real price is 65 - 75% of the list price, i.e. the insurance company isn't really getting a discount. But those outrageous list prices drive more people to purchase insurance. The hospitals naturally understand as well that they have inflated their prices knowing that the discount will bring them down to what their real price was and that the insurance company will go along with it knowing that it means more people buying insurance.

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Re: How to Minimize Your Emergency Care Expenses

Post by AlbertEinstein » Sun Jan 13, 2019 4:04 pm

VictoriaF wrote:
Tue Jul 24, 2018 3:03 pm
dm200 wrote:
Tue Jul 24, 2018 2:57 pm
Not driving under the influence of Versed and endangering others is different from deciding to take my chances with a taxi driver. I have traveled solo in developing countries, walked past midnight in major cities, and took unmarked detours on el Camino de Santiago. I want to believe that I have agency over taking risks as I find appropriate.

As I understand, the prohibition of just a taxi driver after colonoscopy or some other medical procedures is not "danger" from such a driver - but that the driver has no connection (other than just transportation) with the patient.
This is what they tell me but the reason is bogus. They don't try to protect me from disobeying other medical directions that could have worse consequences than fainting after anesthesia. I should be able to sign a disclaimer releasing the hospital from any responsibility and do whatever I find appropriate.

Victoria
Sure, you should be able to sign such a waiver, but with the legal system as it is, it would be ineffective. You may sign the waiver before the procedure when you're nit under the influence of any medication, etc., but because you have no knowledge a priori of your condition after the procedure, courts will argue that a prudent person (the hospital) would have recognized that based on the then current situation you should not have been sent home in a taxi. Unless you're willing to pay the hospital's liability premiums, their policy isn't bogus.

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Re: How to Minimize Your Emergency Care Expenses

Post by AlbertEinstein » Sun Jan 13, 2019 4:13 pm

VictoriaF wrote:
Wed Aug 15, 2018 11:55 am
If I were in your situation, and if I were asked whether I wanted painkillers, I would have declined them. But of course, medical professionals customarily give us stuff we have not asked for.

Your story is instructional. I'll continue declining anesthesia whenever I can and will find someone to escort me when I can't.

Victoria
Sorry if I'm rude (my forte is honesty not political correctness), but you have no freakin' idea what you would do until the crap hits the fan. As we used to say in the military, "all plans go to hell on first contact (with the enemy)." In all likelihood, you would be the first to sue the hospital if you changed your mind because the pain was severe and they refused to give you pain meds.

Believe it or not, patients are allowed to change their minds about stuff like this and they often do. What's the hospital to do if you change your mind a demand narcotics for your severe pain? Give it and then be stuck with you with no chaperone or refuse to give it and listen to you b---h, moan and whine and then sue them?

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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Sun Jan 13, 2019 5:05 pm

AlbertEinstein wrote:
Sun Jan 13, 2019 4:13 pm
VictoriaF wrote:
Wed Aug 15, 2018 11:55 am
If I were in your situation, and if I were asked whether I wanted painkillers, I would have declined them. But of course, medical professionals customarily give us stuff we have not asked for.

Your story is instructional. I'll continue declining anesthesia whenever I can and will find someone to escort me when I can't.

Victoria
Sorry if I'm rude (my forte is honesty not political correctness), but you have no freakin' idea what you would do until the crap hits the fan. As we used to say in the military, "all plans go to hell on first contact (with the enemy)." In all likelihood, you would be the first to sue the hospital if you changed your mind because the pain was severe and they refused to give you pain meds.

Believe it or not, patients are allowed to change their minds about stuff like this and they often do. What's the hospital to do if you change your mind a demand narcotics for your severe pain? Give it and then be stuck with you with no chaperone or refuse to give it and listen to you b---h, moan and whine and then sue them?
Civil discussion is not the same as political correctness, and with the name of Albert Einstein, you should be able to find civil English expressions in lieu of "freakin' idea" and "crap hits the fan."

Litigation is not an excuse to harm patients or deny them self-determination. In a free society we have contracts. Foregoing anesthesia or accepting consequences of our actions after receiving anesthesia are contracts between a patient and a service provider.

Victoria
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Re: How to Minimize Your Emergency Care Expenses

Post by tj » Thu Jan 17, 2019 4:38 pm

dm200 wrote:
Tue Jul 24, 2018 11:54 am
123 wrote:
Tue Jul 24, 2018 11:51 am
I may get a bunch of slings and arrows for this but an easy way to minimize emergency care expenses is to belong to an HMO (like Kaiser that operates their own hospitals and other facilities) and to use Kaiser facilities. Some parts of the country have a strong Kaiser presence, others don't have any. The Emergency Care Expense narrative is still important and helpful because we can't know when we will have an emergency or where we will be taken (regardless of whether we participate in an HMO like Kaiser).
Yes - I agree 100%!! In this area, Kaiser does not own/operate its own hospitals - but has agreements and Physician presence at such hospitals. However, for perhaps 99% of what we might go to n emergency room for, Kaiser has 24x7 Urgent care facilities that seem just like a hospital - and can keep you up to 24 hours.

You are correct, though, that most areas of the country do not have this capacity.
Kaiser operates the only hospital here in Maui, but all insurance works there. Hopefully the doctors are in network too.

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Re: How to Minimize Your Emergency Care Expenses

Post by rashad3000 » Wed Jan 23, 2019 7:15 am

Great post. I had to go to the ER last night.

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Re: How to Minimize Your Emergency Care Expenses

Post by beachteen » Sun Jan 27, 2019 6:49 pm

I was hit by a car and needed to go to the ER last year, multiple broken bones, concussion, but it is all healed now. The ER cost was $50k+ based on charge master pricing. Like the OP said the costs here were inflated, but not as bad as I expected. I was charged $5.92 for 600mg ibuprofen. Not sure what the insurance paid exactly, but I paid a $150 copay for the ER and ambulance. I needed two casts, followup surgery, copays to see a specialist for physical therapy, copays for a bunch of xrays, and some medication. All of that was about $200 out of pocket. I have an HMO plan with Kaiser, but any HMO is going to be similar. The ER was not with Kaiser, but the followup and surgery was. If I had a PPO plan I would have hit the out of pocket max for the year, and the ER would have tried to balance bill me. There are certainly some tradeoffs between PPO and HMO plans, and quality between plans or providers is not the same, but for emergency care an HMO is better.

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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Sun Jan 27, 2019 7:23 pm

beachteen wrote:
Sun Jan 27, 2019 6:49 pm
I was hit by a car and needed to go to the ER last year, multiple broken bones, concussion, but it is all healed now. The ER cost was $50k+ based on charge master pricing. Like the OP said the costs here were inflated, but not as bad as I expected. I was charged $5.92 for 600mg ibuprofen. Not sure what the insurance paid exactly, but I paid a $150 copay for the ER and ambulance. I needed two casts, followup surgery, copays to see a specialist for physical therapy, copays for a bunch of xrays, and some medication. All of that was about $200 out of pocket. I have an HMO plan with Kaiser, but any HMO is going to be similar. The ER was not with Kaiser, but the followup and surgery was. If I had a PPO plan I would have hit the out of pocket max for the year, and the ER would have tried to balance bill me. There are certainly some tradeoffs between PPO and HMO plans, and quality between plans or providers is not the same, but for emergency care an HMO is better.
If you were "hit by a car", I'm hoping that the car/driver's insurance picked up ALL out of pocket (and probably re-paid your health insurer), plus other costs you might have experienced!

[We went through that decades ago, when a young child was struck by a car in the marked crosswalk in front of the main entrance to the elementary school. (Nope, zero understanding of how that could have happened on a clear day...)]

VERY glad you are okay!

RM
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Re: How to Minimize Your Emergency Care Expenses

Post by coastalhiker » Mon Feb 11, 2019 7:14 pm

This thread is perfect for my day today...

I had a stroke in November 2018. I've been watching the bills roll in:
* ~ $50,000 for a brief stop in the emergency room at hospital 1 (lots of imaging, clot buster med)
* $7,800 for an ambulance ride (30 min) to hospital 2 for surgery
* $5,800 for an ambulance ride (30 min) to Kaiser hospital for further recovery
* 12,000 for 2 days in Kaiser hospital

I've been waiting for the big one - thrombectomy and 3 days in ICU at hospital 2. It came today: $179,000.

Grand total (so far) for care over the course of 5 days: $254,000. There was really nothing that I could have done in this case to lower the costs (was not even awake for the first 3 days).

The only thing that has mattered is the quality of my insurance. I'm a Kaiser member; I'm happy with the level of service and they have done a wonderful job of dealing with the other parties. My final bill: $250.

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Wed Feb 13, 2019 1:59 am

coastalhiker wrote:
Mon Feb 11, 2019 7:14 pm
This thread is perfect for my day today...

I had a stroke in November 2018. I've been watching the bills roll in:
* ~ $50,000 for a brief stop in the emergency room at hospital 1 (lots of imaging, clot buster med)
* $7,800 for an ambulance ride (30 min) to hospital 2 for surgery
* $5,800 for an ambulance ride (30 min) to Kaiser hospital for further recovery
* 12,000 for 2 days in Kaiser hospital

I've been waiting for the big one - thrombectomy and 3 days in ICU at hospital 2. It came today: $179,000.

Grand total (so far) for care over the course of 5 days: $254,000. There was really nothing that I could have done in this case to lower the costs (was not even awake for the first 3 days).

The only thing that has mattered is the quality of my insurance. I'm a Kaiser member; I'm happy with the level of service and they have done a wonderful job of dealing with the other parties. My final bill: $250.
Let these numbers be a warning to anyone who is considering going without health insurance.

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Re: How to Minimize Your Emergency Care Expenses

Post by BobTexas » Wed Mar 06, 2019 5:19 pm

I’m laying in a hospital bed today as I write this. Went to the ER Sunday night very dehydrated, with low blood pressure (Creatinine over 7). They treated me there for a few hours, and wanted to admit me to ICU. Before they admitted me they gave me a cost estimate of $4800 for the ER portion and wanted a down payment. I gave them my HSA card and they charged $2,000 before they admitted me. I’ve been wondering what they would have done if I didn’t have it

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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Wed Mar 06, 2019 5:39 pm

BobTexas wrote:
Wed Mar 06, 2019 5:19 pm
I’m laying in a hospital bed today as I write this. Went to the ER Sunday night very dehydrated, with low blood pressure (Creatinine over 7). They treated me there for a few hours, and wanted to admit me to ICU. Before they admitted me they gave me a cost estimate of $4800 for the ER portion and wanted a down payment. I gave them my HSA card and they charged $2,000 before they admitted me. I’ve been wondering what they would have done if I didn’t have it
First, I do hope you are feeling better, and they are able to diagnose/treat whatever has caused this!

Second, about medical care expenses... do you have any insurance?
If so, didn't they just take down the insurance information (company, plan number, your ID number, etc.)?

Good luck with a quick recovery!

RM
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Wed Mar 06, 2019 5:43 pm

Rexindex wrote:
Wed Jul 25, 2018 2:47 am
WCI:

I am curious, it seems the overwhelming number of ER visits could likely be performed at a much cheaper cost per incident at an urgent care. If so, how much of it is because of overhead? I see much, but not all of the same equipment at an urgent care I do at an ER.


A friend of mine is an ER doc who specifically told me he does not work in urgent care because the pay is significantly less than in a hospital setting. Any commment ?

By the way, nice article/post!
I disagree. Urgent Scares can't take care of at least 80% of what I do. Try it. Go to the urgent care with chest pain, abdominal pain, dyspnea, altered mental status, or suicidal ideation and see what happens.
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Wed Mar 06, 2019 5:43 pm

BobTexas wrote:
Wed Mar 06, 2019 5:19 pm
I’m laying in a hospital bed today as I write this. Went to the ER Sunday night very dehydrated, with low blood pressure (Creatinine over 7). They treated me there for a few hours, and wanted to admit me to ICU. Before they admitted me they gave me a cost estimate of $4800 for the ER portion and wanted a down payment. I gave them my HSA card and they charged $2,000 before they admitted me. I’ve been wondering what they would have done if I didn’t have it
The same thing, then sent you a bill. #EMTALA
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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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Wed Mar 06, 2019 5:47 pm

OkieIndexer wrote:
Fri Jan 11, 2019 11:51 am
In my health insurance policy I see some procedures require "pre approval" to be covered. They aren't just elective things either. Does the hospital usually check your insurance and get pre approval when necessary without you asking? What if you're not in a condition to ask for pre approval, e.g.unconscious? Does insurance usually pay for it anyway even if the hospital didn't get pre approval? Maybe as out of network at least?
Lynette wrote:
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.
Is this really true for life threatening situations (e.g. heart attacks)?
No.
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Re: How to Minimize Your Emergency Care Expenses

Post by NotWhoYouThink » Wed Mar 06, 2019 5:51 pm

BobTexas wrote:
Wed Mar 06, 2019 5:19 pm
I’m laying in a hospital bed today as I write this. Went to the ER Sunday night very dehydrated, with low blood pressure (Creatinine over 7). They treated me there for a few hours, and wanted to admit me to ICU. Before they admitted me they gave me a cost estimate of $4800 for the ER portion and wanted a down payment. I gave them my HSA card and they charged $2,000 before they admitted me. I’ve been wondering what they would have done if I didn’t have it
When my husband was taken to the ER after a bike crash (just because he couldn't remember the crash or who was president some pushy EMTs thought he needed to get checked out) they asked me if we wanted to put down a deposit. I said no, and that was that. Which was the right answer, because it was his second ER trip of the year and I had some medical treatments, and we had long since spent our deductible so almost all of the visit was covered. They are allowed to ask, you are allowed to decline.

Hope you recover quickly.

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Re: How to Minimize Your Emergency Care Expenses

Post by NotWhoYouThink » Wed Mar 06, 2019 5:55 pm

coastalhiker wrote:
Mon Feb 11, 2019 7:14 pm
This thread is perfect for my day today...

I had a stroke in November 2018. I've been watching the bills roll in:
* ~ $50,000 for a brief stop in the emergency room at hospital 1 (lots of imaging, clot buster med)
* $7,800 for an ambulance ride (30 min) to hospital 2 for surgery
* $5,800 for an ambulance ride (30 min) to Kaiser hospital for further recovery
* 12,000 for 2 days in Kaiser hospital

I've been waiting for the big one - thrombectomy and 3 days in ICU at hospital 2. It came today: $179,000.

Grand total (so far) for care over the course of 5 days: $254,000. There was really nothing that I could have done in this case to lower the costs (was not even awake for the first 3 days).

The only thing that has mattered is the quality of my insurance. I'm a Kaiser member; I'm happy with the level of service and they have done a wonderful job of dealing with the other parties. My final bill: $250.
Wow. If you can deal with all the bills and history of treatment that soon after a stroke they did a great job for you. Glad you are insured and doing well, and that you were covered.

It's been interesting to see the bills and negotiated amounts from our recent family hospitalizations. I suspect that even uninsured we'd be able to negotiate lower amounts for immediate payment, but it's also been great not to have to.

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Re: How to Minimize Your Emergency Care Expenses

Post by BobTexas » Wed Mar 06, 2019 9:31 pm

ResearchMed wrote:
Wed Mar 06, 2019 5:39 pm
BobTexas wrote:
Wed Mar 06, 2019 5:19 pm
I’m laying in a hospital bed today as I write this. Went to the ER Sunday night very dehydrated, with low blood pressure (Creatinine over 7). They treated me there for a few hours, and wanted to admit me to ICU. Before they admitted me they gave me a cost estimate of $4800 for the ER portion and wanted a down payment. I gave them my HSA card and they charged $2,000 before they admitted me. I’ve been wondering what they would have done if I didn’t have it
First, I do hope you are feeling better, and they are able to diagnose/treat whatever has caused this!

Second, about medical care expenses... do you have any insurance?
If so, didn't they just take down the insurance information (company, plan number, your ID number, etc.)?

Good luck with a quick recovery!

RM
Yes, I’m doing much better and hope to go home tomorrow

I have insurance, but it’s a HDHP and I knew that I would be on the hook for a few thousand, so I just paid the $2000. Since then I have talked to BCBS, and my max Out of Pocket is $6700, so I should end up ok

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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Wed Mar 06, 2019 9:38 pm

BobTexas wrote:
Wed Mar 06, 2019 9:31 pm
ResearchMed wrote:
Wed Mar 06, 2019 5:39 pm
BobTexas wrote:
Wed Mar 06, 2019 5:19 pm
I’m laying in a hospital bed today as I write this. Went to the ER Sunday night very dehydrated, with low blood pressure (Creatinine over 7). They treated me there for a few hours, and wanted to admit me to ICU. Before they admitted me they gave me a cost estimate of $4800 for the ER portion and wanted a down payment. I gave them my HSA card and they charged $2,000 before they admitted me. I’ve been wondering what they would have done if I didn’t have it
First, I do hope you are feeling better, and they are able to diagnose/treat whatever has caused this!

Second, about medical care expenses... do you have any insurance?
If so, didn't they just take down the insurance information (company, plan number, your ID number, etc.)?

Good luck with a quick recovery!

RM
Yes, I’m doing much better and hope to go home tomorrow

I have insurance, but it’s a HDHP and I knew that I would be on the hook for a few thousand, so I just paid the $2000. Since then I have talked to BCBS, and my max Out of Pocket is $6700, so I should end up ok
Glad to hear you are doing well (or, better).

Don't forget... IF you send the billing "through" your insurance company, and they then deny the deductible/OOP/co-pays, at least it will be billed at the negotiated rate.
If you didn't get that, then see if they'll re-do the billing, or if the insurer will help, etc.
It makes sense that you weren't thinking about "negotiated rates" when you were at the ER, heading toward ICU!

Hope all continues okay/well.

RM
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SlowMovingInvestor
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Re: How to Minimize Your Emergency Care Expenses

Post by SlowMovingInvestor » Mon Mar 18, 2019 10:29 pm

This thread covers emergency care expenses, but I am curious about urgent care expenses. Are there any tips to minimize those ?

Do UC centers also add facility charges and the proverbial $90 Tylenol pill charge ? They have to pay for longer hours and cater to walk-ins too, although they need less staff and less fancy equipment. I think many UC centers also have emergency medicine physicians (so presumably specialist rates).

We could start a separate thread on this although I suspect UC expenses are more likely to be annoying rather than the blow out your deductible high of ER.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Mar 19, 2019 7:46 am

SlowMovingInvestor wrote:
Mon Mar 18, 2019 10:29 pm
This thread covers emergency care expenses, but I am curious about urgent care expenses. Are there any tips to minimize those ?
Do UC centers also add facility charges and the proverbial $90 Tylenol pill charge ? They have to pay for longer hours and cater to walk-ins too, although they need less staff and less fancy equipment. I think many UC centers also have emergency medicine physicians (so presumably specialist rates).
We could start a separate thread on this although I suspect UC expenses are more likely to be annoying rather than the blow out your deductible high of ER.
I think these UC centers are widely different.

Some Physician practices have a related UC center - check that out.

I suppose the answer is never get sick!

One key is knowing what conditions/symptoms are serious and what are not. Very tough to do - since most of us do not have medical training.

Some Physician practices may have better after hours services.

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Re: How to Minimize Your Emergency Care Expenses

Post by dodecahedron » Tue Mar 19, 2019 8:32 am

I have a Medicare Advantage PPO. According to my insurance card, my copay for ER is $90 (for either in-network OR out-of-network). Copay for urgent care is $50 (again in or out of network.)

Edited to add: back in Jan 2018, when this thread started, I still had a high deductible ACA Bronze policy. Fortunately, only needed ER care during one of the four years I had that policy. Hit my OOP max that one year. (Ouch!) Grateful for the good though expensive care I got that one year,. Also grateful to have the coverage I have now, thanks to becoming eligible for Medicare. I wish I everyone could have coverage at least as good as what I have now.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Mar 19, 2019 9:51 am

I suppose one aspect of selecting a Primary care Physician (or group) could be access to urgent care or after hours care.

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Re: How to Minimize Your Emergency Care Expenses

Post by SlowMovingInvestor » Wed Mar 20, 2019 6:38 pm

dm200 wrote:
Tue Mar 19, 2019 9:51 am
I suppose one aspect of selecting a Primary care Physician (or group) could be access to urgent care or after hours care.
My impression was that UC facilities attached to a regular practice generally charge higher rates if you're a walk-in, even if you're a regular. This is for something that actually requires a walk-in -- a deep cut, an animal bite etc. And you may be seen by an Emergency Medicine Specialist (even if not strictly required).

Can UC centers charge facility fees as well, akin to ERs ? And also charge for each gauze pad and Tylenol pill they use ? To be more precise, do insurers allow in network UC centers to run up such bills ?

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Wed Mar 20, 2019 10:16 pm

dm200 wrote:
Tue Mar 19, 2019 7:46 am
I think these UC centers are widely different.

Some Physician practices have a related UC center - check that out.

I suppose the answer is never get sick!

One key is knowing what conditions/symptoms are serious and what are not. Very tough to do - since most of us do not have medical training.

Some Physician practices may have better after hours services.
My local hospital has an urgent care clinic on site. It's helpful because if it's actually an emergency, the emergency room is right across the building. You don't have to get a ride or run the risk of a high surprise bill with an ambulance.

If your local hospital has a walk in clinic, make sure that they bill it as an urgent care clinic. Another local hospital has a walk in clinic that looks just like the one I referenced above, but they bill as outpatient hospital which costs much more. They are quite sneaky about that.

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