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
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

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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.

2015
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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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dm200
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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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