How to Minimize Your Emergency Care Expenses

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beehivehave
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Re: How to Minimize Your Emergency Care Expenses

Post by beehivehave » Mon Oct 28, 2019 3:23 pm

pdavi21 wrote:
Wed Mar 20, 2019 11:11 pm
A big point missed is why you have to go to the ER in the first place.
1. Be healthy
2. Don't do stupid stuff

It's great to be prepared, but it's even greater to prevent the trip.
Most of all, inherit good genes.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Oct 29, 2019 8:31 am

beehivehave wrote:
Mon Oct 28, 2019 3:23 pm
pdavi21 wrote:
Wed Mar 20, 2019 11:11 pm
A big point missed is why you have to go to the ER in the first place.
1. Be healthy
2. Don't do stupid stuff
It's great to be prepared, but it's even greater to prevent the trip.
Most of all, inherit good genes.
Yes! Although, as we get older, my understanding is that "good genes" play a lesser role.

I believe that being educated and informed about determining actual health risks can be important as well. Patient pain and discomfort are not the only (or even primary) signs to look for. Family history can help be informed. Some of the most dangerous conditions that required immediate attention may not be all that painful.

Yes - I believe doing "stupid stuff" accounts for a lot of such ER visits. Some of these can be "funny" - especially those related to sexual matters. :oops:

beehivehave
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Re: How to Minimize Your Emergency Care Expenses

Post by beehivehave » Thu Oct 31, 2019 7:26 pm

dm200 wrote:
Tue Oct 29, 2019 8:31 am
beehivehave wrote:
Mon Oct 28, 2019 3:23 pm
pdavi21 wrote:
Wed Mar 20, 2019 11:11 pm
A big point missed is why you have to go to the ER in the first place.
1. Be healthy
2. Don't do stupid stuff
It's great to be prepared, but it's even greater to prevent the trip.
Most of all, inherit good genes.
Yes! Although, as we get older, my understanding is that "good genes" play a lesser role.

True, but we are lucky if we survive childhood and young adulthood.

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VictoriaF
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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Sun Nov 03, 2019 1:45 pm

beehivehave wrote:
Thu Oct 31, 2019 7:26 pm
dm200 wrote:
Tue Oct 29, 2019 8:31 am
beehivehave wrote:
Mon Oct 28, 2019 3:23 pm
pdavi21 wrote:
Wed Mar 20, 2019 11:11 pm
A big point missed is why you have to go to the ER in the first place.
1. Be healthy
2. Don't do stupid stuff
It's great to be prepared, but it's even greater to prevent the trip.
Most of all, inherit good genes.
Yes! Although, as we get older, my understanding is that "good genes" play a lesser role.

True, but we are lucky if we survive childhood and young adulthood.
From what I am reading, epigenomic factors are even more important than the genes.

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

kinaokole
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Re: How to Minimize Your Emergency Care Expenses

Post by kinaokole » Sun Nov 10, 2019 8:25 am

VictoriaF wrote:
Sun Nov 03, 2019 1:45 pm

From what I am reading, epigenomic factors are even more important than the genes.

Victoria
I was unaware this was the case. Do you have a link with which to educate myself?

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VictoriaF
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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Sun Nov 10, 2019 10:04 am

kinaokole wrote:
Sun Nov 10, 2019 8:25 am
VictoriaF wrote:
Sun Nov 03, 2019 1:45 pm

From what I am reading, epigenomic factors are even more important than the genes.

Victoria
I was unaware this was the case. Do you have a link with which to educate myself?
I recommend a book by David Sinclair "Lifespan." For a faster review, Google for podcasts by Joe Rogan and Peter Attia with David Sinclair. Attia had two podcasts with Sinclair, the 2nd discusses ideas in "Lifespan."

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

kinaokole
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Re: How to Minimize Your Emergency Care Expenses

Post by kinaokole » Tue Nov 12, 2019 11:01 pm

VictoriaF wrote:
Sun Nov 10, 2019 10:04 am
kinaokole wrote:
Sun Nov 10, 2019 8:25 am
VictoriaF wrote:
Sun Nov 03, 2019 1:45 pm

From what I am reading, epigenomic factors are even more important than the genes.

Victoria
I was unaware this was the case. Do you have a link with which to educate myself?
I recommend a book by David Sinclair "Lifespan." For a faster review, Google for podcasts by Joe Rogan and Peter Attia with David Sinclair. Attia had two podcasts with Sinclair, the 2nd discusses ideas in "Lifespan."

Victoria
Can’t listen to Joe Rogan for any length of time, but I looked up the notes on the Sinclair interviews. Interesting, but I’m a little skeptical of most supplements and fasting, though I’m sure I have a lot to learn. Thanks.

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Re: How to Minimize Your Emergency Care Expenses

Post by krb » Thu Nov 28, 2019 2:31 pm

MrBeaver wrote:
Fri Jan 19, 2018 11:56 pm



But for a real question:
Is there good guidance for which issues/symptoms to go to urgent care vs ED?

The comment that urgent care is good to send you to the ER if necessary is comforting…as long as they don’t load you into an unnecessary ambulance to get there. My gut says arterial or possible internal bleeding, or sudden internal pain in the chest cavity is an immediate ED trip, while other things, even broken bones could be handled by urgent care (assuming it’s after hours for our GP/pediatrician)?

This is particularly in my mind with two young children who will likely have ‘accidents’ at some point in the next 10 years.
Hi. Yes. I'm a physician. Before you go to the ER call your physician. In most cases (eg not chest pain) he can determine do you need to go to the ER now, or is it reasonable to go to an urgent care, or can you wait 12 hours and come see me tomorrow. My field involves a lot of after hours urgent and emergency problems. But most of the time I can tell the family come in first thing in the morning before we open. We will try to squeeze you in and out. Don't be surprised if there's a long wait because we are squeezing you in and we don't really have time, but we want to make sure this gets addressed promptly. So bring something to read.

Also ...

A lot of what WCI sees in the ER (unless he works for the county) is stuff that really could wait till the next day but people get anxious and go to the ER. A lot of what I see just needs rest and advil but people want to see the doctor for assurance. Artery lacerations and internal bleeding is a lot less common than bruises and benign headaches.

Finally - as he mentioned - the hospital bills just have to get paid. If half of your patients are paying zero, it means the other half will be paying 200% or the doors close. In all major hospitals there is an MRI tech and a CT tech and surgical staff and an entire hospital of workers (skeleton crew after hours of course) 24-7-365 regardless of whether they are working or not because the work needs to able to get done 24-7. So you are not only paying for the MRI that you had, you are also paying for the MRI that you didn't have but you might have needed so they had to have the MRI (eg) and staff ready at all times. That costs money.

I took my kid in to the ER ten years ago. We were far away from my local ER. It was like 11PM on a Friday night. She was up and climbing on everything like 4 y old. She piled a bunch of pillows on a chair, climbed up, fell off, and hit her head on the hardwood. She seemed ... lethargic. So I'm thinking subdural hematoma or similar. But she's also 4 and it's way past her bedtime so maybe she's just tired... I waited for a bit to see how things would go. I called the pediatrician when she started vomiting (!) and he said it's fine, not to worry, given she's 4 years old, in the absence of any other findings. Then she started developing a lump on her head and the pediatrician said you can either keep her awake all night to make sure she's ok or go to the ER. We drove in the middle of the night to the ER where I know who's good. Checked in. My friend asked "do you know where you are?" She was so angry at being kept awake. OF COURSE I DO. IM AT THE HOSPITAL." She was so ornery. At that point we knew she was fine. The ER Doc said if you were anyone else I'd get a head CT for CYA, but medically it's not necessary. CT is a LOT of radiation, particularly in a 4 y f. So I said as long as you're ok without it I'm ok...

We went home she was fine.

A week ago we get a bill from the hospital for like $200 for the doctor evaluation. I was annoyed. I come in all the time to help this guy out for emergencies. Wife says just pay it. Fine. A week later we get another bill for like $500 for the ER. I thought "we paid the doctor bill already." This was the ER charge. Then another bill a week later for like $500. It kept adding up and up and up. Just for my friend to pop his head in and say I think she's fine. So I was so annoyed and this is coming from an insider! I can imagine how much MORE annoyed I would be if I weren't plugged in.

Finally... It takes a long time to get to be good at whatever you do - whether you're a mechanic or an ER doc. But once you've invested the time, solving problems really isn't that hard. So at this point for most patients, WCI probably has figured out each of his patients in about 5 minutes what is the differential, what tests does he need to order, and how is this going to go down. There might be an insurance company that pays you $1000 for an evaluation. Very unlikely but possible. Usual let's say is $150-200 for a new evaluation. If you bill everyone 200 you will get whatever they pay. But that one insurance that pays 1000 - well you WOULD HAVE had 1000 but you only asked for 200. Therefore everyone bills a million dollars for everything, and they take whatever the insurance pays. We all know this. We all know around the ballpark of what reimbursement is. Maybe not every dollar but ballpark.

It is unconscionable to me that a physician who bills 1000 for a visit and is happy to get 200 will demand 1000 from an uninsured patient. When we see uninsured patients we tell them this is how much we get from the insurance company and so we will charge you the same, with a discount for cash because it's less hassle for billing. I hear stories of other physicians who demand the insane billing number, not the actual reimbursement number. I think that's unconscionable and speaks to a bad character.

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Re: How to Minimize Your Emergency Care Expenses

Post by krb » Thu Nov 28, 2019 2:41 pm

White Coat Investor wrote:
Tue May 21, 2019 7:17 pm
skeptastic wrote:
Tue Apr 16, 2019 9:36 pm
This thread is outstanding. Thank you all for the information and questions which have spawned excellent discussions. We recently received an ED bill we're not thrilled with. I will take it as a lesson and be better-informed the next go-round.

We had a child lose consciousness and hit his head in the kitchen. When he came-to, we kept him awake, asking an endless number of questions, while we waited for first responders to reach our residence. They checked him out and recommended we take him to the ED. They were very understanding when we expressed a desire to take him in for care ourselves. I'm not too concerned with whether the ED billing was fair. I'm wondering whether we would have been wiser to visit an urgent care facility first, letting them direct us to the ED as necessary. At the time, we were not panicked and did feel that a trip to the ED was the right choice, given that we had no idea why he'd passed out, as well as the fact that he'd hit his head and remained unconscious for around 15 seconds or so. By the time our son was assessed by first responders, however, he seemed okay and I wonder if we made the right move.

WCI, or any other physicians in the thread, what are your thoughts on the scenario? What would you have done if it were your child? Thanks in a advance for any thoughts you're able and willing to provide.
The UC would have sent you to the ED anyway, so no big deal. At least you saved the UC bill.

I find the "don't let him go to sleep" thing hilarious by the way. As if something happens in a head bleed differently due to a REM cycle. The only reason to have someone awake is to evaluate them, there is no therapeutic benefit. Just one of the funny things about my job.
Hi. I think the keep him awake isn't because someone would die if they went to sleep but THANK G-D YOU KEPT HIM AWAKE! Or "Don't go toward the light!!!!" I think it's if the person's consciousness stays the same you can feel comfortable holding off on the ER trip but if they seem more dazed or confused or lethargic it's time to pack him up. That was always my thoughts. But I'm a physician too so...

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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Thu Nov 28, 2019 4:27 pm

krb wrote:
Thu Nov 28, 2019 2:41 pm
White Coat Investor wrote:
Tue May 21, 2019 7:17 pm
skeptastic wrote:
Tue Apr 16, 2019 9:36 pm
This thread is outstanding. Thank you all for the information and questions which have spawned excellent discussions. We recently received an ED bill we're not thrilled with. I will take it as a lesson and be better-informed the next go-round.

We had a child lose consciousness and hit his head in the kitchen. When he came-to, we kept him awake, asking an endless number of questions, while we waited for first responders to reach our residence. They checked him out and recommended we take him to the ED. They were very understanding when we expressed a desire to take him in for care ourselves. I'm not too concerned with whether the ED billing was fair. I'm wondering whether we would have been wiser to visit an urgent care facility first, letting them direct us to the ED as necessary. At the time, we were not panicked and did feel that a trip to the ED was the right choice, given that we had no idea why he'd passed out, as well as the fact that he'd hit his head and remained unconscious for around 15 seconds or so. By the time our son was assessed by first responders, however, he seemed okay and I wonder if we made the right move.

WCI, or any other physicians in the thread, what are your thoughts on the scenario? What would you have done if it were your child? Thanks in a advance for any thoughts you're able and willing to provide.
The UC would have sent you to the ED anyway, so no big deal. At least you saved the UC bill.

I find the "don't let him go to sleep" thing hilarious by the way. As if something happens in a head bleed differently due to a REM cycle. The only reason to have someone awake is to evaluate them, there is no therapeutic benefit. Just one of the funny things about my job.
Hi. I think the keep him awake isn't because someone would die if they went to sleep but THANK G-D YOU KEPT HIM AWAKE! Or "Don't go toward the light!!!!" I think it's if the person's consciousness stays the same you can feel comfortable holding off on the ER trip but if they seem more dazed or confused or lethargic it's time to pack him up. That was always my thoughts. But I'm a physician too so...
So funny I see this post today. I have a patient in the ED RIGHT THIS INSTANT whose mom just asked if he could go to sleep now (he's being seen for a head injury).
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MrBeaver
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Re: How to Minimize Your Emergency Care Expenses

Post by MrBeaver » Tue Dec 03, 2019 12:38 pm

krb wrote:
Thu Nov 28, 2019 2:31 pm
Hi. Yes. I'm a physician. Before you go to the ER call your physician. In most cases (eg not chest pain) he can determine do you need to go to the ER now, or is it reasonable to go to an urgent care, or can you wait 12 hours and come see me tomorrow.
Now that we have a couple of years under our belt, we have done this. One time it meant going into our physician and getting only antibiotics after our daughter (we think) bit through her lower lip with her front opposing teeth while jumping. The other time, our son got a staple in his head at the physician's office after falling into a furniture corner and getting a gash in his head. Both of those probably saved me $500-$2000 each over urgent care / ED.
krb wrote:
Thu Nov 28, 2019 2:31 pm
I took my kid in to the ER ten years ago. ...The ER Doc said if you were anyone else I'd get a head CT for CYA, but medically it's not necessary. CT is a LOT of radiation, particularly in a 4 y f. So I said as long as you're ok without it I'm ok...

We went home she was fine.
I think this is a big thing that 'normal' non-medically trained reasonably educated people deal with: getting out of unnecessary CYA care that just costs us (and/or our insurance company) money and provides very little benefit. I can usually sense when unnecessary care is being hoisted upon us. But I always have some doubt, and I have to fight tooth and nail to get the same amount of concessions you can get with a wink to colleagues in the industry.

For example, when our twins were born, our son was slightly low in weight (5 lb 5 oz). He was barely borderline for jaundice so they stuck him in a chamber in our room for blue light. We stayed up not sleeping trying to hold his hand through the hand ports so he would have enough comfort to sleep, because otherwise he would just wriggle and cry non-stop. Our ObGyn shaked his head in disbelief when doing rounds the next day. We pleaded with the on-call pediatrician to at least turn on the heater in the chamber as he was so freaking cold – she was surprised that the heater wasn't on, requested it in the chart, which set up many tense moments as the charge nurse was under the opinion that warming a naked baby under blue light therapy in a hospital was a sids risk. That evening, I overheard a nurse in a hallway asking about the chamber because they had a patient who honestly needed it, and they were out. They pretty quickly came in and said 'ok, he doesn't need this any more', and wheeled it out. We could finally hold our son and everyone started getting some sleep. They would have let us go home at that point, but we decided to stay one more night since we were just exhausted and mom & babies were finally sleeping.

The next day, they all of a sudden got concerned about his weight as it had dropped to 4lb 15oz and started talking about a crazy (to us) regiment of formula and donated breast milk to try to get his weight up before they would let us go home. My wife's milk hadn't yet fully come in, possibly because the whole ordeal was so stressful (though it had also only just been 3 days post birth). From our perspective, they were playing whack-a-mole, only concerned with one thing at a time, irrespective of the whole picture or future ramifications. I was furious that they let him shiver for upwards of 24 hours, burning what little precious fat he was born with for a low risk borderline test result, only to turn around and not admit that decision contributed to the current concern of low weight. We were ready to get out of there so everyone (mom and babies) could get some sleep, eat well, and be helped out more effectively by our friends, family, and pediatrician. In order to do that, we had to put two calls into our pediatrician to ensure we would go by their office that afternoon for a weigh-in and back the next morning, pull out name-dropping of my mother who is a retired head nurse of a mother-baby unit, and another family who is a practicing nurse, and were both in town and would be helping. Our son gained 3 ounces that night at home, by the way.

In short, it felt like they were keeping us at the hospital so they could bill the insurance company and to ensure themselves that if we left and turned out to be dead-beat parents, we wouldn't be back with a sick undernourished child. It was exhausting. If we ever do this again, I will be sure to develop a relationship with a pediatrician who has privileges at the hospital so they can be the baby's pediatrician of record and do rounds for them instead of the on-call hospital pediatrician, and then after we are discharged transfer to our own pediatrician.

---

Of course all of that is besides the ED or not to ED question, but it undergirds my feeling that the entire industry is geared to reduce liability risk irrespective of cost to the insurance company or the patient. That inevitably spills over into my reluctance to seek out care when necessary, which is not healthy either. But discussions like this help prepare me for these decisions of seeking care, so thank you all for donating your time to help us.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Dec 03, 2019 1:16 pm

In short, it felt like they were keeping us at the hospital so they could bill the insurance company and to ensure themselves that if we left and turned out to be dead-beat parents, we wouldn't be back with a sick undernourished child. It was exhausting. If we ever do this again, I will be sure to develop a relationship with a pediatrician who has privileges at the hospital so they can be the baby's pediatrician of record and do rounds for them instead of the on-call hospital pediatrician, and then after we are discharged transfer to our own pediatrician.
Very hard for a layperson to know what is and is not medically needed/necessary.

No experience with newborns, but today very few, if any, physicians do hospital "rounds" or see their patients in the hospital. Those duties now tend to go to "hospitalists" .

I suppose, in your example, even if your pediatrician did not actually show up in the hospital, he/she could intervene (on your behalf) about such issues/concerns.

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Re: How to Minimize Your Emergency Care Expenses

Post by tj » Wed Dec 25, 2019 3:11 pm

Broken Man 1999 wrote:
Fri Jul 19, 2019 7:34 pm
tj wrote:
Fri Jul 19, 2019 6:28 pm
Broken Man 1999 wrote:
Fri Jul 19, 2019 3:22 pm
tj wrote:
Fri Jul 19, 2019 12:43 am
I went to the ER for something that turned out to be nothing, though they sold me on getting a tetanus booster because it might have been more than 10 years. There are no urgent cares that I could find on Maui. A little bit worried about what the bill might be....we shall see.

The hospital was allegedly in network. I'm in a HDHP. :-/
How much deductible do you have left?

Broken Man 1999
$1,500 since I haven't used anything yet. They do give me $900 per year in my HSA though. It's the federal GEHA plan so the high deductible isn't really that high compred to other plans.

Wow! That seems pretty good. I was expecting $10,000 or something really high. Great insurance for sure.

Broken Man 1999

So I finally got this EOB processed for this, GEHA allowed like $350 fo the $962 charge and put that towards the deductible. Despite the hospital being in network, the doctor apparently wasn't. I'll owe all of the $962, but GEHA tossed $900 into my HSA, so it's not a big deal. It's definitely annoying though. I'll definitely try to negotiate the provider down though. There are services that charge 35% to do this, so it must not be that uncommon.

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Re: How to Minimize Your Emergency Care Expenses

Post by btq96r » Fri Dec 27, 2019 2:33 am

This thread is a gold mine if you're jotting notes. It's taken me almost three years of working in ops and business analytics for a radiology group to learn what I saw reading the last 8 pages. When WCI used the word "chargemaster" in his original post, I knew this was going to be legit.

A few small things I can add to help to try and minimize emergency care expenses.

1) Outpatient imaging is your friend. The trends are pushing it more and more, but if you're in a well sized suburban area, I'd wager you have an outpatient imaging center in easy enough driving distance if you didn't realize it. Much easier to get in and out of compared to a hospital, and self-pay rates can better too. They can sometimes offer same day or walk-in service on x-rays if you or your kid may want a "just to be sure" scan done. It's worth checking before you may need to think about it after your kid walks in the door limping and you're feeling guilt as a parent over if it means you should go to the ED or not. Report delivery times may vary as what you order won't be STAT, but if you ask nicely, you might be able to get the radiologist to read yours next. X-rays done at urgent care centers or possibly your physicians office are just as cost saving, but the prevalence of those are area/market dependent.

2) It's time consuming, but informative, and possibly dollar saving for you to go over your bill from the hospital, matching it to your EOB line by line on charges/payments, while looking at any discharge paperwork. Medical billing is as prone to errors as any other system that uses human beings. It's even more complicated when you're one of a zillion reports the coders are turning into bills on a measured basis for expediency. When you try to get errors for unused or wrongly billed services corrected, I promise a nice attitude will go further than angst.

3) Try to take someone you trust with you to the ED if you can to help you from making decisions under duress. I'm fully onboard with the advice in this thread about making it slow and clear that you want to understand what you're having done to and for you, but you might not be in the right condition to be intransigent to the needed degree. It helps to have someone you trust help be a clear headed advisor in situations where your mental abilities are being blunted by your physical conditions. There may be limits to where and when they can be by your side depending on where you're at.

4) From the "the worst they can do is say no" department...if you're not insured or trying to see if there is a better price than your high-deductible plan would hit you for after a visit to the ED (for any of the various bills you get) before paying, always deliberately ask something to the effect of "do you offer a discount for self-pay patients?". This seems so shady, but some practice groups have a rule for their billing reps that they aren't allowed to action a discount unless the patient specifically asks for one. This tends to be a billing department management thing and the physician who signs your charts and reports typically has no idea what his back office does once they send you a bill, so don't get mad at them first; they're for the most part trying to be doctors not accountants. I think it should be illegal to charge a true self-pay patient more than Medicare reimburses, but if healthcare overall is akin to a car, the chargemaster is like the engine block so the high price is the basis on which everything else that moves the car is based on.
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Fri Dec 27, 2019 10:06 am

Try to take someone you trust with you to the ED if you can to help you from making decisions under duress. I'm fully onboard with the advice in this thread about making it slow and clear that you want to understand what you're having done to and for you, but you might not be in the right condition to be intransigent to the needed degree. It helps to have someone you trust help be a clear headed advisor in situations where your mental abilities are being blunted by your physical conditions. There may be limits to where and when they can be by your side depending on where you're at.
Yes - absolutely!

This can help minimize medical errors - such as treating you for the wrong ailment. Your illness/condition could prevent you from catching such a mistake.

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Re: How to Minimize Your Emergency Care Expenses

Post by Mako52 » Fri Jan 03, 2020 9:44 pm

Question for WCI and others knowledgeable in emergency treatment as we probably took care of 2020's deductible earlier tonight with an unexpected ER visit.

Let's say your child does one of the following. Other than the hospital ER, is there a more cost-effective place for treatment for the following?

1) falls and breaks a limb.
2) gashes a limb and requires multiple stitches. Butterfly bandage won't fix it.

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Re: How to Minimize Your Emergency Care Expenses

Post by LadyGeek » Fri Jan 03, 2020 10:25 pm

^^^ How close are you to an Urgent Care facility? Insurance companies prefer Urgent Care to a hospital emergency room. They're much cheaper and can handle a wide range of injuries.

If it's the closest facility, they'll have the medical staff on-hand that can at least get the injury under control and decide if a trip to the ER is needed.
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jan 07, 2020 10:45 am

LadyGeek wrote:
Fri Jan 03, 2020 10:25 pm
^^^ How close are you to an Urgent Care facility? Insurance companies prefer Urgent Care to a hospital emergency room. They're much cheaper and can handle a wide range of injuries.
If it's the closest facility, they'll have the medical staff on-hand that can at least get the injury under control and decide if a trip to the ER is needed.
I also think it makes sense to periodically check out such Urgent Care facilities well ahead of encountering a medical issue - requiring immediate attention. This would include what insurance they accept and what kinds of issues they can and cannot handle, as well as any hospital ER connections. From what I see in our neighborhood, these Urgent Care places come and go quite often, as well as changing names and affiliations.

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Re: How to Minimize Your Emergency Care Expenses

Post by oldcomputerguy » Wed Jan 08, 2020 7:02 am

Several off-topic posts were removed. Please try to keep the discussion centered on the original topic (how to reduce emergency care expenses).
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Jan 08, 2020 10:59 am

I wonder if taking some kind of first aid or similar training might help us be better able to identify the seriousness of medical conditions (ours or others) could help. I think it would.

I also believe that having reliable and usable reference material can also help. One book that We have found extremely helpful in this regard is the Merk Manual Home edition. https://www.amazon.com/s?k=merck+manual ... nb_sb_noss

We have also found this very helpful in better understanding medical diagnoses by our Physicians and treatments for various conditions. We, then, are much better able to successfully communicate with Physicians and other medical providers.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Jan 08, 2020 11:12 am

Keep records of your medical history, including when you had X-Rays, lab tests, scans (MRI, CT), EKG, diagnoses, etc. Then, you may be able to avoid unnecessary tests, scans, etc. because there is already the needed information. Many such tests/scans (CT, MRI) can be quite expensive. Just the patient (or family member) being fully aware of the patient's full medical history can reduce some costs.

To the extent possible and practical, seek out urgent/emergency facilities that have, or can easily obtain, your medical history, etc.

Recently, my wife went to our Urgent care facility in the evening - due to severe pain. This was already a situation where she was seeing Physicians about and had some preliminary diagnoses. While the expenses for this were not huge, they amounted to several hundred dollars under our Medicare plan. It turned out (after EKG, X-Ray, CT scan, lab blood tests) that she was not in serious danger and all her symptoms were from conditions she was already being seen for. With 20/20 hindsight, then, objectively, nothing was gained from this visit. However, I do not fault her - since she had very significant pain.

I believe, as well, that it is very wise to go over any of such visits - so we are smarter next time.

DarkHelmetII
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Re: How to Minimize Your Emergency Care Expenses

Post by DarkHelmetII » Thu Jan 16, 2020 2:42 am

1) How does one ascertain what is a "reasonable" level of CPT coding for an ER visit? To my understanding there are five levels … 99281 through 99285. How do I know if the hospital is up-coding beyond what is justified?

2) How can I search for Urgent Care centers by Classification? My understanding is that Urgent Cares range in classification from 1 - 5 with varying requirements but I have no idea as how to search with this "level" as a criteria, e.g. all Level 1 Urgent Cares within 10 miles of an address etc...

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Re: How to Minimize Your Emergency Care Expenses

Post by Broken Man 1999 » Wed Jan 22, 2020 4:51 pm

Our particular insurance has a $50 co-pay for "urgent care" and a $65 co-pay for an ER visit.

So I don't use urgent care facilities. My ER has records on me going back over 20 years.

No incentive to use urgent care at all.

Plus, my PCP is available via a phone call, as he gave us his direct cell phone number years ago. We have called him very, very few times, but it is available.

Around here urgent care facilities open and close, so I don't want to use them, no continuity at all for the most part.

dm200, a 15 year old imaging result seems stale to me, but I'm not a doctor.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go. " -Mark Twain

sawhorse
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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Thu Jan 23, 2020 12:53 am

I'm putting your tips to the test. I've been waiting for five hours in the ER, ordered here by a surgeon for surgical complications. I have only seen the triage nurse, and she ordered a slew of blood and urine tests. I told her that I hoped she wouldn't order too many tests as I'm trying to contain costs. She thought I was joking. I said I was serious, and then I asked her how much the tests would cost. She had no idea. I repeated that I didn't want any tests that weren't essential, she got angry, so I backed off. They drew 5 vials plus urine.

This is the first time I've been to an ER where the triage nurse ordered a slew of blood tests immediately without even asking me for more than my primary complaint. In fact, they did the tests before they even got my insurance information and had me sign consent forms.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Fri Jan 24, 2020 12:58 pm

Broken Man 1999 wrote:
Wed Jan 22, 2020 4:51 pm
Our particular insurance has a $50 co-pay for "urgent care" and a $65 co-pay for an ER visit.
So I don't use urgent care facilities. My ER has records on me going back over 20 years.
No incentive to use urgent care at all.
Plus, my PCP is available via a phone call, as he gave us his direct cell phone number years ago. We have called him very, very few times, but it is available.
Around here urgent care facilities open and close, so I don't want to use them, no continuity at all for the most part.
dm200, a 15 year old imaging result seems stale to me, but I'm not a doctor.
Broken Man 1999
Yes - very little difference in cost for you between Urgent care and ER.

In our case (Kaiser) the cost difference (Medicare) is not great either, but the Kaiser Urgent Care can handle almost any urgent/emergency problem, and is much, much better care.

Regarding the 15 year old imaging report - being old/stale - in this case - was a good thing. This old report showed that I had the same type of kidney cysts for many years.

clip651
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Re: How to Minimize Your Emergency Care Expenses

Post by clip651 » Fri Jan 24, 2020 4:36 pm

sawhorse wrote:
Thu Jan 23, 2020 12:53 am
I'm putting your tips to the test. I've been waiting for five hours in the ER, ordered here by a surgeon for surgical complications. I have only seen the triage nurse, and she ordered a slew of blood and urine tests. I told her that I hoped she wouldn't order too many tests as I'm trying to contain costs. She thought I was joking. I said I was serious, and then I asked her how much the tests would cost. She had no idea. I repeated that I didn't want any tests that weren't essential, she got angry, so I backed off. They drew 5 vials plus urine.

This is the first time I've been to an ER where the triage nurse ordered a slew of blood tests immediately without even asking me for more than my primary complaint. In fact, they did the tests before they even got my insurance information and had me sign consent forms.
You've probably been treated by now. Hope you're doing better! In your case, since your surgeon ordered you over there for complications, the surgeon might have put in the order for blood and urine tests. So the nurse may have been acting on your doctor's orders, not deciding (as a triage nurse) what you needed on the spot.

sawhorse
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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Fri Jan 24, 2020 9:24 pm

clip651 wrote:
Fri Jan 24, 2020 4:36 pm
sawhorse wrote:
Thu Jan 23, 2020 12:53 am
I'm putting your tips to the test. I've been waiting for five hours in the ER, ordered here by a surgeon for surgical complications. I have only seen the triage nurse, and she ordered a slew of blood and urine tests. I told her that I hoped she wouldn't order too many tests as I'm trying to contain costs. She thought I was joking. I said I was serious, and then I asked her how much the tests would cost. She had no idea. I repeated that I didn't want any tests that weren't essential, she got angry, so I backed off. They drew 5 vials plus urine.

This is the first time I've been to an ER where the triage nurse ordered a slew of blood tests immediately without even asking me for more than my primary complaint. In fact, they did the tests before they even got my insurance information and had me sign consent forms.
You've probably been treated by now. Hope you're doing better! In your case, since your surgeon ordered you over there for complications, the surgeon might have put in the order for blood and urine tests. So the nurse may have been acting on your doctor's orders, not deciding (as a triage nurse) what you needed on the spot.
No, the surgeon had no contact with the ER or hospital, and she had no affiliation or admitting privileges at the hospital. She sent me to the ER with a letter describing the procedure and her notes from the day. I offered it to the triage nurse, but she didn't look at it and said I should wait to show it to the doctor. The nurse just ordered a bunch of tests as if it was standard procedure. I know one of them was a complete metabolic panel.

I think I ran into an example of the practice described here.

https://www.kevinmd.com/blog/2019/09/ho ... -care.html

tj
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Re: How to Minimize Your Emergency Care Expenses

Post by tj » Sat Jan 25, 2020 10:43 am

Broken Man 1999 wrote:
Wed Jan 22, 2020 4:51 pm
Our particular insurance has a $50 co-pay for "urgent care" and a $65 co-pay for an ER visit.

So I don't use urgent care facilities. My ER has records on me going back over 20 years.

No incentive to use urgent care at all.

Plus, my PCP is available via a phone call, as he gave us his direct cell phone number years ago. We have called him very, very few times, but it is available.

Around here urgent care facilities open and close, so I don't want to use them, no continuity at all for the most part.

dm200, a 15 year old imaging result seems stale to me, but I'm not a doctor.

Broken Man 1999
The $65 co-pay covers teh facility and the doctor or just the facility?

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Re: How to Minimize Your Emergency Care Expenses

Post by Broken Man 1999 » Sat Jan 25, 2020 11:33 am

tj wrote:
Sat Jan 25, 2020 10:43 am
Broken Man 1999 wrote:
Wed Jan 22, 2020 4:51 pm
Our particular insurance has a $50 co-pay for "urgent care" and a $65 co-pay for an ER visit.

So I don't use urgent care facilities. My ER has records on me going back over 20 years.

No incentive to use urgent care at all.

Plus, my PCP is available via a phone call, as he gave us his direct cell phone number years ago. We have called him very, very few times, but it is available.

Around here urgent care facilities open and close, so I don't want to use them, no continuity at all for the most part.

dm200, a 15 year old imaging result seems stale to me, but I'm not a doctor.

Broken Man 1999
The $65 co-pay covers teh facility and the doctor or just the facility?
All services, though if I'm admitted I don't pay the $65. That is not to say I will be staying there free, though. :D

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go. " -Mark Twain

chalet
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Re: How to Minimize Your Emergency Care Expenses

Post by chalet » Sat Jan 25, 2020 2:23 pm

Broken Man 1999 wrote:
Wed Jan 22, 2020 4:51 pm
Our particular insurance has a $50 co-pay for "urgent care" and a $65 co-pay for an ER visit.

So I don't use urgent care facilities. My ER has records on me going back over 20 years.

No incentive to use urgent care at all.


eventually the insurance company will decide one of your visits was not justified. then, $$$

Broken Man 1999
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Re: How to Minimize Your Emergency Care Expenses

Post by Broken Man 1999 » Sat Jan 25, 2020 2:38 pm

chalet wrote:
Sat Jan 25, 2020 2:23 pm
Broken Man 1999 wrote:
Wed Jan 22, 2020 4:51 pm
Our particular insurance has a $50 co-pay for "urgent care" and a $65 co-pay for an ER visit.

So I don't use urgent care facilities. My ER has records on me going back over 20 years.

No incentive to use urgent care at all.


eventually the insurance company will decide one of your visits was not justified. then, $$$
Why? Don't get the idea I'm constantly at the ER. But, OTOH I've never showed up at the ER where I was not admitted. Last time (2017) I had a simple fracture of right leg, compound fracture w/7 inch gash from bone(s) on left leg. DW drove me to the ER.

I read the title of this discussion as being EMERGENCY CARE. I therefore go to places that would offer me true emergency care.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go. " -Mark Twain

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Re: How to Minimize Your Emergency Care Expenses

Post by abuss368 » Sat Jan 25, 2020 2:59 pm

Excellent summary. Thank you for providing.
John C. Bogle: Two Fund Portfolio - Total Stock & Total Bond - “Simplicity is the master key to financial success."

vanquish
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Re: How to Minimize Your Emergency Care Expenses

Post by vanquish » Wed Jan 29, 2020 5:24 pm

I just wanted to post and say that this is incredibly useful info.

Bill2020
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Re: How to Minimize Your Emergency Care Expenses

Post by Bill2020 » Fri Feb 21, 2020 3:49 pm

If your local ambulance is volunteer, many will waive or reduce fees if you are a supporting member (ie. donate above a certain amount). Our local EMS requires $50 donation for single member or $75 donation for family membership. They will accept insurance as payment in full, or if no insurance, reduce the fee by 50%.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Mon Mar 02, 2020 10:30 am

If it is safe for the particular condition, then take a taxi/Uber/lyft or have a friend drive you vs. the added cost of an ambulance.

barberakb
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Re: How to Minimize Your Emergency Care Expenses

Post by barberakb » Tue Apr 07, 2020 2:16 pm

man reading this thread is interesting. So glad I have tricare.

It will probably save me a fortune over my life

JBTX
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Re: How to Minimize Your Emergency Care Expenses

Post by JBTX » Sat Apr 11, 2020 2:59 pm

I posted about this in one of the coronavirus thread. Few weeks ago young adult DDs friend has all CV symptoms for days. Spending almost all the time in bed. Coughing ect. Finally they get thermometer and has 102 fever. It is Sunday we try calling around urgent care places and none would test for CV. ERs indicated they may if qualified for symptoms

Finally I tell DD to take him to ER. He is uninsured. It really wasnt clear what an urgent care would even do. He gets to ER and they say he has all symptoms and they just assume covid. Tested for flu strep etc all negative. But they are testing nobody for CV. Said he likely had it. Presented with potential $800 ER bill he refuses treatment and they prepare to send him home, but then has rapid heartbeat and seizure and passes out (which had happened in past but rarely). So they put him on IV and Tylenol and send him home about 3 hours later.

I just discovered he was billed about $3000.

I am not sure how non physicians are supposed to evaluate the need for emergency medical care. My DD and I spent several hours calling around trying to figure out options but most of what you are told is 100% cya. Call this phone number. Go to this website.

Now yes, part of this is on him for not having insurance or primary physician, but he doesn't have family to help fund these issues, and does have a job. It is easy for me in my position to pass judgment on somebody who comes from completely different circumstances.

What are options and strategies for negotiating this downward? It just burns me upthat they charge these "chargemaster" rates when insurance or Medicare and Medicaid rates would be a fraction of that.

tj
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Re: How to Minimize Your Emergency Care Expenses

Post by tj » Sat Apr 11, 2020 11:44 pm

JBTX wrote:
Sat Apr 11, 2020 2:59 pm
I posted about this in one of the coronavirus thread. Few weeks ago young adult DDs friend has all CV symptoms for days. Spending almost all the time in bed. Coughing ect. Finally they get thermometer and has 102 fever. It is Sunday we try calling around urgent care places and none would test for CV. ERs indicated they may if qualified for symptoms

Finally I tell DD to take him to ER. He is uninsured. It really wasnt clear what an urgent care would even do. He gets to ER and they say he has all symptoms and they just assume covid. Tested for flu strep etc all negative. But they are testing nobody for CV. Said he likely had it. Presented with potential $800 ER bill he refuses treatment and they prepare to send him home, but then has rapid heartbeat and seizure and passes out (which had happened in past but rarely). So they put him on IV and Tylenol and send him home about 3 hours later.

I just discovered he was billed about $3000.

I am not sure how non physicians are supposed to evaluate the need for emergency medical care. My DD and I spent several hours calling around trying to figure out options but most of what you are told is 100% cya. Call this phone number. Go to this website.

Now yes, part of this is on him for not having insurance or primary physician, but he doesn't have family to help fund these issues, and does have a job. It is easy for me in my position to pass judgment on somebody who comes from completely different circumstances.

What are options and strategies for negotiating this downward? It just burns me upthat they charge these "chargemaster" rates when insurance or Medicare and Medicaid rates would be a fraction of that.

Can always try one of the bill negotiater sites. I used CoPatient.

sawhorse
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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Sun Apr 12, 2020 8:32 am

JBTX wrote:
Sat Apr 11, 2020 2:59 pm
I posted about this in one of the coronavirus thread. Few weeks ago young adult DDs friend has all CV symptoms for days. Spending almost all the time in bed. Coughing ect. Finally they get thermometer and has 102 fever. It is Sunday we try calling around urgent care places and none would test for CV. ERs indicated they may if qualified for symptoms

Finally I tell DD to take him to ER. He is uninsured. It really wasnt clear what an urgent care would even do. He gets to ER and they say he has all symptoms and they just assume covid. Tested for flu strep etc all negative. But they are testing nobody for CV. Said he likely had it. Presented with potential $800 ER bill he refuses treatment and they prepare to send him home, but then has rapid heartbeat and seizure and passes out (which had happened in past but rarely). So they put him on IV and Tylenol and send him home about 3 hours later.

I just discovered he was billed about $3000.

I am not sure how non physicians are supposed to evaluate the need for emergency medical care. My DD and I spent several hours calling around trying to figure out options but most of what you are told is 100% cya. Call this phone number. Go to this website.

Now yes, part of this is on him for not having insurance or primary physician, but he doesn't have family to help fund these issues, and does have a job. It is easy for me in my position to pass judgment on somebody who comes from completely different circumstances.

What are options and strategies for negotiating this downward? It just burns me upthat they charge these "chargemaster" rates when insurance or Medicare and Medicaid rates would be a fraction of that.
Stories like this are heartbreaking. I would not pay anything at this time as it's possible that there will be legislation covering all coronavirus treatment costs.

JBTX
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Re: How to Minimize Your Emergency Care Expenses

Post by JBTX » Sun Apr 12, 2020 11:47 am

tj wrote:
Sat Apr 11, 2020 11:44 pm
JBTX wrote:
Sat Apr 11, 2020 2:59 pm
I posted about this in one of the coronavirus thread. Few weeks ago young adult DDs friend has all CV symptoms for days. Spending almost all the time in bed. Coughing ect. Finally they get thermometer and has 102 fever. It is Sunday we try calling around urgent care places and none would test for CV. ERs indicated they may if qualified for symptoms

Finally I tell DD to take him to ER. He is uninsured. It really wasnt clear what an urgent care would even do. He gets to ER and they say he has all symptoms and they just assume covid. Tested for flu strep etc all negative. But they are testing nobody for CV. Said he likely had it. Presented with potential $800 ER bill he refuses treatment and they prepare to send him home, but then has rapid heartbeat and seizure and passes out (which had happened in past but rarely). So they put him on IV and Tylenol and send him home about 3 hours later.

I just discovered he was billed about $3000.

I am not sure how non physicians are supposed to evaluate the need for emergency medical care. My DD and I spent several hours calling around trying to figure out options but most of what you are told is 100% cya. Call this phone number. Go to this website.

Now yes, part of this is on him for not having insurance or primary physician, but he doesn't have family to help fund these issues, and does have a job. It is easy for me in my position to pass judgment on somebody who comes from completely different circumstances.

What are options and strategies for negotiating this downward? It just burns me upthat they charge these "chargemaster" rates when insurance or Medicare and Medicaid rates would be a fraction of that.

Can always try one of the bill negotiater sites. I used CoPatient.
Thanks. Copatient appears to be for employees.

tj
Posts: 2821
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Re: How to Minimize Your Emergency Care Expenses

Post by tj » Sun Apr 12, 2020 11:55 am

JBTX wrote:
Sun Apr 12, 2020 11:47 am
tj wrote:
Sat Apr 11, 2020 11:44 pm
JBTX wrote:
Sat Apr 11, 2020 2:59 pm
I posted about this in one of the coronavirus thread. Few weeks ago young adult DDs friend has all CV symptoms for days. Spending almost all the time in bed. Coughing ect. Finally they get thermometer and has 102 fever. It is Sunday we try calling around urgent care places and none would test for CV. ERs indicated they may if qualified for symptoms

Finally I tell DD to take him to ER. He is uninsured. It really wasnt clear what an urgent care would even do. He gets to ER and they say he has all symptoms and they just assume covid. Tested for flu strep etc all negative. But they are testing nobody for CV. Said he likely had it. Presented with potential $800 ER bill he refuses treatment and they prepare to send him home, but then has rapid heartbeat and seizure and passes out (which had happened in past but rarely). So they put him on IV and Tylenol and send him home about 3 hours later.

I just discovered he was billed about $3000.

I am not sure how non physicians are supposed to evaluate the need for emergency medical care. My DD and I spent several hours calling around trying to figure out options but most of what you are told is 100% cya. Call this phone number. Go to this website.

Now yes, part of this is on him for not having insurance or primary physician, but he doesn't have family to help fund these issues, and does have a job. It is easy for me in my position to pass judgment on somebody who comes from completely different circumstances.

What are options and strategies for negotiating this downward? It just burns me upthat they charge these "chargemaster" rates when insurance or Medicare and Medicaid rates would be a fraction of that.

Can always try one of the bill negotiater sites. I used CoPatient.
Thanks. Copatient appears to be for employees.
I don't understand your "for employees" comment. I don't see why it would matter if your insurance is through an employer or through the marketplace, or if you have no insurance at all.

Edit: Hmm I guess they changed their marketing to employer plans.


Try the other one - https://www.medicalcostadvocate.com/Negotiate.aspx - then

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