If I got $100 for every time I saw a patient sent in by a primary care doctor’s office for something they could have and should have taken care of in the office, I would be a millionaire.Paul78 wrote: ↑Thu Dec 10, 2020 6:34 pmWell if you say any of the keys words the nurse is always going to recommend the ER... Your life is on the line and their license/job is on the line. So of course if you say anything that "might" be serious/critical they will advise ER. The nurse hotline is really more for triage (ie follow up with PCP, go to urgent care, go to ER) so people with a scraped knee don't go to the ER.
How to Minimize Your Emergency Care Expenses
Re: How to Minimize Your Emergency Care Expenses
A time to EVALUATE your jitters: |
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Re: How to Minimize Your Emergency Care Expenses
A part of my job is negotiating contracts with hospitals, primary care physician, and specialists. After renegotiating 4 hospital contracts last year, I can tell you - hospitals are what’s wrong with healthcare. Spend a few minutes looking up Prem Reddy and Prime Healthcare and you’ll get what I mean real quick.
Re: How to Minimize Your Emergency Care Expenses
I’ve seen them sent to the ED by the PCP when they could have been treated in the office very easily. Only the PCPs bill fee for service and needed the room back to see mo’ patients!EnjoyIt wrote: ↑Thu Dec 10, 2020 8:46 pmIf I got $100 for every time I saw a patient sent in by a primary care doctor’s office for something they could have and should have taken care of in the office, I would be a millionaire.Paul78 wrote: ↑Thu Dec 10, 2020 6:34 pmWell if you say any of the keys words the nurse is always going to recommend the ER... Your life is on the line and their license/job is on the line. So of course if you say anything that "might" be serious/critical they will advise ER. The nurse hotline is really more for triage (ie follow up with PCP, go to urgent care, go to ER) so people with a scraped knee don't go to the ER.
Re: How to Minimize Your Emergency Care Expenses
In the past some emergency room doctors were not contracted with insurance companies and therefore were able to bill hugely exorbitant rates.
I understand there was legislation that was going to fix the issue.. Did that ever happen.
I understand there was legislation that was going to fix the issue.. Did that ever happen.
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Re: How to Minimize Your Emergency Care Expenses
The No Surprises Act passed December 27, 2020. Parts take effect in 2022.
At www.aha.org, type No Surprises in the search box.
Re: How to Minimize Your Emergency Care Expenses
Thanks I read this highlight on the AMA site
"Protects patients from receiving
surprise medical bills resulting from
gaps in coverage for emergency
services and certain services
provided by out-of-network
clinicians at in-network facilities,
including by air ambulances."
Not sure what that means.. Does that cover an actual case where a patient with very severe injury arrives by ambulance at a hospital that is contracted with for example blue cross and is treated by an emergency room doctor/surgeon that is not an in-network provider with blue cross . The bill for the surgeon was in the 40 to 50 thousand dollar range. After the patient was released about a month later the very large hospital and various doctor bills were paid by blue cross except the surgeon bill. The surgeons "billing company" started threating the patient with all kinds of recovery actions" The patient was a college student and over the age of 21 with no resources so the dr got nothing from the patient other than what he could negotiate with B.Cross. . Had the the individual been a minor the parents would have been liable. That is the situation that needs to be fixed. I hope the "no surprise bill" that takes effect soon does it.
"Protects patients from receiving
surprise medical bills resulting from
gaps in coverage for emergency
services and certain services
provided by out-of-network
clinicians at in-network facilities,
including by air ambulances."
Not sure what that means.. Does that cover an actual case where a patient with very severe injury arrives by ambulance at a hospital that is contracted with for example blue cross and is treated by an emergency room doctor/surgeon that is not an in-network provider with blue cross . The bill for the surgeon was in the 40 to 50 thousand dollar range. After the patient was released about a month later the very large hospital and various doctor bills were paid by blue cross except the surgeon bill. The surgeons "billing company" started threating the patient with all kinds of recovery actions" The patient was a college student and over the age of 21 with no resources so the dr got nothing from the patient other than what he could negotiate with B.Cross. . Had the the individual been a minor the parents would have been liable. That is the situation that needs to be fixed. I hope the "no surprise bill" that takes effect soon does it.
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Re: How to Minimize Your Emergency Care Expenses
This was a very useful and interesting post - shared with family members. A big thanks to the OP!
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Re: How to Minimize Your Emergency Care Expenses
How do I find primary doctors, urgent care centers and Emergency departments who have the least incentive in making the most money out of me?
For instance, I'm thinking for ER scenarios - public hospitals are better than private hospitals. Is that assumption right?
How about for primary doctors and urgent care?
Thank you!
For instance, I'm thinking for ER scenarios - public hospitals are better than private hospitals. Is that assumption right?
How about for primary doctors and urgent care?
Thank you!
Re: How to Minimize Your Emergency Care Expenses
This is a generality and does not fit everyone, but hospital systems that are non-for profit where the board of directors are composed of community leaders. I believe these systems tend to be more patient care and quality oriented.nonamer800 wrote: ↑Thu Oct 07, 2021 11:33 am How do I find primary doctors, urgent care centers and Emergency departments who have the least incentive in making the most money out of me?
For instance, I'm thinking for ER scenarios - public hospitals are better than private hospitals. Is that assumption right?
How about for primary doctors and urgent care?
Thank you!
They are all driven by finances unfortunately. But without profit there is no hospital system.
For private physician offices I think it is much harder. Referrals, other physician’s opinions and looking to see if they have any claims on the national provider database or licensing board for the state.
A time to EVALUATE your jitters: |
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Re: How to Minimize Your Emergency Care Expenses
As a healthcare risk manager who reports to and queries the National Practitioner Data Bank (https://www.npdb.hrsa.gov/), it has never been accessible to the public. Looking at the state medical licensing/disciplinary agency is usually a better bet, although there is great variation between states in terms of what is reported and publicly available.EnjoyIt wrote: ↑Thu Oct 07, 2021 1:02 pmFor private physician offices I think it is much harder. Referrals, other physician’s opinions and looking to see if they have any claims on the national provider database or licensing board for the state.nonamer800 wrote: ↑Thu Oct 07, 2021 11:33 am How do I find primary doctors, urgent care centers and Emergency departments who have the least incentive in making the most money out of me?
For instance, I'm thinking for ER scenarios - public hospitals are better than private hospitals. Is that assumption right?
How about for primary doctors and urgent care?
Thank you!
Re: How to Minimize Your Emergency Care Expenses
Upon reviewing this thread, there is no longer a need for it to remain as a 'sticky' topic. This thread is now a "normal" topic - the same as any other thread.
(Thanks to the member who reported the post and provided the suggestion.)
(Thanks to the member who reported the post and provided the suggestion.)
Re: How to Minimize Your Emergency Care Expenses
if you are a veteran and using VA health care, check out the emergency care benefit and urgent care benefit.
Re: How to Minimize Your Emergency Care Expenses
It might be interesting sometime this year if we can coax White Coat Investor or another active doctor to do a followup with what they have seen, if any from the new laws going into place this year, the transparency law and the no surprise act. I imagine it will take a while for these laws to get integrated into the billing system(s), etc and anyone can reasonably know if they made any difference whatsoever.
Whether rich or poor, a young woman should know how a bank account works, understand the composition of mortgages and bonds, and know the value of interest and how it accumulates. -Hetty Green
Re: How to Minimize Your Emergency Care Expenses
I saw what my relatively large hospital system published when the law first came out I think 1-2 years ago regarding cost for services and it was complete garbage. As a physician I found the data useless. As a patient who has no medical experience the data was even more useless. I understand the data is supposed to improve over time, I hope that is the case. Maybe when I have more time I will take a lookzie wrote: ↑Thu Jan 13, 2022 11:41 am It might be interesting sometime this year if we can coax White Coat Investor or another active doctor to do a followup with what they have seen, if any from the new laws going into place this year, the transparency law and the no surprise act. I imagine it will take a while for these laws to get integrated into the billing system(s), etc and anyone can reasonably know if they made any difference whatsoever.
A time to EVALUATE your jitters: |
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