How to Minimize Your Emergency Care Expenses

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telemark
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Re: How to Minimize Your Emergency Care Expenses

Post by telemark » Mon Jan 22, 2018 1:18 pm

Lee Saage wrote:
Fri Jan 19, 2018 7:15 pm
The urgent care PA said they could have done the sutures and shot for maybe $150. One learns. And relearns.

This brings up one other suggestion: keep your inoculations up to date. A TDAP shot is very cheap insurance.

MrBeaver
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Re: How to Minimize Your Emergency Care Expenses

Post by MrBeaver » Mon Jan 22, 2018 2:54 pm

White Coat Investor wrote:
Mon Jan 22, 2018 12:34 am
johne417 wrote:
Sun Jan 21, 2018 11:51 pm
White Coast Investor,

I'm curious your thoughts on payments at time of service. I've had multiple occasions (e.g. during my wife's trips to her OB's office during pregnancy, during my son's visit to the ER a couple months ago, etc), where they request a direct payment at time of service because that's my expected out of pocket cost, or an initial payment towards it. I usually demur, and say please send it to my insurance company, I'll wait for the EOB to come back first, etc. Is my strategy there common and what one should normally do, or an atypical thing where you kindof come across as a jerk to your provider? If the former, why do they even ask?

For my son's ER visit, after I demurred and let it go through insurance, my final out of pocket cost ended up being significantly less than they had requested at the ER. I wondered to myself if it would've worked out that way (by reimbursement or whatever) if I had paid the requested amount at the ER.

Curious as to your thoughts here, and really appreciate your helpful advice on these boards. Thx in advance.
The doc probably doesn't know, so don't worry about offending her.

It depends on the policy, but our registration folks ask for money at the time of the initial visit, but you can get the 25% cash discount by paying up to 30 days later and we certainly can't deny taking care of you if you don't pay due to EMTALA, so we can't really force you. In your OB clinic they could. I've done this and had the clinic have to reimburse me when we overpaid on the initial visit.
We had an odd experience whereby our OB's office pre-billed us in June 2016 for the doctor's delivery charge which was expected in February 2017. We had the cash, so I didn't balk to their face, but I did laugh. Not only did they pre-bill us for services not rendered, but the billed us based on the current insurance reimbursement rate in 2016 (90% since we had hit our deductible and had not hit our OOP max). As a result, we 'owed' about $400 of which all was refunded in February 2017 (without interest, of course) since we had hit our OOP max from hospital bills before they billed the insurance company. If they had run these numbers before we hit our deductible and demanded $4000 of which all would have been refunded, I think I would have blown a gasket, likely with no recourse other than to find a different doctor/clinic.

I should say that it was openly spoken in this clinic that all the practicing doctors there hated the company who owned and operated the office. I'm sure this was indicative of many other annoying and shady business practices. But still, it's practices like these brought on by healthcare businesses who get squeezed, that make consumers feel fleeced and utterly powerless against both insurance companies and providers.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Mon Jan 22, 2018 2:57 pm

Broken Man 1999 wrote:
Mon Jan 22, 2018 11:02 am
Interesting differences when copays are paid.
We have used HMOs, PPOs, EPNs over the years, and we have always paid the copay at time of the visit of PCD or specialist. In fact our copays are paid upon checking in with the receptionist, prior to seeing the doctor.
Currently my copay for PCD is $5.00, specialist visits are $20.00. My current coverage is a PPO, wife's coverage is an EPN.
I don't think I would want to put the burden on the practice to have the expense of billing me when I know what my copay is; the copay info is actually on my insurance ID card, I assume, perhaps incorrectly, copay info is on everyone's insurance card.
Broken Man 1999
Yes - paying the copay at the time of the visit seems both fair and reasonable. Some insurance plans, though, that we had did not have easy to understand copays - either by us or by the office staff. In those cases, I wanted the office to get it right - then bill us for the correct amount.

Under my current plan, one "curious" aspect of copays (for Ophthalmology as an example) is that if I see the doctor and have tests she orders done at the same visit - it is one copay (same as regular office visit). BUT - if the tests are done at a different appointment - then we pay 2 copays. Now that I learned that, I now make every effort to have things done at one "visit"

CppCoder
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Re: How to Minimize Your Emergency Care Expenses

Post by CppCoder » Mon Jan 22, 2018 8:23 pm

telemark wrote:
Mon Jan 22, 2018 1:15 pm
CppCoder wrote:
Sat Jan 20, 2018 8:48 am
I know the above is true, but honestly, the medical providers are the ones who make this industry work. Why don't doctors, nurses, etc. organize and fix the problem? If you don't, you're somewhat complicit. You are taking advantage of the system to receive high pay and abdicating responsibility for billing because "that's someone else's department." I assure you, most hospitals wouldn't be there if doctors organized and stopped working there. If nothing else, you'd think someone would want to do this for self-preservation reasons. Rightly or wrongly, eventually the masses can't take it anymore, and they come with tar, feathers, and pitchforks. In this case, I suspect that would be draconian laws dictating payment, not literal tar and feathering. Maybe this will never be the case because the really poor don't pay, the rich just pay and complain but it has no impact on them, and those stuck in the middle get squeezed but are too few and powerless to fix anything. Personally, I wouldn't be able to sleep at night working in an industry that yes, provides a needed and noble service, but also had a back office that worked like a loan shark. I can't imagine anyone going into medical school today doesn't realize this...they still go.
The state of the computer industry can only be described as a disgrace. Look at the constant tracking and loss of privacy, the tendency toward democracy-threatening information bubbles, the constant hacking exacerbated by error-prone languages like C++, the whole "move fast and break things" ethos, etc. Why don't the programmers get together to stop this? They're the ones who make it
all work.
I don't disagree that things could be better in the computer industry, although I'm not in the computer industry. I'm an engineer, and the only software I write/manage is for proprietary use with no external customer interface. Where our programs have errors, it costs us money, and we do seek to minimize those errors. The big difference, though, in your analogy is that most of the things you cite are not by design but are often errors or technical problems, not business problems (although sometimes exacerbated by bad management decisions). Software developers, in general, do strive to fix these things (the good developers, anyway). Your analogy would be more akin to criticizing doctors for malpractice rather than poor billing. Presumably, all (good) doctors strive not to make technical errors that would affect patients. My guess is that just like in the software industry, management sometimes does "force" technical errors by unrealistic demands.

FYI, when I'm in charge of a project, I do push back on bad management decisions and do not compromise the integrity of my work or my team's work to satisfy unrealistic demands...

SlowMovingInvestor
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Re: How to Minimize Your Emergency Care Expenses

Post by SlowMovingInvestor » Mon Jan 22, 2018 8:36 pm

inbox788 wrote:
Mon Jan 22, 2018 12:51 am
I'm skeptical of the Walmart and CVS clinics that for relative low costs provide very basic services. I expect they'll discover that they're mainly treating people who normally wouldn't have gone to the doctor for conditions that really don't need a doctor, and will ultimately drive the cost of healthcare up as these for profit companies maximize their marketing and profit per square foot.
Based only on personal experience (which is of course no substitute for data), I disagree. I have visited the MinuteClinic for simple things like vaccinations, bruises/cuts/stings etc. that are a little beyond home care, but might have required an urgent care or doc visit otherwise. And the transparency of prices is great !

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Re: How to Minimize Your Emergency Care Expenses

Post by LadyGeek » Mon Jan 22, 2018 8:53 pm

I removed an off-topic post. Please stay on-topic, which how to minimize emergency care expenses.

Expressing frustration or trying to fix the system (medical, computer industry, etc.) is off-topic. Let's focus on working within the current environment.
Wiki To some, the glass is half full. To others, the glass is half empty. To an engineer, it's twice the size it needs to be.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Mon Jan 22, 2018 9:27 pm

Getting "urgent" care is almost always lower cost than "emergency room" care. When researching and selecting a Primary Care physician or practice, I would ask about provisions for after hours needs. With some physicians, an "urgent care" facility (which might be charging as an ER) or the hospital ER are the only choices. Although we never had the need, one practice where we had our Primary Care years ago had an affiliated urgent care facility open evenings and weekends.

inbox788
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Re: How to Minimize Your Emergency Care Expenses

Post by inbox788 » Mon Jan 22, 2018 11:50 pm

SlowMovingInvestor wrote:
Mon Jan 22, 2018 8:36 pm
inbox788 wrote:
Mon Jan 22, 2018 12:51 am
I'm skeptical of the Walmart and CVS clinics that for relative low costs provide very basic services. I expect they'll discover that they're mainly treating people who normally wouldn't have gone to the doctor for conditions that really don't need a doctor, and will ultimately drive the cost of healthcare up as these for profit companies maximize their marketing and profit per square foot.
Based only on personal experience (which is of course no substitute for data), I disagree. I have visited the MinuteClinic for simple things like vaccinations, bruises/cuts/stings etc. that are a little beyond home care, but might have required an urgent care or doc visit otherwise. And the transparency of prices is great !
Sounds like you chose correctly, but with the plethora of choices, I fear other folks will make less optimal choices. Maybe with some experience and education, the general public can be taught where to best get the right level of care, but it's a very complicated process. In the mean time, since this is an investing board, is there a play here with a healthcare ETF? Or directly investing in CVS and Walgreens? Should we short insurers facing higher costs? And if these retail clinics succeed, with this mean less need doctor offices and hospitals? Unfortunately, healthcare demand is endless, so maybe the healthcare ETF is the winning play...

https://www.rand.org/pubs/research_briefs/RB9491-2.html
https://www.fiercehealthcare.com/practi ... healthcare

Retail clinics -> Urgent Care Center -> Stand Alone ED -> Stand Alone Surgical Clinics and Centers, we just need "Uber Med" App to connect all these services together and 90% of patients never need to go to a doctors office or hospital. And if you need a hospital bed, you might find an "Airbnb Med" that meets your needs. Welcome to a new millennium.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jan 23, 2018 10:17 am

On the topic of "incentives" (financial) - to limit healthcare costs because the patient has some "skin in the game" and will make rational choices -

1. On the surface, that makes a good deal of sense. In my opinion, it occasionally can work. Maybe you see your Primary Care Physician for something and pay, say, $10 for the visit vs paying a specialist , say, $50. Or, instead of using a hospital ER - you wait until you can see your PCP.

2. For me, it works a little. BUT - not much. Even though I try, the patient rarely knows BOTH the costs AND the alternatives AND the health/medical risk. In my plan now, for example, I pay $150 for MRIs and CT scans. My doctor orders 2 CT scans and 1 MRI (I only pay $150 for the 2 CT done at the same time). That is $300 to me and probably several thousand paid by insurance. Do I say "NO". Maybe it was a brain tumor.. Or a tumor in my neck or chest?

3. In this time of specialization, even if I choose to see my PCP and pay only $10 or $20, commonly she sends me to a specialist anyway.

4. For some very financially challenged folks, the charges are such that they may just not get things done that are vital. Then, not getting a small charge matter done, it may become much more serious and actually increase medical costs.

Rupert
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Re: How to Minimize Your Emergency Care Expenses

Post by Rupert » Tue Jan 23, 2018 10:31 am

dm200 wrote:
Tue Jan 23, 2018 10:17 am
On the topic of "incentives" (financial) - to limit healthcare costs because the patient has some "skin in the game" and will make rational choices -

1. On the surface, that makes a good deal of sense. In my opinion, it occasionally can work. Maybe you see your Primary Care Physician for something and pay, say, $10 for the visit vs paying a specialist , say, $50. Or, instead of using a hospital ER - you wait until you can see your PCP.

2. For me, it works a little. BUT - not much. Even though I try, the patient rarely knows BOTH the costs AND the alternatives AND the health/medical risk. In my plan now, for example, I pay $150 for MRIs and CT scans. My doctor orders 2 CT scans and 1 MRI (I only pay $150 for the 2 CT done at the same time). That is $300 to me and probably several thousand paid by insurance. Do I say "NO". Maybe it was a brain tumor.. Or a tumor in my neck or chest?

3. In this time of specialization, even if I choose to see my PCP and pay only $10 or $20, commonly she sends me to a specialist anyway.

4. For some very financially challenged folks, the charges are such that they may just not get things done that are vital. Then, not getting a small charge matter done, it may become much more serious and actually increase medical costs.
The skin-in-the-game model doesn't work at all for chronically ill patients. It just bankrupts them. And before someone chimes in to say, "Well, they could just control their lifestyle choices," that isn't always the case. Sometimes your genes really are your destiny. Just ask someone with a child afflicted with cystic fibrosis or an adult afflicted with multiple sclerosis or lupus or ankylosing spondylitis or rheumatoid arthritis. Lifestyle changes can sometimes make living with these conditions less awful, but the patients are nearly always going to need lots of healthcare.

FoolStreet
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Re: How to Minimize Your Emergency Care Expenses

Post by FoolStreet » Tue Jan 23, 2018 12:20 pm

White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
About once a month or so we have someone start a thread about their recent visit to an emergency department. The post usually revolves around the bill being surprisingly high. They all kind of end up the same way. I get lots of PMs on the forum asking similar questions. Since this is a relatively common situation, I thought it might be useful to do a post for forum members about how to minimize their emergency care expenses [this is the actionable, non-medical advice reason for the post.]

First, a few comments about our health care system.
# 1 - It is screwed up, broken, and embarrassing to be a part of.
# 2 - Solutions are to either quit pretending it is a real market or to make it a real market. Depending on your political persuasion, you likely lean one way or the other on this.
# 3 - In order to have a functioning market, most/all of the market participants need to have skin in the game and there must be transparency of prices. Neither of those exists in our current health care "market." Especially transparency of prices.
# 4 - The health care system is unlikely to provide transparency of prices because it is so darn profitable not to have transparent prices. It is also an extremely difficult thing to do in any sort of exact manner, but it would be nice to see even in vague terms.
# 5 - Doctors and nurses generally aren't in control of what's on your bill(s) nor does most of the money paid toward your bill(s) go toward doctors and nurses, so no sense in taking it out on them.

Next, it is important to understand EMTALA- The Emergency Medical Treatment And Labor Act. This requires a hospital (particularly Labor and Delivery and the Emergency Department) and physicians working there to identify and stabilize any emergent medical conditions or labor without first ascertaining whether the patient can or will pay for it. The penalty to not do so is a personal penalty of $50,000. Malpractice insurance does not cover this penalty. A penalty can also be assessed to the hospital.

As an example, if you come in with severe shortness of breath due to your chest being full of fluid from a lung tumor, the hospital must drain the fluid before it can ask you to pay, but it does not need to provide you chemotherapy or surgery to cut out the tumor.

Once an emergent condition has been ruled out or stabilized, the hospital can then ask you to pay before proceeding with any further treatment. In practicality, by the time the emergent condition has been ruled out, the emergency doctor or OB/GYN has pretty much done all her work, so the whole "go charge the patient after the medical screening exam has been completed if they want to continue to get care" gets pretty silly.

In addition, "emergent medical condition" is a very gray area. What is emergent to one person might not be emergent to another. Plus, sometimes the complaint is emergent (such as chest pain) but the final diagnosis (GERD) is not. So it becomes an incredibly difficult law to navigate around. The easiest and most common thing to do for those working in the emergency department is to just take care of anyone who walks in the door as best you can, pretend everything is an emergency, and let the coders, billers, insurance companies, and patients sort it out later.

While the hospital and associated physicians are required to provide this care without first ascertaining ability to pay, they are not required to do it for free. They are allowed to bill the patient and/or their insurance company afterward. Many people that do not have insurance do not pay these bills. The typical reimbursement rate for uninsured patients is less than 10%. For some hospitals, the percentage of uninsured patients can be as high as 50%. In my particular practice, it is closer to 20%. Even in states that expanded Medicaid the number is still often close to 10% because people are either incapable or unwilling to sign-up for Medicaid or a PPACA plan. Many people who have good insurance do not pay their portion of the bill. Given the increasing use of high deductible health plans and health savings accounts, this is happening more and more often. Nevertheless, a bill is sent and if not paid, the account is eventually turned over to collections with the expected effects on the patient's credit score.

Third, hospital and physician billing is seriously screwed up by something called "Chargemaster Pricing." This is where the price on the initial bill is some astronomical amount. These are purposely set high in an effort to maximize profits. The idea is to have it so high that no payor is ever going to be willing to pay more than that. A typical health insurance company will negotiate much lower rates with hospitals and doctors. These negotiated rates are usually pretty fair rates for every one involved. Some payors just pay the chargemaster prices -- auto insurance or liability insurers for instance, since they aren't in the same business as a health insurance company. Some patients just pay the chargemaster price too, although not very many despite typically being offered a 20-25% discount from them for paying promptly (like within 30 days.) One of the best benefits of having an insurance policy, even if your deductible is so high you basically pay everything, is getting the benefit of the insurance company's negotiations with hospitals and doctors.

Fourth, when you go to the ED, you generally get multiple bills, although these are sometimes consolidated if the doctors involved are hospital employees.

Bill # 1 - From the hospital. This usually includes an emergency department charge which varies based on the complexity of your visit. These range from level 1 (perhaps a suture removal) to a level 2 (a wound check on sutures done the day before or an abscessed that was incised and drained 2 days ago) to a level 3 (a cold or back injury for which no medications were administered in the ED and no tests were done) to a level 4 (perhaps a UTI that was given IV antibiotics in the ED) to a level 5 (a work-up for chest pain, belly pain, shortness of breath, or altered mental status.) If you are really ill, there is an additional "critical care" charge. There are additional charges for procedures such as CPR, intubation, or suturing. This charge does not include the services of the doctor, but does include the IV tubing, placing the IV, drawing blood, nursing observations, respiratory therapists, monitors, housekeeping, linens, electricity, heating, crackers and juice, warm blankets, etc etc etc.

The typical amount for a level 4-5 visit that is freely negotiated between the hospital and a good insurance company is probably something around $2K.

The hospital bill also usually includes a charge for any x-rays, CT scans, ultrasounds, or MRIs, a charge for any labs done, and a charge for any medications given. This could easily be another $1-3K, more for an extensive evaluation like multiple CT scans. This does not include the services of a radiologist or pathologist if required.

Emergency care is expensive to provide. There are a great deal of compliance and legal issues, highly trained staff, expensive equipment, consultants, and 24/7/365 availability of all that.

Bill # 2 - From the emergency physician. First there is an emergency visit charge using the same level 1-5 + critical care levels. This includes the doctor's history and physical, counseling, recommendations, prescriptions, work notes, charting, calling consultants, transferring you to other hospitals, talking to your primary doctor, reviewing old records calling an admitting physician etc. About 25% of the work I do for a given patient is visible to the patient so sometimes it feels like "all they did for me was give me a prescription for ibuprofen." If there was a billable procedure done (sutures, intubation, cardioversion, fracture reduction, abscess I&D, CPR, etc) there is an additional charge. Sometimes, the procedure charge is more than the visit charge. A typical level 5 physician bill might be $200-300 after insurance company negotiation. It's $175-200 for Medicare. Procedures are highly variable. Putting a breathing tube in to save your life is $146 when Medicare is paying. A little laceration on your scalp might be $100 when Medicare is paying.

Bill # 3 - From the radiologist. The hospital charges for the tech and machine. The radiologist charges for her expertise reading it. A typical fee to read a single CT might be $250 (Medicare) and up to twice that with a private insurance company.

Bill # 4 - If you were seen by another physician in the ED (a consultant) they will also send you a bill for their consultation and possibly any procedures they do.

As you can see, it doesn't take much to get the bill for a single ED visit into the $5K range for something where there wasn't even anything serious going on. Just like a single hospital admission, surgery, or delivery will hit the max out of pocket for the year on many insurance plans, so will a single emergency department visit. It's just really expensive stuff.

Fifth, nobody you interact with at the hospital at the time of your visit has any idea how much anything costs. Part of that is the whole price transparency thing. Those who know the price don't want the front line workers to know it. Part of it is the fact that there are so many moving parts. Medicine gets inappropriately compared to aviation a lot, but it really isn't a fair comparison. Every one getting on a flight is basically getting the same thing. Medicine is like an airline flight where every row has its own flight attendant, every one on the plane is going somewhere different, and they all get a different movie and meal hand delivered to them. Imagine how much that flight would cost? Finally, despite the fact that there are hundreds of different products and services being sold, everybody pays a different price for them. This is due to dozens of different insurance plans each of which has negotiated a different price for every product and service, co-insurance plans, government plans, and various different levels of deductibles and co-insurance and different amounts of previously consumed care already in the year.

Bottom line, don't expect to be able to "shop" while you're at the ED. It's impossible. We can't even tell you the chargemaster price, much less your price.

Now, let's get to the meat of this post- what you can do to minimize the costs of your emergency care.

# 1 Buy health insurance

When you go to the ED with a truly emergent condition, you're not going to be in any sort of position to negotiate prices. Far better to be associated with someone who has already done that for you and has far more pricing power than you do.

If you can't afford health insurance, apply for Medicaid. If you don't qualify, try to buy through a PPACA exchange. If you have a very low income, the subsidies are typically quite large and most of the middle class qualifies for a subsidy of some type. Even a family of 4 making $80K might be able to buy health insurance at a 50% discount after the tax subsidy.

If that still doesn't work for you, consider a health sharing plan. While these do not provide as comprehensive coverage as a PPACA plan, the "share" might be half as much as health insurance premiums.

Health insurance is expensive stuff because it gets used all the time and health care is expensive stuff. If you think you're only going to pay 2% of your household budget on health care while the nation as a whole spends nearly 20%, you need to reset your expectations. You're doing well if you're only spending 10% of your income on health insurance and health care.

Another option, assuming you can work, is to get a job where health insurance is offered as a benefit. If you can't afford health insurance, and your job doesn't offer it, you should continually be in the job market looking for a better job.

# 2 Expect to pay your maximum out of pocket costs

If your maximum out of pocket cost is $10,000, expect to pay that and be pleasantly surprised if it doesn't get that high. If that is too much for you to afford, buy an insurance policy with a lower deductible/out of pocket cost. The total cost of your ED visit is generally going to be a four figure amount, between $1,000 and $10,000.

# 3 Don't go to the Emergency Department if you don't have to

Since emergency care is such expensive stuff, don't go there if you don't have to. This is a very expensive place for convenience care. If you're not having an emergency, exhaust all other options before turning to the ED. This includes nurse help lines, your cousin, your neighbor, your primary doctor, your cousin's primary doctor, telemedicine, and urgent cares. But if you're clearly having an emergency, for heaven's sake go to the ED. Far better to owe $10K than to lose life, limb, or eyesight. If you're not sure, do the best you can. Doctor's offices and urgent cares are good at quickly sending you to a higher level of care if needed.

# 4 Don't take the ambulance if you don't have to

An ambulance ride costs $1500-2000. An Uber costs $20. If you need the ambulance, for heaven's sake call it. But if not, call an Uber. This also applies to interhospital transfers. "Doc, I don't want to go by ambulance because it's so expensive. I know there is the liability thing, but I'd be willing to sign all that Against Medical Advice paperwork if you think the chances of something happening to me en route are less than 10%."

Just because the ambulance came to your house doesn't mean you have to ride with them to the hospital. Your taxes cover the trip to your house and the assessment by the medics. Your health insurance (and you) covers the trip from home to the hospital. Don't worry, you won't offend the medics. If they're really worried, they'll follow you there. That's a good sign that maybe you should have just gotten in the ambulance.

# 5 When you go to the ED, consume as little care as possible

When you first meet your doctor in the ED, make two things very clear to your doctor. First, that you would like to avoid doing anything today that can safely be done later as an outpatient or not at all. Second, that you understand that there is a great deal of uncertainty in what they're doing today and that you're not going to sue her if something isn't identified on this visit. Repeat this multiple times during your visit. Use words like "I'm willing to share this risk with you if it can save me substantial amounts of money" and "What would you do if it was your wife or child?" "Can this be done safely later if I'm not getting better?" What are the downsides of not doing that test or treatment today?" "What do you think the chances are that this is actually something serious? I'd rather not get a huge work-up today if you think the chances are less than 10%."

If you don't want a $10 tylenol or a $100 morphine shot, don't take any medication while you're in the ED. If you're writhing in pain with a kidney stone, you'll be more than glad to pay $100. If the pain or nausea isn't too bad, just let the doc or nurse know that you'll tough it out and wait until you get prescriptions to go home with to treat those symptoms. "Do you think it would be safe to skip the IV dose here if I go to the pharmacy right away afterward and start taking the antibiotic prescription?" "Is there a cheaper medication you can prescribe that would work? I don't mind a few more side effects or having to take it three times a day if it is 1/10th the cost."

If you've got something serious enough to admit you to the hospital you're definitely going to hit your max out of pocket, so might as well just get what your doc thinks you need done.

By the way, it's important to understand that some admissions to the hospital are "observation admissions" and some are "inpatient admissions." Depending on your insurance, that may involve different amounts of co-pays or co-insurance from you. Medicare in particular is this way.

# 6 When the bills come, read them.

Take a look at the bills once they show up. After you get over the sticker shock, make sure they are reasonably accurate. Is there a pharmacy charge but you didn't get any medications while you were there? Is there lab charge but you didn't get labs? Bills are wrong all the time. Contest them if they are. Wait until it "runs through insurance." That first bill might be showing chargemaster prices, not the real prices.

If you've gone to an out of network hospital, you might be "balance billed." That means your insurance and the hospital or doctor don't have a negotiated agreement and your insurance company refuses to pay the whole bill. This becomes particularly problematic so many people, including legislators, are working on solutions to this. The problem is just outlawing balance billing gives the insurer enormous negotiating power over the hospital/doctors (why should we negotiate with you when we can just pay you whatever we want). But other solutions basically put government in the position to set prices for a private transaction. It's a tricky problem to solve and is best when the hospitals/doctors and insurance companies just make a good faith effort to negotiate a fair price/payment.

If you can't afford the bill, contact the hospital. They often have assistance programs that reduce the bill or allow you to pay interest-free over long periods of time.

If you really can't pay the bill, realize that there is nothing to repossess. Medical bills are like credit card bills. Sure, your credit goes to pot but after it does you can often negotiate to pay pennies on the dollar to the collection agency. Food, shelter, transportation, and utilities first.

If you're a Boglehead millionaire and hate paying $5K for your ED visit because there was nothing wrong with you anyway, but can easily afford it, pay your bill and realize that's why you saved up all that money in the first place. Problems that can be solved with money aren't problems when you have money. If you realize you screwed up and went to the ED when you shouldn't have, chalk it up to life experience and don't make that mistake again. Most of us (including me) have made that mistake.

I would love a post on any tips or tricks you might offer on how best to use Nurse Hotlines and/ or Urgent Care in stressful situations. It would be nice to have a “cheat sheet” card to leave in my wallet for quick reference. Also, would love to have better web/mobile access to get and share my own info, but hipaa makes it difficult to get access to our own stuff.

annielouise
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Re: How to Minimize Your Emergency Care Expenses

Post by annielouise » Tue Jan 23, 2018 5:47 pm

White Coat Investor wrote:
Sun Jan 21, 2018 12:40 am
HIinvestor wrote:
Sun Jan 21, 2018 12:12 am
I have been to the ER twice with my D when she was a baby/toddler in early 1990s, before ever hearing of urgent care. The first time she was ill and dehydrated but couldn’t keep fluids down and needed an IV. The second time she was very ill and needed to be admitted to the hospital.

We also have urgent care clinics in our state that so far appear to be just urgent care. They will X-ray on premises, read the X-ray and provide a soft boot, crutches, a cast or similar. They will also do wound care, treat infections, do physicals and more. I was billed my normal $15 copay and the person I saw was an ER doctor.

Our island also has orthopedic urgent care as well, open 7 days/week. I went there after I had been to the urgent care. They gave me a taller boot and said it appeared I had indeed fractured my fibula. They also had their PA or NP refer me to their orthopedic surgeon who specialized in ankles for follow up. Again I paid my normal $15 copay.

I learned about urgent care after referring a out-of-state friend to the ER after she fell off her horse. She complained that she had to wait MANY, MANY hours to be seen and then just got X-rays and some Rx for pain and finally sent home with mega-bill. Next time she went to urgent care and told me it was much faster and better and they got all they needed in under an hour with a much smaller bill.

On the other hand, another friend said her aunt died because the urgent care provider didn’t diagnose and promptly and aggressively treat her relative’s sepsis but just told them to provide symptomatic care for regular infection.

I guess from a lay perspective, urgent care is great for things like falls, possible orthopedic injuries but perhaps might not be as alert for more esoteric infections and problems. Is this accurate? Was the aunt just “unlucky”?
Minor suturing, minor orthopedic stuff, minor urinary symptoms, minor rashes, medication refills, stuff that doesn't actually need to be seen by anybody (colds, mild anxiety), fever in healthy people, low back pain, cough = urgent care

Chest pain, belly pain, shortness of breath, altered mental status/unconscious, trauma, elderly that just isn't right, weak and dizzy, suicidal, heavy vaginal or GI bleeding, pelvic pain in early pregnancy, loss of vision, focal weakness, difficulty speaking, amputations, difficult to control bleeding, fever in under 6 months, surgical complications, just about anything if you're on chemotherapy, severe acute pain, envenomations, hypothermia, heat stroke, near drowning, cardiac arrest, worst headache of your life, foreign bodies of all types (eye, ear, nose, throat, vagina, rectum, bladder, esophagus, stomach), inability to swallow liquids, G tube or shunt complications, severe allergic reactions, dislocations, hallucinations, severe delusions, abnormal vital signs, palpitations, passing out, severe, vomiting or diarrhea with dehydration, can't pee, can't poop, can't fart, anything else you're worried might be an emergency = emergency department
Thanks for the list.

Lots of items we have had and never went to ED for, never even saw a doctor for about half of those. Amputation would almost definitely send me to the ED, though.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jan 23, 2018 5:49 pm

Also, would love to have better web/mobile access to get and share my own info, but hipaa makes it difficult to get access to our own stuff.
I don't understand why you cannot access your information?

With our provider/plan, I have access to all kinds of my information.

Providers/plans with an "advice nurse" (we have this) can help determine what kinds of things are important for quick followup and which are not. This was especially helpful to me when our child(ren) were small and we encountered issues.

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Re: How to Minimize Your Emergency Care Expenses

Post by FoolStreet » Tue Jan 23, 2018 6:32 pm

dm200 wrote:
Tue Jan 23, 2018 5:49 pm
Also, would love to have better web/mobile access to get and share my own info, but hipaa makes it difficult to get access to our own stuff.
I don't understand why you cannot access your information?

With our provider/plan, I have access to all kinds of my information.

Providers/plans with an "advice nurse" (we have this) can help determine what kinds of things are important for quick followup and which are not. This was especially helpful to me when our child(ren) were small and we encountered issues.
Advice nurse services are provided by the plan, medical records are kept by the hospital system. Two different log-ins. A 3rd one for figuring out which plan you are on at work. Is the user id your email or just the short name. Do you remember your password(s)? And just when you think you have it all figured out, you need to re log in to your mobile app and having forgot the user id and password combo, you now reset them both. What a pain! :-(

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Re: How to Minimize Your Emergency Care Expenses

Post by Hug401k » Wed Jan 24, 2018 8:31 am

White Coat Investor wrote:
Sat Jan 20, 2018 5:13 pm
Hug401k wrote:
Sat Jan 20, 2018 2:45 pm
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.
You were on your way to the ED, you called the ED, and an eye specialist called you back and told you to meet him at his office? Either you're on the medical staff or you live in Lake Wobegon. I hope nobody assumes from your comment that this is a service most EDs offer.

I agree that if you have an eye issue, you're usually better off being seeing seen in ophthalmology clinic than the ED if your eye issue occurs during banker's hours, if it can wait for banker's hours, or by some miracle you can get an ophthalmologist to meet you at the clinic after hours.
It was neither! Large Massachusetts ER and we had no affiliation to the hospital. That's why I was so surprised! I thought my husband was being ridiculous by calling ahead. And it was the weekend, and yes, it was an emergency. I avoid ERs like the plague. Walk in with a sprained ankle, walk out with the flu! I suspect the Ophthalmologist on call may have lived very close to his office.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Jan 24, 2018 8:42 am

Advice nurse services are provided by the plan, medical records are kept by the hospital system. Two different log-ins. A 3rd one for figuring out which plan you are on at work. Is the user id your email or just the short name. Do you remember your password(s)? And just when you think you have it all figured out, you need to re log in to your mobile app and having forgot the user id and password combo, you now reset them both. What a pain! :-(
Our plan is all together. Phone or email. Works great ..

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Re: How to Minimize Your Emergency Care Expenses

Post by snackdog » Wed Jan 24, 2018 8:51 am

We have had some unfortunate accidents in recent years which resulted in deep lacerations requiring sutures. Both times were on vacation in Hawaii, of all places. We visited a convenient urgent care facility which had us in and out in a couple hours for under $1000. I shudder to think what the e-room would have been like in terms of time and cost.

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Re: How to Minimize Your Emergency Care Expenses

Post by Jack FFR1846 » Wed Jan 24, 2018 9:23 am

There are times where a patient simply cannot avoid extra charges and it's of no fault of their own nor the fault of the doctor. Case in point:

I have a cardiac history and was having chest pains. My wife brings me to the nearest hospital (yay, no ambulance charge!). The hospital is in plan. The doctor in the ED is not. Why? You would think that this doctor is not responsible, since he was not in the Cigna network. Later, when we received the balance bill, I asked. He's been trying to become a Cigna contracted doctor for 3 years and keeps getting denied. I call Cigna. They tell me that they have enough ED doctors in plan, so don't need anymore. What?

So it's determined that I have something real and am admitted. After some testing, it's determined that I need an angioplasty to see what's up. But this hospital can't do stents if needed. We live 25 miles from literally the best hospital in the world for this stuff so I am transferred. While waiting for the transfer, I ask if my wife can just drive me. Everyone says no because I'm already admitted and I guess if I go myself, the time-space continuum dissolves. First ambulance arrives and my wife determines they're not in plan and sends them away. Oh, I forgot to mention that my wife worked for a medical HMO and literally wrote to book to train case managers and utilization nurses. We wait for the in plan ambulance to arrive.

The rest went just fine, but speaking of fine, when signing all the forms, I do remember one that mentioned that although Dr. Fine is going to be performing the surgery, other doctors may assist or may actually perform the surgery. So I could get into surgery and Dr. Fine may get an open spot Tee time because someone cancelled. Now Dr. Howard steps in to do the surgery and he's not in plan. He gets his brother, Dr. Howard to push the anesthesiologist out of the seat and takes over. Being a good supporter of his family, this Dr. Howard also is not in plan. So post surgery, I'll be receiving a couple bills out of plan. The Howards also like a specific lab. Curly Joe lab and send all of the labwork there. Of course they're out of plan. Now, I was unconscious on the table during all these decisions and had no control over them and hey....I signed that paper so all is hunky dory. This didn't actually happen, but it could have and the CABG I ended up getting could have cost me more than the few thousand in copays and deductibles and such, instead being in the 6 figure range.

What is my point? I guess that it's hopeless.
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Re: How to Minimize Your Emergency Care Expenses

Post by Tachyon » Thu Jan 25, 2018 2:36 pm

Great post WCI. As a fellow emergency physician, I thought I'd weigh in here.

Most practicing ER docs can tell what will likely be your outcome of your ER visit with a few minutes of interview/exam. 95% of the time, I know exactly what will happen to the patient and my expected test results based on 2 min of interview and exam. I've come to even just tell patient upfront that I won't likely find anything, but "just in case". But I still do tests that aren't really needed. A lot of them. The fine line between what's good for the patient and what protects from liability is very hazy.

Here's the reality. Most physicians are not praised for doing what's right for the patient. This remains intrinsically moral, ethical, etc. They are however "dinged" if something goes wrong. The system is set up to punish physicians for missing things. This could be hospital "QI" (quality improvement) or "M&M" (morbidity and mortality). This could be the state license board. Or this could be legal medical malpractice allegation.
So as time goes on, I find more experienced ER physicians tend to do MORE, not less, because they felt the "dings" over the years. I work with one older doc who does a ton of unnecessary work ups. Every time I ask him why he's doing that, he has a "this one time" story.

What WCI is referring to is not the patient literally saying "I won't sue you". That'd be weird. But as a patient, recognize that the primary MO of an ER doc is to rule out emergency. Try to rule it out (even though we know we can't do it fully) even if it's a 1-2% chance. Now if someone were to ask me "is it necessary", I don't know the answer to that question. Is 1-2% chance of something that's POSSIBLY life threatening necessary? Even most medical conditions considered emergency medical conditions won't actually kill you. Everyone's going to have a different opinion of the answer.

However, the ER does not have the time nor resources to present your options like a dentist office. So the default is just up to the ER doc and their personal "practice". Unless you bring it up. Every now and then, a patient addresses me up front, letting me know cost is a major concern for them. I then, walk them through my thought process. Inform them of risks/benefit. I find a lot of times, for 1-2% possibility, they will forgo the testing. I then have them signed an informed consent/refusal form.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Thu Jan 25, 2018 5:44 pm

Tachyon wrote:
Thu Jan 25, 2018 2:36 pm
Great post WCI. As a fellow emergency physician, I thought I'd weigh in here.
Most practicing ER docs can tell what will likely be your outcome of your ER visit with a few minutes of interview/exam. 95% of the time, I know exactly what will happen to the patient and my expected test results based on 2 min of interview and exam. I've come to even just tell patient upfront that I won't likely find anything, but "just in case". But I still do tests that aren't really needed. A lot of them. The fine line between what's good for the patient and what protects from liability is very hazy.
Here's the reality. Most physicians are not praised for doing what's right for the patient. This remains intrinsically moral, ethical, etc. They are however "dinged" if something goes wrong. The system is set up to punish physicians for missing things. This could be hospital "QI" (quality improvement) or "M&M" (morbidity and mortality). This could be the state license board. Or this could be legal medical malpractice allegation.
So as time goes on, I find more experienced ER physicians tend to do MORE, not less, because they felt the "dings" over the years. I work with one older doc who does a ton of unnecessary work ups. Every time I ask him why he's doing that, he has a "this one time" story.
What WCI is referring to is not the patient literally saying "I won't sue you". That'd be weird. But as a patient, recognize that the primary MO of an ER doc is to rule out emergency. Try to rule it out (even though we know we can't do it fully) even if it's a 1-2% chance. Now if someone were to ask me "is it necessary", I don't know the answer to that question. Is 1-2% chance of something that's POSSIBLY life threatening necessary? Even most medical conditions considered emergency medical conditions won't actually kill you. Everyone's going to have a different opinion of the answer.
However, the ER does not have the time nor resources to present your options like a dentist office. So the default is just up to the ER doc and their personal "practice". Unless you bring it up. Every now and then, a patient addresses me up front, letting me know cost is a major concern for them. I then, walk them through my thought process. Inform them of risks/benefit. I find a lot of times, for 1-2% possibility, they will forgo the testing. I then have them signed an informed consent/refusal form.
Interesting.. (from a patient's view)

Even if, though, cost is not an "issue" for the particular patient - lots of such expensive tests drive up healthcare costs with a very low return of better health. Some such tests have risks (such as CT scans bombarding you with radiation), false positives (and all that entails). How does the patient know that some expensive test (perhaps with risks) might only help 1/10 of 1% of the time?

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Re: How to Minimize Your Emergency Care Expenses

Post by bubbadog » Thu Jan 25, 2018 6:51 pm

dm200 wrote:
Thu Jan 25, 2018 5:44 pm
Tachyon wrote:
Thu Jan 25, 2018 2:36 pm
Great post WCI. As a fellow emergency physician, I thought I'd weigh in here.
Most practicing ER docs can tell what will likely be your outcome of your ER visit with a few minutes of interview/exam. 95% of the time, I know exactly what will happen to the patient and my expected test results based on 2 min of interview and exam. I've come to even just tell patient upfront that I won't likely find anything, but "just in case". But I still do tests that aren't really needed. A lot of them. The fine line between what's good for the patient and what protects from liability is very hazy.
Here's the reality. Most physicians are not praised for doing what's right for the patient. This remains intrinsically moral, ethical, etc. They are however "dinged" if something goes wrong. The system is set up to punish physicians for missing things. This could be hospital "QI" (quality improvement) or "M&M" (morbidity and mortality). This could be the state license board. Or this could be legal medical malpractice allegation.
So as time goes on, I find more experienced ER physicians tend to do MORE, not less, because they felt the "dings" over the years. I work with one older doc who does a ton of unnecessary work ups. Every time I ask him why he's doing that, he has a "this one time" story.
What WCI is referring to is not the patient literally saying "I won't sue you". That'd be weird. But as a patient, recognize that the primary MO of an ER doc is to rule out emergency. Try to rule it out (even though we know we can't do it fully) even if it's a 1-2% chance. Now if someone were to ask me "is it necessary", I don't know the answer to that question. Is 1-2% chance of something that's POSSIBLY life threatening necessary? Even most medical conditions considered emergency medical conditions won't actually kill you. Everyone's going to have a different opinion of the answer.
However, the ER does not have the time nor resources to present your options like a dentist office. So the default is just up to the ER doc and their personal "practice". Unless you bring it up. Every now and then, a patient addresses me up front, letting me know cost is a major concern for them. I then, walk them through my thought process. Inform them of risks/benefit. I find a lot of times, for 1-2% possibility, they will forgo the testing. I then have them signed an informed consent/refusal form.
Interesting.. (from a patient's view)

Even if, though, cost is not an "issue" for the particular patient - lots of such expensive tests drive up healthcare costs with a very low return of better health. Some such tests have risks (such as CT scans bombarding you with radiation), false positives (and all that entails). How does the patient know that some expensive test (perhaps with risks) might only help 1/10 of 1% of the time?
If you were the physician held to a ridiculous standard of zero misses, would you order the test?

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Thu Jan 25, 2018 11:50 pm

Thank you for a truly excellent helpful thread.

I know your knowledge might be limited, and this would be much more appropriate to ask a hospitalist, but could you provide some advice on what to do if you need to be admitted through the emergency room?

When I was admitted overnight, throughout the night they administered various medications and did a scan.

I didn't see a physician in person until at least 8 hours after the admission. So was it the ER doctor who was still in charge of the treatment until I saw the other doctor (a hospitalist I assume), or had the hospitalist already been making the decisions?

I was put into a private room without being asked. In hindsight, should I have asked for potential cost savings for a non-private room?

What would have happened if the hospital was out of network? Some states have limits about patient financial liability for an out of network emergency room. Does this apply to cases in which you're admitted to the hospital via that emergency room? At the time of admission, I would have been in no condition to check whether the hospital was in network.

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Thu Jan 25, 2018 11:56 pm

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

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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Fri Jan 26, 2018 12:18 am

sawhorse wrote:
Thu Jan 25, 2018 11:50 pm
Thank you for a truly excellent helpful thread.

I know your knowledge might be limited, and this would be much more appropriate to ask a hospitalist, but could you provide some advice on what to do if you need to be admitted through the emergency room?

When I was admitted overnight, throughout the night they administered various medications and did a scan.

I didn't see a physician in person until at least 8 hours after the admission. So was it the ER doctor who was still in charge of the treatment until I saw the other doctor (a hospitalist I assume), or had the hospitalist already been making the decisions?

I was put into a private room without being asked. In hindsight, should I have asked for potential cost savings for a non-private room?

What would have happened if the hospital was out of network? Some states have limits about patient financial liability for an out of network emergency room. Does this apply to cases in which you're admitted to the hospital via that emergency room? At the time of admission, I would have been in no condition to check whether the hospital was in network.
No, the hospitalist. Trust me, if the hospitalist was worried about you, she would have come to see you right away. But you were probably a pretty vanilla admission and from the test results and the discussion with the emergency doc, she knew it was safe to not see you for a while. But if something came up, the nurses would call the hospitalist who wrote orders on you without seeing you.

Don't know. Are there still hospitals without private rooms? We don't have any in either of the hospitals I work in. I guess you could ask.

Out of network = higher costs on many insurance plans. But at my hospital, your insurance covers not only the ED visit, but also any emergent admissions. So if you had appendicitis, your out of net work insurance would pay the ED bill, the surgeon's bill, and the hospital bill and you would pay your normal co-insurance/copays etc. There might be a little hassle involved though. But I know that varies quite a bit hospital to hospital and state to state.
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Fri Jan 26, 2018 12:19 am

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

Our policy is to transfer every one by ambulance, but the only ones I can force to do that are the suicidal ones.
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Re: How to Minimize Your Emergency Care Expenses

Post by mindboggling » Fri Jan 26, 2018 1:14 am

Great original post...thank you!

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Fri Jan 26, 2018 1:25 am

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

Our policy is to transfer every one by ambulance, but the only ones I can force to do that are the suicidal ones.
I think your answer indicates another complexity. You're underestimating the degree to which people are hesitant to challenge medical professionals in those situations. I'm sure you have many patients argue with you, but they stand out amid the vast majority of patients who would never think to question the medical staff especially the physician.

I'd hesitate to ask whether I really need all those tests or to push back on being transported by ambulance. With all the other patients waiting, it would be selfish to waste time discussing prices which, as you said, the doctors/nurses don't control and often don't even know. What if I'm a "difficult" patient in their eyes, and that affects the medical care? I've overheard derogatory and derisive comments they made about other patients. I had the meanest nurse ever one time who said that if I didn't produce a urine sample (I had a problem doing it), she would shove a catheter up me "and I won't be gentle", and she would "make me suffer" when she inserted the IV. She thought I was a druggie because I was disheveled and taken to the ER after collapsing in a station. In reality I collapsed due to heat stroke (heat exhaustion?) and dehydration - the reason I couldn't produce a urine sample.

Can you imagine her reaction I had challenged a hospital policy like you recommend? Thankfully she was definitely the exception and not the norm. The doctor that day was wonderful as were the other nurses and assistants.

There are very few places where you're more vulnerable and anxious than when you're in a hospital especially in the emergency room.

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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Fri Jan 26, 2018 9:14 am

sawhorse wrote:
Fri Jan 26, 2018 1:25 am
White Coat Investor wrote:
Fri Jan 26, 2018 12:19 am
sawhorse wrote:
Thu Jan 25, 2018 11:56 pm
White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
An ambulance ride costs $1500-2000. An Uber costs $20. If you need the ambulance, for heaven's sake call it. But if not, call an Uber. This also applies to interhospital transfers. "Doc, I don't want to go by ambulance because it's so expensive. I know there is the liability thing, but I'd be willing to sign all that Against Medical Advice paperwork if you think the chances of something happening to me en route are less than 10%."
How many hospitals allow this? I asked to take a taxi once instead of a ambulance, and they said no. It wasn't due to medical necessity. According to the nurse they just don't allow it. They even insist on transferring someone to another building of the hospital complex by ambulance, no doubt at a pretty hefty price.
It's a hospital, not a prison. It doesn't matter what they "allow." You say, "Nope, my son is driving me, where's the AMA paperwork for me to sign?"

Our policy is to transfer every one by ambulance, but the only ones I can force to do that are the suicidal ones.
I think your answer indicates another complexity. You're underestimating the degree to which people are hesitant to challenge medical professionals in those situations. I'm sure you have many patients argue with you, but they stand out amid the vast majority of patients who would never think to question the medical staff especially the physician.

I'd hesitate to ask whether I really need all those tests or to push back on being transported by ambulance. With all the other patients waiting, it would be selfish to waste time discussing prices which, as you said, the doctors/nurses don't control and often don't even know. What if I'm a "difficult" patient in their eyes, and that affects the medical care? I've overheard derogatory and derisive comments they made about other patients. I had the meanest nurse ever one time who said that if I didn't produce a urine sample (I had a problem doing it), she would shove a catheter up me "and I won't be gentle", and she would "make me suffer" when she inserted the IV. She thought I was a druggie because I was disheveled and taken to the ER after collapsing in a station. In reality I collapsed due to heat stroke (heat exhaustion?) and dehydration - the reason I couldn't produce a urine sample.

Can you imagine her reaction I had challenged a hospital policy like you recommend? Thankfully she was definitely the exception and not the norm. The doctor that day was wonderful as were the other nurses and assistants.

There are very few places where you're more vulnerable and anxious than when you're in a hospital especially in the emergency room.
No reason you can't be polite about it, and there probably are times when you should take the ambulance. In reality, most/all of these "money saving methods" increase your risk some tiny amount. But it's gotten to the point when it is non-sensical.

For example, if you come in after a minor rear ending you have some tenderness on your neck, you get a CT scan of your neck. Why? Because our studies have shown that plain x-rays miss 25% of neck fractures, our best "clinical decision rules" always include "neck tenderness" as criteria for imaging, because the guy who hit you is paying, and because there is no legal defense for missing a neck fracture after a car crash. But guess how many neck fractures I've seen from a minor rear ending in 15 years? I can't think of one. All that money. All that radiation. All that time wasted. Would I get a neck scan if I were in your shoes? No, because I wouldn't have even gone to the ED. I would have taken ibuprofen and gotten a massage. Now, I'm sure there has been a neck fracture in a minor rear ending at some point somewhere. But if you don't mind taking some risk in your life, I can think of a good way to save a lot of money. It won't be your money though, it will be the money of the insurance company of the guy who hit you.

So just have a frank discussion with the doc- "Can we talk about just how much risk there is if I don't get this study/go by ambulance/be admitted/take this drug? Can you help me quantify it somehow so I can make an informed decision?"
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Fri Jan 26, 2018 2:09 pm

More and more, I am thinking and (sometimes) acting like Jack Benny when it comes to expensive tests https://www.youtube.com/watch?v=-tVzdUczMT0

Jackson12
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Re: How to Minimize Your Emergency Care Expenses

Post by Jackson12 » Fri Jan 26, 2018 7:45 pm

THank you so much for taking the time to write these details.Printing it out plus copies. Handing some to friends.

I think it also helps to run the numbers and not automatically assume that a high deductible plan, even with lower premiums, is best. As a general rule ? Maybe. But....what's your take?

We purchased a co- pay plan with a higher deductible because emergency room visits (within network) had a flat $200 fee and regular doctors visits had a set co- pay as did specialist visits. There were also flat fees for specific x- rays.

My spouse ( whose insurance covers the family) has reached Medicare age and can use Medicare's hospital coverage as a back- up for his regular insurance hospital coverage while delaying the rest of Medicare coverage since his employer has a "creditable " plan.

This also allows him to work full time.

We can't have an HSA because having any Medicare coverage automatically takes the HSA option off the table. But not the FSA.

So our reasoning is this: most of our typical and normal medical charges shouldn't be high. But in a case where we'd have a true emergency , requiring a visit to the ER, a flat fee is a clear winner over a high deductible plan, making our somewhat higher premiums worth every cent.

We're still vulnerable to balance billing and other ER charges but so far , so good. One ER visit, after a family member had a nasty fall and a huge head blow only resulted in the flat fee ( plus 2 black eyes and large bruises and a bad sprain )

Point being : circumstances vary. Run the numbers. And if an employer offers some special perks in an effort to entice employees to take the high deductible plan, there's probably a financial benefit for them and possibly less so for the employee. .
Last edited by Jackson12 on Fri Jan 26, 2018 7:53 pm, edited 2 times in total.

2015
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Re: How to Minimize Your Emergency Care Expenses

Post by 2015 » Fri Jan 26, 2018 7:51 pm

Many thanks to WCI for being so generous as to take the time to post and respond in this thread. As a result of reading, I've double-checked the three urgent care centers I'm covered under with my insurance.

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ElJay
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Re: How to Minimize Your Emergency Care Expenses

Post by ElJay » Sun Jan 28, 2018 11:54 am

As a person with a HDHP I find it incredibly frustrating that pricing is the way it is. It is a "market" unlike anything else.

A few months ago I had a fall at night, toughed out the pain until the next day and went to an in-network urgent care center. After waiting about two hours, they then immediately tried to shove me off to the ER. I explained I was concerned about the cost of the ER, and after a little hemming and hawing they offered to do what they could to make sure I hadn't broken something. I had a couple of x-rays and they did an EKG (they thought I possibly had a heart attack that led to my fall.)

Having insurance saved me about 25% with the negotiated prices, though I was still out about $800, mostly for two sets of x-rays. I got four different bills over about two months from two different companies (the radiology company was different than the urgent care center.) There was a bill from the doctor who oversaw my visit, a bill from the doctor who read my x-rays, a bill for the radiologist, and a bill for the EKG.

Ultimately nothing was wrong with me, but I was worried about my back and the peace of mind was worth the cost of the service. Having an HDHP did alter my thinking (delaying my visit to seek care) and that will not always be the best thing for my health. I just hope when I do have something seriously wrong that I don't delay so long that I do further harm to myself.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun Jan 28, 2018 12:07 pm

ElJay wrote:
Sun Jan 28, 2018 11:54 am
As a person with a HDHP I find it incredibly frustrating that pricing is the way it is. It is a "market" unlike anything else.
A few months ago I had a fall at night, toughed out the pain until the next day and went to an in-network urgent care center. After waiting about two hours, they then immediately tried to shove me off to the ER. I explained I was concerned about the cost of the ER, and after a little hemming and hawing they offered to do what they could to make sure I hadn't broken something. I had a couple of x-rays and they did an EKG (they thought I possibly had a heart attack that led to my fall.)
Having insurance saved me about 25% with the negotiated prices, though I was still out about $800, mostly for two sets of x-rays. I got four different bills over about two months from two different companies (the radiology company was different than the urgent care center.) There was a bill from the doctor who oversaw my visit, a bill from the doctor who read my x-rays, a bill for the radiologist, and a bill for the EKG.
Ultimately nothing was wrong with me, but I was worried about my back and the peace of mind was worth the cost of the service. Having an HDHP did alter my thinking (delaying my visit to seek care) and that will not always be the best thing for my health. I just hope when I do have something seriously wrong that I don't delay so long that I do further harm to myself.
The good news seems to be that your health (overall) did not suffer AND (while significant) you might have been a lot worse off financially had you gone to a hospital ER. With 20/20 hindsight, you (apparently) would have been in exactly the same position/condition had you done nothing at all - EXCEPT had $800 more in your pocket (or in the bank).

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

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun Jan 28, 2018 12:18 pm

2015 wrote:
Fri Jan 26, 2018 7:51 pm
Many thanks to WCI for being so generous as to take the time to post and respond in this thread. As a result of reading, I've double-checked the three urgent care centers I'm covered under with my insurance.
Yes - a good idea - get the details straight BEFORE you need to use one.

Years ago, with a former employer insurance and Physicians, on a Saturday I slammed the car door on my wife's hand/fingers. She was in terrible pain. I phoned the doctors' office and explained the situation. The first question was what insurance did we have. [That medical practice had an affiliated urgent care center next door.] The woman answering the call then said that, under our insurance, my wife could come in and they would do an X-Ray to see if she had broken finger(s). If her fingers were broken, then the insurance would cover the X-Rays and visit. However, if the finger(s) were not broken, we would have to pay the full bill. I tried to argue the issue - that since neither of us had been to Medical school, it would need to be a doctor to make the determination. I got nowhere. The good news was that, within 15-20 minutes, my wife's pain had subsided and no further treatment was needed - she just had black and blue fingers. On the following Monday, I called the medical practice to complain and spoke with the practice manager. At first, she maintained I was told correctly -- but after my "pressing" her how idiotic this was, she agreed to research it. She got back to me a few days later. She, reluctantly, admitted that (to a degree) I was not correctly informed and that, under our plan, one of their on-call doctors would have needed to authorize it and had I waited longer on the phone before pressing a button to talk with someone - I could have been passed to an on call doctor who could/would have authorized checking out the hand.

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Re: How to Minimize Your Emergency Care Expenses

Post by danaht » Sun Jan 28, 2018 12:19 pm

Good post. Thanks for the information. I would probably add to make sure you get insurance with the widest "in-network" provider list possible. Make sure all your local hospitals are listed as in-network. Also, make sure that your insurance pays for and has a deductible and maximum out of pocket costs for out of network services. It's not true insurance if you only have only have in-network providers covered. This may cost an extra $100 to $200 a month (per person) in insurance (compared to a cheaper plan) - but probably worth it!

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Sun Jan 28, 2018 3:06 pm

danaht wrote:
Sun Jan 28, 2018 12:19 pm
Good post. Thanks for the information. I would probably add to make sure you get insurance with the widest "in-network" provider list possible. Make sure all your local hospitals are listed as in-network. Also, make sure that your insurance pays for and has a deductible and maximum out of pocket costs for out of network services. It's not true insurance if you only have only have in-network providers covered. This may cost an extra $100 to $200 a month (per person) in insurance (compared to a cheaper plan) - but probably worth it!
Lots of areas don't have any such plans available. And if they do, it's a hell of a lot more than $100-200 month extra.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun Jan 28, 2018 5:17 pm

sawhorse wrote:
Sun Jan 28, 2018 3:06 pm
danaht wrote:
Sun Jan 28, 2018 12:19 pm
Good post. Thanks for the information. I would probably add to make sure you get insurance with the widest "in-network" provider list possible. Make sure all your local hospitals are listed as in-network. Also, make sure that your insurance pays for and has a deductible and maximum out of pocket costs for out of network services. It's not true insurance if you only have only have in-network providers covered. This may cost an extra $100 to $200 a month (per person) in insurance (compared to a cheaper plan) - but probably worth it!
Lots of areas don't have any such plans available. And if they do, it's a hell of a lot more than $100-200 month extra.
Very true.

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Re: How to Minimize Your Emergency Care Expenses

Post by tarnation » Sun Jan 28, 2018 11:41 pm

I think the info on billing and insurance and all that is informative. However, in my opinion, reducing costs by not receiving or declining emergency medical care has to be some of the worst advice I have seen on this forum (or anywhere maybe). The OP may feel confident second guessing medical experts, but to encourage lay persons to do so is questionable at best, reckless at worst.

Personally, one reason I have a job, insurance, and savings is to afford emergency care for myself and my family. That's a high priority; it ranks at the top of the list. I hope some poor soul doesn't read this and die in an Uber trying to transport themselves to another hospital.
Image

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Sun Jan 28, 2018 11:50 pm

White Coat Investor, do you think there are emergency physicians - not you specifically - under pressure from the hospital to run more tests in order to bill the insurance company? A physician relative in another specialty felt pressured to run extra tests to bill insurance even though it was at a non-profit hospital. Is the emergency room different though as they want to get patients out and often don't know the patients' insurance status?

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Re: How to Minimize Your Emergency Care Expenses

Post by Tachyon » Tue Jan 30, 2018 2:06 pm

sawhorse wrote:
Sun Jan 28, 2018 11:50 pm
White Coat Investor, do you think there are emergency physicians - not you specifically - under pressure from the hospital to run more tests in order to bill the insurance company? A physician relative in another specialty felt pressured to run extra tests to bill insurance even though it was at a non-profit hospital. Is the emergency room different though as they want to get patients out and often don't know the patients' insurance status?
My 2 cents. I personally have not felt any sort of pressure to do certain tests. I've worked at academic, non academic, profit, non profit hospitals. Nor have any of my colleagues. Mostly, I don't think ER docs are pressured to do tests. Possibly because tests are chump change in a hospital's revenue in terms of what you can effect. For instance, if your revenue from tests is 10%, trying to effect your docs to ordering more, might get you to 11%, and probably a lot of revolt.

The major hospital revenue comes from admissions and major surgeries. And not just admissions, but high revenue admissions. Medicare inpatients are billed by DRG, diagnosis relate group. Also recognize that there's a ton of gray area in diagnoses. And so yes, hospitals do try and effect what the doctor writes down.

As an example. Not too long ago, I literally sat in a meeting (with hospital administrators) coaching us not just to write down "intracranial hemorrhage" but also add on "brain compression with mass effect". Even though it changes absolutely nothing about the patient, putting down the extra words gets more billing and more revenue. In this case, there's no fraud, as it is true.

However, other cases are more borderline/fraudulent. One particular example is of a hospital chain that is influencing their physicians to diagnose Kwashiorkor in Medicare patients, which is otherwise a very rare diagnoses in the US. It's basically severe malnutrition (think pot-belly starving children in 3rd world countries). This hospital group reported rates of Kwashiorkor at 16%, when baseline is 0.2%. Because "kwashiorkor" pays more. This same hospital chain tries to find reasons to admit insured patients even when they don't really need to.

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Tue Jan 30, 2018 2:39 pm

Tachyon wrote:
Tue Jan 30, 2018 2:06 pm
sawhorse wrote:
Sun Jan 28, 2018 11:50 pm
White Coat Investor, do you think there are emergency physicians - not you specifically - under pressure from the hospital to run more tests in order to bill the insurance company? A physician relative in another specialty felt pressured to run extra tests to bill insurance even though it was at a non-profit hospital. Is the emergency room different though as they want to get patients out and often don't know the patients' insurance status?
My 2 cents. I personally have not felt any sort of pressure to do certain tests. I've worked at academic, non academic, profit, non profit hospitals. Nor have any of my colleagues. Mostly, I don't think ER docs are pressured to do tests. Possibly because tests are chump change in a hospital's revenue in terms of what you can effect. For instance, if your revenue from tests is 10%, trying to effect your docs to ordering more, might get you to 11%, and probably a lot of revolt.

The major hospital revenue comes from admissions and major surgeries. And not just admissions, but high revenue admissions. Medicare inpatients are billed by DRG, diagnosis relate group. Also recognize that there's a ton of gray area in diagnoses. And so yes, hospitals do try and effect what the doctor writes down.

As an example. Not too long ago, I literally sat in a meeting (with hospital administrators) coaching us not just to write down "intracranial hemorrhage" but also add on "brain compression with mass effect". Even though it changes absolutely nothing about the patient, putting down the extra words gets more billing and more revenue. In this case, there's no fraud, as it is true.

However, other cases are more borderline/fraudulent. One particular example is of a hospital chain that is influencing their physicians to diagnose Kwashiorkor in Medicare patients, which is otherwise a very rare diagnoses in the US. It's basically severe malnutrition (think pot-belly starving children in 3rd world countries). This hospital group reported rates of Kwashiorkor at 16%, when baseline is 0.2%. Because "kwashiorkor" pays more. This same hospital chain tries to find reasons to admit insured patients even when they don't really need to.
Wow. One of the biggest problems with the system is that there are so many incentives to practice medicine in a way that increases costs. And, it seems, a lot of corruption (hospital administration like the example here, pharmaceutical companies, etc).

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Re: How to Minimize Your Emergency Care Expenses

Post by Rupert » Tue Jan 30, 2018 3:35 pm

[quote=Tachyon post_id=3752636 time=1517339203 user_id=126844

However, other cases are more borderline/fraudulent. One particular example is of a hospital chain that is influencing their physicians to diagnose Kwashiorkor in Medicare patients, which is otherwise a very rare diagnoses in the US. It's basically severe malnutrition (think pot-belly starving children in 3rd world countries). This hospital group reported rates of Kwashiorkor at 16%, when baseline is 0.2%. Because "kwashiorkor" pays more. This same hospital chain tries to find reasons to admit insured patients even when they don't really need to.
[/quote]

I hope you were one of the whistleblowers. Everyone else: Just Google "kwashiorkor Medicare fraud," and you'll see the extent of it.

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Re: How to Minimize Your Emergency Care Expenses

Post by bubbadog » Tue Jan 30, 2018 3:49 pm

I practiced full time emergency medicine in a variety of settings for about 13 years (1993-2006). I never felt any pressure from hospital administration to order more tests. My private ED group did track patients per hour and RVUs per hour and "encouraged" the slower docs to work faster. This was not coming from the hospital administration.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jan 30, 2018 4:49 pm

We do indeed feel fortunate that, in our plan, there are many ways for us to keep some costs of urgent/emergency care under control. The 24x7 advice line (no charge) can help identify how quickly an urgent situation needs to be treated. [Obviously we would not call if having a heart attack or major loss of blood!] There are 24x7 urgent care centers that can handle almost any situation. Only the specialist copay ($45 in our case) plus fees for some tests and scans. For a few situations, the two way smart phone video connection can be done (my wife did this on a Sunday afternoon last year). A Doctor at the other end and you can see her/him. No charge. One nice thing about not going in person is that they do not run unnecessary tests.

The general model of healthcare, though, is that providers get paid for doing things and the more they "DO" - the more they get paid. In some ways, it would be better to pay providers to do less - as long as that is in the best interest of the patient.

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Re: How to Minimize Your Emergency Care Expenses

Post by bayview » Wed Jan 31, 2018 9:35 pm

Tachyon wrote:
Tue Jan 30, 2018 2:06 pm
...Also recognize that there's a ton of gray area in diagnoses. And so yes, hospitals do try and effect what the doctor writes down.

As an example. Not too long ago, I literally sat in a meeting (with hospital administrators) coaching us not just to write down "intracranial hemorrhage" but also add on "brain compression with mass effect". Even though it changes absolutely nothing about the patient, putting down the extra words gets more billing and more revenue. In this case, there's no fraud, as it is true.

However, other cases are more borderline/fraudulent. One particular example is of a hospital chain that is influencing their physicians to diagnose Kwashiorkor in Medicare patients, which is otherwise a very rare diagnoses in the US. It's basically severe malnutrition (think pot-belly starving children in 3rd world countries). This hospital group reported rates of Kwashiorkor at 16%, when baseline is 0.2%. Because "kwashiorkor" pays more. This same hospital chain tries to find reasons to admit insured patients even when they don't really need to.
The request to document ICH with mass effect is because, if there is truly a mass effect caused by the hemorrhage, the patient is at higher risk for morbidity/ mortality and the ever-so-boring increased length of stay than if the ICH were comparatively minor, not shoving healthy brain tissue around. This does affect the cost of patient care, and I hope to heaven that your leadership was coaching you to only document this if it were present. Otherwise, it would be just as fraudulent as the physician-owned chain in Southern Cal pressuring clinicians (and coders) to capture kwashiorkor.

The whole horrendous healthcare reimbursement methodology has resulted in pressure by medical finance leadership (many of whom have a very incomplete grasp of coding and resulting reimbursement) placed upon clinicians and HIM staff alike to “shine things up” a bit. It’s one thing to ask clinicians to expand their thoughts, as captured in their notes, in a way to express the range of possibilities of an individual patient’s outcome. As we all know, there’s a range of severities for all these diagnoses, whether ICH’s or MI’s or tumor lysis syndrome. Just listing that dx doesn’t fully express your clinical judgment of the severity of the patient’s condition. That’s why there are legitimate requests to expand on things a bit - emphasis on “legitimate”.

And yes, God help me, I work as a clinical documentation improvement specialist. :) But I also follow a professional oath of ethics, and I would be on the phone to OIG in a red-hot minute if I were pressured to act unethically.

And thank you for your work as a physician, treating those who need your expertise.
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Wed Jan 31, 2018 11:11 pm

Tachyon wrote:
Tue Jan 30, 2018 2:06 pm
sawhorse wrote:
Sun Jan 28, 2018 11:50 pm
White Coat Investor, do you think there are emergency physicians - not you specifically - under pressure from the hospital to run more tests in order to bill the insurance company? A physician relative in another specialty felt pressured to run extra tests to bill insurance even though it was at a non-profit hospital. Is the emergency room different though as they want to get patients out and often don't know the patients' insurance status?
My 2 cents. I personally have not felt any sort of pressure to do certain tests. I've worked at academic, non academic, profit, non profit hospitals. Nor have any of my colleagues. Mostly, I don't think ER docs are pressured to do tests. Possibly because tests are chump change in a hospital's revenue in terms of what you can effect. For instance, if your revenue from tests is 10%, trying to effect your docs to ordering more, might get you to 11%, and probably a lot of revolt.

The major hospital revenue comes from admissions and major surgeries. And not just admissions, but high revenue admissions. Medicare inpatients are billed by DRG, diagnosis relate group. Also recognize that there's a ton of gray area in diagnoses. And so yes, hospitals do try and effect what the doctor writes down.

As an example. Not too long ago, I literally sat in a meeting (with hospital administrators) coaching us not just to write down "intracranial hemorrhage" but also add on "brain compression with mass effect". Even though it changes absolutely nothing about the patient, putting down the extra words gets more billing and more revenue. In this case, there's no fraud, as it is true.

However, other cases are more borderline/fraudulent. One particular example is of a hospital chain that is influencing their physicians to diagnose Kwashiorkor in Medicare patients, which is otherwise a very rare diagnoses in the US. It's basically severe malnutrition (think pot-belly starving children in 3rd world countries). This hospital group reported rates of Kwashiorkor at 16%, when baseline is 0.2%. Because "kwashiorkor" pays more. This same hospital chain tries to find reasons to admit insured patients even when they don't really need to.
Could these dubious diagnoses lead to someone being denied insurance such as disability or long term care insurance?

bltn
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Re: How to Minimize Your Emergency Care Expenses

Post by bltn » Sat Feb 03, 2018 8:51 pm

Great idea for a thread. Excellent discussion. Thank you, WCI.

jimmy123
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Re: How to Minimize Your Emergency Care Expenses

Post by jimmy123 » Sat Feb 03, 2018 9:10 pm

"What would you do if it was your wife or child?"
First and best question to ask in my experience.

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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Sat Feb 03, 2018 9:27 pm

sawhorse wrote:
Sun Jan 28, 2018 11:50 pm
White Coat Investor, do you think there are emergency physicians - not you specifically - under pressure from the hospital to run more tests in order to bill the insurance company? A physician relative in another specialty felt pressured to run extra tests to bill insurance even though it was at a non-profit hospital. Is the emergency room different though as they want to get patients out and often don't know the patients' insurance status?
Probably a little, but I don't think it's a big factor. I do tell patients when I recommend against a test that I'm happy to order it for them as the hospital loves it when I order tests. They chuckle and then usually follow my recommendation not to do the test.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Sat Feb 03, 2018 9:33 pm

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

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

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

If you want to spend less on health care, consume less health care, including emergency care. Is there some risk there? Sure. The world is a risky place to live and none of us get out alive. How much of your income are you willing to spend to reduce that risk by a small amount?
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

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