How to Minimize Your Emergency Care Expenses

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pdavi21
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Re: How to Minimize Your Emergency Care Expenses

Post by pdavi21 » Wed Mar 20, 2019 11:11 pm

A big point missed is why you have to go to the ER in the first place.
1. Be healthy
2. Don't do stupid stuff

It's great to be prepared, but it's even greater to prevent the trip.
"We spend a great deal of time studying history, which, let's face it, is mostly the history of stupidity." -Stephen Hawking

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Re: How to Minimize Your Emergency Care Expenses

Post by lostdog » Thu Mar 21, 2019 8:27 am

One of my biggest fears at the moment is the U.S. healthcare system. All I can do is excercise, eat clean, maintain good mental health and avoid alcohol and drugs.

I can save as much of a nest egg as possible but once I get a chronic disease, the healthcare system will bankrupt me, even with insurance. I am ashamed to be apart of it.
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SlowMovingInvestor
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Re: How to Minimize Your Emergency Care Expenses

Post by SlowMovingInvestor » Thu Mar 21, 2019 8:41 am

sawhorse wrote:
Wed Mar 20, 2019 10:16 pm
My local hospital has an urgent care clinic on site. It's helpful because if it's actually an emergency, the emergency room is right across the building. You don't have to get a ride or run the risk of a high surprise bill with an ambulance.

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

This is a question I do have. I know that ERs tack on facility fees, and it seems outpatient centers do too. What about UC centers unattached to a hospital ?

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Thu Mar 21, 2019 9:42 am

pdavi21 wrote:
Wed Mar 20, 2019 11:11 pm
A big point missed is why you have to go to the ER in the first place.
1. Be healthy
2. Don't do stupid stuff
It's great to be prepared, but it's even greater to prevent the trip.
Yes - excellent goals for all of us.

skeptastic
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Re: How to Minimize Your Emergency Care Expenses

Post by skeptastic » Tue Apr 16, 2019 9:36 pm

This thread is outstanding. Thank you all for the information and questions which have spawned excellent discussions. We recently received an ED bill we're not thrilled with. I will take it as a lesson and be better-informed the next go-round.

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

WCI, or any other physicians in the thread, what are your thoughts on the scenario? What would you have done if it were your child? Thanks in a advance for any thoughts you're able and willing to provide.

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Re: How to Minimize Your Emergency Care Expenses

Post by LadyGeek » Tue Apr 16, 2019 9:42 pm

^^^ Sorry, but further details on your child's condition would be considered medical advice and is off-topic here. The reasons medical advice is not permitted in this forum:

1. This is an anonymous internet forum. It is not possible to verify anyone's identity (nor do we want to). Credentials also imply accurate advice, which may not always be the case.
2. There can be disagreement among experts, which can be harmful if someone is basing a medical decision on the advice.
3. A member's description may be incomplete.
4. Readers will misinterpret the member's description.
5. Readers will misinterpret the given advice.

Since real harm can be done, we do not permit medical advice and is the reason for the first sentence in: Medical Issues
Questions on medical issues are beyond the scope of the forum. If you are looking for medical information online, I suggest you start with the Medical Library Association's User's Guide to Finding and Evaluating Health Information on the Web which, in addition to providing guidance on evaluating health information, includes a list of their top recommended sites.
Also, discussions in this thread should be focused on expenses.

A PM is an alternative, but consider that the above comments regarding anonymity and information accuracy still apply.
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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Apr 17, 2019 8:32 am

Over the last few years, I have noticed an increase in neighborhood Urgent Care places. There are two or three within a mile of our house.

It might make sense to check out such urgent care places nearby to see what they can and cannot do, whether they take your insurance and their hours of operation. Do this before you face the need for urgent care.

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Re: How to Minimize Your Emergency Care Expenses

Post by skeptastic » Wed Apr 24, 2019 1:23 am

LadyGeek wrote:
Tue Apr 16, 2019 9:42 pm
^^^ Sorry, but further details on your child's condition would be considered medical advice and is off-topic here. The reasons medical advice is not permitted in this forum:

1. This is an anonymous internet forum. It is not possible to verify anyone's identity (nor do we want to). Credentials also imply accurate advice, which may not always be the case.
2. There can be disagreement among experts, which can be harmful if someone is basing a medical decision on the advice.
3. A member's description may be incomplete.
4. Readers will misinterpret the member's description.
5. Readers will misinterpret the given advice.

Since real harm can be done, we do not permit medical advice and is the reason for the first sentence in: Medical Issues
Questions on medical issues are beyond the scope of the forum. If you are looking for medical information online, I suggest you start with the Medical Library Association's User's Guide to Finding and Evaluating Health Information on the Web which, in addition to providing guidance on evaluating health information, includes a list of their top recommended sites.
Also, discussions in this thread should be focused on expenses.

A PM is an alternative, but consider that the above comments regarding anonymity and information accuracy still apply.
That makes a lot of sense and I apologize for violating the TOS for the site. Thank you for the heads up. I appreciate it.

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Re: How to Minimize Your Emergency Care Expenses

Post by HIinvestor » Wed Apr 24, 2019 3:20 am

I agree that urgent cares vary considerably. There are two newer urgent care clinics within a few miles of our home. I have visited each of them once. I went to one for what turned out to be a broken fibula and took my elderly relative to another years later for a cough with productive mucus she had for over a week.

The care at urgent care places does indeed vary, depending on who is staffing it on any particular day. There’s also an urgent care center at the medical center my internist practices at—it’s connected to their ER, so they will have you seen by them if it’s beyond their abilities. There’s even an orthopedic urgent care that is open 7 days/week.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Apr 24, 2019 8:38 am

A few years ago, several Physicians opened an Urgent care facility in a nearby small space. Then, it was taken over by a large area hospital. Seems to be a trend here that this large hospital conglomerate is doing many things - such as network of Physicians - and a lot of advertising.

With our Kaiser plans, we would not use any of these services - so I don't know if this big and growing conglomerate is good or bad for costs of care or for healthcare access and quality?

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Apr 24, 2019 8:47 am

Some healthcare providers, some health insurance plans and some employers provide a nurse hotline to call 24x7 to halp assess what kind of care may be needed for "urgent" situations.

We have that with Kaiser and it has been very helpful over the years. We found it most helpful when our son was little as well. By calling, on several occasions, we did not need to take our son to the ED - and felt assured that he would be OK.

Seems to me that such a hotline service would lower costs and provide better quality of needed care. For many of us, it is sometimes difficult to assess whether or not we need to seek immediate medical attention. It can be a life or death situation.

A friend of ours, for example, had a situation at home - and his wife and daughter urged him to immediately go to the ED. Good thing he did because it was a ruptured abdominal aorta - and he he delayed delayed seeking treatment - he would have died.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Fri Apr 26, 2019 11:10 am

Driver and all passengers wear seat belts.

Children in appropriate car seats

Drive carefully

Keep car in good condition (including tires)

Do not drink (or use any other such substances) and drive OR ride with driver who does

If applicable, keep prescription glasses up to date

Do NOT use cell phone while driving

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Re: How to Minimize Your Emergency Care Expenses

Post by Buckleyrw » Sun May 12, 2019 7:30 am

This topic is very fresh as I just had an appendectomy 5 days ago. Very sudden, started feeling some stomach discomfort around 6 am. Went ahead to work however around 10, went back home to ”ride it out” thinking it was nothing major. Through the pm, debated what to do as the high cost ER visit was in the back of my mind and the probability it fell into the 80% of stuff that you shouldn’t go to ER for. By 4:00 I decided I needed to do something and called into my PCP and last appointment was 4:15 (I’m a 40 min drive from everything). Luckily they said they would see me so I dashed off to that appointment. After exam and bloodwork, white blood cell count was high and pain still present so decision was to proceed to ER. Long story short, by 11 pm, ny appendix was out and was in recovery

Comments:
1). Try not to debate over what to do....if in doubt, get to your PCP quickly. A smaller bill now can help answer the larger
question of whether you need an ER visit
2). In the ER, things happen so fast. It is good to have someone along to help listen and ask questions.
3). Although, each of us wants to be efficient healthcare consumers, number one priority is to make the best decisions
For your health.

All this said, I haven’t gotten the ER bill yet but have mentally prepared myself to hit the Out of Pocket max for the year. Happy to have health coverage and planned well for occasional high out of pocket costs. You can bet that for the rest of the year, we will be getting lol other foreseeable checks/procedures out of the way prior to retirement in 2020.

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Re: How to Minimize Your Emergency Care Expenses

Post by DonCamillo » Mon May 20, 2019 10:41 am

dm200 wrote:
Fri Apr 26, 2019 11:10 am
Driver and all passengers wear seat belts
NJ has an annual click it or ticket campaign to encourage seat belt use. Interesting statistics from state Web site:

89.6% of drivers use seat belts. 53% of passengers killed in traffic accidents wore seat belts. 47% did not.

Bad math skills can kill; Emergency responders have lower than average seat belt use because they have seen people dead who wore seat belts.

Good math; people not wearing seat belts are NINE TIMES more likely to be killed.

As a financial argument, you can save on medical expenses by dying in the accident, but that does not appeal to me.
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Mon May 20, 2019 11:11 am

DonCamillo wrote:
Mon May 20, 2019 10:41 am
dm200 wrote:
Fri Apr 26, 2019 11:10 am
Driver and all passengers wear seat belts
NJ has an annual click it or ticket campaign to encourage seat belt use. Interesting statistics from state Web site:
89.6% of drivers use seat belts. 53% of passengers killed in traffic accidents wore seat belts. 47% did not.
Bad math skills can kill; Emergency responders have lower than average seat belt use because they have seen people dead who wore seat belts.
Good math; people not wearing seat belts are NINE TIMES more likely to be killed.
As a financial argument, you can save on medical expenses by dying in the accident, but that does not appeal to me.
I always wear a seat belt - and always have. EXCEPT before there were any seat belts on cars.

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Re: How to Minimize Your Emergency Care Expenses

Post by Broken Man 1999 » Mon May 20, 2019 4:20 pm

dm200 wrote:
Mon May 20, 2019 11:11 am
DonCamillo wrote:
Mon May 20, 2019 10:41 am
dm200 wrote:
Fri Apr 26, 2019 11:10 am
Driver and all passengers wear seat belts
NJ has an annual click it or ticket campaign to encourage seat belt use. Interesting statistics from state Web site:
89.6% of drivers use seat belts. 53% of passengers killed in traffic accidents wore seat belts. 47% did not.
Bad math skills can kill; Emergency responders have lower than average seat belt use because they have seen people dead who wore seat belts.
Good math; people not wearing seat belts are NINE TIMES more likely to be killed.
As a financial argument, you can save on medical expenses by dying in the accident, but that does not appeal to me.
I always wear a seat belt - and always have. EXCEPT before there were any seat belts on cars.
I still remember my dad's first new car that had front seatbelts. I asked dad to consider seatbelts for the rear passengers. He agreed and had them installed. This was in 1964. We used seatbelts ALWAYS.

With our children and grandchildren the rule was the vehicle wasn't cranked up until everyone was buckled in securely. No option ever to not buckle up.

I see children today standing up in the front seats. A tiny bit of braking would have sent them into the windshield. Very foolish parents!

Broken Man 1999
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sschoe2
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Re: How to Minimize Your Emergency Care Expenses

Post by sschoe2 » Tue May 21, 2019 12:58 pm

What are people's opinions about going out of the country for any medical procedure that doesn't have to be done immediately even with insurance?

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Re: How to Minimize Your Emergency Care Expenses

Post by LadyGeek » Tue May 21, 2019 3:47 pm

^^^ Please start a new thread with your question.
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue May 21, 2019 3:51 pm

Broken Man 1999 wrote:
Mon May 20, 2019 4:20 pm
dm200 wrote:
Mon May 20, 2019 11:11 am
DonCamillo wrote:
Mon May 20, 2019 10:41 am
dm200 wrote:
Fri Apr 26, 2019 11:10 am
Driver and all passengers wear seat belts
NJ has an annual click it or ticket campaign to encourage seat belt use. Interesting statistics from state Web site:
89.6% of drivers use seat belts. 53% of passengers killed in traffic accidents wore seat belts. 47% did not.
Bad math skills can kill; Emergency responders have lower than average seat belt use because they have seen people dead who wore seat belts.
Good math; people not wearing seat belts are NINE TIMES more likely to be killed.
As a financial argument, you can save on medical expenses by dying in the accident, but that does not appeal to me.
I always wear a seat belt - and always have. EXCEPT before there were any seat belts on cars.
I still remember my dad's first new car that had front seatbelts. I asked dad to consider seatbelts for the rear passengers. He agreed and had them installed. This was in 1964. We used seatbelts ALWAYS.
With our children and grandchildren the rule was the vehicle wasn't cranked up until everyone was buckled in securely. No option ever to not buckle up.
I see children today standing up in the front seats. A tiny bit of braking would have sent them into the windshield. Very foolish parents!

Broken Man 1999
Our new 1963 Plymouth had the anchors for the front seat belts - and I installed them (I was in High School). The next family car was a 1966 Plymouth and it had the lap belts. So did my first car - a new 1967 VW Beetle.

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Re: How to Minimize Your Emergency Care Expenses

Post by neilpilot » Tue May 21, 2019 3:56 pm

dm200 wrote:
Tue May 21, 2019 3:51 pm
Broken Man 1999 wrote:
Mon May 20, 2019 4:20 pm
dm200 wrote:
Mon May 20, 2019 11:11 am
DonCamillo wrote:
Mon May 20, 2019 10:41 am
dm200 wrote:
Fri Apr 26, 2019 11:10 am
Driver and all passengers wear seat belts
NJ has an annual click it or ticket campaign to encourage seat belt use. Interesting statistics from state Web site:
89.6% of drivers use seat belts. 53% of passengers killed in traffic accidents wore seat belts. 47% did not.
Bad math skills can kill; Emergency responders have lower than average seat belt use because they have seen people dead who wore seat belts.
Good math; people not wearing seat belts are NINE TIMES more likely to be killed.
As a financial argument, you can save on medical expenses by dying in the accident, but that does not appeal to me.
I always wear a seat belt - and always have. EXCEPT before there were any seat belts on cars.
I still remember my dad's first new car that had front seatbelts. I asked dad to consider seatbelts for the rear passengers. He agreed and had them installed. This was in 1964. We used seatbelts ALWAYS.
With our children and grandchildren the rule was the vehicle wasn't cranked up until everyone was buckled in securely. No option ever to not buckle up.
I see children today standing up in the front seats. A tiny bit of braking would have sent them into the windshield. Very foolish parents!

Broken Man 1999
Our new 1963 Plymouth had the anchors for the front seat belts - and I installed them (I was in High School). The next family car was a 1966 Plymouth and it had the lap belts. So did my first car - a new 1967 VW Beetle.
My 1964 airplane had seat belts but no shoulder belts. When I bought it in 1989 the first thing I had added were front seat shoulder belts. A few years ago I totaled that airplane. We both walked away with minor injuries. If I hadn't added shoulder belts, it's likely I wouldn't have survived the crash.

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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Tue May 21, 2019 7:17 pm

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

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

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

I find the "don't let him go to sleep" thing hilarious by the way. As if something happens in a head bleed differently due to a REM cycle. The only reason to have someone awake is to evaluate them, there is no therapeutic benefit. Just one of the funny things about my job.
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Re: How to Minimize Your Emergency Care Expenses

Post by financial.freedom » Sun May 26, 2019 8:28 pm

raddoc101 wrote:
Sat Jan 20, 2018 4:35 pm
Great post.

I wish we got 250 from Medicare for a CT. A Ct Abd/ Pelvis with contrast pays the radiologist 93 dollars. For all billing, we average about 25% more than medicare, but of course, the private insurance at 2-3x averages out the no pays.

"I'm willing to share this risk with you if it can save me substantial amounts of money"

Maybe I'm pessimistic, but if a patient said this to me, I wouldn't trust it.

The fear of litigation is a huge driver of medical costs. One of my ED friends told me they estimate 70% of their imaging orders are unnecessary. I couldn't believe it was so low. I thought it would be closer to 90%. It unfortunately shapes how we all practice. Sometimes being 99% sure isn't good enough. Not when you hear about multimillion dollar lawsuits over a missed pulmonary nodule. You wonder whether that vague density that you're almost certain is artifact could me blown up in court as evidence of a pulmonary nodule that turns into a lung cancer in 5 years. It sucks. You can't and don't of course recommend a CT on all of these patients, but if it's a 55 year old with a smoking history and no priors, that density even when you're almost certain may cause you to recommend a CT. But lung cancer is a big deal, so this example probably isn't the worst case. It's just one of too many.

I wanted to respond to that 9000 dollar CT bill thread, but it was locked too soon... That charge makes me sick as a radiologist. The radiologist at most is getting 300 dollars - costs (private practice). If they're employed by the hospital and get even a great amount/ RVU (50 dollars), then they'll make about 125 dollars (2.5 RVU for a CT Abdomen and Pelvis).
I believe there is a technical component (hospital charge) and a professional component (radiologist physician charge) for most imaging studies. A CT in my area is probably $900-1000 for an ER visit (varies depending upon the type of CT). Of that $1k -- the breakdown is about 90% to the hospital ($900) and 10% to the radiologist ($100).

For outpatient imaging in my area, the costs are much less. This reinforces what WCI states about getting work done as an outpatient. Here, there are centers where CT scans are $300-400. Breakdown in my area is about $60 to the physician (radiologist) and $300-340 for the facility. This varies somewhat, but hopefully provides perspective.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue May 28, 2019 8:51 am

Perhaps I posted this before (cannot remember), but here it is:

CT scans are both expensive and expose you to lots of X-Ray radiation. Therefore, it is wise to avoid unnecessary CT scans.

In looking for something causing me some abdominal pain (lower left abdomen), I got a CT scan of that area. They did not find anything wrong in that area, BUT the scan showed cysts on one kidney. My Kaiser PCP referred me to Kaiser Urology (all by email), and the Urologist wanted a CT scan of my kidneys to look at the cysts in more detail. Then - I remembered that about 15 years ago (not with kaiser at the time) - I had a CT scan of that area showing cysts - and was told not to be concerned. I contacted that Doctor's office and got the name of the Radiology center that did the CT scan. That radiology center did not have the images, but did have the radiology report - and (no charge) provided me with a copy. I sent that report to Kaiser Urology - and, since the cysts were there 15 years ago, the Urologist said I did not need a CT scan. Win - win!! No expensive CT scan needed AND not bombarded with more X-Rays!!

Moral of the story - keep track of your medical history, tests, scans, etc.

Now, at Kaiser again for the last 9 years, all of my medical records, tests, scans, etc. are online. It is still a good idea to keep my own records because with so much information, it can sometimes be missed! :sharebeer

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Re: How to Minimize Your Emergency Care Expenses

Post by Bongleur » Fri May 31, 2019 6:17 pm

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

Exactly how do you do this? You go to the clerk at the desk and say ????? and an Urgent Care will reply ???
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Re: How to Minimize Your Emergency Care Expenses

Post by Bongleur » Fri May 31, 2019 6:21 pm

>
Per the ACA (or what's left of it), in a real emergency situation, all facilities are to be paid as "in-network" by your insurance company, until you are stabalized and can be transported to an in-network facility.
>

BUT ONCE YOU ARE STABILIZED, EXACTLY WHEN ARE THEY OBLIGATED TO TELL YOU THAT THEY ARE OUT OF NETWORK & COULD BE TRANSPORTED SOMEWHERE ELSE?
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Re: How to Minimize Your Emergency Care Expenses

Post by Broken Man 1999 » Fri May 31, 2019 6:25 pm

Some states have laws that prevents balance billing.

Check out your own state's protections. Good thing to know.

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

Post by RobLyons » Sat Jun 01, 2019 6:37 am

Great thread. Interesting personal story relating to emergency care expenses. I'm employed in healthcare, have full benefits and a decent understanding of how things work.

Last year, son (8) had appendix out emergently at closest, local community hospital that's considered out of network. He was in 9/10 excruciating abdominal pain, PCP told us to take him to the closest ER immediately. While 80% of my mind was focused on his well being, 20% was concerned over the cost.. Which grew to 50/50 after he was post op.

Every call to Blue Cross Blue Shield received a different answer.
First rep said we needed to pay 10% of the total bill (before insurance covers the rest).
Another rep indicated we would pay the ER fee ($100) plus another fee for surgery, plus a percentage of the total bill.
We were supplied a list of costs where each hospital charged their own predetermined amount for each procedure.
A third call we got a rep whom was very helpful and informed us that "life threatening emergencies" are covered out of network. The issue is, what is life threatening? This comes down to what our kid's PCP instructed us to do, (go to the closest ER, stat) and the documented diagnosis and procedure.

Sitting in the ER bay with him, once medicated and consolable, texts were flying in from coworkers telling us to take him to another in network hospital.
Not really possible with IVs in!

Ultimately we had to submit an appeal and total out of pocket was almost $0 but the anxiety was sky high and process was long and overly frustrating.
'Murica !
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Re: How to Minimize Your Emergency Care Expenses

Post by Bongleur » Sun Jun 02, 2019 4:01 am

I see lots of adverts by companies that specialize in getting Social Security Disability claims thru the system.
You would think that there would be similar experts for insurance appeals?
Might be good to find one with expertise in your plan, every time it changes.
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Re: How to Minimize Your Emergency Care Expenses

Post by CedarWaxWing » Thu Jun 20, 2019 6:02 pm

RobLyons wrote:
Sat Jun 01, 2019 6:37 am
Great thread. Interesting personal story relating to emergency care expenses. I'm employed in healthcare, have full benefits and a decent understanding of how things work.

Last year, son (8) had appendix out emergently at closest, local community hospital that's considered out of network. He was in 9/10 excruciating abdominal pain, PCP told us to take him to the closest ER immediately. While 80% of my mind was focused on his well being, 20% was concerned over the cost.. Which grew to 50/50 after he was post op.

Every call to Blue Cross Blue Shield received a different answer.
First rep said we needed to pay 10% of the total bill (before insurance covers the rest).
Another rep indicated we would pay the ER fee ($100) plus another fee for surgery, plus a percentage of the total bill.
We were supplied a list of costs where each hospital charged their own predetermined amount for each procedure.
A third call we got a rep whom was very helpful and informed us that "life threatening emergencies" are covered out of network. The issue is, what is life threatening? This comes down to what our kid's PCP instructed us to do, (go to the closest ER, stat) and the documented diagnosis and procedure.

Sitting in the ER bay with him, once medicated and consolable, texts were flying in from coworkers telling us to take him to another in network hospital.
Not really possible with IVs in!

Ultimately we had to submit an appeal and total out of pocket was almost $0 but the anxiety was sky high and process was long and overly frustrating.
'Murica !
1. You should not have had to submit an appeal. BCBS however likely would have made you pay more than your coverage should have made you pay... and if you had not been smart and persistent... they would not likely have ever corrected their "mistake". Just imagine what this is like for an adult of any age who is extremely ill and has to navigate that bureaucracy alone...

2. "Every call to Blue Cross Blue Shield received a different answer" is a key phrase. This suggests that BCBS does not meticulously train their folks for the job they have to do... and errors are made, but almost always in favor of the insurance company. It should not be up to the patient or the patient's family to notice that... but you did a superb job of looking out for yourself.. which, unfortunately, is an essential life skill in our commercial health insurance industry. This problem is even made even worse by the fact that every year the policy changes in many small ways with gimicks that the hundreds or thousands of actuaries find to reduce the real benefits every year...in ways that are not immediately discoverable to the purchaser/insured persons, or easy to understand when reading the sales material. My health insurance policies usually had a 150 page book every year showing the changes. The book gets mailed out shortly before the resign dates... and they start designing the next book a year ahead of time.

BCBS is not alone in this pattern of over billing... "fraud by neglect" perhaps, but still willfully done. The evidence of this is that health insurance never... to my knowledge... reviews cases later on their own initiative and contact people to give them refunds that they did not squawk about by appealing the over charge. This pattern happens on both ends of their payment equation... to both patients and physicians.

You are clearly a super mom! :)

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Re: How to Minimize Your Emergency Care Expenses

Post by Arlington2019 » Tue Jul 02, 2019 11:05 am

By way of background, I am a healthcare risk manager and have been working in the area of malpractice liability, insurance and the defense of malpractice claims for 36 years. There have been some suggestions in this thread that a patient can sign a waiver releasing a healthcare provider from liability due to the actions of the provider.

Generally speaking, such liability waivers in healthcare are not worth the paper they are printed on. Each state may have their own laws on the validity of such waivers, specific language and formatting requirements, and the conditions they have to meet to be valid, but for the country as a whole, such waivers in healthcare are usually considered invalid on the grounds of unequal bargaining power and against public policy to release a party from the consequences of their own negligence. If such waivers were legally valid, we would have every patient sign them as a condition of receiving treatment or being admitted to the hospital and throw away our malpractice insurance policies. Liability waivers or releases in other areas can be more successful, as in for participation in sports or an activity.

There is an associated legal concept known as informed refusal, in which a patient refuses recommended treatment, something bad happens to the patient, and the patient sues on the basis that the provider did not tell them about the bad things that could happen. When I have patients refuse treatment, I will write up an informed refusal form for them to sign in which I detail all the bad things that may occur if they don't have the excisional biopsy for that suspicious breast mass with calcifications apparent upon mammography, for example. I explicitly write down the risk that they may become very sick, have disfiguring surgery or even die if the mass turns out to be cancer and there is a delay in diagnosis and treatment.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jul 02, 2019 12:30 pm

raddoc101 wrote:
Sat Jan 20, 2018 4:35 pm
Great post.
I wish we got 250 from Medicare for a CT. A Ct Abd/ Pelvis with contrast pays the radiologist 93 dollars. For all billing, we average about 25% more than medicare, but of course, the private insurance at 2-3x averages out the no pays.
"I'm willing to share this risk with you if it can save me substantial amounts of money"

Maybe I'm pessimistic, but if a patient said this to me, I wouldn't trust it.

The fear of litigation is a huge driver of medical costs. One of my ED friends told me they estimate 70% of their imaging orders are unnecessary. I couldn't believe it was so low. I thought it would be closer to 90%. It unfortunately shapes how we all practice. Sometimes being 99% sure isn't good enough. Not when you hear about multimillion dollar lawsuits over a missed pulmonary nodule. You wonder whether that vague density that you're almost certain is artifact could me blown up in court as evidence of a pulmonary nodule that turns into a lung cancer in 5 years. It sucks. You can't and don't of course recommend a CT on all of these patients, but if it's a 55 year old with a smoking history and no priors, that density even when you're almost certain may cause you to recommend a CT. But lung cancer is a big deal, so this example probably isn't the worst case. It's just one of too many.

I wanted to respond to that 9000 dollar CT bill thread, but it was locked too soon... That charge makes me sick as a radiologist. The radiologist at most is getting 300 dollars - costs (private practice). If they're employed by the hospital and get even a great amount/ RVU (50 dollars), then they'll make about 125 dollars (2.5 RVU for a CT Abdomen and Pelvis).
As a patient, I am concerned about unnecessary CT scans primarily because of being bombarded with the X-Rays! Not sure, though, when to push back and when a CT scan is 100% justified - for health risk/reward. I did successfully "push back" twice in recent years. One case my doctor wanted a kidney CT scan. Fortunately, I recalled I had one in that area years ago - under different provider. I obtained (no charge) the radiologists report - and that was good enough to avoid another CT scan. In another case, a cardiologist wanted me to get another heart CT scan - but, when I pushed back - my PCP referred me to a different cardiologist who said I just needed regular electrocardiograms.

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Re: How to Minimize Your Emergency Care Expenses

Post by sawhorse » Mon Jul 15, 2019 6:49 pm

This was posted in another thread. How can someone avoid this situation other than acting against PCP advice by not going to the ER?
I've gone to ER twice in my life. The last time I went I had a dislocated pinkie (PCP recommended ER). Nine people were involved in examining, x-raying and bandaging. Two of those people belonged to some shadow company owned by one of the ER physicians, which billed me separately. Total bill was 4k (1.5 hours). Took me a month to find out the owner of the company, and almost a year to contest (and win) the separate charge. A lot of things contribute to high insurance premiums.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jul 16, 2019 9:02 am

sawhorse wrote:
Mon Jul 15, 2019 6:49 pm
This was posted in another thread. How can someone avoid this situation other than acting against PCP advice by not going to the ER?
I've gone to ER twice in my life. The last time I went I had a dislocated pinkie (PCP recommended ER). Nine people were involved in examining, x-raying and bandaging. Two of those people belonged to some shadow company owned by one of the ER physicians, which billed me separately. Total bill was 4k (1.5 hours). Took me a month to find out the owner of the company, and almost a year to contest (and win) the separate charge. A lot of things contribute to high insurance premiums.
Good grief! Wonder if the patient could have waited to see the PCP during regular hours? Then again, maybe the PCP does not do that sort of thing.

Nine people sure seems like a lot. Depending on the area/locality - there may be other hospital ERs.

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Re: How to Minimize Your Emergency Care Expenses

Post by trueblueky » Tue Jul 16, 2019 2:01 pm

I remember going to my small town doctor's house on July 4 with mumps. Those days are gone.

Figure 52 Saturdays, 52 Sundays and maybe six major holidays -- that's 110 days/year the PCP office is closed, more than 30% of the days.

There are plenty of conditions that are not life-threatening emergencies, yet still require time-sensitive attention. Conditions that the family physician could deal with, if it weren't the weekend, if it weren't after five, if you could somehow get an appointment today, if you weren't travelling, if you weren't new to the town.

There are far too few primary care physicians, generalists, family doctors in far too many areas of this country. Urgent Care fills the gap.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Tue Jul 16, 2019 3:24 pm

trueblueky wrote:
Tue Jul 16, 2019 2:01 pm
I remember going to my small town doctor's house on July 4 with mumps. Those days are gone.
Figure 52 Saturdays, 52 Sundays and maybe six major holidays -- that's 110 days/year the PCP office is closed, more than 30% of the days.
There are plenty of conditions that are not life-threatening emergencies, yet still require time-sensitive attention. Conditions that the family physician could deal with, if it weren't the weekend, if it weren't after five, if you could somehow get an appointment today, if you weren't travelling, if you weren't new to the town.
There are far too few primary care physicians, generalists, family doctors in far too many areas of this country. Urgent Care fills the gap.
I remember when doctors mad "house calls".

I believe that in many rural areas were population density is low, that many Doctors might be called in evenings or weekends when a patient goes to a Hospital ED.

Yes - urgent care centers often address this situation.

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Re: How to Minimize Your Emergency Care Expenses

Post by tj » Fri Jul 19, 2019 12:43 am

I went to the ER for something that turned out to be nothing, though they sold me on getting a tetanus booster because it might have been more than 10 years. There are no urgent cares that I could find on Maui. A little bit worried about what the bill might be....we shall see.

The hospital was allegedly in network. I'm in a HDHP. :-/

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Re: How to Minimize Your Emergency Care Expenses

Post by Broken Man 1999 » Fri Jul 19, 2019 3:22 pm

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

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

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

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Re: How to Minimize Your Emergency Care Expenses

Post by tj » Fri Jul 19, 2019 6:28 pm

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

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

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

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Re: How to Minimize Your Emergency Care Expenses

Post by Broken Man 1999 » Fri Jul 19, 2019 7:34 pm

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

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

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

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

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

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sat Jul 20, 2019 9:15 am

tj wrote:
Fri Jul 19, 2019 12:43 am
I went to the ER for something that turned out to be nothing, though they sold me on getting a tetanus booster because it might have been more than 10 years. There are no urgent cares that I could find on Maui. A little bit worried about what the bill might be....we shall see.
The hospital was allegedly in network. I'm in a HDHP. :-/
Perhaps a financial reason to keep immunizations fully up to date! On many plans, such regular immunizations are done at no charge to the patient. Every time I see my PCP, she reviews these. [Of course, not to hard for her to do - the computerized records pop up any of these that are due]

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Re: How to Minimize Your Emergency Care Expenses

Post by TravelforFun » Sat Jul 20, 2019 9:25 am

trueblueky wrote:
Tue Jul 16, 2019 2:01 pm
I remember going to my small town doctor's house on July 4 with mumps. Those days are gone.

Figure 52 Saturdays, 52 Sundays and maybe six major holidays -- that's 110 days/year the PCP office is closed, more than 30% of the days.
Don't forget most PCPs don't work on Friday afternoons so that's 26 more days you can't access them; and even on the day they work, they are unavailable 2/3 of the day (PCPs work 8-hour days but sickness can strike any hour of the day). Therefore, it's absolutely critical to know the rules of emergency care and urgent care services.

TravelforFun

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sat Jul 20, 2019 10:28 am

TravelforFun wrote:
Sat Jul 20, 2019 9:25 am
trueblueky wrote:
Tue Jul 16, 2019 2:01 pm
I remember going to my small town doctor's house on July 4 with mumps. Those days are gone.
Figure 52 Saturdays, 52 Sundays and maybe six major holidays -- that's 110 days/year the PCP office is closed, more than 30% of the days.
Don't forget most PCPs don't work on Friday afternoons so that's 26 more days you can't access them; and even on the day they work, they are unavailable 2/3 of the day (PCPs work 8-hour days but sickness can strike any hour of the day). Therefore, it's absolutely critical to know the rules of emergency care and urgent care services.

TravelforFun
Not my experience :)

BUT - your point is valid that there is a limited window for quick access to PCPs.

One, of many, things we really like about Kaiser is access to their Urgent Care Centers 24x7

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Re: How to Minimize Your Emergency Care Expenses

Post by Broken Man 1999 » Sat Jul 20, 2019 11:59 am

dm200 wrote:
Sat Jul 20, 2019 10:28 am
TravelforFun wrote:
Sat Jul 20, 2019 9:25 am
trueblueky wrote:
Tue Jul 16, 2019 2:01 pm
I remember going to my small town doctor's house on July 4 with mumps. Those days are gone.
Figure 52 Saturdays, 52 Sundays and maybe six major holidays -- that's 110 days/year the PCP office is closed, more than 30% of the days.
Don't forget most PCPs don't work on Friday afternoons so that's 26 more days you can't access them; and even on the day they work, they are unavailable 2/3 of the day (PCPs work 8-hour days but sickness can strike any hour of the day). Therefore, it's absolutely critical to know the rules of emergency care and urgent care services.

TravelforFun
Not my experience :)

BUT - your point is valid that there is a limited window for quick access to PCPs.

One, of many, things we really like about Kaiser is access to their Urgent Care Centers 24x7
Although my PCP might not be working, his cell phone will be. Both my PCP and wound care doc offered up their cell phone numbers. I've been a patient of both for around 20 years. They both know I'm not a needy person, and that I would never abuse their trust.

I can't think of a single time we have ever called them outside office hours. Nice to have the numbers, though.

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

Post by tj » Sat Jul 20, 2019 1:11 pm

dm200 wrote:
Sat Jul 20, 2019 9:15 am
tj wrote:
Fri Jul 19, 2019 12:43 am
I went to the ER for something that turned out to be nothing, though they sold me on getting a tetanus booster because it might have been more than 10 years. There are no urgent cares that I could find on Maui. A little bit worried about what the bill might be....we shall see.
The hospital was allegedly in network. I'm in a HDHP. :-/
Perhaps a financial reason to keep immunizations fully up to date! On many plans, such regular immunizations are done at no charge to the patient. Every time I see my PCP, she reviews these. [Of course, not to hard for her to do - the computerized records pop up any of these that are due]
Is there a resource that shows recommended immunizations? II don't recall getting an immunization since maybe college.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sat Jul 20, 2019 1:34 pm

tj wrote:
Sat Jul 20, 2019 1:11 pm
dm200 wrote:
Sat Jul 20, 2019 9:15 am
tj wrote:
Fri Jul 19, 2019 12:43 am
I went to the ER for something that turned out to be nothing, though they sold me on getting a tetanus booster because it might have been more than 10 years. There are no urgent cares that I could find on Maui. A little bit worried about what the bill might be....we shall see.
The hospital was allegedly in network. I'm in a HDHP. :-/
Perhaps a financial reason to keep immunizations fully up to date! On many plans, such regular immunizations are done at no charge to the patient. Every time I see my PCP, she reviews these. [Of course, not to hard for her to do - the computerized records pop up any of these that are due]
Is there a resource that shows recommended immunizations? II don't recall getting an immunization since maybe college.
I am sure there is, but I cannot cite one. My PCP keeps me up on those -but sometimes I ask as well. Last year, I asked about the Shingrix vaccine - and she then checked and it was available and I got the first shot at that appointment - and the second one two months later. At her annual health assessment, my wife asked about Shingrix - and her PCP checked and gave her the first shot.

I am also of the age when Pneumonia shots are recommended. Got the first one about ten years ago - and a new, updated one last year - initiated by my PCP at my annual health assessment.

I think Tetanus is recommended every ten years.

We also get the annual flu shot every year - in the fall, shortly after they are available from our health plan.

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Re: How to Minimize Your Emergency Care Expenses

Post by trueblueky » Sat Jul 20, 2019 3:33 pm

tj wrote:
Sat Jul 20, 2019 1:11 pm
dm200 wrote:
Sat Jul 20, 2019 9:15 am
tj wrote:
Fri Jul 19, 2019 12:43 am
I went to the ER for something that turned out to be nothing, though they sold me on getting a tetanus booster because it might have been more than 10 years. There are no urgent cares that I could find on Maui. A little bit worried about what the bill might be....we shall see.
The hospital was allegedly in network. I'm in a HDHP. :-/
Perhaps a financial reason to keep immunizations fully up to date! On many plans, such regular immunizations are done at no charge to the patient. Every time I see my PCP, she reviews these. [Of course, not to hard for her to do - the computerized records pop up any of these that are due]
Is there a resource that shows recommended immunizations? II don't recall getting an immunization since maybe college.
CDC. https://www.cdc.gov/vaccines/schedules/ ... adult.html
As above, flu every year, tetanus every 10 years, pneumonia (two types), shingles (listed as Zoster), others as your situation indicates.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun Jul 21, 2019 12:31 pm

trueblueky wrote:
Sat Jul 20, 2019 3:33 pm
tj wrote:
Sat Jul 20, 2019 1:11 pm
dm200 wrote:
Sat Jul 20, 2019 9:15 am
tj wrote:
Fri Jul 19, 2019 12:43 am
I went to the ER for something that turned out to be nothing, though they sold me on getting a tetanus booster because it might have been more than 10 years. There are no urgent cares that I could find on Maui. A little bit worried about what the bill might be....we shall see.
The hospital was allegedly in network. I'm in a HDHP. :-/
Perhaps a financial reason to keep immunizations fully up to date! On many plans, such regular immunizations are done at no charge to the patient. Every time I see my PCP, she reviews these. [Of course, not to hard for her to do - the computerized records pop up any of these that are due]
Is there a resource that shows recommended immunizations? II don't recall getting an immunization since maybe college.
CDC. https://www.cdc.gov/vaccines/schedules/ ... adult.html
As above, flu every year, tetanus every 10 years, pneumonia (two types), shingles (listed as Zoster), others as your situation indicates.
I have known and know a lot of folks who have had Shingles - and all report how awful it is to have Shingles. I got the first type about ten years ago, and the Shingrix last year (as soon as my health plan had a sufficient supply). Neither is 100% effective - but just any reduction in risk is worth it to me.

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Re: How to Minimize Your Emergency Care Expenses

Post by kinaokole » Sat Oct 26, 2019 3:50 am

Excellent summary by WCI regarding the nuances/costs of ED care.

I'm employed as a hospitalist. This specialty is relatively new, a little over 20 years old. It evolved to care for hospitalized patients, originally for medical problems like pneumonia, heart failure, stroke, etc., followed by "comanagement" of surgical patients. I work exclusively on admitting shifts, and am intimately familiar with the challenges faced by patients seen in the ED.

In addition to avoiding ER care except in true emergencies, I'll add a few tips to reduce the cost of an ER visit and hospitalization:

1. Find a good primary care provider, one who is willing to advocate for their patients and orchestrate outpatient evaluation of complex medical problems. In general, mid-career physicians are probably best, as they hit the sweet spot between state of the art knowledge and practical experience. And contrary to some opinions offered in this thread, I'd pick a less business savvy doc, as the ones who get too involved with the financial side of medicine sometimes lose sight of actual patient care.

2. If the ER doctor wants to admit you, make sure they run it by your primary physician first. ER medicine is a broad-based discipline, but the training is severely lacking in the nuances of expeditious outpatient care. As a result, ER docs sometimes don't know what is possible outside the hospital. If you've chosen your primary care doc wisely, (s)he may be able to prevent a costly stay altogether.

3. Have a prepared list of your medications, including dosage and timing. Or bring your pill bottles. When possible, ask if you can take you own medications rather than those provided by the hospital, realizing many of your maintenance meds may be held while hospitalized. On a related note, ask you primary doc regularly about simplifying your medical regimen, especially as you get older. Hardly anyone needs to take 10+ meds, as the risk of interactions/side effects often outweighs the benefits of polypharmacy.

4. Ask about the explicit plan for hospitalization - why is it necessary, what tests will be done/treatments provided, what are the alternatives? This is especially important for stays designated as observation status, which usually means you'll spend less than two midnights in the hospital. Obs is often used as a wastebasket catch-all when the diagnosis is unclear, and ED docs are uncomfortable sending you home. If clear criteria for observation or admission are lacking, your insurer may deny payment for your stay.

5. Be wary of certain tests which are over-ordered: CT scans for minor headache/trauma, abdominal and low back pain are prime suspects, as are cardiac stress tests, especially repeat tests, sweeping bloodwork panels and urinalyses absent urinary burning/frequency or new lower abdominal/back pain. No one expects you to understand everything about the practice of medicine, but its certainly within your rights to ask why a test is necessary and alternatives, including forgoing the test altogether.

6. End of live care is ludicrously expensive, and often futile. Have an advanced healthcare directive prepared before you get sick. Make sure it contains clinically useful verbiage - if you have a cardiac arrest, do you want to be resuscitated? The typical "if I have a terminal or irreversible condition, with no meaningful hope of recovery, or am in a vegetative state" doesn't cut it. Base your decision on current quality of life, prognosis of your medical problem(s) and spiritual beliefs. No one can predict the outcome of a cardiac resuscitation before it is attempted.

I agree that our system is hopelessly broken, and believe the free market isn't the answer. No other industrialized country's healthcare is delivered like ours, with anywhere near the GDP expenditure and mediocre outcomes. Hopefully we continue moving toward a centralized, single payor model, but until we do, there's no quick fix to most of the issues brought up in this thread.
Last edited by kinaokole on Sat Oct 26, 2019 1:28 pm, edited 1 time in total.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sat Oct 26, 2019 11:10 am

kinaokole wrote:
Sat Oct 26, 2019 3:50 am
Excellent summary by WCI regarding the nuances/costs of ED care.
I'm employed as a hospitalist. This specialty is relatively new, a little over 20 years old. It evolved to care for hospitalized patients, originally for medical problems like pneumonia, heart failure, stroke, etc., followed by "comanagement" of surgical patients. I work exclusively on admitting shifts, and am intimately familiar with the challenges faced by patients seen in the ED.
In addition to avoiding ER care except in true emergencies, I'll add a few tips to reduce the cost of an ER visit and hospitalization:
1. Find a good primary care provider, one who is willing to advocate for their patients and orchestrate outpatient evaluation of complex medical problems. In general, mid-career physicians are probably best, as they hit the sweet spot between state of the art knowledge and practical experience. And contrary to some opinions offered in this thread, I'd pick a less business savvy doc, as the ones who get too involved with the financial side of medicine sometimes lose sight of actual patient care.
2. If the ER doctor wants to admit you, make sure they run it by your primary physician first. ER medicine is a broad-based discipline, but the training is severely lacking in the nuances of expeditious outpatient care. As a result, ER docs sometimes don't know what is possible outside the hospital. If you've chosen your primary care doc wisely, (s)he may be able to prevent a costly stay altogether.
3. Have a prepared list of your medications, including dosage and timing. Or bring your pill bottles. When possible, ask if you can take you own medications rather than those provided by the hospital, realizing many of your maintenance meds may be held while hospitalized. On a related note, ask you primary doc regularly about simplifying your medical regimen, especially as you get older. Hardly anyone needs to take 10+ meds, as the risk of interactions/side effects often outweighs the benefits of polypharmacy.
4. Ask about the explicit plan for hospitalization - why is it necessary, what tests will be done/treatments provided, what are the alternatives? This is especially important for stays designated as observation status, which usually means you'll spend less than two midnights in the hospital. Obs is often used as a wastebasket catch-all when the diagnosis is unclear, and ED docs are uncomfortable sending you home. If clear criteria for observation or admission are lacking, your insurer may deny payment for your stay.
5. Be wary of certain tests which are over-ordered: CT scans for minor headache/trauma, abdominal and low back pain are prime suspects, as are cardiac stress tests, especially repeat tests, sweeping bloodwork panels and urinalyses absent urinary burning/frequency or new lower abdominal/back pain. No one expects you to understand everything about the practice of medicine, but its certainly within your rights to ask why a test is necessary and alternatives, including forgoing the test altogether.
6. End of live care is ludicrously expensive, and often futile. Have an advanced healthcare directive prepared before you get sick. Make sure it contains clinically useful verbiage - if you have a cardiac arrest, do you want to be resuscitated? The typical "if I have a terminal or irreversible condition, with no meaningful hope of recovery, or am in a vegetative state" doesn't cut it. Base your decision on current quality of life, prognosis of your medical problem(s) and spiritual beliefs. No one can predict the outcome of a cardiac resuscitation before it is attempted.
I agree that our system is hopelessly broken, and believe the free market isn't the answer. No other industrialized country's healthcare is delivered like ours, with anywhere near the GDP expenditure and mediocre outcomes. Hopefully we continue moving toward a centralized, single payor model, but until we do, there's no quick fix to most of the issues brought up I this thread.
Excellent points -

As a patient, let me add or emphasize a few things -
1. Keep track of tests, etc. (X-Rays, CT scans, MRIs, and so on) so that you might not need a repeat of expensive or invasive tests. Or, perhaps, even if you do need such tests, the previous ones can shed light on your condition.
2. Be aware of what local "Urgent Care" facilities can and cannot do - and how/when they can save money - without added risks
3. Yes - to a good relationship with your PCP - as well as selecting a PCP that can do (or not do) things that reduce the need for emergency care.
4. Let's face it - a great number of cases of "emergency care" visits are not necessary. This may not be the fault of the patient, but often, in my opinion, a well educated and informed patient can better judge the seriousness of a condition or symptom. In some cases, as well, family members might be able to assist in judging the seriousness of a condition.
5. While emergency care can save lives, unnecessary visits can harm your health (such as invasive tests and being bombarded with X-Rays)
6. Yes - also to end of life situations and the need for medical directives and educating others in the family. It is also not just about money - but some (or many) things done to extend life can be "torture" for the dying patient.

One "mentality" of many of the folks I know (that really puzzles me) is their desire or belief that going to the Emergency Department is such a good thing to do. They almost seem to actually want to go? I actually regard going to the Emergency department of a hospital as something I really want to avoid.

carolinaman
Posts: 4129
Joined: Wed Dec 28, 2011 9:56 am
Location: North Carolina

Re: How to Minimize Your Emergency Care Expenses

Post by carolinaman » Sun Oct 27, 2019 12:48 pm

Excellent article. I intend to give this to my 50 year old who does not have health care insurance. Hopefully, it will convince him to get HC insurance. Thanks for sharing.

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