Excessive Emergency Room Charges - Options?

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Doom&Gloom
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Re: Excessive Emergency Room Charges - Options?

Post by Doom&Gloom » Wed Aug 22, 2018 2:50 pm

financeperchance wrote:
Wed Aug 22, 2018 2:02 pm
It's weird that so many here are offering advice without having any clarity about OP's insurance.
It's weird that OP has asked for advice without providing that information.

financeperchance
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Re: Excessive Emergency Room Charges - Options?

Post by financeperchance » Wed Aug 22, 2018 3:08 pm

Doom&Gloom wrote:
Wed Aug 22, 2018 2:50 pm
financeperchance wrote:
Wed Aug 22, 2018 2:02 pm
It's weird that so many here are offering advice without having any clarity about OP's insurance.
It's weird that OP has asked for advice without providing that information.
Yes indeed.

fm3040
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Re: Excessive Emergency Room Charges - Options?

Post by fm3040 » Mon Aug 27, 2018 6:07 pm

Insurance - Cigna Open Insurance - HSA 2K in-network deductible and 6K out-of-network

Turbo29
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Re: Excessive Emergency Room Charges - Options?

Post by Turbo29 » Mon Aug 27, 2018 7:52 pm

White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm


That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
Got a cat bite on my arm in the middle of the night (~2am). By 2pm the next day I had red streaks running up my arm. Went to urgent care, they prescribed an antibiotic (Bactrim), told me to take 2 tabs to start and then 2-2x/day until gone. Streaks were gone the next morning when I woke up.

BUT, I was told a cat bite to the hand is go to the ER immediately because the danger of tendon or bone infection is too great.

How is a layperson to know this type of distinction?

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Tue Aug 28, 2018 10:17 am

Turbo29 wrote:
Mon Aug 27, 2018 7:52 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm

That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
Got a cat bite on my arm in the middle of the night (~2am). By 2pm the next day I had red streaks running up my arm. Went to urgent care, they prescribed an antibiotic (Bactrim), told me to take 2 tabs to start and then 2-2x/day until gone. Streaks were gone the next morning when I woke up.

BUT, I was told a cat bite to the hand is go to the ER immediately because the danger of tendon or bone infection is too great.

How is a layperson to know this type of distinction?
That is the $64,000 question!

True story - years ago our primary care physicians were in a group - and that group had an adjacent Urgent Care facility located next door to their regular offices. One Saturday afternoon, I slammed (accidentally) the car door as my wife reached in. She was in terrible pain from the car door smashing her fingers. I called the doctor's office and explained the situation to the woman who answered the phone. First question (as always) "What Insurance do you have?" I told her and she said that under our insurance, my wife could come in and get an X-Ray to see if the bone(s) were broken. If the bones were broken, the insurance would pay, BUT if not broken the insurance would not pay. I replied that this was idiotic, since neither of us had been to medical school. Fortunately for my wife, within 20 minutes or so - the pain subsided and we concluded no action was necessary. On Monday, I called the practice and complained. The first answer was that I received the correct response. I pressed - and then they agreed to research it. They got back to me the next day and said that I should have stayed on the line for the whole recording and then they would have contacted an on call physician who would/could have authorized the X-Ray and treatment under our insurance.

I am so, so glad we have the outstanding access to urgent/emergency services under our current plan!

toofache32
Posts: 1324
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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Tue Aug 28, 2018 10:39 am

dm200 wrote:
Tue Aug 28, 2018 10:17 am
Turbo29 wrote:
Mon Aug 27, 2018 7:52 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm

That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
Got a cat bite on my arm in the middle of the night (~2am). By 2pm the next day I had red streaks running up my arm. Went to urgent care, they prescribed an antibiotic (Bactrim), told me to take 2 tabs to start and then 2-2x/day until gone. Streaks were gone the next morning when I woke up.

BUT, I was told a cat bite to the hand is go to the ER immediately because the danger of tendon or bone infection is too great.

How is a layperson to know this type of distinction?
That is the $64,000 question!

True story - years ago our primary care physicians were in a group - and that group had an adjacent Urgent Care facility located next door to their regular offices. One Saturday afternoon, I slammed (accidentally) the car door as my wife reached in. She was in terrible pain from the car door smashing her fingers. I called the doctor's office and explained the situation to the woman who answered the phone. First question (as always) "What Insurance do you have?" I told her and she said that under our insurance, my wife could come in and get an X-Ray to see if the bone(s) were broken. If the bones were broken, the insurance would pay, BUT if not broken the insurance would not pay. I replied that this was idiotic, since neither of us had been to medical school. Fortunately for my wife, within 20 minutes or so - the pain subsided and we concluded no action was necessary. On Monday, I called the practice and complained. The first answer was that I received the correct response. I pressed - and then they agreed to research it. They got back to me the next day and said that I should have stayed on the line for the whole recording and then they would have contacted an on call physician who would/could have authorized the X-Ray and treatment under our insurance.

I am so, so glad we have the outstanding access to urgent/emergency services under our current plan!
You complained to the practice about the policies of YOUR insurance company??

I perform a certain type of biopsy on a regular basis. Medicare will not pay for them if they turn out to be benign, but they will pay if the biopsy result is malignant. 90% of these are benign. So Medicare was one of the first insurances I dropped.

passiveTiger
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Re: Excessive Emergency Room Charges - Options?

Post by passiveTiger » Tue Aug 28, 2018 1:06 pm

toofache32 wrote:
Tue Aug 28, 2018 10:39 am
dm200 wrote:
Tue Aug 28, 2018 10:17 am
Turbo29 wrote:
Mon Aug 27, 2018 7:52 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm

That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
Got a cat bite on my arm in the middle of the night (~2am). By 2pm the next day I had red streaks running up my arm. Went to urgent care, they prescribed an antibiotic (Bactrim), told me to take 2 tabs to start and then 2-2x/day until gone. Streaks were gone the next morning when I woke up.

BUT, I was told a cat bite to the hand is go to the ER immediately because the danger of tendon or bone infection is too great.

How is a layperson to know this type of distinction?
That is the $64,000 question!

True story - years ago our primary care physicians were in a group - and that group had an adjacent Urgent Care facility located next door to their regular offices. One Saturday afternoon, I slammed (accidentally) the car door as my wife reached in. She was in terrible pain from the car door smashing her fingers. I called the doctor's office and explained the situation to the woman who answered the phone. First question (as always) "What Insurance do you have?" I told her and she said that under our insurance, my wife could come in and get an X-Ray to see if the bone(s) were broken. If the bones were broken, the insurance would pay, BUT if not broken the insurance would not pay. I replied that this was idiotic, since neither of us had been to medical school. Fortunately for my wife, within 20 minutes or so - the pain subsided and we concluded no action was necessary. On Monday, I called the practice and complained. The first answer was that I received the correct response. I pressed - and then they agreed to research it. They got back to me the next day and said that I should have stayed on the line for the whole recording and then they would have contacted an on call physician who would/could have authorized the X-Ray and treatment under our insurance.

I am so, so glad we have the outstanding access to urgent/emergency services under our current plan!
You complained to the practice about the policies of YOUR insurance company??

I perform a certain type of biopsy on a regular basis. Medicare will not pay for them if they turn out to be benign, but they will pay if the biopsy result is malignant. 90% of these are benign. So Medicare was one of the first insurances I dropped.
I thought all insurances use a diagnosis code methodology like Medicare where what is reimbursable at the eligible rate is dependent on the diagnosis code.

CuriousReader
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Re: Excessive Emergency Room Charges - Options?

Post by CuriousReader » Tue Aug 28, 2018 2:26 pm

Ack--then where do I go for biopsies once I go on Medicare?

drawpoker
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Re: Excessive Emergency Room Charges - Options?

Post by drawpoker » Tue Aug 28, 2018 2:48 pm

CuriousReader wrote:
Tue Aug 28, 2018 2:26 pm
Ack--then where do I go for biopsies once I go on Medicare?
I believe toofache32 is referring to a highly specialized type of biopsy (related to dental??)

I have had several different kinds of biopsies done, sent off, ruled to be benign. Medicare anted up for every single one, no arguments.

toofache32
Posts: 1324
Joined: Sun Mar 04, 2012 6:30 pm

Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Tue Aug 28, 2018 3:14 pm

passiveTiger wrote:
Tue Aug 28, 2018 1:06 pm
toofache32 wrote:
Tue Aug 28, 2018 10:39 am
dm200 wrote:
Tue Aug 28, 2018 10:17 am
Turbo29 wrote:
Mon Aug 27, 2018 7:52 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm

That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
Got a cat bite on my arm in the middle of the night (~2am). By 2pm the next day I had red streaks running up my arm. Went to urgent care, they prescribed an antibiotic (Bactrim), told me to take 2 tabs to start and then 2-2x/day until gone. Streaks were gone the next morning when I woke up.

BUT, I was told a cat bite to the hand is go to the ER immediately because the danger of tendon or bone infection is too great.

How is a layperson to know this type of distinction?
That is the $64,000 question!

True story - years ago our primary care physicians were in a group - and that group had an adjacent Urgent Care facility located next door to their regular offices. One Saturday afternoon, I slammed (accidentally) the car door as my wife reached in. She was in terrible pain from the car door smashing her fingers. I called the doctor's office and explained the situation to the woman who answered the phone. First question (as always) "What Insurance do you have?" I told her and she said that under our insurance, my wife could come in and get an X-Ray to see if the bone(s) were broken. If the bones were broken, the insurance would pay, BUT if not broken the insurance would not pay. I replied that this was idiotic, since neither of us had been to medical school. Fortunately for my wife, within 20 minutes or so - the pain subsided and we concluded no action was necessary. On Monday, I called the practice and complained. The first answer was that I received the correct response. I pressed - and then they agreed to research it. They got back to me the next day and said that I should have stayed on the line for the whole recording and then they would have contacted an on call physician who would/could have authorized the X-Ray and treatment under our insurance.

I am so, so glad we have the outstanding access to urgent/emergency services under our current plan!
You complained to the practice about the policies of YOUR insurance company??

I perform a certain type of biopsy on a regular basis. Medicare will not pay for them if they turn out to be benign, but they will pay if the biopsy result is malignant. 90% of these are benign. So Medicare was one of the first insurances I dropped.
I thought all insurances use a diagnosis code methodology like Medicare where what is reimbursable at the eligible rate is dependent on the diagnosis code.
Yes, that's what I was saying. In my example, I am supposed to wait for the biopsy result (which gives the diagnosis) to determine the diagnosis code. If the diagnosis is benign, Medicare (and now many others) won't pay.
Last edited by toofache32 on Tue Aug 28, 2018 3:47 pm, edited 1 time in total.

CedarWaxWing
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Re: Excessive Emergency Room Charges - Options?

Post by CedarWaxWing » Tue Aug 28, 2018 3:14 pm

dm200 wrote:
Mon Aug 20, 2018 6:51 pm
Katietsu wrote:
Mon Aug 20, 2018 6:15 pm
Have you confirmed that the insurance company is paying as an emergency? I have been billed above the co pay for using an out of network ER. All I had to do was justify that it was an emergency. The insurance company picked up the additional charges.
Interesting experience !
The medical records should have validated that it was an emergency. That should have been enough. The default of many insurance companies is to deny proper payment or delay it using any and all excuses.... so they can

1. Collect the payments from the insured who do not understand that the bill was improper.

2. Have the use of their delayed payouts for as long as possible.

MtnTraveler
Posts: 146
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Re: Excessive Emergency Room Charges - Options?

Post by MtnTraveler » Tue Aug 28, 2018 3:38 pm

fm3040 wrote:
Mon Aug 27, 2018 6:07 pm
Insurance - Cigna Open Insurance - HSA 2K in-network deductible and 6K out-of-network
Had you met your deductible? If not, your co-pay means nothing as it would only kick in if your deductible had been met 100% before going to the ER.

toofache32
Posts: 1324
Joined: Sun Mar 04, 2012 6:30 pm

Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Tue Aug 28, 2018 3:50 pm

drawpoker wrote:
Tue Aug 28, 2018 2:48 pm
CuriousReader wrote:
Tue Aug 28, 2018 2:26 pm
Ack--then where do I go for biopsies once I go on Medicare?
I believe toofache32 is referring to a highly specialized type of biopsy (related to dental??)

I have had several different kinds of biopsies done, sent off, ruled to be benign. Medicare anted up for every single one, no arguments.
I perform biopsies of the face/neck/scalp/mouth areas. Many are fibromas, mucoceles, SebK's and the like.

UpperNwGuy
Posts: 979
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Location: Washington DC

Re: Excessive Emergency Room Charges - Options?

Post by UpperNwGuy » Tue Aug 28, 2018 4:03 pm

fm3040 wrote:
Mon Aug 27, 2018 6:07 pm
Insurance - Cigna Open Insurance - HSA 2K in-network deductible and 6K out-of-network
What did you finally end up doing?
Retiree with a pension and a 60/40 taxable portfolio: Total Stock + Total Int'l + Total Bond + Interm Term Tax Exempt.

fm3040
Posts: 69
Joined: Tue Apr 07, 2015 10:07 pm

Re: Excessive Emergency Room Charges - Options?

Post by fm3040 » Sat Sep 01, 2018 12:09 pm

Charges are piling up from other healthcare providers as well plus a surgery in the offing. Pay up by the end of the year. Charge to credit cards and get some miles out of them.

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White Coat Investor
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Re: Excessive Emergency Room Charges - Options?

Post by White Coat Investor » Fri Sep 07, 2018 11:59 am

Turbo29 wrote:
Mon Aug 27, 2018 7:52 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm


That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
Got a cat bite on my arm in the middle of the night (~2am). By 2pm the next day I had red streaks running up my arm. Went to urgent care, they prescribed an antibiotic (Bactrim), told me to take 2 tabs to start and then 2-2x/day until gone. Streaks were gone the next morning when I woke up.

BUT, I was told a cat bite to the hand is go to the ER immediately because the danger of tendon or bone infection is too great.

How is a layperson to know this type of distinction?
I have no idea. I guess you start with the urgent care and if they send you on then you go on.
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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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Fri Sep 07, 2018 12:50 pm

White Coat Investor wrote:
Fri Sep 07, 2018 11:59 am
Turbo29 wrote:
Mon Aug 27, 2018 7:52 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm


That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
Got a cat bite on my arm in the middle of the night (~2am). By 2pm the next day I had red streaks running up my arm. Went to urgent care, they prescribed an antibiotic (Bactrim), told me to take 2 tabs to start and then 2-2x/day until gone. Streaks were gone the next morning when I woke up.

BUT, I was told a cat bite to the hand is go to the ER immediately because the danger of tendon or bone infection is too great.

How is a layperson to know this type of distinction?
I have no idea. I guess you start with the urgent care and if they send you on then you go on.
and then pay twice? Once urgent care and then at emergency department?

toofache32
Posts: 1324
Joined: Sun Mar 04, 2012 6:30 pm

Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Fri Sep 07, 2018 12:59 pm

dm200 wrote:
Fri Sep 07, 2018 12:50 pm
White Coat Investor wrote:
Fri Sep 07, 2018 11:59 am
Turbo29 wrote:
Mon Aug 27, 2018 7:52 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm


That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
Got a cat bite on my arm in the middle of the night (~2am). By 2pm the next day I had red streaks running up my arm. Went to urgent care, they prescribed an antibiotic (Bactrim), told me to take 2 tabs to start and then 2-2x/day until gone. Streaks were gone the next morning when I woke up.

BUT, I was told a cat bite to the hand is go to the ER immediately because the danger of tendon or bone infection is too great.

How is a layperson to know this type of distinction?
I have no idea. I guess you start with the urgent care and if they send you on then you go on.
and then pay twice? Once urgent care and then at emergency department?

What solution do you suggest?

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White Coat Investor
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Re: Excessive Emergency Room Charges - Options?

Post by White Coat Investor » Fri Sep 07, 2018 5:09 pm

I think paying twice ($200 then $2000) occasionally is better than guessing wrong just once and going to the ED for something the UC could handle.
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: Excessive Emergency Room Charges - Options?

Post by Grt2bOutdoors » Fri Sep 07, 2018 5:44 pm

dm200 wrote:
Fri Sep 07, 2018 12:50 pm
White Coat Investor wrote:
Fri Sep 07, 2018 11:59 am
Turbo29 wrote:
Mon Aug 27, 2018 7:52 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm


That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
Got a cat bite on my arm in the middle of the night (~2am). By 2pm the next day I had red streaks running up my arm. Went to urgent care, they prescribed an antibiotic (Bactrim), told me to take 2 tabs to start and then 2-2x/day until gone. Streaks were gone the next morning when I woke up.

BUT, I was told a cat bite to the hand is go to the ER immediately because the danger of tendon or bone infection is too great.

How is a layperson to know this type of distinction?
I have no idea. I guess you start with the urgent care and if they send you on then you go on.
and then pay twice? Once urgent care and then at emergency department?
I’d gladly pay twice to avoid paying for it over the remaining life I have left (pain, loss of appendages).
"One should invest based on their need, ability and willingness to take risk - Larry Swedroe" Asking Portfolio Questions

randomguy
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Re: Excessive Emergency Room Charges - Options?

Post by randomguy » Fri Sep 07, 2018 8:18 pm

White Coat Investor wrote:
Fri Sep 07, 2018 5:09 pm
I think paying twice ($200 then $2000) occasionally is better than guessing wrong just once and going to the ED for something the UC could handle.
There are also advice nurse hotlines. I have no clue if they are good enough to tell about cat bites to hands versus body. I am sure there are some edge cases about when to hit the urgent care versus ER but most of them are pretty clear cut. Think your dying? Hit up the ER. Otherwise Urgent care is probably the right spot. There is some hand waving as urgent care can vary from a step down from an ER with x-ray machines, MDs, and the rest all the way down to walk in clinics with basically no machines and a PA.

pennylane
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Re: Excessive Emergency Room Charges - Options?

Post by pennylane » Fri Sep 07, 2018 11:39 pm

You’re gonna throw your credit out the window for $1,000?

Yea go for it, while you’re doing it, why not just stop paying all your bills all together.

Turbo29
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Re: Excessive Emergency Room Charges - Options?

Post by Turbo29 » Fri Sep 07, 2018 11:41 pm

randomguy wrote:
Fri Sep 07, 2018 8:18 pm
White Coat Investor wrote:
Fri Sep 07, 2018 5:09 pm
I think paying twice ($200 then $2000) occasionally is better than guessing wrong just once and going to the ED for something the UC could handle.
There are also advice nurse hotlines. I have no clue if they are good enough to tell about cat bites to hands versus body. I am sure there are some edge cases about when to hit the urgent care versus ER but most of them are pretty clear cut. Think your dying? Hit up the ER. Otherwise Urgent care is probably the right spot. There is some hand waving as urgent care can vary from a step down from an ER with x-ray machines, MDs, and the rest all the way down to walk in clinics with basically no machines and a PA.
There are but they are not always right. I called one when I was stung by a scorpion; the nurse told me to go to emergency. I questioned that as I didn't feel it was warranted. After a little research I found that it was recommended to call the poison control line run by Banner. This line fields thousands of scorpion calls each year in Arizona. The poison nurse actually chuckled and said, "No, no, no, you don't have to go the emergency room unless you start twitching or hypersalivating." She also told me that if those symptoms were going to develop they would manifest within 6 hours.

That call saved me some money.

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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Fri Sep 07, 2018 11:55 pm

If a nurse hotline is gonna assume the responsibility for the decision making, I would suppose they are gonna err on the side of sending you to the ER.

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Re: Excessive Emergency Room Charges - Options?

Post by pizza8822 » Sat Sep 08, 2018 12:22 am

I must be hardheaded. How do 99-percent on this thread say just pay it? If I was that hospital administrator I would jack up rates triple on everyone here because you will 'just pay it'. I would fight as hard as you can - the hospital is the one that gets to gouge you as hard as they want. Would you 'just pay it' if a mechanic handed you a $18k bill for a new engine after already installing it, without telling you the price? Pay $50k for a roof with a surprise, no-estimate bill? It blows my mind that people think because it is medicine and helpful, somehow price is irrelevant. The incentives are out of whack to be able to gouge without any upfront knowledge of cash costs. I can't think of any other legitimate business that works this way.

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Re: Excessive Emergency Room Charges - Options?

Post by Broken Man 1999 » Sat Sep 08, 2018 10:39 am

The OP is out $2668 for several services.

Any proof of gouging?

Most of us know that bills are high for medical services.

Do you have any expertise in medical billing? If so p!ease share with us your thoughts on what the services the OP received should cost. With your help, if you have the knowledge, perhaps you can help him.

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Re: Excessive Emergency Room Charges - Options?

Post by tibbitts » Sat Sep 08, 2018 11:11 am

pizza8822 wrote:
Sat Sep 08, 2018 12:22 am
I must be hardheaded. How do 99-percent on this thread say just pay it? If I was that hospital administrator I would jack up rates triple on everyone here because you will 'just pay it'. I would fight as hard as you can - the hospital is the one that gets to gouge you as hard as they want. Would you 'just pay it' if a mechanic handed you a $18k bill for a new engine after already installing it, without telling you the price? Pay $50k for a roof with a surprise, no-estimate bill? It blows my mind that people think because it is medicine and helpful, somehow price is irrelevant. The incentives are out of whack to be able to gouge without any upfront knowledge of cash costs. I can't think of any other legitimate business that works this way.
The OP wasn't asking for cash cost. Yes, if the OP asked for cash cost at the facility it probably should have been provided... maybe. I'm not sure an ER should be expected to provide cash cost for every service 24/7, in that I'm not sure the staff on hand will have access to the cash cost.

I don't think the comparisons are useful because a roof or an engine replacement is never an emergency. I had a water leak in my roof five days ago and still haven't been able to get the roofer to show up, but I can work around it with a bucket. And even if the roof leaks, it won't be fatal. Yes, if I had told the roofer to show up immediately and fix the problem no matter what then I might expect a bill for $50k.

Insurance cost could be all over the map and subject to a determination by another party so I wouldn't expect an ER to provide that.

I would assume when I go to the ER for any reason that I will have to pay the ER fee for my insurance ($500 per visit) plus the out-of-pocket limit, which I forget but I think is now up to $6000 or so. I have regular employer insurance, not a high-deductible plan. And of course any drugs on top of that.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Sat Sep 08, 2018 11:22 am

toofache32 wrote:
Fri Sep 07, 2018 11:55 pm
If a nurse hotline is gonna assume the responsibility for the decision making, I would suppose they are gonna err on the side of sending you to the ER.
When our son was little (maybe about 20 months old), he fell off the diaper changing table and hit the back of his head on a radiator. Some slight bleeding. We called the Kaiser nurse hotline - and the nurse told us what to watch for (the bleeding stopped quickly) and then called us back in a few hours to check. Our son displayed no symptoms and all was fine - really helpful for us with small children.

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Re: Excessive Emergency Room Charges - Options?

Post by livesoft » Sat Sep 08, 2018 11:46 am

I haven't read this entire thread, but I see that the OP is asking about other options. Below is an option I chose after a recent emergency treatment. I had the facility charge, the doctor charge, the pathologist charge, the radiologist charge, and probably some other charges. I learned how our health insurance worked with it's high deductible, 20% co-pay once deductible was met until the high out-of-pocket was met.

Since all was in-network, the EOBs show the discounted prices, too. Although the final charges were high, they were not excessive in my opinion.

I was able to talk to the billing office of the biggest charge and get a 0%-interest no-fee 24-month payment plan. They would simply charge my 2%-cash-back credit card each month for the next 24 months 1/24th of what I owed. So that's the option I took even though I could sell some investments and pay in full without delay.

The expenses of the initial visit reached my max out-of-pocket limit, so that all follow-up treatments are paid by my health insurance, so I know what else I need to budget for the rest of the year: $0.00.

Of course, we already knew what the deductible was and what the max OOP was, so it's not like these expenses were totally unexpected.

Bottom line: Know how your health insurance works and budget for it.
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RL1013
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Re: Excessive Emergency Room Charges - Options?

Post by RL1013 » Sat Sep 08, 2018 11:56 am

Believe it or not, ER doesn't cost substantially higher compared to normal times in some other countries. The healthcare system in this country has brainwashed people into believing that affordable healthcare is a privilage and not a right. I read some of the comments in response to OP and they think that the price they are paying for ER is fair. Ludicrous.

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Re: Excessive Emergency Room Charges - Options?

Post by birdy » Sat Sep 08, 2018 12:18 pm

This is not related to an ER visit:
I am having knee pain. Went to doctor who injected them and ordered PT three times/week for 4 weeks. Went to my first PT appointment and was told my out of pocket would be $250 per session! I have INSURANCE! I told them I could not afford that and they offered me self pay rate (doesn't count toward my insurance deductible) of $79 per session! I am still shaking my head at that.

birdy

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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Sat Sep 08, 2018 12:20 pm

birdy wrote:
Sat Sep 08, 2018 12:18 pm
This is not related to an ER visit:
I am having knee pain. Went to doctor who injected them and ordered PT three times/week for 4 weeks. Went to my first PT appointment and was told my out of pocket would be $250 per session! I have INSURANCE! I told them I could not afford that and they offered me self pay rate (doesn't count toward my insurance deductible) of $79 per session! I am still shaking my head at that.

birdy
I have no understood how this happens. The insurance rates of services I perform in my office are about 25% of my regular fees. They were so low I dropped all insurance networks.

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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Sat Sep 08, 2018 1:08 pm

toofache32 wrote:
Sat Sep 08, 2018 12:20 pm
birdy wrote:
Sat Sep 08, 2018 12:18 pm
This is not related to an ER visit:
I am having knee pain. Went to doctor who injected them and ordered PT three times/week for 4 weeks. Went to my first PT appointment and was told my out of pocket would be $250 per session! I have INSURANCE! I told them I could not afford that and they offered me self pay rate (doesn't count toward my insurance deductible) of $79 per session! I am still shaking my head at that.

birdy
I have no understood how this happens. The insurance rates of services I perform in my office are about 25% of my regular fees. They were so low I dropped all insurance networks.
How do other providers (that take insurance) of those same services survive - if they are so low?

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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Sat Sep 08, 2018 1:41 pm

dm200 wrote:
Sat Sep 08, 2018 1:08 pm
toofache32 wrote:
Sat Sep 08, 2018 12:20 pm
birdy wrote:
Sat Sep 08, 2018 12:18 pm
This is not related to an ER visit:
I am having knee pain. Went to doctor who injected them and ordered PT three times/week for 4 weeks. Went to my first PT appointment and was told my out of pocket would be $250 per session! I have INSURANCE! I told them I could not afford that and they offered me self pay rate (doesn't count toward my insurance deductible) of $79 per session! I am still shaking my head at that.

birdy
I have no understood how this happens. The insurance rates of services I perform in my office are about 25% of my regular fees. They were so low I dropped all insurance networks.
How do other providers (that take insurance) of those same services survive - if they are so low?
They work only in institutional settings where they are employees and don't have overhead or employees to pay. The ones in private practice simply don't offer those services if they are in-network.

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Re: Excessive Emergency Room Charges - Options?

Post by eye.surgeon » Sat Sep 08, 2018 1:47 pm

You don't eat a loaf of bread and then negotiate the price. Pay the bill. And don't go to the ER unless it's an actual emergency. If you walked out at the end of the ER visit without hospitalization or surgery it probably could have been managed in a doctors office. Speaking as a doctor who covers half a dozen ERs.
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Sat Sep 08, 2018 1:52 pm

eye.surgeon wrote:
Sat Sep 08, 2018 1:47 pm
You don't eat a loaf of bread and then negotiate the price. Pay the bill. And don't go to the ER unless it's an actual emergency. If you walked out at the end of the ER visit without hospitalization or surgery it probably could have been managed in a doctors office. Speaking as a doctor who covers half a dozen ERs.
If you have a cut or some similar injury that needs prompt attention after hours, the doctors' offices are not open.

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Re: Excessive Emergency Room Charges - Options?

Post by randomguy » Sat Sep 08, 2018 3:36 pm

toofache32 wrote:
Fri Sep 07, 2018 11:55 pm
If a nurse hotline is gonna assume the responsibility for the decision making, I would suppose they are gonna err on the side of sending you to the ER.
Of course. Isn't that what you want them to do? Would you really want to use a service that valued money over your health?

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Re: Excessive Emergency Room Charges - Options?

Post by EddyB » Sat Sep 08, 2018 4:10 pm

eye.surgeon wrote:
Sat Sep 08, 2018 1:47 pm
You don't eat a loaf of bread and then negotiate the price. Pay the bill. And don't go to the ER unless it's an actual emergency. If you walked out at the end of the ER visit without hospitalization or surgery it probably could have been managed in a doctors office. Speaking as a doctor who covers half a dozen ERs.
If the bakers’ guild limited new admissions, and defended a model where pricing was both opaque and variable, there would be radical change in the market for bread. That’s happening in medicine, although it’s slow. The OP seems to have already acknowledged he’ll pay the bill in this case, but that doesn’t mean there aren’t real systemic problems.

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Re: Excessive Emergency Room Charges - Options?

Post by pizza8822 » Sat Sep 08, 2018 5:17 pm

EddyB wrote:
Sat Sep 08, 2018 4:10 pm
eye.surgeon wrote:
Sat Sep 08, 2018 1:47 pm
You don't eat a loaf of bread and then negotiate the price. Pay the bill. And don't go to the ER unless it's an actual emergency. If you walked out at the end of the ER visit without hospitalization or surgery it probably could have been managed in a doctors office. Speaking as a doctor who covers half a dozen ERs.
If the bakers’ guild limited new admissions, and defended a model where pricing was both opaque and variable, there would be radical change in the market for bread. That’s happening in medicine, although it’s slow. The OP seems to have already acknowledged he’ll pay the bill in this case, but that doesn’t mean there aren’t real systemic problems.
It is interesting that this is a financial board where most are obsessed with ridding all finance related costs possible, with good reason - but ER medicine? Naw, pay your bill. I need to get into that business - doesn't matter what it costs - just pay me or else. Oddly enough, I get the feeling the majority of the 'just pay it' posters are getting rich from the medical system. Perhaps we should go find an Edward Jones message board and find out if they think a 1.25% AUM fee is reasonable? No conflict of interest there.

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Re: Excessive Emergency Room Charges - Options?

Post by uberdoc » Sat Sep 08, 2018 5:29 pm

I think drs should refrain from commenting on these type of posts. Most physicians are employees just like postal workers at the post office. We don’t control anything so why to get perked up. If peope have issues with healthcare they can raise it with hospital ceo, insurance companies and local politicians. We drs dont have any say in these matters.

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Re: Excessive Emergency Room Charges - Options?

Post by eye.surgeon » Sat Sep 08, 2018 5:50 pm

dm200 wrote:
Sat Sep 08, 2018 1:52 pm
eye.surgeon wrote:
Sat Sep 08, 2018 1:47 pm
You don't eat a loaf of bread and then negotiate the price. Pay the bill. And don't go to the ER unless it's an actual emergency. If you walked out at the end of the ER visit without hospitalization or surgery it probably could have been managed in a doctors office. Speaking as a doctor who covers half a dozen ERs.
If you have a cut or some similar injury that needs prompt attention after hours, the doctors' offices are not open.
There are half a dozen urgent care centers within 10 miles of my house.
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Re: Excessive Emergency Room Charges - Options?

Post by tetris55 » Sat Sep 08, 2018 6:16 pm

when you go to an ER, the largest fee you pay for is the use of the facility.

For example, I bill about 55 bucks for a wrist x-ray in my office. I expect to receive about 30 dollars after adjustments in payment. That same x-ray in a hospital facility costs five times as much. They call that the "facility fee". The only way to get around it is to not use the facility.

The physician fees (the neurologist, orthopedist, and ER) are all going to be in the 150-250 range, most likely. Some of those people may have to come in in the middle of the night to try and manage your condition. Those fees are not subject to a "facility fee". Those are their fees.

Typically, you can't negotiate the physician fees. Their fee schedules are set and giving a discount for one patients and not for another patient can be considered illegal.

The facility fees, on the other hand, are inflated. The hospital essentially makes up a number and your insurance company negotiates a payment schedule for you. I would attempt to negotiate those. However, I have been unable to get hospitals to budge on those. Trust me, when we got the bill for a 160$ flu shot, I flipped out to no avail.

Pay the bill. you aren't going to fix the system by getting sent to collections

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Re: Excessive Emergency Room Charges - Options?

Post by livesoft » Sat Sep 08, 2018 6:22 pm

My insurance company will negotiate physician fees in the case where one goes to an in-network facility, but the occasional out-of-network physician happens to be the one that treats you.

Many of us saw the recent news about a bill of about $109,000 getting negotiated much lower:
https://www.cbsnews.com/news/how-do-hos ... t-so-high/
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Re: Excessive Emergency Room Charges - Options?

Post by goodenyou » Sat Sep 08, 2018 6:55 pm

What were the fees charged by the physician(s)? Most excessive charges are not the physician fees, but $20,000 charges for durables, implantables, labs and facility fees. We still have cost-shifting in the system; people who can pay a lot more, do. You rarely read published stories about no-pay, uninsured patients racking up hundreds of thousands of charges in hospitals that never get paid. Just ask your doctor how much she wrote off in ARs last year. The anger is usually not pointed at the CEO of the hospital that makes a lot more than many of the staff physicians. That's just "talent retention ". Patients should not be charged out of network fees for physicians taking care of them in emergencies. The hospital should cover the charges if they want to provide the service by an on call doctor. There is probably a good reason the doctor is out of network. That is why many hospitals go uncovered. The fee for transfer to a hospital with a doctor that can (and will) accept the patient can be tremendous.
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Re: Excessive Emergency Room Charges - Options?

Post by Turbo29 » Sat Sep 08, 2018 7:04 pm

randomguy wrote:
Sat Sep 08, 2018 3:36 pm
toofache32 wrote:
Fri Sep 07, 2018 11:55 pm
If a nurse hotline is gonna assume the responsibility for the decision making, I would suppose they are gonna err on the side of sending you to the ER.
Of course. Isn't that what you want them to do? Would you really want to use a service that valued money over your health?
I would expect the advice nurse in my case to be knowledgeable about the question and not recommend the ER when It is only appropriate in a very small percentage of scorpion sting cases. As I pointed out, the Banner Poison Control nurse was knowledgeable (helps that we get lots of scorpion sings here) and advised no care beyond pain killers like ibuprofen unless a very specific set of symptoms manifested.

The United Healthcare advice nurse may have been located in another state but I am still disappointed in her lack of knowledge.

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Re: Excessive Emergency Room Charges - Options?

Post by Earl Lemongrab » Sun Sep 09, 2018 1:44 pm

eye.surgeon wrote:
Sat Sep 08, 2018 5:50 pm
dm200 wrote:
Sat Sep 08, 2018 1:52 pm
eye.surgeon wrote:
Sat Sep 08, 2018 1:47 pm
You don't eat a loaf of bread and then negotiate the price. Pay the bill. And don't go to the ER unless it's an actual emergency. If you walked out at the end of the ER visit without hospitalization or surgery it probably could have been managed in a doctors office. Speaking as a doctor who covers half a dozen ERs.
If you have a cut or some similar injury that needs prompt attention after hours, the doctors' offices are not open.
There are half a dozen urgent care centers within 10 miles of my house.
It might be common for those options to be open 24 hours where you are. Around here, none are open past around 9:00 PM.
This week's fortune cookie: "Your financial life will be secure and beneficial." So I got that going for me, which is nice.

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Re: Excessive Emergency Room Charges - Options?

Post by Earl Lemongrab » Sun Sep 09, 2018 1:47 pm

eye.surgeon wrote:
Sat Sep 08, 2018 1:47 pm
You don't eat a loaf of bread and then negotiate the price. Pay the bill. And don't go to the ER unless it's an actual emergency. If you walked out at the end of the ER visit without hospitalization or surgery it probably could have been managed in a doctors office. Speaking as a doctor who covers half a dozen ERs.
No, it's like going to a restaurant that refuses to tell you what the meal will be until you've eaten. And it might $20, or $100, depending on whether you have a dining plan. And it turns out a sous chef came by and chopped a few vegetables, and wants a separate payment of $30 not covered by your "restaurant card".
This week's fortune cookie: "Your financial life will be secure and beneficial." So I got that going for me, which is nice.

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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Sun Sep 09, 2018 1:59 pm

Earl Lemongrab wrote:
Sun Sep 09, 2018 1:44 pm
eye.surgeon wrote:
Sat Sep 08, 2018 5:50 pm
dm200 wrote:
Sat Sep 08, 2018 1:52 pm
eye.surgeon wrote:
Sat Sep 08, 2018 1:47 pm
You don't eat a loaf of bread and then negotiate the price. Pay the bill. And don't go to the ER unless it's an actual emergency. If you walked out at the end of the ER visit without hospitalization or surgery it probably could have been managed in a doctors office. Speaking as a doctor who covers half a dozen ERs.
If you have a cut or some similar injury that needs prompt attention after hours, the doctors' offices are not open.
There are half a dozen urgent care centers within 10 miles of my house.
It might be common for those options to be open 24 hours where you are. Around here, none are open past around 9:00 PM.
Same thing around here. There was one near my house (never used it) started by several Physicians that was open until 8 pm each day - but then was taken over by a large hospital conglomerate - and they cut back the hours.

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Re: Excessive Emergency Room Charges - Options?

Post by goodenyou » Sun Sep 09, 2018 2:18 pm

dm200 wrote:
Sun Sep 09, 2018 1:59 pm
Earl Lemongrab wrote:
Sun Sep 09, 2018 1:44 pm
eye.surgeon wrote:
Sat Sep 08, 2018 5:50 pm
dm200 wrote:
Sat Sep 08, 2018 1:52 pm
eye.surgeon wrote:
Sat Sep 08, 2018 1:47 pm
You don't eat a loaf of bread and then negotiate the price. Pay the bill. And don't go to the ER unless it's an actual emergency. If you walked out at the end of the ER visit without hospitalization or surgery it probably could have been managed in a doctors office. Speaking as a doctor who covers half a dozen ERs.
If you have a cut or some similar injury that needs prompt attention after hours, the doctors' offices are not open.
There are half a dozen urgent care centers within 10 miles of my house.
It might be common for those options to be open 24 hours where you are. Around here, none are open past around 9:00 PM.
Same thing around here. There was one near my house (never used it) started by several Physicians that was open until 8 pm each day - but then was taken over by a large hospital conglomerate - and they cut back the hours.
They probably lose money after hours. I will bet that the types of patients (in aggregate) that come in after hours aren't the ones that make them money. Hospitals often buy these centers and then close them, so patients have to go to their inefficient and overpriced ERs. If there was an opportunity to make money in this space (late hours urgent care), I would bet it would be filled in a hurry. It's just like out-patient surgery centers. Hospitals buy them and then charge overpriced fees. Hospitals are "allowed" to charge higher fees for the same service.
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Sun Sep 09, 2018 2:22 pm

goodenyou wrote:
Sun Sep 09, 2018 2:18 pm
dm200 wrote:
Sun Sep 09, 2018 1:59 pm
Earl Lemongrab wrote:
Sun Sep 09, 2018 1:44 pm
eye.surgeon wrote:
Sat Sep 08, 2018 5:50 pm
dm200 wrote:
Sat Sep 08, 2018 1:52 pm
If you have a cut or some similar injury that needs prompt attention after hours, the doctors' offices are not open.
There are half a dozen urgent care centers within 10 miles of my house.
It might be common for those options to be open 24 hours where you are. Around here, none are open past around 9:00 PM.
Same thing around here. There was one near my house (never used it) started by several Physicians that was open until 8 pm each day - but then was taken over by a large hospital conglomerate - and they cut back the hours.
They probably lose money after hours. I will bet that the types of patients (in aggregate) that come in after hours aren't the ones that make them money. Hospitals often buy these centers and then close them, so patients have to go to their inefficient and overpriced ERs. If there was an opportunity to make money in this space (late hours urgent care), I would bet it would be filled in a hurry. It's just like out-patient surgery centers. Hospitals buy them and then charge overpriced fees. Hospital are "allowed" to charge higher fees.
When it was owned and operated by the Physicians as a standalone operation, they expanded services (and promoted/advertised) to include "Primary Care". Then, a few years later - sold to the big hospital comglomerate.

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