How to Minimize Your Emergency Care Expenses

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun May 06, 2018 8:21 am

dknightd wrote:
Sat May 05, 2018 5:33 pm
I think the underlying problem is people not judging what is an emergency properly.
Wife has a stroke - emergency
I slip and fall, bonk my head, pass out for a few minutes - emergency
Almost cut off my fingers with a table saw - emergency
I have problems breathing when working too hard - urgent care
I get a horrible looking rash, with infection - urgent care
Flu like symptoms - primary care
Emergency care is expensive. It should be used for emergencies.
I've yet to leave emergency room and been asked to pay more than deductible Maybe I'm lucky?
I think the heath care system in USA is broken. But I will not comment on that. And I could be wrong.
Yes - I agree. There are several problems, though:

1. We, patients, often do not know the difference-

2. Even if we do know (or have a good idea) there are often only the "emergency room" for urgent care needs

Now, DW and I are fortunate that our health plan offers 7x24 advice nurses and 7x24 urgent care facilities normally reachable within 15-30 minutes. Our previous plan/primary care physicians offered no urgent care choices. Calling the "advice nurse" is immensely helpful in determining the seriousness of a situation -

In the last 3 years, DW has needed/used after hours urgent care 2-3 times. One situation, if not dealt with quickly (at 3:30 am on a Sunday) almost certainly would have been an "emergency" had we waited longer. :)

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Re: How to Minimize Your Emergency Care Expenses

Post by blaugranamd » Sun May 06, 2018 9:26 am

CppCoder wrote:
Sat Jan 20, 2018 8:48 am
White Coat Investor wrote:
Fri Jan 19, 2018 6:41 pm
# 1 - It is screwed up, broken, and embarrassing to be a part of.
Thank you for being upfront and honest about this situation. As patients, we often wonder if the doctors even know this or care.
# 5 - Doctors and nurses generally aren't in control of what's on your bill(s) nor does most of the money paid toward your bill(s) go toward doctors and nurses, so no sense in taking it out on them.
I know the above is true, but honestly, the medical providers are the ones who make this industry work. Why don't doctors, nurses, etc. organize and fix the problem? If you don't, you're somewhat complicit. You are taking advantage of the system to receive high pay and abdicating responsibility for billing because "that's someone else's department." I assure you, most hospitals wouldn't be there if doctors organized and stopped working there. If nothing else, you'd think someone would want to do this for self-preservation reasons. Rightly or wrongly, eventually the masses can't take it anymore, and they come with tar, feathers, and pitchforks. In this case, I suspect that would be draconian laws dictating payment, not literal tar and feathering. Maybe this will never be the case because the really poor don't pay, the rich just pay and complain but it has no impact on them, and those stuck in the middle get squeezed but are too few and powerless to fix anything. Personally, I wouldn't be able to sleep at night working in an industry that yes, provides a needed and noble service, but also had a back office that worked like a loan shark. I can't imagine anyone going into medical school today doesn't realize this...they still go.
Agree with WCI. Medical students/pre-medical folks have about the same level of understanding of this issue as does the general population. Most residents (physicians in training) don't either. It isn't until you've either 1) personally experienced expensive healthcare as a patient or 2) settled into your career a bit and have the time to learn about more than just being good at your job.

As far as "why don't doctors/nurses/etc organize" I have wondered this myself a lot. The issue is leverage in most organized work battles is striking/refusing to work. There is simply NO WAY for medical providers to not provide care/not work without hurting patients, which is most of our worst nightmares and a VERY easy way to paint us as the bad guys in negotiations. Obviously it's more complex than this but, IMO, this is a big part of the issue.

As far as doctors trying to help patients minimize medical costs, there are plenty of providers out there who want to do just this. This is a big sticking point for me as a physician who works in medical education training the next generation of doctors in primary care. I try very hard to impress "how is ordering XXX going to help your patient/decision-making?" to get residents to think about this side of medicine. The irony is working in an essentially "socialized" system in the military cost doesn't impact our patients the way it does in the civilian world so "cost saving" medicine is an even weirder dynamic. Personally, I could never function as a ED doc and I don't know how you all do it. I rely VERY heavily on my ability to bring patients back to see me again in a day or two.
# 3 Don't go to the Emergency Department if you don't have to
Cannot emphasize this enough! I fully recognize part of the issue is access: if you can't see your primary care doc for 3 weeks, then you may not have a choice other than an urgent care, which is definitely cheaper but the quality of care can be variable. At the very least, call our primary doc and try to get triaged.
Use words like "I'm willing to share this risk with you if it can save me substantial amounts of money" and "What would you do if it was your wife or child?" "Can this be done safely later if I'm not getting better?" What are the downsides of not doing that test or treatment today?" "What do you think the chances are that this is actually something serious? I'd rather not get a huge work-up today if you think the chances are less than 10%."
Another great suggestion. While I can't speak to the efficacy of this in the ED setting, in the primary care setting a family that is open to not getting a chest X ray or lab testing makes it MUCH easier to not perform unnecessary testing. I would add asking, "How is that test going to change what you think needs to be done?" A classic example in pediatrics is pnuemonia: the diagnosis is entirely based on your doctor's examination and national guidelines explicitly recommend NOT getting a chest x ray or blood work for most patients. Yet I see patients for follow up routinely who appear to have testing they did not require.

Lastly, part of this entails having a plan:
- Know your primary care doc's after hours triaging/nurse line numbers
- Know where your local Urgent Cares are and make sure they're not a "free-standing ER"

To tag on to the above I would add the following bullet to the "avoiding high ER costs"

#7 Find a good primary care doctor!

I realize this is very hard to figure out who is "good" but some tips would be calling primary care docs in your area, finding out their clinic structure, if they have a nurse line or doctor phone triage, walk-in acute appointments, associated with an urgent care, do they offer "virtual doc appts" over the phone with the doctor? I had a great primary care office during my time in medical school who had an urgent care center staffed by the same family care physicians and PAs that used a shared waiting room in the same building. This model, IMO, needs to start becoming the standard for care. I don't know how much the civilian side of medicine has implemented phone-based appointments with doctors.
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Re: How to Minimize Your Emergency Care Expenses

Post by dknightd » Sun May 06, 2018 9:49 am

dm200 wrote:
Sun May 06, 2018 8:14 am

Right - but the discussion issue is the requirement for someone to be with you on discharge when having anesthesia/sedation for the procedure.
This seems reasonable to me

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Re: How to Minimize Your Emergency Care Expenses

Post by Turbo29 » Sun May 06, 2018 9:50 am

dm200 wrote:
Sun May 06, 2018 8:21 am
Calling the "advice nurse" is immensely helpful in determining the seriousness of a situation -
Not always. Two years ago I got stung by a scorpion and called United Healthcare's advice nurse. She wanted me to go the the emergency room immediately. I questioned that because it didn't seem that bad (it was painful but not systemically bad). After a small time on Google I found that poison control was the "go to" here in Arizona for scorpion stings. They field thousands of calls/year regarding this (lots of scorpions here).

The poison control nurse just laughed when I told here about the advice nurse. She said, "No, no, no, they always get it wrong. If you start twitching or drooling, go to the emergency room. If this happens, it will happen within 6 hours. If it doesn't, nothing to worry about. Just take some Tylenol or ibuprofen for pain.

I ended up not needing the ER, as do the vast majority of scorpion sting victims (small childrenn excluded, of course).

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Re: How to Minimize Your Emergency Care Expenses

Post by blaugranamd » Sun May 06, 2018 9:57 am

White Coat Investor wrote:
Sat Feb 03, 2018 9:33 pm
tarnation wrote:
Sun Jan 28, 2018 11:41 pm
I think the info on billing and insurance and all that is informative. However, in my opinion, reducing costs by not receiving or declining emergency medical care has to be some of the worst advice I have seen on this forum (or anywhere maybe). The OP may feel confident second guessing medical experts, but to encourage lay persons to do so is questionable at best, reckless at worst.

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

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

If you want to spend less on health care, consume less health care, including emergency care. Is there some risk there? Sure. The world is a risky place to live and none of us get out alive. How much of your income are you willing to spend to reduce that risk by a small amount?
The point of this post is not to just consume less healthcare but to efficiently consume it. If you think you need to get medical care, then you should get it in the best way possible. As a primary care doctor/pediatrician, I hate getting paperwork from urgent cares and EDs for patients who I think should have come to see me instead and never called our office. The care is more expensive and very often my patients end up going to people who are not extensively trained in the care of children and provide acceptable but suboptimal care and patients unfortunately really can't know that at the point of care. It's why I do my best when families call in with acute concerns to find a way to get them seen or call them myself to triage them over the phone and see if we can see them the following day. Again, this is why I try to say efficiently consume: call your doctors office, utilize the triage systems in place to help you get the best AND most cost efficient healthcare. A great example was a previous poster who talked about getting sutures in the ED and the cost of having an urgent care take care of them. There's the third option: some primary care offices (like mine) can have you just walk in and see a technician or a nurse for suture removal instead of the urgent care. You won't know until you call.
dknightd wrote:
Sat May 05, 2018 5:33 pm
I think the underlying problem is people not judging what is an emergency properly.
Wife has a stroke - emergency
I slip and fall, bonk my head, pass out for a few minutes - emergency
Almost cut off my fingers with a table saw - emergency
I have problems breathing when working too hard - urgent care
I get a horrible looking rash, with infection - urgent care
Flu like symptoms - primary care
To tag along with my above comments, both of those urgent care issues I would want first shot at in primary care. In kids, I would probably also want to see the fall with brief loss of consciousness if we could get them in quickly as I know the PECARN head injury guidelines just like the ED docs do. This also why I feel so bad for the non-medical person who is expected to triage their own problems. This is why having a primary care doc with a strong patient-centered medical home model and utilizing your available phone triage system is critical to getting quality, efficient care because every doc has different comfort levels with what they will treat in their office vs defer to the ED, availability, walk-in/protocol structure, etc. If you're proactive and communicate with your docs office and/or insurance triage you'll be in a much better position to decide WHERE to receive you care and thus pay for the care you need.

BTW, this is not a medical-based discussion, but rather an on topic bit about minimizing your healthcare costs. I tried very hard to stay away from how the current system completely disincentivises this type of care. :P
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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Sun May 06, 2018 10:33 am

blaugranamd wrote:
Sun May 06, 2018 9:57 am
There's the third option: some primary care offices (like mine) can have you just walk in and see a technician or a nurse for suture removal instead of the urgent care. You won't know until you call.
As an aside, suture removal is generally free in the ED where the sutures were put in. It's part of the procedure you already paid for. So in that case, somewhat non-intuitively, it would be cheaper to go back to the ED than your primary care!

What a crazy system!
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun May 06, 2018 10:46 am

Turbo29 wrote:
Sun May 06, 2018 9:50 am
dm200 wrote:
Sun May 06, 2018 8:21 am
Calling the "advice nurse" is immensely helpful in determining the seriousness of a situation -
Not always. Two years ago I got stung by a scorpion and called United Healthcare's advice nurse. She wanted me to go the the emergency room immediately. I questioned that because it didn't seem that bad (it was painful but not systemically bad). After a small time on Google I found that poison control was the "go to" here in Arizona for scorpion stings. They field thousands of calls/year regarding this (lots of scorpions here).
The poison control nurse just laughed when I told here about the advice nurse. She said, "No, no, no, they always get it wrong. If you start twitching or drooling, go to the emergency room. If this happens, it will happen within 6 hours. If it doesn't, nothing to worry about. Just take some Tylenol or ibuprofen for pain.
I ended up not needing the ER, as do the vast majority of scorpion sting victims (small childrenn excluded, of course).
Yes .. Advice nurses tend to err on the side of caution as to what is, or might be, an emergency.

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Re: How to Minimize Your Emergency Care Expenses

Post by blaugranamd » Sun May 06, 2018 10:50 am

White Coat Investor wrote:
Sun May 06, 2018 10:33 am
blaugranamd wrote:
Sun May 06, 2018 9:57 am
There's the third option: some primary care offices (like mine) can have you just walk in and see a technician or a nurse for suture removal instead of the urgent care. You won't know until you call.
As an aside, suture removal is generally free in the ED where the sutures were put in. It's part of the procedure you already paid for. So in that case, somewhat non-intuitively, it would be cheaper to go back to the ED than your primary care!

What a crazy system!
I learned something new today!
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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun May 06, 2018 10:51 am

The point of this post is not to just consume less healthcare but to efficiently consume it. If you think you need to get medical care, then you should get it in the best way possible. As a primary care doctor/pediatrician, I hate getting paperwork from urgent cares and EDs for patients who I think should have come to see me instead and never called our office. The care is more expensive and very often my patients end up going to people who are not extensively trained in the care of children and provide acceptable but suboptimal care and patients unfortunately really can't know that at the point of care. It's why I do my best when families call in with acute concerns to find a way to get them seen or call them myself to triage them over the phone and see if we can see them the following day. Again, this is why I try to say efficiently consume: call your doctors office, utilize the triage systems in place to help you get the best AND most cost efficient healthcare. A great example was a previous poster who talked about getting sutures in the ED and the cost of having an urgent care take care of them. There's the third option: some primary care offices (like mine) can have you just walk in and see a technician or a nurse for suture removal instead of the urgent care. You won't know until you call.
Yes - this makes a lot of sense. BUT - many primary care physicians are just not set up (our previous ones were not) to deal with same day "urgent" situations requiring some kinds of immediate or quick treatment. Although I never had one, for example, I doubt if our previous Primary care physicians would have been set up for a broken arm - non immediate life threatening.

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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Sun May 06, 2018 11:10 am

dm200 wrote:
Sun May 06, 2018 10:51 am
The point of this post is not to just consume less healthcare but to efficiently consume it. If you think you need to get medical care, then you should get it in the best way possible. As a primary care doctor/pediatrician, I hate getting paperwork from urgent cares and EDs for patients who I think should have come to see me instead and never called our office. The care is more expensive and very often my patients end up going to people who are not extensively trained in the care of children and provide acceptable but suboptimal care and patients unfortunately really can't know that at the point of care. It's why I do my best when families call in with acute concerns to find a way to get them seen or call them myself to triage them over the phone and see if we can see them the following day. Again, this is why I try to say efficiently consume: call your doctors office, utilize the triage systems in place to help you get the best AND most cost efficient healthcare. A great example was a previous poster who talked about getting sutures in the ED and the cost of having an urgent care take care of them. There's the third option: some primary care offices (like mine) can have you just walk in and see a technician or a nurse for suture removal instead of the urgent care. You won't know until you call.
Yes - this makes a lot of sense. BUT - many primary care physicians are just not set up (our previous ones were not) to deal with same day "urgent" situations requiring some kinds of immediate or quick treatment. Although I never had one, for example, I doubt if our previous Primary care physicians would have been set up for a broken arm - non immediate life threatening.
Most don't even do sutures. I know because they send them to me. And after the urgent cares close at 10 pm....we get even the little stuff. Why not if it doesn't cost you any more? There are a lot of people in that category- people who won't pay anyway, Medicaid with a $3 co-pay, people who have hit their deductible already etc. Meanwhile those with a $9,000 deductible can't figure out why anyone would ever go to the ED unless they were already half dead.
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun May 06, 2018 11:37 am

Over the years, when I have had surgical sutures removed, it has usually been an assistant or tech that has done it - not a Physician - although in the surgeons' office at follow-up.

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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Thu May 10, 2018 10:49 am

dknightd wrote:
Sat May 05, 2018 5:20 pm
VictoriaF wrote:
Thu Mar 01, 2018 9:41 pm

My hospital would not discharge me after a colonoscopy unless there is someone to pick me up. They would not agree for me taking a taxi. Is there a way for me to assert that it's a hospital, not a prison?

Victoria
I consider a colonoscopy an elective procedure. Not an emergency
Yes, of course.

My cited comment was not about the nature of colonoscopy but about the limits of patients' control over our own healthcare. I wrote that in response to White Coat Investor's statement about patients' power that we give up. I was not arguing with WCI--I agree with his general premise and I value his contributions--I was giving an example of how in many circumstances patients' power is curtailed.

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Re: How to Minimize Your Emergency Care Expenses

Post by GreenGrowTheDollars » Sun May 13, 2018 9:05 pm

I got a real lesson in why medical facilities don't want you taking a taxi or bus home by yourself from a procedure where you had amnesiac sedation when I accompanied a friend for her colonoscopy.

After the procedure, she was awake and chatty. The doctor came in and told us that everything looked great, no polyps, 10-year follow-up.

The nurse helped her get dressed, then I brought her home and walked her up to bed since she was a bit sleepy by then. She was extremely cooperative.

The next day she called me and asked if the doctor had said anything about the results. She didn't remember the doctor's comments, getting dressed, the ride home or that I'd helped her to her bedroom and into bed.

She was highly vulnerable and we didn't even know it.

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Re: How to Minimize Your Emergency Care Expenses

Post by White Coat Investor » Sun May 13, 2018 10:05 pm

Turbo29 wrote:
Sun May 06, 2018 9:50 am
dm200 wrote:
Sun May 06, 2018 8:21 am
Calling the "advice nurse" is immensely helpful in determining the seriousness of a situation -
Not always. Two years ago I got stung by a scorpion and called United Healthcare's advice nurse. She wanted me to go the the emergency room immediately. I questioned that because it didn't seem that bad (it was painful but not systemically bad). After a small time on Google I found that poison control was the "go to" here in Arizona for scorpion stings. They field thousands of calls/year regarding this (lots of scorpions here).

The poison control nurse just laughed when I told here about the advice nurse. She said, "No, no, no, they always get it wrong. If you start twitching or drooling, go to the emergency room. If this happens, it will happen within 6 hours. If it doesn't, nothing to worry about. Just take some Tylenol or ibuprofen for pain.

I ended up not needing the ER, as do the vast majority of scorpion sting victims (small childrenn excluded, of course).
This is what the emergency doc would have told you. You figured out a way to get that advice for free. The more educated you are on when health care is needed, the more you save. It's like the more educated you are on when real financial advice is needed, the more you save on advisory fees.
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Mon May 14, 2018 12:34 pm

GreenGrowTheDollars wrote:
Sun May 13, 2018 9:05 pm
I got a real lesson in why medical facilities don't want you taking a taxi or bus home by yourself from a procedure where you had amnesiac sedation when I accompanied a friend for her colonoscopy.
After the procedure, she was awake and chatty. The doctor came in and told us that everything looked great, no polyps, 10-year follow-up.
The nurse helped her get dressed, then I brought her home and walked her up to bed since she was a bit sleepy by then. She was extremely cooperative.
The next day she called me and asked if the doctor had said anything about the results. She didn't remember the doctor's comments, getting dressed, the ride home or that I'd helped her to her bedroom and into bed.
She was highly vulnerable and we didn't even know it.
I never experienced this, but certainly the drugs used for a colonoscopy can certainly have such an effect.

The other risk (happened to a friend of mine) is that the colonoscopy might have punctured something (like a blood vessel) and it might not be noticed right away. Without immediate emergency surgery, you could die.

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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Mon May 14, 2018 12:47 pm

GreenGrowTheDollars wrote:
Sun May 13, 2018 9:05 pm
I got a real lesson in why medical facilities don't want you taking a taxi or bus home by yourself from a procedure where you had amnesiac sedation when I accompanied a friend for her colonoscopy.

After the procedure, she was awake and chatty. The doctor came in and told us that everything looked great, no polyps, 10-year follow-up.

The nurse helped her get dressed, then I brought her home and walked her up to bed since she was a bit sleepy by then. She was extremely cooperative.

The next day she called me and asked if the doctor had said anything about the results. She didn't remember the doctor's comments, getting dressed, the ride home or that I'd helped her to her bedroom and into bed.

She was highly vulnerable and we didn't even know it.
Our instructions following a colonoscopy with sedation include all the bits about being escorted and also include considerable language about NOT signing any legal documents (and some other similar wording) for 24 hours.

I *think* I remember the post-procedure/pre-discharge discussions, but perhaps DH and I "discussed them" later...

However, most of the "final results" are given at a follow-up appointment soon thereafter, as a matter of policy (even though there has never yet been anything worrisome for either of us; we just are never given any definitive results/information that same day).
Perhaps this possible "amnesia" is also part of the reason we aren't typically given more information at discharge?

RM
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Mon May 14, 2018 1:43 pm

My wife takes a long time to recover from any kind of sedation or anesthesia. I recover very, very quickly.

Once or twice when I had an early morning colonoscopy - and felt 100% great in the early to mid afternoon - and never having had any issues in the past - I resumed my regular routing - including driving mid afternoon.

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Re: How to Minimize Your Emergency Care Expenses

Post by SlowMovingInvestor » Sat May 19, 2018 8:51 am

Article on Anthem denying some ER visit expenses

https://www.nytimes.com/2018/05/19/upsh ... 2Fbusiness

Although the first example they give:

..he felt a jolt in his back ..“It dropped me to my knees instantly,” he said. He thought he’d slipped a disk. His friend, an emergency medical technician, urged him to go to the hospital ..At the emergency room, Mr. Burton, a 37-year-old resident of Lexington, Ky., was found to have a back sprain, with no signs of other serious injury, and was sent home.


I'm not a doctor, but I would think that unless you have other concerning symptoms such as motor problems, incontinence, bleeding. nausea etc., this seems to be a clear case where you shouldn't go to an ER, but to urgent care, or even (depending on level of pain) just take some painkillers.

His ER bill was $1722, which actually doesn't seem too much if the ER did an MRI too.

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sat May 19, 2018 9:40 am

SlowMovingInvestor wrote:
Sat May 19, 2018 8:51 am
Article on Anthem denying some ER visit expenses
https://www.nytimes.com/2018/05/19/upsh ... 2Fbusiness
Although the first example they give:
..he felt a jolt in his back ..“It dropped me to my knees instantly,” he said. He thought he’d slipped a disk. His friend, an emergency medical technician, urged him to go to the hospital ..At the emergency room, Mr. Burton, a 37-year-old resident of Lexington, Ky., was found to have a back sprain, with no signs of other serious injury, and was sent home.

I'm not a doctor, but I would think that unless you have other concerning symptoms such as motor problems, incontinence, bleeding. nausea etc., this seems to be a clear case where you shouldn't go to an ER, but to urgent care, or even (depending on level of pain) just take some painkillers.
His ER bill was $1722, which actually doesn't seem too much if the ER did an MRI too.
Not a doctor either ..

I do believe there are many cases where an ER visit is not needed, but there are many challenges. Often, the patient cannot reasonably determine the seriousness of the condition (seems to be the case here). The other challenge is that there are often no good, accessible "urgent care" facilities available. Over the decades, I have often tried to find/use lower cost alternatives - but that can be challenging. Now, with our Kaiser 24x7 urgent care facility - we are in a great situation. I also notice (never used one) many small "urgent care" places springing up.

With our previous Primary Care Physicians, there was no after hours care available - other than the hospital ER (went there once - false alarm, as it turned out)

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sat May 19, 2018 9:47 am

Under my wife's ACA Kaiser plan (before she became Medicare eligible), there was a very large financial difference between using the Hospital ER vs. Kaiser Urgent Care. Now, on our Kaiser Medicare plans, there is only a small difference. So, now, there is very little financial incentive to stay away from the Hospital ER for conditions that happen after hours or that need immediate attention.

We would almost always, though, go to the Kaiser Urgent care because we believe the care is superior and all records are online -- AND Physicians are there 24x7 - if a specialist is needed, they contact him/her and they come in if needed (happened to my wife). My (very limited, thankfully) experiences at Hospital ER have been annoying and less than pleasant. We have a friend who will always go to the Hospital ER - vs going a few more miles to Kaiser Urgent care. I just don't understand..

TX_Drew
Posts: 33
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Re: How to Minimize Your Emergency Care Expenses

Post by TX_Drew » Wed Jun 13, 2018 8:25 am

This is a somewhat timely thread and I'll share my recent experience thus far.

I went to ER a while back due to having food stuck in my esophagus; it wouldn't pass all the way down to stomach. I could breath fine, but it wouldn't go down. Anyway decided to go to ER close to neighborhood.

They didn't do much. Did an xray that didn't show anything. I believe I was given an IV muscle-relaxer. They had me sign a bunch of papers that I wasn't that interested in reading thoroughly. Later was transferred via ambulance (wouldn't release me for wife to drive) to another hospital who had more machines in case something invasive was needed. Sat there for a bit. They gave me a coke and the food passed. Problem solved for the night.

Fast forward to yesterday. Logged into BCBS site to check out how much I might be charged....can you guess how much? $20k...but discounted to $17k. BCBS is saying they're not covering it...not a "network provider". I really didn't even know there were networks for a PPO BCBS. I've never seen that before, and the ER never said anything. I'm also not sure if my annual insurance limit applies ($6k and already met) as its an out-of-network ER.

So they've not officially billed me yet, and I read up on the process associated with contesting charges. We will see where we end up. It won't be pretty and the whole idea of their charges makes me nauseous. Even if insurance covers most of it, they didn't do $17k of work while I sat there for an hour. :oops:

ResearchMed
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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Wed Jun 13, 2018 8:29 am

TX_Drew wrote:
Wed Jun 13, 2018 8:25 am
This is a somewhat timely thread and I'll share my recent experience thus far.

I went to ER a while back due to having food stuck in my esophagus; it wouldn't pass all the way down to stomach. I could breath fine, but it wouldn't go down. Anyway decided to go to ER close to neighborhood.

They didn't do much. Did an xray that didn't show anything. I believe I was given an IV muscle-relaxer. They had me sign a bunch of papers that I wasn't that interested in reading thoroughly. Later was transferred via ambulance (wouldn't release me for wife to drive) to another hospital who had more machines in case something invasive was needed. Sat there for a bit. They gave me a coke and the food passed. Problem solved for the night.

Fast forward to yesterday. Logged into BCBS site to check out how much I might be charged....can you guess how much? $20k...but discounted to $17k. BCBS is saying they're not covering it...not a "network provider". I really didn't even know there were networks for a PPO BCBS. I've never seen that before, and the ER never said anything. I'm also not sure if my annual insurance limit applies ($6k and already met) as its an out-of-network ER.

So they've not officially billed me yet, and I read up on the process associated with contesting charges. We will see where we end up. It won't be pretty and the whole idea of their charges makes me nauseous. Even if insurance covers most of it, they didn't do $17k of work while I sat there for an hour. :oops:
We've been reading up on this, and one thing to double check if they are going to play the "balance billing" game...
In some states this can't be done.
In other states, apparently they can bill you, but are *not* required to tell you that you are NOT obligated to pay the excessive "balance bill". Nice, eh?
So do check in case you are in one of those states, where they can balance bill, but you are not required to pay.

RM
This signature is a placebo. You are in the control group.

TX_Drew
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Re: How to Minimize Your Emergency Care Expenses

Post by TX_Drew » Wed Jun 13, 2018 8:42 am

ResearchMed wrote:
Wed Jun 13, 2018 8:29 am
TX_Drew wrote:
Wed Jun 13, 2018 8:25 am
This is a somewhat timely thread and I'll share my recent experience thus far.

I went to ER a while back due to having food stuck in my esophagus; it wouldn't pass all the way down to stomach. I could breath fine, but it wouldn't go down. Anyway decided to go to ER close to neighborhood.

They didn't do much. Did an xray that didn't show anything. I believe I was given an IV muscle-relaxer. They had me sign a bunch of papers that I wasn't that interested in reading thoroughly. Later was transferred via ambulance (wouldn't release me for wife to drive) to another hospital who had more machines in case something invasive was needed. Sat there for a bit. They gave me a coke and the food passed. Problem solved for the night.

Fast forward to yesterday. Logged into BCBS site to check out how much I might be charged....can you guess how much? $20k...but discounted to $17k. BCBS is saying they're not covering it...not a "network provider". I really didn't even know there were networks for a PPO BCBS. I've never seen that before, and the ER never said anything. I'm also not sure if my annual insurance limit applies ($6k and already met) as its an out-of-network ER.

So they've not officially billed me yet, and I read up on the process associated with contesting charges. We will see where we end up. It won't be pretty and the whole idea of their charges makes me nauseous. Even if insurance covers most of it, they didn't do $17k of work while I sat there for an hour. :oops:
We've been reading up on this, and one thing to double check if they are going to play the "balance billing" game...
In some states this can't be done.
In other states, apparently they can bill you, but are *not* required to tell you that you are NOT obligated to pay the excessive "balance bill". Nice, eh?
So do check in case you are in one of those states, where they can balance bill, but you are not required to pay.

RM
I'm in Texas....do I have to pay?

ResearchMed
Posts: 6879
Joined: Fri Dec 26, 2008 11:25 pm

Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Wed Jun 13, 2018 8:52 am

TX_Drew wrote:
Wed Jun 13, 2018 8:42 am
ResearchMed wrote:
Wed Jun 13, 2018 8:29 am
TX_Drew wrote:
Wed Jun 13, 2018 8:25 am
This is a somewhat timely thread and I'll share my recent experience thus far.

I went to ER a while back due to having food stuck in my esophagus; it wouldn't pass all the way down to stomach. I could breath fine, but it wouldn't go down. Anyway decided to go to ER close to neighborhood.

They didn't do much. Did an xray that didn't show anything. I believe I was given an IV muscle-relaxer. They had me sign a bunch of papers that I wasn't that interested in reading thoroughly. Later was transferred via ambulance (wouldn't release me for wife to drive) to another hospital who had more machines in case something invasive was needed. Sat there for a bit. They gave me a coke and the food passed. Problem solved for the night.

Fast forward to yesterday. Logged into BCBS site to check out how much I might be charged....can you guess how much? $20k...but discounted to $17k. BCBS is saying they're not covering it...not a "network provider". I really didn't even know there were networks for a PPO BCBS. I've never seen that before, and the ER never said anything. I'm also not sure if my annual insurance limit applies ($6k and already met) as its an out-of-network ER.

So they've not officially billed me yet, and I read up on the process associated with contesting charges. We will see where we end up. It won't be pretty and the whole idea of their charges makes me nauseous. Even if insurance covers most of it, they didn't do $17k of work while I sat there for an hour. :oops:
We've been reading up on this, and one thing to double check if they are going to play the "balance billing" game...
In some states this can't be done.
In other states, apparently they can bill you, but are *not* required to tell you that you are NOT obligated to pay the excessive "balance bill". Nice, eh?
So do check in case you are in one of those states, where they can balance bill, but you are not required to pay.

RM
I'm in Texas....do I have to pay?
Here is what I had been reading (we are not in Texas, so I focused on a different state):

http://www.commonwealthfund.org/publica ... ons-states

And here is a Google result for "Texas balance billing"

https://www.google.com/search?source=hp ... DmleV_MOzE

which leads to:

https://www.tdi.texas.gov/consumer/cpmb ... lling.html

I AM NOT AN ATTORNEY, etc.

It looks like perhaps they *can* balance bill in some places, but there may be state consumer help that, well, actually helps much of the time.
That's probably a lot better than some other places!

Good luck!

RM
This signature is a placebo. You are in the control group.

barefootjan
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Re: How to Minimize Your Emergency Care Expenses

Post by barefootjan » Wed Jun 13, 2018 8:58 am

FWIW, the University of Utah Health Radio has a series called "ER or Not" and they did an episode on "food stuck in throat."https://healthcare.utah.edu/the-scope/s ... 0_1u0qm8fd

I know for me, if I had food stuck in my throat but I was still breathing, I'd be extremely reluctant to go to the ER for that. Not just for financial reasons but because people in worse shape would (rightly) take precedence and who knows how long I'd have to wait in my slightly panicked condition. :wink:

TX Drew, Were you able to talk? Were you drooling (unable to swallow saliva)?

I can't help wondering what would've happened if you'd gone to your primary care provider or an urgent care facility instead. If the urgent care doctor did the muscle relaxer thing and the soda trick and it didn't work, would they have sent you to the ER? What equipment does the ER have to deal with that a medical center doesn't have???

Glad you're OK now.

Jan

Rupert
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Re: How to Minimize Your Emergency Care Expenses

Post by Rupert » Wed Jun 13, 2018 9:09 am

TX_Drew wrote:
Wed Jun 13, 2018 8:25 am
I really didn't even know there were networks for a PPO BCBS. I've never seen that before, and the ER never said anything. I'm also not sure if my annual insurance limit applies ($6k and already met) as its an out-of-network ER.
I never cease to be amazed by the number of people who do not read their health insurance contracts. I'm not picking on you, TX_Drew, lots of people are guilty of the same thing, and it accounts for lots of the surprise billing stories we hear. So I say again to all Bogleheads, a sophisticated group of folks in general: READ YOUR HEALTH INSURANCE CONTRACTS! I carry a copy of a summary of mine in my car glove box and in my brief case. When my family travels, I carry a copy in one of our bags. And all that mail you receive from your health insurance company that sometimes looks like junk mail? Read it too. It may be a letter informing you that such and such emergency room or hospital is now out-of-network or in a lower tier that carries a higher co-pay, etc.

ResearchMed
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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Wed Jun 13, 2018 9:21 am

delete temporarily!
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TX_Drew
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Re: How to Minimize Your Emergency Care Expenses

Post by TX_Drew » Wed Jun 13, 2018 9:26 am

barefootjan wrote:
Wed Jun 13, 2018 8:58 am
FWIW, the University of Utah Health Radio has a series called "ER or Not" and they did an episode on "food stuck in throat."https://healthcare.utah.edu/the-scope/s ... 0_1u0qm8fd

I know for me, if I had food stuck in my throat but I was still breathing, I'd be extremely reluctant to go to the ER for that. Not just for financial reasons but because people in worse shape would (rightly) take precedence and who knows how long I'd have to wait in my slightly panicked condition. :wink:

TX Drew, Were you able to talk? Were you drooling (unable to swallow saliva)?

I can't help wondering what would've happened if you'd gone to your primary care provider or an urgent care facility instead. If the urgent care doctor did the muscle relaxer thing and the soda trick and it didn't work, would they have sent you to the ER? What equipment does the ER have to deal with that a medical center doesn't have???

Glad you're OK now.

Jan
Without getting too graphic, not even saliva would go down....it would come back up. It was the evening so primary care facility was closed for night. And crazy coincidence was their was a bad fatality accident on the road blocking traffic to town. So this kept me from the usual urgent care facility. Didn't have a lot of choice at that time. I waited about 30 min before going, but wasn't going to go to sleep like that and choke all night long.

Regardless, just because I walk in the door, do they have the right to charge me $17k? Why not $170k? Clearly the bill has nothing to do with the actual treatment. I'm happy to pay something reasonable, but an examination, Xray, IV muscle relaxer, and 1-hr of observation doesn't cost $17k.

BTW, I'm pretty sure this doesn't include the ambulance ride they insisted on, which could be another stupid number north of $5k.

TX_Drew
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Re: How to Minimize Your Emergency Care Expenses

Post by TX_Drew » Wed Jun 13, 2018 9:32 am

Rupert wrote:
Wed Jun 13, 2018 9:09 am
TX_Drew wrote:
Wed Jun 13, 2018 8:25 am
I really didn't even know there were networks for a PPO BCBS. I've never seen that before, and the ER never said anything. I'm also not sure if my annual insurance limit applies ($6k and already met) as its an out-of-network ER.
I never cease to be amazed by the number of people who do not read their health insurance contracts. I'm not picking on you, TX_Drew, lots of people are guilty of the same thing, and it accounts for lots of the surprise billing stories we hear. So I say again to all Bogleheads, a sophisticated group of folks in general: READ YOUR HEALTH INSURANCE CONTRACTS! I carry a copy of a summary of mine in my car glove box and in my brief case. When my family travels, I carry a copy in one of our bags. And all that mail you receive from your health insurance company that sometimes looks like junk mail? Read it too. It may be a letter informing you that such and such emergency room or hospital is now out-of-network or in a lower tier that carries a higher co-pay, etc.
Yes, you're right; never read it. This will be an interesting life lesson.

I will say my family has probably gone to 30 different practices over the years on this same BCBS plan. I've never seen an out-of-network facility. So this is uncharted territory.

Rupert
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Re: How to Minimize Your Emergency Care Expenses

Post by Rupert » Wed Jun 13, 2018 9:33 am

TX_Drew wrote:
Wed Jun 13, 2018 9:26 am
barefootjan wrote:
Wed Jun 13, 2018 8:58 am
FWIW, the University of Utah Health Radio has a series called "ER or Not" and they did an episode on "food stuck in throat."https://healthcare.utah.edu/the-scope/s ... 0_1u0qm8fd

I know for me, if I had food stuck in my throat but I was still breathing, I'd be extremely reluctant to go to the ER for that. Not just for financial reasons but because people in worse shape would (rightly) take precedence and who knows how long I'd have to wait in my slightly panicked condition. :wink:

TX Drew, Were you able to talk? Were you drooling (unable to swallow saliva)?

I can't help wondering what would've happened if you'd gone to your primary care provider or an urgent care facility instead. If the urgent care doctor did the muscle relaxer thing and the soda trick and it didn't work, would they have sent you to the ER? What equipment does the ER have to deal with that a medical center doesn't have???

Glad you're OK now.

Jan
Regardless, just because I walk in the door, do they have the right to charge me $17k? Why not $170k? Clearly the bill has nothing to do with the actual treatment. I'm happy to pay something reasonable, but an examination, Xray, IV muscle relaxer, and 1-hr of observation doesn't cost $17k.
You don't just pay for the treatment you receive when you go to the ER. You also pay them for making the ER facility available to you 24 hours a day. You pay for all those nurses and doctors and expensive equipment that is there, on call, should you need it. That's why the ER is so expensive.

Re insurance contracts: You get issued a new one every single year because your employer renews the contract every single year. So you cannot rely on past experience.

TX_Drew
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Re: How to Minimize Your Emergency Care Expenses

Post by TX_Drew » Wed Jun 13, 2018 9:38 am

TX_Drew wrote:
Wed Jun 13, 2018 9:26 am
barefootjan wrote:
Wed Jun 13, 2018 8:58 am
FWIW, the University of Utah Health Radio has a series called "ER or Not" and they did an episode on "food stuck in throat."https://healthcare.utah.edu/the-scope/s ... 0_1u0qm8fd

I know for me, if I had food stuck in my throat but I was still breathing, I'd be extremely reluctant to go to the ER for that. Not just for financial reasons but because people in worse shape would (rightly) take precedence and who knows how long I'd have to wait in my slightly panicked condition. :wink:

TX Drew, Were you able to talk? Were you drooling (unable to swallow saliva)?

I can't help wondering what would've happened if you'd gone to your primary care provider or an urgent care facility instead. If the urgent care doctor did the muscle relaxer thing and the soda trick and it didn't work, would they have sent you to the ER? What equipment does the ER have to deal with that a medical center doesn't have???

Glad you're OK now.

Jan
Without getting too graphic, not even saliva would go down....it would come back up. It was the evening so primary care facility was closed for night. And crazy coincidence was their was a bad fatality accident on the road blocking traffic to town. So this kept me from the usual urgent care facility. Didn't have a lot of choice at that time. I waited about 30 min before going, but wasn't going to go to sleep like that and choke all night long.

Regardless, just because I walk in the door, do they have the right to charge me $17k? Why not $170k? Clearly the bill has nothing to do with the actual treatment. I'm happy to pay something reasonable, but an examination, Xray, IV muscle relaxer, and 1-hr of observation doesn't cost $17k.

BTW, I'm pretty sure this doesn't include the ambulance ride they insisted on, which could be another stupid number north of $5k.
BTW, one more point I'll add...now I have a GI doctor to look at my esophagus. Going in today to get a scope and potentially expand a narrow point by stomach. Anyway, estimated costs for whole procedure, including sedation, is sub $1k...I don't think I'll be out of pocket any of it due to annual limit...just to put in perspective how nuts ER financial people are. Straight predators...maybe I should invest in some shares as they're clearly taking all peoples money.

ResearchMed
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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Wed Jun 13, 2018 9:42 am

Rupert wrote:
Wed Jun 13, 2018 9:09 am
TX_Drew wrote:
Wed Jun 13, 2018 8:25 am
I really didn't even know there were networks for a PPO BCBS. I've never seen that before, and the ER never said anything. I'm also not sure if my annual insurance limit applies ($6k and already met) as its an out-of-network ER.
I never cease to be amazed by the number of people who do not read their health insurance contracts. I'm not picking on you, TX_Drew, lots of people are guilty of the same thing, and it accounts for lots of the surprise billing stories we hear. So I say again to all Bogleheads, a sophisticated group of folks in general: READ YOUR HEALTH INSURANCE CONTRACTS! I carry a copy of a summary of mine in my car glove box and in my brief case. When my family travels, I carry a copy in one of our bags.
I'm still not quite sure what that chart means for our state.

However, IF THERE IS A MEDICAL EMERGENCY, we are going to the nearest ER, and fast.
And almost definitely calling 911 to be taken there, so there is someone other than a panicked driver to attend to the "patient", and someone with training... unless we happen to be someplace really close, like across the street from the ER itself and we can still actually walk.

We are not qualified to know if something that seems to be or might be life threatening actually is.
There have been times when it absolutely "was or could be", and we went to the ER.
There were other times that we just called our PCP and either went right there, or had a later appointment, or the PCP directed us to go straight to the ER.
There have also been times when pain was unbearable, even though it wasn't life-threatening. Those episodes also ended at the ER.

We'll deal with bills (paying, fighting, having insurer pay, not pay, etc.) later, and we'll do our best not to get ripped off (per some outrageous "billing" that has been discussed here).
We'll try to "fight it" if that seems to have promise, IF in fact we do have such an episode.

We are "above average" consumers of medical care/insurance (much below average for auto insurance, etc.), and we've never encountered balance billing... yet. Hope it stays that way.

We've each have had more than one truly life-threatening episode, and having gone through those, we are not going to risk guessing wrong if there is *any* question in our mind(s).
(And we felt the same way, "back in the day", when we had *much* less money, so this isn't only a current "we are now very comfortable financially, so why not..."?)

When we look over the bills, some surprise us, sure.
But we have never had jaws drop upon seeing some astronomical and seemingly outrageous amount.
Nothing even close to some of the seemingly egregious multi-digit "balance billing" that has been discussed here and in the media.

RM
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rantk81
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Re: How to Minimize Your Emergency Care Expenses

Post by rantk81 » Wed Jun 13, 2018 9:44 am

Just a note to add --

Each health insurance company (BCBS, Aetna, Cigna, UnitedHealth, etc.) has hundreds, if not thousands, of different "plans." In addition to having different deductibles, copays, etc, each of these "plans" can have a different set of in-network doctors too. It is entirely possible that the ER you went to is in-network for a whole bunch of BCBS plans, and OUT-of-network for a whole bunch of other BCBS plans. You CANNOT just ask a provider "Do you accept BCBS insurance?" and take their answer at face value. Sure, they make take some of the BCBS plans, and perhaps (most probably) not all of them.

Every single year when I do my annual-enrollment for my employer sponsored health insurance, I am very careful to find out which facilities and doctors are in my network. This list has changed drastically over the years -- and I happen to be on a plan now with an extremely narrow network of doctors. I carry around a print-out of what my in-network providers are, folded up and in my wallet, at all times.

ResearchMed
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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Wed Jun 13, 2018 9:48 am

rantk81 wrote:
Wed Jun 13, 2018 9:44 am
Just a note to add --

Each health insurance company (BCBS, Aetna, Cigna, UnitedHealth, etc.) has hundreds, if not thousands, of different "plans." In addition to having different deductibles, copays, etc, each of these "plans" can have a different set of in-network doctors too. It is entirely possible that the ER you went to is in-network for a whole bunch of BCBS plans, and OUT-of-network for a whole bunch of other BCBS plans. You CANNOT just ask a provider "Do you accept BCBS insurance?" and take their answer at face value. Sure, they make take some of the BCBS plans, and perhaps (most probably) not all of them.

Every single year when I do my annual-enrollment for my employer sponsored health insurance, I am very careful to find out which facilities and doctors are in my network. This list has changed drastically over the years -- and I happen to be on a plan now with an extremely narrow network of doctors. I carry around a print-out of what my in-network providers are, folded up and in my wallet, at all times.
The *real* problem seems to be when a patient is in no condition to "check if the provider who suddenly shows up" is in network or not.
Think... ER, but especially that anaesthesiologist or second surgeon, called in while one is unconscious...!
THAT should not be allowable as astronomical balance billing.

RM
This signature is a placebo. You are in the control group.

rantk81
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Re: How to Minimize Your Emergency Care Expenses

Post by rantk81 » Wed Jun 13, 2018 9:51 am

ResearchMed wrote:
Wed Jun 13, 2018 9:48 am
The *real* problem seems to be when a patient is in no condition to "check if the provider who suddenly shows up" is in network or not.
Think... ER, but especially that anaesthesiologist or second surgeon, called in while one is unconscious...!
THAT should not be allowable as astronomical balance billing.

RM
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. (I know I know..... you'll be fighting the insurance company for months, if not years, in the actual event that this happens... but that's the law.)

ResearchMed
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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Wed Jun 13, 2018 9:55 am

rantk81 wrote:
Wed Jun 13, 2018 9:51 am
ResearchMed wrote:
Wed Jun 13, 2018 9:48 am
The *real* problem seems to be when a patient is in no condition to "check if the provider who suddenly shows up" is in network or not.
Think... ER, but especially that anaesthesiologist or second surgeon, called in while one is unconscious...!
THAT should not be allowable as astronomical balance billing.

RM
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. (I know I know..... you'll be fighting the insurance company for months, if not years, in the actual event that this happens... but that's the law.)
Okay, that seems appropriate.

But is the PROVIDER obligated to accept that in-network payment?

And should this "work" for TX_Drew, for example, regardless of state?

But what about those "strangers in the OR..."?
Is that no longer a problem, either, with current ACA?

RM
This signature is a placebo. You are in the control group.

rantk81
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Re: How to Minimize Your Emergency Care Expenses

Post by rantk81 » Wed Jun 13, 2018 10:01 am

ResearchMed wrote:
Wed Jun 13, 2018 9:55 am
Okay, that seems appropriate.

But is the PROVIDER obligated to accept that in-network payment?

And should this "work" for TX_Drew, for example, regardless of state?

But what about those "strangers in the OR..."?
Is that no longer a problem, either, with current ACA?

RM
In my situation, my insurance company is supposed to pay "involuntary out of network services" as in-network... For example, if I go in for a procedure at an other-wise in-network facility, and some out-of-network provider does something to me while I am unconscience.

I don't know if this protection is specific to my particular plan, or if there is a state law, or if that is part of the ACA or some other federal law, though.

As far as TX_Drew's case -- I think it might largely depend on how successful they can make an argument that it was an "emergency" situation...
Last edited by rantk81 on Wed Jun 13, 2018 10:03 am, edited 1 time in total.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Jun 13, 2018 10:02 am

You don't just pay for the treatment you receive when you go to the ER. You also pay them for making the ER facility available to you 24 hours a day. You pay for all those nurses and doctors and expensive equipment that is there, on call, should you need it. That's why the ER is so expensive.
Very true! BUT - on the rare occasions when I have used an ER (only twice in my life :) ] - it was not like the folks were twiddling their thumbs - there were long waits and lots of scurrying around.

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Wed Jun 13, 2018 10:04 am

It seems to me that the majority of folks who are users or potential users of ERs could use an "education" on how to best determine what is and is not an actual "Emergency" vs "urgent" vs :just see your doctor next week".

Our Kaiser plan has a nurse phone advice hotline that can help - and has helped us on multiple occasions.

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Re: How to Minimize Your Emergency Care Expenses

Post by ResearchMed » Wed Jun 13, 2018 10:13 am

rantk81 wrote:
Wed Jun 13, 2018 10:01 am
ResearchMed wrote:
Wed Jun 13, 2018 9:55 am
Okay, that seems appropriate.

But is the PROVIDER obligated to accept that in-network payment?

And should this "work" for TX_Drew, for example, regardless of state?

But what about those "strangers in the OR..."?
Is that no longer a problem, either, with current ACA?

RM
In my situation, my insurance company is supposed to pay "involuntary out of network services" as in-network... For example, if I go in for a procedure at an other-wise in-network facility, and some out-of-network provider does something to me while I am unconscience.

I don't know if this protection is specific to my particular plan, or if there is a state law, or if that is part of the ACA or some other federal law, though.
Isn't part of the problem (or perhaps only "it used to be"?) that the PROVIDER who is out of network is not obligated to accept only the insurance payment... and can bill "almost any "whatever they like" fees?
Is the insurer really required to pay "any amount that is billed, not matter how many digits"?

IF ACA already covered this, then there shouldn't be many current problems like we've read about.

We have excellent insurance (great Employer, great perks, and we are grandfathered into good retiree benefits on top of Medicare).
But... those that mean our insurer (Employer self-insures, but doesn't handle the paperwork) MUST pay whatever some floating (not meant to be a technical term) physician "decides" to charge?
Isn't that what we've read about most, in the media, e.g., where an out of network second surgeon charged 6 digits or such?
Who requires that person to accept whatever the insurer would regularly pay?
OR... were the media stories not quite, er, accurate?
There *did* seem to be some "fall between the cracks" horror stories.

RM
This signature is a placebo. You are in the control group.

barefootjan
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Re: How to Minimize Your Emergency Care Expenses

Post by barefootjan » Wed Jun 13, 2018 10:15 am

barefootjan wrote: ↑
Wed Jun 13, 2018 9:58 am
FWIW, the University of Utah Health Radio has a series called "ER or Not" and they did an episode on "food stuck in throat."https://healthcare.utah.edu/the-scope/s ... 0_1u0qm8fd

I know for me, if I had food stuck in my throat but I was still breathing, I'd be extremely reluctant to go to the ER for that. Not just for financial reasons but because people in worse shape would (rightly) take precedence and who knows how long I'd have to wait in my slightly panicked condition. :wink:

TX Drew, Were you able to talk? Were you drooling (unable to swallow saliva)?

I can't help wondering what would've happened if you'd gone to your primary care provider or an urgent care facility instead. If the urgent care doctor did the muscle relaxer thing and the soda trick and it didn't work, would they have sent you to the ER? What equipment does the ER have to deal with that a medical center doesn't have???

Glad you're OK now.

Jan

Without getting too graphic, not even saliva would go down....it would come back up. It was the evening so primary care facility was closed for night. And crazy coincidence was their was a bad fatality accident on the road blocking traffic to town. So this kept me from the usual urgent care facility. Didn't have a lot of choice at that time. I waited about 30 min before going, but wasn't going to go to sleep like that and choke all night long.

Regardless, just because I walk in the door, do they have the right to charge me $17k? Why not $170k? Clearly the bill has nothing to do with the actual treatment. I'm happy to pay something reasonable, but an examination, Xray, IV muscle relaxer, and 1-hr of observation doesn't cost $17k.

BTW, I'm pretty sure this doesn't include the ambulance ride they insisted on, which could be another stupid number north of $5k.

Uh, yeah....that would've made me more than "slightly" panicked. Again, I'm really glad you're OK.

As for all this talk about reading the insurance policy and notices, let me tell you my experience: you can *think* you understand what you read, and find out that what they said and how the average person would interpret it are two different things!

Likewise, obtaining a list of in-network providers ahead of time doesn't do you much good. You can THINK that you're going to be covered, but you absolutely cannot KNOW. Even the policy will tell you in so many places and in so many words, that there are NO guarantees. I was told on the phone, the reason for that is that who's in-network can change AT ANY TIME, because they are always in negotiation with providers.

You also have to be careful that the provider you ask them about is in fact the provider you want to see. Case in point: a local imaging center advertises as if they are merely one department of many at a local clinic and there is nothing on the webpage to indicate otherwise. When I gave my insurance company the clinic name they said it was in-network, but when I asked about the imaging center specifically, it wasn't listed. Well, the various departments of another clinic I go to aren't listed separately either, but so far they've all been in network, even the ones at different locations. So I could've just left it that, but I decided to push it.

Turns out the ONLY way I could find out for sure if the imaging center was in or out of network was to get their tax ID number - which I did. The result: "As of this time, they are NOT in-network" with my insurance company. If I hadn't pushed it, I'd be stuck with a big bill right now. Not as big as Tex's, mind you, but not insignificant either.

So sure, read the fine print and all, make some calls, do your research - but realize that you can't 100% prevent nasty surprises. You can only minimize them.

Tex_Drew I hope it works out for you! I really think you have a good shot at getting assistance with your case. I've fought with insurance companies before and it's paid off, sometimes it doesn't take much effort, surprisingly, but sometimes you have to be real persistent. So good luck, and give it your best shot!

Rupert
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Re: How to Minimize Your Emergency Care Expenses

Post by Rupert » Wed Jun 13, 2018 10:32 am

barefootjan wrote:
Wed Jun 13, 2018 10:15 am

Likewise, obtaining a list of in-network providers ahead of time doesn't do you much good. You can THINK that you're going to be covered, but you absolutely cannot KNOW. Even the policy will tell you in so many places and in so many words, that there are NO guarantees. I was told on the phone, the reason for that is that who's in-network can change AT ANY TIME, because they are always in negotiation with providers.
This is unfortunately true. You cannot 100% control, or even predict, costs under our present system, especially in an emergent situation. However, in other situations, when you do have time to do research, you can place yourself in a better negotiation position with providers and with your insurance company by confirming, as best you can, which providers are in network in advance. Call your provider and your insurance company. Write down the names of every person you speak to who tells you a certain provider is in network. Name names when a problem arises. Many people --- many many people -- don't make any effort at all to nail this stuff down. Many people don't even read their insurance contracts or know that their insurance plan has networks. This is inexcusable negligence in the present healthcare environment in our country. You're spending how many thousands of dollars a year on health insurance and don't make any attempt to know what it covers? Really? (I'm speaking rhetorically here, barefootjan, not to you). If you know more about how the infotainment system in your Subaru works than how your health insurance works, well, a lot of your problems are going to be self-inflicted.

Some folks keep insisting that a market-based healthcare system is better than a single payer one. Well, do you know the rule re consumers in market-based systems? It's "buyer beware." Most people don't understand the terms of their mortgage contracts or their installment contracts either, but the law still holds them to those terms.
Last edited by Rupert on Wed Jun 13, 2018 10:39 am, edited 2 times in total.

rantk81
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Re: How to Minimize Your Emergency Care Expenses

Post by rantk81 » Wed Jun 13, 2018 10:37 am

ResearchMed wrote:
Wed Jun 13, 2018 10:13 am
Isn't part of the problem (or perhaps only "it used to be"?) that the PROVIDER who is out of network is not obligated to accept only the insurance payment... and can bill "almost any "whatever they like" fees?
Is the insurer really required to pay "any amount that is billed, not matter how many digits"?
Yes, that particular case is a big problem in a lot of states. Only a handful of states have passed legislation that protects consumers against this. (Fortunately for me, my state is one of those.)

rantk81
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Re: How to Minimize Your Emergency Care Expenses

Post by rantk81 » Wed Jun 13, 2018 10:51 am

barefootjan wrote:
Wed Jun 13, 2018 10:15 am
Likewise, obtaining a list of in-network providers ahead of time doesn't do you much good. You can THINK that you're going to be covered, but you absolutely cannot KNOW. Even the policy will tell you in so many places and in so many words, that there are NO guarantees. I was told on the phone, the reason for that is that who's in-network can change AT ANY TIME, because they are always in negotiation with providers.
Yes, this is true. Networks can change at the whim of the insurance company or the providers.

Again, in my case, I'm on a very narrow network of doctors, that basically only includes the facilities associated with one of the medical universities in my city. Literally nothing else is in-network. I guess the "blessing?" of this is, if I go to their facility, everything damn well better be in-network for me, because there is literally no other choice... and if push came to shove, I'm fairly confidence I would win any network-related-battles with my insurance company, due to there being no other choice, and me being explicitly told that "this medical university is your network."

barefootjan
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Re: How to Minimize Your Emergency Care Expenses

Post by barefootjan » Wed Jun 13, 2018 10:57 am

Rupert wrote:
Wed Jun 13, 2018 10:32 am
barefootjan wrote:
Wed Jun 13, 2018 10:15 am

Likewise, obtaining a list of in-network providers ahead of time doesn't do you much good. You can THINK that you're going to be covered, but you absolutely cannot KNOW. Even the policy will tell you in so many places and in so many words, that there are NO guarantees. I was told on the phone, the reason for that is that who's in-network can change AT ANY TIME, because they are always in negotiation with providers.
This is unfortunately true. You cannot 100% control, or even predict, costs under our present system, especially in an emergent situation. However, in other situations, when you do have time to do research, you can place yourself in a better negotiation position with providers and with your insurance company by confirming, as best you can, which providers are in network in advance. Call your provider and your insurance company. Write down the names of every person you speak to who tells you a certain provider is in network. Name names when a problem arises. Many people --- many many people -- don't make any effort at all to nail this stuff down. Many people don't even read their insurance contracts or know that their insurance plan has networks. This is inexcusable negligence in the present healthcare environment in our country. You're spending how many thousands of dollars a year on health insurance and don't make any attempt to know what it covers? Really? (I'm speaking rhetorically here, barefootjan, not to you). If you know more about how the infotainment system in your Subaru works than how your health insurance works, well, a lot of your problems are going to be self-inflicted.
Oh I agree 100% with getting names! Also the date & time of your calls - collect as much info as you can. You'd be surprised how much their attitude and tone of voice changes when a customer service rep knows you're paying attention and making notes. It's like they go from being a drone to sitting up & paying attention!

If the situation warrants it, I put their call(s) - which are recorded on their end anyway - on speaker phone. That way I can have my own witness to the conversation. Every little bit helps.

Also, I press them to be very clear and unambiguous in their answers. I might say something like, "let me make sure I understand what you just said: You're saying my insurance does cover x&y but not z, is that correct?" and if I get what sounds like a yes, I'll follow up with: ""So if x gets denied I should appeal it, right?"

At some point they're probably gonna tell you you need the CPT code. Good luck with that. I have so many stories about those damn things it's not even funny.

Jan

barefootjan
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Re: How to Minimize Your Emergency Care Expenses

Post by barefootjan » Wed Jun 13, 2018 11:07 am

rantk81 wrote:
Wed Jun 13, 2018 10:51 am
barefootjan wrote:
Wed Jun 13, 2018 10:15 am
Likewise, obtaining a list of in-network providers ahead of time doesn't do you much good. You can THINK that you're going to be covered, but you absolutely cannot KNOW. Even the policy will tell you in so many places and in so many words, that there are NO guarantees. I was told on the phone, the reason for that is that who's in-network can change AT ANY TIME, because they are always in negotiation with providers.
Yes, this is true. Networks can change at the whim of the insurance company or the providers.

Again, in my case, I'm on a very narrow network of doctors, that basically only includes the facilities associated with one of the medical universities in my city. Literally nothing else is in-network. I guess the "blessing?" of this is, if I go to their facility, everything damn well better be in-network for me, because there is literally no other choice... and if push came to shove, I'm fairly confidence I would win any network-related-battles with my insurance company, due to there being no other choice, and me being explicitly told that "this medical university is your network."
Sorry to hear it. My last insurance policy was only accepted by doctors nobody in the right mind would want to go to. The in-network hospital was decent, though, so I felt like, 'at least I have a shot of surviving an emergency.' :wink:

rantk81
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Re: How to Minimize Your Emergency Care Expenses

Post by rantk81 » Wed Jun 13, 2018 11:20 am

barefootjan wrote:
Wed Jun 13, 2018 11:07 am
Sorry to hear it. My last insurance policy was only accepted by doctors nobody in the right mind would want to go to. The in-network hospital was decent, though, so I felt like, 'at least I have a shot of surviving an emergency.' :wink:
Yeah, when my employer "pushed" these plans on the employees last fall as part of the "annual enrollment", I was originally enraged at the limiting of my choices. Previously, I had been on a plan with a very broad, nation-wide network. Since then, I've calmed down a little bit. Although my plan is a very narrow network of doctors, the network is one of the top tier medical universities in the whole country. I'm also very satisfied with my new primary care doctor this year. Still a bummer that there are zero in-network providers outside of my home city. Last year, I went as far as telling my boss, and boss's 3 levels up that I would not be available for any company related travel in calendar year 2018 due to the fact that the company medical plan did not have any in-network providers outside of my home city. :P With the amount of backlash and attrition my employer has experienced (almost as a direct result of this medical plan), I can't fathom them offering the same kind of thing next year. I guess we'll see...

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willthrill81
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Re: How to Minimize Your Emergency Care Expenses

Post by willthrill81 » Sun Jul 22, 2018 6:45 pm

dm200 wrote:
Mon May 14, 2018 12:34 pm
The other risk (happened to a friend of mine) is that the colonoscopy might have punctured something (like a blood vessel) and it might not be noticed right away. Without immediate emergency surgery, you could die.
The same goes for a strangulated hernia. I had one when I was eight, and it was some of the worst pain I've ever experienced. They had me under the knife within a couple of hours from the onset of symptoms. With having both parents work in the medical field, they pretty much knew what it was immediately.

That being said, I think that poor education in the general populace as to what actually constitutes a medical emergency. But Google may be your friend in this area.
“It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to.” J.R.R. Tolkien,The Lord of the Rings

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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sun Jul 22, 2018 6:57 pm

My wife and I both usually do not rush to emergency rooms - almost never thinking a pain or twinge is serious. Two years ago, on a Saturday afternoon/evening - she had abdominal pain. It finally got so bad at 3 am Sunday that I took her to Urgent care. It was pancreatitis - potentially a life threatening condition if not dealt with.

It can sometimes be difficult, even for well informed patients, to know precisely how serious a condition may be. Glad we went in when we did..

mouses
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Re: How to Minimize Your Emergency Care Expenses

Post by mouses » Mon Jul 23, 2018 10:58 pm

VictoriaF wrote:
Thu May 10, 2018 10:49 am
dknightd wrote:
Sat May 05, 2018 5:20 pm
VictoriaF wrote:
Thu Mar 01, 2018 9:41 pm

My hospital would not discharge me after a colonoscopy unless there is someone to pick me up. They would not agree for me taking a taxi. Is there a way for me to assert that it's a hospital, not a prison?

Victoria
I consider a colonoscopy an elective procedure. Not an emergency
Yes, of course.

My cited comment was not about the nature of colonoscopy but about the limits of patients' control over our own healthcare. I wrote that in response to White Coat Investor's statement about patients' power that we give up. I was not arguing with WCI--I agree with his general premise and I value his contributions--I was giving an example of how in many circumstances patients' power is curtailed.

Victoria
That must have someone to accompany you thing makes it difficult for people with no family. However, as annoying as it is in terms of a colonoscopy, you put not only yourself but others at risk due to the lingering effects of Versed. etc. I don't want someone with no long term memory out there driving or depending on a taxi driver who may be a criminal.

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