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Better be an Emergency If You Go to the ER

Paratus

Lifer
Jun 4, 2004
14,720
8,022
146

Health care insurer United Healthcare plans to retroactively deny coverage if you go to the ER and they decide your condition wasn’t serious enough to warrant going to the ER.

Wake up with a pain in your lower abdomen, is it gas or a soon to rupture appendix? Is that chest pain an anxiety attack or a heart attack?

Better guess right because after you go to the ER and they diagnose you UH will know whether it was an emergency or not.

While profits were up last year ($15.4B in 2020 vs $13.8B in 2019) they were down in the last quarter as people were using services again. So these cost controls are very important for improving outcomes….Of shareholders.
 
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Jaskalas

Lifer
Jun 23, 2004
30,054
3,600
126
These shareholders deserve the wrath of the American people. As they look for creative ways to bankrupt and or deny healthcare. We will never know the untold millions of Americans who avoid seeking medical help due to the obscene costs and denials baked into our "system".

Putting these insurers out of business would be a pleasure.
 

K1052

Lifer
Aug 21, 2003
36,586
10,557
136
Cynical strategy to scare people off from going to the ER even though the policy is likely never to be implemented.

Arguments for retaining much of this setup grow thinner by the year.
 
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Paratus

Lifer
Jun 4, 2004
14,720
8,022
146
Cynical strategy to scare people off from going to the ER even though the policy is likely never to be implemented.

Arguments for retaining much of this setup grow thinner by the year.
It could very well be. Every person who questions their need to go to the ER and doesn't go helps their bottom line whether the policy was in place or not.

(How much you want to bet that regardless of the policy being implemented the UH automated phone systems will tell you to hang up and and go to the ER if it's a medical emergency)
 

Meghan54

Diamond Member
Oct 18, 2009
9,993
2,942
136
Interestingly, UH's Medicare policy holders are not going to be subject that (denying appropriateness of an ER visit and denying coverage) at all.

This, the denial of coverage for an ER visit, will only apply to their "commercial" ins. holders...basically everyone else who has health ins. coverage from UH.
 

interchange

Diamond Member
Oct 10, 1999
7,483
2,158
136
As the hospital not getting paid for someone's ER visit is going to cause a lot of ruckus for them, I suspect the most likely outcome of this is that providers will be pushed to document in such a way that it makes them sound legitimately concerned about the possible presence of a medical emergency (I hope more by way of emphasis than outright lie) thereby degrading the accurate interpretation of medical records, creating extra administrative bloat, and putting further distance between the physician and the patient in a way that in no way benefits their direct patient care. There's already way too much of that.

Separately, a lot of people do utilize the ED for what clearly are non-emergencies. Federal law (EMTALA) requires that an ED must do whatever examination is necessary to determine they don't have an emergency medical condition no matter what the patient's complaint is or apparent physical condition. In a way, this is how many uninsured and undocumented people will get (bad) medical care, but it means that the ED has no power to triage out an insured patient they knowingly wouldn't get reimbursed for. This conflict will inevitably cause waste. For any system, having 2 entities whose motivations directly conflict with each other will always cause inefficiency. But for the insurance company, if they can find ways to make the taxpayer foot the bill for that waste, well, I'll let you guess how that generally goes.
 

ondma

Platinum Member
Mar 18, 2018
2,160
813
106
Modern day US health care for you. Hospitals ripping off insurers, insurers ripping off customers, FDA approving snake oils, while the government is too captured or broken to fix anything.
Yea, but we cant have national health care because supposedly people dont want to give up their private insurance.
 

interchange

Diamond Member
Oct 10, 1999
7,483
2,158
136
Yea, but we cant have national health care because supposedly people dont want to give up their private insurance.
For what it's worth, my opinion is that a private insurance model isn't inherently bad. It's just that it isn't an accurate description of US healthcare. Here, we have a mix of national healthcare (national health insurance model -- Medicare & Medicaid, national health service -- VA), private insurance, and self-pay all intertwined with EMTALA.

Because EMTALA mandates that EDs evaluate everyone regardless of inability to pay or the problem that brings them to the ED, I prefer the view that we already have universal healthcare in the US. It's just that we have the absolutely crappiest version of it possible. I think if you can get people to see it that way, they'd be more interested in other models which are more efficient. Either that, or do away with EMTALA's mandate. But I think that would not go over well in reality.
 

MtnMan

Diamond Member
Jul 27, 2004
5,946
4,179
136
So is this severe indigestion, or am I having a heart attack? What does Dr. Google say? Should I contact a psychic, or perhaps a palm reader?

We are a third world country, or at least our health care system is.
 

Amol S.

Senior member
Mar 14, 2015
944
143
106
I wonder what business insurance issues United Healthcare face against its business insurer.
 
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ponyo

Lifer
Feb 14, 2002
18,950
2,283
126
So is this severe indigestion, or am I having a heart attack? What does Dr. Google say? Should I contact a psychic, or perhaps a palm reader?

We are a third world country, or at least our health care system is.
Our health care system is damn good if you’re rich and can afford care, old and covered under Medicare, or poor and covered under Medicaid. We’re nothing like third world country. Travel to third world country and experience their health care. No amount of money will provide you with great health care in third world country.
 

Fenixgoon

Lifer
Jun 30, 2003
28,139
3,470
126
Our health care system is damn good if you’re rich and can afford care, old and covered under Medicare, or poor and covered under Medicaid. We’re nothing like third world country. Travel to third world country and experience their health care. No amount of money will provide you with great health care in third world country.
Implied in your response is "And for everyone else not falling into those categories, you can all fuck right off and die."

Or we can just admit that our healthcare system is wildly inefficient and could be overhauled to dramatically reduce costs AND improve outcomes.
 

killster1

Diamond Member
Mar 15, 2007
5,880
372
126
Implied in your response is "And for everyone else not falling into those categories, you can all fuck right off and die."

Or we can just admit that our healthcare system is wildly inefficient and could be overhauled to dramatically reduce costs AND improve outcomes.
everyone else just pays more. you usually get what you pay for in life right? go figure that your over priced insurance shouldn't pay for the hypochondriacs frequent visits to the ER thus raising the bill even more for insurance.
 

Fenixgoon

Lifer
Jun 30, 2003
28,139
3,470
126
everyone else just pays more. you usually get what you pay for in life right? go figure that your over priced insurance shouldn't pay for the hypochondriacs frequent visits to the ER thus raising the bill even more for insurance.
you get what you pay for works well where there is competition and price-elasticity. critical medical care and supplies are price inelastic. do you have diabetes? you need insulin or you will die. do you have a life-threatening allergy? you need an epipen, or you will die. thus, the prices can be raised and the demand will not fall off (or not fall off much) because these things are needed to live in the first place.

imagine a world where people don't go to the emergency room in the first place because they no longer have to worry about the cost of a proactive doctor's visit, and can actually get the medical care they need before it becomes an emergency /twilight zone.
 

interchange

Diamond Member
Oct 10, 1999
7,483
2,158
136
Implied in your response is "And for everyone else not falling into those categories, you can all fuck right off and die."

Or we can just admit that our healthcare system is wildly inefficient and could be overhauled to dramatically reduce costs AND improve outcomes.
Well, part of me recognizes that those inefficiencies go somewhere. There are a lot of jobs that would get eliminated if we went to a purely public model. My beefs are not necessarily with the overall cost of healthcare but with 1. how the system worsens the quality of care for the patient and 2. how the burden of those costs end up distributed. Here, there is a systemic advantage to bigger and more corporate healthcare entities, and because (except for the VA), no matter who provides your coverage there are costs of utilizing healthcare for the patient. For one, that disincentivizes a lot of folks from seeking care, and for another it becomes extremely costly to the point of bankruptcy for many even well insured folks when significant care is needed.
 

ondma

Platinum Member
Mar 18, 2018
2,160
813
106
Our health care system is damn good if you’re rich and can afford care, old and covered under Medicare, or poor and covered under Medicaid. We’re nothing like third world country. Travel to third world country and experience their health care. No amount of money will provide you with great health care in third world country.
Even medicare still costs a considerable amount of money, especially for seniors on a fixed income. It is also complicated and cumbersome system that consists of several parts, and that requires a supplement (good luck trying to figure out the best one of these) for full coverage. You also have to worry about a Republican president like Trump coming back into power with control of both houses of congress and gutting the system.
 

ponyo

Lifer
Feb 14, 2002
18,950
2,283
126
Implied in your response is "And for everyone else not falling into those categories, you can all fuck right off and die."

Or we can just admit that our healthcare system is wildly inefficient and could be overhauled to dramatically reduce costs AND improve outcomes.
I 100% think our healthcare system needs major overhaul and we need universal healthcare like all other first world countries. We need single payer system and not let for profit insurance companies run the healthcare in our country.

I fall into not being rich enough to afford great health insurance and but not poor enough to receive Medicaid. So my family was in "you can all fuck right off and die" category. My family went many years without having health coverage. I weighed pros and cons of going without coverage and prayed we wouldn't have any major medical emergencies. Have you gone for years without medical coverage because it was too expensive? I bet you haven't. I have and it sucks major donkey dick. Do you know how I received checkups and medical care? I traveled outside the US and received checkups and healthcare during vacations because the cost in the US was too expensive without medical insurance. I know many people who do this. You can preach from your high horse but I'm betting you haven't experienced high cost premiums of our health care and never had to make life choices based on it.

Even today, I pay $1,050 a month for the shittiest bronze health plan for my family of 3. We're still relatively young so that's actually pretty low premium compared to other older families. I pretty much have this shitty health plan only as catastrophic insurance. So how much do you pay for your health insurance?
 
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killster1

Diamond Member
Mar 15, 2007
5,880
372
126
you get what you pay for works well where there is competition and price-elasticity. critical medical care and supplies are price inelastic. do you have diabetes? you need insulin or you will die. do you have a life-threatening allergy? you need an epipen, or you will die. thus, the prices can be raised and the demand will not fall off (or not fall off much) because these things are needed to live in the first place.

imagine a world where people don't go to the emergency room in the first place because they no longer have to worry about the cost of a proactive doctor's visit, and can actually get the medical care they need before it becomes an emergency /twilight zone.
we are talking about the ER and you are talking about the price of epipens and insulin? imagine a emergency room people go for emergencies, yea yea I'm picturing it, you are worried they will overcharge you while saving your life? If its not a emergency then the price SHOULD be high at a emergency room. or have we switched to the topic of insurance and hospitals charging to much?
 

ponyo

Lifer
Feb 14, 2002
18,950
2,283
126
Maybe you should blame the Republicans that tried to block a comprehensive plan at every step.
I blame both parties. Insurance companies own both parties.

Even medicare still costs a considerable amount of money, especially for seniors on a fixed income. It is also complicated and cumbersome system that consists of several parts, and that requires a supplement (good luck trying to figure out the best one of these) for full coverage. You also have to worry about a Republican president like Trump coming back into power with control of both houses of congress and gutting the system.
My mom is on Medicare. It's 100% better than shitty health insurance I have. But even Medicare doesn't really cover things like dental. I'm paying $50k right now for dental work my mom needs and 0% is covered by Medicare. Maybe it is and the dentist we're using doesn't take Medicare. I don't know. But lot of the dental problem she has now was caused by her prior cheap incompetent dentist so I switched her to this new expensive dentist because he's someone I trust will correctly treat her.
 

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