Better be an Emergency If You Go to the ER

[killster1]

You may think that, but the implications of such a decision by a health insurer should be discussed. My experience with UH was not that good, but it was long ago. The "whole issue" here is whether or not an insurer should be allowed to deny an ER visit at all, and what grounds they can do so



Um, no. This thread is about an insurer saying that they reserve the right to deny coverage for anything they deem not an emergency, doesn't have to be a non emergency.

And as pointed out, it's the people in the middle that get screwed the most. Not the lower class or the wealthy, it's the middle class / upper middle class that get reamed.

Look at ponyo's example of his coverage, sounds awful. He and I may disagree on things, but I think we'd both agree that his cost for insurance and care is pretty steep. Personally, I don't think health care or insurance should cost that much. That's the current systems design though.

I dont think healthcare insurance costs very much (its similar to playing the lotto reverse style, don't actually need insurance if nothing goes wrong ), i actually have UH now coming from blueshield ppo (which was soooo inexpensive but kinda like pay as you go plan). I believe people should not be allowed to visit the ER for bs reasons, you are not forced to have any sort of health coverage if you don't like the policy you can switch right? i dont think Kaiser costs very much

 

[Fenixgoon]

I dont think healthcare insurance costs very much (its similar to playing the lotto reverse style, don't actually need insurance if nothing goes wrong ), i actually have UH now coming from blueshield ppo (which was soooo inexpensive but kinda like pay as you go plan). I believe people should not be allowed to visit the ER for bs reasons, you are not forced to have any sort of health coverage if you don't like the policy you can switch right? i dont think Kaiser costs very much

health insurance not costing much is a function of what insurance is available to you in the first place, and what constitutes "not much".

are you self-insured with pre-existing conditions? congrats, you're fucked.

do you work for a massive employer? now you can get decent insurance options.

anecdotes and individual data points are not substitutes for entire data sets.


and no, you can't just switch health insurance if you don't like your current plan.

 

[ch33zw1z]

I dont think healthcare insurance costs very much (its similar to playing the lotto reverse style, don't actually need insurance if nothing goes wrong ),

That's your anecdotal opinion. There's lots of variations in plans and costs accordingly.

Also, as you get older, most americans will use more health services, not less.

i actually have UH now coming from blueshield ppo (which was soooo inexpensive but kinda like pay as you go plan).

Just sayin your anecdotes isn't really an argument. The costs vary between states, coverage types, etc..

I believe people should not be allowed to visit the ER for bs reasons,

I believe that you don't reserve the right to tell others how they're feeling. I don't know a single person who just visits the ER willy-nilly, that's my anecdote. I would venture to say that the people paying the most are the least likely to visit the ER for nothing, and the least likely to visit the ER in times of need. I haven't seen any verbage from United as to what constitutes an Emergency, or why this move is good for the insured. I'm not a damn medical professional, how am I supposed to know if the pain I'm feeling that warrants an ER visit is just passing thru or the cause of something critical.

you are not forced to have any sort of health coverage if you don't like the policy you can switch right? i dont think Kaiser costs very much

You're right for 49 states now because the individual mandate is gone, but not my state. You either have coverage or you pay a fine. The ACA mirrored much of what was put in place in Massachusetts, under Governor Romney, who then argued against the ACA just a few years later.

You didn't provide any arguments against my previous post, so I assume you agree with what the thread is about.

 

[ch33zw1z]

health insurance not costing much is a function of what insurance is available to you in the first place, and what constitutes "not much".

are you self-insured with pre-existing conditions? congrats, you're fucked.

do you work for a massive employer? now you can get decent insurance options.

anecdotes and individual data points are not substitutes for entire data sets

My anecdote doesn't agree with the bolded tho. I work for a global company but their insurance is $1k or more for a PPO for family of 4. Sure, their HSA plans are less money, but the deductibles are pretty damn high. If you're using health services, or have kids, or both....it's very unlikely you won't burn thru all your HSA money every year.

I know a guy in CT that pays $1500 each month to cover his family of 6.

Fwiw, as soon as my wife was a member of the MTA, we switched coverage to her during the next cycle. It's half as much, and I can only assume that's because there's so many members in the state, whereas my employer has been reducing their USA based workforce for decades. This anecdote is more on point with what you're saying. Size matters when it's concentrated in the state you live in.

 

[killster1]

health insurance not costing much is a function of what insurance is available to you in the first place, and what constitutes "not much".

are you self-insured with pre-existing conditions? congrats, you're fucked.

do you work for a massive employer? now you can get decent insurance options.

anecdotes and individual data points are not substitutes for entire data sets.


and no, you can't just switch health insurance if you don't like your current plan.

why cant you switch plans? enlighten me because ive switched loads of times.

 

[killster1]

That's your anecdotal opinion. There's lots of variations in plans and costs accordingly.

Also, as you get older, most americans will use more health services, not less.



Just sayin your anecdotes isn't really an argument. The costs vary between states, coverage types, etc..



I believe that you don't reserve the right to tell others how they're feeling. I don't know a single person who just visits the ER willy-nilly, that's my anecdote. I would venture to say that the people paying the most are the least likely to visit the ER for nothing, and the least likely to visit the ER in times of need. I haven't seen any verbage from United as to what constitutes an Emergency, or why this move is good for the insured. I'm not a damn medical professional, how am I supposed to know if the pain I'm feeling that warrants an ER visit is just passing thru or the cause of something critical.



You're right for 49 states now because the individual mandate is gone, but not my state. You either have coverage or you pay a fine. The ACA mirrored much of what was put in place in Massachusetts, under Governor Romney, who then argued against the ACA just a few years later.

You didn't provide any arguments against my previous post, so I assume you agree with what the thread is about.

yea wow we both agree that i dont reserve the right to tell others how they are felling, i only said what i think should happen not what will or does happen. also i agree you usually use more healthcare as you get older with exception of children then need less and less then 50 years later possibly more i know tons of people that have visited the ER to get DR notes for work they say "its just a 50$ co pay" or what ever the co pay amount is.. its abusing the system obviously.

ya what is the fine for no insurance 150$? some sort of joke compared to the possible cost.

 

[Fenixgoon]

why cant you switch plans? enlighten me because ive switched loads of times.

with the exception of a qualifying life event, you get once per year to change your health insurance plan.

that is not "you can change it if you don't like it".

 

[ch33zw1z]

yea wow we both agree that i dont reserve the right to tell others how they are felling, i only said what i think should happen not what will or does happen. also i agree you usually use more healthcare as you get older with exception of children then need less and less then 50 years later possibly more i know tons of people that have visited the ER to get DR notes for work they say "its just a 50$ co pay" or what ever the co pay amount is.. its abusing the system obviously.

ya what is the fine for no insurance 150$? some sort of joke compared to the possible cost.

Depends on the child. Some children will actually increase your health service requirements.

You could always just google it:

TIR 20-1: Individual Mandate Penalties for Tax Year 2020

Pursuant to G.L. c. 111M, § 2, the Department of Revenue is issuing this Technical Information Release to announce the penalty schedule for individuals who fail to comply in 2020 with the requirements under the Massachusetts Health Care Reform Act (the Act). See St. 2006, c. 58, as amended. The...

www.mass.gov

Funny enough, if the fees are so low that it's not an obstacle, why did the GOP make such a huge deal about it. There were a couple of loons on this forum that went balls crazy over it.

And again, the thread is about whether or not an insurer should even be able to deny ER visits at all, and what the criteria is for it.

With your anecdote, I submit people are going to the ER because that's what they know. Without more information about their plans, coverage, and knowledge....it trivial to call it abuse. Also, when you say "tons", I'm not inclined to go along with it. 5? 10? 20?

What we do know is that insurers are always looking for ways to maximize profits, and this seemingly simple change has abuse written all over it. Not plebian abuse, but insurer abuse.

Headache? denied, we know we know....could have been something serious, but it wasnt

Cut yourself? denied, wasn't serious enough to be life threatening, you suture it yourself next time

Sports injury? xray's are clear, can still walk on it, denied....hope it's nothing serious, so sorry.

Fell down? Nothing broken, just soft tissue damage, suck it up buttercup, denied.

Breathing Trouble? denied, it's spring ya dummy! take care of those allergies yourself next time, when you can't breathe, alone in your home...and btw EMS ride denied also.

the list goes on and on.

 

[MtnMan]

how do you know what i would do? if i cant afford to go to a clinic then the ER is not the choice for me. The ER is for emergencies the whole issue is when people go to the ER for dr's notes for work or for anxiety etc. This thread topic is going to the ER for NON emergencies and everyone has turned it into America should be free healthcare because lower class deserve care too!

And you're a fucking idiot... not the "tough man" you view yourself as. When it hurts bad enough, you'll be in the ER crying like that pussy you are.

 

[ch33zw1z]

And you're a fucking idiot... not the "tough man" you view yourself as. When it hurts bad enough, you'll be in the ER crying like that pussy you are.

Hope he doesn't get denied? although there's the tinge of poetic justice if he did UwU

 

[MtnMan]

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 stupid fuck. Every country with universal health care has a lower cost per person. The care is as good, and no one falls through the cracks, no one is bankrupt by staggering medical bills.

 

[MtnMan]

Hope he doesn't get denied? although there's the tinge of poetic justice if he did UwU

If he happens to live where the hospital is a for-profit corporation, he may lay in the ER for hours, no water, no blanket, no pillow, no pain meds. Happened locally where a woman with broken leg laid there for 6 hours with nothing, not even a pillow to elevate her broken leg.

 

[MrSquished]

Still waiting for this moron to tell me how single payer health insurance is communist health care

 

[MtnMan]

Still waiting for this moron to tell me how single payer health insurance is communist health care

Well, don't hold your breath, or you will have to replace your moniker with a smurf.

 

[Pohemi]

Typically right winger, "If I haven't personally seen it, it doesn't happen."

Don't forget the flipside of that coin:
"If something applies to me, it MUST apply to everyone. Because everyone has been given the exact same chances and opportunities as I have been, so they have no excuses besides laziness..."

 

[Paratus]

Depends on the child. Some children will actually increase your health service requirements.

You could always just google it:

TIR 20-1: Individual Mandate Penalties for Tax Year 2020

Pursuant to G.L. c. 111M, § 2, the Department of Revenue is issuing this Technical Information Release to announce the penalty schedule for individuals who fail to comply in 2020 with the requirements under the Massachusetts Health Care Reform Act (the Act). See St. 2006, c. 58, as amended. The...

www.mass.gov

Funny enough, if the fees are so low that it's not an obstacle, why did the GOP make such a huge deal about it. There were a couple of loons on this forum that went balls crazy over it.

And again, the thread is about whether or not an insurer should even be able to deny ER visits at all, and what the criteria is for it.

With your anecdote, I submit people are going to the ER because that's what they know. Without more information about their plans, coverage, and knowledge....it trivial to call it abuse. Also, when you say "tons", I'm not inclined to go along with it. 5? 10? 20?

What we do know is that insurers are always looking for ways to maximize profits, and this seemingly simple change has abuse written all over it. Not plebian abuse, but insurer abuse.

Headache? denied, we know we know....could have been something serious, but it wasnt

Cut yourself? denied, wasn't serious enough to be life threatening, you suture it yourself next time

Sports injury? xray's are clear, can still walk on it, denied....hope it's nothing serious, so sorry.

Fell down? Nothing broken, just soft tissue damage, suck it up buttercup, denied.

Breathing Trouble? denied, it's spring ya dummy! take care of those allergies yourself next time, when you can't breathe, alone in your home...and btw EMS ride denied also.

the list goes on and on.

@killster1 assumes people easily know whether the symptoms they have are trivial or life threatening. If he’d read about the issue he’d find that 90% of initial symptoms of life threatening events are the same symptoms of non-life threatening events.

An examination and tests by the doctor can separate the two but by that point you’ve risked your financial future if you are covered by UH and they implement that policy or you’ve risked your life by forgoing the examination. Either way UH saves money.

If there was an option for Medicare for everyone I wouldn’t have a problem with folks like killster paying UH for the services they wanted. In that scenario I’m fine if he wants to bet his monthly premiums and his life for the benefit of UH’s shareholders.

Until then they need to be more strictly regulated.

 

[Matt390]

Are you really this stupid? Really? As in you’re too g’damn stupid to have ever seen/heard about or even too f’n stupid to use your mind and imagine a scenario by which a nonprofit hospital, running deficits, sells itself to a private health care corp with the “promise” from said private co. to keep the purchased hosp. open?

As in a local county hosp can no longer be supported by the county itself, and that’d be a nonprofit hosp, btw, being a county-owned/funded entity, and is either sold or closed.

But u too dumb to even be able to conceptualize selling a nonprofit institution

So a failing government privatized its services?

 

[ch33zw1z]

So a failing government privatized its services?

I dunno about failing, but we definitely cater to privatization of health services

 

[Meghan54]

If he happens to live where the hospital is a for-profit corporation, he may lay in the ER for hours, no water, no blanket, no pillow, no pain meds. Happened locally where a woman with broken leg laid there for 6 hours with nothing, not even a pillow to elevate her broken leg.

I worked a couple of HCA hospitals while in FL…was doing short-term contract work back then (early ‘80’s). As bad as it is for those on the outside (patients and family), it’s just as miserable for staff.

Continually got written up for not taking the charge stickers off the item I was grabbing and putting it on the pat’s charge sheet.Invariably, it’d be for Kleenex or cotton balls/swabs. Never consequential crap like IV lines, meds, etc.

Worst write up I got was for taking too long in getting one of my rooms cleaned up…after spending 30 min with the cardiothoracic surgeon doing open chest cardiac massage. Yes, he and I both had our hands in this lady’s chest. Was a first for me, at least.

And when, after it’d been called, room cleared, I decided I’d had just enough mental “abuse” to warrant a 15 min break, which I arranged with a co-worker to cover my other, “easier” pt.

Got badly written up—threatened with suspension (I said, sure, cancel the contract…please!!!) for not manning a mop bucket myself and getting the room ready FASTER!!!! because they needed it…maybe in an hour or two.

Miserable Corp.

 

[Meghan54]

So a failing government privatized its services?

Statesboro,GA, Bulloch County. County sold the county-owned facility to a private co.

That was done over two decades ago and certainly wasn’t the first or last time this has happened.

Honestly, you really sound like you’re quite young, very little real life experience, and are really just spouting naive bullshit grounded by nothing in reality.

 

[MrSquished]

Statesboro,GA, Bulloch County. County sold the county-owned facility to a private co.

That was done over two decades ago and certainly wasn’t the first or last time this has happened.

Honestly, you really sound like you’re quite young, very little real life experience, and are really just spouting naive bullshit grounded by nothing in reality.

He seems to think it's bad ER's can't refuse service. Come in with a gunshot wound, like say as an innocent bystander in any of America's many mass shootings, they should check your credit and back account before they touch you.

 

[esquared]

He seems to think it's bad ER's can't refuse service. Come in with a gunshot wound, like say as an innocent bystander in any of America's many mass shootings, they should check your credit and back account before they touch you.

In the old days didn't private hospitals turn away patients who had no insurance and send them to the nearest county hospital?

 

[MtnMan]

I worked a couple of HCA hospitals while in FL…was doing short-term contract work back then (early ‘80’s). As bad as it is for those on the outside (patients and family), it’s just as miserable for staff.

Continually got written up for not taking the charge stickers off the item I was grabbing and putting it on the pat’s charge sheet.Invariably, it’d be for Kleenex or cotton balls/swabs. Never consequential crap like IV lines, meds, etc.

Worst write up I got was for taking too long in getting one of my rooms cleaned up…after spending 30 min with the cardiothoracic surgeon doing open chest cardiac massage. Yes, he and I both had our hands in this lady’s chest. Was a first for me, at least.

And when, after it’d been called, room cleared, I decided I’d had just enough mental “abuse” to warrant a 15 min break, which I arranged with a co-worker to cover my other, “easier” pt.

Got badly written up—threatened with suspension (I said, sure, cancel the contract…please!!!) for not manning a mop bucket myself and getting the room ready FASTER!!!! because they needed it…maybe in an hour or two.

Miserable Corp.

In the middle of the pandemic, nurses had their fill... and to join a union, the largest margin of victory in the south since 1975... speaks volumes.

Largest hospital union victory in South since 1975

In the first private sector hospital union election win in North Carolina, the largest at any nonunion hospital in the South since 1975 – RNs at Mission voted this week by a stunning 70 percent to join the nation’s largest RN union to secure a powerful voice for improved care and workplace...

www.nationalnursesunited.org

.

I live 2 miles from this hospital, and unless I need immediate care in a trauma center, which this is, I'm going to a nearby non-HCA hospital, 15 or 25 miles away.

 

[MtnMan]

So a failing government privatized its services?

It's too bad that stupidity is not a treatable condition.

Our local non-profit was excellent, highly rated in many categories... but HCA blew a whole lot of smoke up the right asses, because they saw it as a cash cow investment. All the promises now fall under the "fuck you" category as they reduce services, if not eliminating them entirely, close satellite locations in rural areas where people now have to drive up to 5 hours (round trip) to receive treatment such as chemo.

They even went through the books and billed patients for charges prior to the time they actually purchased the hospital.

 

[MtnMan]

He seems to think it's bad ER's can't refuse service. Come in with a gunshot wound, like say as an innocent bystander in any of America's many mass shootings, they should check your credit and back account before they touch you.

Wife had elective surgery years ago. Spinal fusion as she was pretty much an invalid due to the pain and leg numbness, yet still considered "elective". Part of the check-in was to write a check for $4,000 (to the hospital, not the surgeon) up front.

Recovery took months, but today she is fine, can do anything she wants, pain free and without any mobility issues... but without being able to pony up $4K upfront, I hate to think what her life would be like.