Better be an Emergency If You Go to the ER

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MrSquished

Lifer
Jan 14, 2013
26,040
24,351
136
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.

Unbelievable. Elective surgery my ass. What a country. Glad she is ok.

I was talking about this subject with family tonight over dinner. My brother in law's stepdad was quite sick, and he had to go to the ER - he had a blood clot that had to be taken care of before it got to his heart. So they operated. He had insurance, but turns out the surgeon who did the surgery was not in that network. They sent a bill for 6 figures, just around 100K. This was around 10 years ago, in NJ.

'Murica!
 
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Matt390

Member
Jun 7, 2019
144
62
101
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.

Gun shot victims tend to be pushed to the front of the line in an ER. I'm referring to the rest of the cases. Wait time in ER measure in hours.
 

MrSquished

Lifer
Jan 14, 2013
26,040
24,351
136
Gun shot victims tend to be pushed to the front of the line in an ER. I'm referring to the rest of the cases. Wait time in ER measure in hours.

What does it matter if it's a gunshot victim or someone who has to wait a bit longer to get an appendix removed? If they have no insurance and end up not being able to pay, they are still freeloaders, as you said earlier. In fact the gunshot victim with no insurance and who is poor is going to cost the hospital a hell of a lot more money than someone who comes in and can't pay, and things turn out not to be so serious.

Everyone blaming private insurance when this is the government's fault. Y'all want to know why emergency rooms are so expensive? They have to pay for government mandated free loaders. Nixon signed a law mandating that ERs treat all patients regardless of their ability to pay.

Are you now saying that now it matters what the illness is, not about the ability to pay?
 

Pohemi

Lifer
Oct 2, 2004
10,859
16,927
146
In the old days didn't private hospitals turn away patients who had no insurance and send them to the nearest county hospital?
Yes, precisely, which is why Reagan made it law that they couldn't turn patients away due to lack of insurance.
 

ch33zw1z

Lifer
Nov 4, 2004
39,471
20,153
146
There isn't a "correct" way for any country. There's better and worse systems, and we're using the worst of all of the western countries with universal healthcare.

Worse for the insured, yes. Great for the insurer's tho. Their greed will be their demise, hopefully, they've had their run.
 

ch33zw1z

Lifer
Nov 4, 2004
39,471
20,153
146
Unbelievable. Elective surgery my ass. What a country. Glad she is ok.

I was talking about this subject with family tonight over dinner. My brother in law's stepdad was quite sick, and he had to go to the ER - he had a blood clot that had to be taken care of before it got to his heart. So they operated. He had insurance, but turns out the surgeon who did the surgery was not in that network. They sent a bill for 6 figures, just around 100K. This was around 10 years ago, in NJ.

'Murica!

This is the ludicrous scenario's that unfold. If the hospital is in network, anyone working at it should be part of the network, no questions.
 
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pmv

Lifer
May 30, 2008
14,933
9,834
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I know someone in the US who asked if the hospital accepted their insurance, was told it did, then after seeing a consultant, discovered that it didn't, and couldn't therefore pursue the treatment the consultant recommended, and had to pay out-of-pocket for the cost of the consultation.

My impression is, while here we have waiting lists, in the US you can get very similar delays while you argue with your insurance company as to what they will pay for.

Of course, the Conservatives here have managed to replicate some of the inefficiencies of the US system, due to their mania for introducing 'internal markets' whereby parts of the NHS have to arrange contractual relationships with other parts, with money being passed between them. This seems, from my experience, to just introduce more bureaucracy and delays. Also means you can end up being sent to hospitals miles away that you can't easily get to.
 

theeedude

Lifer
Feb 5, 2006
35,787
6,197
126
It's easy to crap on the insurance company, but hospitals are notorious for overcharging on ER care. What we really need are price controls.
 
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Pohemi

Lifer
Oct 2, 2004
10,859
16,927
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My impression is, while here we have waiting lists, in the US you can get very similar delays while you argue with your insurance company as to what they will pay for.
Yep, it's called 'Pre-Authorization required' and is a common thing in the US healthcare system and insurances.

Your doctor orders a test to be done, say...an MRI is a good example. It's your doc ordering the test.

But the request for payment is sent to the insurance immediately (knowing that they will have requirements in order to cover said procedure).
The insurance company sends back a request for pre-authorization, which is basically just asking for a second message or confirmation from the same doctor that ordered the test in the first place, that the test does indeed, need to be done. It's like a game of messaging tag.

It's stupid, and a logisitcal waste of time but it's done frequently as a requirement by the insurance companies before they will cover a procedure.

I have to get a pre-auth just to get my insulin prescriptions and supplies renewed and/or refilled.
 
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DAPUNISHER

Super Moderator CPU Forum Mod and Elite Member
Super Moderator
Aug 22, 2001
31,680
31,538
146
Hopefully critical mass will be reached when all the old people die off, and socialism is not considered a bad word by most Americans.

And the only way I will be in the E.R. is if the amber lamps takes me there. Otherwise, there are a number of good walk-in clinics in my area with x-ray, blood work, etc. on site. If it is too serious for them, they can have me picked up and taken to the E.R.
 
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nickqt

Diamond Member
Jan 15, 2015
8,084
8,940
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Hopefully critical mass will be reached when all the old people die off, and socialism is not considered a bad word by most Americans.

And the only way I will be in the E.R. is if the amber lamps takes me there. Otherwise, there are a number of good walk-in clinics in my area with x-ray, blood work, etc. on site. If it is too serious for them, they can have me picked up and taken to the E.R.
Hopefully.

They're making new old people every day.
 
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NWRMidnight

Diamond Member
Jun 18, 2001
3,488
3,025
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This is the ludicrous scenario's that unfold. If the hospital is in network, anyone working at it should be part of the network, no questions.
Yep, but that isn't how it works. My brother had to take his son to the ER after a bad motorcycle accident (motocross racing).. it was in network, a year later he received a bill for the doctor, who was not in network and the insurance company refused to pay it, even though it was in an emergency situation ... He fought it for a year... Ended up paying for the bill out of his own pocket and learned that there is no protection for this practice.. (that was about 6 to 8 years ago). I don't think we have any protections yet in place for this yet today.
 
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hardhat

Senior member
Dec 4, 2011
433
117
116
Yep, but that isn't how it works. My brother had to take his son to the ER after a bad motorcycle accident (motocross racing).. it was in network, a year later he received a bill for the doctor, who was not in network and the insurance company refused to pay it, even though it was in an emergency situation ... He fought it for a year... Ended up paying for the bill out of his own pocket and learned that there is no protection for this practice.. (that was about 6 to 8 years ago). I don't think we have any protections yet in place for this yet today.
Unfortunately that's still the way it works. I agree that the whole in/out of network is a giant joke, and realistically the only way to get away from it is single payor.
 

brycejones

Lifer
Oct 18, 2005
29,452
29,865
136
Yep, but that isn't how it works. My brother had to take his son to the ER after a bad motorcycle accident (motocross racing).. it was in network, a year later he received a bill for the doctor, who was not in network and the insurance company refused to pay it, even though it was in an emergency situation ... He fought it for a year... Ended up paying for the bill out of his own pocket and learned that there is no protection for this practice.. (that was about 6 to 8 years ago). I don't think we have any protections yet in place for this yet today.
Your friend should have totally shopped around and confirmed every caregiver was in their network before authorizing any care. After all medical care is just like any other consumer transaction.

/s
 

NWRMidnight

Diamond Member
Jun 18, 2001
3,488
3,025
136
Your friend should have totally shopped around and confirmed every caregiver was in their network before authorizing any care. After all medical care is just like any other consumer transaction.

/s
My brother actually brought that up. He asked how someone is supposed to have the time or ability to verify that the staff at a hospital which is in network, are all in a network during an emergency? It doesn't matter.

Personally I believe , if that doctor is working at that hospital, that they should be required to either be in network, or the hospital pays for it. Not the patient.
 

Pohemi

Lifer
Oct 2, 2004
10,859
16,927
146
My brother actually brought that up. He asked how someone is supposed to have the time or ability to verify that the staff at a hospital which is in network, are all in a network during an emergency? It doesn't matter.

Personally I believe , if that doctor is working at that hospital, that they should be required to either be in network, or the hospital pays for it. Not the patient.
Seems like a bit of a 'trap', doesn't it? Why else should it be so over-complicated like this? It's an intentionally obfuscated system of organization in my opinion.
 

brycejones

Lifer
Oct 18, 2005
29,452
29,865
136
My brother actually brought that up. He asked how someone is supposed to have the time or ability to verify that the staff at a hospital which is in network, are all in a network during an emergency? It doesn't matter.

Personally I believe , if that doctor is working at that hospital, that they should be required to either be in network, or the hospital pays for it. Not the patient.
The answer to this problem is single payer. Overnight the fucking "networks" disappear. The joy of switching doctors every other year because your company keeps changing health plan administrators and your current doctors aren't in the in the new network goes away. We had 4 kids in 4 different hospitals while I worked for the same company and took the same basic health care plan every year just because who was in an out of network was constantly changing.
 

kitkat22

Golden Member
Feb 10, 2005
1,464
1,332
136
I am a severe hemophiliac and thank goodness I don't have an inhibitor. My medication is IV every 10 days. We figured out each vial is $15,000 and I take two per dose.

I feel fortunate I have insurance but I cost the system 1,000,000/yr and that does not include the spontaneous bleeds or admissions. I have had two this year for bleeding episodes.

If I don't work I would rapidly end up on medicaid and disability. Our system has so many flaws that would be fixed by a national system. It won't be perfect but a heck of a lot better than what we have now.
 
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shortylickens

No Lifer
Jul 15, 2003
80,287
17,081
136
the reason Americans use ER's as clinics is because clinics suck ass. It takes forever to get in, they do fuck-all, and then charge you a thousand bucks. Oh, and insurance has never been the answer. All insurance does is inflate prices which makes everything worse. And it went downhill after the ACA. My insurance used to cost me 73 dollars a month and it covered a lot. In January 2022 its gonna cost me 811 dollars and it covers considerably less.
 

Meghan54

Lifer
Oct 18, 2009
11,684
5,225
136
the reason Americans use ER's as clinics is because clinics suck ass. It takes forever to get in, they do fuck-all, and then charge you a thousand bucks. Oh, and insurance has never been the answer. All insurance does is inflate prices which makes everything worse. And it went downhill after the ACA. My insurance used to cost me 73 dollars a month and it covered a lot. In January 2022 its gonna cost me 811 dollars and it covers considerably less.

That's $811 a month (?) because that's surely what you're implying....
 

IronWing

No Lifer
Jul 20, 2001
72,333
32,876
136
When your insurance costed you $73/month, someone else was picking up the rest of the tab.
 

thraashman

Lifer
Apr 10, 2000
11,112
1,587
126
Back in March I scalded my hand pretty badly. I've been left with a pretty gnarly and painful scar as a result. Many of my friends have asked why I didn't go to the emergency room. This is pretty much why. I have United Healthcare.