A big health insurer is planning to punish patients for 'unnecessary' ER visits (they won't pay)

The insurance co will not pay the bill if you use the ER and whoops it was a indigestion, not a heart attack.

See private insurance works great.
So now if you have health insurance, you better also have medical degree to avoid a false alarm.

Anthem is the nation’s second-largest health insurer, with thousands of medical professionals on its payroll. Yet its Blue Cross and Blue Shield of Georgia subsidiary has just informed its members that if they show up at the emergency room with a problem that later is deemed to have not been an emergency, their claim won’t be paid.

It’s a new wrinkle in the age-old problem of how to keep patients from showing up at the ER for just anything. But medical experts say the Georgia insurer is playing with fire. By requiring patients to self-diagnose at the risk of being stuck with a big bill, it may discourage even those with genuine emergencies from seeking necessary care. And it’s asking them to take on a task that often confounds even experienced doctors and nurses.

If this stands, we will soon have to have a pre Dr. check up to go to a dr.

www.latimes.com...
Patients don’t come with a sticker on their forehead saying what the diagnosis is,” said Renee Hsia of the Institute for Health Policy Studies at UC San Francisco, who has studied the difficulty of making snap diagnoses at the ER. “We as physicians can’t always distinguish necessary from unnecessary visits.”

Wtf. Wow. Like how would people no something is more or less just a false alarm healthwise until confirmation from ACTUAL medical tests and diagnostics. # will only get more Real. Face palms

a reply to: Indigohues

It is cheaper for the insurance co to have a person die at home avoiding the ER with a heart that needs a cath than go to the ER.
See savings.

My guess is that it's because extremely urban citizens, aka "hoodrats" tend to go to the E.R. everytime someone has a sniffle. Before I moved out of the city my average wait was about 3-4 hours.
I go to the hospital when I can't stop the bleeding or its a compound fracture. The fine people I'd have to wait behind were generally not bleeding, not wounded, and had cold/flu symptoms.

The only time I saw or heard about appointments being made was for pregnant daughters and boys who needed physicals for sports. Otherwise it's the E.R. every damn time.

And people wonder why it's so expensive for those of us who actually PAY for our insurance.

a reply to: seasonal


Well we know there are those sorts. Plus there are folks with advanced health issues that probably should go to the ER much more than others but may have to just off themselves now.

Around here we have these little deals called Urgent Cares springing up all over. But they don't do much and the only reason they are springing up is so they can capitalize of off lower level stuff. Charge you and your insurance 500$ to give you some aspirin and tell you to go see your regular Dr on Monday.

a reply to: Natas0114

If the "hood rats" don't have insurance how does Blue Cross not pay?

a reply to: seasonal

They have government insurance. If they qualified for housing, food stamps, assistance etc. - they get insurance. On the taxpayers dime.

They abuse the system, then cry when it strikes back.

a reply to: Logarock

Yep we have those in Michigan.

29 years ago 3 stitches was $335 . I remember because I made $3.35 min wage.

This system is so far gone that there is little hope that it will again serve the sick and injured.

Get the for profits out. And let's try something else other than this broken exploitative system.

This is a end around death panel.

a reply to: Natas0114

Govt insurance is Blue Cross?

originally posted by: Indigohues
Wtf. Wow. Like how would people no something is more or less just a false alarm healthwise until confirmation from ACTUAL medical tests and diagnostics. # will only get more Real. Face palms

That will stimulate the electronics/medical industries to come up with home diagnosis systems .

a reply to: seasonal

I am going to go against the current thought and agree, something needs to be done about minor problems going to er vs a clinic. Seen way too many folks show up for unknown fever or flu symptoms and other such minor problems. Emergency room means just that an emergency. You have a possible life threatening illness or injury. There are clinics to go to at about 1/10 the cost.

a reply to: stormcell

It will also be a boon for ambulances and funeral homes.

a reply to: liveandlearn

Oh I agree that there is some "abuse".

But when you have a company that pays (or not pays) for a medical service that is agreed to be covered, and then give them the right to refuse payment when they say so. Someone is going to get the banana, and it isn't Blue cross.

ER prices are super high because the hospital has to recoup from those that don't pay or have no insurance.

I know in my neck of the woods, we have a lot of urgent care facilities opening. They aren't ER, but they typically are open late and if you have a sniffle or some other non-life threatening need, but not something that you necessarily want to wait around to get in to see your normal doctor, they work well.

Technology will help with a lot of this stuff. Between cameras, cellphone apps, etc there really is no need to go to a doctor for a sniffle. Imagine being able to log into an app, the doctor can see you through your camera, and then you can take your temp, blood pressure, etc through some relatively cheap device.

a reply to: seasonal

Wellpoint did government insurance and subsidies for quite a while. That's who owns blue cross. They even got sued a few times for playing games with cash they got from government insurance programs.

a reply to: Natas0114

This is an idea that is ripe for abuse. We pay super sized premiums with super high deductibles, co pays, and out of pockets. And now they are going to cut service, for what ever reason.

The US medical system is doomed.

Well damn. I just went to the hospital a couple of weeks ago with severe chest pains that weren't heart related. I wonder if that was before or after they announced this, as that is my insurance company.

a reply to: tebyen

It is totally up the the insurance co, this must be the over regulating we are always hearing about.

Edit: you are the problem. You should have known it was not a heart attack. I believe you are a "hood rat" as another poster put it.

a reply to: Logarock

I went to one of those clinics a couple years ago. Hurt my foot and nearly passed out when I tried to put weight on it.

One xray and a large boot, 2 scrips and a charge of 259 all covered. Not nearly the cost of ER.

Sister was at ER last year and the hospital was covered but the Dr. wasn't. Dr. charge about 1000.

a reply to: liveandlearn

You got all of that for $259, that is a deal indeed. Just to warm up the xrays is usually $350 just for that here in Mich.