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

originally posted by: seasonal
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.

I believe it agrees to pay for an emergency or a differential diagnosis would include a poss emergency.

There is more than a little abuse going on and it is by and large medicaid patients. Plus, if you show up there you have to treat them, whether they are able to pay or not.

As you can see, I feel strongly about the subject.

a reply to: seasonal

I know a woman who has two kids on Medicaid. She will take them to the ER for a cough and mild fever...every time. Even if it's during business hours and their pediatrician is open. Why? Because the ER is closer to her house.

It infuriates me.

Wrist sprained - ER

Stubbed toe - ER

Tummy ache - ER

Yeah, it's no wonder....

The only figure I could find was that 12% of people who go ER aren't going because it's serious, but more convenient. I'm thinking it's being under-reported, they'd try anything to massage the statistics on the ACA.

a reply to: liveandlearn

DO you have a solid source for that abuse?

The only reason I ask is we are supposed to have the best health care system in the world, and it turns out we are #37.
In other words is this more corp media hype?

I can't see people going to hang at the ER, it sucks. I can see them using it as a GP because they have no insurance. So this goes back to accessibility.

How are you going to charge someone for an ER visit that was not an emergency? They will go bankrupt and then the rest of us pay.

a reply to: seasonal

Yep, I shouldn't have checked an MSM source.

30% non-urgent visit ER.

Most studies find that at least 30% of all ED visits in the US are non-urgent

www.ncbi.nlm.nih.gov...

a reply to: GodEmperor

The number means nothing if we do not know what the initial visit was for.

a reply to: seasonal

The link explains that the primary reason for the non-emergency visits was due to 'ease of use'.

That's pretty self-explanatory.

Clearly the only answer left is to Nationalize all medical facilities and personnel.

Then these things won't happen anymore.

or just let them all die so you people who are much more important and the world would stop if god forbid something happens to you get the best top care
hood rats ha ? so just were do you fall on the line of human worth ? right up with Trump ?
or being trump a billion air the pres and all around needed guy his health should be first after all if you die who even reads the obit right above the hood rats ?

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

No. That does happen, but it is only a tiny fraction of the issue.

Prices are high because of the bureaucracy that is government health care; from the regulatory commitments that hospitals must meet (most of which are redundant, many are pointless, some are even counter-productive to quality care and all of them are expensive), to the entire departments that must be maintained to navigate getting the government to actually pay the bill, of which they generally only pay cents on the dollar.

Prices are high because insurance companies avoid payment and in many cases, again, only pay cents on the dollar for treatment or exams.

Prices are high because medical equipment in the United States is ridiculously expensive. I mean, criminally so.

Prices are high because well, big pharma is making money hand over fist.

originally posted by: EdumakatedI 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.

Which is great, and many urgent care facilities can get a little more money from the government for their efforts, but only a little. The same hurdles still apply.

originally posted by: EdumakatedTechnology 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.

I agree that this is where we may be headed. A push toward patient self care is definitely present in healthcare at the moment. I don't necessarily think it is a bad thing, but there are definitely some limitations, and there are some dangers with emphasizing patient responsibility too much regarding self assessment and diagnosis as well. We'll see how it pans out though.

a reply to: Natas0114

So.............basically, if you aren't being paid a minimum $100,000.00 a year for your work............why bother?

a reply to: redhorse

All of which is precisely why the US should adopt single payer and at the earliest opportunity.

a reply to: seasonal

Yes. I'm aware how the #ty system works. Its just I can't help but express my initial thought. I actually have to call bull#. I'm severely allergic to illogical occurances. And as for being aware of the tar pits and WHY they exists doesn't shave off my need to say WTF. By actively doing so and rejecting this bull# as the norm. I'm hoping aside from vehemently questioning and not adopting such a defeatist sentiment, as in this is how it works. Despite being blatantly gnar. That subliminal brainwashing and peer pressure based conditioning won't stick. Maybe enough of us can remember the # is bogus remain pissed about it do everything to undermine it even if its throwing wrenches in the gears. Or call bull# bull# to maintain a sovereign honest mind. Its the part of making people believe its ok or fruitless to challenge the most lethal

a reply to: stormcell

Of course a tier system will be implemented in the functionality of said tech. Its not that I'm naive. I'm more disgusted that there seems to be this anemic vibe regarding this #

a reply to: Natas0114

"Hood rats" as you say, usually have Medicaid. Zero deductible. Fed and State taxpayers foot the bill. So many getting shot and stabbed in Chicago that the state is going broke faster than you can say..Damn!

originally posted by: TonyS
a reply to: redhorse

All of which is precisely why the US should adopt single payer and at the earliest opportunity.

While I agree, there is only one way that single payer will work, and that is, if everyone pays a rather significant share of they're income in. 10-15% of my income is still significantly less than what I am spending on healthcare per year at the moment, but for the wealthy... Well it's different, and there is NO WAY the 1%ers are going to pay to help float a health care system that doesn't really benefit them.

Also, the same bureaucratic inefficiencies would almost certainly still apply, compromising care.

On paper, single payer might work, but unless the government can streamline itself when it comes to healthcare (unlikely) and the wealthy are willing to pay for what will be seen as a social safety net that they won't really benefit from (snow balls chance in hell), then it won't work.

originally posted by: seasonal
a reply to: Natas0114

Govt insurance is Blue Cross?

In many states, Blue Cross is the administrator. They do the paperwork for billing, but the taxpayers pay not only the hospital/doctor, but big bucks to Blue Cross too for doing all the paperwork. That's why so many Medicaid people have Blue Cross ID Cards. But it also says "Medicaid" on the card, so doctors won't invest too much time/effort in you. (Medicaid pays 30%-40% less than what private health insurance pays them.)

When you see in the news that some insurance companies are bad-mouthing the ObamaCare replacement, it's because of the cuts in Medicaid assistance from the Feds. It's ALWAYS about money.

It amuses me. Hood rats. Lol wow. It wouldn't give me such agitation if people had the balls to step from the curtain and show themselves truly. Imagine. Fashioning yourself as an intellect yet too #ing daft to observe gradiation in humans. Cultures races etc. #ing hood rat. So busy coming for the phallacy like an oasis you reveal your own inferiority. You need to believe in that classiest racist bull#. And guess what the system NEEDS YOU TO ALSO!!

originally posted by: Logarock
a reply to: seasonal

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.

The explosion in Urgent Care centers (aka "Doc In The Box") is because ObamaCare feeds them a few Billion dollars a year. Part of the "community health centers" initiative. They're doing OK, even if no patients walk in the door. Repeal ObamaCare and the ones with not enough traffic will close, due to the government nipple being taken away.

a reply to: Logarock

That has not been my experience of urgent care.

The ones we have around are pretty adequate for things like ear infections and strep that you really don't want to let cook for 24 more hours until you can see your doctor but aren't ER-level stuff either. They can diagnose you quick and you can get the meds started, but at the rate those infections escalate, 24 hours might as well be days of waiting by the time you can see regular doc on Monday.