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

originally posted by: carewemust
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!

Illinois' credit rating has just dropped to a record low for any state EVAH!

The credit rating agency S&P Global Ratings has downgraded the state of Illinois’ credit rating to BBB-, just one notch above a noninvestment-grade, or “junk,” rating. S&P has also placed the state rating on “negative” watch, meaning the agency could downgrade Illinois again in the near future.

ILLINOIS NOW HAS THE LOWEST CREDIT RATING ON RECORD FOR A U.S. STATE

originally posted by: Indigohues
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!!

Yeah...you need to come out of your echo chamber more often. Sit in a ER waiting room and watch the parade of drug seekers, baby-mama's with funky orifices and the folks using ambulances as a taxi system. There are MANY blogs by medical personnel fed up with the ridiculousness in the ER/ED that takes away from people who NEED to be there. Somewhere along the line it became easier to just drop into the ER/ED than make an appointment with their own Doctor.

newnurseinthehood.blogspot.com...
emergency-room-nurse.blogspot.com...
erdrama.wordpress.com...
epmonthly.com...
serenitynowhospital.blogspot.com...

Because people have the common sense of a rabid squirrel, not saving ER/ED trips for actual emergencies now a Insurance Company is calling BS. Boo-Hoo. While you seem to think this is elitist thinking and about race I can assure it's about wasted resources, wasted time, wasted man-hours of medical personnel and an actual threat to those who need and deserve emergent care.

Do I begrudge my tax dollars going for care to the person needing it? NO I do not.
Do I have issues with the rest of the shenanigans? HELL YES! and you should too.

a reply to: GodEmperor

Ease of use?

I find it suspect that a 4 hour wait is ease of use. Perhaps these ER's are the few who get you in and out in a 1/2 hour?

Seasonal here's just an older example of abuse of the health care system. It's too easy to say the insurance companies are trying to bump off the baby-boomers without looking at the larger problem. Multiply this across the USA all cities and rural areas and the costs are mind boggling.

I'm saying this as someone who only even see's my own Doc when a body part is falling off. I don't know when as a society we decided we couldn't take care of ourselves, or that we even should. But that decision is part of what is tanking health care in this country.

Nine people accounted for nearly 2,700 of the emergency room visits in Central Texas during the past six years at a cost of $3 million to taxpayers and others, according to a report.
The patients - eight from Austin and one from Luling - went to emergency rooms 2,678 times between 2003 and 2008, said the report from the nonprofit Integrated Care Collaboration, a group of hospitals and other health care providers that treat low-income and uninsured patients in Central Texas.

"What we're really trying to do is find out who's using our emergency rooms ... and find solutions," said Ann Kitchen, executive director of the 26-member group, which presented the report last week to the Travis County Healthcare District board.

The average emergency room visit costs $1,000. Hospitals and taxpayers paid the bill through government programs such as Medicare and Medicaid, Kitchen said.

www.cbsnews.com...

I am going to regret this, there is a reason I have not posted in quite some time here, but the hell with it.

In regards to Medicaid, the state (At least in mine) does not pay for medical services directly. The Medicaid receipt choses a private HMO from a list and the state pays the premium.
This insurance is deductible and limit free. Copays are between $0 - $3. This does not include prescriptions as those are paid by the state.
Insurance companies consider these lucrative and there are multiple HMO to choses from.

The premium? About $554 a month

Added: This includes Dental, optical and mental health.

How much are the insurance companies bending you over for much worse plans?

While prescriptions costs are directly picked up by the state that cannot negotiate precipitation prices by law. I have a copy of the cost list my state pays and you have all been grossly deceived in terms of what is paid for prescriptions vs retail price which NO insurance company pays.

I have posted the following before and it feels as if I am pissing in the wind.

The bill you get for medical services is a INFLATED by quite a large margin. The provider is expecting about 10%-12% to actually be paid by an insurance company to consider the bill paid in full.

If you are a cash customer they hope you will just blindly pay the inflated bill and if you cannot afford it they will act as if they are doing you a big favor by lowering the bill. They will never lower the bill below what they actually expected to be paid and will try and get you to pay as much as possible above expectation.

I know this ill fall on deaf ears and people will continue to blame some of the most powerless (the poor) for all the issues with our systems. It is quite sad to see how easy so many people can be misdirected by the wealthy and powerful.

Do I expect this post to change any minds? Nope, it will pretty much be a waste of my time.

a reply to: Dreamwatcher

Very good post.

I question the ER stuff.

My experiences with the ER is it is a horrible place to get help. If the poor go there there is a reason. I imagine it is cost, it is free (to them). No GP is going to see them, as they know they don't have the copay's and maybe not even the transportation.
Our system is designed to do one thing make money. If anyone gets better that is way way down the list of important goals of our very expensive and horribly bad medical system.

How about their Doctors know their history and won't write scripts for no good reason? Why waste time scheduling necessary tests when you decide it can all be done at the hospital?

People keep buying into the "meme" that poor people don't have a choice. BS...taking public transportation blows when you're sick, but the doctors office is just as far as the hospital in most cases. It's just MORE convenient to hit the ER.
The Med clinics that have sprung up are filling a niche and for non-emergencies when it's after hours from normal business hours FANTASTIC!

Like DreamWatcher said paying cash is usually cheaper. I did that for the last 5 years. My Doc charges me a lesser rate, we decide if tests are worth the cost/informative value for the expense and go from there. Prescriptions are generic which is cheaper for me plus I trust the older meds much more than the newer stuff if it's unavoidable.

People DON'T work WITH their Doctors to manage their health care. Good Doctors are usually happy to have a patient interested and willing to take responsibility for themselves. Even tho I recently got health care again thru work doesn't mean it's OK for me to jack around with tests I probably don't need just cause the AMA "says" they are recommended.

no symptoms,no family history, not necessary.
But people don't think that way anymore. I may agree insurance companies are the scum of the earth, but that doesn't give me license to blow up costs for everyone else and eventually myself.

a reply to: Caver78

If insurance co's had their way, they would only insure 18-35 year olds that make 45,000 and above.

I hope they get sue'd into oblivion after someone dies being afraid to go to emeg..what a sad pathetic system, run by cockroaches.

a reply to: vonclod

And remember, the profits need to increase every quarter. So your cost is going to go up no matter who they omit from the system. No matter how much is made, there needs to be more in 90 days.


Do you think that not paying these bills is going to lower costs? I imagine it will boost profits.

Yay. This is my insurer.

Thankfully, they do pay for kidney stone pain, or my kid would be out about 8 grand right now for the ER.

Urgent care can do the same tests for making sure that chest pain is indigestion or indeed a heart attack. A troponin or a CK is done there. The hospital I work at gets tons of referrals and/or ambulances from UC.

I honestly will be glad to see them do this, just because so many are using the ER as a walk-in clinic, diverting time and resources away from those who truly are emergency cases. Most of the doctors around where I am at do have no insurance fees that are half of what they bill insurance. We also have good Samaritan clinics.

And there is me, who for 12 years had nothing and Google and books were my best friend.

a reply to: flowerpower691

I fail to see this lowering costs.

Has anything lowered costs?

There is a reason people go to the ER and not to a GP. My wild guess is $$$. A GP will not see you with out it and the ER can't kick your ass out by law.

a reply to: Caver78

Dude. I seriously love hate your assumptions. You have no idea who I am. Where I'm from and going. Thus my experience is not something your privy to. My family ALL work in the medical field. Myself a different sector. My point is using a micro fraction to toss around moronic ideals is toxic. Your taxes? Dude...OUR TAXES

a reply to: SBMcG


You know what? The Illinois Credit Rating gets kicked down a notch by one rating service, or another, so frequently, that the local news treats them as an "oh by the way"..a 30-second blurb. Like the 2 to 3 murders that occur every day of the year in Chicago, the downgrades aren't seen as newsworthy.

originally posted by: seasonal
a reply to: flowerpower691



There is a reason people go to the ER and not to a GP. My wild guess is $$$. A GP will not see you with out it, and the ER can't kick your ass out, by law.

BINGO! WE HAVE A WINNER!!!

But how do you punish illegal immigrants who use the E.R. without penalty of ANY KIND?

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


So now folks are gonna need a doctor's note, to go to the doctor?

My typical night in the ED consists of seeing pt's that shouldn't be there. I do realize that it is a "safety net" for some, and that is perfectly fine. However - those pt's make up maybe 1%. Then we have another 1% with actual emergencies, and the other 98% consist of true non-emergent pt's that heavily monopolize resources in the ED.

You've had a cold for 2 days? But now at 0300 it's an emergency? NO. Non emergent.
You've thrown up *once* today but are now chomping down on a bag of doritos? Non emergent
You've stubbed your toe, and want "some of that medicine that starts with a D" -- NO, NO, NO. Non emergent.

These are the type of pt's that should be billed in full for their care. Not their insurance.

Those with conditions that could mimic life threatening ones, but turn out not to be SHOULD be covered.

Generally, unless you are starting to look like a smurf - the ER is not the place for the cold or flu.

originally posted by: justme2
My typical night in the ED consists of seeing pt's that shouldn't be there. I do realize that it is a "safety net" for some, and that is perfectly fine. However - those pt's make up maybe 1%. Then we have another 1% with actual emergencies, and the other 98% consist of true non-emergent pt's that heavily monopolize resources in the ED.

You've had a cold for 2 days? But now at 0300 it's an emergency? NO. Non emergent.
You've thrown up *once* today but are now chomping down on a bag of doritos? Non emergent
You've stubbed your toe, and want "some of that medicine that starts with a D" -- NO, NO, NO. Non emergent.

These are the type of pt's that should be billed in full for their care. Not their insurance.

Those with conditions that could mimic life threatening ones, but turn out not to be SHOULD be covered.

Generally, unless you are starting to look like a smurf - the ER is not the place for the cold or flu.

98%? Bull#. While those situations that you describe happen, probably every day, but that number is crap.

Maybe in a city you might get 60% or 70% but 98% is a ridiculous exaggeration.

when my daughter comes down with something on friday and her doc is not in till monday and she gets worse saturday. im going to the ER

when i call her doc and they cant get me in for 4-5 days im going to the ER

ER patients are seen in order of urgency not who came in first so i really dont buy all the stories of how people sat there bleeding and blah blah while someone with a sniffle was seen

there are some not for profit hospitals and some for profit
when they give you a tylenol and you get your bill and it is $8 for a pill thats bull#. and that is cause people dont pay their bill? bull#

the prices they charge are not true cost. i seriously doubt it cost 1 grand to run an MRI
yeah the machine costs a million and yeah it takes juice and they have to pay the tech but that machine does dozens of MRI's every day all day. that million is recouped pretty fast.
after that they are making money

im just not in agreement and i am also not a doc so when i feel like myself or my daughter has to go to the ER cause it cant wait for our doc for whatever reason then we go
sometimes symptoms that do not seem very severe are and waiting could make things worse
im not risking it
do what you have to do

a reply to: carewemust

build the wall, monitor, deport, imprison managers, directors and CEO's of co's (when there is proof of knowledge) of hiring and using illegals and let's also make it a tad (not a ton) easier to gain access to citizenship.