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Comment by redis_mlc | Hacker News Reader

For non-US readers: Somebody made an incorrect decision to take him to an urgent care office, which requires immediate insurance or payment, rather than a hospital, which has to admit you if you're acutely ill, then bills you later.

You're supposed to use urgent care for minor things like an earache or prescription refill.

The "insurance hack" in the US is that since hospitals must accept you if you're critically ill, you don't need any insurance to get admitted and treated initially. Also the initial paperwork is less burdensome if you're critical.

The reason for that is because hospitals were dumping comatose patients on lawns at other hospitals to reduce their costs. Hey, capitalism.

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I went to one of those urgent care places once. I had food poisoning, but I'd never had it before and thought I was dying.

Here's what happened:

- I had to sit and fill out paperwork for 20 minutes before being admitted

- They put an IV in me and gave me something "for nausea"

- The nausea medication had an extreme anxiety-inducing effect (and I was of course already anxious), which they didn't explain until it was happening. I physically couldn't relax my muscles because of the meds. It was nightmarish. And only after I mentioned this did they add some Benadryl in there to offset it.

- The doctor had no idea what could be wrong (again, I realized later it was food poisoning; they couldn't figure this out) but offered me an MRI (??). Luckily, even in my extremely anxious state (which had been increased since I arrived), I knew that was a ridiculous course of action.

- They sent me home. I received a bill in the mail for $3,500, of which my insurance paid about half.

I will never, ever go to one of those again. You shouldn't either unless you're bleeding out on the floor.

> You shouldn't either unless you're bleeding out on the floor.

That's the thing though, they aren't for life threatening emergencies.

Here's my anecdote: I twisted my ankle while running a 5K and thought I broke something. I hobbled in, signed some paperwork, and waited a few minutes because my injury wasn't life-threatening. My leg was examined by a nurse practitioner and it was determined that it was most likely sprained. Told to rest, take Tylenol for pain, and return if things got worse and they would do an x-ray. My ankle healed and I was fine.

Bill after insurance? $200, which isn't bad here.

This is what an urgent care is for in the US: non-life threatening care that isn't an emergency but can't wait until your next visit with your primary care physician. If you think you're dying, go to the ER.

Here's my anecdote: I've lived in three different countries in my life and, despite seeing a doctor when needed, I have never even so much as seen a medical bill in any of them, let alone had to pay one.

> For non-US readers: Somebody made an incorrect decision to take him to an urgent care office, which requires immediate insurance or payment

Is this something that all US readers would know? What about people who have never been to such a place?

> You're supposed to use urgent care for minor things like an earache or prescription refill.

Surely urgency comes in degrees and someone with the symptoms of COVID-19 is surely in more urgent need than someone who has an earache.

I realize that the name is just what it is called; I'm not really arguing for a change of name, after all it's not my country, but it does seem quite plausible that someone might go to such a place under the (mis)apprehension that urgent needs would be attended to and payment be dealt with afterward.

I doubt most people here realize the emergency room can't refuse a real emergency due to lack of insurance but I almost guarantee fear of large hospital bills is the reason the urgent care was the first stop, it's the cheapest place to get care without needing an appointment. So unfortunately I don't think it was confusion about what an urgent care offers (it's a pretty well known service for the above reason) as much of fear of cost over going straight to the emergency room.

it definitely has the potential to be misleading, but it makes sense in the overall hierarchy of urgency. in increasing order of urgency: general practitioners office, urgent care, emergency room. I believe each tier is also more expensive (although idk about urgent care vs GP's office). if you have insurance/money, you really want to avoid going to the emergency room when you don't need it because it's very expensive. the catch is, if you're broke, you go to the ER for everything because they can't turn you away and the debt doesn't really matter.

>Is this something that all US readers would know?

They should. "Urgent Care" "Immediate Care" etc are oftenin office parks next to lawyers/realtors/dentists. They are where you go when you do not have a primary care provider, or can't be seen by your primary care provider, and are sick. You take your kids to them for physicals for their school sport or when you have a bad cough and don't want to/can't wait a week for your doctor to squeeze you in.

You walk in, sit in a waiting room with 10-20 sick strangers and wait sometimes for hours to be seen, then meet one of umpteen doctors working that you've probably never seen before and will never see again that looks at you for maybe a minute and writes a prescription or tells you to go to your doctor.

They are 100% for acute, non-life threatening illnesses and injury.

In my part of the US they've changed the names of a lot of these places from "Urgent Care" to "Walk-in Clinic", which is really what they are: a doctors office you can go to without an appointment for pressing but non-life threatening issues. For point of reference the Emergency Room is where an ambulance would take you if you called for one. If you are in a similar type of life threatening situation and you choose not to call an ambulance but to drive yourself most Americans know they need to go to the ER.

You actually need to be really careful with Urgent Care clinics, because some work out an arrangement where they are an "extension" of the hospital's ER.

What does this mean? It means they get to inflate what they charge you for certain procedures because they're "an ER", but somehow aren't bound by all the other regulations hospitals are.

In short: be bloody paranoid. The only pattern I've noticed in Urgent Care centers using this weird billing hack is they tend to offer some of the more advanced imaging services in-house.

I've been treated by urgent care for an anaphylactic reaction and a major cut on the hand. They definitely can and will treat and triage something seemingly as mild as flu like symptoms, if you have insurance.

Given the situation, urgent care clinics should be allowed to bill Medicaid or a similar program for treating uninsured people with covid19 symptoms. Sometimes, they are the only general medical care available.

The question I have is if hospitals are unprepared for the surge of covid19 cases, how much can most urgent care clinics do, since they are by design much leaner operations. The whole point of them is low cost, low overhead emergency care.

> I've been treated by urgent care for an anaphylactic reaction and a major cut on the hand.

Good to know. How major was the cut?

Deep enough to require stitching - from a kitchen knife

This is just it. In a 2 Trillion dollar bill, there's no payment for those with Covid directly? It's inhumane but also irrational. During a pandemic, you need those with no insurance or scary-high co-pay to get tested and get help, otherwise, they become vectors for spread. It's literally probably cheaper to pay for their coverage.

It's weird that they were fighting for a few billion here and there in this bill for special projects, I thought some would be saying: "no bailouts without everyone covered for covid" or something like that.

But to see American leaders and press basically spend all day fighting each other on cable news, just another day of bickering, contrasted to almost every other nation where it's mostly muted and they talk about things they are doing, what you should do for Covid, updates etc.. It's really embarrassing.

> urgent care clinics should be allowed to bill Medicaid or a similar program

I believe they can already, at least if it's patients who qualify for Medicaid (if you're proposing expanding Medicaid to temporarily cover all uninsured, then it's true that isn't the case). But it's up to the urgent-care clinics whether they want to take Medicaid patients or not. Around me, some do and some don't. The ones that don't, refuse it because they aren't willing to perform services at the Medicaid rates (Medicaid has fixed reimbursement schedules, set by each state).

> if you're proposing expanding Medicaid to temporarily cover all uninsured, then it's true that isn't the case

Yes, specifically for COVID19 cases.

> The "insurance hack" in the US is that since hospitals must accept you if you're critically ill

Work hard, save hard, get unlucky, go to hospital, go bankrupt. Don’t just lose your health, also lose savings and dignity.

There is no way the US should be considered a first world economy when “freedom” means freedom to become destitute if you have the bad fortune to be a low income earner.

I'm surprised the 2 trillion dollar bill did nothing to cover uninsured people.

Yep, if his family hadn't made that mistake he might be alive and they'd simply be bankrupt instead

Ya whoever took them there made a mistake but that just illuminates the fact the system affords this type of power to this person where any layperson is in position to make a life or death decision of someone elses life. What kind of sick fuck that works at these urgent care centers can look at someone that sick and send them away? Rotten to the core...

Urgent care is also great for somewhat more serious things like minor lacerations—they can put in stitches. If you go to an emergency room (especially right now) you might be waiting for many hours.

The copay is lower at urgent care too.

"You're supposed to use urgent care for minor things like an earache or prescription refill."

And the cold, flu, et all other non-critical conditions. The problem is, O Care or no care, many people still go to the ER for immediate care. That is why hospitals are in jeopardy of being overwhelmed in the US. That, the under-staffing of caregivers in said facilities and the leegions of drug seekers(addicts) that abuse the system daily. The core problems of For-Profit Healthcare in the US have never been addressed, nor will they be in any "Aid" packages, so long as the few "Groups" are making billions in "not-socialism" Guv paybacks & handouts. Crisis times are going to be hugely profitable for the administrations, regardless of the toll it takes on the practitioners.

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