Health insurers are threatening not to cover some patients’ ER bills
vox.com
vox.com
I don't know how you read that and came to this conclusion. Maybe you aren't a parent?
My experience with ERs over the past 20 years largely mirrors that of GPs. Then when we started going urgent care out of frustration we ultimately got inferior care for my wife that delayed a cancer diagnosis by 3-4 months.
The root of my comment was to defend the availability of ER services against someone who literally suggested that ERs were not needed for anyone who didn’t arrive by ambulance or by police, not to argue the specifics of his child’s case for which neither one of us have any real knowledge.
I am sorry about your wife’s experience. It contributes to making healthcare discussions so challenging, because there are incredibly emotional, stressful, and unfair situations in each direction (people who got billed tens of thousands on one side; people who were not diagnosed on the other) — including in countries with socialized medicine.
I would suggest that your wife would have been best served not by an ER doctor, but by a highly trained and thoughtful primary care physician who could have followed her and understood what she’s going through longitudinally. Sadly, we burden medical students with $200K in debt and then ask them to choose between a high-paying good-lifestyle specialty or a low-paying poor-lifestyle specialty.
And then one layer down, the primary issue is it’s hard to pay PCPs more when 99.5% of their visits are for common colds, medication renewals, knee pain, etc. and 0.5% of their visits make huge impacts (e.g. diagnosis of cancer early). Just like trying to discriminate urgent care vs. ER, how does one know which patients to send to an NP who can take care of routine issues, and which to send to a PCP with a better understanding of complex issues including management of multiple specialists’ recommendations.
A friend had a case of a bad virus and the urgent care did a great job with her too.
I'm sure it varies from place to place and need to need, and few of us have the training to tell which. But at least some urgent care centers can do really good work for a lot more than cuts.
In your case the urgent care center did the right thing. A fever of 107 could be a lot of incredibly dangerous things, some of which require surgery, and ASAP. I'm glad your daughter required nothing more, but it was absolutely a situation where the urgent care center was not sufficient.
You and I can't be expected to know that, and it would be great if we lived with a system that didn't draw such sharp lines in order to reduce cost. The urgent and emergency places should be part of the same system and co-located as much as possible. But that requires a complete rebuild of our system from the ground up.
Well, in some cases (it varies by time and particular ER) they are less-than-useful for things that don’t urgently require stabilization because they are loaded with cases that do require such stabilization, that's what triage is about. And, yes, lots of them are overloaded.
> I am sure we will get billed an astronomical amount for this, but there were no other options. We have good insurance.
If it is possible you will be billed an astronomical amount, you have “good” insurance, if at all, only in the sense of preserving a somewhat greater degree largely meaningless choice of providers for which you will be partially reimbursed.
Good insurance that has bounded, low out of pocket expense for both urgent care and emergency room visits exists.
Have any of the people quoted been in an ER? Even accepting the premise that hospital prices are outrageous for ER visits, walk into any hospital and it should be clear that a lot of the patient population is not there for an "emergency". In the US, the ER acts as a catch all for what often should be handled by social services (some of which don't exist). Drug seeking patients, homeless patients, and patients with mental health issues very often end up in the ER.
Doesn't sound like those are the kind of patients this insurer is concerned about? Or is it?
And many people with drug or mental health issues also have successful careers and private insurance plans.
So UHC does pay many of those bills.
A lot of these people end up in the ER because they don’t have any health insurance at all. But that’s well outside the scope of the “issue” the health insurance company describes in the article. I have had friends and family who had to be dragged to the ER because they didn’t think their situation was enough of an “emergency” but it absolutely was: chest pains were a heart attack in progress and a fever with a stiff neck was a pretty serious infection, for example.
How many legitimate emergencies vs “non-emergencies” will be discouraged from receiving ER treatment? I suspect legitimate emergency treatment foregone will be larger (and represent a significantly larger cost savings to the health plan) at the expense of our collective long-term health and well-being.
Simple non-technical solution: Build a regular urgent care facility next to the ER and shunt the non-emergency people to it.
She's also very much an overprotective parent in a lot of other ways, and I can't help but think the hypochondriac part stems from that.
I swear I won't really know when I've actually had a heart attack because I've been faked out too many times by GERD reactions.
I've gone about 6 times to ER for it over the past five years, and probably stayed home another ~20 times. Each time I decided to go it's been nothing.
I've driven myself to the ER each time, though, even if maybe I shouldn't, so that saved a little money. Helps that a hospital is only 5 minutes away.
I am finally getting an endoscopy soon, maybe it'll discover something treatable.
aside from the homeless, what about all the people making minimum wage who neither qualify for medicaid, nor work enough to get employer supplied insurance?
sometimes the head in the sand attitude here is fucking sickening
People making a minimum wage or who are minimally employed can qualify for lower cost affordable healthcare insurance through the ACA. It’s available, whether people take advantage is up to them. I know someone who pays less for their ACA plan than they do for their mobile and Internet services.
Where the ACA fails is more at the middle class family level. That is where the income vs. family plan costs tend to be out of balance.
I got injured (not too bad) and went to urgent care - my wait time was about 10 minutes. It costs me nothing, seems like a good system that would catch a lot of these borderline ER cases we hear about.
In my case, my insurer runs the hospital so it seems like they have an incentive to keep costs reasonable. But maybe, if you're a hospital and you are running numbers on adding ER or Urgent Care you default more to ER since you know you can just bill the insurance 10% over cost (or whatever) no matter what.
The problem with this approach in the US is:
1) Until very recently there was no law requiting even estimated costs for medicine. Since the insurance company always pays for this there was just about no market pressure to lower costs (in other words: we took a "free market" approach without actually having a market.)
2) Insurance is used to cover routine medical procedures. This is the polar opposite of what insurance should be used for.
3) The US has a fairly week social safety net. Most other countries have fairly extensive social programs but in the US people are supposed go ... somewhere. This is probably the case that you're most upset about.
This is the wrong way to frame it. At the most basic level, forming a contract requires agreeing on consideration. For some reason, medical providers are allowed to create arbitrary post-facto charges and then enforce their baseless fantasies through the legal system, likely due to corrupt state laws. For any meaningful market-based healthcare reform, this and other regulatory capture needs to be addressed.
Unbelievably painful and debilitating, but an "emergency"? My life wasn't in danger. There are guides online on how to "handle this yourself".
I don't think we want to get started down this road.
It’s rather like calling 911 for something that is important or urgent, but perhaps not an emergency. Hard to know where to draw the line.
At least I had an uncommon condition so nearly every dr and resident on duty came by to check it out. I didn’t get forgotten in the crowd and had some nice chats while waiting for a slot in the imaging schedule.
Edit: Infections can be really serious, but “I found a tick in a spot where I couldn’t safely remove it by myself.” and sprained ankles etc don’t need to go to the ER.
I am American (living abroad) and I have 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, plus type 1 diabetes (autoimmune and insulin-dependent). My doctors in America told me to never go to urgent care for my health issues in the US.
Even ear infections can be complex. One time I had blisters on my eardrums (bullous myringitis) which is considered to be excruciatingly painful. After 3 out of 5 nights being sleepless due to pain, I wish I had went to the ER instead of waiting to finally see an ENT--after going to an urgent care (where I received improper treatment).
ProTip: With respect to cleaning your ears, don't use Q-Tips, ever. Get a digital otoscope (technically an ear endoscope) instead. It is the best piece of technology that I purchased on Amazon, that I thought would be junk. It allows me to thoroughly clean and inspect my ears daily.
There is absolutely no need to clean your ears ever. Ears are self cleaning. That's why they produce wax and they only do it in the outer section of the ear canal where that can't impact hearing.
Just don't mess with your ears and everything will be fine.
However, I am one of those people, who does sometimes get obstructions that have to be microsuctioned out by an ENT, if I don't clear out my ears.
Like me, I have Tinnitus in my ears, and when the earwax builds up it gets 2-3x worse. I was starting to get real distressed about it, then went to an ENT, and he picked out a bunch of ear wax, and now the Tinnitus is manageable again. Still there, but quieter and easier to ignore.
I agree (and have been told by doctors) you should never use Q-Tips, though. That often does more harm than good (pushes ear wax further into your ear).
But there are other things, like Debrox, that can help you remove earwax without sticking Q-tips in your ears.
Profit in 2020: $15,403,000,000
Around 2010, I separated my shoulder and couldn't move my arm. I went to the er and got checked out.
A few days later the insurance company called and said they didn't want to pay for the visit because "it wasn't an emergency". I very calmly explained that their position was nonsense, and I went to the ER because I COULDN'T MOVE MY ARM. Eventually the insurance agreed the ER was justified.
According to this article, it sounds like this would be a new behavior for insurance companies. But it seems to me like they are just making this behavior official now.
I could see adding the a bank of triage experts "in front" of the ER. The ambulance, of course, skips this phase, but if you come in conscious and able to walk in, they can perform some basic checks before admission, and turn away some patients as better served by urgent care. Maybe this costs some modest flat rate, billed sort of like a repairman who doesn't charge for the trip and diagnosis if you get actual repairs performed.
I suppose then you get into a related matter-- once you're at the hospital, being told to go somewhere else means "get back in the car and travel to the strip mall urgent care elsewhere" which would lead to frustration and delay.
Is why they can't connect the dots in the US.
The important bit is a lot of healthcare makes minimal difference. People have a huge bias around doing something even if it doesn’t help. Governments on the other hand care a lot more about the cost/benefit from healthcare thus vaccination is considered an obvious win but Medicare puts limits on physical therapy etc.
It doesn’t matter to me if you call it “nationalized insurance” or “universal healthcare” or “healthcare that is overwhelmingly funded and controlled by the state but leverages some private components in controlled ways” -— that’s just semantics. All that matters to me is that we don’t try to fool people into thinking that the Netherlands or Sweden have anything like the broken medieval mess we have here in the US, when obviously what they’ve done is radically different.
The govt has strict rules around drug manufacturing but it’s not accurate to say the industry is “nationalized”.
I'm not a fan of United Healthcare, and would never subject myself to their tender mercies, but why should they and other insurers end up holding the bag for colossal policy failures like the above?
No doubt this occurs sometimes but I've never seen it.
Anecdata. My wife says that most people at the ER don't need an ER. Of course they serve as a primary healthcare for the homeless.
How about lowering costs anyway? I assure you, there are real and meaningful ways. Start by removing anticompetitive Certificate of Need laws, at the state level.
Some of the solutions are really easy but it’s hard to get done when some politicians are paid off, some want the system to fail so they can do single payer, and some are vehemently anti regulation.
Something more drastic would be making all health insurance plans be high deductible (as in, make it insurance again), and ensure that prices are up front and transparent. You’d see prices plummet relatively quickly.
TL;DR: If you actually care about this issue, you shouldn’t be offering vague platitudes blaming it on “government”. You should advocate for your preferred solution and name the politicians/party you think we should vote for to get it passed. I know this is political and not loved on HN, but this is how the system works.
So now I paid an extra $100-150 just to be told to go to ER anyway. I don't go to Urgent Care for those things anymore (heart attack scares that end up being heartburn with heart attack symptoms, for example).
There's also the issue that most Urgent Cares around here aren't 24/7, so if it happens late at night (like after 9pm), ER is all you got.
I try to steer clear of the ER at all times. If I'm not functioning enough to be able to make that decision, it's probably time for the ER. Just a personal philosophy.
I had a girlfriend years ago who made me take her to the ER because her stomach really hurt. We waited for 8 hours and by the time she got seen, her stomach didn't hurt. I could have strangled her.