Talk to me when you get a $4000 bill for 2 hours in ER where the actual doc saw you for 5 mins and then the nurses did band-aid and over the counter burn ointment. This with Insurance (biggest mafia). AMerican Healthcare system baby!!
At no point did the ER staff ever talk to me. At no point was I in a room. Or in an ER bed, hallway or otherwise. Just ambulance, transport, and then to pre-op.
But, because the transfer physically happened in the ER, that second hospital tried to bill my insurance for an ER visit to the tune of $2,800 which I appealed (successfully, at least).
Shock, horror, you actually need to read through the form and select the appropriate checkboxes (around ability to stand, need for oxygen, fall risk and hazard, danger to self or others, etc., etc.)
Too many of them literally fill out patient demographics and a signature and say "here you go".
We push back because our organization policy is that we will transport those patients, BUT we would also much rather bill Medicare than the patient (our billing staff and C-suite may disagree, but EMTs and paramedics wholeheartedly understand that routine privately paid ambulance transport is not a viable option for 99.998% of the elderly).
How did the determination that you needed urology, "oops, no urology available", and ambulance transport get arranged? It seems like some level of triage, routing, unable, re-routing had to have happened, right?
But yes, hospital two tried to charge me for an ER visit, as well as the surgical billing (which of course was reasonable).
ER - life or death (if you can drive yourself, it's probably not an emergency)
Urgent Care - you have the flu, and your PCP isn't available; minor emergencies (but you can still drive yourself)
PCP - flu, check-ups, whatever
The balance billing and OON charges are separate issues from over-use of the ER.
Now the doctor has to put an appeal to explain medical necessity, I'm at his mercy.
An MRI shouldn't cost $26k, even with contrast, and at a hospital.
If this was non-emergency, it should have been pre-cleared with insurance per their policy.
You could fly to New Zealand, have a scan on a state of the art machine, get a good report, have 3 weeks holiday and fly home. You’d have heaps of money left over.
The ambulance ride alone from the accident site to the hospital (like, 5 miles) was several thousand dollars.
Probably the biggest surprise there is that a doctor saw you at all instead of you being filtered out by a triage nurse and sent to urgent care.
It is fairly common for someone to be advised to seek emergency treatment out of precaution to ensure that a minor symptom is not indicative of a severe problem.
For example dizziness can be a completely nothing-burger inner ear problem treated with a bunch of motions from youtube, or it can be a stroke. The ER exists to make that distinction.
Part of all those logistics and resources should be used to shunt people to the correct treatment center, but liability suits and extreme profitability mean that the incentive is to treat them in the ER.
Put into other terms, if you were hospital admin incentivized on billing, and could bill someone $5k instead of $160 for a non-urgent issue, wouldn't you? The fixed costs are the same, the ER is running 24/7 with a trauma team, might as well make it profitable.
I feel fairly comfortable assuming that they were being seen for a minor-to-moderate burn.
I don't know either, but the broader point is that people are referred to the ED by medical professionals for seemingly minor issues all the time, and that the incentives are all lined up to treat stupid shit in the ER rather than have someone tell them to go somewhere that makes more sense.
Isn't it CYA for any EMS to recommend you visiting the hospital, so they just say it to anyone. That allows them to later say that you failed to follow recommended advice.
In that case part of the treatment they received was emergency evaluation for smoke inhalation. Just because they don't end up giving you drugs or doing surgery about it doesn't mean the assessment wasn't a valuable service.
Well, at least, a functioning health care system shouldn't penalize for that sort of thing. We don't really have that in the US.
Insurance did try to deny coverage, but fortunately I appealed and won.
What matters is who picks up a bill (or challenges hospital and negotiates). I see little protection in US between patients and healthcare corporations, but its true I look from afar.
That solution doesn't really scream "emergency" and seems like a waste of their time and resources...
Some ERs don't always provide the level of care that they should, some doctors/insurance companies require patients to go to the ER for anything they need after office hours, and sometimes there's a need to be seen for something because of perfectly reasonable and valid concerns that it might be more serious than it ultimately ends up being.
While it's possible that the commenter's visit to the ER was a "waste of time and resources" I don't think it's fair to assume that from what was said.
Personally I am not qualified to determine what a treatable and non-treatable burn looks like. Where I went to school they don't teach that.
My order of operations for medical treatment are:
1) Virtual consultation. Free through my insurance. If you need to pay full price, this about as expensive as option 2. Also worth skipping if you can tell that an in person visit will be needed anyway.
2) A clinic. I use CVS's minute clinic. Looking at their price list [0], a minor burn treatment will run you about $100-$150, which is about what I would expect for talking to a professional.
3) Urgent Care
4) Emergency Room
This is further exacerbated by the limited safety nets in the US–even people who would on principle deign to sue others who tried to help them in a time of bad luck may find that a lawsuit is the only way they'll be able to maintain a decent lifestyle after the loss of a partner, or with a newfound need for long-term care.
One more layer is the fact that doctors are so overbooked. Many people cannot reasonably get appointments with their family doctor (if they have one) on short notice, so some things that, in the past, might have been a "wait-til-morning then call the GP to drop in same-day" are now "GP is booked three months out, guess we're going to the hospital".
Or maybe the patient didn't know what was required.