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Comment by FireBeyond | Hacker News Reader

I was in one hospital ER for a kidney stone, but they had no urology available, so they sent me via ambulance ("thankfully", as a paramedic, one of our company benefits was that if we were ever transported, they'd bill our insurance and waive any charges to us) to another hospital. Ambulance crew wheeled me into the ER bay, where a 'transport' gurney from surgery, was waiting, and I slid from one to the other, and was wheeled to pre-op.

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).

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One of our employees decided to go to a random hospital ER room for a small cut on his finger. It only required a bandage, no stitches. The ER charged us $3,300. We are still fighting them.

Fighting the ER or the employee? Sounds like it could have been handled at a PCP or urgent care or with a bandage at home? Staffing a full trauma center is expensive, it should cost a lot to use it.

Fighting the ER. The employee screwed up and did not go to the urgent care per policy for minor cuts. Still, it’s bad optics to fight an employee.

It’s bad optics to employ someone who doesn’t know what emergency means.

The system should not be that complex and full of traps. I rarely go to a doctor and when I have to go every few years I have no idea how things work and what to avoid.

It's not.

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.

If the system was honest, then the ER would send people to the right place instead of charging them an arm and a leg for basically nothing.

Your simplistic description shows that you don't even know what you're talking about! The ER is for far more than life or death. A broken bone -- no matter how minor -- is a perfectly reasonable reason to visit the ER. Urgent care may work just as well, but there are many reasons why urgent care might not be a great option for people in their circumstances.

ER is definitely not appropriate for a small cut requiring only a band-aid.

Sure. I never said otherwise. There’s obviously some judgement, and some areas won’t have an option. Bit to claim it’s too confusing to figure out (as the prior post suggested) is completely hyperbolic as well.

you're assuming that the employee had an urgent care center open available to them.

No assumption. The employee had several.

Lol true.

> At no point did the ER staff ever talk to me.

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?

Present with abdominal pain, admitted, CT imaging, pain management. Imaging read, kidney stone diagnosis confirmed (and of such a size that it needed immediate management). No urology available at hospital one, and because of narcotics on-board, transferred to nearby hospital via ambulance that did have a urologist available, so I could go straight to theater.

But yes, hospital two tried to charge me for an ER visit, as well as the surgical billing (which of course was reasonable).

I think you misunderstood their story. They [rightfully] got charged for the ER at Hospital #1, but were mistakenly charged for the ER a second time at Hospital #2.

Indeed I did. It now says "second hospital" in the last paragraph. I can't know whether I mis-read or if it was edited to clarify, but I definitely did misunderstand the story.

My elderly disabled mom on a fixed income is being billed for an ambulance ride from a hospital to a long-term care facility because Medicare deemed it "unnecessary" even though the shuttle couldn't take her.

I'm sorry. Hospital staff are notoriously bad for incorrectly filling out the paperwork that Medicare requires to justify ambulance transport, such that we (paramedics and EMTs) are constantly explaining it to them.

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).

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