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I wasn't referring to you, I was speaking in general. I could be on board with universal basic and life-saving care, but there'd have to be very clear restrictions.
Regarding gouging some people so other people can get away with paying nothing - what's the solution? In most cases, hospitals have to accept anyone in the ER - even though those who can't or won't pay. The hospital has bills to pay too, and they can't simply absorb all of the costs of non-payers. My brother is an ER doc and when someone doesn't pay, he doesn't get paid. At one hospital, he didn't get paid for over 50% of his time. Look at it this way: suppose you work as a construction supervisor. Midway through a large project, the buyer pulls out. Should you and you coworkers absorb the cost? Of course not. The lost revenue is recovered through higher prices on future projects. That's all the hospital is doing: recovering lost revenue by spreading it around to people who actually pay.
The words might make sense but if you think about it quantitatively this is crazy. Even if a full 50% of services were not paid (which is unlikely to be true) that would require costs to double, not 10x. The size of the bill this woman has received is absurd, it is not justified by or needed to offset uncompensated care, and that the hospital can pursue her for it is a failure of our legal system that should be fixed.
Quote:
Originally Posted by ContraPagan
And unlike here in the US, Norwegians actually get a decent return on the taxes they pay. Their entire system is geared towards taking care of EVERYBODY, not just the so-called "1%."
Funny how you get more for the same amount of tax dollars when your society and government are being underwritten by oil wealth.
there is not enough info in the vox article to make any kind of informed judgement about the validity of insurance company's decision and the woman's decision to visit the er.
Brittany should have called her primary care physician before going to the hospital. Were not getting the whole story here.
I've been in a similar situation a couple of times and did call my primary care physician and/or the nurse help-line for our insurance company. Now this is after hours and no one does house calls any more. So not wanting the possible liability of a miscall, what do they tell you?
Go ... to ... the ... emergency room.
We're not in one of the four states named here and so the charges have never exceeded our deductible.
Must say, that makes sense for who WANTS to go to an emergency room to wait around for hours. You only go because you know you're not competent to decide what is and is not an life threatening emergency and no professional is about to decide for you on the phone.
But now these insane charges?
This *might* be theoretically justifiable if it's during business hours or when a patient might have access to an urgent care facility - although even then you're taking a "chance."
But if not ... guess wrong and die and/or guess wrong and pay $12,000 - THAT's a broken system.
Crazy.
Last edited by EveryLady; 02-03-2018 at 05:19 PM..
there is not enough info in the vox article to make any kind of informed judgement about the validity of insurance company's decision and the woman's decision to visit the er.
She got it approved on appeal - that says that the insurer themselves decided their initial decision was wrong in her case. There are cases where people abuse the ER, but this wasn't one of them, which is why it became article-fodder and why the insurer reversed their own earlier call. Anthem will eventually save a lot of money for themselves and their customers through lower rates by cracking down on unnecessary ER frequent fliers but they need to tighten up on their program to not have false positives like this where they deny improperly for appropriate care and judgement.
Per the article, Anthem wants to limit ER visits in the four named states to :
The Anthem letter goes on to list “stroke, heart attack, and severe bleeding” as examples of medical conditions for which ER use would be acceptable.
But according to Medline these are the guidelines:
Quote:
Signs of an Emergency
How quickly do you need care? If a person or unborn baby could die or be permanently disabled, it is an emergency.
Call 911 to have the emergency team come to you right away if you cannot wait, such as for:
Choking
Stopped breathing
Head injury with passing out, fainting, or confusion
Injury to neck or spine, especially if there is loss of feeling or inability to move
Electric shock or lightning strike
Severe burn
Severe chest pain or pressure
Seizure that lasted 3 to 5 minutes
Go to an emergency department or call 911 for help for problems such as:
Trouble breathing
Passing out, fainting
Pain in the arm or jaw
Unusual or bad headache, especially if it started suddenly
Suddenly not able to speak, see, walk, or move
Suddenly weak or drooping on one side of the body
Dizziness or weakness that does not go away
Inhaled smoke or poisonous fumes
Sudden confusion
Heavy bleeding
Possible broken bone, loss of movement, especially if the bone is pushing through the skin
Deep wound
Serious burn
Coughing or throwing up blood
Severe pain anywhere on the body
Severe allergic reaction with trouble breathing, swelling, hives
High fever with headache and stiff neck
High fever that does not get better with medicine
Throwing up or loose stools that does not stop
Poisoning or overdose of drug or alcohol
Suicidal thoughts
Seizures
When to Go to an Urgent Care Clinic When you have a problem, do not wait too long to get medical care. If your problem is not life threatening or risking disability, but you are concerned and you cannot see your provider soon enough, go to an urgent care clinic.
The kinds of problems an urgent care clinic can deal with include:
Common illnesses, such as colds, the flu, earaches, sore throats, migraines, low-grade fevers, and limited rashes
Minor injuries, such as sprains, back pain, minor cuts and burns, minor broken bones, or minor eye injuries
There's a disconnect here - with "severe pain" listed as reason for an ER visit as is "trouble breathing" - that an earlier poster said led to a denial for their child even though one hospital transferred the child to another hospital.
She got it approved on appeal - that says that the insurer themselves decided their initial decision was wrong in her case. There are cases where people abuse the ER, but this wasn't one of them, which is why it became article-fodder and why the insurer reversed their own earlier call. Anthem will eventually save a lot of money for themselves and their customers through lower rates by cracking down on unnecessary ER frequent fliers but they need to tighten up on their program to not have false positives like this where they deny improperly for appropriate care and judgement.
I think we let the accepting ER docs decide. If the patient came in with abdominal pain and the doc ordered a CT scan right then and there, that should be considered emergent. Here's a bentyl call your doc in the morning is probably not.
Anthem can save money by training their patients to use their urgent care more often. But it won't happen overnight, maybe a year to get the word out. The urgent care facility can always refer up to the ER if deemed necessary.
The problem is that nothing they did for her costs anywhere near even a fraction of the bill.
Yeah, what in the **** was provided that costs, or is any way in the realm of reality, worth that kind of money?
Our healthcare system is a disgrace.
When I had my first child 20 something years ago, they had the "24 hours and out" policy. Meaning, if there were no complications with mother or baby, you left the hospital in 24 hours. I had an easy delivery, they kept the baby in the room with me the whole time for ME to change and feed, then released us the next day, and the bill was some hugely inflated cost even back then. Fortunately, I had a job that had halfway decent insurance coverage. Really, all the doctor did was give me some good drugs and cut the umbilical cord.
I could have stayed at the nicest, ritziest hotel in town, had room service delivered to my door, hired a nanny to take care of the baby, and just used a midwife, and some good drugs, for the three hour delivery, and come out WAY cheaper than what the insurance company was charged for the crappy hospital room.
The problem is NOT that people lack insurance. It is the obscene cost of care and profiteering that has been, and is still going on!
Yeah, what in the **** was provided that costs, or is any way in the realm of reality, worth that kind of money?
Read my earlier post. Unless you are a hospital administrator, you have no idea what sort of overhead costs (including covering for people who don't pay their bills, malpractice insurance, etc.) are rolled into the bill. As such, you've drawn a conclusion based on insufficient data.
The words might make sense but if you think about it quantitatively this is crazy. Even if a full 50% of services were not paid (which is unlikely to be true) that would require costs to double, not 10x. The size of the bill this woman has received is absurd, it is not justified by or needed to offset uncompensated care, and that the hospital can pursue her for it is a failure of our legal system that should be fixed.
.
Bills are inflated for reasons other than to cover unpaid bills. Malpractice insurance for example. Again, there simply isn't enough empirical data to proclaim the bill outrageous.
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