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We are acutely aware of the differences in treatment and delay at different facilities. Unfortunately, many insurance providers don't cover all facilities - Medicare Advantage for example is liable to boot your aging mother's butt out on the street if they are not in Network. Our system STINKS.
Let’s clear up this misunderstanding:
Eligible enrollees have a choice between traditional Medicare ( and a Supplimental plan if they can afford it) or an Advantage Plan. If the enrollee is healthy and does not mind oftentimes very narrow networks, the Advantage option may make more financial sense. The enrollee may opt back into traditional Medicare during a subsequent Open Enrollment period, if they prefer more broad coverage.
By law, Advantage Plans must cover an ER visit anywhere in the US, regardless of network. It also makes clear the ER reimbursement is based on symptoms, not the diagnosis. For example, if an Advantage Plan enrollee presents in the ER with chest pain and the diagnosis is indigestion, it is required to reimburse the ER/ hospital, no different than a serious diagnosis.
By law, Advantage Plans must cover an ER visit anywhere in the US, regardless of network. It also makes clear the ER reimbursement is based on symptoms, not the diagnosis. For example, if an Advantage Plan enrollee presents in the ER with chest pain and the diagnosis is indigestion, it is required to reimburse the ER/ hospital, no different than a serious diagnosis.
True, but can't your copay still be different for an out of network ER?
Do you really want to compare how much is paid in taxes to actual health care bills? You seriously even want to attempt to try that?
It might be a better deal or it might not be. Either way it is not free. And when Canadians come to the US for medical care that they couldn't get in Canada or it was going to take too long, which they do, how does that resolve with the high taxes they pay to receive their "FREE" care?
True, but can't your copay still be different for an out of network ER?
There are copays and coinsurance fees for ER visits and services performed in relation to the ER visit, with Traditional Medicare and an annual deductible.
Much depends on if the enrollee was admitted as a result of the ER visit or discharged. There is also different schemes, ER vs Urgent Care.
Traditional Medicare Supplimental Plan enrollees often buy Supplimental Plans ( medigap) to pay for all of some of the charges, Medicare does not.
Bottom line, Advantage Plans cannot charge more when an out of network ER is used.
Go to a different doctor. They will get the hint and fix the problem.
Talking about ERs, not doctors, here.
No ER operates on a first come/ first served basis. Wait times are highly variable based on the patient’s symptoms and load.
Those with immediate life threatening symptoms will receive attention before someone with a broken wrist.
Level 1 Trauma Centers are the highest level of ERs in the US. They are more likely to receive inbound from serious car accidents, gunshots wounds and other acts of serious violence. Someone with a broken wrist is more likely to experience a serious wait in one of these hospitals, especially during peak overnight shifts and/ or events associated with high consumption rates of alcohol. Then there’s the sudden impact of relatively large scale mass shootings which can result in diversions to other hospitals as a part of an overall triage plan.
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