Health insurance in the news

[Hawkmoon]

New trick from Anthem:

https://www.cbsnews.com/news/anthem-among-health-insurers-refusing-to-pay-er-bills-doctors-say/

[Regolith]

It would be nice to find a way to keep malingerers and addicts from unnecessarily using the ER, but I seriously doubt this is the way to do it...

[dogmush]

meh.

I'm kind of on Anthem's side.Folks use ER's like a walk in clinic and Ambulances like an Uber.  Certainly you shouldn't have to Dr. House yourself before calling for help, but a little understanding of the word "Emergency" isn't unwarranted.

Since health insurance is , at it's base, spreading the cost of health care around the pool, I'm not outraged that snowflakes that are just SURE their pain is 10 on the scale are given a reason to think twice before running up huge bills.  It's bad enought I have to subsidize the uninsured at ER's without adding the drama queens.

[MechAg94]

Someone needs to tell irresponsible people no every now and then so they think about the alternatives. 

On the other side, is $12,000 for a walk in Emergency Room visit reasonable?  That sounds like the hospital is inflating the bill since that patient had insurance.  I guess it depends on what all they did. 


At some point we really need to allow hospitals to turn away patients or provide minimal life saving care without taking on unlimited liability.  Either turn them away for come up with some way to hold them accountable for the bill.

[lupinus]

My insurance started that this year, and is keeping it for next year. Non-emergency use of the emergency room is no longer covered.

Which I'm fine with, if you've got a runny nose or strep throat take your ass to your regular doc or favorite doc in a box. We've also got MDLive coverage for five bucks, which is nice for relatively minor things regardless of it being after hours or not. My doc hates it but sorry doc, for five bucks and convince of a phone chat I'm calling them when I'm coming down with the flu or strep or something so they can confirm symptoms by consult or visuals on a video chat and call in a script for me.

All that said, we often fall back on the play stupid games win stupid prizes mantra and in this case it goes both ways. Folks being stupid have won the stupid prize of no longer getting to use the ER for the sniffles. But as much as I dislike government sticking it's nose in, if the insurance industry is going to to play such games when folks reasonably think they have an emergency it comes as no real surprise when they too win the stupid prize of the .gov smacking their hand with yet another regulation telling them they can't do that.

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[Nick1911]

Good.  Over inflated prices to private medical insurers are the only thing keeping ER departments afloat, offsetting the losses from Medicare, Medicad and uninsured persons.

Hospitals, on average, earned a 39.6 profit margin for privately insured ED patients. What were the margins on the other insurers? For Medicare, the margin totaled -15.6 percent, while Medicaid was -35.9 percent. Uninsured ED patients led to a -54.4 percent operating margin for hospitals.

Perhaps this can force ER's to close down.

[K Frame]

This is becoming an increasing problem, and it's causing a LOT of concern because it's forcing people to determine, on their own, what constitutes and emergency and what doesn't. It's a bullshit move by insurers in far too many cases.

Yes, people abuse the emergency room. But others don't, believing that they are actually in medical distress. The person in the article is a very good example. The pain she experienced could reasonably be perceived to be acute appendicitis or even a descending aortic aneurysm. A ruptured appendix can kill you in hours, a ruptured aortic aneurysm can kill you in minutes.

Back to the subject of ER/ambulance abuse... I'm not sure of what the recent studies have shown, but the people most prone to using the ER like a family doctor and the ambulance like a taxi are the poor who either don't have insurance, or who have marginal insurance and who live in medically underserved areas.

[Ben]

Back to the subject of ER/ambulance abuse... I'm not sure of what the recent studies have shown, but the people most prone to using the ER like a family doctor and the ambulance like a taxi are the poor who either don't have insurance, or who have marginal insurance and who live in medically underserved areas.

Slight tangent, but I don't understand how in the time of Uber, there aren't more credentialed and vetted "medical transport" services to take people to the doctor. Whether for non-emergency urgent care, elderly medical transport, or stuff like colonoscopies, where you don't get the choice not to be knocked out anymore, and often have to inconvenience someone to be your ride. Stuff like the latter is where "credentialed and vetted" come in, since the passenger is often a little out of it.

Seems like there would be a market for "non-ambulance ambulances".

[dogmush]

Back to the subject of ER/ambulance abuse... I'm not sure of what the recent studies have shown, but the people most prone to using the ER like a family doctor and the ambulance like a taxi are the poor who either don't have insurance, or who have marginal insurance and who live in medically underserved areas.

Anecdotes are not data but I know a bunch (like 4 or 5 families in a shop that employees 18) whom have good health insurance and just don't like going to a Dr.  Their standard practice is to go to an ER if they feel bad enough that they want pills, and skip the whole Primary Care Physician thing.  I think that kind of attitude is more prevalent than many think.

I think Lupinus is also correct.  Both sides are playing stupid games here.

As I said before though, for me personally, I'd rather not pay for every hypochondriac's sneeze when the insurance company passes the costs on to the other people in the pool, so I'm OK with a little stricter versions of what constitutes an "Emergency".

FWIW, in Tampa there are several "Urgent Care" clinics run by hospitals that kinda bridge the gap between "ER" and "Call Doc on Monday".  It's also my opinion that if you are able to transport yourself to the medical facility, it's probably not an emergency, so don't go to the ER.

[lupinus]

Anecdotes are not data but I know a bunch (like 4 or 5 families in a shop that employees 18) whom have good health insurance and just don't like going to a Dr.  Their standard practice is to go to an ER if they feel bad enough that they want pills, and skip the whole Primary Care Physician thing.  I think that kind of attitude is more prevalent than many think.

I think Lupinus is also correct.  Both sides are playing stupid games here.

As I said before though, for me personally, I'd rather not pay for every hypochondriac's sneeze when the insurance company passes the costs on to the other people in the pool, so I'm OK with a little stricter versions of what constitutes an "Emergency".

FWIW, in Tampa there are several "Urgent Care" clinics run by hospitals that kinda bridge the gap between "ER" and "Call Doc on Monday".  It's also my opinion that if you are able to transport yourself to the medical facility, it's probably not an emergency, so don't go to the ER.

We have a lot of the doc in a box here also. The local hospital also has it's own. They share the same general parking lot with the ER side of the hospital, but its a separate building. It's nice because they generally have the most capability, and if they take a look and decide you need the ER instead ten it's right there.

I'm be fine with them saying that they're no longer going to pay for non emergency use of the ER. The problem is that they're just using it as an excuse to cut costs by not paying what should be legitimate claims. So if they get smacked down with yet another regulation, I'd say it's on them and one that's actually well deserved.

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[MillCreek]

A couple of things:

There are cabulance and other medical transport services that will haul you hither and yon to your appointments and the like.  I am now getting solicitations from Uber:  https://www.uber.com/newsroom/uber-health/

If you go to the urgent/walk-in/physician clinic, that just so happens to be owned by the hospital, you will likely get a hefty 'facility fee' added to your bill:  https://www.marketwatch.com/story/how-facility-charges-could-add-hundreds-of-extra-dollars-to-a-doctors-visit-2017-05-03  or an after-hours surcharge: https://www.wric.com/news/8-investigates/exposing-hidden-fees-for-er-and-urgent-care-facilities_2018032002043989/1059767533

Or some places will charge you for walking out the door: https://www.vox.com/2018/5/1/17261488/er-expensive-medical-bill

[MillCreek]

https://www.webmd.com/special-reports/er-violations/20181129/hospital-overview?src=RSS_PUBLIC

https://www.webmd.com/special-reports/er-violations/20181129/women-in-labor?src=RSS_PUBLIC

Two interesting studies about hospitals violating the EMTALA regulations.

[AmbulanceDriver]

https://www.webmd.com/special-reports/er-violations/20181129/hospital-overview?src=RSS_PUBLIC

https://www.webmd.com/special-reports/er-violations/20181129/women-in-labor?src=RSS_PUBLIC

Two interesting studies about hospitals violating the EMTALA regulations.

haven't read through these articles yet, but I'm surprised.  Hospitals around Portland seem to be absolutely terrified of coming within 100 miles of thinking about possibly considering anything that might even remotely sound like it might possibly violate EMTALA.