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ER Costs Outrage

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bebe

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So in February, my 22yr. old son, college student calls home. Mom, I have a really sore throat, fever, headache, and my neck hurts.
Eeek! This was after I knew he had a sore throat a week prior to him calling me. So I told him to get to a Dr. quickly. I suspected the worst of
course, Mennigitis. He went to a local ER, he couldn''t get into a Dr.''s office on such short notice.
Anyway, he goes to the ER, waits forever. The Dr. says he will be fine, tells him to take some over the counter meds. (huh???)

A week later he was still sick, managed to get into the campus clinic. Infected ears, sinus infection, red throat. Dr. prescribes
antibiotics. $10.00 for the visit.

My huge gripe - the ER visit is over $2,000.00 !!!! And our insurance is not paying much. How can this cost this much???
 

oobiecoo

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Wow that does seem high... I''ve been to the ER twice in the past couple of years and each time I want to say was around $500-$1000. Did you get an itemized bill? Sorry you have to deal with such outrageous costs
 

bebe

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Son just got the bill, he is mailing it to us. The Dr.''s "visit" alone was 516.00 !!

DH says he is calling the hospital, this is outrageous. The doc didn''t see him for more than a few minutes!!
And sent him home without any meds or scripts !!
 

neatfreak

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He doesn't have insurance I assume?

Unfortunately those insane prices often go to pay for all the insurance doctors have to carry in the US because we are so sue happy...

But I agree it's insane. If your DH calls you can likely negotiate a smaller bill especially if he's willing to pay upfront.
 

kama_s

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You have GOT to be kidding me. That''s outrageous. I just can''t wrap my head around it. I really hope you dont have to pay it all.

ER visits are completely 100% free here in Canada.
 

movie zombie

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there are those that would argue that going to an ER for a sore throat is outrageous............you feared the worst and had it been the worst, i don''t think you''d be upset by this bill. you''d be thankful he''d received care.

there are walk-in clinics open 24/7 [or have extended hours] that accept insurance. chalk it up to an expensive lesson and research alternatives because it is possible he will need medical attention on short notice once again. checkout Doctors on Call and other groups before the next "emergency" so he''ll know where to go other than ER.

mz

 

bebe

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Date: 4/6/2009 9:00:55 PM
Author: neatfreak
He doesn''t have insurance I assume?

Unfortunately those insane prices often go to pay for all the insurance doctors have to carry in the US because we are so sue happy...

But I agree it''s insane. If your DH calls you can likely negotiate a smaller bill especially if he''s willing to pay upfront.
Yes, we have insurance, he is insured. The insurance company will only pay a certain amount. Our fault for him going to a out of network
facility, but still it''s the total cost of the visit that is making my blood boil!!
 

canuk-gal

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HI:

Seem high--did he see a specialist? Can you write any of it off via Income Tax?

cheers--Sharon
 

cara

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Its not just sue-happy that causes the costs to be so high. Its that the insurance reimbursement system basically drives up the "normal" price that gets charged to uninsured/underinsured/out-of-network people, while all the benefit of negotiated cost-savings goes to the insurance companies and in-network doctors. There is a huge discrepancy between what the hospital usually bills and what it expects to receive from an insurance company... except out-of-network or uninsured people get socked with the whole bill and have much less bargaining power.

For example, for my friend's completely normal, regular birth of a healthy child the hospital billed over $30k. But they actually received less than $10k total from her insurance and from her copays (I believe it was around to $8k) because that was the amount the insurance had negotiated with the hospital and doctors for those services under their contract. An uninsured person would have received the full $30k bill and then had to start their negotiations with the hospital to lower their bill from that point... And even with significant reductions, the chances of getting it down to $8k are not so good. So you are doubly screwed without insurance.

movie-zombie, maybe bebe's was wrong to send her son to the hospital when she suspected meningitis, but isn't the whole point that a DOCTOR should be consulted to accurately distinguish a minor illness from a life-threatening one with some shared symptoms? And congratulations to bebe, for your wrong suspicions there is a $2000 fine.

This is why our health system is such a backwards shambles. People will ignore a lot of warning signs about imminent emergencies if they might get slapped with a $2000 fine for being wrong. Sure, it would be one thing if Bebe or her son knew it was a minor illness and just wanted treatment at the ER for convenience, but that is not the case here.
 

bebe

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Thanks for all the thoughts everyone. The cost just seems so freaking outrageous to us. I spoke with our son just a short while ago.
He confirmed the only test the ER did was a Strep swab on his throat. Nothing else. He even mentioned the Meningitis to the nurse,
guess she assumed he didn''t have it. Geez.

We know well enough not to go to an ER for something as minor as a sore throat. But he really felt awful and in fact, he was scared.
The local clinics were already closed, campus clinic was closing and told him they could see him in 2 days. He really didn''t have much of
an option but to go to an ER. I am not familiar with the town, so I don''t know which hospital is better.... I DO wish he had called me
and asked about insurance, but I felt some comfort knowing he was covered. I don''t mind paying out of network fees, I do it all the time.
It''s the absurd amount that was charged.
 

zhuzhu

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I am sorry that it had happened to you. Unfortunately, the cost you mentioned is pretty universal in all ERs. I have really good insurance, but it only pays 80% of ER visit, and my last visit to ER (a suspected costed me >400 out of packet.

Again, sorry that you must find out this way.
 

Deelight

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Date: 4/6/2009 9:04:50 PM
Author: kama_s



You have GOT to be kidding me. That''s outrageous. I just can''t wrap my head around it. I really hope you dont have to pay it all.


ER visits are completely 100% free here in Canada.
Ditto, they are completly free in Australia too - so what happens if your dying/injured badly need to go to the ER and can''t afford to pay?
 

musey

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My dad's an ER doc and all ailments are pre-diagnosed with him over the phone... so it's often beyond me why people go to the ER for things like a persistent sore throat. I don't mean any offense at all to you or your son, bebe, I'm just saying that after growing up with it (and his constant complaining over people who crowd the ER with more minor ailments), my first reaction is always, well, less extreme.

Getting an 'emergency' appointment with an ENT doc at his college's health center/clinic would most likely have taken less than a day (I'm not talking about calling for an appt, I'm talking about him going in and waiting until someone was available), and would have cost a whole lot less. A sore throat isn't even a primary symptom of meningitis, anyhow.

The bottom line is that he is your baby, and for that reason you needed FAST assurance of his health. You got it. It cost you $2,000+. That (and more) is often the cost of peace of mind. You could have waited a few more days for him to see an (in-network) ENT doc and it would have cost you much less (the $10, apparently), but you'd have been worried about meningitis the whole time.


There are a lot of reasons why an ER visit costs a heck of a lot more than an ENT visit. Rest assured that it is not to pay hefty salaries for the ER docs
 

zhuzhu

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I believe most times you have to already be an established patient before you can even make an ''emergency'' appointment with any doc. At the time of my ER visit I just moved to the city and had no establishment with any PCP facility. I called several offices to make emergency appointment and they all told me the same thing "you have to be our patinet for us to see you, the next available 1st patient appointmen is in X weeks(months), if you need to be seen you today have to go to the ER".

The US healthcare system is a mess, and I really hope the reform will come soon~~!
 

trillionaire

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Date: 4/7/2009 1:33:43 AM
Author: musey
My dad''s an ER doc and all ailments are pre-diagnosed with him over the phone... so it''s often beyond me why people go to the ER for things like a persistent sore throat. I don''t mean any offense at all to you or your son, bebe, I''m just saying that after growing up with it (and his constant complaining over people who crowd the ER with more minor ailments), my first reaction is always, well, less extreme.

Getting an ''emergency'' appointment with an ENT doc at his college''s health center/clinic would most likely have taken less than a day (I''m not talking about calling for an appt, I''m talking about him going in and waiting until someone was available), and would have cost a whole lot less. A sore throat isn''t even a primary symptom of meningitis, anyhow.

The bottom line is that he is your baby, and for that reason you needed FAST assurance of his health. You got it. It cost you $2,000+. That (and more) is often the cost of peace of mind. You could have waited a few more days for him to see an (in-network) ENT doc and it would have cost you much less (the $10, apparently), but you''d have been worried about meningitis the whole time.


There are a lot of reasons why an ER visit costs a heck of a lot more than an ENT visit. Rest assured that it is not to pay hefty salaries for the ER docs
this whole system is ludicrous. Americans should be ashamed and outraged.
 

musey

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Date: 4/7/2009 2:49:21 AM
Author: trillionaire
Date: 4/7/2009 1:33:43 AM
Author: musey
My dad''s an ER doc and all ailments are pre-diagnosed with him over the phone... so it''s often beyond me why people go to the ER for things like a persistent sore throat. I don''t mean any offense at all to you or your son, bebe, I''m just saying that after growing up with it (and his constant complaining over people who crowd the ER with more minor ailments), my first reaction is always, well, less extreme.

Getting an ''emergency'' appointment with an ENT doc at his college''s health center/clinic would most likely have taken less than a day (I''m not talking about calling for an appt, I''m talking about him going in and waiting until someone was available), and would have cost a whole lot less. A sore throat isn''t even a primary symptom of meningitis, anyhow.

The bottom line is that he is your baby, and for that reason you needed FAST assurance of his health. You got it. It cost you $2,000+. That (and more) is often the cost of peace of mind. You could have waited a few more days for him to see an (in-network) ENT doc and it would have cost you much less (the $10, apparently), but you''d have been worried about meningitis the whole time.


There are a lot of reasons why an ER visit costs a heck of a lot more than an ENT visit. Rest assured that it is not to pay hefty salaries for the ER docs
this whole system is ludicrous. Americans should be ashamed and outraged.
I''m not defending the system.
 

bebe

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Date: 4/7/2009 1:33:43 AM
Author: musey
My dad''s an ER doc and all ailments are pre-diagnosed with him over the phone... so it''s often beyond me why people go to the ER for things like a persistent sore throat. I don''t mean any offense at all to you or your son, bebe, I''m just saying that after growing up with it (and his constant complaining over people who crowd the ER with more minor ailments), my first reaction is always, well, less extreme.

Getting an ''emergency'' appointment with an ENT doc at his college''s health center/clinic would most likely have taken less than a day (I''m not talking about calling for an appt, I''m talking about him going in and waiting until someone was available), and would have cost a whole lot less. A sore throat isn''t even a primary symptom of meningitis, anyhow.

The bottom line is that he is your baby, and for that reason you needed FAST assurance of his health. You got it. It cost you $2,000+. That (and more) is often the cost of peace of mind. You could have waited a few more days for him to see an (in-network) ENT doc and it would have cost you much less (the $10, apparently), but you''d have been worried about meningitis the whole time.


There are a lot of reasons why an ER visit costs a heck of a lot more than an ENT visit. Rest assured that it is not to pay hefty salaries for the ER docs
Musey, I totally understand where you are coming from. The campus clinic was closing when he called and told him they couldn''t see him, even though he explained his situation. Local emergency clinics had already closed. But his symptoms were more than just a simple sore throat. Believe me this kid rarely goes to a doctor. His headache was so bad his friend had to drive him to the ER. His neck pain came on suddenly. That was alarming to me. I didn''t think waiting was a wise idea. I understand your point, it is just the outrageous cost of it all. Just this morning on ABC''s Good Morning America, they had a segment about abusive over costs related to hospital charges. I can now say I feel part of that group. The doctor''s fee alone was 516.00, there was 1800.00 in ER costs. I will pay what I have to, it is the costs that I see as a ripoff. I assumed the visit might be around 1,000., never dreamed over 2,000. Lesson learned.
 

cara

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Pre-diagnosing illnesses over the phone? Without seeing the patient, a stranger? And by a doctor, not a nurse? Wow. I don't/didn't know that you can get an ER doc on the phone at your average ER. That seems great if that service is available in your local hospital, but a significant liability to the doctor/hospital providing that service. I can't imagine that all ERs operate that way.

Musey, maybe you are better than your average person at diagnosing yourself. Maybe you can always get your dad (or another doctor) on the phone to consult over something that may be serious. I think your average person should not need to accurately diagnose themselves 100% of the time prior to seeing a doctor without being socked with big fees. And the incentives are perverse. Just as there are people who may go to the ER with only a sore throat, there are people that delay needed treatment and ignore serious warning signs because they are concerned about being socked with the big fee. Studies have shown that even the $20 copay charged by insurance causes *some people* to postpone/avoid needed treatment and preventive care. $2000 is enough to make many people ignore their heart attack, at least at first.
 

cara

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Date: 4/7/2009 1:22:03 AM
Author: Deelight
Date: 4/6/2009 9:04:50 PM

Author: kama_s


You have GOT to be kidding me. That's outrageous. I just can't wrap my head around it. I really hope you dont have to pay it all.

ER visits are completely 100% free here in Canada.
Ditto, they are completly free in Australia too - so what happens if your dying/injured badly need to go to the ER and can't afford to pay?
ERs are required to treat you if you are dying/badly injured RIGHT NOW regardless of your ability to pay. But they are allowed to bill you after, set up a lifetime payment plan, etc.


For example, a friend of my father's fell through a roof and broke both legs. He had no insurance even though he was in his 50s and should know better (though being in his 50s insurance was pretty expensive and he earns little, is divorced with 3 kids). They transported him to the hospital, treated him, performed surgery and put rods in both legs, but released him when he was stable after surgery and didn't perform any rehab or follow up surgeries. He now walks with a limp, where a better outcome was likely with more care. In a case like this, sure he got an appropriate amount of "free" care for someone stupid enough to be doing non-union construction work without insurance. But is society really better off with a gimpy 60 yro handyman?

The really hard situations is when someone is deadly sick, but not with an emergency. ERs are required to treat emergencies, but the middle ground things like certain cancers or other illnesses that are deadly, but not today, can be very hard to find someone willing to treat for free. There are charity clinics and organizations that work with certain diseases or groups, but some cases fall through the cracks.
 

Deelight

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Date: 4/7/2009 10:35:32 AM
Author: cara
Date: 4/7/2009 1:22:03 AM

Author: Deelight

Date: 4/6/2009 9:04:50 PM


Author: kama_s




You have GOT to be kidding me. That''s outrageous. I just can''t wrap my head around it. I really hope you dont have to pay it all.


ER visits are completely 100% free here in Canada.

Ditto, they are completly free in Australia too - so what happens if your dying/injured badly need to go to the ER and can''t afford to pay?
ERs are required to treat you if you are dying/badly injured RIGHT NOW regardless of your ability to pay. But they are allowed to bill you after, set up a lifetime payment plan, etc.



For example, a friend of my father''s fell through a roof and broke both legs. He had no insurance even though he was in his 50s and should know better (though being in his 50s insurance was pretty expensive and he earns little, is divorced with 3 kids). They transported him to the hospital, treated him, performed surgery and put rods in both legs, but released him when he was stable after surgery and didn''t perform any rehab or follow up surgeries. He now walks with a limp, where a better outcome was likely with more care. In a case like this, sure he got an appropriate amount of ''free'' care for someone stupid enough to be doing non-union construction work without insurance. But is society really better off with a gimpy 60 yro handyman?


The really hard situations is when someone is deadly sick, but not with an emergency. ERs are required to treat emergencies, but the middle ground things like certain cancers or other illnesses that are deadly, but not today, can be very hard to find someone willing to treat for free. There are charity clinics and organizations that work with certain diseases or groups, but some cases fall through the cracks.
Thanks for clarifying cara the last paragragh you posted me go
, I know our healthcare system is far from perfect but the thought of having someone suffering from a disease that could be cured with the right treatment but missing out just astounds me.
 

movie zombie

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quotes:
The US healthcare system is a mess, and I really hope the reform will come soon~~!
and
this whole system is ludicrous. Americans should be ashamed and outraged.




both are understatements.

mz
 

musey

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Date: 4/7/2009 9:12:18 AM
Author: bebe
Date: 4/7/2009 1:33:43 AM
Author: musey
My dad''s an ER doc and all ailments are pre-diagnosed with him over the phone... so it''s often beyond me why people go to the ER for things like a persistent sore throat. I don''t mean any offense at all to you or your son, bebe, I''m just saying that after growing up with it (and his constant complaining over people who crowd the ER with more minor ailments), my first reaction is always, well, less extreme.

Getting an ''emergency'' appointment with an ENT doc at his college''s health center/clinic would most likely have taken less than a day (I''m not talking about calling for an appt, I''m talking about him going in and waiting until someone was available), and would have cost a whole lot less. A sore throat isn''t even a primary symptom of meningitis, anyhow.

The bottom line is that he is your baby, and for that reason you needed FAST assurance of his health. You got it. It cost you $2,000+. That (and more) is often the cost of peace of mind. You could have waited a few more days for him to see an (in-network) ENT doc and it would have cost you much less (the $10, apparently), but you''d have been worried about meningitis the whole time.


There are a lot of reasons why an ER visit costs a heck of a lot more than an ENT visit. Rest assured that it is not to pay hefty salaries for the ER docs
Musey, I totally understand where you are coming from. The campus clinic was closing when he called and told him they couldn''t see him, even though he explained his situation. Local emergency clinics had already closed. But his symptoms were more than just a simple sore throat. Believe me this kid rarely goes to a doctor. His headache was so bad his friend had to drive him to the ER. His neck pain came on suddenly. That was alarming to me. I didn''t think waiting was a wise idea. I understand your point, it is just the outrageous cost of it all. Just this morning on ABC''s Good Morning America, they had a segment about abusive over costs related to hospital charges. I can now say I feel part of that group. The doctor''s fee alone was 516.00, there was 1800.00 in ER costs. I will pay what I have to, it is the costs that I see as a ripoff. I assumed the visit might be around 1,000., never dreamed over 2,000. Lesson learned.
I don''t blame you (or him) for heading to the ER. If his symptoms were bad enough that that occurred as an option, then obviously that was the place for him to be at the time.

edit: I''ll address more in my reply to cara below...
 

musey

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Date: 4/7/2009 10:04:50 AM
Author: cara
Pre-diagnosing illnesses over the phone? Without seeing the patient, a stranger? And by a doctor, not a nurse? Wow. I don't/didn't know that you can get an ER doc on the phone at your average ER. That seems great if that service is available in your local hospital, but a significant liability to the doctor/hospital providing that service. I can't imagine that all ERs operate that way.

Musey, maybe you are better than your average person at diagnosing yourself. Maybe you can always get your dad (or another doctor) on the phone to consult over something that may be serious.
Cara, perhaps I wasn't clear. I wasn't suggesting that people could or even should expect to be able to consult with a doctor/nurse on the phone. I was giving a disclaimer for my post, in case it seemed to be from an odd/harsh perspective. Since I grew up with an ER doc in my house, it's difficult for me to imagine going to the ER for... well, almost anything. Because 99% of the time I'd list symptoms, he's say: "You have cancer. Just kidding, you're fine. It's probably __________. If you start ________ing, then we'll get you checked out."

Bebe was saying that they only did a swab (plus lab tests for the swab, which for me even at my college clinic with an appt. ran me $600+, covered by insurance, of course), and the main point of my post was only that the primary thing most people pay for at the ER is peace of mind. It's very expensive, for many reasons which have already been mentioned (and more), but also because it is to be reserved for emergencies. There is a lot of abuse of the ER. I can't tell you how many stories I've heard of the mom bringing in her kid with a cat scratch, then complaining because she had to keep waiting when the person with the broken arm got rushed through. In a roundabout way, this drives up costs as well. Most ERs are completely overloaded because people come in with a runny nose ("it is SARS?!"), a mild headache ("an ANEURYSM?!"), a sore ankle ("is it BROKEN!? Oh wait, I guess I can walk on it. And that it doesn't hurt as much anymore. Whoops..."), which means they need to run a very well stocked (with equipment, supplies, and staff) facility. Is part of the overpriced nature to discourage people from showing up with a runny nose? Maybe. Who knows. I don't work in the health care system.

I am absolutely NOT defending the system, and NOT saying that Bebe/her son necessarily overreacted, I'm just trying to give a little extra outside perspective as a close observer of this 'system' for my entire life. I think it's beyond ridiculous that Bebe had to pay $2000 for this visit, but - I understand where the tab came from. That's all.

In the end, all I was trying to say was that you didn't just get a swab. You got peace of mind. And no, you should not have to pay $2000 for peace of mind, no, it's not necessarily fair/reasonable to charge that much for said peace of mind... but at least you do have that.
 

cara

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Ahh, musey, you meant you personally pre-clear your illnesses with your dad, not the average patient coming into the ER to see him. Makes sense, I would do the same too. Ever since my mom dragged me to the ER to have the doctor set my broken nose so it would be pretty, and the 8-month pregnant doctor that was looking pretty exhausted at ~10pm just referred me to plastic surgery without touching my nose after commenting that I did a decent job of setting it myself, well. Lesson learned. We must have waited like 4 hours or so, which seemed like a long time then.

But at the same time, I broke my finger and did not go to the ER to have it set since I could still move it and somehow imagined that meant it must not be broken (wrong!). When the swelling went down it had healed really crooked and needed surgery. So... maybe wrong lesson learned?

And when my brother was a toddler, he fell backwards off a chair and he walked on a broken leg for 10 days. The clinic we first took him to x-rayed only part of his leg, and told us it wasn't broken and he would heal soon. Ended up going to the ER 10 days later when he was still in pain. Obviously not the best use of an ER, but it can be hard to get a real second opinion the way many insurance programs are set up, at least on something like a hurt leg and not cancer treatment or major surgery.

I guess I write these out to say that its not always clear to a lay person what warrants emergency treatment and what doesn't. Some things are OK to wait a day or two and some things should really be dealt with more promptly. Sometimes people are using the ER for things that aren't true emergencies but have valid reasons why that is the best option for them receiving needed care. Surely it is frustrating for emergency personnel to have to deal with these cases, but it is their job to some extent. And I do understand how treating a sore throat in the ER might rack up $2000 in bills and that someone has to pay that under our current system. There is a reason prescribing and administering a single Tylenol in the hospital costs $10 also. But the system is messed up and clearly has gross inefficiencies and perverse incentives built in. That was more my point.
 

musey

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Date: 4/7/2009 12:50:16 PM
Author: cara
I guess I write these out to say that its not always clear to a lay person what warrants emergency treatment and what doesn't. Some things are OK to wait a day or two and some things should really be dealt with more promptly. Sometimes people are using the ER for things that aren't true emergencies but have valid reasons why that is the best option for them receiving needed care. Surely it is frustrating for emergency personnel to have to deal with these cases, but it is their job to some extent.
I'm not sure if it was for my benefit that you wrote those out, but I don't think I require any convincing that "it's not always clear to a lay person what warrants emergency treatment and what doesn't." I have had the benefit of an in-house (literally) emergency physician my whole life, so my definition of "emergency" is undoubtedly more controlled than most others'.

Just because my dad (and likely most other emergency physicians) complains about runny noses and cat scratches doesn't mean I don't think it's his job to see those patients. If they show up in the ER, it's his job to examine (and hopefully, diagnose) them. Doesn't make it any less annoying that their manpower is wasted on the obviously unnecessary ER visits, which does have a hand in driving up costs (which again, was my point).

People have every right to seek out the medical care they feel is appropriate to their given condition, and I would never suggest otherwise.

And I do understand how treating a sore throat in the ER might rack up $2000 in bills and that someone has to pay that under our current system. There is a reason prescribing and administering a single Tylenol in the hospital costs $10 also. But the system is messed up and clearly has gross inefficiencies and perverse incentives built in. That was more my point.
Yep. And hopefully it is changing. My dad is bummed at the prospect of what the current administration's proposed changes will do to his career and retirement, but even he agrees that it is time for a change.
 

Skippy123

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I am sorry Bebe, did you see this on ABC news about 80% of billings have errors? http://abcnews.go.com/GMA/story?id=7241383&page=1
eta: I see you saw this already; I saw the part about the woman having cancer and was charged double what she should have for her surgery.
 

Keepingthefaith21

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1,531
Bebe - you could always try and appeal for coverage through your insurance company especially because your son is in school. I understand that he was Out of Newtork but this was due to circumstances beyond his control. The most your son should have been looking to pay was an ER co-pay - somewhere within the realm of $50-$200 for typical HMO coverage. Of course, if you have a plan with a deductible and co-insurance these charges will be your responsibility until you meet the deductible amount (which is the downside to having a plan with a dedictible - you can never predict when you will have to use it).

If, however, you have a standard HMO or PPO plan - I would urge you to carefully review your benefit document regarding emergent and urgent care. If you find that these services should have been covered as emergent or urgent care, I would call your insurance company and ask if the provider submitted claims. If none have been submitted, ask the hospital to kindly submit the claims to your insurance company and see if they deny. If these claims deny, check your benefit document for your appeals rights - and exercise them if you have them. The worst case is that you are left holding the bill - best case is that you are responsible only for a co-payment. I think it''s worth the bit of a hassle to file and appeal...

I would also check your benefit document to see if you are responsible for Usual and Customary balance billing. Typically when a hospital or provider contracts with an insurance company, they accept payments at significantly reduced rates and their contract precludes them from balance billing a member. However, when a facility is non-contracting, they often times balance bill the member the differences between their charges and the U&C payment given by the insurance company. Some, but not all, insurance companies will waive the U&C payment and adjust the claims to pay at charges if the care met the emergency or urgent care criteria.

If your are within the US - some drug stores and major chain stores (like Wal-Mart) are putting urgent care clinics into their stores. These are a great alternative to an ER visit and are often times open extended hours and weekend hours. Most of these take insurance which means the client is only responsible for a co-payment. Again, check your benefit documents to determine if these urgent care facilities are covered but if they are they are a fantstic alternative when in a pinch.
 

bebe

Ideal_Rock
Joined
Nov 20, 2007
Messages
2,845
faith, thanks for the info. We will certainly go over the bill in detail and then call our ins. company and fill them in on the lack of care he received.
I hate dealing with ins. companies - grrrr.
 

basil

Brilliant_Rock
Joined
Jun 27, 2006
Messages
1,526
Date: 4/7/2009 7:23:37 PM
Author: bebe
faith, thanks for the info. We will certainly go over the bill in detail and then call our ins. company and fill them in on the lack of care he received.

I hate dealing with ins. companies - grrrr.
I don''t think that arguing with the insurance company about how you felt about your care and how things shouldn''t cost that much is going to be effective.

Arguing about the out-of-network classification may be if there was not an in-network provider near your son''s campus. If he just went to the wrong ER, you may be kind of screwed. Usually, our ER and clinic will let a patient know if they don''t take their insurance if it seems like it''s not a hyperacute issue, if there is another ER in town that takes that plan.

The one time I went to the ER was when I got a really bad GI bug and my doctor boyfriend (now husband) decided that I was so dehydrated that my kidneys were shutting down. Well, they weren''t, but I got a few liters of fluid and a script for an anti-nausea pill and went home feeling a little better. I got a bill for about $2000 too...turned out that the insurance company had sent me a letter asking for me to sign something saying that I didn''t have other health insurance (???) which I apparently never got or threw away as junk mail. Eventually took a bunch of phone calls to clear it up.
 

LtlFirecracker

Ideal_Rock
Joined
Feb 29, 2008
Messages
4,837
I agree that bebe was doing what she has thought was best. I have had more than one occasion where I doing the physical exam to r/o meningitis in someone who, at the end of the day, had a sore throat (I have never actually gone so far to do a spinal tap on someone with a sore throat). If the lymph nodes in the throat are large enough, they can cause neck pain, and many of them are associated with headaches. If it was truly bacterial meningitis, it could not have waited until the next day, and the clinic would have just sent him to the ER.

I am sorry about this bill. Have you started working with your insurance company? Can you discuss this with the hospital, ask for an itemized list. Most ER''s (from what little I know), can not get a lot of money from the insurance company for what they did. Find out how they are justifying their 2k bill.
 
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