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ER: $800!?! With Insurance  
User currently offlineSLC1 From , joined Dec 1969, posts, RR:
Posted (9 years 1 month 4 weeks 1 day 23 hours ago) and read 949 times:

A couple weeks ago I had an ER visit: I woke up with chills that were practically convulsions, a rash all over my body, a headache, and a fever of 105. It seemed like a trip to the ER was a good idea, considering it was a Sunday and the "InstaCare" things we have around here really suck at giving health care. Anyway, I showed them my insurance card (twice), everything seemed fine, and I was admitted and I was there for about 4 hours, stuck in the hallway even though the place was a ghost town. After an hour with no attention except a volunteer who took my vitals, they took a few labs, gave me some IV fluids, some tylenol and released me. So the bill came today. My insurance which is supposedly comprehensive is now charging $800 because I went to the wrong hospital (i.e. the one across the street from my house instead of the one 45 minutes away). I can understand routine care, but an ER visit? The last thing that should have to be on my mind when I'm delirious is how to figure out and then get to the hospital of my choice. OK, there's my vent, this seems like a good place  biggrin  considering I haven't posted here in a while. Any thoughts? A way to get out of this maybe?

16 replies: All unread, jump to last
 
User currently offlinePROSA From United States of America, joined Oct 2001, 5644 posts, RR: 4
Reply 1, posted (9 years 1 month 4 weeks 1 day 23 hours ago) and read 932 times:

Your insurance company should have an appeals process. One thing you might try is claiming that driving 45 minutes to the "approved" hospital would have been unsafe given your condition. With any luck, the company will back down.


"Let me think about it" = the coward's way of saying "no"
User currently offlineAA777 From United States of America, joined May 1999, 2544 posts, RR: 28
Reply 2, posted (9 years 1 month 4 weeks 1 day 20 hours ago) and read 909 times:
Support Airliners.net - become a First Class Member!

Welcome to the wonderful world of the HMO / PPO.... they will get you at any chance they can. Gotta love the healthcare system....

-AA777


User currently offlineFlyingTexan From , joined Dec 1969, posts, RR:
Reply 3, posted (9 years 1 month 4 weeks 1 day 10 hours ago) and read 870 times:

Welcome to modern medicine.

You can thank big business – insurance companies, big drug interests and ~ a lesser extent lawyers ~ for that $800 tab.

Your money goes to help large pharmaceutical companies advertise their latest pill.

And the insurance companies love to blame high costs on *the un-insured* (and whose fault is that?)

 spin 


User currently offlinePope From , joined Dec 1969, posts, RR:
Reply 4, posted (9 years 1 month 3 weeks 6 days 10 hours ago) and read 822 times:

The insurance company is going to argue that this wasn't an emergency. Just stick to the story that you believed that your life was in imminent danger and you'll be okay. Don't ever conceed that you weren't fearful of dying - if you do they'll have you.

Involve your insurance agent - make him earn his commission.


User currently offlineRedngold From United States of America, joined Mar 2000, 6907 posts, RR: 44
Reply 5, posted (9 years 1 month 3 weeks 6 days 9 hours ago) and read 800 times:

Quoting SLC1 (Thread starter):
I woke up with chills that were practically convulsions, a rash all over my body, a headache, and a fever of 105.

I think this is what you should highlight in your appeal letter. It sounds eeriely similar to the symptoms of meningococcemia, which luckily you don't actually have or you would be dead by now.

Are you sure they didn't do a CT scan of your head and neck? That would have raised the bill significantly - but a CT is necessary to rule out meningitis.


redngold



Up, up and away!
User currently offlineBezoar From United States of America, joined Nov 2001, 807 posts, RR: 8
Reply 6, posted (9 years 1 month 3 weeks 6 days 6 hours ago) and read 785 times:

Quoting Redngold (Reply 5):
but a CT is necessary

While a CT might be good idea, it isn't used to diagnose meningitis. That requires a lumbar puncture or spinal tap. The CT helps to make sure there isn't pressure on the brain or hemorrhage prior to doing a lumbar puncture. Removing spinal fluid in that setting could cause the brain to 'herniate,' which isn't good.

I agree that your symptoms (high fever & chills, headache, rash) would be enough for one to suspect meningitis, and so therefore it is an emergency, and going to the nearest ED would be the prudent decision. The risks include seizures, coma, and death. The ED doc might not be too concerned once he's examined you, but that's why you go to the doctor. You weren't going there because of a hangnail.

Insurance companies love to collect premiums, but hate to pay out. These people work in tall buildings and their only patient contact is by phone. They decide what is appropriate for the emergency department only AFTER they have the diagnosis in hand. (Sure, it might be a virus, but viruses cause meningitis, too. My wife nearly died from 'just a viral infection.')

I think you have a good case, and I bet they relent. They often deny at first because most folks don't challenge it, so they save money. Keep pushing!

....a doc's opinion, and you can tell them I said so.



"There are none so blind as those who will not see."
User currently offlineRedngold From United States of America, joined Mar 2000, 6907 posts, RR: 44
Reply 7, posted (9 years 1 month 3 weeks 6 days 6 hours ago) and read 774 times:

Quoting Bezoar (Reply 6):
While a CT might be good idea, it isn't used to diagnose meningitis. That requires a lumbar puncture or spinal tap. The CT helps to make sure there isn't pressure on the brain or hemorrhage prior to doing a lumbar puncture.

Ahhh my bad, that's how I associate a CT with meningitis. I *did* wonder why a CT to examine such thin membranes. Now I know what it's really for.

Thanks, Bezoar.



Up, up and away!
User currently offlineB744F From Germany, joined Jan 2006, 0 posts, RR: 0
Reply 8, posted (9 years 1 month 3 weeks 6 days 6 hours ago) and read 768 times:

You learned your lesson, unless you are elderly theres no reason to go to the hospital just because you have flue-type symptoms. You are the main reason why the ERs are so full and unable to handle real emergencies.

User currently offlineSATX From United States of America, joined Apr 2005, 2840 posts, RR: 6
Reply 9, posted (9 years 1 month 3 weeks 6 days 5 hours ago) and read 763 times:

Quoting AA777 (Reply 2):
Gotta love the healthcare system....

Perhaps you forgot to put American between "the" and "healthcare".

Quoting Pope (Reply 4):
Don't ever conceed that you weren't fearful of dying - if you do they'll have you.

So this is the kind of advice we have to follow to get a fair deal? Yikes.

In any case, I've actually read some of the documentation that came with my last two health plans...

1. True emergencies are covered at almost any hospital so long as you contact the insurance company extremely soon after your condition has stabilized. Waiting even a full day or two is often longer than they will accept before contesting payment.

2. Anything not deemed to be worthy of the term "Emergency Care" never receives full coverage at out-of-network hospitals and clinics unless your policy specifically approves it. "Urgent Care" is still not "Emergency Care" and the line can be very thin or wide depending on the situation.

I would imagine that you can expect to have at least one meeting with your insurance company unless you were taken to an out-of-network hospital while unconscious and/or by trained paramedics who determined that your condition was life-threatening enough to require immediate Emergency Care at the nearest hospital.



Open Season on Consumer Protections is Just Around the Corner...
User currently offlineAA61Hvy From United States of America, joined Nov 1999, 13977 posts, RR: 57
Reply 10, posted (9 years 1 month 3 weeks 6 days 5 hours ago) and read 761 times:

As a side note, here in Plano, TX, it cost $100 per 1/4 mile the ambulance drives, so if you take a ride in one, you better hope your hospital is close to the incident location.


Go big or go home
User currently offlineRedngold From United States of America, joined Mar 2000, 6907 posts, RR: 44
Reply 11, posted (9 years 1 month 3 weeks 6 days 4 hours ago) and read 749 times:

Quoting B744F (Reply 8):
You learned your lesson, unless you are elderly theres no reason to go to the hospital just because you have flue-type symptoms.

A 105 degree fever with headache and rash is an emergency until it's been proven otherwise. See Bezoar's and my posts (#6 and #5.)


redngold

[trying desperately not to call names...]



Up, up and away!
User currently offlineOhTheDrama747 From UK - Scotland, joined Jan 2005, 291 posts, RR: 0
Reply 12, posted (9 years 1 month 3 weeks 6 days 3 hours ago) and read 734 times:

Quoting B744F (Reply 8):
You learned your lesson, unless you are elderly theres no reason to go to the hospital just because you have flue-type symptoms. You are the main reason why the ERs are so full and unable to handle real emergencies.

Who the hell are you to decide that? And since when was convulsions part of the flu jackass?

Anyway back on topic, sorry to hear you got stuck with $800, over here we don't need to pay but our health system is totally fucked up anyway.


User currently offlineJeffM From United States of America, joined May 2005, 3266 posts, RR: 51
Reply 13, posted (9 years 1 month 3 weeks 6 days 3 hours ago) and read 724 times:

Quoting OhTheDrama747 (Reply 12):
over here we don't need to pay

LOL...make me laugh.. Taxes? Remember those? You just pay in advance...


User currently offlineFlyingTexan From , joined Dec 1969, posts, RR:
Reply 14, posted (9 years 1 month 3 weeks 6 days 3 hours ago) and read 723 times:

Quoting B744F (Reply 8):
You learned your lesson, unless you are elderly theres no reason to go to the hospital just because you have flue-type symptoms. You are the main reason why the ERs are so full and unable to handle real emergencies.

Last year, I fell quite severely.

Tore my slacks, cut my knee, bloodied my hands, knocked my head. The next day ~ it still hurt so I went to the ER.

I am not elderly and in exceptional health.

It just hurt so I went to the ER in the spirit of preventive medicine. A routine CT scan discovered a 2” brain tumor (cerebellar hemangioblastoma). TWO INCHES!

I spent the next month in the Nevada Neurosciences Center while a team of neurosurgeons practiced various excavating activities on my noggin.

I guess I could have come here for medical advice instead.  

[Edited 2005-07-26 01:02:33]

User currently offlineOhTheDrama747 From UK - Scotland, joined Jan 2005, 291 posts, RR: 0
Reply 15, posted (9 years 1 month 3 weeks 6 days 2 hours ago) and read 715 times:

Quoting JeffM (Reply 13):
Quoting OhTheDrama747 (Reply 12):
over here we don't need to pay

LOL...make me laugh.. Taxes? Remember those? You just pay in advance...

Very true. Sorry it's been a long day.


User currently offlineBezoar From United States of America, joined Nov 2001, 807 posts, RR: 8
Reply 16, posted (9 years 1 month 3 weeks 6 days ago) and read 694 times:

Quoting B744F (Reply 8):
You are the main reason why the ERs are so full and unable to handle real emergencies.

I was an emergency medicine doc for over 5 years in one of the busier ED's around (60,000 visits/yr). We had more than our share of frustrations with having to provide care to folks who had minor problems. Sometime they had to wait 3 or 4 hours to be seen, but we always were prompt in dealing with the true emergencies. Always. Sometimes we got stretched rather thin, but we were right on them. Sometimes the others patiently waited, sometimes they grumbled, and sometimes they just left without being seen.

Sometimes these 'low acuity' visits were just social calls by our 'regulars' or folks looking for drugs. Most of these were people who were uninsured and had no place else to go. They would have had to pay cash anywhere else, but they could not be turned away from the ED. In our ED the collection rate was about 45%, which is a big reason why the prices there are so inflated.

Sometimes we had patients triaged as 'low acuity' who turned out to have something critical wrong. Sometimes we had people with chest pains who we bet were having heart attacks. We gave them the full court press, only to discover that their problem was 'indigestion.' (I wouldn't be surprised if their insurance - if they had any - balked at having to pay all or part of an ED bill.)

What SLC1 described was a legitimate case for the ED. Fortunately, it turned out ok for him.



"There are none so blind as those who will not see."
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