Breaking off from the discussion in CaliCash’s wait times thread.
The tl;dr version of this: is there a chance that I will run into insurance issues for going to my PCP, the ER, and urgent care all within a few days (Tuesday-Thursday) of each other? I have BCBS and so far it’s been fantastic.
I have been sick since around last Friday and progressively getting worse. I went to my PCP yesterday morning and she gave me some referrals to specialists and some meds to help with immediate symptoms. She told me to go to the urgent care or ER that night if I felt like I was getting worse. By last night, I was feeling significantly worse so my roommate took me to the ER. I spent about 12 hours there, was treated for dehydration, and released. (Have the whole ordeal quoted below from the other thread).
I didn’t even feel better when I left and I’ve been feeling worse ever since leaving the hospital. I have sent emails to my PCP and 2 other relevant doctors. I will probably go back to urgent care tomorrow (not the ER) for the same issues are persisting and getting worse. I have Lupus and am on immunosuppresant medicine so it’s really difficult for me to fight off what other people can easily do. I felt completely ignored by the ER people and am afraid something might be really wrong and they were too rushed to catch it.
My question: Will I run into any insurance problems by going to multiple places for the “same” problem? I am not doctor shopping or anything like that (for certain pills as is often done) but rather legitimately trying to get help. Even with the two bags of IV fluids yesterday, I can tell that I’m still very dehydrated and getting worse.
You may get charged the co-pays at each stop. I was sent from a doctor to the ER, and then had to go back to he ER for the next 3 days. If I had been admitted, no copay, since I wasnt, $50 per trip. I complained and they removed all but one. I just felt it was one treatment t, just took 3-4 days.
I have seen 2 MDs in the same day for the same problem and a 3rd md right around the same time. I’m BCBS too. I’ve actually been seeing a whole bunch of providers for the same general group of problems from Dec thru now. I have paid my copay for each visit and I believe I’ve reached my out of pocket max. BCBS hasn’t given me ANY hassles.
They haven’t contested my seeing multiple lung specialists in several states and med centers, several allergists and ID docs, as well as radiologists and others. I pay all my own travel and they’ve been fine with paying their portion of my medical bills–instate and out of state.
Basically, when we have long term chronic conditions that flare up periodically, it makes sense to work with our medical team to try to get things under the best control possible. This can take multiple visits, testing and different providers to weigh in and add their perspectives.
@romanigypsyeyes Can you call your PCP back rather than go to the urgent care ? Sometimes insurance can difficult about what time you go to an urgent care if your PCP has office hours during that time. Also, you may also encounter " sicker people" at an urgent care or ER ( something to think about while you’re so compromised ). Also, how something is documented plays heavily into whether it is paid for or denied. Your PCP knows you better , and could probably make a better “case” for multiple visits. Also, ask if it is in your original note that your PCP instructed you to go to the ER if not feeling better . I hope you feel better. Make sure that you take care of yourself first , appeal later if necessary.
Rimini, I was In and out of Drs offices and ER a zillion times over a two month period for same reason before I was finally diagnosed and my insurance never question anything. I don’t think you have anything to worry about at all.
You should be fine. If you were on medicare the hospital would be in trouble for all the releases and re admissions. But if you need care, you go and take care of you. Insurance will work itself out on the back end.
Romani, the only time I know an insurance co would not pay was when a patient visited the same doctor’s office twice on the same day (or when the clinic billed 2 visits). Different docs, different clinics on the same day for the same problem - only copays were billed.
When I was in Denver last month, I saw a whole slew of docs and other providers on the same day, as I have had in a prior visit there. Insurer has never had any problems reimbursing. Come to think of it, I haven’t received any bills yet for all the care I received in Denver in June yet.
@carolinamom2boys my PCP and I have been in communications but she is completely booked the rest of this week. The appointment I managed to get on Tuesday was a double book appointment that she squeezed in.
I’m feeling a little better today so we’re going to see how the next few hours go…
Does your PCP’s office take calls after hours? If so, you might ask if she will call ahead to the ER or urgent care clinic if you need to see someone before Tuesday. I’ve found that helps improve the quality of care.
My (adult) son has found that he can usually tolerate flavored Pedialyte when nothing else will stay down and it keeps him from getting dehydrated. He also drinks Ensure when he’s having a flare and cannot eat. One of his old doctors gave him a Rx for phenergan suppositories to use as needed when he had flares over a weekend. He only needed them once, but was grateful to have them on hand. He’s been on immunosuppressant meds for longer than we ever expected.
As for the health insurance, ours (BCBS) gave us some trouble about pre-authorization one time but the GI doc’s office intervened and got it straightened out.
I hope it goes OK with regard to billing. You are doing what your doctors suggested.
My son had the real,flu a couple of years ago. He went to his PCP…got a tamiflu shot…but was told if,the symptoms got,worse to go to the urgent care…or,the ER. He passes out in his shower…called the urgent care who told him to go straight to the ER. A friend drove him.
His insurance refused to pay for the ER visit…said it was not an essential ER visit…even though the urgent care folks told him to go there. This was United Health Care…don’t get me going about them. DS got a $3000 bill…which we told him to appeal…and the negotiate with the hospital. I believe he paid a good portion of that bill.
Romanigypsyeyes, I’m so sorry you’re going through this.
I think that instead of going to the urgent care, in your shoes I would go back to the ER. Make sure they understand when you were last there. By going to the urgi center, you’re starting over, amd it sounds like you’re having a hard time getting heard properly in the first place.
If you go to the same ER, you get put into a whole different category of patient. They must report your visit to their quality control people, and you get entered into a database that the hospital pays attention to. To a hospital, a return visit to the ER within a short time frame is a red flag that they missed something, and they’d better figure it out.
With regard to the billing, you shouldn’t have a problem.
Just an update: I ended up not going in. ER doctors just do not seem to know what to do with Lupus patients (I assume it’s the same for people with other rare/poorly defined conditions). Heck, my Rheumatologist who has been treating Lupus patients for decades doesn’t know which treatments will work for any given person.
I was afraid I’d pay another $100 (the ER copay if I’m not admitted) to be filled with fluids and released again. Again, I don’t think what I had was related to my Lupus but the doctors seemed very quick to write it off as that and move on. To be fair, every other time I’ve been to the ER, it has been for something very concrete and the docs treated me correctly and released.
Romani, hugs. IMO, ER docs know best what they see day to day: fractures, appendicitis, heart attacks, some infectious diseases… Stuff like that that warrants an ER trip. We all tend to do that to a degree. $100 is a very expensive IV drip… Hope they did a urine analysis and culture, and if so, the results should be out soon.
My PCP got the results today and she didn’t know what to do with them either. They were kind of all over the board but she was aggravated that they didn’t give me a round of antibiotics since my WBC was elevated and I have to be really careful about infections due to my meds. She called me in a script.
I’m not trying to blame the ER doctors. I know that this is not what they usually deal with and doctors are certainly human. It just sucks to be in so much pain and not have anywhere to turn.
