From the article: “We deeply regret if we caused Ms. Cloyd any concern,” Anthem said in a statement to Vox.”
If?
Unfortunately, in Southern California, there is a large number of uninsured that use the ER as a doctor. Every ER is crammed full of large extended families with a family member with the flu or some other issue. I’m not sure if mandatory insurance has solved the problem because they don’t have PCPs and I don’t think they know they are supposed to see someone else or urgent care first. They don’t care how much it costs because they don’t have any money to pay the bill.
^ It’s nearly impossible to measure since people will go to the ER now when they need to whereas many (myself included) wouldn’t unless I was actually dying pre-ACA. So a decrease in the # of people going there for a sprained ankle might be offset by the number of people going in who now have insurance.
My doctor is great, but almost never can fit you in same day. Typically you’re told to wait out symptoms to see if they go away on their own. If they don’t go away, I often end up going to urgent care. I’ll call my doctor’s office first, and hope that one of the PAs has time, but they don’t always.
I try NEVER to abuse the ER - but sometimes it is your only option. I’m thankful to be down to a $200 co-pay - mine was $500 at one point! Here are some examples of when I’ve gone to the ER:
- finger broken during basketball game - after 9 pm, no urgent cares open around us that late
- concussion during basketball game, again after urgent cares closed
- large splinter in the ball of the foot that broke when I tried to remove it - 8 pm on a Sunday, no urgent cares open
- Vomiting and pain that lasted several hours - tried calling teladoc, they did not answer for 3 hours. Finally went to ER where D passed out in waiting room and it took 5 nurses to get a line in her she was so dehydrated. Turned out to be a problematic gall bladder
- Chest pains - was tachycardia and needed a heart procedure - was during the day, but only the ER was equipped to diagnose/treat
- broken collarbone, again after hours
I always find it amusing when insurance says “but if you get admitted, we waive the co-pay”. In my experience, if you get admitted you hit your out of pocket anyway so it doesn’t matter!
I’m thankful to have good insurance - the heart procedure alone was over $100,000 in total costs, so $500 for an ER visit is small in relation. But there are so many reasons why you would need to go to an ER that would not require admitting.
For the longest time our urgent cares weren’t equipped with x-ray and CT scanners - so they often had to send you to the ER even if it was during the day!
All urgent care centers are not created equal - some will stitch a wound some won’t, some have radiology services some don’t, some have hours 7 days a week some don’t. It is probably a good idea to know what services the ones nearest you (on your medical plan of course) offer and what their hours are.
About 10 years ago I had a pretty bad experience with United Healthcare. It was for a procedure for which UHC did not have objective requirements to meet their definition of “required”. However my research turned up several other insurers who did publish objective requirements and my situation met those requirements (picture something being out of alignment by a certain minimum number of millimeters to meet the requirement).
Anyway, UHC denied my request for preapproval. When I appealed, they “lost my paperwork”. So I resent it, and they “never received it”. So I fedex’d it. They again claimed “we never received it” but then I said, “Yes you did, and Joe in receiving signed for it”. So later on they “found” it. Anyway, appeal denied.
I went ahead with the surgery and UHC initially covered the hospital fee and anesthesiologist, but not the surgeon, which was expected. So I appealed and again went through the whole, “never received your appeal”, resend via fedex, “never received”, “yes you did”, “ok we found it”. So again they denied the appeal, but also decided to rescind the payment to the anesthesiologist!
So I called up in disbelief and the rep said, “sometimes on review they decide that things that were initially covered shouldn’t have been covered.” I asked if I appealed again (UHC policy permitted 3 appeals), would they find something else to rescind? “Yes, it’s possible”. So that was that, end of appeals for me.
@kiddie - your advice to call 911 and have EMTs take you to the hosp so you’ll be seen first is not correct (perhaps it is more correct to say that it is definitely not correct where we live). My husband is an EMT and he has seen people do this many times. Usually they could have easily gone to the hosp on their own but call 911 so they’ll be seen sooner. In our area, you’ll be seen by the hosp staff in triage order. If you don’t need urgent attention, then you’ll wait behind the urgent cases no matter how you arrived at the hosp.
An EMT is basically required to take you to the hosp if you want to go there (and if they are part of a paid EMS service, they really have no reason to not take you as they get paid if they you to the hosp). So, that you are at the hosp via EMTs does not mean that you need urgent care at the hosp. It merely means that the EMTs were your mode of transportation.
Times we went to urgent care: a) big gash caused by jumping onto a plastic guitar, weekday (D1); b) possible strep throat, on a Sunday (me); c) horse kick to the groin, on a Saturday (D1). Times I should probably have gone to the doctor but didn’t, would have gone to urgent care if it were open but it wasn’t because it was a holiday, didn’t want to go to the ER: d) I fell down while walking the dog, hit my chest on a stepping stone, and possibly broke a rib; e) I slipped on ice, fell backwards, hit my head, and possibly had a concussion.
I’m so repressed about “causing trouble” that I don’t know if I would call 911 for myself in an emergency. I guess I should get over that neurosis given that I live alone.
H had a wound on his leg. (staph) Went to an urgent care center then said can’t treat it you need to go to ER. Went to ER and they treated it. However, the ER dr said come back here in 3 days so we can reevaluate it and give results. He went back and got charged an extra 800 dollars for second non-emergency visit. We faxed a copy of the ER dr. order stating to come back. And were denied. We paid it but still very bitter that and insurance company would override an dr order.
I have been very fortunate in not needing to have ER care myself. I was able to get the care I needed in urgent care when I had a broken fibula that made walking impossible. H has never been seen at Urgent Care or the ER.
Our D did need ER care twice ever–both times on the recommendation of the pediatrician. Once she was given IVs and was OK to go home after she had gotten enough fluids pumped into her. Once she was admitted for a very high fever that I couldn’t get down–we were very lucky that the world expert on that condition she was eventually diagnosed with was in the pediatric hospital where she was admitted and agreed to be her treating MD. Our S had to get stitches from a hatchet cut once in the ER (before Urgent Care was available in most places). Our BCBS insurer never gave us any problems with fully covering the urgent care and ER visits.
We are fortunate that we can generally get a MD to see us the day we need it or at least confer with us via phone or email. My new internist says someone else on her team will see me if she’s not available.
When possible, it’s important to be polite and NOT suddenly call the MD at 3am on a weekend after you have had the medical problem for hours and days but suddenly it becomes urgent. I try to let my docs know as soon as I think something may be an issue so we an figure out options and avoid 3am issues. Of course, if it is something scary that has never come up before, that’s different.
Agree it’s important to have an idea of the services which different urgent care centers have, as they are definitely NOT created equal.
911 is going to get you a big bill for the ambulance, and it is often a different deductible than the ER.
The ones that are bad are the Urgent cares that are really ERs. They are stand alones, but charge like the ER. News reports have shown that sometimes the bills for something like a broken finger are $10k. We are lucky to have an urgent care just down the street, closer than the doctor’s office or the Walgreens clinic.
The urgent care also has a contract with some insurance too, it appears, (medicare? medicaid?) because I’ve been there when people are clearly getting regular care. They have all their documents and pills, and an appointment time.
So why don’t they put an urgent care next to the ER? Sounds like it could save a lot of problems.
At the medical center my lung doc and internist work at, the urgent care IS next to the ER and they seamlessly transfer you from one to the other I’ve been told. I have no personal experience with either yet at this medical center, and hopefully will continue to be able to avoid both as much as possible.
I would always prefer to transport myself to the ER, but the recommendation generally is that in “true” emergencies, the sick or injured person shouldn’t transport himself or herself or even go with a friend or family member. I’m concerned that I would be afraid to call 911 despite having one of those true emergencies someday, such as breathing difficulty or chest pains.
Mass General has an urgent care next to the ER and it works very well.
You guys act like the insurance companies are happy when something is cheaper.
Our PCP clinic has an urgent care associated with it and will send someone needing minor stitches, cast, etc. there. If the clinic is swamped, all callers are referred to the urgent care.
The urgent care would not deal with sharp stomach pains or chest pains - they told us to go straight to the ER as a matter of their policy.
They are.
I have employees who worked at insurance companies previously, one was paid bonuses based on how much she could deny coverage.
Here’s the problem - in most cases a sprain is not an emergency, a broken finger/toe is not an emergency, and there is really not much you can do about it anyway. Where it gets downright scary is the notion of gerd won’t be covered, heart attack will, but every bit of sense, literature and dr’s advice tell you - go to the ER.
Many of us here if we have kids in their young 20’s were born during the time of the drive-thru delivery. I had less than 24 hours in the hospital after having both kids. Apparently the re admittance rate was so high they finally stopped that one.
It’s an interesting problem, you are pushed out so quickly after surgical procedures, told not to go to the ER unless you know for sure that you’re dying makes you wonder what the mission is of these healthcare facilities. But when I’m paying 30k a year for health insurance, I don’t appreciate getting tossed out the door as if I’m a major inconvenience.
Cheaper is great if it’s the appropriate location for the condition. Who doesn’t agree with that?
The issue is when the possible diagnosis of the condition may or may not be an emergency–in that case, you are asking for the patient to make the call, when diagnostically, that will often not be possible. And if you know you could be looking at a 12000 bill, then maybe you’re going to take that appendicitis to the urgent care, or wait a day.
Because you thought you had insurance. And you don’t have that kind of money.