7 ms·

So, basically, if you visit any emergency room then your handing them a blank Check and they can write whatever number on there they want. That's egregious bey

So, basically, if you visit any emergency room then your handing them a blank Check and they can write whatever number on there they want. That's egregious beyond belief. I'm never one to call for legislation and price controls, but in the face of such adversity, I think it may be our last hope. I think they should either provide a quote before they offer the services or there should be a law limiting the amount that can be billed per service.

sametmax 9y ago
The problem is you can't know how healing somebody will turn out. The time and resource require to heal somebody are not fixed.
ajross 9y ago
What if there was a group or coop or company somewhere, where people could get together and collectively fund their health care. Then this entity could make deals with providers like EmCare to ensure that the care provided was as efficient as possible. Sarcasm aside: this problem is solved, and it's called insurance. Private entities sell it. The government does it too. It works. We just need to make sure everyone actually has it.
- michaelmrose 9y ago
  If you had read the article you would know if was about people getting surprise bills for out of network care.
- manarth 9y ago
  The article shows that this issue affects people with insurance. It's not that the patients don't have insurance, it's not even that they go to a hospital without an agreement in place with their insurer - it's that the ER has a number of people outside that insurance contract, you don't know who they are, you don't get to choose whether they treat you, you just get a bill at the end - despite being insured, and choosing a hospital recognised by your insurer. Insurance is not the solution for this problem.
madengr 9y ago
Yep. Took my wife to the ER last week for suspect appendicitis or diverticulitis. Last time this happened a CT scan alone was $3k ($11k prior to insurance reduction). My HDP is $4,500 OOP max per family member; $8,500 for family. What really pisses me off is that the HSA max contribution has not kept up with family OOP max. I contribute the max every year and can't end up with $8,500 saved. I had a decent insurance plan prior to Obamacare. Now it's 3x as much and a HDP. Don't even have dental insurance anymore; use the HSA for that. Work for a Fortune 100 Company too.
- tcbawo 9y ago
  It's doubtful we would be in a different situation without Obamacare. Health care costs have been rising faster than inflation for literally decades. There are too many bad actors at every level trying to grab whatever they can, while they can.
- e40 9y ago
  Work for a Fortune 100 Company too. Your HR department is shit. I manage a 30 person company and our benefits are better than what you've mentioned.
  - astockwell 9y ago
    Unfortunately, the grand-parent poster's experience is par for the course at most Fortune 100 companies.
  - madengr 9y ago
    Yes, no argument there. I work for Fortune #75 (hint; it's probably hanging on your wall). Lost dental insurance last year, vision the previous year, and switched to an HDP the year before (with massive premium increases every year). But hey, the stock price was at an all-time high on Friday. Funny thing about HR directors is that they don't last more than 1 year before rotating out. Don't want them to become too attached to the people they are there to screw.
    - SpaceRaccoon 9y ago
cortesoft 9y ago
This is the fundamental problem of treating healthcare like any other market distributed good; you just don't have the ability to use consumer choice. People using an emergency room are not in a position to negotiate price or seek an alternative service. An unconcious accident victim can't say, "That price is crazy I am going to the hospital across town." Single payer is the only viable solution.
- maxxxxx 9y ago
  "Single payer is the only viable solution. " That's not true. Plenty of European systems are not single payer and work fine.
  - cortesoft 9y ago
    I am not familiar with these alternate systems; how do they work?
    - myke_cameron 9y ago
      A mix of a public payer and private payers, as was proposed in the US in the original draft of the ACA. Edit: a common thread among these systems is that the private payers are not for profit and highly regulated.
    - maxxxxx 9y ago
      In a sense Germany works very similar to Obamacare. Private doctors, health insurances, mandatory insurance for everyone. The difference is that it's much more regulated and the insurances are non-profit as far I know.
    - ballenf 9y ago
      Germany is two-tier. Public health for the masses, private for those making over 80k or so and healthy. The public system premiums are a % of income. The private is a flat cost, so as you make more become much more attractive (even costing less in many cases). Doctors are sometimes private only or have separate private insurance waiting rooms. Hospitals have separate public and private rooms/beds, etc. It's a two-tier system that works pretty well, at least in comparison to the US system. My info is a few years dated, but is based on having been a patient in both US and German hospitals. From friends, I've heard the English system is similar in some respects to the German. Amazingly to me, the German system was instituted under Otto von Bismark in the 1800s. https://en.wikipedia.org/wiki/Timeline_of_healthcare_in_Germany https://en.wikipedia.org/wiki/Timeline_of_healthcare_in_Germ...
Frondo 9y ago
The thing is, if you're in an emergency room, for the most part, you're there because of a medical emergency. (I know this isn't universally true, etc.) If you're bleeding, and someone hands you a price quote, what are you going to do? Or if you're unconscious, they can't even hand you a price quote. (I guess they could shove it in your pocket.) I know the one time I needed to go to the ER, for emergency surgery, I'd have done it if they'd said it was a million billion dollars, because my life was literally on the line. I wasn't going to go shopping around, because leaving that ER would've meant death. What's a price quote supposed to do in those situations? We just need universal coverage, whether single payer or actually universal insurance.
- godot 9y ago
  Your text is grey and you may be getting downvoted and I'm not sure why. You are absolutely right and anyone who has ever been to ER will agree. I was in ER a couple of months ago, and it wasn't even a life-threatening issue, but I felt terrible. I went to the closest hospital with ER department (thankfully, it was in-network), and I was going to get their treatment no matter what price quote they hand me (not that I asked). When you're deeply, physically unwell, nothing else matters to your mind. I think you may be getting downvoted for your last sentence, but the points you're making are very real.
ballenf 9y ago
Another approach would be that a hospital actually has to take responsibility for the doctors and all other care teams working inside. Legislation to this effect would work, but in some cities there is enough competition that a marketing campaign along the lines of "guaranteed no out of network bills!" would catch my attention. I'd happily drive an extra hour for that piece of mind. And the reality is that a large number of ER visits are not true time-critical emergencies. Many times the standard admission procedure starts with reporting to the ER. I spent 4+ hours before a small outpatient procedure at a local hospital trying to find out if the anesthesia group and surgeons were in-network. I never got a straight answer -- no one knew the answer and I was forced to roll the dice. Hospitals are currently more like co-working spaces where each room (ORs, radiology, etc.) is rented out. The support staff is included, but everyone else is their own small business.
- tcbawo 9y ago
  I learned about these independent groups during a jury stint on a medical malpractice trial. This was actually a four way fingerprinting exercise (plaintiff's family, hospital, nurse, physician's group). The incentives in the system are perverse and corrupting. I think the system will need to be reinvented from the ground up.
- Tempest1981 9y ago
  That was a weird concept for me to learn as well. When your surgeon is in-network, you kind of expect the anesthesiologist to also be in-network. But surprise! $3500 for anesthesia. Not sure how the average person would know to expect this... http://consumersunion.org/2014/08/surprise-your-anesthesiologist-is-out-of-network/ http://consumersunion.org/2014/08/surprise-your-anesthesiolo...
snuxoll 9y ago
Cost control right now in the medical industry is all up to your insurance provider, from the article it looks like EmCare is skirting this by simply not participating in any (or very few) provider networks. I work for a medical billing company owned by a competitor to EmCare, we participate it a large number of insurance networks at each site we staff because it's the best way to get reimbursed - I'm rather shocked the hospital didn't investigate how their contracted providers handled insurance contracts and billing. The problem with trying to provide quotes for emergency services is you don't know ahead of time what E&M code will apply to the visit, what labs will be run, what procedures may be required for treatment, and since physician and facility billing are separate the right hand doesn't know what the left is doing. I also have some suspicions about the jump from 6% to 28% rates for billing what I assume is a 99285 (highest level non-trauma ED E&M code) and why it may explain the lack of their participation in insurance networks, but I don't want to tread into libel territory so I'll keep my mouth shut. Disclaimer: I work for MedAmerica Billing Services, Inc. a subsidiary of CEP America - these views, opinions and statements are my own and don't necessarily reflect those of my employer.
acranox 9y ago
> I'm never one to call for legislation and price controls, but in the face of such adversity, I think it may be our last hope. I'm always one to call for legislation and price controls, because time and time again, without the legislation in place, situations like this arise. It's the sad reality. Regulating companies is apparently our only hope to keep people from constantly being stepped on.
spinlock 9y ago
It's not just the emergency room. When you go to any doctor they make you sign a blank check before they will see you.
mapster 9y ago
sinks the whole 'the free market will self-police' fallacy. esp re: health and environment, finance, and worker safety, corporations need regulation, badly.
- pascalxus 9y ago
  this is a unique situation. Customers can't shop around for the best price because there are laws in place that prevent insurance companies from offering plans that are sufficiently cost effective in such emergency room visits (and a host of other conditions as well). Otherwise, I'm sure someone would have recognized these problems and offered an insurance plan that protects you from this. Free-market can't do anything when it's hands are tied behind it's back.
  - mapster 9y ago
    unfettered market results in unfettered greed. means even insured people file bankruptcy for 4 day hospitalization.
chasing 9y ago
If we had an ounce of common sense in this country we would've moved to single payer decades ago.

sametmax 9y ago

The problem is you can't know how healing somebody will turn out. The time and resource require to heal somebody are not fixed.

ajross 9y ago

What if there was a group or coop or company somewhere, where people could get together and collectively fund their health care. Then this entity could make deals with providers like EmCare to ensure that the care provided was as efficient as possible. Sarcasm aside: this problem is solved, and it's called insurance. Private entities sell it. The government does it too. It works. We just need to make sure everyone actually has it.

michaelmrose 9y ago
If you had read the article you would know if was about people getting surprise bills for out of network care.
manarth 9y ago
The article shows that this issue affects people with insurance. It's not that the patients don't have insurance, it's not even that they go to a hospital without an agreement in place with their insurer - it's that the ER has a number of people outside that insurance contract, you don't know who they are, you don't get to choose whether they treat you, you just get a bill at the end - despite being insured, and choosing a hospital recognised by your insurer. Insurance is not the solution for this problem.

madengr 9y ago

Yep. Took my wife to the ER last week for suspect appendicitis or diverticulitis. Last time this happened a CT scan alone was $3k ($11k prior to insurance reduction). My HDP is $4,500 OOP max per family member; $8,500 for family. What really pisses me off is that the HSA max contribution has not kept up with family OOP max. I contribute the max every year and can't end up with $8,500 saved. I had a decent insurance plan prior to Obamacare. Now it's 3x as much and a HDP. Don't even have dental insurance anymore; use the HSA for that. Work for a Fortune 100 Company too.

tcbawo 9y ago
It's doubtful we would be in a different situation without Obamacare. Health care costs have been rising faster than inflation for literally decades. There are too many bad actors at every level trying to grab whatever they can, while they can.
e40 9y ago
Work for a Fortune 100 Company too. Your HR department is shit. I manage a 30 person company and our benefits are better than what you've mentioned.
- astockwell 9y ago
  Unfortunately, the grand-parent poster's experience is par for the course at most Fortune 100 companies.
- madengr 9y ago
  Yes, no argument there. I work for Fortune #75 (hint; it's probably hanging on your wall). Lost dental insurance last year, vision the previous year, and switched to an HDP the year before (with massive premium increases every year). But hey, the stock price was at an all-time high on Friday. Funny thing about HR directors is that they don't last more than 1 year before rotating out. Don't want them to become too attached to the people they are there to screw.
  - SpaceRaccoon 9y ago

cortesoft 9y ago

This is the fundamental problem of treating healthcare like any other market distributed good; you just don't have the ability to use consumer choice. People using an emergency room are not in a position to negotiate price or seek an alternative service. An unconcious accident victim can't say, "That price is crazy I am going to the hospital across town." Single payer is the only viable solution.

maxxxxx 9y ago
"Single payer is the only viable solution. " That's not true. Plenty of European systems are not single payer and work fine.
- cortesoft 9y ago
  I am not familiar with these alternate systems; how do they work?
  - myke_cameron 9y ago
    A mix of a public payer and private payers, as was proposed in the US in the original draft of the ACA. Edit: a common thread among these systems is that the private payers are not for profit and highly regulated.
  - maxxxxx 9y ago
    In a sense Germany works very similar to Obamacare. Private doctors, health insurances, mandatory insurance for everyone. The difference is that it's much more regulated and the insurances are non-profit as far I know.
  - ballenf 9y ago
    Germany is two-tier. Public health for the masses, private for those making over 80k or so and healthy. The public system premiums are a % of income. The private is a flat cost, so as you make more become much more attractive (even costing less in many cases). Doctors are sometimes private only or have separate private insurance waiting rooms. Hospitals have separate public and private rooms/beds, etc. It's a two-tier system that works pretty well, at least in comparison to the US system. My info is a few years dated, but is based on having been a patient in both US and German hospitals. From friends, I've heard the English system is similar in some respects to the German. Amazingly to me, the German system was instituted under Otto von Bismark in the 1800s. https://en.wikipedia.org/wiki/Timeline_of_healthcare_in_Germany https://en.wikipedia.org/wiki/Timeline_of_healthcare_in_Germ...

Frondo 9y ago

The thing is, if you're in an emergency room, for the most part, you're there because of a medical emergency. (I know this isn't universally true, etc.) If you're bleeding, and someone hands you a price quote, what are you going to do? Or if you're unconscious, they can't even hand you a price quote. (I guess they could shove it in your pocket.) I know the one time I needed to go to the ER, for emergency surgery, I'd have done it if they'd said it was a million billion dollars, because my life was literally on the line. I wasn't going to go shopping around, because leaving that ER would've meant death. What's a price quote supposed to do in those situations? We just need universal coverage, whether single payer or actually universal insurance.

godot 9y ago
Your text is grey and you may be getting downvoted and I'm not sure why. You are absolutely right and anyone who has ever been to ER will agree. I was in ER a couple of months ago, and it wasn't even a life-threatening issue, but I felt terrible. I went to the closest hospital with ER department (thankfully, it was in-network), and I was going to get their treatment no matter what price quote they hand me (not that I asked). When you're deeply, physically unwell, nothing else matters to your mind. I think you may be getting downvoted for your last sentence, but the points you're making are very real.

ballenf 9y ago

Another approach would be that a hospital actually has to take responsibility for the doctors and all other care teams working inside. Legislation to this effect would work, but in some cities there is enough competition that a marketing campaign along the lines of "guaranteed no out of network bills!" would catch my attention. I'd happily drive an extra hour for that piece of mind. And the reality is that a large number of ER visits are not true time-critical emergencies. Many times the standard admission procedure starts with reporting to the ER. I spent 4+ hours before a small outpatient procedure at a local hospital trying to find out if the anesthesia group and surgeons were in-network. I never got a straight answer -- no one knew the answer and I was forced to roll the dice. Hospitals are currently more like co-working spaces where each room (ORs, radiology, etc.) is rented out. The support staff is included, but everyone else is their own small business.

tcbawo 9y ago
I learned about these independent groups during a jury stint on a medical malpractice trial. This was actually a four way fingerprinting exercise (plaintiff's family, hospital, nurse, physician's group). The incentives in the system are perverse and corrupting. I think the system will need to be reinvented from the ground up.
Tempest1981 9y ago
That was a weird concept for me to learn as well. When your surgeon is in-network, you kind of expect the anesthesiologist to also be in-network. But surprise! $3500 for anesthesia. Not sure how the average person would know to expect this... http://consumersunion.org/2014/08/surprise-your-anesthesiologist-is-out-of-network/ http://consumersunion.org/2014/08/surprise-your-anesthesiolo...

snuxoll 9y ago

Cost control right now in the medical industry is all up to your insurance provider, from the article it looks like EmCare is skirting this by simply not participating in any (or very few) provider networks. I work for a medical billing company owned by a competitor to EmCare, we participate it a large number of insurance networks at each site we staff because it's the best way to get reimbursed - I'm rather shocked the hospital didn't investigate how their contracted providers handled insurance contracts and billing. The problem with trying to provide quotes for emergency services is you don't know ahead of time what E&M code will apply to the visit, what labs will be run, what procedures may be required for treatment, and since physician and facility billing are separate the right hand doesn't know what the left is doing. I also have some suspicions about the jump from 6% to 28% rates for billing what I assume is a 99285 (highest level non-trauma ED E&M code) and why it may explain the lack of their participation in insurance networks, but I don't want to tread into libel territory so I'll keep my mouth shut. Disclaimer: I work for MedAmerica Billing Services, Inc. a subsidiary of CEP America - these views, opinions and statements are my own and don't necessarily reflect those of my employer.

acranox 9y ago

> I'm never one to call for legislation and price controls, but in the face of such adversity, I think it may be our last hope. I'm always one to call for legislation and price controls, because time and time again, without the legislation in place, situations like this arise. It's the sad reality. Regulating companies is apparently our only hope to keep people from constantly being stepped on.

spinlock 9y ago

It's not just the emergency room. When you go to any doctor they make you sign a blank check before they will see you.

mapster 9y ago

sinks the whole 'the free market will self-police' fallacy. esp re: health and environment, finance, and worker safety, corporations need regulation, badly.

pascalxus 9y ago
this is a unique situation. Customers can't shop around for the best price because there are laws in place that prevent insurance companies from offering plans that are sufficiently cost effective in such emergency room visits (and a host of other conditions as well). Otherwise, I'm sure someone would have recognized these problems and offered an insurance plan that protects you from this. Free-market can't do anything when it's hands are tied behind it's back.
- mapster 9y ago
  unfettered market results in unfettered greed. means even insured people file bankruptcy for 4 day hospitalization.

chasing 9y ago

If we had an ounce of common sense in this country we would've moved to single payer decades ago.