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In the UK, there is a phone service you can reach by dialing 111. There, a nurse can listen to you describe your issue and advise you if you need to go to hospi

In the UK, there is a phone service you can reach by dialing 111. There, a nurse can listen to you describe your issue and advise you if you need to go to hospital, make a next-day appointment with your GP, go to se the local pharmacist, or just get bedrest. My wife and I have used this a couple times and its great. It is something that I’d love to see brought to the US. One aspect of the service that gives us a lot of piece of mind is that they can confidently and immediately tell you how much the NHS would charge you for their recommended course of action. I do wonder how you would build a similar system that could tell you what your medical insurance would cover and what your copay would be.

AnIdiotOnTheNet 7y ago
> I do wonder how you would build a similar system that could tell you what your medical insurance would cover and what your copay would be. This is literally impossible, by design, under the current system in the US. Neither the provider nor the insurer is able to tell you what something costs until they've had a few rounds at the dartboard to determine that.
- Godel_unicode 7y ago
  That's absolutely not categorically true; if you have an American HMO like Kaiser they have price lists and cost estimators on their website. They also have advice lines exactly like the post you're replying to. I can also email my GP or message them through the app if it's less urgent.
  - takeda 7y ago
    Kaiser is very different than the rest of insurances. They have their own facilities and prices are generally known in advance. Any other insurance it's nearly impossible to know. You need to know if the facility accepts your insurance or not (in/out of network), if the service is covered, your copay, deductible, how much the place bills (note this is not how much they are paid), what's the price the insurance company negotiated with the place and actually will pay and bunch of other things. There's no single person who will be able to tell you the price that you will pay. And you need to know a lot and what to ask and who ask. Unrelated to ER, I recently got charged almost $400 for a visit to a primary doctor that should cost $35. Had to go back and forth with doctor bill, hospital bill (apparently if doctor has an office in a hospital zone, they will also issue a bill, even though you don't really use the hospital) and the insurance company. I was going back and forth either side was either everything is correct and that's how much I should pay, or saying that the other side categorized it wrong. After attempting it multiple times. Eventually I gathered enough evidence that when talking to person from insurance she couldn't find excuse, then she suggested that I can submit request to review it. Why didn't they suggest that from the start. Based on information that I collected looks like the doctor's office and hospital categorized everything correctly (despite what insurance person said), I even had to figure out what the medical codes mean on the bill. And the issue is that the insurance company made a mistake. I like Kaiser model it makes things easy to know in terms of billing, but I don't like that Kaiser give bonuses for doctors for minimizing costs. It encourages so called marginal care. For example you generally won't learn about new kind of treatments available from your Kaiser doctors. They will generally suggest them if you're not responding to the cheaper solutions. For example if you have an autoimmune disease they will prefer you to use DMARDs and NSAID type of drugs (even with their side effects) and won't mention biologics, which are much more expensive, but work much better and can often reverse the effects of the disease.
pjc50 7y ago
> how much the NHS would charge you for their recommended course of action. That's because the answers are "nothing", "the ~$10 prescription charge", or one of the fairly short list of allowed price bands for dental work.
- afarrell 7y ago
  Yes, a conceptually simple abstraction layer is easier to build on top of.
mywacaday 7y ago
We have a similar system in Ireland. You log a call with a regional service and nurse calls you back to assess your case, when she does you are referred to out of hours GP service or the hospital. The GP service costs €60 for ages 6+ or is free like a regular GP service up to the age of 6. That scheme is to be extended to age 12 over the next three years. GP is also free for anyone 70+ We have used the out of hours GP service 10+ times over the last three years with a sick toddler, only referred on to A&E once, definitely helps keep A&E free. When we did go to A&E there is a separate waiting room for young kids to keep them away from the trauma/drunks/crazies. If you go straight to A&E without a GP referral it costs approx €110, if you have a letter from GP its free. Our health system is far from perfect but the out of hours GP/referral system and the free kids works for us.
takeda 7y ago
That works well with single payer. In US in addition to not many people knowing that there's urgent care available that you should use for non life threatening issues, you also have to worry which urgent care center accepts your insurance. It is a f*ing mess :( If you live in US you should spent some time researching which is the closest urgent facility that accepts your insurance and also find another that's 24/7 when you need to see a doctor during weekend or at night. So when you need urgent medical attention you won't have to do the research. Sometimes it can be really time consuming to figure it out.

AnIdiotOnTheNet 7y ago

> I do wonder how you would build a similar system that could tell you what your medical insurance would cover and what your copay would be. This is literally impossible, by design, under the current system in the US. Neither the provider nor the insurer is able to tell you what something costs until they've had a few rounds at the dartboard to determine that.

Godel_unicode 7y ago
That's absolutely not categorically true; if you have an American HMO like Kaiser they have price lists and cost estimators on their website. They also have advice lines exactly like the post you're replying to. I can also email my GP or message them through the app if it's less urgent.
- takeda 7y ago
  Kaiser is very different than the rest of insurances. They have their own facilities and prices are generally known in advance. Any other insurance it's nearly impossible to know. You need to know if the facility accepts your insurance or not (in/out of network), if the service is covered, your copay, deductible, how much the place bills (note this is not how much they are paid), what's the price the insurance company negotiated with the place and actually will pay and bunch of other things. There's no single person who will be able to tell you the price that you will pay. And you need to know a lot and what to ask and who ask. Unrelated to ER, I recently got charged almost $400 for a visit to a primary doctor that should cost $35. Had to go back and forth with doctor bill, hospital bill (apparently if doctor has an office in a hospital zone, they will also issue a bill, even though you don't really use the hospital) and the insurance company. I was going back and forth either side was either everything is correct and that's how much I should pay, or saying that the other side categorized it wrong. After attempting it multiple times. Eventually I gathered enough evidence that when talking to person from insurance she couldn't find excuse, then she suggested that I can submit request to review it. Why didn't they suggest that from the start. Based on information that I collected looks like the doctor's office and hospital categorized everything correctly (despite what insurance person said), I even had to figure out what the medical codes mean on the bill. And the issue is that the insurance company made a mistake. I like Kaiser model it makes things easy to know in terms of billing, but I don't like that Kaiser give bonuses for doctors for minimizing costs. It encourages so called marginal care. For example you generally won't learn about new kind of treatments available from your Kaiser doctors. They will generally suggest them if you're not responding to the cheaper solutions. For example if you have an autoimmune disease they will prefer you to use DMARDs and NSAID type of drugs (even with their side effects) and won't mention biologics, which are much more expensive, but work much better and can often reverse the effects of the disease.

pjc50 7y ago

> how much the NHS would charge you for their recommended course of action. That's because the answers are "nothing", "the ~$10 prescription charge", or one of the fairly short list of allowed price bands for dental work.

afarrell 7y ago
Yes, a conceptually simple abstraction layer is easier to build on top of.

mywacaday 7y ago

We have a similar system in Ireland. You log a call with a regional service and nurse calls you back to assess your case, when she does you are referred to out of hours GP service or the hospital. The GP service costs €60 for ages 6+ or is free like a regular GP service up to the age of 6. That scheme is to be extended to age 12 over the next three years. GP is also free for anyone 70+ We have used the out of hours GP service 10+ times over the last three years with a sick toddler, only referred on to A&E once, definitely helps keep A&E free. When we did go to A&E there is a separate waiting room for young kids to keep them away from the trauma/drunks/crazies. If you go straight to A&E without a GP referral it costs approx €110, if you have a letter from GP its free. Our health system is far from perfect but the out of hours GP/referral system and the free kids works for us.

takeda 7y ago

That works well with single payer. In US in addition to not many people knowing that there's urgent care available that you should use for non life threatening issues, you also have to worry which urgent care center accepts your insurance. It is a f*ing mess :( If you live in US you should spent some time researching which is the closest urgent facility that accepts your insurance and also find another that's 24/7 when you need to see a doctor during weekend or at night. So when you need urgent medical attention you won't have to do the research. Sometimes it can be really time consuming to figure it out.