7 ms·

Biggest health insurer plans to deny ER bills if it doubts you had an emergency

• commandlinefan 5y ago
  I remember a co-worker talking about this happening to her in the 90's - she went to the ER for a sudden, large rash that turned out to be a non-emergency (shingles), but she had no way to know that. AFAIK, she had to pay the whole ER bill herself because she didn't know ahead of time how serious what she had was.
  • netizen-936824 5y ago
    Are there cases in which a rash is a legit emergency?
    • programmer_dude 5y ago
      Rashes can appear in cases of allergic reactions, those can be deadly.
    • derbOac 5y ago
      Yes, depending on the scenario. MRSA and other bacterial infections are good (and unfortunately too common) examples.
      • handrous 5y ago
        Yep, the gap between the point where most people would start to think a skin-infection-caused rash is bad enough that they might need help, and the point at which it's moved deeper in the body and begun to infect other tissue, can be pretty damn short, and by the time you've noticed (say) joint aches or immobility, it may be too late for simple solutions. If you've hit that point on a Saturday morning but think "well it's the weekend, I'll try to see my doctor on Monday" but then it's looking really bad by Saturday night (not implausible) and you can't get to an urgent care for whatever reason (none nearby, or just not open), you really don't want to wait until Monday to have a professional look at it. ER's not a crazy choice. If it's truly bad that's where the urgent care will probably send you, anyway.
    • tyingq 5y ago
      Anaphylaxis often first shows as a rash. Toxic shock syndrome and MRSA too. Probably others.
    • debacle 5y ago
      Shingles could be one, actually. It can lead to permanent neurological issues.
    • majormajor 5y ago
      That sounds like a question for a doctor. If something happened in the middle of the night to you, where you would find a doctor in the middle of the night if not at the ER?
      • avereveard 5y ago
        Just copy Italy, we have a backup for the primary care/general practitioner under the form of Guardia medica, which does the same level of triage they'd do but in night shifts
    • Fomite 5y ago
      MRSA (see also 'spider bites'), meningitis, adverse reactions to a drug, Staphylococcal scaled skin syndrome (especially in infants), Stevens-Johnson syndrome (which can be a reaction to medication), toxic shock syndrome, among others.
    • Broken_Hippo 5y ago
      Yup. Allergic reactions, especially to medication. And let me tell you, that rash is absolute agony. So. Much. Freaking. Itching. I wished it was pain instead. I would have tried about anything to get it to stop. It was all over my torso, and just horrible. It is really important to get it taken care of before it gets worse - you don't want to, say, take more medicine and not be able to breathe. The other thing that can cause a rash-like appearance is an infection, though they usually describe this as red streaks (from a cut, anyway). If this is happening on a friday night, you shouldn't wait until monday to take care of it.
  • alexmcc81 5y ago
    Shingles can cause blindness. Early treatment is very important. A friend of mine was hospitalised and left with bad scaring because they delayed seeking help. At least she didn't have any large bills because she was not in the US. No one should be afraid of going to the hospital.
• 1996 5y ago
  So when threatened to have their source of funding cut (as most people wouldn't be able to pay out of pocket), a union of professionals attacked the moved as dangerous/cost cutting/etc? And they were supported by their employer industry representative associations?? Color me surprised!
• josh_fyi 5y ago
  Here in Israel, if you go to the ER without are for referral from an urgent care clinic and the issue is found to be minor, you pay $140. Enough to deter frivolous cases, but not crippling.
  • imadethis 5y ago
    Incidentally, that's about the amount my wife paid for a covered visit to an ER with a legitimate reason in the US. Doesn't matter if she had gone in with toe pain or a GSW, it still would have been the $100 copay plus whatever coinsurance the visit would have cost.
  • tyingq 5y ago
    I remain mystified why our US Healthcare system seems unable to do common sense things. Also, when I last ran my own business, which was a while ago, the monthly premium for ONE employee+family was $2400. A high-end plan, but still...I was well into my late 20's before my entire paycheck was that much.
• murph-almighty 5y ago
  My friend had a bad asthma incident recently, went to an urgent care, and got referred to a hospital because they were at capacity. I wonder if that would count as an emergency.
  • meowster 5y ago
    Edit: misunderstood, cannot delete. Sorry.
    • Spartan-S63 5y ago
      Right, but the original commenter said their friend was referred to a hospital, probably an ER. So, the question remains whether they would be hit by this policy, too.
    • Robotbeat 5y ago
      Right, but the UC facility referred him to the hospital, i.e. the ER, because they were full.
    • majormajor 5y ago
      That's not the question in the post you're replying to. The question is "would the insurance company consider it an emergency because the Urgent Care facility was full and told the patient to go to the ER even if the final discharge condition was classified as a 'non-emergency'?
• derbOac 5y ago
  The article outlines fairly well the primary reasons why this is an atrocious policy to adopt (even if it's fairly typical of some of the rationales for reimbursement or lack thereof). Another problem with the policy, though, is that many people are forced into ED use because there are simply not better options. Urgent care in the US has become fairly restricted in scope of services in a lot of areas, so the grey area between "urgent care worthy" and "ED-worthy" is larger than it should be. Many things that are maybe less ED-worthy become ED visits because urgent care is inaccessible, and delaying to urgent care or outpatient might make them emergency in nature. Even things like routine medication refills for certain groups can become ED visits because urgent care is closed, outpatient visits might be scheduling too far out, and so forth. Do some people abuse the ED? Sure. But then find another solution for those people.
  • selectodude 5y ago
    > Do some people abuse the ED? Sure. But then find another solution for those people. Ironically they tend to be the uninsured because the ER can't turn you away. The solution is to get them insured.
    • Broken_Hippo 5y ago
      This is really important: Health care should be really, really easy to afford. For some comparison: Since I moved out of the states, I pay less than $300 a year out of pocket (in general). My biggest expenses - a neurologist, for example - costs less than $50. As does the ER, honestly, or the clinic that deals with injuries (the ER will send folks over there). The rest is taxes, and taxes are lower than federal + state + insurance premiums in the US. Additionally, it isn't just insurance. If you work while the normal doctor is open and you don't have paid sick days, you might not be able to go to the doctor even if health care is free simply because you can't afford to miss work. You need paid time off for this sort of thing - and honestly, parents need more days since they have responsibility for than one person.
  • treeman79 5y ago
    Urgent care is very lacking. I’ve had many episodes where I go in and they refuse to see me, say goto ER. Get to ER and they are annoyed that I didn’t goto an urgent care. Look I’m sorry my minor stroke annoys you, but something beyond go home and see if it turns into a major stroke would be appreciated.
• ping_pong 5y ago
  What a bunch of fucking scumbags. Politicians need to step in and make this illegal. This industry is disgusting. Now you are talking about regular people trying to self diagnose to avoid going to the ER in fear of getting a large medical bill. Fuck these people.
  • TX0098812 5y ago
    And that's putting it politely.
  • dahdum 5y ago
    > Politicians need to step in and make this illegal. That would only make the situation even worse, hospitals would raise their absurd gouging rates even higher if government required it. Reform is needed but on both sides of that table.
    • wizzwizz4 5y ago
      Break up the insurers (or nationalise the medical care funding system), break up (or nationalise) the hospitals.
  • jvanderbot 5y ago
    When is the last time you went to an ER? We went recently in southern california, and it was saturated by people stopping in for sniffles, flu, and other things that should have been handled in a regular doctor visit. The nurse said as much when we asked if we should go somewhere else for (what turned out to be) an actual emergency. We got right in, thanks to triage. Is this related to the article? Probably not. But I never get enough chances to point out the myriad abuses and misuses of the health care system.
    • ceejayoz 5y ago
      > We went recently in southern california, and it was saturated by people stopping in for sniffles, flu, and other things that should have been handled in a regular doctor visit. This is likely due to an inability to access "regular doctor" care. Either for lack of insurance (which they can't afford), or a giant deductible (which they also can't afford). The doctor's office can turn them away for an unpaid bill; the ER cannot.
• blakesterz 5y ago
  "In a 2018 analysis published in JAMA Open Network, researchers found that up to 90 percent of the symptoms that prompted an adult to go to the emergency room overlapped with symptoms of non-urgent conditions, which may be denied coverage in the future. But those same symptoms could also be linked to life-threatening conditions." From the study: Findings This cross-sectional study found that 1 insurer’s list of nonemergent diagnoses would classify 15.7% of commercially insured adult ED visits for possible coverage denial. However, these visits shared the same presenting symptoms as 87.9% of ED visits, of which 65.1% received emergency-level services. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707430 https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
  • imadethis 5y ago
    Classically, you have gastroenteritis (stomach flu) and appendicitis both presenting with stomach pain, or myocardial infarction and heart burn both presenting with chest pain. A policy like this will result in deaths for those that occupy the middle ground between Medicaid and having enough money to not worry about medical bankruptcy.
• schaefer 5y ago
  I was born in the USA, but every day I question if I will be able to afford to retire in this country, or if I need to plan to emmegrate elsewhere while I still can. My primary concern is healthcare costs. How am I supposed to budget for healthcare costs during retirement when it's already so complicated. 530,000 American households are bankrupt each year due to medical costs [1]. It seems like the most complex piece of the retirement planning puzzle. [1] https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most...
  • andrewmcwatters 5y ago
    Some few months ago I was trying to think of some sort of asset protection vehicle to prevent medical organizations from seizing everything I own in the event I face some catastrophic health issue. I don't think you can transfer property to a trust to shelter you from such events, though. They'd just go after the trust as far as I know. The bigger issue is that I shouldn't have to think about this sort of problem in my emergency or estate planning.
    • rm445 5y ago
      It's weird though, you'd think that would be exactly the kind of risk that would be insurable. Privately or as a whole society. Some of us will keel over on the spot or otherwise incur near-zero end-of-life costs; others will need $2 million of care to make it through the last couple of years. It seems less relevant whether people in society pay their everyday medical costs out of pocket, compared to the fact that any one of us might need rare expensive treatment or complex care. The whole country sharing the risk as a massive national collective self-insurance exercise seems like the best solution.
      • op00to 5y ago
        Sorry, I don’t like it when MY money goes to help THOSE people. (Sarcasm)
  • throwthefuture 5y ago
• slownews45 5y ago
  This occurs because it's the area you can get hit with totally extraordinary out of network bills your insurer may have to pay. Super lucrative for hospital / physician / transport providers. Your kid bumps their head. "There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Korea — to Zuckerberg San Francisco General Hospital (SFGH). The doctors at the hospital quickly determined that baby Jeong Whan was fine. He took a short nap in his mother’s arms, drank some infant formula and was discharged a few hours later with a clean bill of health. ... the bill finally arrived at their home: They owed the hospital $18,836, the bulk of which was for a mysterious fee for $15,666 labeled trauma activation" Hahah. For the insurance companies this happens over and over. Of course, the lobby groups will get everyone riled up over this and HN contributors will be calling UnitedHealth scumbags / capitalist pigs.
  • gotostatement 5y ago
    the insurance companies have posted record profits. They're not having money trouble "UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021"
    • slownews45 5y ago
      This is in part COVID driven. * Significant reductions in demand for standard services. * Generous compensation for COVID services.
      • gotostatement 5y ago
        this has been going on since before COVID https://www.fiercehealthcare.com/payer/big-name-payers-earned-35-7-billion-2019-here-s-one-common-thread-their-reports https://www.fiercehealthcare.com/payer/big-name-payers-earne... In particular see the chart that shows 2018 and 2019 profits
        • 5y ago
• dahdum 5y ago
  While I have no sympathy for the insurance companies, many hospitals are all too eager to gouge the hell out of emergency services and resist attempts to reduce costs. It's where you get slammed with out-of-network specialists.
  • gotostatement 5y ago
    Be that as it may, this is not a decision made due to financial pressure on the insurance companies. "UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021. Despite earning $6.7 billion in a single quarter, UHC enrollees are being asked to pay more for their coverage."
  • gpm 5y ago
    So what, that's not something under the patients control. You (as a society) can't (morally) go "oh, well some hospitals are malicious, so we're just going bankrupt random people who get unlucky". The insurance companies should lobby to make that illegal, if it's already illegal lobby to have that law enforced (if criminal) or take them to court (if civil) or both (if both). In the meantime they shouldn't be shifting the liability to the patients.
• gotostatement 5y ago
  The company claims this is cost-cutting: "Unnecessary use of the emergency room costs nearly $32 billion annually, driving up healthcare costs for everyone. We are taking steps to make care more affordable" But: "UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021. Despite earning $6.7 billion in a single quarter, UHC enrollees are being asked to pay more for their coverage." The greediest, most depraved people in the country are responsible for keeping us healthy.
• hibern8 5y ago
  I will never be able to understand a person who doesn't think healthcare is a human right.
  • hpoe 5y ago
    Well I don't think it is a human right for the simple reason that medical care is technically a limited resource.l, there is not an infinite supply of doctors or medicine there is a limited supply no matter what that theoretical limit is. Ergo it can't be a human right because it is limited, a right is something that everyone should have. Also what do we mean by "healthcare" is it anyone should be allowed to have any medical procedure they want whenever they want it? I ask because by simply having access to penicillin, aspirin, benedryl and ibeprofun you now have better healthcare than any person in human history that lived before the 1950s. So when we say healthcare is a human right we really need to define what we mean by healthcare. I also want to make clear I in no way support the insurance companies or hospitals as I think they are all greedy filthy parasites, and have been in constant combat with them for years, but I also don't understand how any rational person can justify the comment that healthcare is a human right.
    • avgDev 5y ago
      "Healthcare" as what any other first world country has. Everything is covered, sometimes you wait for non life threating issues or you can pay and do things privately. Cosmetic stuff is not covered and some things may not be covered once you are a certain age and there is lack of research proving it may work. We fund police, fire, infrastructure as a society, we can fund healthcare as a society as it is generally cheaper than whatever the fuck we are doing here in the US.
    • effingwewt 5y ago
      Healthcare isn't zero-sum. You aren't not going to receive healthcare because someone else is. Because we don't all get sick/injured at the same. In any common sense Healthcare is most definitely not a limited resource. In fact, due to more preventative Healthcare options available it would definitely decrease the loads on hospitals. See- every other developed nation with basic health care.
• brilee 5y ago
  Healthcare providers tend to overcharge in proportion to how unnegotiable the service is. For example, ambulance charges are a great way to make money, because the person on the hook for the ambulance typically isn't in a position to decline ambulance service. I agree with the implementation because it puts the burden in the right place. The error here is not that the insurer is denying payment, but that the hospital is then passing the bills onto the patient. Somehow, we have to reduce unnecessary use of emergency services. The doctors correctly point out that patients can't make that decision. Since the doctors _can_ make that decision, they should be involved in helping reduce ER misusage. The insurance company is setting up the correct incentives for the hospital to do exactly that; however, the hospital is dodging the incentives by passing costs to the patient. So the hospital is in the wrong here.
  • ceejayoz 5y ago
    The insurance company is dumping a giant turd in the patient's lap and forcing them to either eat it or go fight an immensely well funded and resourced organization over the bill. It's a bit baffling to absolve them of responsibility in that action.
  • Broken_Hippo 5y ago
    Well, honestly, doctors can only do so much too. Serious abdomen pain can be gas or something serious. You can cough hard enough to fracture a rib. Chest pains can be acid reflux or a heart attack: I had gastritis when this happened to me. And this is a good deal of the issue: You don't know how serious it is until you go to the doctor. Now, this doesn't cause all of ER misuse, but we aren't doing anything to make that better. A doctor won't see you if you can't pay upfront. This is the same problem with urgent care: Either pay upfront or don't get helped. The ER, though, will bill you. Which does mean that if you are poor - especially just over the income level to get help with a lot of expenses - you either go to the ER when you need a doctor or you don't get seen and have to wait until it IS serious enough for the ER. We can solve this by making sure everyone can very easily afford health car (I no longer live in the US: My out of pocket is $300 per year, and this includes necessary prescriptions, doctors, physical therapy, some dental stuff, and so on). The rest is paid in taxes, which are less than federal + state + health insurance was in the states: Nevermind having to pay a deductible before the out of pocket. (I know my GP will bill me, by the way). But another way to handle this is to have something akin to urgent care on hospital grounds - a place that folks can see a doctor/nurse practitioner for non-emergency things and get billed later.
• deleted 5y ago
  [deleted]
• rejectedandsad 5y ago
  Absolutely nightmarish. Sounds like a recipe for people to shrug off heart attacks in the fear of a surprise medical bill. This could kill.
• watertom 5y ago
  Employers need to stop providing healthcare, they should end healthcare as a benefit and provide employees with a one time raise to cover the costs, and then be done with providing healthcare. Big companies don't want healthcare to go away, because it's means to control employees, it's a way to suppress competition from small businesses, and is suppresses wages.
• doggodaddo78 5y ago
  For-profit healthcare should be illegal and there should be sufficient doctor appointments to go around. Right now, Americans pay more than anyone, wait weeks or months for appointments, and receive much poorer care than equivalent countries.
• aaomidi 5y ago
  If America's bullshit was happening in any south American country, or most middle east countries, people would have heads on spikes by now. Really surprised how much shit Americans are capable of taking.