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Emergency Room Costs - alternatives
Old 06-21-2013, 10:42 AM   #1
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Emergency Room Costs - alternatives

This article is a broad brush discussion about the high cost of emergency room treatment.
Emergency Room Costs Can Vary By Thousands Of Dollars, Study Finds

Over the years, we have been "customers" from time to time, but now that we are on Medicare, we don't see as much coming out of our pockets, so the actual costs don't mean as much as they did before. That said, the actual costs are commonly outrageous and we all end up paying for the services, one way or another.

It might be interesting to see how members deal with this. Urgent Care Centers? Walmart Clinic? See own doctor? ... or maybe some other ways to keep the costs down?
Your thoughts?
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Old 06-21-2013, 11:02 AM   #2
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I'm interested in seeing this too. My emergency room visit in September was $3,000 for one night, not including the cost for the doctors, the medicines, my CT scan-- Im not exactly sure what it was for. I was in there for about 5 or 6 hours before being admitted for a week, all of which costed over $10,000 more, but it's hard to see why, on top of everything else, basically renting a bed in an emergency room is $500 an hour.

I'm new to handling my own medical care, so it'd be good to see how other people deal with their situations. Also some differences between Medicare and other plans.
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Old 06-21-2013, 11:15 AM   #3
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We head for acute care unless something appears life threatening because we simply abhor waiting endlessly in the ER. It's usually for MIL who's on MC and uses the c__p out of it. Figure sitting around the ER would only expose her to bad stuff, but if it's bad enough for ER she'll likely be admitted anyway.
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Old 06-21-2013, 11:23 AM   #4
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The "rack rate" at hospitals is never paid by insurance companies...they pay a negotiated rate that is probably 25% of the rack rate. One reason why the rates are so high is because they need to cover for all of the people who don't have insurance, and don't have two nickles to rub together. All of those write-offs need to be covered, so if you have a net worth, no insurance, and use US healthcare, you get soaked.

If you live near an international border, you can buy international insurance (which can't be used in the US, for obvious reasons), and get good care in a neighboring country for a small fraction of the cost you would have paid in the US. Or if you are into the whole expat idea, there are plenty of countries with world class healthcare where insurance would, again, be a tiny fraction of the cost of the same thing in the US.
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Old 06-21-2013, 02:50 PM   #5
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Unfortunately, I cannot provide the full article link since Time requires a subscription. But, it you can get to this article, it is a real eye opener about our health care system costs. Why Medical Bills Are Killing Us | TIME.com
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Old 06-21-2013, 02:55 PM   #6
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Originally Posted by davef View Post
Unfortunately, I cannot provide the full article link since Time requires a subscription. But, it you can get to this article, it is a real eye opener about our health care system costs. Why Medical Bills Are Killing Us | TIME.com
It has been discussed here before, but is an insightful article.
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Old 06-21-2013, 03:50 PM   #7
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sengsational,

Do you have further information about international insurance? I live close to Canada ,in the USA, and have never considered such a strategy.

Thanks
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Old 06-21-2013, 04:06 PM   #8
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Out of country care is a good subject, and for those living near the border, or traveling, a necessity.

I was hoping to keep the discussion in the more specific area of emergency room costs, and some way to avoid what so often turns into multiple doctor examinations, tests and periods of room rental, which seem to occur more often when the personnel and the facilities are right there and available.

In our town(s) we are seeing a proliferation of limited facilities, beginning with wellness clinics in Walmart, (staffed by nurses, with limited basic tests, as well as the ability to prescribe medications) for more difficult emergency situations, these clicnics act as triage for reference to hospital emergency rooms, or to direct the patient to a doctor.
From the Walmart Clinic site:
Quote:
All in-store clinics offer essential preventative and routine health services for common ailments as well as screening exams that can be performed without urgent or emergency care. Clinical services may include:*
Allergy Care Common vaccinations
Acne care Earache treatment
Bladder infection treatment Flu treatment
Blood pressure checks Insect bite and sting treatment
Blood sugar testing Sinus infection treatment
Camp / school physicals Upper respiratory infection care
Cholesterol screening Wart removal
The typical charge is $65 for the visit.

There are additional businesses, variously described as "Clinics", "Urgent Care" or other general terms . Wikipedia has a article that delves in to the kinds of services that are offered, and the standards that are required for designation as Urgent Care... by the Urgent Care Association of America.
http://en.wikipedia.org/wiki/Urgent_care

We now are also seeing new limited "outpost" hospital facilities, located in malls or industrial type parks... closer to the local community, and fully staffed with nurses and General Practitioners.

In our limited experience, the use of these "alternative" healthcare sites avoids the basic cost for emergency room service, which is posted in our hospitals at or above a $500 minimum.

In years gone by, the standard action to be taken has been to go directly to the hospital emergency room. For those with insurance, the cost of doing this is often paid or subsidized so the patient doesn't see or have to be concerned with the large bill.

So the question is, do you know what services your local alternative healthcare can provide? When an emergency occurs, the decision of where to go could make a difference... either because of the longer distance to a hospital ER, or the possibility of going to a nearer service where the best care may not be available.

So aside from the cost, knowing where and what capabilities are offered could be critical in an emergency.

The other question that one might ask his/her doctor, is whether that doctor would accept patients on an emergency basis, and if so, for what kind of cases.

Better to know before, than after making an urgent care decision.
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Old 06-21-2013, 05:36 PM   #9
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My doctor offers same day or next day appointments which is good for most of the "I'm not feeling good" types of stuff.
I go to Urgent Care centers for most things like, UTI, cuts, possibly even broken bones.
If I didn't have insurance, the Wal-mart clinic, or similar ones run by drug stores near me would be my first stop. Went to one for a flu shot and was impressed.

I would only go to an emergency room for a suspected heart attack, or if I had a cut that was spurting blood, and it would probably be something I'd go to via ambulance.
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Old 06-21-2013, 06:50 PM   #10
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During the day I would use the urgent care facility 1 block from my apartment, unless it was a life-threatening problem in which case I would go to the ER. During the night it would have to be the ER (no 24h urgent care facility around here).
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Old 06-21-2013, 06:56 PM   #11
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One difference is that some will treat injuries while others do not.

A few years ago I hit the edge of a door right before going to work and had a cut on my eyebrow. I thought it was minor and would stop bleeding and drove to work and it didn't stop so on the way I stopped at an emergency clinic near my office that was run by a well known hospital. There was no problem and they quickly took care of it (I did need a couple of stitches).

On the other hand, about a year ago I was in a grocery store and had a small cut from some sharp metal on the edge of a shelf. The store staff tried to have the clinic in the grocery store look at it, but they didn't actually handle any kind of injury. After considerable pleading from the grocery store, they did ultimately agree to give some gauze to the store to give to me so I could cover the (minor) wound.
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Old 06-21-2013, 07:23 PM   #12
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With our Medicare Advantage plan (BCBS), an emergency room visit has a $65 copay. If you are then admitted because of the nature of your illness, this $65 copay is waived. Then we become an inpatient and our semi-private room costs us $320 for days one thru five. After the fifth day, the plan pays 100% of the cost.

Last year this very thing happened to my wife. Went to the emergency room, they admitted her and she spent the next six days there as an inpatient. Our cost for the the six days in the hospital room was $1500. When she was being released the admitting office came to see me about payment and offered me a $500 discount if I would pay right then. Took them up on that offer. I didn't think that was too bad.
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Old 06-22-2013, 12:01 PM   #13
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Don't believe my gal did much comparison shopping a bit over a month ago. I got to ride in an ungodly expensive taxi with attendants to the nearest emergency room. Bills are starting to come in and they make me feel good about the insurance we pay as well as making the maximum out of pocket cap look like pocket change.

Oddly, only a few months ago I was pretty huffy about spending over $14,000/year on health insurance. Can see where medical care can eat the saving of decades post hasty.
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Old 06-22-2013, 01:02 PM   #14
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The last time I went to the emergency room was for emergency gall bladder surgery, back in 1993. Our insurance covered just about everything, once we proved to them that it was a bona fide life or death emergency situation.

I would imagine that emergency rooms are frightfully expensive by now. I think my insurance combined with Medicare is about as good as it gets, but still I hope I don't have any reason to find out.

An uninsured friend went to the emergency room with a heart attack false alarm (indigestion) in 2004, stayed the night in the hospital being monitored, and after some negotiation he ended up paying $6000.
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Old 06-22-2013, 02:42 PM   #15
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Who goes to the emergency room when they have the option of getting treatment from their own doctor, a nearby walk-in care center or (gulp) Wal-Mart clinic? Emergency room for me means something that needs critical attention and is a place to avoid if at all possible.
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Old 06-22-2013, 03:43 PM   #16
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Who goes to the emergency room when they have the option of getting treatment from their own doctor, a nearby walk-in care center or (gulp) Wal-Mart clinic?..........
..Um...people with no insurance and no money??
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Old 06-22-2013, 04:30 PM   #17
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..Um...people with no insurance and no money??
Of course. But the thread is about people with options, and i was wondering aloud about that.
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Old 06-22-2013, 04:47 PM   #18
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Of course. But the thread is about people with options, and i was wondering aloud about that.
Sometimes people may not be aware of options or they may not be available at the time needed or they may be uncertain if something is an emergency.

Many private physician offices basically tell patients after hours to go to an emergency room if it is something they feel can't wait.

Also the urgent care clinics, clinics in the grocery store, etc. are relatively new and many people who do have a regular physician have never used one so it doesn't cross their mind.

Also, as I mentioned earlier, this clinics vary in what they handle. If I had a cut that needed minor stitches (which I did have) I am not sure which of the various clinics nearby could handle it as some do not handle injuries. So, I could see going to the emergency room if you weren't sure. Also, many of these clinics are not open in the evenings or late at night. In some instances if you are worried it can't wait the emergency room is the only option.

And, most people are not good at knowing what is an emergency and what isn't and will want to err on the side of caution.

A few years ago I went to my regular doctor on a Saturday (I was lucky that he had Saturday hours) after being sick for a few days. I didn't really consider it an emergency. Had his office not had Saturday hours I would have intended to wait until Monday. After seeing me, he thought I had some sort of intestinal virus but told me to go the hospital ER for some fluids. I went there, still not really thinking this was much of an emergency. I spent the next 5 days in the hospital. It actually was an emergency but I hadn't recognized it all (making me more cautious for the future).
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Old 06-22-2013, 04:50 PM   #19
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sengsational,

Do you have further information about international insurance? I live close to Canada ,in the USA, and have never considered such a strategy.

Thanks
-gauss
You might check out "Bupa International". We can take the discussion to Has the Threat of ACA Pushed People Toward Retiring "Overseas"? to keep this thread from getting side tracked.
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Old 06-22-2013, 05:45 PM   #20
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Sometimes people may not be aware of options or they may not be available at the time needed or they may be uncertain if something is an emergency.

Many private physician offices basically tell patients after hours to go to an emergency room if it is something they feel can't wait.

Also the urgent care clinics, clinics in the grocery store, etc. are relatively new and many people who do have a regular physician have never used one so it doesn't cross their mind.

Also, as I mentioned earlier, this clinics vary in what they handle. If I had a cut that needed minor stitches (which I did have) I am not sure which of the various clinics nearby could handle it as some do not handle injuries. So, I could see going to the emergency room if you weren't sure. Also, many of these clinics are not open in the evenings or late at night. In some instances if you are worried it can't wait the emergency room is the only option.

And, most people are not good at knowing what is an emergency and what isn't and will want to err on the side of caution.

A few years ago I went to my regular doctor on a Saturday (I was lucky that he had Saturday hours) after being sick for a few days. I didn't really consider it an emergency. Had his office not had Saturday hours I would have intended to wait until Monday. After seeing me, he thought I had some sort of intestinal virus but told me to go the hospital ER for some fluids. I went there, still not really thinking this was much of an emergency. I spent the next 5 days in the hospital. It actually was an emergency but I hadn't recognized it all (making me more cautious for the future).
I was under the impression urgent care clinics were increasingly dealing with many of the issues seen in emergency care (and where payment was assured). That may only be the case in higher density areas where the population is large enough to justify the investment. We have nearby facilities that will take x-rays and do some blood and other lab work, which seems a very good option for someone in need of treatment but wanting to avoid the hospital emergency room.
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