Blood soaked t-shirt - not an emergency

[RonBoyd]

From the Consumerist: "Yes, copious amounts of blood flowing from your nipples is really something you want to wait out."

CA Insurer: Woman's Bleeding Breast Not Emergency - cbs5.com

 

[donheff]

Bad timing for Blue Cross. Are they conspiring to get a public option?

 

[Bestwifeever]

It probably would have cost the same had she waited and gone to her primary care provider, who would have ordered the same tests the ER did.

 

[DblDoc]

First off as an ED physician this would NOT fall under the category of something that should wait for the clinic to open on monday. Shame on Blue Cross .

On the other hand the number of non-emergent cases I see every shift would boggle your mind. The majority are not true emergencies and could easily await a visit with their PCP. This is a huge $ burden on the system that ultimately WE all pay. Until patients are required to act like consumers with their own $ on the line the system will continue to be abused.

DD

 

[RonBoyd]

Until patients are required to act like consumers with their own $ on the line the system will continue to be abused.

So if this lady knew, in advance, that she would [-]receive [/-] be expected to pay a $2,800 bill out of her own pocket, she would have been more considerate?

 

[DblDoc]

So if this lady knew, in advance, that she would [-]receive [/-] be expected to pay a $2,800 bill out of her own pocket, she would have been more considerate?

No. If she knew it was going to cost her $100 for a copay for the ED visit, the remainder covered by insurance, she would consider it money well spent. Now if she had a low grade fever, sniffles and a cold with a $100 copay and a high probability the insurance company would deny her claim as it was NOT emergent she wouldn't likely show up.

DD

 

[Bestwifeever]

I wonder why hospitals don't establish clinics to shuttle the non-ER patients to. The for-profit urgent care model seems to be quite successful; why can't hospitals do something like that, thus giving the patients DD describes an alternative and creating a new revenue stream?

 

[Gotadimple]

I wonder why hospitals don't establish clinics to shuttle the non-ER patients to. The for-profit urgent care model seems to be quite successful; why can't hospitals do something like that, thus giving the patients DD describes an alternative and creating a new revenue stream?

Well yes it would if they had one, and if they had the triage unit staffed to refer the the urgent care center. But someone has to pay for the triage, and some states have a law that says every patient that comes to an ER needs to be seen and evaluated (not treated, just evaluated). They can charge for the evalation.

-- Rita

 

[Martha]

One of our local hospitals has an urgent care attached to the ER and people get routed during triage to one or the other. Seems to have cut wait times quite a bit. I don't know if it has reduced cost. One problem is that the urgent care is open only week days for maybe 10 hour days.

 

[haha]

The idea that the patient should be able to tell what is and is not an emergency is nuts. In this case, it would depend entirely on the amount of blood. Some bleeding from the nipple would be totally freaky, but likely not an emergency. A lot of bleeding would be a different story. A lot of bleeding from anywhere could be an emergency, and is likely beyond the ken of a patient to decide emergency or not.

But imagine bacterial meningitis. If you don't get seen, and pronto, you are dead or seriously disabled. Do we want people trying to decide if they have menigitis vs some other source of head ache and stiff neck? Same with pneumonia. My ex had pneumonia but she refused to see a doctor because she didn't have a fever. When she finally showed up the doc told her that she was too sick and debilitated to mount a febrile response.

How about MI? Is it indigestion or an MI? I don't want to have to decide this. Being wrong in the too cavalier direction can cost you your life.

Ha

 

[Bestwifeever]

Another insurance-company-stalls-on-paying story:

After aneurysm, Assurant Health causes further headaches -- chicagotribune.com

When the claimant suffered a brain aneurysm, the insurance company launched a "preexisting condition investigation" (or "stalling tactic") that took months and was miraculously resolved when the newspaper contacted them about it.

 

[haha]

'These insurance companies must have a death wish. I hope that it will soon be satisfied.

Ha

 

[RonBoyd]

'These insurance companies must have a death wish.

Yeah. Kinda suspicious. There are beginning to be too many of these type stories. May have to check with Snoopes.com (or whatever) from now on.

 

[Gotadimple]

Interesting . . . did a search on Assurant Health and that led me to their parent company Assurant, which is a specialty insurance carrier, and a Fortune 500 company. I hate it when stockholders come before members.

 

[ERD50]

I hate it when stockholders come before members.

In a free market, stockholders do well when the company provides valuable products/services to its customers. And they employ people in the process. And pay taxes. It is a win-win-win-win.

I don't hate companies, I hate closed markets.

-ERD50

 

[haha]

In a free market, stockholders do well when the company provides valuable products/services to its customers. And they employ people in the process. And pay taxes. It is a win-win-win-win.

I don't hate companies, I hate closed markets.

-ERD50

Thank you Ludwig.

But what has that to do with medicine? If medicine ever was a free market, it hasn't been for at least 50 years and never again will be free .

Ha

 

[ERD50]

If medicine ever was a free market, it hasn't been for at least 50 years and never again will be free .

Ha

I'm afraid you are correct. But, if we are going to talk about HC reform, it makes sense to me to try to make the market more free rather than more closed.

-ERD50

 

[WhoDaresWins]

If I woke up to find myself covered in blood from some source that does not usually bleed, I would hightail it to the ER and not be even thinking about insurance companies. I have never known anyone who was denied a claim for an ER visit. I have never been to the ER as a patient so I am not someone who is wont to go running in with an earache or a rash or a splinter. It is the last place I would go unless I thought death or dismemberment were imminent.

 

[missionfinder]

I suspect that many non-emergencies go to the ER because they know they have to treat them, and they don't intend to pay. Around here, most clinics require payment at time of services, in large part due to all the illegals not paying, so the illegals now go to the ER instead. Sure has changed in the last 20 years.

I suspect a certain side of the media has some collaborating going on right now with Washington, to dig up the exceptions, forgetting the millions of cases serviced without problems each year. Trying to make insurance companies "eeeeeeeevvvvvvvvviiiiiiiiiiiiiillllllllllllll."

 

[LOL!]

I have a great internist. I would not mind calling him on nights/weekends to ask if I should go to the ER or wait to see him. Doesn't anybody else do that I would guess that most of the time, they would suggest seeing a physician right away since that is the CYA answer. Maybe not?

 

[RonBoyd]

, in large part due to all the illegals not paying, so the illegals now go to the ER instead.

Of course, those (arguably) 45 million uninsured citizens would never consider such a thing.

 

[missionfinder]

True, but people who stick around tend to be a little more willing to pay, even if it takes them time to do so. My doctor and I have a lot of talks around the subject of the current medical system and the stories she's told me about the changes are scary. And according to her, at least in this area, the illegals abuse it more than the legals. Its why her office requires insurance or payment in full up front. And, she doesn't milk people, if she knows a patient is having a rough financial time she works with them, if they have a history with the office.

Maybe its not a problem there in Colorado, but illegals are a big issue here. One good side effect of the recession around these parts is you don't see nearly as many of them loitering around the Home Depots and convenience stores --- I suspect many have given up and gone back.

 

[barker]

I have a great internist. I would not mind calling him on nights/weekends to ask if I should go to the ER or wait to see him. Doesn't anybody else do that I would guess that most of the time, they would suggest seeing a physician right away since that is the CYA answer. Maybe not?

Last time I called my doctor on the weekend for some help, I got his answering service and another on-call doctor called me back. Essentially he told me that he couldn't do anything and to go to the hospital ER if I felt I needed help before my doctor was back in on Monday. I think that's their stock answer these days, particularly if you don't reach your own doctor.

 

[RonBoyd]

I would not mind calling him on nights/weekends to ask if I should go to the ER or wait to see him.

Yeah, but... Have you ever actually tested that theory?

 

[LOL!]

Yeah, but... Have you ever actually tested that theory?

Many years ago, I called during a kidney stone episode and gotten a prescription for pain killer over the phone that my spouse went and picked up at an all-night pharmacy. I have all the medications I need at home nowadays, so I haven't called in years.

Last year, when I broke a bone pretty badly, I called my orthopedist who was not open at the time. They suggested going to the ER which as related here a few months ago was a total waste of time as I never saw a doctor at the ER. I had surgery a few days after that.