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Old 12-28-2012, 11:47 PM   #21
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People with no money or resources can get emergency treatment at a hospital even if they can't pay, but that is not health care, and they are cannot get any other type of medical care without first showing proof of payment.
When I was checking in at the ER, I offered my HI card but the ER people said: "Not now, we will do that later after we check you out", which affirms your statement.

When they found out that I am not having a heart attack, they admitted me for further tests. I wonder if they would have discharged me if I did not have any means of paying.
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Old 12-29-2012, 03:22 AM   #22
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Heart attacks are not the only thing considered emergency care. The provisions for this were signed into law by President Reagan in 1986. The law is referred to as EMTALA, and it requires emergency rooms to provide "medical screening examination" whenever "a request is made on the individual's behalf for examination or treatment for a medical condition" which is defined as "a condition manifesting itself by acute symptoms of sufficient severity (including severe pain)". The conditions for discharge include a requirement that the condition, whatever it is, does not preclude the patient from caring for himself or herself, including the ability to walk around on your own, wash yourself, etc. So even a sprained ankle is covered by EMTALA.
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Old 12-29-2012, 07:12 AM   #23
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They are only required to give a screening exam to determine if an emergency condition exists, and only have to stabilize the individual. You can't just walk in and get long term treatment for chronic diseases like hi BP, diabetes etc. Not going to get cancer treatments. FAQ on EMTALA

I was in an ER once after an accident, they didn't even look at me for six hours. Laid on a gurney in the hallway. They couldn't initially verify the insurance, once they did it was game on, meter was running, they ran every test and exam they think of.
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Old 12-29-2012, 07:21 AM   #24
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They are only required to give a screening exam to determine if an emergency condition exists, and only have to stabilize the individual.
The key is what "stabilize" means in the EMTALA context - it isn't just making sure the person isn't about to die. There are explicit requirements that if the condition, even if it is determined not to be life-threatening itself, impedes mobility or other basic things, then the patient cannot be discharged.

Furthermore, EMTALA does not indemnify service providers who follow the letter of the law. By this I mean that if a hospital insists on discharging a patient without treatment, after determining that their condition is not eligible for treatment under EMTALA, and then that person suffers harm as a result, EMTALA doesn't shield the hospital from civil lawsuits (and the general public generally sympathizes with the little guy, not the hospital) on the basis that they didn't want to take the patient's verbal promise that they would find a way to pay.

So effectively EMTALA has a secondary effect which cannot be ignored - it forces hospitals to open the door, and then that effectively obligates the hospital to provide treatment for non-chronic conditions, with no real guarantee of payment.

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You can't just walk in and get long term treatment for chronic diseases like hi BP, diabetes etc. Not going to get cancer treatments.
Precisely so... treatment for chronic conditions are readily side-stepped, though treatment for any critical incidents that occur as a result of inadequate treatment for chronic conditions would fall under EMTALA.
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Old 12-29-2012, 07:42 AM   #25
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my wife gets prescriptions every month for her problems. one in particular makes me wonder. the initial cost on the statement was 24.98 and after the insurance discount it was 2.98. it certainly makes you wonder about the actual cost of the product. and do people actually pay the full price or if you are paying cash do they charge you the discounted price?
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Old 12-29-2012, 08:58 AM   #26
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In Dallas they go to the County Hospital who can't turn anyone away and the rest of us pay for them thru Hospital District taxes on our property tax bill.
I would also add that cost of medical insurance in Texas is among the most expensive in the nation since you end up subsidizing the free loaders.
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Old 12-29-2012, 09:40 AM   #27
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This talk kind of makes me want to get a policy with no lifetime limits .

The policy I have now is only a measly $5 Million limit.
I thought these lifetime caps were abolished under PPACA, no?
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Old 12-29-2012, 09:56 AM   #28
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Under the law, lifetime limits on most benefits are prohibited in any health plan or insurance policy issued or renewed on or after September 23, 2010.
Lifetime & Annual Limits | HealthCare.gov
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Old 12-29-2012, 10:53 AM   #29
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I thought these lifetime caps were abolished under PPACA, no?
My individual plan is grandfathered in. My max limit is $7 million. Seeing the projected insurance premium costs under the new mandated guidelines coming next year, they will have to pry this grandfathered plan policy from my "cold, dead hands" Of course,the only thing I can control is making sure I make the monthly payment. I would assume, however, it is of benefit to the insurance company to keep a healthy, underwritten group of people under their control with a lifetime cap limit to protect themselves, also.
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Old 12-29-2012, 11:00 AM   #30
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And, of course, if you ever do hit the lifetime cap, you can just dump the then-worthless policy and go to the health exchange to find a worthwhile policy that will cover your pre-existing conditions, and without any lifetime cap.
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Old 12-29-2012, 11:25 AM   #31
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And, of course, if you ever do hit the lifetime cap, you can just dump the then-worthless policy and go to the health exchange to find a worthwhile policy that will cover your pre-existing conditions, and without any lifetime cap.
I hadn't actually thought about that. But if I have the need for more than 7 million dollars of medical care, I don't know if I want to be around for "added bonus coverage" . But then again, I have been fortunate enough to where a person making minimum wage could have paid for all the medical care I have received since I left the hospital at birth, so I haven't actually been involved much with the highly inflated cost of medical care.
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Old 12-29-2012, 11:29 AM   #32
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In practice, bicker is correct. ER's have become the 'primary care doc' for much of the un/under-insured in the US. It's not only liability concerns, but also that many come in to ER's claiming to have HI but not their insurance ID cards. Treatment is given & HI followed up later by billing dept. Sometimes folks are found to have HI or Medicaid eligibility, but often not. Some with HI also do not pay their deductibles &/or co-pays. This overhead has to be recovered somehow, and that is by higher charges for paying patients.

The actual interpretation of "grandfathering" under ACA may not be as iron-clad as it is being presented by some in the press. All still must have a "Qualified" HI plan. Courts are already weighing in on whether existing HI must be compelled to cover certain ACA mandated items (e.g. "morning after" birth control)-

Atty: Hobby Lobby Won't Offer Morning-After Pill - ABC News

No reason this stance might not be applied to other issues like life time caps, etc. Have to wait & see.

To OP- Glad things turned out OK.....and that your HI worked for ya.
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Old 12-29-2012, 11:31 AM   #33
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My individual plan is grandfathered in. My max limit is $7 million. Seeing the projected insurance premium costs under the new mandated guidelines coming next year, they will have to pry this grandfathered plan policy from my "cold, dead hands" Of course,the only thing I can control is making sure I make the monthly payment. I would assume, however, it is of benefit to the insurance company to keep a healthy, underwritten group of people under their control with a lifetime cap limit to protect themselves other policyholders, also.
FWIW...
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Old 12-29-2012, 11:53 AM   #34
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I thought these lifetime caps were abolished under PPACA, no?
I think maybe for future policies but not for existing ones.

I had a similar thought when I went for my colonoscopy at 50. I thought with the PPACA that procedure was covered. But after calling my insurance company, that doesn't apply for my current policy since at the time of the contract, that procedure is not covered. (Yet, like the OP's note, the cost was negotiated down pretty much so the cost wasn't that bad after all). I was given the option to get a plan that covers it, but then I'd have to be underwritten again, plus, my next one isn't due until 10 years from now. Plus, before then, I would have to option to go the PPACA route. Having options is not a bad thing
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Old 12-29-2012, 12:03 PM   #35
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I suspect that insurance companies claim some denial or carveout in benefits is due to ACA when its to their advantage, but will say it doesn't apply to your policy when it is not to their advantage.
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Old 12-29-2012, 03:02 PM   #36
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In Israel people all get healthcare but different levels for different folks.Germany and Canada spend half that we do.People I"ve talked to from other countries are fine with there healthcare.I do not listen to cable news drama about death panels etc.This nation truly needs to have a grownup discussion on healthcare.
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Old 12-29-2012, 03:25 PM   #37
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In Israel people all get healthcare but different levels for different folks.Germany and Canada spend half that we do.People I"ve talked to from other countries are fine with there healthcare.I do not listen to cable news drama about death panels etc.This nation truly needs to have a grownup discussion on healthcare.
It's not just Germany and Canada, it's basically ALL other countries...many are less than half. And most other countries have better medical outcomes as well...
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Old 12-29-2012, 06:55 PM   #38
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In Israel people all get healthcare but different levels for different folks.Germany and Canada spend half that we do.People I"ve talked to from other countries are fine with there healthcare.I do not listen to cable news drama about death panels etc.This nation truly needs to have a grownup discussion on healthcare.
Not sure why that would happen. We don't have grownup discussions about anything else.

IMO, nothing reasonable will ever happen until we have truly hit the wall, and have suffered major damage damage that affects all sectors of the population.

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Old 12-29-2012, 07:27 PM   #39
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I would change the title to say "So un-Glad WE have such Health Insurance"
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Old 12-29-2012, 07:39 PM   #40
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So, for those who do not have insurance, do they simply walk away without paying? What would happen then?
A lot of them die.

Harvard study finds nearly 45,000 excess deaths annually linked to lack of health coverage | Physicians for a National Health Program
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