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Cities with Uber Have Lower Rates of Ambulance Usage

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Re: Cities with Uber Have Lower Rates of Ambulance Usage

#121

Post by KyeRussell »

caresource_ta wrote: post #77
nvahalik wrote: post #50

Earlier quoted context omitted.

The system works fairly well if you are poor too. I know several people who have walked into and out of the hospital without paying a dime. It really seems like the middle class gets the raw end of the deal.

Can confirm it works fairly well for the poor. I have been registered for Medicaid the past three years of school and have not had to used it until this year. Every single time I use my insurance (CareSource) I am absolutely blown away by how painless it is. Other than presenting proof of coverage twice in a series of multiple hospital and doctor's visits I have not had to worry about insurance for a single moment. A…

> At one point my physician was ordering lab work and kept asking if I wanted any additional lab work of my choosing and this just seemed absurd because on private insurance I would never consider lab work to be discretionary.

From your perspective that's great, but it's still another sign of the system being broken. As soon as you involve cash flowing between multiple entities, it just becomes a massive cash grab. The physician seemingly knew they could take advantage of your cover in that instance. That in itself seems problematic.

Note: I'm not from the US, so there's probably an aspect of Medicaid that I don't understand. We have a more sane healthcare system :)

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#122

Post by vostok »

throwaway0255 wrote: post #48

I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately. I called an Uber. I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I…

> The system works if your net worth is somewhere above $5 million. For everyone else it's just the mechanism that sends everything you earned back to rich people right before you die.

Must be above my net worth! Sure I can afford to pay out of pocket for everyday medical expenses, but cancer or a heart attack would probably destroy my finances.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#123

Post by rconti »

mysterypie wrote: post #49
will4274 wrote: post #43

A relevant personal anecdote - I hit my head earlier this year and gave myself a concussion, but did not realize it at the time. The next day, I began experiencing severe headaches, sensitivity to noise, sensitivity to light, etc. and decided to go to a hospital. I called an Uber. I'm not sure what I would have done without Uber. I guess I could call a cab, but I don't know that I would have wanted my ride to the hos…

> my ride to the hospital to be 30 minutes late, to refuse to turn the music down, and to tell me the credit card reader is broken As much as I'd like to stick it to taxis because of their decades of price gouging due to being granted a monopoly, I have not had many bad experiences riding a taxi. If I had to put a number on it, I'd say that less than 5% of my taxi rides were in any way unpleasant other than for the c…

Right, but 5% is quite terrible when you're sitting around wondering if the car will ever show up, and if they quoted 20 mins, should you call again after 15 or 20 or 25 or 60?

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#124

Post by azernik »

knz wrote: post #105
bubblethink wrote: post #65

Earlier quoted context omitted.

I'm constantly surprised by costs for x-rays in the US too. It probably has more to do with the cost of labour, but even so, it's quite outrageous.

It's not just x-rays. I'm currently on holiday in New Zealand and had to take my infant daughter to the urgent care. The total cost was $21 USD (including the prescription). Back in the US it's $330 for a 15 minute appointment with her GP. There is no way it costs $1,300/hour to run a GP clinic. Between my employer and I, the cost of family insurance is > $20,000/year and we pay the first $6,000 in expenses. That's s…

These are sticker prices, used for anchoring expectations during negotiations with insurance companies. i.e. if your initial offer to the insurance company was $330, you'd get an actual rate of $25; whereas if your initial offer to the insurance company was $25, you'd get $20.

The problem is that if you don't have insurance, you are charged these total fantasy prices - which is part of why being uninsured in the US is about so much more than just being on the hook for catastrophic costs.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#125

Post by KyeRussell »

djsumdog wrote: post #99
asdfaoeu wrote: post #93

Earlier quoted context omitted.

I don't know about Canada but in Australia the person who the ambulance is called for gets charged.

How much is an ambulance in Australia? Last time I was there, I saw a protest against the Abbot government (yea it was that long ago) because he wanted to put in a co-pay (yes, Australians don't have co-pays). In the US, with insurance, they're typically like $300.

Ambulances are not a nationalised service in Australia. In some States it is State run, in others it is a private company.

I live in Western Australia and it's all done by St John's Ambulance. My partner has needed two non-urgent ambulance call-outs (transfer to a public hospital), which were both charged at ~$500. She's on my private 'extras'* insurance policy, and my insurer fully covers an unlimited amount of ambulance transfers ($50 co-pay for non-urgent). I believe this to be a common thing for this type of insurance policy - I'm not on any fancy tier of coverage.

HOWEVER:

A couple of years ago my significant other had an accident in a public area where she unable to move or call an ambulance. A nearby resident heard her yelling and called the police / ambulance. The paramedics seemingly had the authority to take her away from the police officers who were questioning her. She was taken to the nearest public hospital and was discharged from the ED shortly thereafter. She never received a bill. She's only young and the accident (very apparently) occurred as a result of drug use, so I think that the paramedics operating the ambulance are allowed discretion when deciding whether or not somebody should be charged.

* Physio, psychology, dental.etc. (all non-emergency). These services are not (fully) covered by our public health system, so many people opt for private cover. These policies work heavily on annual limits, so it's a bit unfair to call them insurance.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#126

Post by rconti »

throwaway0255 wrote: post #48

I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately. I called an Uber. I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I…

My wife was in a car accident, and surprisingly, the ambulance bill (perhaps 5 miles, "night" surcharge (7pm), private ambulance in the bay area) was "only" ~$3400. I seem to recall an ambulance ride when I was a kid (20 years ago) costing something like $5k plus when I crashed my bicycle.

Funny thing, though, the ambulance bill was the only thing NOT covered 100% initially. The hospital and surgeons bill your insurance, and we didn't pay a dime (other than a comical $200k+ explanation of benefits telling us our claim was denied when they initially submitted to the wrong insurance). The ambulance company billed us, and I spent ~6 months working it out, and I think it's finally sorted. The upshot is because it was a "car accident", the health insurance doesn't want to pay it; car insurance is primary. In theory the car insurance is the primary on her entire hospital stay, but because the medical payments on our car insurance is only $10k it's basically pointless to involve them. They don't even know there was a hospital visit. So I had to go back and forth a bunch of times to even (re-)open the car insurance claim, get it submitted, send more and more documents, fend off the ambulance company always threatening to send us to collections because I had better things to do than deal with their crap, and so on.

Current status is I've paid maybe $600 on a payment plan, my insurance says they paid in full, the payment wasn't yet reflected on the ambulance co billing site, but in theory once that payment posts they issue me a refund on my payments to date.

We're so incredibly lucky to have insurance; actually she was double-covered at the time of the accident (hence the billing confusion initially), we have money, we have family in the area to help with doctor visits, and there was really only one provider. I can only imagine what a nightmare sorting the bills would have been if we had to manually submit to insurance from multiple providers and stay on top of many many claims. It would be a full time job for sure.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#128

Post by karmelapple »

blhack wrote: post #82
throwaway0255 wrote: post #48

I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately. I called an Uber. I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I…

There is pretty much nothing that infuriates me more than the health insurance system. Here is just one example (other than your ambulance example, which is like some trolley-car problem come real): We use "insurance" for routine medical examinations which are supposedly to be done regardless of health. We use "insurance" for YEARLY checkups. The absurdity of this is on par with insuring yourself against getting hung…

You described a big example in the book “Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It.”

Highly recommend it. It’s got some great ideas.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#129

Post by StreamBright »

rconti wrote: post #126
throwaway0255 wrote: post #48

I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately. I called an Uber. I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I…

My wife was in a car accident, and surprisingly, the ambulance bill (perhaps 5 miles, "night" surcharge (7pm), private ambulance in the bay area) was "only" ~$3400. I seem to recall an ambulance ride when I was a kid (20 years ago) costing something like $5k plus when I crashed my bicycle. Funny thing, though, the ambulance bill was the only thing NOT covered 100% initially. The hospital and surgeons bill your insura…

These sort of stories I usually use to explain to non-US people how is to live there.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#130

Post by Zarel »

djsumdog wrote: post #112
Malician wrote: post #75

Earlier quoted context omitted.

If Uber says 5 minutes, it might be 7, or even possibly 15 if things go very, very wrong. Heck, if it's gonna be 15 you know this ahead of time because you can see the driver making wrong turns. If you call a taxi service, and they say "15 minutes," it could be 30, 45, or 60. Maybe they're mussing with the truth, maybe they're outright lying. You don't know, and without the map showing the driver, you have no way of…

A lot of modern taxi services have apps (often written by just a few big shops and contracted/branded out, but still). So you can start to get some of the same assurances from Taxis that you could get from Uber. Also even before Uber/apps, I never had a problem with calling a Taxi and it not showing up within a few min, and I've lived a lot of places.

I've called a taxi three times in my life.

The first time was in 2012 because Microsoft was paying for it. It was from downtown Bellevue (so not an obscure place). I called them, they estimated 15 minutes, and it took them 40 minutes to show up. I'd never called a taxi before so I didn't realize this was normal; I called them back a few times to ask what was wrong, and they just said "soon!"

The second time was in 2015 in a country that didn't have Uber. They had an app. The app didn't work. They also didn't answer the phone. I tried multiple times, including an hour later after eating lunch. I gave up and spent 50 minutes walking home in ridiculous heat.

The third time was in 2016 because it was in a small town in the US that didn't have Uber. They did have an app. Their "app" displayed a phone number and told me to call it. That was the entire app. I called it, they estimated 30 minutes and showed up in 45 minutes, and they charged me $40 for a ten minute ride. Small town so I can understand the wait, but the price was definitely because they knew I had no other choice.

Meanwhile, I get annoyed when Ubers take longer than 5 minutes to show up because they take wrong turns.

I think it's definitely a matter of luck and location. Some places have horrible taxi services, some places have okay taxi services. Some places only have okay taxi services now because of competition from Uber. Ubers are still nearly always a huge margin better.

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