Biggest health insurer plans to deny ER bills if it doubts you had an emergency
1–10 of 89 posts
Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency
#2I 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.
Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency
#3So 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!
Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency
#4Here 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.
Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency
#5My 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.
Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency
#6I 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.
Are there cases in which a rash is a legit emergency?
Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency
#7I 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.
Are there cases in which a rash is a legit emergency?
Rashes can appear in cases of allergic reactions, those can be deadly.
Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency
#8The 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.
Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency
#9What 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.
Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency
#10"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...