Biggest health insurer plans to deny ER bills if it doubts you had an emergency • Hacker News Board

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#21

Post by gotostatement » Thu, Jun 10, 2021, 8:57 PM UTC

slownews45 wrote: post #16

This occurs because it's the area you can get hit with totally extraordinary out of network bills your insurer may have to pay. Super lucrative for hospital / physician / transport providers. Your kid bumps their head. "There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Ko…

the insurance companies have posted record profits. They're not having money trouble

"UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021"

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#22

Post by meowster » Thu, Jun 10, 2021, 8:57 PM UTC

murph-almighty wrote: post #5

My 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.

Edit: misunderstood, cannot delete. Sorry.

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#23

Post by gotostatement » Thu, Jun 10, 2021, 8:58 PM UTC

dahdum wrote: post #17

While I have no sympathy for the insurance companies, many hospitals are all too eager to gouge the hell out of emergency services and resist attempts to reduce costs. It's where you get slammed with out-of-network specialists.

Be that as it may, this is not a decision made due to financial pressure on the insurance companies.

"UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021. Despite earning $6.7 billion in a single quarter, UHC enrollees are being asked to pay more for their coverage."

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#24

Post by slownews45 » Thu, Jun 10, 2021, 8:58 PM UTC

gotostatement wrote: post #21

slownews45 wrote: post #16

This occurs because it's the area you can get hit with totally extraordinary out of network bills your insurer may have to pay. Super lucrative for hospital / physician / transport providers. Your kid bumps their head. "There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Ko…

the insurance companies have posted record profits. They're not having money trouble "UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021"

This is in part COVID driven.

* Significant reductions in demand for standard services. * Generous compensation for COVID services.

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#25

Post by alexmcc81 » Thu, Jun 10, 2021, 8:58 PM UTC

commandlinefan wrote: post #2

I 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.

Shingles can cause blindness. Early treatment is very important. A friend of mine was hospitalised and left with bad scaring because they delayed seeking help. At least she didn't have any large bills because she was not in the US. No one should be afraid of going to the hospital.

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#26

Post by debacle » Thu, Jun 10, 2021, 8:58 PM UTC

netizen-936824 wrote: post #6

commandlinefan wrote: post #2

I 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?

Shingles could be one, actually. It can lead to permanent neurological issues.

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#27

Post by gotostatement » Thu, Jun 10, 2021, 8:58 PM UTC

slownews45 wrote: post #24

gotostatement wrote: post #21

Earlier quoted context omitted.

the insurance companies have posted record profits. They're not having money trouble "UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021"

This is in part COVID driven. * Significant reductions in demand for standard services. * Generous compensation for COVID services.

this has been going on since before COVID https://www.fiercehealthcare.com/payer/big-name-payers-earne...

In particular see the chart that shows 2018 and 2019 profits

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#28

Post by imadethis » Thu, Jun 10, 2021, 9:00 PM UTC

blakesterz wrote: post #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 nonem…

Classically, you have gastroenteritis (stomach flu) and appendicitis both presenting with stomach pain, or myocardial infarction and heart burn both presenting with chest pain. A policy like this will result in deaths for those that occupy the middle ground between Medicaid and having enough money to not worry about medical bankruptcy.

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#29

Post by brilee » Thu, Jun 10, 2021, 9:00 PM UTC

Healthcare providers tend to overcharge in proportion to how unnegotiable the service is. For example, ambulance charges are a great way to make money, because the person on the hook for the ambulance typically isn't in a position to decline ambulance service.

I agree with the implementation because it puts the burden in the right place. The error here is not that the insurer is denying payment, but that the hospital is then passing the bills onto the patient.

Somehow, we have to reduce unnecessary use of emergency services. The doctors correctly point out that patients can't make that decision. Since the doctors _can_ make that decision, they should be involved in helping reduce ER misusage. The insurance company is setting up the correct incentives for the hospital to do exactly that; however, the hospital is dodging the incentives by passing costs to the patient. So the hospital is in the wrong here.

Re: Biggest health insurer plans to deny ER bills if it doubts you had an emergency

#30

Post by Spartan-S63 » Thu, Jun 10, 2021, 9:01 PM UTC

meowster wrote: post #22

murph-almighty wrote: post #5

My 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.

Edit: misunderstood, cannot delete. Sorry.

Right, but the original commenter said their friend was referred to a hospital, probably an ER. So, the question remains whether they would be hit by this policy, too.