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

arstechnica.com

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

#61

Post by pkaye »

brilee wrote: post #29

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…

> 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.

That is because ambulance are charged on use basis in the US. The ambulance company has to provide the service even in the patient cannot pay for it. So they charge high rates with the hopes that they can recover from someone with good insurance. There are many rural ambulance systems that are failing due to insufficient insured patients. The real solution is cities/counties fund the service through taxes just like police/fire.

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

#62

Post by musicale »

ping_pong wrote: post #9

What 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.

> This industry is disgusting

But it's very profitable.

Physician salaries have certainly outpaced inflation over the past 50 years (in most specialties - pediatrics and internal medicine seem to have dropped slightly) and the profit share of insurance companies has drastically increased over the last 20 years.

After Obamacare, health insurer profitability has actually improved, and health insurance stocks have outperformed the S&P 500 by more than 100%.

If you want a cut, you should really buy some stock.

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

#63

Post by fouric »

toss1 wrote: post #46
ping_pong wrote: post #9

What 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.

Yup, these are the same people who run software to scan for plausible errors in past insurance applications, focusing on people who get the most expensive diseases, then use those errors (e.g., a misstatement or omission of a completely minor and unrelated condition or treatment), as a pretext to now deny coverage. So, not the patient, who has played by the rules their entire life, and properly paid into the system,…

> sworn testimony before congress

Citation please?

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

#64

Post by hpoe »

hibern8 wrote: post #19

I will never be able to understand a person who doesn't think healthcare is a human right.

Well I don't think it is a human right for the simple reason that medical care is technically a limited resource.l, there is not an infinite supply of doctors or medicine there is a limited supply no matter what that theoretical limit is.

Ergo it can't be a human right because it is limited, a right is something that everyone should have.

Also what do we mean by "healthcare" is it anyone should be allowed to have any medical procedure they want whenever they want it? I ask because by simply having access to penicillin, aspirin, benedryl and ibeprofun you now have better healthcare than any person in human history that lived before the 1950s. So when we say healthcare is a human right we really need to define what we mean by healthcare.

I also want to make clear I in no way support the insurance companies or hospitals as I think they are all greedy filthy parasites, and have been in constant combat with them for years, but I also don't understand how any rational person can justify the comment that healthcare is a human right.

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

#65

Post by handrous »

matwood wrote: post #56
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…

I had mallet finger once. Went to a doctor in a nearby hospital (this is pre-doctor's care places on every corner). He saw me, gave me a plastic splint and said don't let your finger bend for 8 weeks and it should be fine. It was. Then I got the bill which insurance paid. The hospital decided to code it as a broken limb and everything that goes along with it, xrays (which I didn't have), plaster cast (which I didn't…

Having dealt with them enough, now, I'm entirely sure that the average hospital billing department sufficiently resembles an organized criminal enterprise that a whole bunch of the people involved would be behind bars, in any remotely just world. There is no fucking way the rate of "errors" they commit can be accounted for by actual, honest mistakes.

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

#66

Post by Broken_Hippo »

selectodude wrote: post #33
derbOac wrote: post #8

The 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 are…

> Do some people abuse the ED? Sure. But then find another solution for those people. Ironically they tend to be the uninsured because the ER can't turn you away. The solution is to get them insured.

This is really important: Health care should be really, really easy to afford.

For some comparison: Since I moved out of the states, I pay less than $300 a year out of pocket (in general). My biggest expenses - a neurologist, for example - costs less than $50. As does the ER, honestly, or the clinic that deals with injuries (the ER will send folks over there). The rest is taxes, and taxes are lower than federal + state + insurance premiums in the US.

Additionally, it isn't just insurance. If you work while the normal doctor is open and you don't have paid sick days, you might not be able to go to the doctor even if health care is free simply because you can't afford to miss work. You need paid time off for this sort of thing - and honestly, parents need more days since they have responsibility for than one person.

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

#67

Post by matwood »

handrous wrote: post #65
matwood wrote: post #56

Earlier quoted context omitted.

I had mallet finger once. Went to a doctor in a nearby hospital (this is pre-doctor's care places on every corner). He saw me, gave me a plastic splint and said don't let your finger bend for 8 weeks and it should be fine. It was. Then I got the bill which insurance paid. The hospital decided to code it as a broken limb and everything that goes along with it, xrays (which I didn't have), plaster cast (which I didn't…

Having dealt with them enough, now, I'm entirely sure that the average hospital billing department sufficiently resembles an organized criminal enterprise that a whole bunch of the people involved would be behind bars, in any remotely just world. There is no fucking way the rate of "errors" they commit can be accounted for by actual, honest mistakes.

Oh, I have more lol. I had a legitimate ER visit for some stitches. At the visit I gave them my insurance, credit card, address, etc... When leaving I asked if there was anything else I owed? Nope.

Fast forward 12 months and I get a letter from collections for ~$500. WTF is this? I never received a bill from the hospital. It took me a bit to even realize where this might be coming from. Once again, this type of stuff annoys me, so I call collections. "It's not much just pay it" - they cut it like $100. Not going to happen. So I wrote them and the hospital asking for the bill details which neither could produce and the delinquent bill was cleared.

I rarely go to any ER type care and I have 2 stories of bills being f'd up. So yeah, the rate of errors seems beyond that of simple mistakes.

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

#68

Post by watertom »

Employers need to stop providing healthcare, they should end healthcare as a benefit and provide employees with a one time raise to cover the costs, and then be done with providing healthcare.

Big companies don't want healthcare to go away, because it's means to control employees, it's a way to suppress competition from small businesses, and is suppresses wages.

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

#69

Post by toomuchtodo »

schaefer wrote: post #14

I was born in the USA, but every day I question if I will be able to afford to retire in this country, or if I need to plan to emmegrate elsewhere while I still can. My primary concern is healthcare costs. How am I supposed to budget for healthcare costs during retirement when it's already so complicated. 530,000 American households are bankrupt each year due to medical costs [1]. It seems like the most complex piece…

Portugal has a great visa program if you can afford to invest in an investment fund or buy a property there (“Golden Visa”). It’s about 250k-500k EUR, but fast tracks your permanent status.

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

#70

Post by op00to »

rm445 wrote: post #55
andrewmcwatters wrote: post #43

Earlier quoted context omitted.

Some few months ago I was trying to think of some sort of asset protection vehicle to prevent medical organizations from seizing everything I own in the event I face some catastrophic health issue. I don't think you can transfer property to a trust to shelter you from such events, though. They'd just go after the trust as far as I know. The bigger issue is that I shouldn't have to think about this sort of problem in…

It's weird though, you'd think that would be exactly the kind of risk that would be insurable. Privately or as a whole society. Some of us will keel over on the spot or otherwise incur near-zero end-of-life costs; others will need $2 million of care to make it through the last couple of years. It seems less relevant whether people in society pay their everyday medical costs out of pocket, compared to the fact that an…

Sorry, I don’t like it when MY money goes to help THOSE people. (Sarcasm)
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