Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

arstechnica.com

Post reply on HN
Print view View original

31–40 of 89 posts

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

#31

Post by dahdum »

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.

> Politicians need to step in and make this illegal.

That would only make the situation even worse, hospitals would raise their absurd gouging rates even higher if government required it.

Reform is needed but on both sides of that table.

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

#32

Post by slownews45 »

gotostatement wrote: post #27
slownews45 wrote: post #24

Earlier quoted context omitted.

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

These will generally be also tied to various govt programs that are getting milked and are not market driven.

You'll have honest / primary care providers going bust under Medicare / Medical and folks who get aggressive on billing / switch to lucrative areas (medicare advantage is mentioned) and milk like crazy.

Large corps shop and cost shift to employees who also shop on price etc so margins are poorer there (where the issue in article is more relevant).

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

#33

Post by selectodude »

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.

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

#34

Post by pavlov »

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…

Why doesn't this problem exist anywhere else in the world?

The insurance companies have contributed to making American healthcare so dysfunctional. They are not the victims here.

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

#35

Post by majormajor »

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?

That sounds like a question for a doctor.

If something happened in the middle of the night to you, where you would find a doctor in the middle of the night if not at the ER?

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

#36

Post by treeman79 »

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…

Urgent care is very lacking. I’ve had many episodes where I go in and they refuse to see me, say goto ER. Get to ER and they are annoyed that I didn’t goto an urgent care.

Look I’m sorry my minor stroke annoys you, but something beyond go home and see if it turns into a major stroke would be appreciated.

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

#37

Post by Robotbeat »

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 UC facility referred him to the hospital, i.e. the ER, because they were full.

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

#38

Post by majormajor »

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.

That's not the question in the post you're replying to. The question is "would the insurance company consider it an emergency because the Urgent Care facility was full and told the patient to go to the ER even if the final discharge condition was classified as a 'non-emergency'?

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

#39

Post by wizzwizz4 »

dahdum wrote: post #31
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.

> Politicians need to step in and make this illegal. That would only make the situation even worse, hospitals would raise their absurd gouging rates even higher if government required it. Reform is needed but on both sides of that table.

Break up the insurers (or nationalise the medical care funding system), break up (or nationalise) the hospitals.

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

#40

Post by ceejayoz »

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…

The insurance company is dumping a giant turd in the patient's lap and forcing them to either eat it or go fight an immensely well funded and resourced organization over the bill. It's a bit baffling to absolve them of responsibility in that action.
Post reply on HN