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 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 Korea — to Zuckerberg San Francisco General Hospital (SFGH).
The doctors at the hospital quickly determined that baby Jeong Whan was fine. He took a short nap in his mother’s arms, drank some infant formula and was discharged a few hours later with a clean bill of health.
... the bill finally arrived at their home: They owed the hospital $18,836, the bulk of which was for a mysterious fee for $15,666 labeled trauma activation"
Hahah. For the insurance companies this happens over and over.
Of course, the lobby groups will get everyone riled up over this and HN contributors will be calling UnitedHealth scumbags / capitalist pigs.
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 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.
"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...
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.
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.
The company claims this is cost-cutting: "Unnecessary use of the emergency room costs nearly $32 billion annually, driving up healthcare costs for everyone. We are taking steps to make care more affordable"
But: "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."
The greediest, most depraved people in the country are responsible for keeping us healthy.
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.
I will never be able to understand a person who doesn't think healthcare is a human right.
Here 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.
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.
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.
For-profit healthcare should be illegal and there should be sufficient doctor appointments to go around. Right now, Americans pay more than anyone, wait weeks or months for appointments, and receive much poorer care than equivalent countries.
Absolutely nightmarish. Sounds like a recipe for people to shrug off heart attacks in the fear of a surprise medical bill.
This could kill.
If America's bullshit was happening in any south American country, or most middle east countries, people would have heads on spikes by now.
Really surprised how much shit Americans are capable of taking.
So 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!
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 of the retirement planning puzzle.
[1] https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most...