Nowhere in this thread have I seen the treatment of illegal aliens mentioned. This has to be a significant segment in some regions. Many times I've heard/read that they will routinely treat ER's like they were primary care facilities, and like most of the rest of the services they receive, they pay nothing. Mothers come to the U.S. for the express purpose of having babies. Of the last several years, our local hospital (in Colorado) has announced the first baby born in the new year and it's from a Latin country more often than not. I would be curious what percentage this abuse accounts for in some cities. It has to be a huge subsidy!

I recently spent 6 hours in the ER for a scratched cornea. I took a arica palm frond to the eyeball. It felt like I had a splinter lodged in there I sat in the waiting room for 2 hours prior to going in. I have insurance (tricare prime) with a $60 copay. My waiting room seat was close enough to the checkin desk to overhear most patients did not have insurance. I saw a nurse practisioner who did not give me proper care. When I finally saw a doctor after 5 hours, she was scolded for not following proper photocall for the injury. It was irritating to get shitty treatment while subsidising the healthcare for those who ride up in nice cars with fancy new I phones coming in for bullshit reasons.

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Originally posted by a1abdj:

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Transparent pricing would help...but not much IMO. the people who won't pay still won't and the honest people with real emergencies still have no choice.

Since I always like to compare hospital pricing policies to that of the normal business world, I don't know why hospitals can't collect payment like the rest of the billing world.

I know insurance complicates things, as do serious events that rack up serious bills. But if you go to the hospital to fix your broken arm why shouldn't you arrange payment prior to treatment and/or leaving? The grocery store doesn't bill me. My mechanic doesn't bill me. My gun shop doesn't bill me. I rarely bill non-commercial customers.

I somewhat agree but the problem is when you have broken arm and are in severe pain you dont have the luxury to call around to find the hospital with the lowest prices.

Another problem is when patients are provided with a bill prior to treatment you will run into self diagnosis. People are going to try to order a la carte services and testing.

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Originally posted by Sigmanic:
Nowhere in this thread have I seen the treatment of illegal aliens mentioned. This has to be a significant segment in some regions. Many times I've heard/read that they will routinely treat ER's like they were primary care facilities, and like most of the rest of the services they receive, they pay nothing. Mothers come to the U.S. for the express purpose of having babies. Of the last several years, our local hospital (in Colorado) has announced the first baby born in the new year and it's from a Latin country more often than not. I would be curious what percentage this abuse accounts for in some cities. It has to be a huge subsidy!

Rarely do I see illegals (even though this area has a good deal) but when I do they are very respectful and polite unlike some non-illegals who will call you a “fucking liar, a Racist, a con artist, etc..” if you don’t diagnose them with what they want or prescribe them what they want.

quote:

Originally posted by Tommydogg:
I recently spent 6 hours in the ER for a scratched cornea. I took a arica palm frond to the eyeball. It felt like I had a splinter lodged in there I sat in the waiting room for 2 hours prior to going in. I have insurance (tricare prime) with a $60 copay. My waiting room seat was close enough to the checkin desk to overhear most patients did not have insurance. I saw a nurse practisioner who did not give me proper care. When I finally saw a doctor after 5 hours, she was scolded for not following proper photocall for the injury. It was irritating to get shitty treatment while subsidising the healthcare for those who ride up in nice cars with fancy new I phones coming in for bullshit reasons.

How the dell does someone mistreat or diagnose a corneal abrasion? Tetracaine, fluorescein, Woods lamp/slit lamp = diagnosis. Pain meds + topical antibiotic = treatment. If it’s really bad you can use some cyclopentolate.

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Originally posted by Dusty78:

quote:

Originally posted by Sigmanic:
Nowhere in this thread have I seen the treatment of illegal aliens mentioned. This has to be a significant segment in some regions. Many times I've heard/read that they will routinely treat ER's like they were primary care facilities, and like most of the rest of the services they receive, they pay nothing. Mothers come to the U.S. for the express purpose of having babies. Of the last several years, our local hospital (in Colorado) has announced the first baby born in the new year and it's from a Latin country more often than not. I would be curious what percentage this abuse accounts for in some cities. It has to be a huge subsidy!

Rarely do I see illegals (even though this area has a good deal) but when I do they are very respectful and polite unlike some non-illegals who will call you a “fucking liar, a Racist, a con artist, etc..” if you don’t diagnose them with what they want or prescribe them what they want.

From what I’ve heard, in Texas the hospitals are primary care for many coming over the border ‘to be taken care of’.

quote:

Originally posted by Dusty78:
Well the biggest issue I see everyday is stupid patients the come to the ER for nonesene. I had a woman who checked herself in because she was “cranky.” Everyday I see kids for falls or bumps and bruises who are walking and moving the extremity without any problem but parents wants to make sure their child is “ok.” People who come in for car accidents at 5 mph with no damage or a acute complaints...”I just thought I should be looked at.” People who lie and say “I have chest pain” and get a 20K dollar work up when in reality they just wanted a work excuse for an $8 an hour job. If you think these cases are exaggerated of the 25-30 patients I see a day half will be there for a non-emergent issue that requires no assessment or treatment at all. People have no concept of what an emergency is. With that said you still have to investigate every complaints so you don’t miss something and get sued.

Often patients will try to go to urgent care or a PCP’s office first but will just be told to “go to the ER” so thier facility doesn’t have to deal with the headache. Some of these outside facilities are truly stupid. They will send a patient from their office in an ambulance to one of our free standing ER’s for lets say an appendicitis...then I have to confirm their findings and put them in another ambulance to another hospital where they can do the surgery when that office could have just sent them to that hospital in the first place. All of this costs money.

These same people will also bitch and yell about wait times when we are back up actually saving someone’s life. Recently I had a 6 year old girl who was actively dying from flu induced acute respiratory failure and an indignant woman with tooth pain told me “that’s not my problem” when she found out the cause of her wait. These overuses and outright abuse of emergency healthcare have lead to widespread overcharging because the vast majority of these people pay nothing. Some of these same people will rack up 20 visits in a month. The ER makes you lose faith in humanity almost daily until that one fleeting day that it completely restores it. There anreason ER burn out for providers and nurses is exceptionally high.

Agree totally here. I worked ER for about 14 years and my supervising ER director called us the modern version of slave labor- law required we treat all without regards to ability to pay-mr.x came in with a toothache last week we treated him and billed $200 in professional fees, he did not pay, did not seek care from a dentist and is back this week and we must treat him again knowing we won’t get paid again. If we don’t treat him and he ends up with life threatening sepsis we get sued.
I now work at an urgent care center but still see a large percentage of people who could stay at home and treat with Advil or simple Boy Scout handbook level first aid that come in to see us instead.
After nearly 30 years in medicine I am getting pretty fried!
Over the years the intellectual level of many patients has gone down significantly

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Originally posted by Dusty78:

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Originally posted by KMitch200:

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Originally posted by sigcrazy7:

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One problem with the exorbitant charges by hospitals is the number of "welfare" cases that use the emergency rooms for primary care, but have no insurance or money. And, as we were told, the hospital must treat them.

Keep in mind this law requiring the hospital to treat (stabilize and transfer, often the same thing) is the result of legislation signed by Ronald Regan. Talk about a law that sounded good on paper, but is a disaster in practice. Unintended consequences indeed.

That was to prevent the "wallet biopsy" which was a real thing. Patient can't pay? Ship them the hell out!
As noted above, the hospital should be able to do a quick triage, a basic exam and tell someone to go to the pharmacy to get their pregnancy test, ibuprophen, etc.
Don't forget the A-HOLES that think calling the big red taxi with red & blue lights is the best way to get your bullshit over-dramatized malady treated.
I hope they enjoy the $600+ bill for not having the sense to call a taxi.
- -
Edit to add: Hospital billing is one of the biggest goat fucks in the system...Yes -> HONOR HEALTH <- I'm looking at you!

I as a provider have no idea if someone does or doesn’t have insurance. My treatment doesn’t change. I can’t just send someone out after a basic triage without a comprehensive exam unless I want to be sued on a daily basis. That 6 year old girl I just discussed in my previous thread had been seen by 4 outside providers before me who told her she “just had a virus.” She currently in ICU with only about 20% of her lungs working. In the last week alone I had 2 patients who had been seen at urgent cares for back pain sent home with muscle relaxants and steroids that would be paralyzed today if I didn’t do comprehensive testing. There’s lot of bullshit that walks in the ER doors but we have to thoroughly investigate it all or we will miss something that will get us sued.

Also a pregnancy test is 99% of the time diagnostic so I can’t just tell them to go get one at the pharmacy and then come back to finish up thier work up. Pain treatment is also diagnostic. If you have a headache that won’t go away and after standard migraine treatment it’s hasnt gotten any better there is a chance it could be a serious neurological condition like subarachnoid bleed of dural venous sinus thrombosis.

As I said, "wallet biopsy" *WAS* a real thing so we got EMTALA. (maybe you weren't around EDs prior to '86 or just didn't see it -> I was and I did see it)
Unfortunately, Tort Reform wasn't passed. So now hospitals and all those that work in them have to practice defensive medicine because of ambulance chasers waiting to file (or threaten) lawsuits.
Smart docs don't order every test they can abbreviate, scared ones do. I know and have worked with both. Smart docs can cycle through a lot of pts in a shift, scared ones sit on them for HOURS needlessly.

A PG test done solely for the purpose because the pt wants to know if they're pregnant isn't diagnostic of anything except pregnancy. W/O associated signs and symptoms of ABD pain, vag bleeding or poss UTI, there isn't any more workup to finish. Yes they're pregnant or no they're not. Those pts should be sent to the pharmacy to pee on a plastic device and quit wasting time and money.

What many folks don't realize (and the BS patients don't care about) is the same STAT testing done for the ED is done not only for sick pts but for the bullshit ones too. That is a HUGE waste of resources and money.
There are way too many A-HOLES that are begging for pain relief but have a slow steady pulse, a normal BP, no postural changes or signs of distress. They're often the same ones who are allergic to every NSAID ever made and most narcotics except hydromorphone.

I'm on your side in this fustercluck.
Changes have to be made or this system is going to crash sooner than it will like it's doing now.

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Originally posted by ZSMICHAEL:
I recall this subject being discussed recently. It is interesting that Texas seems to lead in the problem of surprise bills from out of network docs in the ER.

It's called "balance billing". I consider it to be a scam. I had never heard of balanced billing until I repeatedly visited an ED in Texas earlier this year. I don't think that Obama and Pelosi considered this problem with their exchange insurances. Since the hospital was in bankruptcy, their out of network doctors left me too sick to call the Texas Department of Insurance for mediation (see below). It wasn't clear that there was a reason to try to since my insurance is not of out Texas, and I was not and am not a resident of Texas.

My experience was that the "surprise" medical bills were larger than Texas' example. It was more like a bill for $2,000 to pay a physician to inject morphine into my butt to treat an infected gallbladder, and partially incidentally, create an unusual topic on SIGforum, with the insurance company paying him $400 (seems reasonable) with me supposed to balance out that $1,600 difference. I went through that 4 times, and to the bill collectors' surprise, I am not in Texas.

https://www.tdi.texas.gov/cons...mbalancebilling.html :


Surprise medical bills

Balance billing – or a surprise medical bill – happens when you get a bill from a doctor, hospital, or other health care provider who isn’t part of your health plan’s network. Often, consumers didn’t know they were getting care from out-of-network providers.

For example, a patient goes to an in-network hospital for emergency care and is treated by an out-of-network doctor. The doctor and the hospital each bill $1,000 for their services, and the health plan pays them each $400. The in-network hospital can only bill the patient for copays, deductibles, and coinsurance amounts. The doctor, however, may bill for the $600 that the health plan didn’t pay, as well as any copays, deductibles, and coinsurance.

I got a surprise bill. What can I do about it?

Call the doctor or provider that sent the bill and discuss your concerns. In most cases, Texas law requires providers to provide an itemized bill on request, so review the charges carefully. Some providers might accept a lower payment. You can compare the amount you were charged to the average market price using our Texas Healthcare Costs website or other websites such as NewChoicehealth.com, FairHealthConsumer.org, and TxPricePoint.org.

Call TDI’s Consumer Help Line at 1-800-252-3439 to discuss your options. There are two main ways TDI can help:
Mediation: Texas law allows many consumers to seek mediation for bills that exceed $500. TDI has helped more than 90 percent of these consumers lower their bills in the first stage of the process.
Complaints: Each year, we help thousands of Texans get millions of dollars in additional claim payments and refunds.

How can I protect myself from a surprise bill?

For planned procedures, find out in advance whether your providers are contracted with your health plan. This is especially important in the case of facility-based providers, such as radiologists, anesthesiologists, pathologists, and neonatologists. Even if a hospital is in your health plan's network, some doctors who provide services there might not be.

Call your health plan to make sure the services you will get are covered under your policy. If the services are not covered, you will have to pay the charges.

Texas law gives patients the right to request estimates of charges. Doctors and other providers and health plans have 10 days to give you the estimates, so you won't be able to get them in cases of emergencies. Some providers and health plans also have cost information on their websites.

Shop around. Use the The Texas Department of Insurance’s Healthcare Costs website to find average costs for common medical procedures in your area. Websites – such as NewChoicehealth.com, FairHealthConsumer.org, and TxPricePoint.org – also can help you estimate the prices of various procedures.

If there aren’t any contracted providers available, your health plan might be able to work out a discounted payment. You also might be able to ask your doctor or provider if they’ll accept payment options in advance. In some cases, the health plan may be required to make sure you aren’t balance billed.

Complain to the right agency.

If you believe you’ve been treated unfairly, file a complaint with the agency that regulates your provider or health plan.

File complaints against doctors with the Texas Medical Board.

File complaints against hospitals, ambulatory surgical centers, or other facilities with the How to File a Complaint - Health Facilities.

File complaints against licensed health maintenance organizations and health insurance companies with the Texas Department of Insurance.

Get help from TDI

For insurance questions or for help with an insurance-related complaint, call our Consumer Help Line at 1-800-252-3439 or visit our website. For more information about surprise billing, visit the Avoiding Surprise Bills and Handling Surprise Bills pages.

Question? Call us at 1-800-252-3439.

ZSMICHAEL, is there an online catalog of Codes and expected or average prices for those codes? The ones I have found dance around prices.

Thanks!

Here in Kalispell, Montana, we are also dealing with a crooked bunch of medical providers. I don’t see anyone charged with a crime either. Just chalk it up to increased medical costs. No problem.


Kalispell Regional Healthcare

Kalispell Regional Healthcare agreed in September to pay $24 million to settle a whistleblower lawsuit with the Department of Justice, which during the course of its investigation alleged that 63 physicians were involved in an illegal kickback scheme to boost revenues and enrich themselves, a violation of the federal Anti-Kickback Statute, the False Claims Act and the Stark Law, which prohibit physician self-referrals.

Link: Kalispell, Montana

quote:

ZSMICHAEL, is there an online catalog of Codes and expected or average prices for those codes? The ones I have found dance around prices.

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Do not think so. Some of the other members may have a better answer. It is complicated. There are CPT codes in the thousands as well as ICD 10 diagnostic codes which are very specific.

I just came across this article which may provide some answers. I predict it will not provide much helpful detail.

WASHINGTON — Price transparency is coming to hospitals across America.

A new federal rule requires all hospitals to post an online list of the cost of their standard services.

Patients will be able to compare prices before seeking treatment.

Some consumer advocates say even though those lists will be beneficial, it doesn’t do enough to inform patients about adjusted and sometimes increased costs due to insurance and other factors.

Those prices are expected to be available online Jan. 1.

LINK: https://wgntv.com/2018/12/27/h...ine-beginning-jan-1/

There are some great hospitals out there. A few years ago, I posted the pics of my leg flayed down to the bone after falling off my truck in Twin Falls, ID. I drove the semi to the hospital, walked into the ER with my boot sloshing in blood on every step, and announced that I wanted $1,000 worth of treatment, not a penny more.

To my surprise and pleasure, I got cleaned up, stitched up, and sent on my way. Bill came to $980.00. This was St. Lukes. Great people. The Doc that stitched me up was a smoke jumper during college, a real guy's guy.

quote:

Originally posted by Dusty78:
Well the biggest issue I see everyday is stupid patients the come to the ER for nonesene. I had a woman who checked herself in because she was “cranky.” Everyday I see kids for falls or bumps and bruises who are walking and moving the extremity without any problem but parents wants to make sure their child is “ok.” People who come in for car accidents at 5 mph with no damage or a acute complaints...”I just thought I should be looked at.” People who lie and say “I have chest pain” and get a 20K dollar work up when in reality they just wanted a work excuse for an $8 an hour job. If you think these cases are exaggerated of the 25-30 patients I see a day half will be there for a non-emergent issue that requires no assessment or treatment at all. People have no concept of what an emergency is. With that said you still have to investigate every complaints so you don’t miss something and get sued.

Main reason I didn't go in to EM - 99% urgent care, 1% actual high acuity patients. And depending on where you train and end up practicing that 1% is few and far between. We have to send our EM residents to an inner city hospital to make sure they get their trauma numbers. Some of the worst horror stories regarding airway mismanagement come from our ED....the CCMU is a close second.

quote:

Originally posted by ZSMICHAEL:
I just came across this article which may provide some answers. I predict it will not provide much helpful detail.

WASHINGTON — Price transparency is coming to hospitals across America.

A new federal rule requires all hospitals to post an online list of the cost of their standard services.

Patients will be able to compare prices before seeking treatment.

Some consumer advocates say even though those lists will be beneficial, it doesn’t do enough to inform patients about adjusted and sometimes increased costs due to insurance and other factors.

Those prices are expected to be available online Jan. 1.

LINK: https://wgntv.com/2018/12/27/h...ine-beginning-jan-1/

Ours were posted in our local paper (links to the hospitals). Trying to decipher that was overwhelming, and the paper commented the same.

My recent day stay in a hospital on paper was 114,000. That’s about 12 hours. No complications, and for most of the time, I was just sitting in a bed, waiting. Now I don’t dispute the skill of my doc, or the nurses that did my care, but 114,000 with no overnight? I’m still looking into that.

Note: had the visit prior to the mandatory transparency rule being in place (end of December), but had researched my procedure online earlier last year and it was about 20,000 per the sources I checked.

quote:

Originally posted by ZSMICHAEL:
From our series: A baby was treated with a nap and a bottle of formula. His parents received an $18,000 bill.

There is another way of looking at this. When you come into the ER with your sick baby or your "pain" that is so bad you felt you had to go to the ER, how much would you pay to get "fixed"?

Should the ER stop the family (or you) at the door and ask what saving their child (or healing the pain) is worth so as not to give them "sticker shock" at the end?

Is there anyone alive today the doesn't realize that going to the ER is going to be expensive?

"Save my baby, Save my Baby".....when they do, then they bitch about the bill. Next time fix them yourself.