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Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

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Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Old 05-31-17, 07:43 PM
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Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

http://news.wabe.org/post/blue-cross...cy-room-policy

Text:

Starting in July, health insurance provider Blue Cross Blue Shield will stop covering emergency room visits it deems unnecessary.

And doctors and analysts have a lot to say about it.

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Blue Cross Blue Shield is enacting this policy because it doesn't want people to use the emergency room as their primary health care.

"The cost of care's been going up so much faster than people's earnings. We have got to find a better way to do some of this stuff, taking some of that unnecessary spending out of the system," says Jeff Fusile, president of Blue Cross Blue Shield.

Fusile says BCBS wants patients to use urgent care, retail health clinics and their LiveHealth app, which are all cheaper than an ER visit.

"What this policy is directed at is regular, run-of-the mill colds, maybe even influenza. But you don't need to go to the emergency department to get tested for whether or not you have the flu and to get a Tamiflu prescription," says Jason Hockenberry, who teaches health policy at Emory University.

Hockenberry says, in his research, he's found many people often use the emergency room inappropriately, for urgent care rather than emergency care.

"This is a real problem. Emergency departments are expensive; they're there for a different reason. Blue Cross is clearly staking a claim here that we're going to try to change patient behavior," Hockenberry says.

Donald Palmisano, president of the Medical Association of Georgia, paints a different picture when it comes to this policy: Imagine a BCBS member has chest pains in the middle of the night. He thinks it might be a heart attack, so he goes to the ER. But it turns out that it was just indigestion. Under BCBS's new policy, he gets charged for using the emergency room inappropriately. So the next time he has chest pains, he thinks, in case it's just indigestion, he won't go to the ER. But this time, it's a heart attack, and he dies.

"Blue Cross is clearly staking a claim here that we're going to try to change patient behavior." - Jason Hockenberry

"That's where our physicians are concerned. Because they're like, you know, you're putting the patient, who doesn't have the clinical background, to determine whether their condition is of an emergency nature," Palmisano says.

Palmisano says this policy also might disproportionately affect the elderly, those living in rural areas and adolescents over the age of 14.

"I have four children, and if there's an injury and it's hard to determine the pain they're experiencing, it's hard to determine whether to go to the emergency room or not. It puts that added stress because you're dealing with a loved one and you're putting parents in a very difficult situation," Palmisano says.

But Fusile of BCBS says he knows, in medicine, it's not always black or white.

"There are lots of gray areas where the diagnosis wasn't so bad after all, but you have to look at the situation the person was in at the time they were in it," Fusile says.

Remember that scenario about the man who thinks he's having a heart attack, but it's just indigestion? Fusile says that falls into the gray area, too. He says a panel of doctors will assess claims to make sure everyone's getting fair coverage.

But Palmisano and Hockenberry say they'll have to wait until the policy is implemented to see how effective it really is.

* * * * * * *

Guess they forgot about Gee Dubya saying EVERYONE has health care, they can just go to the emergency room?
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Old 06-03-17, 07:15 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

"Now we all know that Jesus only wanted us to heal people if we thought it was necessary once costs and profits are figured in."

How much will they spend to keep the status quo, at worst, this year?

It's fucking retarded and everyone who thinks differently is stupid. There, it's out there.
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Old 06-03-17, 07:25 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)



All those people can expect at $10k bill if they visit the ER and it turns out you're not going to die.

My local hospital (Dignity Health) will quietly kick you out after they find out you're not insured and not in immediate mortal danger. They won't kill your credit. But your doctor's $1100 charge, x-ray, and an other "contracted" costs will be billed to you and then kill your credit if you can't pay them. If you are insured, they'll keep you in there for as long as possible and milk your insurer for $30k a day.

Nothing like a $10k ER bill for an hour of service to wake you up to how fucked US healthcare is.

I'd personally love to see some low-cost Mexico-quality ER's pop up that offers ER services at reasonable prices. Not sure if that's possible in the USA. I bet that business would be HUGE.

Good luck folks!
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Old 06-03-17, 08:52 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Emergency Rooms are for emergencies.

Somehow that was left out of the common sense of Obamacare and just left in the laps of hospitals.

Next, they'll probably start telling obese people they need to lose weight and smoker's they need to stop smoking.

It's insanity, I tell yah!
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Old 06-03-17, 08:53 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

I thought I was having a heart attack. Went to ER. They said I was OK. And billed me $15k.
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Old 06-03-17, 08:53 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

So ... around 8:30 tonight, I was given a reminder that every home cook gets now and again: mandolin slicers are evil bastards. I wound up with a half-inch long gash in my fingertip that would not stop bleeding.

No problem, I think -- I'll find the nearest urgent care and get a few stitches put in.

Easier said than done. Did you know if you google "Urgent Care DC" -- with or without "open now," you'll get a mix of concierge doctors and emergency rooms? No actual urgent care clinics, and the three hospitals near me that I called that were listed as having them all told me they have ERs but not urgent care clinics.

In this day and age of being smart medical consumers, we're not supposed to go to the ER for stuff that can be handled at an urgent care clinic. And I'd like to do that, I really would. But apparently, in my city -- which is not a small city -- I apparently don't have that option.

BTW, I wound up buying some liquid bandage at Walgreens and sealing the cut with that. It seems to be working well enough, but sooner or later, I'm going to have some sort of misadventure after hours where I actually need a doctor, but not a full ER.
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Old 06-03-17, 08:55 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Originally Posted by Troy Stiffler View Post
I thought I was having a heart attack. Went to ER. They said I was OK. And billed me $15k.
If it matters, I would have only charged you 3% of that, which would be...oh nevermind!
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Old 06-03-17, 08:57 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Originally Posted by DVD Polizei View Post
If it matters, I would have only charged you 3% of that, which would be...oh nevermind!
Shut up. I thought I was going to die. Asshole.
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Old 06-03-17, 09:19 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Originally Posted by Troy Stiffler View Post
I thought I was having a heart attack. Went to ER. They said I was OK. And billed me $15k.
Did this happen after hours? I have friend that went to the ER and was only there for a few minutes. He got charged something around 8k because it was at night.

I broke my finger as a kid and that was 7K out of pocket with insurance. Mom worked for Boeing and I was under her insurance.
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Old 06-03-17, 09:24 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Fusile says BCBS wants patients to use urgent care, retail health clinics and their LiveHealth app, which are all cheaper than an ER visit.
It infuriates me how the medical industry keeps telling us to use an online app when we need medical attention. I get frequent letters from my insurance company telling me to do that. I see billboards telling me to do that.

In the last thirty years, I've been to the ER for a car crash, acid in my eyes, blood clots in my lungs, and heart pain. For which one of those incidents should I have used a fucking online chat with a Genuine Nurse?
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Old 06-03-17, 09:36 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Originally Posted by Nick Danger View Post
I see billboards telling me to do that.
That's a whole other thing. After my scare that sent me to the ER, I followed up with a General Physician and then Cardiologist. Their answer was, 'you're in your 30's. You're uninsured. You'll be fine. Get out of here.'

Now, their prognosis makes me feel better. Then I see all the advertising saying "don't ignore the signs". I had signs. Very real signs. The sign that sent me to the ER was what I'd describe as the worst heart palpitation I ever felt (it wasn't just a skip, it was a 2-3 second STOP and I couldn't inhale), followed by dull chest pain.

So one place tells you to not ignore the symptoms. And then doctors tell me to ignore the symptoms.

Two years later, I've learned a few things. First, taking too many vitamins can really fuck you up. Don't do what Doctor Oz tells you to do (I'm more of a Men's Health reader ... same thing). Just eat food and stay away from "supplements" or "natural remedies" (ie spices). Second, I was left feeling that doctors are somewhat a scam. If I were insured, they would have had me back nonstop and charged my insurer $100k+ by now. It's kind of a scam. That thing where they over-diagnose and over-medicate insured people is very real. Just look at the opioid epidemic.

In the end, I'll probably just keel over and die one day instead of going to the ER again.
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Old 06-03-17, 09:46 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Originally Posted by Baron Of Hell View Post
Did this happen after hours? I have friend that went to the ER and was only there for a few minutes. He got charged something around 8k because it was at night.
It went something like this...

1. Arrived at Noon.

2. Got immediate EKG.

3. Got chest x-ray.

4. Checked legs for blood clots.

5. Got MRI. They screwed up the IV, and injected all the liquid into my forearm.

6. Got 30x shots to neutralize the screwed up IV.

7. Took another stab at the MRI.

8. Sat around for five-or-so hours.

9. They said everything looks good and release me around 3AM.

All-in-all, I was face-to-face with a doctor, nurse, or technician for 1-2 hours.

The hospital bill was around $13k (I honestly forget, it just sits in a stack of bills). The chest x-ray cost was around $400 (which was surprising low). The doctor fee was $1090. At the time, I was BROKE at the time and the $400 and $1090 bills ended up in collections, and I think it took 50-100 points off my credit score. I paid them, but it hasn't seemed to repair my score yet. Dignity Health told me bluntly that they don't send bills to collections. So I just sit it there. I'm gracious to be in a position where $12k might not matter very soon.

In the end, I self-diagnosed that it was my multivitamin and a cayenne/turmeric/lemon tea that was really screwing up my nervous system. I got away from that and am now very skeptical about any of that bullshit. I never did regain feeling on the sides of my two big toes.

...

Anyways - to think that insured people are dissuaded to go to the ER when they're scared something is happening - is crazy. Or they'll go and end up with a similar bill - maybe $5k at best.
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Old 06-04-17, 03:34 AM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

They should just charger a higher deductible if the don't admit you. But coverage should apply. Assuming treatment was medically necessary (even if not emergency).

Course I have BCBS of Texas and that's what they do. So maybe they will change as well.

Surprised the department of insurance is allowing that.
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Old 06-04-17, 04:24 AM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Originally Posted by DVD Polizei View Post
Emergency Rooms are for emergencies.

Somehow that was left out of the common sense of Obamacare and just left in the laps of hospitals.

Next, they'll probably start telling obese people they need to lose weight and smoker's they need to stop smoking.

It's insanity, I tell yah!
I've been to the ER three times as an adult: 1) for chest pains that turned out to be anxiety; 2) for gut pain and nausea that was a small intestine blockage that would've killed me if I'd gone much longer without hospitalization and; 3) for gut pain and nausea that felt identical to the previous instance, but they weren't able to find the cause for it and decided it was likely non-serious food poisoning. Also, for the second instance, the one that would've killed me, I went to an urgent care first. They said I was fine, gave me some anti-nausea pills and sent me home.

Do some people go to the ER unnecessarily? Sure. But one thing that your unjustifiably condescending position ignores is that there are many non-emergency conditions that present with symptoms identical to emergency conditions and oftentimes the two can only be distinguished through tests that an ER will provide, but that an urgent care or primary care doctor likely won't.
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Old 06-04-17, 09:01 AM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

The other issue(s) is how we turned (or are trying to turn) this 100% on the patient.

Why is no one asking "why does it cost 10's of thousands of dollars for an ER to diagnose a cold"?

I get "everything is more" in an ER as they are set up for the worse of the worse. But when someone with the sniffles comes in why can't a candy stripper or other first year med student say "hey, you got a cold, get out"?

But let's say you take your sniffles to an urgent care or primary Dr. It cost what couple hundred? Ok, so it cost 3, 4 or even 5 times that at an ER. That still doesn't seem like the $10,000's we keep hearing about.

Also why is it only on the insurance company to curb abuse/cost? Why isn't it required that the ER have a "quick evaluation" person/team?

On a Friday I went home sick thinking I had the flu. By Sunday I was having trouble breathing and chest pains. Called Primary Dr, told me to have someone take me to ER. When I got there, the first person to check me out, in the waiting area, was a triage nurse. After feeling my skin and seeing me struggling to breath, she snapped her finger and almost instantly there was a wheel chair. Before I knew it, I felt like a scene in the TV show ER at least 3 dr's, several nurses, cutting off my clothing, getting IV started. I remember one Dr seeing grass on my shoes and saying "we're you mowing the yard, it was hot today" (lived in Phoenix at the time). They did EKG and stuff and after a few minutes did an ultra sound where they found fluid in my lungs. Someone said "he has pneumonia". Everyone disappeared....lol. They did check me in with sever pneumonia where I spent 10 days.

I've taken each of my kids to the ER. One with a sever cut when daughter go ahold of a razor. And my son when he broke his fingers.

In all cases, seemed to go through different triage evolutions before going to the next step. In both cases, we saw an actual Dr for mere minutes.

I get the ER is more expensive. But why can't they just say (be required to say) "you have a cold, go home and see your family dr tomorrow". If urgent care is so much cheaper, why can't they have their own? Right there next to the ER?
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Old 06-04-17, 10:37 AM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

I always suspected the overpriced billing was so that they could write it off when the person doesn't pay (which is essentially a tax subsidy). So do the math. They billed me $13k. I don't pay. They write it off as a bad debt. They're essentially getting $4k-or-so less tax liability. Any CPA's in here? Is my logic right?

That said, I have no idea what kind of price they would have billed insurance if I had it. If I had to guess, I'd say it's significantly less.

I was expecting the visit to be more like $2k or $3k. I could have had that paid off in six months. Though I was prepared that it might be some "pie in the sky" amount. So I wasn't shocked when it turned out to be so much.
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Old 06-04-17, 01:56 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

And by the way, I'm a huge fan of Urgent Care. I've used them for sinus infections, etc.

But like any other business, you would think a major hospital would have the advantage in size and resources. And build their own. Hospitals are centrally located. People know where they are. People have comfort level. So build one in.
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Old 06-04-17, 06:19 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

A lot of hospitals used to have outpatient clinics. Not sure why that fell out of fashion.
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Old 06-04-17, 07:26 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

Originally Posted by Troy Stiffler View Post
I thought I was having a heart attack. Went to ER. They said I was OK. And billed me $15k.
It's alright, my friend's wife went to Urgent Care for severe abdominal pain, they looked at her and sent her to the ER where they did tests and sent her home with some antibiotics.

$13k bill, their deductible is something ridiculous like $14.5k, but since they're both independent contractors it was the only plan that would accept them with a new born.
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Old 06-05-17, 12:55 PM
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Re: Blue Cross/Blue Shield to withdraw authorization for ER visits (Atlanta area)

So get a ass reamingly high bill for several K, or DIE.

...choices
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