In 2001, nothing would make the lower abdominal pain go away, so I drove myself to the hospital. There’s some simple poke-test that is a diagnosis of gall bladder problems (in my case, with a side of pancreatitis).. Shot of morphine - ahh.
I guess I had what would be considered “gold standard” insurance now. The laparoscopic surgery was a day or two away yet they just felt like keeping me there till my white blood cell count was satisfactory. Six days in, I told the Doc I wanted out and give me whatever to take and all went well.
Nowadays, they’d probably kick me out and tell me to stay on a low-fat diet and give me a pamphlet. Another hospital nearly did that in 2015 and I had a broken collar-bone and hands shaking from the need for Librium or Diazepam (raging alcoholic), and on Medicare (Medicaid?), My friend who brought me fought them over keeping me a few grudging days, and even there I had to check myself out. With a 180/120 BP which would have gone up if I had to fight my way out.
Forgot to add: The insurance company still wanted a co-pay of $500. I replies something to the effect of “What part of emergency do you not understand?”
I had probably drank enough Barcardi but the pain was overwhelming and adrenaline got me there (not too far away and 2AM). Call an ambulance? Another $2,000 and do you want one tonight?
In the end they backed off, yet I wonder if the “emergency” no-co-pay thing is still generally the thing. Sounds expensive for the insurance companies.
Overall bill (were it out of pocket) would have been a bit north of $10,000. I think fairly cheap by today’s USA standards? In the UK I’d have had to wait a while before the morphine and it’d probably not even be Demerol.
Here’s my emergency room story that financially and medically worked out OK, but fear of a huge bill caused me to make some poor decisions.
My wife had big pain, so we went the nearest emergency room. After much morphine and ultrasound a gall stone was confirmed, and gall bladder removal was recommended. By this point it’s the middle of the night, and she’s feeling tons better so we go home.
We left, partly because morphine effects decision making, and I was afraid of exactly the kind of sticker shock that emergency surgery in a non-network hospital could leave me with. I knew the actual visit would only be $250, but I was afraid of the insurance company disagreeing about how necessary the emergency surgery was. Our intention was to go to the in-network hospital an hour away in the next few days.
A few hours later the pain comes back, so we return, because big pain beats “drive an hour to the in-network hospital.” They admit her, and schedule surgery.
By this point it is early AM on MLK day. I remember my insurance had a statement that I needed to inform them within 24 hours of all non-network emergencies. I call the number on my card and inform them of the pending emergency surgery. The phone rep claims nobody has ever done that before, but she’ll note it in the account.
I did end up paying the deductible for two emergency room visits, but that was my total cost. I never owed anything else.
It never ceases to amaze me just how complicated the US health system is. Now I know that no country has a perfect health system, but fer’ goodness sakes, having to find out whether your treatment/procedure is covered and whether your provider is ‘within your insurance’s coverage plan’ sound awfully dystopian to me.
I am never going to defend the policies of insurance companies. But I review medical records daily as a part of my job and it is pretty incredible what minor issues folk will go to the ER for. Sure, some part of it is indigence/lack of insurance. But plenty of folk could wait til the morning to go to urgent care for their sniffles.
Let’s not overlook the fact that many insurance companies deny claims that are perfectly valid, at least once, as a matter of policy. They make the patient fight to get the claim accepted, figuring some will give up and just pay the bill themselves. If the patient persists, they’ll admit it is a valid claim and pay it, but many won’t-money saved for them!
This has happened to me more than once as a patient but also as an administrator of a lab submitting claims to insurance companies. The reasons they gave us for their denial of payment for our services sometimes amounted to “it’s your turn in the barrell.”
This doesn’t seem like it should be legal, yet it is.
If I recall correctly, it’s not exactly “no copay” when you are admitted with my insurance. They waive the ER copay but there will still be a copay for the hospital.
In and out of network ER’s. Wow. And “deductible/copays” that supposedly go to the hospital. I guess the pain went away because the morphine wore off. In my case it took an ultrasound and/or blood test to determine I had a side of pancreatitis. I’d had this pain recurringly before yet Ibuprofen or Bacardi (sometimes both at once - yeah great for the liver) alleviated it. Not this time. I hadn’t connected it, yet that day at work was every-other-week “Pizza Lunch” and while I had only two slices that was enough to overload my liver, gall bladder which pocketed stones in the pancreas. The morphine was relieving, and they did whatever brought the pancreatitis diagnosis so no checking me out. Maybe now they would, just so your next visit is “non-emergency”
As an aside, when I told my friend I just got out of the hospital, he asked if I’d just lost a lot of weight. 230 → 180 lbs so yeah. I had not heard that had a connection. I didn’t use drugs, just ate less and ran and biked a lot more. And it was pretty fast - maybe 5 months tops. I guess that allowed my liver/gall-bladder to lower their tolerance for even pizza.
I reckon dystopian includes hospitals caring for money - not people, so yeah.
This I was well-aware of. Unless things have become less dystopian I’m not sure if just any poor person can get Medicaid…
yep. To make it harder for poor people without Medicaid to get away with coming in for non-ER things. Almost every visit to a hospital after driving myself for the gall-bladder was waking in an ambulance answering what year it was and who the President was. Twice in the UK - I forget what the questions were yet I still likely said “Obama” and they knew I was American. I guess once it was Trump but Obama was enough. Maybe they asked who the Queen was.
In the USA after seeing any doctors and nurses there was the inevitable visit from the administrator with a clipboard (usually a stern woman - sorry yet that was always the case for me). Name, employed? Insurance company? As much as any other factor, that made the pathway for your treatment. No equivalent (yet) in the UK but if the Reform Party gets big enough (not that Labour or the Tories wouldn’t) but wouldn’t it be really good if we privatised the pesky NHS? Look at the success in America. No more socialist medical care!
Another nifty thing is I take Synthroid/Levothyroxin and that allows me to be exempt from (co-paying for) all prescribed drugs. That was not the case in Ireland, and my dose is 175 micrograms and when the pharmacy was out of 75’s, they charged me for 100 + 50 + 25, so 3 × €9. I used to get that stuff for about $2 in St. Petersburg (made in Germany).
I never realized just how good a deal I would have with medical insurance until I retired from working life. I spent 23 years in the military, but never really thought about retirement benefits because I went right to work after that “retirement”. Fast forward to actual retirement and it slowly dawned on me that much of the population has co-pays that they have to kick in before insurance will pay anything. I didn’t realize that military retired medical would act as a top hat to Medicare and pick up everything that Medicare didn’t cover. As a result of that happy coincidence, I’ve never made a co-pay in my life, either for surgery or for my recent ER visit. It’s criminal how people have to be near death before they will go to a hospital.
I have not studied it, but I’m pretty sure that MedicAID is relatively easy to get. MedicARE requires more than just indigence.
My experience may be somewhat different than many folks’. I am often surprised at the extent of care and services longtime unemployed folk receive - at least in some states. (My job entails reviewing records of such services.) No, I’m not suggesting it is a cushy, enviable lifestyle, or that the recipients are committing fraud or abuse. And yes, I imagine there are all manner of hurdles that a poor, poorly educated person might find insurmountable. But not a week goes by that I do not see a case in which someone with little or no work history is receiving pretty considerable services which surprise me. Joint replacements or surgeries with (to my non-medical eye) equivocal objective findings, counseling and physical therapy, extended nursing home stays, medications, case managers, in home care, and even folk who come out and clean their house, do their laundry and help them run errands.
I repeat - I am not suggesting that poor ill people are living in the lap of luxury or abusing resources that they ought not receive. I’m just saying that I personally have been surprised at the level of services many people receive - at least in some states. And it is not at all obvious to me why some folk receive such services and others don’t.
I believe that Medicaid eligibility varies quite a bit by state; some states have (or are looking at implementing) work requirements, and some states have broader general eligibility for Medicaid (such as based on medical need) than the Federal laws. Some states are increasingly making low-income people jump through hoops to get Medicaid, because they view Medicaid as “welfare,” and because of misconceptions that people can be on Medicaid simply because they are lazy and don’t work.
My understanding is that any American citizen or permanent resident who is age 65+, and who paid into the Medicare fund (i.e., paid Medicare tax as part of their FICA withholding) for “40 qualifying periods” (in essence, 10 years of work), qualifies for Medicare, as does the current or former spouse of someone who paid in sufficiently*. As you note, Medicare isn’t a “needs-based” system; eligibility has nothing to directly do with income, and is much more like Social Security, as far as eligibility.
*- One can also qualify for Medicare before age 65 if one is suffering from certain chronic/debilitating health issues.
I do not disagree. In New York it seemed the complaints were undocumented aliens “abusing” the ER so kicking them to the curb (nearly happened to me with a broken collar bone when I was on Medicaid for a year) was a viable option.
As has been written in this thread, there is no doubt that hospitals are part of various “networks” yet all are for-profit businesses, not charitable. It comes down to how much compassion and respect for fellow humans you, the hospitals, taxpayers are willing to pay.
If I had to out-of-pocket the bill for my gall bladder surgery in 2001 (about $10, 500) it wouldn’t have been ruinous yet of course that’s not what the insurance companies pay the hospitals. When I was last in a hospital with a broken collar bone caused by my alcohol consumption and crashing my bicycle, and had only medicaid, it took a lot of convincing from my friend to grant my admittance, very reluctantly. If I was an undocumented Mexican they’d have called a taxi and had me escorted out the building.
I had no surgery - you get a sling and for the shakes you get Librium. I left the USA after five days in that hospital, hefted my luggage without the sling and made it to JFK. I can’t quite recall, yet even on Medicaid they inform you of the bill - in this case something like $30,000.
Medicaid is supposed to be a safety net - yet not everyone in the USA can get it. I left before Obama-care existed and I know the parameters for it have changed. I had to return to the USA in July and bought travel insurance with a deductible of $1,000 so I would be admitted and discharged without ruinous fees (if necessary, yet it was not)
Medicaid is still really intended for people with very low incomes. “Individual” coverage from private insurers (i.e., Obamacare) is broadly available for people who don’t otherwise have health insurance (i.e., they don’t qualify for Medicaid or Medicare, and don’t get health insurance from their employers), but premiums can be quite high, and the expanded subsidies which have made those Individual policies more affordable for a lot of low-to-moderate-income Americans for the past five years are sunsetting at the end of 2025; the Trump Administration and Congress have shown little urgency in renewing/extending the subsidies.
Roughly 8% of Americans aren’t insured right now, and between the loss of the expanded Obamacare subsidies, and states (and the Federal government) tightening qualifications for Medicaid, it’s likely that the number will be substantially higher next year.
A lot of it does depend on the state. For example, in NY Medicaid will pay for a home attendant if it keeps the patient out of a much more expensive nursing home. Also in NY ( and I think Florida) if only one spouse needs long-term care , the other spouse can formally declare that they will not use their income and assets to care for their spouse which will lessen the spend-down needed for eligibility.
I don’t know the financial details, yet my mother (96) had a morning and evening attendant and i believe that was all out of pocket for her.
Indeed, some 24 years ago she convinced me and my two brothers to enter into a “lifetime” something, not a will, yet it made the three of us deed-holders and that has caused massive grief I’ve wrote about on this board.
Her fear was that Medicare would take her home away if she owned a house. The thing about that is, if you go into a Medicare home they are just waiting for you to die. My wife works at a paid-for care home (in the UK) that costs lots less than a hospital yet an NHS home is exactly the same as a Medicare home. You are not contributing to our bottom line. Please die ASAP.
And we couldn’t get my mother - living in way too much house after my father died - to sell and find a condo. This was her house and stubborn, or not wanting to be far from her friends, it was ultimately her decision and she died there - creating a King Lear kind of situation with one of my brothers being a psycho.
Ultimately, I respect her fortitude and it was her house yet things would have been so much easier if my eldest brother the probate(r?) had the say on the disposition of the house.
It’s a tenet of Anthropology that you can sense a culture’s ciivilization by how they treat their elderly and dead. Hard to tell how people 100,000 years ago treated those with maladies. Rather easy now.
I went to the ER last year, and the insurance company denied the claim, saying the hospital needed to give them better documentation of the charges.
While they were having their slapfight, I needed to go to that same hospital for a test, and the hospital sent me a bill for what they said was my cost for the test, which (like an idiot) I paid. When I got the insurance company statement it showed they paid $500 more than expected (by me at least), so of course I told the hospital I wanted my overpayment back. BUT! The slapfight was still going on, so the hospital wanted to keep my money. They essentially were holding my money hostage in case the earlier ER charges didn’t work out in their favor.
Um, no. I am a former state employee, and the state contract explicitly says that patients cannot be held responsible for charges that are disputed between the hospital and the insurance company.
I bitched and moaned and 4 months later I finally got my money back. And I will never ever trust billing from a hospital again.
Every time something like this happens I think of people with serious illnesses who have to deal with this bullshit - during a time when you are least able to handle administrivia, an avalanche of it is shoved in your face.
