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Lionne posted 11/4/2013 20:57 PM

One requires medical care, say a serious illness, an emergency of some kind? How do people get the care they need? Do hospitals eat the cost? Under what circumstances will they give charity care?

I'm needing some ammunition here for an argument...

StrongerOne posted 11/4/2013 22:29 PM

You go to the ER. You get cared for. At some point they send you away. You may not get all the care you would get if you had insurance. And in any case, you still owe money. Lots and lots and lots of money. A major factor in bankruptcy in this country is medical bills.

Here are examples from my own experience as to why you want health insurance.
1. In getting approved for life insurance increase, I have to get an EKG. Just a formality, they say. Not if you have a wierd EKG! Which I didn't know before. Get it checked out because now I can't get life insurance, and if I have to buy my own health insurance w a job change I'm screwed. See my doc for another EKG, other tests = $$. Referred to cardiologist who, after tests, says, you have a wierd EKG but you have no heart problems. Here's a letter you can use for insurance. = $$$$

2. Seven year old son has strange issues at well child check up. Sees specialists. Has MRI. Hustled off to oncologist. Six years of chemo, outpatient surgery, specialists, MRI, other lab work, emergency room visits, etc etc. We're talking SIX FIGURE bills. Hassle with insurance company but they come through, thank god, because we do not earn six figures.

If we had to pay out of pocket, there was an 18 month stretch where the chemo alone was $50 K a month (doesn't include all the other bills). This is a kid who has never spent a night in the hospital -- all outpatient. We consider ourselves very fortunate.

We would consider ourselves homeless if we did not have health insurance, and I do not exaggerate.

Get health insurance. Please.

[This message edited by StrongerOne at 10:30 PM, November 4th (Monday)]

TrustedHer posted 11/4/2013 22:31 PM

Due to a federal law known as EMTALA, if you show up at an emergency room in need of treatment (or in active labor), they are required to treat you, whether you can pay or not.

That doesn't necessarily mean take care of your condition, it means stabilize you and refer you to "normal" treatment.

This is one of the reasons for the high prices of medical care. About 50 to 80 percent of the ER patients won't pay a dime, and the rest of us pick up the difference.

Hospitals have an entire army of counselors who know the ins and outs of costs, subsidies, charity, medicaid, etc., so they can find ways to get the follow-up care taken care of. Of course, those counselors get paid, too, which adds to the overall cost.

Hospitals budget a certain amount of charity care, and that varies depending on the hospital, and whether it's for-profit, not-for-profit, county, religious, etc. Also, doctors who are here on J-1 visas are required to justify their visa by providing a certain amount of charity or pro bono work. There are a lot of J-1 doctors.

If you get the treatment, and get a bill, and refuse to pay, the worst they do is pursue you through collection agencies.

They write off millions in bad debt every year.

Kajem posted 11/4/2013 23:25 PM

Many years ago we had an insurance glitch-the renewal did not start right away, we had a weekend without insurance. I delivered (by emergency c-section) DD. We were covered when insurance started up, 48 hours AFTER she was born! I was looking at $80.000 in hospital bills. They wrote off over half immediately, set up a payment plan $125 a month and in 2 years time adjusted the balance several times. We paid about $10,000, they wrote off the rest. We weren't bad debt-never showed I our credit rating.

It was a stressful time for me, I had 4 young children and was afraid to take them to the ER in case we were refused treatment and needed it. Nice to know that isn't going to happen.

neverendinghurt posted 11/5/2013 01:45 AM

Those "written off" debts get passed onto everyone else.

Lionne posted 11/5/2013 02:01 AM

All good points. Keep 'em coming...I need to win this disagreement with a family member. It's not political, but practical and moral. Thanks.

NaiveAgain posted 11/5/2013 02:03 AM

How do people get the care they need?
Many don't and that is why they end up in the hospital in serious condition.

Without insurance, most won't go see a doctor until the illness is so severe it lands them in the hospital.

Public hospitals have to take care of anyone who is seriously ill but private hospitals do not and many will not. Many will reroute patients to other hospitals or there are some that will throw the patient out once they cannot pay or their insurance runs out.

Charity care is given on a financial need basis. If you are in need of hospitalization and you are considered "financially disadvantaged" many times public hospitals will write off the bill or will pro-rate it for the patient.

However, hospitals only treat the medical emergency and if you end up with a chronic illness, it can be very difficult to find any after-care. Some pharmaceutical companies, though, will help you with the affordability of their product if you show financial need and have a doctor show that you need their medication.

Pentup posted 11/5/2013 09:12 AM

Think a broken arm is an emergency? Not necessarily. The ER will often not cast it and refer to an ortho. Believe me, the doctors office that sets that arm. They are going to get paid or your credit will take a big hit.

A slip in ice resulting in a torn rotator cuff? Could result in a surgery that costs $40,000. It is an output procedure. Or you will live withit until you can almost can not move your arm and it will hurt always.

My frustration is when folks have a new car, iPhone, smoke heavily and can not "afford" insurance.

Backing out now so I do not violate guidelines.

tushnurse posted 11/5/2013 12:50 PM

ScaredyKat - I assume we are talking here in the USA.

It is true that EMTALA prevents hospitals from turning folks away in the ER, or once that patient is admitted. Once in the hospital here come the Case Managers/Social Workers and their team. They help to determine why you don't have health insurance.
Usually you fall into one of these categories.

1. Unemployed, and can't afford it on your own, but are looking for work, and will get it as soon as you do get work.

2. Too sick to work, too uneducated to navigate the system on your own, or lack the drive to, and actually will qualify for some sort of government assistance.

3. The guy that makes good money, is fairly healthy and just chooses to go without it.

For #1 the Hospitals will assist the patient in working out a payment plan, and place them on a charitable payment system, which is usually much less than what the insurance companies are billed. These folks usually get assistance with other things too while there, an application for food stamps, info on how to get any maintenance meds for free, housing and utility assistance etc.

#2. These folks are usually walked through the Medicaid applications, and placed in the "Medicaid Pending" catagory. The hospital holds billing or does not expect payment from the patient until the Pending is resolved to either on Medicaid, or Medicaid ineligbile. These are the ones that the hospital ends up eating the cost, because these are frequently the folks that don't have an extra cent to their name, and are getting government assistance for other things already.

3. This guy is probably a real genius UNLESS he gets Cancer, or some other ongoing illness. This guy knows that he can Barter his costs, and does, and pays for his healthcare. Often this ends up being a win win for everyone. He pays for just the services he needs, not monthly premiums, and copays, and deductibles, and the hospital, or MD, or service he is using doesn't have to submit billing to insurance, deal with denials, and wait for payment which often takes more than 90 days on complicated claims.

Of course under the "Affordable Healthcare Act" scenario number 3 is now illegal for the patient.

StrongerOne posted 11/5/2013 20:32 PM

Tush nurse (love yr username btw!),
#3 is in good shape as long as he is fortunate and reasonably healthy. Unexpected serious and/or chronic illness, expensive. (Cancer obviously, but also diabetes, migraine, fibromyalgia ...) Sports injury, say, can be expensive in the short term (ER or ortho, cast or boot or brace, minor surgery) and in the long run too (continuing pain, physical therapy, likelihood of reinjury). Anything weird or mysterious that requires multiple visits to multiple specialists -- expensive. Psychiatric problems -- expensive. For example, my sister is BP, difficult to control with meds and lots of IC needed -- her XH didn't file for divorce until she had a job with good health insurance, despite the fact that she had a longterm EA. If he hadn't she would have been in a very bad place. (The man was a saint and my sister was a fool, but that's a different story!). And, everybody gets older. Older = even routine health care gets more expensive, and more things are likely to go wrong.

I'll add too that you don't have to be old for unexpected expensive things to happen. There's my son, for example. There's the college student I work with, who had an idiopathic collapsed lung last month. There's my twenty-something colleague who has the BRCA gene and a mom who died young of breast cancer. Even a bout of food poisoning can rack up scary bills -- college friend was hospitalized because she became badly dehydrated.

[This message edited by StrongerOne at 8:44 PM, November 5th (Tuesday)]

rachelc posted 11/7/2013 06:08 AM

our 24 year old married DD is without health insurance. Her husband has it at his job but to add her would be too expensive for them. So, they are rolling the dice. And breaking the law.
My husband texted them both this last night and he hates it that her husband isn't making health insurance a priority for his DD. She has lost two jobs in the last year and just works part time.
Hubby is sick about it. I say let them fail, what can we do anyway?

His caretaking needs are out of control and she is being very naive.
oh well...

Lucky2HaveMe posted 11/7/2013 06:29 AM

Rachelc - you can carry your dd on your insurance until she is 26 even if she is married. Would that be a possibility for you?

Healthcare shouldn't be tied to employment. The medical care you receive should not be dependent upon the job you have or how much money you have.

Stopping cause this can quickly go against the guidelines if I continue!

authenticnow posted 11/7/2013 06:35 AM

RachelC,

Our DS is on our insurance and isn't a student and doesn't live with us. Lucky is right, this will be until he turns 26.

tushnurse posted 11/7/2013 07:24 AM

Rachelc they are correct you can carry her, and it is probably cheaper for you all to put her on your plan, esp if you are already pay for family. I would just as her to pay for her % of the premium.

rachelc posted 11/7/2013 10:23 AM

omg - really!! Thank you. we will look into this.

Skye posted 11/7/2013 10:44 AM

Was about to offer RachelC the same advice, but in a pm in case it was thought political!

sisoon posted 11/7/2013 11:51 AM

On paying your own way without insurance...

I had outpatient rotator cuff surgery a few years ago, pre-Medicare. IIRC, the total bill was about $25K-$30K. My employer-provided insurance paid about $8500. I paid about $1500.

If I paid my own way, I expect I might have gotten them down to $10,000 (the sum of what my insurance and I paid), but most people don't seem to fight hospitals very effectively.

You can't control what nasty microbes you get exposed to, and you can't control the driver or bike rider who hits you. And there's no way to reduce the probability of a stroke or heart attack to zero.

You probably can't entirely avoid the ER - your doctor's offices are probably open for 1/4-1/3 of a week - the probability is, if you have an emergency, your doc's office will be closed, and you'll be directed to an emergency room.

Too many self-insured people end up using hospitals. When the demands on their finances are too great, the rest of us pick up the tab.

Of course insurance companies make money. That means more money is collected from insures to pay for health care on average than is actually paid out. The problem is that just a little bad luck without insurance can bankrupt most of us.

Eranda posted 11/7/2013 20:59 PM

Every single person in America should read this:

http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdf

We need to understand WHY our health care costs are so astronomical, and what can and should be done to keep them in check.

Until people understand how medical services are billed, a discussion about health insurance in any form is useless. Discussing health insurance without first controlling costs is ludicrous.

With that said... a number of years ago I had a tubal ligation in a local hospital. I had company health insurance that covered it. I paid my premiums. I expected to be billed for 10% of the cost, as per my health insurance contract.

A few months after the procedure, I got a bill in the mail for $11k. The bill said that my insurance wasn't valid. Of course I called the hospital and told them that I did indeed have valid insurance. Turns out they had billed my OLD insurance company in error, and the old company denied the claim, of course.

So I gave them the correct information, and waited. A month later, I get a bill in the mail for $11k. I call the hospital and they say that my current insurance denied the claim because it wasn't submitted within the time frame they require. I called the insurance company and they said that was bullshit- that as long as you had valid insurance on the day of the procedure, they had to cover it. I called the hospital back and gave them the contact number of the person to get in touch with for information about how to re-submit the claim.

A month later, I called to make sure everything was OK because I hadn't gotten a bill for my portion of the cost. They said that they insurance had denied the claim AGAIN, and that they hospital had just "written off" the costs.

I asked why on earth they would do that, because I HAD insurance that was legally obligated to pay that bill per the contract and the premiums I'd paid. They lady from the hospital told me that I shouldn't worry about it because my bill was now $0. I said I didn't care about that, I had paid premiums for a YEAR so that my bills would be PAID. That in effect, the insurance company had violated the contract by taking my money and not paying for my treatment. That the hospital was entitled to that money for services they provided and that I had already paid to cover.

And the lady from the hospital just kept asking me why was I concerned since my bill was now $0?

Absolutely maddening.

And don't fool yourselves by thinking that "everyone" pays the costs of uninsured patients who go to the ER. Oftentimes the actual costs to the hospital are very low, and they use those inflated write-offs to maintain their non-profit status.

sisoon posted 11/8/2013 11:38 AM

Wow, Eranda.

Similar experience - my Mom went to an ER when she was visiting us from out-of-state. She gave the hospital her insurance card to copy. The @#$% hospital kept billing our local Blue Cross, who, of course, kept denying the claim. It took several letters and phone calls to get the idiots off her back. But that was only a tenth of what they wrote off in your case.

This sort of incompetence is compounded by the fact that when hospitals write bills off, they get to call it charity.

Thanks for the link to the article. You're right - it's an article that we all ought to read by next Halloween.

Oh, yeah. After my rotator cuff surgery, I had a respiratory infection on a weekend and was directed to the ER. My bill included $136 for 2 generic Tylenol-3 tablets.... I left with a script for 20 Tylenol-3, which I filled for less than $10.

[This message edited by sisoon at 2:19 PM, November 8th (Friday)]

Cally60 posted 11/8/2013 16:16 PM

To those who are interested in this, I highly recommend the recent documentary The Waiting Room. (Netflix now has it on DVD.)

It was filmed in the ER department of Highland hospital in Oakland, California, which is in an area where many of the local residents don't have insurance.

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