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To go to the ER or not, are you qualified to self-diagnose?
Posted by: Speedy
Date: June 10, 2021 05:15AM
UnitedHealthcare thinks you are and won’t pay if your diagnosis is wrong.

[www.startribune.com]

UnitedHealthcare wants to stop paying for non-emergency care that's provided in emergency rooms, a move that doctors and hospitals are criticizing for its potential to stop patients from quickly getting care in situations they believe are emergencies.

Officials at Minnetonka-based UnitedHealthcare, which is the nation's largest health insurer, say the goal is to encourage patients to use urgent care, clinics or even virtual visits, when appropriate, for low-level health care needs that don't require the expertise of an ER.

Starting in July, the company in most states will review ER claims to evaluate whether the visit should be paid for considering the patient's presenting problem, the intensity of diagnostic services provided and factors such as complicating health conditions. Claims deemed to not meet the criteria of an emergency medical condition, or"non-emergent," either won't be covered or will be subject to limited coverage.

"Unnecessary use of the emergency room costs nearly $32 billion annually, driving up health care costs for everyone," said Tracey Lempner, a UnitedHealthcare spokeswoman, in a statement. "We are taking steps to make care more affordable, encouraging people who do not have a health care emergency to seek treatment in a more appropriate setting."



Saint Cloud, Minnesota, where the weather is wonderful even when it isn't.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: Ombligo
Date: June 10, 2021 06:38AM
This wouldn't be an issue if hospitals weren't treating the ER like a winning lotto ticket. I understand the ER costs may be higher, but the price gouging is insane. A 10x price increase on any service seems to be the norm.



“No persons are more frequently wrong, than those who will not admit they are wrong.”
-- François de La Rochefoucauld

Growing older is mandatory. Growing up is optional.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: Sarcany
Date: June 10, 2021 06:47AM
Quote
Ombligo
This wouldn't be an issue if hospitals weren't treating the ER like a winning lotto ticket. I understand the ER costs may be higher, but the price gouging is insane. A 10x price increase on any service seems to be the norm.

The doctors in my local hospital system have patients check in through the ER in order to get outpatients rapid COVID testing, CT scans and IV antibiotics. Outside of the ER, those patients would need to check in for an extended stay or make appointments several weeks out to get those services.

I don't know which is more expensive in this scenario, but I know that going through the ER can get you back to work the next day where you might otherwise have to miss several days.

This seems to be a problem with the efficiencies of the hospital, but punishing insured patients by bankrupting them over an ER visit is not the solution.



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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: p8712
Date: June 10, 2021 07:37AM
I'm not in favor for this - but GOMERs are some of the dumbest, neediest people out there.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: Lemon Drop
Date: June 10, 2021 07:37AM
What could possibly go wrong?
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: PeterB
Date: June 10, 2021 08:11AM
Quote
p8712
I'm not in favor for this - but GOMERs are some of the dumbest, neediest people out there.

Amongst doctor-slang, I find this one of the most offensive. The patronizing attitude of some doctors and other medical personnel is just stunning.




Freya says, 'Hello from NOLA, baby!' (Laissez bon temps rouler!)
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: p8712
Date: June 10, 2021 08:24AM
Quote
PeterB
Quote
p8712
I'm not in favor for this - but GOMERs are some of the dumbest, neediest people out there.

Amongst doctor-slang, I find this one of the most offensive. The patronizing attitude of some doctors and other medical personnel is just stunning.

Oh, it's nurse slang, too. I can definitely see the need to cut down on people coming in for a turkey sandwich, the mysterious knee pain a 400lb person has for ten years, or a routine doctor's visit.

People that need the ER usually go to urgent care, and people that need urgent care usually go to the ER. I'm not sure that this proposal will fix it, though.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: PeterB
Date: June 10, 2021 08:29AM
Quote
p8712
Quote
PeterB
Quote
p8712
I'm not in favor for this - but GOMERs are some of the dumbest, neediest people out there.

Amongst doctor-slang, I find this one of the most offensive. The patronizing attitude of some doctors and other medical personnel is just stunning.

Oh, it's nurse slang, too. I can definitely see the need to cut down on people coming in for a turkey sandwich, the mysterious knee pain a 400lb person has for ten years, or a routine doctor's visit.

People that need the ER usually go to urgent care, and people that need urgent care usually go to the ER. I'm not sure that this proposal will fix it, though.

There's no question that there may be stupid patients out there, but there's no need to compound that with the use of derogatory slang; doctors and nurses are supposed to be professionals and act professionally. Speaking as a patient who once had to be convinced to go to the ER for a true medical emergency -- I don't think it's a good idea to lump patients all into one category. And every patient is someone's father, mother, son, daughter, etc.




Freya says, 'Hello from NOLA, baby!' (Laissez bon temps rouler!)
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: p8712
Date: June 10, 2021 08:37AM
Quote

There's no question that there may be stupid patients out there, but there's no need to compound that with the use of derogatory slang; doctors and nurses are supposed to be professionals and act professionally.

It's not the kind of thing you say to a patient.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: PeterB
Date: June 10, 2021 09:07AM
Quote
p8712
Quote

There's no question that there may be stupid patients out there, but there's no need to compound that with the use of derogatory slang; doctors and nurses are supposed to be professionals and act professionally.

It's not the kind of thing you say to a patient.

No, it's the kind of thing you can get sued for, if it should happen that the patient overhears you: [www.washingtonpost.com]




Freya says, 'Hello from NOLA, baby!' (Laissez bon temps rouler!)
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: RAMd®d
Date: June 10, 2021 09:10AM
We should all be kinder, gentler people in thought and deed, regardless of who we're taking to or who we're talking about, in all walks and aspects of our lives.





LOL, like that's ever going to be a thing!

Sometimes, I crack myself up.





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We are a government of laws, not men.

Everybody matters or nobody matters.

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all who would be called good
must suffer with him.

You and I have memories longer than the road that stretches out ahead.

There is no safety for honest men except
by believing all possible evil of evil men.

We don’t do focus groups. They just ensure that you don’t offend anyone, and produce bland inoffensive products. —Sir Jonathan Ive

An armed society is a polite society.
And hope is a lousy defense.

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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: S. Pupp
Date: June 10, 2021 10:15AM
Perhaps, rather than punishing patients for making the “wrong” decision, insurance companies should educate patients on the appropriate use of ER vs urgent care vs primary care.

Ideally, the primary care office would be called to triage. but with the lowering of education/training requirements in medicine, the triage would likely be done by a medical assistant or operator rather than an RN or doc. I know of some bad outcomes from this.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: cbelt3
Date: June 10, 2021 10:43AM
We use ER for 'I might be dying" things. Urgent care for "I'm really sick". Call the doctor for "I'm not sure what's going on ". And our own resources for "Not doing well here".

An ER visit destroys our finances.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: $tevie
Date: June 10, 2021 11:04AM
It goes without saying that single payer healthcare for all would stop this BS.



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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: Ammo
Date: June 10, 2021 12:26PM
I think it’s reasonable to ask patients with non-emergency conditions to go through their primary care system.

As usual, the devil is in the details - will the patient be charged at all for that advice? And inevitably, a patient is going to dramatically worsen or even die after they are initially denied care even when they do (or don't do) something to contribute to their woes in the meantime.

Lawsuits will follow.



Where is there dignity unless there is also honesty? - Cicero

Be kind, for everyone you meet is fighting a battle you know nothing about. —Wendy Mass
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: Bill in NC
Date: June 10, 2021 12:31PM
Shouldn't;t there be an urgent care internally so intake can send them there instead?
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: RgrF
Date: June 10, 2021 01:11PM
Quote
$tevie
It goes without saying that single payer healthcare for all would stop this BS.

This is really the crux of it. One of the more unfortunate side effects of ACA was to strengthen the role (and profits) of insurers. The only real solution is to get insurance companies out of the medical care equation
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: S. Pupp
Date: June 10, 2021 01:21PM
Quote
RgrF
Quote
$tevie
It goes without saying that single payer healthcare for all would stop this BS.

This is really the crux of it. One of the more unfortunate side effects of ACA was to strengthen the role (and profits) of insurers. The only real solution is to get insurance companies out of the medical care equation

Absolutely.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: p8712
Date: June 10, 2021 01:33PM
Quote
RgrF
Quote
$tevie
It goes without saying that single payer healthcare for all would stop this BS.

This is really the crux of it. One of the more unfortunate side effects of ACA was to strengthen the role (and profits) of insurers. The only real solution is to get insurance companies out of the medical care equation

It was a republican plan. Thanks, Mitt.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: $tevie
Date: June 10, 2021 02:23PM
Quote
p8712
It was a republican plan. Thanks, Mitt.
My father died under Romneycare and my mother did not have to pay one penny more than what the plan covered. In other words, any bills that showed up that weren't paid for by Romneycare, she could toss in the trash and forget about. I don't know about ACA in the same situation, I wonder if that is how it works?



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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: p8712
Date: June 10, 2021 02:56PM
Quote
$tevie
Quote
p8712
It was a republican plan. Thanks, Mitt.
My father died under Romneycare and my mother did not have to pay one penny more than what the plan covered. In other words, any bills that showed up that weren't paid for by Romneycare, she could toss in the trash and forget about. I don't know about ACA in the same situation, I wonder if that is how it works?

Sorry about your father.

If ACA insurance doesn't cover it and you get a bill....you're on the hook.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: Ombligo
Date: June 10, 2021 03:33PM
Quote
p8712
Quote
$tevie
Quote
p8712
It was a republican plan. Thanks, Mitt.
My father died under Romneycare and my mother did not have to pay one penny more than what the plan covered. In other words, any bills that showed up that weren't paid for by Romneycare, she could toss in the trash and forget about. I don't know about ACA in the same situation, I wonder if that is how it works?

Sorry about your father.

If ACA insurance doesn't cover it and you get a bill....you're on the hook.

You may be liable for a loved one’s debt if …

- You co-signed for the debt, such as a loan.
- You’re a joint account holder for a credit card. This would make you responsible for paying off any balance. If you’re simply an authorized user of the credit card, then you usually won’t have to pay for the credit card debt.
- The deceased person was your spouse and you live in a community property state — or the deceased was your parent and state law requires you to pay a certain kind of debt, such as healthcare costs.
- You were the executor, or other responsible representative, of an estate and you didn’t follow state probate laws as required.



“No persons are more frequently wrong, than those who will not admit they are wrong.”
-- François de La Rochefoucauld

Growing older is mandatory. Growing up is optional.



Edited 1 time(s). Last edit at 06/10/2021 03:33PM by Ombligo.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: p8712
Date: June 10, 2021 03:34PM
Quote
Ombligo
Quote
p8712
Quote
$tevie
Quote
p8712
It was a republican plan. Thanks, Mitt.
My father died under Romneycare and my mother did not have to pay one penny more than what the plan covered. In other words, any bills that showed up that weren't paid for by Romneycare, she could toss in the trash and forget about. I don't know about ACA in the same situation, I wonder if that is how it works?

Sorry about your father.

If ACA insurance doesn't cover it and you get a bill....you're on the hook.

You may be liable for a loved one’s debt if …

- You co-signed for the debt, such as a loan.
- You’re a joint account holder for a credit card. This would make you responsible for paying off any balance. If you’re simply an authorized user of the credit card, then you usually won’t have to pay for the credit card debt.
- The deceased person was your spouse and you live in a community property state — or the deceased was your parent and state law requires you to pay a certain kind of debt, such as healthcare costs.
- You were the executor, or other responsible representative, of an estate and you didn’t follow state probate laws as required.

I was thinking more for living people.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: kj
Date: June 10, 2021 05:56PM
Quote
PeterB
Quote
p8712
Quote

There's no question that there may be stupid patients out there, but there's no need to compound that with the use of derogatory slang; doctors and nurses are supposed to be professionals and act professionally.

It's not the kind of thing you say to a patient.

No, it's the kind of thing you can get sued for, if it should happen that the patient overhears you: [www.washingtonpost.com]

I agree, despicable term. I refuse to believe someone with that attitude would provide high quality care. I would rather have a robot.
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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: AllGold
Date: June 13, 2021 06:54PM
Quote
Bill in NC
Shouldn't;t there be an urgent care internally so intake can send them there instead?

Excellent idea.

I don't think that really exists, though. Some hospital systems operate their own urgent cares but they're likely not in the hospital itself. The largest hospital system in my area has several branded urgent care offices scattered around the region. However, they don't have one inside the hospital. They do have one across the street from the hospital but it's not open 24 hours so late-night you'd have to go to the ER.

There is a 24-hour urgent care in the area but it's not affiliated with the hospital nor located in close proximity.



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Re: To go to the ER or not, are you qualified to self-diagnose?
Posted by: mrbigstuff
Date: June 13, 2021 08:39PM
Quote
AllGold
Quote
Bill in NC
Shouldn't;t there be an urgent care internally so intake can send them there instead?

Excellent idea.

I don't think that really exists, though. Some hospital systems operate their own urgent cares but they're likely not in the hospital itself. The largest hospital system in my area has several branded urgent care offices scattered around the region. However, they don't have one inside the hospital. They do have one across the street from the hospital but it's not open 24 hours so late-night you'd have to go to the ER.

There is a 24-hour urgent care in the area but it's not affiliated with the hospital nor located in close proximity.

It's almost like the health industrial complex doesn't want that, eh?

I can recall the first visit to Europe and getting strep or something similar. Went to a 24 hour clinic where they looked at my throat ("ehhh!") and sent me off with erythromycin. Probably cost me $5. This was in 1990. The USA can't figure it out, though.
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