Hospital Emergency Room Charges – Who is Responsible?

by Linda · February 3, 2018

That used to be a pretty straightforward answer. You go to the emergency room, you have an insurance and they pay less any deductible. Hold the phone, stop the presses, that isn’t the case anymore.

I grew up in an era when people didn’t run to the doctor or hospital for every little thing. We understood there was a time and place for going to the doctor or hospital. “Routine Physicals” were mostly for the rich and kids going to camp or into athletics. We lived a healthier and simpler life back then. (Even margarine with all its trans fats was illegal in my state when I was younger.)

Most people had 80/20 or 90/10 insurance back then – the insurance company paid the first 80% or 90% and you paid the rest. I don’t remember people abusing the insurance, although I’m sure there were some. It was harder to be a hypochondriac back then as you didn’t have commercials telling you that this symptom or that means you might have such and such ailment so ask your doctor if you can take this drug or that. You didn’t have the onslaught of media describing every type of illness known to man. Nor were you told at every turn that you don’t have to put up with any ache, pain, or symptom – even if your lifestyle was bringing it on – if you just take some drug. For the most part, as far as my perception and my world was concerned, insurance believed that you went to the doctor or emergency room when needed and doctors ordered tests and medications only when necessary. That was then.

Fast forward lots of years – more than a half a century later. The tides have changed. The insurance companies now tell us what they deem necessary – AFTER the fact. You often can’t even get the information from them or the hospitals even if you try. The response is to seek reasonable and necessary medical care and they will determine AFTER if they are going to pay for it. Even when you talk to their nurse line and are told to go to the ER – making sure the ER is “in network” – doesn’t guarantee they will pay the bill. Sure, the ER may be covered, but not all the staff in the ER may be covered. I’ve had it happen to me more than once. It’s SO frustrating!

Another time a doctor ordered a test and the insurance company determined he didn’t need to order it so they weren’t going to pay. I asked if they were doctors. They said no. How can an insurance company – who don’t know me and aren’t medical professionals – decide if a test or procedure is medically necessary when my doctor – who does have the education and know my case intimately – has determined it is reasonable and necessary? If they have an issue with a doctor ordering unnecessary tests, remove the doctor from their approved list, don’t blame the patient, who isn’t trained. After arguing with them for 3 hours, filling out the necessary appeal, having that denied also, I ended up paying for the tests when the provider threatened to turn it over to collection as they weren’t going to wait for another appeal.

So, let’s look at what’s happening today. I saw this article in my Google feed the other day and I can’t get it out of my mind You can read the full story here. This lady went to the ER for a possible ruptured appendix. She was in increasing pain in her lower right quadrant overnight to the point where she was doubled over and had a fever. She called her mom, a former nurse, and described the symptoms. Her mom thought it was a ruptured appendix, which can cause sepsis and death, and told her to go right to the ER immediately.

In the end, it was an ovarian cyst. I’ve had those and they ARE painful! Once I went to the ER for one after talking to my doctor and another time to my doctor because he could see me right away. The former was the size of a grapefruit. The doctor let that one burst on its own – after seeing the ER report. The ladder required immediate emergency surgery as an ultrasound showed it was bleeding into the abdomen. I went from the doctor’s office to the hospital. (That time I was only 19 and didn’t have insurance. It took 2 years to pay off all the bills. – over $2,000 back in the 1970’s.)

I’m sure glad I wasn’t the lady in the article and the insurance company believed the necessity of the visit when I did have insurance. How much was her ER visit to determine the cause of pain that had her doubled over? Over $12,000! And the insurance company said since it was “only” an ovarian cyst it wouldn’t be covered. Ovarian cysts aren’t considered a medical emergency. But how would she know that without the diagnostic tests?

The article went on to say that the insurance company, Anthem Blue Cross and Blue Shield, had warned people that they would no longer cover unwarranted ER visits – based on the diagnostic codes assigned AFTER the tests were done. They showed a form letter sent to the insured that for certain things they should go to Urgent care, other things a retail health clinic, still others to talk to one of their virtual doctors, and still others to call their nurse line that was listed on the back of their card. I don’t know about Anthem’s cost, but my insurance company charges $49 for each call to their virtual doctor. That’s way more than my co-pay for the doctor’s office or urgent care! Why would I choose that option?

I am not attempting to fix the health care system in this blogpost. I’m airing my indignation over the audacity of the insurance companies and healthcare system. And I’m offering a solution for one area.

For some things, I agree a virtual doctor just makes sense.

When my daughter was little every time she was around a smoker she came down with an ear infection within 24-48 hours. EVERY TIME! I could almost make the appointment with the doctor for 24 hours after seeing certain family members. She wasn’t “sick” and I hated taking her to the doctor where all these sick, sniveling kids were spreading their germs all over the place because the parents weren’t keeping them contained on their laps or in strollers (eventually the doctor emptied a small office and called it the “non-contagious child room” and we could wait in there). A virtual doctor would have been great for this instance.

When my daughter was older every year around her birthday she came down with strep. EVERY YEAR for like 4 or 5 years. Poor kid! We could see the globby white stuff at the back of her sore throat. She really didn’t need to be swabbed. We knew what it was and she needed antibiotics. Again, a virtual doctor would have been great.

I have a birth defect – a heart condition. It requires antibiotics for certain things like dental appointments. Years ago, I was on strong antibiotics for 10 days – starting the morning of or day before and ending 9 or 10 later. I would always schedule an appointment with my OB/GYN shortly after I finished with the treatment as I was sure to get a yeast infection. Back then you couldn’t buy the treatment OTC, you needed a prescription – and a that required seeing a doctor. It sure would have been nice to call a virtual doctor to get the script.

You get the picture. There are many times, especially when you have multiple children, that it would just be easier to contact a virtual doctor. Personally, I think $49 a pop for the virtual doctor is pretty steep. I mean, they don’t have overhead, they aren’t paying for receptionists, a nurse/assistant, cleaning people, etc. Most virtual doctor visits, I hear, take minutes. If it takes 2 minutes, that’s nearly $25 a MINUTE. But I digress…

Virtual Doctors for your ENTIRE Family

What if you could get a virtual doctor plan for your ENTIRE FAMILY for only $19.99 a month? Would that make sense for you? Not $19.99 per person per month, but $19.99 a month for the entire family? That makes more sense.

Read what this mom wrote after buying the program:

I call that pretty darn convenient! If you’re interested in learning more or getting TeleCare for less than your insurance company’s virtual doctor program, just click below:

TeleCare does take one full business day to get you set up. You can’t call when you’re already sick and ask to join and expect to hear from a doctor right away. It is a monthly plan for the entire family for one price. So join when you’re healthy and use it when you need it.

For Your Budget a & Your Health…