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Biggest health insurer plans to deny ER bills if it doubts you had an emergency (arstechnica.com)
77 points by peanutbutter_ 12 days ago | hide | past | favorite | 87 comments





I was born in the USA, but every day I question if I will be able to afford to retire in this country, or if I need to plan to emmegrate elsewhere while I still can.

My primary concern is healthcare costs. How am I supposed to budget for healthcare costs during retirement when it's already so complicated.

530,000 American households are bankrupt each year due to medical costs [1]. It seems like the most complex piece of the retirement planning puzzle.

[1] https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most...


I've had this concern for a while myself.

I once quit a bay area tech startup job in my 20s due to burn out (5 years no vacation, easily 50+ hour weeks) and in those few months of taking time for myself I got hit by a bout of what I assume was appendicitis. I delayed going to the hospital because I didn't have insurance since I had just left my job. The pain passed that day, but then a few weeks later the same excruciating pain came back -- just really indescribable pain -- to the point where I semi-consciously was asking my partner to make sure I didn't die. Ended up at the hospital, they confirmed appendicitis, did the surgery in less than an hour, and I got hit with a $25k bill. I remember an administrator coming into the room before the surgery and asking me for a credit card while I was completely out of it, because I assume someone told them I didn't have insurance.

After it all happened I was talking to a friend of mine who is an ER doctor and he told me, quite frankly, that if you ever find yourself in a situation like that to just leave your wallet at home and give a fake name. As a doctor they're going to treat you no matter what.

It's horrifying that we have to deal with this system in the United States. It does make me consider seeking citizenship elsewhere, which I consider more seriously the older I get.


Some few months ago I was trying to think of some sort of asset protection vehicle to prevent medical organizations from seizing everything I own in the event I face some catastrophic health issue. I don't think you can transfer property to a trust to shelter you from such events, though. They'd just go after the trust as far as I know.

The bigger issue is that I shouldn't have to think about this sort of problem in my emergency or estate planning.


It's weird though, you'd think that would be exactly the kind of risk that would be insurable. Privately or as a whole society. Some of us will keel over on the spot or otherwise incur near-zero end-of-life costs; others will need $2 million of care to make it through the last couple of years. It seems less relevant whether people in society pay their everyday medical costs out of pocket, compared to the fact that any one of us might need rare expensive treatment or complex care. The whole country sharing the risk as a massive national collective self-insurance exercise seems like the best solution.

Sorry, I don’t like it when MY money goes to help THOSE people. (Sarcasm)

I'm debating this for myself currently. I'm a teacher and, in the low CoL area I live in, I make pretty well with good insurance and decent retirement because of when I started teaching. I am, however, getting a leave of absence to go to Ireland to pursue a masters program in Applied Math and Theoretical Physics.

It's really tempting to just stay and work a data science job, though I do enjoy the time teaching gives me off, the fact it'll pay off my loans and that I can live comfortably with plenty to save to travel abroad for a few weeks every summer (I realize I might be one of the few teachers like this and I credit it solely to being single and no children).

And, yeah, I'll get state insurance when I retire, but it just sounds nice living in Europe (using the Ireland masters as a jumping-off point for networking) and not having to worry about it at all, even if I have to give up a lot of the stuff I value about teaching (namely, 75+ days off a year and a decent work schedule)


I met a girl at a coffee shop with nasal infusion pump and stage IV cancer. She was preparing for her bankruptcy hearing across the street because the doctors and hospitals were taking everything she had and she had to fight to keep some scraps. That's how America works: get sick, die and lose everything to vulture corporations.

Why are there so many American homeless people? Lack of funds... not the drugs, mental, lazy, etc. excuses.

Why are there so many Americans with so little savings and yet hyperconcentration of wealth by a panoply of billionaires? Income inequality derived from the rich owning the political establishment.


Why are there so many American homeless people? Lack of funds... not the drugs, mental, lazy, etc. excuses.

Thank you for saying that. I will add: The US has some sucktastic housing policies that are an underlying cause of this social cancer.


I know a former NY Daily News and Village Voice writer and merchant mariner in Palo Alto/Campbell/Los Gatos, CA who is disabled and has no money except the paltry Social Security. He's perfectly sane, well-read, highly-intelligent (law school dropout in the hippie era), but lacks the funds to miraculously "pickup himself up by his bootstraps." A person can't get anywhere from nowhere without some sensible help like every other civilized country does. America is great if you're rich but it's like Brazil if you're not. European countries tend to be great if you're poor or middle-class, but not as great as the US if you're rich.

Yes, I'm aware. I have about six years of college. I spent nearly six years homeless.

I still write about it sometimes on various blogs of mine, like Street Life Solutions.


Cool. I lived in a vehicle (a car, another car, and then a can) for 9 years to save rent and then to live minimally. It took me 10 years to graduate between work and the echos of the dotcom era messing-up course availability. Doing alright now if anyone were wondering.

Portugal has a great visa program if you can afford to invest in an investment fund or buy a property there (“Golden Visa”). It’s about 250k-500k EUR, but fast tracks your permanent status.

How many of those households are on Medicare?

What a bunch of fucking scumbags. Politicians need to step in and make this illegal. This industry is disgusting. Now you are talking about regular people trying to self diagnose to avoid going to the ER in fear of getting a large medical bill. Fuck these people.

When is the last time you went to an ER? We went recently in southern california, and it was saturated by people stopping in for sniffles, flu, and other things that should have been handled in a regular doctor visit. The nurse said as much when we asked if we should go somewhere else for (what turned out to be) an actual emergency. We got right in, thanks to triage.

Is this related to the article? Probably not. But I never get enough chances to point out the myriad abuses and misuses of the health care system.


> We went recently in southern california, and it was saturated by people stopping in for sniffles, flu, and other things that should have been handled in a regular doctor visit.

This is likely due to an inability to access "regular doctor" care. Either for lack of insurance (which they can't afford), or a giant deductible (which they also can't afford). The doctor's office can turn them away for an unpaid bill; the ER cannot.


As I understand it, it's not primarily an abuse of the system by greedy and wicked freeloaders, but a very predictable result of the lack of safety net coverage in the US.

Specifically, people without insurance end up at the ER because the ER can't legally turn them away for not having insurance or not being able to pay.

Another predictable consequence is patient dumping, where patients who cannot pay at one hospital are sent to the ER at another.


And I've been to plenty of ER visits in many parts of the country and seen nothing like this (although there have been waits), and seen effective triage, including a patient I was with walking in (looking fine) and being admitted in like three minutes flat based on an initial cardiac test. And you got treated quickly also.

Perhaps you are in a local minima of bad conditions.

Even if what you saw is widespread, it is still no excuse for this kind of stupid response from insurers. It is not even close to justified.


At my local hospital, the ER and walk-in clinic have doors next to each other.

The idea that the ER can't triage non-emergency care is some sort of bureaucratic construction designed to facilitate making money.


> Politicians need to step in and make this illegal.

That would only make the situation even worse, hospitals would raise their absurd gouging rates even higher if government required it.

Reform is needed but on both sides of that table.


Break up the insurers (or nationalise the medical care funding system), break up (or nationalise) the hospitals.

> This industry is disgusting

But it's very profitable.

Physician salaries have certainly outpaced inflation over the past 50 years (in most specialties - pediatrics and internal medicine seem to have dropped slightly) and the profit share of insurance companies has drastically increased over the last 20 years.

After Obamacare, health insurer profitability has actually improved, and health insurance stocks have outperformed the S&P 500 by more than 100%.

If you want a cut, you should really buy some stock.


And that's putting it politely.

Yup, these are the same people who run software to scan for plausible errors in past insurance applications, focusing on people who get the most expensive diseases, then use those errors (e.g., a misstatement or omission of a completely minor and unrelated condition or treatment), as a pretext to now deny coverage.

So, not the patient, who has played by the rules their entire life, and properly paid into the system, is now literally fighting for their life, probably without a job, and is now denied the healthcare that they had paid for their entire life.

And when a case manager denies their claim and saves the company $500K, they get promoted for killing the patient.

This is not rumor. This is sworn testimony before congress.

"Fuck these people" indeed!! (except they may no longer qualify as people)


> sworn testimony before congress

Citation please?


Just Google "health insurance recision congressional testimony". There were many, many hours of testimony about the dishonest practice.

It was systemic in the industry before it was banned by the ACA/Obamacare. This is one of the most important features of the ACA.

I've posted below only one of the first appearing links to articles on the testimony of industry insiders [1]. I don't have handy the link to the video I found most memorable. It was a woman who worked at a large insurer, who rescinded the insurance of a man with an expensive disease, who'd never missed a payment, and who died fighting to get the insurer to pay. so he could get treatment. She felt badly enough about it to testify, and was also promoted for saving the company money.

Just because it sounds outrageous and dishonest does not mean that people won't do it.

[1] https://abcnews.go.com/Business/Health/story?id=7911195&page...


In a sense prices are this high because someone keeps paying. If the money dries up maybe the issue will resolve itself.

Maybe a stretch, but possible.


This occurs because it's the area you can get hit with totally extraordinary out of network bills your insurer may have to pay. Super lucrative for hospital / physician / transport providers.

Your kid bumps their head.

"There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Korea — to Zuckerberg San Francisco General Hospital (SFGH).

The doctors at the hospital quickly determined that baby Jeong Whan was fine. He took a short nap in his mother’s arms, drank some infant formula and was discharged a few hours later with a clean bill of health.

... the bill finally arrived at their home: They owed the hospital $18,836, the bulk of which was for a mysterious fee for $15,666 labeled trauma activation"

Hahah. For the insurance companies this happens over and over.

Of course, the lobby groups will get everyone riled up over this and HN contributors will be calling UnitedHealth scumbags / capitalist pigs.


The counter point to this, is that I know of a family member went to the ER after passing out (after the 2nd incident) and was able to diagnose a life threatening condition. If they had a healthcare plan like this, they would have probably not gotten care and would be at risk, because the only reason the diagnosis happened was due to symptoms that only show up immediately after their incident.

The risk here is having patients doing their own triaging. If the insurance company really wants to reduce costs, they can partner with a network of ERs who commit to triaging and transferring to lower cost providers if the issue is not an emergency. The patient is not qualified to make that decision.

I worked at a health tech company where we analyzed bringing down costs through claims data, I can tell you that there are actually hundreds of ways insurance companies can reduce costs that won't risk patient safety, but do not. For example, there are billing mistakes all the time, but insurers do not give a crap. We tried building features to help identify billing mistakes but we never could get insurers to care about it. The amount of times I saw insurers undermine patient safety for "costs" was staggering so I'm really skeptical that the insurers are doing the right thing here. As another example, we saw insurers build "Centers of Excellence" and push patients towards taking care there. Basically what they did was find crappy hospital systems who were willing to take lower rates and they would tailor their insurance plan to push patients that way. Unfortunately when we analyzed claims and outcomes we found these Centers of "Excellence" actually had way worse patient outcomes. We raised this point with the insurers and again, they did not give a crap.


Not arguing insurers care about patient health at all.

But being charged $18,000 for a doctor to look at you for 15 minutes? If people paid out of pocket these bills would be uncollectible.


Why doesn't this problem exist anywhere else in the world?

The insurance companies have contributed to making American healthcare so dysfunctional. They are not the victims here.


One thing I read is public hospitals seem to be overwhelmed with uninsured patients who often come for emergency care because they have no other options. Private hospitals are able to grab the insured patients. Medicaid funding is not enough to pay for the cost of care for low income patients so hospitals survive on those private insurers to balance the books. There was a recent Frontline documentary about this. https://www.pbs.org/video/the-healthcare-divide-rv6npd/

So the "free" healthcare provided to ingident people because it's mandated by law causes insane costs on hospital bills for those that actually can pay. As always, obscure requirements and incentives lead to incomprehensibly perverse outcomes. This is why the libertarian standpoint holds so much attraction - anything the government becomes involved in always gets worse.

What’s the libertarian solution to healthcare? Let people die in the street in front of the hospital if their credit card can’t handle an $18k charge?

Most other countries offer a baseline of health care that DOES NOT go to extraordinary lengths (ie, 10M) that is free to everyone. They pay those doctors a salary, often also cover the medical education for them etc.

Then people can and do pay on top of that for private care. Super wealthy are in their own system, many others go for basic stuff to public option but might pay privately for speed / fancier results.

This mirrors libertarian model in most cases.

The US is a bit unique. For example, end of life care is both fully covered in most cases and insanely expensive - we spend far more than many other countries on things like last 3-6 months of life doing "heroic" measures, full intensive care etc etc. Again very lucrative to hospitals so don't see it stopping, but yes, other countries do not do this unless you pay yourself.


I had mallet finger once. Went to a doctor in a nearby hospital (this is pre-doctor's care places on every corner). He saw me, gave me a plastic splint and said don't let your finger bend for 8 weeks and it should be fine. It was.

Then I got the bill which insurance paid. The hospital decided to code it as a broken limb and everything that goes along with it, xrays (which I didn't have), plaster cast (which I didn't have), etc... Even though insurance paid, this sort of thing just pisses me off. So, I spent hours on the phone getting it fixed which made the bill maybe 1/4 of what is was originally.


Having dealt with them enough, now, I'm entirely sure that the average hospital billing department sufficiently resembles an organized criminal enterprise that a whole bunch of the people involved would be behind bars, in any remotely just world. There is no fucking way the rate of "errors" they commit can be accounted for by actual, honest mistakes.

Oh, I have more lol. I had a legitimate ER visit for some stitches. At the visit I gave them my insurance, credit card, address, etc... When leaving I asked if there was anything else I owed? Nope.

Fast forward 12 months and I get a letter from collections for ~$500. WTF is this? I never received a bill from the hospital. It took me a bit to even realize where this might be coming from. Once again, this type of stuff annoys me, so I call collections. "It's not much just pay it" - they cut it like $100. Not going to happen. So I wrote them and the hospital asking for the bill details which neither could produce and the delinquent bill was cleared.

I rarely go to any ER type care and I have 2 stories of bills being f'd up. So yeah, the rate of errors seems beyond that of simple mistakes.


the insurance companies have posted record profits. They're not having money trouble

"UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021"


This is in part COVID driven.

* Significant reductions in demand for standard services. * Generous compensation for COVID services.


this has been going on since before COVID https://www.fiercehealthcare.com/payer/big-name-payers-earne...

In particular see the chart that shows 2018 and 2019 profits


These will generally be also tied to various govt programs that are getting milked and are not market driven.

You'll have honest / primary care providers going bust under Medicare / Medical and folks who get aggressive on billing / switch to lucrative areas (medicare advantage is mentioned) and milk like crazy.

Large corps shop and cost shift to employees who also shop on price etc so margins are poorer there (where the issue in article is more relevant).


None of what you're saying has anything to do with the issue. The situation is that UHC is posting record profits but they are trying to implement a cost-cutting policy that will punish patients who make the "mistake" of not retroactively knowing their symptoms did not represent an emergency. All your points are about unscrupulous doctors but this policy punishes the patients, not the doctors.

The article outlines fairly well the primary reasons why this is an atrocious policy to adopt (even if it's fairly typical of some of the rationales for reimbursement or lack thereof).

Another problem with the policy, though, is that many people are forced into ED use because there are simply not better options. Urgent care in the US has become fairly restricted in scope of services in a lot of areas, so the grey area between "urgent care worthy" and "ED-worthy" is larger than it should be. Many things that are maybe less ED-worthy become ED visits because urgent care is inaccessible, and delaying to urgent care or outpatient might make them emergency in nature. Even things like routine medication refills for certain groups can become ED visits because urgent care is closed, outpatient visits might be scheduling too far out, and so forth.

Do some people abuse the ED? Sure. But then find another solution for those people.


> Do some people abuse the ED? Sure. But then find another solution for those people.

Ironically they tend to be the uninsured because the ER can't turn you away. The solution is to get them insured.


This is really important: Health care should be really, really easy to afford.

For some comparison: Since I moved out of the states, I pay less than $300 a year out of pocket (in general). My biggest expenses - a neurologist, for example - costs less than $50. As does the ER, honestly, or the clinic that deals with injuries (the ER will send folks over there). The rest is taxes, and taxes are lower than federal + state + insurance premiums in the US.

Additionally, it isn't just insurance. If you work while the normal doctor is open and you don't have paid sick days, you might not be able to go to the doctor even if health care is free simply because you can't afford to miss work. You need paid time off for this sort of thing - and honestly, parents need more days since they have responsibility for than one person.


Urgent care is very lacking. I’ve had many episodes where I go in and they refuse to see me, say goto ER. Get to ER and they are annoyed that I didn’t goto an urgent care.

Look I’m sorry my minor stroke annoys you, but something beyond go home and see if it turns into a major stroke would be appreciated.


"In a 2018 analysis published in JAMA Open Network, researchers found that up to 90 percent of the symptoms that prompted an adult to go to the emergency room overlapped with symptoms of non-urgent conditions, which may be denied coverage in the future. But those same symptoms could also be linked to life-threatening conditions."

From the study:

Findings This cross-sectional study found that 1 insurer’s list of nonemergent diagnoses would classify 15.7% of commercially insured adult ED visits for possible coverage denial. However, these visits shared the same presenting symptoms as 87.9% of ED visits, of which 65.1% received emergency-level services.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle...


Classically, you have gastroenteritis (stomach flu) and appendicitis both presenting with stomach pain, or myocardial infarction and heart burn both presenting with chest pain. A policy like this will result in deaths for those that occupy the middle ground between Medicaid and having enough money to not worry about medical bankruptcy.

Healthcare providers tend to overcharge in proportion to how unnegotiable the service is. For example, ambulance charges are a great way to make money, because the person on the hook for the ambulance typically isn't in a position to decline ambulance service.

I agree with the implementation because it puts the burden in the right place. The error here is not that the insurer is denying payment, but that the hospital is then passing the bills onto the patient.

Somehow, we have to reduce unnecessary use of emergency services. The doctors correctly point out that patients can't make that decision. Since the doctors _can_ make that decision, they should be involved in helping reduce ER misusage. The insurance company is setting up the correct incentives for the hospital to do exactly that; however, the hospital is dodging the incentives by passing costs to the patient. So the hospital is in the wrong here.


> Healthcare providers tend to overcharge in proportion to how unnegotiable the service is. For example, ambulance charges are a great way to make money, because the person on the hook for the ambulance typically isn't in a position to decline ambulance service.

That is because ambulance are charged on use basis in the US. The ambulance company has to provide the service even in the patient cannot pay for it. So they charge high rates with the hopes that they can recover from someone with good insurance. There are many rural ambulance systems that are failing due to insufficient insured patients. The real solution is cities/counties fund the service through taxes just like police/fire.


Well, honestly, doctors can only do so much too.

Serious abdomen pain can be gas or something serious. You can cough hard enough to fracture a rib. Chest pains can be acid reflux or a heart attack: I had gastritis when this happened to me.

And this is a good deal of the issue: You don't know how serious it is until you go to the doctor.

Now, this doesn't cause all of ER misuse, but we aren't doing anything to make that better. A doctor won't see you if you can't pay upfront. This is the same problem with urgent care: Either pay upfront or don't get helped. The ER, though, will bill you. Which does mean that if you are poor - especially just over the income level to get help with a lot of expenses - you either go to the ER when you need a doctor or you don't get seen and have to wait until it IS serious enough for the ER.

We can solve this by making sure everyone can very easily afford health car (I no longer live in the US: My out of pocket is $300 per year, and this includes necessary prescriptions, doctors, physical therapy, some dental stuff, and so on). The rest is paid in taxes, which are less than federal + state + health insurance was in the states: Nevermind having to pay a deductible before the out of pocket. (I know my GP will bill me, by the way).

But another way to handle this is to have something akin to urgent care on hospital grounds - a place that folks can see a doctor/nurse practitioner for non-emergency things and get billed later.


The insurance company is dumping a giant turd in the patient's lap and forcing them to either eat it or go fight an immensely well funded and resourced organization over the bill. It's a bit baffling to absolve them of responsibility in that action.

I remember a co-worker talking about this happening to her in the 90's - she went to the ER for a sudden, large rash that turned out to be a non-emergency (shingles), but she had no way to know that. AFAIK, she had to pay the whole ER bill herself because she didn't know ahead of time how serious what she had was.

Shingles can cause blindness. Early treatment is very important. A friend of mine was hospitalised and left with bad scaring because they delayed seeking help. At least she didn't have any large bills because she was not in the US. No one should be afraid of going to the hospital.

Are there cases in which a rash is a legit emergency?

Yup. Allergic reactions, especially to medication.

And let me tell you, that rash is absolute agony. So. Much. Freaking. Itching. I wished it was pain instead. I would have tried about anything to get it to stop. It was all over my torso, and just horrible. It is really important to get it taken care of before it gets worse - you don't want to, say, take more medicine and not be able to breathe.

The other thing that can cause a rash-like appearance is an infection, though they usually describe this as red streaks (from a cut, anyway). If this is happening on a friday night, you shouldn't wait until monday to take care of it.


Yes, depending on the scenario. MRSA and other bacterial infections are good (and unfortunately too common) examples.

Yep, the gap between the point where most people would start to think a skin-infection-caused rash is bad enough that they might need help, and the point at which it's moved deeper in the body and begun to infect other tissue, can be pretty damn short, and by the time you've noticed (say) joint aches or immobility, it may be too late for simple solutions. If you've hit that point on a Saturday morning but think "well it's the weekend, I'll try to see my doctor on Monday" but then it's looking really bad by Saturday night (not implausible) and you can't get to an urgent care for whatever reason (none nearby, or just not open), you really don't want to wait until Monday to have a professional look at it. ER's not a crazy choice. If it's truly bad that's where the urgent care will probably send you, anyway.

Rashes can appear in cases of allergic reactions, those can be deadly.

That sounds like a question for a doctor.

If something happened in the middle of the night to you, where you would find a doctor in the middle of the night if not at the ER?


Just copy Italy, we have a backup for the primary care/general practitioner under the form of Guardia medica, which does the same level of triage they'd do but in night shifts

Anaphylaxis often first shows as a rash. Toxic shock syndrome and MRSA too. Probably others.

MRSA (see also 'spider bites'), meningitis, adverse reactions to a drug, Staphylococcal scaled skin syndrome (especially in infants), Stevens-Johnson syndrome (which can be a reaction to medication), toxic shock syndrome, among others.

Shingles could be one, actually. It can lead to permanent neurological issues.

The company claims this is cost-cutting: "Unnecessary use of the emergency room costs nearly $32 billion annually, driving up healthcare costs for everyone. We are taking steps to make care more affordable"

But: "UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021. Despite earning $6.7 billion in a single quarter, UHC enrollees are being asked to pay more for their coverage."

The greediest, most depraved people in the country are responsible for keeping us healthy.


While I have no sympathy for the insurance companies, many hospitals are all too eager to gouge the hell out of emergency services and resist attempts to reduce costs. It's where you get slammed with out-of-network specialists.

So what, that's not something under the patients control. You (as a society) can't (morally) go "oh, well some hospitals are malicious, so we're just going bankrupt random people who get unlucky".

The insurance companies should lobby to make that illegal, if it's already illegal lobby to have that law enforced (if criminal) or take them to court (if civil) or both (if both). In the meantime they shouldn't be shifting the liability to the patients.


Be that as it may, this is not a decision made due to financial pressure on the insurance companies.

"UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021. Despite earning $6.7 billion in a single quarter, UHC enrollees are being asked to pay more for their coverage."


I will never be able to understand a person who doesn't think healthcare is a human right.

Well I don't think it is a human right for the simple reason that medical care is technically a limited resource.l, there is not an infinite supply of doctors or medicine there is a limited supply no matter what that theoretical limit is.

Ergo it can't be a human right because it is limited, a right is something that everyone should have.

Also what do we mean by "healthcare" is it anyone should be allowed to have any medical procedure they want whenever they want it? I ask because by simply having access to penicillin, aspirin, benedryl and ibeprofun you now have better healthcare than any person in human history that lived before the 1950s. So when we say healthcare is a human right we really need to define what we mean by healthcare.

I also want to make clear I in no way support the insurance companies or hospitals as I think they are all greedy filthy parasites, and have been in constant combat with them for years, but I also don't understand how any rational person can justify the comment that healthcare is a human right.


"Healthcare" as what any other first world country has. Everything is covered, sometimes you wait for non life threating issues or you can pay and do things privately. Cosmetic stuff is not covered and some things may not be covered once you are a certain age and there is lack of research proving it may work.

We fund police, fire, infrastructure as a society, we can fund healthcare as a society as it is generally cheaper than whatever the fuck we are doing here in the US.


Healthcare isn't zero-sum. You aren't not going to receive healthcare because someone else is. Because we don't all get sick/injured at the same.

In any common sense Healthcare is most definitely not a limited resource. In fact, due to more preventative Healthcare options available it would definitely decrease the loads on hospitals.

See- every other developed nation with basic health care.


Here in Israel, if you go to the ER without are for referral from an urgent care clinic and the issue is found to be minor, you pay $140. Enough to deter frivolous cases, but not crippling.

Incidentally, that's about the amount my wife paid for a covered visit to an ER with a legitimate reason in the US. Doesn't matter if she had gone in with toe pain or a GSW, it still would have been the $100 copay plus whatever coinsurance the visit would have cost.

I remain mystified why our US Healthcare system seems unable to do common sense things. Also, when I last ran my own business, which was a while ago, the monthly premium for ONE employee+family was $2400. A high-end plan, but still...I was well into my late 20's before my entire paycheck was that much.

Employers need to stop providing healthcare, they should end healthcare as a benefit and provide employees with a one time raise to cover the costs, and then be done with providing healthcare.

Big companies don't want healthcare to go away, because it's means to control employees, it's a way to suppress competition from small businesses, and is suppresses wages.


My friend had a bad asthma incident recently, went to an urgent care, and got referred to a hospital because they were at capacity. I wonder if that would count as an emergency.

Edit: misunderstood, cannot delete. Sorry.

That's not the question in the post you're replying to. The question is "would the insurance company consider it an emergency because the Urgent Care facility was full and told the patient to go to the ER even if the final discharge condition was classified as a 'non-emergency'?

Right, but the UC facility referred him to the hospital, i.e. the ER, because they were full.

Right, but the original commenter said their friend was referred to a hospital, probably an ER. So, the question remains whether they would be hit by this policy, too.

For-profit healthcare should be illegal and there should be sufficient doctor appointments to go around. Right now, Americans pay more than anyone, wait weeks or months for appointments, and receive much poorer care than equivalent countries.

Absolutely nightmarish. Sounds like a recipe for people to shrug off heart attacks in the fear of a surprise medical bill.

This could kill.


If America's bullshit was happening in any south American country, or most middle east countries, people would have heads on spikes by now.

Really surprised how much shit Americans are capable of taking.


So when threatened to have their source of funding cut (as most people wouldn't be able to pay out of pocket), a union of professionals attacked the moved as dangerous/cost cutting/etc? And they were supported by their employer industry representative associations??

Color me surprised!




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