United Healthcare will no longer cover uncecessary ER visits

[Anonymous]

Anonymous wrote:My DD broke her arm at the playground. Are you saying she should have gone to urgent care and not the ER? She was 7, it was a compound fracture, she was taken to the ER and had surgery that night. But United Health and DCUM expected me to tape it up and wait for her pediatrician? Since when are fractures not ER situations. Her bone broke through her skin/arm. Her arm was literally dangling and she was screaming like a mad woman and then eerily stopped (we were told she went into shock) but sure United. No ER.

DP. Compound fractures are not the same as simple fractures. Fractures of digits (fingers, toes) are not the same as fractures of entire limbs.

[Anonymous]

Anonymous wrote:My DD broke her arm at the playground. Are you saying she should have gone to urgent care and not the ER? She was 7, it was a compound fracture, she was taken to the ER and had surgery that night. But United Health and DCUM expected me to tape it up and wait for her pediatrician? Since when are fractures not ER situations. Her bone broke through her skin/arm. Her arm was literally dangling and she was screaming like a mad woman and then eerily stopped (we were told she went into shock) but sure United. No ER.

Where the heck are you getting that a COMPOUND FRACTURE is not a real emergency?!

[Anonymous]

Anonymous wrote:My DD broke her arm at the playground. Are you saying she should have gone to urgent care and not the ER? She was 7, it was a compound fracture, she was taken to the ER and had surgery that night. But United Health and DCUM expected me to tape it up and wait for her pediatrician? Since when are fractures not ER situations. Her bone broke through her skin/arm. Her arm was literally dangling and she was screaming like a mad woman and then eerily stopped (we were told she went into shock) but sure United. No ER.

You are a complete idiot if you think a compound arm fracture and a potential finger break are in any way comparable. I have had both, and of course I went to the ER for my arm (and not my finger). It scares me that you are in charge of other human life.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My elderly neighbor went to er after minor surgery as he was having speech cognitive issues and stroke was a concern. MRI was negative for stroke. How could they possibly have ruled that out? That’s crazy. Most people avoid the er, waits are bad and it’s uncomfortable. It’s disgusting they are trying to trim expenses this way. We are well past the need for a profit cap on health insurance companies. They have proved they can make profit even during an international health disaster.

I'm getting pretty tired of insurance and pharmaceutical companies turning record profits while insisting they have to deny claims or raise the cost to consumers.

Insurance companies don't actually make significant profits and most BCBS plans are nonprofits.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

[Anonymous]

Anonymous wrote:My DD broke her arm at the playground. Are you saying she should have gone to urgent care and not the ER? She was 7, it was a compound fracture, she was taken to the ER and had surgery that night. But United Health and DCUM expected me to tape it up and wait for her pediatrician? Since when are fractures not ER situations. Her bone broke through her skin/arm. Her arm was literally dangling and she was screaming like a mad woman and then eerily stopped (we were told she went into shock) but sure United. No ER.

No that's definitely an ER type of situation. I have Kaiser though and would likely go to Kaiser urgent care, get my xray and then head on to the orthopedic surgeon.

[Anonymous]

Anonymous wrote:I’m not saying I agree with UHC’s new policy, but I don’t know that it’s any different from what other insurers do. I have BCBS and they only seem to cover stuff in the ER if it turns out to have been an actual emergency. For example, I once went to the ER on a Sunday with a UTI that had gotten bad over the weekend. This was before UCs we’re all over the place, and Reiter-Hill wouldn’t give me antibiotics when I saw them that Friday because my rapid test had been negative. (So glad I’m no longer their patient.) Anyway, I knew I was taking a risk that it wouldn’t be covered, but I was just too miserable to care. Sure enough, BCBS made me foot the whole bill. Another time I went there because I was seeing flashes of light and thought it might be a detached retina. The ER physician couldn’t see my retina very well ended up sending me to an opthamologist. I paid the whole bill for that one, too.

Hmmmm. We have BCBS and DH is a hypochondriac and stays in the ER (not proud of this). They cover everything

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

Not a single doctor in the entire area could see him? You know orthos have walk-in hours, don’t you?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

Your DH is a problem. He’s had this issue a week, he could easily have gone to his GP or a back specialist, ortho clinics have acute hours. ER is not the place for this kind of thing.

Had he gone to his PCP at all during that week? To wait around a week and then go to the ER is kind of what they are trying to prevent. For every 1 of your husband's case where it actually is something that needs to be treated, there are 15 muscle strains that don't need the ER. But see my above about my issues with blanket policies. It makes it so that people who have a legitimate hospital need (your husband) may choose not to go because of this policy. And then they get worse bevause of delayed care.

That said, Cauda Equina is a serious issue and prompt surgery is often indicated. I'm surprised that they are saying surgery may only possibly be needed.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

Your DH is a problem. He’s had this issue a week, he could easily have gone to his GP or a back specialist, ortho clinics have acute hours. ER is not the place for this kind of thing.

No doctors can see him before July. He went to urgent care. They told him to go to the ER. He put it off for a week as he didn't want to go to the ER. But thanks for the input.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

You should have called your insurance company and asked them to help you find a specialist in network who would see him. People who can't navigate systems shouldn't call other people moronic.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

Not a single doctor in the entire area could see him? You know orthos have walk-in hours, don’t you?

We called every doctor we knew to call. Feel free to recommend some who could have seen him sooner in case anyone we know has issues in the future. Did we call every doctor in the world, now but we got on our insurance directory and called everyone in network AFTER asking PCP for recommendations.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

You should have called your insurance company and asked them to help you find a specialist in network who would see him. People who can't navigate systems shouldn't call other people moronic.

I'm the former ER nurse. Please stop arguing with this poster. Cauda Equinis is a serious medical condition that is absolutely appropriate for the ER. She also said he went to urgent care who suggested the ER but he didn't want to go. But this is why blanket policies are terrible. ER is appropriate for her husband. But the policy is made to deter those who show up with a muscle strain they've had for 2 weeks and haven't been checked out anywhere else.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

You should have called your insurance company and asked them to help you find a specialist in network who would see him. People who can't navigate systems shouldn't call other people moronic.

We did that, moron.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse. I certainly hope they release guidelines to help people. A few things I've noticed on this thread.

I doubt they won't cover chest pain/shortness of breath that's caused by a panic attack. Chest pain and sudden shortness of breath is what the ER is for, even if the cause ends up being not an emergency

Sudden acute pain is also generally ER worthy. Again, it may turn out to be something benign, but sudden acute pain can also be a sign of something serious.

Something acute outside normal hours. You fall down the stairs going to the bathroom at 3am and are in a lot of pain or hit your head? Sure that could wait 5 hours to see your PCP or go to urgent care, but it's also entirely appropriate to go to the ER for that. Those are very common visits on night shift.

Things the ER isn't appropriate for:

A chronic condition that you now decides someone should look at. A cough you've had for 2 months? That can wait for PCP or UC
Abnormal bowel movements for 3 weeks? Same deal
A sprain or not obvious broken finger or toe? That can wait. At best, it will be splinted and you'll be referred to an ortho. Now, a deformed limb, excruciating pain, or a potential fracture caused by a trauma (like MVC or big fall) is ER worthy. That's what on call orthos are for. Also if the suspected break is a baby or elderly.
Anything that can be treated by your PCP and will not turn life threatening over night (pink eye, ear infection, sore throat, etc).

Now, obviously there are exceptions to all of this, and that's why I don't like blanket policies. I think they do more harm than good. People will question whether or not they should go to the ER and may miss a critical illness. Or people will show up thinking it's critical and it's not and will be left with a bill in the thousands.

I think Covid has shown a big vulnerability in the health care system and that's how easily hospitals can get overloaded. Now, that existed well before Covid but your average person wasn't aware. My hospital has zero Covid cases. They've had zero Covid patients show up in the ER in over a week. But our hospital is at max capacity for other issues. The ER was boarding 10 patients last night (means they are admitted but nowhere to go so they hang out in their bay in the ED). When people come in with non emergency issues it does put a strain on resources and there has to be a better way for managing that.

It says no lower back pain. My DH went to the ER today for lower back pain. He's been home withering in pain for a week and cannot walk, move, etc...He's still there now and we were told Cauda Equina Syndrome and he may need surgery. But United Health says no ER for lower back pain. Thank God it's not our insurance. My goodness!

You seem to confuse "needs to seek medical attention" with "needs the ER." They are not the same. Even if he may eventually need surgery.

No doctor could see him until July so you want him to walk around with Cauda Equina Syndrome? You're just as moronic as UH. Glad I don't have to deal with them or you!

Not a single doctor in the entire area could see him? You know orthos have walk-in hours, don’t you?

We called every doctor we knew to call. Feel free to recommend some who could have seen him sooner in case anyone we know has issues in the future. Did we call every doctor in the world, now but we got on our insurance directory and called everyone in network AFTER asking PCP for recommendations.

I already solved this for you, GO TO WALK IN HOURS.