United Healthcare will no longer cover uncecessary ER visits

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Sure.

Health Insurance Premiums More than Double as Insurers Report Billions in Profit
https://www.bloomberg.com/press-releases/2020-09-02/health-insurance-premiums-more-than-double-as-insurers-report-billions-in-profit

" - Health insurance companies report doubling billion-dollar profits during
the pandemic in Q2 2020 compared to Q2 2019.
- Since 2009, employer health care premiums rose 57%, or an average of
$7,459 per year.
- United Healthcare reported a medical loss ratio of 70.2%, accounting for
its record profits in Q2 2020."

Net profit just tells you the size of the industry. What's the margin?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Well we're at the hospital now. He's likely to get surgery. I've been sitting here most the day.

PP here. As you should be at this point, I just feel sorry for your DH he’s been walking around for a week unnecessarily in pain. But really that is just as much on him as you. This sort of learned helplessness annoys me.

First, he wasn't really walking. He can't really walk. Two, what did you want us to do? You point to walk in hours. There were none other than UC. Not sure where you live or what your insurance covers but it must be nice for YOU. We called in network providers and could not be seem before July. He went to UC. They gave him drugs and said to go to ER. He did not want to go to ER due to costs. We are working class. We don't have great insurance. If you do, be grateful and not rude to other people.

I hope he heals quickly. UC told you to go to ER, so I don’t think your situation is really comparable. That is very different than what you first posted (no ER for low back pain). Of course that is not meant for what your poor DH is going through! I am sure the stress of it all makes it seem even more scary. Sorry for being harsh, with the additional facts ER completely makes sense.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Sure.

Health Insurance Premiums More than Double as Insurers Report Billions in Profit
https://www.bloomberg.com/press-releases/2020-09-02/health-insurance-premiums-more-than-double-as-insurers-report-billions-in-profit

" - Health insurance companies report doubling billion-dollar profits during
the pandemic in Q2 2020 compared to Q2 2019.
- Since 2009, employer health care premiums rose 57%, or an average of
$7,459 per year.
- United Healthcare reported a medical loss ratio of 70.2%, accounting for
its record profits in Q2 2020."

Net profit just tells you the size of the industry. What's the margin?

If that's what you are basing your disagreement on, why don't you link it yourself to back your claim?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Sure.

Health Insurance Premiums More than Double as Insurers Report Billions in Profit
https://www.bloomberg.com/press-releases/2020-09-02/health-insurance-premiums-more-than-double-as-insurers-report-billions-in-profit

" - Health insurance companies report doubling billion-dollar profits during
the pandemic in Q2 2020 compared to Q2 2019.
- Since 2009, employer health care premiums rose 57%, or an average of
$7,459 per year.
- United Healthcare reported a medical loss ratio of 70.2%, accounting for
its record profits in Q2 2020."

Net profit just tells you the size of the industry. What's the margin?

https://finance.yahoo.com/quote/UNH/financials?p=UNH

for 2020, 65 billion in profit on 250 billion in revenue

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Well we're at the hospital now. He's likely to get surgery. I've been sitting here most the day.

PP here. As you should be at this point, I just feel sorry for your DH he’s been walking around for a week unnecessarily in pain. But really that is just as much on him as you. This sort of learned helplessness annoys me.

First, he wasn't really walking. He can't really walk. Two, what did you want us to do? You point to walk in hours. There were none other than UC. Not sure where you live or what your insurance covers but it must be nice for YOU. We called in network providers and could not be seem before July. He went to UC. They gave him drugs and said to go to ER. He did not want to go to ER due to costs. We are working class. We don't have great insurance. If you do, be grateful and not rude to other people.

I hope he heals quickly. UC told you to go to ER, so I don’t think your situation is really comparable. That is very different than what you first posted (no ER for low back pain). Of course that is not meant for what your poor DH is going through! I am sure the stress of it all makes it seem even more scary. Sorry for being harsh, with the additional facts ER completely makes sense.

Thank you. I started the post by saying United Health says no ER for lower back pain. They listed things people should not go to the ER for and "lower back pain" was listed. So what if someone is just like my husband but doesn't have an UC visit that told them to go to ER? I only wrote to say even DH did not think he should be in the ER (even after being told) but turns out he should have been. What about others in the same scenario who don't have the ER blessing. They will stay home for fear of being billed and not get treatment.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Sure.

Health Insurance Premiums More than Double as Insurers Report Billions in Profit
https://www.bloomberg.com/press-releases/2020-09-02/health-insurance-premiums-more-than-double-as-insurers-report-billions-in-profit

" - Health insurance companies report doubling billion-dollar profits during
the pandemic in Q2 2020 compared to Q2 2019.
- Since 2009, employer health care premiums rose 57%, or an average of
$7,459 per year.
- United Healthcare reported a medical loss ratio of 70.2%, accounting for
its record profits in Q2 2020."

Net profit just tells you the size of the industry. What's the margin?

If that's what you are basing your disagreement on, why don't you link it yourself to back your claim?

Fluctuating under 3% for the past several years: https://content.naic.org/sites/default/files/inline-files/2019%20Health%20Industry%20Commentary_0.pdf

As a point of comparison, the average profit margin for S&P 500 companies is around 9%. Pretty crappy profits.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Well we're at the hospital now. He's likely to get surgery. I've been sitting here most the day.

PP here. As you should be at this point, I just feel sorry for your DH he’s been walking around for a week unnecessarily in pain. But really that is just as much on him as you. This sort of learned helplessness annoys me.

First, he wasn't really walking. He can't really walk. Two, what did you want us to do? You point to walk in hours. There were none other than UC. Not sure where you live or what your insurance covers but it must be nice for YOU. We called in network providers and could not be seem before July. He went to UC. They gave him drugs and said to go to ER. He did not want to go to ER due to costs. We are working class. We don't have great insurance. If you do, be grateful and not rude to other people.

I hope he heals quickly. UC told you to go to ER, so I don’t think your situation is really comparable. That is very different than what you first posted (no ER for low back pain). Of course that is not meant for what your poor DH is going through! I am sure the stress of it all makes it seem even more scary. Sorry for being harsh, with the additional facts ER completely makes sense.

Thank you. I started the post by saying United Health says no ER for lower back pain. They listed things people should not go to the ER for and "lower back pain" was listed. So what if someone is just like my husband but doesn't have an UC visit that told them to go to ER? I only wrote to say even DH did not think he should be in the ER (even after being told) but turns out he should have been. What about others in the same scenario who don't have the ER blessing. They will stay home for fear of being billed and not get treatment.

Your DH is a tough cookie! Absolutely, I think that is why the policy doesn’t work. I wouldn’t describe a man who can’t walk without excruciating pain to just have “lower back pain” but your DH is tough as nails and self-views what he is going through in those words. Whereas they really mean “I picked up a box and my lower back is a bit sore” types of injuries, and also because it is the #1 complaint of drug seekers trying to get scripts for Vicodin according to my ER doc friend.

[Anonymous]

Anonymous wrote:Former ER nurse here. One more thing. When did it become acceptable for insurance providers to act as medical providers. Don't think they went to any type of medical school!!! So when did it become okay for them to determine what is and is not medically necessary and what should and should not be covered. Oh I could go on and on about my beef with insurance companies!

PREACH! My cousin is an ER nurse and she says exactly the same things you are saying. It is appalling that the insurance companies have so much power and the ability to dictate care against what the doctors and nurses prescribe or determine is appropriate.

[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.

They're just greedy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Former ER nurse here. One more thing. When did it become acceptable for insurance providers to act as medical providers. Don't think they went to any type of medical school!!! So when did it become okay for them to determine what is and is not medically necessary and what should and should not be covered. Oh I could go on and on about my beef with insurance companies!

PREACH! My cousin is an ER nurse and she says exactly the same things you are saying. It is appalling that the insurance companies have so much power and the ability to dictate care against what the doctors and nurses prescribe or determine is appropriate.

Aren't there MDs who work exclusively for insurance companies doing exactly this kind of work (determining what should be covered vs not covered)?
I'm sure it's not just normal employees with very little background knowledge/ experience setting these kinds of policies in insurance companies.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse here. One more thing. When did it become acceptable for insurance providers to act as medical providers. Don't think they went to any type of medical school!!! So when did it become okay for them to determine what is and is not medically necessary and what should and should not be covered. Oh I could go on and on about my beef with insurance companies!

PREACH! My cousin is an ER nurse and she says exactly the same things you are saying. It is appalling that the insurance companies have so much power and the ability to dictate care against what the doctors and nurses prescribe or determine is appropriate.

Aren't there MDs who work exclusively for insurance companies doing exactly this kind of work (determining what should be covered vs not covered)?
I'm sure it's not just normal employees with very little background knowledge/ experience setting these kinds of policies in insurance companies.

I honestly think it's slightly automated. Certain CPT codes generate investigations for possible auto insurance involvement.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I sense a lot of ER doctors leaving united's network and just billing patients personally

This is ignorant. ER docs have a salary.

It’s the hospital corporations that get $$$$$ from expensive ER visits.

ER docs have a salary paid by an employer who is almost never the hospital. Most hospitals contract out their ERs. Those companies now have a lot of incentive to be out of network

And hospital corporations have way more power than “employer” to decide who they will contract with. If your talking about locums, that is not the norm for the majority of employees at most hospitals.

Either way the original poster of this back and forth stated ER docs would begin billing personally. That is false.

And this is a good change. There is too much waste in the ER with non-emergency visits. They train for emergencies and prefer them. They don’t want to be a primary care doctor.

This will ease the strain on our healthcare system and should be the case across the board in order to ease taxpayer dollars.

If it can wait until your primary care is open, wait. If it can’t but isn’t ER/Ambulance worthy, go to urgent care.
If you suspect life and death or severely broken bones, go to the ER.

You’re assuming people know their sprained pinkie isn’t an emergency

Even a broken pinkie isn’t an emergency. All they can do is tape it to a splint unless it is totally mangled.

The average person does not necessarily know how to properly splint and buddy tape a broken finger. That’s why getting prompt medical care is appropriate.

But you can get that at urgent care!

IME, the quality of the care you receive at urgent care is far below that at the ER.

I wish this was always true. I ended up in an ER for severe mastitis at 4am on a Sunday and the Doogie Howser brand new MD printed off some sheets about mastitis from the internet and tried to discuss with me. I think he just learned what it was. But luckily the more seasoned nurse was able to take over. Both she and I knew what it was, and it was taken care of. If it wasn't 4am I would have had other alternatives.

[Anonymous]

Has anyone else had bitter, expensive experience with Delta Dental rejecting an obvious emergency as “not an emergency so you’re not covered”? 😡😡😡😡

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Well we're at the hospital now. He's likely to get surgery. I've been sitting here most the day.

PP here. As you should be at this point, I just feel sorry for your DH he’s been walking around for a week unnecessarily in pain. But really that is just as much on him as you. This sort of learned helplessness annoys me.

First, he wasn't really walking. He can't really walk. Two, what did you want us to do? You point to walk in hours. There were none other than UC. Not sure where you live or what your insurance covers but it must be nice for YOU. We called in network providers and could not be seem before July. He went to UC. They gave him drugs and said to go to ER. He did not want to go to ER due to costs. We are working class. We don't have great insurance. If you do, be grateful and not rude to other people.

I hope he heals quickly. UC told you to go to ER, so I don’t think your situation is really comparable. That is very different than what you first posted (no ER for low back pain). Of course that is not meant for what your poor DH is going through! I am sure the stress of it all makes it seem even more scary. Sorry for being harsh, with the additional facts ER completely makes sense.

Thank you. I started the post by saying United Health says no ER for lower back pain. They listed things people should not go to the ER for and "lower back pain" was listed. So what if someone is just like my husband but doesn't have an UC visit that told them to go to ER? I only wrote to say even DH did not think he should be in the ER (even after being told) but turns out he should have been. What about others in the same scenario who don't have the ER blessing. They will stay home for fear of being billed and not get treatment.

But he didn't go in with just "low back pain". He went in because he couldn't walk. Big difference between "Ow my back hurts" and "my back hurts so bad and something is so wrong that I can't walk anymore"

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Former ER nurse here. One more thing. When did it become acceptable for insurance providers to act as medical providers. Don't think they went to any type of medical school!!! So when did it become okay for them to determine what is and is not medically necessary and what should and should not be covered. Oh I could go on and on about my beef with insurance companies!

PREACH! My cousin is an ER nurse and she says exactly the same things you are saying. It is appalling that the insurance companies have so much power and the ability to dictate care against what the doctors and nurses prescribe or determine is appropriate.

Aren't there MDs who work exclusively for insurance companies doing exactly this kind of work (determining what should be covered vs not covered)?
I'm sure it's not just normal employees with very little background knowledge/ experience setting these kinds of policies in insurance companies.

Yes, and they either spend zero or near zero time with patient records

https://www.cnn.com/2019/04/26/health/aetna-settlement-california-investigation/index.html