United Healthcare will no longer cover uncecessary ER visits

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The article references things like pink eye. Do people really go to the ER for pink eye?

I think the heart attack/panic attack would be covered as it could be something ER-worthy.

I had bacterial pink eye, it came on while I was asleep and when I woke up the goop was so bad that I’d wipe my eyes and 3 minutes later I’d need to do it again because I couldn’t see. I walked to CVS, got in line for minute clinic. When the NP saw me she said “nope that’s outside what I can do. Go to urgent care or the ER.”

In my case, I had Uber on my phone, and at that point could see for a minute or two at a time so I could order one and went to Urgent care, but in other circumstances, I would have needed to go to what’s in walking distance.

So, yeah pink eye can be bad.

I have a friend with similar insurance whose kid woke up screaming that his chest hurt. Eventually diagnosed as heartburn and the claim was denied.

Goop in your eye sucks, but it’s not a life threatening emergency.

Right! Urgent care was definitely the right place for you. You'd likely have been triaged in the ER and waited for hours and hours because they don't care about pink eye. When mine was that bad I just made a doctor's appointment and was seen that day and got my eye drops...

Urgent cares suck at diagnosis of anything complex. Unless it was really basic pinkeye that I had had before and knew the symptoms, I wouldn’t trust them with my eye. That’s why I really like One Medical - it can be used for urgent care and I trust all their practitioners a lot more.

[Anonymous]

What hospitals should do is have an urgent care next to the hospital and if it doesn’t look like urgent care is necessary upon triage, just send them to urgent care.

I have had times when I wasn’t sure but I wound up going to the ER and I’m glad I did, because what are they going to do about a bowl obstruction at the urgent care?

[Anonymous]

are ERs over burdened by insured people seeking unnecessary care? I thought the big problem was uninsured people seeking care because ERs can't turn them away (urgent cares can and do)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The article references things like pink eye. Do people really go to the ER for pink eye?

I think the heart attack/panic attack would be covered as it could be something ER-worthy.

There can be close calls. Two weeks ago we took our son to the ER for what turned out to be a sprained finger, but could have been a fracture. We tried to go to urgent care instead, but they were all closed at that hour on Saturday night. Under other circumstances we would have waited until the next day to get it checked at urgent care, but he had a 7am soccer game the next morning and we wanted to know if there was a fracture in case he said he felt well enough to play.

We have UHC, and by the following Wednesday (holiday weekend, so no mail moving Monday), we already had a mailed notice from UHC reminding us UC was an alternative to the ER. I just got the EOB last night and hadn’t looked at it yet before I saw this post. Fortunately they’re covering the visit, but I could have seen them retroactively denying it under this new policy (which I was not aware of before now).

I don’t mean to sound like a jerk, but IMO this is exactly the type of visits they mean to prevent. Having a soccer game the next day is not an emergency.

Knowing if the finger is fractured is an urgent situation, soccer game or not. If the someone just goes about their business with a fractured finger that isn’t splinted or otherwise stabilized, it’s easy to injure it further in a way that displaces the bone or otherwise requires far more serious treatment, including surgery, that could have been prevented by having it checked right away. Leaving it until the next day (or possibly a day or two after that, since many urgent cares are closed on Sundays) is a risk.

This is not the situation that is driving up the cost of medical care, because it’s not that often that someone has an issue that needs to be addressed right then, would be suitable for urgent care, but urgent care is closed. The people driving up costs are the ones who go to the ER after they’ve been sick with strep for three days because they didn’t want to take off work during the week to see their doctor and/or don’t want to drive further to an UC.

[Anonymous]

Anonymous wrote:

Anonymous wrote:What do you do if you get a nasty cut? Do you need to go to an ER for stitches or can it be done at an urgent care place? How in the hell would a regular person know this kind of cut/wound needs an ER visit, while this size cut can be done at an urgent care clinic. Oh, I'm sure UHC would argue that you could have gone to the urgent care clinic because your wound was only X cm long instead of Y cm.

That's definitely an urgent care. Unless you cut your arm off or you see bone, go to urgent care. It should be obvious from the amount of blood whether you need ER or urgent care. Urgent care can do stitches and can help you clot.

But if it's on my face, I'm seeing neither and having a dermatologist stitch me up.

The problem is some cuts can be bad. Last year my teenage son cut his finger in shop class. When he showed it to me when he got home I called the doctor (pediatrician) and made a same day appointment. At that appointment the doctor freaked out and told us to go straight to the ER. The cut was not bleeding but she was afraid of nerve damage and a bone nick. So then we go to the ER. 5 hours later we are home with a clean bandaid. The ER doctor checked out the cut, told my son he had done a great job cleaning the cut and bandaging it up at school (he never went to the nurses office) and gave us a clean bandaid. That cost me $700 in deductibles and co pays. So under the new UHC policy would that ER have been covered because a doctor told us to go even though in the end it really wasn't ER worthy?

[Anonymous]

Anonymous wrote:It almost seems like hospitals could also have urgent cares on site. Sore throat...turn left. Trouble breathing...turn right.

That would make way too much sense. It would probably cut into profits someway though.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It almost seems like hospitals could also have urgent cares on site. Sore throat...turn left. Trouble breathing...turn right.

That would make way too much sense. It would probably cut into profits someway though.

Ehh I bet hospitals are worried they'd have to cover uninsured at urgent cares too.

[Anonymous]

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.

[Anonymous]

Half the problem is people taking babies and children to the ER for any fever (not just dangerously high) and for things like earaches and stomach aches. People freak out over their kids. The first step should be to call the ped’s after hours number and then only go to the ER if they say you need to.

[Anonymous]

Anonymous wrote:Half the problem is people taking babies and children to the ER for any fever (not just dangerously high) and for things like earaches and stomach aches. People freak out over their kids. The first step should be to call the ped’s after hours number and then only go to the ER if they say you need to.

Every time we called the afterhours number, they told us to go to the ER.

[Anonymous]

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.

[Anonymous]

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!

[Anonymous]

Anonymous wrote:Half the problem is people taking babies and children to the ER for any fever (not just dangerously high) and for things like earaches and stomach aches. People freak out over their kids. The first step should be to call the ped’s after hours number and then only go to the ER if they say you need to.

I completely agree with this. SO many mom friends run their babies to the ER for any random temperature.

[Anonymous]

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!

The original finger injury discussion was a case where UC was closed for the night so they went to the ER, but some posters here thought it would have been more appropriate to leave the finger untreated overnight than go to the ER. If UC is an option, that’s obviously a better choice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The article references things like pink eye. Do people really go to the ER for pink eye?

I think the heart attack/panic attack would be covered as it could be something ER-worthy.

There can be close calls. Two weeks ago we took our son to the ER for what turned out to be a sprained finger, but could have been a fracture. We tried to go to urgent care instead, but they were all closed at that hour on Saturday night. Under other circumstances we would have waited until the next day to get it checked at urgent care, but he had a 7am soccer game the next morning and we wanted to know if there was a fracture in case he said he felt well enough to play.

We have UHC, and by the following Wednesday (holiday weekend, so no mail moving Monday), we already had a mailed notice from UHC reminding us UC was an alternative to the ER. I just got the EOB last night and hadn’t looked at it yet before I saw this post. Fortunately they’re covering the visit, but I could have seen them retroactively denying it under this new policy (which I was not aware of before now).

I don’t mean to sound like a jerk, but IMO this is exactly the type of visits they mean to prevent. Having a soccer game the next day is not an emergency.

I have to agree. What you describe is not an emergency.