United Healthcare will no longer cover uncecessary ER visits

[Anonymous]

Anonymous wrote:

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.

this, if they can't take you they say to go to the ER every single time

[Anonymous]

Hospitals suck at triage. We were at a basketball tournament and kid jammed finger badly. Red, swollen, not dislocated. Staff at the medical office at the tournament told us to go to the hospital. I asked the hospital here or the one near my house 2 hours away. They said 2 hours away was fine. I asked at hospital check in if they would treat or send us to ortho in the morning. They said they would see and treat the patient. I asked again, the nurse, after being brought back and again when finally seen by a doctor.

Doctor said they would xray and send us to ortho in the morning. I refused treatment and said we would leave. Made us stay about 45 minutes for release papers. Cost to insurance for checking in and nurse asking what happened and taking vitals: over $2k

I wrote a letter to the President of the hospital and the President of the health insurance company, because this was just one example of what us wrong with health insurance in our country.

The idea of urgent care built in or next door to a hospital is a good one, with appropriate staff to triage where the patient should go.

[Anonymous]

I felt like an idiot the last time I went to the ER.

I broke my tailbone. I had no idea that it wasn't something you needed to go to ER for.

I started to go to Urgent Care first, but the last time I took a kid with a break to UC, we sat there for 2 hours after getting x-rays only to have them tell us that we would have to go to the ER because their person couldn't tell from the quality of x-rays if it was a break or not. So I had the $50 UC copay, the portion my insurance didn't cover for their x-rays, and then a $100 ER copay, plus the bills from the ER that my insurance didn't cover.

There needs to be a triage line you can call to see where you need to go for your symptoms like they have for pediatrics.

[Anonymous]

Anonymous wrote:I felt like an idiot the last time I went to the ER.

I broke my tailbone. I had no idea that it wasn't something you needed to go to ER for.

I started to go to Urgent Care first, but the last time I took a kid with a break to UC, we sat there for 2 hours after getting x-rays only to have them tell us that we would have to go to the ER because their person couldn't tell from the quality of x-rays if it was a break or not. So I had the $50 UC copay, the portion my insurance didn't cover for their x-rays, and then a $100 ER copay, plus the bills from the ER that my insurance didn't cover.

There needs to be a triage line you can call to see where you need to go for your symptoms like they have for pediatrics.

HMOs have those. People pay for PPOs so that they don't have to deal with calling for permission

[Anonymous]

My insurance company (cigna, not UHC) does have a nurses line we can call. The number is on the back of our insurance card. We've only used them once, and they weren't quite as friendly and helpful as our peds ask-a-nurse, but they did help us triage the situation, and encouraged us to go to an urgent care rather than wait until the next day for the pediatrician.

If UHC offered something like that, and guaranteed to cover anything that their nurses line said to go to the ER for, that might mitigate the issue somewhat. But I'm sure they wouldn't guarantee that.

[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.

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.

DP. It could have become a far more expensive medical event if they didn't get it checked out, the kid said he felt better the day and played, and then fractured it further and displaced the bone, requiring surgery. Even if there weren't a soccer game the next morning, pp was correct to get it checked out that night if it was a possible fracture.

[Anonymous]

Anonymous wrote:

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.

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.

DP. It could have become a far more expensive medical event if they didn't get it checked out, the kid said he felt better the day and played, and then fractured it further and displaced the bone, requiring surgery. Even if there weren't a soccer game the next morning, pp was correct to get it checked out that night if it was a possible fracture.

Nope. Not at the ER. You can buddy tape it, or make a makeshift splint for the night. Urgent care the next morning.

This is why this policy is ever going to work out. Some of these people will try to rationalize every single possible scenario to justify why an ER visit was necessary. Even when it isn’t.

[Anonymous]

Anonymous wrote:My insurance company (cigna, not UHC) does have a nurses line we can call. The number is on the back of our insurance card. We've only used them once, and they weren't quite as friendly and helpful as our peds ask-a-nurse, but they did help us triage the situation, and encouraged us to go to an urgent care rather than wait until the next day for the pediatrician.

If UHC offered something like that, and guaranteed to cover anything that their nurses line said to go to the ER for, that might mitigate the issue somewhat. But I'm sure they wouldn't guarantee that.

I think it would mitigate if they had to give you a specific UC to go to. It doesn't help if they say urgent care and none are open

[Anonymous]

Anonymous wrote: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)

The urgent care near me will take uninsured but you must put a credit card on file with them. You also have to sign a form saying that you agree to let them charge the card any amount when the bill comes.

That can be a HUGE burden for the uninsured. However, they are excellent at giving you the costs 100% upfront. My brother was uninsured for years and relied on urgent care many times. He would always call before going in, tell him his symptoms and ask the cost. Also, in pre-triage, they would tell him how much would be due that day and an approximation of what would be due when the final bill came that would be charged to his card. If it was more than he could afford, he was able to leave or make other arrangements.

The two times he did have to go to the ER while uninsured, he got both bills forgiven by filling out paperwork after the fact proving he was uninsured and had limited income.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

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.

DP. It could have become a far more expensive medical event if they didn't get it checked out, the kid said he felt better the day and played, and then fractured it further and displaced the bone, requiring surgery. Even if there weren't a soccer game the next morning, pp was correct to get it checked out that night if it was a possible fracture.

Nope. Not at the ER. You can buddy tape it, or make a makeshift splint for the night. Urgent care the next morning.

This is why this policy is ever going to work out. Some of these people will try to rationalize every single possible scenario to justify why an ER visit was necessary. Even when it isn’t.

Not everyone knows how to do that properly, and doing it improperly can make the injury worse. If you think there's a broken bone, you get it checked. If UC is closed for the night, you go to the ER. These are not the people causing problems, and you are just being contrary for the fun of it.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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)

The urgent care near me will take uninsured but you must put a credit card on file with them. You also have to sign a form saying that you agree to let them charge the card any amount when the bill comes.

That can be a HUGE burden for the uninsured. However, they are excellent at giving you the costs 100% upfront. My brother was uninsured for years and relied on urgent care many times. He would always call before going in, tell him his symptoms and ask the cost. Also, in pre-triage, they would tell him how much would be due that day and an approximation of what would be due when the final bill came that would be charged to his card. If it was more than he could afford, he was able to leave or make other arrangements.

The two times he did have to go to the ER while uninsured, he got both bills forgiven by filling out paperwork after the fact proving he was uninsured and had limited income.

the people overburdening ERs can't and don't pay. That's the point- urgent cares can turn them away, ERs are legally required to provide care regardless of ability to pay

[Anonymous]

so grateful for my insurance. Used to have United. Escaped that!

3 yrs ago DH went to ER for what seemed to be a ridiculous reason to me. This was pre-covid of course (3 yrs ago) and he has trouble catching his breath and just felt all around awful. His chest hurt but not enough to think it was a heart attack. I told him to see a doctor. He waited a week and then went to ER. I'm like "you waited a week this is not ER worthy." Long story short he had myocarditis. Was told any delay he may have been dead. Ended up needing a pacemaker due to all the damage and how weakly his heart was performing. He was 42 and not overweight. They suspect his bought with flu the months prior brought it on. Had we been nervous to go to the ER due to insurance my husband would have been dead at 42.

[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!

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

[Anonymous]

Anonymous wrote:

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.

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.

DP. It could have become a far more expensive medical event if they didn't get it checked out, the kid said he felt better the day and played, and then fractured it further and displaced the bone, requiring surgery. Even if there weren't a soccer game the next morning, pp was correct to get it checked out that night if it was a possible fracture.

How about you be the parent and tell him he can't play until UC clears him the next day?

I have broken a lot of fingers and toes and have never gone to ER. That is the kind of thing you tape up and go to UC. I usually wait a couple of days to even go to UC.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

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.

DP. It could have become a far more expensive medical event if they didn't get it checked out, the kid said he felt better the day and played, and then fractured it further and displaced the bone, requiring surgery. Even if there weren't a soccer game the next morning, pp was correct to get it checked out that night if it was a possible fracture.

Nope. Not at the ER. You can buddy tape it, or make a makeshift splint for the night. Urgent care the next morning.

This is why this policy is ever going to work out. Some of these people will try to rationalize every single possible scenario to justify why an ER visit was necessary. Even when it isn’t.

I'm a reasonably intelligent person. I would not know how to do this.