New Health Insurance Policies May Have You Paying For Your Emergency Room Visits

Imagine you have a pain in your chest and fear it might be a heart attack. When you get to the emergency room they run their incredibly expensive tests and then, to your great relief, they tell you that your heart is just fine. It was just indigestion. If you need another reason to stay as healthy as possible, now insurance companies may not pay for your emergency room visit. Some insurance companies are telling you that you need to properly diagnose yourself before heading to the emergency room.

With the price of emergency care skyrocketing, a new report says that some insurance companies won’t pay the claim if it is deemed that the patient did not have an emergency after all.

The new analysis shows that the criteria used by one large insurer, if expanded nationally, could result in denial of payment for nearly 16 percent of ER visits, even though these patients may have the same symptoms when they get to the ER as actual emergency cases, researchers report in JAMA Network Open.” – Reuters

Anthem Inc. insures one in eight people in the U.S. They started a policy of denying coverage for ER visits the company decides are unnecessary. The policy started in three states in 2017 and has expanded to a total of six states in 2018.

A certain proportion of emergency room visits are unnecessary and there are people who use the emergency room as if it were their primary care or only doctor. And there is a certain amount of resentment as this creates crowding in the emergency room and slows things down for people who have true emergencies. But this situation reflects a constellation of underlying problems for which neither the patients nor the emergency rooms are to blame.” – Albert Wu of the Johns Hopkins Bloomberg School of Public Health in Baltimore (Reuters)

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Baby Treated with Nap and Bottle of Formula, Parents Received an $18,000 Bill

A South Korean family took a vacation to San Francisco two years ago. In a hotel room, their then-8-month-old son fell off their bed and hit his head.  After unsuccessfully trying to console him, they grew concerned. They called 911. An ambulance showed up and transported the family to Zuckerberg San Francisco General Hospital to check him out for internal injuries.

At the hospital, the doctors determined that the baby was fine. He had a short nap in his mother’s arms and drank some hospital infant formula. He was discharged less than four hours later. The family finished their vacation. Then, some two years later, a hospital bill arrived for $18,836. $15,666 of the charge was  designated “trauma activation.”

It’s a huge amount of money for my family. If my baby got special treatment, okay. That would be okay. But he didn’t. So why should I have to pay the bill? They did nothing for my son.”

If my baby got special treatment, okay. That would be okay. But he didn’t. So why should I have to pay the bill? They did nothing for my son.” – Jang Yeo-im, the mom, told Vox

Jang says they had travel insurance that covers only the first $5,000.

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