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In reply to the discussion: Insurance giant's new ER policy called 'dangerous' by critics. [View all]elias7
(3,991 posts)Our rural hospital does not have people sitting for hours next to sick people. People get their own exam room with minimal to no waiting in the waiting room.
People come in for week(s) long history of this or that and kind of hit critical mass, deciding that now is the time to be seen and I cant wait another minute, typically state that they called their doctor and could not get in right away, or their doctors office didnt call back, or that they could not sleep
so they come in with a subacute problem.
Thing is, theyll get a better workup for a lot of things in the ER because well do bloodwork, x-rays, follow-up studies all in a few hours. But this is stuff that would have been ordered anyway as an outpatient over days perhaps. So the only rationale that a payer would have to deny a claim is if the person got tests or care that they would not have needed for workup of this problem, which is typically not the case.
I think it reasonable to deny a small part of the charges for some ER care, but for the most part, insurance companies shouldnt weasel out of costs that would have been incurred one way or another in the evaluation of a problem.