"don't take me to emergency room - insurance won't cover it"

[radfringe]

these were the words uttered by my 75yr old mother.

She's still running her own bookkeeping business. Yesterday, she was working on-site for one of her clients. As she was leaving, her heel caught on a step (3rd one from the bottom) and she took a fall. She broke her arm just above the elbow.

first she tried calling my dad, but thanks to the comcast phone system - she couldn't get through, kept getting an automated message saying the phone number was not in service, and upon subsequent tries that the phone lines were not in service...

her client called an ambulance. when the ambulance arrived, they wanted to take her to the emergency room at the nearest hospital.

my mother refused because her insurance wouldn't cover an emergency room visit. she insisted they take her to an urgent care clinic. they refused because they were only authorized to transport to an emergency room.

my mother's client drove her the urgent care clinic where she had the necessary medical attention. she managed to get ahold of my sister and got a ride home. Other than the pain, she's doing ok.

I've been at a slow fume about this most of the night. What if she were knocked-out because of the fall and or otherwise unable to communicate? She would have been brought to the hospital emergency room, where upon waking she would have been handed a big fat bill.

All I could think of was that one scene in Sicko near the beginning of the documentry where the woman talked about being in a car accident, being knocked out and transported by ambulance to an emergency room - then she gets a notice from her insurance company saying they won't cover the ambulance because she wasn't "pre-approved".

ARRRRRRRRRRRGGGGGGGGHHHHHHHHHHH! The Health system in this country sucks big time.

[aquart]

1. And nobody plans to fix it.

[roguevalley]

37. hug her for me. I am very sorry for this. No one deserves this.

[Der Blaue Engel]

2. What kind of insurance doesn't cover emergency room visits??

That's just fucking criminal. :o

[Old Codger]

28. Medicare N/T

[Rosemary2205]

35. It certainly covered it for me.

I've been on medicare for 2 years and had no problem last month when I took a tumble out of the wheelchair and needed an X ray on a Sunday (only way in my area to get it done on a Sunday). Medicare covered it no problem.

[SammyWinstonJack]

40. They cover it for my sister in law and she goes quite often to the ER.

[Der Blaue Engel]

36. That is patently false

http://www.medicare.gov/Coverage/Search/Results.asp?State=CA%7CCalifornia&Coverage=27%7CEmergency+Room+Services&submitState=View+Results+%3E

[BelleCarolinaPeridot]

3. I thought that all insurance covered emergency rooms.

I currently have Blue Cross Blue Shield and the hospital up the street from stopped covering patients with BCBS but after a court battle they will. Instead of going to the hospital right up the street from me I would have had to go the hospital 40 minutes away in another city.

[WinkyDink]

31. You would be incorrect.

[MalloyLiberal]

4. It's not gonna be fixed with Hillary Clinton or Barack Obama

Even John Edwards doesn't go as far as I'd like. And Kucinich has a 0% chance of winning anything.

[Naturyl]

9. Doesn't it suck?

You said it. The only guy who would fix it has a 0% chance of winning. That's why even though I stay involved in politics, I do so without a great deal of hope for this country. As far as I can tell, this nation steadfastly refuses every opportunity to become sane.

Kucinich isn't on my state's ballot, so Edwards will have my primary vote.

[liberalnurse]

12. I am backing the Clinton Plan.

So are my peers.

[Naturyl]

15. Why? Her plan treats the HMO's with kid gloves.

Clinton's plan is not real not-for-profit universal health care. It's a plan that is careful not to be too tough on the insurance companies. Why not back Kucinich's HR 676, which is *real* national health care? Or at least Edwards' plan, which is a lot closer? Why not let the insurance companies rot in hell? They're perfectly willing to let us rot there, you know.

[mtnester]

5. First, the paramedics in that area need a new medical director

There is no reason in the world that minor (yes minor) items like lacerations that are not gigantic, simple fractures, minor burns, etc. not be transported to an urgent care. Even though our medical director is on staff at a hospital, there are clear times when a free standing emergent care facility is the best place for a patient to go. They have the ability to Xray, temporarily set, and refer to a bone doc any patient with a simple fracture. If it is a more complex fracture, they can set, relieve pain, and then do the "arranging or referral" needed to a hospital and get the pre-approval to admit. In the meantime, your mom would have had the pain relief she needed, etc.

That said, if your mom had fallen down and went unconscious, I am pretty sure it would be covered under whatever insurance she has. Perhaps she was aware that a simple fracture could possibly result in some pencil pusher determining it was not to ER room standards, and then there would have been a real hassle getting this straightened out.

But first, complain to the EMS Director of the Fire Department or ambulance service who came in the first place. Shame on them. They need to re-examine their outdated transport policy.

[radfringe]

7. ....pretty sure it would be covered under whatever insurance she has

nope it wouldn't - neighbor of her's is also on medicare and has the same supplemental/additional insurance. neighbor had horrific chest pain, his wife called ambulance, transported to hospital emergency room.

he was having a heart attack, needed immediate surgery. they were hit with a bill for the ambulance and emergency room visit - insurance wouldn't cover it.

this was about a year or so ago, at that time my mother started to research other policies - of those she could afford - NONE would cover ambulance/emergency room visits. She would have to buy an additional policy specific for ambulance/emergency room and the deductible on that was outrageous.

as far as transport to urgent care clinic VS emergency room - the "logic" is if you are in need of an ambulance, the problem is more than an urgent care facilty can handle therefore you are only transported to the hospital. Plus, they are concerned about people calling an ambulance for "minor" problems to get a 'free ride' to a clinic.

[mtnester]

19. There is no logic when someone calls 9-1-1 when they or a loved one

are hurt or ill. Most 9-1-1 calls are scared people wanting treatment OR reassurance that they do NOT need emergent treatment...RARE are the abusers, and they most normally are addicts, not someone who fell, is not sure all the way but pretty confident their arm is broken, do not think it is a real emergency that should tie up a hospital ER, but are willing to go to an urgent care because of the diagnosis/opinion of a skilled paramedic.

Any EMS agency concerned about people calling them being half hearted freeloaders who need a free ride, again, need a new medical director or fire chief...immediately..or calls from the public. If this is a for-profit EMS agency, then they may only be able to collect IF they transport to a recognized Emergency Room. THAT also is a problem that your local municipality officials need an earful about.

I am glad your Mom got assistance...things can be seriously scary, especially when she could not get hold of your Dad...I know when I was facing scary medical treatment and pain, my best friend in the world (Mr. MtNester) was my calming focus.

Dear God we need better healthcare options in the country.

[we can do it]

26. My Insurance Has a $500 ER Co-Pay, and I'm a State Fire Dept Retiree

I can see why she did this.

[Mr_Jefferson_24]

6. K & R. I hope your mother makes a quick and full recovery...

..."The Health system in this country sucks big time."

It is an absolute disgrace. We pay enough in taxes to have a great health care system, instead they take that money and use it to start illegal wars and build their empire.

[Naturyl]

8. Yeah, my wife sometimes refuses to go

She has a lot of health problems and I've seen her in bad shape, but she always refuses to go to the ER because she's uninsured and she's afraid of the bill. The two of us live on my measly SSI check of $637 a month, but at least I have Medicaid. She isn't so lucky, because she refuses to get on disability because of the social stigma.

Personally, if I'm in pain and worried, I'm going to the ER regardless of any bill they might send. That's always been my policy since before I had Medicaid. I'm not going to be denied emergency care. If I can't pay for it, I have no qualms whatsoever about leaving them holding the bag. I have a right to emergency care, and that's the bottom line.

I don't just *say* that healthcare is a right, not a privilege. I really *believe* it, and I act accordingly. I wish I could convince my wife to do the same.

[malaise]

10. But but but

Bush says the heath system is terrific!

Hope your mum's pain disappears soon.
What happened to your toons?

[liberalnurse]

11. Yea, but she will get 100% of all health care services

regardless of payment, that is never an issue .....I agree the insurance business is a monster.........but we can't give the impression that people will be denied emergency care due to payment.

[EFerrari]

14. Here where I live, emergency rooms attempt to dump patients all the time.

I went into a ER with a concussion and they tried to make me go away. I had to call my friend to come quickly and witness for me because they tried to shove me off on another ER across town. It was at the old Alexian Bros Hospital in San Jose -- it's called Regional Something now. Pretty scary.

/oops

[Naturyl]

16. I'd quit the medical profession before participating in that

If I were involved in healthcare, the first "dumping" I was involved in would be the last.

I'm not so brainwashed by the stigma against umemployment in this country that I'm willing to participate in evil things for the almighty dollar.

[EFerrari]

20. I didn't have insurance but also, I'd no record of skipping on anything.

It took my four hours to beg them for a scan and they never did check out my ear drum. I'd been assaulted by a family member and was already pretty shaky. It was like pulling teeth with tweezers.

The bouncer told me to go downtown. I said I have no way to do that. Then, he asked me if I was on drugs which I took to be one of the ways they scare people away. He left the room and I immediately called my friend because I knew it would be harder for them to try to get rid of me if there was someone watching the whole thing.

As it was, I sat there and watched my doctor ask a back specialist how to read the scan. I worked in commercial real estate and had actually leased the back guy his suite, that's how I knew him.

There was no follow up, obviously. My net was a slip saying that I had a head injury. Go, team!

[liberalnurse]

17. I'm sorry to hear that.

We don't do that in Ohio....and I work/pick-up time in both ER and Psyche for extra "pocket change" and it keeps my technical skills up to date.

[EFerrari]

22. I think that started here in the 80s. Our state motto should be

"Don't even try to get sick!"

The ER at SF General is fantastic -- if you can survive the wait. The last time I had to go there, I sat for 17 hours and finally gave up and went home because I couldn't physically sit there any longer. That, and a kid died in the hallway and it looked like his 40 relatives and neighbors were going to start a riot. I felt too vulnerable to deal with it.

[Truthiness Inspector]

18. How long ago did that happen? n/t

[Arkansas Granny]

23. I am afraid that we are headed in that direction. I can't find a

source right now, but several days ago on one of our local tv news reports it was announced that one of the hospitals in our area was beginning a new emergency room policy. If you come to the emergency room with a condition that isn't deemed to be a real emergency, you will be asked for a payment before treatment if you don't have insurance.

This is going to hit the uninsured really hard since you cannot schedule an appointment with many doctors and clinics if you have an outstanding balance or cannot pay in advance. This is the reason many people wind up going to the emergency room for all medical conditions. Also, I have noticed that some doctors in our area will only accept cash or credit cards at their office and will not see new patients without payment in advance for the office visit.

I fear that we are moving to the point that the uninsured will not have access to decent health care.

[flashl]

13. Hope your mom heals soon.

When will 'we' wake up to the horrors of the for-profit death industry?

[Maine-ah]

21. if she was on site, then the person she was working for

should be covering her bill. She fell and got hurt on their property. Generally that's how that works. Maybe it's different though if she is more like an independent consultant/contractor:shrug:

[Vinca]

24. Since I can't afford insurance, I've contemplated having a disclaimer

tattooed on my chest: "I refuse medical treatment. Proceed at your own expense." My biggest fear, as a person who can't afford insurance, is to faint in a public place and wind up in a hospital hooked to machines with blood being drawn. I hope your mother is doing better.

[treestar]

25. Too bad she's not an illegal alien

According to most right wing sources, they get treated in emergency rooms at public expense. :sarcasm:

But at 75, doesn't Medicare cover her?

[tblue37]

27. When I had a mild stroke 2 1/2 years ago, I wouldn't call

an ambulance, because even with a relatively decent insurance plan, I would not have been able to afford it. I waited until a friend could come from 45 minutes away to give me a ride to the emergency room--and it took about an hour before I was finally able to find someone who could. It was mid-summer in a college town, and everyone I knew was gone for the summer. Even my neighbors were away on vacation!

Even without the ambulance, I ended up owing around $1000 for the emergency room care and all the tests and stuff. It took me over a year to pay it off!

I don't doubt that is part of what insurance companies count on--that even people with insurance will be afraid to make use of some of their benefits because the accumulated co-pays will be beyond their means.

[WhiteTara]

29. since she was at her clients place of business

they should have liability insurance to cover that sort of accident. This shouldn't fall on your mother's insurance at all.
JMHO

[gratuitous]

38. That occurred to me as well

It's not the victim's insurance that's going to cover these medical expenses, it's the liability insurance for the premises.

[warren pease]

41. Yeah, but what a sick damn thing it is to have to worry about such irrelevant garbage...

...when you've just broken an arm and it hurts like hell and you need medical attention.

In no other industrialized country is this something people even consider. Nor is it on the radar in a bunch of countries that couldn't claim to be industrialized.

What they are is CIVILIZED, unlike this corrupt, for-profit pustule of an alleged modern society we live in.


The American happy talk myth is such unadulterated bullshit that we should spend our entire lives beet red with embarrassment for ever having believed the socialization lies in the first place.


wp

On edit: wrong bone, now corrected

[WinkyDink]

30. Same as my 83-yr-old mother. $700 an ER visit.

[bobbolink]

32. I hope you and your mother BOTH use this opportunity to write to your congresscritters

and DEMAND good health care!

Yours is a sad story, and indicative of what this country has come to.

But-- in the end, trading sad stories and commiserating won't change anything, and change is what we want, right?

PLEASE, take *some* action because of this!

Write a letter to the editor, check to see which of your reps has signed on to HR676, then write or call them and thank those who have signed, and urge those who haven't to do so.

Call/write your relatives and friends, after telling them what happened to your mother, and ask them to do the same with *their* reps. (It helps to furnish the names and phone numbers, as so many people don't even know who their reps are!)

Urge your doctors and other health care professionals (dental hygenists, etc.) to join PNHP, and fight for universal, single-payer health care!

Organize a town hall meeting and round up good speakers.

Call your local nurses association, find out what they're doing (many nurses groups are VERY active with HR676!), and thank them for their efforts.... ask what you can do to help.

Print up information about single-payer universal health care and leave in doctors offices-- people love to have things to read while they wait. :)

Check to see if your state has a state organization (Colorado's is Health Care For All Colorado), join and volunteer.

Finally, a national nurse's organization is apparently putting large ads in national papers. Find out how you can donate to help. Follow up with letters to the editors of those papers. Cut out the ads and share with everyone you can think of.

Pick one or more of the above, and take action!

And, thanks for your efforts in doing so!

[undergroundpanther]

33. We need to destroy the insurance industry

Go to SINGLE PAYER UNIVERSAL health care and the only one cutting corporate insurance profit incentives out of relieving our misery is Dennis K.

http://www.issues2000.org/2004/Dennis_Kucinich_Health_Care.htm

[Mayberry Machiavelli]

34. Is she not on Medicare?

[warren pease]

39. Here's an article on the subject of medical murder incorporated by modesty forbids...

...just came out yesterday in Online Journal.

I mention it because if anyone can use any or all of it to badger their representatives into supporting single-payer, by my guest.

And another thing I think is really important. Instead of calling it "single-payer, universal-access health care" -- which most people don't have a clue about -- why not go the shameless route and try to get this passed on raw emotion for a change? Nothing else seems to work.

In this case, instead of referring to "H. R. 676," we could call it "Nataline's Law," named for the kid Cigna killed via denial of coverage a couple of weeks ago.

We have things like "Amber Alerts" and "Megan's Law" and "The Ryan White CARE Act" because people respond more readily to emotional issues than to the straight story. Suppose Amber Alerts were known as "kidnapped kid phone trees." Think they'd get the attention they get now?

That's how the GOP has been selling its pathological legislative agenda for years. "Healthy Forests" = Clearcut, slash, burn, destabilize hillsides, create mudslides, silt up streams and rivers and kill the fish. "Clear Skies Initiative" = The American way is not negotiable, so buy another Hummer and burn some rubber. "Leave No Child Behind" = Teach to the test so we can kill creativity and critical thinking and turn these little idea engines into conforming corporate androids.

That crap works because Americans are suckers for dumb-ass slogans. And the GOP knows that if it won't fit on a bumper sticker, it's not going to fit between the ears of the average undereducated, misinformed, dummied-down, uncritical, mass media saturated American political illiterate. So they keep it simple.


wp

[fascisthunter]

42. Yet Dick Cheney, One of the Most Evil Humans Get's to Live

with the best medicine has to offer.

[mrreowwr_kittty]

43. But Mittens just said it's our responsibility at the debate

:grr: