Having insurance and still getting hit with a hospital bill. About 8 months ago, my wife came down with a stomach bug. Nothing out of the ordinary – just a lot of vomiting, major cramps, and a fever. We got worried that she might have the flu (we’re not physicians) and decided to go to the emergency room two blocks away from our home. As routine, they gave my wife IV fluids and ran some tests. She started feeling a little better after 6 hours, and the tests turned up nothing serious. So we returned home sometime after.
Less than 2 months pass before we get a bill from the hospital for $1300. We pay a nice monthly premium for my company’s PPO plan, and already paid off our annual deductible for unrelated visits to the specialist – I assumed the emergency room would be covered and was pretty surprised to see this bill. I concluded this was a mistake and planned to clear this up with my insurance company the following week.
There was no mistake! My insurance refused to pay the emergency bill because my wife’s condition was not serious enough to warrant an emergency room visit (as it turns out!). So how exactly are two non-clinicians (my wife and I) supposed to know when a medical condition is not serious? Thousands of people die from the flu every year, and I’m sure some of those unfortunate people made the mistake of not seeking emergency care as soon as possible – thinking something like: “I’ve had fevers before, I’m sure it’ll pass”.
What’s really going on. The insurance company is trying to push patients to go to urgent care clinics, instead of the emergency room, as a cost saving measure. Significant investments were poured into building urgent care clinics across the country, in the hopes that people would go there instead of a hospital. That is all well and good, from a planning perspective, but to penalize people who do go to the ER is a slippery slope. The next time one of us feels really sick, which may turn out to be very serious, we may decide to visit the urgent care clinic instead of the hospital. Thankfully, we have enough savings to make the best decision for our family, go to the hospital if that makes sense to us, and handle any unpaid emergency bills. But what about all the other folks who don’t have much cash on hand? Good luck with urgent care! That’s the message insurance companies are sending.
Maybe telehealth is the answer. If you’ve not heard of telehealth it is a paid consultation with a doctor, nurse or some other healthcare practitioner, via a phone call with video support – I’m sure there are better definitions out there, but this is close enough. I like the idea of reaching out to a doctor, at any time of day, and getting timely medical advice. Now to be fair, this wouldn’t necessarily be my primary care doctor, but a stranger who is qualified to give medical advice. So imagining a scenario where I’m feeling terrible, maybe I could access a telehealth doctor and get help deciding whether I should go to the emergency room, the urgent care clinic, or just stay home. And, if my telehealth doc advises me to go to the hospital, the insurance company should pay for that. I think this is a decent balance where patients can be supported if they decide to go to the ER, but we also promote a more cost-effective system with incentives to use urgent care.
More to come on telehealth in future posts – I think this type of care delivery will continue to expand in the years to come.
Happy Readings!
~ James
