ER and Emergency Services

Just to add my two cents on the whole situation... the hospital could’ve easily spotted everything, noted their opinion, and documented the whole thing—everyone gets a discharge summary with a specific medical record number right at the top. But here’s the kicker: the hospital's real headache is how they’re supposed to bill Medicare for an emergency visit when, logically, those things should be billed through the ER first.
Between all the time wasted, the full physical exam, getting prescribed meds or vaccines, and using up supplies like bandages... well, according to the insurance billing manual, that all adds up to a certain amount of points.
So, how are you supposed to explain it to a Medicare auditor when they show up? You've got this expense on the books where it clearly looks like a minor issue, but you don't have the specific urgent care referral needed to cover the invoice.
It sounds like some ridiculous bureaucratic loophole, but honestly, that’s just how it works in the real world. The auditor doesn't give a damn that you were wandering around Washington, D.C. looking for help. All he sees is that the case wasn't technically an emergency and there’s no red-tape referral to back it up, so that's that. Then he starts breathing down everyone's necks... the department head, the triage nurses, the admins... claiming it's a violation, saying it won't get paid, and just making life miserable for everyone.
Then some new "pest" shows up and you're left wondering how to even handle them... it's just one big vicious cycle.

Rachel Brooks63 said:Are you trying to pick a fight with David Harris44?

I wouldn't do that if I were you, man—he’s an admin, and trust me, you don't want to get on his bad side unless you're looking for trouble. 😬

Oops...🙈 ...wait, is he someone we should be worried about running to the Emergency Room over?....😬

Scott Allen10 said:Just to add a bit more context regarding this specific situation... the hospital could have easily spotted it, noted an opinion, and documented everything—everyone gets a discharge summary with a specific medical record number on the header. But here’s the kicker: the hospital's real headache is how to bill Medicare for an emergency visit when, logically, those costs should be routed through the Emergency Room services first.
By the time they've spent the time, run the tests, prescribed meds or vaccines, and used up supplies... according to the "Blue Book," that translates to a certain amount of points...
How are you supposed to explain it to a Medicare auditor when they show up? They see an expense for something that looks totally trivial, yet there's no red referral slip to back up the invoice.
It feels like some bureaucratic loophole, but honestly, that's just how it works in reality. The auditor doesn't care if you were wandering around Washington, D.C. looking for help. He sees that the issue wasn't an emergency and there's no red referral slip, so that's it. Then he starts breathing down everyone's necks... the boss, the triage nurses, the admins... claiming it's an irregularity, saying it won't be paid, blah blah blah...
And then some new "pest" shows up, and you're stuck wondering how to handle it... it's a total Catch-22.

Scott Allen10, buddy (hope your wife isn't giving you a hard time about this) 🙏 🙏 🙏
I feel like I've practically worn out my fingers and my keyboard trying to explain things to people, but it seems to be all in vain. 🙄
Honestly, I'd much rather be in the OR dealing with a polytrauma—think ruptured diaphragm, torn intestines, maybe even stabilizing a thorax with wire—than listening to the nonsense an auditor spews. A few months ago, my team had 10% of our revenue stripped away (our total revenue, not salaries, since we cover ourselves through procedures that don't go through Medicare) simply because we incurred The Penalty for having a higher volume of exams and services than what was set by the standard quota. 😈
And really, how am I supposed to hunt down someone whose fingers are literally hanging by a thread because they got caught in a circular saw? 😈
And where would I even go to report them—in Washington, D.C.??? 🤣

Scott Allen10 said:OK, let's be real... this guy should have gone straight to the Emergency Room first. But honestly, unless there's a rare exception, our ERs are mostly a joke when it comes to actual expertise. Most of the doctors working there are basically fresh out of med school, just making noise until they actually encounter something serious. It’s a massive paradox because, logically, an ER should be staffed by people with the experience and knowledge necessary to perform proper triage and execute the right procedures at the right time.
Maybe some kind of specialization within the Emergency Room will help, but that's a distant future dream.
As it stands, we face morbid situations where medically incompetent doctors are operating in extremely sensitive environments. It’s actually better for the patient if they just transfer them to a hospital immediately, regardless of whether the cause is something banal that could be fixed on the spot. That might not be the healthiest approach for the healthcare system, but here we are....
The situation turns even more tragic when dealing with genuine emergencies. Since I work in an institution that receives patients from five or six different Emergency Rooms, I can say with total confidence that both doctors and medical technicians could easily find themselves facing long-term prison sentences. We all get a little nervous when we get a call that a specific ER is bringing in an emergency, because you never know what kind of mess you're going to deal with.
The way some ERs operate, you might as well hire thugs to work with Smith—just grab the patient, throw them inside, and dump them at the hospital. Will anyone bother to check if they need to breathe? Will anyone try to administer aspiration? God forbid they even attempt to establish an IV. Forget it; they'll just shove them through a window, put on some dark sunglasses, and call it a day.
My apologies in advance to the Emergency Room staff who actually do their jobs professionally, but I believe that, to paraphrase a saying, there is very little wheat among all the chaff.

I have to agree with this 100%!
Though, I should mention that, at least here in Indianapolis, they have started working intensively on education and various training courses.

But yes, there are definitely hacks out there—doctors who can't tell pulmonary edema apart from ICV and who actually ask if a TIA shows up on an EKG. There certainly are.😬

Scott Allen10 said:Oops...🙈 ...is he some kind of Johnson maybe?....😬

David Harris44 said:something...

🍿

this is gonna be interesting!!! 👍

What makes you think that? 😁
If you're actually expecting me to sit here and engage in some pointless, endless argument... fat chance! 😁

David Harris44 said:What do you mean by that? 😁
If you’re actually expecting me to sit here and argue with you... yeah, fat chance! 😁

Well, I guess I was a little hopeful.

But hey, if you don't want to, no biggie 😢

You guys don't have to do this just for my sake. I'll find someone else to eat these popcorns with... 😬

I'm telling you, if you want to be a doctor in this country, you’ve gotta have some serious guts.

by karmela

Seriously though, you need nerves of steel to pull this off.😬

Hey there... I was wondering, when an ambulance gets dispatched for an emergency call in Tampa, does that response usually kick off from a local community clinic or directly from a major hospital like Mayo Clinic...? And I'm curious if things work differently in other big cities, say in Washington, D.C., for instance?

I realize this might sound like a silly question, but I honestly have no idea.
Suppose I’m experiencing some pain and I want to see a doctor about it (for instance, an earache).
Do I head to a local clinic or go straight to the hospital? Am I just supposed to show up, or is there a specific protocol I need to follow?

Please don't make fun of me 🙈

Nancy Jones12 said:I know this sounds like a silly question, but I honestly have no clue...
Say something hurts and I want a doctor to take a look—like my ear, for example.
Do I head to a local clinic or go straight to the hospital? Do I just show up, or is there some specific procedure I need to follow?

Please don't laugh at me... 🙈

You'd start with your primary care physician.
Now, you really ought to check if you need to make an appointment with your doctor first or if you can just walk in—it varies depending on the practice. They'll either treat you right there or refer you to a specialist...

Nancy Jones12 said:I know this sounds like a stupid question, but I honestly have no clue.
Let's say something hurts and I want to go see a doctor about it (like an earache).
Do I go to a local clinic or straight to the hospital? Do I just show up, or is there some specific procedure I need to follow?

Please don't laugh at me 🙈

You go to a primary care physician first. Do you even know who your doctor is? If you aren't sure, I think you can call Medicare and ask. You can also check on https://usa.gov/ if you're covered.
Once you figure out who your doctor is, you’ll have to call them first to make an appointment.

You always have the option of heading straight to the Emergency Room... 😕

Understood
thank you all

You go to your primary care physician first. They’re the ones who order your labs and checkups. Unless you’re facing a genuine life-or-death crisis where you feel like you're dying, you don't just roll into the ER or call 911. You don't go to the emergency room for an ear infection. Not for a sunburn, either. Not for a fever or a stomach bug.

Kate Jones said:I mean, you *can* go to the ER if you want... 😕

I honestly hope we reach the day when the ER starts handing out bills to everyone who walks through the door without a legitimate reason (remember that whole debate about billing changes? I think it got stuck somewhere in Congress). Right now, people show up for nonsense and clog up the system. Then someone with a real emergency is stuck waiting because some genius decided Saturday night was the perfect time to realize they've been peeing blood for five days or running a fever for a week...

I heard someone say that 80 percent of ER visits and calls aren't even emergencies. Apparently, explaining that doesn't work. Just start hitting them in the wallet. People will learn pretty fast.

People just don't have the capacity to gauge how urgent their situation actually is, and honestly, if they think they need to go, let them go. At any ER, there’s a triage nurse whose entire job is to listen to those symptoms and decide whether someone needs immediate life-saving intervention or if they can wait. That’s how things work at places like Mayo Clinic.

Look, Angela Wright, it’s not that they aren't capable—it's just that they don't give a damn. They can't be bothered to wait at their family doctor or deal with the usual referrals, so they just head straight to the ER. They want everything done all at once, get all their tests immediately, and walk out with a full report.
I actually heard this story from someone in my extended family recently. This guy overindulged in some burgers and cold fruit, felt sick, had a bit of nausea and an upset stomach, so he went to the emergency room. They ran every single test right then and there, including a gastroscopy. Everything came back perfectly fine. A few days later, he's back again because he says his chest feels tight and his heart is racing. Well, yeah, his throat stings because they just did a gastroscopy on him, and his pulse was high because he was rushing up and down stairs. So, they run all the tests again, everything is normal, and he still managed to screw them over enough to get an urgent referral to a cardiologist. His EKG is fine, but now he gets to see a specialist in a week, while everyone else is waiting two or three months if they're lucky. 🙏 Honestly, forget it. She should charge them for this nonsense so they stop wasting everyone's time. One trip for something stupid and they'll never go back.

Of course, if you're in unbearable pain, vomiting twenty times, or running a 104 fever, sure, hit the ER. But if you just have a sore throat, a slight fever, or had diarrhea three times in a day, you have to be a little self-aware. You need to judge whether it's actually an emergency. Not to mention how these people are the first ones to throw a fit when they or their friends have to wait somewhere—like waiting months for a scan or a follow-up—while they themselves are clogging up places they don't belong.

From what I know about doctors and what I hear from people working in the field, I wouldn't blame them one bit if they started charging for half of this. We have public healthcare, so when you actually need something, you either wait like an idiot or pay out of pocket specifically because of people like this. It took me three months just to get an appointment with my immunologist for a check-up because there were no openings. During my visit, the doctor told me herself that on any given day, about 50 percent of her patients shouldn't even be there. They were sent by their primary care physicians just to fill space. Meanwhile, people like me, who actually need these follow-ups and belong in her clinic, are left waiting for months because nobody else can treat us.

melloworca6 said:Oh, Angela Wright, it’s not that they aren't capable; it's just that they don't care. They don't want to deal with waiting at the family doctor or walking through all the tests like everyone else, so they just head straight to the ER. They force them to run every single test at once, and they get everything done immediately, including the results.
I recently heard a story from a distant relative—he overindulged on some burgers and cold fruit, felt sick, had a little nausea and diarrhea, so he went to the ER. They did everything for him right then and there, even a gastroscopy. Everything came back perfect. A few days later, he’s back because he has this chest tightness and a racing pulse (they did the gastroscopy, so of course his throat is sore, and his pulse was fast because he was sprinting up and down the stairs). Again, they ran all the tests, everything was fine, and he actually managed to manipulate the system to get an urgent referral to a cardiologist, even though his EKG was normal. He'll see the specialist in a week, while regular people wait one or two months, if they're lucky. 🙏 Honestly, screw that. They should charge them for such nonsense so they can go bother someone else. One trip for something stupid and they'd never go back.

Of course, if you have unbearable pain, you're vomiting twenty times, or running a 104 fever, you go to the ER. But if you just have a sore throat, a slight fever, or had diarrhea three times in 24 hours, you have to be somewhat rational to realize it isn't an emergency. Not to mention how these types are the first to cause a scene when they or someone they know has to wait somewhere (including waiting months for scans or check-ups), yet they create useless crowds in places they don't belong.

From what I know about doctors and what I hear from the staff, forget it—if I were in their shoes, I'd start charging for half of this. We have public healthcare, so when you actually need something, you either wait like an idiot or pay for private care specifically because of people like this. I spent three months trying to schedule a follow-up with my immunologist because I couldn't get an appointment. At the check-up, she told me point-blank that fifty percent of her patients that day shouldn't have been there; they were sent unnecessarily because their primary care doctors just dump them wherever they want. So, people like me, who actually need the follow-up and are legitimate patients, end up waiting months for appointments while others skip the line.

Well, doctors advise their own that way; they arrange surgeries out of turn and tell them to go to the ER to get their labs done quickly.
You can't bring order to people with connections. People whine about how the system is failing, but when you try to impose order on the web of nepotism that even medical professionals use, they just find a loophole. I know firsthand that everyone uses connections for any kind of surgery; nobody ever waits in line, and they're advised to hit the ER just to get results faster. That's the kind of society we have. We don't want order. We don't care about anyone but ourselves—and obviously, other people's money. That's why our country is broke. Corruption goes from the top all the way down; the higher-ups steal millions, while the low-level guys are just stealing toilet paper. ☕ The society is uneducated.

That’s why I’m actually hoping they eventually implement co-pays at the ER. At least if it’s a real emergency, you won't be stuck waiting forever just because some idiot can't tell the difference between a crisis and a scratch, or honestly, just doesn't give a damn about anyone else's time while they're running through the motions.

What if someone overindulges on greasy burgers, gets a gallbladder attack, suffers intense pain, the stone moves into the bile duct, ruptures, and leaks bile everywhere? I’m exaggerating here, obviously... look, life isn't black and white. People just aren't equipped for this. Yesterday, I was scrolling through a Facebook group and found myself staring in disbelief at this woman who had already gone through a premature birth, contracted beta-hemolytic infections, and was now dealing with heavy bleeding—like, twelve or thirteen pads a day. She’s sitting there asking if it’s an emergency or not, while meticulously analyzing her pads, checking the volume, the color, the texture... hello? Seriously? In the end, she left because we all basically kicked her out of the group, claiming she wasn't "fertile ground" for advice... but what else were we supposed to do?!
There's a triage nurse for a reason; if it’s not an emergency, you get a polite suggestion to head straight to the ER. You shouldn't play doctor, and that rule applies to everyone.