ER and Emergency Services

From what I can gather about how this was supposed to work, doctors would do the initial assessment first. Once they decide if it's actually an emergency or not, they tell the patient, "Look, this isn't urgent." If the patient insists on getting more tests anyway, they pay out of pocket. It’d cost them a certain amount of cash. Honestly, I don't see why we'd charge everyone upfront just to issue refunds later; this way would be perfectly fine.
I guarantee you, after a month of doing it this way—especially if the media starts picking up on it—the number of people clogging up the ERs would drop by half. Actual emergencies would still get treated like they always have, but everyone else? If they're just being difficult, they can pay for it.

That was a solid idea. I have no clue where they messed it up. This was one of those rare gems promised during the healthcare reform, right along with expanding outpatient clinics.

Casey Bennett2 said:I mean, it would be pretty obvious when someone actually IS an emergency and doesn't have to wait.

You said something different in your last post.

melloworca6 said:From what I gathered about how this was supposed to work, doctors would examine you first. Once they decide if it's an actual emergency or not, they'd tell the patient it doesn't qualify for coverage. If the patient insists on more tests, they just pay out of pocket. (So I don't see why everyone would be billed and then reimbursed; this way seems perfectly fine.)
I guarantee you that after a month of this happening—especially with some media coverage—the number of people hitting the ER would be cut in half. Real emergencies would still get treated like they do now; everyone else would either move on or pay up if they felt like being difficult.

It was a solid idea. Not sure where it went sideways. This was one of the few decent things promised in the healthcare reform (alongside increasing outpatient clinics).

And what kind of rate would they charge?

melloworca6 said:From what I gather about how this was supposed to work, doctors would examine you and assess the situation. Once they decide if it’s an emergency or not, they tell the patient it doesn't qualify as urgent. If the patient insists on more tests, they just pay the fee.
I guarantee you, after a month of this being practiced—and getting some media coverage—the waiting room crowds would be cut in half. Emergencies would still be handled like they are now; everyone else would either go home or pay up if they felt like being difficult.

It was a solid idea. Not sure where it went wrong. This was one of the few decent things actually promised in the healthcare reform (alongside increasing outpatient clinics).

The issue remains on the ground: you'll have an angry patient who thinks they're an emergency, only for some doctor to tell them they aren't. Determining the exact parameters of what qualifies as "urgent" shouldn't be a burden for ER doctors or nurses. They shouldn't waste their energy on that; they should just do their jobs according to triage order, and then let the administration look at the results, slot everything into the right categories, and decide whether the patient covers the cost.

It's just like how medical transport costs are approved or denied. Everything gets sorted properly. Based on the findings, the patient pays if they showed up for nothing, or Medicare picks up the tab if it was truly something that couldn't wait until morning.

Again, for patients who are clearly in crisis—where their life is genuinely at risk without immediate action—nobody gets billed. It's just recorded, and the administration handles the paperwork later, just like they always do. (Do people really think every single exam isn't being tracked and logged right now?)

Angela Campbell84 said:You wrote this differently in your last post.

Not really. I said what I said, and I still feel the same way. It’s all just a matter of how and when things actually get recorded.

Angela Campbell84 said:What kind of rate would they even charge for that?

You think there isn't a clear cost for every service? Every single checkup gets billed to Medicare. Nothing is actually free—not now, not then. We all just foot the bill, which makes it look "free" to some people.

Casey Bennett2 said:You think there isn't a clear price tag on every service? Every single checkup gets billed to Medicare. Nothing is actually free—now or ever. We all just foot the bill, which makes it look free to some people.

No, I didn't realize that until now. Thanks for the heads-up.

My question still stands.

They should just set a fixed number.

Let’s say you don't have supplemental insurance and end up in the hospital; you'd pay $67 per day of stay. You'd cap out at maybe $2,000 or $1000. I bet it would work the same way here—there'd be a minimum and a maximum amount you could actually be charged.

Look, if you poke a hedgehog and rush to the ER, the doctor looks at you and says, "This isn't an emergency; go see your primary care physician." They might tell you that if you insist on being treated right there, it's going to cost you a fortune $167 because the base fee for an ER visit is so high. If you really want them digging around your leg at the ER and you have $167 extra cash lying around, fine, pay up and get seen. If not, do what anyone else in the civilized world does: go to your family doctor to get whatever you need.

Angela Campbell84 said:No, I didn't realize that until now. Thanks for the heads up.

My question still stands.

What question? You mean the rates? It shouldn't be a secret—and honestly, I don't think it is—exactly how much every exam or diagnostic procedure costs at any facility. Since we’re all indirectly footing the bill, the rate is just based on what it actually costs to perform.

Sure, the cost varies because equipment, hospital facilities, doctors, and nurses all have different price tags, but let's not get distracted. Every single service has a clear calculation and a set cost based on known parameters.

If someone truly needs emergency care, then the government (meaning, all of us) pays for it. Same goes for people who know it isn't an emergency and go to their primary care doctor in the morning following standard procedure; we pay for them too. I have no issue with that. But those who show up at the ER for non-emergencies—which is way more expensive than routine care—fine, but they should be paying out of pocket.

Honestly, I’m not feeling this. Let’s look past the obvious edge cases—imagine someone just paying a few hundred bucks under the table to skip the line for a specialist. Meanwhile, I’m sitting here like an idiot waiting months because I didn't want to trek all the way to the ER just to play dumb.

I bet a ton of people would cough up that kind of cash for a faster appointment, but they won't be offered the chance since they aren't out there faking an emergency at the hospital.

It just doesn't feel right.

Casey Bennett2 said:What question? About the rates? It shouldn't be a mystery—and honestly, I don't think it is—how much a specific exam or diagnostic test costs at any facility. Since we're all footing the bill indirectly anyway, the rate is just set to cover those actual costs.

If you have basic Medicare coverage, they can't just charge you the full amount no matter how they spin it. They might tack on something similar to a supplemental plan fee.

Angela Campbell84 said:Look, I’m not okay with this. Let's just set the whole hedgehog thing aside for a second. It’s about the fact that someone can just slide through the cracks and score an appointment with a specialist by paying a few hundred bucks extra, while I’m stuck sitting around like an idiot waiting months because I didn't feel like trekking down to the ER just to play dumb.

I honestly think a lot of people would cough up the cash for a faster checkup, but they’ll never offer it. Why? Because they aren't interested in playing hero at the ER.

Doesn't feel particularly fair.

Angela Campbell84, you’re seeing how they cut corners now, but hey, it’s all free to them. They just waltz in, lie through their teeth, and run full diagnostic panels while regular people are stuck playing phone tag with doctors and waiting months for an appointment. Honestly, they have a massive leg up even on the specialists in the hospital wings because they get sent in straight from the ER.

This is exactly why I’m always losing my cool on this thread. You have regular people waiting forever for specialist appointments or basic diagnostic tests, while these geniuses decide to hit up the ER instead. They walk in, get everything done in a matter of hours, and call it a day. Take my situation, for example: I had all my cardiac testing finished and managed to snag a follow-up with a cardiologist within just a few days. Meanwhile, other people are calling ahead only to be told they'll be waiting a month or two just to see a specialist, depending on how backed up the clinic is.

If people actually paid for stuff like this, maybe things would change. But let's be real—most of the people doing this wouldn't even think to try if they knew there was a bill coming. Since it’s free right now, they just jump on it. They’ll process you, sure, so why wouldn't they?

Angela Campbell84 said:If you have basic coverage through Medicare, they can't just charge you the full amount no matter how they spin it. They might charge a copay or supplemental fee, but that's it.

Why couldn't they? It’s not some mysterious "them." It’s us—the citizens paying for all these services through our taxes and premiums. It isn't like an imaginary force is dropping cash onto the country from a spaceship. 🙄Every single one of those services is funded by the budget, which means it's paid for by everyone.

If I recall correctly, current laws define what healthcare covers. It doesn't say anyone can walk into an ER for every little thing and expect Medicare to foot the bill. The law defines what actually constitutes an emergency and which specific costs are covered under emergency care.

Besides, there's just zero political will to fix this and make it crystal clear for everyone. That's not the topic here, and frankly, I don't want to talk about it. I won't be replying to any more posts on that subject.

The ER doctor just plain missed the mark here. He can talk all he wants, but you can't fake symptoms. If there aren't any major red flags, then what’s the point of all those intensive tests and rushing to see a specialist? There has to be some kind of clinical suspicion or an actual indication for all this... right? 😕

Take that racing heart, for example. If it’s just from anxiety, it settles down in twenty minutes—usually before you even see a nurse. But if someone is actually shaking and dizzy... well, damn, just send them over to the specialist already.

Casey Bennett2 said:Why wouldn't we? It's not some vague "them"—it's us, the taxpayers funding all these services.

Right, everyone, including the guy sitting in the ER waiting room.

Look, I don't have the energy to spell this out. Some things should just be common sense.

Classic internet armchair expert move.

Angela Campbell84 said:But that’s just an ER doctor making a mistake. Sure, they can talk all they want, but you can't fake symptoms. If there aren't any serious signs, then why bother with all those intensive tests at the ER and rushing for a specialist appointment? There has to be some kind of indication, some suspicion, something... right? 😕

Take that fast heart rate thing, for example. If it's just from being worked up, that clears up in maybe thirty minutes. You won't even make it to the front of the line before it passes. But if it actually lasts and the person is shaking and dizzy... well, whatever. Let them send him.

Look, he was so "urgent" that they didn't even see him until eight hours after he walked in.😁

Do you seriously not realize how annoying and persistent some people can be? Sometimes it's just easier for doctors to write a referral than to deal with someone badgering them every few days. Unfortunately, I spend enough time sitting in waiting rooms to know. I hear the stories people tell each other; you've got groups of people who are basically living in the doctor's office every single week.
Some are lonely, some are hypochondriacs, and some just love to mess around—to them, this is practically a sport. Someone who is actually sick? They try to avoid the doctor as much as possible because they're sick of the doctors, the appointments, and the endless testing.

Angela Campbell84 said:And which billing code would they even apply to that?

I assume there’s already a set fee schedule for specific procedures
though I’d probably double it—given that we're talking about emergency services.

melloworca6 said:Look, they weren't exactly rushing; he didn't even get seen until eight hours after showing up.😁

Do you really not get how annoying and persistent some people can be? Sometimes doctors find it easier to just write a referral than to deal with someone badgering them every few days. I spend enough time sitting in waiting rooms to hear all the chatter—you always have that group that hangs out at the clinic every single week.
Some are lonely, some are hypochondriacs, and some just do it for the thrill, treating medical visits like a hobby. Someone who’s actually sick usually tries to avoid the doctor because the whole ordeal—the appointments, the tests, the waiting—is just exhausting.

I fall into that last category (even though I'm not seriously ill), so what you're saying doesn't quite click for me. 😲

But those types aren't just limited to the ER; they're everywhere. They clog up every waiting room imaginable and sign up for every test under the sun.

Still, you have to handle them differently. You have to find a way to set boundaries.

If someone rarely ever sets foot in a hospital, they don't understand the dynamic, and it isn't right to mock them or brush them off just because they showed up with an earache... maybe they panicked, maybe the pain was unbearable and they just needed advice on how to make it through the night. It's hard to say where to draw the line on who deserves certain levels of care.🤷

Angela Campbell84 said:It’s hard to pin down who actually qualifies for specific types of healthcare coverage. 🤷

Are we still discussing emergency services?
It would be helpful to categorize what counts as urgent—what needs immediate attention versus what can wait a bit longer.
Think of it like triage levels—immediate, within an hour, a few hours, or maybe within 24 hours—where everything falls into a specific bucket.

So, yes, regarding emergency care, there are established protocols that dictate who has "rights" (to borrow the term from the quote—though it's a bit of a loaded word in this context) to receive that level of care.

Just to jump in here 😁

So, the bottom line seems to be that people flock to the ER thinking they can just knock out every single test at once and be done with it quickly.
The folks posting like that clearly have never actually stepped foot in an ER at a major metropolitan hospital or a county clinic. 🙄

Regarding those "quick" diagnostic tests—it’s about time the system finally realized what we needed. We now have this D2 referral for outpatient clinics, which basically allows you to get everything a specialist orders completed in a single day.
And honestly, it works well enough; things move fast, you take one day of sick leave, get everything done, and you usually have the raw data within a day or two.

But, of course, there is always a catch. You might have the results, but then you find yourself waiting a month and a half just to have someone actually interpret them. 🙄
I just had a very recent experience at a local hospital downtown.
And when you tell them to shove it and demand your own records so you can take them somewhere else where a doctor will actually look at them immediately—they refuse.
It isn't until you bring up the Patient Bill of Rights and specific legal protections that they suddenly pivot and say, "Oh, fine, we can provide you with copies." 🙄

The whole setup is backwards and nonsensical. It feels like the entire structure is designed solely to minimize patient volume—which is really just a way to cut costs.

In these outpatient settings, they'll often write down that you need a CT or an MRI, but then they won't actually order it.
So, unless you're looking to get unnecessary radiation exposure, you end up paying out of pocket for private imaging, which can easily run you several hundred dollars.

Absolute vultures.

George Peterson49 said:Are we still talking about the ER?
It would be nice if they could actually figure out what’s urgent, what’s an emergency, and what can just wait a bit.
They have triage levels—immediate, within an hour, within a few hours, within 24 hours. There’s supposed to be a system where everyone knows where they fit in.

So, yeah, regarding the ER: there are specific protocols meant to decide who has the "right" (to use the term from the quote, though I wouldn't normally use it unless I'm responding directly) to receive that level of care.

A little on how those systems actually work in reality—my dad almost died in the ER at the local county hospital while waiting his turn. It was a rib issue. They didn't even put him in emergency triage because their assessment was completely wrong.
His ulcers had ruptured. It wasn't until after several failed interventions that they finally decided to hurry up. We even had a doctor threatening us with security.

Another case—my mom was at that same hospital on the north side, waiting from 7 PM all the way until 5 AM. We eventually lost our minds and caused a scene. By 8 AM, she was finally in surgery for a ruptured gallbladder.

Based on that and several other cases, both close to home and further afield (I won't list them all now), my conclusion is simple: the triage system at that ER is a disaster.

George Peterson49 said:It would be nice if we could just easily sort out what’s an emergency and what can sit on the back burner.

If it were actually that simple, we wouldn't be having this conversation in the first place.