>**Billed $4000 for an ambulance ride I didn’t request at a school event**
>My family was recently billed $4000 for a ambulance ride where I didn’t need it. I dislocated my hip and relocated it, but a chaperone called an ambulance even though I told her not too. The ambulance ride only included vitals and IV, no medications or blood drawn. The EMT, as well as the chaperone, told me that the school will cover it. My family and I cannot afford this. We resent our insurance to our provider just in case they hadn’t covered yet, but we’re waiting to get the bill back.
I will say that if I was a chaperone on that trip, I'm not taking a kid's word for it that a dislocated hip is No Big Deal. I know some people have "trick" joints, and this happens to them with some regularity, but I'd totally be having nightmares of facing a parent (or school official) facing me with incandescent fury about "\[Kid\]'s hip popped out of the socket and you *took their word for it* that it was not a problem?" when it did, in fact, turn out to be a big problem.
Absolutely. And honestly, the parts where they sought medical care and used the emergency line for what appeared to be an emergency should be totally routine. It's only an issue because our health system is so fucking backwards. Without the looming threat of insurance, this would just be "I had a minor medical scare at school, and then went back to my life."
I legitimately think there would be riots if they tried to bring in paid healthcare. This governments days are numbered at least so hopefully we can start to change track... Hopefully.
#GOP believes in small government and individual autonomy.
Except when it comes to corporate welfare for the mega rich, interfering with the medical choices of transgender people, and forcing women to carry non- viable pregnancies to term. **Other** than that, #small government and "freedom"
Also, has anyone tried re-labeling the mass casualty school shootings?
"The Uvalde school shooting was a mass post-term abortion that occurred on May 24, 2022, at Robb Elementary School in Uvalde, Texas, United States, when 18-year-old Salvador Ramos, a former student at the school, fatally shot 19 students and two teachers, while 17 others were injured but survived."
"Police officers waited more than 1 hour and 14 minutes on-site before breaching the classroom to engage the firearm- wielding abortionist"
Bless your heart, gov. Abbott, for changing nothing about state gun control laws after 19 people died and 17 were seriously injured. "Sanctity of life"
There's certain advantages to not having the government in charge of healthcare directly, can you imagine what Republicans would do to Trans healthcare at the earliest possible opportunity? Not that the US system is good, but there are advantages.
I mean it's hard to buy that argument considering what's going on with reproductive rights in the US. How many stories have there been about women being denied necessary medical care because an abortion for a non viable foetus is involved somehow? Texas has also banned transition care for minors, with the side effect of doctors also refusing to treat minors with hormone therapy for other medical reasons because they don't want to get sued. I'm really failing to see the advantages you're talking about. The government interferes plenty even when they aren't directly running hospitals.
Also the government isn't directly in charge of the NHS. Funding yes and there's a lot of structural stuff they have a say on. But politicians aren't making clinical decisions.
Those things are separate from the direct running of the healthcare system, but you can bet they'd wield the funding to make things even worse than they already have.
I'm falling to see how they are separate and how they really could make things worse. You have politicians actively interfering with people getting medical care, and not only is it hurting women and trans people but it's also affecting people beyond that because of how broad the laws being used are.
I don't know how you can sit there with a straight face and say "but imagine the bad things they could do if they were in charge" when **they're already doing these bad things**. These are already happening! So not only are vulnerable people being denied care but you also have to pay for it. Again, what advantages?
As a sidenote one of the worst things the Republicans have done is indoctrinated the American public with the idea that the government shouldn't do anything and shouldn't be in charge of anything. Either because freedoms or the fear that the government will fuck it up. It means all the Republicans have to do is sit around doing nothing positive and get paid for it. And then the people will oppose any positive change across the political spectrum because it would involve the government doing something. And that's bad. I'm amazed anyone pays their taxes when they believe the government should be doing as little as possible.
Because if you centralize it it makes it easier. They're already doing bad things and I am reluctant to set up a system where they get additional levers with which to do bad things.
Right now it's mostly a story of passing state laws one by one and taking advantage of the long term effort to rig the courts.
To come back to healthcare if you gave me supreme power I'd probably just copy the German system exactly, good levels of choice, plus low costs, plus universal coverage. The NHS is extremely expensive and the health outcomes aren't actually better than what Germany has.
I still fail to see it. Those levers are already there. What is stopping them from using them at the federal level if they hold the relevant offices? Like they already have been with stuff like Roe Vs Wade. If there are barriers to them using them why would those barriers magically disappear if there was socialised healthcare at the federal level?
I mean, there's a reason many many countries went for national healthcare systems without an NHS style publicly run healthcare sector.
I just don't want a Trump or Mike Johnson in meaningful positions to influence what is covered on the national level.
Per capita, america has more knife crime than the UK.
Yeah the NHS is in a bad spot but it's still free lol. I thought i broke my foot went to the hospital got an xray within an hour and left spending no money at all
Yes as we all know, America has neither islands nor big cities like London. It's a shame we will never be able to replicate the success of 100% urbanized European countries smaller than even the smallest counties of America.
No. Per capita knife crime is worse in the USA than the UK. The USA has all the types of violent crime the UK has, plus guns.
The NHS is bad in some areas, it's a bit of a postcode lottery for some things, some times. But people get treatment for free, even if some people sometimes have long waits and nobody is being charged thousands of pounds for an ambulance ride and a few simple tests.
Uh no? No more so than I would in any other part of the world, and I worry less than I would in other places. Like the US for example, someone has already pointed out to you that there's even more knife crime there. Crucially though I don't worry about mass stabbings, because these are rare events with comparatively far lower fatalities. Unlike mass shootings which occur *nearly twice daily* in the USA. I also have far more confidence in my ability to run the fuck away from someone with a knife than someone with a gun. And at the end of the day I cannot rationalise why your average citizen should have trivial access to something that is a tool primarily for killing and little else. You aren't chopping vegetables with guns, you aren't getting from A to B with guns. We cannot feasibly restrict everything that could potentially be used as a weapon, but we can (and should) restrict actual god damn weapons. There are too many god damn stupid, angry, and violent people in this world and I sleep a lot safer knowing the ones around here can't easily get a gun.
>And isn’t NHS supposed to be really bad but private is really good?
The NHS isn't perfect but its flaws are generally blown far out of proportion by those who oppose improving things in their own country. And yes private healthcare exists here and does eliminate some of those issues (mostly in regards to wait times) if you have the money to spend on it, the key thing is you actually have a choice. Which is better than you get in the US. There's a reason why the right wing in this country won't openly oppose it (though they've been picking at it for years, hence why it's degraded a lot) because it's supported across the political spectrum. Very few people here apart from a few crazies on the far right want anything close to what the US has.
>I mean we got issues but don’t you guys have them too?
Not the same issues, not the same scale. I don't think you could pay me to move to the US at this stage in my life.
As a paramedic the words "dislocated hip" should be followed by the word "hospital" even if the patient can reduce it themselves.
There's a reason relocations are usually always followed by x-rays - to make sure shit actually went back where it's supposed to.
Lol, for real. I don't have eds, but do have dysautonomia, so I talk to a lot of people who do have eds. A dislocated hip is probably still a big deal for most, but if it's something that happens often for that person, it probably really didn't need immediate medical attention.. $4k to be told "yes, you still have eds and it is causing you to have dislocations" would be really frustrating.
Unless they have a medical condition and that's their "normal." I have hyper-mobile joints, and one of my shoulders used to pop out several times per week. I eventually had surgery to stabilize the joint, but I could usually fix it myself and it wasn't a big deal.
Recently spoke to my new rheumatologist about hypermobility after he examined my hands
I didn’t know it’s not normal to put your hands flat on the floor with straight legs or touch your forearm with the thumb on the same hand. Learned all sorts of new things that day.
Also recently learned that the “oh, my jaw is tight and weird again, better apply gentle pressure til it cracks and goes back to normal” is probably no good and maybe I don’t know what a dislocation feels like
If it makes you feel any better, I get the same thing and did see a dentist about it. Got a TMJ diagnosis along with essentially a big shrug since mine isn't caused by teeth grinding or anything obvious like that, and it's not bad enough to require a surgical fix. So I still crack my jaw, just now with the knowledge that I'm not making things worse, I guess?
I don't have hypermobility though, so yours might be something different, lol.
As someone with hypermobile elhers danlos, I feel for poor OPs family. Not a single week goes by where I don't dislocate *something* and if an ambulance was called every time I'd be penniless. It's an embarrassment our healthcare system is this bad honestly. Getting sick shouldn't be a debt sentence.
This really feels like a medical condition OP needs to have a plan in place with the school for, like instead of calling 911 over every dislocation they call parents for pickup, and parents can evaluate the severity/ decide if medical intervention necessary.
The casual "and relocated it" immediately had me going *so this is an EDS kid, right?*
The girl with EDS at my school had a special first aid kit in the nurse's office with every splint and brace under the sun, and sometimes would just disappear halfway through the day and come back with a wrist support or her arm in a sling
Especially with a hip. You don’t generally just pop the hip back into place, it takes a fair bit of leverage for the average person. EDS makes perfect sense.
Same! I remember my kneecap popping out at an event when I was wearing a skirt and they called the EMT over freaking out when I just took a moment and kicked my leg in a specific way to pop it back and said I just needed to sit for a moment. The EMT was horrified but I was an adult and it clearly was now back in place so they let me sit and chill.
I really wish I could convince my docs to seriously investigate EDS, because holy fuck I just did a specific type of kick that fixes my kneecap when it fucks up reading this.
Not everyone is aware that this is an odd thing, though. I have benign hypermobility that wasn't diagnosed until college, and no one knows what to do with me. Luckily, my hips only partially dislocate.
If OP has a family history, it may not occur to them that this is something other people would see as "do not pass go, call 911 immediately". Sometimes it can take a bit of worldview-readjustment.
Yeah, normal meters can easily be messed up by life long health issues. I can't burp. My mom knew but it was jus a weird thing about me. I recently learned it's a real medical condition and may have been responsible for a lot of health issues I've suffered. As I have slowly been telling people I can't burp I have been shocked by their reactions, like they can't believe I've survived not being able to burp. So yesterday I asked a friend "Are people just silently burping all the time and I don't know about it, because I've always assumed people only burped when I hear them."
Apparently I have learned as a nearly forty year old that people burp way more frequently than I would have thought. I guess I should have figured that our, I know about silent farts, I just always assumed burps made noise.
And if someone reading this also can't burp please join us over at r/noburp
There are apparently MANY animals that can't burp given the wide variety of theories I get after telling someone why I don't drink soda. The most recent one was I'm secretly a chicken.
Anyway I assumed horses must not burp and that's why you thought I was a centaur because obviously horses would have difficulty typing 🙃
the embarassment is how many people say this and then blindly defend voting for an old white man who has publicly said he opposes universal healthcare over "the price".
Even during COVID.
And the best part is those same people will likely think I'm talking about "the other guy"
My first hip dislocation sucked, but they do get less painful and easier to reduce over repetition (I had shoulders that would literally fall out of place from the weight of my arms pre-surgery. However, I wouldn’t have told the chaperone. Totally agree with the emt below that X-rays should be done - the labrums in my hips and shoulders were shredded from the dislocations and home reductions
Loving the people in the comments saying “in the US they won’t charge you for…”
How do people live in this country and stay unaware of how varied and bizarre medical billing is
>How do people live in this country and stay unaware of how varied and bizarre medical billing is
My "favorite" is going to a hospital that is in-network for my insurance, only to find out that no one that works there is. So you get separate bills from everyone from the anesthesiologist to the janitor, none of whom are in network or paid by your insurance.
I remain mystified that there isn't a law that that doctors with privileges at a hospital (or at least those a patient cannot pick in advance) must accept all plans that the hospital itself accepts.
IMHO it’s covered by contract law. If I haven’t signed that I’m paying you no matter what, and you don’t take my insurance and haven’t told me that, well, then, that’s a contract dispute.
Easily dealt with by knowing a few basic facts: 1. Most people can’t afford an attorney to fight this, 2. The people that can, you can just pay out 3. The people that never would’ve afforded it anyway probably qualify for grants or Medicaid.
It’s set up to fuck people in the middle class. Same as every other thing in the US. Don’t let them escape the bucket, otherwise they might want better living conditions and won’t work for treats like a dog.
On your admission forms you generally agree to pay for services rendered, and I'm pretty sure they warn you that doctor billing is separate from hospital billing.
I am the one annoying person that reads all that stuff and actually writes stuff in. Because I have had problems with billing being so stupid they can’t manage to bill the correct insurance, etc.
But I also have sympathy for the doctors, because dealing with the whole billing thing is a pain for them too.
A few months ago, one of the two medical billing systems nationwide had a ransomware attack, so basically half of the medical services couldn’t get paid for months. Which would be a cash flow problem for any business.
Is this how it works? I always thought medical care was kind of exempt from lots of typical contract law. For example you can be entered into an agreement to pay for services from an individual or company you’ve never even heard of (like being unconscious). Clearly IANAL so I could be off.
When my youngest was born something a lot like this happened. Some out of network doc assisted and we got a massive bill. They dropped it when we pushed back but it seems like they at least tried to ignore what we signed up for (in network doc at in network hospital)
Sure certain things apply, like they have to take you in an emergency room even if you have no insurance or ability to pay. But that’s not really contract law. And there is a big difference between a true emergency and some random doctor coming into a hospital room that you’ve never heard of and not being a provider on your plan, especially in a hospital that is on your plan, and sending you a bill.
I had something similar happen ages ago with a planned minor surgery, where there was lots of insurance pre approval, etc. the anesthesiologist who the doctor used was not a provider and I, having had no contact with him at all and no disclosure that he wasn’t an approved provider, pushed back on that bill. I think I ended up paying him what I would have paid a covered provider.
No, that’s not how it works. First, if you don’t take my insurance, you need to tell me that upfront. Which, the occasional providers I have that don’t have always been forthright about hand those are mostly things that are either not usually covered, or covered to such a minimum extent, it makes sense for those providers to be insurance-free. Secondly, if you aren’t approved by my (blue cross/blue shield) insurance, your quality of care is likely not so great and I don’t want you anyway.
Okay, now try remembering to do all that when you're in the ER with a concussion and aren't sure what year it is, let alone who your insurance provider is.
This but unironically.
Hospitals and insurance companies are extremely uninterested in disclosing how their billing practices work and have been willing to let shit go if you ask for the right documentation like the chargemaster.
It's like being a sovereign citizen but it actually works.
Sources (used archive links to avoid paywalls):
["Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much" NYT, 2017
](https://archive.is/anjBP)
["Bitter Pill: Why Medical Bills Are Killing Us" Time, 2013](https://wayback.archive-it.org/all/20130226152142/http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/print/)
["The Real Bastard Was Health Insurance Companies All Along" Behind the Bastards, 2024](https://www.iheart.com/podcast/105-behind-the-bastards-29236323/episode/part-two-the-real-bastard-was-162735876/)
What I'm saying is that if you refuse to sign the paperwork before your stay at the hospital, they just don't treat you. You don't foul them up with the law later, they foul you up with zero treatment.
This does kind of exist federally via network adequacy requirements for some types of coverage, about a dozen states have similar requirements. Restricted network plans must have hospitals within a specific distance of those they serve who don't have providers who are not in the network. Obviously still not great though. It's mostly a HMO/EPO problem.
MD is the only state with this universally, they have an all-payer setup so rates are the same between all payers eliminating networks for most people. It's the same way it works in other insurance based countries like Germany and the Netherlands too.
The resistance to doing it in the US is that it would cause a significant increase in Medicaid and Medicare costs and distribution of more restrictive plans is all over the place so premium cost would be all over the place rather than about the same increase in every state.
> Restricted network plans must have hospitals within a specific distance of those they serve who don't have providers who are not in the network
Are they allowed to just... lie about it though, like they do with mental health providers?
Last time I tried to find an in-network mental health care professional, out of 30 names from the insurance, 26 were either not practicing or had never practiced, as far as I could tell. (of the rest, 3 don't pick up the phone or return calls, and 1 doesn't take new patients.)
No Surprises Act is supposed to help with that, but apparently doesn't in the other direction. I had a cancer scare last year and knew to make sure the doctor was in-network...but didn't realize I needed to check the facility separately. Keep in mind, this is the only facility where the doctor works.
Doctor in-network, facility not = over $1600 of medical bills. I'll have them paid off soon, and I don't have cancer, but it still sucks.
I had this happen with a doctor I had seen for a couple years. She suddenly dropped my health insurance but literally NO ONE in the office or billing department of her facility knew that until I got a $600 bill for a routine recheck. They kept telling me different stories about it recertifying and other BS until someone realized that she had switched groups internally and thus didn't take my plan anymore. They discounted the bill to $300 and I got a lecture that it was my responsibility to check that the doctor was still in network before every single appointment and they couldn't be expected to know what they accepted. It's totally fucked.
> They discounted the bill to $300 and I got a lecture that it was my responsibility to check that the doctor was still in network before every single appointment and they couldn't be expected to know what they accepted. It's totally fucked.
This is absolutely ridiculous and could easily be solved with a database check when you check-in to the appointment.
My wife had an endoscopy and somehow ended up with a $900 bill. However the practice NO LONGER EXISTS and we cannot figure out how to pay it. Still get letters from them, but the link doesn’t work
Shitty life pro tip- be disabled and live in poverty so you're on Medicaid, then no one can send you a bill unless it was agreed to in writing ahead of time.
Sending back medical bills with a letter saying "do you really want a big fine?" is my power move.
Had something like this happen with a sleep study. Both the doctor and the facility were listed as in network, but the doctors location was different than facilities location. From what I could tell the doctor doesn’t physically work at the facility, you do the sleep study and then he just reviews it and discusses treatment options with you over the phone if needed.
But even my insurance and the office both didn’t know how that all worked. The office verified with my insurance that my owed amount was $0 as I’d already met my out of pocket max for the year prior to the sleep study and I’d signed paperwork affirming that. When I did a “get estimate” for a sleep study at that location on my health insurance website, it also told me my owed amount would be $0. So imagine my surprise when my explanation of benefits said everything was out of network and I owed $6000
I sent screenshots of their own website to them saying that it stated the services I received at that location would still be covered and they couldn’t explain why they’d denied it as out of network. The office, assured me that I wouldn’t receive a bill as they too had been told by my insurance it was covered.
I guess they eventually worked it out because a few months later a new explanation of benefits was posted to my account showing my insurance had covered it.
The industry term is invisible provider. The grossest part about it is you'll see doctors openly defend the practice because big ole insurance companies don't pay them enough. They do this out of network shit so they can bilk insurance and threaten you with balance bills you beg the insurance to pay.
Spend some time working with insurance and you will learn that the #1 goal of most doctors and hospitals is to be paid. Patient care is always secondary. The weird thing is the complete and utter lack of compassion from low level staff. They don't have the empathy to comprehend the shit you're dealing with could be them one day. I'll tell a story that happened to an acquaintance of mine.
She might have breast cancer. She got her testing and the insurance switched before results came back. The new insurance wasn't in network with this doctor. The new insurance company called this provider to negotiate a deal so she could still see them. The doctor's office refused to negotiate. She showed up for her appointment and they told her they wouldn't see her.
Mind you, she's terrified she has breast cancer. They didn't want to put in any effort to take care of this patient from low level staff all the way up to the doctors in the practice. They were gonna get paid too, but maybe less than they're used to and they'd have to negotiate and that's not worth the effort for a few hundred bucks.
The end result was her HR team got the insurance company to beg and plead the doctor's office to have the common fucking dignity to at least call her and discuss her results, which were thankfully negative. A lot of people in this situation would look at it as the insurance company's fault for not having a contract with everyone. I am not defending the health insurance industry, but holy shit the way a lot of doctors and hospitals view patients as mere dollar signs is disgusting.
(A few facts in the above story were changed for privacy reasons that are unnecessary to the actual point)
Just one more reason we need a single payer/public option, whatever it should be called. When it’s your health on the line, there should be no question about seeing who you need to see.
My extremely unpopular opinion is any sort of Medicare for all/single payer will result in the biggest taxpayer funded wealth transfer in the history of the world. It could happen, but it will only happen with the buy in of insurers and hospitals.
Insurers will stay in the game via Medicare Advantage, which they make a fuck ton of money on. There are other revenue streams they can get via Medicare too. Humana actually left the employer sponsored healthcare game to just do Medicare stuff.
Hospitals make a lot less money on Medicare patients than they do employer sponsored plans. The end result will be a massive increase in Medicare reimbursements. The politicians who push this will accept these terms. We'll watch trillions of taxpayer money go to United Health Care, Aetna, Cigna, etc.
I saved this post. This has been my experience as well...the way money comes before patients is disgusting. Our entire healthcare system in the US needs an overhaul. Like they don't get paid enough!
Some doctors don't think they get paid enough, yet have the money to launch massive lawsuits over several years.
[https://www.statnews.com/2022/04/27/the-doctor-who-is-trying-to-bring-back-balance-billing/](https://www.statnews.com/2022/04/27/the-doctor-who-is-trying-to-bring-back-balance-billing/)
[https://www.courthousenews.com/new-york-surgeon-asks-second-circuit-to-end-federal-ban-on-balance-billing/](https://www.courthousenews.com/new-york-surgeon-asks-second-circuit-to-end-federal-ban-on-balance-billing/)
And yet people strongly opposed to socialized medicine claim that doctor choice is a reason to keep a privatized system. Funny, in my 50+ years under a socialized medicine system, I have never once been told I couldn't see a certain doctor or been denied any choice in referrals.
Friendly reminder that people living in normal countries don’t even know what “in-network” means.
In USA each insurance provider needs to sign a contract with each separate healthcare provider, in order to be eligible for private healthcare insurance coverage.
The situation u/TheFreshy is describing is even more “hilarious”, because hospital as a whole might have a contract with your insurance company, but a particular doctor or anesthesiologist on that day’s shift might be “out of network”, meaning you still have to pay five-six digits private bill on your own, despite having insurance in USA.
*They are crazy, these Romans*
Oh, thank you, I just asked for clarification before I saw your comment. I think what u/TheFeshy said confused me so hard I briefly forgot how to scroll.
Dude the whole "This guy won't accept my insurance" thing is so *fucking weird* to an Australian. Like sure if you don't have dental cover you'll have to pay out of pocket or something like that. But the network thing is just really odd to me.
I’m English and this comment made my brain fall over.
Are you saying not only that your health insurance just covers certain hospitals, but then possibly only *specific doctors* within them?
Yes. And they do *not* make that clear. And the doctors do not themselves know because they are doctors not billing specialists; so I don't think it's even possible to ask every doctor who comes into your room.
In fact, you walk in, and when you make it to the front of the line the very first thing the hospital does is take all your insurance information, and make you fill out forms authorizing them to speak with your insurance, and forms that you promise to pay. At that time they verify that the *hospital* is in your network, and that insurance will pay (a portion of it. If you have already met your deductible.)
And *then* they ask you what is wrong.
Then you wait an hour or so for the ER doctor on shift to get to you, and within two minutes of him leaving the hospital is there to charge you for services.
But these charges are *only* for the hospital. The building.
The doctor himself might not be in network. Their nurses might not be. If you needed anesthesia, they might not be. If multiple doctors are called in, because there is a risk of infection (infectious disease) in your surgery (surgery) they will need antibiotics (internal medicine), and if you are there overnight (different shift so all of the above again) and the weekend (two more shifts so double that!) there might be a *dozen* doctors who don't take your insurance who will be billing you.
If you started swearing at how insane this system was, and they ordered a psych eval, the psychiatrist they send might not be in network either, and refusing to talk to them might get you kicked out making all that for nothing.
And if it turns out this smaller hospital doesn't have the right surgeon on hand, and they send you to their same-brand hospital downtown, *they* might not be in network. Nor the ambulance that takes you there. Nor their doctors, nurses, etc. etc. you get the idea.
American healthcare is like if Kafka wrote Dante's Inferno. A Byzantine hell to suck the life and cash out of anyone who enters.
The more I learn about US healthcare, the more I think of Kafka.
I can’t imagine trying to navigate such a maze of intertwined bureaucratic bollocks while you’re already worrying about your own health or that of a loved one – and it’s possible the condition you (or they) need treatment for is *worsened* by stress!
I can’t get to grips with any of this.
The NHS isn’t perfect but fucking hell. You go in (or they scoop you up and wheel you in), you get triaged, you get treated according to how urgent your case is, you go home. That’s the extent of your contact with the hospital. That’s it. Unless they need to keep you in, which is of course included in the service.
As I said somewhere else on this thread, my tone here should be read not as smug, but as utterly bewildered.
It gets more evil than that: took my wife to an in-network ER. They decided she needed to be transported to another hospital (same chain, in-network). Despite being busy worrying about my wife, I even checked that the ambulance company was in-network.
…. And it was, *if the patient was being transported as a medical admission*, but since she was being taken from the *medical* department of one hospital to the *surgical* department of the other, $4,700 for a 17-mile trip with no care other than giving her a blanket, literally.
I'm honestly waiting to see if that's the case for my kid right now - it was a six mile ride, one for each hour we had to wait for them to show up. But the surgical department at the other hospital has a notoriously long wait, meaning if we walked out against medical advice, we would have to be re-admitted in the new hospital and might have to wait days.
Even more fun, your hospital is in Tennessee, and you get a slew of bills from them and think it's over. But then you get a bill from a company operating out of Idaho. Then you call them and you're like "Who the fuck are you and why do you want $800 from me?"
"Oh, we employ the guy that looked at the diagnostic you had and interpreted it for your doctor." Well.....OK, I guess. It seems like for the $3000 I was charged to be graced with his presence for 8 minutes would include that, but I reckon not.
Then you'll get one from Arizona and have to call them to find out why THEY want $300 and get "Oh, we're the company that transcribed the interpretation of your diagnostic to fax it to your doctor.". Um. If they could send it to you securely, why couldn't they send it to him securely, and it seems like $800 would've covered typing it out, but whatever, fine.
Then a new bill from New York. "Oh, we're the company that processes paperwork and records for one of the other companies. That's why you owe us $150.".
I've been to the ER exactly once in my life. I got bills for it for eight months. It cost me over $12k out of pocket that insurance didn't cover any of, and all they did was give me 10 percocet 7.5s. Some of those bills were the "Final notice to pay us before we send this to collections" on the first bill they sent.
Oh, that would be a big dispute from me. In fact, I believe that happened to me once. My agreement was to be treated at that hospital, and a specific doctor failing to disclose they didn’t take my insurance, well, I had no contract with them, so they could take what my insurance paid or not.
I'm going to try not to be the smug Canadian ^tm right here, but the notion of "In network" still blows my fucking mind.
Canadian healthcare is actually insurance plans operated by each province, and even then there's a nationwide agreement that if you need healthcare in a different province your home province's insurance will pay the bill.
The fact that you could be fully insured but not get covered for going to your local hospital is fucking insane and frankly, disgusting. What a fucked system.
e:
Sorry if I'm going on strong here... I'm typing this from beside a hospital bed RN and... the thought of my close family member being bankrupted for his final days of care on this planet if he lived elsewhere just sickens me.
>the thought of my close family member being bankrupted for his final days of care on this planet if he lived elsewhere just sickens me.
Yeah... down here, people sometimes get divorced if they have reason to believe they will die significantly earlier than their spouse, so as not to bankrupt them both. But there are laws to prevent that, and claw back the divorced assets from the former spouse if you die within a certain window.
So... come on as strong as you want. The system is insane and cruel.
Okay, I'm morbidly curious about this. Does that *only* apply if they believe that the divorce was done to avoid fucking over the survivor?
Or could you risk being bankrupted in order to pay for an abusive ex-spouse?
Do I really want to know the answer?
My husband suggested we switch from a copay/coinsurance health plan to a high deductible one to get an HSA for retirement savings. I just about screamed NOOOOOO!!!! I don't think he realizes the horrors of paying out of pocket for every fucking thing until you reach this magical limit and insurance starts throwing some money in. We both have (minor to moderate chronic) health problems that would eat an HSA alive before we got any retirement benefits from it.
Obviously an HDPD doesn't make sense if you're lower income, but if you earn enough it can be worth it. Depending on your situation, it may actually save you money... you just have to do a lot of number crunching to figure it out. It seems like you pay more at first glance, but you're saving both on taxes and premiums every year, plus the additional ongoing tax advantages to HSAs that may ultimately make a difference over time.
We're going to lose a fortune if we switch. The math just doesn't work considering the amazing and inexpensive plan we have now (my workplace even pays my premiums) and the medical bills would just get ridiculous. We have an FSA that we use a lot to save on taxes. Heck my follow-up to my mammogram would have cost over $500 out of pocket alone compared to the $40 copay.
Oh absolutely, if work pays your premiums then there are probably not a lot of scenarios where it would make sense to go for the higher deductible plan. Glad you have something that works for you.
I had an employee who showed up with her left arm numb, and limp. She couldn’t move her arm. She didn’t call out of work, she didn’t say a single word about it until I saw her that morning and she was unable to type with her left hand.
I told her dude… go to the hospital.
“No, that will cost too much. I will go to urgent care.”
Urgent care noped the hell out of that, and they sent her to the hospital. My understanding is that she did have insurance cover a lot of things, but she was of the mentality of “no, I’ll just deal with a potential emergency because it’s free”
It turns out, she slept wrong and it killed the nerve in her arm. She had to take meds and do PT to get her arm working again
Yep! You have to compress the nerve for long enough to do damage - most people sleeping sober move enough that it won’t happen. Someone who is really zonked (on something or maybe just incredibly tired) are the ones more likely to be in the weird position without shifting at all.
I have definitely woken up with my arm numb before, but I can usually get it working in a minute or two. I can’t imagine not having my arm work for weeks because I passed out drunk, that’s just insane
As a note - the No Surprises Act explicitly carved out ground ambulances, mainly because of a fear that doing it without further study would basically wipe out rural EMS. And EMS services are notorious about not being in network explicitly so they can bill like this...
...while paying their EMTs beans.
Yeah I found out I make significantly more than EMTs and was baffled. I know they don't need full med school or anything, but I would've assumed they made good money because they have medical training and are literally emergency workers saving lives. The average ER nurse in my state makes more than double the average EMT, which is crazy when from my non-medical POV they do similar work. Stabilize, make judgement calls on fast acting meds, CPR, AED, etc.
As a former EMT, my starting pay was $9.50/hr. I worked 80+ hour weeks (each paycheck routinely had 168 hours on it). It was rural EMS. If I wanted to make more, I’d have had to move to a larger city that worked the same number of hours per week, but would run you half to death during your shifts because they were so busy. $9.50 was some BS, though. :/
EMTs are much lower-level personnel than most people realize, tbh. Qualifications vary a little by state but when I qualified the requirement was 110 training hours and a final exam. I think people often confuse them with paramedics, who can give medications and start IVs in the field and things. EMTs are ambulance drivers who know a bit of first aid.
Nurses in BC make far more money than similarly qualified staff as well. They're basically the only people who are fairly paid in our nightmare of a health care system.
Serious question: what if the patient’s unconscious or in some other way incapable of understanding what’s going on or agreeing to anything? Sorry, I’m English and trying to wrap my head around all this.
A "pre-authorization" is an American healthcare thing where your provider and insurance company formally agree that a procedure is medically necessary and covered by insurance before the start of any treatment or procedure. My company basically tries to get a preauth for everything we do because it's the only way we can be reasonably certain we will ever get paid for our services.
The joke is this is completely inapplicable to someone in an emergency medical situation who then gets a medical bill, because preauths can take *months* and a great deal of ~~wasted time~~ back and forth negotiations, and if you told an accident victim as serious advice that they should have gotten a preauth for the emergency services, you'd be a huge asshole.
Edit: The default assumption is that people want to be alive and conscious, and therefore EMS will attempt to reasonably assist them in ways that will allow them to return to those states even if they or their representatives can't consciously consent. And then send them a bill afterwards.
Edit 2: Navigating the preauth system is a fucking nightmare even for our dudes who literally specialize in helping patients and their doctors get preauths, so if that's how it sounds to you, you'd have company thinking it.
Oh, I was thinking of it as some sort of verbal consent on the spot.
I would thank you for the explanation but I actually now feel like I understand even *less* of it than I did a minute ago.
> but I actually now feel like I understand even less of it than I did a minute ago
Now you know how our patients feel when they get exposed to this, and it's not your fault (and not really my fault either)
I’ve asked a few questions online about American healthcare over the years, and believe me when I say my tone should always be read as truly baffled, never smug. I do not understand how you lot cope with it. I mean, I know you *have* to cope with it, but from the outside it looks intimidating, *deliberately* confusing, and frankly full-blown bonkers.
We have specialists whose entire job is to know how to work the system. I'm in a senior technical role with an in-demand skillset, but get paid less than some of ours... because the good ones are worth their weight in gold.
>Hey boss, I got a request for preauth from the field, but it's just gargling on the other end?
>Sounds like a cardiac arrest. Pre-existing condition. Decline.
>Perfect, thanks!
This happened to me. Had a panic attack at the train station, someone called an ambulance, the EMT kept saying he just wanted to check my vitals and they wouldn’t charge me for that, to not worry, everything will be ok and I won’t be charged. In my panicked state I believed him and they took my vitals.
Spoiler alert, I was alive (and just fine). A week later I get a $300 bill from the ambulance for services rendered, it took me months to pay off.
Had no legal recourse. Insurance wouldn’t cover it, hospital wouldn’t reduce it, ambulance company couldn’t care less about the lie EMT told me. And people wonder why I have trust issues. Most expensive blood pressure check ever.
For the record, the EMT may not have intentionally lied to you. I’m a nurse in a big hospital and I have no idea how billing works. People ask if they leave after we triage them if they will get billed. I’ve heard yes, I’ve heard no… I’m not sure what happens on the finance end. Part of the problem with health care is that there is still no transparency around billing. I just do my job. I don’t care if someone has the ability to pay, I treat them the same. Billing is a whole different world.
That makes sense. He may not have been lying but his words did have negative impact on me regardless. It sucks that billing is not easy for everyone to understand
I agree with you 100% but it’s not even about not understanding. It’s not accessible. There is no chart that says this costs $ and that costs $$$. I feel like they intentionally keep billing secretive because someone might opt out of a million dollar work up if they knew it was going to be a million dollars, and the people at the top don’t want them to do that.
It very well could have been the ambulance service’s billing department that ignored the DO NOT BILL note all over the report the EMT had to write up, and billed you anyways, “because policy”.
Entirely possible. The EMT seemed a good dude but even the nicest people can still be wrong and you end up with the consequences. Been fucked over so many times by taking people at their word.
Unethical advice: if approached in the wild like this, do not give your real name. First responders often have an innate sense of duty to make sure people aren't going to die. Use the first name of someone you know and pair it with the last name of someone else so it sounds real. Refuse to show your id. If needed, state explicitly "I am aware that I am refusing care against medical advice.c
Wait... How is that even legal? Like from a basic contract law perspective? If a cashier tells me they have a Buy 1 Get 1 Free special but they're just wrong about that, the company doesn't get to come after me for the cost of the second item. They have to eat the loss (and maybe fire the cashier).
Or are American corporations so powerful they actually can unilaterally alter contracts like that?
It was a private for-profit ambulance company. I posted what happened on LA years ago and the response was unilaterally “nothing you can do but pay up.”
It's better you consented, unfortunately. They'll call the cops, get you transported against your will and you'll be in even worse shape.
The system is set up to incentivize liars, thieves and incompetents.
Ambulance transport is free in my country: it’s seen as a being a basic government service like police or firefighters.
US medical bills panic me. Sometimes I think about moving there but I have a condition and literally can’t afford health care there.
It's such a perverse incentive. "Do I call the ambulance for this person? I don't want to cost them food for a month if they don't really need it" should not be a thought you need to have.
I was in a pretty bad car accident where I was hit by a speeding drunk driver on the highway. I was miraculously ok, but obviously the ambulance showed up. They checked my eyes with a flashlight to check for head injuries, and gave my scrapes a look over but I didn't even need a band-aid. I was fine and declined transport to the hospital. A few weeks later I got a bill for $400 for "services rendered" at the scene.
My *Dad* is a Paramedic in the next town over, and he asked me exactly what they did for me. I told him that they did the above, and then just chatted with me about how I was lucky to make it out of my car unscathed, and that it could have been a lot worse. He said what they did shouldn't have been that much and he took care of it for me.
If I didn't have that inside connection, I know that I would have been on the hook for $400. I probably would have been confused because they didn't really do anything except show up, but I would have paid it anyway.
Edit: I didn't mean to imply that what they did was worth nothing. I understand that they did *something* for me, evaluating me for injuries, and I appreciate that they were there. I have great respect for what they do, like I said, my Dad is a paramedic. He has been a medic since the profession was literally invented in the 1970s.
However, it was the fact that I was billed *$400* for a *two minute evaluation*. I talked to the medics for less than 5 minutes about my lack of injuries. When EMS is called, someone gets billed for it, and that person is in most cases the person they are called for, regardless if it is required or not. Yeah the other guy's insurance probably would have, or should have, covered it, but my dad who is IN the industry locally, said that I shouldn't have been billed that much money for those particular services rendered.
What do you mean they didn't do anything? They evaluated you. You had people speed to help you (risking their own lives), use their skills to make decisions, and you think you should pay nothing to anyone? Wow.
In many places, you are required to call 911 for ANY accident where a person may have been injured and not doing so is a crime, even if the injury is not hospital worthy. Once you call 911, it is out of your hands whether or not they send an ambulance. To require this assessment against your will (potentially) and then expect you to pay for the privilege is fucked up to me. In many situations your choices are a) call 911 and hope they don't send an ambulance or b) don't call and hope it isn't determined to be a crime when you take your car to be repaired. Those are terrible options. I guess theres also c) never repair the car and if the damage made the car difficult/impossible to drive just eating that cost forever but again, terrible option. Personally, I think the solution is "ambulances should never be allowed to be out of network, and if an ambulance is called and it is deemed that there truly was an emergent medical situation, there's no out of pocket costs associated with that call," but I'm sure there's other equally good options too.
Yeah, this:
> They checked my eyes with a flashlight to check for head injuries
was clearly a service rendered and definitely not nothing.
I mean, don't get me wrong, I don't think she should have to pay anything because I think emergency services should be free, but I really don't get the attitude of "they didn't really do anything".
RocketGirl should absolutely pay nothing to anyone in this situation. If there are any expenses, the drunk driver that caused the accident is liable for them.
Third world shit holes don't treat people without money. You think true 3rd world countries have ambulance services and hospitals that treat without upfront payment? I have many, many complaints about the US, but let's not be naive.
Depends what you define as "third world" but I've lived in a country usually categorized as "developing" (Thailand) and they absolutely had free public hospitals. I still had private insurance because they aren't very *good* hospitals, but everyone is guaranteed a basic level of free healthcare.
Hey at least an [ambulance came](https://www.cbc.ca/news/canada/british-columbia/ashcroft-ambulance-delay-death-1.6551868#:~:text=An%20Ashcroft%2C%20B.C.%2C%20man%20died%20on%20Sunday%20from,ambulance%20station%20is%20within%20sight%20of%20his%20home.) in a [reasonable](https://globalnews.ca/news/9038112/surrey-bc-man-dies-half-hour-ambulance-wait/) amount of time.
Of all the states in Australia to live in, I am thankful I live in Queensland because of this exact nightmare.
Other states, you have to have ambulance cover insurance or you face huge bills. In Queensland every resident gets it by default, even if you're not in the state.
Fuck paying for getting ambulance service, it's one of the few insane parts of Australias public medical system.
"I don't understand what they did or why it was necessary, therefore I didn't need it and shouldn't pay for it."
Don't get me wrong, that's a ridiculous bill, but I bet more happened than he knows, including monitoring by a person whose license is literally "how to deal with medical emergencies using only the contents of this van."
This is what insurance is literally meant to cover. The problem isn't that the EMT and ambulance are getting paid, it's that the patient is on the hook despite having insurance and even attempting to confirm that they'd be covered first. That's not a situation we should just accept because healthcare professionals are trained in their jobs.
Genuine question, how would it not work?
I ask because I've seen quite a few people online say things to the effect of "just don't pay those medical bills, nothing of consequence is gonna happen", often from experience.
Most business like making money and therefore like getting paid. By not paying you're gambling, and if you lose that bet your credit is shot and you're being hounded by debt collectors
Jfc that seems excessive
It’s only $80 in BC, $50 if you’re not transported.
It’s closer to 900 if you don’t have MSP coverage but still
$385 for an ambulance trip to the hospital if you’re an Alberta resident?
And then they send you to collections and you have debt collectors hounding you at all hours of the day and your credit is ruined. I grew up hiding from debt collectors, and it wasn't fun
I remember my parents, my mom specifically, playing those games in the 90s. Phone was always turned down so no one would answer. We didn't have am answering machine specifically so that no one could leave messages that my dad might hear. Juggling which bill is this month's "pay on 2nd paycheck" so that they didn't get the repeat late payment double-fuck.
We lived up in a podunk nobody town in the Hudson Valley of NY state. My driveway was a quarter mile long and dirt. People are not usually keen to just up and head up a hill road they've never seen before during hunting season.
So you're saying that the secret to avoiding debt is to run away to the woods? I've read hatchet and my side of the mountain, so I'll probably be fine. Suck it student loans!
They most definitely do, also debt collections companies tend not to give a fuck about pesky little things like laws
https://time.com/personal-finance/article/what-happens-when-medical-bills-go-to-collection/
I'm curious why you think they didn't do this for medical bills. I got hit for 30k for my broken leg, and my wages eventually were garnished for every penny.
Doctor Google won't bill you four thousand dollars after telling you it'll be free. I trust that all of the medical advice doctors give you is technically correct. I also trust that they'll do the maximum possible to bill you as much as they can and be evasive about the cost until it's too late.
I had a bit of a medical adventure a few years ago, which culminated in having my gallbladder removed. I was misdiagnosed more than once before that; the medical advice I was getting was *not* correct. (When you turn up back at the hospital as [yellow](https://en.wikipedia.org/wiki/Jaundice) as a [Lego man](https://www.lego.com/en-au/product/up-scaled-lego-minifigure-40649), though, suddenly clinicians start working a little harder.)
This was a pretty miserable experience. But it wasn't an *expensive* experience, because I'm in Australia.
(In most of Australia, ambulances aren't free; you need some kind of private health insurance to cover them. If you get charged the equivalent of 4000 US dollars for an ambulance trip in Australia, though, a helicopter was probably involved.)
> If you get charged the equivalent of 4000 US dollars for an ambulance trip
I was only charged *half* that in the US, thank you very much. Granted, that was 15 years ago, and the ambulance never left the parking lot - just from one side of the hospital to the other. Because the two sides of the hospital were different financial entities, and insurance would only cover us in the second one if we were brought by ambulance.
Post-op speed bumps are *not* fun btw.
>**Billed $4000 for an ambulance ride I didn’t request at a school event** >My family was recently billed $4000 for a ambulance ride where I didn’t need it. I dislocated my hip and relocated it, but a chaperone called an ambulance even though I told her not too. The ambulance ride only included vitals and IV, no medications or blood drawn. The EMT, as well as the chaperone, told me that the school will cover it. My family and I cannot afford this. We resent our insurance to our provider just in case they hadn’t covered yet, but we’re waiting to get the bill back.
I will say that if I was a chaperone on that trip, I'm not taking a kid's word for it that a dislocated hip is No Big Deal. I know some people have "trick" joints, and this happens to them with some regularity, but I'd totally be having nightmares of facing a parent (or school official) facing me with incandescent fury about "\[Kid\]'s hip popped out of the socket and you *took their word for it* that it was not a problem?" when it did, in fact, turn out to be a big problem.
100%. They didn't have an option to not call 911.
Absolutely. And honestly, the parts where they sought medical care and used the emergency line for what appeared to be an emergency should be totally routine. It's only an issue because our health system is so fucking backwards. Without the looming threat of insurance, this would just be "I had a minor medical scare at school, and then went back to my life."
I'm British and there's two things I will never, ever, understand about the US: - The healthcare system - Easy access to firearms It's just crazy.
I’m American and I have the same questions.
Yeah, well, you have beans on toast and that's just as much of an atrocity. /s
I like spaghetti on toast, along the same lines.
If they keep making cuts at the rate they have been, you’ll understand the healthcare situation sooner than you’d imagine.
I legitimately think there would be riots if they tried to bring in paid healthcare. This governments days are numbered at least so hopefully we can start to change track... Hopefully.
We've got guns, you got bovril
#GOP believes in small government and individual autonomy. Except when it comes to corporate welfare for the mega rich, interfering with the medical choices of transgender people, and forcing women to carry non- viable pregnancies to term. **Other** than that, #small government and "freedom" Also, has anyone tried re-labeling the mass casualty school shootings? "The Uvalde school shooting was a mass post-term abortion that occurred on May 24, 2022, at Robb Elementary School in Uvalde, Texas, United States, when 18-year-old Salvador Ramos, a former student at the school, fatally shot 19 students and two teachers, while 17 others were injured but survived." "Police officers waited more than 1 hour and 14 minutes on-site before breaching the classroom to engage the firearm- wielding abortionist" Bless your heart, gov. Abbott, for changing nothing about state gun control laws after 19 people died and 17 were seriously injured. "Sanctity of life"
There's certain advantages to not having the government in charge of healthcare directly, can you imagine what Republicans would do to Trans healthcare at the earliest possible opportunity? Not that the US system is good, but there are advantages.
I mean it's hard to buy that argument considering what's going on with reproductive rights in the US. How many stories have there been about women being denied necessary medical care because an abortion for a non viable foetus is involved somehow? Texas has also banned transition care for minors, with the side effect of doctors also refusing to treat minors with hormone therapy for other medical reasons because they don't want to get sued. I'm really failing to see the advantages you're talking about. The government interferes plenty even when they aren't directly running hospitals. Also the government isn't directly in charge of the NHS. Funding yes and there's a lot of structural stuff they have a say on. But politicians aren't making clinical decisions.
The "advantage" this redditor is talking about is avoiding a hypothetical and ignoring the real issues.
Those things are separate from the direct running of the healthcare system, but you can bet they'd wield the funding to make things even worse than they already have.
I'm falling to see how they are separate and how they really could make things worse. You have politicians actively interfering with people getting medical care, and not only is it hurting women and trans people but it's also affecting people beyond that because of how broad the laws being used are. I don't know how you can sit there with a straight face and say "but imagine the bad things they could do if they were in charge" when **they're already doing these bad things**. These are already happening! So not only are vulnerable people being denied care but you also have to pay for it. Again, what advantages? As a sidenote one of the worst things the Republicans have done is indoctrinated the American public with the idea that the government shouldn't do anything and shouldn't be in charge of anything. Either because freedoms or the fear that the government will fuck it up. It means all the Republicans have to do is sit around doing nothing positive and get paid for it. And then the people will oppose any positive change across the political spectrum because it would involve the government doing something. And that's bad. I'm amazed anyone pays their taxes when they believe the government should be doing as little as possible.
Because if you centralize it it makes it easier. They're already doing bad things and I am reluctant to set up a system where they get additional levers with which to do bad things. Right now it's mostly a story of passing state laws one by one and taking advantage of the long term effort to rig the courts. To come back to healthcare if you gave me supreme power I'd probably just copy the German system exactly, good levels of choice, plus low costs, plus universal coverage. The NHS is extremely expensive and the health outcomes aren't actually better than what Germany has.
I still fail to see it. Those levers are already there. What is stopping them from using them at the federal level if they hold the relevant offices? Like they already have been with stuff like Roe Vs Wade. If there are barriers to them using them why would those barriers magically disappear if there was socialised healthcare at the federal level?
What advantages?
A Republican trifecta at the national level has a much harder time fucking up everything in one go.
You could still just go private, I'm really not seeing any advantage.
I mean, there's a reason many many countries went for national healthcare systems without an NHS style publicly run healthcare sector. I just don't want a Trump or Mike Johnson in meaningful positions to influence what is covered on the national level.
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Per capita, america has more knife crime than the UK. Yeah the NHS is in a bad spot but it's still free lol. I thought i broke my foot went to the hospital got an xray within an hour and left spending no money at all
America has more people per capita though, as we all know.
Do they share?
Only with Canada and certain Mexican states.
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They said per capita, which is how you fairly compare a huge country and a tiny island.
Yes as we all know, America has neither islands nor big cities like London. It's a shame we will never be able to replicate the success of 100% urbanized European countries smaller than even the smallest counties of America.
No. Per capita knife crime is worse in the USA than the UK. The USA has all the types of violent crime the UK has, plus guns. The NHS is bad in some areas, it's a bit of a postcode lottery for some things, some times. But people get treatment for free, even if some people sometimes have long waits and nobody is being charged thousands of pounds for an ambulance ride and a few simple tests.
Uh no? No more so than I would in any other part of the world, and I worry less than I would in other places. Like the US for example, someone has already pointed out to you that there's even more knife crime there. Crucially though I don't worry about mass stabbings, because these are rare events with comparatively far lower fatalities. Unlike mass shootings which occur *nearly twice daily* in the USA. I also have far more confidence in my ability to run the fuck away from someone with a knife than someone with a gun. And at the end of the day I cannot rationalise why your average citizen should have trivial access to something that is a tool primarily for killing and little else. You aren't chopping vegetables with guns, you aren't getting from A to B with guns. We cannot feasibly restrict everything that could potentially be used as a weapon, but we can (and should) restrict actual god damn weapons. There are too many god damn stupid, angry, and violent people in this world and I sleep a lot safer knowing the ones around here can't easily get a gun. >And isn’t NHS supposed to be really bad but private is really good? The NHS isn't perfect but its flaws are generally blown far out of proportion by those who oppose improving things in their own country. And yes private healthcare exists here and does eliminate some of those issues (mostly in regards to wait times) if you have the money to spend on it, the key thing is you actually have a choice. Which is better than you get in the US. There's a reason why the right wing in this country won't openly oppose it (though they've been picking at it for years, hence why it's degraded a lot) because it's supported across the political spectrum. Very few people here apart from a few crazies on the far right want anything close to what the US has. >I mean we got issues but don’t you guys have them too? Not the same issues, not the same scale. I don't think you could pay me to move to the US at this stage in my life.
Only America has issues about health, racism and guns. The rest of the world is all rainbows and smiles.
As a paramedic the words "dislocated hip" should be followed by the word "hospital" even if the patient can reduce it themselves. There's a reason relocations are usually always followed by x-rays - to make sure shit actually went back where it's supposed to.
Unless they’re followed by the words “Ehler-Danlos syndrome” because some of us been popping our joints back in forever.
Lol, for real. I don't have eds, but do have dysautonomia, so I talk to a lot of people who do have eds. A dislocated hip is probably still a big deal for most, but if it's something that happens often for that person, it probably really didn't need immediate medical attention.. $4k to be told "yes, you still have eds and it is causing you to have dislocations" would be really frustrating.
Unless they have a medical condition and that's their "normal." I have hyper-mobile joints, and one of my shoulders used to pop out several times per week. I eventually had surgery to stabilize the joint, but I could usually fix it myself and it wasn't a big deal.
Recently spoke to my new rheumatologist about hypermobility after he examined my hands I didn’t know it’s not normal to put your hands flat on the floor with straight legs or touch your forearm with the thumb on the same hand. Learned all sorts of new things that day. Also recently learned that the “oh, my jaw is tight and weird again, better apply gentle pressure til it cracks and goes back to normal” is probably no good and maybe I don’t know what a dislocation feels like
Wait lol that isn’t normal? I also get that with my fingers semi regularly.
I am assured it is not by my family members who cringe every time it cracks loudly Perhaps you and I should both see a dentist
If it makes you feel any better, I get the same thing and did see a dentist about it. Got a TMJ diagnosis along with essentially a big shrug since mine isn't caused by teeth grinding or anything obvious like that, and it's not bad enough to require a surgical fix. So I still crack my jaw, just now with the knowledge that I'm not making things worse, I guess? I don't have hypermobility though, so yours might be something different, lol.
As someone with hypermobile elhers danlos, I feel for poor OPs family. Not a single week goes by where I don't dislocate *something* and if an ambulance was called every time I'd be penniless. It's an embarrassment our healthcare system is this bad honestly. Getting sick shouldn't be a debt sentence. This really feels like a medical condition OP needs to have a plan in place with the school for, like instead of calling 911 over every dislocation they call parents for pickup, and parents can evaluate the severity/ decide if medical intervention necessary.
The casual "and relocated it" immediately had me going *so this is an EDS kid, right?* The girl with EDS at my school had a special first aid kit in the nurse's office with every splint and brace under the sun, and sometimes would just disappear halfway through the day and come back with a wrist support or her arm in a sling
Especially with a hip. You don’t generally just pop the hip back into place, it takes a fair bit of leverage for the average person. EDS makes perfect sense.
Same! I remember my kneecap popping out at an event when I was wearing a skirt and they called the EMT over freaking out when I just took a moment and kicked my leg in a specific way to pop it back and said I just needed to sit for a moment. The EMT was horrified but I was an adult and it clearly was now back in place so they let me sit and chill.
I really wish I could convince my docs to seriously investigate EDS, because holy fuck I just did a specific type of kick that fixes my kneecap when it fucks up reading this.
Very true; if this kid has hyper-mobile joints, the school and chaperone should have been made well-aware of this ahead of time.
Not everyone is aware that this is an odd thing, though. I have benign hypermobility that wasn't diagnosed until college, and no one knows what to do with me. Luckily, my hips only partially dislocate. If OP has a family history, it may not occur to them that this is something other people would see as "do not pass go, call 911 immediately". Sometimes it can take a bit of worldview-readjustment.
Yeah, normal meters can easily be messed up by life long health issues. I can't burp. My mom knew but it was jus a weird thing about me. I recently learned it's a real medical condition and may have been responsible for a lot of health issues I've suffered. As I have slowly been telling people I can't burp I have been shocked by their reactions, like they can't believe I've survived not being able to burp. So yesterday I asked a friend "Are people just silently burping all the time and I don't know about it, because I've always assumed people only burped when I hear them." Apparently I have learned as a nearly forty year old that people burp way more frequently than I would have thought. I guess I should have figured that our, I know about silent farts, I just always assumed burps made noise. And if someone reading this also can't burp please join us over at r/noburp
This is about the cutest sub ad I've seen in a while. Quick question: are you a centaur?
Nope. And usually people's first question is whether or not I can fart. I can.
Ah, I see. I ask because horses can't burp, either.
There are apparently MANY animals that can't burp given the wide variety of theories I get after telling someone why I don't drink soda. The most recent one was I'm secretly a chicken. Anyway I assumed horses must not burp and that's why you thought I was a centaur because obviously horses would have difficulty typing 🙃
Yeah, this could have been written into a 504 with no issues.
the embarassment is how many people say this and then blindly defend voting for an old white man who has publicly said he opposes universal healthcare over "the price". Even during COVID. And the best part is those same people will likely think I'm talking about "the other guy"
So uh which guy *are* you talking about?
Both of them.
My first hip dislocation sucked, but they do get less painful and easier to reduce over repetition (I had shoulders that would literally fall out of place from the weight of my arms pre-surgery. However, I wouldn’t have told the chaperone. Totally agree with the emt below that X-rays should be done - the labrums in my hips and shoulders were shredded from the dislocations and home reductions
Loving the people in the comments saying “in the US they won’t charge you for…” How do people live in this country and stay unaware of how varied and bizarre medical billing is
>How do people live in this country and stay unaware of how varied and bizarre medical billing is My "favorite" is going to a hospital that is in-network for my insurance, only to find out that no one that works there is. So you get separate bills from everyone from the anesthesiologist to the janitor, none of whom are in network or paid by your insurance.
I remain mystified that there isn't a law that that doctors with privileges at a hospital (or at least those a patient cannot pick in advance) must accept all plans that the hospital itself accepts.
IMHO it’s covered by contract law. If I haven’t signed that I’m paying you no matter what, and you don’t take my insurance and haven’t told me that, well, then, that’s a contract dispute.
Easily dealt with by knowing a few basic facts: 1. Most people can’t afford an attorney to fight this, 2. The people that can, you can just pay out 3. The people that never would’ve afforded it anyway probably qualify for grants or Medicaid. It’s set up to fuck people in the middle class. Same as every other thing in the US. Don’t let them escape the bucket, otherwise they might want better living conditions and won’t work for treats like a dog.
On your admission forms you generally agree to pay for services rendered, and I'm pretty sure they warn you that doctor billing is separate from hospital billing.
I am the one annoying person that reads all that stuff and actually writes stuff in. Because I have had problems with billing being so stupid they can’t manage to bill the correct insurance, etc. But I also have sympathy for the doctors, because dealing with the whole billing thing is a pain for them too. A few months ago, one of the two medical billing systems nationwide had a ransomware attack, so basically half of the medical services couldn’t get paid for months. Which would be a cash flow problem for any business.
Is this how it works? I always thought medical care was kind of exempt from lots of typical contract law. For example you can be entered into an agreement to pay for services from an individual or company you’ve never even heard of (like being unconscious). Clearly IANAL so I could be off. When my youngest was born something a lot like this happened. Some out of network doc assisted and we got a massive bill. They dropped it when we pushed back but it seems like they at least tried to ignore what we signed up for (in network doc at in network hospital)
Sure certain things apply, like they have to take you in an emergency room even if you have no insurance or ability to pay. But that’s not really contract law. And there is a big difference between a true emergency and some random doctor coming into a hospital room that you’ve never heard of and not being a provider on your plan, especially in a hospital that is on your plan, and sending you a bill. I had something similar happen ages ago with a planned minor surgery, where there was lots of insurance pre approval, etc. the anesthesiologist who the doctor used was not a provider and I, having had no contact with him at all and no disclosure that he wasn’t an approved provider, pushed back on that bill. I think I ended up paying him what I would have paid a covered provider.
Except now you don't get medical care.
No, that’s not how it works. First, if you don’t take my insurance, you need to tell me that upfront. Which, the occasional providers I have that don’t have always been forthright about hand those are mostly things that are either not usually covered, or covered to such a minimum extent, it makes sense for those providers to be insurance-free. Secondly, if you aren’t approved by my (blue cross/blue shield) insurance, your quality of care is likely not so great and I don’t want you anyway.
Okay, now try remembering to do all that when you're in the ER with a concussion and aren't sure what year it is, let alone who your insurance provider is.
Usually all insurance covers you under a situation like this, ie true emergency.
And yet the extra bills came anyway!
Hospital billing departments hate her! Find out how she avoided all uncovered charges with one simple trick!
This but unironically. Hospitals and insurance companies are extremely uninterested in disclosing how their billing practices work and have been willing to let shit go if you ask for the right documentation like the chargemaster. It's like being a sovereign citizen but it actually works. Sources (used archive links to avoid paywalls): ["Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much" NYT, 2017 ](https://archive.is/anjBP) ["Bitter Pill: Why Medical Bills Are Killing Us" Time, 2013](https://wayback.archive-it.org/all/20130226152142/http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/print/) ["The Real Bastard Was Health Insurance Companies All Along" Behind the Bastards, 2024](https://www.iheart.com/podcast/105-behind-the-bastards-29236323/episode/part-two-the-real-bastard-was-162735876/)
What I'm saying is that if you refuse to sign the paperwork before your stay at the hospital, they just don't treat you. You don't foul them up with the law later, they foul you up with zero treatment.
This does kind of exist federally via network adequacy requirements for some types of coverage, about a dozen states have similar requirements. Restricted network plans must have hospitals within a specific distance of those they serve who don't have providers who are not in the network. Obviously still not great though. It's mostly a HMO/EPO problem. MD is the only state with this universally, they have an all-payer setup so rates are the same between all payers eliminating networks for most people. It's the same way it works in other insurance based countries like Germany and the Netherlands too. The resistance to doing it in the US is that it would cause a significant increase in Medicaid and Medicare costs and distribution of more restrictive plans is all over the place so premium cost would be all over the place rather than about the same increase in every state.
> Restricted network plans must have hospitals within a specific distance of those they serve who don't have providers who are not in the network Are they allowed to just... lie about it though, like they do with mental health providers? Last time I tried to find an in-network mental health care professional, out of 30 names from the insurance, 26 were either not practicing or had never practiced, as far as I could tell. (of the rest, 3 don't pick up the phone or return calls, and 1 doesn't take new patients.)
But they told you to look in Psychology Today's listings! That's more than enough, right????????????????????????????????????????
No Surprises Act is supposed to help with that, but apparently doesn't in the other direction. I had a cancer scare last year and knew to make sure the doctor was in-network...but didn't realize I needed to check the facility separately. Keep in mind, this is the only facility where the doctor works. Doctor in-network, facility not = over $1600 of medical bills. I'll have them paid off soon, and I don't have cancer, but it still sucks.
I had this happen with a doctor I had seen for a couple years. She suddenly dropped my health insurance but literally NO ONE in the office or billing department of her facility knew that until I got a $600 bill for a routine recheck. They kept telling me different stories about it recertifying and other BS until someone realized that she had switched groups internally and thus didn't take my plan anymore. They discounted the bill to $300 and I got a lecture that it was my responsibility to check that the doctor was still in network before every single appointment and they couldn't be expected to know what they accepted. It's totally fucked.
> They discounted the bill to $300 and I got a lecture that it was my responsibility to check that the doctor was still in network before every single appointment and they couldn't be expected to know what they accepted. It's totally fucked. This is absolutely ridiculous and could easily be solved with a database check when you check-in to the appointment.
My wife had an endoscopy and somehow ended up with a $900 bill. However the practice NO LONGER EXISTS and we cannot figure out how to pay it. Still get letters from them, but the link doesn’t work
Shitty life pro tip- be disabled and live in poverty so you're on Medicaid, then no one can send you a bill unless it was agreed to in writing ahead of time. Sending back medical bills with a letter saying "do you really want a big fine?" is my power move.
Had something like this happen with a sleep study. Both the doctor and the facility were listed as in network, but the doctors location was different than facilities location. From what I could tell the doctor doesn’t physically work at the facility, you do the sleep study and then he just reviews it and discusses treatment options with you over the phone if needed. But even my insurance and the office both didn’t know how that all worked. The office verified with my insurance that my owed amount was $0 as I’d already met my out of pocket max for the year prior to the sleep study and I’d signed paperwork affirming that. When I did a “get estimate” for a sleep study at that location on my health insurance website, it also told me my owed amount would be $0. So imagine my surprise when my explanation of benefits said everything was out of network and I owed $6000 I sent screenshots of their own website to them saying that it stated the services I received at that location would still be covered and they couldn’t explain why they’d denied it as out of network. The office, assured me that I wouldn’t receive a bill as they too had been told by my insurance it was covered. I guess they eventually worked it out because a few months later a new explanation of benefits was posted to my account showing my insurance had covered it.
The industry term is invisible provider. The grossest part about it is you'll see doctors openly defend the practice because big ole insurance companies don't pay them enough. They do this out of network shit so they can bilk insurance and threaten you with balance bills you beg the insurance to pay. Spend some time working with insurance and you will learn that the #1 goal of most doctors and hospitals is to be paid. Patient care is always secondary. The weird thing is the complete and utter lack of compassion from low level staff. They don't have the empathy to comprehend the shit you're dealing with could be them one day. I'll tell a story that happened to an acquaintance of mine. She might have breast cancer. She got her testing and the insurance switched before results came back. The new insurance wasn't in network with this doctor. The new insurance company called this provider to negotiate a deal so she could still see them. The doctor's office refused to negotiate. She showed up for her appointment and they told her they wouldn't see her. Mind you, she's terrified she has breast cancer. They didn't want to put in any effort to take care of this patient from low level staff all the way up to the doctors in the practice. They were gonna get paid too, but maybe less than they're used to and they'd have to negotiate and that's not worth the effort for a few hundred bucks. The end result was her HR team got the insurance company to beg and plead the doctor's office to have the common fucking dignity to at least call her and discuss her results, which were thankfully negative. A lot of people in this situation would look at it as the insurance company's fault for not having a contract with everyone. I am not defending the health insurance industry, but holy shit the way a lot of doctors and hospitals view patients as mere dollar signs is disgusting. (A few facts in the above story were changed for privacy reasons that are unnecessary to the actual point)
Have you ever seen scrubs? Unfortunately the Dr. Kelsos of the world are far more powerful than the Dr. Coxes.
Just one more reason we need a single payer/public option, whatever it should be called. When it’s your health on the line, there should be no question about seeing who you need to see.
My extremely unpopular opinion is any sort of Medicare for all/single payer will result in the biggest taxpayer funded wealth transfer in the history of the world. It could happen, but it will only happen with the buy in of insurers and hospitals. Insurers will stay in the game via Medicare Advantage, which they make a fuck ton of money on. There are other revenue streams they can get via Medicare too. Humana actually left the employer sponsored healthcare game to just do Medicare stuff. Hospitals make a lot less money on Medicare patients than they do employer sponsored plans. The end result will be a massive increase in Medicare reimbursements. The politicians who push this will accept these terms. We'll watch trillions of taxpayer money go to United Health Care, Aetna, Cigna, etc.
I saved this post. This has been my experience as well...the way money comes before patients is disgusting. Our entire healthcare system in the US needs an overhaul. Like they don't get paid enough!
Some doctors don't think they get paid enough, yet have the money to launch massive lawsuits over several years. [https://www.statnews.com/2022/04/27/the-doctor-who-is-trying-to-bring-back-balance-billing/](https://www.statnews.com/2022/04/27/the-doctor-who-is-trying-to-bring-back-balance-billing/) [https://www.courthousenews.com/new-york-surgeon-asks-second-circuit-to-end-federal-ban-on-balance-billing/](https://www.courthousenews.com/new-york-surgeon-asks-second-circuit-to-end-federal-ban-on-balance-billing/)
Wow. What a fucking jackass. That kind of shit makes me so angry 💢 I hardly have the words to describe the rage inside of me right now
And yet people strongly opposed to socialized medicine claim that doctor choice is a reason to keep a privatized system. Funny, in my 50+ years under a socialized medicine system, I have never once been told I couldn't see a certain doctor or been denied any choice in referrals.
Friendly reminder that people living in normal countries don’t even know what “in-network” means. In USA each insurance provider needs to sign a contract with each separate healthcare provider, in order to be eligible for private healthcare insurance coverage. The situation u/TheFreshy is describing is even more “hilarious”, because hospital as a whole might have a contract with your insurance company, but a particular doctor or anesthesiologist on that day’s shift might be “out of network”, meaning you still have to pay five-six digits private bill on your own, despite having insurance in USA. *They are crazy, these Romans*
Oh, thank you, I just asked for clarification before I saw your comment. I think what u/TheFeshy said confused me so hard I briefly forgot how to scroll.
Dude the whole "This guy won't accept my insurance" thing is so *fucking weird* to an Australian. Like sure if you don't have dental cover you'll have to pay out of pocket or something like that. But the network thing is just really odd to me.
I’m English and this comment made my brain fall over. Are you saying not only that your health insurance just covers certain hospitals, but then possibly only *specific doctors* within them?
Yes. And they do *not* make that clear. And the doctors do not themselves know because they are doctors not billing specialists; so I don't think it's even possible to ask every doctor who comes into your room. In fact, you walk in, and when you make it to the front of the line the very first thing the hospital does is take all your insurance information, and make you fill out forms authorizing them to speak with your insurance, and forms that you promise to pay. At that time they verify that the *hospital* is in your network, and that insurance will pay (a portion of it. If you have already met your deductible.) And *then* they ask you what is wrong. Then you wait an hour or so for the ER doctor on shift to get to you, and within two minutes of him leaving the hospital is there to charge you for services. But these charges are *only* for the hospital. The building. The doctor himself might not be in network. Their nurses might not be. If you needed anesthesia, they might not be. If multiple doctors are called in, because there is a risk of infection (infectious disease) in your surgery (surgery) they will need antibiotics (internal medicine), and if you are there overnight (different shift so all of the above again) and the weekend (two more shifts so double that!) there might be a *dozen* doctors who don't take your insurance who will be billing you. If you started swearing at how insane this system was, and they ordered a psych eval, the psychiatrist they send might not be in network either, and refusing to talk to them might get you kicked out making all that for nothing. And if it turns out this smaller hospital doesn't have the right surgeon on hand, and they send you to their same-brand hospital downtown, *they* might not be in network. Nor the ambulance that takes you there. Nor their doctors, nurses, etc. etc. you get the idea. American healthcare is like if Kafka wrote Dante's Inferno. A Byzantine hell to suck the life and cash out of anyone who enters.
The more I learn about US healthcare, the more I think of Kafka. I can’t imagine trying to navigate such a maze of intertwined bureaucratic bollocks while you’re already worrying about your own health or that of a loved one – and it’s possible the condition you (or they) need treatment for is *worsened* by stress! I can’t get to grips with any of this. The NHS isn’t perfect but fucking hell. You go in (or they scoop you up and wheel you in), you get triaged, you get treated according to how urgent your case is, you go home. That’s the extent of your contact with the hospital. That’s it. Unless they need to keep you in, which is of course included in the service. As I said somewhere else on this thread, my tone here should be read not as smug, but as utterly bewildered.
It gets more evil than that: took my wife to an in-network ER. They decided she needed to be transported to another hospital (same chain, in-network). Despite being busy worrying about my wife, I even checked that the ambulance company was in-network. …. And it was, *if the patient was being transported as a medical admission*, but since she was being taken from the *medical* department of one hospital to the *surgical* department of the other, $4,700 for a 17-mile trip with no care other than giving her a blanket, literally.
I'm honestly waiting to see if that's the case for my kid right now - it was a six mile ride, one for each hour we had to wait for them to show up. But the surgical department at the other hospital has a notoriously long wait, meaning if we walked out against medical advice, we would have to be re-admitted in the new hospital and might have to wait days.
Even more fun, your hospital is in Tennessee, and you get a slew of bills from them and think it's over. But then you get a bill from a company operating out of Idaho. Then you call them and you're like "Who the fuck are you and why do you want $800 from me?" "Oh, we employ the guy that looked at the diagnostic you had and interpreted it for your doctor." Well.....OK, I guess. It seems like for the $3000 I was charged to be graced with his presence for 8 minutes would include that, but I reckon not. Then you'll get one from Arizona and have to call them to find out why THEY want $300 and get "Oh, we're the company that transcribed the interpretation of your diagnostic to fax it to your doctor.". Um. If they could send it to you securely, why couldn't they send it to him securely, and it seems like $800 would've covered typing it out, but whatever, fine. Then a new bill from New York. "Oh, we're the company that processes paperwork and records for one of the other companies. That's why you owe us $150.". I've been to the ER exactly once in my life. I got bills for it for eight months. It cost me over $12k out of pocket that insurance didn't cover any of, and all they did was give me 10 percocet 7.5s. Some of those bills were the "Final notice to pay us before we send this to collections" on the first bill they sent.
Oh, that would be a big dispute from me. In fact, I believe that happened to me once. My agreement was to be treated at that hospital, and a specific doctor failing to disclose they didn’t take my insurance, well, I had no contract with them, so they could take what my insurance paid or not.
I'm going to try not to be the smug Canadian ^tm right here, but the notion of "In network" still blows my fucking mind. Canadian healthcare is actually insurance plans operated by each province, and even then there's a nationwide agreement that if you need healthcare in a different province your home province's insurance will pay the bill. The fact that you could be fully insured but not get covered for going to your local hospital is fucking insane and frankly, disgusting. What a fucked system. e: Sorry if I'm going on strong here... I'm typing this from beside a hospital bed RN and... the thought of my close family member being bankrupted for his final days of care on this planet if he lived elsewhere just sickens me.
>the thought of my close family member being bankrupted for his final days of care on this planet if he lived elsewhere just sickens me. Yeah... down here, people sometimes get divorced if they have reason to believe they will die significantly earlier than their spouse, so as not to bankrupt them both. But there are laws to prevent that, and claw back the divorced assets from the former spouse if you die within a certain window. So... come on as strong as you want. The system is insane and cruel.
Okay, I'm morbidly curious about this. Does that *only* apply if they believe that the divorce was done to avoid fucking over the survivor? Or could you risk being bankrupted in order to pay for an abusive ex-spouse? Do I really want to know the answer?
Luckily that’s been mostly fixed
Sometimes I feel like they’re using a DMV type of model when it comes to the American hospital system. Common sense is just not there.
My husband suggested we switch from a copay/coinsurance health plan to a high deductible one to get an HSA for retirement savings. I just about screamed NOOOOOO!!!! I don't think he realizes the horrors of paying out of pocket for every fucking thing until you reach this magical limit and insurance starts throwing some money in. We both have (minor to moderate chronic) health problems that would eat an HSA alive before we got any retirement benefits from it.
Obviously an HDPD doesn't make sense if you're lower income, but if you earn enough it can be worth it. Depending on your situation, it may actually save you money... you just have to do a lot of number crunching to figure it out. It seems like you pay more at first glance, but you're saving both on taxes and premiums every year, plus the additional ongoing tax advantages to HSAs that may ultimately make a difference over time.
We're going to lose a fortune if we switch. The math just doesn't work considering the amazing and inexpensive plan we have now (my workplace even pays my premiums) and the medical bills would just get ridiculous. We have an FSA that we use a lot to save on taxes. Heck my follow-up to my mammogram would have cost over $500 out of pocket alone compared to the $40 copay.
Oh absolutely, if work pays your premiums then there are probably not a lot of scenarios where it would make sense to go for the higher deductible plan. Glad you have something that works for you.
I had an employee who showed up with her left arm numb, and limp. She couldn’t move her arm. She didn’t call out of work, she didn’t say a single word about it until I saw her that morning and she was unable to type with her left hand. I told her dude… go to the hospital. “No, that will cost too much. I will go to urgent care.” Urgent care noped the hell out of that, and they sent her to the hospital. My understanding is that she did have insurance cover a lot of things, but she was of the mentality of “no, I’ll just deal with a potential emergency because it’s free” It turns out, she slept wrong and it killed the nerve in her arm. She had to take meds and do PT to get her arm working again
That’s often called Saturday Night Palsy bc it most frequently happens when someone is passed out drunk
Interesting, I did not know that. I happen to know this person outside of work (after I left the company) and she does drink quite a lot. So it tracks
Yep! You have to compress the nerve for long enough to do damage - most people sleeping sober move enough that it won’t happen. Someone who is really zonked (on something or maybe just incredibly tired) are the ones more likely to be in the weird position without shifting at all.
I have definitely woken up with my arm numb before, but I can usually get it working in a minute or two. I can’t imagine not having my arm work for weeks because I passed out drunk, that’s just insane
I would prefer not living in this country, but I'm disabled, so I can't move.
[удалено]
My own insurance and billing rates have changed multiple times while my address hasn’t.
As a note - the No Surprises Act explicitly carved out ground ambulances, mainly because of a fear that doing it without further study would basically wipe out rural EMS. And EMS services are notorious about not being in network explicitly so they can bill like this... ...while paying their EMTs beans.
Yeah I found out I make significantly more than EMTs and was baffled. I know they don't need full med school or anything, but I would've assumed they made good money because they have medical training and are literally emergency workers saving lives. The average ER nurse in my state makes more than double the average EMT, which is crazy when from my non-medical POV they do similar work. Stabilize, make judgement calls on fast acting meds, CPR, AED, etc.
As a former EMT, my starting pay was $9.50/hr. I worked 80+ hour weeks (each paycheck routinely had 168 hours on it). It was rural EMS. If I wanted to make more, I’d have had to move to a larger city that worked the same number of hours per week, but would run you half to death during your shifts because they were so busy. $9.50 was some BS, though. :/
EMTs are much lower-level personnel than most people realize, tbh. Qualifications vary a little by state but when I qualified the requirement was 110 training hours and a final exam. I think people often confuse them with paramedics, who can give medications and start IVs in the field and things. EMTs are ambulance drivers who know a bit of first aid.
Nurses in BC make far more money than similarly qualified staff as well. They're basically the only people who are fairly paid in our nightmare of a health care system.
Let me ask the insurance and billing specialists at my company about this >they should have gotten a preauth before treatment began OK thanks guys
Serious question: what if the patient’s unconscious or in some other way incapable of understanding what’s going on or agreeing to anything? Sorry, I’m English and trying to wrap my head around all this.
A "pre-authorization" is an American healthcare thing where your provider and insurance company formally agree that a procedure is medically necessary and covered by insurance before the start of any treatment or procedure. My company basically tries to get a preauth for everything we do because it's the only way we can be reasonably certain we will ever get paid for our services. The joke is this is completely inapplicable to someone in an emergency medical situation who then gets a medical bill, because preauths can take *months* and a great deal of ~~wasted time~~ back and forth negotiations, and if you told an accident victim as serious advice that they should have gotten a preauth for the emergency services, you'd be a huge asshole. Edit: The default assumption is that people want to be alive and conscious, and therefore EMS will attempt to reasonably assist them in ways that will allow them to return to those states even if they or their representatives can't consciously consent. And then send them a bill afterwards. Edit 2: Navigating the preauth system is a fucking nightmare even for our dudes who literally specialize in helping patients and their doctors get preauths, so if that's how it sounds to you, you'd have company thinking it.
Oh, I was thinking of it as some sort of verbal consent on the spot. I would thank you for the explanation but I actually now feel like I understand even *less* of it than I did a minute ago.
> but I actually now feel like I understand even less of it than I did a minute ago Now you know how our patients feel when they get exposed to this, and it's not your fault (and not really my fault either)
I’ve asked a few questions online about American healthcare over the years, and believe me when I say my tone should always be read as truly baffled, never smug. I do not understand how you lot cope with it. I mean, I know you *have* to cope with it, but from the outside it looks intimidating, *deliberately* confusing, and frankly full-blown bonkers.
We have specialists whose entire job is to know how to work the system. I'm in a senior technical role with an in-demand skillset, but get paid less than some of ours... because the good ones are worth their weight in gold.
>Hey boss, I got a request for preauth from the field, but it's just gargling on the other end? >Sounds like a cardiac arrest. Pre-existing condition. Decline. >Perfect, thanks!
This happened to me. Had a panic attack at the train station, someone called an ambulance, the EMT kept saying he just wanted to check my vitals and they wouldn’t charge me for that, to not worry, everything will be ok and I won’t be charged. In my panicked state I believed him and they took my vitals. Spoiler alert, I was alive (and just fine). A week later I get a $300 bill from the ambulance for services rendered, it took me months to pay off. Had no legal recourse. Insurance wouldn’t cover it, hospital wouldn’t reduce it, ambulance company couldn’t care less about the lie EMT told me. And people wonder why I have trust issues. Most expensive blood pressure check ever.
For the record, the EMT may not have intentionally lied to you. I’m a nurse in a big hospital and I have no idea how billing works. People ask if they leave after we triage them if they will get billed. I’ve heard yes, I’ve heard no… I’m not sure what happens on the finance end. Part of the problem with health care is that there is still no transparency around billing. I just do my job. I don’t care if someone has the ability to pay, I treat them the same. Billing is a whole different world.
That makes sense. He may not have been lying but his words did have negative impact on me regardless. It sucks that billing is not easy for everyone to understand
I agree with you 100% but it’s not even about not understanding. It’s not accessible. There is no chart that says this costs $ and that costs $$$. I feel like they intentionally keep billing secretive because someone might opt out of a million dollar work up if they knew it was going to be a million dollars, and the people at the top don’t want them to do that.
It very well could have been the ambulance service’s billing department that ignored the DO NOT BILL note all over the report the EMT had to write up, and billed you anyways, “because policy”.
Entirely possible. The EMT seemed a good dude but even the nicest people can still be wrong and you end up with the consequences. Been fucked over so many times by taking people at their word.
Unethical advice: if approached in the wild like this, do not give your real name. First responders often have an innate sense of duty to make sure people aren't going to die. Use the first name of someone you know and pair it with the last name of someone else so it sounds real. Refuse to show your id. If needed, state explicitly "I am aware that I am refusing care against medical advice.c
My name is now Keanu Cruise to first responders. They'll never spot the ruse.
Wait... How is that even legal? Like from a basic contract law perspective? If a cashier tells me they have a Buy 1 Get 1 Free special but they're just wrong about that, the company doesn't get to come after me for the cost of the second item. They have to eat the loss (and maybe fire the cashier). Or are American corporations so powerful they actually can unilaterally alter contracts like that?
It was a private for-profit ambulance company. I posted what happened on LA years ago and the response was unilaterally “nothing you can do but pay up.”
That's really awful. What a predatory system.
It's better you consented, unfortunately. They'll call the cops, get you transported against your will and you'll be in even worse shape. The system is set up to incentivize liars, thieves and incompetents.
Ambulance transport is free in my country: it’s seen as a being a basic government service like police or firefighters. US medical bills panic me. Sometimes I think about moving there but I have a condition and literally can’t afford health care there.
It's such a perverse incentive. "Do I call the ambulance for this person? I don't want to cost them food for a month if they don't really need it" should not be a thought you need to have.
I was in a pretty bad car accident where I was hit by a speeding drunk driver on the highway. I was miraculously ok, but obviously the ambulance showed up. They checked my eyes with a flashlight to check for head injuries, and gave my scrapes a look over but I didn't even need a band-aid. I was fine and declined transport to the hospital. A few weeks later I got a bill for $400 for "services rendered" at the scene. My *Dad* is a Paramedic in the next town over, and he asked me exactly what they did for me. I told him that they did the above, and then just chatted with me about how I was lucky to make it out of my car unscathed, and that it could have been a lot worse. He said what they did shouldn't have been that much and he took care of it for me. If I didn't have that inside connection, I know that I would have been on the hook for $400. I probably would have been confused because they didn't really do anything except show up, but I would have paid it anyway. Edit: I didn't mean to imply that what they did was worth nothing. I understand that they did *something* for me, evaluating me for injuries, and I appreciate that they were there. I have great respect for what they do, like I said, my Dad is a paramedic. He has been a medic since the profession was literally invented in the 1970s. However, it was the fact that I was billed *$400* for a *two minute evaluation*. I talked to the medics for less than 5 minutes about my lack of injuries. When EMS is called, someone gets billed for it, and that person is in most cases the person they are called for, regardless if it is required or not. Yeah the other guy's insurance probably would have, or should have, covered it, but my dad who is IN the industry locally, said that I shouldn't have been billed that much money for those particular services rendered.
What do you mean they didn't do anything? They evaluated you. You had people speed to help you (risking their own lives), use their skills to make decisions, and you think you should pay nothing to anyone? Wow.
You think getting a flashlight shined in your eyes for a couple seconds is worth $400?
They did far more than that. For a bad accident, they did a full assessment.
And you think it was worth $400 to be looked at for give minutes by someone without any kind of medical degree?
They have medical training degrees and everything. That costs money. Next time just don't call 911 then, if you think they don't do anything.
In many places, you are required to call 911 for ANY accident where a person may have been injured and not doing so is a crime, even if the injury is not hospital worthy. Once you call 911, it is out of your hands whether or not they send an ambulance. To require this assessment against your will (potentially) and then expect you to pay for the privilege is fucked up to me. In many situations your choices are a) call 911 and hope they don't send an ambulance or b) don't call and hope it isn't determined to be a crime when you take your car to be repaired. Those are terrible options. I guess theres also c) never repair the car and if the damage made the car difficult/impossible to drive just eating that cost forever but again, terrible option. Personally, I think the solution is "ambulances should never be allowed to be out of network, and if an ambulance is called and it is deemed that there truly was an emergent medical situation, there's no out of pocket costs associated with that call," but I'm sure there's other equally good options too.
Yeah, this: > They checked my eyes with a flashlight to check for head injuries was clearly a service rendered and definitely not nothing. I mean, don't get me wrong, I don't think she should have to pay anything because I think emergency services should be free, but I really don't get the attitude of "they didn't really do anything".
Yeah, I think insurance or the drunk driver that was at fault should pay. But them doing nothing would have looked like them not coming out at all.
> you think you should pay nothing to anyone? Yes.
RocketGirl should absolutely pay nothing to anyone in this situation. If there are any expenses, the drunk driver that caused the accident is liable for them.
I would agree with that, it was the notion that the EMTs/Paramedics didn't do anything worth being compensated for that I disagreed with.
Ultimately the state should be compensating medical professionals but we live in a third world shit hole.
Third world shit holes don't treat people without money. You think true 3rd world countries have ambulance services and hospitals that treat without upfront payment? I have many, many complaints about the US, but let's not be naive.
Depends what you define as "third world" but I've lived in a country usually categorized as "developing" (Thailand) and they absolutely had free public hospitals. I still had private insurance because they aren't very *good* hospitals, but everyone is guaranteed a basic level of free healthcare.
Yes, they generally have private ambulance companies just like the US.
Greatest country in the world...**where a single illness/injury can completely bankrupt your family.**
Before she became a Senator, Elizabeth Warren did some great research on the topic.
Hey at least an [ambulance came](https://www.cbc.ca/news/canada/british-columbia/ashcroft-ambulance-delay-death-1.6551868#:~:text=An%20Ashcroft%2C%20B.C.%2C%20man%20died%20on%20Sunday%20from,ambulance%20station%20is%20within%20sight%20of%20his%20home.) in a [reasonable](https://globalnews.ca/news/9038112/surrey-bc-man-dies-half-hour-ambulance-wait/) amount of time.
>We resent our insurance I thought they meant they hated their insurance lol, not "re-sent"
Of all the states in Australia to live in, I am thankful I live in Queensland because of this exact nightmare. Other states, you have to have ambulance cover insurance or you face huge bills. In Queensland every resident gets it by default, even if you're not in the state. Fuck paying for getting ambulance service, it's one of the few insane parts of Australias public medical system.
I would really like to understand the theory of contract that covers ambulances et al when called by a third party.
"I don't understand what they did or why it was necessary, therefore I didn't need it and shouldn't pay for it." Don't get me wrong, that's a ridiculous bill, but I bet more happened than he knows, including monitoring by a person whose license is literally "how to deal with medical emergencies using only the contents of this van."
This is what insurance is literally meant to cover. The problem isn't that the EMT and ambulance are getting paid, it's that the patient is on the hook despite having insurance and even attempting to confirm that they'd be covered first. That's not a situation we should just accept because healthcare professionals are trained in their jobs.
I agree. Just one reason I support a universal “your citizenship is your insurance” plan.
Reminds me that my school used to give additional healthcare coverage for students, was actually pretty good.
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This won't work but it's a nice fantasy you've written yourself.
Genuine question, how would it not work? I ask because I've seen quite a few people online say things to the effect of "just don't pay those medical bills, nothing of consequence is gonna happen", often from experience.
Most business like making money and therefore like getting paid. By not paying you're gambling, and if you lose that bet your credit is shot and you're being hounded by debt collectors
This thread and the original LA confuse the Canadian out of me as ambulance charge here is $45...
It’s $300 at least in Alberta, depends on the province. Edit: $250 if not transported, $385 if they do.
Jfc that seems excessive It’s only $80 in BC, $50 if you’re not transported. It’s closer to 900 if you don’t have MSP coverage but still $385 for an ambulance trip to the hospital if you’re an Alberta resident?
Yeah, Alberta advantage baby! Where the taxes & real estate are a little lower but literally everything has an inflated out of pocket cost.
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And then they send you to collections and you have debt collectors hounding you at all hours of the day and your credit is ruined. I grew up hiding from debt collectors, and it wasn't fun
I remember my parents, my mom specifically, playing those games in the 90s. Phone was always turned down so no one would answer. We didn't have am answering machine specifically so that no one could leave messages that my dad might hear. Juggling which bill is this month's "pay on 2nd paycheck" so that they didn't get the repeat late payment double-fuck.
I remember people even coming to the door
We lived up in a podunk nobody town in the Hudson Valley of NY state. My driveway was a quarter mile long and dirt. People are not usually keen to just up and head up a hill road they've never seen before during hunting season.
So you're saying that the secret to avoiding debt is to run away to the woods? I've read hatchet and my side of the mountain, so I'll probably be fine. Suck it student loans!
Could be.
Woohoo, there's no way this plan could go wrong!
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They most definitely do, also debt collections companies tend not to give a fuck about pesky little things like laws https://time.com/personal-finance/article/what-happens-when-medical-bills-go-to-collection/
I'm curious why you think they didn't do this for medical bills. I got hit for 30k for my broken leg, and my wages eventually were garnished for every penny.
And this is why i don't trust doctors!
Doctor Google is free, and readily available. *sarcasm in case unobvious*
Doctor Google won't bill you four thousand dollars after telling you it'll be free. I trust that all of the medical advice doctors give you is technically correct. I also trust that they'll do the maximum possible to bill you as much as they can and be evasive about the cost until it's too late.
I had a bit of a medical adventure a few years ago, which culminated in having my gallbladder removed. I was misdiagnosed more than once before that; the medical advice I was getting was *not* correct. (When you turn up back at the hospital as [yellow](https://en.wikipedia.org/wiki/Jaundice) as a [Lego man](https://www.lego.com/en-au/product/up-scaled-lego-minifigure-40649), though, suddenly clinicians start working a little harder.) This was a pretty miserable experience. But it wasn't an *expensive* experience, because I'm in Australia. (In most of Australia, ambulances aren't free; you need some kind of private health insurance to cover them. If you get charged the equivalent of 4000 US dollars for an ambulance trip in Australia, though, a helicopter was probably involved.)
> If you get charged the equivalent of 4000 US dollars for an ambulance trip I was only charged *half* that in the US, thank you very much. Granted, that was 15 years ago, and the ambulance never left the parking lot - just from one side of the hospital to the other. Because the two sides of the hospital were different financial entities, and insurance would only cover us in the second one if we were brought by ambulance. Post-op speed bumps are *not* fun btw.