Dodged a Medical Expense Today with One of My Family Members-With A "Cadillac" Gov't Plan

[TheBlackAdder]

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This family member works for the Federal Government and has the highest plan possible.

This morning, this person experienced chest pains at 4AM, and has a congenital heart defect. We almost went to the Regional Trauma Center that is well known for heart issues. It was a good fucking thing we didn't go there. They don't take their insurance, and if they showed up, they would have held them there for observation and study, or else they would have required an ambulance to take them to another hospital. If they even agreed to release them.

This person held off going to the hospital and rode it out until morning and went to another heart center that was 35 minutes away, but opened at 8AM. This other heart center is paired with a moderate general hospital chain, so you really don't want to get admitted to the hospital side.

We're just glad that this person dodged a bullet, because if they were really in need of medical care, they would have been taken to a fee-for-service hospital as an uninsured patient. The other hospital near us is still trying to get their heart center certified and when my sister went there, they held her overnight, then had to transfer her to that other hospital because they lacked the skill. That was a $25,000 uninsured ambulance ride that she had to eat.

Something is really fucked up when you have a top notch plan, and your plan is not honored at the regional trauma centers--the ones you get automatically taken to if you were unconscious or seriously injured. How many people are thinking they are covered only to find out they aren't after they arrive there.

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[Freddie]

1. Helicopter medical emergency rides are the worst

$$$$ and rarely covered by insurance. Back before I retired as a payroll admin, one of our employees was injured hiking and had to get medi-vac’d to a hospital. The bill came to $30k and her insurance hardly covered any of it. The company was really nasty and aggressive about collecting, threatened to garnish her pay. Thankfully in PA wages can only be garnished for court-ordered support, taxes and student loans. I suggested she get an attorney, never heard how it was resolved. There’s much to be said for a sedentary lifestyle that will not involve injuries in remote areas.

[MissB]

4. My plan actually covers them, including out of country

Which is good because one of my kids is a mountain climber. He has a few more years on my plan before he ages out.

It’s a $500 emergency deductible if used. I looked into it when he was heading for a remote area of Canada accessible only by helicopter.

[stopdiggin]

2. you're right ...

Emergency services are 'covered' on almost all decent (much less top notch) health coverage. Possible heart attack certainly qualifies. I'm not going to wade into this as I'm not the most knowledgeable source. But, this kind of has me scratching my head.

[yellowdogintexas]

7. Even if you are out of network (which is probably why they 'don't take his insurance'

most plans have some sort of exception for emergency care and admission.

[3Hotdogs]

3. General advice, if you suspect a heart attack, call the ambulance. Yeah, it costs more, but

you get immediate treatment while in route to hospital. Also, E.R. is waiting for you with a basic diagnosis before you go in the door.... as opposed to trying to walk in the door, get out your insurance card and wait in line for intake.

[TheBlackAdder]

13. THIS! 👍 But at 4:20AM after finding out they weren't going to take insurance, a decision to wait.

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We shouldn't be put in the position to weigh whether or not we should call the ambulance, and roll that dice. After all, we're the 'greatest nation' right?


They haven't looked into the emergency plan acceptance yet. I did ask them after reading your post.

It was a long night, and both they and I took off work today because of it. Yes, with major issues, it's viewed that someone taking an ambulance is more critical than a drive in. I live in a town with 2 minute Tier 1 police, fire and medical service. I mean the vehicles will roll up as they're still taking your information and the town subsidizes some of the taxpayer's costs as we pay taxes for this service.

But I've lived in towns in NJ where it could take an hour for police to arrive, which is why a lot of people own firearms, because a lot of shit can happen in an hour. The ambulance squads can take 20 minutes to arrive. I could be at a hospital by car in that same amount of time. The hospitals here will start to take someone back if there is someone to work the desk and provide the information.

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[malaise]

5. Any comment from Fuckabee

and his daughter - asking for a friend

[yellowdogintexas]

6. He probably has a plan with a network and the facilities were not in that net. I hate networks

I believe the Federal plans offer several options to the employees. The best thing to do is find out the networks the facilities near you use. Then you will know what the next step should be when open enrollment comes around.

Call them up and ask for the department which verifies benefits. They should know all their participating networks. This gives you something to work with at open enrollment. The carriers for the various plans offered will be able to tell you the network for their plan.

[haele]

9. Problem is those plans are always changing.

We just found out the Neurologist spouse was seeing last year "in network" was no longer in network as of Jan. 1st.
We didn't know that during open enrollment, and we also have a Federal "Cadillac"plan. Nothing changed, other than the doctor is now out of network - perhaps he charged too much?
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Hello, $900 for two visits out of network, and we are going on the second month trying to get his records sent to a closer Neurologist that is in network.

Haele

[haele]

10. Problem is those plans are always changing.

We just found out the Neurologist spouse was seeing last year "in network" was no longer in network as of Jan. 1st.
We didn't know that during open enrollment, and we also have a Federal "Cadillac"plan. Nothing changed, other than the doctor is now out of network - perhaps he charged too much?
.
Hello, $900 for two visits out of network, and we are going on the second month trying to get his records sent to a closer Neurologist that is in network.

Haele

[crickets]

12. I just had a problem with this last week.

My ACA plan was 'in network' until just recently. The hospital in our town has decided they no longer accept the plan I'm on, and all of the doctors in town are part of the hospital system. It's a package deal. I suddenly have expensive insurance that is absolutely useless to me, and I'm not quite sure what to do about it yet. I'm sure I have some sort of options; I just haven't researched them yet. Still, it's ridiculous.

[Midnightwalk]

8. I wondered how does that compare to body work on car

So I googled and read a little. Badly.

There’s no “we don’t take that insurance” so we’ll charge you max.

You take it where you want and the body shop and insurance company wrangle and you get involved only if they don’t reach a deal. You aren’t there dying while the negotiations are happening. Worst thing that happens is you go where the insurance company says and again while you aren’t sick or dying.

It’s not a perfect analogue but it is messed up that you aren’t gouged by the body shop just because they don’t like your insurance.

Single payer simpler for solving this. You can buy better insurance gets you closer to being as good as a body shop, but could go too far. I’d rather be single payer.

Here’s a paragraph from the article i found

But if there is even a possibility of more serious damage, take your car directly to your body shop of choice and tell the insurer to send its estimator there. For serious repairs, you need the shop to advocate for quality. Don’t count on your insurance company to look out for your interests. Also, bringing your car to a body shop rather than an insurance company’s drive-in appraisal center allows the company’s adjuster to make a thorough inspection for hidden damage.

[link:https://www.checkbook.org/national/auto-body-shops/articles/Dealing-with-Your-Insurer-When-Your-Car-Needs-Body-Repairs-2163|]

[Celerity]

11. The US for profit health care system is the biggest wealth extraction scheme

in the planet. Utter scam, you soend by far the most money per person and the overall quality is not even in the top 25 or 30. Plus there are, as you just showed, huge holes in coverage that can literally bankrupt you.

The most we pay for ALL care, all pharma in a rolling 12 month period here in Sweden is around 375 usd per year. Total. And our quality if care is far higher overall on average.

Sure, if you are rich in the US, you can buy the best care in the planet, but for hundreds of millions, the path is littered with pickpockets and dodgy quality. Obamacare was far better (especial the pre-existing conditions part) than what was before or the Rethug death cult alternative, but it still allows the weath extraction schemes to go on for the most part and the premiums and deductibles and in most cases, co-pays, are outrageous compared to the rest of the advanced world. A gaslit nation the US is on healthcare (amongst other things).

[area51]

14. +1 n/t