Drudge Retort: The Other Side of the News
Tuesday, November 27, 2018

Brittany Cloyd of Frankfort, Kentucky, said she experienced pain "worse than childbirth." Her mother -- who had been to nursing school -- drove her to the nearest emergency room. Brittany thought her appendix had burst, but tests at the ER found she had ovarian cysts. She was given pain medication and told to follow up with her primary doctor. Cloyd had an Anthem Blue Cross PPO health insurance plan and thought she would get charged just a co-pay for her ER visit. Instead, 15 days later she received a letter from health insurer Anthem. "Your condition does not meet the definition of emergency," read the letter. She was responsible for the total ER bill -- $12,596. What Brittany endured is becoming more common in the health insurance industry, according to a Doctor Patient Rights Project (DPRP) study.

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Per the link ...

137 million ER visits annually

But that puts millions of Americans in a vise. In an average year, nearly one in five people report going to the ER, according to the DPRP, for a total of 137 million visits.

Doctors, patients and insurers note that statistics from 2012 indicating the average cost of an ER visit, at $1,233, is outdated.

One reason for the surge in price since then, according to a University of Maryland study: the increased number of substance abuse cases -- particularly among young and middle-aged adults -- that now pass through an ER.

Anthem said even a small savings could benefit the health care system, in which Americans spent nearly $3 trillion dollars in 2015.

The percentage of patients who leave the ER with no treatment whatsoever is 5 percent according to Anthem, while the Centers for Disease Control and Prevention (CDC) said it's at least 3.3 percent. Some of these may be psychiatric patients.

But CDC data also appears to show that going to the ER might be the right choice for a serious condition such as chest or stomach pain and high fever.

It said 43 percent of all ER cases lead to hospital admissions.


U.S. healthcare is a mess.

Republicans should have worked with Obama instead of obstructing when the Affordable Care Act was written ... doing so would have better addressed the problems on how to unclog the nation's ERs while getting all Americans regular access to a primary care doctor.

#1 | Posted by PinchALoaf at 2018-11-27 07:38 PM | Reply | Newsworthy 1

I've always believed there should be a walk-in clinic next to every ER. I've heard doctors and nurses complain A LOT over the years about the folks who have no business being there. They're called GOMERs, which stands for Get Out of My Emergency Room.

Huge savings for the consumer, but at the expense of hospital profits, so....

#2 | Posted by Danforth at 2018-11-27 07:41 PM | Reply | Newsworthy 3

Republicans should have worked with Obama instead of obstructing when the Affordable Care Act was written ... doing so would have better addressed the problems on how to unclog the nation's ERs while getting all Americans regular access to a primary care doctor.

POSTED BY PINCHALOAF AT 2018-11-27 07:38 PM | REPLY

Oh but the First black President would have a grand legacy and those racist Republicans wouldn't stand for that.

#3 | Posted by LauraMohr at 2018-11-27 07:48 PM | Reply | Newsworthy 2

This is Trumpcare.

#4 | Posted by fresno500 at 2018-11-27 08:08 PM | Reply | Newsworthy 1

After not properly clamping a piece of wood on my drill press (I was holding it firmly in my hand) The hole saw tore it out of my hand and opened a 4" gash in my hand. I wrapped it and rushed to the nearest ER where they put my name on some list, but only after I showed them my insurance card. 1 hour later I left for an Insta-care Facility and was sewn up about 45 minutes later with 11 stitches.

#5 | Posted by bayviking at 2018-11-27 09:52 PM | Reply | Newsworthy 2

In an emergency I go to a local crucial care clinic, not the E.R. Florida Blue encourages it. $40 co pay versus $500++++ co pay. Wait time is next to none. In fact if they determine it an emergency at check in you are immediately brought back and diagnosed/treated.

#6 | Posted by gracieamazed at 2018-11-27 10:27 PM | Reply

"Your condition does not meet the definition of emergency," read the letter. She was responsible for the total ER bill -- $12,596."

Thanks, Capitalism!

#7 | Posted by snoofy at 2018-11-27 10:43 PM | Reply

This is crazy. This woman was penalized for not knowing her diagnosis in advance.

People need someone with training to evaluate and make a competent differential diagnosis. I start with a good history. Knowing what the symptoms the patient has and the subsequent questions to ask is one of the hardest parts.

An ER workup for severe acute abdominal pain will likely include a CT (or ultrasound), CBC (complete blood count) and CMP (comprehensive metabolic profile). Pregnancy test if chance of this to check for possible tubal. If there's any chance of upper GI bleed they will likely get endoscopy, colonoscopy if lower GI bleed suspected.

How else would the insurance company have determined her condition wasn't an emergency but through an evaluation like this?

We should not be looking at everyone that visits the ED. We should focus on people who use the ED a lot. These people account for a small percentage of patients but a large percentage of visits and cost.

The Healthcare Cost and Utilization Project (HCUP) and the Agency for Health Care Research and Quality (AHRQ) did an analysis in 2017 of Super-utilizers: www.hcup-us.ahrq.gov

If that same patient presented with abdominal pain multiple times per year, had gotten the same workup over and over again and yielded no diagnosis might be reasonable to look at meeting her needs through outpatient PCP or specialist care.

If they have mental health needs make sure they continue to be addressed. We have no formal program but I've worked with a nurse care manager, medical social worker and/or clinical pharmacist which usually we're able to reduce ED visits.

#8 | Posted by zarnon at 2018-11-27 11:43 PM | Reply | Newsworthy 1

Medicare for all. Medical insurance company's need to be destroyed, the sooner they are put out of business the better!

#9 | Posted by aborted_monson at 2018-11-28 01:45 AM | Reply

Insurance companies make money by denying claims, not paying claims. So just what do you think their incentive is? This is why for profit health care is such a disaster. Civilized countries pay a lot less for much better health care.

#10 | Posted by SomebodyElse at 2018-11-28 08:55 AM | Reply

1 hour later I left for an Insta-care Facility and was sewn up about 45 minutes later with 11 stitches.
#5 | POSTED BY BAYVIKING AT 2018-11-27 09:52 PM

I had a cut over the summer that probably needed sewn.
I avoided the emergency room because I know that it's a $300 minimum (if everything goes according to plan) with my insurance just for visiting.

So I went to the urgent care clinic (the next day, after some wishful thinking was dashed by reality when I looked underneath the bandage). Turns out they stopped doing stitches recently. So it was a hodgepodge of cleaning, glue and bandages.

I thought it odd that they once were ok stitching people up, but stopped.

Anyway, it may be that they want to leave that stuff to the moneygrabbers in the ER.

My best ER experience: mid nineties, at university, cut my head. Went to the campus doctor. She was about to leave for the day, but looked at her watch, then looked at my head. Sat me down and sewed it up in about 10 minutes. Walked out, no paperwork, no charge, just some cool looking Frankenstein stitches in my scalp. It was borderline ---- enjoyable!

Compare that to now.
I'm literally looking at a bad cut, convincing myself (with good reason) not to get professional treatment.

#11 | Posted by schifferbrains at 2018-11-28 09:31 AM | Reply

"She was responsible for the total ER bill -- $12,596."

Yeah, but you're not seeing the big picture.
Behind every crippling, bankrupting medical bill is another minimum wage job at a debt collection agency!

#circleoflife

#12 | Posted by schifferbrains at 2018-11-28 09:47 AM | Reply

I've always believed there should be a walk-in clinic next to every ER.

While they're not right next to an ED, there are an increasing number of ready clinics all over where I live. The last two years there has been three chains that either started or moved into town.

For non-life threatening injuries they're far superior to an ED as each has had x ray capability, pharmacy ect. I think the newer locations may even have MRI capabilities.

#13 | Posted by jpw at 2018-11-28 09:53 AM | Reply | Newsworthy 1

#13 Yep. The one near me has a lab, X RAY and MRI. They can set and dry cast breaks to get you to an ortho. They have EKG's and can stabilize you if you are having a heart attack before calling 911. Same with a stroke. Hands down better/quicker treatment and cheaper.

#14 | Posted by gracieamazed at 2018-11-28 10:19 AM | Reply


#@8 ... This is crazy. This woman was penalized for not knowing her diagnosis in advance. ...

Worth a repeat.

#15 | Posted by LampLighter at 2018-11-28 10:25 AM | Reply | Newsworthy 3


@#2 ... I've always believed there should be a walk-in clinic next to every ER. I've heard doctors and nurses complain A LOT over the years about the folks who have no business being there. They're called GOMERs, which stands for Get Out of My Emergency Room. ...

You're making too much sense.

#16 | Posted by LampLighter at 2018-11-28 10:27 AM | Reply

Trump promises we will have the best healthcare the cheapest healthcare and everyone would have access.

What happened Gracie?

#17 | Posted by donnerboy at 2018-11-28 10:28 AM | Reply

"This woman was penalized for not knowing her diagnosis in advance. ... "

Same thing almost happened to me.

29 months ago, I had a heart attack. Turns out it was VERY mild; I really won the lottery on that one. But I realized I had 3-4 warning signs in the weeks leading up to the incident i shouldn't have ignored.

11 months after that, I had another trip to the ER, and it turned out not to be a life-threatening event (although it took them 3 days to come to that conclusion). The insurance company initially balked...

...until I told them I'd had ALL the warning signs, and all more intense, back-to-back that day, forcing me to take my ever-present nitro-glycerine. I asked the gal what SHE would do in that circumstance.

They covered it.

#18 | Posted by Danforth at 2018-11-28 10:32 AM | Reply

#17 I have it. I now have a $40 Co Pay for a crucial care clinic that operates just like an ER. If I went the ER the Co Pay is $500+++++. I'm very pleased to have that new business nearby and new benefit from Florida Blue.

#19 | Posted by gracieamazed at 2018-11-28 10:33 AM | Reply

"You're making too much sense."

Serving 30 years on health committees, and becoming a Trustee for a national Health Care Plan, will do that to a guy.

#20 | Posted by Danforth at 2018-11-28 10:34 AM | Reply

until I told them I'd had ALL the warning signs, and all more intense, back-to-back that day, forcing me to take my ever-present nitro-glycerine. I asked the gal what SHE would do in that circumstance.
They covered it.
#18 | POSTED BY DANFORTH

How insane is it that you now have to get into a showdown at high noon with someone on the phone over life-and-death healthcare issues?

#21 | Posted by schifferbrains at 2018-11-28 10:42 AM | Reply

"How insane is it that you now have to get into a showdown at high noon with someone on the phone over life-and-death healthcare issues?"

It also pissed me off to no end she caved immediately, knowing some folks would be kowtowed at that point instead.

It reminded me of an auto accident where a guy turned left in front of me and we collided. His insurance company wanted to assign a percentage of blame to me, until I pointed out the guy was 100% breaking the law, 100% in my lane, and I had a 100% right to drive straight through, as I had a light that was 100% green. I also told her if they went forward, there was a 100% chance I'd demand all my legal fees as well, since it was 100% clear he was 100% at fault and they were clearly 100% f^cking with me.

They paid. 100%.

#22 | Posted by Danforth at 2018-11-28 10:49 AM | Reply

#18 | Posted by Danforth at 2018-11-28 10:32 AM
That stress will catch up with you. Take care of yourself.

#23 | Posted by Avigdore at 2018-11-28 11:23 AM | Reply

Trump promises we will have the best healthcare the cheapest healthcare and everyone would have access.
What happened Gracie?

#17 | POSTED BY DONNERBOY AT 2018-11-28 10:28 AM | REPLY

It got blocked in the house in favor of keeping Obama Care. Remember how you celebrated?

#24 | Posted by fishpaw at 2018-11-28 11:28 AM | Reply


@#24 ... It got blocked in the house in favor of keeping Obama Care. ...

The plan that was not passed by the House was a giant step backwards in quality of healthcare from what Obamacare provided.

It was so bad, in fact, that even the Republican majority in the House did not want to pass it.

#25 | Posted by LampLighter at 2018-11-28 11:38 AM | Reply | Newsworthy 1

catostophic care is how the republican plan covers preexisting conditions. What that means really is that you get no care until your condition reaches catastophic levels. Preventing it from getting to catastrophic levels is not covered.

#26 | Posted by hatter5183 at 2018-11-28 12:01 PM | Reply

Lol, the banter back and forth that has gone on for many decades regarding healthcare is so hilariously backwards now to what it was before. If anyone actually did a shred of research, they would see that the Dems were fighting for what the Reps are fighting for now and vice versa. Yet, both sides try to find ways to blame the other side for the problem. It's so hilariously absurd that a facepalm isn't even a grand enough gesture to get across the absurdity.

#27 | Posted by humtake at 2018-11-28 12:22 PM | Reply


@#27 ... If anyone actually did a shred of research, they would see that the Dems were fighting for what the Reps are fighting for now and vice versa. ...

I have done the research, and I have noted here on multiple occasions that Obamacare was really just a re-packaging of what the Republicans were proposing in the mid-1990's. I believe it was the Heritage Enterprise group (or a similarly-named group) that wrote the initial research paper.

It was also quite similar to what fmr Gov Mitt Romney instituted in Massachusetts.

I suspect that when the tribalism finally settles out, any healthcare plan will have a similar architectural infrastructure to Obamacare.

#28 | Posted by LampLighter at 2018-11-28 12:30 PM | Reply

It got blocked in the house in favor of keeping Obama Care. Remember how you celebrated?

#24 | Posted by fishpaw

As apposed to TrumpCare whcih was NO CARE at all?

Ignorance is Bliss. Until the Hospital Bill arrives.

I was furious. They charged me $2000 (10% of the charges instead of ER Co-paypay)for an emergency appendectomy.

BECAUSE IT WAS NOT PERFORMED IN THE EMERGENCY ROOM. (Like I had any say in the matter)

I would have probably died had I not gone to the ER.

Insurance Companies are taking advantage of every scam they can pull and every loop hole they can find because they know.

They know Humpy and the Gang of ReTHUGlicans won't do a damn thing about it.

Take your lies and stick them where the sun don't shine you POS.


#29 | Posted by donnerboy at 2018-11-28 01:20 PM | Reply

"They have EKG's and can stabilize you if you are having a heart attack before calling 911."

EKGs will not show an MI 30% of the time (Non ST elevation MI).
You need serial enzymes to rule this out.

If you're having an MI the usual way to stabilize you is getting the cath lab as fast as possible.

In fact, time to cath from the ED is measured frequently. It's that critical. 90 minutes is the goal they try to meet.

Minutes matter in an MI. Ditto for stroke (you will not qualify for thrombolytics if you wait too long).

I called our urgent care to verify: Anyone having stroke or heart attack symptoms are advised to call 911.

#30 | Posted by zarnon at 2018-11-28 01:29 PM | Reply

"I called our urgent care to verify: Anyone having stroke or heart attack symptoms are advised to call 911."

But you should be calling your insurance company. Your provider doesn't care nearly so much as your insurance company who pays.

#31 | Posted by snoofy at 2018-11-28 01:52 PM | Reply

"Anyone having stroke or heart attack symptoms are advised to call 911."

"But you should be calling your insurance company."

You might be joking; in reality, you're right.

I called 911 for the second incident. It was only later I was told, "911 isn't in your network".
$940

#32 | Posted by Danforth at 2018-11-28 01:57 PM | Reply

"I think the newer locations may even have MRI capabilities.
#13 | POSTED BY JPW"

Careful, too much talk of MRI and you'll summon MadBomber.

He says our health care system is better than the rest because we have the most MRI machines per capita. (Nevermind that something like 99.999632% of health interventions do not require an MRI.)

#33 | Posted by snoofy at 2018-11-28 01:57 PM | Reply

"You might be joking; in reality, you're right."

The joke being played on the American people is that I'm right.

#34 | Posted by snoofy at 2018-11-28 01:59 PM | Reply

Yikes.

#35 | Posted by Tor at 2018-11-28 02:29 PM | Reply

I called our urgent care to verify: Anyone having stroke or heart attack symptoms are advised to call 911.

All of them here have a list of ailments that they're meant to treat. Typically they're things that you want to get treated quickly but are mild enough that you'd be low priority at an ER.

I've adopted the standard that I'll only go to an ER if an ambulance is necessary or even considered a serious option.

#36 | Posted by jpw at 2018-11-28 08:50 PM | Reply

Insurance Companies love stories like this going mainstream. Every subscriber they can scare into not seeking treatment increases their bottom line. If a few die in the process, se la vie.

#37 | Posted by 726 at 2018-11-29 01:02 PM | Reply

Trump promises we will have the best healthcare the cheapest healthcare and everyone would have access.
What happened Gracie?
#17 | POSTED BY DONNERBOY AT 2018-11-28 10:28 AM | REPLY
It got blocked in the house in favor of keeping Obama Care. Remember how you celebrated?

#24 | POSTED BY FISHPAW

This imaginary bill that got blocked in a House controlled completely by Republicans that would somehow magically give us the best and cheapest healthcare in the world with everyone having access...

What bill was that and what did it do?

(I have a hunch you won't answer this)

#38 | Posted by Sycophant at 2018-11-29 02:55 PM | Reply

I'm very pleased to have that new business nearby and new benefit from Florida Blue.

#19 | Posted by gracieamazed

I am not sure I read you right.

Did you just say that you are pleased with Obamacare?

FYI... Florida Blue is an Obamacare plan.

#39 | Posted by donnerboy at 2018-11-29 06:36 PM | Reply

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