Dear God, make it stop:

Are you having chest pain, a possible miscarriage, shortness of breath or abdominal pain? You should head into the emergency room and get that checked out.

Well, unless you are poor.

In an effort to cut back on Medicaid costs, the state of Washington is proposing a new set of “non-emergent” conditions that are no longer are covered if you go into the emergency room too many times in one year. Among those new “not an emergency” symptoms are excessive bleeding due to possible miscarriage, pain that could indicate severe appendicitis or organ failure or the tell-tale signs of the beginnings of a heart attack.

Under the new system, if you are a Medicaid patient you are allowed three “non-emergent” visits to an emergency room each year, otherwise, you need to either see your primary care provider (whenever you can manage to make an appointment with him or her) or you can have your claim denied and be forced to cover the full costs out of pocket.

But don’t worry, the system isn’t totally heartless. There are a few exceptions to the “three visits then you’re done” rule. If you happen to die in the E.R., they won’t turn down your final claim.

3 thoughts on “Efficiency

  1. Does anyone know these statistics; What percentage of the total US population visits an emergeny room each year? Wanna bet it’s the same small group of people who make multiple visits? Not that there’s anything wrong with that. Perhaps these folks are really, really unlucky or they’re just very unhealthy. If we had a single-payer universal health care system none of this would matter. Except to those people who would abuse the system. We could always expand Medicare to include everybody.

  2. I don’t know what percentage of ER users are repeaters and have situations which do not need ER care.

    I do know that my past Big Name health insurer told me to go to an ER with a bad rash, when I was out of area visiting family. They would cover (with me making a higher co-pay) an ER visit, but not to a regular doctor or in-store clinic type thing.

    I didn’t go — finally managed to get one of my home doctors to call in a prescription which helped get me through the visit. (I was getting huge hives all over my body, really itchy, and breaking out on my face near my eyes. It was very scary. And I am a huge backer of Medicare Improved! For ALL!)

    I have a friend who had to use the ER three times this past winter-early spring as she felt she was having a heart attack, couldn’t breath, couldn’t sleep. On a weekend night, of course. She spent a week in the cardiac unit and, after many tests, was sent home with prescriptions for her newly diagnosed heart fibrillation.

    Her second visit, also on a weekend, came after she’d seen her new cardiac specialist and he said the meds were fine, keep taking, tests were good, etc. Almost another week in the hospital, more tests, new meds.

    She made it a few more weeks and two cardiac doc visits before the next emergency, with all the symptoms she now was beginning to recognize quite well.

    This time she was only in the hospital for 4 days, more tests, new meds, new levels of some of the initial meds — and, knock on wood, no ER visits have been needed since then.

    Her hospitalizations indicate that even as a Medicaid patient she would not –should not– have been considered a Bad Patient. But, when people on limited income are told they will be held financially responsible for visits to an ER or any medical service IF it’s determined post-visit or post-care they didn’t need to see a health care provided, they try to not go. Because they can’t predict how much having something checked out will cost them — and their family in medical bills left to them. It’s almost financially the wise thing to do to wait and see. If death comes before care, at least their family is not going to paying through the nose for years and years.

    This is part of the Hurry Up and Die Already, non-wealthy scum and leeches.

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