Insurance: The Urban Legend. - page 2

Once you're in a facility you'll be treated the same as everybody else. It's laughible to imagine that staff look at somebodies insurance and treat them any differently. I mean it's hard enough to... Read More

  1. by   CritterLover
    Quote from thecommuter
    i work at an upscale nursing home where the payors include a mixture of medicaid, private insurance, and cash. private rooms cost $6,900 monthly. semiprivate rooms cost $4,600 monthly.

    i can state confidently that management and the administrators bend over backwards for the cash patients while not providing the same service for the medicaid patients. in addition, all of the nurses stations have updated census sheets that indicate the patient's form of payment.

    it doesn't surprise me at all that things are different in ltc. there is no way medicaid is paying $4600 a month for those rooms. if they don't cater to the private pay patients, they'll lose them. and that is probably the only way they make any money.
  2. by   TinyNurse
    I worked at a hospital in Houston, where as if you were not insured and couldn't pay on the spot you were sent to a "seperate part" of the ER. This was in 2005. Amazing.
  3. by   mercyteapot
    Quote from Tweety
    In my hospital it's the one with the insurance that gets the lowest length of stays because the insurance RN comes in and deems the patient stable and "we will no longer pay for any further stay, does not meet inpatient criteria", so the insured gets thrown out quicker.
    Agreed. When my son was born, I had to share a room. My roommate, who had Medi-Cal, was in an abusive relationship and didn't want to go home. This I know because pre-HIPAA, the hospital social worker just came up and started talking to her, as if the curtain was somehow soundproof. She had already stayed 2 days longer than a typical C-section and on the day of our discharge, she was trying to maneuver an extra night's stay. I couldn't think of anything I would have liked less because I wanted to bring my child home, but it did strike me that if I had tried to get an extra night paid for, when it was clearly not medically indicated. my insurance (and it was fee for service, not an HMO as is so common now) would've told me to take a hike.
  4. by   CritterLover
    Quote from tinynurse
    i worked at a hospital in houston, where as if you were not insured and couldn't pay on the spot you were sent to a "seperate part" of the er. this was in 2005. amazing.

    i wonder how they get away with this?

    i'm trying to remember when emtala really went into effect (in a practical sense)

    when i first started working in the er, the order of things was registration --> insurance info --> triage --> to the back (unless you were in distress).

    shortly after that (maybe 6 mo?), it was changed to no insurance info asked/accepted until after the doctor had seen the patient. so registration --> triage --> to the back --> md visit --> insurance info. (as an aside, this really impacts that other ed aggrivation -- turn-around time. many days, if the doc is quick and the complaint is minor, i have the patient discharged long before registration has gotten their info. so they sit in a room, waiting for a clerk to come copy their cards. i can't give their dc instructions/rx's/work excuse, because if i do, the patient will leave....)

    however, my understanding is that emtala states that the mse cannot be delayed due to insurance issues (gathering insurance info, lack of insurance). it doesn't state that the doctor has to see the patient before the insurance info is gathered. in theory, if the waiting room time is pretty long, the clerks could be out there gathering insurnace info while the patient waits to get called to the back, making things more efficient. but, at some point, someone would complain that it took them longer to get called back because they didn't have insurance, or becasue they didn't have "good" insurance. (rather than the delay being for the real reason -- they have had a pain in their big toe for 3 months and thought they needed to be "checked out") so, many hospitals have developed that kind of policy (no insurance info gathered before the mse is done) because it is the easiest way to prove that insurance issues did not delay care.

    i would imagine that this hospital is arguing that asking about insurance/lack of insurance isn't delaying care. somehow i doubt that is going to work for long, it will probably eventually catch up with them.
  5. by   hope3456
    Reading this thread infuriates me that insurance companies have so much power to dictate what kind of care people receive. Our politicians are 'in bed' with the big insurance companies and we the voters need to demand change.

    I normally vote republican but this past november voted democrat only b/c they seemed more concerned about the problems facing uninsured working americans and are more apt to do something about it.

    Oh, and the day after the election, when the democrats took the majority, the major insurance companies (Cigna, BCBS, ect) and the pharmaceutical companies stocks fell drastically in value!
  6. by   Roy Fokker
    Quote from SmilingBluEyes
    NO difference in care or accomodations where I am.
    Ditto.

    Might have something to do with the extensive roots amongst area Mennonite churches - or the 'not for profit' status of the establishment, but there are no differences at work.

    cheers,
  7. by   UM Review RN
    Quote from mercyteapot
    Agreed. When my son was born, I had to share a room. My roommate, who had Medi-Cal, was in an abusive relationship and didn't want to go home. This I know because pre-HIPAA, the hospital social worker just came up and started talking to her, as if the curtain was somehow soundproof. She had already stayed 2 days longer than a typical C-section and on the day of our discharge, she was trying to maneuver an extra night's stay. I couldn't think of anything I would have liked less because I wanted to bring my child home, but it did strike me that if I had tried to get an extra night paid for, when it was clearly not medically indicated. my insurance (and it was fee for service, not an HMO as is so common now) would've told me to take a hike.

    But wouldn't the hospital be liable if she was D/C'd and then went home to a stated abusive situation if something happened to her or the baby? Doesn't the SW have a responsibility to DC the patient to a safe environment?

    I would think she might've needed a shelter or somewhere safe to stay.

    I had a patient once who was put in ICU due to an abusive relationship, to protect her from visitors and the abuser, who was somehow still at large. That had to cost some money, but don't you agree that those were appropriate actions, given the extraordinary circumstances?
  8. by   gonzo1
    Our uninsured and medicaid pts get better care because the docs are afraid they will get sued for not taking "good enough care" of these pts if something happens to them. I want to drop my insurance and be uninsured so I would get better care.
  9. by   TheCommuter
    Quote from gonzo1
    Our uninsured and medicaid pts get better care because the docs are afraid they will get sued for not taking "good enough care" of these pts if something happens to them. I want to drop my insurance and be uninsured so I would get better care.
    I've never quite thought of it in this manner before. Physicians are actually catering to their underinsured and uninsured patients out of the nagging fear of getting sued someday? Interesting.....

    I can recall the well-publicized situation of a welfare mom on Medicaid who was giving birth in a Los Angeles area hospital a few years back. The laboring mom, who planned to deliver vaginally, requested an epidural because she was in pain. The obstetrician and L&D nurses all refused because, as the mother claims, her payor was Medicaid. She sued the obstetrician, hospital, and several L&D nurses, and eventually won the case.
  10. by   Altra
    Quote from Angie O'Plasty, RN
    But wouldn't the hospital be liable if she was D/C'd and then went home to a stated abusive situation if something happened to her or the baby? Doesn't the SW have a responsibility to DC the patient to a safe environment?

    I would think she might've needed a shelter or somewhere safe to stay.

    I had a patient once who was put in ICU due to an abusive relationship, to protect her from visitors and the abuser, who was somehow still at large. That had to cost some money, but don't you agree that those were appropriate actions, given the extraordinary circumstances?
    I'm sorry but I have to disagree. The hospital and the social worker are not the magic cure ... they do not have the means (nor, IMO, the responsibility) to fix the patient's life situation. The SW is an important link to shelter info & other resources, but if every effort has been made to place the pt. & her baby in a shelter, but there are no available beds ... just how long can the hospital reasonably be expected to act as a shelter?

    If SWs (or nurses, for that matter) were to be held liable for what happens to the pt. outside the hospital ... what would happen in the all-too-common scenario where a pt. denies, denies, denies that she is being abused ... even when we bend over backwards to offer shelter or other resources? Also, off the top of my head I can think of 3-4 ER frequent flyers who move from one abusive relationship to the next ... present to the ER w/injuries from an assault ... are placed in a shelter ... and have been evicted from multiple shelters for theft, drug use or other infractions. It reaches the point where placement is next to impossible.

    And no, I don't agree that it was appropriate to place a non-critical pt. in a critical care bed - an ICU is not a shelter.
  11. by   mercyteapot
    Quote from Angie O'Plasty, RN
    But wouldn't the hospital be liable if she was D/C'd and then went home to a stated abusive situation if something happened to her or the baby? Doesn't the SW have a responsibility to DC the patient to a safe environment?

    I would think she might've needed a shelter or somewhere safe to stay.

    I had a patient once who was put in ICU due to an abusive relationship, to protect her from visitors and the abuser, who was somehow still at large. That had to cost some money, but don't you agree that those were appropriate actions, given the extraordinary circumstances?
    I don't know what the SW's legal obligations would be in such a situation, but a hospital is not meant to be a shelter from domestic abuse. Perhaps she could've gotten hospital approval to keep Mom there on a very temporary basis based on having a newborn child, but sooner or later, someone (probably Medi-Cal) was bound to say WTH is going on here and why are we paying for this? The SW perhaps had an obligation to help this Mom find a safe place to go, but IMHO, the hospital had no obligation to actually be that haven.
  12. by   meownsmile
    I think if you are going to see any difference at all through the Er it may be the difference between a HMO and a PPO.
  13. by   AlsgalRN
    In 1995, I had a laparascopic cholecystectomy. I worked at the hospital and had insurance. I had to share a room with a patient who had the same surgery at the same time that I had my surgery. She had Medicaid. My insurance said that I had to be discharged in less than 24 hours from surgery. Despite my diabetes, I was discharged the morning after surgery. (I felt amazingly well and was absolutely ready to go home that morning.) My roomie had not even left her bed as of the time I was discharged. She said that Medicaid gave her 3 days postop. She also said that the nurses were going to wait on her hand and foot until the second that she was discharged. She was making good on that promise when I left the hospital. Now, tell me that having insurance always gets better/more care?!

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