Do you think it will come to this?

[MrsWampthang]

Patient presents to ER with minor symptoms, i.e. cough for several days, rash, excessive ear wax. Patient is asked if they have insurance, and if the answer is no or they are on medicaid, patient is refused service. Or maybe their name is flagged like it is in doctor's offices and when a patient presents with a non-lifethreatening complaint, that owes a certain amount of money, then they are told to pay something toward their bill before they will be seen this time.

Right now all the ER docs have to do is assess them for life threatening stuff and if there is none, then they can discharge them without so much as a script for tylenol. These patients are far and few between because it seems like in this day and age of litigation, more and more docs are afraid of missing something and being sued for malpractice.

I get so frustrated sometimes. Case in point: morbidly obese woman came in for a cough times 2 days. When I asked her if she had contacted her doctor, she said she didn't have any insurance so she had to come to ER. I wanted so badly to ask her how she was going to pay the ER bill if she didn't have insurance, but I restrained myself.

Sorry to vent, but just wondered if anyone else had any thoughts on this.

Pam:o

[amycar11]

i really hate to divulge this but...i think that my country's economy also stink when it comes to giving medical assistance to its population...

we also have a lot of insurance companies here who requires the beneficiaries to "deposit" a certain amount of money (depending on the company) every month for the next couple of years... only to have your "benefits" returned to you MONTHS after you were already released from the hospital... the processing of the papers for the reimbursement is even preposterously slower than a turtle, especially if you don't have relatives or friends who works in that company to facilitate following up your file...

the scenario is even more bleak for those who are in the rural area and those who belong below the poverty line (the indigent people) since they do not even have the money to avail of the membership of the insurance company... more often than not, those people who go into their respective provincial hospital often ends up with even more complications than necessary (mostly avoidable ones) or worst DEATH... IF ONLY they were given the appropriate medical attention that they need, instead of being left alone (or ignored) because of lack of insurance or lack of money...

so so so very very sad...

that's not even 1/8 of the entire picture of this devastating reality... it gets even more disgusting when i see politicians bickering over each others "wealth" ... making up issues and digging up each other's trash and skeletons-in-the-closet... while the rest of the population slowly die from poverty because of the corruption issue in the government...

[berry]

The er i am at now requires a 75$ deposit for any uninsured pt that is triaged a level 3 or 4(basically means clinic pts you are not in any way shape or form at risk of losing life or limd with delay of tx and level 4 is like suture removal). This is the first place i have been at that does this but it is a great idea. 50% of the people i see could go to rite aid(insert name of local drug store or any pharmacy aisle in walmart or grocary store) and fix the problem. you dont need to come to an er cause you back hurts for the last six years we are not going to fix it today, you have a fever 101 or less take some tylonal or just ride it out a fever means your body is actively fighting what is wrong with it. if you have have a nonproductive cough and you smoke that is not a er vist that is you baseline. I told a pt last week who c/o that she was coughing and needed some ab(she had normal white count expected xray for 20 year smoke)r no you need to go home and quit smoking you complaining about coughing is like someone telling me their hand hurts and reporting that they slam it into a car door 20x a day for the last 20 years. courese some of them slip back as a level 2 I had one girl vague complaint n/v i brought her back she had to pee so i went ahead and collected a sample she ask is that for the pregancy test. I asked why she said cause i need one, i ask if that is the only reason you are here she said pretty much, and the n/v stuff you reported "not really i just wanted you guys to give me a pregancy test" she then proceed to tell me she came her because medcaid pays fro this instead of spending a couple of bucks for a ept stick test at drug store.

[Rapheal]

Another part of the equation is that many MD's will not accept medicaid patients.

[MrsWampthang, BSN, RN]

So many medicaid pts come into our ER that have no family doc yet, or whose doc is too far away to get to easily. That's one of many reasons they come in for minor complaints.

Our hospital is so focused on "customer satisfaction" that they wouldn't dare ask anyone for any kind of copay, even though I think it would be a great idea.

One of our ER docs told the powers that be, that he didn't care about satisfying the patients that are frequent flyers who don't pay their bills. He told them in so many words that he didn't want them to come back so why should he be nice to them in the first place? Kind of harsh, but I can see his point.

It was so funny, one day I was in triage with an orientee, we checked in a patient that some kind of really stupid complaint. After the patient went to the registration area, I remarked to my orientee that that patient had picked the wrong day to come in. It just so happened that we had one of our docs that basically assesses patients for life threatening stuff then would boot them out the door if there was nothing wrong with them. Anyway, later when we went to the back, that doc was remarking on the very patient and almost quoted me word for word by saying "she picked the wrong day to come in." I almost fell off my chair I was laughing so hard!:chuckle

I wish our docs would do that more often, then maybe our hospital wouldn't have to write off in excess of 64 million dollars a year in uncompensated services.

My favorite phrase to use when checking someone in that has a chronic complaint is "what's new or different that brought you to the ER today?" They usually just say "well it's worse today." Yeah, ok, whatever. Sorry to rant, but it gets really frustrating sometimes.

Pam