An Emergency Room story for Medicare recipients. My experience.

[Paper Roses]

Can't afford the supplement? The lack of it will cost you more.

This past weekend, I ended up in the ER because of an allergic reaction to a drug I was put on. I did not know I was allergic to this drug and neither did my doctor. I found out quickly that I had a problem.

After phone consultation with the doctor and a realization that my allergic symptoms were getting worse, I went to the ER because I was told to go for treatment. Weekend and all that.

I sat in the ER for 4 hours waiting to be seen. Got there about 12:45, no-one waiting there. Foolish of me to think that was a good sign. I waited until 4PM to be seen. About 100 people came and went while I waited. Not rushed in on ambulances, just walked in, gave some info and sat for a few minutes. I reached a point that I thought they'd lost my paperwork. The reason for my wait?

Triage. You are assigned a number, 1 to 5. I was a 3. The middle category. Not dying, not free.

Critical cases in first--certainly. At the same time the free care pool is seen by another field of doctors and nurses. Anyone needing attention that is not in immediate danger of dying (#3) is put in a middle category and has to wait for a free doctor.

I understand that. Certainly I have no problem waiting if someone has a life threatening situation. What bothered me is the fact that at least 100 people came and went while I was siting there, scared that something major was happening and all the receptionist would tell me is that they are waiting for a bed so I could be seen.

He continued to explain that the non-emergency ER visitors are seen and treated by staff and their needs tended to as routine. This is where they got their free care. That is OK, if you need care and this is the only option. What bothers me is the fact that I had an emergency, I have inadequate insurance because of my inability to afford it and I will be billed. I bet when I get everything, I am looking at well over a thousand dollars. I don't know where I'm going to get the money to pay it.

Here's the situation. I am on Medicare. Retired and living on Social Security. My monthly check is not much and I cannot afford the supplements to Medicare. Well, this emergency visit will cost me more than the supplements would have cost. I will be balance billed for all that Medicare will not cover. I'm stuck paying for something I cannot afford. I also have to pay for 2 visits to the doctors office plus tests that were done in the office prior to this visit and after. I stalled on some additional tests because I am hoping that things will clear up on their own. I can't afford the tests.

This is a good example of things that are wrong with our health care delivery system. To be treated in the ER because it is the weekend, to be billed a good portion of this visit because your Medicare is inadequate, to have to accept the fact that all these people are getting it free and you are not. Your ability to pay is no greater than theirs. Discouraging.

I don't have much, I try to be thrifty and to stretch a dollar as far as I can. It is not because I chose to go to the ER as a lark, I needed medical attention and this was my only option. It is discouraging to know that what you have for coverage, even thought it is the best you can afford is inadequate. I have no way to fight this. I have some assets so I cannot get free care and I am automatically enrolled in Medicare because I am a Senior and this is the way it works.

If I could afford proper insurance, I'd have it. Now all I will get is the bill I cannot pay.

If I stopped paying my bills and things like my house taxes, I would have no trouble paying for supplemental coverage.

I am not resentful of the folks receiving free care. They deserve help as much as the rest of us. What I do resent is the way the system works. I will have to find a way to pay these bills with some kind of payment plan. I cannot even sign up for a supplement until December for January coverage. I will do so but something else will have to go. Shall I not but food? Not pay my Real Estate taxes? Don't pay the fuel delivery people?

Is it better not to pay your bills and buy a supplement? Try to be self sustaining and it bites you in the backside. I am discouraged.

What a mess.

Damned if you do and damned if you don't.

[elleng]

1. When you say 'not dying, not free,' what do you mean by free?

Who and why is 'free?' And where are you/the hospital located? Trying to learn somethings about medicare. Thanks.

[JeanGrey]

2. Stop it. Medicare is wonderful. Just ask people on this

board. You are mistaken.

[Paper Roses]

5. I am not knocking Medicare. I am discouraged by the way the

healthcare delivery system works. Medicare is paying a lot of these bills, I pay for Medicare. What is discouraging is the fact that, because the supplements are so expensive, I do not have a policy that picks up where Medicare leaves off.

I do not qualify for any assistance at all and will not apply. I can sustain myself as best I can. I do wonder sometimes why the delivery of care is so uneven.

I hoped someone would understand the direction I was going with this post. Maybe I did not word it properly.

[JeanGrey]

17. I left off the "sarcasm" label - I'm sorry.

[sinkingfeeling]

3. How do you know all those people were getting care for 'free'? I have a young

woman friend who has about $500 in total assets. She called me one weekend to take her to the ER. We got there and they discovered that her gall bladder was infected and she needed emergency surgery. When they opened her up, they found gangrene. She had a hospital bill of over $37,000 and a bill from the surgeon, the anesthetist, a general doctor, and a 'specialist'. She had to fill out a request for a 'hardship case' and multiple financial forms. It took about 6 months before the hospital and surgeon waived their fees. She has been sued by the rest and a judgment is out there for her to pay the rest.

[raccoon]

4. I'd love to be able to buy into Medicare. nt

[Texasgal]

6. As a former TRIAGE RN

You are wrong.

Nobody rounds patients into groups based on their ability to pay/coverage etc. Your issue was obviously not as medically pressing as the person before you.

And just so you know, there is no "FREE CARE" everyone that receives care their insurance is billed or they are billed. I am a bit confused that you assume that there is a "free care" bed somewhere in triage???

[KatyMan]

8. I was told the same thing

by my wife the RN/BSN. Doctors and nurses in the hospital don't know or care what your status is with regard to payment. No one is treated differently or with less care because of their ability to pay (or their citizenship!).

[FlaGranny]

9. Might not be any "free beds"

but there certainly is free care in ERs and hard-working people pay for the free care of others through insurance premiums and paying their out-of-pocket expenses for the very high cost of ER visits. Until single payer, where everyone pays what they can afford to cover everyone, things won't change much.

The last time I was in the ER for an injury, I discovered that they had a whole new triage system, and one that worked very well. I had to have sutures and was taken to a "section" of the ER where there was no doctor in sight. That whole area was run by nurses and techs. My wait was about half an hour. The nurses referred patient's needing a doctor on to the main ER. The huge waiting room was nearly empty and the wait was almost nonexistant. This was in a hospital where previous waiting times were up to 8-12 hours. Needless to say, I was impressed and pleased with the new system. I went back twice, once for suture check, and once for suture removal and had the same experience each time. I don't know if the bill was cheaper because I had a $50 copay for each visit and never saw a full bill. I do know that it was cheaper for the hospital but don't know if they pass the savings along.

[Paper Roses]

13. Perhaps I am wrong, I am willing to admit that. I was told by the

ER receptionist that these visits were non-emergency care. They are not turned away.I cannot account for his words but just what I was said. If I am in the middle range, why were all these people admitted before me? They were obviously not critical, no-one was upset, in obvious pain, bleeding or anything like that. The critical patients were seen immediately, we could hear the ambulances coming and going. Two came in the front door and were immediately taken in.

I cannot imagine why all these people were in there before me if I was in the mid-range of needing care. This mid-range is obviously more critical than some, less than others.

I had to go into a little room with the medical records person first, give my medical information, Insurance info (Medicare), and then meet with a nurse to discuss my problem and be assigned a number. I was there because the doctor told me to go. I would have made it until Monday for an office but I did what I was told. I did not know what was happening or whether to stop taking the medication I was prescribed. I felt miserable and was afraid of things getting worse. Perhaps it would have been better if they told me to go home, that I should wait until I can see the MD on Monday. Hindsight is great, it would have been better for me if I waited. Certainly it would have been less expensive.

It is said that hasty generalizations are dangerous. Perhaps I did make a hasty generalization. I really do not know why all these others were there based on any real knowledge. Just some kind of a deduction on my part.

I will somehow find a way to buy the supplement when enrollment opens and hope I can rework the budget to accommodate the additional cost.

It was not my intention to cause any great debate, just to point out that lack of Medicare supplemental insurance is costly. I feel for anyone who is without insurance, I have been there. No disparagement was intended.

[FlaGranny]

7. Medicare certainly isn't

the best payment for health care, but it is cheaper than any other insurance you can get. People with private insurance have to pay anywhere from 5 to 15 times the monthly premium of Medicare with just as much or more out-of-pocket expenses. There is no good answer for health care except a single payer option with everyone paying their share (as they can afford) and everyone getting all the care they need.

That said, I completely understand what you're going through.

[asjr]

10. I understand about the supplemental

insurance premiums. I had to drop mine about 2 years ago because of the premium.

[Kindigger]

11. Uninsured, 'state papers', and Medicaid

I'm sorry your experience sucked, but I suspect you had to sit there because you were the only one who was going to get to see a REAL doctor. Being uninsured or having Medicaid is like having a big X on your forehead. As Tom Coburn said on CSpan one morning, "If you're on Medicaid, you may as well not have any insurance at all."

I've finally realized it's the reason I've been lied to, told partial truths, and treated as 'crazy' for over 20 years, even with evidence of a real medical condition right in front of their faces. Even with an ex-ray of a collapsed neck (which I found an exact replica of on the internet), I was told "We don't give MRIs to just anybody." Shortly after the doctor left the office for a moment, I quickly skimmed my hefty file only to find the words 'somatic' and 'malingerer'. Two weeks later I was in the operating room getting a cadaver vertebra surrounded by rods and pins.

Just recently this happened to me. (Sorry if this post seems disjointed/mixed up, but I wrote this before I wrote the above):

I'm disabled & have medicare/medicaid. My knee was full of fluid and my calf was so swollen the skin would have split open if it'd got any worse.

I got an appointment on a Monday with a doctor's office where the PA had been giving me cortisone shots. Turned out the doctor was off, and the only person there was the PA. He looked at my leg and asked, "What do you want me to do about it, why didn't you go to the ER over the weekend?"

I replied that I knew they would tell me to elevate it and ice it, which I'd been doing since the previous Thursday without success. I went on to say, "You've seen the ex-ray, I need a new knee. Everyone I've seen knows I've needed a knee for the past 20 years. If I were an athlete with a $10 million dollar contract this would have been taken care of a long time ago."

He replied, "In a perfect world you would get a new knee, but anyone who would give you a new one now would be committing malpractice."

The PA eventually took 50ml of fluid off my knee. I got no appointment for follow-up, no take home instructions.

I thought about this, and realized:
1. I was never really a patient of this office. The PA gave me cortisone shots only because it was quick, and they either made money or didn't lose money giving them to me.

2. A new knee is malpractice because people with medicaid are expected to hobble around in pain until they reach an age where one knee replacement will outlive them.

My friend suggested I don't mention Medicaid next time--tell them Medicare and pay the extra myself. I think if someone punched in my Medicare number, eventually Medicare would get around to telling them I also have Medicaid.

I went to my regular dentist, only to find they no longer accepted Medicaid. I asked them if I could pay to have my teeth cleaned, and was told it was against the law for them to take my money.

I thought this was the most ludicrous thing I'd ever heard, but later found out it was true.

[Greyskye]

12. Send this to your congress-critters

You never know, one of them may be able to do something to help you out.

And if nothing else, it will help raise their awareness of this disaster of a health care system.

Thanks for posting, and good luck!

[Old Codger]

14. Last time I checked

Medicare does not cover emergency room unless they admit you ... not absolutely sure of this though... just seem to remember something along those lines.... might be that was ambulance for emergency...have to look into this a little ..

[TexasObserver]

15. This is so very wrong to people like you.

You have Medicare, but without the supplement that costs you $96 a month, you always end up short on any kind of serious charges. Even if you get the supplement, you end up short. My parents have the supplement, and another supplemental policy that costs them another $350 a month, and they still have medical charges that none of the coverages will pay. And they don't go unless they need to go.

[sinkingfeeling]

16. Part A = no cost, Part B= $96.40 a month (outpatient care), Part C= provided by

private insurance companies, may be PPO, HMO, PFFS, Part D=drug benefit with premium charge, Medigap polices = private plans to pay co-pays and out-of-pocket expenses not covered by Medicare.