For those of you who have a similar unfortunate experience in an ER your insurance company should be able to help. Most can direct you to the Fraud and Abuse hot-line. Excessive charges and procedures are considered "abuse" and should be reported. Overlake Hospital offers the services of a "patient advocate," however don't be mislead - they advocate for the hospital first.
Insurance companies are your friend. They want to keep their costs down while servicing their clients. Our insurance rep from Regence arranged a conference call with Overlake to find out why Jane was charged weeks ago without any notification to the carrier. The agent assured me Jane would get a good rate on insurance and we did. Appealling the insurance company wasn't necessary. They certainly did their job.
The Washington State Hospital Association reported on 2/11, "One in nine ER visits are avoidable. Potentially avoidable ER visits can be appropriately treated in another setting at the time the ER visit occurred."
Evergreen Hospital appears to have really caught on to this concept. I've found pamphlets in their medical hallways to educate patients on how to choose the best place to go for health care. In addition, Evergreen's Redmond & Woodinville primary care and urgent cares are in the same buildings to facilitate appropriate treatment in a setting other than an ER.
Unfortunately, Overlake Redmond Urgent Care didn't have a clinical laboratory or contrast Cat Scan, so they sent Jane to the ER for these tests. Evergreen's Redmond clinics have a lab and imaging department so you don't have to be admitted to an ER. Same with Virginia Mason - Kirkland. Read More >>
Probably the biggest service any medical institution can do to cut down on preventable ER visits is provide convenient primary care office hours. If it's not emergent, see your doctor! Know their hours. Many doctors cover for each other so by going to your clinic, all your medical records are on file with your doctor. Your doctor knows you better than any Urgent Care physician could. Avoid Urgent Care at all costs unless it's necessary to see a doctor after 8 p.m.
Primary care clinic hours keep getting better and better. All offer same-day appointments, except for Overlake's restriction to same-day non-acute appointments. All offer full imaging and specialists except Overlake Medical Clinics. (Click the link to know your doctor's hours and services!)
Evergreen Redmond Primary Care have 7:30 a.m - 8 p.m. same day appointments, Lab, Imaging, spec.
Virginia Mason-Kirkland Primary Care has similar hours to Evergreen. Lab, Imaging, specialists
Overlake Redmond Primary Care has shorter 9:00 - to 5:30 p.m. hours with same day appointments for non acute patients. Lab only
Swedish-Redmond Primary Care has eight primary care doctors with same day apts. from 7:30 - 5. Lab, Imaging, specialists
WSHA states the common reasons for avoidable ER's visits are: 1) "People *think they have an emergency 2) People may have access to Primary Care but think they can't get into the office on time, 3) Primary Care isn't open, 4) People lack disincentives to use the ER for non-emergent symptoms."
People on the Eastside have plenty incentive to visit ER's with five Urgent Care clinics routing their patients to five ER's, all located within 11 miles of Redmond. Low occupancy, high overhead, competition for insurance dollars, and clinical marketing all incent doctors to use ER's when possible. Overlake Urgent Care really makes it easy to choose their ER by quoting low "wait times."
Disclosure: I've done business with each hospital quoted. I report on Evergreen Healthcare for a more Open Government. Evergreen's Malte Administration appears at the leading edge of several WSHA initiatives: 1) education on monitoring of narcotics is posted and 2). patient awareness brochures explaining appropriate service choices. 3) Hand washing hygeine has constant emphasis.
* Nurse Call Lines at night may lead to unecessary ER visit's when primary doctors are unavailable.
OPINION By Bob Yoder
Ref: WSHA, WSMA, ACEP-WA, Jane's medical records.
4/30
To name a few of many insurance companies that have Fraud and Abuse Hotlines:
Regence BlueShield of Washington
Medicare Supplement Members: Call Medicare Fraud and Abuse Hotline, 1-800-447-8477, option 1
Boeing Contract: 1-800-922-4325
Primera of Washington
Call our Fraud Hotline, 24/7 at 800-848-0244 or 425-918-5500 to report possible fraudulent and abusive activity
Aetna Fraud and Abuse Line: 1-800-338-6361 or AetnaSIU@aetna.com
The hospitals themselves try to steer you in the direction of the ER. No doubt because they charge such a steep rate just to walk in the door. I had an incident about 6 months ago where I wound up getting bit several times by a 110lb dog. He wasn't attacking me per say just panicking because he was choking on a tennis ball. Since it has been a good 20 years since I have had a tetanus shot and I wasn't sure if I needed stitches I showed up at the Evergreen Urgent Care facility in Redmond. I got there 10 minutes before they closed and they wouldn't see me. Apparently they stop taking patients 15 minutes before closing time. My primary care doc who also works in that bldg was off that day and noone else would see me either. They just kept telling me to go downstairs to the ER. I don't have insurance and there was NO WAY I was going to rack up a huge bill just for a dog bite so I wound up getting totally frustrated and leaving to deal with it myself. In the end it cost me about $7 for disinfectant and bandages and $75 for a tetnus shot from Fred Meyers. If I had gone to the ER like I was being instructed I would still be paying off the bill.
ReplyDeleteHi Carla - I'm glad you are healed and know you're immunized now.
ReplyDeleteOh my, this is an unfortunate experience - and sad. It's so hard to believe this kind of thing would happen at Evergreen.
I'll make suroe the Administration and commissioners hear what you went through. If you're still reallyy upset you can go talk to the commissioneric at their next public meeting, Tuesday, May 15 at 6:30 (Physicians & Surgeons bldg #200. Tan.
Hi Bob! It's all water under the bridge at this point.
ReplyDeleteAt the time I didn't appreciate the fact that I was standing there bleeding with multiple bite wounds and all the chick at the desk would do is tell me to go to the ER. Thankfully it turns out the bites were all straight in and out puncture wounds and had missed all of my tendons. It would appear I got lucky and will have no permanent damage except for a few scars.
I went there specifically because my primary doc is there and because I have had such a great experience in the past with them. Like I mentioned before I don't have insurance and really appreciate that Evergreen offers me a discount on their services because I am paying out of pocket and another if I pay at the time the service is rendered. Getting 35% off the top has made it possible for me to finally get help managing my HBP.
I was simply sharing my story in an attempt to illustrate how easy it is for Urgent & Primary Care staff to just steer people to the ER with no regards to the cost for anyone involved.
According to the Evergreen Administration the primary care clinic is supposed to be open til 7p.m. for same day apts. So all you have to do is call for an apt. for that day. If your doctor isn't available you can use another one (and they share med. records). Redmond Urgent Care presently closes at 5:30 I think so you have a good option to see you a PCP - better than the ER!
ReplyDeleteWhen Jane was in the OVERLAKE ER for her in-depth work-up for abdom. pain afterwords we asked financial how much it would cost if we didn't have ins. The Finance Dept. mgr. answered: 30% off. So it sounds like Evergreen is more generous then Overlake for those without.
I was reading your article with serious interest until I stumbled on the line "Insurance companies are your friend"...after that I had a hard time taking the post seriously. You probably made some good points, but that one line is so very far from the truth that it tainted the entire article.
ReplyDeleteThe cost of providing care in the ER is high. A study featured in the September 2010 issue of Health Affairs
ReplyDeletefound that many people seek care in the emergency room for ailments that are not emergencies and that
inappropriate ER use could be attributed, in part, to a lack of access to primary care services.1 In a recent
survey by the Healthcare Intelligence Network, 95 percent of responding hospitals stated that avoidable ER
visits were a problem.
I have also noticed many ER only buildings going up around the Puget Sound. Not primary care facilities, but Emergency Room only.
ReplyDeleteYes, it's not just the stand-alone Urgent Cares like Overlake that contribute to excessive ER use. It's the growing number of stand alone ER's (and re-modernized ER's like at Multi-care Med. Ctr. in Tacoma and V. Mason in Seattle.)
ReplyDeleteER's have become the swimmingly posh boutiques of medical care catering to the fully insured.