Why I oppose the Framework for Protecting Patients When Emergency Care is Out-of-Network by ER DR's.

Er physicians have put forth a plan to help deal with surprise medical bills, which does need to happen, However, there is one stipulation in the plan that is a serious issue. How Copayments and deductibles are handled. We need to remove copayments and deductibles, not have it billed by the insurance company where you could be at risk to lose access to care if you cannot afford to make them.

THIS IS the section that is problematic below:

Insurers will directly pay any coinsurance, copay, and deductible for emergency care to the provider.
o Insurers can then collect back these amounts from the patient. This ensures patients only have a
single point of contact for emergency medical billing and payment, and will no longer receive and
have to reconcile multiple, confusing bills and EOBs that result from the many providers that are
often involved in a single emergency episode.

https://www.acep.org/globalassets/new-pdfs/advocacy/acep-framework-for-addressing-oon-emergency-care.pdf

The reason these bills often go unpaid is the people cannot afford to pay them. They have no means to pay them at all and they should be eliminated. Until we can get a completely universal healthcare system in place, we need to at least either include copays and deductibles in insurance coverage or have those subsidized by the government and stop expecting people to have high deductibles that they can never afford to pay when they are stuck in the hospitals. Even worse are the people who do not have needed surgeries and procedures because they cannot afford the high deductible before receiving it.

The entire purpose of the copay and deductible is to create a barrier to prevent patients from being able to access their care if they cannot afford it and it directly causes many to go without the procedures, tests and surgeries they need because they do not have the money to pay in advance. These fees need to be eliminated, not moved to a position to where they could deny the patient care entirely. If insurers are not paid by the patient, the patients will lose their insurance. We have to prevent that from happening.

Copays and deductibles are there for insurance companies to involve the customer in the process. That way they view involving the insurance company as costing money and not "free". It's something useful to have, even for "free" healthcare. Reducing the hassle involved in any sort of hospital visit is definitely something I'd be in favor of.

If people can't pay at all due to money issues, there should be other methods of dealing with that besides removing copays and deductibles for everyone.

Xeorm:
Copays and deductibles are there for insurance companies to involve the customer in the process. That way they view involving the insurance company as costing money and not "free". It's something useful to have, even for "free" healthcare. Reducing the hassle involved in any sort of hospital visit is definitely something I'd be in favor of.

If people can't pay at all due to money issues, there should be other methods of dealing with that besides removing copays and deductibles for everyone.

The patients are already involved in the process, as they already pay for monthly premiums. However, when one needs to have a MRI or Hernia surgery and the copays start at $800 deductible when we have 40% of Americans cannot even manage to come up with $400, they do not have the needed tests or treatment at all. This is in place as nothing more than an obstacle and serves no purpose than to prevent people from being able to access their treatment even when they already pay for insurance. Remove the copays and deductibles entirely , there is absolutely no reason to continue them. You still have to fill out the forms and give them your insurance card when you come in, you just should not expect to pay anything at the time of visit as to not discourage people from seeking treatment for themselves and their loves ones. I work with families every single day that worry about whether they can afford their medication or treatment for their children while we literally have to threaten to sue their insurers to get them to cover it. I know what this is for and see the results first hand the damage it is causing.

https://money.cnn.com/2018/05/22/pf/emergency-expenses-household-finances/index.html

Can you cover an unexpected $400 expense?
Four in ten Americans can't, according to a new report from the Federal Reserve Board. Those who don't have the cash on hand say they'd have to cover it by borrowing or selling something.

https://www.theatlantic.com/business/archive/2017/06/medical-bills/530679/
https://www.marketwatch.com/story/1-in-4-americans-have-to-refuse-medical-care-because-they-cant-afford-it-2017-06-06

Larger payments are a bit much. Even something as small as like $20 is enough to trigger the proper response. Really it's more an issue of stupidly expensive healthcare from a terrible system.

Xeorm:
Larger payments are a bit much. Even something as small as like $20 is enough to trigger the proper response. Really it's more an issue of stupidly expensive healthcare from a terrible system.

How many packages of Ramen noodles does $20 buy? Apples? Peanut butter and jelly sandwiches? How many trips to school or work does that pay for? bottles of infant formula or diapers? For those who are already struggling, when they pay an extra $20 at the doctors office, that means they do without something else just as important. People are living off of Thirty cent per meal Ramen noodles as it is because they cannot afford anything else. What happens when you take away the minuscule amount of food they have to pay a copay? $20 is the equivalent of removing 67 meals worth of Ramen noodles or apples. People should not have to miss meals to be able to go to the doctor.

Another day another person telling me they could not afford to get their necessary prescriptions, even when they have insurance due to copays being too high. I really wish they actually would track this data for us more accurately so we would have solid cause and effect trail of what happens to these patients short and long term showing when they cannot afford their medication tests and treatment. People are dying from this and outreach to help these people is mostly nonexistent.

Xeorm:
Larger payments are a bit much. Even something as small as like $20 is enough to trigger the proper response. Really it's more an issue of stupidly expensive healthcare from a terrible system.

Until you've been poor enough that 20 dollars means the difference between eating or paying rent and not.

We've got government workers right now who had to start making hard choices the minute that first paycheck came into question because of the government shutdown. This included people with insurance who were rationing their insulin.

Something Amyss:

Xeorm:
Larger payments are a bit much. Even something as small as like $20 is enough to trigger the proper response. Really it's more an issue of stupidly expensive healthcare from a terrible system.

Until you've been poor enough that 20 dollars means the difference between eating or paying rent and not.

We've got government workers right now who had to start making hard choices the minute that first paycheck came into question because of the government shutdown. This included people with insurance who were rationing their insulin.

That brings up another important issue, many insurers do not cover OTC medication, including insulin and patients pay for these things out of pocket in full. ALL medication prescription or otherwise should be covered. I would actually like to go as far as to covering special dietary needs as well some how for the people who are unable to afford them as they can also be very expensive including but not limited to supplements such as vitamins and meal replacements for example, ensure, gluten free products, organic fruits and vegetables, cage free eggs and even tap water alternatives are frequently far too expensive for for patients who have special needs that it is dangerous to their health to eat the more affordable options. Foods that are fine for healthy patients can be detrimental for Patients with compromised immune systems or other conditions that are impacted more severely by toxins or food allergies. Adding a swipe or chip option to insurance cards allowing people to walk in and purchase OTC items such as Tylenol or organic apples and utilize existing credit card machines would be ideal, however, would likely cause mass panic and existing insurers, however, this would be a great addition to a universal healthcare system.

Separating these things to be covered under SNAP it is more difficult to ensure they still can receive them because these items are more expensive than what is provided under the meager amounts provided under SNAP. Then you also have the issue of availability of food products in their area, having this under their insurance would make it easier for them to order their medical necessity dietary needs online. Many grocery stores still do not carry pesticide free fruits and vegetables or gluten free options Celiac patients, this way patients in areas where these things are not readily available they could order them and have them delivered in the same manner their medications are.

It is also easier to keep track of which medications the patient is receiving by having them all in one spot, especially when some medications and supplements can be purchased both with a prescription or OTC. For example, Xyzal can be purchased off a store shelf or you can receive a prescription for the generic Levocetirizine. IF you prescribe a patient Levocetirizine with their insurance it often has little to no copay, patients can actually afford their medication. IF they walk in and grab the name brand off the shelf they often cannot and frequently do without their medication because it is too expensive to purchase. Currently we have to navigate what is and is not covered by different insurers to be able to make sure patients can actually receive their medications when this would be made so much better if we had them all in one spot and they were all covered, of course covering generics more so than name brands, but if there is no generic available or there is a shortage they should be forced to cover the name brand at the same rate as the generic. While I ALSO would like to address Pharma and the whole name brand vs Generic to begin with, that is another topic in itself.

Lil devils x:

Something Amyss:

Xeorm:
Larger payments are a bit much. Even something as small as like $20 is enough to trigger the proper response. Really it's more an issue of stupidly expensive healthcare from a terrible system.

Until you've been poor enough that 20 dollars means the difference between eating or paying rent and not.

We've got government workers right now who had to start making hard choices the minute that first paycheck came into question because of the government shutdown. This included people with insurance who were rationing their insulin.

That brings up another important issue, many insurers do not cover OTC medication, including insulin and patients pay for these things out of pocket in full. ALL medication prescription or otherwise should be covered. I would actually like to go as far as to covering special dietary needs as well some how for the people who are unable to afford them as they can also be very expensive including but not limited to supplements such as vitamins and meal replacements for example, ensure, gluten free products, organic fruits and vegetables, cage free eggs and even tap water alternatives are frequently far too expensive for for patients who have special needs that it is dangerous to their health to eat the more affordable options. Foods that are fine for healthy patients can be detrimental for Patients with compromised immune systems or other conditions that are impacted more severely by toxins or food allergies. Adding a swipe or chip option to insurance cards allowing people to walk in and purchase OTC items such as Tylenol or organic apples and utilize existing credit card machines would be ideal, however, would likely cause mass panic and existing insurers, however, this would be a great addition to a universal healthcare system.

Separating these things to be covered under SNAP it is more difficult to ensure they still can receive them because these items are more expensive than what is provided under the meager amounts provided under SNAP. Then you also have the issue of availability of food products in their area, having this under their insurance would make it easier for them to order their medical necessity dietary needs online. Many grocery stores still do not carry pesticide free fruits and vegetables or gluten free options Celiac patients, this way patients in areas where these things are not readily available they could order them and have them delivered in the same manner their medications are.

It is also easier to keep track of which medications the patient is receiving by having them all in one spot, especially when some medications and supplements can be purchased both with a prescription or OTC. For example, Xyzal can be purchased off a store shelf or you can receive a prescription for the generic Levocetirizine. IF you prescribe a patient Levocetirizine with their insurance it often has little to no copay, patients can actually afford their medication. IF they walk in and grab the name brand off the shelf they often cannot and frequently do without their medication because it is too expensive to purchase. Currently we have to navigate what is and is not covered by different insurers to be able to make sure patients can actually receive their medications when this would be made so much better if we had them all in one spot and they were all covered, of course covering generics more so than name brands, but if there is no generic available or there is a shortage they should be forced to cover the name brand at the same rate as the generic. While I ALSO would like to address Pharma and the whole name brand vs Generic to begin with, that is another topic in itself.

I didn't think insulin was ever OTC. I thought the prices listed were for buying without insurance.

But I agree with the overall point in any case. There are some cases where you can get an OTC prescribed, but when I had to do it it was pretty much a hassle to do so. I'm sort of baffled by what is and isn't covered and they make a lot of things more difficult than they need to be, and this could, among other things, help streamline.

But also, especially the bit about knowing what you're on. I've needed medical care for a long time and take great care with OTC drugs, but I know people who can't even tell you hte prescription meds they're on, let alone OTC and supplements.
And considering potential interactions, this can be dangerous. Hell, it's nice to have the pharmacy as a stopgap for if my doctor misses anything, because I as the patient won't necessarily know or be able to find all the potential interactions and how likely they are.

Being unwell is already a pretty bad time to be dealing with this stuff. Being really sick is even worse.

Yup, deductibles are absolute bullshit and should be done away with.

I have health insurance through my work, and I have a $2000 deductible, so unless my medical bills exceed $2000 in a year I end up paying for everything out of pocket and might as well not even have health insurance.

I got really bad food poisoning last year and went to the emergency room after I vomited so hard it caused me to pass out. My emergency room visit cost me $2200, so my insurance paid for $200. I'm a young physically fit person who takes care of my health. Unless I suffer a horrific car accident or something it's basically guaranteed that I will not spend much more than $2000 on medical bills in a year, and most years will spend nothing. Despite having health insurance I'm still paying out of pocket for nearly 100% of my healthcare.

And there's plenty of people who have it much worse. At least I can pay the $2000 out of pocket expense without issue if I do end up needing to go to the hospital. Many people don't have even a fraction of that money on hand, and if you can't pay unforeseen medical bills because you're too sick to work it damages your credit and screws you even harder in the long run.

Something Amyss:

Lil devils x:

Something Amyss:

Until you've been poor enough that 20 dollars means the difference between eating or paying rent and not.

We've got government workers right now who had to start making hard choices the minute that first paycheck came into question because of the government shutdown. This included people with insurance who were rationing their insulin.

That brings up another important issue, many insurers do not cover OTC medication, including insulin and patients pay for these things out of pocket in full. ALL medication prescription or otherwise should be covered. I would actually like to go as far as to covering special dietary needs as well some how for the people who are unable to afford them as they can also be very expensive including but not limited to supplements such as vitamins and meal replacements for example, ensure, gluten free products, organic fruits and vegetables, cage free eggs and even tap water alternatives are frequently far too expensive for for patients who have special needs that it is dangerous to their health to eat the more affordable options. Foods that are fine for healthy patients can be detrimental for Patients with compromised immune systems or other conditions that are impacted more severely by toxins or food allergies. Adding a swipe or chip option to insurance cards allowing people to walk in and purchase OTC items such as Tylenol or organic apples and utilize existing credit card machines would be ideal, however, would likely cause mass panic and existing insurers, however, this would be a great addition to a universal healthcare system.

Separating these things to be covered under SNAP it is more difficult to ensure they still can receive them because these items are more expensive than what is provided under the meager amounts provided under SNAP. Then you also have the issue of availability of food products in their area, having this under their insurance would make it easier for them to order their medical necessity dietary needs online. Many grocery stores still do not carry pesticide free fruits and vegetables or gluten free options Celiac patients, this way patients in areas where these things are not readily available they could order them and have them delivered in the same manner their medications are.

It is also easier to keep track of which medications the patient is receiving by having them all in one spot, especially when some medications and supplements can be purchased both with a prescription or OTC. For example, Xyzal can be purchased off a store shelf or you can receive a prescription for the generic Levocetirizine. IF you prescribe a patient Levocetirizine with their insurance it often has little to no copay, patients can actually afford their medication. IF they walk in and grab the name brand off the shelf they often cannot and frequently do without their medication because it is too expensive to purchase. Currently we have to navigate what is and is not covered by different insurers to be able to make sure patients can actually receive their medications when this would be made so much better if we had them all in one spot and they were all covered, of course covering generics more so than name brands, but if there is no generic available or there is a shortage they should be forced to cover the name brand at the same rate as the generic. While I ALSO would like to address Pharma and the whole name brand vs Generic to begin with, that is another topic in itself.

I didn't think insulin was ever OTC. I thought the prices listed were for buying without insurance.

But I agree with the overall point in any case. There are some cases where you can get an OTC prescribed, but when I had to do it it was pretty much a hassle to do so. I'm sort of baffled by what is and isn't covered and they make a lot of things more difficult than they need to be, and this could, among other things, help streamline.

But also, especially the bit about knowing what you're on. I've needed medical care for a long time and take great care with OTC drugs, but I know people who can't even tell you hte prescription meds they're on, let alone OTC and supplements.
And considering potential interactions, this can be dangerous. Hell, it's nice to have the pharmacy as a stopgap for if my doctor misses anything, because I as the patient won't necessarily know or be able to find all the potential interactions and how likely they are.

Being unwell is already a pretty bad time to be dealing with this stuff. Being really sick is even worse.

Yes, Insulin is OTC, anyone, diabetic or not can walk into any pharmacy and ask for it and you do not even have to show ID to keep track as they do with medications such as 12 hour Sudafed and such. Some manage to have insulin covered by insurance and delivered, but that is also difficult due to the refrigeration requirement so someone has to be there to collect it and put it in the fridge immediately. Most people simply walk into the pharmacy and purchase it however. I agree, most people do not want to have to keep track of if their medications are conflicting and if we have OTC medications all covered under the same card it would prevent that from happening as frequently. The reality is most people do not understand what is in their medications, nor do they bother to ask if there are conflicts when they take OTC medications, when conflicts are extremely common. I could not even begin to count the number of people I have spoken to that do not understand simple things like Acetaminophen and Tylenol are the same thing and try to give their children a cold medication with it AND Tylenol on it's own. The current system expects the patients to understand all of these things but our reality shows us that is far from being the case.

Of course you would expect insurers to completely have a conniption fit over having these added costs put upon them into one system, though that is all the more reason we need to shift to taxpayer funded healthcare system that exists for the health of the people rather than to fatten the pockets of those profiting from people being sick.

EDIT: I think I should clarify how they will help prevent dangerous interactions by having them all on one card. When you go to check out, if your medication history shows you purchased conflicting medications, a warning will pop up to inform you. If you purchase from the pharmacy itself, it will signal for a consultation from the pharmacist as well. This way even if you are buying cold medicine at 3 am from a self checkout register, the system will still give you a warning pop up when you swipe your card, even if you do not have a pharmacist available at the time for simple conflicts such as cold medications containing antihistamines and Acetaminophen. Frequently these medications already signal for an employee to verify your age when purchasing, this could be an additional warning that could be added easily as well.

 

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