Health Insurance

kzizok
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6/5/2016 9:52am Edited Date/Time 6/5/2016 10:38am
Hell, I didnt even see the chocale post. I work for one of the major groups he talks about in St. Louis.

I forgot to mention, the hospital was in was Level 2, and the largest psych hospitals in the state. So not just psych, but medical as well that includes all the homeless, etc being downI town. I also worked at the level 1. Busy, but you add the pysch in, and it goes crazy (no pun intended).

Honest to God I have no idea how they stay open. I would bet probably around 75% that cant/dont pay and dont ever have to worry about. Cant get blood from a stone. You or I or any working person not being able to have insurance and we have to go, theyll come after us for payment and if it a facility you work for, theyll fire you. The really cool part about is all those patients that cant pay leave a pretty good deficit. So our bill has a certain percentage in it to offset the cost? WTF?.

Georgie, I orderd Canadian Mist the other day for ETOH intoxication. Pored it dirctely into his feed tube! But rarely do it any more. Oh he was w/d at .500!

BTW, my grammer, spelling sucks. Using my phone.
6/5/2016 10:07am Edited Date/Time 6/5/2016 10:07am
Wow. Next time ask for precedex as well. That's insane. I've never put alcohol down the NG or feeding tube. Banana bag and precedex. Nicotine withdrawal too. All the patches we gotta put on these people is insane.
kzizok
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6/5/2016 10:12am Edited Date/Time 6/5/2016 10:13am
Here let me save your life but I cant afford my own health insurance
kzizok
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6/5/2016 10:29am Edited Date/Time 6/7/2016 10:45am
APLMAN99 wrote:
I thought that you were an ER nurse. No?
Yea I am.
APLMAN99 wrote:
I don't think I've ever had a nurse, especially an ER nurse, ask me about my insurance or financial info at all. That's generally the admitting...
I don't think I've ever had a nurse, especially an ER nurse, ask me about my insurance or financial info at all. That's generally the admitting rep it seems.

Are you digging into their financial information because you alter your level of care based on their ability to pay or their levels of insurance? Are you determining how they came about having that insurance?

I find your level of involvement in your patients' financial affairs a bit strange.
Its against the law to ask before treatment. EMTALA. Man, Im sorry, I completely missed the rest of your question. It doesnt matter if you are Donald Trump or the homeless guy from down the street. Ability to pay isnt a concept whatsoever when determining level of care. It is a complete non issue on how the patient gets resources, etc. However, I am describing what happens in an ER. As a person becomes less acute, then that model begins to change. There is a lot to it but in an ER setting most things are short time, possibly life or death. Throw the kitchen sink at them. What happens for more chronic issues is where things get really convuluted. This are looked at to see if they are medically necessary, etc. Additionally, regulations occur that you have to have 3 midnights for certains levels of care and less arbitrary things lose coverage. The system totally encourages as many ER visits as is wanted. Everything is free and you're gonna get a good, very expensive workup. Heres the treat, if you go back to work it all goes away then you lose all the benefits.

The Shop

kzizok
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6/5/2016 10:34am Edited Date/Time 6/5/2016 4:20pm
kkawboy14 wrote:
Has Obamacare helped or hurt you? I provide group for my company and it keeps going thru the roof but it is easier to get good...
Has Obamacare helped or hurt you?

I provide group for my company and it keeps going thru the roof but it is easier to get good coverage
Luckily, there wont be a next time at that level anyway. Im sitting and eating bon bons in family practice. Do some cough and cold, order labs, and write prescriptions for people that actually care and vise versa
6/5/2016 10:35am
kkawboy14 wrote:
Has Obamacare helped or hurt you? I provide group for my company and it keeps going thru the roof but it is easier to get good...
Has Obamacare helped or hurt you?

I provide group for my company and it keeps going thru the roof but it is easier to get good coverage
Haha we might work at the same hospital. I won't mention the name.

I have wished that I could just give some alcoholic patients a beer at different times, bu it probably wouldn't help much for someone that drinks 1-2 fifths per day. We usuallu end up just giving Ativan and a banana bag.

The tricky part is when alcoholics fall and you can't tell if their symptoms are coming from the alcohol or a brain bleed. They need head CTs! Someone with chronic pain doesn't need the CT, but the doctors have to order it because lawyers.
kzizok
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6/5/2016 10:47am Edited Date/Time 6/5/2016 10:50am
kkawboy14 wrote:
Has Obamacare helped or hurt you? I provide group for my company and it keeps going thru the roof but it is easier to get good...
Has Obamacare helped or hurt you?

I provide group for my company and it keeps going thru the roof but it is easier to get good coverage
Haha we might work at the same hospital. I won't mention the name. I have wished that I could just give some alcoholic patients a beer...
Haha we might work at the same hospital. I won't mention the name.

I have wished that I could just give some alcoholic patients a beer at different times, bu it probably wouldn't help much for someone that drinks 1-2 fifths per day. We usuallu end up just giving Ativan and a banana bag.

The tricky part is when alcoholics fall and you can't tell if their symptoms are coming from the alcohol or a brain bleed. They need head CTs! Someone with chronic pain doesn't need the CT, but the doctors have to order it because lawyers.
For sure about giving ETOH for wd. Ive only done it once. But the guy was having major w/ds at .500!!

I thought I read you are in St. Louis? My post was a little confusing. The company I was referring to is based in St. Loius but thats not where I am.
kzizok
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6/5/2016 11:00am Edited Date/Time 6/5/2016 11:17am
I know we kind of took this thread hostage. But, if I didnt know any better(like not working in healthcare), I would be very curious about what happens for real with hands on experience.

Like, defibrillators dont work to restart the heart and run as fast as you can if you get a fibromyalgia (obviously they arent in on iIt, like tbe TYLER of dieasest) patient. Cause they are going to wear your ass out for narcotics under the disquise of a pseudo illness.
6/5/2016 11:26am
kkawboy14 wrote:
Has Obamacare helped or hurt you? I provide group for my company and it keeps going thru the roof but it is easier to get good...
Has Obamacare helped or hurt you?

I provide group for my company and it keeps going thru the roof but it is easier to get good coverage
It's kind of funny I was actually just about to bring up a story about a defibrillator. I love hijacking threads to tell crazy ER stories.

Every single one of these threads is always about the negative aspects of health care so I always share my opinion on all the craziness that goes down at my job. This makes some people think I have a pretty bad attitude and shouldn't be in nursing.

When I am actually able to do my job I love it. The other day they brought in a lady who was having a heart attack and looked like complete shit, so I slapped the defibrillator pads on her. She went into cardiac arrest and we were able to shock her heart back into a rhythm very quickly. That is why I'm in healthcare. She literally died and we brought her back to life in a split second.
kzizok
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6/5/2016 11:57am Edited Date/Time 6/5/2016 12:01pm
kkawboy14 wrote:
Has Obamacare helped or hurt you? I provide group for my company and it keeps going thru the roof but it is easier to get good...
Has Obamacare helped or hurt you?

I provide group for my company and it keeps going thru the roof but it is easier to get good coverage
It's kind of funny I was actually just about to bring up a story about a defibrillator. I love hijacking threads to tell crazy ER stories...
It's kind of funny I was actually just about to bring up a story about a defibrillator. I love hijacking threads to tell crazy ER stories.

Every single one of these threads is always about the negative aspects of health care so I always share my opinion on all the craziness that goes down at my job. This makes some people think I have a pretty bad attitude and shouldn't be in nursing.

When I am actually able to do my job I love it. The other day they brought in a lady who was having a heart attack and looked like complete shit, so I slapped the defibrillator pads on her. She went into cardiac arrest and we were able to shock her heart back into a rhythm very quickly. That is why I'm in healthcare. She literally died and we brought her back to life in a split second.
You are right. The vaaaaast majority of what we go through is shit, kind of ironic because we will jump in anywhere, anytime to save a life. Kinda like golf, shity round but a couple of those sweet spot bombs make iit all worth it (If anyone thinks I compariing golf to life keep it to yourself).

Heres what I can say, I had an epic day about a year ago. Personally, I brought a person back to life, w/my own two hands. As codes go, obviously I wasnt solo, Pretty good feeling as you are doing chest compressions and you get a rhythm. If I never accomplish any thing else in life, Im still ecstatic.

Same day, I was in triage a 19 yo comes in with labor pains. I didnt think anything of it, they all say it but really not an emergency. She walked in @ 09:01 and full delivery at 09:08. I delivered that baby, in the triage room , totally by myself. Not much can top bringing a person back to life and solo delivery of a healthy baby!
SCR
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6/5/2016 12:41pm
Interesting listening to your guys ER stories.

What is your guys opinion on regulations. I mean If your Hospitals and ERs were allowed freedom to make their own decisions on how best to treat people. If they were not restricted by threats of lawsuits. And treatment protocols could be made by the within the Hospital without so much interference from Lawyers, Insurers, and Bureaucrats.
Do you think that people would see better care at better prices? Or do you think that it would take the handcuffs off of the Hospital and Doctors and they would charge even more, or would compromise peoples care in the name of the bottom line.

I know a lot of people think that without Govt regulation that Businesses, Hospitals, etc would just let screw people to death because that is all they know how to do. Im not saying their should be no regulation whatsoever but at some point it seems it gets very misguided and has negative effect.

One of the things I think about with Govt provided Healthcare. It seems that a lot of people think that its good that Hospitals and Doctors can be sued for these massive amounts and that it is what keeps them from killing us all or maybe forces them to be more careful or provide better care. ( I disagree). But I believe that if we had Doctors, and Hospitals owned by the Fed. Gov. no one would be able to file lawsuit against that Govt agency. I don't believe patients can sue the VA Hospital or Doctors when the are negligent. Legal action has its place for sure but it seems lawyers have been able to lobby so that they can use private health care as a piggy bank.
kzizok
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6/5/2016 2:09pm Edited Date/Time 6/5/2016 4:35pm
SCR wrote:
Interesting listening to your guys ER stories. What is your guys opinion on regulations. I mean If your Hospitals and ERs were allowed freedom to make...
Interesting listening to your guys ER stories.

What is your guys opinion on regulations. I mean If your Hospitals and ERs were allowed freedom to make their own decisions on how best to treat people. If they were not restricted by threats of lawsuits. And treatment protocols could be made by the within the Hospital without so much interference from Lawyers, Insurers, and Bureaucrats.
Do you think that people would see better care at better prices? Or do you think that it would take the handcuffs off of the Hospital and Doctors and they would charge even more, or would compromise peoples care in the name of the bottom line.

I know a lot of people think that without Govt regulation that Businesses, Hospitals, etc would just let screw people to death because that is all they know how to do. Im not saying their should be no regulation whatsoever but at some point it seems it gets very misguided and has negative effect.

One of the things I think about with Govt provided Healthcare. It seems that a lot of people think that its good that Hospitals and Doctors can be sued for these massive amounts and that it is what keeps them from killing us all or maybe forces them to be more careful or provide better care. ( I disagree). But I believe that if we had Doctors, and Hospitals owned by the Fed. Gov. no one would be able to file lawsuit against that Govt agency. I don't believe patients can sue the VA Hospital or Doctors when the are negligent. Legal action has its place for sure but it seems lawyers have been able to lobby so that they can use private health care as a piggy bank.
Wow, great questions. As far as each hospital making their own care models? No way.

Less governmental money dependence, could certainly be a positive. Personally, what the market decides is accurate and fair. This is really complicated. I think there is a nice middle ground of oversight and innovation. But beware of a few things, when free market capitaliztion takes over, hospitals, for example will turn into highend hotels, that have healthcare services. Quite a few of those popping up around my area. Priorities brcome what? Money.

Middle ground would be a good place to start. Now, I want to play devils advocate for a minute. Our system is crazy, expensive, confusing and on and on. However, like almost all things in the US, money is king. So if you come out with the next lipitor, cardiac procedure, you are rewarded extremly well. So, my point is, the amount of innovation that goes on here is staggering. But it can be at a tremendous price.


Sorry, I had to stop mid post! You were probably like what the crap was that.
SCR
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6/5/2016 2:40pm
SCR wrote:
Interesting listening to your guys ER stories. What is your guys opinion on regulations. I mean If your Hospitals and ERs were allowed freedom to make...
Interesting listening to your guys ER stories.

What is your guys opinion on regulations. I mean If your Hospitals and ERs were allowed freedom to make their own decisions on how best to treat people. If they were not restricted by threats of lawsuits. And treatment protocols could be made by the within the Hospital without so much interference from Lawyers, Insurers, and Bureaucrats.
Do you think that people would see better care at better prices? Or do you think that it would take the handcuffs off of the Hospital and Doctors and they would charge even more, or would compromise peoples care in the name of the bottom line.

I know a lot of people think that without Govt regulation that Businesses, Hospitals, etc would just let screw people to death because that is all they know how to do. Im not saying their should be no regulation whatsoever but at some point it seems it gets very misguided and has negative effect.

One of the things I think about with Govt provided Healthcare. It seems that a lot of people think that its good that Hospitals and Doctors can be sued for these massive amounts and that it is what keeps them from killing us all or maybe forces them to be more careful or provide better care. ( I disagree). But I believe that if we had Doctors, and Hospitals owned by the Fed. Gov. no one would be able to file lawsuit against that Govt agency. I don't believe patients can sue the VA Hospital or Doctors when the are negligent. Legal action has its place for sure but it seems lawyers have been able to lobby so that they can use private health care as a piggy bank.
kzizok wrote:
Wow, great questions. As far as each hospital making their own care models? No way. Less governmental money dependence, could certainly be a positive. Personally, what...
Wow, great questions. As far as each hospital making their own care models? No way.

Less governmental money dependence, could certainly be a positive. Personally, what the market decides is accurate and fair. This is really complicated. I think there is a nice middle ground of oversight and innovation. But beware of a few things, when free market capitaliztion takes over, hospitals, for example will turn into highend hotels, that have healthcare services. Quite a few of those popping up around my area. Priorities brcome what? Money.

Middle ground would be a good place to start. Now, I want to play devils advocate for a minute. Our system is crazy, expensive, confusing and on and on. However, like almost all things in the US, money is king. So if you come out with the next lipitor, cardiac procedure, you are rewarded extremly well. So, my point is, the amount of innovation that goes on here is staggering. But it can be at a tremendous price.


Sorry, I had to stop mid post! You were probably like what the crap was that.
What ?
6/5/2016 3:11pm Edited Date/Time 6/5/2016 3:14pm
We should be able to turn people away, the government should get of healthcare (haha) and doctors should go back to actually working instead of just scanning everyone including the pregnant patients that they scan because they're too scared of getting sued because they missed a ruptured appendix.

Also we should be able to post a sign letting people know that they will be getting stuck with a needle and they can leave if they don't want to accept that reality. Hahaha
kzizok
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6/5/2016 4:37pm
kkawboy14 wrote:
Has Obamacare helped or hurt you? I provide group for my company and it keeps going thru the roof but it is easier to get good...
Has Obamacare helped or hurt you?

I provide group for my company and it keeps going thru the roof but it is easier to get good coverage
Well said.
6/5/2016 8:57pm Edited Date/Time 6/5/2016 8:58pm
Might sound crazy but I think the goal is Globalization.....

Meh.


New world order all that crack pot stuff. We Might be actually heading that direction. Im warching too much Fox News or tuned into glen beck too much last week probably.


I wish the government would stay out of healthcare. Clinicians are competent enough to evaluate patients and care for them. If that means turning them away, so be it. Gregorian I know. But I know of many frequent flyers that would get turned away that wouldn't die. But then some episodes of American greed scare me.

But on the other side the govt will eventually dictate who will and who will not recieve care. So aren't we fighting the same monster on both sides ? One corrupt individual (greedy provider) that wants money? Over another corrupt entity that demands money ? (Govt)



My brain hurts. I can't justify either side because I think it leads to the same thing. Shit. Although I believe it be beneficial to man kind of man was determining care and not a collective group of man that make a living through control of people.
6/6/2016 3:16pm
In a perfect world I think we would have to educate people about how their bodies work before they get out of high school so that maybe they would realize that shitty food actually does kill you and that you don't need to come to the hospital every time you get more than a paper cut.

I do think there is a conspiracy to keep people fat and dumb. If people just cut out half of the sugar that they eat in a day and walked more we could probably fix the Obesity epidemic.

There is way too much money involved. Seems like the system was designed to keep people fat and dumb so that they have to spend their money on medications and need a doctor just to survive. So many Americans wouldn't need that doctor if they just knew about portion control and how important it is to stay active, not smoke, etc.

Of course, would be no way to make sure that everyone stays healthy. It's not like we can make cigarettes illegal and expect people not to smoke. I just think a lot of these problems could be fixed with education.

I realize there are people with legitimate medical conditions, I'm just talking about all the BS waste that I see everyday.

kzizok
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6/6/2016 3:55pm Edited Date/Time 6/7/2016 10:52am
I tend to have a general philosophy like this, America is a new country and a lot of things that happen here, other country's "have been there, done that" and learned their lesson and figured out better ways to do things. Particularly western Europe. Sure, there are a million "yeah, but they do this do that" exeptions. For instance, alcohol is more accepted, but doesn't seem to have the large amount of negs like here. Cigarettes, eating dinner for two hours, vastly smaller portions. Alfresco dining, Norway, Switzerland, etc. Are they perfect? No. Do they drink a 44 ounce coke three times a day? No. Health and obesity is not in as much of a crisis mode like it is here. There are exceptions to everything, but maybe we should look more into there healthcare, insur. Etc issues.

Its so much easier to grab a wheel and put it on versus recreating it and seeing if it works.
6/6/2016 4:17pm
I've always said before you have a gastric bypass surgery. Just come to me. Sign papers to allow me to lock you in a compound and feed you 800 calories a day until you lose the weight. But once your locked in. You stay in until you lost your goal weight.

To hell with gastric bypass surgeries. I see more complications with them. Always within 5 years. If God wanted your asshole connected to your mouth you woulda been born as such.
6/6/2016 4:46pm Edited Date/Time 6/6/2016 4:47pm
This is also part of the problem. both the patient and the hospital. It isn't a resort. It's a damn hospital. Stop offering wifi. And if you're asking for the password you ain't sick.




You might laugh at that. But that's pretty spot on point.

kzizok
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6/7/2016 10:55am
kkawboy14 wrote:
Has Obamacare helped or hurt you? I provide group for my company and it keeps going thru the roof but it is easier to get good...
Has Obamacare helped or hurt you?

I provide group for my company and it keeps going thru the roof but it is easier to get good coverage
And holding their finger up, like give me a minute, while we are trying to initiate care. Immediate exit for me.
6/7/2016 8:39pm
I've been having a decently busy night with actual sick patients. But once we get them out of here I will start to get those people from waiting that have been here six hours. If I was in fast track I would be inundated with the BS patients.

You will never guess who is here. It's Mr. 40 cat scans per year himself. So far this year he has been here 60 times. Since we switched computer systems in 2008 he has had 170 x-rays or cat scans. You'll never guess who gets to pay for those....I better stop before the HIPAA police get me.
6/7/2016 8:51pm
You don't say. He will sue hospital when he get ca secondary to radiation. Or MSOF. Eventually the boy who cries wolf will eventually be face to snout with a wolf.
6/9/2016 1:32am
I'm at work again tonight and thought of a semi interesting concept. Someone needs to make a map of average hcahps scores based on geographic locations to see if the satisfaction scores are regional. I have a theory that they are and it would be a pretty interesting idea to test
6/9/2016 6:56am
All right I have to chime in. While there are a LOT of good people in the health care industry. There are also many just going through the motions. I couldn't see your vid on asking about the WiFi but the reality is that when they put you in the back room it could be hours before they actually come and see you. I went to the ER one day (by direction of my nurse at my onc's office) to get tested for clot in my leg. Had to wait for minimum of 2 hours to get called back. Then another hour before test. The tech operating the doplar (after close to 3 hours) the device tested all around except where the pain was. I said since I waited 3 hours could you at least test where the pain is? So she does, and then goes to get the more experienced tech to ask questions. She says, " they tell us not to worry below the knee" the other tech says "yeah but look at that" then says go higher, (pause) didn't you see that? go higher, (pause) didn't you see that there?. Now they tell me like I didn't hear any of the talk, "you'll have to wait for results from the doc". Ok, another 1 1/2 hour wait, So yeah people need a distraction while waiting.
In contrast to that I spent approx 2 months at UCSD and EVERY nurse/tech/food delivery/clean up person... I had was awesome. While they might be a little more picky about who they put in the BMT wing I don't know, but they were pretty damn awesome.
TM
BTW, The first story is one of many that were a very bad experience.
kzizok
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6/9/2016 7:26am Edited Date/Time 6/9/2016 7:28am
Toolmaker,

Our stories have been about the large number of patients who abuse the system so much that it interferes with the care of legitimate patients, like yourself. If the non legitimate patients were not a factor, ER's would run like they are designed to. So next time you have long waits, etc. Dont blame the ER, blame the huge number of people who abuse the system. The point about the wi-fi scenario isn't about giving people something to pass the time. Its just an example to show you that with true emergencies, peoples' first priority is their health issue.
CDswinehart
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Mendon, NY, USA
6/9/2016 8:11am
Great thread guys, very informative.
6/9/2016 12:17pm Edited Date/Time 6/9/2016 12:29pm
In theory I had a patient like this last night, "Patient states that he was playing video games when he noticed a spider on his leg causing him to jump up quickly, then he had pain to left chest that felt like his heart was being squeezed, pain minimal at this time "

He didn't have insurance. And how likely do you think you will be to pay his bill when we can't explain why he had chest pain briefly after jumping up? We won't have any kind of answer for him because he is totally healthy and his complaint is BS, but his visit will require hours of work by the time we chart, get an EKG, start an IV, and do x-rays. This all adds up to a lot of time that could have spent on real patients.

also had a patient who got a room but didn't want to go to it yet because she wasn't ready, and once she got back 45 minutes later she refused to talk to any of us and refused any testing. She left after demanding a pair of pants and refused to sign out against medical advice when I told her that we couldn't help her. She also didn't have insurance.
6/9/2016 1:05pm
kkawboy14 wrote:
Has Obamacare helped or hurt you? I provide group for my company and it keeps going thru the roof but it is easier to get good...
Has Obamacare helped or hurt you?

I provide group for my company and it keeps going thru the roof but it is easier to get good coverage
Simple:

Inner city: BAD. Only people that fill them out are the ones that want to bitch.

Rural area: relatively good because not many people fill them out because they don't need to bitcg. They're generally happy with their care.

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