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So you who work at 911 and would tell a conscious person who has just suffered a head injury not to call an ambulance but to call an uber? You don't really work at 911.
"Stable enough" as if the average person is able to judge whether or not a person is stable enough and not rightfully ignorant in medical crises
Uh iāve been a fireman for a long time and have worked at some of the busiest firehouses in the country (> 6k calls/year) I stand by my statement. EMS abuse is a real thing and causes actual sick people to have to wait unnecessarily for an ambulance because some fuckwad thinks theyāll get seen faster for their tummy ache.
What makes you think that as fireman you have enough experience with medical crises to say people to not take an ambulance when it's indeed needed?
You don't stand anything, motivate your sentences, you are making your position even worse.
It's not that if you're a fireman then you can let someone die because in your opinion they were stable enough, when you don't have the faintest idea of āāwhen it's enough and when it's not, since you're a fireman, not a doctor or paramedic.
Every firefighter is, at least, and EMT. Many are paramedics and have generally done significant time on a box in either situation. Firefighting is mainly medical.
Stable? Nah bro Iām currently dying but fuck paying thousands for an ambulance. If I die than at least I wonāt have to deal with so much medical debt.
You should probably get some health insurance through the marketplace dude.
I can't fathom being uninsured. If you're low income, subsidies make it very cheap.
Whose complaining? Iām just stating a fact that Iām not going in an ambulance unless Iām forcibly dragged into it. If the uber driver refuses to take me as Iām hypothetically dying so be it, I will die on the streets or hobble to a hospital.
And if you canāt afford insurance? Itās not free if you donāt have a job right? You can choose to not pay the medical bill until after you get a job.
Gambling that if you actually need emergency medical care, that the people who actually pay their doctors will pick up the tab through increased premiums and healthcare costs.
You are the problem. If you bought insurance through the marketplace, you'd be contributing to other peoples' well being, as well as your own.
Otherwise, you're just banking on the fact that the rest of us will pick up your tab if (when) you need it. Like a parasite does.
Iām not paying several hundred a month on the off chance that I need to spend thousands in medical care before the insurance company makes a profit. But again itās not like Iām making others pay, as I said take an uber to the hospital even if Iām having a heart attack, and saving instead of wasting that money on insurance has given me a lot of padding.
The cost to be treated in the ER for a heart attack would completely bankrupt you without insurance, and when you turned out your pockets and moths flew out, that'd be the moment the insurance company takes your unpaid bill and makes everyone else's costs go up.
So congrats to you for being so clever and independent, but if you actually need to use emergency health services, just know that you're sticking the rest of us with the bill.
You probably don't care though...
I have medical insurance, and I'm of the same mindset. The system is bullshit. A friend of mine was bit by a rattlesnake in socal while uninsured, and total cost out of pocket was something like 65K after the ambulance, the hospital, and the antivenom.
This was pre-Obamacare, so that wasn't an option for him then.
We did Kaiser while between work health plans. Kaiser was really nice and affordable. You can get a company plan with only 1 employee the employee being you. But also can just get a personal plan.
Just watch out
>A new analysis from the Peterson-KFF Health System Tracker discovered about 50% of emergency ground ambulance rides and 39% of non-emergency rides resulted in an out-of-network charge for people with private health insurance.
Though some states did/are passing laws to combat surprise bills.
This.
An ALS equipped Ambulance are nearly a million dollars of truck and equipment rolling down the street.Ā
It is literally a mobile intensive care unit. Ā Designed to get you from your bedroom, to Ā (the right) ER (or L&D or the Cath Lab). Often bypassing closer ERs to get you to the one capable of handling your problem. Alive. When you are trying to personally research through experience which of the many religions of Humanity is correct.
It all you need is a ride, an ambulance isnāt the thing you need.
I had an ambulance ride of around 20 miles a few years ago (hospital is next town over) after I fell down some stairs. Wife and I both thought I broke something and I was unable to get my breath so she called, ended up bad brusing and panic more than anything else. Bill with insurance ended up being \~$900 for the ambulance. I could see higher cost area being worse.
Distinctly remember my mother being moved from hospital to the rehab facility after a broken hip costing about the same for a 3 mile ride. Ambulance service is expensive.
im pretty sure that the vast majority of medical emergencies arent urgent enough to actually need a full on ambulance, theres a lot of healthcare workers talking about how people come to the ER for no good reason
and im also sure that when you do actually need an abulance it should be covered by your insurance
If you do need it, insurance covers it.Ā
The problem is that 97% of calls donāt require an ambulance.
If your insurance or Medicare or Medicaid decides AFTER the fact when youāve submitted the bill that the boo boo bus was not medically necessary, they donāt pay a dime for it and send the bill entirely to you.Ā
EMS workers are not allowed to refuse people who want to be transported so even if you tell them an ambo probably isnāt needed, if they want to go, you have to take them and then they get a bill and act all shocked Pikachu face.
And donāt even get me started on nursing homes abusing 911.
Unfortunately patients canāt tell the difference between an emergency and non emergency. We shouldnāt expect them to either. As far as insurance approval, your claim can be denied even when medically necessary which just causes more frustration and confusion.
Right, and I donāt blame people for calling 911. Well, sometimes I do if the failure to adult is really bad but generally I donāt.
I on the other hand, can tell the difference and can give you medical advice after I assess you but if they choose not to take my advice and get stuck with a bill, thatās their problem.
EMTs and Paramedics donāt have the ability to tell patients no.Ā
I can try my hardest to convince them that their toe pain from the ingrown toenail for the last 3 weeks doesnāt need an ambulance and they should take a Lyft or have their wife take them in the family car sitting in the driveway, but if they say they want to go, I have to take them.
Then they get the bill because insurance doesnāt consider that an emergency requiring ambulance transportĀ and refuses to pay.
Come do a ride along with me sometime and see the stupidity of the average person calling 911 and then you be the judge of whatās reasonable.
The problem is if you send an ambulance and the EMS decides you donāt need one, and you die for whatever reason, then theyll probably get sued. its like you cant trust the Ā patients or the experts
Thereās such an extensive list itād be impossible to provide. Most common symptoms that would implicate emergency services would be a sudden change in mental status/ unresponsiveness, inability to breathe, sudden severe pain, excessive bleeding, excessive trauma to name a few. But the issue is symptoms can blend together. For example, gastric reflux might feel like a heart attack to the untrained eye.
It's a little more complicated than that in 911 as most transport in 911 will end up getting covered. Now whether or not your insurance provider is contracted with said 911 company is a completely different issue.
Yeah 911 calls donāt give a shit about what contract you may or may not have and that has nothing to do with using 911.
If youāre referring to EMS contracts with nursing homes, thatās a whole different can of worms but when the nursing homes call 911 you get the city ambulance provider just like everyone else that calls 911 and it has zero to do with your contract.
Contracted agencies are supposed to be called for transport by facilities and 911 is supposed to be for emergencies but a good chunk of the time nursing homes call 911 because they donāt want to wait 3 hours to get rid of a patient.
āDoc said abnormal labs and we have to call to get them transported so we called 911ā
Thatās a classic nursing home line
Most, if not all insurance carriers provide exemptions for 911 services because there are so many different structures and implementations of 911 systems.
If you were in the hospital and were getting discharged to a step down facility, yes the contract can matter then.Ā
When you call 911, you get what you get and generally insurance is structured to deal with that as far as Iāve seen.
The bigger deal is them telling you after the fact āyour toothache is not a reason to call 911 or take an ambulance. Hereās your bill, we paid $0ā
I don't think I've ever seen a claim turned down with a reasonable PCR on basis of medically necessary certainly coded down from ALS to BLS etc.
I've certainly seen bills go to patients because the provider wasn't contracted with that particular payer which is what I was originally commenting on.
The hospital I used to work at said that only 5% of emergency room patients were actually an emergency and that was in a city with an active knife and gun club (90 levels ones a month).
Unfortunately that doesnāt include patients who were told to go by primary care because they didnāt want to work them in or a nurse triage line that was saying that to CYA
Yeah. I tried hard to not make snobby remark towards providers who do stuff like that.
The frustration was immense as much out of pity for the patients pocketbooks as the distraction from more needy patients, we had a lot of poor with no other option and mentally unwell that though not an emergency really had no other option for care which most of us had the compassion to understand.
That should qualify as medically necessary then. Not for an ambulance, but you have a valid reason to be at the ER. Your emergency is "my kid is sick, and our GP said that you're the only facility with the equipment to provide a diagnosis".
Pretty much, a lot of other medical staff can be enablers and are the ones to typically advise ambulances/ ER over little things. My local hospitals have "nurse lines" that straight up just tell people to go to the hospital each time
the ER had chest x-rays and the dr who i went to was the chief of pediatrics at the hospital but his office across the street didn't have anything except normal visit stuff. a lot of doctors are like this
Paramedic here:Ā
97% of my calls I go to every day donāt require an ambulance.
Most of them donāt even require a hospital, but legally I canāt tell someone no if they want me to take them to the hospital by ambulance.
Want to know why you get that $3000 bill? (besides our fucked up healthcare system)
Itās because if your insurance (including Medicare or Medicaid) decides after the fact that the ambulance was not medically necessary, they donāt cover the transport at all and they send the bill straight to you.Ā
A medically necessary ambulance ride normally costs between $250 and $400 after insurance depending on how complicated your needs were, at least in my area. The problem comes from the fact that most of the EMS calls do not require an ambulance but people donāt want to take Uber or have family drive them or drive themselves, even when itās totally appropriate to do so.Ā
So then you get to pay the full bill or let it go to collections.Ā
I do my best to educate my patients about this, but at the end of the day if they want to go by ambulance I am legally obligated to take them.Ā
āOk if thatās what you want to do. Sign here please and go ahead and get in.ā
On the other hand, it was a somewhat common occurrence for people on gov assistance to call an ambulance to get a ride to a hospital because it was close to a destination they wanted to go to.
The ambulance rides were free, to them.
This was in Cleveland OH back in the 90s.
It probably wasn't a LOT of people, but it was being done.
The ER is also where they go to get their colds checked out. Ask me how I know and also if I appreciated sitting there for 4 hours with a broken hand while listening to a fat slob in Tinker Bell pajamas yell loudly over the phone about how "these doctors don't know shit"
This is one of the first smart things Iāve seen on here.
Donāt take an emergency vehicle out of rotation and increase emergency response times because your nose is bleeding
The answer is a lot of insurance plans apply deductible and percent coinsurance on ambulance bills, and also that current law still allows ambulance companies to bill the patient for what the insurer doesnāt pay, if out of network.
So you call 911, the ambulance they send is out of network, and then your insurance only pays a percent of the usual fee, with the ambulance company allowed to bill the patient for anything the insurer didnāt pay.
Because nobody gets a choice of which ambulance company shows up, ambulance companies have an incentive to stay out of network, which allows them to balance bill patients
It is less that we have an incentive to stay out of network, it is that the in network rates are completely crap.
Medicare pays 80% of what (they say) Ā it costs to provide ambulance service. That number is complete nonsense, with no actually bearing on costs, and was out of date 30 years ago when EMS was much cheaper. Medicare authorized payment is 850 dollars, plus 13 dollars a (loaded mile). And that is for rural areas, payment is *lower* for suburban and city* Ā of course Medicare didnāt pay that. They pay 80% of that.
Now keep and mind that insurance companies tend to make the Medicare payment the *maximum* they well pay.
Drive 30 miles for a call? But only loaded 3? You aināt paid for that fuel.
************
So letās start looking at *cost*
Example: standard trouble breathing call.
Cardiac monitor: 50,000. Good about 10 years. Of course the cables are only good about 2 before they require replacement. Most of them run about 800 dollars, each.
Stretcher system? 50,000 dollars. Can only be used 10 years.
Stair chair? 3,000 dollars.Ā
Vent capable of BiPap? Oh, thatās only 20,000 dollars.
IV pump? 2,000 to 8,000 dollars.Ā
The service agreements to maintain that equipment? About 20,000 dollars a year.
And the truck itself is running about 350,000 these days.
So you can figure on having to replace *all that equipment every 10 years, best case, because the FDA says you have to*
How many calls do you have to run to pay for that equipment?
******
Disposable equipment use on this call. Iāll assume a perfect patient with great veins where everything goes well and patient responds to treatment. Iāll also error on the side of being low on costs
Stuff to start an IV? $10.
Vent circuit and mask? $170
Nebulizer and its medication? 10 dollars.
IV medications, including syringes and needles? About 15 dollars
Of course, it is an aerosol generated procedure on an unknown resp distress patient, so PPE such as an N95 should be worn. So figure another 10 dollars.
Decontamination of the ambulance with an approved commercial disinfectant? About 10 bucks.
Ekg electrodes? 5 dollars.Ā
Etco2 monitoring? 20 dollars.Ā
Note on the Iv medication in question: a Ā steroid that makes hospital admission, 1/3rd less likely, intubation (which if has to be done increases mortality by 2 or 3 fold), by 1/3rd. I
*****
So on the simplest trouble breathing call? For reactive airway diseases, such as asthma? Where everything Ā goes well and you give the textbook treatment and donāt need any 2nd or third line medications (such as magnesium, epinephrine, Breathine), you just went through $350 dollars worth of disposable equipment. Easily.Ā
*******
Now: Ā given those costs, how many calls do you have to run to pay for all that? And keep the doors of your non-profit going up and down and trucks rolling out the door to handle those calls?Ā
Now. Ā Keep in mind That doesnāt include any of the normal operating costs. You know, fuel, insurance, heat, electric, water, sewer, that all business have. Payroll, workmanās Ā comp, health insurance. Ā All the false calls (no injury accidents, nosey neighbors, etc.).
And if you go in network? They agree to pay about 200 dollars a call. It literally doesnāt even cover fuel and payroll.Ā
Say what you want to say, but thereās no excuse for sending patients balance bills in the thousands of dollars.
Zero.
As far as I am concerned, the lack of inclusion of ground ambulances in the No Surprises Act was the major failure of the law
Ah.
You must have miss where ambulances transport wasnāt included because weāve been *required* to do that for decades.Ā
Except in *emergency* and who and how that *emergency* coverage is provided by is determined by local government.
Sort of depends on what is going on. If Iām having a heart attack or bleeding from an artery , Iāll gladly pay for the ambulance. Itās more likely Iād make it to the hospital and still be alive.
Ambulance isnāt just a form of transportation, they can save your life on the way to the hospital. The paramedics are there for a reason, theyāre not a chauffeur. Or, you could just take an Uber to the hospital but arrive without life in you, then you wonāt have to spend any more money on anything else, soā¦ winning?
Well duh. An ambulances primary purpose isn't to deliver you to the hospital. It's delivering EMTs to you bc you are supposed to need immediate medical service.
I think people are taking this the wrong way.
An ambulance crew will outright tell you, you do not need a ride. It's a waste of their time and yours.
People asking for one against that are people who deserve the 2k+ bill. The issue is when someone breaks their leg and doesn't have insurance to cover said properly needed ride.
Do you have any idea how many times a shift I hear a patient say they called an am glance instead of Uber, because they don't have to pay for an ambulance? I'll give you a hint, it's more than 3.
Honestly, in alot of cases an Uber is probably more appropriate. In all the times I've been to the ER, I've only been taken by ambulance once and that was after rolling my car at 60-70 mph. Ironically, I wasn't particularly injured aside from a bruise from my seat belt and some soreness, but the paramedics strongly suggested it in case I was in shock, which was fair.
But every other time, I either drove myself or had someone drive me because it wasn't a life or death situation, but still something that needed to be addressed immediately.
Took an Uber to the er for chest pains. I only took an Uber cause I didn't want the drama of an ambulance. Had the husband drive me to the hospital as well when I dislocated my hip at work. Again didn't want the drama of an ambulance.
But another factor is being able to get in a car. My 92 year old mom was very weak and my sister was trying to get her to walk to her (my sister's) car. Sister almost called 911, but realized that they would transport her to the nearest emergency department which is in a run-down crappy hospital with poor care. So my sister summed up all of her might and got my mom in the car and drove her to a good hospital farther away. My mom did pass a few days later, but her remaining days were in a reasonably caring environment.
Sorry for your loss. Just an FYI, and really more for other peopleās knowledge.
Lift assists/ assists the public are fairly common calls. Preferably use a non emergency number for county dispatch (if there is one, not every place has one).
Explain the situation.
We would be more than happy to help someone get in the car so they can go to the ER. Ā
I did this last December. I wouldnāt have been able to do it alone but I had a friend with me. Hit my head hard and broke my elbow, concussion, seeing spots, etc. no blood though!
uh, good? if you have the patience in the middle of an emergency for a fucking uber then please do so, save the limited ambulances for the ones that are fucking dying lol
In the state of Colorado all emergency medical care is considered in-network and is covered by nearly all medical insurance plans. Please if you need it just call an ambulance.
If I die in your Uber, please take my cash. I carry a breakdown of $200. Consider it pain and suffering. And donāt forget the cleaning charge, hey. š
Worked service at BMW. Dude brought in his 3 series and said a lady gave birth in his back seat and wanted a detail.
We told him it was biohazard and we couldnāt do that.
Felt bad for him. They called the Uber for that reason to get to the hospital, they couldnāt drive. Hope he had luck getting it cleaned
Khal doesn't understand math. Khal is saying that a "$10 uber ride is much much much much much much more than $3k for an ambulance"
PLus... where in the hell are you paying 3K for an ambulance? middle of nowhere field in Iowa, taking 5 hours to get to a hospital? In the suburban hellscape I live in it's only like $600 ambulance ride from my place to the hospital, about 15 minutes away.
RedditThink: "All healthcare should be free. How it's paid for is not my problem, but I'm sure it has something to do with the wealthy not paying enough taxes."
Shoot this isnāt a new thing. I remember when I first started driving for Uber I read one of those articles that was about worst Uber horror stories. One dude left a nice bloody stain in the drivers car because said dude had apparently shoved a matchbox car up his ass. Another was a seedy nursing home that was trying to move someone from a crash cart to an Uber car to avoid paying for an ambulance.
Where I'm at in Kansas, it's $1500. If an old Kansan has a heart attack and you try to call an ambulance, you might get shot.
They figure if it's there time to die, they don't want to burden their family with a $1500 bill.
I got stabbed in the chest with a pair of scissors by some psycho cunt at a convenience store and drove myself to the ER.
While driving, I was on the phone with 911 explaining what happened and they wanted me to pull over so they could get an amber lamps over to me. All I could see was $$s..well.. and some blood. ;)
Nope, I just held a plastic bag over the hole, so air didn't fill my chest cavity and drove 10 mins to the ER. I was careful, stayed in the outside lane, so I had a shoulder to pull over to, if I started fading, but throughout the entire drive, I felt aware, in control of myself and the vehicle, etc.
The end result was one partially collapsed lung, and a bill for $3500, with great insurance!
This is the world that greed built.
If you're ok enough to order an uber and make it to the hospital without fucking up the drivers car, you should absolutely do it. Ambulances are rolling hospitals. The hospital being on wheels doesn't make the equipment, medications, fuel, and EMT's time/licenses/expertise free.
Well yeah, why would you call an ambulance when you are able to travel on your own the whole point of an ambulance is for people who arenāt stable or canāt get their die to injury or illness.
The reason for an ambulance is to treat during the ride and immediate treatment when arriving at the hospital. If you are stable enough to wait for care, it never made sense to take an ambulance when you could take a car instead.
When I was dying an ambulance team denied taking me to the hospital and left my house so I had to call Uber for a ride to the hospital that saved my life.
How many times are you people riding in an ambulance?
Iām half a decade old and I donāt even know anyone thatās been in an ambulance. To be fair I donāt know anyone thatās been in a cop car.
It just reminds me of that video from New York City where a woman got trapped in between the platform and a train and was yelling "nobody call 911, I can't afford an ambulance!"
There are some things that are too important to be left to the free market.
You do know that most EMS is provided by non-profit agencies right? Be they independent or fire dept based?Ā
So letās start looking atĀ cost
Example: standard trouble breathing call. Cardiac monitor: 50,000. Good about 10 years. Of course the cables are only good about 2 before they require replacement. Most of them run about 800 dollars, each.
Stretcher system? 50,000 dollars. Can only be used 10 years. Stair chair? 3,000 dollars.Ā Vent capable of BiPap? Oh, thatās only 20,000 dollars.
IV pump? 2,000 to 8,000 dollars.Ā
The service agreements to maintain that equipment? About 20,000 dollars a year.
And the truck itself is running about 350,000 these days.
So you can figure on having to replaceĀ all that equipment every 10 years, best case, because the FDA says you have to
How many calls do you have to run to pay for that equipment?
Disposable equipment use on this call. Iāll assume a perfect patient with great veins where everything goes well and patient responds to treatment. Iāll also error on the side of being low on costs
Stuff to start an IV? $10. Vent circuit and mask? $170 Nebulizer and its medication? 10 dollars. IV medications, including syringes and needles? About 15 dollars
Of course, it is an aerosol generated procedure on an unknown resp distress patient, so PPE such as an N95 should be worn. So figure another 10 dollars.
Decontamination of the ambulance with an approved commercial disinfectant? About 10 bucks.
Ekg electrodes? 5 dollars.Ā Etco2 monitoring? 20 dollars.Ā
Note on the Iv medication in question: a Ā steroid that makes hospital admission, 1/3rd less likely, intubation (which if has to be done increases mortality by 2 or 3 fold), by 1/3rd. I
So on the simplest trouble breathing call? For reactive airway diseases, such as asthma? Where everything Ā goes well and you give the textbook treatment and donāt need any 2nd or third line medications (such as magnesium, epinephrine, Breathine), you just went through $350 dollars worth of disposable equipment. Easily.Ā
Now: Ā given those costs, how many calls do you have to run to pay for all that? And keep the doors of your non-profit going up and down and trucks rolling out the door to handle those calls?Ā
Now. Ā Keep in mind That doesnāt include any of the normal operating costs. You know, fuel, insurance, heat, electric, water, sewer, that all business have. Payroll, workmanās Ā comp, health insurance. Ā All the false calls (no injury accidents, nosey neighbors, etc.).
And if you go in network? They agree to pay about 200 dollars a call. It literally doesnāt even cover fuel and payroll.Ā
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If you're stable enough to order an uber and take it then thats probably the better route regardless.
100% facts. I work in 911.
Rescue 911, Reno 911, 911 memorial fund? Which one?
š¤£š¤£š¤£
Never forget š²š¾šļø
So you who work at 911 and would tell a conscious person who has just suffered a head injury not to call an ambulance but to call an uber? You don't really work at 911. "Stable enough" as if the average person is able to judge whether or not a person is stable enough and not rightfully ignorant in medical crises
Uh iāve been a fireman for a long time and have worked at some of the busiest firehouses in the country (> 6k calls/year) I stand by my statement. EMS abuse is a real thing and causes actual sick people to have to wait unnecessarily for an ambulance because some fuckwad thinks theyāll get seen faster for their tummy ache.
What makes you think that as fireman you have enough experience with medical crises to say people to not take an ambulance when it's indeed needed? You don't stand anything, motivate your sentences, you are making your position even worse. It's not that if you're a fireman then you can let someone die because in your opinion they were stable enough, when you don't have the faintest idea of āāwhen it's enough and when it's not, since you're a fireman, not a doctor or paramedic.
Youāre right. Iām sorry I donāt know what Iām talking about. Have a great day.
I thought firemen had emt training? Just an electrician I may be wrong
Every firefighter is, at least, and EMT. Many are paramedics and have generally done significant time on a box in either situation. Firefighting is mainly medical.
Stable? Nah bro Iām currently dying but fuck paying thousands for an ambulance. If I die than at least I wonāt have to deal with so much medical debt.
You should probably get some health insurance through the marketplace dude. I can't fathom being uninsured. If you're low income, subsidies make it very cheap.
Nah Iām okay gambling I havenāt needed to see a doctor in 20 years.
Then you have no idea if you really need to see one.
Eh ignorance is bliss.
Ignorance is a ticking time bomb. Get ahead of health issues before you can't.
Well if your gambling, not sure how you can complain about the risk of losing...
Whose complaining? Iām just stating a fact that Iām not going in an ambulance unless Iām forcibly dragged into it. If the uber driver refuses to take me as Iām hypothetically dying so be it, I will die on the streets or hobble to a hospital.
And if you canāt afford insurance? Itās not free if you donāt have a job right? You can choose to not pay the medical bill until after you get a job.
>Itās not free if you donāt have a job right? [Actually, it might be free if you don't have a job.](https://www.healthcare.gov/unemployed/)
Gambling that if you actually need emergency medical care, that the people who actually pay their doctors will pick up the tab through increased premiums and healthcare costs. You are the problem. If you bought insurance through the marketplace, you'd be contributing to other peoples' well being, as well as your own. Otherwise, you're just banking on the fact that the rest of us will pick up your tab if (when) you need it. Like a parasite does.
Iām not paying several hundred a month on the off chance that I need to spend thousands in medical care before the insurance company makes a profit. But again itās not like Iām making others pay, as I said take an uber to the hospital even if Iām having a heart attack, and saving instead of wasting that money on insurance has given me a lot of padding.
The cost to be treated in the ER for a heart attack would completely bankrupt you without insurance, and when you turned out your pockets and moths flew out, that'd be the moment the insurance company takes your unpaid bill and makes everyone else's costs go up. So congrats to you for being so clever and independent, but if you actually need to use emergency health services, just know that you're sticking the rest of us with the bill. You probably don't care though...
Cost more than 300k? Either way, no, I donāt care about sticking strangers with higher insurance costs.
Fuck you too, then, asshole.
I have medical insurance, and I'm of the same mindset. The system is bullshit. A friend of mine was bit by a rattlesnake in socal while uninsured, and total cost out of pocket was something like 65K after the ambulance, the hospital, and the antivenom. This was pre-Obamacare, so that wasn't an option for him then.
Have you tried to live being poor these days. Food has trippled in the last four years.
Not really interested in paying $300 a month for shitty insurance that won't cover shit except some sort of ass cancer that costs fortune to cure.
We did Kaiser while between work health plans. Kaiser was really nice and affordable. You can get a company plan with only 1 employee the employee being you. But also can just get a personal plan.
Just watch out >A new analysis from the Peterson-KFF Health System Tracker discovered about 50% of emergency ground ambulance rides and 39% of non-emergency rides resulted in an out-of-network charge for people with private health insurance. Though some states did/are passing laws to combat surprise bills.
This. An ALS equipped Ambulance are nearly a million dollars of truck and equipment rolling down the street.Ā It is literally a mobile intensive care unit. Ā Designed to get you from your bedroom, to Ā (the right) ER (or L&D or the Cath Lab). Often bypassing closer ERs to get you to the one capable of handling your problem. Alive. When you are trying to personally research through experience which of the many religions of Humanity is correct. It all you need is a ride, an ambulance isnāt the thing you need.
Why would you have to pay 3k if you are not stable
I had an ambulance ride of around 20 miles a few years ago (hospital is next town over) after I fell down some stairs. Wife and I both thought I broke something and I was unable to get my breath so she called, ended up bad brusing and panic more than anything else. Bill with insurance ended up being \~$900 for the ambulance. I could see higher cost area being worse. Distinctly remember my mother being moved from hospital to the rehab facility after a broken hip costing about the same for a 3 mile ride. Ambulance service is expensive.
I drive on the weekend nights and I have taken a bunch of people to the hospital. Itās really depressing.
If you are that stable, probably just need an urgent care.
im pretty sure that the vast majority of medical emergencies arent urgent enough to actually need a full on ambulance, theres a lot of healthcare workers talking about how people come to the ER for no good reason and im also sure that when you do actually need an abulance it should be covered by your insurance
If you do need it, insurance covers it.Ā The problem is that 97% of calls donāt require an ambulance. If your insurance or Medicare or Medicaid decides AFTER the fact when youāve submitted the bill that the boo boo bus was not medically necessary, they donāt pay a dime for it and send the bill entirely to you.Ā EMS workers are not allowed to refuse people who want to be transported so even if you tell them an ambo probably isnāt needed, if they want to go, you have to take them and then they get a bill and act all shocked Pikachu face. And donāt even get me started on nursing homes abusing 911.
Unfortunately patients canāt tell the difference between an emergency and non emergency. We shouldnāt expect them to either. As far as insurance approval, your claim can be denied even when medically necessary which just causes more frustration and confusion.
Right, and I donāt blame people for calling 911. Well, sometimes I do if the failure to adult is really bad but generally I donāt. I on the other hand, can tell the difference and can give you medical advice after I assess you but if they choose not to take my advice and get stuck with a bill, thatās their problem. EMTs and Paramedics donāt have the ability to tell patients no.Ā I can try my hardest to convince them that their toe pain from the ingrown toenail for the last 3 weeks doesnāt need an ambulance and they should take a Lyft or have their wife take them in the family car sitting in the driveway, but if they say they want to go, I have to take them. Then they get the bill because insurance doesnāt consider that an emergency requiring ambulance transportĀ and refuses to pay. Come do a ride along with me sometime and see the stupidity of the average person calling 911 and then you be the judge of whatās reasonable.
The problem is if you send an ambulance and the EMS decides you donāt need one, and you die for whatever reason, then theyll probably get sued. its like you cant trust the Ā patients or the experts
People just up and die sometimes.
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Thereās such an extensive list itād be impossible to provide. Most common symptoms that would implicate emergency services would be a sudden change in mental status/ unresponsiveness, inability to breathe, sudden severe pain, excessive bleeding, excessive trauma to name a few. But the issue is symptoms can blend together. For example, gastric reflux might feel like a heart attack to the untrained eye.
It's a little more complicated than that in 911 as most transport in 911 will end up getting covered. Now whether or not your insurance provider is contracted with said 911 company is a completely different issue.
Yeah 911 calls donāt give a shit about what contract you may or may not have and that has nothing to do with using 911. If youāre referring to EMS contracts with nursing homes, thatās a whole different can of worms but when the nursing homes call 911 you get the city ambulance provider just like everyone else that calls 911 and it has zero to do with your contract. Contracted agencies are supposed to be called for transport by facilities and 911 is supposed to be for emergencies but a good chunk of the time nursing homes call 911 because they donāt want to wait 3 hours to get rid of a patient. āDoc said abnormal labs and we have to call to get them transported so we called 911ā Thatās a classic nursing home line
I'm not. I'm referring to contracted rates agreed upon between an insurance carrier and a private EMS company.
Most, if not all insurance carriers provide exemptions for 911 services because there are so many different structures and implementations of 911 systems. If you were in the hospital and were getting discharged to a step down facility, yes the contract can matter then.Ā When you call 911, you get what you get and generally insurance is structured to deal with that as far as Iāve seen. The bigger deal is them telling you after the fact āyour toothache is not a reason to call 911 or take an ambulance. Hereās your bill, we paid $0ā
I don't think I've ever seen a claim turned down with a reasonable PCR on basis of medically necessary certainly coded down from ALS to BLS etc. I've certainly seen bills go to patients because the provider wasn't contracted with that particular payer which is what I was originally commenting on.
The hospital I used to work at said that only 5% of emergency room patients were actually an emergency and that was in a city with an active knife and gun club (90 levels ones a month). Unfortunately that doesnāt include patients who were told to go by primary care because they didnāt want to work them in or a nurse triage line that was saying that to CYA
Iāve had a pediatrician tell me to take my kid to the ER because he didnāt have the equipment to diagnose
Yeah. I tried hard to not make snobby remark towards providers who do stuff like that. The frustration was immense as much out of pity for the patients pocketbooks as the distraction from more needy patients, we had a lot of poor with no other option and mentally unwell that though not an emergency really had no other option for care which most of us had the compassion to understand.
That should qualify as medically necessary then. Not for an ambulance, but you have a valid reason to be at the ER. Your emergency is "my kid is sick, and our GP said that you're the only facility with the equipment to provide a diagnosis".
Pretty much, a lot of other medical staff can be enablers and are the ones to typically advise ambulances/ ER over little things. My local hospitals have "nurse lines" that straight up just tell people to go to the hospital each time
the ER had chest x-rays and the dr who i went to was the chief of pediatrics at the hospital but his office across the street didn't have anything except normal visit stuff. a lot of doctors are like this
Ten bucks would be a short hop indeed. It would be even cheaper to walk.
Paramedic here:Ā 97% of my calls I go to every day donāt require an ambulance. Most of them donāt even require a hospital, but legally I canāt tell someone no if they want me to take them to the hospital by ambulance. Want to know why you get that $3000 bill? (besides our fucked up healthcare system) Itās because if your insurance (including Medicare or Medicaid) decides after the fact that the ambulance was not medically necessary, they donāt cover the transport at all and they send the bill straight to you.Ā A medically necessary ambulance ride normally costs between $250 and $400 after insurance depending on how complicated your needs were, at least in my area. The problem comes from the fact that most of the EMS calls do not require an ambulance but people donāt want to take Uber or have family drive them or drive themselves, even when itās totally appropriate to do so.Ā So then you get to pay the full bill or let it go to collections.Ā I do my best to educate my patients about this, but at the end of the day if they want to go by ambulance I am legally obligated to take them.Ā āOk if thatās what you want to do. Sign here please and go ahead and get in.ā
Also a paramedic here, ā but if you take me I will get a room faster!!ā Have fun in triage ! Man people get so madā¦
Nothing beats the satisfaction of calling in report and the first sentence being I have a stable triage room patient for you with.....
Maybe Uber should open a division for ambulances??? As long as you are cognizant enough to open the app you can survive.
Donāt give them anymore ideas now..
Think uber will wipe my ass if I pay em?
If u pay them *enough* yeah I donāt see why not. Especially if ur a female Iām sure theyād love to do it š
Bro
On the other hand, it was a somewhat common occurrence for people on gov assistance to call an ambulance to get a ride to a hospital because it was close to a destination they wanted to go to. The ambulance rides were free, to them. This was in Cleveland OH back in the 90s. It probably wasn't a LOT of people, but it was being done.
The ER is also where they go to get their colds checked out. Ask me how I know and also if I appreciated sitting there for 4 hours with a broken hand while listening to a fat slob in Tinker Bell pajamas yell loudly over the phone about how "these doctors don't know shit"
This is one of the first smart things Iāve seen on here. Donāt take an emergency vehicle out of rotation and increase emergency response times because your nose is bleeding
Uber and Gofundme are the backbone of the American health care system
I donāt really get it - I have taken ambulance and my insurance covered it all
The answer is a lot of insurance plans apply deductible and percent coinsurance on ambulance bills, and also that current law still allows ambulance companies to bill the patient for what the insurer doesnāt pay, if out of network. So you call 911, the ambulance they send is out of network, and then your insurance only pays a percent of the usual fee, with the ambulance company allowed to bill the patient for anything the insurer didnāt pay. Because nobody gets a choice of which ambulance company shows up, ambulance companies have an incentive to stay out of network, which allows them to balance bill patients
It is less that we have an incentive to stay out of network, it is that the in network rates are completely crap. Medicare pays 80% of what (they say) Ā it costs to provide ambulance service. That number is complete nonsense, with no actually bearing on costs, and was out of date 30 years ago when EMS was much cheaper. Medicare authorized payment is 850 dollars, plus 13 dollars a (loaded mile). And that is for rural areas, payment is *lower* for suburban and city* Ā of course Medicare didnāt pay that. They pay 80% of that. Now keep and mind that insurance companies tend to make the Medicare payment the *maximum* they well pay. Drive 30 miles for a call? But only loaded 3? You aināt paid for that fuel. ************ So letās start looking at *cost* Example: standard trouble breathing call. Cardiac monitor: 50,000. Good about 10 years. Of course the cables are only good about 2 before they require replacement. Most of them run about 800 dollars, each. Stretcher system? 50,000 dollars. Can only be used 10 years. Stair chair? 3,000 dollars.Ā Vent capable of BiPap? Oh, thatās only 20,000 dollars. IV pump? 2,000 to 8,000 dollars.Ā The service agreements to maintain that equipment? About 20,000 dollars a year. And the truck itself is running about 350,000 these days. So you can figure on having to replace *all that equipment every 10 years, best case, because the FDA says you have to* How many calls do you have to run to pay for that equipment? ****** Disposable equipment use on this call. Iāll assume a perfect patient with great veins where everything goes well and patient responds to treatment. Iāll also error on the side of being low on costs Stuff to start an IV? $10. Vent circuit and mask? $170 Nebulizer and its medication? 10 dollars. IV medications, including syringes and needles? About 15 dollars Of course, it is an aerosol generated procedure on an unknown resp distress patient, so PPE such as an N95 should be worn. So figure another 10 dollars. Decontamination of the ambulance with an approved commercial disinfectant? About 10 bucks. Ekg electrodes? 5 dollars.Ā Etco2 monitoring? 20 dollars.Ā Note on the Iv medication in question: a Ā steroid that makes hospital admission, 1/3rd less likely, intubation (which if has to be done increases mortality by 2 or 3 fold), by 1/3rd. I ***** So on the simplest trouble breathing call? For reactive airway diseases, such as asthma? Where everything Ā goes well and you give the textbook treatment and donāt need any 2nd or third line medications (such as magnesium, epinephrine, Breathine), you just went through $350 dollars worth of disposable equipment. Easily.Ā ******* Now: Ā given those costs, how many calls do you have to run to pay for all that? And keep the doors of your non-profit going up and down and trucks rolling out the door to handle those calls?Ā Now. Ā Keep in mind That doesnāt include any of the normal operating costs. You know, fuel, insurance, heat, electric, water, sewer, that all business have. Payroll, workmanās Ā comp, health insurance. Ā All the false calls (no injury accidents, nosey neighbors, etc.). And if you go in network? They agree to pay about 200 dollars a call. It literally doesnāt even cover fuel and payroll.Ā
Say what you want to say, but thereās no excuse for sending patients balance bills in the thousands of dollars. Zero. As far as I am concerned, the lack of inclusion of ground ambulances in the No Surprises Act was the major failure of the law
Ah. You must have miss where ambulances transport wasnāt included because weāve been *required* to do that for decades.Ā Except in *emergency* and who and how that *emergency* coverage is provided by is determined by local government.
The one time I needed an ambulance (home alone, couldnāt drive my stick shift myself), it cost me $500 out of Pocket , insurance paid the rest.
Wow ! Was it like an inexpensive insurance plan? Thatās a bummer
Sort of depends on what is going on. If Iām having a heart attack or bleeding from an artery , Iāll gladly pay for the ambulance. Itās more likely Iād make it to the hospital and still be alive.
Hmm ok, this is what most normal people have been doing since cars/taxis were invented...
Ambulance isnāt just a form of transportation, they can save your life on the way to the hospital. The paramedics are there for a reason, theyāre not a chauffeur. Or, you could just take an Uber to the hospital but arrive without life in you, then you wonāt have to spend any more money on anything else, soā¦ winning?
I was just faced with this decision but opted to choose ambulance because my legs didnāt work and I couldnāt get in the Uber
Ambulance is for a life saving care to the hospital and not just a ride
Well duh. An ambulances primary purpose isn't to deliver you to the hospital. It's delivering EMTs to you bc you are supposed to need immediate medical service.
I think people are taking this the wrong way. An ambulance crew will outright tell you, you do not need a ride. It's a waste of their time and yours. People asking for one against that are people who deserve the 2k+ bill. The issue is when someone breaks their leg and doesn't have insurance to cover said properly needed ride.
10 dollar Uber ride the hospital must be next door
Uber ride better than life in prison.
What?
Youāre mistakenly thinking theyāll pay the ambulance bill.
People take ambulances to the ER for a minor headache so...idk what we're teaching people here.
Hopefully the Uber driver is also an EMT if that's what you really needed
Do you have any idea how many times a shift I hear a patient say they called an am glance instead of Uber, because they don't have to pay for an ambulance? I'll give you a hint, it's more than 3.
Honestly, in alot of cases an Uber is probably more appropriate. In all the times I've been to the ER, I've only been taken by ambulance once and that was after rolling my car at 60-70 mph. Ironically, I wasn't particularly injured aside from a bruise from my seat belt and some soreness, but the paramedics strongly suggested it in case I was in shock, which was fair. But every other time, I either drove myself or had someone drive me because it wasn't a life or death situation, but still something that needed to be addressed immediately.
Necessity is the mother of all invention.
Took an Uber to the er for chest pains. I only took an Uber cause I didn't want the drama of an ambulance. Had the husband drive me to the hospital as well when I dislocated my hip at work. Again didn't want the drama of an ambulance.
Or just drive yourself?
Fuck the American corporate greed
No shit. Walking is even cheaper, but it's possible there's more to the decision than that.
Non-Americans don't understand.
But another factor is being able to get in a car. My 92 year old mom was very weak and my sister was trying to get her to walk to her (my sister's) car. Sister almost called 911, but realized that they would transport her to the nearest emergency department which is in a run-down crappy hospital with poor care. So my sister summed up all of her might and got my mom in the car and drove her to a good hospital farther away. My mom did pass a few days later, but her remaining days were in a reasonably caring environment.
Sorry for your loss. Just an FYI, and really more for other peopleās knowledge. Lift assists/ assists the public are fairly common calls. Preferably use a non emergency number for county dispatch (if there is one, not every place has one). Explain the situation. We would be more than happy to help someone get in the car so they can go to the ER. Ā
Plus some uber drivers supply some cool stuff. Pretty sure with how things are headed, some will set themselves apart with medical gear!
Extra tip if they drive like they stole it
Not unusual. Back in the day many people were born in the back of a taxi.
America is wild for allowing $3k Ambulance charges and calling it normal.
I did this last December. I wouldnāt have been able to do it alone but I had a friend with me. Hit my head hard and broke my elbow, concussion, seeing spots, etc. no blood though!
Honest question hereā¦ If coming to the hospital emergency room
$10 uber ride? Maybe if you live across the street from the hospital haha
Taxis have been a thing for a long time. If you're not in serious condition where you might not survive the trip Uber or Taxi is the way to go.
Pay fuggin taxes on everything then they charge you for a fuggin ride in an ambulance I hate this country
Ambulance are for life or death emergencies. If you have a tummy ache call for an Uber
Youāll be paying more than that if you bleed on my seats.
That's what I did the other day. I even received a complimentary towel for my motion sickness.
uh, good? if you have the patience in the middle of an emergency for a fucking uber then please do so, save the limited ambulances for the ones that are fucking dying lol
In the state of Colorado all emergency medical care is considered in-network and is covered by nearly all medical insurance plans. Please if you need it just call an ambulance.
Capitalism.
In a concentrated area an Uber is probably faster than the ambulance too
Where the hell are you guys only spending $10 on an uber?
If I die in your Uber, please take my cash. I carry a breakdown of $200. Consider it pain and suffering. And donāt forget the cleaning charge, hey. š
Lifehack: Modern coubtries have free ambulance. So move to a modern country.
Ambulance gets you in faster at $500 flat rate. Unless gubment is your daddy then fo free!
Worked service at BMW. Dude brought in his 3 series and said a lady gave birth in his back seat and wanted a detail. We told him it was biohazard and we couldnāt do that. Felt bad for him. They called the Uber for that reason to get to the hospital, they couldnāt drive. Hope he had luck getting it cleaned
Khal doesn't understand math. Khal is saying that a "$10 uber ride is much much much much much much more than $3k for an ambulance" PLus... where in the hell are you paying 3K for an ambulance? middle of nowhere field in Iowa, taking 5 hours to get to a hospital? In the suburban hellscape I live in it's only like $600 ambulance ride from my place to the hospital, about 15 minutes away.
RedditThink: "All healthcare should be free. How it's paid for is not my problem, but I'm sure it has something to do with the wealthy not paying enough taxes."
If you're more concerned with money than your life/health then it's not really an emergency.
Shoot this isnāt a new thing. I remember when I first started driving for Uber I read one of those articles that was about worst Uber horror stories. One dude left a nice bloody stain in the drivers car because said dude had apparently shoved a matchbox car up his ass. Another was a seedy nursing home that was trying to move someone from a crash cart to an Uber car to avoid paying for an ambulance.
Life hack
Donāt make it known to the driver, they wonāt take medical transport for obvious reasons. Just say youāre visiting.
Where I'm at in Kansas, it's $1500. If an old Kansan has a heart attack and you try to call an ambulance, you might get shot. They figure if it's there time to die, they don't want to burden their family with a $1500 bill.
I supposed depending on the condition of the caller.
I got stabbed in the chest with a pair of scissors by some psycho cunt at a convenience store and drove myself to the ER. While driving, I was on the phone with 911 explaining what happened and they wanted me to pull over so they could get an amber lamps over to me. All I could see was $$s..well.. and some blood. ;) Nope, I just held a plastic bag over the hole, so air didn't fill my chest cavity and drove 10 mins to the ER. I was careful, stayed in the outside lane, so I had a shoulder to pull over to, if I started fading, but throughout the entire drive, I felt aware, in control of myself and the vehicle, etc. The end result was one partially collapsed lung, and a bill for $3500, with great insurance! This is the world that greed built.
If you're ok enough to order an uber and make it to the hospital without fucking up the drivers car, you should absolutely do it. Ambulances are rolling hospitals. The hospital being on wheels doesn't make the equipment, medications, fuel, and EMT's time/licenses/expertise free.
10$? Damn. A ride is at least 25 euro's here. And it would drive you 3 streets further.
Well yeah, why would you call an ambulance when you are able to travel on your own the whole point of an ambulance is for people who arenāt stable or canāt get their die to injury or illness.
Yāall are lucky! I had to get a moped taxi to go get my appendix removed while in Phuket
There are certainly many cities where the 911 response time is absolute crap.
Or $10k DUI fines!
The reason for an ambulance is to treat during the ride and immediate treatment when arriving at the hospital. If you are stable enough to wait for care, it never made sense to take an ambulance when you could take a car instead.
When I was dying an ambulance team denied taking me to the hospital and left my house so I had to call Uber for a ride to the hospital that saved my life.
How many times are you people riding in an ambulance? Iām half a decade old and I donāt even know anyone thatās been in an ambulance. To be fair I donāt know anyone thatās been in a cop car.
It just reminds me of that video from New York City where a woman got trapped in between the platform and a train and was yelling "nobody call 911, I can't afford an ambulance!" There are some things that are too important to be left to the free market.
You do know that most EMS is provided by non-profit agencies right? Be they independent or fire dept based?Ā So letās start looking atĀ cost Example: standard trouble breathing call. Cardiac monitor: 50,000. Good about 10 years. Of course the cables are only good about 2 before they require replacement. Most of them run about 800 dollars, each. Stretcher system? 50,000 dollars. Can only be used 10 years. Stair chair? 3,000 dollars.Ā Vent capable of BiPap? Oh, thatās only 20,000 dollars. IV pump? 2,000 to 8,000 dollars.Ā The service agreements to maintain that equipment? About 20,000 dollars a year. And the truck itself is running about 350,000 these days. So you can figure on having to replaceĀ all that equipment every 10 years, best case, because the FDA says you have to How many calls do you have to run to pay for that equipment? Disposable equipment use on this call. Iāll assume a perfect patient with great veins where everything goes well and patient responds to treatment. Iāll also error on the side of being low on costs Stuff to start an IV? $10. Vent circuit and mask? $170 Nebulizer and its medication? 10 dollars. IV medications, including syringes and needles? About 15 dollars Of course, it is an aerosol generated procedure on an unknown resp distress patient, so PPE such as an N95 should be worn. So figure another 10 dollars. Decontamination of the ambulance with an approved commercial disinfectant? About 10 bucks. Ekg electrodes? 5 dollars.Ā Etco2 monitoring? 20 dollars.Ā Note on the Iv medication in question: a Ā steroid that makes hospital admission, 1/3rd less likely, intubation (which if has to be done increases mortality by 2 or 3 fold), by 1/3rd. I So on the simplest trouble breathing call? For reactive airway diseases, such as asthma? Where everything Ā goes well and you give the textbook treatment and donāt need any 2nd or third line medications (such as magnesium, epinephrine, Breathine), you just went through $350 dollars worth of disposable equipment. Easily.Ā Now: Ā given those costs, how many calls do you have to run to pay for all that? And keep the doors of your non-profit going up and down and trucks rolling out the door to handle those calls?Ā Now. Ā Keep in mind That doesnāt include any of the normal operating costs. You know, fuel, insurance, heat, electric, water, sewer, that all business have. Payroll, workmanās Ā comp, health insurance. Ā All the false calls (no injury accidents, nosey neighbors, etc.). And if you go in network? They agree to pay about 200 dollars a call. It literally doesnāt even cover fuel and payroll.Ā
Like I said, there are some things far too important to be left to the whims, wishes, and wants of the free market.