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Insurance Company Mischief: Be Your Own Doctor

For some people, you had better be right in your decision to go to the ER. If not, as the Associated Press reports, you could be stuck with the (substantial) bill.

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As described in the AP report, a woman had a ruptured ovarian cyst, which "forced her to the floor," presumably in pain, in her kitchen. Upon the advice of her physician neighbor, she went to the ER, only to find out that ruptured ovarian cysts don't count as emergencies.

This is Blue Cross-Blue Shield's effort to "curb unnecessary and costly ER visits" - presumably costly to BCBS and other like-minded healthcare insurers - but as the woman is quoted in the AP's report, "How are you supposed to know that?" in reference to her ruptured ovarian cyst, which was only diagnosed in the ER itself. "I'm not a doctor. That's what the emergency room is for."

It's generally true that the ER isn't the place for primary care. From the standpoint of treating problems that aren't life-threatening illness or injury, relying on the ER for care is indeed unnecessary and costly.

But what about the gray areas? What about ruptured ovarian cysts?

In the case of the woman described earlier, she was hit with a medical bill that totaled more than four thousand dollars, the amount BCBS apparently refused to cover for her visit. This puts patients like her in an interesting bind: Be your own doctor and figure out for yourself (or with the help of a hotline) whether what you're facing is a true emergency, or risk a huge medical bill if you're wrong.

If you go to the ER for something non-life threatening, like the common cold in a relatively healthy person, the patient probably should be expected to front at least some of the costs. But to fall to your knees in your kitchen in pain from something - and you don't know what it is - well, that's something entirely different.

Read more:

Is it an emergency? Insurer makes patients question ER visit

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