Emergency Room Woes Go Beyond the Long Wait

Have you ever sat in the emergency room with a legitimate emergency only to be put behind what seemed like dozens of people ahead of you? Did some seem like their “emergency” wasn’t a real emergency? It isn’t your imagination. Actually, it’s happening all over the United States.

Many people go to the emergency room when it isn’t necessary. Why? While some just simply may not know if their issue is serious or not, many others are choosing the emergency room because they have inadequate or no insurance coverage.  Unfortunately this is becoming a growing problem in the U.S – and a costly one at that.

Billions of dollars are spent each year for the care of uninsured people who visit the emergency room. Recently, a report from the California Institute for County Government at California State University, Sacramento indicated most emergency room abusers either lack insurance, are on Medicare or a state equivalent.  The tab is then usually picked up by the state – one factor that contributed to California’s financial crisis. Additionally, Medicare or Medicaid (Medi-Cal in the State of California) will also pay for emergency room visits even if it is not an emergency. Some patients may even misrepresent their condition or the condition of their child in order to receive Medicaid/Medi-Cal benefits in the emergency room.

Not only does this habit disrupt the normal operation of the emergency room and prevent people with legitimate emergencies from getting prompt care, it also disrupts finances. Treatment in the emergency room costs six times more than treatment in a doctor’s office.

Some states are now looking at programs to combat this growing problem. For example, Medicaid in the state of Washington is rapidly going broke. The state is faced with a $1.4 billion budget gap in the FY 2012-2013. As of April 1, 2012 the state has implemented new rules as it pertains to Medicaid coverage. Medicaid officials say the program will no longer pay for any medically unnecessary emergency-room visits, even when patients or parents have reason to believe they’re having an emergency. The new rules would block payment for emergency room visits for about 500 different conditions. It is unknown at this time if other states, including California, will be adopting a similar program.

Filed under: Health Insurance

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