I was noticing the rates on a local taxi stating that it is $2.20 per first 1/4 mile and something like 55 cents each additional 1/4 mile. Yet these cabs do stay in business as they have to pay drivers, overhead, fleet maintenance, etc.
Yet those stupid Ambulances you see transporting sick people to the hospital or ER, have to charge a flat rate of at least $900 even if they take you a 1/4 mile that the other transport charges only $2.20. I know its considered normal and we as society have accepted it for years, but why?
First of all, an ambulance is a taxi with a bed in it! Why do they need to charge that per trip when even when you add the operator, the paramedic, and the fuel along with wear and tear it does not all come to that. Also, why don't they just take you directly to the hospital instead of keeping you at the place you had your incident and spend a half hour or so asking your questions about why you are sick and what and where it happened. You could already be in the hospital being treated for what you have. As we all know ER's charge their own fee that does not include all the physicians that examined you as each of them have their own bill they will send you that is the same high price as the Emergency Room service. Then if you get admitted, every little thing they do to you,even administer and aspirin will be a hundred or so dollars per happening.
Maybe the cops need to arrest these people who are supposed to be saving lives and not ruining them by taking away a month's worth of wages on many people.
It's all Obamacare's fault.
Cabs spend a good chunk of their time transporting people. Ambulances spend most of their time sitting idle. Fewer rides = greater cost per ride.
Also, being a paramedic requires more special skill than being a cab driver and so the pay grade is higher. Not to mention that while in a cab you get a seat, in an ambulance you get a bunch of medical equipment (not just a bed).
The folks who operate these things aren't turning obscene profits. They're charging what it takes to cover their costs.
Ambulances are a bit more than a taxi with a bed. They're full of extremely expensive medical equipment, plus two or more EMT's who are paid more than taxi drivers.
Regardless, ambulance and hospital costs are usually included in health insurance coverage so it's not a concern for most people. If you don't have insurance and aren't able to pay, the hospitals are very open to negotiating lower bills and working out a payment plan. If you still can't pay, that's what personal bankruptcy laws are for. Personally, I'd rather owe hospital bills than be dead.
If you're an adult and a $900 emergency ambulance bill would destroy your life, you should really reevaluate your current financial situation because you're doing something wrong.
When I didn't have a car, living in the Chicago area, people asked what would happen if my daughter had to be taken to the hospital during my time with her (I had her on weekends). I told them I'd call for a taxi. Or, in a dire emergency, an ambulance. They'd never thought of that.
Quote from: realjd on April 11, 2012, 10:18:54 AM
Ambulances are a bit more than a taxi with a bed. They're full of extremely expensive medical equipment, plus two or more EMT's who are paid more than taxi drivers.
Regardless, ambulance and hospital costs are usually included in health insurance coverage so it's not a concern for most people. If you don't have insurance and aren't able to pay, the hospitals are very open to negotiating lower bills and working out a payment plan. If you still can't pay, that's what personal bankruptcy laws are for. Personally, I'd rather owe hospital bills than be dead.
If you're an adult and a $900 emergency ambulance bill would destroy your life, you should really reevaluate your current financial situation because you're doing something wrong.
My ambulance bill was $911 plus mileage. A 7 1/2 mile ride cost $6000 ...and I wasn't given a choice.
Quote from: US71 on April 11, 2012, 03:03:33 PM
Quote from: realjd on April 11, 2012, 10:18:54 AM
Ambulances are a bit more than a taxi with a bed. They're full of extremely expensive medical equipment, plus two or more EMT's who are paid more than taxi drivers.
Regardless, ambulance and hospital costs are usually included in health insurance coverage so it's not a concern for most people. If you don't have insurance and aren't able to pay, the hospitals are very open to negotiating lower bills and working out a payment plan. If you still can't pay, that's what personal bankruptcy laws are for. Personally, I'd rather owe hospital bills than be dead.
If you're an adult and a $900 emergency ambulance bill would destroy your life, you should really reevaluate your current financial situation because you're doing something wrong.
My ambulance bill was $911 plus mileage. A 7 1/2 mile ride cost $6000 ...and I wasn't given a choice.
Was that the cost to you or the cost to your insurance company? If that was your portion, the amount your insurance paid must have been huge!
My last hospital visit was to the ER for stitches. It cost me $75; my insurance company paid around $750 total to the hospital and to the doctors.
It must be nice to have medical insurance. :meh:
This is one of the weirder rants I've ever seen
Quote from: kphoger on April 11, 2012, 05:48:30 PM
It must be nice to have medical insurance. :meh:
It is. I'm fortunate enough to have a good job.
I'd be happy to throw a few tax dollars to you and others in your situation to help remedy your insurance deficiency, but unfortunately most of the rest of the country disagrees.
Quote from: realjd on April 11, 2012, 05:58:52 PM
Quote from: kphoger on April 11, 2012, 05:48:30 PM
It must be nice to have medical insurance. :meh:
It is. I'm fortunate enough to have a good job.
I'd be happy to throw a few tax dollars to you and others in your situation to help remedy your insurance deficiency, but unfortunately most of the rest of the country disagrees.
You need more than just a good job these days. My wife works at home, and I make $10.80 an hour. You'd think we'd be able to afford health insurance. But, geez, Louise, it's outrageous!
By good job I meant one that comes with insurance. I'll bet it's outrageous trying to buy it yourself.
Aren't companies required to provide insurance for full time employees, or is that a state-by-state thing? I know my brother was stuck at 35 hours per week for a while so his company wouldn't have to buy him insurance.
Ambulances fit neatly in under my deductible, costing me hundreds with very little paid by insurance. If I can't drive myself, I'm gonna make damn sure to use some other type of service.
Quote from: Steve on April 11, 2012, 07:10:22 PM
Ambulances fit neatly in under my deductible, costing me hundreds with very little paid by insurance. If I can't drive myself, I'm gonna make damn sure to use some other type of service.
The EMTs I know will thank you for this. Their number one complaint is abuse of ambulance services by people who don't need it. If everyone is tied up dealing with old people with a headache, who's going to respond to the heart attack patient or the car crash?
In my area, ambulances are used often to transport the elderly or severely disabled from their residences to doctors' appointments. Many of these people are basically bedfast or have difficulty moving, and it takes specialized personnel and equipment to move them.
I used to think that ambulances were for emergency transportation only, but since learned that this is not the case at all.
My dad spent the last two years of his life in a nursing home. He was non-ambulatory, and went to the hospital three times during the last 8 months of his life. Once was for an emergency, the other two times because of other health concerns. It would have been nearly impossible to transport him in a passenger vehicle, so he was taken to the hospital, and back to the nursing home, via ambulance.
In my area, there has been a proliferation of air ambulances. It's a 90-minute drive from where I live to Lexington under normal circumstances. A lot of air ambulance activity takes place around here, and I live under what is obviously the flight path for not only local flights, but flights to other places in southeastern Kentucky. Sometimes I wonder if all these life flights are really necessary.
I also wonder if a certain infamous one-legged unkempt racist scumbag taxi driver would accept fares from people asking to be taken to a hospital or a medical appointment?
Quote from: realjd on April 11, 2012, 06:52:44 PM
By good job I meant one that comes with insurance. I'll bet it's outrageous trying to buy it yourself.
Aren't companies required to provide insurance for full time employees, or is that a state-by-state thing? I know my brother was stuck at 35 hours per week for a while so his company wouldn't have to buy him insurance.
It doesn't matter. . . not totally, anyway. A company can offer a group plan, but that doesn't mean the group plan is affordable either.
Anyway, if I were without a car and needed to go to the hospital, I would first check with the neighbor to see if they'd give me a ride. If, for some crazy reason, none of my neighbors could give me a ride, I'd call my parents. If, for some crazy reason, they couldn't give me a ride, I'd call a taxi.
Over here ambulances are paid for by taxpayers so the service is free. Some people abuse the service such as here (http://www.dailymail.co.uk/news/article-1335861/Derek-Sergeant-gets-Asbo-sparking-73-Ambulance-calls-playing-dead.html). At the bottom it says every call out costs £197 which is around $300 so it's substantially less than $900.
So if I understand it correctly if you dial 911 and need an ambulance in an emergency you will be billed for it and pay $900 plus mileage? No wonder people use taxis :ded:
Quote from: Truvelo on April 12, 2012, 03:22:27 PM
Over here ambulances are paid for by taxpayers so the service is free. Some people abuse the service such as here (http://www.dailymail.co.uk/news/article-1335861/Derek-Sergeant-gets-Asbo-sparking-73-Ambulance-calls-playing-dead.html). At the bottom it says every call out costs £197 which is around $300 so it's substantially less than $900.
So if I understand it correctly if you dial 911 and need an ambulance in an emergency you will be billed for it and pay $900 plus mileage? No wonder people use taxis :ded:
Yes, all medical care here is billed. A standard ER visit for stitches can cost upwards of $1,000 without insurance. Since its against the law to refuse emergency medicine to those who cannot afford it, prices are high partly to offset the costs of those who don't pay. Bills are generally negotiable because hospitals would rather work out a payment plan for a smaller sum than have a patient go into bankruptcy or otherwise pay nothing.
Where it gets really absurd is that bills for individuals without insurance are generally significantly higher than the equivalent payment an insurance company would make. Insurance companies negotiate significant discounts with hospitals that individuals don't get automatically. Like I said though, simply asking for a hospital bill to be reduced is usually enough to at least get it down to the insurance company contract rate.
When I visit the doctor, a normal bill breaks down as follows:
Amount you paid: $20 (copy)
Total cost: $150
Insurance contracted amount: $100
Insurance paid: $80
Balance: $0
My insurance will pay for health care overseas (such as what I'm sure would be a healthy bill from your NHS if I needed care in the UK). Does your NHS provide similar coverage overseas or do you have to buy travel health insurance on your own?
Quote from: realjd on April 12, 2012, 05:48:24 PMYes, all medical care here is billed. A standard ER visit for stitches can cost upwards of $1,000 without insurance. Since its against the law to refuse emergency medicine to those who cannot afford it, prices are high partly to offset the costs of those who don't pay. Bills are generally negotiable because hospitals would rather work out a payment plan for a smaller sum than have a patient go into bankruptcy or otherwise pay nothing.
Where it gets really absurd is that bills for individuals without insurance are generally significantly higher than the equivalent payment an insurance company would make. Insurance companies negotiate significant discounts with hospitals that individuals don't get automatically. Like I said though, simply asking for a hospital bill to be reduced is usually enough to at least get it down to the insurance company contract rate.
The more cynical take on this explanation: hospitals and other medical care providers follow a "pitch it high and see if it sticks" strategy and deliberately bill high, in hopes that the eventual negotiated-down value will give them a healthy profit margin.
QuoteMy insurance will pay for health care overseas (such as what I'm sure would be a healthy bill from your NHS if I needed care in the UK). Does your NHS provide similar coverage overseas or do you have to buy travel health insurance on your own?
A bill from the NHS, no matter how "healthy," will still be far less than a comparable bill from a US healthcare provider. Doctors have no profit participation, and direct-to-consumer advertising of prescription drugs is illegal, so doctors tend not to order unnecessary procedures or drugs, and patients tend not to pester them for such things unless they are independently following the medical literature (which is a very middle-class thing to do and is one reason the NHS tends to work better for the middle class than for the working class).
To answer your question about overseas health coverage: it depends on the country. Under an EU-wide reciprocity rule, EU citizens have access to coverage under the health care system of the country they are in if they are in any EU country (for example, if you are British but in Spain, you can access services and register as a patient under the Spanish healthcare system). My understanding, however, is that you do not obtain this access automatically--you have to do something in advance of travel (in the past, you used to have to fill out an E-111 form which you carried with you, but arrangements have changed and I am not familiar with the new ones). As a general rule, Britons don't have any kind of automatic health coverage outside the EU, including in the US, nor do Americans automatically have access to the NHS. (I am in fact a registered NHS patient, but only because I came to the UK originally as a student.) There is, however, some supplementary provision of private healthcare coverage--in the UK this is often offered as a fringe benefit of high-paying jobs. If you are covered by BUPA through your job, for example, you can get a private room in a NHS hospital and bypass waiting lists (to an extent). Overseas health coverage may be available through BUPA as well.
Although your eligibility (as a foreign national) to access publicly funded healthcare services in an EU country in theory lapses when you are no longer a resident of that country, in practice there is no systematic process for "scrubbing" foreigners who leave. This means that, for example, a NHS registration is effectively for life. Years ago I took a short haul flight from London to Barcelona and talked with a Londoner who had spent a few years in Spain and was returning for a back operation. She had returned to the UK a number of years ago but had chosen to have the operation in Spain, on the strength of her registration as a patient there, because waiting lists were then shorter in Spain than in the UK.
I have seen some signs EU healthcare services are trying to close this loophole--for example, the last time I was in my doctor's surgery in Oxford, there was a sign advising patients to let the front desk staff know if they were leaving Oxford permanently--but at this point it is all very tenuous and voluntary.
As an American, I can visit the A&E department of a hospital in the UK and receive free emergency care, but i would have to pay if I'm admitted. I would see a general practitioner as a private, paying patient. I looked into it before my last trip to London, before I figured out my company's overseas health insurance coverage (which incidentally is 100% coverage with no deductible or copay - better than I get at home!).
My first trip to London, there was a giant march protesting government spending cuts and the privatization of the NHS, which I found ironic considering we were at the same time having protests and marches against the socialization of our health care system.
There are some other services that are free to all (no need for NHS registration), and they are listed here:
http://www.dh.gov.uk/en/Healthcare/Entitlementsandcharges/OverseasVisitors/Browsable/DH_074379
STD treatment and family planning services, for example, are also free. Otherwise it is broadly as you describe--emergency treatment free only if admission to hospital is not involved, etc.
I tend to see what is happening with the NHS now (inflation of doctors' salaries under New Labour, followed by creation of the so-called "NHS internal market," and now--under the current coalition government--the proposed substitution of the "duty to provide" with a "duty to promote") as a rush to repeat American mistakes. I think Britain in general has been very fortunate to have received socialized health care as part of the post-1945 Labour government's "New Jerusalem" program, well before entrenched interests developed in the healthcare sector and made systematic reform all but impossible.
Quote from: J N Winkler on April 12, 2012, 06:42:54 PM
Quote from: realjd on April 12, 2012, 05:48:24 PMYes, all medical care here is billed. A standard ER visit for stitches can cost upwards of $1,000 without insurance. Since its against the law to refuse emergency medicine to those who cannot afford it, prices are high partly to offset the costs of those who don't pay. Bills are generally negotiable because hospitals would rather work out a payment plan for a smaller sum than have a patient go into bankruptcy or otherwise pay nothing.
Where it gets really absurd is that bills for individuals without insurance are generally significantly higher than the equivalent payment an insurance company would make. Insurance companies negotiate significant discounts with hospitals that individuals don't get automatically. Like I said though, simply asking for a hospital bill to be reduced is usually enough to at least get it down to the insurance company contract rate.
The more cynical take on this explanation: hospitals and other medical care providers follow a "pitch it high and see if it sticks" strategy and deliberately bill high, in hopes that the eventual negotiated-down value will give them a healthy profit margin.
My slightly less cynical take, from my experience as a lawyer once involved in regulating hospitals: Hospitals give breaks to insurance companies often because the companies have some price sensitivity -- for example, they can threaten to cut you out of their networks if your price is too high, or promise to steer business your way if your price is better than the competition's. Even if the hospital has a lock on its local market, insurance companies have some leverage, such as promising to reimburse the hospital directly rather than pay the patient and make the hospital's collection department chase after the patient for payment. Individual patients usually have less leverage except to give the hospital a hard time about paying the bill, especially if the most price-sensitive patients join HMOs or other relatively economical health plans. So that's where the hospitals try to make their money, plus they can always dream of some uninsured rich person showing up in their emergency rooms.
There are plans out there where you still pay your own hospital and other healthcare bills, but you pay an insurance company or other health plan to get access to its network and the discount rates it's negotiated on behalf of its other clients. Better than nothing, I suppose.
Something I was fascinated to find out about recently is tribal healthcare systems. My girlfriend is a card-carrying member of the Chickasaw tribe, and she is allowed free treatment at several Chickasaw-administered clinics and pharmacies in south central Oklahoma, and at a tribal hospital in Ada. Of course, this does little good in an emergency, since it would make no sense to try to get to Ada (which is about an hour drive from Norman) in a life-threatening emergency. But it has allowed her to seek treatment for migraines, which she probably wouldn't be able to afford if there were no tribal healthcare available to her.
These operations are, of course, funded mostly through casino profits.
I still say to bring back the rescue squads and just let them pick you up, place you on a stretcher and let the ER do what they are going to do anyway. I think it is redundant that the ambulance staff tries to figure out what is wrong with you when its the ER that really treats you. That drives insurance costs up cause they are paying for two treatments that are the same!
To me and ambulance is, and always will be to me, a taxi just like the vehicle that picks you up at the airport and drives you to your hotel. To me they are stealing our money and should be not allowed to operate as a business! If a cab can charge a fraction of what these idiots charge, than they can do it too! And, yes, I am quite comfortable having a taxi cab take me to the ER if I need an emergency. I am not like everyone else who racks up debt, I would like to pay for things as much as I can and owe nobody nothing! If it is a choice between dying and paying thousands of dollars, I would rather pick the former no matter what I suffer.
Quote from: roadman65 on April 18, 2012, 05:51:29 PM
I still say to bring back the rescue squads and just let them pick you up, place you on a stretcher and let the ER do what they are going to do anyway. I think it is redundant that the ambulance staff tries to figure out what is wrong with you when its the ER that really treats you. That drives insurance costs up cause they are paying for two treatments that are the same!
"gee, he's bleeding out. should we put on a tourniquet?"
"nah, that's the hospital's job."
"I call a cab 'cause a cab will come quicker" - Public Enemy, 911 is a Joke, from Fear of a Black Planet
Quote from: roadman65 on April 18, 2012, 05:51:29 PM
I still say to bring back the rescue squads and just let them pick you up, place you on a stretcher and let the ER do what they are going to do anyway. I think it is redundant that the ambulance staff tries to figure out what is wrong with you when its the ER that really treats you. That drives insurance costs up cause they are paying for two treatments that are the same!
To me and ambulance is, and always will be to me, a taxi just like the vehicle that picks you up at the airport and drives you to your hotel. To me they are stealing our money and should be not allowed to operate as a business! If a cab can charge a fraction of what these idiots charge, than they can do it too! And, yes, I am quite comfortable having a taxi cab take me to the ER if I need an emergency. I am not like everyone else who racks up debt, I would like to pay for things as much as I can and owe nobody nothing! If it is a choice between dying and paying thousands of dollars, I would rather pick the former no matter what I suffer.
Yep, trained paramedics totally shouldn't try defib heart attack patients. Or offer a saline IV to heat stroke patients. Or birth a baby for a mother who went into early labor.
It's not duplicating treatment like you claim. While they aren't as sophisticated as what the ER docs can do, the whole point of paramedics is to begin life saving treatment ASAP when seconds count. The fact that some people use them as a hospital taxi for non-emergencies is an unfortunate but unrelated truth.
Personally, I'd rather be in debt than dead. But I don't consider debt inherently bad like you apparently do. Taking out a mortgage for a house often makes financial sense. Low interest car loans aren't necessarily bad debt as long as you don't overspend. Debt is only bad if abused, like maxing out a high-interest credit card on toys.
Quote from: agentsteel53 on April 18, 2012, 05:56:33 PM"gee, he's bleeding out. should we put on a tourniquet?"
"nah, that's the hospital's job."
Tourniquet? What is this 1990? considered bad practise now.
Quote from: J N Winkler on April 12, 2012, 06:42:54 PMMy understanding, however, is that you do not obtain this access automatically--you have to do something in advance of travel (in the past, you used to have to fill out an E-111 form which you carried with you, but arrangements have changed and I am not familiar with the new ones).
It's apply for a card - I've got one, but it was so long ago I can't remember how.
Travel insurance often covers a level of overseas (non-EU) massive emergency (eg you'd need to undo surgery and be admitted) treatment.
I can fully understand why many Americans don't want socialised healthcare - it is the ultimate way to get statism ingrained into the national psyche. It was the flagship of the cradle-to-grave care of
big brother Clement Attlee's government (I'm not sure they got out of the mindset of running a country that was fighting total war) with good reason - it provides that expectation of cradle-to-grave care and locks it in. Not even Thatcher-the-milk-snatcher would touch the NHS - and she stopped the giving of free milk to kids at school (earning her the nickname that makes her sound like the Grinch), defeated the militant unions, dismantled a lot of the state-owned monopolies. The NHS is practically untouchable - changing the way it is run, or decreasing the increase in budget it is an attempt at political suicide.
One big difference and the reason I'd want an ambulance if it was a true emergency: ambulances have emergency equipment and can legally run red lights and exceed the speed limit to get you to the hospital. Taxis can't. All they can do is turn their flashers on, and I have a tendency to ignore non-emergency vehicles that are trying to speed by me if they have their flashers on. Those flashers don't give you a legal right to pass illegally or expect other motorists to pull over and defer to you.
I work at a health insurance company that you've heard of, so I see a lot of ambulance claims. My favorite is a kid that crashed his car into a tree across the street from the hospital. The ambulance went out and got him and billed us the base charge plus the minimum 1 mile loaded mile charge.
Employers don't have to offer health insurance. It's universally expected that they do, however. Under Obamacare large employers would have to or pay a fine. However the fine is less than the cost of insurance to them, so some very, very large companies are thinking about dropping coverage for their employees, paying the fine, and sending their employees to buy their own policies on the exchanges.
Quote from: Mdcastle on April 25, 2012, 10:33:38 AM
I work at a health insurance company that you've heard of, so I see a lot of ambulance claims. My favorite is a kid that crashed his car into a tree across the street from the hospital. The ambulance went out and got him and billed us the base charge plus the minimum 1 mile loaded mile charge.
Employers don't have to offer health insurance. It's universally expected that they do, however. Under Obamacare large employers would have to or pay a fine. However the fine is less than the cost of insurance to them, so some very, very large companies are thinking about dropping coverage for their employees, paying the fine, and sending their employees to buy their own policies on the exchanges.
See that is so stupid! Money wasted there completely! Yeah we all know too much about the socialized healthcare that is coming. The funny thing is that either way we get it. Either though Obama or Romney, they both are going to make us sure that it happens. Obama Care verses Romney Care its going to be as well as their religions as both are prominent in two faiths that are considered off key by many Americans.
This is how the whole thing needs to be handled is address charges and services that ARE NOT NEEDED such as what ambulance companies pull on the GP.
Quote from: roadman65 on April 28, 2012, 03:16:48 PM
Obama Care verses Romney Care its going to be as well as their religions as both are prominent in two faiths that are considered off key by many Americans.
what
I foresee nothing good coming out of this thread at this point.