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[Vrede too]

I've had a similar experience after a hospital was incorrectly informed that I didn't have insurance, but never with ER or nurses. As I remember, it was hospital administrators that would order the dumping of nonpaying patients in back alleys. The practice was so bad that even the Republicans like Reagan stepped up to sign legislation to end it - back in the 80s, yet I had a similar experience after my big insurance company told the hospital that I didn't have insurance. After that things got real strange.

Exactly, 1986.

Emergency Medical Treatment and Active Labor Act

Occasionally a hospital is still caught dumping uninsured patients to the street. More common is transferring them from a private hospital to a public one under some pretext. However, this happens with indigent patients with chronic, expensive and non-life threatening conditions, not with people on the verge of dying, like Ulysses thinks is routine and even more deplorably thinks should be routine.

A couple of personal examples:

Another nurse that could only hear part of my triaging thought that I had discouraged a Latino patient with a sore throat from being seen. She reported my potential EMTALA violation to the ED manager. In fact, the patient was accompanied by a family member and a translator that the other nurse did not know about. He was drunk and it turns out that he had thrown up, hence the sore throat. I did not discourage care at all, but after the full story was known all of them decided not to seek it. Issue resolved and the complaining nurse apologized to me.

An ER MD at a receiving hospital called and berated me about not sending the paperwork with a transferred patient and spat out that he was going to report my EMTALA violation. In fact, I had faxed it per protocol and the fault laid with the receiving hospital's Medical Records Dept. My boss sorted it out. The ER MD never apologized.

This is how seriously we take EMTALA over somewhat minor stuff. Anyone suggesting that we discriminate in emergent lifesaving situations is ignorant. Anyone saying that we should discriminate in favor of their insured ass in a lifesaving situation is a dick.

[O Really]

I'm not usually one to defend insurance companies nor medical billing practices, but verification of insurance is a practice that is in the best interests of the patient. For a variety of reasons, people screw up - they report the wrong coverage, they contact the wrong insurance provider, they put in the wrong code...yada. So sure, in most instances it can be sorted out after the fact, but that's usually a pain in the ass for all, particularly if the procedure was for something a pre-authorization was required. Much better to get it right up front even if it takes a little more time.

[Vrede too]

I'm not usually one to defend insurance companies nor medical billing practices, but verification of insurance is a practice that is in the best interests of the patient. For a variety of reasons, people screw up - they report the wrong coverage, they contact the wrong insurance provider, they put in the wrong code...yada. So sure, in most instances it can be sorted out after the fact, but that's usually a pain in the ass for all, particularly if the procedure was for something a pre-authorization was required. Much better to get it right up front even if it takes a little more time.

Thanks, I should have thought of that. Perhaps my not doing so is a further indication of the wall between ER care and insurance considerations.

Back with paper charts the insurance status was often right there on the 2nd page, if anyone cared to look. Now, with e-charts it's on it's own page, one that ER staff don't bother with other than to possibly offer a patient a cheaper option for care IF available and effective - again, in the best interests of the patient.

[neoplacebo]

I'm not usually one to defend insurance companies nor medical billing practices, but verification of insurance is a practice that is in the best interests of the patient. For a variety of reasons, people screw up - they report the wrong coverage, they contact the wrong insurance provider, they put in the wrong code...yada. So sure, in most instances it can be sorted out after the fact, but that's usually a pain in the ass for all, particularly if the procedure was for something a pre-authorization was required. Much better to get it right up front even if it takes a little more time.

Thanks, I should have thought of that. Perhaps my not doing so is a further indication of the wall between ER care and insurance considerations.

Back with paper charts the insurance status was often right there on the 2nd page, if anyone cared to look. Now, with e-charts it's on it's own page, one that ER staff don't bother with other than to possibly offer a patient a cheaper option for care IF available and effective - again, in the best interests of the patient.

I don't know how or why my situation became an insurance anomaly; always assumed it was due to the time of year....two days before Christmas. Or it could have been that I initially came to the ER in an ambulance (blood pressure was 200 and something over 100 and something) and then sent to my own room in the Heart Tower at Mission Hospital. I had the same insurance at the same job for over ten years when all this happened, no lapses in coverage, and I don't think I had even ever used the insurance up until that point, which could also have had something to do with it.....maybe they thought I was already dead. Anyway, they eventually broke me open and fixed my pipes. Oh, and I wasn't specifically knocking your personal handle, hominy, just conveying my historical distrust of doctors, dentists, and faith healers.

[Vrede too]

... Oh, and I wasn't specifically knocking your personal handle, hominy, just conveying my historical distrust of doctors, dentists, and faith healers.

Okay, my hominy, I retract "neoplacenta" . . . though I almost wish I had reason to keep it.

Your distrust is apt and I'm not offended by it. There may even be a crappy ER RN somewhere out there :liar: . My issue is with the accusation about what we do when someone is dying in front of us.

[neoplacebo]

... Oh, and I wasn't specifically knocking your personal handle, hominy, just conveying my historical distrust of doctors, dentists, and faith healers.

Okay, my hominy, I retract "neoplacenta" . . . though I almost wish I had reason to keep it.

Your distrust is apt and I'm not offended by it. There may even be a crappy ER RN somewhere out there :liar: . My issue is with the accusation about what we do when someone is dying in front of us.

One of the nurses in the heart tower I suspect was a Nazi. She had some sort of accent, was tall and blonde, and menaced me about hobbling around the area just to make me do some walking. I sort of think my opinion of her was justified because I referred to her as a Nazi when talking to a different nurse and she laughed about it. So I figure they all knew that she was a Nazi. I was lucky to get out of that damn place.

[O Really]

I don't know how or why my situation became an insurance anomaly; always assumed it was due to the time of year....two days before Christmas. Or it could have been that I initially came to the ER in an ambulance (blood pressure was 200 and something over 100 and something) and then sent to my own room in the Heart Tower at Mission Hospital. I had the same insurance at the same job for over ten years when all this happened, no lapses in coverage, and I don't think I had even ever used the insurance up until that point, which could also have had something to do with it.....maybe they thought I was already dead. ...

Lots of little things can cause glitches - that have nothing to do with your coverage itself. F'rinstance, you think you had the same employer insurance for over 10 years, but there are no 10-year insurance contracts. The actual "policy year" is probably only one, maybe two years. Somewhere on your insurance record with the hospital will have an "effective date." If that doesn't match what the insurance people have on you now, then the process stalls. If you think you've had the same coverage for 10 years, but the plan administrator changed, then you can get glitches. The group insurance my firm had was a self-insured plan, with a plan administrator. For a few years, the administrator was CIGNA, and for all normal purposes it was the same as straight-up CIGNA insurance. Then, the firm picked up another third-party administrator, but continued to use the CIGNA PPO/HMO list. For the patient, it didn't really matter still - you went to a doc from the list, and your bill got paid. But from the provider standpoint it was different because they had to contact a different approval source and somehow understand it wasn't really CIGNA even though it was CIGNA structure/plan. Good potential for screw-up. Then Lady O scheduled her semi-annual Prolia shot, and the doctor's office reported that it had been rejected by the insurance. Said pre-authorization was required and had been denied. So I called the administrator - nope, shouldn't be a problem; nope, no pre-auth required... Turns out somebody in the doctor's office had coded the procedure as an "infusion" not an "injection." Way different. Easily fixed, though not easily found, and she got her shot without problem.

[billy.pilgrim]

I've had a similar experience after a hospital was incorrectly informed that I didn't have insurance, but never with ER or nurses. As I remember, it was hospital administrators that would order the dumping of nonpaying patients in back alleys. The practice was so bad that even the Republicans like Reagan stepped up to sign legislation to end it - back in the 80s, yet I had a similar experience after my big insurance company told the hospital that I didn't have insurance. After that things got real strange.

Exactly, 1986.

Emergency Medical Treatment and Active Labor Act

Occasionally a hospital is still caught dumping uninsured patients to the street. More common is transferring them from a private hospital to a public one under some pretext. However, this happens with indigent patients with chronic, expensive and non-life threatening conditions, not with people on the verge of dying, like Ulysses thinks is routine and even more deplorably thinks should be routine.

A couple of personal examples:

Another nurse that could only hear part of my triaging thought that I had discouraged a Latino patient with a sore throat from being seen. She reported my potential EMTALA violation to the ED manager. In fact, the patient was accompanied by a family member and a translator that the other nurse did not know about. He was drunk and it turns out that he had thrown up, hence the sore throat. I did not discourage care at all, but after the full story was known all of them decided not to seek it. Issue resolved and the complaining nurse apologized to me.

An ER MD at a receiving hospital called and berated me about not sending the paperwork with a transferred patient and spat out that he was going to report my EMTALA violation. In fact, I had faxed it per protocol and the fault laid with the receiving hospital's Medical Records Dept. My boss sorted it out. The ER MD never apologized.

This is how seriously we take EMTALA over somewhat minor stuff. Anyone suggesting that we discriminate in emergent lifesaving situations is ignorant. Anyone saying that we should discriminate in favor of their insured ass in a lifesaving situation is a dick.

yep, rules are for individuals, but often not for doctors and hospitals. I have literally had my life saved twice, well once would have only killed my ability to earn a living, the other - death would have been a sure thing. Both times 2nd opinion docs saved me. One was a Duke grad and son of two Duke medical professors.

Over the years I've had a lot of trouble getting insurance companies to pay. I have learned a few of their tricks.

[Vrede too]

One of the nurses in the heart tower I suspect was a Nazi. She had some sort of accent, was tall and blonde, and menaced me about hobbling around the area just to make me do some walking. I sort of think my opinion of her was justified because I referred to her as a Nazi when talking to a different nurse and she laughed about it. So I figure they all knew that she was a Nazi. I was lucky to get out of that damn place.

I can't know, but one possibility is that they all get recalcitrant post-op patients up and moving sooner than they want - verified improved outcomes - and they all get called Nazis for it. Hence the laughter - at you, not with you .

[billy.pilgrim]

One of the nurses in the heart tower I suspect was a Nazi. She had some sort of accent, was tall and blonde, and menaced me about hobbling around the area just to make me do some walking. I sort of think my opinion of her was justified because I referred to her as a Nazi when talking to a different nurse and she laughed about it. So I figure they all knew that she was a Nazi. I was lucky to get out of that damn place.

I can't know, but one possibility is that they all get recalcitrant post-op patients up and moving sooner than they want - verified improved outcomes - and they all get called Nazis for it. Hence the laughter - at you, not with you .

my rules for hospital and ER

if they say to do something 10 times, I do it 20
if they say that we are going to have you up and walking this afternoon, I say, let's do it now

and above all, don't ever press the damn call light unless you think that you will actually die before they get to your room on their regular schedule. Like I had to tell my wife once, Stop bothering them, they're working.


edit:

oh, and I also can't sleep in a hospital, so when the Vampire comes for the 4 a.m. blood draw, she gets my happy smiling face asking her how she is and complimenting her skill at a pain free draw - part true, part survival.

[Vrede too]

my rules for hospital and ER

if they say to do something 10 times, I do it 20
if they say that we are going to have you up and walking this afternoon, I say, let's do it now

and above all, don't ever press the damn call light unless you think that you will actually die before they get to your room on their regular schedule. Like I had to tell my wife once, Stop bothering them, they're working.

Don't deny yourselves too much. Except for the needy and abusive psych patients I had no problem with calls for comfort measures and minor needs. A fully positive experience improves health outcomes. This may not be the case for other nurses and CNAs. I also mostly avoided using the intercom for calls. Our dept wasn't so big that it was all that hard to show up in person.

[billy.pilgrim]

my rules for hospital and ER

if they say to do something 10 times, I do it 20
if they say that we are going to have you up and walking this afternoon, I say, let's do it now

and above all, don't ever press the damn call light unless you think that you will actually die before they get to your room on their regular schedule. Like I had to tell my wife once, Stop bothering them, they're working.

Don't deny yourselves too much. Except for the needy and abusive psych patients I had no problem with calls for comfort measures and minor needs. A fully positive experience improves health outcomes. This may not be the case for other nurses and CNAs. I also mostly avoided using the intercom for calls. Our dept wasn't so big that it was all that hard to show up in person.

No sacrifice here, but some people ask nurses questions that can't be answered. Why waste their time?
My attitude may have something to do with the several nurses who have spent time in my room just hanging out.

[Vrede too]

No sacrifice here, but some people ask nurses questions that can't be answered. Why waste their time?

Sounds like the MDs are not spending enough time answering questions. When possible, I would strive to alert the MD to the questions and hope that s/he answered them the next time in the room. This is easier to do in an ER than on the floor, but it can be done there, too.

Besides, patients and family often trust us more than they do MDs. I can't fault them for trying.

My attitude may have something to do with the several nurses who have spent time in my room just hanging out.

If so, and not actually subtle "therapeutic communication," sounds like they didn't have that much pressing work to do and/or valued your company above the alternatives. Take it as an honor.

[O Really]

One of the nurses in the heart tower I suspect was a Nazi. She had some sort of accent, was tall and blonde, and menaced me about hobbling around the area just to make me do some walking. I sort of think my opinion of her was justified because I referred to her as a Nazi when talking to a different nurse and she laughed about it. So I figure they all knew that she was a Nazi. I was lucky to get out of that damn place.

I can't know, but one possibility is that they all get recalcitrant post-op patients up and moving sooner than they want - verified improved outcomes - and they all get called Nazis for it. Hence the laughter - at you, not with you .

Yeah, they probably called in a physical terrorist.

[billy.pilgrim]

No sacrifice here, but some people ask nurses questions that can't be answered. Why waste their time?

Sounds like the MDs are not spending enough time answering questions. When possible, I would strive to alert the MD to the questions and hope that s/he answered them the next time in the room. This is easier to do in an ER than on the floor, but it can be done there, too.

Besides, patients and family often trust us more than they do MDs. I can't fault them for trying.

My attitude may have something to do with the several nurses who have spent time in my room just hanging out.

If so, and not actually subtle "therapeutic communication," sounds like they didn't have that much pressing work to do and/or valued your company above the alternatives. Take it as an honor.

what about a wife who stops every passing nurse to find out when I'll get a room?

as for the call button - I really wasn't able to think of anything, other than being discharged, I ever wanted while stuck in a hospital bed - they brought me food, water and snacks without my asking.

You know, now that we talk about the EMTATA, I'm seeing an answer about why a nurse told me the truth to a direct question, rather than following the doctor's uninformed lead.
ER doc ordered something that my other doctors had told me never to do. When I refused, the nurse talked to the doc and came back with a "revised plan" (the nurse may have been in violation at this point), when I demanded to know how much "revised" - he admitted that it was still at 90% strength by doctors orders (the doc was wrong on so many levels).
Later my real doctor told me that I definitely did the right thing.

[neoplacebo]

One of the nurses in the heart tower I suspect was a Nazi. She had some sort of accent, was tall and blonde, and menaced me about hobbling around the area just to make me do some walking. I sort of think my opinion of her was justified because I referred to her as a Nazi when talking to a different nurse and she laughed about it. So I figure they all knew that she was a Nazi. I was lucky to get out of that damn place.

I can't know, but one possibility is that they all get recalcitrant post-op patients up and moving sooner than they want - verified improved outcomes - and they all get called Nazis for it. Hence the laughter - at you, not with you .

Yeah, that is a possibility.

[billy.pilgrim]

http://eng.auburn.edu/reinvent

WGDMFE

"A team of Auburn University engineering professors, students and alumni have successfully re-purposed a standard CPAP machine into a functional emergency ventilator for health care providers potentially coping with ventilator shortages during the Coronavirus Disease 2019 (COVID-19) crisis. The team’s research goal was to develop a robust and reliable option for an emergency ventilator that could be assembled using readily available commercial off-the-shelf components combined with a home CPAP machine."

"Built with approximately $700 worth of components, the RE-INVENT is an accessory designed to pair with, and modify, a common household CPAP machine."


But sadly, no profits for jared

and in Mississippi they use garden hose and other Home Depot parts to construct a $70 ventilator, or venty-later as the locals had rather.

if dumbass southerners are making $70 and $3,000 ventilators, why aren't we having contests? Quick, someone post on solar's forum - we all know that team trump consults there.

https://www.msn.com/en-us/news/us/its-n ... spartanntp

[Vrede too]

what about a wife who stops every passing nurse to find out when I'll get a room?

as for the call button - I really wasn't able to think of anything, other than being discharged, I ever wanted while stuck in a hospital bed - they brought me food, water and snacks without my asking.

You know, now that we talk about the EMTATA, I'm seeing an answer about why a nurse told me the truth to a direct question, rather than following the doctor's uninformed lead.
ER doc ordered something that my other doctors had told me never to do. When I refused, the nurse talked to the doc and came back with a "revised plan" (the nurse may have been in violation at this point), when I demanded to know how much "revised" - he admitted that it was still at 90% strength by doctors orders (the doc was wrong on so many levels).
Later my real doctor told me that I definitely did the right thing.

Sounds like your wife knows that the squeaky wheels get the grease. Probably works at home, too . To a point I understood and accepted it.

* EMTALA*

I can't know what you're referring to, but a patient has the absolute right to refuse any care that s/he chooses to. Then, at the top of the list for all healthcare providers, including nurses, is to do what is in the interests of the patient's rights, health and safety. If the nurse can justify her/his comms and actions, s/he is usually safe from punishment . . . except under poor mgmt or MDs. Even then, s/he has recourse - hospital ethics committees, state and federal regulators, courts.

One irl example:

I triaged a psych patient with medical issues. When a BP is high the machine deflates and then pumps up even higher is order to correctly read the BP as it deflates. This can hurt a little bit, but has never killed anyone. The patient freaked out and said she wanted to leave. I told her that she could have a stroke in the parking lot. She stayed, I recorded the very high BP, and she was treated for it and whatever else had brought her to us in the first place.

She complained to the state. I had to then explain in detail to my boss that I had done nothing to actually prevent the patient from leaving, and that I was actually kind of proud of myself for scaring her into staying (I don't think I used the word "scaring" with my boss ). My boss then explained this to the state - I didn't see or hear exactly how - and the complaint was dismissed. :thumbsup:

[Vrede too]

and in Mississippi they use garden hose and other Home Depot parts to construct a $70 ventilator, or venty-later as the locals had rather.

if dumbass southerners are making $70 and $3,000 ventilators, why aren't we having contests? Quick, someone post on solar's forum - we all know that team trump consults there.

https://www.msn.com/en-us/news/us/its-n ... spartanntp

Further discussion:
viewtopic.php?f=3&t=4069&p=115914&hilit ... pi#p115914

[Vrede too]

I can't know, but one possibility is that they all get recalcitrant post-op patients up and moving sooner than they want - verified improved outcomes - and they all get called Nazis for it. Hence the laughter - at you, not with you .

Yeah, that is a possibility.