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I had to go to the ER twice this year due to debilitating kidney stones. My insurance called to tell me if I went a third time I'd be penalized

Bentendo24

Bentendo24

Member
Feb 20, 2020
5,348
It's just so inhumane. They said I'd have to pay an additional $300 on top of the already $1,000+ I've paid per visit. I asked if there are any options for me to fight it and they said im free to call them to make my case.

Guys... My stones were so bad that they were blocking my pee from coming out and the urine could have backed up into my kidney. But apparently I'm abusing the system. Guess I'll just die 😒
 
Torpedo Vegas

Torpedo Vegas

Member
Oct 27, 2017
22,642
Parts Unknown.
mp,504x516,gloss,f8f8f8,t-pad,600x600,f8f8f8.u2.jpg
 
brawndolicious

brawndolicious

Member
Oct 27, 2017
4,927
I didn't even know that's a thing they can do. I thought it was just premiums, copays, and deductibles.

Is this actually in the contract?
 
ChrisBliss117

ChrisBliss117

Member
Oct 28, 2017
1,842
Kidney stones are terrible. I've only had one but it was the most pain I've ever been in. Did they test the stones to see what kind they were? I know some diets may improve your chances of not having another one.

American healthcare is garbage. Abusing the system makes no sense considering you have to pay no matter what.
 
demosthenes

demosthenes

Member
Oct 25, 2017
11,604
First, your insurance company sucks. Second, are you predisposed to them? OP, drinking enough water?
 
echoshifting

echoshifting

very salt heavy
The Fallen
Oct 25, 2017
14,730
The Negative Zone
Hmmm you might call a patient advocate at your hospital and see if there's anything they can do to help you out if there's a next time. There might be some foundation you can establish ahead of time to avoid the penalty. Though I certainly hope there just isn't a next time!
 
OP
OP
Bentendo24

Bentendo24

Member
Feb 20, 2020
5,348
demosthenes said:
First, your insurance company sucks. Second, are you predisposed to them? OP, drinking enough water?
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Yes I get them about once a year. This year has just been killer

And yeah I drink a lot of water, I don't believe it helps much. My mom gets golf ball sized kidney stones and my dad gets stones too. So I'm fucked lol
 
brawndolicious

brawndolicious

Member
Oct 27, 2017
4,927
Bentendo24 said:
It's United Healthcare, so I guess they know what's legal and what's not
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They have no interest in paying for your medical care. Do not trust them. Look at the contract and make it clear that you're willing to fight it.

If you're getting the insurance through work, meet with HR I guess to go over it and if it's through a state insurance marketplace, then call their customer support number. Either one should have the expertise to guide you through whatever the contract actually says and what it doesn't say.
 

Deleted member 43

Account closed at user request
Banned
Oct 24, 2017
9,271
They can penalize you for using the insurance without reason, but as long as the hospital doc says you needed treatment, you should be able to win an appeal.
 
monapon

monapon

Member
Nov 9, 2017
253
Definitely call them. Ask to see the actual section in the contract where this rule is. Have them point it out to you. Maybe even mention that you want the actual copy with the relevant section highlighted so you can take it to a lawyer. Definitely don't trust them without seeing the actual details because that just sounds like them trying to squirm out of paying up.
 
elLOaSTy

elLOaSTy

Member
Oct 27, 2017
3,848
Healthcare in the US is terrible and what's really noticeable is how much worse it seems to be getting, like what health providers do offer now is kinda awful compared to even a few years ago.

I really really really fucking hate the US healthcare situation.
 
HeySeuss

HeySeuss

Avenger
Oct 25, 2017
8,858
Ohio
Yeah they want to limit er trips because people just go to the er for anything. That's why the copay is so high and they want to steer you to your doctor or urgent care. It's one of they ways they try to keep your medical bills down and premiums low for everyone

Edit: I have UHC too and I remember them having some sort of limit on er trips
 
NinjaScooter

NinjaScooter

Member
Oct 25, 2017
54,164
Yeah I was going to ask is this specific to Emergency visits? Not that insurance companies aren't shit, but is it possible they may be wanting to steer you towards seeing your primary physician for these things if they are recurring as I think it costs them less. Still incredibly shitty to make it sound as if you are abusing the system and threaten you with penalties.
 
MinusTydus

MinusTydus

The Fallen
Jul 28, 2018
8,198
"We didn't think you'd actually USE your insurance! You monster!"

Greatest country in the world.
 
TooBusyLookinGud

TooBusyLookinGud

Graphics Engineer
Verified
Oct 27, 2017
7,964
California
It sucks ass OP. Your mom and dad and yourself are at risk for stones? Your mom and dad aren't related so have you reviewed your diet or gotten a professional opinion?

Yes the system sucks ass and no one is going to debate that fact, but have you tried other ways to reduce them or gotten a diagnosis?

I have insurance, but OP I try my damn hardest to not use it because I'm afraid of the consequences. Your situation is what I want to avoid because insurance companies will buck on you.
 
TheDestructiveSquirrel

TheDestructiveSquirrel

Member
Oct 25, 2017
27,856
Can't really go to your family Dr when you get a sudden attack, it's not like it slowly builds up lol

I guess the ER can't really do much unless they see an infection as well, just give you meds to help you deal with the pain and something to help you pee easier.

At least that's what it was like when I went to the ER for stones........the morphine def. helped with the pain though lol

This is in Canada though, so I wasn't told to not come back if I had another attack but a kidney Dr said unless I was showing signs of an infection like chills or vomiting all I could really do is take pain killers at home and wait it out :|
 

Deleted member 8257

Oct 26, 2017
24,586
D_NFy90XUAUdEfo.png


Please think of how much your insurance costs are hurting the hardworking CEO's. /s

So sorry OP. Fuck every single one of the insurance companies. I think you should call them and make your case, as much as it sucks.
 
entremet

entremet

You wouldn't toast a NES cartridge
Member
Oct 26, 2017
60,142
ER visits are a huge ripoff. Not saying you didn't need it, but the pricing structure is insanity.
 
Seirith

Seirith

Member
Oct 25, 2017
3,311
That's awful, both the stones and insurance. I was just in the ER for a stone and I have 2 more still in my kidney.

I would call and talk to your insurance.

Have you had your stones analyzed?
 
Cheesebu

Cheesebu

Wrong About Cheese
Member
Sep 21, 2020
6,177
I'm assuming USA. Because of course. I would fight tooth and nail. This minor (monetarily) stuff is what insurance is for.

Not to pry, but do you know if there is an outside cause in your case (medication, diet, etc)? I'm so fucking scared of kidney stones. Like hypochondriac level fear.
 
sbenji

sbenji

Member
Jul 25, 2019
1,882
I am curious, what is the ER actually doing in this case? It seems like it is below emergency surgery so I'm just curious.
 
TheDestructiveSquirrel

TheDestructiveSquirrel

Member
Oct 25, 2017
27,856
weemadarthur said:
Pain relief, monitoring, potentially diagnosis particularly the first time. Referral for emergency surgery if advised.
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Yea

Should also refer you to a uroligist to help you get the stones passed or a nephrologist to investigate why you might be getting stones. Get ready to collect all your pee in a big jug for 24 hours! There are so many things that can lead to stones but there are some things they can look for and then tell you to avoid certain foods or whatever.
 
Cheesebu

Cheesebu

Wrong About Cheese
Member
Sep 21, 2020
6,177
One other thing that hopefully you wouldn't have to go through, but my wife is a nurse and at 2 if her 3 hospitals, they would occasionally work with a patient to skip the insurance and pay the absolute bare minimum. The hospital would rather be paid for the work than spend a year fighting insurance, so if you semi casually asked if they could work with you, they may possibly give you a very small bill.

Now if your personal bill only goes up by $300 that might not be helpful, but she has told me about people facing tens of thousands that worked out a payment plan to pay a small fraction of that just to cover their costs.

Edit: and just so people know, the USA is a fucking shithole for medical care, but a hospital cannot turn you away for emergency care. They work with homeless people every day. They took an oath. I'm sure there are conservative doctors looking after the hospitals bottom line for political reasons, but they will be paid no matter what.
 
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OP
OP
Bentendo24

Bentendo24

Member
Feb 20, 2020
5,348
Senator Toadstool said:
no out of pocket maximums?
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So here's actually my favorite part that I forgot to include in the op

I hit my out of pocket maximum of $4,000 on March 26th. My plan restarts April 1. So now I'm back to zero, but this whole 3 strikes you're out thing is for the Jan - Dec time period I guess and doesn't start over along with your out of pocket max.

So, I've already spent about $3000 in 2022 in medical expenses (the other 1k from random things last year) but because that 3k was in March it allll starts over and who knows what I might spend now

And since my wife and I aren't on a family plan and she and my daughter have their own insurance, we're about to spend about 6k more in July since she's due then with our son.

After our son comes in the picture it'll make sense to get on a family plan but the out of pocket max is $10k.. Which makes me want to cry so bad

Note: some of the details I might be wrong about. It's all so confusing
 
Cels

Cels

Member
Oct 26, 2017
6,775
dafuq, i have a $1,500/person, $3,000/family annual out of pocket maximum plan

my copay for emergency care is $50, but waived if admitted.
i'm guessing (bc i haven't had any ER visits yet for any reason under this coverage) that if i was admitted to the ER twice bc of kidney stones i wouldn't pay anything at all

your plan sucks man, damn.
 
OP
OP
Bentendo24

Bentendo24

Member
Feb 20, 2020
5,348
Cels said:
dafuq, i have a $1,500/person, $3,000/family annual out of pocket maximum plan

my copay for emergency care is $50, but waived if admitted.
i'm guessing (bc i haven't had any ER visits yet for any reason under this coverage) that if i was admitted to the ER twice bc of kidney stones i wouldn't pay anything at all

your plan sucks man, damn.
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This makes me want to cry. Literally. 3k out of pocket max? I would kill for that man
 
Cheesebu

Cheesebu

Wrong About Cheese
Member
Sep 21, 2020
6,177
Bentendo24 said:
This makes me want to cry. Literally. 3k out of pocket max? I would kill for that man
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Directly replying just to make sure you see this.
You may need to be direct, but you don't legally have to pay. It will just be the hospital instead of insurance. But again, this may necessitate you being very vocal. It may not be "automatic".

m3IhZVg.jpg
 
OP
OP
Bentendo24

Bentendo24

Member
Feb 20, 2020
5,348
Cheesebu said:
I'm assuming USA. Because of course. I would fight tooth and nail. This minor (monetarily) stuff is what insurance is for.

Not to pry, but do you know if there is an outside cause in your case (medication, diet, etc)? I'm so fucking scared of kidney stones. Like hypochondriac level fear.
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A lot of people have asked if I know what has caused it, and unfortunately since my stone ended up passing right around April 1 (when my out of pocket resets) I decided not to go to any more Dr visits because I can't afford it right now especially since we are having a kid in July and that'll probably cost 6k
 
Cels

Cels

Member
Oct 26, 2017
6,775
Bentendo24 said:
This makes me want to cry. Literally. 3k out of pocket max? I would kill for that man
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Yeah. I work for the county, and Kaiser HMO is one of the options. My up front pay is not great compared to my peers in the private sector but i prefer the lifestyle and non-salary benefits. Cigna HMO is another option and it also has a $3,000 family annual maximum. If you go with the non-hmo plans, like PPO or point of service plans,, the annual maximums go up to 8,000 or even 18,000 in some cases, like with anthem blue cross PPO.

I'm guessing you are under a PPO or HDHP.

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Cheesebu

Cheesebu

Wrong About Cheese
Member
Sep 21, 2020
6,177
Cheesebu said:
Directly replying just to make sure you see this.
You may need to be direct, but you don't legally have to pay. It will just be the hospital instead of insurance. But again, this may necessitate you being very vocal. It may not be "automatic".

m3IhZVg.jpg
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Don't be rude of course, just tell them you can't pay. It doesn't need to be totally true. It SHOULD be true. Some of American healthcare is just playing along 😔

Edit: whoops, meant to edit, not quote myself. No more pints for me.
 
OP
OP
Bentendo24

Bentendo24

Member
Feb 20, 2020
5,348
Cheesebu said:
Directly replying just to make sure you see this.
You may need to be direct, but you don't legally have to pay. It will just be the hospital instead of insurance. But again, this may necessitate you being very vocal. It may not be "automatic".

m3IhZVg.jpg
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This is really interesting to me.... I really resent that I have to figure all this shit out 😅
 
sbenji

sbenji

Member
Jul 25, 2019
1,882
Bentendo24 said:
According to my bill:

Catheter (since I couldn't pee)
Medicine (so many drugs)
Ct scan
Pelvic exam
Blood labs
Urine labs
Something called level 5 emergency
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That seems like reasonable treatment. Did you get a referral to a specialist for ongoing care?

Bentendo24 said:
This makes me want to cry. Literally. 3k out of pocket max? I would kill for that man
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US healthcare system ranges from amazing to literal hell depending on your insurance. I am strongly in favor of nationalized healthcare but the reality is that for those with good insurance, it would be worse care. Unfortunately, better insurance means higher paying job which corresponds with higher participation in the elections.
 
Wereroku

Wereroku

Member
Oct 27, 2017
6,247
Bentendo24 said:
A lot of people have asked if I know what has caused it, and unfortunately since my stone ended up passing right around April 1 (when my out of pocket resets) I decided not to go to any more Dr visits because I can't afford it right now especially since we are having a kid in July and that'll probably cost 6k
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As soon as you are in a better place you should see a urologist if you are getting them that often. Also if you want to try my urologist recommended crystal light lemonade, specifically the powder mix, as a good thing to drink. Apparently it's got some ingredients that can help stop their development. Also don't drink soda or tea. Also as someone said you are going to have to pee in a jug for 24 hours then make up the tubes to send off yourself. That was a fun experience.
 
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