Quote:
Originally Posted by Cicero
Hmmm....I'm sorry, I read- negotiation to determine authorization.
What are you negotiating?
What are you appealing?
You are right....I am totally lost...
I also have another question....
Is it that costly to provide an emergency service? Or are, we that pay our bills, helping to eat the cost for the 50 percent that don't?
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Whenever a patient arrives at a hospital for services, after they are evaluated, there's a lot of stuff that goes on behind the scenes that patients don't know about. One of those things is presenting the clinical information to the insurance provider to notify them of the patient's need for treatment. Typically between one and five days of inpatient treatment get authorized at the "front door," with concurrent review handled by treatment staff on the inpatient unit.
Psychiatric Emergency Care and Medical Emergency Care are two different creatures, with different billing structures. I know that we're pretty cheap as far as things go ... our actual billable rate for an evaluation, for example, is around $100. Our inpatient treatment day rate is $1000. We do not get paid that much by insurance companies. I think that we end up with around $350/day for acute psychiatric treatment for patients with insurance.
Medical Emergency Room treatment is very expensive, which is why it's a bad idea to use the ER as your family doctor. That many uninsured people do this is one of the reasons that ERs are overloaded. A friend of mine is an ER doc and has been discussing ways around this ... having a triage doctor or nurse practitioner who can refer non-emergent patients to a "clinic" that exists side by side with the ER.