Emergency Room Bill

[Sarah in SC]

Sorry this has happened to you, but glad he's okay now.
I've only paid for one ambulance ride, and it was 15 years ago for DH, who took a gainer off of a pool slide headfirst. The ambulance ride was $350 back then, of a total of about $900 for the whole ER experience. And the glare from the ER doc when he reported DH's BAC was free. Sigh...boys!

[ratto]

Quote:

Originally Posted by Corporate ORphan We got the bill today. $12,500 not including the ambulance!!! I kept saying we would meet our high deductible of $11,000 but I really didn't think we would. Silly me. We are both stunned.

Holy grief! Do hospitals and doctors charge an outrageous upfront amount because they know the bill will be at least halved by insurance companies, or they want to make up any possible losses from patients who can't pay, or just both? This is absolutely insane.

[MichaelB]

Quote:

Originally Posted by ratto Holy grief! Do hospitals and doctors charge an outrageous upfront amount because they know the bill will be at least halved by insurance companies, or they want to make up any possible losses from patients who can't pay, or just both? This is absolutely insane.

I have found labs to have the highest uplifted price. The average price reduction that our insurance (UHC) applies to LabCorp is 90%. A reasonable explanation is beyond me.

[audreyh1]

Quote:

Originally Posted by ratto Holy grief! Do hospitals and doctors charge an outrageous upfront amount because they know the bill will be at least halved by insurance companies, or they want to make up any possible losses from patients who can't pay, or just both? This is absolutely insane.

That's the impression I get.

[Corporate ORphan]

BCBS got the bill down to about $3500 from 12,500 for the hospital.

DH is feeling better so he tried to go over it to see if we are getting billed for what he actually got. No way we can tell. The hospital's itemized bill uses a bunch of medical jargon. We called the hospital and got the run around. No one can go over it and explain the charges listed. They suggested we call the doctor's office (he doesn't have one) or get DH medical records.

Here's the kicker... the hospital will charge us 52 cents a page to copy the records. They can give us the estimated copy costs after they get a signed HIPPA form through snail mail from DH. My guess we are talking about 100 pages since some of the blood test results I have gotten from doctors have been 10 pages long and he had numerous tests done. Some are listed on the bill just as "lab test".

Bottom line we have to pay more than a nominal fee just to see if the bill is correct. What a racket.

I told hubby, it probably isn't worth his time to pursue this (which I guess is why they charged $12,500 to begin with so we woudl feel $3500 isn't much to pay). Especially, if I can get it kicked down another 25% by paying the bill right away when we get it.

Have any of you been able to get a hospital to explain their bill? If you did, how did you do it?

Thanks again!

[powerplay]

Quote:

Originally Posted by Corporate ORphan BCBS got the bill down to about $3500 from 12,500 for the hospital. DH is feeling better so he tried to go over it to see if we are getting billed for what he actually got. No way we can tell. The hospital's itemized bill uses a bunch of medical jargon. We called the hospital and got the run around. No one can go over it and explain the charges listed. They suggested we call the doctor's office (he doesn't have one) or get DH medical records. Here's the kicker... the hospital will charge us 52 cents a page to copy the records. They can give us the estimated copy costs after they get a signed HIPPA form through snail mail from DH. My guess we are talking about 100 pages since some of the blood test results I have gotten from doctors have been 10 pages long and he had numerous tests done. Some are listed on the bill just as "lab test". Bottom line we have to pay more than a nominal fee just to see if the bill is correct. What a racket. I told hubby, it probably isn't worth his time to pursue this (which I guess is why they charged $12,500 to begin with so we woudl feel $3500 isn't much to pay). Especially, if I can get it kicked down another 25% by paying the bill right away when we get it. Have any of you been able to get a hospital to explain their bill? If you did, how did you do it? Thanks again!

How on earth can an institution that clearly can get the bill put together and totaled up yet claims they cannot explain it. This appears to be one of the things that is badly broken about the US medical system. I can't think of another business where you could do this and get away with it!!

[Gatordoc50]

Quote:

Originally Posted by powerplay How on earth can an institution that clearly can get the bill put together and totaled up yet claims they cannot explain it. This appears to be one of the things that is badly broken about the US medical system. I can't think of another business where you could do this and get away with it!!

Or another business that charges every customer differently. Let's see, that bag of groceries is free for half of you, 20 bucks for twenty percent of you, and for the rest.....9354.67.

[zinger1457]

Quote:

Originally Posted by Corporate ORphan Bottom line we have to pay more than a nominal fee just to see if the bill is correct. What a racket.

You're still somewhat in the drivers seat since they don't have your money yet. What would happen if you told them that you'll only submit your payment after you receive a full explanation of all charges? And you're not going to pay additional for the full explanation.

[travelover]

Quote:

Originally Posted by Gatordoc50 Or another business that charges every customer differently. Let's see, that bag of groceries is free for half of you, 20 bucks for twenty percent of you, and for the rest.....9354.67.

................but we'll give you 25% off if you pay in cash right away.

[Bestwifeever]

Quote:

Originally Posted by Gatordoc50 Or another business that charges every customer differently. Let's see, that bag of groceries is free for half of you, 20 bucks for twenty percent of you, and for the rest.....9354.67.

And we're not even going to tell you what groceries we put in the bag, just how much you owe.

[sengsational]

Quote:

Originally Posted by Corporate ORphan BCBS got the bill down to about $3500 from 12,500 for the hospital.

I've learned to just throw out bills from any and all medical providers, and only look at paperwork from my insurance company. If the bill keeps coming, I'll look for non covered things on the EOB. I pay a lot for the insurance, so I take advantage of the "you only owe this much" documentation and the negotiated rates.

Can you imagine getting soaked if you didn't have negotiated rates? I couldn't/wouldn't. They'd take 25% or nothing.

[Surewhitey]

EOB is the way to go...DW was in the insurance claims biz and they only paid this and sometimes negotiated that down with a prompt payment promise.

Otherwise, you can drag out the payment over much time. I'd go in and ask for a 50% lump sum payment of the EOB and see where it goes. Can't hurt to ask and then negotiate from a low number.

[Ronnieboy]

Quote:

Originally Posted by Gatordoc50 Or another business that charges every customer differently. Let's see, that bag of groceries is free for half of you, 20 bucks for twenty percent of you, and for the rest.....9354.67.

+1

[Alan]

Quote:

Originally Posted by powerplay How on earth can an institution that clearly can get the bill put together and totaled up yet claims they cannot explain it. This appears to be one of the things that is badly broken about the US medical system. I can't think of another business where you could do this and get away with it!!

This has been an irritation to me for years. The one time I was convinced that I was being charged too much I formally put in a complaint to our BCBS company plan account administrator when I got the EOB and couldn't understand it. She got to me fairly quickly and said a code had been mistyped and my co-pay for the procedure dropped by $500.

Could you and your husband list all the procedures you thought you had done and submit a challenge to the insurance company?

[Free To Canoe]

A Users Guide for Health Care Billing


Taking care of the billing for health care can be a perplexing and frustrating experience for the inexperienced. It is much different than paying a vendor for a service or even resolving problems with a defective product. The problem is that most people never got the users guide. I was able purchase the Guide below for only 23 easy, weekly installment payments. I wish I had bought it before.


Users Guide


Most of the dissonance that many experience with health care bills comes from not understanding the health care billing process.


1st When you receive any correspondence in the mail from a health care entity, be glad. Do not feel a pain in your gut and don't let that vein in your forehead pop out. You will open it and it will undoubtedly be some sort of bill. This is your first mistake. All inquiries come in the form of a bill. The billing department is either confused or they have a question about something. It is against the custom to call you and ask a question. I know that to your untrained eyes it looks like a bill but it is not. I repeat, it looks like a bill that the other vendors send but it is not. It is a cry for help.


2nd What to do about the recent letter(“bill”)? It is best to let the confusion subside. The best way to do this is to let it age. The more confusing the billing looks, the more it needs to age. Stick it on top of the laundry basket. Just as Doctors practice Medicine, billing entities practice billing. Be patient.
For the uninitiated, the first impulse is to call and try to help straighten it out. Don't! You can only make matters worse. Who would you call that knows what is going on anyway?
The next thing that will happen is that they will send you more “bills”. If they are identical to the previous one, it means they are on the right track and you can move to the 3rd step. Sadly, this is usually not the case. The doctor, hospital, testing lab and insurance company etc will answer each others questions if you can just be patient and keep aging the bills. When the “final, final” bill comes, then you can try to talk to a person. But if you are patient, the collection agency will call you to ask for information.


3rd Intervention. If the bills are consistent, then you can contact them to correct the billing accuracy if it is needed. This is the time to tell them that you had a colonoscopy, not plastic surgery. This is also a good time to clear up who gets paid for what. If these facts are in order, then it is time to talk about the suggested bill. They never know what exactly to charge so they always charge real high, knowing the real price is somewhere between zero and infinity. This negotiation process is a lost art in our culture. Haggling is still a part of everyday life Europe, Mexico and other places. It is a fascinating opportunity to practice up on your medical vocabulary and get to know the people at the insurance company / collection agency. In the end, you will be happy to pay some reduced amount.
So many bills, so many offices, agencies and entities to pay.

[Corporate ORphan]

Quote:

Originally Posted by Alan Could you and your husband list all the procedures you thought you had done and submit a challenge to the insurance company?

We have done this but the problem is since we didn't sign off on anything, it is from memory plus who knows what they do with the blood they took?? On the bill there are three lines that just say "laboratory test".

Anyone ask their insurance co to explain the hospital bill? BCBS's EOB just lists a bunch of tests only with numbers and says they and we pay zero on it. At the end they give the $3500 amount owed by us with the $9000 discount.

[Alan]

Quote:

Originally Posted by Corporate ORphan We have done this but the problem is since we didn't sign off on anything, it is from memory plus who knows what they do with the blood they took?? On the bill there are three lines that just say "laboratory test". Anyone ask their insurance co to explain the hospital bill? BCBS's EOB just lists a bunch of tests only with numbers and says they and we pay zero on it. At the end they give the $3500 amount owed by us with the $9000 discount.

It sounds like a real mess. How about the big stuff? Can you see the lines on the EOB for MRI's etc, as I would expect those to be big ticket items.

Given the number of tests and scans you said you had, I think $3,500 is a huge improvement on $12,500. That alone must be improving your blood pressure.

[Lancelot]

Scary! I listen to National Public Radio a lot and as I recall a person with no insurance paid $100 cash, on the spot to settle a ~$1,000 "list price" emergency room visit.

I use the VA and they tell us to go to the emergency room for a life threatening emergency. I read some where that the VA reimburses the hospital at 70% of the Medicaid rate...

[Corporate ORphan]

Quote:

Originally Posted by Alan It sounds like a real mess. How about the big stuff? Can you see the lines on the EOB for MRI's etc, as I would expect those to be big ticket items. Given the number of tests and scans you said you had, I think $3,500 is a huge improvement on $12,500. That alone must be improving your blood pressure.

We can see some of the big stuff and those are correct. (Just coming in at a level 5 (possible stroke) was about $1500. One MRI was over $3000.)

DH doesn't think they should get away with not explaining the bill (which I agree shouldn't be too much to ask) so he wants to "fight" it. (You can tell he is feeling better!) I say pay it and get on with our lives.

This hospital is suppose to be "the best" hospital to go to in our city but its emergency room is filled with people who can't pay their bill because it is one of the only ones in the city. My guess is most of the people don't question the emergency room bill since they don't end up paying it.

One nurse told us they had someone come in an ambulance just to get a pregnancy test.

[Alan]

Quote:

Originally Posted by Corporate ORphan DH doesn't think they should get away with not explaining the bill (which I agree shouldn't be too much to ask) so he wants to "fight" it. (You can tell he is feeling better!) I say pay it and get on with our lives.

I can appreciate his fighting spirit, as long as doesn't end with nightmares about it and falls out of bed again.