Insurance negotiations

[calmloki]

About three months ago I had a little medical adventure. We pay plenty for insurance and the insurance company is moving towards getting all the providers paid off. This morning I got an "explanation of benefits" from the insurance company. A hospital had billed $64,603. The insurance company disallowed $60,034 and will pay $4569.

If I had no insurance and had to negotiate with hospital bookkeeping I'd feel like I'd scored a major victory if I got a bill reduced by 10-20%. Kaiser Permanente managed a 93% reduction. Sheesh.

Pity the working folks who are NOT insured, because I doubt they could negotiate anything like that reduction.

 

[Meadbh]

Given the catastrophic nature of your medical adventure I'd say Kaiser scored a major coup. I don't know about $64K+, but at <$5K, the hospital definitely took a loss on you! We're glad you're here to tell the tale!

 

[Peter]

Was this at a Kaiser hospital? Or was it an emergency and you had to go elsewhere?

 

[rbmrtn]

A hospital had billed $64,603. The insurance company disallowed $60,034 and will pay $4569.

Pity the working folks who are NOT insured, because I doubt they could negotiate anything like that reduction.

Doesn't that mean you're responsible for the rest of it ? Just because the insurance company disallowed it doesn't the hospital doesn't want their money, they may send you the bill and turn it over to collections.

 

[Katsmeow]

Doesn't that mean you're responsible for the rest of it ? Just because the insurance company disallowed it doesn't the hospital doesn't want their money, they may send you the bill and turn it over to collections.

I don't know about calmloki's situation but on my policy if it is in network then I am not responsible for the amount of the discount. If it is out of network then I am.

 

[calmloki]

Two different hospitals, both were not Kaiser hospitals but were Kaiser contracted hospitals. This EOB is only for the second and doesn't indicate that I am responsible for anything. Good ol' irresponsible me.
The first hospital billed $64,602 and accepted $4928. Thus far I'm less than $1000 out of pocket; I expect to spend maybe $9000 more, anything less is bonus. Somebody needs to start charging me some money.

 

[Meadbh]

Somebody needs to start charging me some money.

If you end up paying nothing more, I would seriously think about including the hospital's foundation in your will (which we all hope will not be needed for many years!). They did a terrific job. The least they deserve is a thank you. Your story could be inspirational to others.

 

[calmloki]

I made some diced chili/sharp cheddar cheese bread and delivered it to the firefighter crew that worked me over - think the hospital foundation would appreciate that or do you guess they might be more into lettuce? blink blink

 

[Meadbh]

I made some diced chili/sharp cheddar cheese bread and delivered it to the firefighter crew that worked me over - think the hospital foundation would appreciate that or do you guess they might be more into lettuce? blink blink

I think they might be more into something green and papery.