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Negotiating on medical bills
Old 02-21-2008, 10:02 AM   #1
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Negotiating on medical bills

DH recently had surgery - in the hospital for 1 night in ICU, but total time spent there was just under 24 hours.

The bills have started rolling in, cost is at $130k so far. We have medical insurance and did have the operation pre approved though the PPO is starting to play the expected games of wanting more info. However, it appears that we are going to end up with a substantial gap - $15k or more. For example the hospital and surgeon were in network but the anethetist was out of network. One day his blood tests are in network, the next they are out of network.

I am wondering if it would seem reasonable for us to try and negotiate a deal on the amounts that are our responsiblity and if so how do we do it? In the past we have always just written a check but figured maybe this time we should do something different to try and save a few bucks.

Any suggestions would be appreciated.
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Old 02-21-2008, 10:29 AM   #2
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It is unfortunate in the midst of all that one has to worry about insurance… I really have no answers for you, but I can share my experience - my case was not as complex as yours, but there are similarities.

My hospital admission was pre-approved by the insurance. Both the hospital & my doc were in-network and I thought I was set! Wrong! In my case, just like in yours, most of the labs and the anesthesiologist turned out to be out-of the network. Mind you, no one asked for my input on who should handle the labs or which docs ended up seeing me… In other words, I was in the dark until the bills started rolling in.

I complained to my insurance and to my doc who admitted me to the hospital and refused (for the time being) to pay any out of the network bills. In the end, after a few months of aggravation, the lab company and the anesthesiologist accepted standard in network payment from my insurance as "payment in full".

Good luck!
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Old 02-21-2008, 12:26 PM   #3
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I tried to negotiate with an out of network lab for some blood work that my in network Doctor had sent to them, I offered $300 on a $500 bill.

They refused, I stated to the CSR that they would not receive that much from an insurance company but they still refused saying they had contracts with insurance companies for lesser amounts.
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Old 02-21-2008, 12:39 PM   #4
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If you are able to do, call the billing department for all the folks you owe as soon as possible and just ask what kind of discount they can offer you for paying in full right away. When I did that after my daughter was born the hospital gave me about a 20% discount off the bill and they allowed me to pay via credit card right then and there.

Also, I think if you argue with the out-of-network folks that you didn't pick, they may be willing to accept the in-network payment from your insurance.

A third possibility is that sometimes there is no in-network option -- for example, if none of the anesthesiologists in your area are in your insurance network -- in this case I think you can get either the insurance company to pay them in full or get the doctor to accept the in-network payment as payment in full.

Good luck,

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Old 02-21-2008, 12:51 PM   #5
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It is unfortunate in the midst of all that one has to worry about insurance… I really have no answers for you, but I can share my experience - my case was not as complex as yours, but there are similarities.

My hospital admission was pre-approved by the insurance. Both the hospital & my doc were in-network and I thought I was set! Wrong! In my case, just like in yours, most of the labs and the anesthesiologist turned out to be out-of the network. Mind you, no one asked for my input on who should handle the labs or which docs ended up seeing me… In other words, I was in the dark until the bills started rolling in.

I complained to my insurance and to my doc who admitted me to the hospital and refused (for the time being) to pay any out of the network bills. In the end, after a few months of aggravation, the lab company and the anesthesiologist accepted standard in network payment from my insurance as "payment in full".

Good luck!
MY BIL has had the same issues at lucija.... and did not pay anything...

YOU made a 'good faith' agreement (in your mind) with your doctor and insurance that everything was going to be covered by insurance... it was NOT your decision to go out of network.. and YOU did not sign anything agreeing to pay those expenses.... so don't pay them...


The one that my BIL hated the worst was once when the cops pulled him over and were harassing him.... he started to have 'chest pains' and took some medication... the police called an ambulance and they came... he said he did not need them or want them... the police insisted... so he went to the hospital in the ambulance and they checked him out... but he refused to sign ANYTHING... he got the bills and never paid a dime... and did not send them to insurance.... again, he never agreed to pay them anything so he did not feel like he owed them anything...
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Old 02-21-2008, 02:01 PM   #6
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I have no advice about your situation but can anyone chime in on how to prevent this from happening? If you have advance notice of surgery or other procedures how the heck can you make sure everyone participating on your case will be in your network? When I have routine blood work I know I have control over what lab is used but if you're in the hospital and getting post surgical testing you probably aren't in any position to deal with that aspect of your care.
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Old 02-21-2008, 02:04 PM   #7
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I suggest starting first with the insurance company. If the provider went out of network in the midst of your treatment they will often treat them as in-network for payment purposes if you (1) call; (2) complain; and (3) potentially write a letter to your State Department of Insurance.
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Old 02-21-2008, 02:23 PM   #8
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I had a similar issue with some services in relation to a surgery that were, unknownst to me, provided by a non-network provider. The non-network provider (a MRI provider) was actually operating within the hospital but deemed a serparate business not in the network.

I followed the appeal procedure provided by my insurance provider and they finally agreed to pay at the in-network rate. If that had failed, my next step would have been to offer the MRI provider the in-network amount.

After that, I guess I'd cuss and kick the wall.
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Lots of Answers
Old 02-22-2008, 06:23 AM   #9
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Lots of Answers

$15K left out of $130 still gives you a lot of options. It's a lot of cash to be sure, but you've got options. Once the dust has settled a bit (i.e. you've called your insurer, gotten EOBs, etc.) pick up the phone and call your hospital and/or docs. Tell them you will pay promptly and what kind of discount will you get for doing so. 60% + of people who did that got a reduction. Alternatively, you could ask to set up[ a payment plan - start out with "I can only afford to pay you $50 a month." As for the out of network anesthesist, you may not have to pay that. And get everything from your insurer in writing. If they are asking for more info, it may be part of a 30-90 day review process. After their review process, they may simply give up and pay it. Take a look at this site and it's tipson those issues:» 9 Secrets Health Insurers Don’t Want You to Know. If you want to get an idea of what you costs might should be after being adjusted, check out the Compare tab on MedBillManager (soon to be change:healthcare).

Good luck!
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Old 02-22-2008, 10:15 AM   #10
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......... Take a look at this site and it's tipson those issues:» 9 Secrets Health Insurers Don’t Want You to Know. If you want to get an idea of what you costs might should be after being adjusted, check out the Compare tab on MedBillManager (soon to be change:healthcare).

Good luck!
Great links, thanks for posting.
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Old 03-26-2008, 09:42 AM   #11
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I have no advice about your situation but can anyone chime in on how to prevent this from happening? If you have advance notice of surgery or other procedures how the heck can you make sure everyone participating on your case will be in your network? When I have routine blood work I know I have control over what lab is used but if you're in the hospital and getting post surgical testing you probably aren't in any position to deal with that aspect of your care.
How to prevent this from happening? Let me just state that I am in the middle of disputing a bill from the anesthesiologist. My husband's surgery was pre-approved, but guess what the anesthesiologist was out-of-network, now how were we suppose to know that! This is what my insurance company told me to do to prevent this from happening in the future - state that you do not want ANY providers to treat you if they do not accept your insurance. ummm...will it work, well that's what I will be stating next time, because next time the bill might be larger and I don't want any surprises!

I will be drafting a letter stating that we had no say about anesthesiologist and therefere shouldn't have to pay any additional fees.

Take care!
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Old 03-26-2008, 10:05 AM   #12
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Are there consultants or advocates that you can hire for this kind of thing? Seems I saw something about that on TV once.
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Old 03-26-2008, 10:55 AM   #13
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If they did no inform you before the surgery that the anesthesiologist was out of network you can fight the bill . I worked in a surgery center and the anesthesiologist was sometimes out of network and we had to inform people before the surgery of what the charges would be . I'd call up the anesthesiologist 's billing people and start complaining about not being informed.
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Old 03-26-2008, 11:08 AM   #14
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Moemg - thanks for that info - that will help me out as well.

By the way - loved AbFab - I chuckled just seeing your pic!
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Old 03-26-2008, 03:03 PM   #15
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My wife needed surgery on her wrist so we were careful to chose an in-network facility and an in-network doctor to do the procedure.

Six months after the procedure we get a bill for $36 for an arm sling (the cloth type you can buy at Walgreens for $6).

We call and find out the company that provides slings at the in-network facility is out of network.

We had to pay the $36.
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Old 03-26-2008, 03:42 PM   #16
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I think many of us are seeing a change in our medical insurance. We are expected to pay more, and this is a tactic.
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Old 03-26-2008, 09:18 PM   #17
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For megafun, try going to an in-network hospital, with an in-network doctor, and discovering after the fact that the lab is subcontracted to a firm out of the network.

Then throw in the pre-approval nonapprovals.

"Yes, we pre-approved your colonoscopy. The polypectomy and use of general anesthesia was not pre-approved."

The polypectomy is the 30 seconds of a colonoscopy where a polyp is snipped off. Do they really think it would be cheaper to... er... rinse and repeat another day?

I'm pretty sure that both the doctor and I wanted that anesthesia.

I dropped United HealthCare and switched to a real HMO, Kaiser (ranked very highly for this region by Consumer Reports). I'm pretty sure they don't have any out of network subcontractors or doctors.
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Old 03-26-2008, 11:15 PM   #18
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Lab bills seem to be a particular problem. I have a family member who had a bout with cancer last year (surgery/radiation/etc) & the insurance paid a lot, but the bills keep coming mostly form labs. (5 or 6 of them!)

I dealt with one over the past few days that has been sending us threatening final collection letters for over two months wanting $722. We've been sending them nickels & dimes to keep them happy until we could find out what we really owe because the insurance company has repeatedly told us we are only responsible for about $200.

After going back & forth with them & the insurance the past few days, the lab company finally called me back & told me that we not only did not owe them anything else, but they were sending us a refund check for $150! She couldn't explain why.

My reaction was !!! !!!
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Old 03-28-2008, 12:15 PM   #19
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Moemg - thanks for that info - that will help me out as well.

By the way - loved AbFab - I chuckled just seeing your pic!

I love AB fab . I have all the dvd's and whenever I need a chuckle I put one on .
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Old 03-29-2008, 08:08 PM   #20
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If they did no inform you before the surgery that the anesthesiologist was out of network you can fight the bill . I worked in a surgery center and the anesthesiologist was sometimes out of network and we had to inform people before the surgery of what the charges would be . I'd call up the anesthesiologist 's billing people and start complaining about not being informed.
That's plan, I will be calling (actually I have I'm just waiting for them to return my call) because I was NOT informed that the anesthesiologist was out of network. Hopefully I will have an answer this week. I did talk to my insurance rep again and she stated that they should of told me that the anesthesiologist was out of network. Thanks!
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