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Strategically not paying medical bills for 90 days for a discount
Old 11-25-2014, 07:56 AM   #1
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Strategically not paying medical bills for 90 days for a discount

I had an acquaintance tell me they don't pay their medical bills right away so they can negotiate upwards of a 50% discount. This person has the ability to pay. Has anyone hear of this? I tried doing Internet research and didn't find anyone else strategically paying medical bills late.

I originally felt this was unethical but during my Internet search I found a company called copatient.com that would review you medical bills for errors and would expect 35% cut when you get the refund. They also noted that 80-85% of medical bills have errors.

Seems like a dog eat dog situation, if they can justify strategically over billing though "errors" then I could justify strategically paying late for a discount.
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Old 11-25-2014, 08:13 AM   #2
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While I have heard of such companies that audit medical bills, I haven't used them and would be interested in others experience.

One thing I do regularly is call the hospital or doctor's office and ask if they offer a discount for immediate payment. Commonly they offer me 20% and I put it on my credit card and get another 2% reward from the credit card company.
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Old 11-25-2014, 09:39 AM   #3
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Is this in the context of coinsurance or for paying all cash for the services (i.e no insurance)?
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Old 11-25-2014, 09:46 AM   #4
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Originally Posted by mike143 View Post
I had an acquaintance tell me they don't pay their medical bills right away so they can negotiate upwards of a 50% discount. This person has the ability to pay. Has anyone hear of this? I tried doing Internet research and didn't find anyone else strategically paying medical bills late.

I originally felt this was unethical but during my Internet search I found a company called copatient.com that would review you medical bills for errors and would expect 35% cut when you get the refund. They also noted that 80-85% of medical bills have errors.

Seems like a dog eat dog situation, if they can justify strategically over billing though "errors" then I could justify strategically paying late for a discount.
When I have a large out of pocket expense I know to go to the cashier dept at the hospital and ask for a discount for paying all at once.

Usually get about a third off. I don't wait to pay. When I get the bill I go ask.
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Old 11-25-2014, 09:56 AM   #5
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In my experience, they give cash customers the discount automatically, and then they won't budge.

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In my case, I came in without insurance, and I was charged a sky-high price that "nobody pays", since they usually give you an automatic discount. I've wrestled with several institutions to try to get down to what the negotiated rate would be for someone that did have insurance (PPO rate), but to no avail. I said it's negotiate or you'll get nothing. They just said they'd turn it over to collections.

They play hardball.
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Old 11-25-2014, 10:44 AM   #6
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When I have a large out of pocket expense I know to go to the cashier dept at the hospital and ask for a discount for paying all at once.



Usually get about a third off. I don't wait to pay. When I get the bill I go ask.

Are you referring to an additional 1/3 off from the already discounted rate provided from your insurance provider?


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Old 11-25-2014, 11:26 AM   #7
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There is no discount here. When the published price is 5x - 10x greater than the price to insurers, the list price is meaningless, 50% off is no discount, it is still price gouging. Worse, for much health care the total price isn't even known up front. Choosing not to have health insurance is a risky proposition.
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Old 11-25-2014, 11:35 AM   #8
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Yea, I think the OP needs to give more info on what kind of bill etc....


Whenever I have gone in for a procedure, they ask for payment up front... if you do not pay, you do not get the service... no discount for anything since the price has been negotiated with the insurance company... and they have talked to the insurance company to know my share....

Usually the only ones that I have not paid are the surprise bills from someone who does something behind the scene that I find out about later...
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Old 11-25-2014, 01:45 PM   #9
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Yea, I think the OP needs to give more info on what kind of bill etc....
Made it seem like all of them. Wait 80 days before paying and offer a reduced amount or you can't pay.
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Old 11-25-2014, 03:59 PM   #10
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Made it seem like all of them. Wait 80 days before paying and offer a reduced amount or you can't pay.

I was meaning if this was with insurance or not Was this necessary procedures or not? Etc. etc.


I can tell you that if I were a doc and he did this to me once, he would not be coming back...

yet, I am still surprised that he was able to get anything done without paying for it upfront.... I just got a call from the outpatient center for something I am getting done and they told me what my cost would be.... do I want to put it on my CC now? Heck, even the regular docs want their copay upfront now a day....
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Old 11-25-2014, 04:05 PM   #11
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Yea, I think the OP needs to give more info on what kind of bill etc....


Whenever I have gone in for a procedure, they ask for payment up front... if you do not pay, you do not get the service... no discount for anything since the price has been negotiated with the insurance company... and they have talked to the insurance company to know my share....

Usually the only ones that I have not paid are the surprise bills from someone who does something behind the scene that I find out about later...
Agree OP's "acquaintance" scenario is too vague to comment on. But generally, IMHO- If bills are submitted to insurance it is best to wait to get an EOB (Explanation of Benefits) from the HI company. This should have a breakdown of billed amount, HI negotiated discount, HI paid amt, and what the person owes. No need to overpay your share of the total bill.

Paying up front for a "discount" can be a 2-edged sword. Those who try to shop around for a better price on (non-emergency) service can still get shafted when the real bill comes in significantly higher. Unfortunately, in most states there seems to be very little consumer protection for this kind of thing. Like any other business, it's prob best to get the advance quote in writing as well as a promise of "paid-in-full" if you do choose to pay in advance.

No doubt errors are common in medical billings, and errors should be questioned/disputed. But just routinely refusing to pay all bills for months risks having a collection agency on your tail. Medical facilities generally have access to folks' credit records just like any other business. Folks just above the charity-care line may well get their bills reduced. Billing offices know they cannot 'squeeze blood out of a turnip' & would like to get some $$ rather than nada. OTOH- my guess is that the attitude is quite different towards folks they see have multi-6-figure incomes
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Old 11-25-2014, 04:16 PM   #12
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There is no discount here. When the published price is 5x - 10x greater than the price to insurers, the list price is meaningless, 50% off is no discount, it is still price gouging. Worse, for much health care the total price isn't even known up front. Choosing not to have health insurance is a risky proposition.
Absolutely!

I googled "charge master", which is the hospital's "rack rate" and found a PDF that had a short blurb called "BRINGING SUNLIGHT TO HEALTHCARE PRICING". I found it interesting. It's a PDF though. http://www.bakerlaw.com/files/Upload...U_May_16_1.pdf


Quote:
Using travel industry parlance, the charge data released this month by CMS
represents each hospital’s "rack rate" as reflected on its "chargemaster" or "charge
description master." A relic of the past with regard to Medicare payment principles,
the hospital chargemaster lists the gross price for each service/procedure provided
and item used. Hospitals readily admit that their chargemaster prices are inflated and
bear little systemic relationship to amounts actually collected from patients or third
party payers.
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Old 11-25-2014, 04:39 PM   #13
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Originally Posted by mike143 View Post
I had an acquaintance tell me they don't pay their medical bills right away so they can negotiate upwards of a 50% discount. This person has the ability to pay. Has anyone hear of this? I tried doing Internet research and didn't find anyone else strategically paying medical bills late.

I originally felt this was unethical but during my Internet search I found a company called copatient.com that would review you medical bills for errors and would expect 35% cut when you get the refund. They also noted that 80-85% of medical bills have errors.

Seems like a dog eat dog situation, if they can justify strategically over billing though "errors" then I could justify strategically paying late for a discount.
On 2 occasions in the past , I negotiated specific services down to what I consider about the going rate without any particular difficulty( about what the insurance co would have paid) , by finding the person in the Dr. office / Imaging clinic who could do this, clearly stating up front I will pay at time of service. One was a minor office surgical procedure, that the Dr. said might not be covered, could be considered cosmetic , and the other was an MRI. The MRI " List price of $1100 and change , went down to $640 cash / credit card or check up front, including Dr. reading / report on same.

Late pay to get your cash discount ? Ya, the "List price" is Total B.S. but so is being a deliberate deadbeat, IMO.

I wonder if part of the " List price" being so high is to write off/charge off as a loss for those times that no payment is ever received ?
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Old 11-25-2014, 05:53 PM   #14
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I like that if we put "strategic" in front of something, it makes it seem like a clever thing to do, something to brag about, instead of being ashamed of.
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Old 11-25-2014, 07:55 PM   #15
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I can tell you that if I were a doc and he did this to me once, he would not be coming back...
Even better, hold out a kidney until the check clears.
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Old 11-25-2014, 11:01 PM   #16
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I had a big operation, and I did not pay in advance. I considered it motivation for the surgeon to not screw it up.

I had the same experience with MRI, phoned around and got quoted about $1,200 without insurance, with super crappy insurance (that would only pay $200 of MRI bill) the charge they quoted was about $600.
They did have a hard time coming up with the insurance price, until I told them the reason I had to know was: whatever they billed the ins. company, I was paying everything except $200.

It proved to me that even cheap, lousy ins is better than none.
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Old 11-26-2014, 08:42 AM   #17
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For Medicare and supplement:
We always wait for at least two months before paying, as it takes that long for Medicare and Supplement to settle the account. Sometimes, when lab work or additional services, an extra month. Hospitals and doctors seem ok with that. One part of our time frame has to do with supplement, which comes from a different state.

Kudos to both Medicare and our supplement provider. In fourteen years, not a single problem with either.
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Old 11-26-2014, 09:54 AM   #18
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I usually pay but keep close track of the EOB payments and in this last 2 years have had 4 instances of the balance being wrong at the end of the treatment. In 2 cases I had to call the provider and ask for the excess payment to be paid back to me (their accounts agreed with mine in each case so they refunded the balance). In one series of PT sessions I reckon I ended up owing them a little over $30 but I didn't call to offer to pay.

The most difficult however is now coming up to 1 year ago when DW and I had colonoscopies and they slipped in histology tests on removed polyps to an out of network provider who sent me a bill for $1,500 ($750 for each of us) and I had to go through an appeals process twice (first one rejected) with the HI company before they finally paid a grand total of $100.16, with the EOB's saying my coinsurance was $1,399.84. The lab in question hasn't got back to me so I guess the $100 was sufficient. If I had no HI and was doing this myself I wonder how much they would actually have accepted?
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Old 11-26-2014, 11:16 AM   #19
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I had the same experience with MRI, phoned around and got quoted about $1,200 without insurance, with super crappy insurance (that would only pay $200 of MRI bill) the charge they quoted was about $600.
They did have a hard time coming up with the insurance price, until I told them the reason I had to know was: whatever they billed the ins. company, I was paying everything except $200.

It proved to me that even cheap, lousy ins is better than none.
My gut feel on the status quo of healthcare in the US - patients wish to live better lives without pain and disease. Individual health care providers sincerely desire to provide that service to their patients as economically as possible. But when it comes to the business end of the equation, providers overcharging for services gain even more leverage on those without insurance, and are perhaps enriched if an insurance company pays the claim with some overcharges intact. Or maybe overcharging is just easier and cheaper than submitting an accurate bill with precise detail, because they know the insurer pretty much has the say in what a reasonable charge for a given service is. The insurer, while potentially exposed to risks of overpaying is benefited by that practice as long as they remain vigilant and allow only 'reasonable' charges for services, as the insured is left with a warm fuzzy feeling because the insurance company 'saved' them money.

But then, I've wondered too, regarding a surgery in 2012 why the surgeon's billed amount matched exactly the OR nurse’s billed amount - according to the insurance company. Initially I thought it was a case of the provider blatantly overcharging - but now I suspect it may more a matter of how the insurer reported the charges to me on the EOB. Maybe the identical amounts were merely the total of an itemized bill, with the actual billed amounts for each portion much closer to the reasonable charge that was paid? Never saw the actual provider's billing, so I can't really say. Perhaps not intended, but in any case the if insurance company causes it to appear as if they so vastly reduced the bill it would serve to exponentially increase those warm and fuzzy feelings.

DW and I owe a debt of gratitude for the providers, and yes also the insurers who have had a part in improving our odds in survival, mobility, and relief from pain. And I don't like feeling so cynical and suspicious of healthcare billing and insurance, but it does appear to me that it is a mess.
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Old 11-26-2014, 01:46 PM   #20
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I like that if we put "strategic" in front of something, it makes it seem like a clever thing to do, something to brag about, instead of being ashamed of.
+1, that was my impression at well. Sad.
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