outragous emergency room charges

[ER_Hopeful]

So my daughter sprained her ankle and her roommate took her to a local hospital emergency room. I think they took a few x-rays, wrapped her foot up, gave her a pair crutches and sent her home.



A few weeks later, she got billed for almost $3k . I have Anthem BlueCross thru my employer, it's a PPO with a $3k individual deductible. DD is a full time student and is covered under my plan. The bill has just a grant total without any details. She already called and asked for an itemized list of charges, should be coming in the mail. They gave her an estimate charge of $500 (see attached) before they admitted her on that day but $3k is far from that!


any course of action she can take (to lower the bill at least)? She has a part time job but makes very little and I'm supporting her thru college, so can they come after me?

 

[RetiredAndLovingIt]

Wait till Anthem sends you the EOB after they've reduced the bill to the contracted charges.

 

[REWahoo]

Wait till Anthem sends you the EOB after they've reduced the bill to the contracted charges.

^ This.

 

[Cayman]

The contracted charges should be much less. Write the check. Been there done that. Yes, our health care system is broken.

 

[PaunchyPirate]

Never pay a doctor/hospital bill presented to you until you have the corresponding claim fully processed by your insurance company. Has that happened yet?

If the hospital was "in network", then the actual amounts you pay should be much less. The insurance bill will show an "agreed to" charge between the insurance company and the service provider. That should significantly reduce the amount due. You should still compare the amounts to what your policy actually says it covers. If you disagree, contact your insurance company and explain your reasoning. The last thing done in the process is to finally pay the service provider, once you finally agree on the amount you owe.

 

[swakyaby]

Yes on waiting for the insurance EOB. For such non life threatening injuries, an urgent care may have been preferable and less costly than a hospital ER. But the girls likely would not have known that.

 

[youbet]

So my daughter sprained her ankle and her roommate took her to a local hospital emergency room. I think they took a few x-rays, wrapped her foot up, gave her a pair crutches and sent her home.



A few weeks later, she got billed for almost $3k . I have Anthem BlueCross thru my employer, it's a PPO with a $3k individual deductible. DD is a full time student and is covered under my plan. The bill has just a grant total without any details. She already called and asked for an itemized list of charges, should be coming in the mail. They gave her an estimate charge of $500 (see attached) before they admitted her on that day but $3k is far from that!


any course of action she can take (to lower the bill at least)? She has a part time job but makes very little and I'm supporting her thru college, so can they come after me?

As others have said, you don't actually know what you owe yet. Get the EOB.

After that, you can negotiate. Likely, knowing she's primarily a student and getting money out of students is like getting blood from a turnip, they'll eventually settle for less.

Obviously, a hospital ER was a poor choice for a sprained ankle. Using a facility set up to handle gun shot wounds, strokes, heart attacks, mangled limbs from industrial accidents, etc., for a sprained ankle was asking for financial trouble. A local doc-in-a-box would have worked out better. A lesson learned.

It would probably be a good idea to advise your DD that she should call you before going for medical care in non-emergency situations. And you should go through some what-if planning, with your particular medical insurance in mind, so if she has other health or injury issues in the future you'll have a quick and specific answer.

Hope whatever discomfort she's experiencing is mild and brief! Sprained ankles are a pita!

 

[ER_Hopeful]

As others have said, you don't actually know what you owe yet. Get the EOB.

After that, you can negotiate. Likely, knowing she's primarily a student and getting money out of students is like getting blood from a turnip, they'll eventually settle for less.

Obviously, a hospital ER was a poor choice for a sprained ankle. Using a facility set up to handle gun shot wounds, strokes, heart attacks, mangled limbs from industrial accidents, etc., for a sprained ankle was asking for financial trouble. A local doc-in-a-box would have worked out better. A lesson learned.

It would probably be a good idea to advise your DD that she should call you before going for medical care in non-emergency situations. And you should go through some what-if planning, with your particular medical insurance in mind, so if she has other health or injury issues in the future you'll have a quick and specific answer.

Hope whatever discomfort she's experiencing is mild and brief! Sprained ankles are a pita!

Thanks for all the replies. sorry for the ignorance, but what is an EOB? We rarely use the hospitals so not very well informed of medical billings. The only times we go see a doc is for the annual physical but in general I'm aware that our medical/healthcare system is very broken. In the very few times where we had to use the ER, I think we got billed but nothing like this one.

 

[REWahoo]

EOB = Explanation of Benefits

Your insurance should send you an EOB once they process your claim.

 

[PaunchyPirate]

Most insurance companies have websites where you can view the claims through the process. If you don't have an account with your insurance company yet, you should create one. It is very possible that there will be multiple claims submitted to your insurance company. One for the ER, one for a doctor, another one if a second doctor looked at your daughter, etc. Claims generally show up on the website when the provider creates it. It will generally take your insurance company 1-3 weeks to "process" it for payment to the provider. When it is fully processed from the insurance company's perspective, they will generate an Explanation of Benefits (EOB) for your to print out and save. This should contain an amount that you "May" owe to the provider(s). If that amount does not match what the provider sends you a bill for, you should contact the provider's billing department to resolve it. They may have just billed you before any insurance payment was paid to them. They will eventually catch up. If they don't then you have issues where you need to work with both the insurance company and the provider to find out why it wasn't covered as you might expect.

But, you need to know what your expected charges SHOULD be. You can only find this by researching your coverage in the insurance plan.

 

[joesxm3]

My friend, who is a nurse, and should have known better, went to the ER for a broken nose. They basically did nothing and charged her $7000.

 

[youbet]

My friend, who is a nurse, and should have known better, went to the ER for a broken nose. They basically did nothing and charged her $7000.

Yep, definitely the wrong place to take a broken nose. Like taking your soap box racer to the Jaguar dealer for a check-up.

 

[W2R]

My friend, who is a nurse, and should have known better, went to the ER for a broken nose. They basically did nothing and charged her $7000.

Wow!

When I suddenly came down with Covid (delta variant) double pneumonia in Arkansas (while evacuating from Hurricane Ida last August), the EMTs took me to the emergency room, too, from where I was transferred to the ICU.

Good thing I was too sick to look over the bills for a few weeks! When I was able to do so, I was shocked - - they were charging me in the mid 6 figures plus more. They charged me for a number of expensive things I couldn't remember (an hour phone appointment with a cardiologist, MRI's, CATscans, and so on). But then I had bad Covid mind fog which was sort of like dementia for me, so I suppose it is possible these services were rendered, though not likely. I decided to just ignore the bills and focus on getting better.

Meanwhile, Medicare and BCBS got busy and I ended up paying for very little. I really wish our health care system would get their act together! But then, I also wish for global peace, an end to Covid, love from each of us to all of us, and a low cost immortality pill but none of that seems to be in our immediate future, either.

 

[pacergal]

Yes, wait for the EOB and make sure the hospital has your current insurance info.
Normally, I don't get a bill from the hospital until after they have received ins payment and I get "final balance due" notice, or my bill will state that the insurance has been billed, so I know.

 

[travelover]

Small time crooks wear hoodies, big time crooks wear suits and white lab coats.

 

[Sunset]

OP - save yourself future issues, by looking up which doc-in-a-box (Urgent Care) is in your network and close to your child.

I made the mistake of going to an Urgent Care not "really" in my network and even after many negotiations ended up paying about $1,000 more than if I had gone to the one in network.

 

[aja8888]

Small time crooks wear hoodies, big time crooks wear suits and white lab coats.

Nah, it's the MBA's on the top floors of the hospitals where the executive offices are that call the shots on billing.

 

[Car-Guy]

Yes, our health care system is broken.

Actually the doctors and hospitals (around here anyway) seem to do a pretty good job, usually. It's the insurance/billing that "seems" to be broken but I think that is by design. It doesn't seem anyone is willing or capable of taking them on. Maybe someday.

 

[youbet]

Actually the doctors and hospitals (around here anyway) seem to do a pretty good job, usually. It's the insurance/billing that "seems" to be broken but I think that is by design. It doesn't seem anyone is willing or capable of taking them on. Maybe someday.

If insurance companies become eager and generous payers with more flexible rules on what they'll pay for, there will surely be rate increases. It's a two-edged sword. Be careful what you ask for.

If we take them on, what specifically should we ask for?

 

[travelover]

Nah, it's the MBA's on the top floors of the hospitals where the executive offices are that call the shots on billing.

Yes, they are the "suits". The crooks in the white lab coats are the out of network, but working in your network "surprise billers".

 

[MichaelB]

One positive aspect about the unfortunate circumstances in the OP is that this past January the “No surprises act” went into effect. Now emergency room care must be covered as “in network” by one’s insurer even if the ER or any of its services are out of network. The OP still does not know how much the “insured rate” is for this care, but that’s all it will be. And as others have pointed out, that should be known once the insurer processes the EOB.

It’s easy to say the OPs DD should have looked for an alternative care center that wasn’t an ER. At that moment of need, however, it’s not such an easy call. Is the ankle broken? Does an alternative care have x-ray facilities? Unfortunately, our health care system is built around revenue more than care, so finding the most appropriate provider at the moment of need can be a challenge.

 

[ivinsfan]

So my daughter sprained her ankle and her roommate took her to a local hospital emergency room. I think they took a few x-rays, wrapped her foot up, gave her a pair crutches and sent her home.



A few weeks later, she got billed for almost $3k . I have Anthem BlueCross thru my employer, it's a PPO with a $3k individual deductible. DD is a full time student and is covered under my plan. The bill has just a grant total without any details. She already called and asked for an itemized list of charges, should be coming in the mail. They gave her an estimate charge of $500 (see attached) before they admitted her on that day but $3k is far from that!


any course of action she can take (to lower the bill at least)? She has a part time job but makes very little and I'm supporting her thru college, so can they come after me?

Well settle down a little... it looks me the paper you attached estimates the out of pocket costs to your DD would be around 500 bucks. That's not an estimated charge its an OOP cost IMO. At that price it would a lesson learned that most likely would stick with her.



Can they "come after you" most likely not but your DD made a mistake in judgement that many people not familiar with HC make. I'd be loath to let her deal with possible credit score or employment issues because of a simple mistake. But I certainly would make DD pay for part of it as a lesson in adult living.



The EOB will trickle in eventually so don't get excited until that happens.

 

[ivinsfan]

One positive aspect about the unfortunate circumstances in the OP is that this past January the “No surprises act” went into effect. Now emergency room care must be covered as “in network” by one’s insurer even if the ER or any of its services are out of network. The OP still does not know how much the “insured rate” is for this care, but that’s all it will be. And as others have pointed out, that should be known once the insurer processes the EOB.

It’s easy to say the OPs DD should have looked for an alternative care center that wasn’t an ER. At that moment of need, however, it’s not such an easy call. Is the ankle broken? Does an alternative care have x-ray facilities? Unfortunately, our health care system is built around revenue more than care, so finding the most appropriate provider at the moment of need can be a challenge.

The OP doesn't say if this happened during regular or urgent care hours. Us old folks know enough to go home, elevate, break out the ice and keep an eye on things until regular care hours resume. How and where to seek medical care is now a life skill and likely to stay that way. Consider this thread a PSA for posters who have kids in college and might need some schooling in this subject.

 

[momoftwo]

Hey, as a 40yr veteran medical technologist in a WHITE COAT, I tell you I'm just as confused by health care billing as everyone else��

 

[njhowie]

We have instilled in DD that emergency room is really only if it's life or death. Most anything else can be handled at the nearest urgent care location less expensively, and generally faster.