outragous emergency room charges

[Turbo29]

In my area there seems to be a proliferation of stand alone "Emergency Rooms." From what I have read, they are almost a scam. They depend on people who are looking for an urgent care thinking that this free standing building with the sign "Emergency Room" out front is that same thing.


You Thought It Was An Urgent Care Center, Until You Got the Bill

 

[GoBears]

When my then unmarried non-dependent DD became pregnant, she was still covered by my work provided insurance. We dropped family coverage at the next open enrollment period before the baby was born because my employer’s benefits department advised per the terms of its self-insured medical coverage that if she could not pay that I would be responsible for paying DD’s out of pocket expenses since I was the subscriber to the plan. (DD qualified for and enrolled in Medicaid.) Your plan’s terms may differ. So, I recommend reviewing the specific terms of your insurance plan (the applicable legal contract). The opinions of forum members, as well-intentioned as the may be, are irrelevant when analyzing your legal obligation, if any, to pay your daughter’s out of pocket costs.

 

[ivinsfan]

When my then unmarried non-dependent DD became pregnant, she was still covered by my work provided insurance. We dropped family coverage at the next open enrollment period before the baby was born because my employer’s benefits department advised per the terms of its self-insured medical coverage that if she could not pay that I would be responsible for paying DD’s out of pocket expenses since I was the subscriber to the plan. (DD qualified for and enrolled in Medicaid.) Your plan’s terms may differ. So, I recommend reviewing the specific terms of your insurance plan (the applicable legal contract). The opinions of forum members, as well-intentioned as the may be, are irrelevant when analyzing your legal obligation, if any, to pay your daughter’s out of pocket costs.

How long ago was this? A lot about this has changed in recent years...I fail to understand how buying a certain insurance puts you legally obligated to pay bills for other.s.. It seems as though that should be consistent and not change according to insurance plans. I would think ACA plans would have the same standards.

 

[GoBears]

How long ago was this? A lot about this has changed in recent years...I fail to understand how buying a certain insurance puts you legally obligated to pay bills for other.s.. It seems as though that should be consistent and not change according to insurance plans. I would think ACA plans would have the same standards.

Granddaughter just turned four, so not that long ago.

Not sure that I agree that OP’s daughter can be lumped in and described simply as an “other.” She was insured under OP’s plan. I agree that OP wouldn’t be responsible if the daughter (presumably not a minor) had her own insurance. But in this case OP has the insurance and, I suspect, that under the terms of the contract OP agreed to pay out of pocket costs for all of the insureds as a condition of their coverage. That was the situation in my case. Of course, the specific provisions of OP’s plan will govern and OP needs to review those.

 

[ivinsfan]

Granddaughter just turned four, so not that long ago.

Not sure that I agree that OP’s daughter can be lumped in and described simply as an “other.” She was insured under OP’s plan. I agree that OP wouldn’t be responsible if the daughter (presumably not a minor) had her own insurance. But in this case OP has the insurance and, I suspect, that under the terms of the contract OP agreed to pay out of pocket costs for all of the insureds as a condition of their coverage. That was the situation in my case. Of course, the specific provisions of OP’s plan will govern and OP needs to review those.

You bring up an interesting issue....so say for the sake of argument there is a 3000 deductible and the insured simply doesn't have the money to pay it. Are you saying your insurance can be canceled if that bill isn't payed. Or are you saying the policy holder agrees that the insurance company is not responsible for paying that amount?


If your are saying the hospital can send bills to the name insured and not the actual patient (who is not a minor) that's something different. What a mess got made when Health insurance was invented!

 

[rodi]

ER_Hopeful -

Hopefully you daughter presented her insurance info at the ER. If not - you need to make sure your PPO gets involved.

The negotiated rates will be MUCH less, as others have mentioned. I'm on a High Deductible plan. The Explanation Of Benefits (EOBs) are very eye opening. My son had a 4 hour, yet outpatient, surgery. Prior to negotiated rates it was over $30k. Negotiated down to about 12K, then we just paid the max OOP.

 

[ivinsfan]

OP that info you scanned at the bottom of your opening post? Where did that come from? As Rodi says don't worry too much my DH's heart surgery got discounted by over 75K...so the number will be going down.

 

[GoBears]

You bring up an interesting issue....so say for the sake of argument there is a 3000 deductible and the insured simply doesn't have the money to pay it. Are you saying your insurance can be canceled if that bill isn't payed. Or are you saying the policy holder agrees that the insurance company is not responsible for paying that amount?


If your are saying the hospital can send bills to the name insured and not the actual patient (who is not a minor) that's something different. What a mess got made when Health insurance was invented!

I am saying that under the terms of the contract, the carrier MAY be able to cancel coverage if the provider is not paid and the provider MAY be able to sue not only OP’s daughter for the unpaid services, but also OP as a guarantor or under a third-party beneficiary theory based upon the insurance contract. When DW was on my insurance as a dependent just like DD was a dependent, I believe the local hospital and her healthcare providers listed me as the guarantor because she was insured under my work plan; OP’s plan MAY have similar terms. The operative word is “may” since we don’t know what the contract actually states.

 

[youbet]

Consider this thread a PSA for posters who have kids in college and might need some schooling in this subject.

+1

Our granddaughter has been tutored by her parents and her "helicopter grandparents" (Me) about getting medical attention. It's an important skill. Dont send kids away to school on a wish and a prayer regarding medical issues and paying for them.

 

[retire to nature]

I went to ER in last Feb because I had a car accident. I didnt injure but suddenly had headache later in the night. I have RN background, so I knew I was ok, but I had to drive back home for a few days, so I wanted make sure. no test, but Dr just checked me. charged $1200. I didnt have an insurance. And I knew hospital do discount. So called the bill part, and asked for discount and paid $150. because it is all insurance business, hospital make numbers big.

 

[ER_Hopeful]

OP that info you scanned at the bottom of your opening post? Where did that come from? As Rodi says don't worry too much my DH's heart surgery got discounted by over 75K...so the number will be going down.

DD did give them her current HC insurance info. The estimate was from the ER (I assumed they checked our policy etc and gave her that print out) before they did anything for her.



Also, the hospital is in-network.


Thanks again for all the replies. I think I can relax a little now and just wait for the "dust to settle".

 

[Bamaman]

Last Fall, my wife had a neurostimulator implanted. Helped just a little, but the cost was $65K--paid by Medicare.

4 years ago, her knee replacement was $92K. She spend 3 days in PT classes doing circles on the floor with her foot--$550 per hour twice a day. They were grossing $5500 per session x 2 per day.

In 3 hours, we're heading for the hospital to have her bottom 4 lumbar discs removed and replaced with "cages." Then they're going to do elaborate fusion and straighten her back from scoliosis. Total time in surgery 10-12 hours spread over 2 days. I estimate 6 days in the hospital, however there's no way to estimate the total cost. It's going to be enormous to Medicare and our Plan F. It's going to be a 3-6 month recover and perhaps a year to really get her back into shape. But such surgery is a must do as her leg & foot pain prohibits her from sleeping. Pray for us, please.

 

[mystang52]

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.

Reiterating the above reply. OP: your legal obligation will be whatever the insurance company's "allowed charge" (or similar phrase) is, less whatever the insurance company's payment is for those charges. Also, scrutinize the EOB as it's possible there are charges not yet paid because insurer needs more information. Do not pay any part of this portion until it's resolved.

 

[old medic]

The Tale of Two Ankles...

DW twisted her ankle walking down a set of stairs... instant pain swelling and bruising...
She goes to the ER... Gets X-Rays, Icepacks, wrapped and sent home with a sprained ankle and to follow up with her family doctor...
Billed nearly $6000, after deductible, we paid $1600 out of pocket....

2nd Act.... 6 months later, I managed to twist my ankle during a stupid human trick... and figured I broke something... Ice and Ibuprofen and suffered the rest of the day... following morning I go to my Dr, that also is part Urgent Care, They fit me in, Get the same exact service, X-Rays, Icepacks, wrapped and sent home with a sprained ankle, but have already seen my Doctor...
Billed $683... paid... My $25 Co-Pay....

Nearly 1000% difference in billed, and 6000% in paid...

 

[pacergal]

Last Fall, my wife had a neurostimulator implanted. Helped just a little, but the cost was $65K--paid by Medicare.

4 years ago, her knee replacement was $92K. She spend 3 days in PT classes doing circles on the floor with her foot--$550 per hour twice a day. They were grossing $5500 per session x 2 per day.

In 3 hours, we're heading for the hospital to have her bottom 4 lumbar discs removed and replaced with "cages." Then they're going to do elaborate fusion and straighten her back from scoliosis. Total time in surgery 10-12 hours spread over 2 days. I estimate 6 days in the hospital, however there's no way to estimate the total cost. It's going to be enormous to Medicare and our Plan F. It's going to be a 3-6 month recover and perhaps a year to really get her back into shape. But such surgery is a must do as her leg & foot pain prohibits her from sleeping. Pray for us, please.

Sending healing prayers, Bamaman. Please keep us updated on your DW recovery.

 

[chris2008]

Best wishes and prayers @Bamaman and DW.

Sent from my SM-G950F using Early Retirement Forum mobile app

 

[Car-Guy]

I guess it depends a lot on your insurance policy... Mine says hospital ER visits are a flat $50 per visit... (I recall reading that when I first got the policy and thought, surely that doesn't cover everything) I unfortunately had to make an emergency room visit last year and they took the info from my medicare advantage card. After they did their thing (doctors, nurses, tests, etc) I was released in about 2 hours without paying anything. The EOB came in at over 3k, IIRC, and the hospital eventually sent me a bill for exactly $50. Actually I was surprised there wasn't some hidden charges for tests or for deductibles or co-insurance (or something else).

 

[aja8888]

I guess it depends a lot on your insurance policy... Mine says hospital ER visits are a flat $50 per visit... (I recall reading that when I first got the policy and thought, surely that doesn't cover everything) I unfortunately had to make an emergency room visit last year and they took the info from my medicare advantage card. After they did their thing (doctors, nurses, tests, etc) I was released in about 2 hours without paying anything. The EOB came in at over 3k, IIRC, and the hospital eventually sent me a bill for exactly $50. Actually I was surprised there wasn't some hidden charges for tests or for deductibles or co-insurance (or something else).

The thing about Medicare (any plan) is everything is pre-negotiated. With the ACA and other individual plans, it's always open season.

14 years on Medicare here and between DW and I, all kinds of surgeries, etc and always knew our cost.

 

[ivinsfan]

The thing about Medicare (any plan) is everything is pre-negotiated. With the ACA and other individual plans, it's always open season.

14 years on Medicare here and between DW and I, all kinds of surgeries, etc and always knew our cost.

FYI Car guy says he has Medicare Advantage plan which is not the same as Medicare plus supplement...so depending in your Advantage plan is could be open season. All Advantage plans are not created equal.

 

[Gremlin]

Sending so many prayers and best wishes!!!!

Last Fall, my wife had a neurostimulator implanted. Helped just a little, but the cost was $65K--paid by Medicare.

4 years ago, her knee replacement was $92K. She spend 3 days in PT classes doing circles on the floor with her foot--$550 per hour twice a day. They were grossing $5500 per session x 2 per day.

In 3 hours, we're heading for the hospital to have her bottom 4 lumbar discs removed and replaced with "cages." Then they're going to do elaborate fusion and straighten her back from scoliosis. Total time in surgery 10-12 hours spread over 2 days. I estimate 6 days in the hospital, however there's no way to estimate the total cost. It's going to be enormous to Medicare and our Plan F. It's going to be a 3-6 month recover and perhaps a year to really get her back into shape. But such surgery is a must do as her leg & foot pain prohibits her from sleeping. Pray for us, please.

 

[aja8888]

FYI Car guy says he has Medicare Advantage plan which is not the same as Medicare plus supplement...so depending in your Advantage plan is could be open season. All Advantage plans are not created equal.

How true, and a close friend on mine sells MA plans and they are very specific on coverages with max out of pocket in most, if not all, plans. What gets MA and Medigap plans in trouble is going to facilities that don't accept the coverages.

 

[Car-Guy]

How true, and a close friend on mine sells MA plans and they are very specific on coverages with max out of pocket in most, if not all, plans. What gets MA and Medigap plans in trouble is going to facilities that don't accept the coverages.

And my plan (for the DW and I) says we are covered by any doctor or facility that accepts Medicare assignments. (Their terminology) So far we have never found one that didn't. And we do have a 3k OPP annual max, per person which includes all co-pays and co-insurances.

 

[MichaelB]

And my plan (for the DW and I) says we are covered by any doctor or facility that accepts Medicare assignments. (Their terminology) So far we have never found one that didn't. And we do have a 3k OPP annual max, per person which includes all co-pays and co-insurances.

My mother’s MA plan also has the same Medicare wide network. Some MA plans are limited, and I think there’s an assumption by some that they all have limited networks.

Another attribute of my mum’s MA plan is it includes pharmaceutical coverage, with requires a separate Plan D when using traditional medicare.

 

[reneeh63]

You didn't consider some kind of prompt/urgent care/doc in the box? Or is that not an option for you?

 

[tenant13]

I can’t believe that a few years ago when I fractured my toe in Thailand, the whole ER visit (with X-rays, seeing doctor twice and a bottle of painkillers) cost me $42 and took maybe 2 hrs in one of the nicest hospitals I’ve ever visited (Chiang Mai). I didn’t even bother filing the claim with my travel insurance.