outragous emergency room charges

[Montecfo]

An ankle sprain is not an emergency. Next time visit an urgent care facility rather than the emergency room at a hospital. That would have saved a lot of money.

Or do RICE and avoid the trip to medical altogether.

 

[MichaelB]

So my daughter asked for an itemized charges and she finally got something in the mail a few days ago, basically it is just an one liner stating ER procedure $2900.


So I went on Anthem website again, and the EOB is pretty much the same. see attached. So had a quick live chat with their rep and she looked over the claim and said it was processed properly.



So what can DD do now?

ER_Hopeful, this is unfortunate. You don’t have much recourse. It looks like the insurer says the charge is legit and the plan doesn’t pay, perhaps because the deductible has not yet been met. They may also be treating this as a normal medical service and not an emergency.

To answer one question you asked in the OP, the hospital can’t come after you. Next step would be to appeal to the insurer to cover this like an emergency, and if they refuse, file a complaint to the state insurance regulator.

Your daughter could also contact the hospital, tell them she has no resources and ask for a reduced bill.

 

[Irishgirlyc58]

So my daughter asked for an itemized charges and she finally got something in the mail a few days ago, basically it is just an one liner stating ER procedure $2900.


So I went on Anthem website again, and the EOB is pretty much the same. see attached. So had a quick live chat with their rep and she looked over the claim and said it was processed properly.



So what can DD do now?

Can she file an appeal on the denied claim?
I don’t recall the specifics of the circumstances but I would think going to the ER for a broken bone would be acceptable if Urgent Care was closed or had stopped accepting new cases due to being booked.
That actually happens in my area and also where my bff lives so I’m assuming it happens in other places.

 

[RetMD21]

That's it, one line item? I am used to seeing ER doctor charge, hospital charge with meds and radiology broken out. Anyway a 3k deductible and nearly 3k bill is unfortunate. It looks like it was processed and there is a small discount. That is, I don't know what you would appeal. If she asks for a payment plan they may offer a discount. My daughter was offered a discount for a smaller bill in a high deductible situation. They told her it was a "special program" but it seemed like they wanted to get payments before the end of the quarter.

 

[Irishgirlyc58]

Oh, this is to cover the high deductible. My mistake. I thought the insurance company declined payment.
Yeah, I just assume that I will cover the entire amount with a high deductible plan.

 

[RetiredAndLovingIt]

That's it, one line item? I am used to seeing ER doctor charge, hospital charge with meds and radiology broken out. Anyway a 3k deductible and nearly 3k bill is unfortunate. It looks like it was processed and there is a small discount. That is, I don't know what you would appeal. If she asks for a payment plan they may offer a discount. My daughter was offered a discount for a smaller bill in a high deductible situation. They told her it was a "special program" but it seemed like they wanted to get payments before the end of the quarter.

I agree, I've never seen a one line EOB and a measly $48 discount, it makes me think there may be more bills coming unless they now lump whatever happens in the ER into a single charge.
I do remember back in 2017/2018 when I was still working Anthem sent out letters to everyone letting them know that they were reducing benefits on ER charges for non emergency care. We were all very upset because neither the company or Anthem would provide a detailed list of what would and would not be considered an emergency.
Needless to say they took a lot of flack about it and may have made some minor changes to the policy. I'm not sure if this applies to the OP's situation but it might.

Regardless, I would have your daughter call and negotiate with them and don't agree to any kind of payment plan. She wants a cash price to pay it on the spot or they can go pound sand. Tell her to threaten to post the bill on Facebook and other social sites, neither Anthem nor the hospital will want that publicity

https://www.npr.org/2018/05/23/6136...oidable-emergency-room-visits-faces-criticism

https://www.politico.com/story/2018...ck-by-reducing-emergency-room-coverage-612842

 

[ivinsfan]

I agree, I've never seen a one line EOB and a measly $48 discount, it makes me think there may be more bills coming unless they now lump whatever happens in the ER into a single charge.
I do remember back in 2017/2018 when I was still working Anthem sent out letters to everyone letting them know that they were reducing benefits on ER charges for non emergency care. We were all very upset because neither the company or Anthem would provide a detailed list of what would and would not be considered an emergency.
Needless to say they took a lot of flack about it and may have made some minor changes to the policy. I'm not sure if this applies to the OP's situation but it might.

Regardless, I would have your daughter call and negotiate with them and don't agree to any kind of payment plan. She wants a cash price to pay it on the spot or they can go pound sand. Tell her to threaten to post the bill on Facebook and other social sites, neither Anthem nor the hospital will want that publicity

https://www.npr.org/2018/05/23/6136...oidable-emergency-room-visits-faces-criticism

https://www.politico.com/story/2018...ck-by-reducing-emergency-room-coverage-612842

Well these article are from 2018...why you advise someone to get into an online ***ing contest with a hospital and insurance company. Much, much more likely to have success by simply calling the office and politely inquiring about discounts. This was not a life threatening or even serious issue that required the ER. A mistake was made and hopefully learned from. I dont think one person reading here thinks the OP's daughter needed to go to the ER...

 

[martyp]

In the US my insurance deductible for an emergency room visit was $150 and $25 for a doctors visit. Here in Bangkok; Thailand I recently went to the emergency room with a kidney stone attack. I saw the doctor, got blood and urine tests and some pain killers. Total cost - $137. That is not the deductible. That was the total cost. I saw a urologist the next day. The cost for a CAT scan was $400. The cost to see the urologist and nurses - $37. The quality of care in that modern hospital was every bit as good as it was at my hospital in the San Francisco East Bay also for kidney stone treatment.

 

[martyp]

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.

I am living in Bangkok. Five years ago I was in Chaing Mai and fell out of bed head first onto a concrete floor (just a bad dream ). I went to a modern hospital emergency room, got a CAT scan, stitches, and pain killers. The cost was $200. The following week I went to a clinic to get the stitches removed - $5. I got $130 of the costs reimbursed by my Thai bank’s accident insurance.

 

[Walt34]

This was not a life threatening or even serious issue that required the ER. A mistake was made and hopefully learned from. I dont think one person reading here thinks the OP's daughter needed to go to the ER...

I for one do not fault her one instant for going to the ER. How is she supposed to know the difference between a sprained ankle and a broken bone? I believe that most medical folks will acknowledge that the distinction is at best difficult without an x-ray.

It's all wonderfully clear in hindsight but she didn't happen to have that.

 

[MichaelB]

I for one do not fault her one instant for going to the ER. How is she supposed to know the difference between a sprained ankle and a broken bone? I believe that most medical folks will acknowledge that the distinction is at best difficult without an x-ray.

It's all wonderfully clear in hindsight but she didn't happen to have that.

Exactly.

 

[swakyaby]

Well these article are from 2018...why you advise someone to get into an online ***ing contest with a hospital and insurance company. Much, much more likely to have success by simply calling the office and politely inquiring about discounts. This was not a life threatening or even serious issue that required the ER. A mistake was made and hopefully learned from. I dont think one person reading here thinks the OP's daughter needed to go to the ER...

Agree 100%

 

[ivinsfan]

I for one do not fault her one instant for going to the ER. How is she supposed to know the difference between a sprained ankle and a broken bone? I believe that most medical folks will acknowledge that the distinction is at best difficult without an x-ray.

It's all wonderfully clear in hindsight but she didn't happen to have that.

When I say a mistake was made,I'm talking about going directly to the ER. No one said she shouldn't get it treated just that in modern times you need to think about if something is ER worthy because of the cost. A young person without experience isn't likely to know that. Because the end result is she has a big bill to pat...

 

[swakyaby]

Likewise, I am not surprised she chose to go directly to an ER. Because she is young, likely scared, doesn’t have much experience of dealing with health insurance requirements, and probably the last thing she was concerned about was whether this would be covered on her insurance. An urgent care facility, their purpose, and what they are useful for is possibly not even on her awareness radar. But now she knows.

 

[RobbieB]

Yeah, education is expensive. Now she knows.

Emergency hospital is as expensive as it comes. Even the insurance Co agrees.

Pay the bill and avoid future bills.

 

[badatmath]

Yeah might want to look up the closest urgent care to the kid and tell her go there next time. Make sure it does xrays (not all do).