outragous emergency room charges

[wbrosche]

The best advice given is to wait with clarification that I have seen it take as long as six months before the dust settles. My BCBS plan rarely pays more than thirteen cents on the dollar for the bill submitted by our hospital which simply takes time for things to go back-and-forth a few times.

 

[badatmath]

My insurance would charge a penalty I think for going in a non urgent situation without notifying them. This is an urgent care situation at best maybe get some ice and rest for a day or so to see how it is before doing anything at the worst.

A broken bone also may be not fun but my insurance would consider that ALSO not an emergency because it is not life threatening. If you had bones sticking out of the skin of course it would be different. I just know this from other people who have thought well it hurts it is an emergency um no, not really.

I think the penalty for not notifying insurance is an extra $100-$200. I haven't ever done it. I just know its a possibility.

 

[badatmath]

Sending good thoughts and prayers, Bamaman.

 

[Al in Ohio]

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

No you never do that until the EOB is settled snd sent to you.

 

[6miths]

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.

Yes the US is about the only country that the state of healthcare gives us pause to travel to.

 

[MarieIG]

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.

Prayers for you and your DW.

 

[Freedom56]

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?

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.

 

[FlaMariner]

At a minimum, when you get the final number from your insurance, call the hospital and ask for a discount if you give a credit card and pay it all off now. That's usually good for 10%.

 

[RetMD21]

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.

This an issue of deductible and OOP max, right? I think you can use any Medicare facility and get the Medicare rate.

 

[Walt34]

A broken bone also may be not fun but my insurance would consider that ALSO not an emergency because it is not life threatening.

I would double check on that. According to several ER nurses I've talked to a broken bone is in fact an emergency and it can kill you. I've forgotten the details but it has to do with bone marrow and things getting into the blood stream that shouldn't be there. Granted it doesn't happen often, but it does happen. This is true even if it is not a compound fracture (with bone sticking through the skin). According to the nurses anyway.

 

[Car-Guy]

I would double check on that. According to several ER nurses I've talked to a broken bone is in fact an emergency and it can kill you. I've forgotten the details but it has to do with bone marrow and things getting into the blood stream that shouldn't be there. Granted it doesn't happen often, but it does happen. This is true even if it is not a compound fracture (with bone sticking through the skin). According to the nurses anyway.

Well according to folklore, the world lost a great individual (Jack Daniel) to gangrene from a broken toe he got while kicking his safe when he couldn't get it open. I saw the safe and it's a bruiser. (Well they tell that tale on tours of the distillery anyway.

 

[Badger]

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.

I understand only too well what she is going through regarding nerve damage in the lumbar area and the associated variety of pain in her leg and foot. I sincerely hope she gets relief from the surgery soon. Prayers for her and the surgeon's hands too.

Cheers!

 

[youbet]

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.

This is also how my DW's MA plan works.

 

[badatmath]

I would double check on that. According to several ER nurses I've talked to a broken bone is in fact an emergency and it can kill you. I've forgotten the details but it has to do with bone marrow and things getting into the blood stream that shouldn't be there. Granted it doesn't happen often, but it does happen. This is true even if it is not a compound fracture (with bone sticking through the skin). According to the nurses anyway.

Well they should know! I haven't ever had any reason to find out thank goodness.

 

[Venturer]

Thanks for all the replies. sorry for the ignorance, but what is an EOB? .

Explanation of Benefits is what they will pay & what you will pay.

 

[EastWest Gal]

When you get the EOB, if it is still high, watch for wrong codes and upcoding. You can look up the codes by number. 4 years ago when DS broke his heel, the ER charged the comprehensive care code for putting on a splint. Comprehensive care is the code the podiatrist uses to cover all visits for 90 days after the injury. They also upcoded the visit by faking unnecessary parts of the history and physical. Getting the hospital to correct the code and charge took multiple letters and he obtained a copy of the ER visit so we could see the fraudulent codes. The hospital pushed back at every step. I was still working there, which was even more infuriating.

When you get the EOB, you’ll see letter and number codes. You can look up codes here:

https://www.icd10data.com

 

[ivinsfan]

When you get the EOB, if it is still high, watch for wrong codes and upcoding. You can look up the codes by number. 4 years ago when DS broke his heel, the ER charged the comprehensive care code for putting on a splint. Comprehensive care is the code the podiatrist uses to cover all visits for 90 days after the injury. They also upcoded the visit by faking unnecessary parts of the history and physical. Getting the hospital to correct the code and charge took multiple letters and he obtained a copy of the ER visit so we could see the fraudulent codes. The hospital pushed back at every step. I was still working there, which was even more infuriating.

When you get the EOB, you’ll see letter and number codes. You can look up codes here:

https://www.icd10data.com

I see this quite often in the Medicare EOB coded as denied this service was already included in a previous charge. It's annoying...on a good day I assume since Medicare reimbursement can be so low the provider wants to be sure they didn't leave any stone unturned. I won't tell you what I think on a bad day.

 

[swakyaby]

I would double check on that. According to several ER nurses I've talked to a broken bone is in fact an emergency and it can kill you.

Insurance companies rarely based covered services on the opinions of ER nurses. An urgent care facility is the appropriate and less expensive treatment option for an ankle sprain vs closed ankle fracture. Exceptions would be if there was a displaced closed fracture with loss of sensation (nerve impingement) or loss of circulation. Then the ER doc would need to provide documentation in their notes that this is an emergency and that delay of care could result in permanent disability. They do xrays of potential ankle fractures at Urgent Care. If there was any doubt, a call could be placed to the nearest urgent care center while elevating the leg with a bag of frozen peas over the ankle. One could also ask if the facility is in-network, but the likely answer would be that the patient should check with their own insurance.

 

[EastWest Gal]

I would double check on that. According to several ER nurses I've talked to a broken bone is in fact an emergency and it can kill you. I've forgotten the details but it has to do with bone marrow and things getting into the blood stream that shouldn't be there. Granted it doesn't happen often, but it does happen. This is true even if it is not a compound fracture (with bone sticking through the skin). According to the nurses anyway.

A few types of broken bones need immediate care-femurs, hips, certain fractures of the humerus. However, the biggest need is pain relief-broken bones hurt. The ER nurses are quite wrong about the marrow and all that. You don’t heal a broken bone by setting it in position, or immobilizing it. You do allow the bone to heal in position and immobilizing it reduces pain.

 

[EastWest Gal]

+1.

 

[ER_Hopeful]

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?

 

[ExFlyBoy5]

Insurance companies rarely based covered services on the opinions of ER nurses. An urgent care facility is the appropriate and less expensive treatment option for an ankle sprain vs closed ankle fracture. Exceptions would be if there was a displaced closed fracture with loss of sensation (nerve impingement) or loss of circulation. Then the ER doc would need to provide documentation in their notes that this is an emergency and that delay of care could result in permanent disability. They do xrays of potential ankle fractures at Urgent Care. If there was any doubt, a call could be placed to the nearest urgent care center while elevating the leg with a bag of frozen peas over the ankle. One could also ask if the facility is in-network, but the likely answer would be that the patient should check with their own insurance.

Funny you mention this. A fella I used to fly with back in my Air Force days slipped on his front porch while taking out the garbage. He thought he sprained his ankle, so he went to an urgent care. Long story short...a couple of hours later he was taken to a prestigious university hospital BY MEMED EVAC HELICOPTER and was having surgery within an hour of arrival. I don't recall the particulars, but he ROYALLY messed up his ankle/foot and didn't fly again for almost TWO YEARS. So...you just never know.

 

[ExFlyBoy5]

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?

She might be stuck paying that since it wasn't an emergency situation. She *could* appeal it, but I don't think it would be successful.

I know about 252 posters have already mentioned urgent care, but I will add one thing my insurer has offered as "advice" in regards to going to an ER.

When should you go to an ER? If there is a threat to life, limb, or sight.

 

[ivinsfan]

The only other option would be for your DD.. not you to call the provider explain she is a college student very limited income and ask for a reduction on the total to settle the bill.


Something might be worked out as it appears they are billing at rack rate due to it not being medically necessary.

 

[captain3d]

Wait until it goes to collections then negotiate. Or pay to save your credit score