Any way to negotiate ER bill down?

[soupcxan]

Went to the ER with a kidney stone - knew what it was because I'd had one before - total bill was $10k, after negotiated rate was $5k:

$100 pharmacy
$400 lab
$2,250 CT scan
$2,250 emergency services

I have 25% co-insurance so I owe $1,250. Are there any tactics (more specific than just asking for a lower bill) that might get the bill down?

 

[Senator]

Let it go to collections, then negotiate a settlement.

 

[mn54]

if it goes to collections wouldn"t that cause your credit score to go down.

 

[soupcxan]

I'm not willing to let it go to collections for practical as well as ethical reasons. But I would negotiate it down in good faith. $2,250 for a CT scan is outrageous...that normally costs <$500 outside of the ER.

 

[rodi]

I haven't figured out a way, yet. Perhaps call the billing department.

That said - your OOP ($1250) is only 12.5% of the original bill. IMO the biggest reason we have insurance is for the negotiated rates. I have a HDHP - and the final bill, like yours, is usually 50% of full charges... or less.

 

[zinger1457]

I'm not willing to let it go to collections for practical as well as ethical reasons. But I would negotiate it down in good faith. $2,250 for a CT scan is outrageous...that normally costs <$500 outside of the ER.

My local Radiology lab does CT Scans to check for the buildup of calcium in your arteries for $99.

 

[rodi]

Just a quick comment about why some imaging/testing is more expensive when done in a hospital. My husband did hospital architecture for several decades in 3 different states.

Hospitals are under different guidelines/building codes than regular commercial or residential spaces. Power has to be handled differently. Here in CA the normal "earthquake codes" are out the window in favor of much more stringent building codes.

My husband was involved in the moving of a CT scanner from one part of a basement to another at a Kaiser Permanente facility here in SoCal. It required approval and inspections from OSHPD (the California state agency that is in charge of hospitals, outpatient surgical buildings, nursings homes, etc...) It was a much bigger project than you'd ever imagine. Even moving blood analyzer equipment can require special OSHPD approval... especially if it needs to be plugged into power (which it does.)

That's not the only reason it's more expensive to get an x-ray, mri, or CT in a hospital - but it's one factor.

 

[Senator]

I'm not willing to let it go to collections for practical as well as ethical reasons. But I would negotiate it down in good faith. $2,250 for a CT scan is outrageous...that normally costs <$500 outside of the ER.

In order to make up for all the CT scans they have that they do not get paid for, or get paid less than they would like, they have to charge you, and others with insurance, more.

I would call the provider, but the odds of success are slim. The insurance company already shaved them down a bit. You can call the insurance company too, but that is likely a failed effort.

Have another kidney stone or two, the next one will be cheaper if you have met your max out-of-pocket cost. Sooner or later they are 'free', until next year.

 

[pb4uski]

Many of our local hospitals will offer a discount if you pay immediately with a credit card. Some don't but those that do offer as much as 20%. Call the billing department and ask if they offer a discount for immediate payment. On our bigger hospital bills, I get 20% plus 2% from the credit card company. For a $1,250 bill I would expect 10% around here, perhaps a bit less.

 

[HadEnuff]

If you can't negotiate a lower bill, you may be able to negotiate some extended payment options. Very extended.

 

[Sojourner]

In my experience, hospitals and most other providers will not negotiate with you on price once the insurance company has submitted their EOB (explanation of benefits). They will say that they have a contract with the insurance company and that it forbids them from lowering the price. I've tried to negotiate on a few different occasions with various providers, and they've all said basically the same thing, i.e. "you have to pay us what your insurance says you owe."

 

[jim584672]

ER bills are the first phase of a negotiation. They expect to be negotiated down.

 

[soupcxan]

In my experience, hospitals and most other providers will not negotiate with you on price once the insurance company has submitted their EOB (explanation of benefits). They will say that they have a contract with the insurance company and that it forbids them from lowering the price. I've tried to negotiate on a few different occasions with various providers, and they've all said basically the same thing, i.e. "you have to pay us what your insurance says you owe."

I called them today and this is exactly what they said - would not negotiate. They offered to put me on a 12-month no-interest payment plan but for only $1,200 it wasn't worth fooling with.

 

[karen1972]

Many of our local hospitals will offer a discount if you pay immediately with a credit card. Some don't but those that do offer as much as 20%. Call the billing department and ask if they offer a discount for immediate payment. On our bigger hospital bills, I get 20% plus 2% from the credit card company. For a $1,250 bill I would expect 10% around here, perhaps a bit less.

I second this, I had a similar hospital bill.. one hospital took 15% off if paid within 30 days, one hospital did nothing.

In the future, if you have united (not sure of other insurances), they have an app where you can put in your procedure (aka. kidney stone) and they will compare hospital prices for you..so you could maybe have found a cheaper hospital in your area. I know same standard bloodwork ranges from $150-$500 across 80 doctors/labs within 5 miles of my house. and it totally depends as I've seen MRIs super cheap at one facility, but their xrays were 3x what the other one was...I think they just play the system on what they use most often to game it to get the most money possible and insurances game the system the same way.. I'll pay you more for X, if you give me Y for cheap assuming less people will use X and thus overall cheaper for the insurance company.

 

[ivinsfan]

There again some of this can be income dependent. We hit our OOP when my DH had a cardiac valve repair. The OOP that year was 4000 and the hospital billed 3600 of it.

It's a large hospital with a Catholic connections. I just made one call, since they accepted CC to see if I could get a quick pay or a pay be check discount. They said no to that, but immediately asked about my family income and such. Under a certain income level they have assistance for bill reduction.

 

[travelover]

.......... Under a certain income level they have assistance for bill reduction.

Under a certain income, they know they aren't going to get paid anyway.

 

[ivinsfan]

Yes, for a low income person and the hospital it's a win/win but those of us who pay for good insurance and have some income end up subsidizing those who don't.

 

[youbet]

Under a certain income, they know they aren't going to get paid anyway.

Yes. Your income/wealth level has a big influence on how much you'll pay and how hard you'll be chased.

A close friend in Florida has only a medium level of SS for income, owns a modest condo and has a few kilobux in an IRA. He had only Medicare Part A when he had a significant emergency surgery. I encouraged him to stay calm, not pay anything and just keep calling the providers and explaining the situation. He didn't really negotiate but rather just explained he couldn't and wouldn't be sending a penny, ever. That seemed to work.

The hospital was great and their financial office and social workers did the bulk of the work of getting him enrolled in aid programs. The state wound up picking up the portion of the bills that Part B would have covered and also put him on Part B going forward with the state paying the bill (nothing deducted from his modest SS). The hospital and docs wrote off (no longer consider him owing money) the portions that Part A and the state did not pick up. Only the private ambulance company was a pita chasing him harder for a few hundred bux than the hospital and docs did for many tens of thousands.

Now that he is on Part B, the docs he is seeing for follow-up have agreed to forgive the Part B deductible and 20% co-pay going forward.

I'm sure a person with, say, a combined pension and SS income of $50k and maybe a few hundred kilobux in savings would have been treated far differently.

 

[Ronnieboy]

In my experience, hospitals and most other providers will not negotiate with you on price once the insurance company has submitted their EOB (explanation of benefits). They will say that they have a contract with the insurance company and that it forbids them from lowering the price. I've tried to negotiate on a few different occasions with various providers, and they've all said basically the same thing, i.e. "you have to pay us what your insurance says you owe."

This is what my PCP was just talking about at my last visit because we were complaining about 3rd party payors.

I had mentioned how we might sell 90 tabs of lisinopril for $10 cash but a patient with a $15 copay goes to Walgreens and their cash price might be $45 but through insurance they get a negotiated $35 payment ($20 from ins and $15 from pt copay) while if they come to our place, we only get the $10 (all from the patient) because we can't get more than our usual and customary price (i.e. cash price). You'd think that the insurance would say everyone just go to xxx pharmacy because they are cheaper, but no, they would rather have us raise the price 1,000x to get to a higher cash price.

My PCP said they were in a similar situation, they can only discount the office visit at the time of payment and not submit to ins, once it goes through ins they have to charge what the ins says is the patients contracted price.

 

[pb4uski]

Not applicable to the OP's situation, but an interesting recent article nonetheless. Times are a changing.

How to Cut Your Health-Care Bill: Pay Cash - WSJ

 

[Bamaman]

ER's are different animals from the rest of the hospital.

I pay dearly for my daughter's Blue Cross Blue Shield cash policy, and she had to go to the Emergency Room a number of times--$300 deductible. It galls me to see people in there on Medicaid walking out paying nothing. Then I see them at Walgreens paying nothing for prescriptions when I'm paying $50 or $100 for the prescription for my daughter.

And a couple of weeks later, I'll get a $400 bill from the Emergency Room Physician who doesn't even work for the hospital. That's for 3 minutes' contact. And he's not a BCBS authorized provider. It's like he works for whatever he can get out of insurance companies and individuals.

So the ER bill is not the only bill. You've got to deal with the ER physician, and his billing service will charge off the bill if unpaid. And they report the charge off to the Credit Bureaus at the same time they sell the note to a collection agency.