Hospital Bills?

[dennis thompson]

About a month ago we had a family member visit a hospital emergency room (he is fine). Yesterday we got a bill for $2200 telling us that was the portion not covered by our healthcare plan and please send a check for that amount. No breakout of the costs in the $2200 was shown. We called and asked for a detailed breakout of all the costs in included in the total bill , the details behind what the healthcare plan paid and the details behind what we owe. They immediately said we didn't owe $2200 but owed $800! I wonder if some people would have just sent a check for the $2200 without questioning them? I wonder if this is some kind of scam?:mad:

[Bruce Pratt]

Often it is a matter of timing. Depending on the billing cycle of the hospital and the payment cycle of the insurance company, bills and payments can cross in the mail. Recommend that you call your insurance carrier and discuss the status of outstanding claims and bills.

[George Bokros]

Everyone needs to insist on details. That is one good thing about Medicare. You can get a detailed EOB (Explanation of Benefits) that shows how much they approved and how much they paid toward each service provided and what the patient's responsibility is. The private insurances used to provide the same but have gotten away from it.

Everyone must review their medical bills to keep from being taken advantage of. The other thing is do not pay any more than what your insurance says is your co-pay until all charges have been paid by the insurance. My father paid one bill and waited for over a year to get his money because the doctor would not furnish how my units of anesthesia were administered. The doctor had no interest because he was paid in full by my father so his office did not care. If they have some "skin in the game" they are much more likely to cooperate.

George

[Rich Riddle]

Almost all health providers will negotiate the price if you call them on the telephone. Our local hospital comes down to about half with a simple phone call. Scrutinize your bill and make the telephone call.

[Pat Barry]

I almost never pay a medical bill until I am fairly certain that the insurance has been settled. Until that is done I really don't know what I owe. If anything I might send in a partial payment. Ever wait for a refund check from a hospital or doctor?? I have and it wasn't quick in coming.

[Brian Elfert]

My insurance plan sends an explanation of benefits for every insurance claim. My experience is that I don't get a bill from the doctor or hospital until after they have collected from insurance first.

[Al Launier]

Not intending to hijack this thread, but everyone should be aware of the difference between being admitted overnight for "Treatment" vs. being admitted overnight for "Observation".

Example based on Medicare & Medicare Part C insurance coverage:

As explained to me by a CS Rep. for my Medicare Suplement Health insurance:
If you are kept overnight for “Observation” for a typical non-emergency situation, that is not considered as being “Admitted”. It’s a different situation than being admitted normally for "Treatment". Medicare doesn’t cover this overnight stay for “Observation”. However, in this situation Supplementary insurance (Medicare Part C) becomes the “primary” insurer & the patient would only be responsible for the co-pay, in my case $65. However, if one is kept over for “Observation” following an emergency room treatment, Medicare still doesn’t cover the cost, the Supplemental insurer does. It’s considered an “outpatient” service & the patient would be responsible for this co-pay which in my case would be $300.
Big difference how one is “admitted”. Be careful!

[George Bokros]

Not intending to hijack this thread, but everyone should be aware of the difference between being admitted overnight for "Treatment" vs. being admitted overnight for "Observation".

Example based on Medicare & Medicare Part C insurance coverage:

As explained to me by a CS Rep. for my Medicare Suplement Health insurance:
If you are kept overnight for “Observation” for a typical non-emergency situation, that is not considered as being “Admitted”. It’s a different situation than being admitted normally for "Treatment". Medicare doesn’t cover this overnight stay for “Observation”. However, in this situation Supplementary insurance (Medicare Part C) becomes the “primary” insurer & the patient would only be responsible for the co-pay, in my case $65. However, if one is kept over for “Observation” following an emergency room treatment, Medicare still doesn’t cover the cost, the Supplemental insurer does. It’s considered an “outpatient” service & the patient would be responsible for this co-pay which in my case would be $300.
Big difference how one is “admitted”. Be careful!

This is extremely important. BEWARE.

George

[Myk Rian]

One rule is to wait 1 year before paying the bill. It can take that long for everything to be ironed out.

I recently spent 5 days, then 2 more when I had a defib unit implanted. Total bill was 200k. Insurance paid 67k and the hospital seems to be satisfied with that.

[Mark Bolton]

Wholly cow.. 200k.. My head is spinning..

[John T Barker]

About a month ago we had a family member visit a hospital emergency room (he is fine). Yesterday we got a bill for $2200 telling us that was the portion not covered by our healthcare plan and please send a check for that amount. No breakout of the costs in the $2200 was shown. We called and asked for a detailed breakout of all the costs in included in the total bill , the details behind what the healthcare plan paid and the details behind what we owe. They immediately said we didn't owe $2200 but owed $800! I wonder if some people would have just sent a check for the $2200 without questioning them? I wonder if this is some kind of scam?:mad:

I would call your healthcare provider. I was very surprised a couple of times with what kind of information they could give me. Very helpful, like how to find a lower cost MRI (not everyone charges the same amount.)

I recently had a bill for $500 from my local hospital for an ER visit by my wife. When I called them to tell them I would be paying in installments I was told not to pay it yet, as it had not gone through all the insurance completely. Unfortunately the bill did not get smaller and I'm in the process of paying it. This is a good practice by the way. Take your time to pay it...they don't care, they're happy to get the money.

[Brian Elfert]

If insurance is paying for something like an MRI why wouldn't the insurance company pay basically the same rate to any facility that has an MRI machine? I suppose some MRI machines might be better than others so they might be able to charge a little more. It seems wasteful to negotiate prices with every facility separately. If I ran an insurance company I would probably have a book of standard rates for basic procedures like MRIs and tell any facility that wanted to take my insurance to accept these prices or not accept my insurance.

There is some thinking that a set fee per patient is the way to go, but that could mean your doctor skips an expensive test/procedure you really need to put more money in their pocket. With today's model there is no penalty to ordering more tests and procedures so doctors will order up everything to avoid liability.

[Ken Fitzgerald]

There are a lot of variables that go into why hospital charges vary from hospital to hospital.

Did you know that in some cases, Medicare doesn't even cover the expenses a hospital incurs when they perform a certain exam? Thus they mark it up and those of us with insurance pay more to cover the amount the hospital lost to Medicare.

Did you know that often large companies and corporations are "self-insured" but have a insurance company administering the program?

Insurance companies often have an agreement with hospitals but it's not always on a nationwide basis. For example, when I had my cochlear implant surgery, the cost was $138,000 for everything including the surgeon, the hospital expenses, the internal implant, 2 sound processors and accessories. My out of pocket expenses were minimal since I was able to have the surgery by an "in-network" surgeon and at an "in-network" hospital. The insurance company didn't pay the "$138,000" bill either. They paid a little over half.

Different hospitals incur different costs for various reasons. For example, the hospital in Grangeville, Idaho has a very low surrounding population density. The cost of have a CT scan there may be more than having it at St. Joseph Regional Medical Center, Lewiston, Idaho. You can argue that the smaller hospital doesn't necessarily need a CT scanner but tell that to the family of the logger who's injured in a logging accident, driven a short distance to Syringa Hospital in Grangeville where the CT scan indicates severe but treatable, survivable brain damage if treated quickly and he's helicoptered to St. Joe's for neurosurgery rather than driven by ambulance for over an hour. Yet, Syringa Hospital has a mobile MRI that comes into town 1 day a week so local patients don't have to drive 75 miles to the hospital with a resident MRI.

That smaller hospital doesn't have a CT scanner with all the whistles and bells. They don't do as many patients but still have to pay for their lower cost scanner.

The cost of labor can differ tremendously around the country and thus labor expenses become a variable depending on location.

The cost of utilities varies by location and varying weather etc. effect expenses and thus hospital charges.

There are a lot of reasons hospitals to have varying charges.

[Brian Elfert]

I'm thinking more about hospitals in a large metro area where you may have several hospitals within miles of each other. We must have 20+ hospitals in the metro area here. The state actually has a moratorium on building new hospitals. Why shouldn't the insurance companies pay the same for facilities that should have similar expenses? One facility may have a higher res MRI and then yes, the insurance company maybe should pay a little more, but what about all the cases where a higher res MRI is of no value? (I have no idea if there really are higher resolution MRI machines or not.)

[John T Barker]

If insurance is paying for something like an MRI why wouldn't the insurance company pay basically the same rate to any facility that has an MRI machine? I suppose some MRI machines might be better than others so they might be able to charge a little more. It seems wasteful to negotiate prices with every facility separately. If I ran an insurance company I would probably have a book of standard rates for basic procedures like MRIs and tell any facility that wanted to take my insurance to accept these prices or not accept my insurance.

There is some thinking that a set fee per patient is the way to go, but that could mean your doctor skips an expensive test/procedure you really need to put more money in their pocket. With today's model there is no penalty to ordering more tests and procedures so doctors will order up everything to avoid liability.

My insurance company was helping me find the best rate. I don't recall if they pay a percentage or flat rate for the MRI. If it's a percentage it's pretty easy to figure out why they help a person find the cheaper imaging joint.

[Garth Almgren]

About a month ago we had a family member visit a hospital emergency room (he is fine). Yesterday we got a bill for $2200 telling us that was the portion not covered by our healthcare plan and please send a check for that amount. No breakout of the costs in the $2200 was shown. We called and asked for a detailed breakout of all the costs in included in the total bill , the details behind what the healthcare plan paid and the details behind what we owe. They immediately said we didn't owe $2200 but owed $800! I wonder if some people would have just sent a check for the $2200 without questioning them? I wonder if this is some kind of scam?:mad:

Some people would just write a check, but in cases like these it's best to talk to both the provider and to the insurance company to confirm that they're talking to each other; Make sure the provider sent the claim in to the insurance, and make sure that the insurance received it and processed it.

Providers generally have multiple prices - one (much higher) price that they give to people without insurance, and a negotiated, contracted rate that they give to insurance companies. It's possible that the $2200 price they billed you for was the non-insured rate, but that amount was adjusted once your insurance company had finished processing the claim and let the hospital know how much your share would be.

The reason providers charge people without insurance more is because there is no guarantee that they'll ever get payment. They might luck out some percentage of the time (maybe 50%, maybe 80% - I don't know what the real numbers are) and have someone who is willing and able to pay off their full bill, but all too often they just have to write it off as a partial or complete loss.

With insurance, they give a discount largely because they're guaranteed payment for services rendered. If you talk with the billing department of the hospital and tell them you don't have insurance but want to make payments, they'll almost always work with you to lower the price to near insurance levels, just so they can recoup some of their expenses.

You should be getting an EOB (explanation of benefits) from your insurance company that will break down exactly how much the provider billed, what the allowed amount was (the contracted rate for that particular service, procedure, and/or diagnosis), how much the insurance company paid, and how much your share was (deductible and coinsurance).

[paul cottingham]

Man, all this discussion makes me glad I live in Canada.
Reminds me of a cartoon I saw about Breaking Bad being set in Canada. Walter White goes to the doctor. He has cancer. He gets treatment. The end.

[Phil Thien]

In the past, our insurance company has sent us a statement after they've paid their share. The statement shows the original amount billed, the contract amount paid by the insurance company, and the amount we're required to pay.

For a while we had this one insurance company that didn't cover a lot of stuff (per the policy, we were young and only had major medical). But we were still entitled to the contracted rates. So an exam which may normally cost $300 only cost us maybe $50 or $60. That insurance was awesome. The policy was cheap, protected us in case of disaster, and discounted everything else to us, as well.

[Myk Rian]

Wholly cow.. 200k.. My head is spinning..
Mine would be if I didn't have HAP Senior insurance. That was at the UofM hospital A.A.

[Jack Jackson]

Wait, Paul.. I thought it was: Walter White feels ill... he has to wait 2 months to see an MD... he has cancer.... he waits another 3 months to see an oncologist.... he needs chemo.... he has to wait another month to start chemo... then he dies and the show ends before it begins..... lol.. j/k - I can't believe I actually clicked on this thread and read it...

[william watts]

"I wonder if this is some kind of scam". Yes, Dennis it is, and it is standard practice. The hospital will accept as full payment whatever your insurance will pay plus your deductible. For a patient without insurance they will bill 3 or 4 times the amount the insurance will pay and hope to collect or negotiate an amount that is still more than insurance will pay. If you are not a good negotiator, or cannot pay, the hospital will write off the bill. The patient could be forced into bankruptcy. I think most hospitals do not know their cost of doing business and do not know what a fair charge would be. They will bill these absurd amounts because their patients are in no condition to object.