Hospital billing - Ugh!

[Brian Elfert]

Why can't hospitals just send you one bill for an ER visit? I had to visit the ER in the middle of the night for a very high fever and had a bunch of tests done. (Diagnosed with pneumonia.) Now I have bills for the doctor, the radiologist, and the hospital itself. I'm not sure if I will get a separate bill for the Xray. Why can't the hospital just send me one bill for the entire visit? They can pay the doctors and radiologist from the money I pay them.

I can't believe the ER doctor billed $850 for probably 20 minutes worth of work. He probably was with me for five to ten minutes, and I doubt he spent more than 10 or 15 minutes looking at Xrays and test results.

I do have insurance, but I still have to pay 20% myself.

[Rich Engelhardt]

Don't get me started.....

IMHO, we are no longer human beings. We are nothing more than cash crops that the health care industry cultivates and harvests.

Every single thing about it is geared towards one end - making the whole process more streamlined for their benefit.

Edit to add- - -Oh man, this is just great timing! This just showed up on my Facebook:

[Rich Riddle]

Brian,

Those bills can be negotiated. Look at the doctor's bill closely and see what he charged. If you call they must provide an itemized bill. If he charged for anything he didn't do, have that removed. You can also negotiate the remaining balance. Trust me, your insurance isn't paying 80% of face value.

[Brian Elfert]

I'm not contesting the amount of the bill. I just think the hospital should send me one bill instead of separate bills for the doctor, radiologist, hospital, and so on. It would be a lot easier to keep track of.

[Rich Engelhardt]

That's if those are bills at all.

Every time I go to the doctor's, I get a bill-like thing in the mail that lists the charges, then says "This is not a bill". That's followed a week or two or three by something with completely different numbers on it that says the insurance company will pay 80% of some figure that's nothing at all like anything I've seen.
That thing also says I haven't met some kind of deductible and I have to pay the whole thing.

[George Bokros]

Some doctors and facilities are also now charging "Facility Charges" which in some cases may no be covered by insurance. My wife received a shot for something and also received an additional charge for giving her the shot.

If they ever want to keep you for observation insist on being admitted. Some insurance, including Medicare I believe, will not pay the hospital charges if you are no admitted as an in-patient.

Life used to be so much simpler before every one became money focused.

[Scott Shepherd]

At a minimum, it would be nice to have some sort of summary when you left as to who treated you. I went to the ER 2 years ago and people that I had never heard of sent me bills. I had no way of knowing if they were real or if I was being scammed, other than to contact each one and get the details. They send very vague bills saying you owe money. Several of them stopped trying when I asked them to provide detailed information on just what they did for me during the visit. They like to phish as well. They'll ask you questions like "What's your social?" and "What was the date of care". Well, if you're sending me a bill about it, then I suspect you should have that information. Verifying my identity and GIVING you my identity happen to look identical.

I got a bill for $1,000 from a doctor and they said he treated me. I never once saw the doctor, never heard the name, never had anyone tell me he was involved at all (and they never did provide a detailed account of what he did on my behalf).

I understand some doctors are behind the scenes and you might not see them reading a MRI, but at a minimum, I should walk out of there with a list of :

Treated by :

City Hospital
Dr. Seuss
Dr. Phil
Dr. Feelgood
Incredibly Clear MRI's Inc.
etc....

Just my opinion. At the end of it all, I felt like I was being scammed by about 3 different people that contacted me because they couldn't provide any proof of treatment.

[Brian Elfert]

That's if those are bills at all.

Every time I go to the doctor's, I get a bill-like thing in the mail that lists the charges, then says "This is not a bill". That's followed a week or two or three by something with completely different numbers on it that says the insurance company will pay 80% of some figure that's nothing at all like anything I've seen.
That thing also says I haven't met some kind of deductible and I have to pay the whole thing.

I get these things from the insurance company called Explanation of Benefits for every bill. It shows how much the provider billed, how much the insurer paid, and how much I have to pay. It also shows the discount the insurer took from the amount billed which the provider has to eat. No provider has ever tried to bill me for me than my portion, so far. I get them electronically instead of by my mail.

[Bill Orbine]

Did you review your summary of benefits from the insurance company? You need to pay special attention to the SOB's because it explains what claims are valid and for what amount of money. It's also explains what your responsibilities for payment keeping in check with your deductibles and your maximum out-of-pocket expenses. So you have to watch out for bogus or double billing that doesn't conform to the SOB. That happens a lot. You need to pay attention to the SOB like a hawk! And don't be afraid to confront or question the claims or bill if you sense a problem. You'd be surprised how some of those bills.... or even claims disappear with a simple dispute ...."Hey, what the heck is this?"

[Brian Henderson]

In some of these cases, the doctors are not actual employees of the hospital, they are actually paying to use the hospital facilities for their practices. Therefore, you are going to have to pay for the doctors separately because that is how they are billing the insurance.

[Ken Fitzgerald]

Brian nailed it.

Often the lab that performs the lab tests is an independent business too. They just happen to be located in the hospital for expediency of performing the lab tests.

[Rich Engelhardt]

I get these things from the insurance company called Explanation of Benefits for every bill.I get those too...My biggest problem with them is that the numbers (charges) never jibe.
I had one for $7 some thousand dollars for a sleep study.
Nothing was said of what the insurance covered.
I looked up online what the insurance allowed and it was something like $1200.
The bill came and it was something like $5000 and it said the insurance would only pay $3000 something and I had to meet the deductible first.

Then a week after, other bills from other people and places started rolling in.
In the end - - with my head swimming - I had to shell out a few hundred dollars from my pocket.
I never once got and detailed explanation of what was done and who did what.

Since the final tab was some figure that was reasonable - a few hundred dollars IIRC, I just rolled my eyes an chalked it uNo provider has ever tried to bill me for me than my portion, so fa to life.


No provider has ever tried to bill me for me than my portion, so fa
Under our old insurance, things were confused, but, the bills seemed to get paid & we ended up not having to shell out a whole lot.

That all changed last December when my wife retired. The retirees are all covered under a different policy.
Not only is it more expensive, it seems like every time we need something it's not covered.
My wife had a prescription for some medication for her knee.
The discounted price for a 1 ounce tube was $1700! My wife asked what our co -pay was and the girl said the insurance didn't cover that medication. The approved alternate was- - over the counter Aleve. The $1700 price was after getting a $1200 discount!

I went into the doctor last week. My legs got all swollen and started to ooze fluid. I had to get them wrapped last Thursday. No one can or will tell me how much this is going to cost. Every time they ask if I'm still taking other medications, I tell them the same thing - - I can't afford the stuff, so ,no, I'm not taking anything.
Then I get a lecture about how i should always follow the doctors orders. (What part of "I can't afford it", is lost on these people?).

We'll have to see how unaffordable this latest wonder cure is....

[Jim Koepke]

Reading this makes me appreciate my medical provider that much more. It is a nonprofit HMO with most of the services in one place. At times some services are authorized through out of plan providers.

In the case of getting a bill from a doctor who had nothing to do with your treatment, I would wonder if it isn't outright fraud. It isn't a new trick to send a bill to a person or business "for services rendered" in the hope some sucker will just pay the bill and forget it.

Yes, when challenged they will claim a billing error. Maybe there should be a report to the state medical board or insurance commissioner.

jtk

[Brian Elfert]

I get those too...My biggest problem with them is that the numbers (charges) never jibe.
I had one for $7 some thousand dollars for a sleep study.
Nothing was said of what the insurance covered.
I looked up online what the insurance allowed and it was something like $1200.
The bill came and it was something like $5000 and it said the insurance would only pay $3000 something and I had to meet the deductible first.


I had a sleep study last winter. The claim from the insurance company was easy to read. The clinic charged $1728 for the sleep study, the insurance discount was $605.31, and the amount I owed was $224.58 (20%).

[Terry Hatfield]

I understand why the billing is how it is but I agree with Brian that's it's really confusing to get so many bills from all over. I had gallbladder and hernia surgery at the same time in September. I had an assortment of tests, cat scan, ultrasound, hida scan etc.., leading up to the surgery. The shear number of bills was ridiculous. Added to that is the ongoing nightmare of what Bill spoke about, incorrect billing. Every person involved with the whole ordeal billed the correct amount except the hospital. They billed over $40k more to the insurance company than their contracted amounts for those procedures. What has transpired is a totally ridiculous situation.

Some of the charges were reduced to the proper amount and some were denied all together. There were procedures that needed prior approval by the insurance company that the hospital did not get the proper authorization. The insurance company denied those charges which the hospital promptly billed to me which they cannot do per their contract. They refused to remove those erroneous charges even after repeated phone calls including conference calls between me, the insurance company and the hospital. They finally agreed to put those charges under review. By then I had threatening letters from the hospital saying they were going to turn me over to collections. Another conference call between all of us resulted in the hospital representative promising they would not do anything until the reviews were complete. They turned me over to collections the next day anyway. After many more calls I have the collections deal on hold...I hope. I made it clear from the very start that I'll pay the correct amount as soon as I'm billed the correct amount. I found out during this process that the hospital is already in a class action law suit because of improper billing practices. I've since filed a complaint with the Arkansas attorney general.

[George Bokros]

My wife had a hospital bill that I requested I be permitted to pay over three months. I had no response to my request to pay over three months. Next thing I get is a letter from a collection agency. I called them and they offered to let me pay over six months. Guess the hospital lost on that one. They had to pay the collection agency probably 1/2 of what they collected and took them twice as long to get their money as I originally offered.

[Wade Lippman]

I do have insurance, but I still have to pay 20% myself.

Be very careful of this. You only have to pay 20% of what the insurance company negotiates with the provider; not what the provider bills.

We got a $950 bill for an ambulance. I told them to put it though my insurance. I had to pay 100%, but it was reduced to $400 because that was the insurance company's cost.

[Brian Elfert]

Be very careful of this. You only have to pay 20% of what the insurance company negotiates with the provider; not what the provider bills.


Correct. In the case of my sleep study the insurance contracted cost was $1122.69. I had to pay 20% of the $1122.69. I always check to be sure the providers are charging me the correct amount and they have never over billed me, so far.

I stayed overnight in the hospital once. The hospital charged over $7,000 for their services and my insurance only paid them $2,250. The hospital had to eat about $5,000.

[Michael Weber]

I've been entertained by insurance EOB's for years. What the insurance pays as a percentage of the charge is often ridiculous. Sometimes just a few cents on the dollar. I always feel bad for those without insurance who are billed for the entire amounts. Of course they may not pay but the health industry knows that. A businessman once told me hospitals love those big uncollectable debts. Probably worth more in tax write offs than the percentage they would have been paid by an insurance company. It's just way to complex a situation to last. Powerful people and companies constantly butting heads to maximize profits. Sad

[Brian Deakin]

To Contrast

I live in the United Kingdom and if treated within the National health service there are no costs other than prescription charges and dental charges

(There are no prescription charges when you are in hospital and no prescription charges for your discharge medicines )

The prescription charges when seeing your doctor are are £8.20 per item ($12 approx )and that cost is only made if you fall outside the groups below

Further you have a number of medicines you can buy a pre payment certificate which costs about $150 per year which covers the cost of all prescriptions



Who is entitled to get free prescriptions in England?



If you are aged 60 or over.
If you are aged under 16.
If you are aged 16, 17 or 18 and in full-time education.
If you are pregnant, or have had a baby in the previous 12 months, and have a medical exemption certificate (see below).
If you have a listed medical condition and have a medical exemption certificate (see below).
If you are an NHS inpatient.
If you (or your partner) get one of the following:

Universal Credit.
Income Support.
Income-based Jobseeker's Allowance.
Income-related Employment and Support Allowance.
Pension Credit Guarantee Credit.


If you are entitled to, or named on, a valid NHS tax credit exemption certificate.
Some war pensioners - if treatment is connected with the pensionable disability.
People on a low income who have a certificate HC2 (see below).

If you are entitled to free prescriptions, complete the declaration on the back of the prescription and sign it. You may be asked for proof that you are exempt.

Who can get a medical exemption certificate?

If you are pregnant or have had a child in the past year

You need to apply for a Maternity Exemption Card, using form FW8. The form is available from doctors, nurses, midwives and health visitors. You are required to complete the form and your doctor, nurse, midwife or health visitor will sign the form to confirm the information given by you is correct.
The card will last until 12 months after the expected date of the birth (you can apply for an extension if the baby is born late). If you have a Maternity Exemption Card all your prescriptions are free, whatever the medication is for.
Related articles (http://patient.info/health/free-or-reduced-cost-prescriptions/related)



Help With Health Costs (http://patient.info/health/help-with-health-costs)
Employment and Support Allowance (http://patient.info/health/employment-and-support-allowance)
Healthy Start (http://patient.info/health/healthy-start-leaflet)
More related content (http://patient.info/health/free-or-reduced-cost-prescriptions/related)



People who have certain medical conditions

Although there are many conditions requiring regular medication, only the following qualify for an exemption certificate:


Treatment for cancer; note this includes treatment for the effects of cancer, or treatment for the effects of a current or previous cancer treatment.
A permanent fistula requiring dressing.
Forms of hypoadrenalism such as Addison's disease.
Diabetes insipidus and other forms of hypopituitarism.
Diabetes mellitus, except where treatment is by diet alone.
Hypoparathyroidism.
Myxoedema (underactive thyroid) where thyroid hormone replacement is necessary.
Myasthenia gravis.
Epilepsy requiring continuous anticonvulsive medication.
A continuing physical disability which means you cannot go out without help from another person.

If you have one of the specified conditions ask for an application form, FP92A, from your doctor's surgery. You need to fill it in and your doctor (or an authorised member of the practice staff) will sign to confirm the information you've given is correct. You will then be sent a Medical Exemption Certificate which is valid for five years.
If you have a Medical Exemption Certificate all your prescriptions are free, whatever the medication is for.

How can people on a low income apply for help?

Some people on a low income may qualify for help with prescription charges. Your entitlement to help is based on your circumstances, such as your level of income, savings, etc. You will have to fill in an HC1 form 'Claim for Help with Health Costs' giving various details of your circumstances and then send it off in the prepaid envelope provided.
If you qualify for help, you will be sent an HC2 Certificate for full help, or an HC3 Certificate for partial help, which you will need to produce when paying for your prescription. The certificate will tell you whom it covers and how long it lasts. If your circumstances change for the better, you can continue using the certificate until it expires. If your circumstances change for the worse during the period of the certificate, you should make another claim. If your circumstances will remain unchanged after the time period then make a new claim before the current certificate expires.


regards Brian

[Terry Hatfield]

To Contrast

I live in the United Kingdom and if treated within the National health service there are no costs other than prescription charges and dental charges

The prescription charges are £8.20 per item ($12 approx )and that cost is only made if you fall outside the groups below



You can get free NHS prescriptions if, at the time the prescription is dispensed, you:


are 60 or over
are under 16
are 16-18 and in full-time education
are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx)
have a specified medical condition and have a valid medical exemption certificate (MedEx)
have a continuing physical disability that prevents you from going out without help from another person and have a valid MedEx
hold a valid war pension exemption certificate and the prescription is for your accepted disability
are an NHS inpatient


You are also entitled to free prescriptions if you or your partner (including civil partners) are named on, or are entitled to, an NHS tax credit exemption certificate or a valid HC2 certificate (full help with health costs), or you receive either:


Income Support
Income-based Jobseeker’s Allowance
Income-related Employment and Support Allowance, or
Pension Credit Guarantee Credit
Universal Credit (http://www.nhs.uk/NHSEngland/Healthcosts/Pages/universal-credit.aspx) and meet the criteria (http://www.nhs.uk/NHSEngland/Healthcosts/Pages/universal-credit.aspx#entitlement)

regards Brian





That's it. I'm moving. Do you have an extra room, Brian? :D