The shocking truth about medical bills that can save you thousands

This reader story is by a longtime GRS reader Sumitha from afineparent.com, a blog founded on the simple belief that “Good Parents Are Made, Not Born.”

Some reader stories contain general advice; others are examples of how a GRS reader achieved financial success or failure. These stories feature folks with all levels of financial maturity and income.

How much would you think it would cost to treat an ant bite?

Yes, an ant bite.

Nope, its not $100. It's not even $1,000. How about $2,356?

On Easter Sunday, my husband and I got together with a bunch of friends and took the kids for the annual egg hunt at the neighborhood park. As the little ones were scrambling around for the eggs, we parents stood on the sidelines discussing their antics, the weather and the latest gossip. My husband, who is extremely allergic to ant bites, happened to be standing at the edge of an ant hill.

Suddenly, he started to itch all over and then right before our eyes, he began to inflate like a big red balloon. Considering that it was the Easter Sunday, we thought nothing would be open and rushed him to the closest emergency room. After a shot and an hour of observation, they sent him home, hale and healthy, to enjoy the rest of the weekend with our friends.

We thought nothing about it for a few weeks, until the bill arrived. When I opened the bill, I just about needed an emergency room. Since we have a high-deductible insurance plan, the entire portion of the bill was our responsibility!

Once I regained my bearings, I huffed and puffed — railed and ranted. Normally, after letting out the steam, I would have grudgingly paid the bill. But this happened just the month after I‘d quit my job, and I was not going to spend a chunk of my savings on an ant bite. I don't mind paying a doctor for a complicated procedure – they sure do earn their fees. But, this wasn't brain surgery; it was an ant bite!

I sat on that bill for a couple of days until I calmed down a bit. And then one day after my husband left for work and my daughter was in school, I settled down in a sofa with my phone and the bill.

First, I called the billing phone number. Unfortunately, I ended up talking to a very unsympathetic lady. When I failed miserably to appeal to her sympathy, in frustration, I asked her if she could provide me the hospital's direct number. She suggested that I talk to someone in their business office instead.

I was feeling quite hopeless already by the time I called the business office. This time, however, I got lucky and ended up talking to an extremely kind and sympathetic lady.

Did you even know that you could bargain down a medical bill?

I didn't either. Here's how our conversation went.

Me: <explaining our woe at length>

She: <listening patiently>

Me: So, is there anything you can do to help me out? I just can't bring myself to pay $2,356 for an ant bite.

She: Well, I have to offer you the same thing that I offer our other customers. Will you be able to pay the bill if I extended the due date on your bill by 30 days?

Me: No, you don't understand. It's not that I can't pay the bill, I just don't want to. It does not seem right to pay thousands for an ant bite

She: <Still very patient, and talking in a slow conspirator voice> I understand, but I have to offer you the same thing that I offer our other customers. Now, would you be interested in delaying your bill by 30 days?

Me: <Sighing deeply> No.

She: How about if I offered to split it into six equal payments?

Me: <Starting to feel hopeless again> Please try to understand. It's not that I cannot afford it. On a principle, I cannot bring myself to pay thousands of dollars for an ant bite.

She: <In the same, slow conspirator voice as before> Ma'am, I understand. But, I have to offer you the same thing that I offer our other customers. Now, would it help if we split your bill into no equal payments?

Me: No, thanks.

She: OK. How about if I offered you a 10 percent discount? Would you be able to pay the bill today? That would come up to $2,120.

Me: <Slowly catching on> No, thanks.

She: How about if I took off 20 percent? That would come up to $1,884. Would you be able to pay the bill today?

Me: You are very kind, but no, I still cannot pay that.

She: That is the most I am authorized to offer.

Me: <Sigh. Silence>

She: Do you mind if I put you on hold for a minute? Let me talk to my supervisor and see if there is something more we can do.

Me: Thank you very much! I will hold.

She: <After a short silence> Ma'am, my supervisor said we can offer you a 30 percent discount. That will bring your bill to $1,649.20. Is that something you can pay today?

Me: <Feeling like I'm in an episode of “Deal or No Deal”> Thanks, but I will pass.

She: <It's easier now. She knows I'm onto the game.> How about 40 percent? That will come to $1,413.60.

Me: No, thanks.

She: I can offer you 50 percent off to bring your balance to $1,178.00. Will you be able to pay that today?

Me: No, thanks.

She: <In a soft voice signaling that the game is over> Ma'am, this really is the best we can offer.

Me: Thanks, I appreciate that you have been so kind. But I really don't want to pay more than a thousand for an ant bite. Is there anything you can do to bring it to triple digits? Can you speak with your supervisor again?

She: I wish I could, but this is the most our department is allowed to offer. I could offer you 30 days to pay it or let you pay it in six equal payments, but that is as far as we can go.

Me: <Still not ready to give up> No, I don't need extra time, I just need some more reduction in the bill. Put yourself in my spot: Would you be willing to pay $1,000-plus for an ant bite?

She: <In a very kind and gentle voice> I completely understand. But please understand that this is really the best we can do. There may be other means you could pursue…

Me: <I suspect she meant that I let it go to collections. I let out a deep sigh.> OK, thanks. Let me go ahead and take care of it then.

So, I ended up paying $1,178. It's a lot more than what I would have liked to pay, but also a lot less than what I would have paid had I not picked up the phone and negotiated!

The adjusted medical bill

The adjusted medical bill

Lessons learned from this experience:

  1. Don't rush to the emergency room if you can avoid it. I learned later that going to an urgent care facility, which is usually open on weekends, might have resulted in a much lower bill.
  2. Medical bills are negotiable. Don't just pay the bill if you feel that the services rendered do not justify it. Call up the billing number and ask to be connected to the business office and see if they can help you reduce the bill.
  3. Be kind to the representative on the phone. I've recently been reading a lot of Dale Carnegie and Napoleon Hill's books and so, I decided to let myself calm down before making the phone call and venting out my frustration. I suspect this helped persuade the lady on the other end to show me (despite my slowness in catching on!) that it's possible to negotiate a medical bill.

How about you? What's the worst medical bill you've had to pay? Did you try negotiating it down?

More about...Health & Fitness

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Beth
Beth
7 years ago

I have to say the U.S. healthcare system baffles me. Here’s how it looks to an outsider: Patient: health insurance is really expensive, so I keep my costs low with a higher deductible and an emergency fund. Hospital: we’re happy to treat you, but we won’t tell you upfront how much things costs. You’ll get a surprise in the mail later on! Patient: Wow. This bill is huge for something relatively simple. I have the money in savings, but I don’t want to pay that much. Hospital: That’s okay, if you say you can’t afford it (whether it’s true or… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Beth

Beth, I don’t understand a whole lot about the health care system, but I know that the answer to your question “I can’t help but wonder if hospitals charge insurance companies one rate and individuals another.” is “Yes”. And it is done quite openly. When I receive a bill, there is regularly a line item for “insurance adjustments” which sometimes knocks as much as 80% off the original charges. I’ve always wondered what would happen if I didn’t have any insurance and shuddered.

Debi
Debi
7 years ago
Reply to  Sumitha

The uninsured get charged the full amount and when they can’t or don’t pay, the providers eventually have to write off the charges and then increase the amount that they charge the insured to make up the difference. The insurance companies increase the patient portions of the billed amount and the insured patients pay for the uninsured. The cycle repeats and the costs for those of us with insurance goes up and up and up.

RickyJo
RickyJo
6 years ago
Reply to  Sumitha

I just want to confirm with Sumitha said. Strange is it may be, it is common knowledge in the United States that insurance companies pay less. They negotiate contracts that explicitly get them partially off the hook. If a hospital wants costumers with certain insurance they have to cut the insurance company a deal. In my experience the insurance company negotiates away >50% in almost all cases. If the hospital won’t play ball, and you have to go that hospital, you may end up footing almost the whole bill(which, again, is twice as much) no matter how “good” your insurance… Read more »

Rubymermaid
Rubymermaid
7 years ago
Reply to  Beth

Yes my surgery last year was original about 70,000 and the insurance company only paid 30,000 for it. If I would have had to pay it without insurance I would have paid the 70,000…

Libit
Libit
7 years ago
Reply to  Beth

Beth, I dropped my health insurance when it went up to $1,000 a month just for me, over ten years ago. I have found that some doctors and all hospitals will give a discount to the uninsured. A few years ago I had to spend the night in the hospital and have several tests. The hospital bill was $13,000 dollars. That did not include the tests and those preforming the test or those reading the tests. We spoke with a friend in the health insurance industry and he suggested we call the hospital administrator and offer to pay 30%, what… Read more »

Ross Williams
Ross Williams
7 years ago
Reply to  Libit

One of the good things about the new health care law is that no one is “uninsurable” any more. The insurance companies will no longer be able to deny coverage for pre-existing conditions.

cheryl
cheryl
6 years ago
Reply to  Beth

So, what do you do when your husband goes into the hospital for colonoscopy? its a preventive thing and not to cost any thing but we are getting billed over 900.00 and there were 2 other people that he works for that said they didnt pay a dime, not even the co-pay!!! i say rip off!!!

uri
uri
6 years ago
Reply to  cheryl

cheryl,

that might be a mistake that could get sorted out by talking to the insurance company. if that doesn’t work out, you might try your union rep or if you don’t have one, your company’s HR person.

Alex
Alex
6 years ago
Reply to  Beth

I am a single Parent of a 16 year old Boy (insured throgh Blue Cross blue Shield w/ a $700 deductible) Last 4 th of July weekend I allowed my Son to stay at his Aunt’s for a couple of weeks in Oklahoma, we reside in TX. I dropped him off on Saturday, he ate dinner with his Aunt that same evening and apparently got really sick on Sunday early morning. I got the call at 4am on Sunday, He was pale and complainng a lot, so before calling me, she took him directly to the emergency room at St.… Read more »

Tracey H
Tracey H
7 years ago

I agree with Beth. And I can’t understand how such a big country can’t have universal government-paid (from taxes) health-care with no middleman. It’s incomprehensible.

Beth
Beth
7 years ago
Reply to  Tracey H

I don’t mean to make this conversation political. I just don’t understand why negotiating for a lower bill as if you’re buying a car or something should be necessary?

I don’t know if universal health care is possible or even practical for the U.S. — it’s not my call to make. But I can’t help but wonder if greater transparency about the process and the costs would help people make more informed decisions?

(To be fair, our heath care systems is flawed too, but in different ways. I think Canadians could also be better informed about the process and costs.)

Adam
Adam
7 years ago
Reply to  Tracey H

It certainly is a screwy system, and far from optimal, but it’s that “government paid” part that a lot of us Americans get stuck on, including me. Simply do not want the government involved.

Kingston
Kingston
7 years ago
Reply to  Adam

I don’t know, I’ve found the government does a pretty good job with my mom’s Medicare. I’d be really happy if I could pay into Medicare rather than give my money to an insurance company whose business model is to deny claims or try to kick me out of the program if I get sick.

Adam
Adam
7 years ago
Reply to  Kingston

(snark)The run it so well that it’ll be in the red as soon as 2017.(snark)

I truly believe a single-payer system is inevitable, the practical benefits are just too great. And it’s probably the best option we have. But, on principle, I can never bring myself to support it. And Medicare doesn’t make me feel any better about the idea.

Judy
Judy
7 years ago
Reply to  Tracey H

This is a personal experience note. While I like the “idea” of an easier universal healthcare, other countries that already have it they have their own issues. My cousin, who lives in Sweden where they have socialized medicine, was diagnosed with a brain tumor. At the time he was still active and fine, if he were in the US he could have had the surgery in under two weeks (another relative had the same issue in the US, hereditary I guess). My cousin ended up waiting almost 2 years for the surgery. In that time he got worse and worse,… Read more »

Daisy
Daisy
7 years ago
Reply to  Judy

…and if he had been unemployed and living in the US he would never have found the brain tumor because he would not have had a primary care physician to visit. He would have been rushed to the emergency room when his symptoms got too bad to ignore and had to bankrupt his family for the surgery.

Healthcare tied to employment = injustice.

Robert
Robert
7 years ago
Reply to  Daisy

while not having employment does make it hard to have healthcare, there are already programs that we pay for by our tax payer dollars to cover the uninsured. There is medicaid and many county clinics were local counties pay for indigent care. So to say that healthcare is totally tied into employment here in the United States is absolutely untrue. If you do feel its a right and justice to have everyone covered. I am fine with that. That would fix the problem of the original poster “negotiating” fees out of hard working physicians and increasing cost as it would… Read more »

Ross Williams
Ross Williams
7 years ago
Reply to  Daisy

Medicare is the least expensive medical insurance in the country because the government can negotiate the best rates. Similar universal care for everyone paid for by government would reduce the cost of health care. It would do that at the expense of insurance companies, medical equipment manufacturers, drug companies, hospital and other health care administrators and medical providers. Which is why it hasn’t happened.

To reduce costs either someone needs to get less service or the service they get has to be less expensive. Less expensive means less money for the people who provide it.

Robert
Robert
7 years ago
Reply to  Judy

Ross, actually medicaid is the least expensive medical insurance…in general. Also, Medicare doesn’t negotiate a rate. They just unilaterally state that they will pay X rate for X procedure, test, visit etc… and that is set for the year. Physicians and hospitals do get a chance to argue the rate but the decision is pretty unilateral. The sequester where all of healthcare took a automatic 2% cut across the board. This unilateral rate determination is why some physicians are no longer taking medicare patients and doing “concierge care” as they feel that the payment is less than the cost of… Read more »

Robert
Robert
7 years ago
Reply to  Robert

whoops sorry you did mention patients…less services

=]

Margaret
Margaret
7 years ago

I have to agree with Beth. I am Canadian and my husband is British, so neither of us understand the American medical system.

I think this whole thing is insane. No one should have to pay for basic medical treatment.

Marsha
Marsha
7 years ago
Reply to  Margaret

Why shouldn’t we have to pay for basic medical treatment? We pay for food, shelter, clothing, and other necessities, right? Doctors, nurses, hospitals don’t work for free. Someone is paying for it–usually the taxpayer.

I’m not saying the US health care system isn’t seriously broken. I’m just saying health care isn’t free.

Brent
Brent
7 years ago
Reply to  Marsha

Seriously? Do you really think that Margaret meant no one should pay anything whatsoever at any time for medical care? I am giving her the benefit of the doubt and assuming she meant health care should be paid for collectively, by taxes, and not left up to the individual. Our taxes already pay for unpopular wars, why not divert some to healthcare while we’re at it? I don’t think Margaret was implying doctors and nurses should be handing out free medical care and then going out and working second and third jobs to cover their living expenses. Cut her some… Read more »

Marsha
Marsha
7 years ago
Reply to  Brent

I was making a simple statement. You’re the one that read all the political stuff into it. And you didn’t answer my question–how is health care any different than other necessities of life that we pay for?

phoenix1920
phoenix1920
7 years ago
Reply to  Brent

@ Marsha I must be misunderstanding you because it sounds like you are fine with a system where we as a society have to tell a poor parent, “I’m sorry but your child will die because you are too poor to pay for medical services.” We, the taxpayers, pay for roads, but not life-saving medical treatment?! Are you suggesting that people should DIE because they can’t pay for medical treatment? Here, the OP’s situation would have been dire–life-threatening–if it was not for modern medicine. OTOH, if you recognize that people should be about to access medical care for life-threatening situations… Read more »

Anna
Anna
7 years ago
Reply to  Marsha

When people go bankrupt because of their medical bills, there’s a problem! I too am Canadian, and, through my taxes, pay for health care. I’m happy to do that…it means that if you’re sick, you go to the doctor without worrying if you can afford it. It means that if you have to go to the hospital, you don’t have to worry that you can’t afford to live for the next few years to pay for it. It means that you can have cancer screening tests that could save your life, again without worrying if you can afford it. How… Read more »

Marsha
Marsha
7 years ago
Reply to  Anna

Everyone has their own opinion of what is “fair”; there’s certainly no universal consensus.

And even in a country with universal health care, there will always be advantages to those who can pay for more or better care, even if they must travel to obtain it.

Dianth
Dianth
7 years ago

That’s ridiculous. My husband is chronically ill and I, as his caretaker, go through this crap all of the time. I can’t get on the phone with them because now my blood pressure goes up! I have gotten to the point of telling the healthcare industry that, if it is this much of a hassle to get my bills paid, I am no longer going to have mammograms, pap smears and well checks! And to imagine that we are paying large amounts of money to be put through this baloney!

Will
Will
7 years ago

Quite a few years ago, I was exposed to a child with chicken pox. I was unemployed and uninsured, and called a friend who was a doctor to see what

Will
Will
7 years ago
Reply to  Will

Oops. Posted before it was done. Anyway… He said go get a blood test. All the local hospitals said it would be $25-40, except the one I could walk to wouldn’t give me a price. I went to that one anyway, thinking it would be close to the same price. Before I even got my test results back, I was charged $125! I called, explained what happened and offered to pay %50. They said I owed $125 and that is what I had to pay. They wouldn’t negotiate at all. I let it got to Collections, and I got my… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Will

Ouch Will, I am so sorry to hear that! I guess to a certain extent it depends on who you end up talking to as well… in my case the first person I spoke to was completely unsympathetic and quite impatient with me when I tried to explain the situation. I guess I got lucky with the second lady who was nice. $1,178 for treating an ant bite is still too steep for my liking, but I am glad she helped me get it down from $2,356!

Carla
Carla
7 years ago
Reply to  Will

That’s been my experience too – I had to pay 100% of it or close to it. The only time I had a bill wiped out is when I was unemployed and my unemployment insurance expired.

hina
hina
7 years ago

even though one has a high deductable. the insurance card should be given to any medical professional when using services. i have a high deductable insurance and the first year i didnt give my medical card, so i was paying a higher price for medical services…i talked to a patient advocate at this medical clinic went back and looked at my previous year and credited me. talking to different people i realize will improve your outcome…

Sumitha
Sumitha
7 years ago
Reply to  hina

That’s interesting, Hina, thanks for sharing. I think we did provide our card, but I did not see a “insurance adjustment” kind of line item on our bill. That is something I should have probably looked into first.

Lindsay
Lindsay
7 years ago
Reply to  Sumitha

Here’s another trick that works in the US healthcare system, if you have insurance, don’t pay the first bill you get from the hospital. Don’t pay the second. You may notice something interesting. Your insurance company might be negotiating the prices down further with each bill you receive. So if you pay your bill promptly when you get it, you lose. Wait until they’re threatening to send it to collections, then pay it.

Robert
Robert
7 years ago
Reply to  Lindsay

Lindsay, you can’t be serious. Not only is this a bad idea it is totally irresponsible. Would you not pay your mortgage and wait until something happens then renegotiate? Also, this shows how little you understand about the payment with insurance. The price between the insurance company and the hospital has already been determined. It’s a contract. When you don’t pay, the hospital already got it’s payment from the insurance…it’s just waiting for your portion. YOUR PORTION that you also agreed to when you purchased your insurance…read the contract! It will say 80/20 with a $500 deductible but no name… Read more »

Rhonda
Rhonda
7 years ago
Reply to  Lindsay

I work in medical billing. I have for many years. I can assure you that the insurance company does not negotiate rates on a case by case basis. I do not recommend you delay paying the bill hoping for the insurance to step in and save the day. Here’s the deal folks…hospitals & doctors have negotiated rates with insurance companies and Medicare. Insurance companies generally base their rates on what Medicare allows. Some a little more, some a little less. Hospitals only anticipate collecting about 40% of billed services from the insurance. Some claims receive a higher percentage, some alot… Read more »

Robert
Robert
7 years ago
Reply to  Lindsay

wonderful post!

Amy
Amy
7 years ago

” No, you don’t understand. It’s not that I can’t pay the bill, I just don’t want to. It does not seem right to pay thousands for an ant bite” Wow. You just don’t want to? Wow. Short of figuring out if you were over billed for services rendered, I question the ethics of your bargaining down the bill, just because you didn’t want to pay it. I just paid over a thousand dollars for some blood work. I too churned over the rate, and ultimately decided that, as I hadn’t been over billed (I looked into it) I would… Read more »

Will
Will
7 years ago
Reply to  Amy

COULD you pay $100 for a $10 hamburger? Probably. SHOULD you pay $100 for a $10 hamburger? I think not. As I related in my story above, I was told by the hospital “We can charge whatever we want.” That doesn’t make it fair, ethical, or justifiable.

Amy
Amy
7 years ago
Reply to  Will

I think that might be a poor analogy – to compare a serious allergic reaction to an insect bite to a hamburger. Taking things strictly at face value – yes the hospital can charge whatever they want, as they are the certified professionals and have a business to run. You have the option to not patronize that business if you don’t like the prices. As the commenter after me surmised “you ate the steak”. Does your negotiating out of your financial obligations lay a burden on someone else to pay the difference? I just don’t see how this was the… Read more »

Will
Will
7 years ago
Reply to  Amy

Okay, we can’t compare it to a hamburger but we can compare it to a steak. Anyhow, the point is, prices are not posted. If I went to Ruth’s Chris Steakhouse, I wouldn’t expect to get a great steak at the same price as I would at Ponderosa. Why not? Because the prices are posted/listed, and I’d know going in what I was getting into. “But it saved your husband’s life! It wasn’t just a bug bite, it was a life-saving procedure!” Then why just charge a couple thousand? Isn’t a life worth much much more than that? The charge… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Amy

Amy, yes, I didn’t *want* to. As I mentioned in my OP, I don’t mind paying for the services if it is justified. But I sincerely don’t think $2000+ for an anti-inflammatory shot was justified. Like Will said, I don’t pay $100 for a $10 burger or $1000 for a handbag, so I don’t see why I should pay $2000+ for a shot that costs much, much less.

Holly
Holly
7 years ago
Reply to  Sumitha

Yes, but you want the hospital to have a 24/7 space available for you to go if you need care. And you want that space to be staffed with highly-trained professionals, stocked with any expensive pharmaceuticals and supplies that *might* be needed, and equipped with a wide range of super-expensive medical equipment ready to go, *just* in case you or your loved ones need it.

That costs a lot of money.

If you want the $100 appointment, you should have taken your husband to the CVS Minute Clinic.

stellamarina
stellamarina
7 years ago
Reply to  Amy

Our local blood testing lab will give an instant discount on the day you give blood if you pay the total amount right there. It is a special for those who do not have insurance.

Debi
Debi
7 years ago
Reply to  Amy

I don’t see how bargaining down the final cost of the bill is any different than bargaining for a price on a car, house, furniture, etc. The only difference is that medical providers will not tell you what a service will cost before they perform it. You have no choice but to bargain after the fact.

Kate
Kate
7 years ago

I am disabled due to a congenital condition and have been dealing with the system for many years. There are multiple causes for the problems in our system. The author’s husband had an allergic reaction- a frightening and potentially life- threatening scenario. She admits she could have gone to an urgent care but did not. So, she went to the hospital, received treatment and only quibbled about the bill later. She freely admits that she was able to pay the bill, she just didn’t WANT to. By haggling, she has potentially deprived someone truly needy from getting medical treatment. One… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Kate

Kate, Thanks for taking the time to comment. I see you point, and I admit I don’t understand the health care system. All I want is to pay for the services that were rendered to me – no more, no less. I didn’t go to the emergency room with the intention to get the services and then haggle it down. I went to the emergency room because it was an emergency and in the moment, I didn’t think any other doctors offices were open that day. They treated my husband with a shot. So, charge me for the shot and… Read more »

LeRainDrop
LeRainDrop
7 years ago
Reply to  Sumitha

It sounds like that is what they charged you for, and you just didn’t like the price. That said, I applaud you for negotiating down so much of the bill, especially since it seems clear the hospital business office had no problem giving such a discount.

Maddie
Maddie
7 years ago
Reply to  Kate

“She freely admits that she was able to pay the bill, she just didn’t WANT to. By haggling, she has potentially deprived someone truly needy from getting medical treatment.” Really? She was very open and honest about the fact that she was NOT truly needy when she was on the phone. She said that she could pay, she simply thought it was wrong to have to pay so much. The woman on the other line made the choice to come down on the price, knowing the real reason. The hospital isn’t going to run out of money to serve truly… Read more »

Mark
Mark
7 years ago

You weren’t charged $2400 for the treatment of an ant bite, you were charged for the treatment of a very serious allergy. What triggered that allergy is irrelevant, whether its an insect bite or a peanut.

Acute analphylaxis can be life threatening, and I’m sure the emergency room treated it with the urgency it deserved. Being kept under observation by trained professionals in a facility prepared to deal with the worst case scenario isn’t inexpensive, even in a single payer system where those costs aren’t obvious.

Good job on negotiating down the price you paid though.

Sumitha
Sumitha
7 years ago
Reply to  Mark

Mark, Thanks for stopping by to comment. Yes, I understand that the care we received is not inexpensive. But I personally don’t think it should be so expensive either (and I agree I am biased here). If they have room to negotiate the price down with a clear cut guidelines of 50%, I am guessing that may be their “margin” and what I paid may be what really cost them?

Mark
Mark
7 years ago
Reply to  Sumitha

Insurance companies and medicare/caid arent shy about negotiating down the price they pay for various services.Out of pocket patients will often be charged more up front though, with most hospitals knowing they’ll never get the full amount. I’d say in your case, you probably got down to a similar amount that an insurance company would have paid. Just to be clear though, that doesnt mean it necessarily covered the costs of your treatment. Most hospitals are not for profit, and rely on charity in order to keep functioning. If you went to an urgent care facility, they will probably have… Read more »

Rhonda
Rhonda
7 years ago
Reply to  Sumitha

You’re on target with the cost estimates. In our hospital system we hope to collect 60% of charges but 40-45% is typical….Yes, yes, we would all prefer to just bill the actual cost, but that is not how the US healthcare system is set up. The insurance “discount” is deeply ingrained as a selling point for insurance and governmental payers alike.

SAHMama
SAHMama
7 years ago

If your husband spends any amount of time outdoors and knows he’s allergic to insect bites, WHY DOESN’T HE HAVE AN EPI-PEN??? That alone could have saved you the trip!

Sumitha
Sumitha
7 years ago
Reply to  SAHMama

We do have a prescription for an epi pen now. I think my husband is allergic to a particular kind of ant (fire ant?). He’s been bit before, but it wasn’t so bad. Well, lesson learned 🙂

Kate
Kate
7 years ago
Reply to  SAHMama

Actually, he should still have gone to an emergency room (or urgent care centre, depending on what services the urgent care centre offers) even if he had used an epi-pen. I had always learned (or maybe assumed?) that an epi-pen stops an allergic reaction in its tracks. Now that I’m married to someone with an anaphylactic allergy to peanuts, I’ve learned that it doesn’t actually stop the reaction. It just buys you an extra *fifteen minutes*. If you live any further than 15 min from a hospital (or you’re travelling, etc.) you should really carry more than one and be… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Kate

Whoa, I didn’t know that! Thanks for letting me know, Kate! I’m starting to think that I should take this allergic reaction a lot more seriously than I have!!!!

Kate
Kate
7 years ago
Reply to  Sumitha

No problem!

I was so surprised when I learned that, I figured I should spread the word…

Barbara
Barbara
7 years ago

I am a registered nurse and want to say loudly and vehemently… IT WAS NOT “JUST” AN ANT BITE! Your husband had a life threatening allergic reaction to a bite and the emergency room staff may have saved your husband’s life by having the knowledge and the medication on hand to treat him. Would you have paid under $2,500 to save his life? I suspect you would have paid many multiples of that if it was framed that way. Yes…you could have saved money by going to an urgent care center where again there would have been professionals (working on… Read more »

Will
Will
7 years ago
Reply to  Barbara

“…is one that kills dozens of people a day.” Why? Because the “dead beats” can’t afford to have it treated.

Sumitha
Sumitha
7 years ago
Reply to  Barbara

Barbara, Thanks for stopping to comment and for your services as an RN. I really do appreciate it. And you have officially freaked me out about the incident. When you put it that way, yes, I probably would have paid multiples more. But should I? I don’t agree with you however that the hospital negotiated the price because they have learned that some dead beats won’t pay for the services. If that were the case they would probably have negotiated more. They had very clear guidelines – 50% was the limit. I suspect they are just shrewd businessmen…. overcharge and… Read more »

Mark
Mark
7 years ago
Reply to  Sumitha

If they were shrewd businessmen, they’d never be running a hospital in the first place. Its pretty much the only business in the world where a person can come in unconscious and receive potentially hundreds of thousands of dollars worth of service, without certainty that they’re going to get paid back for them. If all it really was about was money and profit, they simply would have turned you away and your husband might no longer be around. Hospitals don’t get that choice, they literally can’t turn people away…and that’s part of why it’s so expensive. Also keep in mind… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Mark

Mark, you’re probably right. I don’t know the first thing about the health care system, and was probably out of line calling judgement on how it is run. That said, I am a regular person. If I run into a medical situation, that don’t seem to require an expensive intervention (in my case just an anti-inflammatory shot, as I see it — or at least *saw* it), I hope to have access to it at a reasonable cost. And a fixed cost…. I shouldn’t have to negotiate (if I hadn’t recently quit my job and didn’t have my savings account… Read more »

stellamarina
stellamarina
7 years ago
Reply to  Mark

The hospital was probably willing to only negotiate down to the same amount that is already negotiated as an insurance group rate.

Rhonda
Rhonda
7 years ago
Reply to  Sumitha

Again, there are laws in place regarding medical billing. Medical providers are required to bill the same rates to all payers equally regardless of insurance coverage. They do not actually expect to receive 100% of the charges on all bills though due discounts that negotiated with private insurance companies and the set Medicare rates (established as a percent of charges up to a maximum allowed rate). Under this system providers are forced to continually raise their rates to recoup the minimum amount needed to keep the doors open for all. This also places the hospitals in a position of having… Read more »

Nicole
Nicole
7 years ago
Reply to  Barbara

I am going to have to second this to some degree (disclaimer, I am a physician). Your husband had a life threatening condition which was treated by the emergency department. That charge covers the fees for a facility that has the things necessary to implement life saving procedures (i.e. emergency tracheostomy, intubation, defibrillation, etc) and the trained professionals at the ready on a holiday weekend to carry that out if necessary. It covers the triage nurse who saw him and determined his condition was life threatening and thus was able to have the MA room him and get his vitals… Read more »

Mark
Mark
7 years ago
Reply to  Nicole

Indeed. It’s a shame that our system is set up in such a way that people even need to consider cost savings alternatives like this. But the ER isnt concerned with saving you money….they’re concerned with saving your life, period. That’s the lens through which their decisions are made, they’re not just trying to run up your bill. Believe me, they want you in and out as soon as possible. You’re probably just associating allergies with hay fever, which is no big deal. No one can say for sure what would have happened had you gone to urgent care instead,… Read more »

Nikki
Nikki
7 years ago
Reply to  Mark

Actually, funerals cost less than a trip to the ED, especially if you opt for cremation. I don’t believe that a bag of salt water which costs $30-$60, should be marked up to $300-$600. And especially since hospitals do not post the price, they engage in all kinds of shenanigans to increase the cost then give a “discount”. If the hospitals choose to play that game, it is up to the consumer to beat them at it. The consumer (and yes, CONSUMER is the right word) is powerless in the matter because the hospitals and medical device industries buy off… Read more »

Robert
Robert
7 years ago
Reply to  Mark

Nikki,

I think that is the problem is that “you don’t believe” it should cost that. Do you know the true cost? To make a sterile solution to put in someones body and not give them an infection? The cost to pay for the other patients that can’t pay. That goes into the cost of the bag. You fail to see the big picture and the other elements that goes into the cost.

Not only that, due to healthcare contracts with insurance, we are only allowed to bill what YOUR insurance contracted with us.

Uri
Uri
7 years ago
Reply to  Mark

robert,

the problem is: if nikki refuses to pay a 1000% markup, and the medical provider takes her to court, not having signed a contract with nikki that says what the cost is, how is the medical provider going to prove to the court that the 1000% markup is reasonable?

Robert
Robert
7 years ago
Reply to  Mark

Uri, 1. you assume the mark up is 1000% when you don’t really know the true cost of the item, services do you? You just assume that the price is inflated and don’t take into consideration the other factors that go into the cost 2. and I won’t try to talk to you as you seem to have disregarded all the post Rhonda made about how insurances work. When you sign up for an insurance its a 3 way contract between you, your insurance provider and the healthcare official. She stated it sooo many times clearly. You seem to totally… Read more »

Robert
Robert
7 years ago
Reply to  Nicole

I am a physician too like Mark…and agree with him. A couple things about Sumitha and her family in this case. 1. Yes there are different prices. This came about due to the complexities of the insurance system. That is a provider will negotiate a rate with a health insurance company or have it determined by medicare/medicaid. The problem with some of those contracts is that it can be less than the cost of doing business so it has to be made up by higher cost else where. My friend who is an ER doc collects less than 40% of… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Nicole

Nicole, Thanks for stopping by to comment. Point taken.

Mark, I will move on from this discussion now. Its growing a little too morbid for me to stomach 🙁

Ingrid
Ingrid
7 years ago

Despite the good arguments that some of the other readers make (comment 15 and 16 for example) I have to agree with Sumitha that ER care (and almost all other medical care)in this country is way too high and if you have read recent articles in for example Time magazine you will have to agree that something is terribly wrong with our health care system. One warning, though. I tried before to take one of my son’s to urgent care for a serious problem to avoid the extremely high cost of an ER and they refused to accept him, because… Read more »

Robert
Robert
7 years ago
Reply to  Ingrid

Ingrid,

I understand your frustration…but you state if “procedures are billed fairly”.

Do you know or can you state what it “cost” for a procedure, test, doctors visit?

That is what is the overhead cost for those? If you know what it cost, please itemize it and explain it.

I think this is what the real problem is in America is people don’t understand what health care “cost”.

Sumitha
Sumitha
7 years ago
Reply to  Ingrid

Thanks, Ingrid. Yeah, I wish it was not necessary to negotiate too!

Peds ICU Doc
Peds ICU Doc
7 years ago

What bothers me a little bit is that the writer is making a value judgement about what certain medical care “should” cost. One of the biggest problems with healthcare in this country is that people do not place value on the cost of healthcare the way they place value on other services. People go to their mechanic for a noise and come out with a $1500 bill and do not flinch. However, people make an ER trip and think it’s unreasonable. Your husband had a life threatening allergic reaction and probably got steroids, epinephrine, and fluids. He had an MD… Read more »

Matt @ Your Living Body
Matt @ Your Living Body
7 years ago

It’s hard to get people to understand health care for those that don’t work in it. There are so many problems with it and Obama Care just adds another layer of problems. It would probably baffle people out there even more that just to stay on the unit that I work on is $10,000! Just to stay there! That doesn’t include any other costs!

Thomas | Your Daily Finance
Thomas | Your Daily Finance
7 years ago

Doctors office and hospital bills are a joke. We just had our daughter and when we spoke to our insurance about the bill we were like we don’t have 25k for a hospital bill the lady on the phone laughed. She was like thats what they want but thats not the negotiated rate. So I ask what was the rate and it was 5k!!!! WTF really they billed us 25k but were only going to get 5g’s. Just crazy. The lady said they do that just to see what they are able to get. Some places will pay them. Now… Read more »

Sumitha
Sumitha
7 years ago

Thanks, Thomas! Glad that you were able to get your bill down to $5K. I went through insurance for my delivery and paid around $2K-$2.5K. I have a friend who had a baby around the same time as me, but a C-Section and an additional day at the hospital, but she paid ~$1.5K. Go figure.

Stephen
Stephen
7 years ago

I agree with Marsha, health care isn’t free. Whether we pay more per procedure or we pay higher taxes for “universal healthcare”, the money has to come from somewhere and citizens will pay for it in the end one way or another. You may think universal health care is great but are the extra taxes great if you never get sick and never need the hospital? A low upfront payment per visit to the doctor feels great but you’re charged thousands more on taxes without fail every year. I think I’d rather pay a few thousand per visit and just… Read more »

Ely
Ely
7 years ago
Reply to  Stephen

This only works if you’re fortunate enough to be healthy. Many aren’t. You may think it’s not ‘fair’ to pay more in taxes when you aren’t sick. I bet they think it’s not ‘fair’ that they’re sick. To a healthy person, money seems like everything. A sick person would much rather have your health.
Go ahead and make all those judgements about lifestyle choices. Sure they are occasionally true. But keep in mind when you do that you punish the innocent as well as the guilty.

Gloria
Gloria
7 years ago
Reply to  Stephen

Stephen: Good luck on trying to stay healthy. You are also betting you will never have an accident. If you can control your future that well, you should figure out how to sell that gift. I’d love to never be sick again, and never have accidents. I work three part time jobs, but had to have a couple of procedures done. I have insurance from one of my jobs, but it is a “limited” plan and found out just how limited it was. My procedures cost me $60,000. I have less than $50 in checking. I’m already going through a… Read more »

Carmen
Carmen
7 years ago

I would have done exactly what the OP did in this situation, based simply on the principle of the thing. Our medical system here in the U.S. is grossly inequitable. Upon reading the OP, though, my first thought was “How different an experience would this have been for a person with no insurance?” Would they have received services at all, despite the possibility of losing their life? This is my bone of contention with our ridiculous medical system…one person (insured)negotiates a reduced (yet still exorbitantly priced) bill while another (uninsured) might not receive treatment at all. The uninsured person must… Read more »

Mark
Mark
7 years ago
Reply to  Carmen

The experience would have been exactly the same. ERs are mandated by federal law to provide *emergency* care, regardless of the patient’s ability to pay….they’re not even supposed to ask. Anaphylaxis is unquestionably an emergency.

Kingston
Kingston
7 years ago
Reply to  Mark

Well, as a parent who had a kid in the emergency room a couple of years ago, I can tell you that they most certainly do ask, the first chance they get, and I can only imagine what our experience would have been if we had not had insurance at the time. And if you want to know about the practice of actually embedding debt collectors in emergency rooms, check out the article “Debt Collectors Take Places Alongside Hospital Staff,” April 24, 2012, New York Times. From that article: “To patients, the debt collectors may look indistinguishable from hospital employees,… Read more »

hena
hena
7 years ago

alot of magazines have written articles how to keep the costs down for medical care…people need to do research…how to manueuver the health care system..

Kallin
Kallin
7 years ago

Hi Sumitha, I understand your furious when you recieved the bill. It is outrageous. I am also angry and disappointed with our Heath care system here. A month ago, my husband had a itchiness around his eye. He was very worry and concerned how much it would cost to see the eye doctor. Luckily, we know friends who live in Tijuana-Mexico. She helped to buy the medication and just two times applying, my husband eye look a lot better. We never had any Heath insurance since we came to United States twenty something years ago. Thanks god we never have… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Kallin

Kallin, I am from India where the medical cost is much lower. I’m not saying that the medical system there is better…. I just find the overprice-and-negotiate policy of the US medical system hard to stomach.

Jane
Jane
7 years ago

I agree with others that the discussion with the representative and your insistence on it being just an “ant bite” was a bit disingenuous and designed to downplay the service that the hospital provided. A few years ago my husband passed out unexpectedly in our house. As a precaution, we took him to the emergency room to be sure that it wasn’t heart trouble. An EKG and thousands of dollars later, it turned out to be a simple vasovagal response. In other words, my husband faints easily. Does that mean I should have called and insisted that they lower the… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Jane

Jane, I guess my outrage about the amount of bill was misinformed to a certain extent. I still don’t understand how similar services can cost so very different though (see comment #49 above). What is a layperson to do – just “trust” the system and pay whatever they’ve been asked to pay and not feel outraged? How can I trust a system where they will “negotiate”…. and most people don’t know that negotiation is even an option (*I* didn’t until I called and the lady on the phone so kindly helped me figure it out!)

Jane
Jane
7 years ago
Reply to  Sumitha

You bring up a good point here, Sumitha – namely the lack of cost transparency in the system. I also find this outrageous. I guess I’ve just been exposed to how expensive hospitals are that I have lost the outrage and sticker shock. But that doesn’t mean I think the whole system is acceptable by any means. A long time ago, a certain specialist thought I had a specific disorder. She wanted me to take a test but wasn’t sure if my paltry student insurance would cover it. So, I called the office to ask how much it would cost… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Jane

Ouch, Jane… I’m sorry you decided not to take the test because you didn’t know how much it cost! I hope things sorted out over time and your health did not suffer due to this decision. I remember when I came to the US first as a student — none of us ever saw a doctor. Period. All of us brought with us 1-2 years supply of common medicines and we self-medicated. Every time we went back home, we re-stocked. Once we started working though, things changed, and over the years, God knows I’ve paid may share of dues to… Read more »

Debi
Debi
7 years ago
Reply to  Jane

I had a similar experience with my insurance provider a few years ago. I called with specific diagnosis codes and the exact charges I had been quoted by the medical provider and they still refused to tell me up front what my portion of the bill would be. Every other time I’ve asked a medical provider what a service will cost I’ve always been told “We don’t know for sure”. Until medical AND insurance providers are forced to be transparent in their billing processes, negotiating bill discounts will have to be done after the fact. It’s not being cheap, it’s… Read more »

Kate
Kate
7 years ago

I think that the only real change will happen when people are annoyed enough by padded bills to start protesting. However, as I said earlier, it’s just too easy to ignore costs when they are even partially subsidized. One of the newest trends in medical care is the old way of doing things. Some doctors are eschewing paperwork entirely and not accepting any insurance whatsoever. They treat you and bill you a reasonable amount. If you need further services, you will be referred. If you want insurance reimbursement, you do it yourself. Regarding Mrdicare/Medicaid, many physicians limit their exposure to… Read more »

Jen Y
Jen Y
7 years ago

What makes me angry about this is that you had to basically be dishonest to get your bill lowered. Technically, you could pay the bill & she did realise that. But you had to ‘state’ that you couldn’t before she would lower it. It just adds to the ridiculousness of the whole situation – forcing you to lie basically to lower a bill that should never have been that high in the first place. I have a friend that this happened to as well. Pretty much the very same senario. Even though she explained technically she could pay it, they… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Jen Y

Jen Y, Sad, isn’t it?

Michael @ The Student Loan Sherpa
Michael @ The Student Loan Sherpa
7 years ago

The urgent care advice is so good. Emergency rooms should be reserved for true emergencies where the ER is the only place that can address you issues. Urgent Care, is quicker, more affordable, and they can fix most ailments.

Carla
Carla
7 years ago

I had a somewhat similar experience a few weeks ago. It was an allergic reaction, but it was to camomile tea of all things to be allergic to. There was no room or time to consider going to urgent care (didn’t know where one was), especially since I didn’t know where the reaction was from or how it was going to affect me in the short or long term. My skin was rapidly starting to look like a worst case scenario out of a dermatology textbook and I was running out of time. Time was only going to make it… Read more »

Anna
Anna
7 years ago
Reply to  Carla

Carla…if you are allergic to ragweed/goldenrod (do you get very itchy/wheezy/sneezy/running in late summer?), chances are good you’re also allergic to camomile (they’re from the same family I believe).

Carla
Carla
7 years ago
Reply to  Anna

Anna – Thanks for the heads up! I’m not allergic to ragweed/goldenrod (I guess I wasn’t until now) so this was a shock. Then again after I turn 30 my body started to rebel and I developed an allergy to certain foods so this wouldn’t be unusual.

Kallin
Kallin
7 years ago

Hi Sumitha,
I agree that most of the time the medical bill are over priced here. I work near the Mexico boarder so I often hear form many customers complaining about the price the dentists charge. There are many people who take the time to travel there for that purpose. I have doubt about the quality there, but most of them said not only is alot cheaper, less time waiting for appointment and often they are happy with the result.

Vasiliy
Vasiliy
7 years ago

In my opinion the article author didn’t do anything unethical or inappropriate in the situation. It never hurts to ask for something. Whether you get it or not is another thing. Why is it OK to bargain somewhere else but not here? If the hospital were not able to provide a discount up to 50%, then they would not have a policy in place allowing such a discount, right? Now, in response to people who claim that the $2K+ is justifiable. Yes, there are costs incurred to maintain equipment, have staff working on a holiday, etc. However, (based on my… Read more »

nicoleandmaggie
nicoleandmaggie
7 years ago
El Nerdo
El Nerdo
7 years ago

You didn’t pay for “an ant bite”, you paid for a potentially life-threatening condition that required a visit to the emergency room. It’s like saying “’tis just a nick, less than an inch” in your carotid artery. (I mean, if the ant bite was really a life-threatening thing). Now, I’m in favor of negotiating any kind of price, but let’s call a spade a spade. In this sense, framing it as “an ant bite” is a good negotiating tactic, for which you might be called either a jerk or a genius depending on culture/geography/context etc. (There are no absolutes, and… Read more »

Sumitha
Sumitha
7 years ago
Reply to  El Nerdo

El Nerdo, I’m neither a jerk not a genius. Can’t say the same about “ignorant” and “foolish” though. Frankly, I thought of it as just an “ant bite” until I read all the comments here. My husband tends to downplay medical issues, and though I knew my husband’s immediate reaction was bad, I didn’t think much about it because he was fine within a few hours of the incident. After reading what the RNs and Physicians and everyone else has been writing here, I will make sure we have a couple of epi-pens handy from now on.

El Nerdo
El Nerdo
7 years ago
Reply to  Sumitha

Ha ha, I didn’t say you were either, but I’ve been in places when even the mention of negotiating a price is considered highly offensive (one was a market, and I never returned because of it), and there are others where it’s expected that you’ll bargain and the price is padded upfront. Which is I think why you get the different responses here because people will perceive the situation differently. Like I said, there are no absolutes. Anyway, negotiation has its tactics. In this case, perhaps unknowingly, you applied the “call girl principle” which states that the perceived value of… Read more »

Ross Williams
Ross Williams
7 years ago

There are some things to consider: 1) You can negotiate down your credit card bill in the same way. The problem in that case is your credit rating will take a big hit. You might want to check to make sure that didn’t happen here. 2) What you now call “an ant bite”, was something you considered a medical emergency at the time you obtained the treatment. I think you would have been outraged if they had refused you care because it was just “an ant bite.” I also doubt you would have decided to leave the condition untreated if… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Ross Williams

Ross, 1) I was actually worried about that. I asked her several times “will my account be in good standing” and she said that it would be. I don’t trust the system, but I trust that lady — she was really nice and kind to me, not just in helping me figure out the system, but in the way she talked. 2) No, I wouldn’t have left the condition untreated if I’d been told the price. I’m guessing here, but I would have probably said “what the heck” and depending on the kind of explanation I received, I would have… Read more »

Ross Williams
Ross Williams
7 years ago
Reply to  Sumitha

Sumitha – I agree, a explanation would have been a starting point. But I suspect it would be tough to train their customer service staff to explain the costs of every medical bill. I don’t want to defend all hospital costs because there are no doubt some people making more money from health care than its “objective” value. But hospitals are mostly non-profit and they have costs they have to cover. That includes providing care to people whether they can afford to pay the bill or not. If you pay less, someone else has to pay more. Put another way,… Read more »

Carmen
Carmen
7 years ago
Reply to  Ross Williams

I respectfully disagree here. I had new carpet put in my home a couple of weeks ago and we were in the worst part of the grass pollen season. I was already suffering from allergies to begin with and the carpet adhesive fumes triggered a severe allergic reaction–I couldn’t get a good breath. I took myself to an Urgent Care place, the kind doctor saw me pronto, gave me a cortisone injection and some Atarax for my itchy, swollen eyes, and sent me on my way in under 45 minutes. Because my deductible for the year is paid, my cost… Read more »

Ross Williams
Ross Williams
7 years ago
Reply to  Ross Williams

Carmen –

I am assuming the other folks that posted here who said this was a life threatening condition are correct. This guy ended up under observation in a hospital. You didn’t.

Mark
Mark
7 years ago

Sorry to all the “collectivists” on here, but America isn’t a collectivist state. America is about individualism, which means individual responsibility. You may like collectivism and some degree of socialism, but that’s not what our country was founded on. I’m sorry if you don’t like it or can’t understand it. Yes, the healthcare system in the U.S. is not perfect, but its pretty damn good. That’s why people come from all around the world to be treated here. What IS going to drive our healthcare system into the ground, and eventually bankrupt us is government controlling it. Obamacare has barely… Read more »

Ross Williams
Ross Williams
7 years ago
Reply to  Mark

Frankly, that is ideological BS. The Pilgrims were collectivists and collectivist barn raisings were as American as mom and apple pie. Insurance is by nature “collectivist”. Yes, I know you can make any set of facts fit your ideology’s world view, but that should tell you something about ideological world views.

Ely
Ely
7 years ago
Reply to  Mark

This is not actually true. Yes there is a strong libertarian/puritan streak in this country, but most Americans do see the value of community and looking out for others than just oneself. The rest have just been lucky enough not to need that kind of support… yet.

Daria
Daria
7 years ago

I was traveling abroad in Ireland when I had my first severe allergic reaction to shellfish. I had had shellfish several days before. We didn’t know where a hospital was. We stopped at the hotel we were staying at and the concierge had two benedryl from a visit to the States that he gave me and then told us how to get to a hospital. The benedryl probably saved my life because it allowed us time to find the hospital. I got a shot at the hospital and spent several hours there being observed before being sent on my way.… Read more »

Christine
Christine
7 years ago

I just wish medical bills were more straightforward: it’s going to cost you x for y procedure. Instead, it’s a guessing game. When my husband got back surgery a few years back, we basically had to get it done (no one would tell me how much it would cost; I think they were afraid of being held to that amount), then sit at home and wait for the bills to come rolling in. And not just one, SEVERAL: from the surgeon, from the anesthesiologist, from the hospital, from the secondary surgeon or whatever, etc. When I go to Target to… Read more »

Bryan
Bryan
7 years ago

I had a similar situation regarding ER costs but with a different take on the negotiation. I too have a high deductible plan and received an acute laceration to the face. Which is to say a ~1/4″ long cut. My guess was maybe 2 stitches to get it closed up. Based on everything I know about the medical system (and previous experience) I sought out an urgent care center, but evidently in my area urgent care isn’t very urgent. At 7pm on a week night there were no urgent care centers open and all the answering services referred me to… Read more »

Sumitha
Sumitha
7 years ago
Reply to  Bryan

Bryan, Ouch, I’m sorry it went in a different direction for you 🙁 Just want to reiterate a couple of things though – a) I’m personally convinced that I did not get a 50% discount — I just didn’t end up paying the 100% mark up to cover for the next person who would not pay anything at all b) I’ve paid full amount for years now, so I’ve contributed my fair share to the hospitals fund for the un-insured as well. We’re all in the same boat, dude — I just happened to save a few bucks this time… Read more »

Tarun Sikri, India
Tarun Sikri, India
7 years ago
Reply to  Bryan

Dear Bryan,

$580 for a tetanus shot !!!
Tetanus shot plus injection and syringe is priced equivalent to $0.20 in India at Drug stores and a Doctor will charge you somewhere around $3-4 for it.

Evangeline
Evangeline
7 years ago

True story: I had to have a series of medical procedures and each one cost $750 with my portion being $200. Right before the final treatment, my spouse changed jobs which meant the final treatment wouldn’t be covered by the new insurance. I called the doctor’s office to ask if I could make payments on the $750 so I could complete the treatment. Nope. They would just bill me as ‘uninsured,’ resulting in my total out of pocket expense as $120—far less than I paid when I was insured. The system is definitely wonky and they seem to get you… Read more »

Jake @ Common Cents Wealth
Jake @ Common Cents Wealth
7 years ago

This is an awesome story. I just recently found how how negotiable medical bills are. It’s even better if you ask to pay ahead because they are more willing to allow you to pay less if you pay them right away. Nice work on getting it down 50%!

C. Leck
C. Leck
7 years ago

My went through over a year of intensive cancer treatment – 24 weeks of weekly chemo, 6 weeks of bi-weekly radiation, surgery, and at LEAST weekly dr. visits. I took her bills from her, and negotiated EVERY SINGLE BILLER (there were more than 17 billers, and obviously, 100’s of individuals line items) down to 10-25% of the original bill (through sliding fee scales, payment discounts, and outright negotiation). And worked with Medicare and Medicaid to cover, and worked directly with drug companies for 90-95% reduction in VERY expensive drug costs (most have discounted prescription programs – thank god…ONE PILL cost… Read more »

Tarun Sikri, India
Tarun Sikri, India
7 years ago
Reply to  C. Leck

Dear Mr. Leck, This is true that Pharma Companies price their products very steeply in the case of Cancer and other Life Saving Medicines. A $300 pill is billed to the distributor for around 70-80 dollars by the company (company cost is usually 10% of Maximum Retail Price), that distributor bills it to a dealer for around $120-130 and he in turn bills it to retailer for $170-180 and customer pay for it in full $300. So, in a way these guys are criminals because they are charging way too high for their product and its R&D cost(in case of… Read more »

Erin
Erin
7 years ago

I had the same experience when I saw what my recent ER bill should have been. But, there were lots of discounts provided through rates that my (high-deductible) insurance had already worked out with the provider. Since I was going to have to have surgery anyway and was definitely going to meet my deductible I went ahead and paid what was left. I did find it interesting though that what would have been a bill over $10,000 was reduced down to about 10% of that due to insurance. Yes, hospitals can charge you whatever they want, but you can negotiate… Read more »

Robert
Robert
7 years ago
Reply to  Erin

Erin, your quote that you have “hospitals can charge you whatever they want” is not true. We are obligated by a contract with the insurance carrier for a fee. Whether fee for service or capitated. We can not charge more for that. What ends up being negotiated is your deductible. That is money in our pocket. So you are taking money out of the people who are working the hardest for you. On the flip side, look at Medicare. Because of the federal rules, you have a deductible, BUT if I discount that deductible, Medicare can put me in jail…for… Read more »

Jennifer
Jennifer
7 years ago

Still paying over $1000 for a one hour outpatient prostrate biopsy for my husband, and over $1000 for his dental bill from 2012. Insanity!!

Robert
Robert
7 years ago
Reply to  Jennifer

Jennifer,

are you saying 1000 is insanity to do a prostate biopsy??

You do realize there is cost for the surgeon to do the procedure, risk (has to pay malpractice insurance), OR fees, nurses fees etc…

Then…it has to go to pathology for a technician to process. Have you ever processed a pathology slide and sectioned it? Do you realize how labor intensive that is? Then a pathologist has to go over the slide cell by cell to make sure he isn’t missing any potentially malignant cell AND pay for his malpractice…

It COSTS A LOT OF MONEY!

Carla
Carla
5 years ago
Reply to  Robert

Robert, I’m not Jennifer but what I took out of her comment is that its “insane” that they’re still paying for a medical bill from 2012, not a rant about the cost of health care.

Robert
Robert
5 years ago
Reply to  Carla

perhaps but the tone of the comments and the theme of the post was about costs. It seems more logical to imply that the cost were so high in her opinion that it was outrageous as she still was paying them off 2 years later. Again, costs.

Brandon
Brandon
7 years ago

I concur with others that our medical system has issues. I also think that the prices should be posted when you walk in the door for any number of common ailments. I wondered what Sumitha would have done if, before seeing any health care provider, if payment were required upfront. Would you have paid, negotiated then, or left to try finding somewhere cheaper?

Robert
Robert
7 years ago

FOR THE LOVE OF GOD! Please don’t take what this article said as something good. Do you realize who this hurts when you “ask for a discount”??? Where does this money come from?! Ask that! It’s not free money. It is coming from the cost that it takes to do your care. The more you ask for a discount the less money in the system to pay and the more we have to get from somewhere else. The reason we accept a discount is that if we don’t and you don’t pay it cost us more money to send you… Read more »

Robert
Robert
7 years ago

About why there are so many different costs… its pretty simple, its our fault. That is the consumers. We want certain plans with ones that pay more or less and certain benefits. Do you realize all the different parts of Medicare? When you have all those different contracts within the same insurance carrier, that creates different tiers. The insurance carrier in term tries to even out those that pay less with more and negotiates a rate with each individual physician, group, hospital etc.. Even with that, insurances sometimes will reject a payment or not know the rate as they have… Read more »

Jacob
Jacob
7 years ago

Thats a crazy story. But how can you put a value on saving someones life! There is a good chance he would have died if he didnt get care. Is $3k too much to save your husbands life?

Granted it seems over priced but look at the alternative.

Golfing Girl
Golfing Girl
7 years ago

So let me get this straight. No one held a gun to your head to choose a high deductible and no one held a gun to your head to make you go to the ER, but you don’t think you should pay for the services that highly trained individuals provided to your husband. Those individuals probably have tens of thousands of dollars in student loan debt and spent years studying to go into a field that pays well. But because you made poor choices, you don’t think you should pay them? I bet you don’t feel like you should pay… Read more »

Robert
Robert
7 years ago
Reply to  Golfing Girl

AGREE! More people need to re-read what you just wrote

Casey
Casey
7 years ago

I recently was able to apply for financial aid at my local hospital. I had gone in for a slight cut on my finger – two stitches – and the bill clocked in at almost a grand.

I’m a broke young professional and after much paperwork – the financial aid was approved and the balance of the bill was paid in full. I know they extend these plans to students and to lower income homes at most hospitals. So if you can – apply! I saved a thousand dollars!

Rhonda
Rhonda
7 years ago
Reply to  Casey

Yes, that’s it exactly. There are programs in place to help low income individuals without robbing the medical providers. Many of these programs are established and fully funded privately by the doctors themselves. Medical professionals in general are very concerned that care is available to those who are least likely to be able to afford it. They are not in the business to over bill and rob their patients.

uri
uri
7 years ago

ever try to get a quote for medical services in advance? How about getting a medical provider to justify a cost after the fact? i’ve tried both but never succeeded. medical providers overcharge people, especially uninsured people, as a matter of routine. keep this in mind: if they want to make you pay, they need to justify the charges. if you agreed to a specific amount or a method for calculating the amount beforehand, then you are liable as the signer of a contract. if you did not, then you and the medical provider most likely have a contract that… Read more »

Jacob
Jacob
7 years ago
Reply to  uri

I almost always insist on getting a quote before I get medical care. Granted they cant know complications but they can give you the codes they will use and you can call the insurance company and see you benefits. Its not a easy process and there is a lot of uncertainty but it worked pretty well for me.

Debi
Debi
7 years ago
Reply to  Jacob

You must not have Anthem as your insurance carrier. I did the same thing and they absolutely would not tell me what my portion of a charge would be, even with the codes provided by my medical provider. Several times I asked for a supervisor and was always told they needed to be billed by the provider before they could give me any information about the claim.

Robert
Robert
7 years ago
Reply to  uri

quote “…. medical providers overcharge people, especially uninsured people, as a matter of routine.” Uri, respectfully, but you can’t be serious with this quote. Where is your data and more importantly…your common sense. Why on gods green earth would I want to charge someone more money when they can’t pay? Just so I can raise my overhead have my billing department send letter after letter or calling every day to get payment? Or better yet paying to get a debt collector to get this money? Is that why we charge more? So I can lose more money? It’s like getting… Read more »

uri
uri
7 years ago
Reply to  Robert

robert, i’m extrapolating from personal experience and from what i’ve been told by my medical providers, my insurance company, and others. if you do not overcharge uninsured people and i’ve offended you with overgeneralization, i apologize. that being said, it remains my view that by and large, uninsured patients get charged way more than insured patients. i’d be very pleased to see data to the contrary. i do not agree with your appeal to common sense. my common sense tells me that charging people more money, in a situation where they can’t shop around for lower prices beforehand, would result… Read more »

Robert
Robert
7 years ago
Reply to  uri

Uri, for some reason i wasn’t notified of your response. I can provide data of my billing for non paid patients this last year and show it was lower than insured patients. I can also show that even with the discounts, the remainder remains unpaid of 80% of the amount for more than 120 days. This data is even worse for ER patients. About appealing to your common sense. How about looking at numbers. If I have a 100 patient practice and 90 are insured and 10 are self pay and they all get billed 100 for services. The “bulk”… Read more »

uri
uri
7 years ago
Reply to  uri

robert, i’m not talking about your practice in particular – i’m talking about overall trends. Do you know where to find data for the medical industry more generally? i’m afraid i still don’t agree with you after seeing the examples you’re giving. all it tells me is that yields from uninsured patients are lower. i don’t see how it follows that you would not want to charge them more so you can collect a higher percentage. you personally might find it hardly worth bothering to try to collect from them at all, but it sounds like you have a small… Read more »

Robert
Robert
7 years ago
Reply to  uri

Uri, because patients are uninsured, there isn’t a database that can be pulled to see what they are charged. You could look at county clinics or ERs. I am actually NOT solo and in a very very large practice. Even with that, it is NOT cost effective to have a collections department. Out billing will do some collections but after a certain AR it isn’t worth the time of the department to go after the claims. And while we could charge them more, my point is the uninsured have limited funds. You still won’t collect all of the bill. Hence… Read more »

Robert
Robert
7 years ago
Reply to  uri

Uri,

also please read Rhonda’s post #162.

I don’t know how we can be more transparent and clear than that.

Uri
Uri
7 years ago
Reply to  uri

unless i’m misreading rhonda’s post #162, it supports what i’m saying.

Robert
Robert
7 years ago
Reply to  uri

Uri,

I’m not sure how you are reading into her quote..but maybe you can expand one how this supports your assertion on how underinsured are billed.

Uri
Uri
7 years ago
Reply to  uri

what rhonda describes, as i understood it: by law, uninsured people are charged at least what insurance companies are charged. they can’t be charged less. i understand her as saying there’s a uniform rate. this is the base price. insurance companies negotiate to pay much less than the base price – about 40%. this is a uniform discount and not a case-by-case negotiation. by contrast, uninsured people may get a discount on a case by case basis if they negotiate. nonprofits will discount bills up to 40%. i inferred that discounts at for-profits will be smaller, if any. so in… Read more »

Robert
Robert
7 years ago
Reply to  uri

I think this is the problem…

“I inferred that …”

Rhonda
Rhonda
7 years ago
Reply to  uri

Wow..interesting how we all read the same thing and come out with different interpretations… Here is what I am stating. For the example below, assume a plain old office visit for an established patient exam for the exact same time duration, diagnosis, age, etc. In otherwords a truly apples to apples comparison. Patient A is insured and is billed $300. Patient B is insured and is billed $300. Patient C is not insured and is billed $300. Patient D is not insured and is billed $300. Patient E is not insured and is billed $300. In real life, this is… Read more »

Rhonda
Rhonda
7 years ago
Reply to  uri

Note—a patient that does not ask for a discount and just pays the bill may be paying more than a patient that has insurance and receives a discount. This is an extremely rare occurance & I provided this illustration mostly as a hypothetical. Most people who can afford to just pay the bill have some sort of health insurance. Also, many people have multiple layers of insurance and are over-insured for medical expenses through secondary and tertiary coverages. So my opinion is this…..if you are paying a third party payer to negotiate your rates for you, please do not ask… Read more »

Robert
Robert
7 years ago
Reply to  uri

Rhonda,

thanks for the excellent explanation. I wish Meghan from a previous post would read this too and other people who first commented on this thread weeks ago.

I hope Uri reads it thru a couple times

Uri
Uri
7 years ago
Reply to  uri

thanks for breaking it down even more, rhonda. i read it through a couple of times. it seems to me that to the extent that any amount in your example could be considered a fair price, its the $120 price that the insurance companies actually end up paying, and that the $300 figure is what i consider the “ripoff amount.” if there was a market for medical services, so that consumers could shop around for the best deal, the actual cost would be closer to $120, maybe less. the $300 figure may be consistent and uniform, but is not a… Read more »

Rhonda
Rhonda
7 years ago
Reply to  uri

Uri, please read through my last post at least one more time. I understand where you are getting confused and so I will make one more attempt to clarify and then I need to move on to other topics. Here are some key points you need to observe- A. The amount the insurance company paid is $185.00 or about 62%. B. The amount the uninsured patient that received a discount paid was $180.00 or about 60%. C. The providers MAY offer a discount if they have a discount policy in place to do so. They are not required to offer… Read more »

Uri
Uri
7 years ago
Reply to  uri

rhonda, thank you for clarifying the numbers. i now understand you saying that insurers pay about 60% of what’s billed, and that collection from uninsured patients is so low that it pushes overall recovery rates to about 40% of the billed amount. i am not offended at all. i am learning from this discussion and i appreciate you contributing your knowledge. i think we’re approaching the issue from different perspectives. i am looking at it from the perspective of legal rights and obligations. for my particular case, these are issues like: what right does the medical provider have to charge… Read more »

Robert
Robert
7 years ago
Reply to  uri

Rhonda, again fabulous post. I know that this blog entry is several weeks old but wish some of the people would read your post again and again. Uri, about the legality of the contract…remember that when you sign up for health insurance, you are bascially giving the negotiating rights to your insurance carrier. They negotiate the rates that are to be paid. Also, on the physician side we negotiate if we want to be paid for those rates. If we don’t like it we get off of the plan (that’s why you sometimes see physicians no longer on some plans).… Read more »

Uri
Uri
7 years ago
Reply to  uri

robert, i don’t know what a health insurance contract says, since i’ve never seen one or signed one, to my knowledge. as far as i know, i contracted with my employer, and my obligation is to pay a portion of the cost of the insurance, not to pay what medical providers bill me and the insurance doesn’t pay. it shouldn’t be a problem to figure it out if i ever have a serious dispute over a copay, deductible, or charge not covered by the insurer: if i ask the service provider or the bill collector to validate the debt, they… Read more »

Rhonda
Rhonda
7 years ago
Reply to  uri

OK…only because I have the day off, I will take a few more minutes to entertain this thread…. Uri, you signed a legal contract prior to receiving medical care. While there is possibly a .01% chance that the front desk staff neglected to give you this form or neglected to ensure you completed this form as you were being registered for your care, I am 99.99% confident that you signed a financial responsibility form. That form gives legal consent for you to be billed for any and all medical services that are provided to you. The financial responsiblity form extends… Read more »

Uri
Uri
7 years ago
Reply to  uri

rhonda, i agree that i don’t know the costs of all the components of the health care i received. this puts me in the same position as most consumers buying most goods and services. it doesn’t justify unilateral pricing decisions. assembling the component costs and rents of this laptop i’m typing on into a single price is undoubtedly just as complex as figuring out the component costs and rents of my 10-minute appointment, if not vastly more complex. but the company that sold me my laptop didn’t get to unilaterally determine its price, and neither does the doctor who examined… Read more »

Rhonda
Rhonda
7 years ago
Reply to  uri

Ah yes…the Canadian medical system argument. Well, Uri I only have one personal experience with the Canadian medical care philosophy. It was a single physician completing his medical internship at an American hospital after attending specialty training at one of our fine medical colleges. He was the attending physician on duty in the ER when my 18 month old daughter broke her leg on a slide. (Her shoelace caught and her leg twisted up under her while she was sliding down.) This #[email protected]%@$$ spent the whole time critizing the medical care in the US, refused to order x-rays and wrapped… Read more »

Rhonda
Rhonda
7 years ago
Reply to  uri

Uri, Re-read my post at 188. Also open the link to the sample Financial Responsibility form. I will provide it again here. ——————————————- http://www.nova.edu/healthcare/forms/patient_financial_responsibility.pdf NOVA SOUTHEASTERN UNIVERSITY FAMILY MEDICINE CLINIC STATEMENT OF FINANCIAL RESPONSIBILITY PRINT PATIENT NAME __________________________________________________ 1. PRIVATE INSURANCE AUTHORIZATION FOR ASSIGNMENT OF BENEFITS AND RELEASE OF INFORMATION I hereby authorize and direct payment of my medical benefits to Nova Southeastern University Health Care Center, for any services furnished to me by the physicians. I authorize the physician to release any information, including diagnosis and the records of any treatment or examination rendered to my child or me… Read more »

Ross Williams
Ross Williams
7 years ago
Reply to  uri

Rhonda – I have heard horror stories about medical care from almost every system of medical care. There are mistakes, arrogant incompetents and lousy medical facilities everywhere. The complaints about American HMO’s are almost endless. Having had HMO coverage almost all my life, I have never experienced those problems. I don’t know, but it is plausible that ER’s in Canada see their role as providing emergency treatment, rather than as 24-hour medical treatment centers. You had the expectation of a particular immediate response to your daughter’s injury. You wanted x-rays and a plaster caste. This doctor didn’t give it to… Read more »

Robert
Robert
7 years ago
Reply to  Robert

Uri, I’ll clarify one thing that Rhonda didn’t emphasize. You did sign a contract. Technically the contract is between you and your insurance carrier. The “contract” is the insurance policy that you sign and what the OP signed. When you sign it you are giving permission for the insurance company to leverage their pool of patients to get the lowest cost treatment. In term for this work, you are responsible for your portion. And in that contract it states you are responsible to pay your portion as the insurance is responsible to pay their amount. I’m also a CFP and… Read more »

Uri
Uri
7 years ago
Reply to  Robert

robert,

can you point me to a typical insurance contract online where i can see the language requiring the insured to pay what the insurer doesn’t pay?

thanks,
uri

Rhonda
Rhonda
7 years ago
Reply to  Robert

Uri, the document you are looking for is called an SPD or Summary Plan Description of Benefits. If you have group health insurance provided by your employer, your human resource department either has copies available or they can request copies from the insurance carrier. If you purchased insurance directly from the insurance carrier or an insurance broker, you can contact them for copies of the SPDs. Insurance benefits offer through employers are regulated by ERISA.

Uri
Uri
7 years ago
Reply to  Robert

i’m looking at an SPD online. this one: http://teamworks.wellsfargo.com/benefitsbookspd/2011/Anthem_Blue_Cross_Blue_Shield_Plan_SPD.pdf

there’s language on p. 6 about what the insurer will pay and what i won’t. i don’t see any language saying the insured agrees to pay deductibles etc.. in fact, i don’t see any agreement language at all – it’s a description rather than a set of promises. a court would be looking for much clearer language of commitment if a medical provider was relying on the plan as a source of the insured’s legal obligations.

Rhonda
Rhonda
7 years ago
Reply to  Robert

Key points: * The contract that the patient signs is with the medical provider called a Statement of Financial Responsibility. * Health insurance is the product that patients/or employers purchase separately that helps the patients meet the financial responsibilities to the medical providers. * When you purchase the health insurance products (or sign up for benefits) you agree to the limited coverages that they provide, but that does not absolve you from your legal financial obligations to your medical providers. * There are 2 reasons that people agree to purchase medical coverage. a-The contract between the medical providers and the… Read more »

Robert
Robert
7 years ago
Reply to  Robert

“PS. Robert, I hope when you are evaluating your billing staff or contracting with a billing office in the future, you will think about this conversation. We (medical billers) are worth our wages as well. smiles!” absolutely! We have our own in house billing. They work so hard. Both good cop and bad. I am always impressed with the extra effort they go thru to sign up patients for access programs, get pre-approvals and fight to get treatments covered that patients need that are FDA approved treatments that insurance companies will first deny. Many people like in this blog don’t… Read more »

M
M
7 years ago

I go to a pain manegment doctor who is covered by my insurance. For the past couple years they do drug testing every few months and I’ve never been billed for it. Apparently the last time it was done, they switch companies to one that is not covered by my insurance without my knowledge and a couple months later I have a bill for 1200 dollars. I talked with the testing company and they won’t budge. My doctor, who screwed me and other patients I’m sure, won’t budge either. I’ve had outpatient procedures that cost less than this simple drug… Read more »

Steve
Steve
7 years ago

Yea, you should have seen this coming when you chose the high deductible plan. You not paying the face price because you don’t “want to pay” for hospital services that was top quality and potentially life saving is not something any of us should be proud of. The hospital and doctor did everything right, they carried out their job, and you don’t want to pay even tho you can. Why do you pay for anything? would you pay more for food when you’re really hungry and had no option? I bet if they showed you the bill before the procedure… Read more »

Robert
Robert
7 years ago
Reply to  Steve

totally agree!!

Vasiliy
Vasiliy
7 years ago
Reply to  Robert

Is it ok to bargain when somebody buys a car at a dealership, for example? Why is it not considered ok to obtain a discount for a service? The article author was transparent when she called the hospital and said she had the money, but didn’t feel it was appropriate to pay the 100%. The hospital agreed to give a discount, nobody forced the hospital to do that. Why? Probably because they can still be fine / profitable with getting 50% of the price (which is what – or less – they get when insurance companies or the government pays… Read more »

Robert
Robert
7 years ago
Reply to  Vasiliy

yes it is ok to bargain with a car dealership as there is no contract between you, the dealer or Ford, BMW etc.. However, there is a contract between you, the insurance company and the hospital. It happens when you sign up for your insurance and pick your plan. That contract states you pay a certain percentage and the insurance pays the rest. Ask it another way, if you got into a car accident, can you bargain your deductible? If you have an umbrella policy and someone slips and falls on your porch, can you negotiate the claim that will… Read more »

Robert
Robert
7 years ago
Reply to  Vasiliy

if we really were fine and “profitable” with getting paid 50%…why are there so many doctors subscribed to a blog called “get rich slowly”….

Mike
Mike
7 years ago

Great story and example. A reminder that EVERYTHING is negotiable.

Meghan
Meghan
7 years ago

I wish that every single negotiated rate for the top 10 insurers was publicized for every single billing code. The fact that all the negotiating is done behind closed doors is a big part of why the system is broken and why the uninsured are screwed. If BCBS can pay $170, why does the uninsured pay $900? That’s wrong. I guarantee that an insurance plan wouldn’t have paid the full cost for that ant bite. She did pay her share, probably more. They almost certainly started out trying to rob her.

Robert
Robert
7 years ago
Reply to  Meghan

Meghan,

I’m not sure if you read the article fully. She is insured. She just chose a high deductible plan. That is she is responsible 3-5k of cost before the insurance picks up the rest.

This is a way for the patient to try to save money in premiums….at the risk of paying that deductible if something happens. She took the risk.

So no, you cannot guarantee that the insurance plan pay the full amount because that is not how her plan is set up….and she absolutely did not pay her share as she was responsible for her deductible.

Meghan
Meghan
7 years ago
Reply to  Robert

Yep, I sure did! I also read the comments below. At no point did she say that the amount that they tried to charge her was her insurance company’s negotiated rate and that she checked to see what that rate was, did she?

Robert
Robert
7 years ago
Reply to  Meghan

but Meghan,

again, the insurance companies negotiated rate is different the the deductible.

If you have a $2000 deductible, you have to pay that before the insurance kicks in.

That is the contract. When you sign up for the insurance you agree to pay the deductible amount. Do you ask what your car deductible amount is on an auto claim? Is it what they would charge you for the whole car? Do they inflate it or change it if you have a high deductible?

Robert
Robert
7 years ago
Reply to  Meghan

also, what she did was to again cost the system MORE and create higher prices for the health care system as a whole for those non-payments.

She has a high deductible plan. She didn’t pay her full deductible…great. But she still owes the remainder if she has another claim before her insurance kicks in.

So what did this help? Sure she paid less, but she still would owe the remainder in future claims and it cost the health care system as they are getting less reimbursement driving up cost.

Meghan
Meghan
7 years ago
Reply to  Meghan

No, that does not make sense. One, who said that what they charged her = what it cost them to perform the service? You’re asking her to pay whatever they decide to charge her, regardless of what is reasonable, simply because she has a deductible. Someone else pointed out in the comments that it is strange that we don’t know what medical bills are going to be until they show up. Don’t you think this is the least bit off? You’re quick to assume that there was a loss to the hospital here, and that she has somehow passed on… Read more »

Robert
Robert
7 years ago
Reply to  Meghan

first they reason cost are so screwy is people don’t pay! you guys create the problem. When one person decides not to pay their amount or a whole string of non insured come in it varies the cost.

That’s why health practices negotiate. If you are on an HMO plan they might pay a doctor X money….If you are on a PPO Y. Why is that?!

I’m a physician and can say for certain, that those A/R (accounts receivable cost us a lot of money and is a loss). Period. Please don’t assume that it isn’t

Robert
Robert
7 years ago
Reply to  Meghan

Meghan,

and i think you are missing something…when you say you don’t know what was charged and if it was insurance rates…

you do. It was charged her insurance rates. Period. Like I have stated before and now…it is a contract between you, the insurance company, and the healthcare provider.

When you have a high deductible we can only bill what our contract is with the insurer…the contracted rate. Period.

This is what gets me so mad is people don’t understand the healthcare system and don’t understand what the insurance contract is when you sign it.

Matt
Matt
7 years ago

I fully support and applaud you for negotiating and will do so myself in the future. To those of you comparing this to an auto repair – I can and do negotiate for a lower labor and parts fee when getting a quote done for work. How is negotiating after the fact any different, especially if the hospital AGREES to the price? Does me negotiating for cheaper labor costs on a car repair screw you? To many posters seem to think this negotiation is unethical because it raises costs for everyone else. If that is true, wouldn’t it apply to… Read more »

Robert
Robert
7 years ago
Reply to  Matt

and this is why health care cost are high….you argue for having a fee and knowing what things cost but not paying your due part creates the very problem that you are arguing about.

I am glad you negotiate the auto repair. But if it is an insurance claim that is not negotiable.

If pay out of pocket, don’t claim insurance, they certainly negotiate away.

Meghan
Meghan
7 years ago
Reply to  Robert

Are you joking with me right now? Who are you to judge what her “due part” is? Why would you immediately think that the hospital charged her a fair price for the service? A hospital is not supposed to charge the insured more than the negotiated rate, regardless of the portion paid by the insured. I would be floored if any insurance company would have paid the high first offer. That’s why I suggested calling the insurance company. If they tried to charge the insured more, regardless of the out of pocket arrangement between the insurance company and the insured,… Read more »

Robert
Robert
7 years ago
Reply to  Meghan

nope not joking. People want cheap health care but don’t realize what it truly cost.

Again, it is a contract. We can only bill her deductible her insurance rates.

Meghan
Meghan
7 years ago
Reply to  Meghan

Did you bill her yourself Robert? Just because they weren’t supposed to over-bill doesn’t mean that they didn’t. There are mistakes in medical bills all the time! This is personal for you and maybe your office never makes mistakes but you have no right to speak for the masses or take up for a hospital that you know nothing about.

Also, don’t be a jerk and assume to know what I am willing to pay for.

Robert
Robert
7 years ago
Reply to  Meghan

Meghan, if I am coming off as a jerk I apologize. But these are the things we face in medicine all the time.

People who think things in medicine should cost x,y, or z but don’t realize the real cost.

Also, Like I have been trying to explain over and over and over…it is a contract that we have to bill her deductible the insured rate.
Absolutely she can look over the bill to see if anything was miss billed. But the rate that we all have to bill is the contracted rate that is negotiated.

Meghan
Meghan
7 years ago
Reply to  Robert

No Robert, you are assuming that they charged her the negotiated rate. At no point in that post is that stated/confirmed/checked.

Robert
Robert
7 years ago
Reply to  Meghan

it is always checked…that is why we have to spend so much overhead money for billing offices to keep track of this. That is why you present your insurance card and we know your carrier and deductible. When the bill get submitted it is with that rate. Like I said, I know. We have our own billing office. So no I am not assuming. It is breaking the law and contract to bill something other than the negotiated rate. Like my example with Medicare, I can not give a discount to a medicare patient (write off their co-pay) as according… Read more »

Robert
Robert
7 years ago
Reply to  Matt

I do make mistakes as our last bit of billing is still done on a paper APS and not thru the computer. But most of the time the bills are correct. Sometimes my check box will be into another and my billing office makes a mistake. But we refund that to the patient. But we are not talking about billing mistakes. We are talking about the patient stating she didn’t want to pay her insurance rates on her deductible for her care. That is a contracted rate. There is no “speaking for the masses” or hidden agenda. This is a… Read more »

Meghan
Meghan
7 years ago
Reply to  Robert

Robert, you don’t know that they billed her the contracted rate! She never checked to make sure that the bill she got from the hospital was for the contracted rate. THAT’S MY POINT. THAT IS MY POINT. DID YOU READ IT? I DID NOT SAY WHETHER I AGREED WITH HER DECISION TO PAY LESS BASED ON WHAT SHE THOUGHT WAS FAIR, WITHOUT ANY BASIS AS TO WHAT A FAIR RATE WAS. THAT IS WHY SHE SHOULD VERIFY THE CONTRACTED RATE AND MAKE SURE THEY DIDN’T MAKE A MISTAKE! I can’t believe that this conversation is still going on! If you… Read more »

Robert
Robert
7 years ago
Reply to  Meghan

Meghan, yes I read it. Please calm done and don’t shout. She can absolutely check to see if it is her contracted rate. But again, it is illegal for us to bill the deductible amount more than what was in the contract with the insurance company. It doesn’t matter if the carrier is in Alaska or Florida. A contract is a contract. Please take a second and think about that calmly. She was billed her contracted rate. That’s how calms are submitted. Our billing office has to shift though all these different insurances and submit those claims in. If she… Read more »

Ross Williams
Ross Williams
7 years ago
Reply to  Matt

“the contracting company bills the insurance company but didn’t charge me a deductible).” If, in fact, your insurance required you to pay a “deductible” this is called fraud. With a deductible you agree to pay the first part of the bill, the insurance only pays what is left. The problem with the analogy to other services is that they aren’t required by law to provide you service. The car mechanic can tell you to take a hike if you don’t want to pay what they charge. The hospital can’t. Whether we like it or not, our health care system is… Read more »

uri
uri
7 years ago
Reply to  Ross Williams

ross,

i’m sorry but i think that’s absurd. hospitals are always looking to maximize income, to the point that many have ripped off medicare, sacrificed patient care, and exploited their workers to improve their bottom line. on your approach, what’s to stop a hospital from charging bill gates a billion dollars next time he comes in with a hangnail?

Ross Williams
Ross Williams
7 years ago
Reply to  uri

“what’s to stop a hospital from charging bill gates a billion dollars next time he comes in with a hangnail?” Nothing, unless they have a contract with his insurance company. There is nothing preventing me from billing Microsoft for my time lost when Windows crashes. They won’t pay it and no court will enforce the claim. “So when I arrive for my appointment I’ll ask “How much is this visit going to cost me?” I’ll be told, “I don’t know” and all is good. Now I’m free to negotiate. That was easy!” Sounds like the same thing that happens when… Read more »

Debi
Debi
7 years ago
Reply to  Ross Williams

“As with health care, there is an implicit acceptance that you will be responsible for paying for the service at the price set. If you don’t ask the price in advance, you are agreeing to pay the amount charged.”

So when I arrive for my appointment I’ll ask “How much is this visit going to cost me?” I’ll be told, “I don’t know” and all is good. Now I’m free to negotiate. That was easy!

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