The shocking truth about medical bills that can save you thousands
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
Lessons learned from this experience:
- 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.
- 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.
- 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?
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There are 242 comments to "The shocking truth about medical bills that can save you thousands".
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 not), we’ll be happy to offer you a discount if you’ve got good haggling skills.
Don’t get me wrong — I mean no disrespect to the OP and no judgment on her. It sounds like a scary situation and I’m glad it was quickly resolved. Her points about cooling off first and being polite to everyone with whom you deal are spot on.
I can’t help but wonder if hospitals charge insurance companies one rate and individuals another. (Or should I say overcharge? How else are they able to offer 50% discounts?) Have other people had similar experiences? I’m curious to learn more.
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.
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.
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 coverage is. In other words, the people that need help most are charged (often) more than twice as much.
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…
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 they would normally get from the insurance company. He had no problem accepting it.
I can afford health insurance but am basiclly uninsurable because of a brain aneurysm 20 years ago. I did get a policy that had a rider that would not cover anything related to the cirrulatory system. Really? I dropped it after a month.
I keep up with required testing for my age. I shop around for price. I always ask for a discount.
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.
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!!!
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.
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. John’s Hospital. As Guardian I had to authorize intake and give all information including Insurance. Since it was right after 4th of July, apparently they were understaffed, and testing took longer than expected, they were having problems with his blood drying out and there was speculation of Apendicitis. To make a long story short, Him and his Aunt were there from 4am until 10pm to find out he was constipated… Total charges sent to Insurance were over $5,000, I am stuck with a $1,000 Balance for a couple of Enemas…
I have talked to my insurance but have not talked to Financial Services yet, My Son’s Aunt is a succesful attny. there and I was told I have no chance fighting the Hospital or asking them to reduce my Bill.
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.
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.)
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.
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.
(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.
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, unable to work, unable to function, unable to be there for his family. After he finally got the surgery, he spent more than a year recuperating before he could go back to work. Total time lost, over 3 years and a hell of a lot of suffering and stress on his family. He had looked at coming to the US and just paying for the surgery to ease the suffering, but by that time he couldn’t travel.
My take from all this is that the question between the systems boil down to what’s worth more to you, money or quality of life? The US’s healthcare may be expensive and confusing, but if you take steps to prepare (i.e. have decent insurance), at least you can get the care you need before it majorly impacts your life. The family over there no longer has a rosy view of their healthcare system either.
…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.
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 come out of all of our pockets in a non-negotiatable tax. I think she will find that what she saved and thought was “overcharged” will be cheap once we have universal coverage.
If you think about the US system, if we pay universal care by tax, its going to cost us a lot more money that is only going to go up. The population is aging with less people in the work force to contribute. When the baby boomers hit Medicare and senior health issues those cost will sky rocket. Someone will have to pay…..so no more negotiating for Sumitha
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.
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 doing business.
Also, when you mentioned who it would effect..you forgot one, that is the patients. There will probably be a limit on test that can be ordered, procedures done, cancer therapies that extend life a couple months, cataract surgeries, MRIs etc….basically any expense test/procedures.
whoops sorry you did mention patients…less services
=]
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.
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.
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 slack.
We have strength in numbers. Large organizations, or countries, can bargain for and command realistic prices. Ironically, in America, the home of the rugged individual mythology, the individual is practically powerless.
This all smacks of the medical industry’s version of sweatshop profits. A clothing company can charge American consumers $60, $40, or $10 for the same damn shirt, made in the same damn factory, with different logos on it. Even at $10, the company is still making a healthy profit you better believe it. Even after bargaining down to $1000 for the ant bite treatment, they are still raking it in. Maybe just not as much as they would have off the sucker’s “paying retail”.
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?
@ 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 and you realize that based on their income, they will never be able to pay it back, then you have already recognized that people should not necessarily be required to pay for the medical expenses they used.
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 many women die from cervical cancer because they can’t afford to get a pap test??! Breast cancer? It also means that I pay relatively high taxes, but that’s the cost of having universal health care. It also means that someone who is earning a minimum wage enjoys the same standard of basic health care that a millionaire does – that’s fair. Just because you have more money does not make your life any more important or “saveable” than someone who doesn’t have a lot of money and can’t afford health care in the US.
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.
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!
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
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 results back AFTER my pox broke out.
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!
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.
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…
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.
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.
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 brands but generics ok etc…
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 less (Medicare & Medicaid). But in the grand scheme of things, 40% is what we hope to end up with at the end of the year. Billing rates are established based on this figure. (Yes, we medical billing people would rather just charge what we need to cover the service, but that is not how the US healthcare system is set up. Insurance companies like to sell insurance on the idea that they are really saving everyone a lot of money.)
There are laws established to prevent hospitals & doctors from billing the insurance higher amounts than a cash paying customer even though insurance contracts force medical providers to accept huge discounts. There are also laws regarding the ability to offer discounts on charges based on the type of insurance you have or do not have. In general, most NON PROFIT hospitals have a standard discount they offer for uninsured patients regardles of income (40% is average). Some apply the discount automatically, some you need to ask for a discount.
Nearly all hospitals offer a need based discount program called HCAP in addition to many privately funded assistance programs. The HCAP program is subsidised by the government for the care of poor people. I strongly recommend all people apply for any financial assistance programs the hospitals offer whether you think you qualify or not. Nearly everyone who applies receives some sort of discount.
Another thing you may not realize is that you should carefully choose which hospital your family uses. There can be a wide range in the cost of care based on which hospital you go to even within the same city. I recommend you use the tools that many insurance companies now offer that list the average charges for various types of procedures. Do this before you have an emergency, so you know which hospital is your preference. A level 1 trauma hospital with neuro-surgeons on staff 24 hrs a day that receives frequent write-ups for their advanced level of care may be just what you are looking for, but be prepared to pay for those medical services when the bill hits your door. Chances are if you or a member of your family ever really needs level 1 trauma care, you won’t be the one making the decision of which hospital to use anyway.
Happy health everyone and be sensible in your financial decisions regarding medical care.
wonderful post!
” 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 pay my share. Broken healthcare system or no, I felt it was my duty to pay my share (after taking notes on how to get cheaper care next time) – I had the means to do so just like you say you do and I felt I had the obligation to pay for services rendered even if I didn’t like it.
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.
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 best course of action when you a non-fraudulent bill and the ability to pay it.
This is not to say you didn’t do a great job at negotiating. Obviously you got what you wanted and therefore, you ‘won the prize’ where your bottom line was concerned.
I think sometimes, in the quest to be frugal, people work the systems so they can be cheap. There’s a difference between the two (I’m learning this via all the hard lessons myself). I think there’s some honor in being as frugal as possible while still being as ethical as possible. It might not be the least expensive route, but maybe a better sleep-well-at-night route to financial independence.
I don’t know for sure though. Anyone feel that cheap vs frugal (and there may be a better way to phrase that, so feel free to do so) is a valuable difference to make for the big picture of life?
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 should have been hundreds of thousands, maybe even millions.
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.
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.
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.
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.
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 of the problems with insurance is that people lose sight of the actual costs. If something is free or highly discounted, we lose track of how much it costs. Years ago, an acquaintance twisted his ankle while day hiking in the California mountains. He demanded a life flight for a twisted ankle. Since his insurance paid 100%, he didn’t give a damn how much it cost in real dollars. His explanation was that he needed peace of mind.
The author paid for peace of mind as much as she did for emergency care.
She should have questioned the costs at the time, rather than later. As Judge Judy points out, “You ate the steak!”
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 a premium for the use of emergency room — not an arm and a leg!
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.
“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 needy people no matter how much individuals haggle. Gov’t healthcare is supplied by the gov’t (taxpayers), not directly by the hospital or high-deductable insurance plan.
She did nothing wrong. It’s a great idea!
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.
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?
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 much less overhead – but if your husband was in serious danger, the first thing they’ll have done was call an ambulance to get your over to the hospital asap.
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.
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!
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 🙂
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 prepared to move pretty fast to a hospital!
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!!!!
No problem!
I was so surprised when I learned that, I figured I should spread the word…
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 Easter Sunday by the way just in case you needed them). But the allergic reaction your husband had and that you correctly interpreted as requiring immediate attention is one that kills dozens of people a day.
It would have been more appropriate for you to report here what a miracle it was that medical professionals and medications were available to save your husband’s life for the bargain price you were charged instead of whining (in ignorance) was the cost was too much. And yes, I am not surprised that the hospital negotiated the price for you because they have learned that some dead beats won’t pay for the services they receive at all and better to get what they can up front.
“…is one that kills dozens of people a day.” Why? Because the “dead beats” can’t afford to have it treated.
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 see who will pay (and I suspect most people will — I know I have up until now). But then, if someone does contest it, drop the margin and settle so you can at least recover the base cost.
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 that the negotiation process itself is a added cost – there’s a whole medical billing dept dedicated to dealing with this, and it’s not cheap either. They save real money by not engaging in a protracted negotiation. Its very difficult for them to even determine the true cost of service, because of the way the organization functions.
There’s a lot wrong with the system, for sure, but it’s not as cut and dry as you’re making it out to be.
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 balance at the forefront of my mind, I wouldn’t even have called or known that you can negotiate a bill…. which means another person with a similar situation who knew the “system” would have paid half of what I did!).
The hospital was probably willing to only negotiate down to the same amount that is already negotiated as an insurance group rate.
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 to create and maintain discount programs for those who are not insured or are insured but do not have adequate coverage. That is where my job comes into play. It does not matter if I like you or you talk sweetly to me, I can not offer a greater discount than what has already been established for all patients—to do so would be against the law. I also can not refuse you the right to apply for a discount even if you cuss me up and down and threaten to come to the hospital and blow my brains out.–yes this does happen. If a distraught customer calls in threatening suicide over the bill, we have professionals on call to help.—yes it does happen. In medical billing (for non-profit hospitals) our only goal is to bring in enough money to keep the doors open so that we can offer services to all people who need help. You should not feel ashamed to request a discount or negotiate the rate- your insurance company does not have a problem doing this. However, when you reach the lowest level of discount available, please understand that is all you get.
The real question that rarely comes out in these types of conversations is “How much are you paying your insurance company each year to not pay your medical bills?” Is it possible that you could assume all or most of that risk and greatly reduce your dependence on medical insurance?
Congratulations on opting for a high deductible plan. By accepting that financial responsibility, you have already taken a big step towards fixing our broken medical system.
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 ASAP instead of putting him next in line, it covered the physician to make some immediate decisions about his clinical status and write the necessary orders to prevent swelling of his airway (and then to later prescribe an epi pen!) and the RN to admin the life saving medicine. All the while having staff at the ready if his airway were to become compromised. Also, there was likely a facility fee because the emergency department was connected to a hospital, which means if something did go wrong he could be whisked off to the ICU or the OR without needing transport in an ambulance first.
I don’t know, I do agree that the way our healthcare system is structured makes no sense and needs to be fixed, but I would gladly pay $2k+ to save my husband’s life, no questions asked. Signing up for a high deductible plan you are accepting the risk of getting some big bills. And again, to echo what some of the other healthcare professionals are saying, if this happens again this is still an ER visit, not urgent care, for the above reasons. Everything went perfectly right this time, but that doesn’t always happen! Now if someone gets a cut that needs a few stitches and they aren’t bleeding out, that is a perfect urgent care visit, or a bladder infection on the weekend. But anaphylaxis can kill you! That is definitely for the emergency department.
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, or just tried to wait it out. But if his condition had deteriorated, you may have been facing a MUCH larger ER bill, or his funeral. You did exactly the right thing by bringing him to the ER….don’t play around with allergies like this.
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 politicians in Congress and the White House. I learned to see myself as a “business” in which I am the primary shareholder.
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.
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?
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 disregard that even after looking at your own insurance policy
3. if she was self pay she should certainly argue her bill
4. Since you are a lawyer, please take someone to court to challenge the “contract” and I think you find the answers better than what I don’t seem to be able to convey to you
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 what he bills. Just imagine that. In US, if you come to the ER you have to be treated wether you have insurance or not. So either two things happen A) patients with insurance get charged more to make up the non-insured B) we can get universal care and have all of use pay more
2) your insurance is a contract and a choice. The person in this article specifically took the risk to take a high deductible plan! They could have paid more out of pocket to have a lower deductible but instead chose something that would provide them with more savings. It was THEIR CHOICE and they should be responsible for it. I am not sure how many people would get a high deductible auto insurance and then state the deductible part is too high (if you chose a higher deductible) and not pay!
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 🙁
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 of the severity of the problem and sent us to the ER instead.
But it’s good to know that you can negotiate a bill, although, it should really not be necessary if procedures would be billed fairly.
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”.
Thanks, Ingrid. Yeah, I wish it was not necessary to negotiate too!
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 at his bedside ready to manage his breathing, give him infusions to support his blood pressure, etc, etc. What’s that worth to you?
I do feel empathy for those WITH insurance coverage who have shoddy coverage (but have no real choices since insurance is now tied to their job). I have personally dealt with situations and negotiations between medical providers and insurance companies with overcharges, dentists charging for things they THINK they can charge for when they have no ability to do so based on the contract. (Being an MD they can’t pull a fast one on me).
TO me the best option for most of us is to make health insurance like car insurance. All of us should have an emergency fund for the minor stuff (up to 5k or so) and then have insurance for catastrophic stuff.
Obviously there are other issues that go beyond this comment (i.e. what do to with those with chronic issues who are “uninsurable”, role of government, role of rationing, the poor, the elderly, children of course!)
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!
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 we always haggle those bills. 2k for an ant bite and here we are complaining about insect spray. Glad you got it down.
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.
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 stay healthy and avoid the doctor than pay the few thousands every year whether or not I’m seeing the doctor. After all, higher taxes aren’t negotiable, but medical bills are 😉
In any case, I loved the article and now I know if ever the time comes, I can negotiate the medical bill.
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.
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 chapter 13 bankruptcy and I have no idea what’s going to happen to me. I’ve thought about suicide. Why not? That would nip future health issues in the bud.
Health care is something everyone needs. I can choose not to buy a Bentley, or expensive jewelry, but health care is something that everyone will need at some point in time. It needs to be made affordable. But everything in this country runs on money. Perhaps they should just execute the poor and chronically sick, and just allow people with incomes of $100,000 or more to live. That would solve a lot of problems. Everyone would be rich and be able to pay their bills.
I’ve pretty much given up. I can’t get excited about the future, because I think I’ll be in debt for the rest of my life, and have a bankruptcy on my record. With four surgeries in four years time, I’ll be broke for a long time.
I thought about going back to school, but I’d have to borrow money for that. Is it worth it? Maybe so, since I’ll have to work until I drop, and I’d much rather teach than work retail. It pays a bit better, at least. I guess if I’m going to be in debt, I might as well go to school.
Good luck on not ever getting sick. Easier said than done. And you might want to stop saving for retirement and put aside some money for any possible “accidents.” I’d start with $60,000 for starters.
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 also face the fact that if they did get treatment, they may be making payments on that (equally exorbitant) bill for the next 5 years.
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.
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, may demand they pay outstanding bills and may discourage them from seeking emergency care at all, even using scripts like those in collection boiler rooms, according to the documents and employees interviewed by The New York Times.”
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..
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 to vist the hospital.Two years ago we went to Taiwan for an comprehensive checkup for only$700 dollar only.
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.
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 enormous bill because the diagnosis was “just a simple reflex?” I guess I could have, but we didn’t. We paid the bill and moved on.
And regarding your high deductible plan, this was a calculated risk on your part, and you lost the gamble when you had a big emergency bill. I don’t fault you for trying to lower your bill, but I also don’t feel the same outrage. I think we can all agree that medical costs are often rather inflated. The $5 for each dose of ibuprofen they gave me in the hospital post-delivery testifies to this. I actually would discourage someone from asking for a cost break down for a hospital visit. It will annoy you too much.
But the reader is right; you should always ask about a discount when you go to pay. They will often give it to you. In fact, the hospital delivery bill had a little bubble on it that said “Ask about a discount!” When my husband called, he asked, and they immediately knocked 10% off the bill. But I think the writer took this whole thing too far out of a misplaced sense of outrage and lack of understanding about what the staff actually did for her husband. She saved money, for sure, but that doesn’t mean I enjoyed reading the recreated dialogue. I found it rather distasteful and sympathized more with the representative.
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!)
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 and if they would cover it. They said, “Well, we can’t tell you until it is done.” I called three different offices and none one would give me a straight answer. It was absolutely ridiculous. I ended up not taking the test, because I couldn’t risk them not covering it and having to pay an unforeseen amount out of pocket.
And it’s not as if they have the cost of procedures or medicines listed on a wall like in a restaurant or spa. You truly don’t know what you are paying until it is over.
Basically if you step foot in a hospital at all, expect to pay thousands. 🙁 I have never seen a bill for less than $1,500 to $2,000 and this included an ER visit that just ended up being a severe ear infection. And don’t assume that urgent cares are cheap either. I had a horrible migraine and got an IV with drugs at an urgent care center and that ended up being over a thousand. Unfortunately, treatment of any kind is expensive.
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 the medical system. I guess that’s part of why I feel so outraged – all these years I paid my bills like a good little citizen, and then I find out that these bills are *negotiable*. Makes you feel a little like a sucker, you know?
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 not being unethical. It’s a fact of life.
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 such patients because of the poor reimbursement rates/onerous paperwork involved.
BTW, I am the same Kate as the first one who commented.
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 went through the ‘act of saying she couldn’t. If you really want to be honest & pay your own way there is no hope for you.
Jen Y, Sad, isn’t it?
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.
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 worse so I had to act quickly. When I was examined by the ER MD, she saw inflammation in my throat which isn’t a good sign.
I healed after several rounds of steroids – internal and topical and time at the ER. I don’t regret that decision.
Yes, the poster’s husband is fine now but what would have happened that they waited and procrastinated looking for the cheapest option in the moment? The use of the phrase “ant bite” as if it was nothing serious is interesting. Of course, hindsight is always 20/20.
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).
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.
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.
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 experience working in a hospital), the “retail” price of a procedure is not what most hospitals get. Medicare/Medicaid pay much lower than that, sometimes 10-15 cents on a dollar of the retail price of a procedure. So, if the retail price is $1,000, the hospital may only get $100-150 from the government. The situation is somewhat better with private insurers, but hospitals still don’t get 100% of what they bill (retail price). Now, the only people who get stuck with the full retail price are those without insurance. Why do such people have to pay the full price for a procedure which can be provided to an insured person at a lower rate?
Just to note, self-insured people (those without insurance) usually don’t pay at all. And hospitals know that, but they still set high prices for such patients hoping that at least some of them will pay (which will cover the costs of procedures provided to patients who can’t pay at all).
Here’s our experience: http://nicoleandmaggie.wordpress.com/2011/04/25/dissecting-an-emergency-room-bill/
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 I say “yes” to bargaining.)
Now, speaking of emergencies, etc, I have to ask– if a person suffers from allergies, why not carry around either a) antihistamines, or b) an epipen? I know a couple of people who are severely allergic to bees who never leave home without their epipen, but I think, for lesser cases, why not just chew some benadryl (or some other thing, I’m not current on allergy meds) for quick absorption? Not a bad idea to carry a couple in the wallet.
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.
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 services is much higher before than after the services are rendered.
In other words, suppose the value of the services is $2,5000. At the door of the emergency room you may perceive the value of the services to be $5,000 or $10,000 or maybe more. Afterwards however you feel it’s worth only $999 or less. That’s just human nature!
Anyway, this was an interesting story and it’s cool to read all the comments.
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 you had been told the price.
3) You were charged for emergency room service, which is very expensive. That is because to provide that service in an emergency, such as yours, requires having very expensive staff and equipment ready whether they are actually needed or not.
4) The costs of providing your husband’s care didn’t go down as a result of your negotiations, they just got transferred to someone else. The hospital needs to recover the full cost of providing emergency services, which means other people are going to pay more for the emergency services they receive.
Health care in the United States is too expensive and our system for paying for it is a convoluted mess. This is another example of that.
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 paid up the full amount either gladly of grudgingly. Come to think of it, I actually might have paid the full amount even now, if the lady I spoke to on the phone explained the hospitals reason for the high cost instead of helping me negotiate!
3) Agree (see 2)
4) I don’t agree with that. If the business office at the hospital has guidelines to negotiate instead of being asked to explain the true cost to the agitated customers (and they have “negotiated rates” for insurance companies), I would place my bets on the fact that what I finally paid was the true cost. Had I paid the full amount (like I’ve always done!), I would have made a deposit into their funds for covering the cost of someone who refused to pay anything at all.
Amen to the convoluted mess part.
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, the folks that are paying full freight for health care are subsidizing the lower prices paid by those of us with private insurance or on medicare.
We are all paying for high priced emergency room visits by people who wait until a condition is a crisis because they can’t afford a doctor. They can’t afford the emergency room either, but the hospital will provide them care and try to collect later, just as they did with you. When they can’t pay, the hospital adds it to our bills as part of their overhead costs.
There are tradeoffs to Health Maintenance Organizations, but one of the good quality is the triage in situations like yours. If you had an HMO, you would have been sent to the emergency rooom. But if you had a less life threatening condition, they would send you to urgent care. And if they didn’t think the situation was urgent, they would make an appointment with a doctor during the week. That process creates lower overall costs by making sure people get appropriate treatment.
Just imagine what your costs would have been if you had mistakenly gone to urgent care. They would have had to get your husband to the emergency room via ambulance.
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 was zero.
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.
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 gotten going and costs are already going up.. Doctors are quitting the profession because they see the oncoming train. Doctors who aren’t retiring are going to no insurance models.
So, anyway, keep your collectivism and socialism. We don’t want it here. Good day.
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.
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.
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. You said that your husband downplays his health. I can tell you that even after my shot, I felt sick for several days afterwards. I never want to have a reaction like that again. It wasn’t just an ant bite.
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 buy a pair of pants, I know it costs x and I’m willing to pay x. I don’t take the pants home, then later get an influx of bills. Bills, by the way, that are not typically itemized, so you have no idea what you’re paying for what. It’s ridiculous.
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 go to the ER. Long story short, I got a tetanus shot and they super glued (or the medical equivalent) the cut back together.
Now comes the fun part and what I believe is wrong with the medical system, noone could tell me anything about costs while I was there. I even asked the desk that did paperwork as I was leaving how much I owed and they didn’t know…services were already rendered, they should know at that point what I need to pay them. Earlier in the comments someone noted that noone bats an eye at $1500 at the mechanic but does balk at the same for a doctor. I’ll take a different approach on that: the mechanic gives you an estimate and asks if you still want the service, the doctor justs asks if you want it and has no idea how much it will be. In both cases, the expert has done it enough times to be able to have a reasonably close estimate. And it is just an estimate, in both cases it is understood that something can go wrong that would change the costs.
Now to the bill: $75 for ER consumables, OK, $580 for the tetanus shot, steep but OK (and covered as preventative care so $0 to me), and the whopper $1140 for the ER services. Now I realize that yes it was “just a shot and a dab of super glue” but there are so many hidden things at the hospital you are paying for. Theres the doctor and nurse and consumables, yes, but there are also the myriad support staff check-in, billing, maintenance, cleaning, HR/admin, legal, building and utilities (and yes the dead-beats that don’t pay) that some chunk of your bill goes towards on top of the previously mentioned equipment and staff on stand-by for things that go wrong. So while I too was a bit outraged at the price, I could rationalize it and was willing to pay it.
What got me and caused me to call was that while the hospital billed $1140, the insurance company told me I had to pay the hospital $1480 for that same service. $340 more than the ER was asking for! Not to the insurance company, directly to the hospital. Evidently for the privelege of having insurance that I have to pay for, I also have to pay the insurance companies negotiated rate based on the way the procedure was coded even though it is more than the hospital is asking for. Unfortunately, my negotiations did not go so well despite waiting till I calmed down, being polite and rationale and all such things like you mentioned. I was told by insurance there was nothing they could do unless the hospital was willing to accept a lower rate. Of course they would be, they billed a lower rate after all, right? Wrong, the hospital held the line that the negotiated rate was the negotiated rate regardless of what they actually bill. Even after talking to hospital employees in a few different departments I still had to pay $340 higher than they billed for services rendered.
Sounds to me like you got lucky and happened to have a nice employee answer your call who wanted to help you out despite not needing to. And hey, my $340 might have covered part of your 50% discount, so from those of us that have paid full price (or more) for ER services, you’re welcome.
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 around 🙂
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.
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 one way or the other.
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%!
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 $300.00). The business “cost” me about 2-3 hours a week, average, during the height of the negotiations, and took about a year after treatment to negotiate ALL of the bills down. In the end, what would have cost 90,000.00 +, cost less than $2,000. What floors me, is that had I not been there, I can’t imagine how my VERY ILL mother would have managed to save her life AND not go bankrupt.
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 a new product – less than 10 yrs. old) because they know the customer will buy it to stay alive. Pharma Companies and their channel partners form a nexus to loot people.
Always ask for a generic version of the drug prescribed by the doctor, that will save you around 70-80% of the cost of medicines.
(A generic version of a medicine is a version having same substance but a different brand name. when a pharma company develops a new drug, it is given 10 years protection to price the drug at a higher price, sometimes insanely higher and to recover its R&D costs and no other pharma company is allowed to manufacture that medicine. This is fine, but these pharma companies don’t reduce prices even after this 10 year period and continue to fleece the customers, here comes the generic versions)
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 with them and let them know that you can’t or won’t pay their rates. Thats what insurance does, even with a high-deductable plan. After all, they want to pay as little as possible.
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 being nice. Why? Because they say it sets up an incentive for other medicare patients to see you for a cheaper rate.
So as you can see, it is a contract between the doctor/health care provider, insurance and patient. The doctor agrees to be paid an amount, the insurance agrees to a premium from the patient and a payment to the health care organization and the patient agrees to pay a premium and pay the doctor their deductible.
Again, I ask you…if you had a car wreck and you have a 1000 deductible….how many of you ask for discount on that from the body shop?! Where does that money come from!!!
Still paying over $1000 for a one hour outpatient prostrate biopsy for my husband, and over $1000 for his dental bill from 2012. Insanity!!
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!
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.
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.
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?
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 to collections and an increase accounts receivable! When that happens we are happy with just anything.
The next time you ask for a discount, get it from the person hoarding your cash….your insurance carrier. Why is it acceptable to ask the doctor who is taking his risk to treat you and not the insurance carrier who has collected your premiums each money and only pays out a fraction!
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 many different ones.
Frequently in my practice I try to get pre approval so the patient isn’t caught off guard with a bill. I have had more than one occasion where we call the insurance company and they say “we don’t know, submit the claim and lets see what happens”.
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.
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 your mortgage if the market is in a slump and your house drops in value either. Personal accountability is gone. It is pathetic.
AGREE! More people need to re-read what you just wrote
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!
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.
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 is lacking an essential term – a price for the service.
in such circumstances, the medical provider does not get to set the term unilaterally. rather, if the parties cannot reach agreement, a court would determine the amount based on what’s fair, reasonable and customary. that would presumably be a lot lower than the price set by the provider.
that doesn’t mean you have to go to court. it does mean you have some leverage for negotiation based on something other than the threat of nonpayment.
disclaimer: i am a lawyer but this is not my area of specialization; and i am only licensed in one state, while laws vary from state to state. see restatement (second) of contracts, section 204.
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.
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.
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 water out of a rock. It makes no sense to overcharge uninsured and it’s frankly insulting to suggest that we do it “out of routine”.
seriously think about it.
In your law firm, do you call the person up that doesn’t pay your bill and offer a discount?
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 in more income, not less.
i don’t follow what you’re getting at in asking about my law firm. as a point of fact, i work at a law firm that provides free legal representation. supposing i worked at a firm that charged its clients, i doubt that i would call up clients and offer them a discount, but like i said, i’m not sure what point you’re making.
i should add that if a law firm conducted itself the way medical companies conduct themselves, the principals of the firm would probably be disciplined by the state bar. the code of ethics for the legal profession requires attorneys to be forthright, transparent and informative about their fees.
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” of income comes from the 90 paying patients. or $9000.
I billed $1000 to the 10 patients but it’s hard for them to pay and only collect 20% in the first 120 days….or $200.
Why would I bother even with this amount when my collections are so low? Maybe there is a mass conspiracy where I charge MUCH more for non insured patients. So I charge $200, but again only collect 20% so I get $400. Woohoo.
That is such a small fraction of income with all the hassles and overhead to call and try to collect that why would I bother?
Also, if overcharging self pay patients was so lucrative, why wouldn’t practices not just say they wanted self pay patients only? Does that appeal to common sense better?
The point of asking for a discount from your law firms was just to try to personalize what happens to healthcare providers when people ask us for a discount.
For us, the contract was determined as well as the rate. People don’t seem to ask for a negotiation with their monthly insurance premium but feel it is ok to ask for it on the service side.
Also, when you state about if law firms operated like medical firms we would be disbarred is not accurate and again, shows how little people understand about health insurance.
If your law firm was like a medical practice, there would be a middleman the insurance company. The client would pay a monthly premium to see lawyers and you would contract to the insurance company a premium to see these clients. The problem is the law group down the street negotiated a higher premium, but another lower. But the other problem is there isn’t just one insurance company. You have contracts with BCBS, Aetna, Medicare, etc..Not only that there are BCBS HMO BCBS PPO, BCBS high deductible plan etc..
To add to that problem, is that even if you have your contract, the insurance company can state a certain thing you did was not covered.
So when a client comes in and says “what will my bill be”…its hard to determine.
There is no dishonestly or non forthwrightness about fees it really just depends on what gets covered, which insurance carrier, and it can be hard to determine.
I would LOVE to go back to the old days like it is now in your law field. That is a straight forward fee for service. That is I charge a patient directly. I can tell them my fee like you do and tell them what the cost will be upfront. But medicine is not like that. I hope your conversations with medical providers, insurance companies and your personal experience help you to see the difference.
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 or solo practice. what about a hospital or a large medical corporation that has the resources to go after accounts receivable?
you ask why practices don’t limit themselves to uninsured people if it’s so lucrative. first, i don’t claim that overcharging uninsured patients is lucrative. what i’ve claimed is that uninsured patients get charged more than insurers get charged for the same service. i assume providers value insured patients because it’s easier to collect from insurance companies (especially since providers agree with them up front about costs). second, i understand there are medical providers out there who do only deal with uninsured persons. there’s been some media coverage in the last few days of such practices, although the focus was less on lucrativeness and more on the hassle of dealing with insurance companies.
i understand how lawyers get paid differently than medical providers, but my point is about the fact that medical providers will not tell people the cost of services before providing them. that point stands. you make the point that you can’t be sure about insured patients’ costs up front because the insurer might dispute coverage of certain procedures. that does not explain why medical providers will not account for charges after the fact. it also does not explain why they could not make information available before the fact about the costs of different services, without any commitment as to whether the insurer will bear the cost or not. and it certainly does not explain why information will not be given in advance to an uninsured patient, who will be personally responsible for the entire cost.
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 the low collection rate. I don’t know how else to be forthright with you as I am in the business and trying to explain in business terms why uninsured patients are not “routinely” overcharged. There is no point to over charge when you can’t collect it. Also, my reference to an AR of 120 is important because we know that if we don’t collect before then the rate of collections is almost zero.
Also, like I stated it isn’t cost effective for us to have a collections department. It is easier to outsource to a collections company. Typically the way they work is they collect a certain % of collections from a patient but won’t collect if they can’t collect anything at all. So again, as you can see its more of a hassle and cost for us as we take a loss just to get some reimbursement.
So again, even if I over charged an uninsured patient a bill for a million dollars…what’s the point? It really is moot as they are limited in what they can pay out. Why establish a business model where your numbers look terrible on your business income statement where I charged the one patient a million dollars and collected 10?
Again, I am in the business and this is what we see day in a day out. I don’t know how I can be any more transparent which was what everyone was demanding. Yet when I try to explain this everyone states “it can’t be true” and discounts it.
In reference to physicians taking uninsured patients…they are not. I think you are thinking of concierge care. That is for a fee of $10-15k a year physicians will see a limited amount of patients but the patients have full access and walk in status to their doc. They are doing this to not have to deal with insurances.
Again, about your point about telling patients the cost. We do, but like I stated its hard. Again, I don’t know how else I can clearly state it. Because of the negotiated contracts between the provider and insurance there can be varying rates and plans.
I can try to have our billing department get an estimate, but it also depends on what I see that day, that is, is it a complex exam, detailed, focused. There are levels that we can bill. For example, is this a guy with a ongoing heart attack, gun shot wound or a simple hang nail?
Also, if it is more complex then I have to order a test. Then that can add cost. If I have to do an intervention, that can add cost.
So you state “the provider will not tell people the cost of services before providing it”. Its almost impossible! I have to see what insurance you have, then even before seeing you “guess” what your diagnosis is and what I need to do. Actually, it isn’t me guessing. It is a non medical person that you are asking what medically is going on to get an estimate. Is this collusion by the medical field? No, its just the complexities of medicine.
In Sumithas case, if she would have asked beforehand, what will this visit cost. What would you have us say? Ask a non medical person who doesn’t even know your problem to give an estimate? What do you expect them to say?
Also, if you want the know the cost of different services, you would have to know what services you will need.
Uri,
also please read Rhonda’s post #162.
I don’t know how we can be more transparent and clear than that.
unless i’m misreading rhonda’s post #162, it supports what i’m saying.
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.
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 the best case scenario for an uninsured patient (a nonprofit with the maximum discount) the uninsured person pays 50% more for the same service as the insurance company (20% of the base price is 50% of the actual price paid by the insurer).
I think this is the problem…
“I inferred that …”
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 how it happens no patient is billed a different amount for the services the physician provided at least initially because it is against the law to do so. Now come the variables.
A- $185 allowed and paid by insurance remaining $115 is written off per the contracted rate. ($185 received.)
B- $185 allowed $50 applied to deductible or co-insurance $135 paid by insurance and $115 is written off per the contracted rate. ($185 received.)
C- $300 billed and paid by patient no discounts offered or requested. ($300 received)
D- Patient makes no attempts to pay the bill. $300 is written off and may or may not be refered to collections. ($0 received)
E- Patient either requests a discount or provider offers a 40% discount for payment of the remaining balance. $120 written off and patient pays $180 maybe… ($180 received.)
As you can see, the provider of services is not billing any entity more or less for the same services. The provider is expecting, anticipating, and hoping to receive $300 for each service he provided. Also keep in mind, there are hundreds of variables that can alter the amount to be paid from both the individual medical condition being treated and from the contracted fee reduction system. It is a truly complicated system where the medical provider does not have the ability to establish fair rates and simply be paid the amount his/her services are worth. It is unlike any other industry and as such should not be compaired in an apples to oranges scenario.
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 for further discounts on medical services. They have already discounted the services and you are responsible for your portion of the expenses that were applied to the deductible or coinsurance.
However, if you do not have medical coverage of any sort, ask for a discount. It is not unethical to do so under our current payer system and most providers are willing to write off similiar to what they must discount for the insured patient bills.
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
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 reflection of the actual value.
my own situation doesn’t it neatly into any of the categories above. it’s more like the following:
patient F is not insured. he calls up several medical providers and nobody will give him a quote for what he needs (an annual checkup). finally he goes to an office of a nonprofit medical provider and gets someone to quote him an estimate: $150. he then gets two bills, one for the service and one for a “hospital charge,” despite the fact that the appointment was in an office building. the charges total over $500. he writes a letter disputing he owes the $500 but saying he’ll be happy to pay $150 to cover both bills. the bills get sent off to 2 separate debt collectors, with the result that patient F can’t settle them together. in response to the dunning letters, he disputes the debts and demands that they be validated. the debts are not validated. one of them is sent off to a different debt collector, who illegally continues to pursue the debt.
this is the kind of thing i’m talking about when i talk about medical ripoffs (when i’m not talking about giant for-profit hospital chains ripping billions off medicare). at this point, i think the debt is uncollectable, since the medical provider’s liability to me for illegal debt collection practices is potentially many times greater than what i owe for the doctor’s visit.
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 a discount.
D. If the provider does offer a discount it will not be more than the discount offered for insured patients unless there is a charity program available that is need based (privately funded or the federal HCAP). The average discount is 40%.
E. The average discount negotiated with insurance companies is roughly 40% of billed charges. 40% is the discount not the paid amount. The insurance companies generally pay 60% of the charges as in my example above the $180-185 was the paid amount in all cases that actually paid.
F. Now for why I say the providers hope to get 40% at the end of the year…..most SELF PAY patients do not pay a dime toward their medical expenses. Deductibles & coinsurance amounts often go upaid. Even after being offered discounts and low dollar payment plans many still do not pay. Whether it is because they can not afford to pay or because they refuse to pay, the provider is left holding the bag for unpaid medical bills. This fact pushes medical expenses ever higher. It is a game of averages. The insurance companies for the most part pay an average of 60%, but because most SELF PAY accounts end up being uncollectible, the average net recipts end up being only 40% of all billed charges. Whether you are a SELF PAY account or an insured account matters little. We all share the inflated costs of unpaid medical bills.
As far as your personal situation I disagree that you are your own distinct “example F”. You are clearly in the refused to pay example. A discount was not agreed to at the time of service and can not be demanded after the services have been rendered. All you can do is ask for a discount, but the providers are under no obligation to negotiate with you. You agreed to the services and signed your financial responsiblity agreement before you were led back into the doctor’s office.
I know you think it is unfair that your bill could not be estimated in advance. I know you believe you should not be charged a “hospital fee’ although I suspect those were actually lab fees for bloodwork or other tests associated with a routine physical. However, those services were provided to you and you are responsible for them.
As far as your credit haggling and validating the debt, perhaps you can write a post as a lawyer on how to perform those tasks to clean up your credit report. I’m sure that would be beneficial information to many of us. As a lawyer, I am sure that you are aware of the steps you can follow to dispute your credit report and remediate the illegal collection practices.
Please understand, however, that your medical provider is no longer participating in the collection activities against you. Your debt with the provider’s office has already been written off as uncolletible bad debt and has been assigned to the collection agency. At some point, perhaps a judgement can be obtained against you to resolve the debt that you owe. However, because it is a small balance, that is unlikely.
Either way, you will most likely need to find another physician to attend to your medical needs in the future. Hopefully between now and then you will take steps to either obtain medical insurance coverage to negotiate your bills for you, or better yet, you will put back some money now so you are prepared to pay for the medical services when you need them. Do your research now so that you can become an educated healthcare consumer and you will feel comfortable with the doctor you choose for your medical needs.
I know this post may offend you, I am sorry. I have a bad habit of telling people what they need to hear. I do hope you will consider my advice to improve both your medical health and your financial health. That is after all the greater goal in this discussion. Wishing you happy health and peace in your financial decisions regarding healthcare.
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 me the amount it charged me? what is the amount i have to pay if the bill is unreasonable? what do i do if the provider rejects my offer and splits the bill, eliminating my ability to do an accord and satisfaction? how does the debt collector’s illegal action fit in?
the main reason i joined this discussion (besides the interesting discussion of how medical billing works) is to make this point: just because the bill says you owe $X, doesn’t mean you owe $X. a medical provider (like any provider of a good or service) does not get to unilaterally decide how much you owe. the contract that you sign determines how much you owe.
if the contract says that one side gets to unilaterally determine the price of the service after the fact, that term is probably unconscionable and not legally valid. unconscionability is determined in an analysis that lets the court consider all relevant factors. the fact that there’s a huge power imbalance between the parties, the fact that health services are critical to one party’s well-being, the fact that the provider will not provide the service unless the recipient signs a contract, and the fact that it is difficult to impossible to comparison shop all militate in favor of the analysis that it is an unconscionable term. if the service provider actually determined an unreasonable amount, that will be an additional factor. a court determining that a contractual term is unconscionable has a wide range of remedies that it can impose. in this case, it would probably strike the term, leaving a contract without a price term. unconscionability is discussed in the second restatement of contracts, section 208.
price is an essential term of a contract for services. the way to determine the price term when the contract doesn’t supply it is to figure out the price that is “reasonable in the circumstances.” that’s from the second restatement of contracts, section 204, which i cited in a previous post. if a contract is silent on the issue of price, then the service provider does not have the right to unilaterally determine the price, any more than the consumer does.
how does one determine what is reasonable under the circumstances? since there is effectively no market for medical services, the starting point would probably be a resource guide like the healthcare blue book. in my case, a 10-15 minute annual physical checkup with no additional services (and no lab tests) might be considered an office visit, level 1 or 2, new patient (or another category, if a more appropriate one is found). the reasonable charge would therefore be in the $85-$150 range, probably closer to the former than the latter. the fact that i was quoted an estimate in that range would reinforce that $150 is probably the cap. other available and uniform standards, such as medicare, might also be used by the court.
the medical provider may argue that the $500+ amount is reasonable, in view of the medical provider’s need to charge some people more in order to offset lower prices paid by insurers and defaults by uninsured people. a court is probably not going to be very sympathetic with this point of view. in light of the fact that i offered a reasonable or more than reasonable amount of $150, the court will not think that it is fair or reasonable to gouge me because other people, including non-payers, are getting good deals. the court may reason that if the medical provider had more fair and transparent practices to begin with, it might have less of a problem with default. even if the court believed that the medical provider’s reasonability analysis is correct, it would require it to *show* that the numbers work out. (i am putting it mildly; if i was actually taken to court over this, i would countersue for unfair and deceptive acts and practices, and i think i’d have a pretty good case; remember, judges used to be lawyers, and had to charge clients in fair, honest and transparent ways or face serious consequences.)
i do not agree that the billing practices that you describe charges everyone at the same rate. if a hospital bills everyone at $300, but has a side deal with a customer that they only need to cover 60% of what’s billed, then they are in reality charging people different amounts.
when i was sent two separate bills, each for substantially more than $150, i disputed the bills and asked for a validation of the debt. that requires the medical provider to stop debt collection activity until it has shown me any contract i signed related to the debt. my case is governed by the laws of massachusetts, which applies this requirement both to the original creditor and to debt collectors. federal law has a parallel provision that applies to debt collectors, but it is an unresolved issue whether original creditors are subject to the debt validation requirement. (as an aside: anyone who has issues with debt collectors can use form letters created by the consumer financial protection bureau: http://www.consumerfinance.gov/pressreleases/the-cfpb-puts-companies-on-notice-about-harmful-debt-collection-practices/. i’m told you can also file complaints there).
as to who owns my debts now: one of the bills seems to be in the hands of a debt collector. the other one, after i wrote them a demand letter detailing their unlawful conduct and threatening to sue, sent me a letter back saying they’re closing my account and returning it to the original medical provider. i think you’re right that they’ve written off the debt as uncollectible. i may, once i’m more caught up on life, decide to sue my creditors/debt collectors. in my professional life i almost exclusively sue banks, which is rewarding, but sometimes a little monotonous. it might add some spice for me to sue other institutions for unfair and deceptive acts and practices.
this post is subject to the usual legal disclaimer: i am not offering legal advice. i am stating my understanding of an area of the law that i am not an expert on, based on knowing some legal authority that supports it and none that contradicts it. i do not represent you, and you should talk to a qualified attorney about your particular situation (feel free to show them this analysis as a starting point). any general guideline that i can offer may be trumped by a specific legal rule that applies to your situation. additionally, the statements of law i have stated above is from a restatement, which is not an authoritative source of law, but rather a distillation of rules from many different jurisdictions.
i appreciate your concern about my personal situation. i have, happily, found an employer which covers most of my health insurance and lets me pay a reasonable monthly premium with low deductibles. i have found a doctor who i trust both with my health and with being fair.
i would love to do one or more posts about fighting for your rights as a consumer that goes beyond my brief advice here about using the CFPB’s forms and complaint system. as i think i’ve made clear, my own practice is limited and i am in the process of learning about debt collection and consumer litigation more generally, and it is probably premature for me to post right now. i can answer questions about foreclosure in massachusetts, and maybe give people some guidance, in limited circumstances, to help them fight mortgage foreclosures in other states (especially FHA mortgages).
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).
But once that is all set, the contract is done. So your legal obligation is to pay the deductible, copay, etc. out of the total bill that you contracted the insurance company to get for you.
As Rhonda stated, the “price” isn’t “unilaterally determined after the fact”. So you are legally responsible for the amount that you contracted with your insurance (total amount of the bill – insurance paid amount).
And you are breaking your contract when you say “just because the bill says you owe X doesn’t mean you owe X”. That is because you agreed with your insurance company your plan to pay a certain amount of the bill that the insurance will cover. So the debt collectors have evert legal right to collect.
In regards to this quote “i do not agree that the billing practices that you describe charges everyone at the same rate. if a hospital bills everyone at $300, but has a side deal with a customer that they only need to cover 60% of what’s billed, then they are in reality charging people different amounts. ”
I’m not sure how you can have a leg to stand on when both a billing person and a physician is telling you how the system works. There are no “side deals” that happen. While people do get charged different rates, it is because of the plan. Like Rhonda stated, Medicare will pay a certain amount for the same service that BCBS will pay more. This is part of free economy and competitive bidding to lower cost.
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 should be able to show me a valid contract in which i agreed to pay the charges. the OP can do the same.
i did have the experience of asking a lab to justify its charges, which it was unable or unwilling to do. since the amount was low and i didn’t need the hassle, i just paid it. if i had a high deductible like the OP, i would have disputed it and demanded validation. what’s the point of getting a high deductible plan if the medical provider gets to overcharge?
in any event, the health insurance context is not relevant to my situation that i described in my last comment, which happened when i was uninsured. my main point here has been that uninsured people are getting ripped off and can fight it. i assume the same is true for insured people when their charges aren’t covered, but i haven’t had that experience myself.
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 to all medical care both in the physician’s office and all medical tests such as labs, x-rays, etc. for other providers working in conjunction for your complete medical care. I pulled an example Financial Responsiblity form from the net as a remineder of what this form may have looked like. This is your legal binding contract with your medical provider regardless of any other contracts you may have entered in to with your insurance and or employer. http://www.nova.edu/healthcare/forms/patient_financial_responsibility.pdf
In addition to the Financial Responsibility form you also would have been given a Consent to Treat form. Again, another legally binding contract between you and your medical provider authorizing medical services to be provided to you with your consent. You would not have received any medical treatment without both of these items being validated prior to you being seen by a medical care provider. If the office staff neglected to give you either one of these forms (or a combined version of both statements on one form) then you might have a case.
If you do have a case, then most likely the lowest paid staff member at the medical office will receive severe discipline and/or may lose his/her job because it is that important. It is akin to the binding contract & retainers your clients must sign prior to you representing them. You would not dare take on a case without completing this paperwork and neither will a medical care provider except in the event that you are incompacitated and medical care is need to save your life.
Many years ago, I was away at a youth camp and had to be rushed to the hospital. After a few tests they determined I needed to go into surgery for an appendectomy, but my parents were still a 6 hour drive from the hospital. They actually had to do a special voice recorded verbal consent over the telephone with the doctor and a nurse witness as well as fax a hand written consent to treat form in the event of an emergency escalating before my parents could arrive.
I was given a room and some pain medication so I could sleep. My parents arrived around midnight and I went in for emergency surgery around 1:30AM. The hospital & doctor waited for my parents to arrive, both because I was young and scared and would probably feel better with my parents there, but also because of the need for the consent to treat & financial responsibility. I do not fault the hospital or doctor for this decision. My care was well managed and I am very confident that I would have been rushed in for emergency surgery even if my parents did not arrive in time if my condition took a down turn.
In this sue happy age, these forms are critical. And while we are thinking on that, let’s not forget the massive malpractice insurance coverages the medical providers must carry to protect themselves from frivilous lawsuits that push medical costs ever higher.
This whole conversation revolves around your perspective. You feel you have been somehow wronged, though you lack the understanding of excatly what goes into the providing of your medical care. It is your opinion that your care should not cost what it did. The same as the original ant bite/ anaphylactic reaction medical care. You fail to account for the number of staff members that “touch” your medical care from the cleaning staff, the medical assistant that took your vitals, the billing staff, the currier to rush your labs before they spoil, the lab techs and pathologists, the nurses, and the doctor. Every one of these people have been highly trained for the service they perform. Even the cleaning staff receives more training than the average cleaning staff due to the risks they come into contact with daily.
All of these people are needed to provide the excellent medical care the American healthcare system in known for and all of the costs for the excellent service you were provided were neatly billed into two claims. The physician’s bill only includes the costs that his office provided and so you were billed separately for the costs that the hospital and it’s staff provided to you. You can not demand these bills be combined. That is an unreasonable expectation based on your limited understanding of how your charges were incurred and who the actual provider of services were.
Finally, as a side note, I recently felt the frustration of what I felt was an unfair over-billing. After multiple attempts to fix my daughter’s car, we finally had to send it to the shop. When I made the arrangements with the local shop, they told me they would check it out and give me a call before they did anything. Instead, they received the car at 2:30pm and by 10:30am the next day they called to tell me it was finished. It ended up just needing a minor part that we didn’t check out before hand and the bill was $374.70. At first I was upset, because they didn’t call me with an estimate and it was a part we could have replaced ourselves and saved the labor charge. However, after evaluating everything, the repair shop saved us hours of delay and the car is back on the road the next day which is something that would have taken us at least another week to get to. They did exactly what I asked them to do- find the problem and get it fixed as quickly as possible. They did not over charge for labor or parts. I was only frustrated because we did not think to check that part first. The moral is—-A worker is worth his wages.
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 me or the hospital that has an unclarified relationship to my examination (which took place in the same office building that i worked in as a lawyer; should i have been charging my clients a hospital fee?)
at least, my legal analysis – which is, as i keep emphasizing, inexpert and not the final word – leads me to believe that i don’t owe more than whatever the reasonable charge for the service would be. i’d be very happy to learn of any legal authority to the contrary. it could be very profitable for me to start a business where i can charge whatever i like and justify it only by saying “it’s complicated; you don’t understand.”
as for your car repair situation, it seems to me you were not obligated to pay the bill, since you had no agreement for the service. you were, of course, free to pay it. i have to say that i’ve found car mechanics to generally be fair.
finally, at the risk of turning this conversation political, i don’t agree that the united states has an excellent health care system. i personally have been much better served by the canadian system. it’s my understanding that my experiences are not unique to me, but that the canadian system performs better on objective metrics than the U.S. system, despite having more challenges, such as less money per health care recipient, an older population (itself largely a product of having a better health system), a more geographically dispersed population including very small, very remote communities, and a lessened ability to take advantage of economies of scale. it’s also my understanding that this is not unique to canada but is true of most of the “developed” countries.
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 #$@%@$$ spent the whole time critizing the medical care in the US, refused to order x-rays and wrapped my daughters leg in a soft splint which basically amounted to an ace bandage. He assured me that he was confident she did not break any bones because of her age. That bones simply flex at that age and she only needed some light support for soft tissue damage.
He then congratualated himself for saving a lot of money on healthcare and if we Americans were not so spoiled, we would not have to pay for so many non-medically necessary tests and treatments. 18 hours later, we went back to the ER with my screaming daughter. An American doctor examined her and sent her for x-rays. When the films came back and were placed on the light boards, the fracture twisting up her leg was plain as day even to this untrained young mother’s eyes. If that is representative of the Canadian philosophy on medical care, no thanks.
Good luck Uri. I can see this topic has run it’s course.
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 during the period of such medical services to third party payers and/or health practitioners. In the event that my health plan determines a service to be “not covered”, I will be responsible for the complete charge. I agree to be responsible for payment of all unpaid services rendered on my behalf or my dependents, including any fees for collection services needed.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
2.
PAYMENT
I hereby assume responsibility to pay the costs of all services provided by Nova Southeastern University Health Care Center and its physicians to the patient.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
3.
AUTHORIZATION OF PAYMENTS
I understand that Nova Southeastern University Health Care Center will assist me in submitting my claim to my insurance carrier. I hereby authorize payment directly to Nova Southeastern University and its physician(s) of medical benefits, otherwise payable to me, for the services provided. I understand that I am financially responsible for my health insurance deductibles, coinsurance and non-covered services.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
4.
LABORATORY BILLS
I understand the outside reference laboratory will bill me directly for all laboratory tests performed by the company. I understand that fee schedule (cost) for laboratory tests performed by the Health Center shall be available to the patient upon request.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
5.
TEACHING FACILITY
I have been informed and understand that Nova Southeastern University Student Health Care Center is a teaching facility. I hereby authorized that a physician assistant and/or a resident under the supervision of an attending physician may render my medical care jointly. I authorize the physician assistant and/or resident to communicate my diagnosis and treatment with his or her supervising attending physician, as well as, with other health care practitioners involved in my care. I authorize the admittance of qualified observers, including medical students, during my consultation and/or examination.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
6.
MEDICARE LIFETIME SIGNATURE ON FILE
I request that payment of authorized Medicare benefits be made either to me or on my behalf to Nova Southeastern University Health Care Center for any services furnished me by the physicians. I authorize any holder of medical information about me to release to the Centers for Medicare and Medicaid Services and its agents any information needed to determination these benefits or the benefits payable for related services.
_______________________ ______________________________________
Date Signature of Patient (or Responsible Party)
7.
MEDIGAP AUTHORIZATION FOR ASSIGNMENT OF BENEFITS AND RELEASE OF INFORMATION
I request that payment of authorized Medigap benefits be made to either to me on my behalf to Nova Southeastern University Health Care Center for any services furnished to me by the provider of service. I authorize any holder of medical information about me to release to the Medigap insurer any information needed to determine these benefits payable for related services.
_______________________ ______________________________________
Date Signature of Patient (or Responsible Party)
___________________________________
Health Insurance Claim Number
___________________________________
Medigap Policy Number
Revised 5/26/04
———————————————
If this contract language does not completely clarify for you who is 100% liable for your medical services, then I don’t think I can help you any further.
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 you. Instead, he stabilized the leg and sent you home unhappy.
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 a physician.
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
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.
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.
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 insurance carriers for discounts and limits on medical billing and b.-The group pool that helps spread the cost of care among a larger population so that the premiums for generally healthy people help to pay the costs of those that are not healthy and consume more medical care.
* The benefits to medical care providers to enter into contract with the insurance carriers are a- that they receive access to the patient pool because they are part of the “network” of recommended providers. (The discount works like paid advertising.)and b- there is greater assurance of actually getting a payment for the medical services. Insurance companies usually pay their obligations better than the patients who are legally responsible.
I hope this helps…and now I definately think this conversation has run its course…..
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!
197Rhonda says:
23 July 2013 at 5:57 am
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 during the period of such medical services to third party payers and/or health practitioners. In the event that my health plan determines a service to be “not covered”, I will be responsible for the complete charge. I agree to be responsible for payment of all unpaid services rendered on my behalf or my dependents, including any fees for collection services needed.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
2.
PAYMENT
I hereby assume responsibility to pay the costs of all services provided by Nova Southeastern University Health Care Center and its physicians to the patient.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
3.
AUTHORIZATION OF PAYMENTS
I understand that Nova Southeastern University Health Care Center will assist me in submitting my claim to my insurance carrier. I hereby authorize payment directly to Nova Southeastern University and its physician(s) of medical benefits, otherwise payable to me, for the services provided. I understand that I am financially responsible for my health insurance deductibles, coinsurance and non-covered services.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
4.
LABORATORY BILLS
I understand the outside reference laboratory will bill me directly for all laboratory tests performed by the company. I understand that fee schedule (cost) for laboratory tests performed by the Health Center shall be available to the patient upon request.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
5.
TEACHING FACILITY
I have been informed and understand that Nova Southeastern University Student Health Care Center is a teaching facility. I hereby authorized that a physician assistant and/or a resident under the supervision of an attending physician may render my medical care jointly. I authorize the physician assistant and/or resident to communicate my diagnosis and treatment with his or her supervising attending physician, as well as, with other health care practitioners involved in my care. I authorize the admittance of qualified observers, including medical students, during my consultation and/or examination.
_______________________ _____________________________________
Date Signature of Patient (or Responsible Party)
6.
MEDICARE LIFETIME SIGNATURE ON FILE
I request that payment of authorized Medicare benefits be made either to me or on my behalf to Nova Southeastern University Health Care Center for any services furnished me by the physicians. I authorize any holder of medical information about me to release to the Centers for Medicare and Medicaid Services and its agents any information needed to determination these benefits or the benefits payable for related services.
_______________________ ______________________________________
Date Signature of Patient (or Responsible Party)
7.
MEDIGAP AUTHORIZATION FOR ASSIGNMENT OF BENEFITS AND RELEASE OF INFORMATION
I request that payment of authorized Medigap benefits be made to either to me on my behalf to Nova Southeastern University Health Care Center for any services furnished to me by the provider of service. I authorize any holder of medical information about me to release to the Medigap insurer any information needed to determine these benefits payable for related services.
_______________________ ______________________________________
Date Signature of Patient (or Responsible Party)
___________________________________
Health Insurance Claim Number
___________________________________
Medigap Policy Number
Revised 5/26/04
–––––––––––––––
If this contract language does not completely clarify for you who is 100% liable for your medical services, then I don’t think I can help you any further.
“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 understand the complexities of billing. The different coding levels for care and the complexity for care. The frequent denials from insurance with documentation to justify the levels all done by super hard working billing staff.
And you can tell. The patience that you have to try to explain to Uri what he totally doesn’t understand about insurance is impressive….as well as well as your assertiveness for things obviously that step over the line.
Thanks again for posting and trying to honestly educate people on the “TRUTH” about medical bills.
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 test. It’s insane to be charged so much for such a common test.
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 and your husband’s foot was in that condition, you would have paid upfront. Just because you aren’t in the desperate condition you were when he got the bite, it doesn’t mean you should forfeit payment. Them not billing you upfront is for your benefit. As much as I dislike some parts of the healthcare system, this is not their fault. I hope you have at least learned from this and will get a better insurance plan.
totally agree!!
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 for such services). Otherwise, if the article author had paid the full amount, the hospital would have got 50% more than is needed to sustain hospital operations, including ER.
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 be paid out? No, it is clearly written in your contract what you owe and what insurance will cover.
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”….
Great story and example. A reminder that EVERYTHING is negotiable.
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.
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.
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?
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?
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.
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 the difference between her reduced payment and the original charge to us. If I were her, I would have also called my insurance company to see what the negotiated rate was for their other plans, and that’s what I would have been comfortable paying. Maybe she got a great deal here and maybe she didn’t. We don’t know! I will say that I don’t think any taxpayer got suckered because the writer still paid over $1100 for an ant bite. We can go back and forth, but if we still don’t agree after this post Robert, then the meeting of the minds simply isn’t going to happen.
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
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.
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 negotiating for ANY service?
Similarly, I have negotiated a roof replacement being done for the cost the insurance will pay only (ie, the contracting company bills the insurance company but didn’t charge me a deductible).
TL;DR – negotiate away; if someone is willing to lower the price for you capitalize on the opportunity and enjoy the fruits of your work and savvy.
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.
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, the hospital violated the contracted rate. Make sense now?
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.
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.
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.
No Robert, you are assuming that they charged her the negotiated rate. At no point in that post is that stated/confirmed/checked.
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 to Medicares eyes it creates an incentive for other patients. I could get whistle blow for that.
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 plan straight forward contract. There is a agreed upon rate that we are legally abided to follow for that contract period. When that contract is up they can renegotiate or go with another health group. Why do think doctors drop on and off of insurance plans.
What I am trying to explain to you and get “common” ground is that IT IS A LEGAL CONTRACT THAT WE HAVE TO BILL HER INSURANCE RATES.
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 weren’t so stubborn, you’d agree with what I said. I’m not getting notifications of any follow up comments because I already want to bang my head on my desk.
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 pays X amount on her deductible it gets submitted to the insurance company who looks at it and knows that now she owes 3000-X.
its a contract.
“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 not individually priced. It is a closed system whose costs are shared. If one person pays less, someone else almost always pays more. That is not true of most services we purchase.
This was less negotiations, than a public relations cost to the hospital that benefited one customer at the expense of others. As “negotiations” it was really a threat to not pay for services rendered unless the bill was lowered after the fact. I worked for a guy who did that routinely. Once a contractor had finished the work, he would refuse to pay until they renegotiated the price. I didn’t stay long.
I suspect if you wait until you have eaten a meal at a fancy restaurant without prices on the menu and refuse to pay the bill until they cut the price they will call the cops. 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.
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?
“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 you take your car to a mechanic for a “knock”. In fact, they can tell you how much your appointment will cost. But you might want to ask before you make the appointment, rather than when you arrive.
If you are paying all your medical expenses out of pocket, maybe you ought to find out what an emergency room visit will cost you. But most people have insurance and the insurance company negotiates the price they pay for services. That is true even for those with large deductibles. You agreed to a payment schedule when you bought the insurance.
Imagine your outrage if hospitals did, in fact, renegotiate your price based on what they thought you were willing to pay in an emergency. If the price is negotiable, its negotiable for both parties.
“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!
Thank you very much. We must learn to be more careful in our scrutiny of every account
Reading this article made me feel dirty. I just don’t get the outrage – you willingly purchased a high deductible plan, lady!
I’m not sure where/if you work, but no one willing purchases a high deductible plan there is a reasonable alternative. We have too options, high or super high deductible. Even so, why do you think that give the care provider to charge whatever they feel like charging? I am just curious what you do for healthcare, Kristen.
Dave,
as a small business owner, if you know how they work, most require you to offer a high deductible plan. After that there is usually an ala carte plan but it can get expensive for the small business.
Could you explain one of your sentences? You stated “why do you think that give the care provider to charge whatever they feel like charging”
are you saying the the health care provider can charge whatever they feel like charging?
Right now it’s estimated that 14% of the population is uninsured with the ACA. Like the original poster and you, we are insured.
Please explain to me how a physician charges whatever they want to BCBS or Medicare?
Could you please explain to me how you think medical charges and insurance works?
I have negotiated ome of my past medical bills as well. They make it pretty easy to gt them at a lower price. A friend of mine used a debt consolidation company to help her.
apropos the discussion of health care ripoffs, see yesterday’s new york times article on the cost of childbirth.
http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?_r=0
here’s a wikipedia article on hospital billing practices. i just learned the term “chargemaster” today. useful word to know.
http://en.wikipedia.org/wiki/Chargemaster
and here’s a presentation by the national consumer law center and another organization about helping older americans cope with medical debt. there’s a lot in there that can be useful for non-older americans as well.
http://www.nclc.org/images/pdf/conferences_and_webinars/webinar_trainings/presentations/2011-2012/helping_older_americans_cope_with_medical_deb_webinar.pdf
Yes, people who do not understand medical billing often are surprised to discover the high prices on the charge master. Please keep in mind, that the charge master is designed to log the absolute highest price for each service. No hospitals or doctors expect to see any of those charges paid in full although it does sometimes happen for small self funded plans that administer their own benefits, third party payers like auto accident insurance, or SELF PAY patients who do not know to ask for a discount.
This is why I encourage all SELF PAY (or uninsured) patients to call and ask for a discount on all medical bills. There is nothing unethical about this practice.
The reason the charge master charges are so high is to ensure the hospitals & doctors receive the highest level of compensation that the insurance companies allow. Say the charge is $100. Insurance company A might pay $42.85. Ins B pays $34.87, Ins C pays $67.42, but ins D would pay $115.24. If the hospital only charges $100.00, they would lose out on that extra $15.24 that ins D pays.
As you can imagine, it is very important for the healthcre providers to collect every penny they are able to collect in order to keep the doors open 24/7/365. The truth is, most uninsured patients never pay a dime towards the medical bills even if a discount is offered. Many can’t afford to, some can afford to pay something but don’t. No matter where you fall on the scale of ability to pay, you should always ask for a discount though.
The laws in place require the hospital to bill all payers equally. This puts the hospital in a tricky spot because they know under the current payer system, the self pay patients are being overbilled for services. In order to make things more fair, most hospitals offer a discount system that they can offer to all patients regardless of the ability to pay in addition to the need based discount programs that the government funds.
SO long as this discount plan is made available to all SELF PAY patients equally, this is the legal way to bill SELF PAY patients less than what is billed to the insurance payer who have contracted payment rates.
Now for anyone out there wondering…Ins plan A represents a typical Medicare payment, Ins B represents a typical Medicaid (welfare) payment, Ins C represents a typical big name commercial carrier like Blue Cross Blue Shield, or United Healthcare, and Ins D represents a Small self funded plan (like small businesses) or third party payer like auto accident insurance.
I don’t know how much experience many of the readers here have with the costs of insurance, but please note the inversely proportional payment scales. The most costly to administer insurance plans (Medicare & Medicaid funded with tax dollars) pay the least amount to the healthcare providers, while the least costly to administer plans (Self funded and small business insurance) pay the highest payments to the providers. Interesting hmmm?
are you saying that for-profits give uninsured patients steeper discounts than non-profits? if so, what’s the basis? it seems unlikely to me.
this blog post and the washington monthly article it’s about is interesting reading on medical pricing for medicare.
http://www.nakedcapitalism.com/2013/07/how-the-ama-engages-in-government-sanctioned-price-fixing.html
robert,
1. the 1000% markup is a given in the facts in the hypothetical scenario that nikki gave. it is not assumed. the fact that consumers are charged many times the cost of producing medical items is widely known.
2. you *are* trying to talk to me, and I am not disregarding Rhonda’s posts. I am not assuming that all consumers are insured. and I don’t agree with the assertion (I think it was yours, not Rhonda’s, but it’s been a while and i’m not reviewing the whole history of comments, so that is from memory) that an insurance contract is between the insured, the insurer and the medical provider. my insurance contract, for example, is not signed by any medical provider. i’m disagreeing with your position, not disregarding it.
3. exactly.
4. this seems reasonably likely to happen. i’ll report back on what I find.
1. Uri, the “cost” of saline doesn’t just include the cost to make it. There is a cost for the labor, cost to pay for the labors 401k, health insurance, etc.
2. It was both mine and Rhonda that tried to explain it multiple times to you. When you sign up for insurance, you agree to pay your share (copay amount, deductible, etc) in return you allow the insurance company to negotiate on your behave and their “pool” of people for the rates of medical care. Once that is done, our prices are set for that contract period with the insurance provider for that group of people for that length of time.
3. please read Rhonda’s post again about the negotiations with and without insurance and mine about how insurance works
4. please do!
@Robert: Yeah, I actually have a good idea of what a saline solution costs because this is not my first time at the rodeo when it comes to hospital billing practices. I’ve done my due diligence as far as it is possible, since different hospitals charge different prices for the same procedure. At every hospital I’ve been to in the last six years there have been suspect charges for procedures. It’s all in the coding. I dare you to go to your local ER, ROBERT, and ask for a price on an MRI.
Nikki,
you don’t have to dare me. I am a physician. Please go thru this post and read the ones by Rhonda.
If you understand the cost of a product or procedure, why do people pay a different amount for their insurance?
Also, for coding, you do realize things are bundled right? You understand what that means?
and Nikki, I can’t tell your tone, but it comes off as emotionally charged. I am just trying to explain to people how the system works and the cost. Not to justify that it’s right or wrong.
The problem with all of these post and the one from the original blogger is they don’t understand how medical cost and billing work.
I would just kindly ask you that you do a search (ctrl F) for Rhonda’s post and read them. She is a medical biller and give her side of things.
@Robert–Well, then, doc–I assume you’re in the perfect position to tell us the cost of an MRI at your hospital, versus surrounding hospitals. Please answer my question.
Nikki,
please read Rhonda’s posts.
I don’t own or work at a hospital. I am private practice.
And if you understood how medical billing works you would understand how there isn’t a one price answer for your MRI question.
Ask yourself why people pay different amounts for their insurance? On the same aspect insurances pay different amounts for the same procedure.
So while one person with one type of insurance say medicare, will get charged X amount for the MRI. A person with BCBS will get charged another.
Most of us have a charge amount for accounting purposes that help us track these cost. That is, where one insurer will pay more another insurer will pay less.
and Nikki,
when you question why the cost of the MRI is different at a city hospital versus an outside rural hospital, you do realize that is pretty common right?
There are different payors with different patients and risk groups. When I see a patient in Dallas I get paid less for seeing the same type of patient in my office in Sherman (more rural). You understand how that works? Its common, because there are different people groups that the insurance bundles to pay rates.
If you lived in an area where everyone was 20 and barely used healthcare services vs a area of that had a lot of HTN, DM, etc…would be different.
So even you, as a physician with admitting privileges at a hospital, can’t give me a straight answer when it comes to the cost of the service a hospital renders? That is one of the factors why hospitalization is so expense: the billing department gets to make up its own prices based on questionable formulas.
Nikki,
Did you read my post? I don’t operate at a hospital and their billing is done thru them not thru us. Again do you understand how the billing works?
How about I give an example of a New patient visit then to an outpatient office?
A new patient visit for Medicare code 99204 I would get paid 500
same code for BCBS none HMO 600.
Does that help then?
What kind of medical doctor does not have admiring privileges at some kind of hospital? You didn’t answer my question with all your voluminous writing. As a physician and one who should be more familiar with the system than your patients, one wonders why you haven’t cut through the muck of bureaucracy to actually find out what procedures cost.
Nikki,
I am sorry that you are so upset but I can see that your emotions are not lending to a conversation.
I hope you have a good day.
Sincerely
@Robert–No, I’m as cold-blooded as you can get when it comes to hospital overcharges. But you must be a physician in the way you dismiss people when you can’t or won’t answer their questions.
That is crazy. My brother also had a story similar to this. He broke his arm and when he got his bill it was itemized. He had 4 screws put in and each one was $123 a piece. It was just a regular hardware screw you could have got at Ace.
Rick,
I hope you aren’t serious. You know that anything that goes into the body and is sold has to get FDA approval, research studies that proves that it is safe in the body and cost for sterilization and packaging.
$123 is cheap!
If you are so confident, next time you have a problem bring your own ACE screws to the OR with you and have the surgeon use those!
I really need help urgently! I was bit by a dog a couple months ago and needed stitches badly on my nose and lip. I should have gone to urgent care. But instead I was quikly taken to emergency room. They stitched it up and I went home. My limited insurance only covers a very small percentage of emergency room visits. I just received a bill for almost $4000! I cant even come close to paying that and now they are calling constantly! Even making small monthly payments will take forever to pay off. Cant afford to have my wages garnished! My brother was just diagnosed with M.S. and money and resources all go to that! So stressed out! What can I do???
brian – read through the comments here for some suggestions. in addition, i’d suggest looking up the procedures you’re being billed for in the healthcare bluebook (https://www.healthcarebluebook.com/) to see if you’re being charged appropriately. you may be able to stop the creditors from calling you by asking them to stop. see here for information about protection from abuse of debt collection: http://www.consumerfinance.gov/askcfpb/search/?selected_facets=category_exact:debt-collection
I don’t understand all of the people here who seem to think that the bill was justified because of the potential risk of death. I might die from choking on a piece of food at a restaurant, but that doesn’t meant that a person who saves my life by using the Heimlich on me deserves to be paid $3000 for their “work”.
The true issue here is that in many cases, it is IMPOSSIBLE to find out what the costs will be before you agree to accept service. There is no other scenario like that that is accepted in our lives…
I went to urgent care at the ER once for a split lip, to see if it needed stitches. It was in the evening, and if I did need stitches but waited until the next day, it would have been too late.
I explained the situation to the receptionist and asked how much it would cost to be seen by a nurse. She said, “I don’t know, and I’m not allowed to discuss cost with patients anyway”. I kept pushing, asked for a ballpark figure, said I really think it’s fine but I just want someone to take a look to make sure before the window to stitch closes. The ballpark figure I was finally given was “it shouldn’t be more than a hundred or so”.
The nurse saw me, poked my lip with a qtip, and said it looked fine and I don’t need stitches. It took about 5 minutes of her time. I later received a bill for upwards of $800. Do you think for a second that if I’d been told up front that it would cost $800 for a nurse to poke me with a qtip, that I would have agreed to it? But despite my best efforts NO ONE COULD TELL ME how much it would cost. That is the true ridiculous nature of health care, and I can’t believe you are obligated to pay an amount you never really agreed to.
“Sure, I’ll sell you this desk. But I can’t tell you how much it costs until after you agree to buy it. And if you don’t like the price, too bad – you still have to pay” Does this sound in any way reasonable to you?
i mostly agree with you, andrea. see my comments above.
there is, however, a plausible argument that you can be “obligated to pay an amount you never really agreed to.” the argument is that you voluntarily went to get checked, and continued even after you were told that they couldn’t give you a figure. by doing so, you entered into a contract.
entering into a contract does not, of course, mean that one party can make up any arbitrary number and make the other pay it. rather, where there is a contract with no agreement on the price, what would be owed is the reasonable price. see my comments above.
i’m not an expert on medical pricing. you may be able to look it up in the health care blue book or some other objective guide to medical costs. the $100 ballpark you were quoted sounds about right to me. $800 does not.
I agree that the whole model of medical billing is totally ferkakt. I just had an experience where I was quoted a price before my checkup, which I paid. I was then sent a bill for more charges after the appointment. ferkakt!
Andrea,
like Uri mentioned, the issue is that the original author has insurance and when she signed up she picked a high deductible plan. Also, when you pick your plan you agree to pay your OOP (out of pocket expenses) and copay and for that you allow the insurance to negotiate a rate with the hospital or physician group.
As to not being able to quote a price, the reason is as above. There is no way a front desk worker or even a physician can keep track of everyones different insurance. Out of the insurance plans offered at your work do you know how much each plan covers and for what? Also many times we don’t know what the insurance will cover. We will submit a bill that they will reject and not cover only to pay 85% of it later even though its a covered part of the insurance plan.
Also about the price for your $800. Like you, we don’t know if you are going to require stitches, a tetanus shot, a CT to look for more trauma etc. While in the end you might think the price was high, we have to stock all of those items in the facility to treat people. Some items if not used have to be discarded after a certain period of time as required by law. Also, in the facility, there are a lot of expert people to be on staff there. Doctors, nurses, US techs etc. These all add to overhead expenses that get spread out. Also take into account people like the original poster that decides not to pay their bill and those cost again get spread to others to cover cost.
So when you ask about selling the desk, the price you should have know from your insurance plan. You can get a lower deductible plan to lower your OOP cost if that would make you feel better. But in your analogy of the desk, what has happened is you pay a third party a monthly or yearly fee and agree to pay a portion of that if you buy a desk. When you goto the furniture store, the 3rd party pays the contracted rate to the furniture store and you pay your % to the store. Thats how it works.
As a Brit I have paid my taxes since 1954 to receive the “socialised medicine” that so infuriates the American right. Never been asked to pay a penny for any treatment including angioplasty and ongoing treatment for lymphoma.
Query – a CT scan can be had in the UK for less than $300, so why do they costs thousands in US?
Because it isn’t subsidized by the government. Isn’t limited to how many CT machines you can have or what types (spiral CT’s etc).
So,wait a minute—she knowingly carries a high deductible health plan, which means that anything up to a certain amount will come out of her pocket, & when she gets the bill she doesn’t want to pay it? Does she think the hospital staff works for free? Does she have the ability to say what her husband’s care was “worth”? (In her opinion, they gave him a shot, but what they really did was save the guy’s life because they are too stupid to carry an EpiPen with them wherever they go, since he is SO VERY ALLERGIC to ant bites—and there are ants EVERYWHERE in the world!!) How much is it worth to save your husband’s life because you’re too cheap & stupid to carry an EpiPen around with you? Next time, figure it out yourself—you won’t have to pay a dime for that treatment. Although, funeral costs are a lot more than medical costs are, if you’re looking at what it’s WORTH.
amen!
diane, this blog is called “get rich slowly”. not “get scolded by petty, moralistic termagants when you blog about saving money”.
W‌ith new concerns over the effects of the Affordable Care Act (ACA)[1] on access to care and continued frustration with third-party reimbursement, innovative care models such as direct primary care may help to provide a satisfying alternative for doctors and patients. Doctors paid directly rather than through the patients’ insurance premiums typically provide patients with same-day visits for as long as an hour and offer managed, coordinated, personalized care. Direct primary care–also known as “retainer medicine” or “concierge medicine”[2]–has grown rapidly in recent years. There are roughly 4,400 direct primary care physicians nationwide,[3] up from 756 in 2010 and a mere 146 in 2005.[4]
Direct primary care could resolve many of the underlying problems facing doctors and patients in government and private-sector third-party payment arrangements. It has the potential to provide better health care for patients, create a positive work environment for physicians, and reduce the growing economic burdens on doctors and patients that are caused by the prevailing trends in health policy. With some specific policy changes at the state and federal levels, this innovative approach to primary care services could restore and revolutionize the doctor—patient relationship while improving the quality of care for patients.
In general, direct primary care practices offer greater access and more personalized care to patients in exchange for direct payments from the patient on a monthly or yearly contract. Physicians can evaluate the needs and wants of their unique patient populations and practice medicine accordingly. Patients relying on a direct primary care practice can generally expect “all primary care services covered, including care management and care coordination … seven-day-a-week, around the clock access to doctors, same-day appointments, office visits of at least 30 minutes, basic tests at no additional charge, and phone and email access to the physician.”[5] Some practices may offer more services, such as free EKGs and/or medications at wholesale cost.
This approach would enable doctors and patients to avoid the bureaucratic complexity, wasteful paperwork and costly claims processing, and growing frustrations with third-party payer systems. It can also cultivate better doctor—patient relationships and reduce the economic burden of health care on patients, doctors, and taxpayers by reducing unnecessary and costly hospital visits.
While the rapid growth in direct primary care is a relatively recent trend, policymakers could help by eliminating barriers to such innovative practices and creating a level playing field for competition. At the state level, policymakers should review and clarify existing laws and regulations, repealing those that impede these arrangements. At the federal level, policymakers should consider facilitating greater access for patients to direct primary care through the federal tax code and also within existing federal entitlement programs.
First of all check the annual report of a hospital,clinic,etc you will see a huge Profits each year. Yes, there are losses with negotiated amounts and people not paying ,but even with the so called losses there is still much profit. Then take a look at the CEOs pay and bonuses as well. By the way a liter bag of saline costs around $2 at my local pharmacy (cash price)in 2014. I know hospital ,doctors have many bills to pay but their PROFIT is still humungous. Dont be fooled by so called high malpractice insurance costs either. Most people who pay their own insurance pay much higher rates!
Medical cost will never be fair in this country. Congress is in the back pocket of the medical profession. Medicine is big business first benefiting Ceo’s then shareholders,then doctors, nurses ,etc. Patients are DEAD LAST.pun intended. It is extortion only legal in the medical field. They can ride their high horses now robbing people,but when their time comes they WILL have to answer to a Higher Source. And just because they healed ?? ,for huge sums of money-( its basically your money or your life)- that wont count and send them through the pearly gates.So, now, who has the last laugh?
Lisa,
it is truly an insult to suggest that the people in the medical profession, who have sacrificed years of training at sometime minimal wage, incurred high student loans, and see patients pro bono, that our “pay” for all of this work would ultimately decide our fate into heaven. It just demonstrate the complete lack of understanding of the problem and only your knee jerk emotional response.
In regards to profits, are those gross or net? Does that include future expenses such as the cost for a new ER, facilities, MRI machines, robots, etc.
Are those profits more than what people value from their last concert ticket or sporting event? Are those people also judged into heaven by their salary too?
Did you ever think that those people who pay higher rates for insurance are HIGHER to pay for those that can’t pay for their own insurance or don’t have any? Do you know even HOW the Accountable Care Act works and where the money is coming from???
Please have more of an educated argument and not an emotional one and leave my ultimate judge to the afterlife to the one person that has the only right to judge.
Today I negotiated a 40% discount on a medical bill. I’m feeling proud of myself but it still hurt to pay even after the discount. Next time I’ll negotiate a bigger discount.