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Thread: Hospital Bills?

  1. #16
    Quote Originally Posted by dennis thompson View Post
    About a month ago we had a family member visit a hospital emergency room (he is fine). Yesterday we got a bill for $2200 telling us that was the portion not covered by our healthcare plan and please send a check for that amount. No breakout of the costs in the $2200 was shown. We called and asked for a detailed breakout of all the costs in included in the total bill , the details behind what the healthcare plan paid and the details behind what we owe. They immediately said we didn't owe $2200 but owed $800! I wonder if some people would have just sent a check for the $2200 without questioning them? I wonder if this is some kind of scam?
    Some people would just write a check, but in cases like these it's best to talk to both the provider and to the insurance company to confirm that they're talking to each other; Make sure the provider sent the claim in to the insurance, and make sure that the insurance received it and processed it.

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

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

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

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

  2. #17
    Join Date
    Jun 2009
    Location
    Victoria, BC
    Posts
    2,367
    Man, all this discussion makes me glad I live in Canada.
    Reminds me of a cartoon I saw about Breaking Bad being set in Canada. Walter White goes to the doctor. He has cancer. He gets treatment. The end.
    Paul

  3. #18
    In the past, our insurance company has sent us a statement after they've paid their share. The statement shows the original amount billed, the contract amount paid by the insurance company, and the amount we're required to pay.

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

  4. #19
    Join Date
    Jun 2006
    Location
    The Hartland of Michigan
    Posts
    7,628
    Quote Originally Posted by Mark Bolton View Post
    Wholly cow.. 200k.. My head is spinning..
    Mine would be if I didn't have HAP Senior insurance. That was at the UofM hospital A.A.
    Never, under any circumstances, consume a laxative and sleeping pill, on the same night

  5. #20
    Wait, Paul.. I thought it was: Walter White feels ill... he has to wait 2 months to see an MD... he has cancer.... he waits another 3 months to see an oncologist.... he needs chemo.... he has to wait another month to start chemo... then he dies and the show ends before it begins..... lol.. j/k - I can't believe I actually clicked on this thread and read it...

  6. #21
    Join Date
    Apr 2012
    Location
    Sacramento, ca.
    Posts
    269
    "I wonder if this is some kind of scam". Yes, Dennis it is, and it is standard practice. The hospital will accept as full payment whatever your insurance will pay plus your deductible. For a patient without insurance they will bill 3 or 4 times the amount the insurance will pay and hope to collect or negotiate an amount that is still more than insurance will pay. If you are not a good negotiator, or cannot pay, the hospital will write off the bill. The patient could be forced into bankruptcy. I think most hospitals do not know their cost of doing business and do not know what a fair charge would be. They will bill these absurd amounts because their patients are in no condition to object.
    Bill

    " You are a square peg in a square hole, and we need to twist you to make you fit. " My boss

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