Medical advice, well billing at least

[Jgault]

I generally don’t see doctors, seldom at least. But I was having chest pain last month so my wife talked me into care now, they ran an ekg which was fine but recommended I go to the hospital immediately. I did so and they took my blood pressure, oxygen level, 3 blood tests, and an ekg. I wasn’t admitted and spent 3 hours in the exam room. Good news is with the exception of slightly high blood pressure everything was normal. I made an appointment with a cardiologist in case, did the stress test and he said I’m fine. My issue is the care now ekg was $185, the cardiologist with all the tests and EKG’s was about $500, and the hospital was $6000 and after insurance I’m due for $4000. The blood tests they ran cost $200 at quest, the ekg going rate seems to be $185, so I’m being asked to pay basically $5600 for using a exam room for 3 hours and have my blood pressure taken. I’m not cheap and normally don’t bitch about bills but this just seems excessive compared to the same test any where else. Is this something I can or should try to dispute or just shut the hell up and write the check?

 

[7.62willdo]

My wife and sister in law do medical billing I’ll ask them

 

[Joebill]

I do billing for primary care. I would question the $6000 on the hospital.

 

[Kfive73]

Ask for an itemized receipt of services received. It can make it easier to dispute some charges

 

[IronSkillet]

…surcharge in away, maybe you are helping to pick up the tab for a few of the illegals that past through this hospital recently

 

[KYAggie]

I don’t know anything about what hospitals charge these days, but the first thing that came to my mind was this is another example of how we the productive get stuck with the bills of the unproductive, ie. those who don’t have insurance and no way to pay their hospital bills. They still get care, and we get stuck with the bill on top of paying taxes, social security, and Medicare.

I hope you get it worked out, that sounds absolutely ridiculous.

 

[7.62willdo]

Hi, my wife fights our medical bills always. Her questions, are do you have insurance or Medicare? Having Medicare is a help. If you don’t have either one, that’s fine too. You can still negotiate a cash price, letting them know that you can’t afford their crazy bills and tell them to have them look it over and see if there’s over billing. the bills are always highest if you have no insurance because they think they can get you. Also tell them that you will need a payment plan. She always gets a reduced bill, hope this helps.

 

[n2ishun]

I'm just surprised they've already billed you.
My asshat doc has a lame ass billing dept that any day now I'll get the bill from like 18 months ago.....no shit, they are really that slow.
It makes it hell for me to try and keep track....but....maybe that's the angle they are shooting for ?

 

[Norther]

I just got the bill for my broken knee from December. Not even in the hospital, I went to an orthopedic clinic that had immediate care. X-rays, crutches, a leg brace, and maybe an hour in the exam room, most of which was just waiting…$5000. Ridiculous.

Edit: bill was more, that’s what I’m supposed to pay.

 

[EddieNFL]

…surcharge in away, maybe you are helping to pick up the tab for a few of the illegals that past through this hospital recently

X-Ring.

 

[kenny1773]

My daughter fell and thought she broke her ankle, went to the ER to get xrays

was NOT broken
Ankle xray
Xray being read by someone
ace bandage applied to ankle
ice
crutches

total bill was over $20,000 (Twenty Thousand Dollars US)

I have gold plated insurance and didn't pay a dime towards that specific hospital visit, but I did see the EOB and the cost of everything.

That said, paying out of pocket I would question everything.

 

[UKDslayer]

I generally don’t see doctors, seldom at least. But I was having chest pain last month so my wife talked me into care now, they ran an ekg which was fine but recommended I go to the hospital immediately. I did so and they took my blood pressure, oxygen level, 3 blood tests, and an ekg. I wasn’t admitted and spent 3 hours in the exam room. Good news is with the exception of slightly high blood pressure everything was normal. I made an appointment with a cardiologist in case, did the stress test and he said I’m fine. My issue is the care now ekg was $185, the cardiologist with all the tests and EKG’s was about $500, and the hospital was $6000 and after insurance I’m due for $4000. The blood tests they ran cost $200 at quest, the ekg going rate seems to be $185, so I’m being asked to pay basically $5600 for using a exam room for 3 hours and have my blood pressure taken. I’m not cheap and normally don’t bitch about bills but this just seems excessive compared to the same test any where else. Is this something I can or should try to dispute or just shut the hell up and write the check?

First of all, find the terms of your insurance plan. This can be done with a simple call to the number on the back of your card. I know with many plans, including Obamacare/ACA, the deductible, or amount you must meet first before the insurance company pays a dime, is very high- up to $5000 per person. If this is the first time you have used the insurance this calendar year - it is likely that all this portion is going to that, and yes you are responsible for your deductible. (See if your employee has an HSA that may contribute). Then, there is a maximum OOP or out of pocket, which can be as much as $9800 but may or may not still cover your mandatory portion or "co-pays", which they still can charge after this has been met. If you have a family plan - make sure that they are considering what has been spent year to date on that on the entire family as that can supercede individual charges- I have caught them many times not realizing family OOPs were met.
So you may be paying your deductible + co-pay charges (i.e. 20%, 30% of billed charges are common co-pays or set amounts like $1250 for just walking through an ER door).The other issues in some hospital is that not all providers, even labs, may be in your network - I know in Texas this was a big issue with radiologists who were offered something like $30 for a scan reading - to them not worth the liability. If you are charged that amount ($4000) and your OOP is say $9800 - it might be worth hitting that OOP and getting all the "etc." issues that you wouldn't otherwise see a doc for urgently this year, like colon cancer screening, sleep study, bad knee etc. Just don't wait unil December. Many insurances have an automatic charge for walking through an ER door - usually $1250 or 1500. Yes, this is intended to prevent us normal folks from using ERs.
The other big issue is that - and this may sound strange - the insurance company basically has the right to decide whether you received appropriate services for your chief complaint - or what you came in for. If something was ordered that they consider out of scale for a specific problem or chief complaint, they have the right to deny any payment for it even if the ER doctor or specialist felt it was necessary/appropriate to order (and goodluck getting the doc to fight or an insurance claim in a hospital/ER vs. private office environment). Is the insurance company practicing medicine in this regard? Yup, they sure are.
If you do owe that amount- don't not pay it unless you want to be sent to collections and have an impact on your credit score. You may call the hospital insurance/financial dept. if you have an issue with that amount up front, they are often willing to divide it up into a reasonable (to them) payment plan (typically not over a year), but better than paying credit card rates.
If you went to a hospital that was in network and you had coverage in place at the time of service - make sure that all fees charges were the network arranged rates, which are significantly discounted from their set, standard rates (may make your eyeballs pop) which they will charge for private pay patients that don't have coverage (unless you are an undocumented migrant). You can confirm this by looking up your claim electronically on the insurance company websites. If you see even dollar amounts - like $500, $1500 instead of $498, $1479 you may not be given the insurance discount. Not always 100% true, but more common than not.
Honestly, hospitals and group practices are very much struggling to stay afloat because of the migrant issue and migrants using ERs for what should have been outpatient management issues in their native countries. This is affecting EVERY hospital and many private group practices as well. They are terrified of being called out, so they often receive better care that someone with best PPO plan coverage. Go figure. Some docs are trying to avoid this by not accepting any new patients without a certain federal program, like Medicare, but this screws the people who have worked hard and forced into Medicare by age/employment status to find new docs. I was recently at a very Gucci neurosurgeon's office in Dallas and saw for myself two patients that didn't speak English just present passports for coverage- no insurance card, no upfront copayments required for them. Not sure how thats working out but I know those docs wouldn't see those patients for free, so I'm sure its coming out of your tax dollar.
BTW anyone with Medicare needs to be familiar with the "No Surprise Laws" that exist for Medicare intended to prevent a hospital bill that leaves a family bankrupt.
Hope this helps.

 

[SRW]

In Network/Out of Network plays a big role but also the facility type could add charges. I believe CareNow is an urgent care not an Emergency Room, hospital or Free Standing Emergency Center. Urgent Cares shouldn't be allowed to charge "facility fees" like you are describing.
That said, I believe CareNow is owned by HCA which is one of the largest for profit healthcare/hospital providers in the country so I wouldn't put it past them to add any and all fees to every bill because you never know if they will get paid or not.

An urgent care isnt' required to have a MD on staff when they are open. They aren't open 24/7 like an ER, typically 7am-7pm or 7pm-9pm, something like that.

If you went to a Free Standing ER or hospital attached ER, something where they are open 24/7, have a MD, usually trauma surgeon type on site 100% of the time, then they have the ability to charge a facility fee like a hospital would.

I had some major medical issues 2 years ago, in and out of the hospital 3 times with a major abdominal surgery at the end of it, total cost was $275K. My insurance company had a "patient advocate" that they assigned to me who negotiated with the hospital and doctors on my behalf and provided me updates. Maybe dig into your insurance to see if there's anyone like that that can help you navigate this annoying process. My hospital stays and surgery was at a HCA hospital and I still have 1 outstanding bill from June 2022.

 

[Jgault]

Thank all of you, allot of good advice, and I really do appreciate it. My wife has been watching you tube videos to see how it can be lowered, most of them said what allot of you did. I just consider myself so lucky I have the silver plan under the Obama changes. I mean we lost the doctors my wife actually liked years ago, my deductible is twice as much, my out of pocket twice as much, but I’m forever grateful that if I get pregnant or want a sex change I’m covered. Yes ukslayer my out of pocket will be covered shortly, and I will be having every inch of me poked, prodded, and scanned to hopefully avoid seeing a doctor for the next 10 years or so God willing. I scheduled a colonoscopy for next month I’ve been putting off, my first one, being old fashioned I hope he at least sends flowers after. I guess what’s so irritating is I’ve been paying for insurance for 3+ decades without any meaningful claim, I’m just thrilled beyond measure that I’m privileged enough now to pay for a truck full of illegals that fell out of a hay truck in El Paso yesterday.

 

[NoDopes]

Never go to an ER unless it's truly a life emergency. Insurace will refuse coverage.

 

[Oryx]

You can also ask for a payment plan.
I have a bill for something like $2000 and just for giggles I told them I couldn't pay it right now.
"That's OK, how much can you afford right now?" I told them nothing.
I ended up negotiating a 5 year term at 0% interest ... I can't remember the absurdly small payment ...my wife pays all the bills.
She just set it up on an auto pay and it takes out something stupid like $30/mo

 

[powdahound76]

I generally don’t see doctors, seldom at least. But I was having chest pain last month so my wife talked me into care now, they ran an ekg which was fine but recommended I go to the hospital immediately. I did so and they took my blood pressure, oxygen level, 3 blood tests, and an ekg. I wasn’t admitted and spent 3 hours in the exam room. Good news is with the exception of slightly high blood pressure everything was normal. I made an appointment with a cardiologist in case, did the stress test and he said I’m fine. My issue is the care now ekg was $185, the cardiologist with all the tests and EKG’s was about $500, and the hospital was $6000 and after insurance I’m due for $4000. The blood tests they ran cost $200 at quest, the ekg going rate seems to be $185, so I’m being asked to pay basically $5600 for using a exam room for 3 hours and have my blood pressure taken. I’m not cheap and normally don’t bitch about bills but this just seems excessive compared to the same test any where else. Is this something I can or should try to dispute or just shut the hell up and write the check?

There are a lot of things that go into an ER bill.
Part of what you pay for is knowledge and ability (of which you used knowledge, thank God!!).
You hit my ER with CP and EKG shows MI, we can have you in the cath lab and a needle in an artery in 10-15 minutes during the day and 30 at night.
We see a few of those a day, several a week, and are at the top of the game.
Door to artery opened for a ST elevation MI from the field is under 30. We often take them up on the EMS Pram.

Im not sure what our price is for a chest pain rule out (we run you through in 2 hrs or less, run 2 troponins, 1 ekg as long as everything keeps turning up OK.
Things arent, its longer and more tests or intervention.

Not sure your age and guessing mid-late 50’s based on your paying into insurance for 3 decades plus.
Always skip an Urgent Care for anything beyond small lacerations, simple fractures or fracture rule out, or stuff like strep or suspected.
CP, respiratory issues, stroke symptoms, bad abd pain (gall bladder or diverticulitis like pain) need an ER with CT scan, rapid labs, and loads of knowledge.

They cant do much and send 10+ a day to our ER.
And thats not the Freestanding EDs that do a full work up and need admitted or an MRI. They send more.

CP and MI (myocardial infarction, or heart attack) symptoms are not to be trifled with.
Good way to make yer wife a widow. (Pics please in case yer stubborn….)
This is the Hide, of course we are ornery!!!

See what risk factors you have and what you can do to reduce them.
Eat well (keto and carnivore are well in my book, while I work in the Biz, I do see a lot of the BS in a lot of what is preached).
Be active
Lose excess lbs. we aint all supposed to be same build/size, so find out yours and chase it. FYI, modern western medicine is not the place to get this. They are BMI obsessed and docked a buddy of mine “health points” for being 5’ 10” and 195.
Benches 260, lifts a lot of weights, at 60 could do 10 perfect dead hang pull ups.
Fitter than anyone in the room, but “the chart!”

Glad you didnt have a heart attack or die.
Sorry the useless commies in charge of insurance are screwing you over.
For sure call them and the hospital. See whats up.

 

[stemikel]

Call and negotiate. I know a few places that will give a sizable discount if you pay everything at once.

 

[stemikel]

Door to artery opened for a ST elevation MI from the field is under 30.

That’s impressive. I believe that 60 minutes is the standard

 

[Short-bus]

I didn't have great insurance when I was having gall bladder problems, and was looking to have it removed. The doc my primary care doc recommended didn't accept my insurance. They were offering a cash price for the surgery at something just under $25K IIRC. I dont have $25k to throw around, and was just working to get better insurance when my gall bladder basically died inside of me, and got really infected, and my daughter had to drive me to the ER. The Hospital billed my insurance $81K for the surgery, and 2 nights in the hospital. The insurance paid $57K, and the hospital is after me for $8100. They didn't want to work with me, unless it was to make payments. I have a very negative view of the complete lack of transparency when it comes to pricing, and the way insurance does everything they can to fuck over the people buying their service.

Branden

 

[powdahound76]

Standards are meh.
Healthcare has shifted a lot and we used to invest heavily to have the baddest ass team and speed around.
I know we are still very good, despite cuts darn near everywhere.

I used to be super involved in it.
We were ranked platinum for a long time. Honestly not sure now.

Will see if I can get ahold of our rolling numbers and last 12 months.
People leave and retire, so my usual contacts and people who know arent the same ones I worked with 20, even 10 yrs ago.

 

[748rpilot]

You can also ask for a payment plan.
I have a bill for something like $2000 and just for giggles I told them I couldn't pay it right now.
"That's OK, how much can you afford right now?" I told them nothing.
I ended up negotiating a 5 year term at 0% interest ... I can't remember the absurdly small payment ...my wife pays all the bills.
She just set it up on an auto pay and it takes out something stupid like $30/mo

I did similarly. The smaller bills I just paid, after verifying that they were correct. The larger ones, I would setup payment plans, and pay on it for awhile. $10/mo, $20/mo....then after like a year, I'd call and ask if we can just settle up, and what would it take. One bill, I had $95 left on, and another for $3xx at the same provider. They cancelled the $95 if i paid the other bill immediately. Done.

You really have to read your bills and EOBs carefully @Jgault . For example, during my hospital stay I had to have blood work done 2-3 times a day, every day. It was billed incorrectly, so insurance rejected the vast majority of it; the hospital billed it as if I came in to have a blood test done (twice daily, every day, for a month). I called my insurance and explained to them that I was actually IN THE HOSPITAL and this bloodwork was part of my care. They gave me the exact code to tell the hospital to use and then resubmit the bills, then insurance covered it 100%.

Oh and another one, insurance incorrectly reimbursed the provider and I got a (large) bill for the rest. The provider was out of network for my plan, and insurance paid as such. However, the provider was used by the hospital (that was in network) and I was taken there, I forget the exact term, but I didn't decide to go on my own, I was taken via ambulance because they were the closest Level 1 Trauma center. Anyway, in that case, since it wasn't my choice to pick that facility or provider, insurance was not allowed to reimburse the out-of-network rate. But again, I had to catch that on the EOB and call the insurance company and explain the situation.

 

[Franko]

As was mentioned above you have to make sure to look at the fine print in your explanation of benefits (EOB). That is going to control how the cost is split between you and your insurance provider. You mentioned that you have a silver plan which is a 70/30 split between you and the carrier; so for every $100 the hospital charges the carrier pays $70 and you pay $30.

The presence of a deductible will complicate this situation but being asked to pay $4000 of a $6000 emergency room services bill feels wrong. You should check if your insurance carrier is trying to bill you at the "out of network" rate for the ER care. But the first step is to look at your EOB and find out what your deductible is before your 30% copay kicks in.

Also, healthcare billing is the most complicated thing on the face of the earth to deal with because the complexity lets the hospitals and carriers screw everybody up down and sideways.

Good luck.

 

[NiteQwill]

Never go to an ER unless it's truly a life emergency. Insurace will refuse coverage.

As an experienced clinician in the ED, not the greatest advice. I can guarantee you that 99.999% of the population does NOT know what a life emergency is.

The most life threatening condition is the one that is not a textbook presentation.

 

[Gemsbok]

1) With plenty of respect for paying ones own debts, and
2) Double checking and negotiating as described above,

Because no one else has brought it up, and depending on personal circumstances ....

3) Consider finding out what ouststanding medical dept looks like on your credit report.

An 65-yr old acquaintance spent her inheritance/life savings paying off one medical bill b/c she was willfully proud of #1, incapable of considering #2, and never thought about #4. Just because she could pay, doesn't mean that she should have.

 

[LuckyDuck]

Don't have much of value to add other than to wish the OP the best of luck working this out. I'm hopeful that you'll see that expense shrink just by asking for an itemized statement of charges/bill. Glad to hear that your tests all came back as you being a-ok for what it's worth.

-LD

 

[fpgt72]

My daughter fell and thought she broke her ankle, went to the ER to get xrays

was NOT broken
Ankle xray
Xray being read by someone
ace bandage applied to ankle
ice
crutches

total bill was over $20,000 (Twenty Thousand Dollars US)

I have gold plated insurance and didn't pay a dime towards that specific hospital visit, but I did see the EOB and the cost of everything.

That said, paying out of pocket I would question everything.

Part of the problem with health care is there are two prices for things. One if you pay yourself and one if you use insurance. That is true.

Now I will also say, at the moment the US has the best health care on the planet, if not why do people come to the US from for example Canada to have surgery done and it is all out of pocket. Because they are looking at 6 months + wait in their country for that "great free health care.

I don't think it is a health care issue, but an insurance issue. I also know it will never be "fixed" and anything "they" do will only make it much worse.

 

[roostercogburn98]

They are BMI obsessed and docked a buddy of mine “health points” for being 5’ 10” and 195.
Benches 260, lifts a lot of weights, at 60 could do 10 perfect dead hang pull ups.
Fitter than anyone in the room, but “the chart!”

Fuck the chart

 

[Lightning8]

1) With plenty of respect for paying ones own debts, and
2) Double checking and negotiating as described above,

Because no one else has brought it up, and depending on personal circumstances ....

3) Consider finding out what ouststanding medical dept looks like on your credit report.

An 65-yr old acquaintance spent her inheritance/life savings paying off one medical bill b/c she was willfully proud of #1, incapable of considering #2, and never thought about #4. Just because she could pay, doesn't mean that she should have.

Interesting. What does outstanding medical bills look like on credit report?

 

[roostercogburn98]

Interesting. What does outstanding medical bills look like on credit report?

Since most hospitals turn them over to a legit collection agency, most look like a 30,60,90,120, whatever day failure to make payment on a line of credit. The credit bureau doesn’t give a fuck what it’s from, they just post it. It’s up to the individual to file a dispute.

 

[kenny1773]

yes, unpaid medical bills will destroy your credit

We have government run healthcare at this point, don't fool yourself. Those that have insurance or money pay for all the medical care for those that don't.

I use to want a fake ID to get into bars and drink under age, now I want one for free medical care

 

[Herb Stoner]

What insurance are you guys on? We have been covered through my wife's work or my company plan for decades and never paid much OOP for surgeries, etc. Both of us have had multiple surgeries and most were around $200-$400 out of pocket. An ER visit was $250 - done. My last shoulder rebuild was close to $500 but that's it. Out of pocket for PT at 20-25 a visit is additional but not a big deal.

The plans lay out pretty clearly what is covered, what is not, and what it costs.

You fail to plan for health coverage and its someone else's fault?

 

[NiteQwill]

What insurance are you guys on? We have been covered through my wife's work or my company plan for decades and never paid much OOP for surgeries, etc. Both of us have had multiple surgeries and most were around $200-$400 out of pocket. An ER visit was $250 - done. My last shoulder rebuild was close to $500 but that's it. Out of pocket for PT at 20-25 a visit is additional but not a big deal.

The plans lay out pretty clearly what is covered, what is not, and what it costs.

You fail to plan for health coverage and its someone else's fault?

A lot of people buy the lowest Obamacare insurance and don't realize that it's basically catastrophic insurance. Meaning, you may be paying out of pocket for the first couple $k but you won't go into lifetime debt with a $2 million ICU bill.

 

[Doc68]

…surcharge in away, maybe you are helping to pick up the tab for a few of the illegals that past through this hospital recently

Exactly, they were starting to increase charging when I was still working at an ED last year due to this.

Illegals are killing the system currently. They come in for anything/everything and don't pay. They have no SSN so they can't even try to bill them. And with EMTALA, EDs cannot refuse treatment if a patient walks in, whether they can pay or not.

Welcome to America.....

Doc

 

[Baron23]

I generally don’t see doctors, seldom at least. But I was having chest pain last month so my wife talked me into care now, they ran an ekg which was fine but recommended I go to the hospital immediately. I did so and they took my blood pressure, oxygen level, 3 blood tests, and an ekg. I wasn’t admitted and spent 3 hours in the exam room. Good news is with the exception of slightly high blood pressure everything was normal. I made an appointment with a cardiologist in case, did the stress test and he said I’m fine. My issue is the care now ekg was $185, the cardiologist with all the tests and EKG’s was about $500, and the hospital was $6000 and after insurance I’m due for $4000. The blood tests they ran cost $200 at quest, the ekg going rate seems to be $185, so I’m being asked to pay basically $5600 for using a exam room for 3 hours and have my blood pressure taken. I’m not cheap and normally don’t bitch about bills but this just seems excessive compared to the same test any where else. Is this something I can or should try to dispute or just shut the hell up and write the check?

Two things strike me after reading this...1) "I generally don’t see doctors"...your profile says you are 51 so I strongly recommend that you reconsider your adverse view of going to see Dr for regular check up and maintenance and; 2) get better insurance...as you age, you will be glad you did.

 

[NiteQwill]

Two things strike me after reading this...1) "I generally don’t see doctors"...your profile says you are 51 so I strongly recommend that you reconsider your adverse view of going to see Dr for regular check up and maintenance and; 2) get better insurance...as you age, you will be glad you did.

You know how many 50+ year olds I've diagnosed with cancer, uncontrolled diabetes, heart failure, etc because they've "been healthy their whole life." Unfortunately for me, job security...

A ounce of prevention prevents years of pain.

Regular physicals and screenings (which are FREE with most insurance companies) are the key to life success.

 

[Baron23]

A ounce of prevention prevents years of pain.

 

[Franko]

Also, a lot of the preventative stuff is either free or really affordable as it's a whole lot cheaper for the insurer to treat your condition early before it gets really expensive.