Negotiating Hospital Bills

[cabowabo 4,514]

So about three months ago, I was sitting in my office and began having what I’ll call “flickering” in my vision. I became disorientated and was sort of out of it. Needless to say, this got my attention and my wife drove me to the ER. They ran a CT scan and everything was clear.  After a couple of hours I was ok again except for a dull ache in my head that lasted about day.  The ultimate diagnosis was a migraine.  Now, I have had infrequent instances with this flickering in my vision, but never with the disorientation that I had this time.  Pretty scary shit  

My insurance has paid a lot of the bills for this ER trip, but I’ve got about $6k in bills sitting on my desk. I am intending to call a couple of the billers tomorrow and tell them I ain’t got no money. Then I am going to see if I can settle the bills at a discount. Anyone else done this and have any tips?  What kind if discount should I expect?  Is it like negotiating with SiriusXM?  I’d be much obliged for any advice on this. Fuck going to the ER in the future. 

[Spur08 382]

First thing first -- are these actual bills or EOBs from your insurance company?  If they're the latter, just throw them away -- an EOB does NOT equal a bill.  Even though it says it all over the document, people always assume it's what they're going to pay.

[Lobwedgephil 1,139]

Having been through this a few times with having children, etc. I have been able to usually pay about 40% of the stated bills after insurance kicked in. Hasn't worked for every bill, but has for most. Just explain the situation, ask about payment plans, etc. Usually end up asking if there is a pay in full discount, which there usually is. No idea if that 40% number was good or not, just my experience and was happy not paying the 100% I thought I would have to pay. 

[Deej 76,935]

After surgery a few years ago, I received the bill from St. David's, called them to see if I could set up a payment plan, and they immediately asked if they cut the amount by 50% would I be able to pay it all right then? Yep. 

[cabowabo 4,514]

First thing first -- are these actual bills or EOBs from your insurance company?  If they're the latter, just throw them away -- an EOB does NOT equal a bill.  Even though it says it all over the document, people always assume it's what they're going to pay.

They are bills. I know the difference.

[Post Oak 20,277]

Paid 40% of the bill when my kids were born.  It was so easy I was thinking shit I should've said I was poorer.

[Sparky 149]

I had some and they offered me about 50% off if I could pay all at once but I was in no position to at the time.  But after I got to a position to where I was able to after a few payments then I called and asked what they would settle for then and got about 30% off.

[luke duke 6,414]

It wasn’t too hard when I tried. He obviously was reading a script. I believe the conversation went like this.

 

Me: I’m broke and can’t pay my bill.

Insurance guy: Can you make 2 equal payments?

Me: No.

Billing guy: Can you make 3 equal payments?

Me: No.

Billing guy: Can you make 4 equal payments?

Me: No.

Billing guy: Can you make 6 equal payments?

Me: No.

Billing guy: Can you make 12 equal payments?

Me: No.

Billing guy: Can you pay in full today if I give you a 10% discount?

Me: No.

Billing guy: Can you pay in full today if I give you a 15% discount?

Me: No.

Billing guy: Can you pay in full today if I give you a 20% discount?

Me: No.

Billing guy: Can you pay in full today if I give you a 25% discount?

Me: No.

Billing guy: That’s the best deal that you’re getting.

Me: Here’s my credit card info.

 

[cabowabo 4,514]

Just called and they said some shit like a lump sum discount was not available because what I owed was a deductible or some such.  Not really sure she even knew what she was talking about.  I told her to send me an itemize bill and I guess I'll call back at some point and see if I can get more favorable operator.  She asked if I wanted to do a payment arrangement and I said no.  There is probably some note in my file that I was middle aged white guy who looked like he could pay because I guarantee you 99% of the people in the ER with me that day were not going to and will never pay a penny for their ER trip.  At least these fuckers got some of my insurance money.

[Nice Guy Eddie 13,523]

Do you have an understanding of why these charges were not covered by your insurance?  Is it part of a deductible, co-insurance, or was a doctor not accepting your insurance plan?

Before negotiating, I would recommend having a full picture of the reason behind the charges and I would ask the insurance company for their explanation on why they didn't pay for it.  Only then do you want to talk to the billing clerk.

[T’Boo Ted Marshall 2,740]

We are trying this right now for an ER bill.
They offered zero discount after multiple attempts with both the ER and the Dr that saw my wife.

Oddly enough, they will both take monthly payments of $25 for as long as it takes. They’ll be waiting a while.

[cabowabo 4,514]

49 minutes ago, Nice Guy Eddie said:

Do you have an understanding of why these charges were not covered by your insurance?  Is it part of a deductible, co-insurance, or was a doctor not accepting your insurance plan?

Before negotiating, I would recommend having a full picture of the reason behind the charges and I would ask the insurance company for their explanation on why they didn't pay for it.  Only then do you want to talk to the billing clerk.

Looking at the EOB for this charge, the "billed amount" was $13,964.00, and there was a "provider discount" of $5,585.50.  This left $8,378.40 "Covered by Plan."  There was a "deductible amount" of $3,000, a "Co-Pay Amount" of $200, and a "Coinsurance amount" of $1,553.52.  The insurance made a total payment of $3,624.88 and the EOB indicates a "patient responsibility" of $4,753.52, which is the bill that I called and tried to negotiate this morning.  

Edited June 20, 2019 by cabowabo

[Nice Guy Eddie 13,523]

I guess your plan is something like:

$3000 annual deductible; $200 ER co-pay, and finally a 30% co-insurance after you meet the deductible. Which equals you owing 4753.  

Admittedly I don't know what I'm taking about, but I would think the easier part of the negotiation is the $1553 co-insurance.  I don't know how you will get out of paying the deductible as the insurance company will agree you owe that.   And if you don't pay the deductible, then the insurance company might balk at paying their share.

By meeting the deductible, you at least have the opportunity to pay less for other medical services for the year, if needed.

 

[Quagmire 2,147]

The fact they can’t cut bills in half just shows how much they try to fuck you in the first place. Shit is out of control.

My wife went in for a pretty small procedure , we were on our way home 1 hour later. 33k bill to insurance , fucking robbers

[tx 3 putt 77,450]

#1 - pics of your wife 

#2 - how much is she cashing out if you prematurely kick the bucket ?

[cabowabo 4,514]

4 hours ago, Nice Guy Eddie said:

I guess your plan is something like:

$3000 annual deductible; $200 ER co-pay, and finally a 30% co-insurance after you meet the deductible. Which equals you owing 4753.  

Admittedly I don't know what I'm taking about, but I would think the easier part of the negotiation is the $1553 co-insurance.  I don't know how you will get out of paying the deductible as the insurance company will agree you owe that.   And if you don't pay the deductible, then the insurance company might balk at paying their share.

By meeting the deductible, you at least have the opportunity to pay less for other medical services for the year, if needed.

I get that there is a deductible and coinsurance, but not sure why this would matter to the hospital. They already got their insurance money. On top of all that, as I stated earlier, I ain’t got any money and am living in a van down by the river. So, they should take what they can get. Of course, I don’t want to damage my excellent credit either. 

Quote

 

 

[Francisco 2.0 32,430]

In 2000, my daughter was born nearly 2 months early, and spent just over a month in NICU  Also, my ex had preeclampsia, went into a coma during the delivery, and spent 2 weeks in the hospital.  In the back of my mind, I knew we were going to have some bills, but I had no idea what to expect.

As spring rolled into summer, we would get bills here and there, plus notices from the insurance company what they would pay, etc.  The hospital actually had a department that reached out to us and told us not to pay anything until the insurance company had finished.

Months pass.  It's late November, and the insurance company says they are finished.  A few days later, I get no less than 42 bills in the mail from the hospital, breaking down what was left.  It was just shy of $20,000.  Wasn't sure what to do with this, so I called the hospital, asked for a full breakdown of what was owed and to consolidate this into one bill---I wasn't going to tackle 42 bills one at a time.  They told me it would be a few weeks to get it all gathered up.  I was also told that once they had it all consolidated, interest would start accruing on the amount owed.  I wasn't given a rate, but I had nightmares of something like 20% or more, just because they could.

In the meantime, while I was waiting on the consolidated bill, I called my banker.  He recommended a second mortgage, since the interest probably would be lower than what the hospital might charge.  Turns out, he was right.

Once I got the consolidated bill, I reached out to the hospital to make sure there were no more outstanding bills they had "forgotten".  After getting in writing from the hospital the total amount owed for all services for the ex and my daughter were listed, I borrowed enough against the house, paid the hospital in full, and had the second mortgage paid off in 4 years.  

[NeverMarryAStripper 21,926]

And you paid for about ten ER freeloaders by doing that

[cabowabo 4,514]

1 hour ago, NeverMarryAStripper said:

And you paid for about ten ER freeloaders by doing that

That’s what pisses me off about the whole thing. They want to buttfuck me to pay for all the shitbags who show up to the ER for free medical care.  Half of the fuckers there probably were illegal alie.....errr immigrants too. 

At this point I am going to wait until they send me my itemized bill to make my next move.. in all likelihood, I’m gonna be forced to put  the system on trial. 

[MadTrapper 153]

Definitely always push back and slow-play any payment.

My wife went to the doctor and ended up getting a heart monitor for precaution. The damn thing never worked properly and we sent it back to the third party company that made the device once we she was done using it. Wife is fine, most importantly.

I eventually get a $1000 bill for the monitor and about had my own heart issue. Once the bill was late (on purpose), I negotiated a 30% reduction. Next bill came and didn't pay it. Called the company to 'kill them with kindess' and negotiate an extension only to find out that "management has cleared the bill" and I didn't owe anything. $1000 to $0. Assholes.

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[Nice Guy Eddie 13,523]

4 hours ago, MadTrapper said:

Definitely always push back and slow-play any payment.

My wife went to the doctor and ended up getting a heart monitor for precaution. The damn thing never worked properly and we sent it back to the third party company that made the device once we she was done using it. Wife is fine, most importantly.

I eventually get a $1000 bill for the monitor and about had my own heart issue. Once the bill was late (on purpose), I negotiated a 30% reduction. Next bill came and didn't pay it. Called the company to 'kill them with kindess' and negotiate an extension only to find out that "management has cleared the bill" and I didn't owe anything. $1000 to $0. Assholes.

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And this is different from an ER freeloader who is probably in this country illegally?  When someone is bragging about not paying their ER bill, it’s the same result in that the next person with insurance is covering them.  

[MadTrapper 153]

And that's a fair point. However, I should have made it clear that this was a third party equipment provider who was price gouging after they received insurance payment. All doctor bills were responsibly paid, but this was $1000 for poor functioning, recycled equipment. It's unethical and is something for which I have no patience. It's ok to push back.

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[gyroprotagonist 2,595]

I think most will offer some sort of x$ per month until paid off.  I had a surgery and was between jobs on COBRA insurance and there was a huge difference between what the surgery costs and what my insurance thought the surgery should cost (and would pay).  I think i paid $100/mo for like 3-4 years until it was all paid off (no interest accruing).  

[52-80 19,258]

man, US medical management is fun. 

(note, i am not implying ANY alternative system is better... but this ones fucked)

[Sandman 3,414]

13 hours ago, Francisco 2.0 said:

In 2000, my daughter was born nearly 2 months early, and spent just over a month in NICU  Also, my ex had preeclampsia, went into a coma during the delivery, and spent 2 weeks in the hospital.  In the back of my mind, I knew we were going to have some bills, but I had no idea what to expect.

As spring rolled into summer, we would get bills here and there, plus notices from the insurance company what they would pay, etc.  The hospital actually had a department that reached out to us and told us not to pay anything until the insurance company had finished.

Months pass.  It's late November, and the insurance company says they are finished.  A few days later, I get no less than 42 bills in the mail from the hospital, breaking down what was left.  It was just shy of $20,000.  Wasn't sure what to do with this, so I called the hospital, asked for a full breakdown of what was owed and to consolidate this into one bill---I wasn't going to tackle 42 bills one at a time.  They told me it would be a few weeks to get it all gathered up.  I was also told that once they had it all consolidated, interest would start accruing on the amount owed.  I wasn't given a rate, but I had nightmares of something like 20% or more, just because they could.

In the meantime, while I was waiting on the consolidated bill, I called my banker.  He recommended a second mortgage, since the interest probably would be lower than what the hospital might charge.  Turns out, he was right.

Once I got the consolidated bill, I reached out to the hospital to make sure there were no more outstanding bills they had "forgotten".  After getting in writing from the hospital the total amount owed for all services for the ex and my daughter were listed, I borrowed enough against the house, paid the hospital in full, and had the second mortgage paid off in 4 years.  

Interest? It's not a fucking loan. And like you said, what sort of rate were they planning to charge? That's some bullshit. Back when I was extra-poor, any time I had a medical bill, I went directly to the A/P office and asked to make payment arrangements. Usually $50 a month, but there were a few months where $20 was all I could afford. They took whatever I gave them without complaint.

 

[Francisco 2.0 32,430]

4 minutes ago, Sandman said:

Interest? It's not a fucking loan. And like you said, what sort of rate were they planning to charge? That's some bullshit. Back when I was extra-poor, any time I had a medical bill, I went directly to the A/P office and asked to make payment arrangements. Usually $50 a month, but there were a few months where $20 was all I could afford. They took whatever I gave them without complaint.

 

It was around 9% interest at that time, as I recall.  And their reason for charging interest was it was a "service fee" of some kind.  My assumption was since they knew no one could pay it off all at once and would be paying for months, they saw it as a way to make some on the side for carrying the outstanding debt.  

 

[Lobwedgephil 1,139]

Just now, Francisco 2.0 said:

It was around 9% interest at that time, as I recall.  And their reason for charging interest was it was a "service fee" of some kind.  My assumption was since they knew no one could pay it off all at once and would be paying for months, they saw it as a way to make some on the side for carrying the outstanding debt.  

  

That is the first I have heard of interest, I have a lot of experience in the last 3 years of massive ER, hospital bills, etc. Never once did they try to charge interest for an extended payment. 

[Francisco 2.0 32,430]

Just now, Lobwedgephil said:

That is the first I have heard of interest, I have a lot of experience in the last 3 years of massive ER, hospital bills, etc. Never once did they try to charge interest for an extended payment. 

What my banker said at the time as well.  It pissed him off enough that he offered the loan on the spot.

On the bright side, I got to take the interest off my taxes, plus add on the medical bills I had paid.  Worked out pretty well.

[royiv 9,363]

14 hours ago, cabowabo said:

I get that there is a deductible and coinsurance, but not sure why this would matter to the hospital. They already got their insurance money. On top of all that, as I stated earlier, I ain’t got any money and am living in a van down by the river. So, they should take what they can get. Of course, I don’t want to damage my excellent credit either. 

 

That’s where you’re wrong. Your deductible and coinsurance means that they haven’t gotten their money. Use this example assuming you signed up for an insurance policy and agreed to a $2k deductible and 20% coinsurance:

Hospital Bill: $10,000

Rate that your insurance company has prenegotiated on your behalf: $4,000

Insurance cuts a check for the negotiated rate less your deductible and coinsurance: $1,200

Hospital discounts the bill by $6,000 and bills you for $2,800. These are amounts you agreed to pay when you purchased the policy. I get that healthcare in this country is expensive, but would you expect the body shop to give you your car back after a repair if you refused to pay your $1,000 collision deductible?

[TwiceHorn 31,539]

8 minutes ago, royiv said:

That’s where you’re wrong. Your deductible and coinsurance means that they haven’t gotten their money. Use this example assuming you signed up for an insurance policy and agreed to a $2k deductible and 20% coinsurance:

Hospital Bill: $10,000

Rate that your insurance company has prenegotiated on your behalf: $4,000

Insurance cuts a check for the negotiated rate less your deductible and coinsurance: $1,200

Hospital discounts the bill by $6,000 and bills you for $2,800. These are amounts you agreed to pay when you purchased the policy. I get that healthcare in this country is expensive, but would you expect the body shop to give you your car back after a repair if you refused to pay your $1,000 collision deductible?

Yep, if you don't pay your agreed share of the cost through the deductible, I imagine the insurance company has grounds to cancel you.  

Insurance has agreed with the provider to pay X for a service, of which some fraction (X/y) is yours.  If the hospital doesn't get paid that, they not only can bitch at you, they can bitch at the insurance company, at which point the insurance company can bitch at you, possibly culminating in cancellation.  Further, you are getting credit toward your deductible of X/y and if you pay less than X/y, you may be cheating the deductible.

Edited June 21, 2019 by TwiceHorn

[cabowabo 4,514]

The last two posts were very informative.  Thanks for the explanation.

[Nice Guy Eddie 13,523]

Without a doubt, the patient with commercial (BCBS, Aetna, etc.) insurance is shouldering a huge burden.  They're covering for losses due to patients who don't pay, losses due to Medicaid/Medicare, and actually the rest of the world which piggybacks on healthcare advancements financed by US patients.

 

[TwiceHorn 31,539]

Shit, anyone paying medical bills is subsidizing those that don't pay their bills.  Maybe not to an individual practitioner, but any kind of hospital, ER, or facility.

In my thankfully limited recent experience, most of those outfits, short of hospitals and ERs, are ultravigilant about collecting in advance.  I don't know what happens if you are unable to pay in advance. I assume no soup for you.

[52-80 19,258]

2 hours ago, royiv said:

That’s where you’re wrong. Your deductible and coinsurance means that they haven’t gotten their money. Use this example assuming you signed up for an insurance policy and agreed to a $2k deductible and 20% coinsurance:

Hospital Bill: $10,000

Rate that your insurance company has prenegotiated on your behalf: $4,000

Insurance cuts a check for the negotiated rate less your deductible and coinsurance: $1,200

Hospital discounts the bill by $6,000 and bills you for $2,800. These are amounts you agreed to pay when you purchased the policy. I get that healthcare in this country is expensive, but would you expect the body shop to give you your car back after a repair if you refused to pay your $1,000 collision deductible?

why isnt the insurer collecting that deductible and coinsurance?  why is the hospital having to do that?

[Gene Parmesan 4,015]

20 minutes ago, 52-80 said:

why isnt the insurer collecting that deductible and coinsurance?  why is the hospital having to do that?

Because the hospital is the entity that is issuing the bill.  Why would anyone want to step in and take the burden of collections off them?

[Nice Guy Eddie 13,523]

If you don’t pay your deductible, then the insurance shouldn’t have paid the provider yet. So if you end up stiffing the hospital, I assume the insurance company is going to come after you to cover what they paid the hospital. 

Why the system makes it relatively easy for  uninsured people to not pay a dime, insured people don’t have that option. 

[HRSchenker 2,274]

What's your max out of pocket? Outside of copays and the max I wouldn't pay them a dime. These are contracted rates.

[CooterBrown 18,031]

Shit, anyone paying medical bills is subsidizing those that don't pay their bills.  Maybe not to an individual practitioner, but any kind of hospital, ER, or facility.

It even applies to subsidizing insurance companies. Three years ago my doctor had me admitted to Seton for chest pain. Ended up with 3 stents and a week stay in the hospital. United Healthcare decided that since I should not have been admitted to the hospital due to undetermined chest pain, the blockage should’ve never been discovered and thus treatment not performed. So, they declined to pay the $210,000 bill. Their contract with Seton said that the hospital had to eat the cost beyond my copay so, luckily, I was only out $2K or so.

[T’Boo Ted Marshall 2,740]

That’s jacked and sad that insurance is determine protocols.

[Nice Guy Eddie 13,523]

8 hours ago, T’Boo Ted Marshall said:

That’s jacked and sad that insurance is determine protocols.

Yes but someone has to look out for the other insured and their future ability to pay.  In a perfect world, you should pay for whatever test or procedure the physician orders but what if the physician goes beyond norms.  Should every test be paid out because the doc is practicing extreme defensive medicine? You can't expect the patient to be the voice of reason during treatment.

[Bevo 13,601]

1 hour ago, Nice Guy Eddie said:

Yes but someone has to look out for the other insured and their future ability to pay.  In a perfect world, you should pay for whatever test or procedure the physician orders but what if the physician goes beyond norms.  Should every test be paid out because the doc is practicing extreme defensive medicine? You can't expect the patient to be the voice of reason during treatment.

Insurance companies look for any reason not to pay. They have taken cues from Medicaid which will require preapproval and deny all initial preapproval claims and require a second preapproval (in the hope that some providers will not jump through the hoops) and then following preapproval may or may not pay the claim based on an internal review made by an insurance employee. If the provider wishes to dispute the claim, they must provide full documentation to the state government agency which regulates insurance and the agency more than likely will never get around to reviewing the case.

So from a provider's perspective, they file the claim with the insurance company as a courtesy to the patient. But because of the way insurance companies treat providers, this will slowly end and providers will collect from the patient upfront and the patient will have to fight with the insurance company for payment.

[Bevo 13,601]

11 hours ago, CooterBrown said:

 

It even applies to subsidizing insurance companies. Three years ago my doctor had me admitted to Seton for chest pain. Ended up with 3 stents and a week stay in the hospital. United Healthcare decided that since I should not have been admitted to the hospital due to undetermined chest pain, the blockage should’ve never been discovered and thus treatment not performed. So, they declined to pay the $210,000 bill. Their contract with Seton said that the hospital had to eat the cost beyond my copay so, luckily, I was only out $2K or so.

Fuck United. This is why people have to pay a shit ton for things like aspirin and bandages when they are admitted. Someone else has to pay that $210,000 or else the hospital will go out of business.

[Spur08 382]

Insurance companies look for any reason not to pay. They have taken cues from Medicaid which will require preapproval and deny all initial preapproval claims and require a second preapproval (in the hope that some providers will not jump through the hoops) and then following preapproval may or may not pay the claim based on an internal review made by an insurance employee. If the provider wishes to dispute the claim, they must provide full documentation to the state government agency which regulates insurance and the agency more than likely will never get around to reviewing the case.
So from a provider's perspective, they file the claim with the insurance company as a courtesy to the patient. But because of the way insurance companies treat providers, this will slowly end and providers will collect from the patient upfront and the patient will have to fight with the insurance company for payment.

Not only that but that peer to "peer" review is often performed by someone of a different speciality. We frequently have specialities like pediatrics trying to do a review for spine/neuro procedures, something which they have little to no experience with and making determinations that are detrimental to the patient's overall health.

UHC can claim all they want about the losses they have to take, but all you have to do is look at their stock over the past 3 years to call bullshit. Aetna has recently started refusing to pay for interbodies on spine cases claiming them unnecessary. What are you supposed to do? A discectomy then leave the segment collapsed? Are you kidding?

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[Bevo 13,601]

22 minutes ago, Spur08 said:

What are you supposed to do? A discectomy then leave the segment collapsed? Are you kidding?

Well you could, but then you could get sued by the patient. I guess the answer is to get consent for the inferior treatment and likely outcomes and if the patient wants the better treatment they need to pay out of pocket. No really, how do you handle it, overcharge for other parts of the procedure and take a loss on the interbodies? 

[Okie State 3,848]

We are trying this right now for an ER bill.
They offered zero discount after multiple attempts with both the ER and the Dr that saw my wife.

Oddly enough, they will both take monthly payments of $25 for as long as it takes. They’ll be waiting a while.

This is what I did with our bills when I broke my foot and my daughter had emergency surgery within two months of each other. Methodist offered around 20% off for paying in full so I did. Memorial Hermann offered no discount so I took the free financing option. Fuck em, they can wait.