Refusing to sign or altering hospital billing admission forms?

Questions on how we spend our money and our time - consumer goods and services, home and vehicle, leisure and recreational activities
vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Wed Jan 25, 2017 3:24 am

This is a broad topic but I'm wondering what patients ("consumers") can legally and realistically do (these are two different things) if they enter a hospital or other provider, especially under an emergency circumstances, in order to not get financially destroyed by many of the gotchas in the system such as balanced billing and out of network exploits that are becoming ever more common.

I've researched this topic and haven't found any comprehensive answers; everything I've found is about fighting bills and "abuses" after the damage is done, when the provider has an open-ended contract you signed, to charge basically whatever they want, especially in an out of network situation.


If one has scheduled work it should be possible (I think?) to get all the billing information approved in advanced on paper, whether via an in-network rate or a cash upfront rate.

Two strategies that come to mind and again this would be typically in an emergency type of circumstance where one has to go out of network, such as when travelling:

- Refuse to sign any contract or admission form at this time, with the excuse that you must have your attorney first review it.
- Modify or cross out billing sections with a phrase such as: "I will only pay Medicare rate for any billed service." (Or instead of Medicare rate, 2x Medicare rate or you agree to pay no more than the in network rate for the largest commercial insurance carrier in your region.)

I'm looking for feedback from anyone who'd have insight on this issue - people who work in medical billing, lawyers, doctors, etc. What are the likely consequences of these strategies? Are there other better strategies to accomplish the main goal?

These videos are motivating me to make this post:

Lawmaker steps in after extreme hospital billing investigation
https://www.youtube.com/watch?v=HFxaI7kzB2s

Family fights $474K hospital bill
https://www.youtube.com/watch?v=2ZjadBbfX9c&t=41s
Last edited by vmsx on Wed Jan 25, 2017 4:52 am, edited 1 time in total.

User avatar
celia
Posts: 7095
Joined: Sun Mar 09, 2008 6:32 am
Location: SoCal

Re: Refusing to sign or altering hospital billing admission forms?

Post by celia » Wed Jan 25, 2017 3:59 am

I'd like to hear back what happens when you try it. :beer

I can imagine them saying "We think you'd be happier getting your care elsewhere".

(I was once told this when we had 2 dental insurance plans and refused to pay a co-pay up front knowing that I wouldn't owe anything. I should have asked, "How much do you want me to pay besides what my dual coverages pay?")
A dollar in Roth is worth more than a dollar in a taxable account. A dollar in taxable is worth more than a dollar in a tax-deferred account.

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Wed Jan 25, 2017 4:21 am

celia wrote:I'd like to hear back what happens when you try it. :beer

I can imagine them saying "We think you'd be happier getting your care elsewhere".

(I was once told this when we had 2 dental insurance plans and refused to pay a co-pay up front knowing that I wouldn't owe anything. I should have asked, "How much do you want me to pay besides what my dual coverages pay?")


Emergency rooms cannot refuse treatment. I believe at a minimum they have a legal duty to stabilize someone. A more grey area might be if one needs life saving emergency surgery, such as a heart attack relief stent, and where one might stand regarding not signing or modifying any relevant forms given the time parameters.
Last edited by vmsx on Wed Jan 25, 2017 4:27 am, edited 1 time in total.

sport
Posts: 6081
Joined: Tue Feb 27, 2007 3:26 pm
Location: Cleveland, OH

Re: Refusing to sign or altering hospital billing admission forms?

Post by sport » Wed Jan 25, 2017 4:26 am

I recently went to a routine annual appointment with a doctor that took place in a hospital. The form they gave me to sign explicitly stated that no alterations or deletions to the form would be acceptable. Of course, if I refused to sign the form, they would not let me see the doctor. They also asked me to sign a little electronic signature box without letting me see what I was signing. I refused until they gave me a printed copy of the form. Of course, I had no way of knowing if the printed copy and the electronic one I signed were actually the same. I just had to trust them on that. All of this was for an in-network doctor at an in-network hospital where I had been numerous times previously. Because of this, next year, I will see that doctor at his private office instead of the hospital. Maybe that will also eliminate the "facility fees".

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Wed Jan 25, 2017 4:33 am

sport wrote:I recently went to a routine annual appointment with a doctor that took place in a hospital. The form they gave me to sign explicitly stated that no alterations or deletions to the form would be acceptable. Of course, if I refused to sign the form, they would not let me see the doctor. They also asked me to sign a little electronic signature box without letting me see what I was signing. I refused until they gave me a printed copy of the form. Of course, I had no way of knowing if the printed copy and the electronic one I signed were actually the same. I just had to trust them on that. All of this was for an in-network doctor at an in-network hospital where I had been numerous times previously. Because of this, next year, I will see that doctor at his private office instead of the hospital. Maybe that will also eliminate the "facility fees".


I think in the circumstance of routine care one is on somewhat more solid ground to safely sign as one can confirm prices and network status of the doctor.

There is still the other gotcha though - when they send you down the hallway for a routine scan that is priced at $30,000 that should be $300 if one shopped around. The contract you sign may have agreed to this. (Doctors typically are silent partners in these scams, as they have fractional ownership of the image scanning LLC.)

For example:
Investigation - Extreme Billing for Imaging
https://www.youtube.com/watch?v=Qyc6pBYx7Cw

sport
Posts: 6081
Joined: Tue Feb 27, 2007 3:26 pm
Location: Cleveland, OH

Re: Refusing to sign or altering hospital billing admission forms?

Post by sport » Wed Jan 25, 2017 6:56 am

vmsx wrote:I think in the circumstance of routine care one is on somewhat more solid ground to safely sign as one can confirm prices and network status of the doctor.

I agree. However, the whole process of "sign this" "you don't see what you sign" "alterations and deletions not allowed" creates an environment subject to abuse. The whole attitude is we can charge whatever we want, we can do whatever we want with your information, and you agree to pay whatever we ask if your insurance will not. They just say "please sign this insurance release form". It's a good thing I have Medicare/insurance protecting me from most abuses. Being forced to sign a one-way contract is most objectionable to me.

SimonJester
Posts: 1317
Joined: Tue Aug 16, 2011 12:39 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by SimonJester » Wed Jan 25, 2017 9:07 am

So here is the alternative, you roll up to the emergency room with chest pains. The admitting staff tells you Mr. Jones we think you might be having a heart attack, the charge to examine you tonight will be $1,500 will that be on your visa card, or would you like to apply for a hospital charge card at 27% interest?

"But I have insurance", quips Mr. Jones, "Well yes that is very good, when you get your invoice of services tonight file a claim with your insurance company. What they reimburse you will depend on you insurance company and plan you are enrolled in..."

Now during the middle of the exam the ER Doctor believes you will need and MRI with contrast to see if there is a blockage. Mr. Jones that MRI will be another $3500, would you like us to charge that to the card you provided earlier? Yes, sign here...

Now after the imaging here is where the fun begins... Mr Jones we need to take you into surgery to place a stint, now the hospital fee is $8000, the Surgeons fee $4000, and the anthologist is going to be another $2000. Charge card again Mr Jones? Ohhh sorry your card was declined, application for the hospital charge account? No you want to shop around, ok let me print out a quote for your surgery, it will be good for the next 15 days.

At sometime we are going to hit the point where this is preferable to the mystery agreement of paying an known sum for services rendered based on a secret contract between insurance the provider.

It seems insurance companies have a vested interest in NOT having transparency in billing, competition between providers and competition between insurance companies.

Once I refused to write my social security number on a medical form. When turning it in the lady accepting the form said it didn't matter they had it in the system anyways :annoyed
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

User avatar
snackdog
Posts: 116
Joined: Wed Nov 12, 2014 4:57 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by snackdog » Wed Jan 25, 2017 10:03 am

Just sign with an "X". Make them prove it was you later.

User avatar
Watty
Posts: 11574
Joined: Wed Oct 10, 2007 3:55 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by Watty » Wed Jan 25, 2017 10:14 am

celia wrote:I'd like to hear back what happens when you try it. :beer

I can imagine them saying "We think you'd be happier getting your care elsewhere".


And you might very well receive a bill for the missed appointment.

User avatar
nisiprius
Advisory Board
Posts: 34151
Joined: Thu Jul 26, 2007 9:33 am
Location: The terrestrial, globular, planetary hunk of matter, flattened at the poles, is my abode.--O. Henry

Re: Refusing to sign or altering hospital billing admission forms?

Post by nisiprius » Wed Jan 25, 2017 10:32 am

It is what it is. It's a bad situation, an intolerable situation in fact, but I just don't think there's anything effective you can do as an individual by trying to negotiate with front-desk medical staff on the spot. Especially not when you are suffering severe pain from a kidney stone. (Don't ask why that particular hypothetical occurred to me).

That's the whole problem with treating medical care as a consumer situation, it's not at all like any other consumer situations.
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.

pshonore
Posts: 5648
Joined: Sun Jun 28, 2009 2:21 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by pshonore » Wed Jan 25, 2017 10:49 am

Reading these threads always makes me very happy that I'm on Medicare. I'm sure some of them could still happen but i haven't been asked for a co-pay ever.

Rupert
Posts: 2668
Joined: Fri Aug 17, 2012 12:01 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by Rupert » Wed Jan 25, 2017 11:32 am

nisiprius wrote:It is what it is. It's a bad situation, an intolerable situation in fact, but I just don't think there's anything effective you can do as an individual by trying to negotiate with front-desk medical staff on the spot. Especially not when you are suffering severe pain from a kidney stone. (Don't ask why that particular hypothetical occurred to me).

That's the whole problem with treating medical care as a consumer situation, it's not at all like any other consumer situations.


+1000. Every time I read a post complaining that healthcare should be run just like other businesses, I always think "careful what you wish for."

btenny
Posts: 4162
Joined: Sun Oct 07, 2007 6:47 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by btenny » Wed Jan 25, 2017 11:42 am

There is not a thing you can do. I have been subjected to these issues a few times. The first time I broke my arm badly way back when. This was on my big corp insurance with big deductibles and 25% co-pays. I was about 5 miles from the hospital. The firemen demanded I ride in a ambulance that cost $1000 that was not covered. They made me wait about 15 minutes for it to arrive. I had to sign a form to get taken away. I ask them to let my friend drive me as there was really nothing for anyone to do until I got to the hospital. They would not let him drive me. They insisted I go by ambulance. My arm was resting on a pillow while I gritted my teeth as the darn truck hit tons of bumps.

When I got to the hospital they gave me more forms to sign and then knocked me out to go do surgery and so forth. About a hour later they woke me up (still groggy but sort of knew where I was) to sign a second set of forms. They told me I needed a different surgery so sign some more forms. I was in the hospital about 8 hours before they released me at 1AM or so. The bill was way over $25K just for the hospital plus the doctors and other stuff. Since it was a accident my insurance told me to get the other guys plan to pay. His plan said to get my plan to pay. They were not paying anything unless I signed a detail waiver. So no one wanted to pay and no one wanted to deal with it and the hospital did not want to give me any discounts. It was a mess. I eventually got my insurance to pay about $12K and set up a payment plan with the hospital to create some discounts. I was responsible for the rest plus the doctors and ambulance. I sued the other guy to try to get some money back. My lawyer got 55% of the money and I got $10K or so when we settled two years later. I about broke even.

I had a kidney stone incident at the same place a few years later. That time the bill was only $2K or so because their MRI machine was broke and the doctor and nurse were sure it was a stone. So they just let me go home after a pain shot. But I was not released until I signed a set of forms guaranteeing I pay in full. So I paid $2K for a shot and 5 minutes of talk and 30 minutes of waiting for a clerk to bring me papers to sign.

So do not bother arguing. Your only recourse is to not go to the emergency room. I did that once too. I fell and hurt my elbow. I did not go to the ER that Saturday. I took some pain pills and stayed home.

On Monday I went to the Orthopedic doctor. He said my elbow was broke and needed surgery. They started getting authorization to set up the surgery for that afternoon and were turned down. I guess if you wait at all after an accident it is elective surgery. So the insurance wanted me to shop around for a clinic to do the surgery cheaper. No expensive local hospital allowed. It took me until Thursday to find a out patient surgery center that was cheap and good with my doctor and OK with the insurance company. So I lived on pain pills for 4 days with my arm in a sling. The center agreed to a flat price of $4K including the doctor and everything.

So beware things are just complicated and the medical bills are the bills and we have no control over what they charge or what the insurance company will pay.

Good Luck.

leonard
Posts: 5993
Joined: Wed Feb 21, 2007 11:56 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by leonard » Wed Jan 25, 2017 12:18 pm

If you are serious about mitigating this risk, I'd get the forms from the ER's you would most likely visit in your area. Then, sit down and review them with a lawyer that specializes in healthcare law to understand what your precise obligations are under the forms for each local hospital. This would be time consuming and potentially expensive - but doable.

Traveling - I don't know what you might do. Too many variables to mitigate this risk - unless you wanted to screen hospitals in the areas you were going to - which would be extremely time consuming.
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

Quark
Posts: 1045
Joined: Sun Nov 01, 2015 5:32 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by Quark » Wed Jan 25, 2017 12:32 pm

leonard wrote:If you are serious about mitigating this risk, I'd get the forms from the ER's you would most likely visit in your area. Then, sit down and review them with a lawyer that specializes in healthcare law to understand what your precise obligations are under the forms for each local hospital. This would be time consuming and potentially expensive - but doable.

Traveling - I don't know what you might do. Too many variables to mitigate this risk - unless you wanted to screen hospitals in the areas you were going to - which would be extremely time consuming.

The odds are that you'll find they're all pretty much the same. And what are you going to do when you have a serious problem and the ambulance insists on taking you to the closest ER?

leonard
Posts: 5993
Joined: Wed Feb 21, 2007 11:56 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by leonard » Wed Jan 25, 2017 12:41 pm

Quark wrote:
leonard wrote:If you are serious about mitigating this risk, I'd get the forms from the ER's you would most likely visit in your area. Then, sit down and review them with a lawyer that specializes in healthcare law to understand what your precise obligations are under the forms for each local hospital. This would be time consuming and potentially expensive - but doable.

Traveling - I don't know what you might do. Too many variables to mitigate this risk - unless you wanted to screen hospitals in the areas you were going to - which would be extremely time consuming.

The odds are that you'll find they're all pretty much the same. And what are you going to do when you have a serious problem and the ambulance insists on taking you to the closest ER?


Presumably - when you've screened the ER's in your area - the "closest ER" will be in that net.

And, see that I specifically pointed out that if you are traveling out of your immediate area - the cost/benefit of mitigating those risks and screening all those ER's may just be infeasible.
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

PVW
Posts: 270
Joined: Mon Dec 29, 2014 11:01 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by PVW » Wed Jan 25, 2017 12:44 pm

snackdog wrote:Just sign with an "X". Make them prove it was you later.


Maybe you jest, but "X" is a legitimate signature. They probably can't prove it was you, but you might have to perjure yourself to get out of paying the bill.

Quark
Posts: 1045
Joined: Sun Nov 01, 2015 5:32 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by Quark » Wed Jan 25, 2017 12:53 pm

leonard wrote:
Quark wrote:
leonard wrote:If you are serious about mitigating this risk, I'd get the forms from the ER's you would most likely visit in your area. Then, sit down and review them with a lawyer that specializes in healthcare law to understand what your precise obligations are under the forms for each local hospital. This would be time consuming and potentially expensive - but doable.

Traveling - I don't know what you might do. Too many variables to mitigate this risk - unless you wanted to screen hospitals in the areas you were going to - which would be extremely time consuming.

The odds are that you'll find they're all pretty much the same. And what are you going to do when you have a serious problem and the ambulance insists on taking you to the closest ER?

Presumably - when you've screened the ER's in your area - the "closest ER" will be in that net.

And, see that I specifically pointed out that if you are traveling out of your immediate area - the cost/benefit of mitigating those risks and screening all those ER's may just be infeasible.

You will have reviewed the information for the ERs, but what are you going to do with the information, especially if the closest is not your favorite but the ambulance driver insists on going there anyway, even though you'd prefer one farther away?

Quark
Posts: 1045
Joined: Sun Nov 01, 2015 5:32 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by Quark » Wed Jan 25, 2017 12:59 pm

PVW wrote:
snackdog wrote:Just sign with an "X". Make them prove it was you later.

Maybe you jest, but "X" is a legitimate signature. They probably can't prove it was you, but you might have to perjure yourself to get out of paying the bill.

The last ER admission form I saw allowed for an "X" and also allowed for a signature by someone acting on your behalf. They asked for ID. They have clearly thought of this and are prepared to deal with it.

One reason was that they could search medical records. I saw them arguing with a family member of a barely conscious patient on a stretcher about identity and prior treatment.

Katietsu
Posts: 847
Joined: Sun Sep 22, 2013 1:48 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by Katietsu » Wed Jan 25, 2017 1:08 pm

The primary reason the ID requirement came about was to prevent fraud where a person uses someone else's insurance.

leonard
Posts: 5993
Joined: Wed Feb 21, 2007 11:56 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by leonard » Wed Jan 25, 2017 1:45 pm

Quark wrote:
leonard wrote:
Quark wrote:
leonard wrote:If you are serious about mitigating this risk, I'd get the forms from the ER's you would most likely visit in your area. Then, sit down and review them with a lawyer that specializes in healthcare law to understand what your precise obligations are under the forms for each local hospital. This would be time consuming and potentially expensive - but doable.

Traveling - I don't know what you might do. Too many variables to mitigate this risk - unless you wanted to screen hospitals in the areas you were going to - which would be extremely time consuming.

The odds are that you'll find they're all pretty much the same. And what are you going to do when you have a serious problem and the ambulance insists on taking you to the closest ER?

Presumably - when you've screened the ER's in your area - the "closest ER" will be in that net.

And, see that I specifically pointed out that if you are traveling out of your immediate area - the cost/benefit of mitigating those risks and screening all those ER's may just be infeasible.

You will have reviewed the information for the ERs, but what are you going to do with the information, especially if the closest is not your favorite but the ambulance driver insists on going there anyway, even though you'd prefer one farther away?


I don't know what to tell you - I think you glossed details in my original post. I said:

"I'd get the forms from the ER's you would most likely visit in your area."

So, this would be - well - the ER's in your area.

The best you can do is tell - or instruct someone else to tell - the ambulance driver to go to a specific hospital. But, you are right - the ambulance driver might do whatever he/she wants and take you wherever they want. They may stop for coffee on the way - again, you can't control what irrational steps someone might take. The best you can do is plan in advance, tell the ambulance driver what you - the paying customer - wants.

The other thing I thought i'd made clear is that under this scenario there is only so much of the risk of going to a 'bad' ER that you can mitigate. Evidently that nuance was lost - might you help me find it?
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

Quark
Posts: 1045
Joined: Sun Nov 01, 2015 5:32 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by Quark » Wed Jan 25, 2017 1:57 pm

leonard wrote:
Quark wrote:
leonard wrote:
Quark wrote:
leonard wrote:If you are serious about mitigating this risk, I'd get the forms from the ER's you would most likely visit in your area. Then, sit down and review them with a lawyer that specializes in healthcare law to understand what your precise obligations are under the forms for each local hospital. This would be time consuming and potentially expensive - but doable.

Traveling - I don't know what you might do. Too many variables to mitigate this risk - unless you wanted to screen hospitals in the areas you were going to - which would be extremely time consuming.

The odds are that you'll find they're all pretty much the same. And what are you going to do when you have a serious problem and the ambulance insists on taking you to the closest ER?

Presumably - when you've screened the ER's in your area - the "closest ER" will be in that net.

And, see that I specifically pointed out that if you are traveling out of your immediate area - the cost/benefit of mitigating those risks and screening all those ER's may just be infeasible.

You will have reviewed the information for the ERs, but what are you going to do with the information, especially if the closest is not your favorite but the ambulance driver insists on going there anyway, even though you'd prefer one farther away?

I don't know what to tell you - I think you glossed details in my original post. I said:

"I'd get the forms from the ER's you would most likely visit in your area."

So, this would be - well - the ER's in your area.

The best you can do is tell - or instruct someone else to tell - the ambulance driver to go to a specific hospital. But, you are right - the ambulance driver might do whatever he/she wants and take you wherever they want. They may stop for coffee on the way - again, you can't control what irrational steps someone might take. The best you can do is plan in advance, tell the ambulance driver what you - the paying customer - wants.

The other thing I thought i'd made clear is that under this scenario there is only so much of the risk of going to a 'bad' ER that you can mitigate. Evidently that nuance was lost - might you help me find it?

The nuance is that the entire exercise of reviewing admission forms with a lawyer is most likely to be a complete waste of time and money. Two reasons are that there's not likely to be much of a difference between the forms and that in many (but not all) ER situations you're not going to have a choice of hospitals. I almost always read doctor and hospital paperwork and can't recall seeing any substantial differences in recent years.

It's not irrational for an ambulance driver to take you to the closest hospital or to the hospital they regard as most appropriate. Their usual mission is to save your life, not your wallet. You could probably win if you sued an ambulance driver who stopped for coffee.

Have you gone through this exercise?

littlebird
Posts: 1257
Joined: Sat Apr 10, 2010 6:05 pm
Location: Valley of the Sun, AZ

Re: Refusing to sign or altering hospital billing admission forms?

Post by littlebird » Wed Jan 25, 2017 2:06 pm

In the last few years my spouse was taken to the emergency room several times. They use electronic signing, but there are several separate forms. I sign - with POA on file there - all the forms except the one that has me agree that if Medicare won't pay, we will. My position is that If Medicare won't pay, or more usually, it's not clear that Medicare will pay for a certain procedure or drug, then I want to be consulted at the time the procedure or drug is contemplated.

I learned that lesson when once they forgot to ask me to sign that form and they did a procedure that was appropriate, but because of poor documentation in their records, appeared inappropriate and Medicare refused to pay. Because we had not signed that form, we were not required to pay. The hospital appealed the non-payment to Medicare and since I was notified of that fact, I gave written testimony of my knowledge of the appropriateness of the procedure, citing previous instances and Dr.'s names and diagnoses. Despite my and the hospital's testimonies, Medicare chose to rely on the incomplete hospital records and deny the hospital's appeal. The hospital had to eat it, and I don't want to have to do that if I don't have to.

There were never any repercussions from refusing to sign that form.

leonard
Posts: 5993
Joined: Wed Feb 21, 2007 11:56 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by leonard » Wed Jan 25, 2017 4:01 pm

Quark wrote:
leonard wrote:
Quark wrote:
leonard wrote:
Quark wrote:The odds are that you'll find they're all pretty much the same. And what are you going to do when you have a serious problem and the ambulance insists on taking you to the closest ER?

Presumably - when you've screened the ER's in your area - the "closest ER" will be in that net.

And, see that I specifically pointed out that if you are traveling out of your immediate area - the cost/benefit of mitigating those risks and screening all those ER's may just be infeasible.

You will have reviewed the information for the ERs, but what are you going to do with the information, especially if the closest is not your favorite but the ambulance driver insists on going there anyway, even though you'd prefer one farther away?

I don't know what to tell you - I think you glossed details in my original post. I said:

"I'd get the forms from the ER's you would most likely visit in your area."

So, this would be - well - the ER's in your area.

The best you can do is tell - or instruct someone else to tell - the ambulance driver to go to a specific hospital. But, you are right - the ambulance driver might do whatever he/she wants and take you wherever they want. They may stop for coffee on the way - again, you can't control what irrational steps someone might take. The best you can do is plan in advance, tell the ambulance driver what you - the paying customer - wants.

The other thing I thought i'd made clear is that under this scenario there is only so much of the risk of going to a 'bad' ER that you can mitigate. Evidently that nuance was lost - might you help me find it?

The nuance is that the entire exercise of reviewing admission forms with a lawyer is most likely to be a complete waste of time and money. Two reasons are that there's not likely to be much of a difference between the forms and that in many (but not all) ER situations you're not going to have a choice of hospitals. I almost always read doctor and hospital paperwork and can't recall seeing any substantial differences in recent years.

It's not irrational for an ambulance driver to take you to the closest hospital or to the hospital they regard as most appropriate. Their usual mission is to save your life, not your wallet. You could probably win if you sued an ambulance driver who stopped for coffee.

Have you gone through this exercise?


In your world - evidently it's an impossible risk to mitigate - so why bother worrying about it?

In my world, OP wanted possible suggestions to mitigate this risk. I gave a reasonable course of action that - though not bulletproof - is one approach to mitigate the risk. I never claimed it solved the problem. But, it is a reasonable avenue to pursue.

I'm done with this exchange - as you and I aren't going anywhere.
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Wed Jan 25, 2017 7:44 pm

littlebird wrote:In the last few years my spouse was taken to the emergency room several times. They use electronic signing, but there are several separate forms. I sign - with POA on file there - all the forms except the one that has me agree that if Medicare won't pay, we will. My position is that If Medicare won't pay, or more usually, it's not clear that Medicare will pay for a certain procedure or drug, then I want to be consulted at the time the procedure or drug is contemplated.

I learned that lesson when once they forgot to ask me to sign that form and they did a procedure that was appropriate, but because of poor documentation in their records, appeared inappropriate and Medicare refused to pay. Because we had not signed that form, we were not required to pay. The hospital appealed the non-payment to Medicare and since I was notified of that fact, I gave written testimony of my knowledge of the appropriateness of the procedure, citing previous instances and Dr.'s names and diagnoses. Despite my and the hospital's testimonies, Medicare chose to rely on the incomplete hospital records and deny the hospital's appeal. The hospital had to eat it, and I don't want to have to do that if I don't have to.

There were never any repercussions from refusing to sign that form.


Could you explain in more detail how you were able to put a POA on file and also how you were able to not sign the form where you have to pay if Medicare won't? Did you have to negotiate this with the ombudsman type of person? How did that transpire?

staythecourse
Posts: 4966
Joined: Mon Jan 03, 2011 9:40 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by staythecourse » Wed Jan 25, 2017 8:03 pm

As a physician and a consumer I have ALWAYS advocated voting with your feet. If you don't like the policy take your business elsewhere. BUT what is NOT allowed is to think as the consumer you can alter the flow of a private business. That is NOT your right. Frankly, pretty arrogant of you as well. Not sure what business you are in, but imagine someone coming into your work and telling you how to proceed in your line of work.

As I tell my patients my job is to make the menu and your job is to choose from the menu. What is not allowed is to make up the menu. If you don't like the menu time to go elsewhere. For example, you can't go into McDonalds and ask for a filet or ask to eat the food first and then pay on the way out. If you don't like a business policy then just go elsewhere. Simle as that. I find it SO COMICAL that folks think they can dictate to a medical business how they "should" operate. They don't do it at Walmart, McDonalds, or even the local dry cleaner.

Just remember the ER's only ethical and legal responsibility is to make sure they don't deny a life saving measure. That is it. Anything else they are more then happy to so no and kick you out on the street.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

User avatar
White Coat Investor
Posts: 12852
Joined: Fri Mar 02, 2007 9:11 pm
Location: Greatest Snow On Earth

Re: Refusing to sign or altering hospital billing admission forms?

Post by White Coat Investor » Wed Jan 25, 2017 8:13 pm

vmsx wrote:This is a broad topic but I'm wondering what patients ("consumers") can legally and realistically do (these are two different things) if they enter a hospital or other provider, especially under an emergency circumstances, in order to not get financially destroyed by many of the gotchas in the system such as balanced billing and out of network exploits that are becoming ever more common.

I've researched this topic and haven't found any comprehensive answers; everything I've found is about fighting bills and "abuses" after the damage is done, when the provider has an open-ended contract you signed, to charge basically whatever they want, especially in an out of network situation.


If one has scheduled work it should be possible (I think?) to get all the billing information approved in advanced on paper, whether via an in-network rate or a cash upfront rate.

Two strategies that come to mind and again this would be typically in an emergency type of circumstance where one has to go out of network, such as when travelling:

- Refuse to sign any contract or admission form at this time, with the excuse that you must have your attorney first review it.
- Modify or cross out billing sections with a phrase such as: "I will only pay Medicare rate for any billed service." (Or instead of Medicare rate, 2x Medicare rate or you agree to pay no more than the in network rate for the largest commercial insurance carrier in your region.)

I'm looking for feedback from anyone who'd have insight on this issue - people who work in medical billing, lawyers, doctors, etc. What are the likely consequences of these strategies? Are there other better strategies to accomplish the main goal?

These videos are motivating me to make this post:

Lawmaker steps in after extreme hospital billing investigation
https://www.youtube.com/watch?v=HFxaI7kzB2s

Family fights $474K hospital bill
https://www.youtube.com/watch?v=2ZjadBbfX9c&t=41s


Just refuse to pay the bill. That's what most people do. Or don't bother coming. Then you don't need to worry that those of us who are federally mandated under threat of a $50K fine to take care of you without doing a wallet biopsy first will "financially destroy you." We can't "destroy you." At the very most all we can do is hurt your credit score and if you're a good Boglehead, you eventually won't need one of those anyway.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

TravelforFun
Posts: 832
Joined: Tue Dec 04, 2012 11:05 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by TravelforFun » Wed Jan 25, 2017 8:17 pm

leonard wrote:
Quark wrote:
leonard wrote:If you are serious about mitigating this risk, I'd get the forms from the ER's you would most likely visit in your area. Then, sit down and review them with a lawyer that specializes in healthcare law to understand what your precise obligations are under the forms for each local hospital. This would be time consuming and potentially expensive - but doable.

Traveling - I don't know what you might do. Too many variables to mitigate this risk - unless you wanted to screen hospitals in the areas you were going to - which would be extremely time consuming.

The odds are that you'll find they're all pretty much the same. And what are you going to do when you have a serious problem and the ambulance insists on taking you to the closest ER?


Presumably - when you've screened the ER's in your area - the "closest ER" will be in that net.

And, see that I specifically pointed out that if you are traveling out of your immediate area - the cost/benefit of mitigating those risks and screening all those ER's may just be infeasible.

The form may look OK now it could change next year when you need the service.

littlebird
Posts: 1257
Joined: Sat Apr 10, 2010 6:05 pm
Location: Valley of the Sun, AZ

Re: Refusing to sign or altering hospital billing admission forms?

Post by littlebird » Wed Jan 25, 2017 8:23 pm

vmsx wrote:
Could you explain in more detail how you were able to put a POA on file and also how you were able to not sign the form where you have to pay if Medicare won't? Did you have to negotiate this with the ombudsman type of person? How did that transpire?


POA- Hospital admitting person asks if I am spouse's POA. I say yes. They say: Can you bring us a copy for our records?" I do that. For ever after my name is linked to his in computer record and they treat me as his POA.

Refusal: They give me tablet computer and explain each form they want me to sign with a stylus. When they get to form where I'd agree to pay if Medicare doesn't, I simply say "I won't sign that form". They say: "That's fine".

Marylander1
Posts: 87
Joined: Sat Jan 04, 2014 3:18 pm
Location: Baltimore & DC

Re: Refusing to sign or altering hospital billing admission forms?

Post by Marylander1 » Wed Jan 25, 2017 8:46 pm

Quark wrote:...Two reasons are that there's not likely to be much of a difference between the forms and that in many (but not all) ER situations you're not going to have a choice of hospitals. I almost always read doctor and hospital paperwork and can't recall seeing any substantial differences in recent years.


If your emergency isn't so urgent that you need an ambulance, it's often better to go to your chosen ER in a private vehicle. The past dozen times I've been to an ER (as a patient or companion), it wasn't via ambulance—and it was never never the closest ER. There was always a better facility further away who knew the patient's history, or was known to be far less crowded and therefore far faster at patient intake. Of course, this doesn't apply in any situation where minutes or seconds are critical—but those have been rare in my experience.

-Marylander1

User avatar
Watty
Posts: 11574
Joined: Wed Oct 10, 2007 3:55 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by Watty » Wed Jan 25, 2017 9:35 pm

Another situation to consider is the cost if you ever need a helicopter Air Ambulance to get to a hospital.

I have a relative that was unconscious after a car accident in a rural area so she was taken by helicopter to a hospital. I don't know what the bill was but her insurance company did not want to pay most of it because the helicopter company was out of network so they would only pay a reduced amount. After it went back and forth a few time she paid about $12,000 of the helicopter bill.

All in all it was worth it but she was surprised by how much she had to pay.

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Wed Jan 25, 2017 9:41 pm

staythecourse wrote:As a physician and a consumer I have ALWAYS advocated voting with your feet. If you don't like the policy take your business elsewhere. BUT what is NOT allowed is to think as the consumer you can alter the flow of a private business. That is NOT your right. Frankly, pretty arrogant of you as well. Not sure what business you are in, but imagine someone coming into your work and telling you how to proceed in your line of work.

....

Good luck.


Please watch the 3 videos that I link to in my posts. How would you respond to these situations? I'm genuinely asking. How would you respond if you were the woman who was charged $386,000 for a 5 hour non complication gall bladder surgery? $30,000 for a CT scan that is normally under $500?

Can you understand why I wouldn't want to sign a form saying you can charge me literally any price whatsoever?

The "take your business elsewhere" attitude is fine except what you're in a situation that's totally out of your control. The medical system is totally uncomparable to any of kind of "business" in this regard, especially in emergency situations.

Some doctors may be getting rich from this dystopian system (see videos), but as consumers, we need to do all we can to not lose our life saving's due to the rapacious greed of providers and such is why I seek strategies to not get bankrupted.
Last edited by vmsx on Wed Jan 25, 2017 9:59 pm, edited 2 times in total.

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Wed Jan 25, 2017 9:52 pm

White Coat Investor wrote:
Just refuse to pay the bill. That's what most people do. Or don't bother coming. Then you don't need to worry that those of us who are federally mandated under threat of a $50K fine to take care of you without doing a wallet biopsy first will "financially destroy you." We can't "destroy you." At the very most all we can do is hurt your credit score and if you're a good Boglehead, you eventually won't need one of those anyway.


I beg to differ about not being to financially destroy people. In my research I've found many anecdotal stories of people having their wages garnished and real property seized to satisfy judgement of medical creditors, sometimes based on the phony "charge master" hyperinflated price. Why do you think that medical bankruptcy is the most common kind? It's people backed against the wall of having their homestead homes seized. (Google related terms and you can read yourself.)

For what it's worth, I'm sympathetic to doctors who don't get paid and I know you've a lot of of BS to deal with; but until such time that there are regulatory changes that stop the abuses I mention, I as a consumer want to know what I can do to maximally protect myself from these all-too-real nightmare scenarios.

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Wed Jan 25, 2017 9:55 pm

littlebird wrote:
vmsx wrote:
Could you explain in more detail how you were able to put a POA on file and also how you were able to not sign the form where you have to pay if Medicare won't? Did you have to negotiate this with the ombudsman type of person? How did that transpire?


POA- Hospital admitting person asks if I am spouse's POA. I say yes. They say: Can you bring us a copy for our records?" I do that. For ever after my name is linked to his in computer record and they treat me as his POA.

Refusal: They give me tablet computer and explain each form they want me to sign with a stylus. When they get to form where I'd agree to pay if Medicare doesn't, I simply say "I won't sign that form". They say: "That's fine".


Thanks for this detail. I wonder if the Medicare aspect is required by law, that one can refuse it? Maybe someone who reads this thread might know.

sandramjet
Posts: 164
Joined: Thu Oct 23, 2014 11:28 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by sandramjet » Wed Jan 25, 2017 10:50 pm

vmsx wrote: In my research I've found many anecdotal stories of people having their wages garnished and real property seized to satisfy judgement of medical creditors, sometimes based on the phony "charge master" hyperinflated price. Why do you think that medical bankruptcy is the most common kind? It's people backed against the wall of having their homestead homes seized. (Google related terms and you can read yourself.)


It is often much easier to find "anecdotal stories" than actual real numbers. Yes, certainly this kind of thing has gone on. However, what is the REAL actual risk of this happening? That is, are those stories 1 of 100, or 1,000,00, or ??? (I honestly don't know, but I know that there must WAY more ones that don't have this problem. Anecdotally, I have never met anyone in my family or my friends who have EVER had this happen to them. I have known people who were bankrupted by medical bills, but NOT because of phony charges, etc. In all the cases I know of, the charges were legitimate, and (at least in one case, actually below what the same procedures were for someone else who did have insurance)

I guess I just don't see this as a risk that is great enough for me to worry so much about. I would rather spend my time worrying about how to avoid the behaviors that might land me in the hospital than worrying about whether I might be the 1 of ?? that has a phony, hyperinflated charge.

Loandapper
Posts: 101
Joined: Mon Jul 21, 2014 11:49 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by Loandapper » Wed Jan 25, 2017 11:33 pm

sport wrote:...They also asked me to sign a little electronic signature box without letting me see what I was signing. I refused until they gave me a printed copy of the form. Of course, I had no way of knowing if the printed copy and the electronic one I signed were actually the same. I just had to trust them on that...


This.

How is this even legal? My local Dr.'s office (owned by a local hospital) does the same thing. When I asked my doctor about it, he said he has no idea about how the "business side" is run.

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Wed Jan 25, 2017 11:49 pm

sandramjet wrote:
vmsx wrote: In my research I've found many anecdotal stories of people having their wages garnished and real property seized to satisfy judgement of medical creditors, sometimes based on the phony "charge master" hyperinflated price. Why do you think that medical bankruptcy is the most common kind? It's people backed against the wall of having their homestead homes seized. (Google related terms and you can read yourself.)


It is often much easier to find "anecdotal stories" than actual real numbers. Yes, certainly this kind of thing has gone on. However, what is the REAL actual risk of this happening? That is, are those stories 1 of 100, or 1,000,00, or ??? (I honestly don't know, but I know that there must WAY more ones that don't have this problem. Anecdotally, I have never met anyone in my family or my friends who have EVER had this happen to them. I have known people who were bankrupted by medical bills, but NOT because of phony charges, etc. In all the cases I know of, the charges were legitimate, and (at least in one case, actually below what the same procedures were for someone else who did have insurance)

I guess I just don't see this as a risk that is great enough for me to worry so much about. I would rather spend my time worrying about how to avoid the behaviors that might land me in the hospital than worrying about whether I might be the 1 of ?? that has a phony, hyperinflated charge.


I don't know the real risk either or if there have been academic studies. A couple of states - New York is one of them - have banned balanced billing for example, leaving the full burden on the insurance company and provider to resolve disputes, instead of dumping the matter on the hapless consumer, who has no legal protections, as they signed an agreement to pay, literally, whatever they are charged. If there were a federal law to end balanced billing, it'd remove one avenue of abuses. (I write federal, as many states have political systems funded in part by those who profit off these practices; it's the "free market" after all.) Article on NY's reform: http://www.modernhealthcare.com/article ... /304079996

Until then, even a little bit of advantage based on information might help us strength our position if we find ourselves like the people in the videos I posted.

User avatar
TinkerPDX
Posts: 231
Joined: Sun Jun 08, 2014 4:38 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by TinkerPDX » Wed Jan 25, 2017 11:52 pm

I often strike out arbitration clauses, but I've never done it on something high stakes. (Think u-haul, cell phone, etc.)

If you ask for time to review in the medical context, and especially in an ER context, and then they say you can't, you've already built a lot of the case for terms being "unconscionable" and therefore could argue later that they are unenforceable, provided there's something substantively unfair about it/them to go with the procedural unfairness of requiring someone to sign a contract pending medical treatment w no time to review.

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Thu Jan 26, 2017 12:01 am

TinkerPDX wrote:I often strike out arbitration clauses, but I've never done it on something high stakes. (Think u-haul, cell phone, etc.)

If you ask for time to review in the medical context, and especially in an ER context, and then they say you can't, you've already built a lot of the case for terms being "unconscionable" and therefore could argue later that they are unenforceable, provided there's something substantively unfair about it/them to go with the procedural unfairness of requiring someone to sign a contract pending medical treatment w no time to review.


This tactic might help but I think one would have to record the verbal exchange for it to have any weight, otherwise it becomes a dispute from memory about statements. Luckily we all have smart phones and can record it. In addition, the contract may have a catch all that there are no verbal promises that can supersede what's in writing.

It'd be great to hear comment from a lawyer on this scenario.

User avatar
White Coat Investor
Posts: 12852
Joined: Fri Mar 02, 2007 9:11 pm
Location: Greatest Snow On Earth

Re: Refusing to sign or altering hospital billing admission forms?

Post by White Coat Investor » Thu Jan 26, 2017 12:09 am

vmsx wrote:
White Coat Investor wrote:
Just refuse to pay the bill. That's what most people do. Or don't bother coming. Then you don't need to worry that those of us who are federally mandated under threat of a $50K fine to take care of you without doing a wallet biopsy first will "financially destroy you." We can't "destroy you." At the very most all we can do is hurt your credit score and if you're a good Boglehead, you eventually won't need one of those anyway.


I beg to differ about not being to financially destroy people. In my research I've found many anecdotal stories of people having their wages garnished and real property seized to satisfy judgement of medical creditors, sometimes based on the phony "charge master" hyperinflated price. Why do you think that medical bankruptcy is the most common kind? It's people backed against the wall of having their homestead homes seized. (Google related terms and you can read yourself.)

For what it's worth, I'm sympathetic to doctors who don't get paid and I know you've a lot of of BS to deal with; but until such time that there are regulatory changes that stop the abuses I mention, I as a consumer want to know what I can do to maximally protect myself from these all-too-real nightmare scenarios.


I find it interesting that I haven't even heard of these anecdotes. If someone has so many assets that bankruptcy isn't an option, why wouldn't they just pay their bill? I guess I find it hard to believe that someone who has actually purchased medical insurance with some sort of reasonable maximum out of pocket would lose their house to medical bills. Almost 20% of our ED patients don't pay their bills. If they were all losing their house that would be something like 6,000 homes lost per year. I think that would make the paper. And that's not even considering all the other medical providers not getting paid.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

User avatar
TinkerPDX
Posts: 231
Joined: Sun Jun 08, 2014 4:38 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by TinkerPDX » Thu Jan 26, 2017 12:12 am

vmsx wrote:
TinkerPDX wrote:I often strike out arbitration clauses, but I've never done it on something high stakes. (Think u-haul, cell phone, etc.)

If you ask for time to review in the medical context, and especially in an ER context, and then they say you can't, you've already built a lot of the case for terms being "unconscionable" and therefore could argue later that they are unenforceable, provided there's something substantively unfair about it/them to go with the procedural unfairness of requiring someone to sign a contract pending medical treatment w no time to review.


This tactic might help but I think one would have to record the verbal exchange for it to have any weight, otherwise it becomes a dispute from memory about statements. Luckily we all have smart phones and can record it. In addition, the contract may have a catch all that there are no verbal promises that can supersede what's in writing.

It'd be great to hear comment from a lawyer on this scenario.


A recording would be better evidence, or a third party witness.

It wouldn't be an oral modification - so those clauses wouldn't matter. Unconscionability is a defense to enforcement of a contract/term, not a way to change the term.

A written modification, on the other hand, would in fact be written.

NOLA
Posts: 308
Joined: Sun Jul 10, 2011 1:23 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by NOLA » Thu Jan 26, 2017 12:24 am

btenny wrote:There is not a thing you can do. I have been subjected to these issues a few times. The first time I broke my arm badly way back when. This was on my big corp insurance with big deductibles and 25% co-pays. I was about 5 miles from the hospital. The firemen demanded I ride in a ambulance that cost $1000 that was not covered. They made me wait about 15 minutes for it to arrive. I had to sign a form to get taken away. I ask them to let my friend drive me as there was really nothing for anyone to do until I got to the hospital. They would not let him drive me. They insisted I go by ambulance. My arm was resting on a pillow while I gritted my teeth as the darn truck hit tons of bumps.

When I got to the hospital they gave me more forms to sign and then knocked me out to go do surgery and so forth. About a hour later they woke me up (still groggy but sort of knew where I was) to sign a second set of forms. They told me I needed a different surgery so sign some more forms. I was in the hospital about 8 hours before they released me at 1AM or so. The bill was way over $25K just for the hospital plus the doctors and other stuff. Since it was a accident my insurance told me to get the other guys plan to pay. His plan said to get my plan to pay. They were not paying anything unless I signed a detail waiver. So no one wanted to pay and no one wanted to deal with it and the hospital did not want to give me any discounts. It was a mess. I eventually got my insurance to pay about $12K and set up a payment plan with the hospital to create some discounts. I was responsible for the rest plus the doctors and ambulance. I sued the other guy to try to get some money back. My lawyer got 55% of the money and I got $10K or so when we settled two years later. I about broke even.

I had a kidney stone incident at the same place a few years later. That time the bill was only $2K or so because their MRI machine was broke and the doctor and nurse were sure it was a stone. So they just let me go home after a pain shot. But I was not released until I signed a set of forms guaranteeing I pay in full. So I paid $2K for a shot and 5 minutes of talk and 30 minutes of waiting for a clerk to bring me papers to sign.

So do not bother arguing. Your only recourse is to not go to the emergency room. I did that once too. I fell and hurt my elbow. I did not go to the ER that Saturday. I took some pain pills and stayed home.

On Monday I went to the Orthopedic doctor. He said my elbow was broke and needed surgery. They started getting authorization to set up the surgery for that afternoon and were turned down. I guess if you wait at all after an accident it is elective surgery. So the insurance wanted me to shop around for a clinic to do the surgery cheaper. No expensive local hospital allowed. It took me until Thursday to find a out patient surgery center that was cheap and good with my doctor and OK with the insurance company. So I lived on pain pills for 4 days with my arm in a sling. The center agreed to a flat price of $4K including the doctor and everything.

So beware things are just complicated and the medical bills are the bills and we have no control over what they charge or what the insurance company will pay.

Good Luck.


Not the OP, but thanks for sharing. Just crazy when you think about it.

leonard
Posts: 5993
Joined: Wed Feb 21, 2007 11:56 am

Re: Refusing to sign or altering hospital billing admission forms?

Post by leonard » Thu Jan 26, 2017 12:36 am

TravelforFun wrote:
leonard wrote:
Quark wrote:
leonard wrote:If you are serious about mitigating this risk, I'd get the forms from the ER's you would most likely visit in your area. Then, sit down and review them with a lawyer that specializes in healthcare law to understand what your precise obligations are under the forms for each local hospital. This would be time consuming and potentially expensive - but doable.

Traveling - I don't know what you might do. Too many variables to mitigate this risk - unless you wanted to screen hospitals in the areas you were going to - which would be extremely time consuming.

The odds are that you'll find they're all pretty much the same. And what are you going to do when you have a serious problem and the ambulance insists on taking you to the closest ER?


Presumably - when you've screened the ER's in your area - the "closest ER" will be in that net.

And, see that I specifically pointed out that if you are traveling out of your immediate area - the cost/benefit of mitigating those risks and screening all those ER's may just be infeasible.

The form may look OK now it could change next year when you need the service.


yes, it's possible. but, easy to bring the old form and new, place them side by side and ask "Did this change?"

I never proposed that my proposed solution would be risk or work free for the OP. It's just one option that has both costs/benefits and trade offs, but actually begins to address the problem.

What's your suggestion? You Travel for Fun, so you must have this issue locked up.
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

Erwin007
Posts: 175
Joined: Tue Aug 19, 2008 8:29 am
Location: Intermountain West

Re: Refusing to sign or altering hospital billing admission forms?

Post by Erwin007 » Thu Jan 26, 2017 12:42 am

White Coat Investor wrote:
vmsx wrote:
White Coat Investor wrote:
Just refuse to pay the bill. That's what most people do. Or don't bother coming. Then you don't need to worry that those of us who are federally mandated under threat of a $50K fine to take care of you without doing a wallet biopsy first will "financially destroy you." We can't "destroy you." At the very most all we can do is hurt your credit score and if you're a good Boglehead, you eventually won't need one of those anyway.


I beg to differ about not being to financially destroy people. In my research I've found many anecdotal stories of people having their wages garnished and real property seized to satisfy judgement of medical creditors, sometimes based on the phony "charge master" hyperinflated price. Why do you think that medical bankruptcy is the most common kind? It's people backed against the wall of having their homestead homes seized. (Google related terms and you can read yourself.)

For what it's worth, I'm sympathetic to doctors who don't get paid and I know you've a lot of of BS to deal with; but until such time that there are regulatory changes that stop the abuses I mention, I as a consumer want to know what I can do to maximally protect myself from these all-too-real nightmare scenarios.


I find it interesting that I haven't even heard of these anecdotes. If someone has so many assets that bankruptcy isn't an option, why wouldn't they just pay their bill? I guess I find it hard to believe that someone who has actually purchased medical insurance with some sort of reasonable maximum out of pocket would lose their house to medical bills. Almost 20% of our ED patients don't pay their bills. If they were all losing their house that would be something like 6,000 homes lost per year. I think that would make the paper. And that's not even considering all the other medical providers not getting paid.


How dare you bring things like "logic" and "facts" into these sensationalized discussions.

The only group of people more disparaged, slandered, and spoken ill of on these forums than physicians are whole life insurance salesman. It's unbelievable really.

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Thu Jan 26, 2017 2:19 am

White Coat Investor wrote:
vmsx wrote:
White Coat Investor wrote:
Just refuse to pay the bill. That's what most people do. Or don't bother coming. Then you don't need to worry that those of us who are federally mandated under threat of a $50K fine to take care of you without doing a wallet biopsy first will "financially destroy you." We can't "destroy you." At the very most all we can do is hurt your credit score and if you're a good Boglehead, you eventually won't need one of those anyway.


I beg to differ about not being to financially destroy people. In my research I've found many anecdotal stories of people having their wages garnished and real property seized to satisfy judgement of medical creditors, sometimes based on the phony "charge master" hyperinflated price. Why do you think that medical bankruptcy is the most common kind? It's people backed against the wall of having their homestead homes seized. (Google related terms and you can read yourself.)

For what it's worth, I'm sympathetic to doctors who don't get paid and I know you've a lot of of BS to deal with; but until such time that there are regulatory changes that stop the abuses I mention, I as a consumer want to know what I can do to maximally protect myself from these all-too-real nightmare scenarios.


I find it interesting that I haven't even heard of these anecdotes. If someone has so many assets that bankruptcy isn't an option, why wouldn't they just pay their bill? I guess I find it hard to believe that someone who has actually purchased medical insurance with some sort of reasonable maximum out of pocket would lose their house to medical bills. Almost 20% of our ED patients don't pay their bills. If they were all losing their house that would be something like 6,000 homes lost per year. I think that would make the paper. And that's not even considering all the other medical providers not getting paid.


It's important not to conflate people who cannot pay their bills due to no insurance at all and the point of my post to begin with, which are the abusive practices that I link to in the videos, which can affect anyone, including you. You may not have heard of these anecdotes, but the hyperinflated billing practices are very obviously happening and they certainly must tie into the medical bankruptcy rate. (Do you think someone charged $386,000 for a 5 hour surgery could not be forced into bankruptcy? Which would liquidate almost all their wealth outside of a few protect categories? They signed a contract agreeing to pay WHATEVER was charged.) http://www.cnbc.com/id/100840148

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Thu Jan 26, 2017 2:27 am

-delete- mistaken copy.
Last edited by vmsx on Thu Jan 26, 2017 2:29 am, edited 1 time in total.

vmsx
Posts: 37
Joined: Wed Jan 07, 2015 6:48 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by vmsx » Thu Jan 26, 2017 2:28 am

Erwin007 wrote:
How dare you bring things like "logic" and "facts" into these sensationalized discussions.

The only group of people more disparaged, slandered, and spoken ill of on these forums than physicians are whole life insurance salesman. It's unbelievable really.


What is being sensationalized? Did you watch the videos I posted? Do you think they were just made up? Are those not facts? If you research Google terms like 'medical wage garnishment' and 'charge master billing' and similar terms you can read a litany of facts and accounts.

In no way am I trying to slander physicians - I am bringing attention to the practices that IN FACT exist and seek to know how consumers, which includes you, can try to protect our finances. It's not about not paying one's bills that are reasonable market rates, such as commercial insurer payment rates, but the "cash" or out of network / balanced billed rates that can be 10x that.

Can you help with that information?

MtnTraveler
Posts: 114
Joined: Thu Jun 12, 2014 7:32 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by MtnTraveler » Thu Jan 26, 2017 12:52 pm

So vmsx I get what you are kind-of after but at the same time I don't. I can tell you that no 5 hr gallbladder operation is normal and I think you might be confusing that with the heart stent surgery in NY that had a surgical tech fee of ~300k. I know about the NY case cause I found it googling after I got a bill for an out-of-network surgical tech used during my gallbladder surgery. The total bill was for $800 so I was not going to go bankrupt over it but given the operation had been pre-approved by the insurance company I was mad. Turns out that while I am in a state that has protections like NY my insurance through my work is a self-insured plan so they are not required to follow state law. This is why a lot of companies are going to self-insured plans because the federal mandates are sparse compared to state mandates. I appealed the claim with the insurance company and also with my company (depending on when you were hired you either got a state plan or were defaulted to the self-insured plan with no option to move to the state plan). The insurance company gave me a one-time exception and paid the bill. Thing is if I would of come in through the ER and needed surgery immediately or would have been hospitalized and had surgery during my hospital stay everything would of been paid. That is Aetna's policy as I am told. Since I had out-patient surgery I was supposed to not only get pre-approved for the operation but also pre-approved to have out-of-network surgical techs there. Now I know and I will make sure I am covered. The times I have been in the ER for myself or someone I love I could of cared less if things were in network or out-of-network. We only go to the ER when it is an absolute emergency so I will deal with whatever the cost is once the emergency has passed. In those moments I don't care, the ER only needs to stabilize you they aren't required to save limbs/organs/etc. We are covered at all ERs in town so the bulk of the bill will be covered. Again I will deal with the rest later.

I have a co-worker who had to file bankruptcy which they say was because of medical bills. Thing is it had more to do with not wanting to cut back expenses/lifestyle when a long-term serious illness hit the family. They wanted to continue to spend like no tomorrow regardless of the fact that they were going to be forced to go from 2 incomes to 1 plus disability. I've talked with that co-worker a lot and I know for a fact my families average medical/prescription bills are about 4x higher and I make less money. We are no where close to bankruptcy. People do go bankrupt because of medical bills but I think sometimes it's also used as an easy thing to say cause the truth is uncomfortable.

kmurp
Posts: 223
Joined: Fri Jun 01, 2007 1:53 pm

Re: Refusing to sign or altering hospital billing admission forms?

Post by kmurp » Thu Jan 26, 2017 1:05 pm

"Modify or cross out billing sections with a phrase such as: "I will only pay Medicare rate for any billed service." (Or instead of Medicare rate, 2x Medicare rate or you agree to pay no more than the in network rate for the largest commercial insurance carrier in your region.)"

At least for my specialty, the Medicare rate is about 25% of our commercial rate so I don't think that we would agree to that. That said, we are in network for pretty much any insurance in our area. For a rare out of network patient I imagine we would be pretty flexible in negotiating a fair settlement on the price.

User avatar
czeckers
Posts: 930
Joined: Thu May 17, 2007 3:49 pm
Location: Upstate NY

Re: Refusing to sign or altering hospital billing admission forms?

Post by czeckers » Thu Jan 26, 2017 1:07 pm

You have to understand that the financial side of medicine is intentionally opaque. Large practice groups and hospitals are gobbling up all the independent providers, small groups, and small hospitals. Everything is now controlled at top administrative levels by non-clinicians. Billing is completely decentralized. You go to the hospital, but instead of receiving one bill, you get a bill from the surgeon, a bill from the anesthesiologist, one for the hospital stay, more from pharmacy, then various facility fees. Why the separate bills? They are all employees of the hospital. As an anesthesiologist, I have absolutely no idea how my patients get billed for my services, nor how much revenue I contribute to the hospital's bottom line. One of the greatest crises of our health care systems is this shell game where no one knows how the money flows except for a few key individuals.
The Espresso portfolio: | | 16% LCV, 16% SCV, 16% EM, 8% Int'l Value, 8% Int'l Sm, 8% US REIT, 8% Int'l REIT, 20% Inter-term US Treas | | "A journey of a thousand miles begins with a single step."

Post Reply