Strategically not paying medical bills for 90 days for a dis

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mike143
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Strategically not paying medical bills for 90 days for a dis

Post by mike143 »

I had an acquaintance tell me they don't pay their medical bills right away so they can negotiate upwards of a 50% discount. This person has the ability to pay. Has anyone hear of this? I tried doing Internet research and didn't find anyone else strategically paying medical bills late.

I originally felt this was unethical but during my Internet search I found a company called copatient.com that would review you medical bills for errors and would expect 35% cut when you get the refund. They also noted that 80-85% of medical bills have errors.

Seems like a dog eat dog situation, if they can justify strategically over billing though "errors" then I could justify strategically paying late for a discount.
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Re: Strategically not paying medical bills for 90 days for a

Post by Crow Hunter »

mike143 wrote:I had an acquaintance tell me they don't pay their medical bills right away so they can negotiate upwards of a 50% discount. This person has the ability to pay. Has anyone hear of this? I tried doing Internet research and didn't find anyone else strategically paying medical bills late.

I originally felt this was unethical but during my Internet search I found a company called copatient.com that would review you medical bills for errors and would expect 35% cut when you get the refund. They also noted that 80-85% of medical bills have errors.

Seems like a dog eat dog situation, if they can justify strategically over billing though "errors" then I could justify strategically paying late for a discount.
I don't pay my medical bills until I have a EOB in hand as well as an itemized bill from the provider.

Sometimes it has taken upwards of 90 days to get the provider to provide such information.

I have found several errors this way, including several bills for a completely different person on my Mother's final medical bills. I calculated that I saved in excess of $600 on my Mother's final expenses by checking for coding errors and requesting more information.

One hospital just wrote everything off rather than comply with my requests. :shock:

I don't do it in an effort to pay less. I do it in an effort to pay what I owe but no more.
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Re: Strategically not paying medical bills for 90 days for a

Post by livesoft »

I'm chuckling if you believe this works for more than a smidgeon of bills. I'd like you to try to get some kind of audited statements that your friend has made more than $100 doing this.

I have several times let medical bills go much more than 90 days late, but mostly because they are confusing and inaccurate. Eventually, they have been sorted out and get fixed with insurance covering most of them. No one has offered 50% off and I did not ask because I usually got 95% or 100% "off".
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Re: Strategically not paying medical bills for 90 days for a

Post by adamthesmythe »

> No one has offered 50% off

Maybe if you were uninsured and billed at the "list" price this would be possible. We all know that the list prices are way more than the insurance companies have negotiated. One of the deeply unfair aspects of our health care system is that those without insurance- and presumably least able to pay- get billed at the highest rates.

Now if insured- and your insurance company discovered that you were weaseling out of paying your share- I suspect there would be problems.
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Re: Strategically not paying medical bills for 90 days for a

Post by mike143 »

Crow Hunter wrote:One hospital just wrote everything off rather than comply with my requests. :shock:
I saw a news story of a woman standing in front of her >$1m home and she had the same thing happen, instead of complying they wrote it off. Strange world we live in.
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Re: Strategically not paying medical bills for 90 days for a

Post by nisiprius »

I wonder if the discount is any different from what they would have gotten if they'd called the business office when they got the bill, and said "I have my credit card in my hand, and if you will agree to accept the same amount Medicare would pay you, I will be glad to settle the bill with you on the phone right now?"

One huge problem in our current system that nobody seems to be interested in fixing is the issue of those crazy "chargemaster" prices that do not bear any resemblance to the payments medical providers accept from Medicare or insurance companies. The non-negotiated price for Mr. Uninsured Patient might reasonably expected to be 10% or 20% higher than the negotiated rates--not 200% to 300% higher (3X or 4X the negotiated rates).
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Re: Strategically not paying medical bills for 90 days for a

Post by Auream »

As others have said, I doubt a 50% discount would be from the already reduced insurance negotiated price, but from some fake, inflated "list" price that nobody really pays. When my daughter was born, the hospital did agree to a 10% discount on the already insurance-reduced price if we paid within 30 days. Also got a 15% discount on the bill at a pediatric specialist (again, this was 15% off the already insurance negotiated price).

So I think its reasonable to expect a 10-20% discount, even without waiting 90 days. But I think 50% is unlikely relative to the already reduced insurance price.
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Re: Strategically not paying medical bills for 90 days for a

Post by beyou »

One of my doctors sent out a note saying they no longer take my major medical plan (one of largest in the nation).
They offered to have patients come in to pay out of pocket, and mentioned discounts could be worked out
for those no longer "in network".

You have to have your head examined to pay the absurd "list price" on a medical bill.
Insurance companies are ridiculous with low payouts, but doctors are ridiculous with high list price.
This leaves consumers in a very bad position, having to consider the steps discussed in this thread,
if they have no insurance.

And if you do have insurance, you have 2 parties to contact/negotiate/fight with.
Torture...but is there a better medical system out there ?
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Re: Strategically not paying medical bills for 90 days for a

Post by Call_Me_Op »

Must do wonders for one's credit score.
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Re: Strategically not paying medical bills for 90 days for a

Post by denovo »

nisiprius wrote: One huge problem in our current system that nobody seems to be interested in fixing is the issue of those crazy "chargemaster" prices that do not bear any resemblance to the payments medical providers accept from Medicare or insurance companies. The non-negotiated price for Mr. Uninsured Patient might reasonably expected to be 10% or 20% higher than the negotiated rates--not 200% to 300% higher (3X or 4X the negotiated rates).
The reason the chargemaster price is high has to do with taxes. Let's say that Doctor X bills the insurance policy $3,000 for a colonoscopy, but his list or chargemaster price is $7,000.00 If someone without insurance doesn't pay the bill, he can write it off as a $7,000 loss so there's good incentive for them to keep that price high.
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Re: Strategically not paying medical bills for 90 days for a

Post by Auream »

denovo wrote:
nisiprius wrote: One huge problem in our current system that nobody seems to be interested in fixing is the issue of those crazy "chargemaster" prices that do not bear any resemblance to the payments medical providers accept from Medicare or insurance companies. The non-negotiated price for Mr. Uninsured Patient might reasonably expected to be 10% or 20% higher than the negotiated rates--not 200% to 300% higher (3X or 4X the negotiated rates).
The reason the chargemaster price is high has to do with taxes. Let's say that Doctor X bills the insurance policy $3,000 for a colonoscopy, but his list or chargemaster price is $7,000.00 If someone without insurance doesn't pay the bill, he can write it off as a $7,000 loss so there's good incentive for them to keep that price high.
That's not how a "write off" works. He can only "write off" that $7000 vs. the $7000 of expected income from that procedure, which is a net zero on taxes. The effect would be the same no matter what the price of the procedure was.

EDIT: The real reason the chargemaster price is high is because the idea is for each procedure to have a price that is definitely, positively higher than any insurance company is willing to pay. Because the insurance company will only pay the lower of their "negotiated price" or the "list price" for a procedure. Say if procedure X has a list price of $500. Insurance company A will pay $1000 for that procedure, B will pay $500, and C will only pay $300. The provider can collect $500 from B and $300 from C, but only $500 from A, even though they'd be willing to pay $1000. By setting the "list price" artificially high, say, in this case to $2000, the provider is assured that they are always able to capture the absolute maximum price that any particular insurer is willing to pay for that procedure.

The only one that gets completely screwed in this scenario is the cash-paying customer.
Last edited by Auream on Tue Nov 25, 2014 12:15 pm, edited 1 time in total.
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Re: Strategically not paying medical bills for 90 days for a

Post by TX_TURTLE »

mike143 wrote:I had an acquaintance tell me they don't pay their medical bills right away so they can negotiate upwards of a 50% discount. This person has the ability to pay. Has anyone hear of this? I tried doing Internet research and didn't find anyone else strategically paying medical bills late.

I originally felt this was unethical but during my Internet search I found a company called copatient.com that would review you medical bills for errors and would expect 35% cut when you get the refund. They also noted that 80-85% of medical bills have errors.

Seems like a dog eat dog situation, if they can justify strategically over billing though "errors" then I could justify strategically paying late for a discount.
It si entirely possible, but I don't suppose it will always work. As an example, early this year I had the following experience.
1) Family member went to the ER and gave the correct insurance information.
2) Hospital billing clerk made a mistake when filing the claim. Therefore, the insurance company replied there was no coverage.
3) A month later I received a bill for a 'level 4 visit' for $635.
4) I called the billing office, and quickly clarified the situation. They told me to disregard the bill.
5) Hospital filed a new claim to the insurance company. This time they knew for sure there was coverage so they itemized (the original bill was a flat charge). The bill went up to $2,470.
6) Insurance company applied the usual discounts, and the amount was reduced to $1,430. They paid this amount (minus my copayment).

In this case the 'cash price' they tried to charge me, when the thought I didn't have insurance, was in fact less than 50% of what the insurance would pay.
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Re: Strategically not paying medical bills for 90 days for a

Post by denovo »

Auream wrote:
denovo wrote:
nisiprius wrote: One huge problem in our current system that nobody seems to be interested in fixing is the issue of those crazy "chargemaster" prices that do not bear any resemblance to the payments medical providers accept from Medicare or insurance companies. The non-negotiated price for Mr. Uninsured Patient might reasonably expected to be 10% or 20% higher than the negotiated rates--not 200% to 300% higher (3X or 4X the negotiated rates).
The reason the chargemaster price is high has to do with taxes. Let's say that Doctor X bills the insurance policy $3,000 for a colonoscopy, but his list or chargemaster price is $7,000.00 If someone without insurance doesn't pay the bill, he can write it off as a $7,000 loss so there's good incentive for them to keep that price high.
That's not how a "write off" works. He can only "write off" that $7000 vs. the $7000 of expected income from that procedure, which is a net zero on taxes. The effect would be the same no matter what the price of the procedure was.
The doctor is putting the same amount of work into the same procedure whether or not its paid by insurance, Medicare, or etc. Leaving the list price high maximizes the writeoff.
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Re: Strategically not paying medical bills for 90 days for a

Post by Auream »

denovo wrote: The doctor is putting the same amount of work into the same procedure whether or not its paid by insurance, Medicare, or etc. Leaving the list price high maximizes the writeoff.
Seriously, do you even know what a write-off is? The list price of a procedure has no bearing on how much a provider can "write off."
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Re: Strategically not paying medical bills for 90 days for a

Post by an_asker »

adamthesmythe wrote:> No one has offered 50% off

Maybe if you were uninsured and billed at the "list" price this would be possible. We all know that the list prices are way more than the insurance companies have negotiated. One of the deeply unfair aspects of our health care system is that those without insurance- and presumably least able to pay- get billed at the highest rates.

Now if insured- and your insurance company discovered that you were weaseling out of paying your share- I suspect there would be problems.
This is incorrect (or at least, it is not correct for everyone). I have documented my case a couple of years ago when I received an initial bill that did not go through my insurance - the list price had been discounted by about 60%. When I requested to have the bill be processed through insurance, they were more than happy to oblige ... and I was appalled to discover that my co-payment, after the insurance, was more than what my original final bill had been!! :oops:
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Re: Strategically not paying medical bills for 90 days for a

Post by Luke Duke »

I've gotten 20% off of the negotiated rate on two different occasions by waiting it out.
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ClevrChico
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Re: Strategically not paying medical bills for 90 days for a

Post by ClevrChico »

I think the risk would be that the bill would be turned over to collections.
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Re: Strategically not paying medical bills for 90 days for a

Post by leonard »

If your going to negotiate - do it up front - as you would for any other goods or services.

If someone let their AP slide for 90 days just to get some sort of "deal" with me - wouldn't be a customer any longer.
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Re: Strategically not paying medical bills for 90 days for a

Post by Erwin007 »

denovo wrote:
nisiprius wrote: One huge problem in our current system that nobody seems to be interested in fixing is the issue of those crazy "chargemaster" prices that do not bear any resemblance to the payments medical providers accept from Medicare or insurance companies. The non-negotiated price for Mr. Uninsured Patient might reasonably expected to be 10% or 20% higher than the negotiated rates--not 200% to 300% higher (3X or 4X the negotiated rates).
The reason the chargemaster price is high has to do with taxes. Let's say that Doctor X bills the insurance policy $3,000 for a colonoscopy, but his list or chargemaster price is $7,000.00 If someone without insurance doesn't pay the bill, he can write it off as a $7,000 loss so there's good incentive for them to keep that price high.
This is not at all how this works. Please do some research before posting inaccurate information like this. And not only can I not write off the bill that the patient doesn't pay for the surgery I performed on him in the middle of the night (for free), but the patient can still sue me the same as any patient who pays full "rack rate". Great system, huh?

I would be more than thrilled if I could "write off" even a reduced rate for all of the free work I do. I would be much happier when I'm dragged out of bed in the middle of the night, or away from my family, to fix (for free) people who decide to cut off their fingers or hands and then turn around and not pay me a cent for all that work. But unfortunately this isn't how the game is played.
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Re: Strategically not paying medical bills for 90 days for a

Post by ejvyas »

I have received huge bills >$1000 due to my son's medical conditions and I tried my best to get a discount. Called almost 10+ times on various bill but I was unable to get any. They clearly mentioned that this is negotiated insurance rate and they can't do anything about it. The best they could do was to give me a very generous payment plan with no interest OR income based discount which I was not eligible for.

The only time I got a discount was when we did a lot of Lab work totalling > $2000 since it was done on my wife and coded as <male>. I had to co-ordinate :oops: with insurance, doctor, nurse, lab billing and other hell for 6+ months to get it rectified with correct female codes. In the end the lab offered me $65 final price. I just paid it immediately. The insurance applied $1000+ to the deductible. So it was a win for me :-)

I dont even know if it is correct to take a discount when insurance company has applied a higher deductible. Esp for HDHP plans.
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Re: Strategically not paying medical bills for 90 days for a

Post by ejvyas »

an_asker wrote:
adamthesmythe wrote:> No one has offered 50% off

Maybe if you were uninsured and billed at the "list" price this would be possible. We all know that the list prices are way more than the insurance companies have negotiated. One of the deeply unfair aspects of our health care system is that those without insurance- and presumably least able to pay- get billed at the highest rates.

Now if insured- and your insurance company discovered that you were weaseling out of paying your share- I suspect there would be problems.
This is incorrect (or at least, it is not correct for everyone). I have documented my case a couple of years ago when I received an initial bill that did not go through my insurance - the list price had been discounted by about 60%. When I requested to have the bill be processed through insurance, they were more than happy to oblige ... and I was appalled to discover that my co-payment, after the insurance, was more than what my original final bill had been!! :oops:
Its not correct for everyone but its correct in most cases.

Did you have HDHP when in the previous case?
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Re: Strategically not paying medical bills for 90 days for a

Post by toofache32 »

Next time my IT guy sends me a bill, maybe I should not pay it for a few months and then ask for a discount.
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Re: Strategically not paying medical bills for 90 days for a

Post by BolderBoy »

denovo wrote:The reason the chargemaster price is high has to do with taxes. Let's say that Doctor X bills the insurance policy $3,000 for a colonoscopy, but his list or chargemaster price is $7,000.00 If someone without insurance doesn't pay the bill, he can write it off as a $7,000 loss so there's good incentive for them to keep that price high.
We cannot write off our paper losses against real income. Nice thought, though.
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Re: Strategically not paying medical bills for 90 days for a

Post by celia »

Crow Hunter wrote:One hospital just wrote everything off rather than comply with my requests. :shock:
Writing it off worked better for you (financially) and them (timewise) than recalculating and supplying the info you requested. :)

I was talking to someone in the insurance dept. at my health provider over a year ago (just before the ACA took effect). She told me that according to the terms they have agreed to with my insurance company, they aren't allowed to offer a discount to those who were uninsured. I thought it was strange that the uninsured is not a party to this agreement but is affected by it!
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Re: Strategically not paying medical bills for 90 days for a

Post by Leesbro63 »

nisiprius wrote:I wonder if the discount is any different from what they would have gotten if they'd called the business office when they got the bill, and said "I have my credit card in my hand, and if you will agree to accept the same amount Medicare would pay you, I will be glad to settle the bill with you on the phone right now?"

One huge problem in our current system that nobody seems to be interested in fixing is the issue of those crazy "chargemaster" prices that do not bear any resemblance to the payments medical providers accept from Medicare or insurance companies. The non-negotiated price for Mr. Uninsured Patient might reasonably expected to be 10% or 20% higher than the negotiated rates--not 200% to 300% higher (3X or 4X the negotiated rates).
[OT comment removed by admin LadyGeek]
Last edited by Leesbro63 on Wed Nov 26, 2014 3:11 am, edited 1 time in total.
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Re: Strategically not paying medical bills for 90 days for a

Post by Leesbro63 »

Call_Me_Op wrote:Must do wonders for one's credit score.
You still can't just ignore medical bills and expect no credit hit, but Clark Howard was talking about this recently. Many very responsible people end up with medical bill "dings" on their credit. Often for bills they never even received or perhaps thought an insurer had paid or was written off. So they are revising credit scoring to SOMEWHAT allow for this:

http://www.foxbusiness.com/personal-fin ... urts-some/

"In May the U.S. Consumer Financial Protection Bureau released a study that found people with medical debts were overpenalizedon their credit scores, based on their overall debt payment record. For people with paid-off medical debts, the penalty amounted to credit scores 16 points to 22 points lower than people with similar repayment histories, the agency found."
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Re: Strategically not paying medical bills for 90 days for a

Post by bnes »

The situation resembles the "robo signing" mortgage mess.
I've seen the health groups send out bills they know they can't defend in hopes they stick.
The system sucks.
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Re: Strategically not paying medical bills for 90 days for a

Post by TPS_Reports »

I have insurance and have waited to pay, to negotiate later. It hasn't worked. They ask to set up a payment plan, so at least you can spread out the payments. My credit score has not been affected. I think they want to avoid collections, as they must pay them a % of the bill. I haven't heard about the write-off scenario mentioned by others.
AviN
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Re: Strategically not paying medical bills for 90 days for a

Post by AviN »

Here's an academic paper on the subject:

http://content.healthaffairs.org/content/25/1/57.long
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Re: Strategically not paying medical bills for 90 days for a

Post by toofache32 »

celia wrote:
Crow Hunter wrote:One hospital just wrote everything off rather than comply with my requests. :shock:
Writing it off worked better for you (financially) and them (timewise) than recalculating and supplying the info you requested. :)

I was talking to someone in the insurance dept. at my health provider over a year ago (just before the ACA took effect). She told me that according to the terms they have agreed to with my insurance company, they aren't allowed to offer a discount to those who were uninsured. I thought it was strange that the uninsured is not a party to this agreement but is affected by it!
This has been true for many years, but the way you phrase this is inaccurate, just how everyone else here complains that "the price gets jacked up for uninsured people" which is also false. There is only one fee and that fee gets billed to everyone....but insurance companies don't reimburse the entire fee. Doctors agree to accept this lower fee as payment in full because the insurance company gives "free" :oops: advertising by putting that doctor on their list of providers. Patients without insurance are billed the same, except they pay the full fee. In my office, I get uninsured people asking me if I can write off a portion like I do for insurance companies. I tell them sure, as long as they send me 10 new paying patients each week just like the insurance company does.

As for the agreement above where the "uninsured patient is not a party to this agreement but is affected by it"....The agreement is not with the uninsured party. The agreement is between the doctor and the insurance company. The doctor agrees to the insurance company that they will bill the insurance company the same as they bill everyone else. Insurance companies audit practices periodically to verify this. If the doctor routinely gives a discount to other patients (uninsured or not) then that office basically has more than 1 fee schedule, which is a violation of the insurance contract. So....back to my first point above....everyone is billed the same amount. Doctors can give occasional discounts to uninsured patients but extensive documentation has to be made to justify it in case of insurance audit.
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Re: Strategically not paying medical bills for 90 days for a

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