Got hit with a $2800 Medical bill. Can I negotiate?

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Erwin007
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Erwin007 »

vtBob wrote: Wed Apr 18, 2018 10:42 am
adamthesmythe wrote: Tue Apr 17, 2018 9:21 pm
ig77 wrote: Tue Apr 17, 2018 6:32 pm
michaeljc70 wrote: Tue Apr 17, 2018 6:23 pm A lot of provider contracts with health insurers don't allow further discounting to people insured. Don't you get an insurance discount? Was it in network? You say a small portion was covered, yet you hadn't reached your deductible. We had to get a CT Scan last year. The bill was $2100 but the insurance discount brought it down to $230.
Yes it was in network. The insurance covered around 20-30%. The final bill that I need to pay is $2800.
It was in network (so you got the discounted rate) and it was medically necessary (otherwise the insurance company wouldn't pay their share).

You received the service and your insurance did their part. It seems to me the only excuse you have for not paying the remainder is poverty. Not finding it inconvenient, not wishing it was less, but real poverty- losing your job, etc.

Asking for a payment plan if you can't handle a large unexpected payment seems reasonable. Expecting a further price concession is not.
This criticism is only valid if he consented to the prices and costs beforehand understood the risk / benefit of each additional test. Given our medical system doesn't work this way and there's basically no chance of understanding those components in advance it is entirely ethical to negotiate after the fact.
You should try and take that to court and see how that works out for you. Then report back here to see if you were right or wrong.
Erwin007
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Erwin007 »

samsoes wrote: Wed Apr 18, 2018 12:03 pm A raw nerve seems to have been struck among some docs here.

Truth be told, this is the only service where a "consumer" of s service is legally obligated for payment without having the dollar amount known in advance.

Imagine getting a bill for an airline flight a month after the fact for an outrageous amount. I know what the docs here would say, that training, equipment, and staff cost money. Don't airplanes, flight staff and fuel cost money? Apparent so, and amazingly we're able to know our cost fir a flight in advance.

My dentist can nail my out of pocket costs to the dollar before I agree to a procedure. Don't his training, equipment, and staff cost money? Yet there are no financial surprises and he does quite well financially.

Docs: you deal with this every day. We, the unwashed masses, only deal with it when we need care. Be trail-blazers to improve the system. In every revolution, there's one person with a vision.
What airline insurance do you have? Then I can give you the cost of your ticket.

You’ve made an apples to orangutans comparison here with your airline example.

There are practically infinite fewer insurance plans and procedures/codes for dentistry than there is for medicine. Hence the difference there.
Erwin007
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Erwin007 »

samsoes wrote: Wed Apr 18, 2018 12:50 pm
toofache32 wrote: Wed Apr 18, 2018 12:46 pm
samsoes wrote: Wed Apr 18, 2018 12:38 pm
toofache32 wrote: Wed Apr 18, 2018 12:34 pm
samsoes wrote: Wed Apr 18, 2018 12:03 pm A raw nerve seems to have been struck among some docs here.

Truth be told, this is the only service where a "consumer" of s service is legally obligated for payment without having the dollar amount known in advance.
But you ARE told in advance that you might use your entire deductible EVERY YEAR. This is NOT a surprise. Everyone needs to have their deductible stashed away as part of their emergency funds. This is NOT a surprise.
The dollar amount of thw procedure/service involved IS a surprise. That's unconscionable.
$5900 at most. How's that? To get closer, you need to ask your insurance since THEY determine coverage, prices, coinsurance/deductibles and everything else, and the doctor does not have a copy of the insurance policy. The doctor's "billed" fees are irrelevant if this is in-network. The insurance controls all of this. Of course this is an insurance problem. Why do you suspect my insurance free office can give you an estimate right down to the penny and it never changes? Because the insurance company is not involved.
$5900 is a bank-breaker for most Americans. A person may have delayed the procedure if it meant no food or heat in the winter if the amount was divulged ahead of time.
Then they should not choose a health plan with a $5900 deductible.
OnTrack
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by OnTrack »

I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
CFM300
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by CFM300 »

staythecourse wrote: Wed Apr 18, 2018 8:01 pm
CFM300 wrote: Wed Apr 18, 2018 7:05 pm
staythecourse wrote: Wed Apr 18, 2018 10:56 am I don't like getting bills either, but if I sign off yes to x testing I feel legally and morally obligated to pay. Call me responsible.
But rarely are patients given a price prior to being asked to sign off on a procedure, so the choice they face is to either agree to pay some unknown price or refuse treatment. That's hardly a fair contract. I suspect even you would have your limits, where you would not feel responsible for paying a bill, regardless of what you signed. The system is broken, hence the negotiations. After the fact.
Nope I have no issues saying no. If I don't then I will fulfill my obligation I signed up for in relation to my insurance. I INTENTIONALLY signed up for a HD plan of 10k for whole family (the classic catastrophic plan). That means I chose a plan AT MOST I will pay 10k in any given year. So, what do I do? I make sure I have access to 10k at any one time AND have the money for all premiums that allows me that coverage. The story basically comes down to responsibility. Anyone who WILLINGLY signs up for x plan is agreeing to the terms of the plan. Just like any other legal contract. If you don't like it don't sign up or decline care when offered.

In this case (OP) it is NOT a situation of non transparency which is the issue (which somehow intentional or unintentional this board LOVES to gravitate to explain every medical billing issue on earth. It is an issue of irresponsibility. He/ she said yes to x, y, z procedures. They happily got it done putting FULL risk onto the provider and facilities expecting that he will honor the contract and pay them when the bill comes due even though they already gave him the service. But in the end he is trying to get out of paying what he knew he would have to (the unmet deductible). He KNOWS how much their deductible is (max and how much met already) yet have no problem screwing someone else over. Sorry that is not cool. I have NO ISSUE with him/ her trying to get a bargain if they can, BUT if they can't they should feel obligated to pay. The problem is saying one is responsible in life is easy, but to walk the walk is much harder.

Good luck.
Just because patients choose policies with a certain deductible doesn't mean they have to accept the final pricing of any service below the deductible.

Because the system is broken, the final price is typically unknown until well after the procedure has been performed. At that point, patients negotiate. They'd probably negotiate (or at least comparison shop) at an earlier stage, except that no one will give them a price.

Sure, patients sign agreements to accept and pay the final price. That's because they have no other choice since the price could not (for whatever reason) be provided before hand.
CFM300
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by CFM300 »

toofache32 wrote: Wed Apr 18, 2018 7:40 pm Yes the system is broken. Nobody cares, but the doctors are in the same boat. Just like patients don't know how much it will cost, the doctors don't know what they will be paid by the insurance. The public thinks they do but they only have a rough idea which can change from patient to patient and plan to plan. This is an INSURANCE issue.
I understand that the system is challenging for doctors as well. And I certainly understand that a doctor cannot tell me how much I'm going to owe after my insurance is applied. But a doctor ought to be able to tell me how much he or she will bill for a particular service before insurance is applied, right?
MrBeaver
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by MrBeaver »

toofache32 wrote: Wed Apr 18, 2018 8:48 pm
samsoes wrote: Wed Apr 18, 2018 8:19 pm
toofache32 wrote: Wed Apr 18, 2018 7:59 pm
samsoes wrote: Wed Apr 18, 2018 7:47 pm
toofache32 wrote: Wed Apr 18, 2018 7:40 pm
Yes the system is broken. Nobody cares, but the doctors are in the same boat. Just like patients don't know how much it will cost, the doctors don't know what they will be paid by the insurance. The public thinks they do but they only have a rough idea which can change from patient to patient and plan to plan. This is an INSURANCE issue.
With all due respect, doc, and absolutely no offense intended, this sounds like a cop-out. Most of your posts on this site seem to be complaints about the insurance billing system.

The OP and other OP's of the various medical insurance issues on this site largely post about an occasional problem, or a one-off situation, etc. You are in the trenches every day, and although you may not be the customer, you are indeed a stakeholder. Your colleagues are stakeholders. Your non-doc ancillary provider colleagues are stakeholders. Organize them (I don't mean unionize.) Pool your resources. Take the initiative, take action, become a trailblazer, spearhead changes, make a difference!

One man can make a difference. It has happened countless times throughout history. Be that man; make the difference!
You're absolutely correct and I already did take the initiative and made changes. I dropped all insurance. Now I offer price transparency, increased efficiency, a doctor/patient relationship unobstructed by 3rd party payers without surprises, higher levels of service, more personalized care, and competitive fees. My patients truly value this and I have started seeing patients travel from over 6 hours away and from 2 adjacent states. This is a growing movement of trailblazers taking the initiative, as you stated. Thank you for acknowledging our efforts.
You're welcome. The pleasure is all mine, I assure you.

Now, focus on others. Get yourself elected to Congress and sponsor a bill to fix this hideous mess! Or, start a PAC to fund candidates to accomplish the same thing. I'm proud of you, Doc! Make that difference in all of our lives!
There are already people smarter than me doing this at https://aapsonline.org/
I'm just a dumb cancer/reconstructive surgeon who has no idea how politics work.
Out of curiosity, do your patients simply pay out of pocket and assume their charges from you will be lower than their insurance deductible? Or do they pay you and then submit a claim with their insurance company themselves?

I like the idea of initiatives like this, but all of them I’ve seen seem to increase my maximum out of pocket during an expensive year.
MrBeaver
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by MrBeaver »

In general, I find the information asymetry and incentives are poorly aligned to provide quality care for an affordable price.

I spoke to someone the other day and mentioned that I felt my HDHP hadn’t changed my healthcare consumption one bit. Why? If it’s cheap stuff ($100 a month), I budget for it and it’s not a big deal. If it’s expensive stuff ($xxxx+ diagnostics, surgery, etc.) then I will hit my deductible and OOP max, and I care a lot more that I’m getting the best possible treatment since my incremental cost is low or zero at that point.

This sets up a dynamic where patients trust their doctors to provide advice, but the doctors based on this thread must provide this advice with little to no knowledge of how much their suggested action will cost the patient. I do have doctors who know a little, usually with prescription drugs, and will try to help their patients by ordering different dosage pills and take three vs two pills, or order medicated eye drops instead of ear drops because they are 1/10 the price even though it’s the same medicine in the same bottle. But I can imagine this experience and knowledge is spotty and can’t be depended on even though I appreciate it.

I propose the following:
Start an insurance company who (1)makes cost comparison shopping easy between providers, and then (2)cuts patients a check for some percent (10-50% suggested) of the discount from the median cost for that procedure of the provider the patient chooses. If it’s above the median, insursnce covers it as usual. The theory would be that enough people would actively seek more affordable care to receive a check so that the total payout per diagnosis for the insurance company actually goes down even including incentive payments to patients.

This has several beneficial effects:
  • Patients have a monetary incentive to consume cost effective care even after they have met their deductible or OOP max.
  • Patients with more limited means or lower income can choose cheaper care when cash is worth more to them than the quality of care difference.
  • Doctors (primary care or specialist consults) can continue to provide advice to patients on their suggested options, but then patients can make the final decision based on recommendations and cost, and the doctors can focus solely on their medical opinion.
This would require minimum standards of care, but that seems already covered with as many licensing boards we have.

Thoughts?
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nps
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by nps »

Erwin007 wrote: Wed Apr 18, 2018 9:25 pm
vtBob wrote: Wed Apr 18, 2018 10:42 am This criticism is only valid if he consented to the prices and costs beforehand understood the risk / benefit of each additional test. Given our medical system doesn't work this way and there's basically no chance of understanding those components in advance it is entirely ethical to negotiate after the fact.
You should try and take that to court and see how that works out for you. Then report back here to see if you were right or wrong.
Ethics court?
toofache32
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by toofache32 »

CFM300 wrote: Wed Apr 18, 2018 11:28 pm
toofache32 wrote: Wed Apr 18, 2018 7:40 pm Yes the system is broken. Nobody cares, but the doctors are in the same boat. Just like patients don't know how much it will cost, the doctors don't know what they will be paid by the insurance. The public thinks they do but they only have a rough idea which can change from patient to patient and plan to plan. This is an INSURANCE issue.
I understand that the system is challenging for doctors as well. And I certainly understand that a doctor cannot tell me how much I'm going to owe after my insurance is applied. But a doctor ought to be able to tell me how much he or she will bill for a particular service before insurance is applied, right?
Yes they should be able to provide the CPT codes. But they don't know the codes that will be used by the facility.
staythecourse
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by staythecourse »

CFM300 wrote: Wed Apr 18, 2018 11:20 pm Because the system is broken, the final price is typically unknown until well after the procedure has been performed. At that point, patients negotiate. They'd probably negotiate (or at least comparison shop) at an earlier stage, except that no one will give them a price.

Sure, patients sign agreements to accept and pay the final price. That's because they have no other choice since the price could not (for whatever reason) be provided before hand.
Unless it is an emergency (likely you would not care in that situation) ANY patient can get the CPT and diagnosis code and call their insurance and they will tell them the cost. It isn't that difficult. It requires the patient to take on more responsibility for their care (which is what it should be as they have the most to gain or lose).

There is NO problem with trying to bargain just like in any other aspect of consumerism BUT the other party has to be willing to negotiate.

Take a minute (and others out there who keep saying the same thing over and over). If you ran the business of doing lets say an MRI and go into contract with, for example, BCBS and LEGALLY have to bill every patient of theirs the same way. You do what is expected of you taking on FULL Risk of not being paid down the road. Would you be happy taking any less money when you did everything you were supposed to do and the consumer just throws up their hands and goes, "well the system is broken so I am justified not paying the bill in full". It may not be fair to the consumer, but it should be obvious that it would not be fair to the MRI folks (in this example). Just because the system is not a good one is not a reason to screw others over who are just players within that same system. Does that make sense?

Good luck.
Last edited by staythecourse on Thu Apr 19, 2018 8:54 am, edited 1 time in total.
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toofache32
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by toofache32 »

MrBeaver wrote: Thu Apr 19, 2018 1:04 am
toofache32 wrote: Wed Apr 18, 2018 8:48 pm
samsoes wrote: Wed Apr 18, 2018 8:19 pm
toofache32 wrote: Wed Apr 18, 2018 7:59 pm
samsoes wrote: Wed Apr 18, 2018 7:47 pm

With all due respect, doc, and absolutely no offense intended, this sounds like a cop-out. Most of your posts on this site seem to be complaints about the insurance billing system.

The OP and other OP's of the various medical insurance issues on this site largely post about an occasional problem, or a one-off situation, etc. You are in the trenches every day, and although you may not be the customer, you are indeed a stakeholder. Your colleagues are stakeholders. Your non-doc ancillary provider colleagues are stakeholders. Organize them (I don't mean unionize.) Pool your resources. Take the initiative, take action, become a trailblazer, spearhead changes, make a difference!

One man can make a difference. It has happened countless times throughout history. Be that man; make the difference!
You're absolutely correct and I already did take the initiative and made changes. I dropped all insurance. Now I offer price transparency, increased efficiency, a doctor/patient relationship unobstructed by 3rd party payers without surprises, higher levels of service, more personalized care, and competitive fees. My patients truly value this and I have started seeing patients travel from over 6 hours away and from 2 adjacent states. This is a growing movement of trailblazers taking the initiative, as you stated. Thank you for acknowledging our efforts.
You're welcome. The pleasure is all mine, I assure you.

Now, focus on others. Get yourself elected to Congress and sponsor a bill to fix this hideous mess! Or, start a PAC to fund candidates to accomplish the same thing. I'm proud of you, Doc! Make that difference in all of our lives!
There are already people smarter than me doing this at https://aapsonline.org/
I'm just a dumb cancer/reconstructive surgeon who has no idea how politics work.
Out of curiosity, do your patients simply pay out of pocket and assume their charges from you will be lower than their insurance deductible? Or do they pay you and then submit a claim with their insurance company themselves?

I like the idea of initiatives like this, but all of them I’ve seen seem to increase my maximum out of pocket during an expensive year.
My patients pay out of pocket prior to scheduling surgery. My fees are not necessarily lower than their deductible and have nothing to do with the deductible. If my fee is higher than their out-of-network deductible, then we will file a claim. This only applies if they have OON benefits (no
government plans). You're correct this does not necessarily decrease your out of pocket costs since insurance companies are set up to discourage this. But I am not competing with insurance because I offer care not available in the insurance world. It depends on what you value. If you only value the lowest price, I am not the lowest bidder.
I create packages where one most common surgery I do is $5000 and it's $10,000 if I have to also do a complex reconstruction like a free flap. This includes everything....all hospital care, rounding, wound care, and post-op visits forever. I don't want to lead us off topic any further.
Now I am booked up for several few weeks and just cancelled my trip to a surgery conference in Arizona where I am supposed to be right now, because I have too many patients to get caught up on.
SlowMovingInvestor
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by SlowMovingInvestor »

OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
LiterallyIronic
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by LiterallyIronic »

SlowMovingInvestor wrote: Thu Apr 19, 2018 8:41 am
OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
My wife's individual plan has a deductible of $7,500. The plan we had in 2010 had an individual deductible of $11,100 (but I think the ACA has since banned deductibles that high). The plan my baby and I are on has an individual deductible of $4,500 (or $9,000 for the family deductible). If you want low monthly premiums, you can usually crank your deductible pretty high.

Not saying OP should have a deductible as high as $5,900, but if one does, I'd recommend ensuring that your emergency fund is at least $5,900.
Jags4186
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Jags4186 »

I don’t understand all of the whining on this thread. The system sucks but it’s the system. Most people have two choices HDHP or PPO. HDHP has lower premiums but higher outlays for smaller issues. PPO has higher premiums and lower outlays for smaller issues. I’m surprised any adult with a HDHP doesn’t know that going to see a “specialist” for a “test” means big time $$$ outlay up to your deductible and or OOP max.

If you don’t want the chance of a large bill don’t get a HDHP. But realize you’re paying more, usually significantly more, for the peace of mind for PPO copays. Unless you are chronically ill it makes more long term sense to have a HDHP, even if every so often you get hit with a $2800 bill for an MRI.

I’d bet if the OP had saved the difference of the PPO and HDHP premium cost every pay period, then he or she would have been able to cover the $2800 bill. That’s how it’s supposed to work.
FireSekr
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by FireSekr »

LiterallyIronic wrote: Thu Apr 19, 2018 9:19 am
SlowMovingInvestor wrote: Thu Apr 19, 2018 8:41 am
OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
My wife's individual plan has a deductible of $7,500. The plan we had in 2010 had an individual deductible of $11,100 (but I think the ACA has since banned deductibles that high). The plan my baby and I are on has an individual deductible of $4,500 (or $9,000 for the family deductible). If you want low monthly premiums, you can usually crank your deductible pretty high.

Not saying OP should have a deductible as high as $5,900, but if one does, I'd recommend ensuring that your emergency fund is at least $5,900.
With a $7.5k deductible, i hope the premiums are next to nothing because the plan is useless something really really bad happens

I have a high deductible individual plan through work and my in network deductible is $1.5k. My company also contributes $750 a year to HSA effectively making my deductible 750. The more expensive plan offered at work has a 500 deductible.
MnyGrl
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by MnyGrl »

Jags4186 wrote: Thu Apr 19, 2018 9:49 am I don’t understand all of the whining on this thread. The system sucks but it’s the system. Most people have two choices HDHP or PPO. HDHP has lower premiums but higher outlays for smaller issues. PPO has higher premiums and lower outlays for smaller issues. I’m surprised any adult with a HDHP doesn’t know that going to see a “specialist” for a “test” means big time $$$ outlay up to your deductible and or OOP max.

If you don’t want the chance of a large bill don’t get a HDHP. But realize you’re paying more, usually significantly more, for the peace of mind for PPO copays. Unless you are chronically ill it makes more long term sense to have a HDHP, even if every so often you get hit with a $2800 bill for an MRI.

I’d bet if the OP had saved the difference of the PPO and HDHP premium cost every pay period, then he or she would have been able to cover the $2800 bill. That’s how it’s supposed to work.
+1. I’m paying for a PPO plan that is pricey even though I have no health problems. Basically 6k a year comes out of my paycheck, and I might get one physical per year. That’s an expensive physical! But my employer doesn’t offer high deductible plans.

Everyone has this trade off - pay more up front or more if something happens.
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dm200
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by dm200 »

Note that, depending on the details of the plan, you may not have to pay the "full" cost of many things (such as office visits and some tests, etc.) before meeting the annual deductible. My wife was on such an Obamacare plan before Medicare.
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dm200
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by dm200 »

MnyGrl wrote: Thu Apr 19, 2018 10:11 am
Jags4186 wrote: Thu Apr 19, 2018 9:49 am I don’t understand all of the whining on this thread. The system sucks but it’s the system. Most people have two choices HDHP or PPO. HDHP has lower premiums but higher outlays for smaller issues. PPO has higher premiums and lower outlays for smaller issues. I’m surprised any adult with a HDHP doesn’t know that going to see a “specialist” for a “test” means big time $$$ outlay up to your deductible and or OOP max.
If you don’t want the chance of a large bill don’t get a HDHP. But realize you’re paying more, usually significantly more, for the peace of mind for PPO copays. Unless you are chronically ill it makes more long term sense to have a HDHP, even if every so often you get hit with a $2800 bill for an MRI.
I’d bet if the OP had saved the difference of the PPO and HDHP premium cost every pay period, then he or she would have been able to cover the $2800 bill. That’s how it’s supposed to work.
+1. I’m paying for a PPO plan that is pricey even though I have no health problems. Basically 6k a year comes out of my paycheck, and I might get one physical per year. That’s an expensive physical! But my employer doesn’t offer high deductible plans.
Everyone has this trade off - pay more up front or more if something happens.
A few years ago, because of employer changes, we were on an HMO for a while, then a PPO - with mostly the same Physicians. We did not find the HMO plan much more challenging than the PPO - and the costs of premiums were lower.
MnyGrl
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by MnyGrl »

dm200 wrote: Thu Apr 19, 2018 10:33 am
MnyGrl wrote: Thu Apr 19, 2018 10:11 am
Jags4186 wrote: Thu Apr 19, 2018 9:49 am I don’t understand all of the whining on this thread. The system sucks but it’s the system. Most people have two choices HDHP or PPO. HDHP has lower premiums but higher outlays for smaller issues. PPO has higher premiums and lower outlays for smaller issues. I’m surprised any adult with a HDHP doesn’t know that going to see a “specialist” for a “test” means big time $$$ outlay up to your deductible and or OOP max.
If you don’t want the chance of a large bill don’t get a HDHP. But realize you’re paying more, usually significantly more, for the peace of mind for PPO copays. Unless you are chronically ill it makes more long term sense to have a HDHP, even if every so often you get hit with a $2800 bill for an MRI.
I’d bet if the OP had saved the difference of the PPO and HDHP premium cost every pay period, then he or she would have been able to cover the $2800 bill. That’s how it’s supposed to work.
+1. I’m paying for a PPO plan that is pricey even though I have no health problems. Basically 6k a year comes out of my paycheck, and I might get one physical per year. That’s an expensive physical! But my employer doesn’t offer high deductible plans.
Everyone has this trade off - pay more up front or more if something happens.
A few years ago, because of employer changes, we were on an HMO for a while, then a PPO - with mostly the same Physicians. We did not find the HMO plan much more challenging than the PPO - and the costs of premiums were lower.
My employer offers a PPO, POS and HMO. I may try the HMO next year, I think they have a good reputation in this area.
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FlyAF
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by FlyAF »

ssquared87 wrote: Thu Apr 19, 2018 9:52 am
LiterallyIronic wrote: Thu Apr 19, 2018 9:19 am
SlowMovingInvestor wrote: Thu Apr 19, 2018 8:41 am
OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
My wife's individual plan has a deductible of $7,500. The plan we had in 2010 had an individual deductible of $11,100 (but I think the ACA has since banned deductibles that high). The plan my baby and I are on has an individual deductible of $4,500 (or $9,000 for the family deductible). If you want low monthly premiums, you can usually crank your deductible pretty high.

Not saying OP should have a deductible as high as $5,900, but if one does, I'd recommend ensuring that your emergency fund is at least $5,900.
With a $7.5k deductible, i hope the premiums are next to nothing because the plan is useless something really really bad happens

I have a high deductible individual plan through work and my in network deductible is $1.5k. My company also contributes $750 a year to HSA effectively making my deductible 750. The more expensive plan offered at work has a 500 deductible.
Sorry, but this is not normal and you have anything but a high deductible plan.

My wife and I (who work for a giant mega corp with great benefits) have the lowest deductible plan offered by our employer and ours is $3,200 with an out of pocket max $6,850.
CFM300
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by CFM300 »

staythecourse wrote: Thu Apr 19, 2018 8:13 am Take a minute (and others out there who keep saying the same thing over and over). If you ran the business of doing lets say an MRI and go into contract with, for example, BCBS and LEGALLY have to bill every patient of theirs the same way. You do what is expected of you taking on FULL Risk of not being paid down the road. Would you be happy taking any less money when you did everything you were supposed to do and the consumer just throws up their hands and goes, "well the system is broken so I am justified not paying the bill in full". It may not be fair to the consumer, but it should be obvious that it would not be fair to the MRI folks (in this example). Just because the system is not a good one is not a reason to screw others over who are just players within that same system. Does that make sense?
I'm sympathetic to the plight of physicians as well as patients. If I were a physician, I would accept that I work in a highly unusual market where customers cannot get prices in advance and thus will feel entitled to haggle after the fact. Also, let's not forget that in many cases the bulk of the charges are coming from facilities, not physicians, and that chargemaster prices are grossly inflated.
N10sive
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by N10sive »

SlowMovingInvestor wrote: Thu Apr 19, 2018 8:41 am
OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
My current deductible is $6650 as a single person(however it is also my OOP max which is also the max OOP for an individual). $13.3k if I had a family. The minimum qualify deductible I believe for 2017 at least was 1,300/2,600 individual/family. $5900 is probably on the low side if you are covered as a family. Single it is near the max.
OnTrack
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by OnTrack »

ssquared87 wrote: Thu Apr 19, 2018 9:52 am With a $7.5k deductible, i hope the premiums are next to nothing because the plan is useless something really really bad happens.
The premiums will not be next to nothing. The reality is that it is not uncommon for a plan to have an individual deductible of $7000+ and premiums of $15,000+/year. I guess if a plan is through an employer with exceptionally good benefits, then the premiums might be low.
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Grt2bOutdoors »

OnTrack wrote: Thu Apr 19, 2018 11:31 am
ssquared87 wrote: Thu Apr 19, 2018 9:52 am With a $7.5k deductible, i hope the premiums are next to nothing because the plan is useless something really really bad happens.
The premiums will not be next to nothing. The reality is that it is not uncommon for a plan to have an individual deductible of $7000+ and premiums of $15,000+/year.
Think of it another way - the cost of an individual's health plan per month is $1,850. If you're making $50K per year in salary, over 40% is going towards the cost of health care which is ridiculous, but if you are able to remain healthy, part of the cost will be rebated back to you if you save it instead of spending it, up to $7,000 worth. That is the downfall of HDHP accounts, those accounts were developed for the wealthy who could absorb total annual outlays of $20K+ for families (HSA's to invest for retirement). The average american who is chronically ill will be working for health insurance coverage.
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theplayer11
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by theplayer11 »

The problem is that our system is set up to do procedures to correct problems because that is where the money is. How about preventative care??
I see a specialist for kidney stones and have never been asked about my diet and how I can maybe stop the formation of stones. Not even a hand out to read over after the visits. This is a well respected urologist. The pessimist in me has to question the motives as lithotripsy and other procedures for kidney stones is a cash cow. Everyone must be their own advocate...question everything and never blindly believe everything a doctor or whoever is telling you.
theplayer11
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by theplayer11 »

N10sive wrote: Thu Apr 19, 2018 11:29 am
SlowMovingInvestor wrote: Thu Apr 19, 2018 8:41 am
OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
My current deductible is $6650 as a single person(however it is also my OOP max which is also the max OOP for an individual). $13.3k if I had a family. The minimum qualify deductible I believe for 2017 at least was 1,300/2,600 individual/family. $5900 is probably on the low side if you are covered as a family. Single it is near the max.
I believe under the ACA, the max deductible per person is around $6,500
theplayer11
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by theplayer11 »

Jags4186 wrote: Thu Apr 19, 2018 9:49 am I don’t understand all of the whining on this thread. The system sucks but it’s the system. Most people have two choices HDHP or PPO. HDHP has lower premiums but higher outlays for smaller issues. PPO has higher premiums and lower outlays for smaller issues. I’m surprised any adult with a HDHP doesn’t know that going to see a “specialist” for a “test” means big time $$$ outlay up to your deductible and or OOP max.

If you don’t want the chance of a large bill don’t get a HDHP. But realize you’re paying more, usually significantly more, for the peace of mind for PPO copays. Unless you are chronically ill it makes more long term sense to have a HDHP, even if every so often you get hit with a $2800 bill for an MRI.

I’d bet if the OP had saved the difference of the PPO and HDHP premium cost every pay period, then he or she would have been able to cover the $2800 bill. That’s how it’s supposed to work.
A HDHP can be a PPO...are you assuming all HDHP are HMOs? My previous HDHP was a PPO, I switched this year to a HDHP which is a HMO.
LiterallyIronic
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by LiterallyIronic »

ssquared87 wrote: Thu Apr 19, 2018 9:52 am
LiterallyIronic wrote: Thu Apr 19, 2018 9:19 am
SlowMovingInvestor wrote: Thu Apr 19, 2018 8:41 am
OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
My wife's individual plan has a deductible of $7,500. The plan we had in 2010 had an individual deductible of $11,100 (but I think the ACA has since banned deductibles that high). The plan my baby and I are on has an individual deductible of $4,500 (or $9,000 for the family deductible). If you want low monthly premiums, you can usually crank your deductible pretty high.

Not saying OP should have a deductible as high as $5,900, but if one does, I'd recommend ensuring that your emergency fund is at least $5,900.
With a $7.5k deductible, i hope the premiums are next to nothing because the plan is useless something really really bad happens
It's $101.32/month, including maternity coverage (wind the clock back a few years, though, and it was only $70/month). But, more importantly, it's not through an employer, so if I lose my job, we can simply move our baby from my plan to my wife's. When we had the $11,100/person deductible plan, the premiums were $60/month for two people. Frankly, I'm only interested in insurance if something "really really bad" happens. That's what I'm insuring against, not against a $100 doctor's appointment.
Jags4186
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Jags4186 »

theplayer11 wrote: Thu Apr 19, 2018 12:06 pm
Jags4186 wrote: Thu Apr 19, 2018 9:49 am I don’t understand all of the whining on this thread. The system sucks but it’s the system. Most people have two choices HDHP or PPO. HDHP has lower premiums but higher outlays for smaller issues. PPO has higher premiums and lower outlays for smaller issues. I’m surprised any adult with a HDHP doesn’t know that going to see a “specialist” for a “test” means big time $$$ outlay up to your deductible and or OOP max.

If you don’t want the chance of a large bill don’t get a HDHP. But realize you’re paying more, usually significantly more, for the peace of mind for PPO copays. Unless you are chronically ill it makes more long term sense to have a HDHP, even if every so often you get hit with a $2800 bill for an MRI.

I’d bet if the OP had saved the difference of the PPO and HDHP premium cost every pay period, then he or she would have been able to cover the $2800 bill. That’s how it’s supposed to work.
A HDHP can be a PPO...are you assuming all HDHP are HMOs? My previous HDHP was a PPO, I switched this year to a HDHP which is a HMO.
Sorry, I may have used PPO incorrectly...that's how it is described in our handbook.

I'm taking about the traditional copay insurance (you pay $30 to go to the doctor, $50 to go to emergency room, $70 to go to the specialist) vs. a HDHP where you pay the first $X up to your deductible, then co insurance up to your OOP max.
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by SlowMovingInvestor »

theplayer11 wrote: Thu Apr 19, 2018 12:00 pm
N10sive wrote: Thu Apr 19, 2018 11:29 am
SlowMovingInvestor wrote: Thu Apr 19, 2018 8:41 am
OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
My current deductible is $6650 as a single person(however it is also my OOP max which is also the max OOP for an individual). $13.3k if I had a family. The minimum qualify deductible I believe for 2017 at least was 1,300/2,600 individual/family. $5900 is probably on the low side if you are covered as a family. Single it is near the max.
I believe under the ACA, the max deductible per person is around $6,500
The Out of pocket max for 2018 is $7350 for individuals. That is obviously the max limit for deductibles as well, but most plans I've seen have significantly lower deductibles (the poster above might be an exception in that OOP = deductible).
oldfatguy
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by oldfatguy »

Jags4186 wrote: Thu Apr 19, 2018 12:13 pm
I'm taking about the traditional copay insurance (you pay $30 to go to the doctor, $50 to go to emergency room, $70 to go to the specialist) vs. a HDHP where you pay the first $X up to your deductible, then co insurance up to your OOP max.
My insurance has all of those elements - copay, deductible, and coinsurance.
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munemaker
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by munemaker »

SlowMovingInvestor wrote: Thu Apr 19, 2018 12:23 pm
The Out of pocket max for 2018 is $7350 for individuals.
Yes, that's the max. but my current ObamaCare plan has zero deductible. There is co-insurance for many things.
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Bfwolf »

OP, did you call the medical provider? What happened?
staythecourse
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by staythecourse »

CFM300 wrote: Thu Apr 19, 2018 11:11 am
staythecourse wrote: Thu Apr 19, 2018 8:13 am Take a minute (and others out there who keep saying the same thing over and over). If you ran the business of doing lets say an MRI and go into contract with, for example, BCBS and LEGALLY have to bill every patient of theirs the same way. You do what is expected of you taking on FULL Risk of not being paid down the road. Would you be happy taking any less money when you did everything you were supposed to do and the consumer just throws up their hands and goes, "well the system is broken so I am justified not paying the bill in full". It may not be fair to the consumer, but it should be obvious that it would not be fair to the MRI folks (in this example). Just because the system is not a good one is not a reason to screw others over who are just players within that same system. Does that make sense?
I'm sympathetic to the plight of physicians as well as patients. If I were a physician, I would accept that I work in a highly unusual market where customers cannot get prices in advance and thus will feel entitled to haggle after the fact. Also, let's not forget that in many cases the bulk of the charges are coming from facilities, not physicians, and that chargemaster prices are grossly inflated.
It doesn't matter if you are a patient or physician. You made a decision and are legally obligated to pay. That simple. Any other circular logic is not the LAW, but your, my, or someone else's opinion. You may be right or wrong either way does not matter. If you do not pay you go to collections. That simple. If you can bargain as a consumer then great. If you can't then you have 2 options. Pay or go to collections. Either way is fine. It is that simple and to try to justify it otherwise is just sad.

I expect trust with my patients. If I say I will do x they expect me to do x. If I expect them to pay y then I expect them to pay y. I don't let stuff like this slide and have NO PROBLEM ending the patient doctor relationship for things like this. No big deal then the patient can find a doc who wants to haggle.

Good luck.

p.s. Everyone is entitled to their opinion so we will just have to agree to disagree. Discussing this any further is useless so this will be my last post on the subject.
Last edited by staythecourse on Thu Apr 19, 2018 1:13 pm, edited 1 time in total.
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dm200
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by dm200 »

oldfatguy wrote: Thu Apr 19, 2018 12:27 pm
Jags4186 wrote: Thu Apr 19, 2018 12:13 pm
I'm taking about the traditional copay insurance (you pay $30 to go to the doctor, $50 to go to emergency room, $70 to go to the specialist) vs. a HDHP where you pay the first $X up to your deductible, then co insurance up to your OOP max.
My insurance has all of those elements - copay, deductible, and coinsurance.
I never had an HDHP, but I thought that some of them (could be wrong) do pay (perhaps with modest copay) for some things, such as office visits and some tests.
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by FireSekr »

LiterallyIronic wrote: Thu Apr 19, 2018 12:12 pm
ssquared87 wrote: Thu Apr 19, 2018 9:52 am
LiterallyIronic wrote: Thu Apr 19, 2018 9:19 am
SlowMovingInvestor wrote: Thu Apr 19, 2018 8:41 am
OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
My wife's individual plan has a deductible of $7,500. The plan we had in 2010 had an individual deductible of $11,100 (but I think the ACA has since banned deductibles that high). The plan my baby and I are on has an individual deductible of $4,500 (or $9,000 for the family deductible). If you want low monthly premiums, you can usually crank your deductible pretty high.

Not saying OP should have a deductible as high as $5,900, but if one does, I'd recommend ensuring that your emergency fund is at least $5,900.
With a $7.5k deductible, i hope the premiums are next to nothing because the plan is useless something really really bad happens
It's $101.32/month, including maternity coverage (wind the clock back a few years, though, and it was only $70/month). But, more importantly, it's not through an employer, so if I lose my job, we can simply move our baby from my plan to my wife's. When we had the $11,100/person deductible plan, the premiums were $60/month for two people. Frankly, I'm only interested in insurance if something "really really bad" happens. That's what I'm insuring against, not against a $100 doctor's appointment.
Thats not bad at all then. My company charges employees $289/month for spouse+children High Deductible plan with 3k deducible. You've got a higher deductible for sure, but 101/month is total cost without an employer contributing anything so it seems like a really good deal. I'm not sure how much my employer pays on this plan in addition to that 289.

I'm all in favor of high deductible if you take care of yourself and have enough savings to cover an emergency.
Last edited by FireSekr on Thu Apr 19, 2018 1:55 pm, edited 3 times in total.
FireSekr
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by FireSekr »

FlyAF wrote: Thu Apr 19, 2018 10:56 am
ssquared87 wrote: Thu Apr 19, 2018 9:52 am
LiterallyIronic wrote: Thu Apr 19, 2018 9:19 am
SlowMovingInvestor wrote: Thu Apr 19, 2018 8:41 am
OnTrack wrote: Wed Apr 18, 2018 10:58 pm I'm a little confused why there are so many comments that $5900 is a high deductible. Of the plans I've seen available, this is on the low end.
This is the highest I've seen for an individual. 2 or 3K is more common.

However, I think 5900 may not be the deductible in this case, but the OOP max. Even in that case, $5900 is on the high side for an individual.

But there are several other factors too -- premiums, possible company match for HSA that dictate whether a plan is good or not.
My wife's individual plan has a deductible of $7,500. The plan we had in 2010 had an individual deductible of $11,100 (but I think the ACA has since banned deductibles that high). The plan my baby and I are on has an individual deductible of $4,500 (or $9,000 for the family deductible). If you want low monthly premiums, you can usually crank your deductible pretty high.

Not saying OP should have a deductible as high as $5,900, but if one does, I'd recommend ensuring that your emergency fund is at least $5,900.
With a $7.5k deductible, i hope the premiums are next to nothing because the plan is useless something really really bad happens

I have a high deductible individual plan through work and my in network deductible is $1.5k. My company also contributes $750 a year to HSA effectively making my deductible 750. The more expensive plan offered at work has a 500 deductible.
Sorry, but this is not normal and you have anything but a high deductible plan.

My wife and I (who work for a giant mega corp with great benefits) have the lowest deductible plan offered by our employer and ours is $3,200 with an out of pocket max $6,850.
According to the law, my plan is a high deductible plan and is eligible for HSA contributions. $39 a month is taken out of my paycheck and my employer pays the insurance company another $400 a month. Deductible is 1500. The company also deposits 750/year into my HSA, so I only need to contribute 2.5k to hit the annual max

If I were to chose the lowest deductible plan, I'd have to pay $154 a month and my deductible would be 300. There's also a plan thats in between these two.

I work for a mid sized company which I assumed was cheap on benefits. I didn't realize they were providing better benefits than mega corps.
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MossySF
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by MossySF »

As a point of reference, my company's PPO plan is a $0 deductible plan. The average premium is $34K/yr per employee.

...(choke) (gasp) (choke)...

Premiums are paid 100% by employer so nobody knows how crazy the costs are. If my company would let me pocket the difference on a HDHP with "just" $15K/yr premiums, I'd pick that offer easily. But the other 85% of the company can't handle that kind of personal finance -- they'd immediately spend the money and then panic when the medical bills come in.
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by SlowMovingInvestor »

dm200 wrote: Thu Apr 19, 2018 1:12 pm
oldfatguy wrote: Thu Apr 19, 2018 12:27 pm
Jags4186 wrote: Thu Apr 19, 2018 12:13 pm
I'm taking about the traditional copay insurance (you pay $30 to go to the doctor, $50 to go to emergency room, $70 to go to the specialist) vs. a HDHP where you pay the first $X up to your deductible, then co insurance up to your OOP max.
My insurance has all of those elements - copay, deductible, and coinsurance.
I never had an HDHP, but I thought that some of them (could be wrong) do pay (perhaps with modest copay) for some things, such as office visits and some tests.
I think the only things that HDHPs are required to cover (free) are preventive tests. Its certainly possible that some do pay for regular visits and some tests. But the idea of an HDHP is to make consumers more cost conscious and have them avoid taking unnecessary tests, so the more isnurance pays, the less cost conscious a consumer is likely to be.

The HDHPs I've seen typically do not have the $40 or so office visit cost, rather they have a %age (20%). More significantly, the deductible is applied immediately, so you have to start paying in full from your first visit rather than being able to get off by paying $40.
theplayer11
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by theplayer11 »

staythecourse wrote: Thu Apr 19, 2018 1:10 pm
CFM300 wrote: Thu Apr 19, 2018 11:11 am
staythecourse wrote: Thu Apr 19, 2018 8:13 am Take a minute (and others out there who keep saying the same thing over and over). If you ran the business of doing lets say an MRI and go into contract with, for example, BCBS and LEGALLY have to bill every patient of theirs the same way. You do what is expected of you taking on FULL Risk of not being paid down the road. Would you be happy taking any less money when you did everything you were supposed to do and the consumer just throws up their hands and goes, "well the system is broken so I am justified not paying the bill in full". It may not be fair to the consumer, but it should be obvious that it would not be fair to the MRI folks (in this example). Just because the system is not a good one is not a reason to screw others over who are just players within that same system. Does that make sense?
I'm sympathetic to the plight of physicians as well as patients. If I were a physician, I would accept that I work in a highly unusual market where customers cannot get prices in advance and thus will feel entitled to haggle after the fact. Also, let's not forget that in many cases the bulk of the charges are coming from facilities, not physicians, and that chargemaster prices are grossly inflated.
It doesn't matter if you are a patient or physician. You made a decision and are legally obligated to pay. That simple. Any other circular logic is not the LAW, but your, my, or someone else's opinion. You may be right or wrong either way does not matter. If you do not pay you go to collections. That simple. If you can bargain as a consumer then great. If you can't then you have 2 options. Pay or go to collections. Either way is fine. It is that simple and to try to justify it otherwise is just sad.

I expect trust with my patients. If I say I will do x they expect me to do x. If I expect them to pay y then I expect them to pay y. I don't let stuff like this slide and have NO PROBLEM ending the patient doctor relationship for things like this. No big deal then the patient can find a doc who wants to haggle.

Good luck.

p.s. Everyone is entitled to their opinion so we will just have to agree to disagree. Discussing this any further is useless so this will be my last post on the subject.
if you expect them to pay Y, shouldn't the patient know what Y will be BEFORE any service?
staythecourse
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by staythecourse »

theplayer11 wrote: Thu Apr 19, 2018 2:22 pm if you expect them to pay Y, shouldn't the patient know what Y will be BEFORE any service?
I am really starting to think the issue here is LACK OF READING prior replies before replying randomly with the same trite response. Read any of my posts I give the patient ALL the info. they need to call their insurance company and get that info. BEFORE signing up for any procedure IF they are interested.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle
Erwin007
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Erwin007 »

staythecourse wrote: Thu Apr 19, 2018 3:16 pm
theplayer11 wrote: Thu Apr 19, 2018 2:22 pm if you expect them to pay Y, shouldn't the patient know what Y will be BEFORE any service?
I am really starting to think the issue here is LACK OF READING prior replies before replying randomly with the same trite response. Read any of my posts I give the patient ALL the info. they need to call their insurance company and get that info. BEFORE signing up for any procedure IF they are interested.

Good luck.
I agree. I fell into the same trap on a few of my replies at the top of this page.

The truth is, in the event of a non-emergent situation, patients can get an idea about how much some service is going to cost but it takes some work on their part. I have some patients who want to know the cost and I am happy to provide them with the CPT code for the procedure, as well as numbers for my billing department, the facility where the surgery will be done, the anesthesia group who does the anesthesia, etc. It is disingenuous to say that you have no idea how much an MRI costs, again unless it was done in an emergent situation. Get on the phone with your insurance company after the test is ordered and before it is scheduled (many MRI appointments in my town take 7-10 days to be scheduled if they are ordered as routine and not urgent or emergent). You’re telling me in 7-10 days you couldn’t call your own insurance company to figure out how much it was going to cost?

The doctor likely has zero idea how much the MRI costs because he/she doesnt own the imaging center so sees zero of those statements.

In my case when patients ask me how much a surgery is going to cost they are wanting to know the total out of pocket cost, not how much my fee is going to be (and this is a small part of the overall charge anyway). I can give them a rough estimate of how much my group might bill for their surgery, but I have no idea what the contracted rate is with their insurance company, or how much their insurance will cover, etc.

The out of pocket cost includes the surgeon fee, the facility fee (may or may not be owned by the surgeon so they may have zero idea what the facility fee would be), the anesthesia fee (probably a completely separate group), how much an inpatient hospitalization will be, etc. Do you really expect your physician/surgeon to have all that information at their fingertips?

Like I said, I’m happy to give the (very few) patients who ask the CPT codes and estimated time for their surgery, and then they can do the legwork of calling their insurance company or the 3-4 offices that handle billing for all of the components of what goes into their total bill themselves.
Erwin007
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Location: Intermountain West

Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Erwin007 »

theplayer11 wrote: Thu Apr 19, 2018 2:22 pm
staythecourse wrote: Thu Apr 19, 2018 1:10 pm
CFM300 wrote: Thu Apr 19, 2018 11:11 am
staythecourse wrote: Thu Apr 19, 2018 8:13 am Take a minute (and others out there who keep saying the same thing over and over). If you ran the business of doing lets say an MRI and go into contract with, for example, BCBS and LEGALLY have to bill every patient of theirs the same way. You do what is expected of you taking on FULL Risk of not being paid down the road. Would you be happy taking any less money when you did everything you were supposed to do and the consumer just throws up their hands and goes, "well the system is broken so I am justified not paying the bill in full". It may not be fair to the consumer, but it should be obvious that it would not be fair to the MRI folks (in this example). Just because the system is not a good one is not a reason to screw others over who are just players within that same system. Does that make sense?
I'm sympathetic to the plight of physicians as well as patients. If I were a physician, I would accept that I work in a highly unusual market where customers cannot get prices in advance and thus will feel entitled to haggle after the fact. Also, let's not forget that in many cases the bulk of the charges are coming from facilities, not physicians, and that chargemaster prices are grossly inflated.
It doesn't matter if you are a patient or physician. You made a decision and are legally obligated to pay. That simple. Any other circular logic is not the LAW, but your, my, or someone else's opinion. You may be right or wrong either way does not matter. If you do not pay you go to collections. That simple. If you can bargain as a consumer then great. If you can't then you have 2 options. Pay or go to collections. Either way is fine. It is that simple and to try to justify it otherwise is just sad.

I expect trust with my patients. If I say I will do x they expect me to do x. If I expect them to pay y then I expect them to pay y. I don't let stuff like this slide and have NO PROBLEM ending the patient doctor relationship for things like this. No big deal then the patient can find a doc who wants to haggle.

Good luck.

p.s. Everyone is entitled to their opinion so we will just have to agree to disagree. Discussing this any further is useless so this will be my last post on the subject.
if you expect them to pay Y, shouldn't the patient know what Y will be BEFORE any service?
Yes and they can call their own insurance company to get that information. Why should a doctor, who probably doesn’t even own the lab or imaging center where the tests are being done be expected to know how much a patient will have to pay?

It would be like me walking into an eyeglass store and asking how much it would cost to get a couch delivered to my house from the furniture store down the street.
theplayer11
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by theplayer11 »

staythecourse wrote: Thu Apr 19, 2018 3:16 pm
theplayer11 wrote: Thu Apr 19, 2018 2:22 pm if you expect them to pay Y, shouldn't the patient know what Y will be BEFORE any service?
I am really starting to think the issue here is LACK OF READING prior replies before replying randomly with the same trite response. Read any of my posts I give the patient ALL the info. they need to call their insurance company and get that info. BEFORE signing up for any procedure IF they are interested.

Good luck.
well,
i'm glad you do..from, my experience it always goes something like this:
Me-"what will the procedure cost me"
dr-"I don't deal with billing, don't you have insurance?"
I call my my insurance company, and they need need to know specific codes.
I call the drs office back and I'm given a code with the caveat that it really depends on what the dr actually does at the time of the procedure and there is really no way to know that, so there may be other codes involved.
End result...I have know idea what the procedure will actually cost me.
Erwin007
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Location: Intermountain West

Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by Erwin007 »

theplayer11 wrote: Thu Apr 19, 2018 4:09 pm
staythecourse wrote: Thu Apr 19, 2018 3:16 pm
theplayer11 wrote: Thu Apr 19, 2018 2:22 pm if you expect them to pay Y, shouldn't the patient know what Y will be BEFORE any service?
I am really starting to think the issue here is LACK OF READING prior replies before replying randomly with the same trite response. Read any of my posts I give the patient ALL the info. they need to call their insurance company and get that info. BEFORE signing up for any procedure IF they are interested.

Good luck.
well,
i'm glad you do..from, my experience it always goes something like this:
Me-"what will the procedure cost me"
dr-"I don't deal with billing, don't you have insurance?"
I call my my insurance company, and they need need to know specific codes.
I call the drs office back and I'm given a code with the caveat that it really depends on what the dr actually does at the time of the procedure and there is really no way to know that, so there may be other codes involved.
End result...I have know idea what the procedure will actually cost me.
So you would rather they just do part of what may be necessary when they are in there and not the whole thing? Then you can have them go back in again for another thing? And again, and again?

There’s always a chance that something unexpected may show up, but in my practice (hand and wrist/upper extremity surgery) that is very, very uncommon, particularly for something that would involve a separate billable code that isn’t already bundled with the original code.

I also think a lot of angst is misplaced on the physician. How much of a total surgical bill ends up in the pocket of a physician? Way less than 10% in my experience.

Here’s an example. My father had his knees replaced, one at a time, and the surgeon fee (what the doc got paid for the pre-op visit, performing the surgery, rounding on my dad in the hospital for the 2 days he stayed there, and all office visits for 3 months after surgery) was $1800. My dad also has sleep apnea and needed a CPAP machine provided by the hospital, even though he has his own, because they wouldn’t guarantee that his worked well enough even though he’s had it for years and it works fine. They charged $300/night for use of the CPAP, so 1/3 what his surgeon got paid for all of his work.
CFM300
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by CFM300 »

staythecourse wrote: Thu Apr 19, 2018 1:10 pm If you do not pay you go to collections. That simple. If you can bargain as a consumer then great. If you can't then you have 2 options. Pay or go to collections.
But in fact, patients do have a third option, which is to call and negotiate the final price after the fact, which is exactly the advice that at least one physician has given the OP in this thread. (It may have been the very first response.)

So perhaps some of your anger, indignation, and moralizing should be directed at your colleagues and medical facilities who do in fact negotiate -- which only strengthens the patients' sense that the prices are arbitrary and negotiable -- not unlike the retail price of cars.
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samsoes
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by samsoes »

CFM300 wrote: Thu Apr 19, 2018 6:50 pm
staythecourse wrote: Thu Apr 19, 2018 1:10 pm If you do not pay you go to collections. That simple. If you can bargain as a consumer then great. If you can't then you have 2 options. Pay or go to collections.
But in fact, patients do have a third option, which is to call and negotiate the final price after the fact, which is exactly the advice that at least one physician has given the OP in this thread. (It may have been the very first response.)

So perhaps some of your anger, indignation, and moralizing should be directed at your colleagues and medical facilities who do in fact negotiate -- which only strengthens the patients' sense that the prices are arbitrary and negotiable -- not unlike the retail price of cars.
It blows my mind how some of the responses are as you said, full of " anger, indignation, and moralizing." In what other profession or service is a person threatened with collections for not paying a bill received after-the-fact for which the biller didn't provide the price up front?? Docs: it is possible. There's at least one service which will provide out-of-pocket expenses tailored to the patient and his/her insurance: RevRunner.

Imagine going out to dinner at a fine restaurant. Appetizers, salad, wine, entree, dessert, coffee. You have no idea what it will cost. Nobody can tell you, and there are no prices posted. Seems weird, but you're hungry, so you eat.

A month later the itemized bill comes.

Cost of Maitre de: $67
Cost of food: $125
Cost of server: $85
Cost of bus boy: $60
Consultation with cook re dietary requirements: $50
Cost of laundering napkins: $27
Cost of cleaning silverware: $34
Misc dishwasher services: $42
Cooking food, 34 minutes x 4.75/min = $161.50
Rest room usage fee: $19
Excessive toilet paper usage, $4

Total: $674.50. You ate the food, so pay-up, or you're going to collections.
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kiddoc
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Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by kiddoc »

OP, your eventual outcome will be healthcare facility specific. Whether you get a write-off or not depends on institutional policy and what particular contract the facilities have with the insurance company. Don't be surprised if they tell you they can't write anything off as they may be contractually bound. A payment plan may be the best they can offer.

For everyone asking for transparency, back when I was in private practice, we really wanted to give our patients transparent rate quotes, at least for our most common billed codes. It is very relevant with HDHPs. We even got separate quotes from our biller and a local billing/ practice solutions firm for what this will cost. It turned out that on average, for the 6 codes we used most commonly, our staff would had to process ~1500-2000 combinations to give patients the quotes. Providing transparecy would cost the 3 physician practice an average of around $120 a clinic day. Unfortunately, this meant we would not break even if we saw mostly medicare/medicaid patients that day. We could not afford to drop those patients.

1 partner retired, 1 became concierge and I have joined a large healthcare system which is an HMO. Their billing department budget is around 2 million a year. They can be reasonably (not exactly) transparent and patients seem to be happier. The catch: added on facility fees and negotiating power means the net cost to insurance and patients per visit is about 40% higher than our lowly 3 physician practice charged. 8-) People seem to be happy with the transparency despite paying more though. :moneybag :moneybag

If each patient was willing to pay a small practice $10 to obtain rate quotes from THEIR insurance, the whole system would be much more transparent as far as the insurance companies allow it. Small practices want to be pathbreakers and provide this service but when we floated the idea, only 4 of our 2000 patient panel agreed :annoyed It sounded like everyone wanted transparency, no one wanted to pay :dollar for it.
"The four most dangerous words in investing are: 'this time it's different.'" - Sir John Templeton
kiddoc
Posts: 553
Joined: Mon Aug 24, 2015 10:52 pm

Re: Got hit with a $2800 Medical bill. Can I negotiate?

Post by kiddoc »

samsoes wrote: Thu Apr 19, 2018 8:49 pm
A month later the itemized bill comes.

Cost of Maitre de: $67
Cost of food: $125
Cost of server: $85
Cost of bus boy: $60
Consultation with cook re dietary requirements: $50
Cost of laundering napkins: $27
Cost of cleaning silverware: $34
Misc dishwasher services: $42
Cooking food, 34 minutes x 4.75/min = $161.50
Rest room usage fee: $19
Excessive toilet paper usage, $4

Total: $674.50. You ate the food, so pay-up, or you're going to collections.
You are making an apples to oranges comparison but if the restaurant was required to stay open 24/7, feed hungry patrons regardless of their ability to pay, run these charges through patrons' food insurance companies, each of which offered separate discounted rates, use separate ingredients in carefully measured and regulated quantities to make the same dish for different patrons, offer some menu items all the time regardless of how many people order/pay for them, pay hefty licensing/insurance fees for each chef and server, keep chefs, servers, maitre'd and staff on paid call 24/7; and can be sued without much merit if the patron did not like the way the food turned out...

I think even you would agree that $674.50 is maybe a fair bill
Last edited by kiddoc on Thu Apr 19, 2018 9:26 pm, edited 1 time in total.
"The four most dangerous words in investing are: 'this time it's different.'" - Sir John Templeton
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