Excessive Emergency Room Charges - Options?

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OnTrack2020
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Re: Excessive Emergency Room Charges - Options?

Post by OnTrack2020 » Mon Aug 20, 2018 6:00 pm

fm3040 wrote:
Mon Aug 20, 2018 12:40 pm
Much much less. An ultrasound should not cost more than $200.
You went to the ER and had an ultrasound; you did not go to a doctor's office and have an ultrasound.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Mon Aug 20, 2018 6:12 pm

OnTrack2020 wrote:
Mon Aug 20, 2018 6:00 pm
fm3040 wrote:
Mon Aug 20, 2018 12:40 pm
Much much less. An ultrasound should not cost more than $200.
You went to the ER and had an ultrasound; you did not go to a doctor's office and have an ultrasound.
Do NOT know the answer - but on occasion one of my doctors orders an ultrasound and one choice was to have it at a local hospital (normal procedure like blood tests or X-rays) and the charge was very normal (cannot remember details) and covered by insurance. Does the ER at most such hospitals have its own, separate ultrasound equipment and staff? If it is the same equipment and staff, shouldn't the charges be similar? Same question with X-Rays and blood tests?

Katietsu
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Re: Excessive Emergency Room Charges - Options?

Post by Katietsu » Mon Aug 20, 2018 6:15 pm

Have you confirmed that the insurance company is paying as an emergency? I have been billed above the co pay for using an out of network ER. All I had to do was justify that it was an emergency. The insurance company picked up the additional charges.

chessknt
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Re: Excessive Emergency Room Charges - Options?

Post by chessknt » Mon Aug 20, 2018 6:21 pm

dm200 wrote:
Mon Aug 20, 2018 6:12 pm
OnTrack2020 wrote:
Mon Aug 20, 2018 6:00 pm
fm3040 wrote:
Mon Aug 20, 2018 12:40 pm
Much much less. An ultrasound should not cost more than $200.
You went to the ER and had an ultrasound; you did not go to a doctor's office and have an ultrasound.
Do NOT know the answer - but on occasion one of my doctors orders an ultrasound and one choice was to have it at a local hospital (normal procedure like blood tests or X-rays) and the charge was very normal (cannot remember details) and covered by insurance. Does the ER at most such hospitals have its own, separate ultrasound equipment and staff? If it is the same equipment and staff, shouldn't the charges be similar? Same question with X-Rays and blood tests?
It usually isn't. If it is there is still the difference that you have top priority and don't have to wait in line and frequently they bring the equipment to bedside to do it there instead of an ultrasound suite.

It's like reserving a seat on a plane. Just because we get seats in the same class doesn't mean they cost the same, especially if I bought mine 1 hour before the plane took off and they had to kick someone else off so I could have it.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Mon Aug 20, 2018 6:51 pm

Katietsu wrote:
Mon Aug 20, 2018 6:15 pm
Have you confirmed that the insurance company is paying as an emergency? I have been billed above the co pay for using an out of network ER. All I had to do was justify that it was an emergency. The insurance company picked up the additional charges.
Interesting experience !

SeekingAPlan
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Re: Excessive Emergency Room Charges - Options?

Post by SeekingAPlan » Mon Aug 20, 2018 7:07 pm

dm200 wrote:
Mon Aug 20, 2018 6:12 pm
OnTrack2020 wrote:
Mon Aug 20, 2018 6:00 pm
fm3040 wrote:
Mon Aug 20, 2018 12:40 pm
Much much less. An ultrasound should not cost more than $200.
You went to the ER and had an ultrasound; you did not go to a doctor's office and have an ultrasound.
Do NOT know the answer - but on occasion one of my doctors orders an ultrasound and one choice was to have it at a local hospital (normal procedure like blood tests or X-rays) and the charge was very normal (cannot remember details) and covered by insurance. Does the ER at most such hospitals have its own, separate ultrasound equipment and staff? If it is the same equipment and staff, shouldn't the charges be similar? Same question with X-Rays and blood tests?
For one thing, the charge would be greater in the ER because you do not have to wait days for the results.

ResearchMed
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Re: Excessive Emergency Room Charges - Options?

Post by ResearchMed » Mon Aug 20, 2018 7:32 pm

SeekingAPlan wrote:
Mon Aug 20, 2018 7:07 pm
dm200 wrote:
Mon Aug 20, 2018 6:12 pm
OnTrack2020 wrote:
Mon Aug 20, 2018 6:00 pm
fm3040 wrote:
Mon Aug 20, 2018 12:40 pm
Much much less. An ultrasound should not cost more than $200.
You went to the ER and had an ultrasound; you did not go to a doctor's office and have an ultrasound.
Do NOT know the answer - but on occasion one of my doctors orders an ultrasound and one choice was to have it at a local hospital (normal procedure like blood tests or X-rays) and the charge was very normal (cannot remember details) and covered by insurance. Does the ER at most such hospitals have its own, separate ultrasound equipment and staff? If it is the same equipment and staff, shouldn't the charges be similar? Same question with X-Rays and blood tests?
For one thing, the charge would be greater in the ER because you do not have to wait days for the results.
At our large hospital, the ER does indeed have it's own separate imaging equipment, at least in terms of x-ray and CAT-scans. I'm assuming that they also have MRI equipment, but haven't actually used it in the ER (only as outpatient or inpatient).
Some years ago, they did tend to wheel ER patients "downstairs" (well, in the elevator, not literally "wheeling them downstairs"!) where most of the imaging department is located.

It turns out there are more and more of these machines scattered throughout the hospital, so even "inpatients on the floors" no longer have to go to a central department for many/most of these images.

But in the ER, there isn't the same queuing and "scheduled times". Typically, if an ER patient needs an image urgently, they are just wheeled right down the hall and into the appropriate room, and the machine is right there, available.

So that would indeed be another reason for the higher costs in the ER. Those machines aren't being used by an almost endless queue of patients, in some cases almost round the clock. (The non-ER imaging machines are kept running with appointments at almost all times, even at some satellite facilities.)

And of course, the ER has full staffing 24/7/365, although they do schedule the staffing according to expected numbers. There is always a "full staff", but probably not multiples of all positions at, say, 2am on a weeknight/morning.

RM
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GreenGrowTheDollars
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Re: Excessive Emergency Room Charges - Options?

Post by GreenGrowTheDollars » Mon Aug 20, 2018 10:02 pm

I was initially balance billed by the ambulance company in California on a trip to the ER. It turned out that my insurer "assumed" (hoped is more like it) that the county ambulance service would accept what Aetna deemed the payment ought to be. The billing rep at the ambulance company simply sighed and said that quite a few insurance companies try that routine, and that all I needed to do was speak to an insurance rep and file an appeal. I did, and the insurance company picked up the balance of the several thousand dollar ambulance charge. Before getting too bent out of shape about the bill I would check with your insurance company to find out WHY you're being charged so much if you don't have a high deductible plan. They may have made a mistake.

toofache32
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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Mon Aug 20, 2018 11:49 pm

fm3040 wrote:
Mon Aug 20, 2018 12:40 pm
Much much less. An ultrasound should not cost more than $200.
How much of that is the technical component and how much is for the radiologist who reads it?

toofache32
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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Mon Aug 20, 2018 11:55 pm

ResearchMed wrote:
Mon Aug 20, 2018 3:08 pm
strongboy2005 wrote:
Mon Aug 20, 2018 3:04 pm
BusterMcTaco wrote:
Mon Aug 20, 2018 2:45 pm
I once had an ER visit where the attending came in towards the end (after the resident treated me), checked on how everything was going, and then billed my insurance $250 for that minute.
Residents can’t bill. The attending takes total responsibility and liability for your care. The resident is there to learn. All of their decisions have to be cleared by the attending. This is why you get a bill from the attending and not the resident even though the resident spends more time with you. Note also that the separate bill from the physician is all the money they get. Exactly $0 of the other hospital charges goes to paying the emergency physician.
Also, that physician probably spent some additional time reviewing your chart (and records if you had been there before) and discussing your status with the resident and possibly nursing staff.

And you are also paying in part for the physician's "down time", given that physicians are often there for the full shift, patients or not.
That is, you are paying part of the convenience of having that physician *there* at the specific time that you need him/her. That's what ER's "do".

RM
Everyone thinks the doctor's job is done when he walks out of the room. They whine "he only spent 1 minute with me". They never see the 20 minutes of time documenting the encounter, checking the boxes in EMR, and reviewing the case with the resident.

toofache32
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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Mon Aug 20, 2018 11:59 pm

fm3040 wrote:
Mon Aug 20, 2018 3:27 pm
I know I will pay my bills as I always have. I was just upset that Billing Services was not willing to work with me on reducing what seemed like and likely are exorbitant charges. When I asked about monthly payments, she did not offer me anything more than 6 equal payments.
Was this all in-network? If so, the fees have ALREADY been negotiated down by your insurance company. If the claim has been adjudicated by your insurance company then this is the amount you are contractually obligated to pay. You signed up for this. You already agreed to this in writing. I am truly confused as to what the complaint is here.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Tue Aug 21, 2018 9:44 am

Everyone thinks the doctor's job is done when he walks out of the room. They whine "he only spent 1 minute with me". They never see the 20 minutes of time documenting the encounter, checking the boxes in EMR, and reviewing the case with the resident.
True of many professions.

2015
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Re: Excessive Emergency Room Charges - Options?

Post by 2015 » Tue Aug 21, 2018 11:12 am

dm200 wrote:
Mon Aug 20, 2018 3:21 pm
One thing I would recommend is, before needing medical services, scout out any Urgent Care facilities in the area, hours of operation, services available, insurance options, etc. I have never used any of them, but I notice over the last few years, many of these are popping up all over the place. There are two, in fact, within a mile of our house.
+1
The time to be thinking about the financial aspect of medical care is before having to access it, not after. I've made it a point to be aware of where my urgent care services are located, along with hours of operation, etc. If I ever choose to go to the emergency room, it will be because I believe it either is or could develop into a life threatening emergency. In that case, "system broken" or not, I will gladly pay to have my life saved (OTOH, should such an event occur, I do intend to inquire to the greatest extent possible into what the final bill might look like).

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Tue Aug 21, 2018 11:18 am

2015 wrote:
Tue Aug 21, 2018 11:12 am
dm200 wrote:
Mon Aug 20, 2018 3:21 pm
One thing I would recommend is, before needing medical services, scout out any Urgent Care facilities in the area, hours of operation, services available, insurance options, etc. I have never used any of them, but I notice over the last few years, many of these are popping up all over the place. There are two, in fact, within a mile of our house.
+1
The time to be thinking about the financial aspect of medical care is before having to access it, not after. I've made it a point to be aware of where my urgent care services are located, along with hours of operation, etc. If I ever choose to go to the emergency room, it will be because I believe it either is or could develop into a life threatening emergency. In that case, "system broken" or not, I will gladly pay to have my life saved (OTOH, should such an event occur, I do intend to inquire to the greatest extent possible into what the final bill might look like).
DW and/or I are fully aware of our health plan's 24x7 Urgent Care facilities - and know the best/closest one. I thought another one might be closer, but I made a test drive there - and it is actually more time to get there. We consider BOTH the financial AND medical/health aspects of after hours urgent and emergency services.

2015
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Re: Excessive Emergency Room Charges - Options?

Post by 2015 » Tue Aug 21, 2018 11:38 am

dm200 wrote:
Tue Aug 21, 2018 11:18 am
2015 wrote:
Tue Aug 21, 2018 11:12 am
dm200 wrote:
Mon Aug 20, 2018 3:21 pm
One thing I would recommend is, before needing medical services, scout out any Urgent Care facilities in the area, hours of operation, services available, insurance options, etc. I have never used any of them, but I notice over the last few years, many of these are popping up all over the place. There are two, in fact, within a mile of our house.
+1
The time to be thinking about the financial aspect of medical care is before having to access it, not after. I've made it a point to be aware of where my urgent care services are located, along with hours of operation, etc. If I ever choose to go to the emergency room, it will be because I believe it either is or could develop into a life threatening emergency. In that case, "system broken" or not, I will gladly pay to have my life saved (OTOH, should such an event occur, I do intend to inquire to the greatest extent possible into what the final bill might look like).
DW and/or I are fully aware of our health plan's 24x7 Urgent Care facilities - and know the best/closest one. I thought another one might be closer, but I made a test drive there - and it is actually more time to get there. We consider BOTH the financial AND medical/health aspects of after hours urgent and emergency services.
Yep. And this is exactly why your medical care costs are under control.

If we do what have to do in advance of when we have to do it (such as what you have done), we don't have to accept the idea that we have no power to impact health care costs.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Tue Aug 21, 2018 11:46 am

2015 wrote:
Tue Aug 21, 2018 11:38 am
dm200 wrote:
Tue Aug 21, 2018 11:18 am
2015 wrote:
Tue Aug 21, 2018 11:12 am
dm200 wrote:
Mon Aug 20, 2018 3:21 pm
One thing I would recommend is, before needing medical services, scout out any Urgent Care facilities in the area, hours of operation, services available, insurance options, etc. I have never used any of them, but I notice over the last few years, many of these are popping up all over the place. There are two, in fact, within a mile of our house.
+1
The time to be thinking about the financial aspect of medical care is before having to access it, not after. I've made it a point to be aware of where my urgent care services are located, along with hours of operation, etc. If I ever choose to go to the emergency room, it will be because I believe it either is or could develop into a life threatening emergency. In that case, "system broken" or not, I will gladly pay to have my life saved (OTOH, should such an event occur, I do intend to inquire to the greatest extent possible into what the final bill might look like).
DW and/or I are fully aware of our health plan's 24x7 Urgent Care facilities - and know the best/closest one. I thought another one might be closer, but I made a test drive there - and it is actually more time to get there. We consider BOTH the financial AND medical/health aspects of after hours urgent and emergency services.
Yep. And this is exactly why your medical care costs are under control.
If we do what have to do in advance of when we have to do it (such as what you have done), we don't have to accept the idea that we have no power to impact health care costs.
I am still in the process of investigating the (more common as we age) situation where assistance would be needed to get one of us out of the house for emergency or urgent medical conditions. If DW fell, I probably would not be able to lift her. A call to 911 would result in very qualified folks getting her out - BUT then they would only transport her to the nearest hospital ER. If this were "urgent" but not emergency - then I would probably want to take her to out health plans 24x7 urgent care facility. Better BOTH medically and financially. I think I/we/she could decline to be transported if they got her out of the house.

Yes! DW and I are unusual and some call us "weird".

Call_Me_Op
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Re: Excessive Emergency Room Charges - Options?

Post by Call_Me_Op » Tue Aug 21, 2018 11:54 am

Perhaps an uninformed question, but if one's insurance plan has a deductible of $1000, does this (generally) mean that $1000 is the largest medical bill that person can expect from an emergency situation?
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Nate79
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Re: Excessive Emergency Room Charges - Options?

Post by Nate79 » Tue Aug 21, 2018 12:09 pm

Call_Me_Op wrote:
Tue Aug 21, 2018 11:54 am
Perhaps an uninformed question, but if one's insurance plan has a deductible of $1000, does this (generally) mean that $1000 is the largest medical bill that person can expect from an emergency situation?
Certainly not. You need to figure out how your plan covers the costs above the deductible and up to the out of pocket max. To be safer the max you may pay in a year is your out of pocket max, not your deductible.

passiveTiger
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Re: Excessive Emergency Room Charges - Options?

Post by passiveTiger » Tue Aug 21, 2018 12:29 pm

dm200 wrote:
Mon Aug 20, 2018 3:21 pm
One thing I would recommend is, before needing medical services, scout out any Urgent Care facilities in the area, hours of operation, services available, insurance options, etc.
On its face, dm200's post sounds like ridiculously excessive pre-planning. What rational person should be scouting out the locations of nearby medical services that they may POTENTIALLY need?

But... it is GREAT advice.

For example, free-standing emergency rooms began to appear after ACA - especially in Texas. Wherever they are, almost none will be in-network. Someone needs to know that BEFORE they are looking for emergency room service.

https://www.dallasnews.com/business/hea ... aw-working

If you go to one of them, you will pay around $2,200. I do not know whether the OP went to one, but the OP indicated being in Texas earlier.

People need to know the location of nearby retail clinics, urgent care clinics, and emergency room services - and whether they are in-network - before using any of those. The best time to obtain all of that information is when you do not need them.

I mention retail clinics, because they are amazingly convenient for acute care, if they are in-network. A visit to one has a co-pay the same as the one for your PCP. You can also walk-in whereas I must schedule weeks (or occasionally, months) in advance to see my PCP. Waits, if any, are often better measured by seconds than minutes. They are perfect for a rapid flu or strep test. I have been happy with the care that I have received from them.

https://www.youtube.com/watch?v=TnI6Yh0Sko4

In regards to the OP's original post with three questions (with the assumption the OP is in Texas):

1) You can ignore the bills forever - and you will be harassed forever. If you are not paying per an agreed-upon plan, your debt will probably be turned over after 120-180 days - not two years like someone else posted. The statute of limitations on the collection of debt in Texas is only four years, so no one is going to let two years pass without attempting aggressive collection. Your credit score will be impacted for almost four years, but then the collection agency will file suit before the statute takes effect, since the cost to do so is so low.

When they get a judgment against you, they might file a garnishment, judgment liens, etc., but what you will fear is the post-judgment depositions. They will obtain court orders to interview you, your employer, etc. (http://www.texascollections.com/post-ju ... deposition). You will have to produce a lot of information, and you will be jailed if you do not (http://texascollections.com/the_list/).

Or you could pay your debt.

2) Yes. The trick is to agree to a payment plan and then pay according to the plan.

3) Probably not.

4) "Could it hurt me in terms of new employment if I have to look for a new job in the next few years?" It is hard to say for certain. Ask your supervisor after he or she receives a summons to be deposed about your unpaid debt.

5) "Are medical bills treated differently in computing credit scores so your credit score is not impacted as much?" I do not know, but it will probably be the least of your worries.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Tue Aug 21, 2018 12:35 pm

passiveTiger wrote:
Tue Aug 21, 2018 12:29 pm
dm200 wrote:
Mon Aug 20, 2018 3:21 pm
One thing I would recommend is, before needing medical services, scout out any Urgent Care facilities in the area, hours of operation, services available, insurance options, etc.
On its face, dm200's post sounds like ridiculously excessive pre-planning. What rational person should be scouting out the locations of nearby medical services that they may POTENTIALLY need?

But... it is GREAT advice.

For example, free-standing emergency rooms began to appear after ACA - especially in Texas. Wherever they are, almost none will be in-network. Someone needs to know that BEFORE they are looking for emergency room service.

https://www.dallasnews.com/business/hea ... aw-working

If you go to one of them, you will pay around $2,200. I do not know whether the OP went to one, but the OP indicated being in Texas earlier.

People need to know the location of nearby retail clinics, urgent care clinics, and emergency room services - and whether they are in-network - before using any of those. The best time to obtain all of that information is when you do not need them.

I mention retail clinics, because they are amazingly convenient for acute care, if they are in-network. A visit to one has a co-pay the same as the one for your PCP. You can also walk-in whereas I must schedule weeks (or occasionally, months) in advance to see my PCP. Waits, if any, are often better measured by seconds than minutes. They are perfect for a rapid flu or strep test. I have been happy with the care that I have received from them.

https://www.youtube.com/watch?v=TnI6Yh0Sko4

In regards to the OP's original post with three questions (with the assumption the OP is in Texas):

1) You can ignore the bills forever - and you will be harassed forever. If you are not paying per an agreed-upon plan, your debt will probably be turned over after 120-180 days - not two years like someone else posted. The statute of limitations on the collection of debt in Texas is only four years, so no one is going to let two years pass without attempting aggressive collection. Your credit score will be impacted for almost four years, but then the collection agency will file suit before the statute takes effect, since the cost to do so is so low.

When they get a judgment against you, they might file a garnishment, judgment liens, etc., but what you will fear is the post-judgment depositions. They will obtain court orders to interview you, your employer, etc. (http://www.texascollections.com/post-ju ... deposition). You will have to produce a lot of information, and you will be jailed if you do not (http://texascollections.com/the_list/).

Or you could pay your debt.

2) Yes. The trick is to agree to a payment plan and then pay according to the plan.

3) Probably not.

4) "Could it hurt me in terms of new employment if I have to look for a new job in the next few years?" It is hard to say for certain. Ask your supervisor after he or she receives a summons to be deposed about your unpaid debt.

5) "Are medical bills treated differently in computing credit scores so your credit score is not impacted as much?" I do not know, but it will probably be the least of your worries.
Thanks! :)

asterix0
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Re: Excessive Emergency Room Charges - Options?

Post by asterix0 » Tue Aug 21, 2018 12:39 pm

I just found a show on TrueTV called "Adam Ruins Everything." Season 2 has an episode on hospital billing that sheds some light on why discussions like this become so convoluted so quickly.

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dual
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Re: Excessive Emergency Room Charges - Options?

Post by dual » Tue Aug 21, 2018 1:17 pm

HomerJ wrote:
Mon Aug 20, 2018 2:35 pm

This is not a fair question. The system is broken.

It's not like they give you a list of prices, and you get a chance to "agree" to pay that amount.

You get to agree or disagree if they should try to save you during a medical emergency. You don't get to haggle over the prices. You don't even get to KNOW the prices.

It's perfectly legitimate to want to question the prices after the fact, since they were not disclosed to you before the fact.

You (while having problems breathing, with a pounding headache, and feeling like you're going to throw up or pass out): "How much will this cost?"
Doctor: I don't know. Do you want me to help you or do you want to go home?
I agree with this. The medical billing system is broken. In almost all cases you cannot get a price even for non-emergency services. All you get is "it depends." I think this is deliberate so medical providers do not have to compete on price like every other business does.

To the OP, play hardball. Delay your payment a few months until the calls get desperate and then give them a low-ball offer. If they ding your credit rating you can add an explanatory note plus it will fall off your record in a few years,

edit: competing on price would be great for both the medical business and consumers. Look at radial keratotomy where prices are openly quoted. With this competition, the price has been lowered and the quality increased.
Last edited by dual on Tue Aug 21, 2018 1:20 pm, edited 1 time in total.

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Ted Valentine
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Re: Excessive Emergency Room Charges - Options?

Post by Ted Valentine » Tue Aug 21, 2018 1:19 pm

My experience is medical providers will always accept a payment plan. Call them and tell them you can pay them $200 a month (or whatever). You had an emergency and they treated you and you are still alive. Be thankful.

Do not ignore it. Do not send them $5 a month. These are bad ideas.I believe they will sue you for anything over $800.

If some of the charges or procedures are wrong you can dispute the charges, but you need to respond in writing within 30 days explaining why. I have successfully disputed extra charges once before, but this is not common and the amount was much lower than your bill.
Although our intellect always longs for clarity and certainty, our nature often finds uncertainty fascinating.

2015
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Re: Excessive Emergency Room Charges - Options?

Post by 2015 » Tue Aug 21, 2018 2:27 pm

dm200 wrote:
Mon Aug 20, 2018 3:21 pm
Yes! DW and I are unusual and some call us "weird".
What could possibly be weird about being proactive, organized and effective?

Some people live at cause in life while others choose to live at effect. The results each group produce couldn't be more dramatically different. It's obvious which group you fall into as your results (your managed, lower health care costs) speak for themselves.

Not to derail the thread, were I OP, I would make every effort to ensure I was never in a situation like this related to health care charges again.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Tue Aug 21, 2018 2:52 pm

2015 wrote:
Tue Aug 21, 2018 2:27 pm
dm200 wrote:
Mon Aug 20, 2018 3:21 pm
Yes! DW and I are unusual and some call us "weird".
What could possibly be weird about being proactive, organized and effective?

Some people live at cause in life while others choose to live at effect. The results each group produce couldn't be more dramatically different. It's obvious which group you fall into as your results (your managed, lower health care costs) speak for themselves.

Not to derail the thread, were I OP, I would make every effort to ensure I was never in a situation like this related to health care charges again.
Such folks seem to believe that the "best" way to deal with emergency and urgent health needs is to go (or be transported by ambulance) to a hospital ER. My (informed, I believe) very strong opinion and conclusion is that going to a hospital ER can often be much more expensive and no better treatment (sometimes worse).

T4REngineer
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Re: Excessive Emergency Room Charges - Options?

Post by T4REngineer » Tue Aug 21, 2018 3:00 pm

True but getting those estimates even for standard procedures is borderline a fools errand. This is why data tables and averages exist, the automotive industry lives and dies by this. AC condenser replacement on 2014 Camry is a 6hr billable job, if it takes you 4 great if it takes you 8 to bad that difference should be built into this timetable. The medical field has no transparency and they have more then enough data to say at $500 dollars an ultra sound we will make money - that's our price outside of insurance and then whatever they negotiate with your insurance you pay the remaining (assuming not met your out of pocket max - then insurance pays). I have no expectation of doctors providing me an exact cost of my procedures during an emergency but try getting costs before hand in a routine procedure its a HUGE pain, I have done it for both an standard Surgery and a pregnancy and its almost impossible they essentially say "we have no standard and it depends on what is needed" so unless you are well aware of the medical codes and then request through the hospital and insurance how much it will cost for each code only then do you have hope of coming up with a rough cost before hand - all this in an industry that costs hundreds of thousands in school debt to get into, beats the providers (doctors and nurses) into a pulp.......needless to say I love them when my life is on the line but outside of that they can pound sand and need a complete overhaul. They being the admin/leaders more then the providers.

For non emergency procedure they also make it a huge pain to make an informed choice - so we have done X, we know Y now we can do S, T and Z tests - start asking what those tests will cost, what the results may or may not indicate and how treatment or prevention plan will be effected by those test results and they treat you like you are insane. They seem think because they are the professionals that's we should just do as we are told, that's all well and good expect I am paying for it! Rant over

*thank you to all the providers that do provide healthcare, while I may hate the system I do love knowing I have access to great health case but I feel blatantly over charged for it because the system refuses to be transparent and while I don't expect Apple to tell me what is costs to make an I-phone a consumer good is different than Healthcare IMHO.
Last edited by T4REngineer on Tue Aug 21, 2018 3:01 pm, edited 1 time in total.

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Re: Excessive Emergency Room Charges - Options?

Post by White Coat Investor » Tue Aug 21, 2018 3:01 pm

rantk81 wrote:
Mon Aug 20, 2018 12:41 pm
Those dollar amounts seem pretty standard for emergency room charges.
I thought they sounded pretty cheap. I kept reading waiting for the excessive charges to appear. It would appear the OP has no idea what emergency care costs. You know that little ultrasound probe they used to do your ultrasound? That little thing costs $10-15K and we haven't even discussed the machine it is connected to.

Tip: If it isn't life, limb, or eyesight threatening, don't go to the ED. If it is, don't complain about the bill.

Imagine if your job was legally required to provide your services without being paid in advance and then people posted on internet forum to try to figure out how to get out of paying you and the forum is actually supportive of that approach. No wonder docs are leaving medicine as soon as they're financially able to. Who needs that sort of hassle?

People need to stop thinking of an ED visit as more similar to going to clinic than being admitted to the hospital overnight.
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Tue Aug 21, 2018 4:28 pm

White Coat Investor wrote:
Tue Aug 21, 2018 3:01 pm
rantk81 wrote:
Mon Aug 20, 2018 12:41 pm
Those dollar amounts seem pretty standard for emergency room charges.
I thought they sounded pretty cheap. I kept reading waiting for the excessive charges to appear. It would appear the OP has no idea what emergency care costs. You know that little ultrasound probe they used to do your ultrasound? That little thing costs $10-15K and we haven't even discussed the machine it is connected to.

Tip: If it isn't life, limb, or eyesight threatening, don't go to the ED. If it is, don't complain about the bill.

Imagine if your job was legally required to provide your services without being paid in advance and then people posted on internet forum to try to figure out how to get out of paying you and the forum is actually supportive of that approach. No wonder docs are leaving medicine as soon as they're financially able to. Who needs that sort of hassle?

People need to stop thinking of an ED visit as more similar to going to clinic than being admitted to the hospital overnight.
Yes - I agree - and that is common advice.

However, one issue is "urgent care" and how to find lower cost care when something needs to be done soon, but you will not die or suffer bodily damage if it takes a few hours. As I have posted, we are fortunate that we have 24x7 urgent care within a 20-30 minute drive that is capable of handling about 99% of situations we might encounter.

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Re: Excessive Emergency Room Charges - Options?

Post by boglegirl » Tue Aug 21, 2018 5:21 pm

fm3040 wrote:
Mon Aug 20, 2018 3:27 pm
...
I was wondering if I could force them not to send it to collections by sending an automatic monthly payment from my bank and take, say, a year or two to pay off all my current bills plus more that I am expecting in the future for the medical event that I am still not out of.
No, I don't think sending small payments will "force" them to do anything except perhaps send you to collections. In my experience, if you don't pay in full, medical providers require you to call and get set up on a payment plan (e.g. the 6-month plan they offered you) to keep an account from being considered in default. If I were you, I'd take them up on that offer.

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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Tue Aug 21, 2018 5:23 pm

boglegirl wrote:
Tue Aug 21, 2018 5:21 pm
fm3040 wrote:
Mon Aug 20, 2018 3:27 pm
...
I was wondering if I could force them not to send it to collections by sending an automatic monthly payment from my bank and take, say, a year or two to pay off all my current bills plus more that I am expecting in the future for the medical event that I am still not out of.
No, I don't think sending small payments will "force" them to do anything except perhaps send you to collections. In my experience, if you don't pay in full, medical providers require you to call and get set up on a payment plan (e.g. the 6-month plan they offered you) to keep an account from being considered in default. If I were you, I'd take them up on that offer.
Yes! Make arrangements to pay

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Re: Excessive Emergency Room Charges - Options?

Post by rooms222 » Tue Aug 21, 2018 6:21 pm

dm200 wrote:
Mon Aug 20, 2018 3:33 pm
rooms222 wrote:
Mon Aug 20, 2018 3:23 pm
Jags4186 wrote:
Mon Aug 20, 2018 2:50 pm
Don’t pick a high deductible health plan if you are going to be upset when you have to pay that deductible. My wife and I have an $8000 deductible, $12,000 out of pocket max. I do that because I save roughly $7000/yr on premiums vs my employers copay insurance plan. Seems like a good tradeoff to me. But I never kid myself—I know at any time I could have to write a $12,000 check.

We have no choice at our governmental employer but to have a high deductible plan, including employees making $24,000 a year gross,
You do not have an HMO choice for health insurance?
e

There is an HMO choice-- an HDHP eligible HMO with the same deductibles as the PPO. All available plans are HDHP plans with the same deductibles. The deductibles are the minimum amount under Federal law to be HDHP eligible.

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Re: Excessive Emergency Room Charges - Options?

Post by White Coat Investor » Tue Aug 21, 2018 6:21 pm

dm200 wrote:
Tue Aug 21, 2018 4:28 pm
White Coat Investor wrote:
Tue Aug 21, 2018 3:01 pm
rantk81 wrote:
Mon Aug 20, 2018 12:41 pm
Those dollar amounts seem pretty standard for emergency room charges.
I thought they sounded pretty cheap. I kept reading waiting for the excessive charges to appear. It would appear the OP has no idea what emergency care costs. You know that little ultrasound probe they used to do your ultrasound? That little thing costs $10-15K and we haven't even discussed the machine it is connected to.

Tip: If it isn't life, limb, or eyesight threatening, don't go to the ED. If it is, don't complain about the bill.

Imagine if your job was legally required to provide your services without being paid in advance and then people posted on internet forum to try to figure out how to get out of paying you and the forum is actually supportive of that approach. No wonder docs are leaving medicine as soon as they're financially able to. Who needs that sort of hassle?

People need to stop thinking of an ED visit as more similar to going to clinic than being admitted to the hospital overnight.
Yes - I agree - and that is common advice.

However, one issue is "urgent care" and how to find lower cost care when something needs to be done soon, but you will not die or suffer bodily damage if it takes a few hours. As I have posted, we are fortunate that we have 24x7 urgent care within a 20-30 minute drive that is capable of handling about 99% of situations we might encounter.
That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.

Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.

I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Tue Aug 21, 2018 6:34 pm

White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm
dm200 wrote:
Tue Aug 21, 2018 4:28 pm
White Coat Investor wrote:
Tue Aug 21, 2018 3:01 pm
rantk81 wrote:
Mon Aug 20, 2018 12:41 pm
Those dollar amounts seem pretty standard for emergency room charges.
I thought they sounded pretty cheap. I kept reading waiting for the excessive charges to appear. It would appear the OP has no idea what emergency care costs. You know that little ultrasound probe they used to do your ultrasound? That little thing costs $10-15K and we haven't even discussed the machine it is connected to.

Tip: If it isn't life, limb, or eyesight threatening, don't go to the ED. If it is, don't complain about the bill.

Imagine if your job was legally required to provide your services without being paid in advance and then people posted on internet forum to try to figure out how to get out of paying you and the forum is actually supportive of that approach. No wonder docs are leaving medicine as soon as they're financially able to. Who needs that sort of hassle?

People need to stop thinking of an ED visit as more similar to going to clinic than being admitted to the hospital overnight.
Yes - I agree - and that is common advice.

However, one issue is "urgent care" and how to find lower cost care when something needs to be done soon, but you will not die or suffer bodily damage if it takes a few hours. As I have posted, we are fortunate that we have 24x7 urgent care within a 20-30 minute drive that is capable of handling about 99% of situations we might encounter.
That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.
Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.
I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
OK - maybe I define things according to both what I perceive and the facilities available to us.

Our (Kaiser) urgent care 24x7 facility (which we have used several times) handles things like most broken bones, getting a piece of something in your eye, etc. My wife, for example, had severe pain (and getting worse) at 3 am on a Sunday. Took her to the Urgent care facility - and they quickly diagnosed pancreatitis. They treated her pain, ran many tests - and later in the day on Sunday - sent her by ambulance to be admitted to a Hospital (not the emergency department). I think, though, that if I had 3 stents and crushing chest pain I would go to the Hospital ED. They can keep patients (some quite sick) there for up to 24 hours. That "Urgent care" facility has access to MRIs, X-rays, CT scanners, etc.

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Re: Excessive Emergency Room Charges - Options?

Post by goodenyou » Tue Aug 21, 2018 6:43 pm

HomerJ wrote:
Mon Aug 20, 2018 2:35 pm
dm200 wrote:
Mon Aug 20, 2018 2:08 pm
Why do you think you should not pay legitimate bills for services that, apparently, you agreed to in seeking medical help? To go to the ER, it would seem that you must have been very concerned about the immediacy of an "emergency" vs seeing physician(s) the next day or seeking care from an urgent care" facility.
This is not a fair question. The system is broken.

It's not like they give you a list of prices, and you get a chance to "agree" to pay that amount.

You get to agree or disagree if they should try to save you during a medical emergency. You don't get to haggle over the prices. You don't even get to KNOW the prices.

It's perfectly legitimate to want to question the prices after the fact, since they were not disclosed to you before the fact.

You (while having problems breathing, with a pounding headache, and feeling like you're going to throw up or pass out): "How much will this cost?"
Doctor: I don't know. Do you want me to help you or do you want to go home?
Just keep in mind, the patient is blinded to the cost and the doctor is blinded to the reimbursement (if at all). Bad for both.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

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Re: Excessive Emergency Room Charges - Options?

Post by passiveTiger » Tue Aug 21, 2018 6:45 pm

dm200 wrote:
Tue Aug 21, 2018 6:34 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm
dm200 wrote:
Tue Aug 21, 2018 4:28 pm
White Coat Investor wrote:
Tue Aug 21, 2018 3:01 pm
rantk81 wrote:
Mon Aug 20, 2018 12:41 pm
Those dollar amounts seem pretty standard for emergency room charges.
I thought they sounded pretty cheap. I kept reading waiting for the excessive charges to appear. It would appear the OP has no idea what emergency care costs. You know that little ultrasound probe they used to do your ultrasound? That little thing costs $10-15K and we haven't even discussed the machine it is connected to.

Tip: If it isn't life, limb, or eyesight threatening, don't go to the ED. If it is, don't complain about the bill.

Imagine if your job was legally required to provide your services without being paid in advance and then people posted on internet forum to try to figure out how to get out of paying you and the forum is actually supportive of that approach. No wonder docs are leaving medicine as soon as they're financially able to. Who needs that sort of hassle?

People need to stop thinking of an ED visit as more similar to going to clinic than being admitted to the hospital overnight.
Yes - I agree - and that is common advice.

However, one issue is "urgent care" and how to find lower cost care when something needs to be done soon, but you will not die or suffer bodily damage if it takes a few hours. As I have posted, we are fortunate that we have 24x7 urgent care within a 20-30 minute drive that is capable of handling about 99% of situations we might encounter.
That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.
Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.
I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
OK - maybe I define things according to both what I perceive and the facilities available to us.

Our (Kaiser) urgent care 24x7 facility (which we have used several times) handles things like most broken bones, getting a piece of something in your eye, etc. My wife, for example, had severe pain (and getting worse) at 3 am on a Sunday. Took her to the Urgent care facility - and they quickly diagnosed pancreatitis. They treated her pain, ran many tests - and later in the day on Sunday - sent her by ambulance to be admitted to a Hospital (not the emergency department). I think, though, that if I had 3 stents and crushing chest pain I would go to the Hospital ED. They can keep patients (some quite sick) there for up to 24 hours. That "Urgent care" facility has access to MRIs, X-rays, CT scanners, etc.
Many infographics available:

https://www.google.com/search?q=urgent+ ... s&tbm=isch

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Re: Excessive Emergency Room Charges - Options?

Post by OnTrack » Tue Aug 21, 2018 7:42 pm

earlyout wrote:
Mon Aug 20, 2018 1:18 pm
What kind of health insurance do you have? ER visits are usually expensive and In a true emergency, most insurers will cover both in-network and out-of-network facilities.

Since the billing agrees with the EOBs from your insurance company and there are still sizable amounts due, it appears you have minimal insurance coverage of some kind. You should be able to use some of the money you saved on premiums to pay the bills.
The OP said the amount owed is $2668. What makes you say this appears to be minimal coverage? I believe under the ACA about a $7000 deductible is pretty standard.

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Re: Excessive Emergency Room Charges - Options?

Post by GottaGetThisGoing » Tue Aug 21, 2018 8:57 pm

fm3040 wrote:
Mon Aug 20, 2018 12:31 pm
She said that they CANNOT offer me any kind of discount other than financial assistance for low-wage earners if I show proof of income.
If I were you, I would send a certified letter to the hospital addressed to "Hospital Administrator" and a second letter to "She" who CANNOT.

I would explain that I cannot pay the amount they asked. I would explain that I do not care about my credit and they can try to collect all they want, I don't have the money, and I don't care to fill out their arbitrary forms.

I would explain that I have exactly 25% that I was going to pay to my child's college, that I could instead send them if they would settle, and they can send a letter to agree to same to my address.

That's what I'd do.

After 1 week I'd call and ask to speak with "She who CANNOT"'s manager and explain the letter and confirm they received it.

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Re: Excessive Emergency Room Charges - Options?

Post by jacoavlu » Tue Aug 21, 2018 9:30 pm

Caveat: I’m just a doc not a lawyer or hospital admin. But we deal with this stuff sometimes.

These things are trickier than you think. Medicare fraud, anti kickback considerations, stuff like that. I know I know. Government makes the rules.

There are Medicare / HHS rules and regs that address these things. It gets into language of “usual and customary” charges and what facilities and physicians charge Medicare versus private payers and cash customers. Entities can’t charge Medicare substantially more than their usual and customary charge to others. In practice usual and customary charges are somewhat inflated because Medicare (the largest payer) pays so little, and private payer contracts get reflected as a percentage of Medicare rate (say 150%).

So. HHS has said its ok for hospitals to discount their usual and customary charges for uninsured patients and underinsured patients who have demonstrated financial need.

Right or wrong not my point.

This is probably where “the lady” from billing is coming from. Are you underinsured? Do you have demonstrated financial need?

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Re: Excessive Emergency Room Charges - Options?

Post by White Coat Investor » Wed Aug 22, 2018 11:10 am

dm200 wrote:
Tue Aug 21, 2018 6:34 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm
dm200 wrote:
Tue Aug 21, 2018 4:28 pm
White Coat Investor wrote:
Tue Aug 21, 2018 3:01 pm
rantk81 wrote:
Mon Aug 20, 2018 12:41 pm
Those dollar amounts seem pretty standard for emergency room charges.
I thought they sounded pretty cheap. I kept reading waiting for the excessive charges to appear. It would appear the OP has no idea what emergency care costs. You know that little ultrasound probe they used to do your ultrasound? That little thing costs $10-15K and we haven't even discussed the machine it is connected to.

Tip: If it isn't life, limb, or eyesight threatening, don't go to the ED. If it is, don't complain about the bill.

Imagine if your job was legally required to provide your services without being paid in advance and then people posted on internet forum to try to figure out how to get out of paying you and the forum is actually supportive of that approach. No wonder docs are leaving medicine as soon as they're financially able to. Who needs that sort of hassle?

People need to stop thinking of an ED visit as more similar to going to clinic than being admitted to the hospital overnight.
Yes - I agree - and that is common advice.

However, one issue is "urgent care" and how to find lower cost care when something needs to be done soon, but you will not die or suffer bodily damage if it takes a few hours. As I have posted, we are fortunate that we have 24x7 urgent care within a 20-30 minute drive that is capable of handling about 99% of situations we might encounter.
That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.
Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.
I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
OK - maybe I define things according to both what I perceive and the facilities available to us.

Our (Kaiser) urgent care 24x7 facility (which we have used several times) handles things like most broken bones, getting a piece of something in your eye, etc. My wife, for example, had severe pain (and getting worse) at 3 am on a Sunday. Took her to the Urgent care facility - and they quickly diagnosed pancreatitis. They treated her pain, ran many tests - and later in the day on Sunday - sent her by ambulance to be admitted to a Hospital (not the emergency department). I think, though, that if I had 3 stents and crushing chest pain I would go to the Hospital ED. They can keep patients (some quite sick) there for up to 24 hours. That "Urgent care" facility has access to MRIs, X-rays, CT scanners, etc.
That's a free standing ED, not an urgent care by most definitions. Most urgent cares do not have access to CT scanners, much less MRIs. Heck, they can't even do the labs that would diagnose Pancreatitis. Now if you can get a facility that will do CT scans and labs for you and charge you urgent care prices, I recommend you use it for your emergency care needs. Few urgent cares will reduce broken bones or extract foreign bodies even though those are routine procedures for an emergency physician. Urgent cares in my area generally don't even employ physicians (much less emergency physicians) because they can't stay profitable while doing so and charging urgent care prices. There is obviously some variation.
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Wed Aug 22, 2018 11:25 am

White Coat Investor wrote:
Wed Aug 22, 2018 11:10 am
dm200 wrote:
Tue Aug 21, 2018 6:34 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm
dm200 wrote:
Tue Aug 21, 2018 4:28 pm
White Coat Investor wrote:
Tue Aug 21, 2018 3:01 pm


I thought they sounded pretty cheap. I kept reading waiting for the excessive charges to appear. It would appear the OP has no idea what emergency care costs. You know that little ultrasound probe they used to do your ultrasound? That little thing costs $10-15K and we haven't even discussed the machine it is connected to.

Tip: If it isn't life, limb, or eyesight threatening, don't go to the ED. If it is, don't complain about the bill.

Imagine if your job was legally required to provide your services without being paid in advance and then people posted on internet forum to try to figure out how to get out of paying you and the forum is actually supportive of that approach. No wonder docs are leaving medicine as soon as they're financially able to. Who needs that sort of hassle?

People need to stop thinking of an ED visit as more similar to going to clinic than being admitted to the hospital overnight.
Yes - I agree - and that is common advice.

However, one issue is "urgent care" and how to find lower cost care when something needs to be done soon, but you will not die or suffer bodily damage if it takes a few hours. As I have posted, we are fortunate that we have 24x7 urgent care within a 20-30 minute drive that is capable of handling about 99% of situations we might encounter.
That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.
Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.
I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
OK - maybe I define things according to both what I perceive and the facilities available to us.

Our (Kaiser) urgent care 24x7 facility (which we have used several times) handles things like most broken bones, getting a piece of something in your eye, etc. My wife, for example, had severe pain (and getting worse) at 3 am on a Sunday. Took her to the Urgent care facility - and they quickly diagnosed pancreatitis. They treated her pain, ran many tests - and later in the day on Sunday - sent her by ambulance to be admitted to a Hospital (not the emergency department). I think, though, that if I had 3 stents and crushing chest pain I would go to the Hospital ED. They can keep patients (some quite sick) there for up to 24 hours. That "Urgent care" facility has access to MRIs, X-rays, CT scanners, etc.
That's a free standing ED, not an urgent care by most definitions. Most urgent cares do not have access to CT scanners, much less MRIs. Heck, they can't even do the labs that would diagnose Pancreatitis. Now if you can get a facility that will do CT scans and labs for you and charge you urgent care prices, I recommend you use it for your emergency care needs. Few urgent cares will reduce broken bones or extract foreign bodies even though those are routine procedures for an emergency physician. Urgent cares in my area generally don't even employ physicians (much less emergency physicians) because they can't stay profitable while doing so and charging urgent care prices. There is obviously some variation.
Thanks for the information. I suppose they call it "Urgent Care" due to regulations, etc. Yes, we would (and have) use it for 99% of after hours issues OR other emergency/urgent needs. For us - a real financial bargain - on Medicare and the copay is only $45 - lab tests are no charge - CT/MRI scans are $150. Emergency Physicians on staff at all times and they call in specialists when needed. The lab, radiology, CT/MRIs, etc. are the same ones used for other patients and this facility is located in the same building as many Specialists (surgeons, Urologists, Cardiologists, Ophthalmologists, etc.)

I have never used it, but there is a standalone Urgent care near my house (in a strip shopping area) that (as best I understand) has Physicians (one is emergency medicine) there all the time.

Thanks again - I now know that if ever in this situation away from the area - what to expect at such a facility. It seems like not much.

toofache32
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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Wed Aug 22, 2018 11:39 am

dm200 wrote:
Wed Aug 22, 2018 11:25 am
White Coat Investor wrote:
Wed Aug 22, 2018 11:10 am
dm200 wrote:
Tue Aug 21, 2018 6:34 pm
White Coat Investor wrote:
Tue Aug 21, 2018 6:21 pm
dm200 wrote:
Tue Aug 21, 2018 4:28 pm


Yes - I agree - and that is common advice.

However, one issue is "urgent care" and how to find lower cost care when something needs to be done soon, but you will not die or suffer bodily damage if it takes a few hours. As I have posted, we are fortunate that we have 24x7 urgent care within a 20-30 minute drive that is capable of handling about 99% of situations we might encounter.
That's not what urgent cares do. That is the definition of an emergency and that's what EDs are for. Urgent care is for tiny lacerations that barely need suturing, reassurance that your child's fever isn't fatal, stuff that doesn't need treated anyway like sinus infections and bronchitis and pharyngitis, dysuria, poison ivy etc. Basically stuff that can be diagnosed with a minimum of testing and treated with oral medications by a PA or NP.
Something you'll die from in a few hours if it isn't treated? That's an emergency and should go to the emergency department.
I don't know of any urgent care that can handle 20% of the situations I encounter in the ED, but if you're very healthy perhaps it can handle 99% of your situations. Seems unlikely though. I'm amazed how many people go to urgent cares with chest pain, abdominal pain, dyspnea, broken bones, large lacerations etc just to be sent to me. I mean, you're 60 years old, have three stents, and are having crushing chest pain. You really thought that PA in the urgent care was going to take care of you with an aspirin and an EKG machine?
OK - maybe I define things according to both what I perceive and the facilities available to us.

Our (Kaiser) urgent care 24x7 facility (which we have used several times) handles things like most broken bones, getting a piece of something in your eye, etc. My wife, for example, had severe pain (and getting worse) at 3 am on a Sunday. Took her to the Urgent care facility - and they quickly diagnosed pancreatitis. They treated her pain, ran many tests - and later in the day on Sunday - sent her by ambulance to be admitted to a Hospital (not the emergency department). I think, though, that if I had 3 stents and crushing chest pain I would go to the Hospital ED. They can keep patients (some quite sick) there for up to 24 hours. That "Urgent care" facility has access to MRIs, X-rays, CT scanners, etc.
That's a free standing ED, not an urgent care by most definitions. Most urgent cares do not have access to CT scanners, much less MRIs. Heck, they can't even do the labs that would diagnose Pancreatitis. Now if you can get a facility that will do CT scans and labs for you and charge you urgent care prices, I recommend you use it for your emergency care needs. Few urgent cares will reduce broken bones or extract foreign bodies even though those are routine procedures for an emergency physician. Urgent cares in my area generally don't even employ physicians (much less emergency physicians) because they can't stay profitable while doing so and charging urgent care prices. There is obviously some variation.
Thanks for the information. I suppose they call it "Urgent Care" due to regulations, etc. Yes, we would (and have) use it for 99% of after hours issues OR other emergency/urgent needs. For us - a real financial bargain - on Medicare and the copay is only $45 - lab tests are no charge - CT/MRI scans are $150. Emergency Physicians on staff at all times and they call in specialists when needed. The lab, radiology, CT/MRIs, etc. are the same ones used for other patients and this facility is located in the same building as many Specialists (surgeons, Urologists, Cardiologists, Ophthalmologists, etc.)

I have never used it, but there is a standalone Urgent care near my house (in a strip shopping area) that (as best I understand) has Physicians (one is emergency medicine) there all the time.

Thanks again - I now know that if ever in this situation away from the area - what to expect at such a facility. It seems like not much.
This sounds like my hospital which has an urgent care clinic on site. They triage and send the bad stuff down the hall to the ER.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Wed Aug 22, 2018 11:47 am

This sounds like my hospital which has an urgent care clinic on site. They triage and send the bad stuff down the hall to the ER.
BUT - if they take care of your needs - do they charge less than the ER?

toofache32
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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Wed Aug 22, 2018 12:22 pm

dm200 wrote:
Wed Aug 22, 2018 11:47 am
This sounds like my hospital which has an urgent care clinic on site. They triage and send the bad stuff down the hall to the ER.
BUT - if they take care of your needs - do they charge less than the ER?
I have no idea.

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Re: Excessive Emergency Room Charges - Options?

Post by dodecahedron » Wed Aug 22, 2018 12:39 pm

dm200 wrote:
Mon Aug 20, 2018 3:33 pm
rooms222 wrote:
Mon Aug 20, 2018 3:23 pm
We have no choice at our governmental employer but to have a high deductible plan, including employees making $24,000 a year gross,
You do not have an HMO choice for health insurance?
Not sure why you are asking about whether he has an HMO choice.

Even if he has an HMO choice, it may well be a high deductible HMO. I have a very high deductible HMO policy. (A $6,700 family deductible and OOP family max of almost $14K, even if I stay in network. No coverage outside of network except for emergencies. I had an emergency out of state four years ago and hit my OOP max in December of my first year on the policy. Went to ER, had lots of tests and imaging, wound up in OR for surgery and spending the night there. Never bothered to look at the detailed breakdown of the hospital bill, which went on for pages and pages. Knew I was going to be out my OOP max no matter what. Cést la vie. Grateful there was no balance billing due to being out of state. I have been lucky enough not to have another year like that since then.)

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Re: Excessive Emergency Room Charges - Options?

Post by Grt2bOutdoors » Wed Aug 22, 2018 1:23 pm

fm3040 wrote:
Mon Aug 20, 2018 3:27 pm
I know I will pay my bills as I always have. I was just upset that Billing Services was not willing to work with me on reducing what seemed like and likely are exorbitant charges. When I asked about monthly payments, she did not offer me anything more than 6 equal payments.

As they will not report it to collections immediately, maybe I should cool off and call again, and hope to get a different rep on the line that is willing to work with me and offer me a long time horizon to pay the bill or reduce the bill so I can pay it immediately.

I was wondering if I could force them not to send it to collections by sending an automatic monthly payment from my bank and take, say, a year or two to pay off all my current bills plus more that I am expecting in the future for the medical event that I am still not out of.
Pay it and be grateful that such services exist to help you in your time of need. The alternative could be much much worse. Pay $5 a month? You’re joking right?
"One should invest based on their need, ability and willingness to take risk - Larry Swedroe" Asking Portfolio Questions

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Re: Excessive Emergency Room Charges - Options?

Post by drawpoker » Wed Aug 22, 2018 1:56 pm

Grt2bOutdoors wrote:
Wed Aug 22, 2018 1:23 pm

Pay it and be grateful that such services exist to help you in your time of need. The alternative could be much much worse......
Inclined to agree. Apparently, whatever condition it was that generated the ER visit, it wasn't serious enough to make an impression on him. And feel Lucky to come out alive.

Let him have one or two brushes with death like some of us on this forum. He will change his tune in a hurry. :shock:

Besides, unless this was a private hospital, doesn't he know hospital charges and rates have to be approved by the health care commission in his state? They can't just bill people willy-nilly, anything they wanna.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Wed Aug 22, 2018 1:59 pm

dodecahedron wrote:
Wed Aug 22, 2018 12:39 pm
dm200 wrote:
Mon Aug 20, 2018 3:33 pm
rooms222 wrote:
Mon Aug 20, 2018 3:23 pm
We have no choice at our governmental employer but to have a high deductible plan, including employees making $24,000 a year gross,
You do not have an HMO choice for health insurance?
Not sure why you are asking about whether he has an HMO choice.

Even if he has an HMO choice, it may well be a high deductible HMO. I have a very high deductible HMO policy. (A $6,700 family deductible and OOP family max of almost $14K, even if I stay in network. No coverage outside of network except for emergencies. I had an emergency out of state four years ago and hit my OOP max in December of my first year on the policy. Went to ER, had lots of tests and imaging, wound up in OR for surgery and spending the night there. Never bothered to look at the detailed breakdown of the hospital bill, which went on for pages and pages. Knew I was going to be out my OOP max no matter what. Cést la vie. Grateful there was no balance billing due to being out of state. I have been lucky enough not to have another year like that since then.)
True. It all depends on the details.

toofache32
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Re: Excessive Emergency Room Charges - Options?

Post by toofache32 » Wed Aug 22, 2018 2:00 pm

fm3040 wrote:
Mon Aug 20, 2018 12:31 pm
The total I owe to different medical providers at this point is $2668.
What is your deductible? Is it over this amount?

financeperchance
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Re: Excessive Emergency Room Charges - Options?

Post by financeperchance » Wed Aug 22, 2018 2:02 pm

It's weird that so many here are offering advice without having any clarity about OP's insurance.

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dm200
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Re: Excessive Emergency Room Charges - Options?

Post by dm200 » Wed Aug 22, 2018 2:05 pm

drawpoker wrote:
Wed Aug 22, 2018 1:56 pm
Grt2bOutdoors wrote:
Wed Aug 22, 2018 1:23 pm
Pay it and be grateful that such services exist to help you in your time of need. The alternative could be much much worse......
Inclined to agree. Apparently, whatever condition it was that generated the ER visit, it wasn't serious enough to make an impression on him. And feel Lucky to come out alive.

Let him have one or two brushes with death like some of us on this forum. He will change his tune in a hurry.
:shock:

Besides, unless this was a private hospital, doesn't he know hospital charges and rates have to be approved by the health care commission in his state? They can't just bill people willy-nilly, anything they wanna.
Right. We are fortunate that none of ever came near death - when needing emergency care. A friend of ours' life was saved when he promptly (at his wife and daughter's insistence) went to a hospital emergency room when suffering a ruptured abdominal aorta.

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