Big Hospital Bill - Any way to negotiate ?

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sawhorse
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Re: Big Hospital Bill - Anyway to negociate ?

Post by sawhorse » Thu Jul 04, 2019 4:28 pm

I'm a bit confused. Is the $6k part of your deductible? If so, pay it. That's how high deductible plans work. In exchange for paying the high deductible, you get to pay lower monthly premiums that quite possibly saved you much more than $6k over the years.

If this is the hospital billing you on top of your deductible, and on top of their contracted insurance agreement, then try to negotiate with them and also look into your state laws about "balance billing".

mrc
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Re: Big Hospital Bill - Anyway to negociate ?

Post by mrc » Thu Jul 04, 2019 4:32 pm

Before this thread is locked, I have a serious question. I have BCBS Basic, which pays ZERO if I go out of network. I would never intentionally go out of the network. If by chance, an out of network provider did participate in my care, the EOB would look something like this:

Provider Charges $2500
Plan Allowance: $0 [Note: This provider is out of network]
What We Paid: $0
You Owe the Provider: $2500

But say the provider was in network. The EOB would look something like this:

Provider Charges $2500
Plan Allowance: $1250 [See NOTE]
What We Paid: $1000
You Owe the Provider: $250
[NOTE: Because your provider has a contractual agreement with your plan, you are not responsible for the difference between the submitted charges and our allowable charges.]

In this case of surprise billing, would it be prudent to offer to pay $1250 (the full in-nework amount) rather than the entire $2500? Is it reasonable for the OP offer to pay an appropriate in-network amount?

This is one of the few things I can still lose sleep over.
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HueyLD
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Re: Big Hospital Bill - Anyway to negociate ?

Post by HueyLD » Thu Jul 04, 2019 4:36 pm

mrc,

If the provider is not in your EPO network, how will you know how much the plan allowance is? Will the EOB tell you that for a out of network provider?

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Re: Big Hospital Bill - Anyway to negociate ?

Post by mrc » Thu Jul 04, 2019 4:46 pm

HueyLD wrote:
Thu Jul 04, 2019 4:36 pm
mrc,

If the provider is not in your EPO network, how will you know how much the plan allowance is? Will the EOB tell you that for a out of network provider?
I'm spitballing here. I could call and ask. The point is there are always two prices: The higher (often a LOT higher) pay out of pocket uninsured price, and the lower negotiated price. Would a provider take a check for $1250 today, or would they prefer $2500 at $50/month for four years? I would never do this if I agreed to out out of network of course.
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HueyLD
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Re: Big Hospital Bill - Anyway to negociate ?

Post by HueyLD » Thu Jul 04, 2019 4:53 pm

A family member had a procedure performed at a preferred facility by a preferred surgeon. However, they used an out of network pathologist without his knowledge. He was on BCBS Basic and the insurance paid nothing.

So, he called BCBS and asked for help because he had no say in selecting the OON pathologist. BCBS told him what the plan allowance would have been and he called the billing office to negotiate. The pathologist’s office agreed to take the plan allowance as payment in full.

It never hurt to ask nicely with good reasoning. YMMV.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by mrc » Thu Jul 04, 2019 5:07 pm

HueyLD wrote:
Thu Jul 04, 2019 4:53 pm
A family member had a procedure performed at a preferred facility by a preferred surgeon. However, they used an out of network pathologist without his knowledge. He was on BCBS Basic and the insurance paid nothing.

So, he called BCBS and asked for help because he had no say in selecting the OON pathologist. BCBS told him what the plan allowance would have been and he called the billing office to negotiate. The pathologist’s office agreed to take the plan allowance as payment in full.

It never hurt to ask nicely with good reasoning. YMMV.
Thanks for that information.
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toofache32
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Re: Big Hospital Bill - Anyway to negociate ?

Post by toofache32 » Thu Jul 04, 2019 5:11 pm

mrc wrote:
Thu Jul 04, 2019 4:32 pm
Before this thread is locked, I have a serious question. I have BCBS Basic, which pays ZERO if I go out of network. I would never intentionally go out of the network. If by chance, an out of network provider did participate in my care, the EOB would look something like this:

Provider Charges $2500
Plan Allowance: $0 [Note: This provider is out of network]
What We Paid: $0
You Owe the Provider: $2500

But say the provider was in network. The EOB would look something like this:

Provider Charges $2500
Plan Allowance: $1250 [See NOTE]
What We Paid: $1000
You Owe the Provider: $250
[NOTE: Because your provider has a contractual agreement with your plan, you are not responsible for the difference between the submitted charges and our allowable charges.]

In this case of surprise billing, would it be prudent to offer to pay $1250 (the full in-nework amount) rather than the entire $2500? Is it reasonable for the OP offer to pay an appropriate in-network amount?

This is one of the few things I can still lose sleep over.
Doesn't hurt to ask. It depends greatly on the actual cost difference. In your example, the in-network fee is about 50% of the billed fee. In reality, in-network rates (in my area) are much worse...20-30% of the UCR rates. If the in-network fees were higher and more reasonable, then the doctor would want to be in-network to get more volume.

This is why we are approaching a 2-tiered healthcare system. Insurance patients will be relegated to institutional settings (like hospital systems) that are eligible to charge facility fees (private practices are not). These facility fees help buffer what the hospital is able to pay the doctor.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by White Coat Investor » Thu Jul 04, 2019 7:31 pm

JackoC wrote:
Thu Jul 04, 2019 2:59 pm
White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?
I see your point. I walked into a car dealership the other day and the MSRP for the car was $30k, so I just paid it. :D That's the price, right?
The MSRP is the Chargemaster price. The negotiated price is already set with your insurer. That's the one you've been presented with. It's the real price. If you don't like it, get a new insurance company or tell them to negotiate better. But at this point, you've already bought the product so pay the bill.
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Re: Big Hospital Bill - Anyway to negociate ?

Post by White Coat Investor » Thu Jul 04, 2019 7:33 pm

alpenglow wrote:
Thu Jul 04, 2019 11:47 am
researcher wrote:
Tue Jul 02, 2019 8:25 am
Bb073084 wrote:
Tue Jul 02, 2019 6:48 am
Let them know that you will be paying out of pocket for the remainder and this is a hardship. Ask if they can give you a “self-pay” discount.
Typically hospitals give a self pay discount that is quite substantial.
Do exactly this and you are very likely to get an immediate 20%-50% discount.
I've gotten this type of discount every time.

Just make sure to stress that you are paying out-of-pocket, and are willing to pay the bill in full now with a credit card if they are able to give you a 'self pay' discount.
I have received a 50% discount doing this.
That's because we collect 3% of what we bill "self-pay" patients. So 50% seems awesome. But this isn't a self pay patient. It's an insured patient who was apparently fine with a $6K deductible when he/she bought the insurance but not now that it is time to pay his or her portion of the bill.
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Re: Big Hospital Bill - Anyway to negociate ?

Post by FoolStreet » Thu Jul 04, 2019 11:15 pm

White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm
confusedinvestor wrote:
Tue Jul 02, 2019 12:17 am
Folks, Recently went to emergency room and now got a 6K hospital bill (after insurance adjustments) meet the deductible

Is there any recommendations to negotiate this with the hospital billing dept ?

Is it better to not pay and let it go to collections and then negotiate with them ?

I could use some help and tips on this issue, thanks all.
Oh, are we doing this again? I thought we just did this "how to get out of paying doctors" thing yesterday.

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?

Is it better to not pay and let it go to collections and then negotiate with them?

I could use some help and tips on this issue, thanks all.

Feel any different? I bet it would if you were an A/C guy or an emergency doctor.

If you don't want a $6K bill, don't go to the ED. That's what it costs to go there. If you don't meet your max out of pocket with one ED visit, you certainly will with two. Too many people think the cost is more similar to a clinic visit than a hospitalization. It isn't because the service you receive is more similar to a hospital stay than 8 minutes with a family doc and her medical assistant.
I applaud the OP for negotiating. The medical industry rips off consumers by not publishing the cost of service ahead of time.

One idea for the OP is to ask their insurance to re submit and audit the expenses. That worked for me on one bill.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by White Coat Investor » Fri Jul 05, 2019 12:32 am

FoolStreet wrote:
Thu Jul 04, 2019 11:15 pm
White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm
confusedinvestor wrote:
Tue Jul 02, 2019 12:17 am
Folks, Recently went to emergency room and now got a 6K hospital bill (after insurance adjustments) meet the deductible

Is there any recommendations to negotiate this with the hospital billing dept ?

Is it better to not pay and let it go to collections and then negotiate with them ?

I could use some help and tips on this issue, thanks all.
Oh, are we doing this again? I thought we just did this "how to get out of paying doctors" thing yesterday.

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?

Is it better to not pay and let it go to collections and then negotiate with them?

I could use some help and tips on this issue, thanks all.

Feel any different? I bet it would if you were an A/C guy or an emergency doctor.

If you don't want a $6K bill, don't go to the ED. That's what it costs to go there. If you don't meet your max out of pocket with one ED visit, you certainly will with two. Too many people think the cost is more similar to a clinic visit than a hospitalization. It isn't because the service you receive is more similar to a hospital stay than 8 minutes with a family doc and her medical assistant.
I applaud the OP for negotiating. The medical industry rips off consumers by not publishing the cost of service ahead of time.

One idea for the OP is to ask their insurance to re submit and audit the expenses. That worked for me on one bill.
I'm all for more price transparency, but one person's "chest pain service" could run $2K and another person's "chest pain service" could run $20K and there is no way for them to have any idea how much service their condition requires a priori.

Buy insurance. Pick a deductible/out of pocket max you can actually afford. Plan to pay it every single year and be grateful when you don't.

My insurance is $1400/month. My OOP Max is something like $6-10K. I budget $25K a year for health care. That's what it costs to have "full service" health care. Yes, I am fully aware that most people cannot afford that price without governmental assistance. That's why most people qualify for government assistance via Medicare, Medicaid, Tricare, or PPACA subsidies.

This idea some people have that they'll only spend $2K a year on health care is bizarre. It's really expensive stuff, like housing.
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Re: Big Hospital Bill - Anyway to negociate ?

Post by FoolStreet » Fri Jul 05, 2019 2:46 am

White Coat Investor wrote:
Fri Jul 05, 2019 12:32 am
FoolStreet wrote:
Thu Jul 04, 2019 11:15 pm
White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm
confusedinvestor wrote:
Tue Jul 02, 2019 12:17 am
Folks, Recently went to emergency room and now got a 6K hospital bill (after insurance adjustments) meet the deductible

Is there any recommendations to negotiate this with the hospital billing dept ?

Is it better to not pay and let it go to collections and then negotiate with them ?

I could use some help and tips on this issue, thanks all.
Oh, are we doing this again? I thought we just did this "how to get out of paying doctors" thing yesterday.

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?

Is it better to not pay and let it go to collections and then negotiate with them?

I could use some help and tips on this issue, thanks all.

Feel any different? I bet it would if you were an A/C guy or an emergency doctor.

If you don't want a $6K bill, don't go to the ED. That's what it costs to go there. If you don't meet your max out of pocket with one ED visit, you certainly will with two. Too many people think the cost is more similar to a clinic visit than a hospitalization. It isn't because the service you receive is more similar to a hospital stay than 8 minutes with a family doc and her medical assistant.
I applaud the OP for negotiating. The medical industry rips off consumers by not publishing the cost of service ahead of time.

One idea for the OP is to ask their insurance to re submit and audit the expenses. That worked for me on one bill.
I'm all for more price transparency, but one person's "chest pain service" could run $2K and another person's "chest pain service" could run $20K and there is no way for them to have any idea how much service their condition requires a priori.

Buy insurance. Pick a deductible/out of pocket max you can actually afford. Plan to pay it every single year and be grateful when you don't.

My insurance is $1400/month. My OOP Max is something like $6-10K. I budget $25K a year for health care. That's what it costs to have "full service" health care. Yes, I am fully aware that most people cannot afford that price without governmental assistance. That's why most people qualify for government assistance via Medicare, Medicaid, Tricare, or PPACA subsidies.

This idea some people have that they'll only spend $2K a year on health care is bizarre. It's really expensive stuff, like housing.
A procedure with Insurer 1 is $60 and with Insurer 2 is $300. Insurer 2 is the HDHP. Consumers pick the HDHP because they can afford the $60. Insurers play 3 card Monty and charge the 300 to get the max out of the consumer before the Deductible is hit. Not cool. Whether my example or yours, the medical Industry ought to publish their costs upfront or else they have an extortion business model.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by sawhorse » Fri Jul 05, 2019 6:23 am

White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm
Too many people think the cost is more similar to a clinic visit than a hospitalization. It isn't because the service you receive is more similar to a hospital stay than 8 minutes with a family doc and her medical assistant.
While I'm not arguing that the facility costs are greater than those of a primary care or urgent care clinic, I have to point out that when ER doctors bill for their own fee, separate from the hospital's fee, it's often many times more than my primary care doctor, neurologist, immunologist, psychiatrist, etc charge.

My psychiatrist, whom I pay out of pocket for because I don't want my insurance company knowing about it, charges me $250 for an hour or $85 for 20 minutes.

My psychiatrist in my old location, who operates a walk-in psychiatry clinic that takes most insurance and has a large percent of Medicaid patients, charged $70 for about 15 minutes to self-pay patients.

Another out of network specialist, who is considered one of the best - actually one of the only - in that particular disease, charges $150 for 20-30 minutes. I've always been billed as level 3.

Part of this money goes to rent, overhead, and staff costs as they have their own practice. The last doctor is in a VERY high rent location.

A primary care physician that is an acquaintance is in a solo practice. As she's in a solo practice, she is on call 24 hours a day 7 days a week. She will sometimes even see a patient in the office in the middle of the night. She takes some insurance, but for patients that are out of network, she charges $70 for level 3 and $100 for level 4 as of a few years ago. She said she's very conscious of the fact that some patients struggle to pay medical bills, so she tries hard to lower overall costs for the patients (tests, prescriptions, etc) unlike some ERs that seem to bill you for as much as they can. She owns the house where her practice is based, so she doesn't have the cost of rent, but she does pay property tax.

Some out of network ER doctors spend less than five minutes with you, doing nothing other than talking to you, and they charge much more. None of this goes to overhead and staff as those are covered by the facility fees.

As documented in a New York Times article, Emcare, a large emergency physician staffing company which is out of network for almost all insurances even though they work at in network hospitals, code 28% of their ER visits at the highest level - compared to 6% at the same ER before Emcare - for which they billed $1649 for just the physician portion of the visit.

As these bills come as a surprise to patients, that indicates that the ER doctors were not upfront with their fee and the fact that they were out of network despite the hospital being in network for the patient.

At the ER, patients don't have a choice as to which doctor they see, and they are usually not in position to refuse - same as the doctor and hospital I suppose. I know that ER physicians have higher malpractice insurance premiums than psychiatry and primary care, but at the same time they don't have the overhead of office based private practice physicians.

You can't tell me that the disparity in fees between out of network ER doctors and out of network private office based doctors isn't at least in part an attempt to take advantage of the vulnerable and restricted situation the patient is in.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by toofache32 » Fri Jul 05, 2019 9:16 am

FoolStreet wrote:
Thu Jul 04, 2019 11:15 pm
White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm
confusedinvestor wrote:
Tue Jul 02, 2019 12:17 am
Folks, Recently went to emergency room and now got a 6K hospital bill (after insurance adjustments) meet the deductible

Is there any recommendations to negotiate this with the hospital billing dept ?

Is it better to not pay and let it go to collections and then negotiate with them ?

I could use some help and tips on this issue, thanks all.
Oh, are we doing this again? I thought we just did this "how to get out of paying doctors" thing yesterday.

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?

Is it better to not pay and let it go to collections and then negotiate with them?

I could use some help and tips on this issue, thanks all.

Feel any different? I bet it would if you were an A/C guy or an emergency doctor.

If you don't want a $6K bill, don't go to the ED. That's what it costs to go there. If you don't meet your max out of pocket with one ED visit, you certainly will with two. Too many people think the cost is more similar to a clinic visit than a hospitalization. It isn't because the service you receive is more similar to a hospital stay than 8 minutes with a family doc and her medical assistant.
I applaud the OP for negotiating. The medical industry rips off consumers by not publishing the cost of service ahead of time.
Let me help you there. The INSURANCE industry, not the medical industry, determines the fees. If you want the cost of something ahead of time, just ask your insurance company.

sawhorse
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Re: Big Hospital Bill - Anyway to negociate ?

Post by sawhorse » Fri Jul 05, 2019 9:21 am

toofache32 wrote:
Fri Jul 05, 2019 9:16 am
Let me help you there. The INSURANCE industry, not the medical industry, determines the fees. If you want the cost of something ahead of time, just ask your insurance company.
Kind of hard when you're in the middle of an emergency. You also need to have the codes which can often be hard or impossible to get in advance for various reasons.

To the OP, when you have a high deductible plan, you need to be prepared to pay up to the deductible. The alternative is to get a lower deductible plan, but then you'd pay more in monthly premiums.

If the hospital was charging you above what the insurance rate is, then you would have a case. As it is, these are the terms of the insurance plan that you have.

However, I would definitely ask for an itemized bill to see if you were charged for something that didn't happen. I was once charged by a clinic for 3 nostril swabs even though I only have 2 nostrils.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by researcher » Fri Jul 05, 2019 9:49 am

White Coat Investor wrote:
Thu Jul 04, 2019 7:33 pm
That's because we collect 3% of what we bill "self-pay" patients. So 50% seems awesome. But this isn't a self pay patient. It's an insured patient who was apparently fine with a $6K deductible when he/she bought the insurance but not now that it is time to pay his or her portion of the bill.
I'm struggling to understand what your beef is.

I have a high deductible plan, so until I reach my $6K deducible, I am effectively 'self-pay'.

I get a $5000 bill from the hospital.
I call the billing department, explain I am paying out of pocket for the full amount, ask if they offer a discount if I pay right then.
Hospital immediately gives me a 50% (or whatever) discount without any hesitation.

Shouldn't EVERY responsible consumer take the discount offered by the hospital?

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Re: Big Hospital Bill - Anyway to negociate ?

Post by sawhorse » Fri Jul 05, 2019 10:05 am

researcher wrote:
Fri Jul 05, 2019 9:49 am
White Coat Investor wrote:
Thu Jul 04, 2019 7:33 pm
That's because we collect 3% of what we bill "self-pay" patients. So 50% seems awesome. But this isn't a self pay patient. It's an insured patient who was apparently fine with a $6K deductible when he/she bought the insurance but not now that it is time to pay his or her portion of the bill.
I'm struggling to understand what your beef is.

I have a high deductible plan, so until I reach my $6K deducible, I am effectively 'self-pay'.

I get a $5000 bill from the hospital.
I call the billing department, explain I am paying out of pocket for the full amount, ask if they offer a discount if I pay right then.
Hospital immediately gives me a 50% (or whatever) discount without any hesitation.

Shouldn't EVERY responsible consumer take the discount offered by the hospital?
If you act as a self-pay patient for this bill and take the 50% discount, I don't think you can submit it to your insurance to count toward the deductible. Later if you incur another large bill you're starting from square one with your deductible. At least that's how I understand my policy to work.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by researcher » Fri Jul 05, 2019 10:26 am

sawhorse wrote:
Fri Jul 05, 2019 10:05 am
If you act as a self-pay patient for this bill and take the 50% discount, I don't think you can submit it to your insurance to count toward the deductible. Later if you incur another large bill you're starting from square one with your deductible. At least that's how I understand my policy to work.
I'm not "acting" like anything.

I wait for all of the bills to be processed and sent to me.
I then call the hospital and tell them I will be paying the full $x,xxx bill out of pocket.
They offer me a XX% discount, then I pay the bill in full over the phone with a credit card.

The insurance doesn't care about the payment details between me and the healthcare provider.
Whether I paid in full, got a discount, put on payment plans, didn't pay at all and sent to collections...the amount of the initial bills is what counts towards the deductible.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 10:28 am

With twice the amount of money spent on healthcare in the US as in countries with comparable or better overall outcomes, it seems there’s plenty of room to blame both the providers and the insurers.
Yes! To a degree, as well, patient overuse and over expectations contribute to this as well, in my opinion.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by sawhorse » Fri Jul 05, 2019 10:30 am

researcher wrote:
Fri Jul 05, 2019 10:26 am
sawhorse wrote:
Fri Jul 05, 2019 10:05 am
If you act as a self-pay patient for this bill and take the 50% discount, I don't think you can submit it to your insurance to count toward the deductible. Later if you incur another large bill you're starting from square one with your deductible. At least that's how I understand my policy to work.
I'm not "acting" like anything.

I wait for all of the bills to be processed and sent to me.
I then call the hospital and tell them I will be paying the full $x,xxx bill out of pocket.
They offer me a XX% discount, then I pay the bill in full over the phone with a credit card.

The insurance doesn't care about the payment details between me and the healthcare provider.
Whether I paid in full, got a discount, put on payment plans, didn't pay at all and sent to collections...the amount of the initial bills is what counts towards the deductible.
Have you actually been able to get this to work? I only know of situations when you take the self-pay discount but don't have it count toward your deductible. Have you actually been able to a) get a discount on top of the insurance rate and b) also get your insurance company to have it count toward the deductible?

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Re: Big Hospital Bill - Anyway to negociate ?

Post by FoolStreet » Fri Jul 05, 2019 11:17 am

toofache32 wrote:
Fri Jul 05, 2019 9:16 am
FoolStreet wrote:
Thu Jul 04, 2019 11:15 pm
White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm
confusedinvestor wrote:
Tue Jul 02, 2019 12:17 am
Folks, Recently went to emergency room and now got a 6K hospital bill (after insurance adjustments) meet the deductible

Is there any recommendations to negotiate this with the hospital billing dept ?

Is it better to not pay and let it go to collections and then negotiate with them ?

I could use some help and tips on this issue, thanks all.
Oh, are we doing this again? I thought we just did this "how to get out of paying doctors" thing yesterday.

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?

Is it better to not pay and let it go to collections and then negotiate with them?

I could use some help and tips on this issue, thanks all.

Feel any different? I bet it would if you were an A/C guy or an emergency doctor.

If you don't want a $6K bill, don't go to the ED. That's what it costs to go there. If you don't meet your max out of pocket with one ED visit, you certainly will with two. Too many people think the cost is more similar to a clinic visit than a hospitalization. It isn't because the service you receive is more similar to a hospital stay than 8 minutes with a family doc and her medical assistant.
I applaud the OP for negotiating. The medical industry rips off consumers by not publishing the cost of service ahead of time.
Let me help you there. The INSURANCE industry, not the medical industry, determines the fees. If you want the cost of something ahead of time, just ask your insurance company.
Not to quibble, but there are at least 3 legs to the stool:. Insurance, health providers and consumers. Right now there is no real transparency between the 3, and worse, no incentive to lower costs between the 3.

To your point, the idea of an HDHP is to encourage the consumer to pick the lowest cost health care provider while under their deductible. Further, the health care provider can use this initial pre deductible time to charge the max they can, even above rates that they might otherwise negotiate with an insurer when not using an HDHP.

Edit to add:. Not that consumers are saints, but once the out of pocket us hit, a savvy consumer can (should) use the rest of the year to load up on as many extra procedures as possible.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by sawhorse » Fri Jul 05, 2019 11:21 am

FoolStreet wrote:
Fri Jul 05, 2019 11:17 am
To your point, the idea of an HDHP is to encourage the consumer to pick the lowest cost health care provider while under their deductible. Further, the health care provider can use this initial pre deductible time to charge the max they can, even above rates that they might otherwise negotiate with an insurer when not using an HDHP.
Really? That's not my experience. My experience is that they submit the claim to insurance, and the bill is adjusted for insurance rates. Then if you haven't met your deductible, the insurance company pays nothing, so you owe the insurance rate. Then that amount gets applied toward your deductible.

I've never had an in network provider that even knew my deductible status at the time they filed with insurance, let alone charged me extra because I hadn't met the deductible.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by FoolStreet » Fri Jul 05, 2019 11:26 am

sawhorse wrote:
Fri Jul 05, 2019 11:21 am
FoolStreet wrote:
Fri Jul 05, 2019 11:17 am
To your point, the idea of an HDHP is to encourage the consumer to pick the lowest cost health care provider while under their deductible. Further, the health care provider can use this initial pre deductible time to charge the max they can, even above rates that they might otherwise negotiate with an insurer when not using an HDHP.
Really? That's not my experience. My experience is that they submit the claim to insurance, and the bill is adjusted for insurance rates. Then if you haven't met your deductible, the insurance company pays nothing, so you owe the insurance rate. Then that amount gets applied toward your deductible.

I've never had an in network provider that even knew my deductible status at the time they filed with insurance, let alone charged me extra because I hadn't met the deductible.
I only have two data points. First related to charging against one code that insurance doesn't cover as fully. And the second compares the treatment cost under insurance A vs insurance b (HDHP), where the cost under insurance b is significantly more.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by Erwin007 » Fri Jul 05, 2019 11:27 am

Seems like people like to pay the lower premium for a HDHP, but then not pay the OOP costs commensurate with the lower premium.

Either choose a plan with a lower OOP max (and higher copays), or choose a plan with lower premiums, knowing you may have to pay more out of pocket.

Can’t have your cake and eat it too.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 11:28 am

sawhorse wrote:
Fri Jul 05, 2019 11:21 am
FoolStreet wrote:
Fri Jul 05, 2019 11:17 am
To your point, the idea of an HDHP is to encourage the consumer to pick the lowest cost health care provider while under their deductible. Further, the health care provider can use this initial pre deductible time to charge the max they can, even above rates that they might otherwise negotiate with an insurer when not using an HDHP.
Really? That's not my experience. My experience is that they submit the claim to insurance, and the bill is adjusted for insurance rates. Then if you haven't met your deductible, the insurance company pays nothing, so you owe the insurance rate. Then that amount gets applied toward your deductible.
I've never had an in network provider that even knew my deductible status at the time they filed with insurance, let alone charged me extra because I hadn't met the deductible.
This is my understanding as well. I believe the amount you pay towards the deductible is at the rate/price negotiated and would be paid by the insurance company - not at the higher retail or list price.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 11:29 am

Erwin007 wrote:
Fri Jul 05, 2019 11:27 am
Seems like people like to pay the lower premium for a HDHP, but then not pay the OOP costs commensurate with the lower premium.
Either choose a plan with a lower OOP max (and higher copays), or choose a plan with lower premiums, knowing you may have to pay more out of pocket.

Can’t have your cake and eat it too.
Yes - I agree.

I see nothing wrong, though, with asking for a payment plan to pay the full amount due.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by sawhorse » Fri Jul 05, 2019 11:31 am

FoolStreet wrote:
Fri Jul 05, 2019 11:26 am
sawhorse wrote:
Fri Jul 05, 2019 11:21 am
FoolStreet wrote:
Fri Jul 05, 2019 11:17 am
To your point, the idea of an HDHP is to encourage the consumer to pick the lowest cost health care provider while under their deductible. Further, the health care provider can use this initial pre deductible time to charge the max they can, even above rates that they might otherwise negotiate with an insurer when not using an HDHP.
Really? That's not my experience. My experience is that they submit the claim to insurance, and the bill is adjusted for insurance rates. Then if you haven't met your deductible, the insurance company pays nothing, so you owe the insurance rate. Then that amount gets applied toward your deductible.

I've never had an in network provider that even knew my deductible status at the time they filed with insurance, let alone charged me extra because I hadn't met the deductible.
I only have two data points. First related to charging against one code that insurance doesn't cover as fully. And the second compares the treatment cost under insurance A vs insurance b (HDHP), where the cost under insurance b is significantly more.
With regard to the first charge, I doubt your deductible status (met/unmet) had anything to do with it because I can't see how they would know your status. With regard to the second one, it sounds like that insurance plan just pays better. Some insurance companies are more generous, some are more selectively generous (and at the same time selectively ungenerous), and some providers, such as the really major centers, have more bargaining power. Again, nothing to do with whether the patient has met the deductible.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by FoolStreet » Fri Jul 05, 2019 11:38 am

sawhorse wrote:
Fri Jul 05, 2019 11:31 am
FoolStreet wrote:
Fri Jul 05, 2019 11:26 am
sawhorse wrote:
Fri Jul 05, 2019 11:21 am
FoolStreet wrote:
Fri Jul 05, 2019 11:17 am
To your point, the idea of an HDHP is to encourage the consumer to pick the lowest cost health care provider while under their deductible. Further, the health care provider can use this initial pre deductible time to charge the max they can, even above rates that they might otherwise negotiate with an insurer when not using an HDHP.
Really? That's not my experience. My experience is that they submit the claim to insurance, and the bill is adjusted for insurance rates. Then if you haven't met your deductible, the insurance company pays nothing, so you owe the insurance rate. Then that amount gets applied toward your deductible.

I've never had an in network provider that even knew my deductible status at the time they filed with insurance, let alone charged me extra because I hadn't met the deductible.
I only have two data points. First related to charging against one code that insurance doesn't cover as fully. And the second compares the treatment cost under insurance A vs insurance b (HDHP), where the cost under insurance b is significantly more.
With regard to the first charge, I doubt your deductible status (met/unmet) had anything to do with it because I can't see how they would know your status. With regard to the second one, it sounds like that insurance plan just pays better. Some insurance companies are more generous, some are more selectively generous (and also selectively ungenerous), and some providers, such as the really major centers, have more bargaining power. Again, nothing to do with whether the patient has met the deductible.
Who can tell. That's my point.

In the first case, they are going to play with codes to be able to charge the max. In the second case, my hypothesis is that an HDHP won't have negotiated lower costs because the majority of costs are paid pre deductible by the consumer and then post deductible can be trimmed up in the back room.

But who knows. I try to educate myself so that if I or family get sick I'll be prepared. I'm saving in an HSA because I figure I will get bills as I get older. But it shouldn't be considered a blank check to the medical industry either.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 12:04 pm

In the first case, they are going to play with codes to be able to charge the max. In the second case, my hypothesis is that an HDHP won't have negotiated lower costs because the majority of costs are paid pre deductible by the consumer and then post deductible can be trimmed up in the back room.
Don't know - but I wonder if that is true? Do most HDHP insured not meet the deductible?

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Re: Big Hospital Bill - Anyway to negociate ?

Post by Erwin007 » Fri Jul 05, 2019 12:05 pm

dm200 wrote:
Fri Jul 05, 2019 11:29 am
Erwin007 wrote:
Fri Jul 05, 2019 11:27 am
Seems like people like to pay the lower premium for a HDHP, but then not pay the OOP costs commensurate with the lower premium.
Either choose a plan with a lower OOP max (and higher copays), or choose a plan with lower premiums, knowing you may have to pay more out of pocket.

Can’t have your cake and eat it too.
Yes - I agree.

I see nothing wrong, though, with asking for a payment plan to pay the full amount due.
Agreed.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by Erwin007 » Fri Jul 05, 2019 12:07 pm

FoolStreet wrote:
Fri Jul 05, 2019 11:38 am
sawhorse wrote:
Fri Jul 05, 2019 11:31 am
FoolStreet wrote:
Fri Jul 05, 2019 11:26 am
sawhorse wrote:
Fri Jul 05, 2019 11:21 am
FoolStreet wrote:
Fri Jul 05, 2019 11:17 am
To your point, the idea of an HDHP is to encourage the consumer to pick the lowest cost health care provider while under their deductible. Further, the health care provider can use this initial pre deductible time to charge the max they can, even above rates that they might otherwise negotiate with an insurer when not using an HDHP.
Really? That's not my experience. My experience is that they submit the claim to insurance, and the bill is adjusted for insurance rates. Then if you haven't met your deductible, the insurance company pays nothing, so you owe the insurance rate. Then that amount gets applied toward your deductible.

I've never had an in network provider that even knew my deductible status at the time they filed with insurance, let alone charged me extra because I hadn't met the deductible.
I only have two data points. First related to charging against one code that insurance doesn't cover as fully. And the second compares the treatment cost under insurance A vs insurance b (HDHP), where the cost under insurance b is significantly more.
With regard to the first charge, I doubt your deductible status (met/unmet) had anything to do with it because I can't see how they would know your status. With regard to the second one, it sounds like that insurance plan just pays better. Some insurance companies are more generous, some are more selectively generous (and also selectively ungenerous), and some providers, such as the really major centers, have more bargaining power. Again, nothing to do with whether the patient has met the deductible.
Who can tell. That's my point.

In the first case, they are going to play with codes to be able to charge the max. In the second case, my hypothesis is that an HDHP won't have negotiated lower costs because the majority of costs are paid pre deductible by the consumer and then post deductible can be trimmed up in the back room.

But who knows. I try to educate myself so that if I or family get sick I'll be prepared. I'm saving in an HSA because I figure I will get bills as I get older. But it shouldn't be considered a blank check to the medical industry either.
I don’t think you understand how codes work...

You can’t submit a code for something you didn’t do, and there aren’t 2 codes for the same service.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 12:07 pm

For those who have a choice between HDHP and a regular plan, is it possible to compare the rates/amounts paid for the same procedures/appointments between the two plans?

Has anyone done that?

Seat of the pants - seems to me for the same insurer - they would be the same? BUT do not know.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by researcher » Fri Jul 05, 2019 12:09 pm

sawhorse wrote:
Fri Jul 05, 2019 10:30 am
Have you actually been able to get this to work? I only know of situations when you take the self-pay discount but don't have it count toward your deductible. Have you actually been able to a) get a discount on top of the insurance rate and b) also get your insurance company to have it count toward the deductible?
Yes, absolutely.
This has happened every time I've used hospital services since being on an HDHP, including pre-planned events (2 baby deliveries).

The bills are processed through insurance, which pays nothing since deductible isn't met.
EOB's are issued by insurance.
Bills sent by healthcare providers.
Call hospital, ask for discount, pay in full.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by CFM300 » Fri Jul 05, 2019 12:11 pm

Erwin007 wrote:
Fri Jul 05, 2019 11:27 am
Can’t have your cake and eat it too.
Unfortunately, you can -- which is part of the problem. Lots of people successfully negotiate, protest, appeal, and otherwise worm their way out of paying the amount they're initially presented.

The current system is an insane hodgepodge of pricing, networks, rules, and practices. Several posters have drawn an analogy with negotiating car prices. Whether that analogy is technically accurate, it certainly captures how many people feel: that if they don't negotiate, they'll be the sucker, paying more than they should (or than others do).
Last edited by CFM300 on Fri Jul 05, 2019 12:12 pm, edited 1 time in total.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by sawhorse » Fri Jul 05, 2019 12:11 pm

Erwin007 wrote:
Fri Jul 05, 2019 12:07 pm
I don’t think you understand how codes work...

You can’t submit a code for something you didn’t do, and there aren’t 2 codes for the same service.
Happens all the time. Sometimes deliberately, sometimes not. That's why I recommend that the OP request an itemized bill to see if anything is on there that clearly shouldn't be, e.g., a swab of a third nostril that I don't have.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by researcher » Fri Jul 05, 2019 12:13 pm

dm200 wrote:
Fri Jul 05, 2019 11:29 am
Yes - I agree.

I see nothing wrong, though, with asking for a payment plan to pay the full amount due.
Or asking if they provide a discount for paying in full at that time.

If they are going to offer a 25%-50% discount for paying in full, why wouldn't you take it?

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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 12:13 pm

CFM300 wrote:
Fri Jul 05, 2019 12:11 pm
Erwin007 wrote:
Fri Jul 05, 2019 11:27 am
Can’t have your cake and eat it too.
Unfortunately, you can -- which is part of the problem. Lots of people successfully negotiate, protest, appeal, and otherwise worm their way out of paying the amount they're initially presented.
The current system is an insane hodgepodge of pricing, networks, rules, and practices. Several had drawn an analogy with negotiating car prices. Whether that analogy is technically accurate, it certainly captures how many people feel: that if they don't negotiate, they'll be the sucker, paying more than they should (or than others do).
OK - then you should not be able to have your cake and eat it too!

When folks do that, I believe the rest of us end up paying more.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 12:15 pm

researcher wrote:
Fri Jul 05, 2019 12:13 pm
dm200 wrote:
Fri Jul 05, 2019 11:29 am
Yes - I agree.

I see nothing wrong, though, with asking for a payment plan to pay the full amount due.
Or asking if they provide a discount for paying in full at that time.

If they are going to offer a 25%-50% discount for paying in full, why wouldn't you take it?
Even though I might take a discount, I don't think it is proper for the discount to be given. Just my opinion, though.

For an HDHP plan, my opinion also is that the discounted amount paid should be used as the amount towards the deductible.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by JackoC » Fri Jul 05, 2019 12:18 pm

quantAndHold wrote:
Thu Jul 04, 2019 3:42 pm
JackoC wrote:
Thu Jul 04, 2019 3:20 pm
quantAndHold wrote:
Thu Jul 04, 2019 3:09 pm
JackoC wrote:
Thu Jul 04, 2019 2:59 pm
White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?
I see your point. I walked into a car dealership the other day and the MSRP for the car was $30k, so I just paid it. :D That's the price, right?
In this case, OP is using a buying service (the insurance company), that already did the negotiating.
OK, so if I go to a car dealer with a TrueCar certificate I have to pay that price? They already did the negotiating, didn't they? Actually on my last purchase a car dealer told me exactly that, 'we're contractually obligated not to further negotiation the TrueCar price'. I said 'yeah, right', and the negotiation continued to a lower price. :happy
In this case, yes. You take the price. The hospital has a contract with the insurance company for that price. You have a contract with the insurance company. You don't have a contract with TrueCar, so you can walk out of that deal. You already did the deal with the insurance company when you signed up for coverage. So you pay the bill.
I have a contract with my health insurance company but it doesn't anywhere say I can't further negotiate costs which are not covered by the insurance. Maybe your insurance has different fine print, but I'm quite sure mine doesn't say that. :D

If the provider is really contractually obligated to accept no less than the full insurance price you'll find that out by negotiating. I specifically said only that you don't know what discount you can get if you don't try. My own experience though makes me skeptical of statements that providers really can't give discounts on insurance prices not actually reimbursed by insurance. I've often gotten them.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by UpsetRaptor » Fri Jul 05, 2019 12:20 pm

EddyB wrote:
Fri Jul 05, 2019 9:54 am
toofache32 wrote:
Fri Jul 05, 2019 9:16 am
FoolStreet wrote:
Thu Jul 04, 2019 11:15 pm
White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm
confusedinvestor wrote:
Tue Jul 02, 2019 12:17 am
Folks, Recently went to emergency room and now got a 6K hospital bill (after insurance adjustments) meet the deductible

Is there any recommendations to negotiate this with the hospital billing dept ?

Is it better to not pay and let it go to collections and then negotiate with them ?

I could use some help and tips on this issue, thanks all.
Oh, are we doing this again? I thought we just did this "how to get out of paying doctors" thing yesterday.

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?

Is it better to not pay and let it go to collections and then negotiate with them?

I could use some help and tips on this issue, thanks all.

Feel any different? I bet it would if you were an A/C guy or an emergency doctor.

If you don't want a $6K bill, don't go to the ED. That's what it costs to go there. If you don't meet your max out of pocket with one ED visit, you certainly will with two. Too many people think the cost is more similar to a clinic visit than a hospitalization. It isn't because the service you receive is more similar to a hospital stay than 8 minutes with a family doc and her medical assistant.
I applaud the OP for negotiating. The medical industry rips off consumers by not publishing the cost of service ahead of time.
Let me help you there. The INSURANCE industry, not the medical industry, determines the fees. If you want the cost of something ahead of time, just ask your insurance company.
With twice the amount of money spent on healthcare in the US as in countries with comparable or better overall outcomes, it seems there’s plenty of room to blame both the providers and the insurers.
Very little of this is either the providers' or insurers' fault.

1) The main reason we spend much more on healthcare than other developed countries is we're a much worse healthcare population. We're fatter, exercise less, eat worse, do more drugs, have more guns, more shootings, drive faster, and get into more car accidents. None of that's the fault of our providers or insurers.

2) Better overall outcomes elsewhere isn't really true either, once you understand that because of #1, statistics should be measured from point of diagnosis, not as a general observation. If you're going to be admitted to an ER with a gunshot wound, there's no place in the world you'd rather be shot than a close drive to a big inner city hospital in America, because our vascular surgeons have lots of experience with that and are actually pretty amazing at saving lives. But measures like "life expectancy" essentially ding our vascular surgeons for simply having more gunshot victims to deal with. "Infant mortality" is affected by mothers' drug use and obesity. Etc.

You could maybe blame high costs in part on providers just because they make good money. Though that's in large part societal - our society seems generally OK with doctors having to go to really expensive school for a lot of years and rack up huge debts, and eventually work in a highly litigious society. So they eventually get paid really good money, and our society seems generally OK with all that.

Insurance is just a scapegoat.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 12:23 pm

In my opinion, for the US to even begin to keep medical costs under control - all of the multiple reasons for high costs should be addressed. Patient behavior, choices and gaming the system should all be targets.

"Overuse" of medical services is a big contributor as well.

As a patient, how do we know and what can we do?

If a doctor says I need a CT scan for something, how would I know that it may not be necessary? And, even if I conclude it is not necessary, how can I get the doctor to back off?

One example - I needed eyelid surgery for a droopy eyelid. Took the Ophthalmologist a photo of me as a two year old showing the droopy eyelid. My mother had the same thing. The Ophthalmologist then told me that that eyeball protruded a bit more than the other eye. He insisted on a CT san of my eye socket - just in case I had a brain tumor pushing out my eyeball. So I got the CT scan - no brain tumor. I have an odd shaped head - and I believe that was the situation.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by researcher » Fri Jul 05, 2019 12:25 pm

JackoC wrote:
Fri Jul 05, 2019 12:18 pm
quantAndHold wrote:
Thu Jul 04, 2019 3:42 pm
In this case, yes. You take the price. The hospital has a contract with the insurance company for that price. You have a contract with the insurance company. You don't have a contract with TrueCar, so you can walk out of that deal. You already did the deal with the insurance company when you signed up for coverage. So you pay the bill.
I have a contract with my health insurance company but it doesn't anywhere say I can't further negotiate costs which are not covered by the insurance. Maybe your insurance has different fine print, but I'm quite sure mine doesn't say that. :D

If the provider is really contractually obligated to accept no less than the full insurance price you'll find that out by negotiating. I specifically said only that you don't know what discount you can get if you don't try. My own experience though makes me skeptical of statements that providers really can't give discounts on insurance prices not actually reimbursed by insurance. I've often gotten them.
JackoC is 100% correct.
There is nothing to stop the consumer from negotiating a bill based on insurance contracted rates.
I've done this every time I've used hospital services and been successful every time...

Me: "Can you offer me a discount if I pay in full now?"
Hospital Billing Dept: "Yes, we can give you a 40% discount."
Me: "Thanks. Here's my credit card info."

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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 12:26 pm

1) The main reason we spend much more on healthcare than other developed countries is we're a much worse healthcare population. We're fatter, exercise less, eat worse, do more drugs, have more guns, more shootings, drive faster, and get into more car accidents. None of that's the fault of our providers or insurers.
Yes - I believe this is very true.

No medical expert here, but I also think that many medical procedures and treatments don't do much, if any, good - in actually reducing the death rates from those conditions.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by JackoC » Fri Jul 05, 2019 12:31 pm

White Coat Investor wrote:
Thu Jul 04, 2019 7:31 pm
JackoC wrote:
Thu Jul 04, 2019 2:59 pm
White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?
I see your point. I walked into a car dealership the other day and the MSRP for the car was $30k, so I just paid it. :D That's the price, right?
1. The MSRP is the Chargemaster price. The negotiated price is already set with your insurer. That's the one you've been presented with. It's the real price. If you don't like it, get a new insurance company or tell them to negotiate better.

2. But at this point, you've already bought the product so pay the bill.
1. Yeah like the price TrueCar or Costco presents is what they've negotiated. Doesn't mean you can't negotiate further, though it doesn't gtee your further negotiations will yield anything.

2. A product you had limited or no ability to price out or negotiate before you bought it. Certainly emergency care. The idea that that creates an ethical obligation to pay whatever they bill present you with with no further negotiation is untenable. How about if you don't have insurance and you get a bill for the up to 10x higher list price (I once went to an ER and the MSRP was literally 10x the insurance price, no hyperbole)? By your logic you still already bought the product, you don't have insurance, so just have to pay the 10x.

There's nothing magical about the insurance adjusted price, and contrary to the claims in other posts, no, one doesn't contractually commit to pay those prices for non-reimbursed expenses by buying the insurance.

If the provider absolutely refuses to give a discount, there you go, the consumer doesn't get one. But in reality IME they often will make some further concession for immediate payment.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by Erwin007 » Fri Jul 05, 2019 12:38 pm

sawhorse wrote:
Fri Jul 05, 2019 12:11 pm
Erwin007 wrote:
Fri Jul 05, 2019 12:07 pm
I don’t think you understand how codes work...

You can’t submit a code for something you didn’t do, and there aren’t 2 codes for the same service.
Happens all the time. Sometimes deliberately, sometimes not. That's why I recommend that the OP request an itemized bill to see if anything is on there that clearly shouldn't be, e.g., a swab of a third nostril that I don't have.
Sure, accidents happen. My MA would occasionally submit a charge in Epic for an injection i did in clinic, and then I would submit the same charge (because she rarely submitted the charge, but my pay was somewhat dependent on it so I did it every time). But that’s easy for an insurance company or billing person to look at the note and say only one injection was done, so there should only be one charge. I see no problem with a patient looking for items like that on their bill (EOB really).

I was responding to the false insinuation that doctors or billing people massage the codes to find the one that the insurance company will pay the most for. That is just patently false. In probably almost every case, the doctors or billing people don’t even have access to the amount allows by insurance. Do they both look at what was done and try to code/charge the highest level for what was done? Absolutely. No reason to not get paid for everything that you did. But to say that they finagle codes after the fact to maximize reimbursement is completely incorrect.

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Re: Big Hospital Bill - Anyway to negociate ?

Post by Erwin007 » Fri Jul 05, 2019 12:40 pm

JackoC wrote:
Fri Jul 05, 2019 12:31 pm
White Coat Investor wrote:
Thu Jul 04, 2019 7:31 pm
JackoC wrote:
Thu Jul 04, 2019 2:59 pm
White Coat Investor wrote:
Thu Jul 04, 2019 12:28 pm

I had an A/C guy over yesterday. He gave me a $6K bill. Any recommendations to negotiate this with the company?
I see your point. I walked into a car dealership the other day and the MSRP for the car was $30k, so I just paid it. :D That's the price, right?
1. The MSRP is the Chargemaster price. The negotiated price is already set with your insurer. That's the one you've been presented with. It's the real price. If you don't like it, get a new insurance company or tell them to negotiate better.

2. But at this point, you've already bought the product so pay the bill.
1. Yeah like the price TrueCar or Costco presents is what they've negotiated. Doesn't mean you can't negotiate further, though it doesn't gtee your further negotiations will yield anything.

2. A product you had limited or no ability to price out or negotiate before you bought it. Certainly emergency care. The idea that that creates an ethical obligation to pay whatever they bill present you with with no further negotiation is untenable. How about if you don't have insurance and you get a bill for the up to 10x higher list price (I once went to an ER and the MSRP was literally 10x the insurance price, no hyperbole)? By your logic you still already bought the product, you don't have insurance, so just have to pay the 10x.

There's nothing magical about the insurance adjusted price, and contrary to the claims in other posts, no, one doesn't contractually commit to pay those prices for non-reimbursed expenses by buying the insurance.

If the provider absolutely refuses to give a discount, there you go, the consumer doesn't get one. But in reality IME they often will make some further concession for immediate payment.
Except there is “magic” about the insurance adjusted price. Providers or hospital systems are ready to accept lesser charges for certain procedures or hospitalizations from an insurance company because of the captive audience that insurance plans’ subscribers will be. In other words, it is sort of a volume discount.

sawhorse
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Re: Big Hospital Bill - Anyway to negociate ?

Post by sawhorse » Fri Jul 05, 2019 12:51 pm

Erwin007 wrote:
Fri Jul 05, 2019 12:38 pm
I was responding to the false insinuation that doctors or billing people massage the codes to find the one that the insurance company will pay the most for. That is just patently false. In probably almost every case, the doctors or billing people don’t even have access to the amount allows by insurance. Do they both look at what was done and try to code/charge the highest level for what was done? Absolutely. No reason to not get paid for everything that you did. But to say that they finagle codes after the fact to maximize reimbursement is completely incorrect.
This definitely happens, and when it happens in the hospital, it's usually not the doctors' fault. Look at the kwashiorkor scandal.

Sometimes it's done explicitly against the doctor's orders. A hospitalist recounted a story of a patient that she had given albuterol to. The patient didn't have asthma. The billing office asked if they could code for exacerbation of asthma (or something like that). She said no. Later she found out that they did it anyway.

Sometimes it is the doctors' fault though perhaps not directly. As I mentioned above, when a hospital started using Emcare to staff the emergency room, the percent of ER visits coded at the highest level skyrocketed from 6% to 28% in the same ER. Even if they were slightly undercoding before, I have a really hard time believing that 28% of ER visits warranted the highest code. Unfortunately, when doctors refused to play along, they were fired. I can imagine that scared other doctors from also resisting.

rich126
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Re: Big Hospital Bill - Anyway to negociate ?

Post by rich126 » Fri Jul 05, 2019 1:14 pm

I see a few comments stating if you don’t like one insurance plan then just get a different one. For many people they have limited or no choice and have to take what their employer provides.

In this case I didn’t see any real explanation why the OP won’t pay the bill. Too often now it seems like people are always looking for a way out even after agreeing to the deal. Fortunately I’ve never worked in a restaurant but have friends who do and you see people trying to weasel out of bills. Most recently in an open air restaurant a fly flew into a glass of water, the waitress gave the customer a new glass but the person demanded to see the manager. She was trying to get something free for the issue. The manager wouldn’t give in.

I do agree there are reasons to complain about billing, especially if unnecessary tests are done, an in network facility uses out of network doctors within letting you know, etc. there wasan excellent article written years ago by a doctor who had a medical event and was in the emergency room. He wrote how he let himself be talked into receiving tests he, as a medical professional on reflection, didn’t need. And gained a better understanding what a patient in pain has to deal with.

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dm200
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Re: Big Hospital Bill - Anyway to negociate ?

Post by dm200 » Fri Jul 05, 2019 1:21 pm

I see a few comments stating if you don’t like one insurance plan then just get a different one. For many people they have limited or no choice and have to take what their employer provides
Yes - very true. Many of those on employer plans have no choice. Many others, such as Federal Government employees, have a wide variety of choices.

JackoC
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Re: Big Hospital Bill - Anyway to negociate ?

Post by JackoC » Fri Jul 05, 2019 1:30 pm

Erwin007 wrote:
Fri Jul 05, 2019 12:40 pm


Except there is “magic” about the insurance adjusted price. Providers or hospital systems are ready to accept lesser charges for certain procedures or hospitalizations from an insurance company because of the captive audience that insurance plans’ subscribers will be. In other words, it is sort of a volume discount.
That's a good explanation why insurance adjusted prices are lower than medical MSRP's, besides the MSRP's often being obviously too high and out of whack with any rational concept of marginal cost. But it still isn't a good argument IMO to not ask for a further discount. Lots of stuff is offered for a discount, but you can get a further discount. Again like a TrueCar price.

The arguments not to ask for a discount on a medical bill seem to be;
-you've contractually agreed with your insurance company not to ask for one: false.
-you've already bought the product: that would mean they can charge literally whatever they want, that doesn't work logically.
-the *provider* is contractually prohibited by the insurance co from giving a further discount: a good practical argument if it were true, but IME it's not. It's either not even technically true, or if technically true they must account for the additional discount as something other than 'additional discount'.

Because they often given them. And that it seems to me is the bottom line answer to OP's question.

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