Received a $17,000 medical bill! Can we negotiate?

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SamSammie
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Received a $17,000 medical bill! Can we negotiate?

Post by SamSammie » Fri Aug 09, 2019 9:37 am

We live in New Jersey, we had to rush to the ER and I had called and made sure the hospital we were going to is in-network. After being in ER for a few hours they didn’t allow us to leave and said that our four-year old needed immediate assistance due to pneumonia in her left lung and we were moved to ICU. A day in ICU we were told she needed to be operated on to get the fluids out and in comes the surgeon and his team. Now we received a bill for $17,000.00 from the surgeon’s office for their service. Turns out the hospital was in network and but the surgeon wasn’t! Even then shouldn’t they just accept the amount the insurance would pay to them given the circumstance where they wouldn’t allow us to leave the hospital? $17,000 is a lot of money and it’s very disheartening to see the medical bill! Any advice or tips to negotiate or contest would be greatly appreciated. Thank you.

niceguy7376
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by niceguy7376 » Fri Aug 09, 2019 9:43 am

Welcome to the forum.
The incident that you experienced is fairly common in the US Health Industry.

First things first.
You got the bill from the doctor. Did they submit to your Insurance?
You should wait till the Insurance makes a decision on that bill first.

CoastalWinds
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by CoastalWinds » Fri Aug 09, 2019 9:47 am

I would appeal to your insurance company that in an ER, there should be no differentiation of in vs out of network since you don’t have control of which physicians are assigned or on-call.

You are not the first to experience the frustration of trying to do up-front research on options/pricing, stick to in-network, only to get get burned [OT comment removed by moderator prudent]

MrsBDG
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by MrsBDG » Fri Aug 09, 2019 9:49 am

Once the insurance company has processed the claim, then, if they have rejected it, you ca file an appeal, in writing, pointing out that the hospital was in network and that you had no control over the network of the surgeon the hospital provided.

HomeStretch
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by HomeStretch » Fri Aug 09, 2019 9:51 am

I hope your child has recovered and is doing well.

Have you reviewed the “Explanation or Benefits” from your insurance company to see if the “patient pays” amount is the same as the bill from the surgeon’s office?

Have you talked with your insurance company?

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by BarbBrooklyn » Fri Aug 09, 2019 9:54 am

Several years ago , we were sent by an in network doctor to an out of network hospital. My husband had an aortic aneurysm that was quite large but not yet about to burst.

He was immediately admitted and worked up for open heat surgery ( turned out he had a leaking aortic valve as well). I called our health insurance company to find out if there was an in network surgeon at this facility. There was not. They said I should take him to a different hospital. I declined (I didn't think they were going to let him go, nor should they have).

The facility and the surgeon accepted insurance assignment. We paid for the anesthesia. 3K.

Wait for the dust to settle. Glad your child is okay.
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."

CoastalWinds
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by CoastalWinds » Fri Aug 09, 2019 10:08 am

dwickenh wrote:
Fri Aug 09, 2019 9:57 am
CoastalWinds wrote:
Fri Aug 09, 2019 9:47 am
I would appeal to your insurance company that in an ER, there should be no differentiation of in vs out of network since you don’t have control of which physicians are assigned or on-call.

You are not the first to experience the frustration of trying to do up-front research on options/pricing, stick to in-network, only to get get burned by the insurance industry’s ridiculous and greedy antics. The health insurance industry in this country has devolved into nothing more than a criminal enterprise.
Can you link some articles to prove this?
Personal experience, experiences of friends/colleagues, and discussions with several close friends that work with health insurance companies. It has painted a very clear picture to me. Good luck.

JackoC
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by JackoC » Fri Aug 09, 2019 10:09 am

SamSammie wrote:
Fri Aug 09, 2019 9:37 am
We live in New Jersey, we had to rush to the ER and I had called and made sure the hospital we were going to is in-network. After being in ER for a few hours they didn’t allow us to leave and said that our four-year old needed immediate assistance due to pneumonia in her left lung and we were moved to ICU. A day in ICU we were told she needed to be operated on to get the fluids out and in comes the surgeon and his team. Now we received a bill for $17,000.00 from the surgeon’s office for their service. Turns out the hospital was in network and but the surgeon wasn’t! Even then shouldn’t they just accept the amount the insurance would pay to them given the circumstance where they wouldn’t allow us to leave the hospital? $17,000 is a lot of money and it’s very disheartening to see the medical bill! Any advice or tips to negotiate or contest would be greatly appreciated. Thank you.
In NJ, "The Out-of-network Consumer Protection, Transparency, Cost Containment, and Accountability Act, (P.L.2018, c.32), (“Act”), was signed into law on June 1, 2018, and became effective on August 30, 2018. "
https://www.state.nj.us/dobi/division_c ... twork.html

I would check out the provisions and compare it to your situation. We haven't had a 'surpriiiiise! it's out of network!' incident since the law passed. A $17k charge though is certainly worth getting familiar with it, and probably consulting a lawyer.

With due respect to any later posters who tell you the $17k is now your 'moral' obligation to pay, I would ignore them. Although by the same token I wouldn't get bogged down either in accusing the doctor, hospital or insurance company of moral turpitude for sending a bill like that. It's a difficult system, to put in the mildest possible terms. You've got to negotiate it as best you can to pay as little as you can for services you had no opportunity to shop around for or compare prices on. It's not the same as agreeing to buy something for a particular price when you had the opportunity to accept it or not, then reneging on payment. You're morally in the clear IMO to pay as little as you possibly can based on negotiating as hard as you possibly can, and taking advantage of the new law if it's determined it applies in this case.

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dm200
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by dm200 » Fri Aug 09, 2019 10:10 am

CoastalWinds wrote:
Fri Aug 09, 2019 9:47 am
I would appeal to your insurance company that in an ER, there should be no differentiation of in vs out of network since you don’t have control of which physicians are assigned or on-call.
You are not the first to experience the frustration of trying to do up-front research on options/pricing, stick to in-network, only to get get burned by the insurance industry’s ridiculous and greedy antics. The health insurance industry in this country has devolved into nothing more than a criminal enterprise.
Fortunately, no personal experience -

Sure seems like you did everything that a "reasonable" insured person/family should do. If I could end up talking or communicating with someone at your insurance company - I might just bluntly and frankly ask, "What would you have us do - let our child die because that, in network, hospital engages a surgeon that is not 'in network'?"

If you have not already done so, I would go through all the fine print in this insurance for such emergency and life threatening conditions.

No medical credentials here, but sounds like this was a "life threating" situation - confirmed by the fact that they would not let you leave.

To be fair to the surgeon, this may not be his/her "fault" - but just the normal way of doing business.

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sk2101
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by sk2101 » Fri Aug 09, 2019 10:15 am

dwickenh wrote:
Fri Aug 09, 2019 9:57 am
CoastalWinds wrote:
Fri Aug 09, 2019 9:47 am
I would appeal to your insurance company that in an ER, there should be no differentiation of in vs out of network since you don’t have control of which physicians are assigned or on-call.

You are not the first to experience the frustration of trying to do up-front research on options/pricing, stick to in-network, only to get get burned by the insurance industry’s ridiculous and greedy antics. The health insurance industry in this country has devolved into nothing more than a criminal enterprise.
Can you link some articles to prove this?
https://www.npr.org/2019/03/13/70297539 ... -insurance

Hugh Prolly-Wright
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Hugh Prolly-Wright » Fri Aug 09, 2019 10:17 am

You might consult https://brokenhealthcare.org/
They have been fighting for price transparency, and have had success in some situations. (Not sure if it's exactly yours.)
They have asked for detailed explanations of charges, and quite often, rather than provide these, the provider sometimes walks away, or negotiates payment. May be worth investigating.

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dm200
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by dm200 » Fri Aug 09, 2019 10:18 am

With due respect to any later posters who tell you the $17k is now your 'moral' obligation to pay, I would ignore them. Although by the same token I wouldn't get bogged down either in accusing the doctor, hospital or insurance company of moral turpitude for sending a bill like that. It's a difficult system, to put in the mildest possible terms. You've got to negotiate it as best you can to pay as little as you can for services you had no opportunity to shop around for or compare prices on. It's not the same as agreeing to buy something for a particular price when you had the opportunity to accept it or not, then reneging on payment. You're morally in the clear IMO to pay as little as you possibly can based on negotiating as hard as you possibly can, and taking advantage of the new law if it's determined it applies in this case.
Very well stated, in my opinion.

Again, no medical credentials - but "seat of the pants" $17k for such surgery for a child - in emergency (life threatening) situation does not seem very excessive. The issue, to me, seems that somewhere in the insurance company, hospital, and "in network" agreements - there should be reasonable provisions that insurance should cover this.

This is not some kind of surgery, although medically needed, is not an emergency and where the patient can take time to make such choices and clear them, in advance, with the insurance company.

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SamSammie
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by SamSammie » Fri Aug 09, 2019 10:20 am

Thank you, each one of you, this gives me hope and some guidance/ammo to do some ground work and to pick up the phone to start discussing with the insurance company. First couple of days I just went numb in denial and didn't even want to acknowledge we got the bill. Will keep you guys posted on how things shape out. Appreciate your time and assistance.

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Flyer24 » Fri Aug 09, 2019 10:23 am

You need to talk to your insurance company. I ran into this issue with my insurance provider. There is actually a clause in the benefits. As long as you visit an in-network hospital then all further bills are considered in-network. My insurance ended up covering it.

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by CoastalWinds » Fri Aug 09, 2019 10:25 am

dm200 wrote:
Fri Aug 09, 2019 10:10 am


Sure seems like you did everything that a "reasonable" insured person/family should do. If I could end up talking or communicating with someone at your insurance company - I might just bluntly and frankly ask, "What would you have us do - let our child die because that, in network, hospital engages a surgeon that is not 'in network'?"
I did this very thing as a hypothetical recently, as I was trying to research and understand my local ER options. My insurance company claimed that they do not differentiate in-network vs out-of-network for ER visits, but upon further questioning they acknowledged this was for “facility charges.” I asked about the scenario where physicians rotate between hospitals and is there an issue with an out-of-network physician treating me in the ER. They coyly hummed and hawed, appreciating That I figured out the bs but they were unable to acknowledge it for the scam it was.

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by marcopolo » Fri Aug 09, 2019 10:28 am

Flyer24 wrote:
Fri Aug 09, 2019 10:23 am
You need to talk to your insurance company. I ran into this issue with my insurance provider. There is actually a clause in the benefits. As long as you visit an in-network hospital then all further bills are considered in-network. My insurance ended up covering it.
This sounded like an emergency situation. I thought with the ACA regulations, emergencies are treated as in-network regardless of the hospital being in-network?
Once in a while you get shown the light, in the strangest of places if you look at it right.

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by cas » Fri Aug 09, 2019 10:33 am

JackoC wrote:
Fri Aug 09, 2019 10:09 am
SamSammie wrote:
Fri Aug 09, 2019 9:37 am
We live in New Jersey [ . . .]
In NJ, "The Out-of-network Consumer Protection, Transparency, Cost Containment, and Accountability Act, (P.L.2018, c.32), (“Act”), was signed into law on June 1, 2018, and became effective on August 30, 2018. "
https://www.state.nj.us/dobi/division_c ... twork.html

I would check out the provisions and compare it to your situation.

Here's how the National Law Review summarizes what seem (to non-lawyer me) to be relevant clauses in the new (New Jersey) law (https://www.natlawreview.com/article/ne ... rk-billing). (Probably especially the "inadvertent out-of-network services" clause, since surgery happened after hospital admittance):
Billing Requirements: The [law] establishes specific requirements for carriers, health care facilities, and health care providers with regard to billing and payment for OON services, for example:
  • Medically necessary services provided at any health care facility on an emergency or urgent basis: neither the health care facility nor the health care professional may bill the patient in excess of his or her deductible, copayment, or coinsurance (“cost-sharing amount”) applicable to in-network benefits provided under his or her health benefits plan. Carrier and facility must agree on payment or go through binding arbitration.
  • Inadvertent out-of-network services: health care professional shall not bill the patient in excess of any cost-sharing amounts pursuant to his or her health benefits plan (i.e., no balance billing).

    “Inadvertent out-of-network services” means covered services provided by an out-of-network health care provider in an in-network facility when in-network providers are unavailable in that facility. “Inadvertent out-of-network services” also includes “laboratory testing ordered by an in-network health care provider and performed by an out-of-network bio-analytical laboratory.” The bill further requires carriers and health care facilities and professionals to adhere to specific timing requirements with respect to payment terms and enter into arbitration if they cannot agree on such terms.

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dm200
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by dm200 » Fri Aug 09, 2019 10:46 am

marcopolo wrote:
Fri Aug 09, 2019 10:28 am
Flyer24 wrote:
Fri Aug 09, 2019 10:23 am
You need to talk to your insurance company. I ran into this issue with my insurance provider. There is actually a clause in the benefits. As long as you visit an in-network hospital then all further bills are considered in-network. My insurance ended up covering it.
This sounded like an emergency situation. I thought with the ACA regulations, emergencies are treated as in-network regardless of the hospital being in-network?
In my (non-medical) opinion, I agree. Not only from the patient/parent view, but seems well documented by the hospital itself. It also appears that the patient/parent had no choice either.

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Kenkat
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Kenkat » Fri Aug 09, 2019 10:54 am

cas wrote:
Fri Aug 09, 2019 10:33 am
JackoC wrote:
Fri Aug 09, 2019 10:09 am
SamSammie wrote:
Fri Aug 09, 2019 9:37 am
We live in New Jersey [ . . .]
In NJ, "The Out-of-network Consumer Protection, Transparency, Cost Containment, and Accountability Act, (P.L.2018, c.32), (“Act”), was signed into law on June 1, 2018, and became effective on August 30, 2018. "
https://www.state.nj.us/dobi/division_c ... twork.html

I would check out the provisions and compare it to your situation.

Here's how the National Law Review summarizes what seem (to non-lawyer me) to be relevant clauses in the new (New Jersey) law (https://www.natlawreview.com/article/ne ... rk-billing). (Probably especially the "inadvertent out-of-network services" clause, since surgery happened after hospital admittance):
Billing Requirements: The [law] establishes specific requirements for carriers, health care facilities, and health care providers with regard to billing and payment for OON services, for example:
  • Medically necessary services provided at any health care facility on an emergency or urgent basis: neither the health care facility nor the health care professional may bill the patient in excess of his or her deductible, copayment, or coinsurance (“cost-sharing amount”) applicable to in-network benefits provided under his or her health benefits plan. Carrier and facility must agree on payment or go through binding arbitration.
  • Inadvertent out-of-network services: health care professional shall not bill the patient in excess of any cost-sharing amounts pursuant to his or her health benefits plan (i.e., no balance billing).

    “Inadvertent out-of-network services” means covered services provided by an out-of-network health care provider in an in-network facility when in-network providers are unavailable in that facility. “Inadvertent out-of-network services” also includes “laboratory testing ordered by an in-network health care provider and performed by an out-of-network bio-analytical laboratory.” The bill further requires carriers and health care facilities and professionals to adhere to specific timing requirements with respect to payment terms and enter into arbitration if they cannot agree on such terms.
Sounds like the New Jersey law covers you in this situation. I would find out what your insurance would pay if this was provided in network and provide that information to the surgeon’s billing party. If they balk at accepting that amount, I would tell them they are in violation of New Jersey law and can you file an official billing dispute / appeal or should you just contact the state insurance office?

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by sawhorse » Fri Aug 09, 2019 12:34 pm

dm200 wrote:
Fri Aug 09, 2019 10:18 am
This is not some kind of surgery, although medically needed, is not an emergency and where the patient can take time to make such choices and clear them, in advance, with the insurance company.
Such situations are very rare because it's almost impossible to get prices ahead of time, and while you might verify that the surgeon and hospital are in-network, you can't protect against "drive by doctoring" or other surprise bills.

When I've gone into surgery or into the emergency room, my biggest anxiety is not whether I'll live but whether I'll be hit with large surprise bills. That's the sad state of healthcare in the country. I know you're going to give your standard answer of "Kaiser never does this", so I'll say it for you to save you the effort, and I'll once again remind you that most people don't have access to Kaiser.

To the OP, the others on this thread have given you good advice. It sounds like you got lucky with the state this happened in as New Jersey has protections against surprise bills.

My recommendation is to document everything. Do as much in writing as you can, and record every phone call.

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Fallible » Fri Aug 09, 2019 12:58 pm

You've received good advice here, in particular to deal mainly with your insurance company, get copies, keep records of your correspondence, and persist.

Here is a situation similar to yours about a woman who did all of this over a $12,000 bill for her son's surgery - she won. The link is from the Boston Globe (via "The Finance Buff" website which I subscribe to):

https://www.bostonglobe.com/business/20 ... story.html

Good luck!
Last edited by Fallible on Fri Aug 09, 2019 1:10 pm, edited 2 times in total.
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by HueyLD » Fri Aug 09, 2019 12:59 pm

marcopolo wrote:
Fri Aug 09, 2019 10:28 am
Flyer24 wrote:
Fri Aug 09, 2019 10:23 am
You need to talk to your insurance company. I ran into this issue with my insurance provider. There is actually a clause in the benefits. As long as you visit an in-network hospital then all further bills are considered in-network. My insurance ended up covering it.
This sounded like an emergency situation. I thought with the ACA regulations, emergencies are treated as in-network regardless of the hospital being in-network?
No. The insurance company is required to pay the in-network amount for out-of-network ER services. And the patient is responsible for the difference.

However, negotiating directly with the provider is always an option. Good luck to everyone with the one big messy health care system in this country.

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by TexasPE » Fri Aug 09, 2019 1:14 pm

niceguy7376 wrote:
Fri Aug 09, 2019 9:43 am

First things first.
You got the bill from the doctor. Did they submit to your Insurance?
You should wait till the Insurance makes a decision on that bill first.
+1

...and... if you get your insurance through your employer, find out whether Megacorp is self-insured and just uses an insurance company for claims processing. If this is the case, your HR department should have someone (probably at headquarters) assigned to work with employees to handle situations like this. Over my career I had a half dozen decisions reversed in my favor over the claim processor's "official" policy, including this very situation (in-network/out of network in an emergency situation).

Good luck!
At 20: I cared what everyone thought about me | At 40: I didn't give a damn what anyone thought of me | Now that I'm 60: I realize that no one was really thinking about me at all | Winston Churchill (?)

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dm200
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by dm200 » Fri Aug 09, 2019 2:49 pm

niceguy7376 wrote:
Fri Aug 09, 2019 9:43 am

First things first.
You got the bill from the doctor. Did they submit to your Insurance?
You should wait till the Insurance makes a decision on that bill first.
Yes! I was, perhaps wrongly, assuming that the surgeon had already submitted a claim to your insurance company.

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El Greco
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by El Greco » Fri Aug 09, 2019 5:03 pm

I never thought I would say this but, I'm glad me and DW are going to be on Medicare soon. Our health system is a wreck.

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burt
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by burt » Fri Aug 09, 2019 5:16 pm

El Greco wrote:
Fri Aug 09, 2019 5:03 pm
I never thought I would say this but, I'm glad me and DW are going to be on Medicare soon. Our health system is a wreck.
+1
I am about 1 year away from Medicare.
Nervously waiting.

Big Dog
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Big Dog » Fri Aug 09, 2019 5:21 pm

dm200 wrote:
Fri Aug 09, 2019 2:49 pm
niceguy7376 wrote:
Fri Aug 09, 2019 9:43 am

First things first.
You got the bill from the doctor. Did they submit to your Insurance?
You should wait till the Insurance makes a decision on that bill first.
Yes! I was, perhaps wrongly, assuming that the surgeon had already submitted a claim to your insurance company.
Exactly. Until the insurance company processes the claim and sends you an EOB, there is no issue (yet).

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by cherijoh » Fri Aug 09, 2019 5:55 pm

dm200 wrote:
Fri Aug 09, 2019 10:18 am
With due respect to any later posters who tell you the $17k is now your 'moral' obligation to pay, I would ignore them. Although by the same token I wouldn't get bogged down either in accusing the doctor, hospital or insurance company of moral turpitude for sending a bill like that. It's a difficult system, to put in the mildest possible terms. You've got to negotiate it as best you can to pay as little as you can for services you had no opportunity to shop around for or compare prices on. It's not the same as agreeing to buy something for a particular price when you had the opportunity to accept it or not, then reneging on payment. You're morally in the clear IMO to pay as little as you possibly can based on negotiating as hard as you possibly can, and taking advantage of the new law if it's determined it applies in this case.
Very well stated, in my opinion.

Again, no medical credentials - but "seat of the pants" $17k for such surgery for a child - in emergency (life threatening) situation does not seem very excessive. The issue, to me, seems that somewhere in the insurance company, hospital, and "in network" agreements - there should be reasonable provisions that insurance should cover this.

This is not some kind of surgery, although medically needed, is not an emergency and where the patient can take time to make such choices and clear them, in advance, with the insurance company.
It isn't clear to me whether the surgeon billed his full charge or if this is "balance billing" where the out-of-network doctor bill the part of his bill that isn't paid for by the insurance company. Have you gotten an EOB (explanation of benefits) from your insurance company for this charge? That is the place to start.

I have had doctors send a bill immediately before the insurance company makes a decision; I have also had doctors wait and bill 60 - 90 days after the office visit (when the insurance check has been received). For some standard stuff (not just co-pays) they may estimate the patient portion and expect you to pay on the day of the visit.

I've gotten stuck paying the out-of-network anesthesiologist for a non-emergency outpatient procedure. I had checked that the surgery center and doctor were in network. I didn't think about the anesthesiologist, but they probably use both in- and out-of network people. In any case, that was about 2 orders of magnitude smaller than the OP's surgeon's bill.

randomguy
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by randomguy » Fri Aug 09, 2019 6:51 pm

almostretired1965 wrote:
Fri Aug 09, 2019 5:50 pm
I know our system is simply dysfunctional, but it seems to me that one way we could solve this is for a hospital to require that every surgeon that operates at that hospital abide by it's agreement with all of its in-network insurance providers wrt to billing. Is there some reason this is not a workable solution?
It might be very hard to get all doctors signed up with all providers given how often they all change. The reality is that system is broken in that patients get exposed to stuff that isn't their concern. I should be buying an a treatment for pneumonia. I shouldn't be buying a room for 36 hours of room time, an anesthesiologist, surgeon, 2 nurses, and so on. It is up to the hospital to figure out how to provide those services (i.e. do they subcontract, employee people, pay by the hour, pay by the service) in a way that efficient. Right now we get that with places like Kaiser. There are cases where it gets inverted with elective surgery where the doctor should be in charge of billing but again the details don't concern the patient.

But that is off in fantasy world. As people have said what you need to do is talk to the insurance company. It is a total pain to deal with but this is the type of issue they deal with constantly. When they suggest you pay the bill, it is time to esclate to the state insurance boards and the like.

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Good Listener » Fri Aug 09, 2019 7:56 pm

burt wrote:
Fri Aug 09, 2019 5:16 pm
El Greco wrote:
Fri Aug 09, 2019 5:03 pm
I never thought I would say this but, I'm glad me and DW are going to be on Medicare soon. Our health system is a wreck.
+1
I am about 1 year away from Medicare.
Nervously waiting.
I agree. But some doctors are not in Medicare and the same situation could arise.

lawman3966
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by lawman3966 » Fri Aug 09, 2019 8:30 pm

Another poster addressed the situation in which you have health insurance is directly through your employer.
I'm writing to address a related situation - that in which your employer uses an external health insurance company.

I faced a similar situation upon getting a biopsy in 2001. The hospital was in network, but the lab that the sample was sent to (while I was unconscious in a recovery room) wasn't. I got a bill from the lab, and was initially unable to resolve things with the ins co.
I set up a three-way call including myself, the ins co, and my law firm's insurance rep. With our firm's rep on the phone, the ins co caved in two minutes and agreed to cover the bill.

I was left with the impression that the ins co initially resisted paying on the chance I would give up and the pay the bill myself.

If this applies to your situation, you should contact your employer's insurance rep about it.

randomguy
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by randomguy » Fri Aug 09, 2019 8:47 pm

Good Listener wrote:
Fri Aug 09, 2019 7:56 pm
burt wrote:
Fri Aug 09, 2019 5:16 pm
El Greco wrote:
Fri Aug 09, 2019 5:03 pm
I never thought I would say this but, I'm glad me and DW are going to be on Medicare soon. Our health system is a wreck.
+1
I am about 1 year away from Medicare.
Nervously waiting.
nt

I agree. But some doctors are not in Medicare and the same situation could arise.
Medicare has some pretty strict balancing billing rules that make situations like this pretty rare. A couple years back Tom Price wanted to allow it and it generated a ton of negative press.

tibbitts
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by tibbitts » Fri Aug 09, 2019 9:26 pm

I had an out-of-network emergency bill where I went through two levels of appeals with the insurance company but lost. However, the amount involved was was only about 12% of the amount in the OPs case. Sometimes you can be convinced you're entitled to certain benefits, but once you've exhausted the insurance company appeal process, you have to decide how much further appeals are worth to you. I ended up paying the full amount billed.

FireSekr
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by FireSekr » Fri Aug 09, 2019 10:03 pm

Everything is negotiable.

I had a very similar situation with a surgery and got them to cut the bill by 60%. I didn’t even put much effort into negotiating, I just told them that the bill was a lot higher than I could afford and was not expecting it and asked them if there was anything g they could do. They offered to take 60% off. I probably could have gotten them lower but it was a number I was okay with and didn’t want to stress about it.

Read the book “Never Split The Difference” by Chris Voss. https://www.amazon.com/Never-Split-Diff ... 0062407805

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southerndoc
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by southerndoc » Fri Aug 09, 2019 11:43 pm

Sounds like your child was not stable for transfer if they wouldn't let you leave. Most insurance companies will not force out-of-network charges if a provider writes something in the chart to the effect that the patient was not stable for transfer to an in-network facility.

Despite what someone told you earlier, an insurer is not obligated to pay the in-network rate for out-of-network physicians and hospitals. They can pay whatever your contract says they will pay. Sometimes it's as low as 20% with a $30,000 deductible. Out-of-network care is a huge profit maker for the insurers. They like taking money from their members and paying minimal amounts for their care.

EnjoyTheJourney
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by EnjoyTheJourney » Sat Aug 10, 2019 7:49 am

Several years ago we received well over 10K in medical bills from out-of-network doctors who performed services in an in-network facility. It was disorienting at first because I couldn't remember any of the names for the doctors involved and I couldn't understand the cryptic codes / language used to justify the bills. Also, we had no control over from whom my wife and our (newly born) sons received services once they were in the hospital and, since the NICU was involved in much of that billing medical personnel decided when our sons could leave, and not us.

If your experience is like ours, then you can expect that any employee you contact at the medical billing company will simply tell you that you need to pay up. They didn't (of course) know or seem to care whether we had insurance coverage or not or how making a payment might affect us; the suggestion "Talk to your insurance company" wasn't voiced by anybody. All they cared about was getting paid ASAP and they applied pressure to try to get us do it.

The first insurance company customer service rep with whom I spoke assured me that those bills were not the responsibility of the insurance company. I don't know if that happened because I didn't frame the questions well enough on my first effort or because the rep just didn't know what they were doing. Both scenarios are possible, as it takes a bit of time to learn how to frame questions the right way for issues like this. In the end it took three calls to customer service to firmly establish that the insurance company had a responsibility to pay and to get things moving. Then came the process in which the insurance company insisted on mailing us checks to give to the out-of-network providers, rather then pay them directly themselves. One of the medical billing company employees tried to talk me out of requesting a receipt when I first brought checks to their office. I needed to make it crystal clear that there was no way I was handing over close to $10,000 in checks unless I received a receipt. In the end I got a receipt.

Because of hospital billing errors for which the insurance company (rightly) refused to pay we had a couple of payments end up with a collection agency. The collection agency sent me a letter and, after checking to see if it was fraud, I contacted them. After conversations with all concerned, a three-way phone call with a collection agency employee and a helpful insurance company representative fixed that. More bills followed as the hospital kept trying to bill us incorrectly, over and over. After several phone calls I finally got somebody to admit to there being an error in their records. In the end we paid nothing. But, it took about a year and a half before we stopped receiving bills.

Through this experience I learned to never pay bills concerning which I had questions until after asking questions of all involved; any kind of error can and will happen and others in the system are too busy handling their (probably) relatively high intake of workflow to ask questions on their own or to suggest that you ask questions.

I agree with others that the US health care system is broken. It mostly serves the interests of providers, and not patients. It's not just the world's most expensive health care system, either, as it takes an inordinate amount of time to find and fix problems because of the number of parties involved.

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prudent
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by prudent » Sat Aug 10, 2019 7:57 am

Let's keep replies focused on how to help the OP with his situation. I removed a number of posts that were off-topic to this subject.

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by neilpilot » Sat Aug 10, 2019 9:21 am

Good Listener wrote:
Fri Aug 09, 2019 7:56 pm
burt wrote:
Fri Aug 09, 2019 5:16 pm
El Greco wrote:
Fri Aug 09, 2019 5:03 pm
I never thought I would say this but, I'm glad me and DW are going to be on Medicare soon. Our health system is a wreck.
+1
I am about 1 year away from Medicare.
Nervously waiting.
I agree. But some doctors are not in Medicare and the same situation could arise.
Not exactly....a doctor who does not accept Medicare could charge you up to 15 percent more for his or her services, so there's a defined upper limit.

HomeStretch
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by HomeStretch » Sat Aug 10, 2019 12:48 pm

EnjoyTheJourney wrote:
Sat Aug 10, 2019 7:49 am
Through this experience I learned to never pay bills concerning which I had questions until after asking questions of all involved; any kind of error can and will happen and others in the system are too busy handling their (probably) relatively high intake of workflow to ask questions on their own or to suggest that you ask questions.
In addition to this good point, I learned never to make a payment of “my portion owed” with the assurance that the insurance company contract price adjustment and/or any other errors “would be corrected after”. That often doesn’t happen. I insisted on having the bills corrected to reflect the balance as my portion owed before I paid.

Broken Man 1999
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Broken Man 1999 » Sat Aug 10, 2019 1:06 pm

niceguy7376 wrote:
Fri Aug 09, 2019 9:43 am
Welcome to the forum.
The incident that you experienced is fairly common in the US Health Industry.

First things first.
You got the bill from the doctor. Did they submit to your Insurance?
You should wait till the Insurance makes a decision on that bill first.
This!

No reason to worry until you know what is happening. There will be plenty of time to panic later.

Does your insurance have online access to display medical and pharmacy claims submitted by your medical providers? If so you will have a track to follow. If you see the claim rejected, just understand rejected claims are often paid, once the correct billing codes are sent. So, don't get too worried until the claim has had a chance to work through any issues between the service provider and the insurance company. And, sometimes the corrections progress makes glaciers seem like speed demons.

I'm glad to see your little one is OK. I'm sure that was a very frightening situation.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

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dm200
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by dm200 » Sat Aug 10, 2019 2:20 pm

EnjoyTheJourney wrote:
Sat Aug 10, 2019 7:49 am
Several years ago we received well over 10K in medical bills from out-of-network doctors who performed services in an in-network facility. It was disorienting at first because I couldn't remember any of the names for the doctors involved and I couldn't understand the cryptic codes / language used to justify the bills. Also, we had no control over from whom my wife and our (newly born) sons received services once they were in the hospital and, since the NICU was involved in much of that billing medical personnel decided when our sons could leave, and not us.
If your experience is like ours, then you can expect that any employee you contact at the medical billing company will simply tell you that you need to pay up. They didn't (of course) know or seem to care whether we had insurance coverage or not or how making a payment might affect us; the suggestion "Talk to your insurance company" wasn't voiced by anybody. All they cared about was getting paid ASAP and they applied pressure to try to get us do it.
The first insurance company customer service rep with whom I spoke assured me that those bills were not the responsibility of the insurance company. I don't know if that happened because I didn't frame the questions well enough on my first effort or because the rep just didn't know what they were doing. Both scenarios are possible, as it takes a bit of time to learn how to frame questions the right way for issues like this. In the end it took three calls to customer service to firmly establish that the insurance company had a responsibility to pay and to get things moving. Then came the process in which the insurance company insisted on mailing us checks to give to the out-of-network providers, rather then pay them directly themselves. One of the medical billing company employees tried to talk me out of requesting a receipt when I first brought checks to their office. I needed to make it crystal clear that there was no way I was handing over close to $10,000 in checks unless I received a receipt. In the end I got a receipt.
Because of hospital billing errors for which the insurance company (rightly) refused to pay we had a couple of payments end up with a collection agency. The collection agency sent me a letter and, after checking to see if it was fraud, I contacted them. After conversations with all concerned, a three-way phone call with a collection agency employee and a helpful insurance company representative fixed that. More bills followed as the hospital kept trying to bill us incorrectly, over and over. After several phone calls I finally got somebody to admit to there being an error in their records. In the end we paid nothing. But, it took about a year and a half before we stopped receiving bills.
Through this experience I learned to never pay bills concerning which I had questions until after asking questions of all involved; any kind of error can and will happen and others in the system are too busy handling their (probably) relatively high intake of workflow to ask questions on their own or to suggest that you ask questions.
I agree with others that the US health care system is broken. It mostly serves the interests of providers, and not patients. It's not just the world's most expensive health care system, either, as it takes an inordinate amount of time to find and fix problems because of the number of parties involved.
Amazing!

Your perseverance paid off!

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goodenyou
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by goodenyou » Sat Aug 10, 2019 3:58 pm

Doctors who are not in network should refuse to provide services to hospitals unless they are indemnified by the hospital to pay for the services that the hospital has agreed to provide to in-network patients. The surgeon took emergency call knowing full well that patients could show up out of network. The in-network hospital should only have employed doctors taking call. If they don't have enough employed surgeons available, the patient should be diverted to a hospital that does. This way patients and doctors know the agreement before services rendered.

Texas has legislation pending that is trying to stop surprise billing. Only one hospital in our area has employed doctors in many specialties. The hospital loves it because they get all the emergencies and more revenue. The on-call employed doctor hates it. All the emergencies go there, and the non-employed community doctors at other hospitals don't have to take call at other hospitals. Being on-call is miserable.
"Ignorance more frequently begets confidence than does knowledge" | Do you know how to make a rain dance work? Dance until it rains.

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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Northern Flicker » Sat Aug 10, 2019 4:33 pm

This sometimes is called balance billing. Some states have tried to regulate or eliminate it, and NJ seems to have some legislation in place. It may be that the surgeon’s practice has not agreed to contracts with any insurance companies because they are unwilling to accept the payment level mandated by the insurance company.

The most important thing is not to pay the bill while you are negotiating. Sometimes people put a bill on their credit card to eliminate the concern about a negative credit event, and then try to negotiate. Once you pay it, you will lose all leverage.

I think a strong case can be made that this was emergency care, which must be processed as in-network care by the insurance company under ACA. You will not get a lower surgeon’s in-network fee because there is no such fee negotiated, but the fee will be applied to your in-network deductible and out-of-pocket maximum. This would be the first thing to do.

You also may check if the state insurance regulators have claims enforcement authority and file a complaint with them if so. If not, services of an attorney would be needed to challenge an unfavorable final claims decision.

Once these options are exhausted, if there is no remedy, then try to negotiate with the surgical practice. If they do not negotiate contractual charges with any networks, you may be out of luck, but if they are in some networks, just not yours, they may be willing to lower their fee to the contractual fee of a network they are a part of.

Good luck with this. It will be a time-consuming process.

toofache32
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by toofache32 » Sat Aug 10, 2019 8:15 pm

MrsBDG wrote:
Fri Aug 09, 2019 9:49 am
Once the insurance company has processed the claim, then, if they have rejected it, you ca file an appeal, in writing, pointing out that the hospital was in network and that you had no control over the network of the surgeon the hospital provided.
Such a double standard.

toofache32
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by toofache32 » Sat Aug 10, 2019 8:24 pm

Good Listener wrote:
Fri Aug 09, 2019 7:56 pm
burt wrote:
Fri Aug 09, 2019 5:16 pm
El Greco wrote:
Fri Aug 09, 2019 5:03 pm
I never thought I would say this but, I'm glad me and DW are going to be on Medicare soon. Our health system is a wreck.
+1
I am about 1 year away from Medicare.
Nervously waiting.
I agree. But some doctors are not in Medicare and the same situation could arise.
Medicare/Medicaid were the first insurance plans I dropped from my practice. These are usually the first plans dropped once a doctor gets established. The government plans are being relegated to institutional settings since they are no longer viable in private practices. Just too expensive.

toofache32
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by toofache32 » Sat Aug 10, 2019 8:56 pm

goodenyou wrote:
Sat Aug 10, 2019 3:58 pm
Doctors who are not in network should refuse to provide services to hospitals unless they are indemnified by the hospital to pay for the services that the hospital has agreed to provide to in-network patients. The surgeon took emergency call knowing full well that patients could show up out of network. The in-network hospital should only have employed doctors taking call. If they don't have enough employed surgeons available, the patient should be diverted to a hospital that does. This way patients and doctors know the agreement before services rendered.

Texas has legislation pending that is trying to stop surprise billing. Only one hospital in our area has employed doctors in many specialties. The hospital loves it because they get all the emergencies and more revenue. The on-call employed doctor hates it. All the emergencies go there, and the non-employed community doctors at other hospitals don't have to take call at other hospitals. Being on-call is miserable.
Be careful what you wish for. Many hospitals DO try to hire their own doctors, but most quit within a year after being treated like dirt. Have you seen those contracts? So it's a revolving door of new doctors while the old ones stay in town and flood the community. Every year the hospital dumps a new doctor of your specialty into the community and it's not long before it's over saturated. Happened here when our local hospital hired their own ENT. Now they have 5 new ENTs over 7 years. All the old ENTs are still in the community.

My surgical group met with the CEO of one of my hospitals to request payment for taking call. He said they have 59 specialties and only 7 are paid to take call. I told him they are about to have 58 specialties. So they paid us for about a year ($12.50 an hour) before sending us a letter that they will no longer pay us. So we told them we will no longer take call, they agreed.
Now I still get calls about once a week for a consult. I politely decline the consult and tell them to call their CEO to complain since he does not want our services at their hospital.

pyld76
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by pyld76 » Sat Aug 10, 2019 9:35 pm

As has been mentioned, the ACA and NJ law seem to be in your favor here. Pay nothing without an EOB, and frankly, at that amount, a consult with an attorney who does this stuff.

While you are doing that, name the doctor and/or call your local TV station’s consumer issues reporter. The “professionals” who engage in this kind of thing deserve some sunlight.

toofache32
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by toofache32 » Sat Aug 10, 2019 9:58 pm

pyld76 wrote:
Sat Aug 10, 2019 9:35 pm
While you are doing that, name the doctor and/or call your local TV station’s consumer issues reporter. The “professionals” who engage in this kind of thing deserve some sunlight.
...along with the insurance company who refuses to pay market rates. If insurance paid market rates, doctors would be lining up to accept their fees.

ENT Doc
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by ENT Doc » Sat Aug 10, 2019 10:21 pm

Legislation is going through Congress to address this issue. Hopefully a reasonable compromise can be found and it passes.

This isn’t as simple as “make a hospital employ all its doctors”. Some don’t find it advantageous to have an employed service line. Some specialties are notoriously not employed and are contracted with by the hospital (ER, Anesthesia). So no one should “force” a hospital to hire anyone, nor should a given group or individual be forced to be in network if they can’t reach a reasonable negotiated contract with insurers. But legislation provides an out whereby these billing situations get resolved by a third party.

As for the OP:
Don’t pay anything. The EOB and whatever you got from the surgeon will explain a lot. Looks like you may have an out due to the law in NJ. Explore that further and get everything in writing.

ENT Doc
Posts: 157
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by ENT Doc » Sat Aug 10, 2019 10:25 pm

pyld76 wrote:
Sat Aug 10, 2019 9:35 pm
As has been mentioned, the ACA and NJ law seem to be in your favor here. Pay nothing without an EOB, and frankly, at that amount, a consult with an attorney who does this stuff.

While you are doing that, name the doctor and/or call your local TV station’s consumer issues reporter. The “professionals” who engage in this kind of thing deserve some sunlight.
And why should the provider be called out exactly? They are billing the balance of what the insurer did not pay them. If they didn’t do this the insurance companies would have no incentive to negotiate for anything more than Medicare rates, which doesn’t keep the lights on.

Locked