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

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

Post by fru-gal » Sun Aug 11, 2019 12:24 am

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.
Medicare plus a Medigap policy is a wonderful thing.

Now if I weren't still paying thousands of dollars a year for prescriptions despite having a Plan D and if there were real dental insurance...

Cyanide123
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Cyanide123 » Sun Aug 11, 2019 3:06 am

BarbBrooklyn wrote:
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.
There are very few things more emergent than a leaking aortic aneurysm. If such a person leaves without a fix, there is a extremely high probability of dropping dead. Insurance saying "take him to a different hospital" is absolutely absurd. I wish someone would Sue the insurance companies that are dictating care. That aorta needs to be emergently repaired by the closest surgeon who is willing and able to fix it.

vested1
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by vested1 » Sun Aug 11, 2019 5:26 am

How bad can it get? A close family member had her 2nd child prematurely, checking into a hospital that had been removed from network without her being informed right before she checked in. She had serious complications, as did her child, and both had to stay in the hospital for several weeks. When the bill came it was over $350,000, which the insurance refused to pay because it was out of network.

The bill was eventually written off because neither her insurance nor the hospital informed her that she wasn't covered at that facility, which she only found out months after leaving the hospital. She gave them her insurance cards when she was admitted, and the admitting clerk missed it, which was fortunate for her as it turned out.

I had emergency surgery lately and was concerned that the various doctors (surgeon and anesthesiologist) wouldn't take Medicare. I was told that all the doctors who offered services at the hospital, the best in the area and one that accepts Medicare, were required to accept Medicare. Contrary to what has been stated upthread, these doctors are the finest in the area.

It sounds like the OP has grounds to dispute the bill. Good luck.

vested1
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by vested1 » Sun Aug 11, 2019 5:29 am

fru-gal wrote:
Sun Aug 11, 2019 12:24 am
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.
Medicare plus a Medigap policy is a wonderful thing.

Now if I weren't still paying thousands of dollars a year for prescriptions despite having a Plan D and if there were real dental insurance...
Agree. My wife's co-pay on a single prescription on Medicare part D is over $5,300 a year.

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

Post by goodenyou » Sun Aug 11, 2019 9:33 am

toofache32 wrote:
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.

I don't wish for it, but that has been the trend. It was to illustrate that taking voluntary call for the privilege of being abused is stupid. If you take call with the issue of network problems unresolved, you own it. The new generation of doctors will rue the day that they have given up all autonomy by aligning with hospitals. Yes, you are correct...this new employed relationship is not working out so well. Many employed doctors want to go beck to independence. I am one of those older ones in that community that you mention, and very glad that I am close to retiring.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

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

Post by Northern Flicker » Sun Aug 11, 2019 11:55 am

toofache32 wrote:
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.
There is no market to establish rates for emergency surgery. When someone needs it, a nearby available surgeon is engaged. It is not like the patient can wait to get competitive bids so that surgeons have to compete with each other for emergency procedures. That’s why the surgeon can choose not to be in network for insurance.

Doctors who provide service scheduled on a discretionary basis cannot afford to be out of insurance networks as they would not get much business, so competitive market rates do prevail for them.

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

Post by toofache32 » Sun Aug 11, 2019 2:31 pm

Northern Flicker wrote:
Sun Aug 11, 2019 11:55 am
toofache32 wrote:
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.
There is no market to establish rates for emergency surgery. When someone needs it, a nearby available surgeon is engaged. It is not like the patient can wait to get competitive bids so that surgeons have to compete with each other for emergency procedures. That’s why the surgeon can choose not to be in network for insurance.

Doctors who provide service scheduled on a discretionary basis cannot afford to be out of insurance networks as they would not get much business, so competitive market rates do prevail for them.
Of course emergency surgery fees can be negotiated ahead of time (with insurance) just like elective fees. But most insurance companies refuse to negotiate, especially if you're talking about Medicare/Medicaid. And now more and more insurance companies are using "narrow networks" where they refuse to enroll additional doctors into their plans, even if the doctors are willing. This is a great way to limit their costs and shift them to the patients.
I used to do those emergency surgeries but the pay was so bad I stopped. I am not the lowest bidder. I would do an emergent tracheostomy and I would get $162 from your beloved Medicare. I know women who pay that much for their hair every month.
Now I just do elective surgery. I'm not sure what you mean by "cannot afford to be out of insurance networks" because I am no longer in network with ANY insurance and am booked out for a few weeks. Quite the opposite of what you say...insurance was too expensive for me, combined with their low fees which sometimes are lower than the costs of providing the service. I can charge competitive rates because I no longer have to pay a room full of women to sit on the phone and argue with the insurance companies. The insurance is a bloated middle man that only serves to increase costs.
I have found the https://www.fairhealthconsumer.org/ rates to be accurate and on par with my fees.

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

Post by toofache32 » Sun Aug 11, 2019 4:21 pm

neilpilot wrote:
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.
Not exactly true. Doctors who "opt-out" of Medicare are not bound by this 15% rule.

https://www.medicareinteractive.org/get ... -providers

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

Post by JGoneRiding » Sun Aug 11, 2019 5:04 pm

vested1 wrote:
Sun Aug 11, 2019 5:29 am
fru-gal wrote:
Sun Aug 11, 2019 12:24 am
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.
Medicare plus a Medigap policy is a wonderful thing.

Now if I weren't still paying thousands of dollars a year for prescriptions despite having a Plan D and if there were real dental insurance...
Agree. My wife's co-pay on a single prescription on Medicare part D is over $5,300 a year.
You realize that that is because of the pharmaceutical company and not because of a failure if part d to work correctly

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

Post by Northern Flicker » Sun Aug 11, 2019 5:43 pm

Of course emergency surgery fees can be negotiated ahead of time (with insurance) just like elective fees. But most insurance companies refuse to negotiate, especially if you're talking about Medicare/Medicaid. And now more and more insurance companies are using "narrow networks" where they refuse to enroll additional doctors into their plans, even if the doctors are willing. This is a great way to limit their costs and shift them to the patients.
I used to do those emergency surgeries but the pay was so bad I stopped. I am not the lowest bidder. I would do an emergent tracheostomy and I would get $162 from your beloved Medicare.
The OP’s issue has nothing to do with Medicare (I suppose unless the surgeon is gouging the non-Medicare patients to compensate for low Medicare fees).

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

Post by SlowMovingInvestor » Sun Aug 11, 2019 6:53 pm

JackoC wrote:
Fri Aug 09, 2019 10:09 am
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.
it seems like self funded plans in NJ do not have to pay unless they opt in to arbitration. That may be because self funded plans are covered by Federal law, which pre-empts state law ?

But the member can still ask for arbitration between himself/herself and the provider.

Members of self-funded plans that do not opt in and providers - In the case of a self-funded plan, which does not elect to be subject to the claims processing and arbitration provisions of the Act, a covered person under that plan or an out-of-network health care provider may initiate arbitration, wherein the arbitrator will choose a final amount that the arbitrator determines is reasonable, which is binding on the covered person and the out-of-network health care provider, but not on the self-funded health benefits plan that did not opt-in to arbitration.


It also seems like NJ is similar to NY in that the arbitrator picks either the provider's offer or the other party's offer (member or plan). So that gives both sides an incentive to make 'fair' offers.

ADDED: Correcting myself, it seems like the arbitrator in NJ can pick a number on his/her own, and doesn't just have to pick a number from either side.
Last edited by SlowMovingInvestor on Sun Aug 11, 2019 8:32 pm, edited 1 time in total.

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

Post by toofache32 » Sun Aug 11, 2019 8:08 pm

Northern Flicker wrote:
Sun Aug 11, 2019 5:43 pm
Of course emergency surgery fees can be negotiated ahead of time (with insurance) just like elective fees. But most insurance companies refuse to negotiate, especially if you're talking about Medicare/Medicaid. And now more and more insurance companies are using "narrow networks" where they refuse to enroll additional doctors into their plans, even if the doctors are willing. This is a great way to limit their costs and shift them to the patients.
I used to do those emergency surgeries but the pay was so bad I stopped. I am not the lowest bidder. I would do an emergent tracheostomy and I would get $162 from your beloved Medicare.
The OP’s issue has nothing to do with Medicare (I suppose unless the surgeon is gouging the non-Medicare patients to compensate for low Medicare fees).
The insurance provider doesn't matter, you're missing the point.
Private insurance is only marginally better these days and getting worse every year.
This is why most physicians are now employed instead of owning their own private practice. Insurance is too expensive to deal with.

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

Post by Northern Flicker » Sun Aug 11, 2019 10:20 pm

The insurance provider doesn't matter, you're missing the point.
Private insurance is only marginally better these days and getting worse every year.
I didn’t miss the point. You chose not to make the point, instead using Medicare-level reimbursement as an example to try to show how terribly low in-network private insurance fees are.

The doctors who choose not to be in any networks always seem to practice in a specialty where the patient typically has no input into the choice of the doctor.

It is often not the higher fee that is the problem for the patient, but that out-of-network care does not apply to in-network deductibles and out-of-pocket maximums. This makes it akin to not having insurance at all for the out-of-network care. Our current insurance will not cover out-of-network care at all. Our previous insurance did, but when the out-of-network deductible rose to $52,000/family, we stopped paying extra for a plan with out-of-network benefits at that enrollment.

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

Post by tarmangani » Mon Aug 12, 2019 12:24 am

Northern Flicker wrote:
Sun Aug 11, 2019 10:20 pm
The insurance provider doesn't matter, you're missing the point.
Private insurance is only marginally better these days and getting worse every year.
I didn’t miss the point. You chose not to make the point, instead using Medicare-level reimbursement as an example to try to show how terribly low in-network private insurance fees are.

The doctors who choose not to be in any networks always seem to practice in a specialty where the patient typically has no input into the choice of the doctor.

It is often not the higher fee that is the problem for the patient, but that out-of-network care does not apply to in-network deductibles and out-of-pocket maximums. This makes it akin to not having insurance at all for the out-of-network care. Our current insurance will not cover out-of-network care at all. Our previous insurance did, but when the out-of-network deductible rose to $52,000/family, we stopped paying extra for a plan with out-of-network benefits at that enrollment.
Indeed. For those interested in this subject, I'd recommend this outstanding paper from Cooper et al.: https://www.nber.org/papers/w23623.pdf

"In this way, physicians in high demand or with few substitutes are able to command higher prices, a characteristic of functioning labor markets. By contrast, because they are part of a wider bundle of hospital care and cannot be avoided once the hospital choice is made, ED physicians (and other specialist physicians like radiologists, pathologists) face inelastic demand from patients and will not see a reduction in their patient volume if they fail to negotiate contracts with insurers."

MikeG62
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by MikeG62 » Mon Aug 12, 2019 6:25 am

Northern Flicker wrote:
Sun Aug 11, 2019 10:20 pm

It is often not the higher fee that is the problem for the patient, but that out-of-network care does not apply to in-network deductibles and out-of-pocket maximums. This makes it akin to not having insurance at all for the out-of-network care. Our current insurance will not cover out-of-network care at all. Our previous insurance did, but when the out-of-network deductible rose to $52,000/family, we stopped paying extra for a plan with out-of-network benefits at that enrollment.
It is this that worries me the most about our health insurance policy/coverage.
Real Knowledge Comes Only From Experience

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

Post by IngognitoUSA » Mon Aug 12, 2019 6:45 am

Will be interested to know how this turns out.

I think balance billing is no longer allowed in NJ.

And the next over billing strategy has been air ambulance, would be good to know if anyone had recent experience.

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

Post by sawhorse » Mon Aug 12, 2019 7:14 am

IngognitoUSA wrote:
Mon Aug 12, 2019 6:45 am
And the next over billing strategy has been air ambulance, would be good to know if anyone had recent experience.
Certainly not these people.

https://abcnews.go.com/US/sky-rage-bill ... d=37669153

https://www.consumerreports.org/medical ... or-a-ride/

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

Post by bertilak » Mon Aug 12, 2019 8:16 am

To answer based on my own direct experience: Yes, you can negotiate, at least with the doctor.

I had a minor operation and the surgeon tacked on a substantial extra charge for an assistant surgeon. Insurance rejected it because the operation was not listed as one requiring an assistant. Upon talking to the doctor I found out that the "assistant" was a recent graduate satisfying his residency requirement. I said I didn't want to pay for some future doctor's education. The charge was dropped.

The morals:
1. Be sure you know the details of what you are being charged for.
2. You CAN negotiate if you have a reasonable cause.
May neither drought nor rain nor blizzard disturb the joy juice in your gizzard. -- Squire Omar Barker, the Cowboy Poet

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

Post by Prahasaurus » Mon Aug 12, 2019 8:21 am

The amount of money wasted in the US healthcare industry on inefficient admin is just staggering. It is such a major drag on our economy. Having to closely follow if a doctor or lab is “within your network” during a medical emergency is just insane. As an American who has lived many years in Europe, it just all boggles my mind Americans continue to accept this. But whatever.

I hope you work this out, OP. Sorry for this stress.

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

Post by CoastalWinds » Mon Aug 12, 2019 8:51 am

Prahasaurus wrote:
Mon Aug 12, 2019 8:21 am
The amount of money wasted in the US healthcare industry on inefficient admin is just staggering. It is such a major drag on our economy. Having to closely follow if a doctor or lab is “within your network” during a medical emergency is just insane. As an American who has lived many years in Europe, it just all boggles my mind Americans continue to accept this. But whatever.

I hope you work this out, OP. Sorry for this stress.
It boggles my mind too. The system is completely broken and it is obvious for all with eyes and brains to see. But those who profit off the current system only have to call the alternative ”government-provided” healthcare and a large swath of people freak out.

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

Post by dm200 » Mon Aug 12, 2019 9:34 am

Prahasaurus wrote:
Mon Aug 12, 2019 8:21 am
The amount of money wasted in the US healthcare industry on inefficient admin is just staggering. It is such a major drag on our economy. Having to closely follow if a doctor or lab is “within your network” during a medical emergency is just insane. As an American who has lived many years in Europe, it just all boggles my mind Americans continue to accept this. But whatever.
I hope you work this out, OP. Sorry for this stress.
Yes - in my opinion, as well.

It is also my opinion, that there are many and varied causes. I believe, to make it better, each of the "causes" needs to be addressed.

One cause, I believe, that I have certainly experienced is "defensive" type things Physicians order and do that "protect" them from lawsuits, etc. As patients, we often have no idea whether such, often expensive, tests are really needed. As a layperson, the one that really sticks in my mind is that before he would do droopy eyelid surgery, the Ophthalmologist insisted on a CT scan of my eye socket to make sure that my slightly protruding eyeball was not caused by a brain tumor pushing behind my eye.

Another cause, in my opinion, is the, often reasonable and justifiable from the Physician's viewpoint, of office visits, tests, etc. because an equally good process for the patient would not provide any compensation to the Physician. I do notice that, somehow, my Kaiser Medicare plan has been able to figure out a way that Physicians can do many things by email, telephone conversations with patients, and extending the followup in person followup appointments. They also are able to have, for some kinds of specialties, the specialist review not requiring an in person visit with the specialist. In my case, the two specialties where this is being done is cardiology and hematology. In several cases, I have contacted a Physician about an issue and the Physician has ordered test(s) and fully dealt with the issue without my seeing him/her in person. I tend to believe that these kinds of things significantly reduce costs - without any adverse impact on my health or health risks.

In most cases, Physicians are compensated for "doing" things - and not on keeping patients healthy.

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

Post by JackoC » Mon Aug 12, 2019 10:16 am

tarmangani wrote:
Mon Aug 12, 2019 12:24 am
Northern Flicker wrote:
Sun Aug 11, 2019 10:20 pm
The insurance provider doesn't matter, you're missing the point.
Private insurance is only marginally better these days and getting worse every year.
I didn’t miss the point. You chose not to make the point, instead using Medicare-level reimbursement as an example to try to show how terribly low in-network private insurance fees are.

The doctors who choose not to be in any networks always seem to practice in a specialty where the patient typically has no input into the choice of the doctor.

It is often not the higher fee that is the problem for the patient, but that out-of-network care does not apply to in-network deductibles and out-of-pocket maximums. This makes it akin to not having insurance at all for the out-of-network care. Our current insurance will not cover out-of-network care at all. Our previous insurance did, but when the out-of-network deductible rose to $52,000/family, we stopped paying extra for a plan with out-of-network benefits at that enrollment.
Indeed. For those interested in this subject, I'd recommend this outstanding paper from Cooper et al.: https://www.nber.org/papers/w23623.pdf

"In this way, physicians in high demand or with few substitutes are able to command higher prices, a characteristic of functioning labor markets. By contrast, because they are part of a wider bundle of hospital care and cannot be avoided once the hospital choice is made, ED physicians (and other specialist physicians like radiologists, pathologists) face inelastic demand from patients and will not see a reduction in their patient volume if they fail to negotiate contracts with insurers."
Important point, and it's not to go back on what I said earlier about not getting bogged down in (pseudo)-moralizing about doctors, hospitals, insurance...or patients who resist paying high bills they didn't agree to upfront.

Particular doctors are out of particular networks for a reason, and it needn't be exaggerated as 'they couldn't feed their families at the insurance rates'. It's because they believe they can make more money OON, in particular situations of specialty. It's a business, and doctors are business people (which doesn't exclude them also having non-monetary aka 'higher' motives, or some having only non-monetary motives). But it's a business with lots of restrictions on competition, some of them inherent, some of which perhaps could be addressed. And lots of cases where public policy limits what people have to pay, even as things are. This isn't to propose or debate the all-in public policy 'solution' to the health care issue in the US, which we're not supposed to do here. It's just to reiterate that the individual patient in the existing system can and should negotiate medical bills vigorously when they feel it's appropriate, including getting the authorities involved if that helps (which might be applicable in this case, under NJ law). There's nothing magic even about a out of pocket charge at the insurance rate, let alone one like this. Even for those you can ask for a discount, and IME you usually get one in return for immediate payment. Which you also have to weigh against your ongoing relationship with the provider, like any other business transaction. But that's what it is, business.

Not that a big donnybrook is required in every case. In this case I agree with the advice to let the dust settle*, before consulting a lawyer on how the NJ law applies. But even in initial discussions you might ask what the ins co or doctor's office thinks is the implication of that law wrt this bill.

*Two years ago (in NJ but prior to that law) I had an endoscopy. I asked the Dr specifically if it would in network and she said it would be. Later I got an Explanation of Benefits from Horizon Blue Cross saying there would be a ~$10k :shock: subscriber due amount for the facility, which turned out OON (I was supposed to know that how?) plus the Dr's in-network charge. But the facility never sent me a bill, at all. Whether that was the outcome of a fight between Dr and facility given her representation to me, or just some billing screw up, I don't know. OP's case is further along since an actual huge bill received, and just hoping it goes away is not IMO a wise course, but the negotiation to get it drastically reduced might or might not be a big fight.

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

Post by sawhorse » Mon Aug 12, 2019 10:19 am

bertilak wrote:
Mon Aug 12, 2019 8:16 am
To answer based on my own direct experience: Yes, you can negotiate, at least with the doctor.

I had a minor operation and the surgeon tacked on a substantial extra charge for an assistant surgeon. Insurance rejected it because the operation was not listed as one requiring an assistant. Upon talking to the doctor I found out that the "assistant" was a recent graduate satisfying his residency requirement. I said I didn't want to pay for some future doctor's education. The charge was dropped.

The morals:
1. Be sure you know the details of what you are being charged for.
2. You CAN negotiate if you have a reasonable cause.
One man's surprise bill was from an "assistant surgeon" who charged him $117k and then had his lawyers go after the patient.

https://www.nytimes.com/2014/09/21/us/d ... bills.html

If you don't have a subscription, here is a summary of the main story.

http://www.hngn.com/articles/43148/2014 ... -costs.htm

Here are some excerpts. The article is much longer, and I encourage you to read the full article.

"Two plastic surgeons billed more than $250,000 to sew up the incision, a task done by a resident during previous operations for Ms. Kaufman’s chronic neurological condition. ... Doctors’ offices often pursue patients for payment. Ms. Kaufman’s insurer paid about $10,000 to the plastic surgeons, who then sent a bill for the remainder. "

"The hospital sent his blood tests to an out-of-network lab and required him to have an echocardiogram (eventually billed for $950), even though he had no cardiac history. (The American Society of Echocardiography discourages such testing for patients with no known heart problems.)"

" “The idea of having an assistant in the O.R. has become an opportunity to make up for surgical fees that have been slashed,” said Dr. Abeel A. Mangi, a professor of cardiac surgery at Yale, who said the practice had become commonplace."

"Dr. Mangi, the Yale cardiac surgeon, said hospitals often encouraged extra visits for both billing and legal reasons. He said he was required to request a physical therapy consult before each discharge, for example, even if he felt there was no need.

“You can cut fees, but institutions find ways” to make the money back, he said. “There’s been a mushrooming industry of mandatory consultants for services that neither doctors nor patients want.” "

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

Post by sawhorse » Mon Aug 12, 2019 10:31 am

tarmangani wrote:
Mon Aug 12, 2019 12:24 am
Indeed. For those interested in this subject, I'd recommend this outstanding paper from Cooper et al.: https://www.nber.org/papers/w23623.pdf

"In this way, physicians in high demand or with few substitutes are able to command higher prices, a characteristic of functioning labor markets. By contrast, because they are part of a wider bundle of hospital care and cannot be avoided once the hospital choice is made, ED physicians (and other specialist physicians like radiologists, pathologists) face inelastic demand from patients and will not see a reduction in their patient volume if they fail to negotiate contracts with insurers."
Thanks for the paper. Yes, most surprise out-of-network bills arise when the patient is unconscious, in an emergency situation, and/or hospitalized. Not just with doctors but also with tests and ambulances.

You rarely see surprise out-of-network bills from doctors who do solely outpatient consults. However, in those situations you can be hit with a massive out-of-network lab fee. Like a $17,850 bill for mandatory urine drug testing that insurance valued at $101.

https://www.npr.org/sections/health-sho ... prise-bill

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

Post by HomeStretch » Mon Aug 12, 2019 10:55 am

OP - any update? Did you check for an “Explanation of Benefits” (EOB) online since you posted to see how the EOB patient payment amount compares to the amount billed by the provider? Hopefully, the provider bill was sent to you before the EOB was processed and the bill just needs to be adjusted.

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

Post by bertilak » Mon Aug 12, 2019 10:57 am

sawhorse wrote:
Mon Aug 12, 2019 10:19 am
One man's surprise bill was from an "assistant surgeon" who charged him $117k and then had his lawyers go after the patient.
So i guess my situation was not an isolated case. In my case, being called on it was enough to get the charge dropped.
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Re: Received a $17,000 medical bill! Can we negotiate?

Post by Prahasaurus » Mon Aug 12, 2019 11:22 am

dm200 wrote:
Mon Aug 12, 2019 9:34 am
One cause, I believe, that I have certainly experienced is "defensive" type things Physicians order and do that "protect" them from lawsuits, etc.
Sure, it's a factor, but a relatively small factor. It's all rather easy. Look at EVERY healthcare system in other developed countries. EVERY one. Canada. France. Whatever. Pick any developed country. They all do one thing that America refuses to do. Address that one thing and you have a solution to this. It's a political solution, full stop.

The ridiculous healthcare system is one reason - the main reason - I'm still in Europe. I have my own company and it's just too expensive for me to do what I do from the USA at this time, since my healthcare costs would be crazy. And I'd alway worry about what happened to the OP: Surprise! You have a 17k USD bill! Ha, ha, ha! Sucker!

That would never happen in Europe.

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

Post by EnjoyTheJourney » Mon Aug 12, 2019 11:25 am

I found a couple of resources that might help the OP:

First, the name of the law passed in 2018 is the "New Jersey Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act". You can search for more information about that law and what it means.

Second, here is a link to a law firm's take on the law mentioned above:

https://www.csglaw.com/new-jerseys-outo ... ns-for-you

The new law makes things quite a bit better than they were before for patients. So, the OP might be in good shape after asking some questions.

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

Post by dm200 » Mon Aug 12, 2019 1:13 pm

The US practice of commonly linking health insurance coverage to employers (to me) makes no sense and, also in my opinion, contributes to the medical/health cost problem.

I was chatting with an acquaintance who seems very familiar with the US history of health/medical insurance - and he told me this was done during World War II to get around wage and price controls. Employers were restricted from paying more in wages and salaries - so they looked for added benefits that would not be counted.

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

Post by DarkHelmetII » Mon Aug 12, 2019 1:42 pm

from a .gov source https://www.healthcare.gov/using-market ... ency-care/:

"Insurance plans can’t make you pay more in copayments or coinsurance if you get emergency care from an out-of-network hospital. They also can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network."

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

Post by Northern Flicker » Mon Aug 12, 2019 2:26 pm

“Insurance plans can’t make you pay more in copayments or coinsurance if you get emergency care from an out-of-network hospital. They also can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network."
Correct. But if a patient is admitted to a hospital from an emergency room for continued treatment, there can be a disagreement about when emergency care ends and when non-emergency care begins. This is at the core of the OP’s issue. If the out-of-network surgeon’s procedure is viewed as part of addressing the emergency then the charge won’t be at in-network level, but any amount over the in-network deductible would be subject to reimbursement and any amount over in-network out-of-pocket maximum would be reimbursed in full.

Policies have separate OOP maximums for out-of-network care and they can be high or in some cases there is no maximum, or there may be no out-of-network coverage at all. Paying the out-of-network fee level but having it covered as an in-network service usually would not be a problem because a hospitalization is usually sufficient to hit one’s in-network out-of-pocket maximum.

Kaiser is one insurer that has addressed this issue. All care that occurs in a Kaiser facility will always be in-network for Kaiser. In emergency situations at a non-Kaiser facility, the patient or a representative of the patient contacts Kaiser within 24 hours or as soon as possible after the start of receiving emergency care at a non-Kaiser facility and if it is not medically feasible/advisable for the patient to be moved to a Kaiser facility, Kaiser will approve all of the care as being in-network.

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

Post by bertilak » Mon Aug 12, 2019 3:03 pm

dm200 wrote:
Mon Aug 12, 2019 1:13 pm
The US practice of commonly linking health insurance coverage to employers (to me) makes no sense and, also in my opinion, contributes to the medical/health cost problem.

I was chatting with an acquaintance who seems very familiar with the US history of health/medical insurance - and he told me this was done during World War II to get around wage and price controls. Employers were restricted from paying more in wages and salaries - so they looked for added benefits that would not be counted.
I believe that's it. Once we had a benefit that was not taxed it was hard to break away. Companies could afford to pay more than individuals could since they were subsidised by tax breaks due ability to write it off as an expense and individuals got the equivalent of untaxed income in the form of health benefits. Some kind of vicious circle or unintended consequences or something like that!
May neither drought nor rain nor blizzard disturb the joy juice in your gizzard. -- Squire Omar Barker, the Cowboy Poet

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

Post by sawhorse » Mon Aug 12, 2019 7:11 pm

bertilak wrote:
Mon Aug 12, 2019 8:16 am
I had a minor operation and the surgeon tacked on a substantial extra charge for an assistant surgeon. Insurance rejected it because the operation was not listed as one requiring an assistant. Upon talking to the doctor I found out that the "assistant" was a recent graduate satisfying his residency requirement. I said I didn't want to pay for some future doctor's education. The charge was dropped.
I'm amazed this was even legal. I thought that residents are all on salary, and their training is subsidized by the government. I never knew that residents can bill separately for services.

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

Post by toofache32 » Mon Aug 12, 2019 7:46 pm

dm200 wrote:
Mon Aug 12, 2019 9:34 am
Prahasaurus wrote:
Mon Aug 12, 2019 8:21 am
The amount of money wasted in the US healthcare industry on inefficient admin is just staggering. It is such a major drag on our economy. Having to closely follow if a doctor or lab is “within your network” during a medical emergency is just insane. As an American who has lived many years in Europe, it just all boggles my mind Americans continue to accept this. But whatever.
I hope you work this out, OP. Sorry for this stress.
One cause, I believe, that I have certainly experienced is "defensive" type things Physicians order and do that "protect" them from lawsuits, etc. As patients, we often have no idea whether such, often expensive, tests are really needed. As a layperson, the one that really sticks in my mind is that before he would do droopy eyelid surgery, the Ophthalmologist insisted on a CT scan of my eye socket to make sure that my slightly protruding eyeball was not caused by a brain tumor pushing behind my eye.
So you're saying that if a brain tumor was discovered later that could have been detected earlier with a simple xray, you would not be angry with your doctor?

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

Post by toofache32 » Mon Aug 12, 2019 7:50 pm

sawhorse wrote:
Mon Aug 12, 2019 7:11 pm
bertilak wrote:
Mon Aug 12, 2019 8:16 am
I had a minor operation and the surgeon tacked on a substantial extra charge for an assistant surgeon. Insurance rejected it because the operation was not listed as one requiring an assistant. Upon talking to the doctor I found out that the "assistant" was a recent graduate satisfying his residency requirement. I said I didn't want to pay for some future doctor's education. The charge was dropped.
I'm amazed this was even legal. I thought that residents are all on salary, and their training is subsidized by the government. I never knew that residents can bill separately for services.
They can't. This was most likely a fellow. My fellows bill for their portion of the surgery.

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

Post by crystalbank » Mon Aug 12, 2019 7:57 pm

dm200 wrote:
Mon Aug 12, 2019 1:13 pm
...
The US practice of commonly linking health insurance coverage to employers (to me) makes no sense and, also in my opinion, contributes to the medical/health cost problem.
...
Absolutely. It is also a huge pain for self employed.

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

Post by Broken Man 1999 » Tue Aug 13, 2019 4:10 pm

I am perfectly happy to have had free insurance from MegaCorp for the last 20 years. My first 26 years as an active employee saw us paying a pittance for Cadillac insurance.

So, employee insurance can be a beautiful thing.

Now retired, we pay only the $134.50 Medicare Part B.

Many federal/state/municipal governmental health plans are great, even today.

No complaints from us. But both of us always worked for companies with great insurance. Not everyone is/was so fortunate.

When my brother worked for my father, providing brother and his family insurance was a PIA, and an expensive PIA. Expensive, and crap coverage as well. :(

Broken Man 1999

ETA: OP, what is your insurance telling you about the claim? Any movement?
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

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

Post by dm200 » Wed Aug 14, 2019 8:37 am

toofache32 wrote:
Mon Aug 12, 2019 7:46 pm
dm200 wrote:
Mon Aug 12, 2019 9:34 am
Prahasaurus wrote:
Mon Aug 12, 2019 8:21 am
The amount of money wasted in the US healthcare industry on inefficient admin is just staggering. It is such a major drag on our economy. Having to closely follow if a doctor or lab is “within your network” during a medical emergency is just insane. As an American who has lived many years in Europe, it just all boggles my mind Americans continue to accept this. But whatever.
I hope you work this out, OP. Sorry for this stress.
One cause, I believe, that I have certainly experienced is "defensive" type things Physicians order and do that "protect" them from lawsuits, etc. As patients, we often have no idea whether such, often expensive, tests are really needed. As a layperson, the one that really sticks in my mind is that before he would do droopy eyelid surgery, the Ophthalmologist insisted on a CT scan of my eye socket to make sure that my slightly protruding eyeball was not caused by a brain tumor pushing behind my eye.
So you're saying that if a brain tumor was discovered later that could have been detected earlier with a simple xray, you would not be angry with your doctor?
This was not a "simple X-Ray", but a CT scan of my eye socket. My "guess" is that this exposure to the X-Rays from the CT scan may have increased my risk of some kind of cancer there more than the risk of having a brain tumor.

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

Post by toofache32 » Wed Aug 14, 2019 8:43 am

dm200 wrote:
Wed Aug 14, 2019 8:37 am
toofache32 wrote:
Mon Aug 12, 2019 7:46 pm
dm200 wrote:
Mon Aug 12, 2019 9:34 am
Prahasaurus wrote:
Mon Aug 12, 2019 8:21 am
The amount of money wasted in the US healthcare industry on inefficient admin is just staggering. It is such a major drag on our economy. Having to closely follow if a doctor or lab is “within your network” during a medical emergency is just insane. As an American who has lived many years in Europe, it just all boggles my mind Americans continue to accept this. But whatever.
I hope you work this out, OP. Sorry for this stress.
One cause, I believe, that I have certainly experienced is "defensive" type things Physicians order and do that "protect" them from lawsuits, etc. As patients, we often have no idea whether such, often expensive, tests are really needed. As a layperson, the one that really sticks in my mind is that before he would do droopy eyelid surgery, the Ophthalmologist insisted on a CT scan of my eye socket to make sure that my slightly protruding eyeball was not caused by a brain tumor pushing behind my eye.
So you're saying that if a brain tumor was discovered later that could have been detected earlier with a simple xray, you would not be angry with your doctor?
This was not a "simple X-Ray", but a CT scan of my eye socket. My "guess" is that this exposure to the X-Rays from the CT scan may have increased my risk of some kind of cancer there more than the risk of having a brain tumor.
Sorry I should have said "readily available" xray. So you still would not be upset? Upset patients tend to sue.

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

Post by dm200 » Wed Aug 14, 2019 9:03 am

toofache32 wrote:
Wed Aug 14, 2019 8:43 am
dm200 wrote:
Wed Aug 14, 2019 8:37 am
toofache32 wrote:
Mon Aug 12, 2019 7:46 pm
dm200 wrote:
Mon Aug 12, 2019 9:34 am
Prahasaurus wrote:
Mon Aug 12, 2019 8:21 am
The amount of money wasted in the US healthcare industry on inefficient admin is just staggering. It is such a major drag on our economy. Having to closely follow if a doctor or lab is “within your network” during a medical emergency is just insane. As an American who has lived many years in Europe, it just all boggles my mind Americans continue to accept this. But whatever.
I hope you work this out, OP. Sorry for this stress.
One cause, I believe, that I have certainly experienced is "defensive" type things Physicians order and do that "protect" them from lawsuits, etc. As patients, we often have no idea whether such, often expensive, tests are really needed. As a layperson, the one that really sticks in my mind is that before he would do droopy eyelid surgery, the Ophthalmologist insisted on a CT scan of my eye socket to make sure that my slightly protruding eyeball was not caused by a brain tumor pushing behind my eye.
So you're saying that if a brain tumor was discovered later that could have been detected earlier with a simple xray, you would not be angry with your doctor?
This was not a "simple X-Ray", but a CT scan of my eye socket. My "guess" is that this exposure to the X-Rays from the CT scan may have increased my risk of some kind of cancer there more than the risk of having a brain tumor.
Sorry I should have said "readily available" xray. So you still would not be upset? Upset patients tend to sue.
If the eye surgeon (Ophthalmologist) did not inform me of such a possibility, and, later, I had a brain tumor - I doubt I would even have known it could have been detected with a CT scan and that the "eyeball protrusion" was even detected.

If every one of us went to the expense of such scans, probes, extensive tests of our entire bodies now, there would certainly be some number of us where some, potentially deadly, condition is detected and medical intervention would save our lives. On the other hand, more than offsetting the number of us whose lives are saved - are those who are harmed by such invasive tests and have "false positives" result in more harmful invasive procedures and tests. So, in this situation, there would be a large expense to the whole process with a, net, of worsening of death rates and quality of life. The real "winners" financially, in such a scenario are the healthcare providers.

A real "challenge" for patients is discerning the net risks - and even if we (as lay persons) could make such a "discernment" - how to avoid unnecessary tests.

As I have posted elsewhere, relating to another health situation of mine, one Cardiologist pressed my PCP for another CT angiogram of my heart while another cardiologist recommended only an echo-cardiogram. Neither Cardiologist saw me in-person, but reviewed my records and previous tests. My PCP was "in the middle" and I did not want an unnecessary CT X-Ray exposure. We (my PCP and I) resolved the issue (to my satisfaction) by making an in-person office visit to the Cardiologist that recommended the echo-cardiogram only.

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

Post by JGoneRiding » Wed Aug 14, 2019 1:07 pm

bertilak wrote:
Mon Aug 12, 2019 3:03 pm
dm200 wrote:
Mon Aug 12, 2019 1:13 pm
The US practice of commonly linking health insurance coverage to employers (to me) makes no sense and, also in my opinion, contributes to the medical/health cost problem.

I was chatting with an acquaintance who seems very familiar with the US history of health/medical insurance - and he told me this was done during World War II to get around wage and price controls. Employers were restricted from paying more in wages and salaries - so they looked for added benefits that would not be counted.
I believe that's it. Once we had a benefit that was not taxed it was hard to break away. Companies could afford to pay more than individuals could since they were subsidised by tax breaks due ability to write it off as an expense and individuals got the equivalent of untaxed income in the form of health benefits. Some kind of vicious circle or unintended consequences or something like that!
Law of unintended consequences. The problem is in every other developed country doctors are paid a tiny amount compared to US docs and drug companies profits are controlled. If we want free health care for all we have to be willing to live with those consequences too.

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

Post by prudent » Wed Aug 14, 2019 1:16 pm

Topic is locked (derailed).

OP, if you want to respond to this thread to share the resolution of your problem, PM a moderator.

-moderator prudent

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