Arguing down medical bills

So, most of the bills have finally rolled in from my ruptured Achilles' tendon. For the most part it's ended up far less painful than I was expecting based on the initial claims- but there are a few particular bills that I think it's only fair to be fighting to get reduced because they're patently ridiculous. The most notable one being for the ER doctor who saw me for like 5 minutes tops- despite the hospital I was in being in-network, the doctor as out-of-network and the bill they sent is only about a $100 less than what the doctor who did the surgery to repair the tendon charged.

The problem I have is how exactly do I go about trying to do this? Just call up the customer service number on the bill and say, "How about you knock half off this bill and I send you a check today instead of setting up a payment plan and things dragging out?"

Most ED physicians are not hospital employees. They are contracted labor. Here's the problem, even though they may have "only" saw you face to face for "5 minutes", they just like the nursing staff, are waiting in the test results to come back for a definitive diagnosis. Realistically, that doc prolly has over an hour of their time invested to make sure the appropriate tests are ordered, carried out in a timely manner, and reviewed the results. This is on top of the time to dictate your chart for transcription and made available to you afterwards in printed form.

As to reduction in payments, call them. All they can say is no.

I would imagine that would be the best way to start.

I mentioned in another thread earlier this year about my billing scenario. Imaging company sent me a bill for $1,995 (not including my $50 co-pay) for an MRI that should have been covered by my insurance. Called my insurance company and they put me on a 3-way call with the imaging company. That's where I found that the insurance company had already sent a check for $450 to cover the MRI. My cost would be $2K, but they only wanted $450 from insurance?

In other words, there is a E36 M3-ton of wiggle room in billing. Sometimes you just have to ask.

I've accrued late charges from credit cards, cable companies, and mortgages that were easily waived by a simple phone call. No begging and pleading, just asked them to make it go away, and they always did.

I went to the ER and was then admitted for tests. Ten bills came my way from the many doctors, hospital, and labs.

I called and was honest and told them I didn't have the $2500 my insurance didn't cover. Can we do a payment plan? Most all said yes and the best was the hospital that told me to make a $35 monthly payment until done.

I work for an insurance company. Always, always, make sure each provider who treats you, not just the facility, is in network.

OP: not sure who you use, but many companies pay for all emergency room treatment regardless of network. Is your insurance company aware the doc was treating you in an ER context?

I've got nothing to add on the OP's post but I will take this opportunity to share my billing nightmare.

After my head-on collision last October I have over $600K in bills from 3 different hospitals and 4 different stays plus out and in-patient PT. You want to talk about an accounting nightmare? Because it was an accident it all had to be routed through my auto insurance ($10K medical coverage) and then passed on to my health care provider who paid for everything else per my wife's policy.

My auto policy and offending driver's policy paid out the max of their policy limits. Yeah! Now our health insurance provider is coming after that money under their subrogation clause. Boo! AND I get to go under the knife next Friday to most likely have my small intestine re-sectioned from trauma from the accident which hasn't healed and is getting worse. I'm so over this E36 M3 especially as the other driver walked free and clear. Rant off. Sorry for that.

Your insurance will tell you, and rightfully so, to take it up with the docs. Start with the hospital billing dept.

Datsun310Guy wrote: I went to the ER and was then admitted for tests. Ten bills came my way from the many doctors, hospital, and labs. I called and was honest and told them I didn't have the $2500 my insurance didn't cover. Can we do a payment plan? Most all said yes and the best was the hospital that told me to make a $35 monthly payment until done.

In my experience, none of them wanted to play ball with anything resembling reasonable until I contacted them a week prior to the "We'll send you to collections" nonsense. Seriously, they went from "600/mo for 6 months" to "60/mo for 60 months" berkeleying morons.

My mom has had a lot of medical bills and how she did it was this:

She told them they had to accept low payments or recieve nothing. It worked everytime for her. And they usually cut the bill a bit

There is a legal doctrine that allows you to dispute a bill, and to then send a payment you believe is representative of the value of the services rendered. The payment must be clearly identified as such, and must include clear language indicating you are sending this payment as payment in full.

If the party accepts that payment, the whole deal is done. If they reject it, the negotiations continue.

WOW Really Paul? wrote:

Datsun310Guy wrote: I went to the ER and was then admitted for tests. Ten bills came my way from the many doctors, hospital, and labs. I called and was honest and told them I didn't have the $2500 my insurance didn't cover. Can we do a payment plan? Most all said yes and the best was the hospital that told me to make a $35 monthly payment until done.

In my experience, none of them wanted to play ball with anything resembling reasonable until I contacted them a week prior to the "We'll send you to collections" nonsense. Seriously, they went from "600/mo for 6 months" to "60/mo for 60 months" berkeleying morons.

Problem is sometimes its difficult to know when you are that one week away from going to collections. We got sent to collections once without ever having gotten a bill.

I asked my hospital if we qualified for reduced payment. Turns out, we were eligible for a 50% reduction, we just had to fill out the paperwork. Took about an hour of paperwork and an hour of phone calls. Then the bill was sent to a credit card agency (basically) who gives us zero percent interest. We'll have the 60 month term paid off in about a year.

Ask everybody for debt reduction, and pay something. You'll "earn" more per hour getting bills reduced than you will going to work, so take a day off here and there to do this. Write notes about everybody and every conversation.

In reply to spitfirebill:

Mine thankfully were great about sending notices, they have however been complete E36 M3 at sending me the paid in full receipts I need to submit to my secondary provider for reimbursement. FML

Will wrote: I work for an insurance company. Always, always, make sure each provider who treats you, not just the facility, is in network. OP: not sure who you use, but many companies pay for all emergency room treatment regardless of network. Is your insurance company aware the doc was treating you in an ER context?

This is the first time either myself or SWMBO have ever really had anything happen that is this complex. It never remotely crossed our minds to have to ask at every step whether every component of the service was in-network. From a hassle standpoint it would have been far less to have risked driving the extra few miles to the hospital where my PCP is- but it would have been a definite risk to make that drive with my ankle out of commission AND it sounds like the Ortho I would have ended up with might not have used as advanced of a technique as the one I did get liked to use- so my recovery could have taken almost twice as long.

My (current, will change next year as my employer was sold by our former umbrella company to a different one) insurance is through Cigna. I'm not aware of them paying for all emergency room treatment- they knocked the bill down a fair bit from the hospital itself for what they did, but I was still on the hook for about $1k for the visit (before the doctor's bill).

Looking at the EOB for this charge, there's no indication as to what it was submitted as. It does surprise me that there was no adjustment on the bill at all (everything else, even the other out-of-network charges, has been knocked down by the insurance). I guess I'll start with calling them up and asking and if necessary starting the appeal process for it.

I know from experience that if you start asking questions about insurance networks and cost of service in an ER they will look at you like you are some sort of lunatic and generally won't be able to give you any answers... (and trust me, I merely broached the subject, I wasn't actually acting like a lunatic nor demanding answers)

This clusterberkeley is why I've long been saying the focus on health insurance is a red herring to distract us form the real healthcare issue which is the cost and billing practices of providers, especially hospitals. There is a reason we pay more for equivalent services here than anywhere else in the world, even places with better health outcomes. The business model is severely broken. In what other service industry does anyone blindly agree to submit to an open ended agreement in which someone will do something (or not, doesn't matter) and you will just pay them whatever amount they decide to bill you later with no limit?

In reply to WilD:

Oh, I agree it's completely ridiculous. How many of us would take a car in to a shop for work- especially if it's pretty much known what is wrong (I knew exactly what I'd done, and said so from the get-go...)- and be willing to just leave it without being given any kind of estimate at all? In pretty much no other situation except health care is there no way to get any kind of estimate or compare costs between providers.

Another great negotiating tactic (aside from already mentioned "take a little or take nothing", do I qualify for "financial aid", and the "this is a payment in full representative of what value I believe I have received" letter) is:

"How much would Medicare pay for this entire bill?" (It's very likely 25-40% of the initial bill they sent).

ALL healthcare billing accounting systems should have those calculations built in that they can run your account against the complex medicare "expected reimbursement" algorithms. Many should be able to do it instantly while you wait on the phone, others might need to take an overnight cycle. Medicare pays the least of any insurance (in almost all situations), and trust me, the providers are usually very happy to get even that much from a patient.

Just got off the phone with my insurance's customer service, and the answer as to what's going on with it is pretty much BS (though not on their part). The answer is that they automatically convert ('enhance' as they put it) any ER expenses to in-network- but that the doctors are all contracted by the hospital individually and are not in any way bound to accept the 'enhanced' rates- and in this case, the doctor (or whoever handles things for him) refused to accept any reduction in the rate from the insurance company. My insurance could still have processed it with the enhanced rate- but I would still have gotten billed for the full amount by the doctor and on top of it wouldn't have gotten the full credit for that bill toward my deductible, just what the 'enhanced' rate was (which is kind of silly since the out-of-network deductible is a laughably high number that I thankfully will get nowhere NEAR hitting this time around).

This is completely berking BS. OK, so even assuming the doctor should get to set his rates- if they're going to insist on twice what everyone else would be getting paid, I should know about the UP FRONT and have the option to decide whether I think he's worth it (spoiler alert: in the case of the ER, I'd have laughed at them and asked for someone else. In the case of the ortho surgeon? It would probably have been worth it).

sigh So, now I guess I get to take it up with the company that sent the actual bill.

I just had surgery, got a bill detailing the costs to me and my insurance carrier. The bill was a smidge over $12,000. The insurance company paid $2,000. I am responsible for $100. The rest was "adjusted." No wonder no one trusts the healthcare system.

They will "adjust" 10k for an insurance company that is paid (quite well) to cover my medical expenses. Mind you I RARELY require medical care. Then, when it comes to the people they "help," they bill the crap out of them. Pisses me off.

HunterBenz wrote: I just had surgery, got a bill detailing the costs to me and my insurance carrier. The bill was a smidge over $12,000. The insurance company paid $2,000. I am responsible for $100. The rest was "adjusted." No wonder no one trusts the healthcare system. They will "adjust" 10k for an insurance company that is paid (quite well) to cover my medical expenses. Mind you I RARELY require medical care. Then, when it comes to the people they "help," they bill the crap out of them. Pisses me off.

Yep, this is quite normal. Essentially the insurance company is buying healthcare services in bulk, and they do get a bulk-pricing discount.

My earlier point is that Medicare is the largest bulk buyer there is, and they therefore generally get the best rates. And if you have no or little insurance coverage, the healthcare provider is still happy to get the "Medicare" level of reimbursement.

Of course, the problem end of this system is that actual reimbursement and the "charges" have gotten so out of whack from each other. If I was mining coal, and a powerplant near me wanted to buy some at a bulk discount, but only wanted to pay 25% of the price of coal, I would probably laugh them out of the room. But that is normal in healthcare.

My wife's been dealing with the billing for a routine colonoscopy - it's taken multiple phone calls to the referring doctor, the gastro office and the insurance company. But finally, the $900 bill (our cost) has turned into $0 simply by calling it preventative instead of diagnostic in one of the codes.

If one of us truly gets sick, someone's gonna have to quit their job just to navigate the payments and insurance. This is one really broken system.

Meanwhile, my Mom got breast cancer. Her total cost was the cost of parking. She doesn't live in the US, as you can probably guess.

Keith Tanner wrote: Meanwhile, my Mom got breast cancer. Her total cost was the cost of parking. She doesn't live in the US, as you can probably guess.

I'm an Army Brat. Until I turned 25/left college, my costs under my parents' military insurance were whatever it cost me to get to the hospital/doctor...

Ashyukun wrote: In reply to WilD: Oh, I agree it's completely ridiculous. How many of us would take a car in to a shop for work- especially if it's pretty much *known* what is wrong (I knew exactly what I'd done, and said so from the get-go...)- and be willing to just leave it without being given any kind of estimate at all? In pretty much no other situation except health care is there no way to get any kind of estimate or compare costs between providers.

If your car was causing you ridiculous amounts of pain or potential for death, you'll sign whatever waiver about not getting an estimate you can to get it fixed. Thus, medical billing.

In reply to Keith Tanner:

That reminds me of an incident many years ago when we had an HMO and a primary care physician. We were out of town on vacation and my wife got sick with something (I don't recall what, relatively minor, really just needed an antibiotic) and went to one of those "urgent care" clinics. This type of visit was supposed to be covered under the HMO, but the claim was completely denied. I called the insurance provider who agreed that yes, that should be covered, BUT that wasn't what the clinic billed for. It was showing up as primary care, new patient or some such, basically as if we had just decided to unilaterally go to a new family doctor instead of going to our PCP. Insurance tells me to contact clinic and have the billing corrected to indicate urgent care visit or some such. Call them, they don't know how to do that. Back and forth, back and forth, until I just give up and cut a check for a couple hundred bucks.

This just breaks my heart. Hobiercr, that sounds like a frikkin nightmare. Keep fighting, all the power to you. To OP: Best of luck with fighting the bills. 

Seriously, guys, I have lived and worked for years in the US, as well as in Italy, in Germany and now in Sweden. Trust me when I say that pre-paid health care provided for everyone is something I'm willing to pay taxes for. 

There is no such thing as a "Better country" - some things are good and some are bad in every place I lived. But the very foundation of a nation is to provide safety and lower the risks for its people. That is why we gathered in villages, that is why we built cities and surrounded them with walls, that is why nations were formed and that goes for ALL threats. To help one another, to care for the weak and to transfer the risk of the individual to the state. 

I'm in the segment of people who wants fewer/less taxes and more individual liability. But NOT when it comes to health care, because it is completely out of the hands of the individual citizen. It's not within the power of the individual citizen to make sure you don't get cancer, never need major surgery, or avoid getting hit by a random drunk driver. All modern states insure the banks, to make sure customers don't go bankrupt when/if the banks do. Why should tragic events like a car accident be allowed to financially ruin a family? 

Getting of my soap box...