Please hope me, President Obama

January 27, 2009 6:03 PM

NoInsuranceFilter: I awoke New Years Day in the hospital. My clothes had been cut off, I had a catheter in and a wrist restraint on my left wrist. I had five stitches in my eyebrow. The bill has arrived.

Out with a friend, drinking and apparently got ahead of myself. Said friend was concerned with other things and claims to have not noticed my state. He says that he recalls seeing someone steal my shoulder bag off my prone body after I was struck and fell to the sidewalk head first but claims to have been more concerned with the blood coming from my head. I lost a digital camera and my passport along with numerous objects and papers gathered during years living abroad. Despite his claim at having been concerned with my safety, I awoke six hours later alone in the hospital. He wasn't so concerned to have even gone to the hospital with me. I called him and asked him to please pick me up when the hospital indicated it was time for me to go and he called back and asked if I could find anyone else to get me.

Now, the bill has arrived.

Blood bank - $137.00
Emergency - $18,637.50
Pharmacy - $218.00
IV Solutions - $116.00
Pulm Func - $86.00
Drug/Detail Code - $682.00
CT Scan - $24,379.00
Speech Therapy - $307.00
Radiology - $1015.50
IV Therapy - $636.00
Clinical Labs - $2700.50
Clinic - $25.00
Total: $48,940

I was in the emergency room from ~0230 until ~1130. The UC hospital even sent a small blue envelope so I could send my remittance.

I've contacted the county and asked for assistance. I'm a late-30's full-time community college student preparing to transfer. I receive financial aid and pick up occasional daily work as a consultant. On paper, I don't have a job.

I meet with the California county tomorrow and wonder what they will be looking for on my bank statement? The depression I felt after taking a beating, losing personal and valuable possessions along with losing a friend was beat back a bit with the purchase of an LCD TV made before the bill arrived. While I spent less than $500 should I be concerned with the county representative line-itemizing my most recent expenses? I haven't made any withdrawals and am not hiding monies. Should I hide expenses? My checking and savings are less than $600, combined. I just received a $1000 financial aid check but it won't be on my current statement. It is earmarked for the next two months rent.

I own a car but it is registered non-op. My possessions worth noting are the car, my bike, a bed, the tv and my laptop.

Finally, a professor suggested writing to my representatives both locally and nationally regarding the ridiculousness of this bill. Should I bother?

If I've left anything relevant out, I can be emailed at [e-mail]

posted by anonymous to work & money (43 answers total)

My experience as a member of the uninsured who happens to be accident prone, that bill is a first shot over your bow. That's what they would charge your nonexistent insurance company.They'll cut it in half to a third with barely any haggling. And that's if you're employed.

You can always just stiff them and let them send it to collections. Not the best idea, but it's been done.
posted by notsnot at 6:15 PM on January 27, 2009

I am sure someone will speak to this with greater authority and detail than I, but I believe the bills the hospital sends out are highly negotiable. I have heard of people settling with the hospital for less than half the amount they owe, sometimes considerably less than half.

You may be able to call up the hospital, explain your situation, and ask if they will accept what you can afford as payment in full. If they do accept your offer, get it in writing before you pay. And then keep that statement that they sent you for the rest of your life, so they can never come back on you for it -- I've heard tell of this happening too.

On preview -- you might have more negotiating power with them before they send it to collections, because they take quite a cut when they do send it. If, that is, the collections is not in-house, as it is in many hospitals.
posted by jennyjenny at 6:19 PM on January 27, 2009 [1 favorite]

Honestly explain your situation to the hospital. There's a chance that they'll (not sure if this is the right term) write off some or all of the debt. A friend in college was hospitalized due to an intestinal disease, and was able to get the hospital to forgive the debt. It's worth a shot.
posted by drezdn at 6:19 PM on January 27, 2009

Definitely go talk to them. My old roommate was in a motorcycle accident and ended up in almost exactly the same debt you are in. They dropped it down to around $15k as soon as they (the billing department) found out that he didn't have insurance
posted by thekiltedwonder at 6:21 PM on January 27, 2009 [1 favorite]

It certainly couldn't hurt to question the charges, 24k for a CT scan is flabbergasting, certainly in England, the cost from what I remember was around 400 quid ($800 dollars at the time).

From Googling about, the current costs seems to agree with that. I'm amazed they would charge 23k+ extra for emergency priority.

I'm very sorry for your situation, America absolutely blows my mind with regards to medical bills, I do hope it works out well for you, fight for as much as you can.
posted by Static Vagabond at 6:29 PM on January 27, 2009

Negotiate.

When you get the bill reduced to something reasonable ($5k to $20k), tell the hospital you would like to set up a payment plan. Tell them you can afford $25 a month, or suchlike.
posted by fantabulous timewaster at 6:29 PM on January 27, 2009 [4 favorites]

I assume it would mean you could never get back into the US and you'd have to leave University but could you just leave the country (once you get your passport sorted)?

$48K or even $15K is a ridiculous amount. How can there be a system where you wake up somewhere and find out that $48K worth of services were performed that neither you or your next of kin asked for?

Yes they were making sure you were alright but is this a product of private hospitals taking emergency patients?
posted by Man_in_staysis at 6:34 PM on January 27, 2009

I'm only throwing my voice into the crowd here affirming that you should attempt to negotiate with the hospital. I used to work in claims for an auto insurer, and the injury claims we evaluated were considered to be highly negotiable with the hospital. As notsnot mentioned, they start way-high anticipating that negotiation will be going on with insurers.
posted by SpacemanStix at 6:35 PM on January 27, 2009

That bill is laughable. No one -- not even the insurance companies -- pay the full amount on a hospital bill. It's like buying a car: they highball it, you lowball it, and hopefully you can meet someone in the middle. No reason to get overly stressed about it.

There will be a department at the hospital that handles billing questions. I bet that without even batting an eye they'll knock a huge chunk of your bill. Bringing documentation of your situation can't hurt either. Pretty much everything you've gathered for your county meeting. The billing department should also have pamphlets about organizations and programs for the uninsured.

And if you have an Italian relative, bring them along ;) That's the kind of game you have to play with these people.
posted by sbutler at 6:36 PM on January 27, 2009

yeah - their payment plans are often interest free, too! :) so while your final bill might be 10-15K, you'll probably only have to pay 25-50 bucks a month for eternity. look on the bright side...while your friend wasn't the most responsible/friendly by not taking you to the e-room and you lost some stuff...way worse things could have happened then waking up in the emergency room. way worse.
posted by citystalk at 6:36 PM on January 27, 2009 [1 favorite]

Yep, yep, just adding to the chorus that the initial bill is the maximum they find to put on paper, and that you can talk to the hospital administrator and negotiate it down to something much more reasonable for your circumstances.
posted by desuetude at 6:36 PM on January 27, 2009

I had to apply for the "charity program" at a local hospital due to an ER visit. I was also a student at the time. They asked me for my bank *balance*, not a statement examining my spending. They want to know what kind of assets I had, not what kind of expenditures I'd been making. They asked me for proof of ownership of a car or a house and asked questions about parental assets/contributions. They may have asked more asset related questions--I can't remember. But I was approved for the program.
posted by hecho de la basura at 6:37 PM on January 27, 2009 [2 favorites]

This was at a University of California hospital? They will definitely have a charity program that you may well qualify for. Could result in total forgiveness of the bill. If not, as others have stated, hospital bills for uninsured, low-income people are negotiable.

If the assistance you're seeking through the County is Medi-Cal, I don't think you will qualify regardless of your financial details, unless perhaps you are a parent.

Yes, your bill is ridiculous. But before writing your elected officials, you should get some more information. The bill amounts you listed are summary totals. You should ask the hospital for an Itemized statement. The reason I suggest this is that the charges for "emergency" and "CT scan" appear to be way out of range, and could be in error. The other charges look (sadly) typical for minor trauma.

If you find yourself having to negotiate a reasonable balance with the hospital, a good starting point is to find out how much Medicare or Medicaid would pay for the same set of services. The itemized statement will be needed for this. Feel free to MeMail me for more information.
posted by Snerd at 6:37 PM on January 27, 2009

If by UC, you mean California, I can speak here.

It seems to me that you were the victim of a VIOLENT CRIME. And if there was any doubt about who started the fight...stealing stuff from your passed out body qualifies them as the agressor. Maybe they kicked your ass just to take the bag. Who knows?

Anyways, I forgot the actual program, but you can be compensated (I don't mean money to live off of, I mean take care of medical bills) by the state. The FIRST thing you want to do is file a police report. I hope you were smart enough to do that as soon as you got the hell out of the hospital.
posted by hal_c_on at 6:45 PM on January 27, 2009 [5 favorites]

Here's what I would do:

1. Freak out for a few hours
2. Contact hospital and explain your financial situation. If what other people are saying is accurate, they may very will significantly slash the total cost right away
3. Request an itemised bill
4. When itemised bill arrives, contact hospital again to negotiate certain charges. US$25k for a CT scan? Speech therapy?
5. ???
6. Payment plan!
posted by turgid dahlia at 6:49 PM on January 27, 2009

Since no one seems to be specifically mentioning it, you may want to ask about charity. My husband went to the emergency room three times for the same issue last summer, and was billed around $8,000 altogether. Due to his income being below a certain amount, the fact that he was uninsured, and didn't qualify for state assistance (he did have to apply and be denied for state benefits before they would consider him for charity), the hospital took off the charges for all of the emergency room time and resources, the CT scan (which was nowhere near $48,000 - nthing other posters who say you should call and clarify the amounts), and other such charges. All we paid was the Emergency Physicans bill, which was about $800. They let us arrange for a payment plan on this.

I was told that many hospitals have some funds in place for people in situations like these and who qualify and they can write it off as charitable deductions. Good luck, and get well soon!
posted by alpha_betty at 7:10 PM on January 27, 2009

Oh, and I'm in Washington, so YMMV. ...And people have specifically mentioned charity, but please believe that I can read. Just not very well.
posted by alpha_betty at 7:16 PM on January 27, 2009

If you were a victim of violent crime, consider contacting the following organizations for advice about possible financial compensation and other aid: Attorney General's Office of Victims' Services, California Victim Compensation and Government Claims Board, and Victims of Crimes Resource Center. Best wishes to you.
posted by terranova at 7:17 PM on January 27, 2009 [3 favorites]

After you file a police report, you will want to get in touch with the local victim/witness program. You can start here. I would start the discussions with the hospital in the meanwhile. Also be aware that there may be an ambulance bill in the mail to you and possibly a separate doctor's bill depending on the services.
posted by metahawk at 7:18 PM on January 27, 2009 [1 favorite]

follow-up from the OP

I am a childless, late-30s white male. I called the police in the week that followed, in hopes that my passport might surface but they had no record. Neither did metro fire. I will file a police report and apply for the state program.

It is a University of California hospital and after telling them that I am unable to pay they have referred me to apply to the county for aid as a matter of policy. The program isn't Medi-Cal but something called County Medically Indigent Services Program, CMISP. They are asking for 'tax statements, vehicle registrations, bank statements, other' in the brochure included in my forms packet.

I did receive an itemized bill but at 5 pages wasn't inclined to type it. Despite only suffering a head injury, I was given CT scans on head for $4161, a cspine for $4951, an lspine for $5445, a pelvis ct for $4950 and an abdomen ct for $4871. The other large costs were 'Use of ER Level 5' at $6939 and 'Trauma OP Service at $11,220.50.

Speech therapy? Who knows.

posted by jessamyn at 7:18 PM on January 27, 2009

I don't have much of an answer for you, but my girlfriend (who has acquired the AskMeFi habit) works in a hospital in central California, and had this to say:

The name of the California program that hal_c_on is referring to is Victims of Violent Crime (the hospital bills the program instead of billing the patient, is how it works). Follow up with the hospital's billing office on that. You said:

On paper, I don't have a job.

Another option is that Legislation AB774 requires all CA hospitals to establish a charity program where patients are screened and if the patient is found to earn 200% of the federal poverty guideline or less, hospitals must provide free care. A charity application will likely be required, but contact either the business office or the financial counselor of the hospital for details. (Under the same program, if you make between 201% and 300%, the hospital must reduce your bill to what it would expect Medicare to pay.)

Lastly, she says that the charges are pretty typical of a California hospital emergency room, mostly the terrible result of HMO contracting over the years.
posted by LooseFilter at 7:19 PM on January 27, 2009 [3 favorites]

It certainly couldn't hurt to question the charges, 24k for a CT scan is flabbergasting, certainly in England, the cost from what I remember was around 400 quid ($800 dollars at the time, about $401 now...). From Googling about, the current costs seems to agree with that. I'm amazed they would charge 23k+ extra for emergency priority.

I'm very sorry for your situation, America absolutely blows my mind with regards to medical bills, I understand, from the other comments, that the hospital seems to pick a random ridicluous figure out of the air before the bargaining begins, but surely that should be a justifyable expense. I do hope it works out well for you, fight for as much as you can, then chalk the rest up to a begrudged life lesson.

Your friend saw you badly hurt and unconscious and put you in a place that could remedy that situation, in my mind, whatever the costs incurred, that's still a friend doing the right thing. You should fix that relationship.

I've been meaning to chase my private medical insurance up for over a year now, I think I'll actually get around to it tomorrow. I've been firmly in the mental 'bulletproof' zone for too long now.
posted by Static Vagabond at 7:30 PM on January 27, 2009

You had the full trauma workup. Since you were just found unconscious they had no way of knowing if you were injured and thus ran the full program which includes a near full body CT and attention from a trauma team. Thus the astronomical bill. If you "friend" would have gone to the ER with you, they wouldn't need to have gone through the full program and the bill would have been much, much lower. Just something you might want to mention to your "friend".

$5,000 for each of those CTs still seems very high. I just had an abdominal CT in the ER recently which was billed at $1,200.
posted by Brennus at 7:32 PM on January 27, 2009

If you're from the US, you can report your passport as stolen with this form.
posted by aquafortis at 7:33 PM on January 27, 2009

For the follow up info: I wouldn't begrudge their giving you multiple CT scans. Because you were unconscious and alone they likely had no way of knowing the extent of your injuries without those scans.
posted by ImproviseOrDie at 7:36 PM on January 27, 2009

Also, call free legal advice groups in your state/county/whatever, and maybe look at finding a pro-bono lawyer to represent you.
posted by arimathea at 7:38 PM on January 27, 2009

Since the Blood Bank charged you, I'm assuming you had a transfusion...although that price looks really cheap for even one unit of blood (that's less than the hospital's cost of a pint of blood, and way less what they charge the patient). Anyhoo, if you did use blood, you should recruit friends & family to donate blood on your behalf. Most blood banks have a replacement program - when someone donates blood and designates it as a "replacement" for you, you get a monetary credit. At my blood bank it's $15 for whole blood and $45 for apheresis products (platelets or plasma). You can contact the hospital to find out who their blood bank is (it may be part of the hospital or a separate private non-profit).
posted by radioamy at 7:43 PM on January 27, 2009

Don't be so hard on your friend btw, if he was drunk the ER would have made him leave and probably told him not to come back.
posted by fshgrl at 7:44 PM on January 27, 2009

Good christ, $24k for a CT scan? That's impossible. I've had CT scans, with insurance they were a couple of hundred dollars (my deductible) and even the negotiated total amount was somewhere in the neighborhood of $3k. You are being hooooooosed. I have to second/third/fifteenth the calls here to call up and negotiate. Certainly this will come down by at least 50%.
posted by xmutex at 7:59 PM on January 27, 2009

Finally, a professor suggested writing to my representatives both locally and nationally regarding the ridiculousness of this bill.

A stupid suggestion which will get you nowhere. Anyone who thinks an elected official is going to do anything for you in this situation is a moron.

You had the full trauma workup. Since you were just found unconscious they had no way of knowing if you were injured and thus ran the full program which includes a near full body CT and attention from a trauma team. Thus the astronomical bill.

Bingo, that's exactly right. Be glad someone was trying to save your life when you had a lapse in personal responsibility, and stop looking for an enemy where there isn't one.

At the very least, if you don't just pay the bill, your New Year's Eve is going to result in a destroyed credit rating no matter what you do. I would suggest consulting a bankruptcy attorney.
posted by jayder at 8:18 PM on January 27, 2009

I was treated at a UC hospital (UCSF) emergency room when I was unemployed and had no money. Once they realized that, they immediately slashed the bill in half and then put me on an installment plan. Granted my bill was WAY less than yours but they'll be reasonable about it. Just tell them your story.
posted by otherwordlyglow at 8:28 PM on January 27, 2009

Speech therapy is about much, much more than 'speech' -- it's about cognition of all types, the ability to count, recognize letters and numbers and read, on and on and on. A friend of mine was assaulted, took a terrible beating, lost language AND numbers, had to be taught everything again, and it was speech therapists who helped her do so. When I had all those heart attacks and died, and was dead for 8 minutes WO oxygen before I hit the emergency room, they (all of the docs) were certain I was going to need time with a speech therapist also. I didn't but that's very, very unusual for someone gone that long, you're 'supposed' to have serious dain bramage in that amount of time; I lost my sense of smell, and maybe some memory problems, can't really say, as I've never had a mind like a steel trap anyways, more like a sieve.

The comments upthread are right on -- they were making sure that whoever assaulted you didn't kick you in the stomach or chest or whatever and you were unconscious and could not report. Good medical care; next time I die, if I'm not in Austin, I hope I'm near that hospital.

The money. You're a student with a bike and a car and a tv. I'd bet dollars to dimes that everyone involved will waive the whole damn thing, tell you to stop back next time you've got insurance and say hello. What a lot of people don't understand is that it IS a horror show to be uninsured in America if you have a little money, or a bit more than a little, but that if you're impoverished you get as good as the next guy and often free and at least next to free, as others have mentioned, $25 bucks a month until the end of time...

Next time you see your 'friend' stomp a mudhole in his worthless ass -- he's a piece of shit.

Truth be told, you 'are' lucky to have gotten off as light as you did, everyone thinks that drunken fights are like the ones in the movies, you get hit seventy-four times but still walk away after stomping their butt. But drunken fights often are not like in the movies; you could easily be in my friends shoes, speech therapy for a year or more, however long it took her. Not to negate the heaviness of the whole deal or anything. Still, there is a bright side.

Good luck.
posted by dancestoblue at 9:18 PM on January 27, 2009

Wow! I was on a Harley and got hit in the side by an SUV doing in excess of 70mph. I was in the hospital for 3 weeks. When I got my first bill my imaging, x-rasy, MRI's and CT's were only 30,000. I really can't see how they are justifying 24k for what you had done. Also, recently I had a chest CT for chest pains at the local ER and it was only 1200.00

I don't know about CA but the hospital I go to is UAB in Birmingham, AL and they have a program for people that don't have insurance. You might want to check with yours to see if they have something like that.
posted by Jules22871 at 11:43 PM on January 27, 2009

Negotiate. Hospitals inflate billing because of the way private insurance (and Medicare/Medi-Cal) pay out. Depending on their contract with the insurer and the billing codes used, they might get as a high of 80% of a contracted rate of reimbursement... or as low as 30%. They most certainly will not get whatever it is they've charged you.

They're expecting you to come back to them with either insurance information or to contact them about making a payment plan. And yes, you can get that bill down by half, easily. But free? No. You'll have to pay something for all the work they did on you.

Contacting your congressman, etc, is probably not going to help you much with your particular bill. If you want to allege that the public is being gouged, sure, get in touch and tell them your story. I very seriously doubt they'll be able to make much of an impact on this particular bill, though. Some of it looks high, true, but the $18Kish ER charge (docs, nursing staff) for a head injury where you were completely unconscious at the offset? No, not really.

Not really getting where the ire is with your friend taking you to the ER. As fshgrl said, if he was drunk, and you were in such a terrible state, they would have told your friend to go home and sleep it off. Your friend isn't your next of kin, are they? In other words, what kind of input do you expect your friend to have? If your friend called an ambulance, sat with you, waited for the EMT to show up, did the smart thing and didn't try to move you around or treat you himself... what more do you want?
posted by Grrlscout at 11:55 PM on January 27, 2009

It's possible that the people urging you to write to your congressional representative are hoping it will benefit the efforts to reform health care and insurance, not necessarily out of the (remote) hope that the representative will be able to help in your individual case. Being charged that much for one evening's experience is quite a story, and could provide a helpful illustration to someone arguing that things are just unmanageable.

On the other hand, there may not be a huge shortage of these cases... but you never know. I'd love for this particular bill to find its way into the hands of a smart advocate, just in case they needed something like it.
posted by amtho at 2:29 AM on January 28, 2009

In Massachusetts, full-time college students are required to have medical insurance and it can be somewhat transparently wrapped up in the tuition and fees. From what I can find, it seems this is also true in California, at least at University of California schools, where it is called SHIP. I would explore the possibility that you do have health insurance through your school.
posted by McGuillicuddy at 3:56 AM on January 28, 2009

LooseFilter is on the right track, but the California law turns out to be not quite that generous. AB 774 limits the amount hospitals can charge uninsured people with incomes up to 350% of the Federal Poverty Level, according to this summary from Health Access California.

Your application to the County Medically Indigent Services Program is probably required by the hospital to establish that no other source of payment is available. To get back to your original question, don't worry about your financial details, just answer all their questions honestly and you'll be fine.

AB774 will make sure the rates you're charged are fair, but the number of CT scans they performed is still a reasonability issue. Maybe Health Access can give you some advice on getting further reductions.
posted by Snerd at 5:31 AM on January 28, 2009 [1 favorite]

For $25k you could buy your own entire CT scanner on eBay.

Also, the first thing that occurred to me, without any knowledge of the laws that would be involved (and without being a lawyer at all anyways), was that if you arrived at the hospital unconscious you cannot have actually consented to any of the treatments that occurred before you woke up. I would think that this ought to give you somewhat of an upper hand as far as negotiating the bill - if indeed you are in any way ethically required to enter in to such a negotiation. There wasn't any contract between you and the hospital, not even a handshake or verbal agreement. I don't see why you can't make your own estimate of the value of those services and generously pay the hospital whatever seems a fair amount in gratitude for services that were essentially a gift, and consider any obligation you might have discharged and regard the hospital as fully compensated.

Friends of mine who are EMTs (though not in California, and this is hearsay of course) have told me that in the areas where they work, there are laws that compel ambulance companies to answer emergency calls and transport people to the hospital, but there aren't any laws that require them to be paid. Consequently, in some cases where no consent is involved uninsured people aren't in any way legally bound to pay for the ambulance transport and the company simply ends up having to eat the cost.

And just a little procedural aside - it probably would be best for you to carry out any communication with the hospital in written letters you keep copies of and to insist that the hospital always respond to you in writing.
posted by XMLicious at 6:17 AM on January 28, 2009

There are private medical auditing firms which can cut big chunks out of the bill, in return for their being paid ~33% of whatever they save you.

I've used one of these services myself, and found it to be really quite painless: gave them a bunch of info online, about a week later I get an email saying they cut $780 from my bill, then I paid them and they paid the bill. About a month after that I got paperwork from my insurance company & the hospital saying I didn't owe anything.

So, if you choose to pay & they're being unwilling to negotiate, sic the professional wolves on 'em.
posted by aramaic at 6:50 AM on January 28, 2009 [1 favorite]

I think you've gotten a lot of good advice above, especially about negotiating and the Violent Crimes Bill, but if all that doesn't pan out or if you start to hit a lot of roadblocks, I would look into law school clinics in your area. If you are near a UC you are a probably near a lot of law schools. In law school I had a number of friends working on similar cases to yours and were able to get some really impressive payment plans for people. Things like $10 a month for the next 20 years, no interest, etc. Law school clinics can be a great resource and I feel like enough people know about them.
posted by whoaali at 1:29 PM on January 28, 2009

XMLicious- when you are found unconscious, there is "implied consent" for you to receive treatment.
posted by kamikazegopher at 3:28 PM on January 28, 2009

I went and looked into that before I made my post and as best I could tell, implied consent is about the permission to give emergency aid to someone (which you would have to get from a conscious person even if you were giving that aid for free) - something along the lines of good Samaritan protections. It didn't look to me as though it's referring to an implied consent of the person to a compensated exchange of goods and services, i.e. I don't think it's an implied consent to be billed. Because of HIPAA I there are limits on what they can even do as far as entering your name and other personal information into certain hospital databases or answering questions from loved ones before you wake up and sign some HIPAA forms.

If you see here in these search results in "The Medical Assistant: Administrative and Clinical" halfway down the results list, see how it says "There is no creation of a contract in giving emergency care."

But again, I'm not a lawyer at all or even involved in professional health care myself, I just did a quick peruse of some legal references on Google Books and I could very well be wrong in my interpretation of this.
posted by XMLicious at 7:48 PM on January 28, 2009

Sorry, that 3rd sentence was supposed to say "Because of HIPAA I think there are limits...", fat fingers fumble.
posted by XMLicious at 7:51 PM on January 28, 2009