Hospital bill over a year later? Really?

July 31, 2010 8:44 AM

Just received a $1400 hospital bill for a ER visit I made OVER 14 MONTHS AGO. How is this okay, and what do I say to plead with them?

I had a sprained ankle in Redding, California in May 2009. Went to the ER, got at x-ray, they gave me a boot, ace bandage and crutches and sent me home.

$1400 bill shows up yesterday, insurance paid their share of $400. I have since changed insurance - it was the crappy, cheap kind. I remember already paying the hospital for this around $100-$200 a year ago, and I thought they were all set and done with charging me. I haven't received anything telling me what the charges on this bill are for.

So I'm calling the hospital on Monday and have every intention of arguing them down. Please help me with my arsenal of pleading. I'm currently on U/I.

Bonus points if you can tell me how hospitals and mysterious lab facilities get away with the random-bill-showing-up-in-the-mail-centuries-later trick. Are there any rules with this? Is there a "must bill within ____ days" kind of timeframe at all? This has happened to me before, but never with this much time elapsing or with this kind of amount.

I greatly appreciate your answers! Thank you so much!

posted by ashtabula to opelika to Work & Money (21 answers total)

Insurance companies can take a long time to pay. What probably happened here is that you were charged your co-pay (which you already paid), the insurance company was charged the remainder, and they opted not to pay the full amount (which insurance companies usually do). Hospitals usually have contracts in place with large insurance carriers to accept whatever the insurance company is wiling to pay - which is usually far less than the amount billed - and then the hospital writes off the difference. If the hospital doesn't have a contract in place with your insurance company, however, they are not obligated to accept the lower amount paid by the insurer and they will charge you the difference.

That said, you probably can talk them down if you argue financial hardship. Someone I know got their bill cut in half by speaking with the billing department. And when I was in college, my best friend paid $10 a month on a huge ER bill until the hospital finally wrote the rest of it off. So talk to someone in billing, stay calm, and ask what they can do for you.
posted by something something at 8:56 AM on July 31, 2010

Is there a "must bill within ____ days" kind of timeframe at all?

Your state probably has a statute of limitations beyond which they can't sue you to recover the money. This is likely to be measured in years, not months, though.
posted by grouse at 8:58 AM on July 31, 2010

Assuming you're resigned to paying this (and don't intend to take it up with the insurance company), you can certainly argue it down. You don't even need to lie or exaggerate; just ask them how much they would be willing to take to settle the bill today.
posted by meta_eli at 9:17 AM on July 31, 2010

The hospital may have had to resubmit the bill a few times, which would also slow down the turn-around process. That's not terribly unusual.

What happens is, the hospital submits the bill, the insurance returns it unpaid for some bogus reason, the hospital resubmits with the "required information," the insurance company returns it with a check for 5% of the total bill, the hospital resubmits again for the complete amount, etc.

Eventually it's clear the hospital isn't going to get any more money from the insurance company, so they have to give up and send it to you.
posted by ErikaB at 9:52 AM on July 31, 2010

I work at a hospital billing dept and I would suggest the same thing as something something.
Ask for financial assistance, may hospitals offer it.
posted by DrGirlfriend at 9:57 AM on July 31, 2010

That said, you probably can talk them down if you argue financial hardship. Someone I know got their bill cut in half by speaking with the billing department. And when I was in college, my best friend paid $10 a month on a huge ER bill until the hospital finally wrote the rest of it off. So talk to someone in billing, stay calm, and ask what they can do for you.

A good friend of mine's dad was a hospital admin for many years and often says that he wishes that it was directly communicated to patients to ASK about financial arrangements and to be proactive. It's ridiculous that the possibility of negotiation is some sort of weird open secret.

something something is totally right. Stay calm, write down the chain of events as best you remember them so that you can present yourself clearly, and talk to billing about reducing the bill. Half would be maybe a good target, though I don't know if you'll get it reduced quite that much, and get on a payment plan for the remainder.
posted by desuetude at 10:26 AM on July 31, 2010 [1 favorite]

Oh the joys of medial billing. Bear in mind when you go to a facility for treatment you may not be getting services from just one organization. It's entirely possible for various specialists to be billing you separately, even though it all happened at one place. Probably not for a sprained ankle, but certainly possible. Start by asking the hospital for a complete bill and talk with them about what's on it. Then look at what they sent to your previous insurer and how much they were paid. Then talk to the insurer and ask why the total wasn't paid. These days it's entirely reasonable to assume that the insurance company screwed up in paying, so be prepared to put up with playing telephone tag with them. If in fact they paid the appropriate amount as per your policy then ask the hospital for a billing plan. More often than not they're more than willing to work out payments over time.

You had services performed and those providing them have a reasonable expectation of getting paid their stated charges for it. You wouldn't expect any other service provider to accept less, so pay the proper amount.
posted by wkearney99 at 10:52 AM on July 31, 2010 [1 favorite]

We got a similar bill for an ambulance ride.
I remember seeing a BCBS (health care insurance) document in which it was clearly stated that we did not have to pay if the bill was over 90 days (?) old and it was received nearly a year after the incident.

Just because they can't enforce payment does not mean they won't ask for it.
posted by Drasher at 11:17 AM on July 31, 2010

You had services performed and those providing them have a reasonable expectation of getting paid their stated charges for it. You wouldn't expect any other service provider to accept less, so pay the proper amount.

I'm sorry, but this is simply not true. Health care is more like buying a car or a mattress, where the sticker price is the opening offer in negotiation. No health care provider has any expectation at all of getting paid the full stated price for any service they provide (other than maybe a plastic surgeon who takes cash up front for elective surgery), and they certainly factor in a very large expected discount between gross charges and actual reimbursement whenever they set prices for their services.

No participating insurance plan would pay anywhere close to the chargemaster price for any kind of hospital service - why should you, OP? If you're on unemployment right now, the hospital billing office more than likely has some kind of charity care policy that explicitly lays out how much of the patient balance should be written off in a case like this.
posted by strangely stunted trees at 11:42 AM on July 31, 2010

I can't speak of hospitals from personal experience, but I can speak of labs: It's because they are THIEVES. Some time back I had a simple test done, and a provider with Smith and Kline in their name did the lab work. All 100% covered by my insurance. So six months later I get a bill for $760. Fortunately my employer still has the same insurance and a pretty sharp specialist consultant, we forward him the bill and he goes eight rounds with the lab. Upshot is SKB had a contract with United Healthcare agreeing that the full and complete cost of the procedure, to be fully and completely remanded by UHC, which they had done, was $25. Finally, after tens of man-hours of effort on my employer's part, we get a letter grudgingly admitting that the bill is paid in full.

Six months later I had another test done. I told the doctor SKB was not acceptable for the labwork and why, and he looked perplexed and said "but according to our contract with UHC we have to use them." So they did the labwork again and then they pulled the EXACT SAME STUNT. Exact same result. How many people pay these bogus bills to keep their credit clean because they don't have the time or inclination or knowledge to get them purged?

So I would send them a registered letter, return receipt requested, explaining that I am not paying the bill because (1) it was my understanding at the time that it was fully covered by the insurance, and that (2) my obligation was satisfied by the copay, and (3) if this was not the case the time to inform me was a year and a half ago. Other businesses do not get to send someone a random bill more than a year after performing a service and expect it to be paid. Do not discuss it with them on the phone -- put everything in writing and use registered mail. They will lie like rugs on the phone but they are much more reluctant to put fraudulent demands in writing.
posted by localroger at 11:49 AM on July 31, 2010 [5 favorites]

In case it helps: a quick word on the approach to the billing department.

I know folks who work in billing and believe-it-or-not they're mostly human. Most just hate putting the screws to people. And their institution's policies that might require doing so. If they have any leeway (depends where they work) they'll extend themselves a lot for pleasant people they can identify with.

Yelling and demanding (which probably isn't your style anyway) works a lot less than saying honestly, "this came as a terrible surprise, and I'm confused about what happened and how to proceed. Paying it is going to hurt. Can you explain any of this? Any advice? I'm in a bad situation here."

Good luck. I hope they'll work something out with you.
posted by wjm at 11:49 AM on July 31, 2010 [1 favorite]

They will lie like rugs on the phone but they are much more reluctant to put fraudulent demands in writing.

This, this, this!
posted by Civil_Disobedient at 12:33 PM on July 31, 2010

Another data point, not involving medicine: In an entirely different dispute with a large credit card company whose name is synonymous with "pursuit," they actually refused delivery of two registered letters. Our state attorney general found that fascinating, and whatever he told them it put an end to the matter.
posted by localroger at 3:04 PM on July 31, 2010 [2 favorites]

We're going through a similar issue with Meridian Services (a mental health services chain) We received a bill from them last week for services rendered in 2008!!! It was for several hundreds of dollars on services that were subject to our paying only a co-pay. So, now we have to play tag with both our insurer and Meridian Health in order to figure out WTF is up with this bill.

Their excuse for sending us a two-year-old bill? They've had issues with their new billing software and haven't been able to send out bill for two years. Yes, they honestly expect us to believe that one. One wonders how they managed to pay their doctors if they haven't been able to bill for two years.
posted by Thorzdad at 3:35 PM on July 31, 2010

Consumerist suggests that you can get medical bills discounted up to 50% if you negotiate.
posted by Susurration at 4:11 PM on July 31, 2010

You could also check with the insurance company as to why they only paid $400. I received a bill where the reason-for-non-payment was that the bill was presented too long after the service had been provided. I refused to pay on the basis that, if they could not get their act together to bill on time, this was not my responsibility.
posted by Susurration at 4:14 PM on July 31, 2010

So I would send them a registered letter, return receipt requested, explaining that I am not paying the bill because (1) it was my understanding at the time that it was fully covered by the insurance, and that (2) my obligation was satisfied by the copay, and (3) if this was not the case the time to inform me was a year and a half ago. Other businesses do not get to send someone a random bill more than a year after performing a service and expect it to be paid.

I would do research before doing this to be sure that you actually have satisfied your financial obligation. Because if you do legitimately owe the money, and they (or worse, a collection company) decide to pursue this, a letter from you saying "I won't pay" will most likely lead to a bad outcome for you. (IANAL, so take it for what it's worth.)

As recommended above, do check with the insurance company and find out why they only paid $400. If they say that you weren't covered for the whole thing or something like that, ask them to point out where in your policy that's spelled out.

As for negotiation, we had to get some hospital bills sorted out for my father-in-law. Billing said that "yes, it's $X amount, but if you pay it in full within a month (or so, I forget exactly) we will take $Y amount." We didn't even have to negotiate, since they started off with this right off the bat. $Y ended up being over 50% less. So, depending on the billing department, you may not even have to negotiate. Some are better than others about this.
posted by azpenguin at 5:35 PM on July 31, 2010 [1 favorite]

I had a similar situation; I was told the hospital had 5 years to collect in California. I literally started crying on the phone with the rep. The crying did not help my situation, but perseverance did.
posted by samthemander at 6:03 PM on July 31, 2010

azpenguin, I have had several encounters of this sort. Every one is different so what I did in the case I related might not work for the OP, which is why I said "I would..." rather than "You should..." My personal experience is that they are a bunch of chickenshit fraudsters who should not be given anything; the worst they can do is tarnish your credit record if you give them the middle finger, and they know this. And if they make one wrong move, or if your other history is adequate, they can't even do that. What really puts the fear of God into the collection agency set is that you know your rights because you can sue them for fraud based on a lot of standard crap they do.

Do not call them on the phone, insist on doing everything by mail, send all of your mails registered return receipt, and learn your rights. You probably don't owe the knucklewads anything.
posted by localroger at 6:44 PM on July 31, 2010 [2 favorites]

Also, until you decide what you are going to do about the debt, DO NOT ACKNOWLEDGE IT! On the chance that you decide not to pay and take the credit hit (not saying you should do this at all), then there is a statute of limitations for suing you for the money (I can't recall what it is in the US, maybe 6 or 7 years?), and if you acknowledge the debt then it resets the statute of limitations for collecting the money.

But you're probably better off double-checking with your insurance co. first and then trying to work something out (it sucks, but you did in fact receive the "service").

IANAL IANAmerican etc.
posted by 1000monkeys at 10:00 PM on July 31, 2010

wjm: "I know folks who work in billing and believe-it-or-not they're mostly human. Most just hate putting the screws to people. And their institution's policies that might require doing so. If they have any leeway (depends where they work) they'll extend themselves a lot for pleasant people they can identify with."

This. Be nice. My cousin called up a business about a bill, not knowing she was speaking to my mom, her aunt. She screamed and cursed my mom out. My mom had the power to have her bill wiped out, had she been nice. Needless to say, my mom didn't use it.
posted by IndigoRain at 12:45 AM on August 1, 2010