owe alota money

March 11, 2013 4:17 PM

Our daughter broke her arm yesterday, required surgery, and an overnight stay. We have no insurance. The hosptial will likely allow me to set up a payment plan (for the rest of my life). anything else to know?

suffice it to say that we irresponsibly allowed the insurance on the kids to lapse. I know, very stupid. now there's about to be a huge bill.

Is there anything I can do, like special negotiating tricks? Is it true the charges are padded for insurance? I know I'll be making payments to the hospital for the rest of my life, but anything would be helpful. what happens if we just don't pay?

We don't own our home (folks do), but we do own a rental property, in case thats relevant, and we're in az. My earnings probably disqualify us from public assistance.

posted by hollyanderbody to work & money (27 answers total)

The only thing I think of is that some practitioners in a hospital work as independent contractors, the result of which is that they do their own billing. Ask the billing department about that - you'd hate to make an arrangement and then wind up getting a separate set of charges from Doctor So-and-so down the road.
posted by jquinby at 4:25 PM on March 11

Ask the hospital if there is financial / charity aid available. If they say no, straight-up ask for a discount. You would be amazed how they can come down sometimes. Tell them you have no insurance.
posted by KathrynT at 4:29 PM on March 11 [29 favorites]

Is it true the charges are padded for insurance?

I believe this is often called the "negotiated rate" for insurance. It's roughly like the difference between full price vs. sale price at a retail store; in the case of hospitals, consumers without health insurance get billed at full price (say, $5000 for a specific procedure), whereas the insurance companies get billed at a discount (say, $2200, or whatever). (Of course, the grotesque irony is that the people without insurance are precisely the ones who are least likely to be able to afford the full price. But that's another topic.)

So when you call or meet to set up a payment plan with the hospital, the first thing you do is ask what they can just write off, if there's a charity fund you can apply for, etc. Once you've exhausted all those options, the second thing you do is ask about the negotiated/discount rate. (Be sure to ask about the negotiated/discount rate with any doctors, labs, etc. who might be sending you separate bills, too.)
posted by scody at 4:32 PM on March 11 [2 favorites]

Ask the billing department about that - you'd hate to make an arrangement and then wind up getting a separate set of charges from Doctor So-and-so down the road.

And get it in writing—the hospital billing people are not on your side and they will not hesitate to lie to you to extract a payment. After a recent surgery the hospital billing rep swore up and down, in response to my very specific questions, that the bill I was paying was all-inclusive and that there would be no third-party bills. This was a flat-out lie, but when the third-party bills did subsequently arrive, I had no recourse because the conversation took place over the phone.
posted by enn at 4:38 PM on March 11 [8 favorites]

Definitely ask for a discount. When my sister had expensive surgery sans insurance, the hospital did knock the bill down quite a bit. But it was still thousands of dollars at a time she had nothing. They sent a bill, she paid $50. Or maybe it was $25. Anyway, the only decent thing about this process was that as long as she paid SOMETHING, the hospital was cool with it. They never hassled her for more, just sent another bill the next month.
posted by BlahLaLa at 4:38 PM on March 11

This might not work for you, but when you negotiate the bill (which is possible, and something that you really need to try), offer to pay the bill off more quickly if they lower the amount you owe.

Let's say you owe $5,000. If you offer to pay it off in a six months, will they lower it to $3,500? (I'm sure I'm completely off base, numbers wise, but adjust it to fit your situation). The hospital would rather get some money than no money.

Also, see if Care Credit will help you at all. The hospital/provider might not accept it, but it's a credit card that offers no or low interest for a certain period. If you have decent credit, you should qualify with a high limit.
posted by ablazingsaddle at 4:40 PM on March 11

And get it in writing

Yes. If you meet in person, take notes during your conversation. If you're on the phone, make a point of asking the name of the person you're speaking with so that you can add it to your notes. This will be helpful down the road whether they actively try to go back on an agreement, or simply (and more commonly, I've found) drop the ball due to incompetence, bad communication on their end between different offices, etc. Do this every single time you talk to anyone about the matter. I would suggest getting a notebook and an expandable file that you can dedicate to the project. There will be many conversations to follow up, and lots of paperwork to double-check (and more phone calls to make when they bill you twice for something, or don't give you the discount they said they would, or don't credit last month's payment, or all the many little irksome ways they make this a pain).

All that said: don't go into your first conversation with an immediately adversarial mindset -- a friendly assertiveness is the tone you probably want to strike from the get-go -- but be prepared for the fact that this will be a little bit of a part-time job for awhile.

Hope your daughter's OK!
posted by scody at 4:52 PM on March 11 [6 favorites]

what happens if we just don't pay?

In most states, the same thing that happens if you don't pay anyone to whom you owe money. They can send your account to a collection agency and the unpaid debt can appear on your credit report and damage your credit. If the hospital chooses, they can attempt to secure a civil judgment against you.

I'm sorry you're dealing with this, but simply choosing not to pay is a losing proposition.
posted by DWRoelands at 4:55 PM on March 11 [1 favorite]

Is it true the charges are padded for insurance?

As it happens, Time magazine's issue last month was focused on this: How to Review, Understand and Lower Your Hospital Bill, promo video clip, Daily Show interview with the author of the cover story: 1, 2, 3
posted by XMLicious at 5:04 PM on March 11 [9 favorites]

Any chance "allowed the insurance on the kids to lapse" means one of you got laid off, say, 28 days ago and didn't pay COBRA because it was too expensive and you don't know that you have 30 days to pay for the first month of COBRA?
Note: my job in the health insurance world was 14 years ago and I was in marketing, so my really long shot info could even be totally wrong.
I think it might be 60 days instead of 30.
posted by artychoke at 5:11 PM on March 11 [2 favorites]

How old is your child? When were they last insured?
posted by barnone at 5:22 PM on March 11

If it helps ease your mind at all, my husband has a $10K+ hospital bill that he negotiated into monthly $25 payments. They'll never get all of their money, but he pays his $25 like clockwork and they've never reported his debt to a credit agency. I'm not sure what his magic words were, but I do know he was firm in that all he could afford was $25. YMMV
posted by PorcineWithMe at 5:26 PM on March 11

Sorry to keep chiming in, but one more thing: once you've set up your payment plan, make sure to keep track of everything you pay annually, in the event that you wind up qualifying for the tax deduction on medical expenses.
posted by scody at 5:36 PM on March 11

Daughter is 6, and we stopped paying for insurance about 4 months ago.

artychoke, no, but thanks.

and thanks to you all!
posted by hollyanderbody at 5:39 PM on March 11

My husband (our sole income earner) doesn't make a ton of money, but we're definitely way beyond most scales to qualify for low income services. But when we ended up with a $15k bill (the we accrued in a 30-day period between old job and new job, ugh), the hospital negotiated down to $1500 and we paid it off $50 a month (last payment made yesterday, yay). That's just our experience, but I think it's worth a shot to talk to them. The hospital we dealt with had a form for us to fill out and there was a sliding scale for what % would be negotiated based on your income. We weren't even at the top income level to qualify. If you don't pay, it will definitely go to collections, which is way worse.
posted by upatree at 5:42 PM on March 11 [2 favorites]

Yes, all these answers are right, but upatree's is the first one to get even remotely close to what your opening position should be when you argue the bill (at around 10% of the list price.)
posted by Maxwell_Smart at 6:02 PM on March 11 [1 favorite]

Absolutely just straight up ask for a break on the price. Say that you're willing to pay this much today and you can do a payment plan but you stopped paying for insurance because you could not afford it so you need to focus on what you can afford. Check out the Time article referred to above. The horrible truth about our lousy healthcare system is that people like you who do not have health insurance subsidize the cost of healthcare for people like me who do have insurance because my insurer negotiates on my behalf so you have to negotiate for yourself.

You should consider asking about what someone would pay for the treatment your daughter has received if you had health insurance. The negotiated rate for insurance is dramatically different than the cost they bill. For example, a prescription I take every day without health insurance costs more than $400 but with my insurance, I pay $50 (plus I use a coupon which brings the price down to $5). It doesn't hurt to ask.
posted by kat518 at 6:04 PM on March 11 [1 favorite]

Check also with your state DSHS office; they were immensely helpful to my dad. Stepmom died of cancer, left him with staggering hospital bills; DSHS helped him get them reduced significantly and there were some state programs he successfully applied for that also covered some of the costs.
posted by xedrik at 6:52 PM on March 11

They will come to you with a ridiculous bill, X. What you do is you say I cannot pay X. I can pay 1/20x. Then, instead of laughing at you, they will say OK, you will pay us 1/20X. It is simply mindboggling how many items with many zeroes after them can just simply be wiped off the list just by asking. The first number is a sucker's game.

It's a very strange system, basically the uninsured who are bad at negotiating but with some means subsidize the insured (whose insurance negotiate for them) and the poverty-stricken.
posted by spatula at 7:14 PM on March 11 [2 favorites]

From what I understand, the hospital bill cannot be different amounts for different payers, but the different payers (private health insurance, medicare, workers' compensation, uninsured patients, etc) all pay it at different rates. So if an ER visit costs $1000, that's the number that goes on the bill regardless of where it's mailed, but it's rarely (if ever) the amount that's actually paid to settle the bill. Basically, it's not really like full price vs. sale price, and more like full price vs. bringing in a 20% off coupon.

Anyway, the financial aid limits go up surprisingly high sometimes and you are quite possibly still eligible. Please don't hesitate to ask the hospital for an application to find out. Even if you don't qualify for full-on financial aid, there is probably a basic self-pay discount that they can apply.

Also, it is likely that the ER physician, surgeon, and/or radiologist who treated your daughter billed for their services separately from the main hospital bill. The billing people at the hospital should (hopefully) be able to give you a contact number for them.

Good luck, and I hope your daughter's arm heals quickly!
posted by mismatched at 7:53 PM on March 11

Check to see if your kids are eligible for CHIP, which is for children whose families make too much to qualify for Medicaid. In some states, benefits are retroactive.
posted by Wordwoman at 8:10 PM on March 11 [4 favorites]

Ask the hospital's finance department for an application for financial aid.

If the hospital is in the United States and accepts federal grant money, it is required to provide these forms.

They outright forgave over $14,000.00 in medical bills when I was uninsured and in a car accident. Do it now because the aid is limited (I think) but it's still early in the year.
posted by mibo at 9:24 PM on March 11

Another angle: What were the circumstances of the broken arm? Would you have the ability to file against homeowner's insurance, or someone else's liability insurance?
posted by FergieBelle at 5:38 AM on March 12

Be prepared...When I had my back surgery a few years ago, we ended-up owing the hospital several thousand dollars (the out-of-pocket expenses and deductible of our insurance). It turned out that the hospital no longer carried payment plans. If you couldn't either write a check or put the balance on a card at the time of checkout, you were referred to a local finance company to arrange a short-term loan for the balance.

They had an arrangement with the hospital to provide interest-free loans for patients. If you paid the loan off within a couple of years, the money was interest-free. If you didn't, of course, you were on the hook retroactively for all interest that would have accrued over that time, plus new interest going forward.
posted by Thorzdad at 5:39 AM on March 12

Yes, check into CHIP. Here's the link for Arizona.
posted by mareli at 6:25 AM on March 12 [1 favorite]

I am going to Nth negotiating the rate you have to pay. The hospitals expect you to negotiate now because so many Americans are without insurance. I have medical bills that the insurance company did not pay and it was negotiable to an affordable amount. I also experienced having no medical insurance and being able to negotiate.

Just keep trying until you can get the bill down to an affordable rate for you. Just be super nice to the billing people, they are likely to help if you are, they get calls with people screaming at the other end all day.
posted by Yellow at 7:36 AM on March 12

Is there anyway to get retroactive coverage? For instance, I was laid off from a job and thought I'd just go on without insurance. However, after almost two months, I realized I do need health insurance so I opted into Cobra and it retroactively covered the previous two months, so the prescriptions I already paid out of pocket can now be covered and I get a refund. I also did a similar thing a few years ago, not through Cobra, but through a subsidized healthcare insurance offered by the state of NY to low-income people. They also allowed me retroactive coverage.

Sometimes if the lapse isn't too long, you can re-opt in, paid the premiums for the months you missed, and get covered retroactively. Four months of no coverage seems rather negligent to me, but I'd make sure you don't have any other options than to just pay out of pocket.
posted by AppleTurnover at 8:38 AM on March 12