E.R. Bill HIGHER after submitting Insurance

August 19, 2013 4:26 PM

After submitting an ER claim to insurance, my bill from the hospital INCREASED. Is there any way to fight the hospital on this?

I went to the E.R. in early July. They did not ask for my insurance information. I received a bill in the maill for roughly $560, and an offer of a 60% discount if I paid within 10 days. (These were the weirdest payment terms I've ever seen.) So if paid in 10 days, it would've been a little over $200.

On the back of the bill, it had an opportunity to write your insurance info and have a claim submitted. I chose to do this, thinking that after insurance discounts, the bill would be even lower.

Wrong. The bill is now almost $900. Reading online, this is probably the result of a practice being used by the hospital where they do two-tiered billing-- for the insured, and uninsured. I guess they orginally assumed I was uninsured.

Point in case, a $200 is now a $900 one, AFTER insurance submission. Is there any way to fight this? I could have barely paid $200, and I definitely can't afford $900. I'm also horrified that my insurance made things WORSE.

Thanks for any help you can offer.

posted by unmouton88 to Work & Money (26 answers total)

Is that after your insurance covers things, or before? It's very standard for hospitals to give a steep discount to uninsured people (because they give a steep discount to insurance companies), but then your insurance should cover a lot of it. Depending on what you were there for, they may cover more or less of that, but have you looked into what your insurance is covering, and if they're covering as much as they should?
posted by brainmouse at 4:31 PM on August 19, 2013 [1 favorite]

Definitely call the billing office and ask for an explanation of why this statement is higher than the initial one you received. See if they can put you on a payment plan to pay off the balance, or direct you towards any financial aid the hospital might offer that could help get you a discount based on financial need.
posted by ThePinkSuperhero at 4:39 PM on August 19, 2013 [1 favorite]

It is unclear from your post whether or not the $900 is the total, with zero covered by insurance, or what proportion of the bill total it represents. Could you update with that?

There is always a chance to reduce your bill at a hospital. They would rather get paid sooner and not have to keep spending money trying to get money from you, as evidenced by their initial offer.

After you figure out whether your insurance is covering what it is supposed to cover (by calling your insurance company to inquire about the claim), call the hospital billing department and negotiate the remainder with them. If they would accept $200 before, they ought to still accept it now - having this other bill in hand gives you leverage to know how low they're willing to go. You can probably also ask to be put on a payment plan if you can't afford to pay as a lump sum.

Bottom line, if you're paying $200 total for an emergency department visit, you're getting a steal - that's not much more than most people's co-pay and it probably isn't even enough to cover the physician's professional charge much less any other services you received.
posted by treehorn+bunny at 4:42 PM on August 19, 2013 [3 favorites]

You didn't pay within 10 days and you made them go through insurance billing which costs them extra money and work so the ship has sailed on any entitlement to paying $200 under that deal. You might be able to convince them to take it though.

Are you sure that the $900 is after insurance payments have been made? It's likely that they would send you a bill, then bill the insurance, then send you another bill reflecting the amount owed after the insurance company paid them part. If the insurer has already paid them you should be able to get an explanation of benefits from your insurer listing how much they paid and how much is your responsibility.

It's still possible that you might end up paying less.
posted by grouse at 4:42 PM on August 19, 2013 [1 favorite]

Not enough information to go on. Unfortunately insurance is pretty complicated.

Was the original bill for just the hospitals portion or did it include the physicians services? Same question for the second bill.

On the second bill. Do you have a deductible for an ER visit?

Did you get an EOB from your insurance company yet? What does it say?
posted by Bonzai at 4:47 PM on August 19, 2013 [1 favorite]

Call the hospital and find out if the $900 is before the hospital got paid by your insurance, or after the hospital got paid. I seem to recall getting the full billing statement from the hospital after my last ER visit, shortly followed by a notice that almost all of it had been paid by my insurance, and I now owed some small co-pay amount.
posted by NotMyselfRightNow at 4:48 PM on August 19, 2013

Oh, also, keep in mind that it is common (but definitely not universal) for an ER/hospital visit to get billed to you in many bills -- the individual doctors who saw you, for example, may charge you separately on different bills (and may accept your insurance in different ways). Be aware of this.
posted by brainmouse at 4:51 PM on August 19, 2013

Response by poster: To offer more detail:

I received a bill from the hospital for roughly $560 (with no insurance coverage.) They offered a 60% discount off of the original $560 if I paid within 10 days. They also offered an option on the back for insurance submission. I submitted the bottom stub with insurance information and pitched the original bill. (Kicking myself now for that.)

I mailed the bill back with my insurance information.

I then received a statement of benefits from my insurance company (I'm not sure if that's what you call it? But my actual insurance company mailed me a statement, showing what the hospital billed, and what discounts were given via insurance. Then a "total patient responsibility" was listed at the bottom as roughly $900. Much higher than the original bill. So I decided to wait it out and see what the actual hospital re-billed me.)

Then, the hospital billed me for the exact amount my insurance said it would, essentially. Which is much higher than the original bill. I realize at this point $200 is probably unrealistic to expect. I am fresh out of school, and this is my first time paying my own medical bills. While I realize now that $200 is a steal and I should've taken it (considering the hospital billed my insurance over $3500) it's probably too late now as I've put them through the hassle of insurance submission.

But I am finding it insane that my bill is now $900, insured, instead of $500, uninsured.

I don't have the expectation of paying $200 now, but I guess I'm curious as to whether I can fight the hospital on the $900 and pay the original bill instead.

I did not realize insurance would make things worse, and not better. (Lesson learned.)
posted by unmouton88 at 4:52 PM on August 19, 2013

Something does not add up here. There is no way your insurance company negotiated a deal where they pay 7X retail for services. Are the bills for the same set of diagnostic codes?
posted by COD at 4:57 PM on August 19, 2013 [3 favorites]

Response by poster: Also, the bill I've received is not thoroughly itemized, but it does show charges for:

Pharamacy, Laboratory, ER, Pharmacy Detailed Coding, and an Insurance Adjustment (negative, drops the bill $2,900), an insurance payment of $0 (presumably because I haven't met my deductible?)

So I'm pretty sure they have received my insurance claim and included it in the bill.

I did not consider that multiple parties may be charging seperately. (This sounds like bad news bears. If those two bills are separate, god help me.)

Thanks for all your help as I muddle through this. I've googled for hours and this process seems incredibly confusing.
posted by unmouton88 at 4:57 PM on August 19, 2013

You should do what ThePinkSuperhero said—call the billing office and ask them why the bill is higher, and how that possibly makes sense. Tell them that this higher bill is a financial hardship for you and ask them for an adjustment (you might as well ask them to reduce it to $200). If you don't get the results you want, ask for a supervisor and ask them the same things.

Try to stop thinking of this as a "fight." You are asking the hospital to voluntarily reduce the bill. Stay nice for now.
posted by grouse at 4:58 PM on August 19, 2013 [3 favorites]

Response by poster: Also, it appears as if insurance paid nothing. The ER basically granted me my Reasonable and Customary discount that the insurance company receives simply by being contracted with them.
posted by unmouton88 at 4:59 PM on August 19, 2013

Have you tried just calling the hospital's billing department? I once had an ER bill for over $1200 uninsured and when I called to talk about my total inability to pay more than about 10% of that, the bill was cut in half before I even asked for anything else. There's no reason to think they won't be nice about this until they aren't.
posted by teremala at 5:00 PM on August 19, 2013

If you saw a medical doctor you are likely to receive another bill from the physician for their services. You can ask about this when you call the billing office as well.
posted by grouse at 5:01 PM on August 19, 2013

I wonder it's possible that the first statement you received did not include all of the charges from all of the various departments that treated you during your visit. It seems odd to me, too, that a $560 bill to you became a $3500 bill to your insurance company. Definitely ask the contact at the billing office about that.
posted by ThePinkSuperhero at 5:01 PM on August 19, 2013 [3 favorites]

The higher bill is probably related to your deductible.
posted by jaguar at 5:10 PM on August 19, 2013 [1 favorite]

So it's $900 after the insurance. That's a bad break.

It sounds like either you had a large deductible or your ER was not in your health care network.

If I were you I would still call my insurance company. It's probably a long shot that they can change anything but you never know. I work for a large insurance company in the claims department and I find mistakes on our part every day.

Since your EOB from the insurance company said there were discounts given it sounds like you were in-network which means you almost certainly have that deductible. In the future consider putting a few bucks a month into an HSA if your company has them. They are great because they roll over from year-to-year and come out of your pre-tax dollars so it's like getting a discount from uncle sam.

Finally hospitals are usually pretty good at giving you a payment plan on a large balance.

Good luck. Call your insurance company.
posted by Bonzai at 5:12 PM on August 19, 2013 [1 favorite]

I had a procedure that involved overnight stay, was done through insurance, and I *still* got a discount of almost 25% by agreeing to pay within 30 days. So yeah, call the billing office and see if they will work with you. If they won't, consider calling the office in your state in charge of health insurance (often an 'commisioner' of some sort) - they might be able to help out. This sounds like a raw deal.
Good luck.
posted by dbmcd at 5:22 PM on August 19, 2013

You went to the ER, but was that because it really was an urgent matter that required immediate care (broken bones, gunshot wound, bitten by a rabid coyote, whatever) or because you felt sick and your doctor's office was closed over the weekend?

That matters because most insurance companies require you to get pre-approved for (whatever they consider) non-emergency healthcare. Generally, you should at least call your doctor's office before going to the ER if that is at all possible, even if the doctor's office is closed. If they are closed, the doctor on call will either tell you to come in during office hours or that you need to go to the hospital, and then. You should have no trouble getting the insurance to cover you.

So you may be getting dinged because you never notified your insurance company and the hospital had to go through this process of finding out your insurance info. Either the hospital or the insirance company or both may be penalizing you for not providing your insurance info.

Also, if you have not met your copay yet, of course you will be responsible for paying that, and that amount may be higher for emergency visits than regular office visits. The copay might explain why your bill is higher now.

I am telling you all this because you indicate that you are young and not familiar with the process, and I am going to tell you two more things as well that are vital for you to do going forward:

1. If you have insurance, always make sure everyone who treats you knows that! Do not use the excuse that no one asked you for that information. You're not a kid any more. You know they need that info! Make sure they have what they need. When you make other people jump through hoops because you can't be bothered to make an effort yourself? You always end up paying for it in the end. Trust me on this. Don't be that guy.

Which brings me to:

2. You must be your own advocate in the healthcare system, because no one else is going to be as invested in ensuring your needs are met as you are! This goes for medical issues as well as the financial ones. Be proactive, not reactive. Speak up, ask questions. Keep copies of all your healthcare bills and insurance statements until everything has been paid. Make sure the statements and the bills match up. If you are unsure about a charge, call up the billing department and ask for an itemized bill. I personally know--this is NOT an urban myth!--a man who was charged for a circumcision after his wife gave birth to a baby girl. Hospitals and insurance companies make mistakes all the time. People get double-billed. Insurance companies may not pay, even when you are covered, if something was coded wrong, like two numbers getting transposed by the hospital. So call the insurance company if you think something should be covered but hasn't been. Basically, stay on top of those bills!
posted by misha at 5:33 PM on August 19, 2013 [9 favorites]

Oh, and rereading your question, since you went to the ER in early July and it is now late August, your bill may also be higher because 30 days went by without a payment and you missed the billing cycle the first time around (or missed the window for submitting your claim to insurance).
posted by misha at 5:37 PM on August 19, 2013

The shortest amount of time you have to file a claim that I have ever seen is six months. Usually 12 months, sometimes 18.
posted by Bonzai at 6:12 PM on August 19, 2013

I did not consider that multiple parties may be charging seperately... If those two bills are separate, god help me.

$900 sounds really low for an emergency room visit.

If you don't remember specifically who sent you the first bill, this could be a bill from someone else.

The good news is that you can submit it to your insurance as well.

You're probably going to need to do more to get insurance to pay than just jot something on the back of the bill and send it off though.

Of course, if you are under your deductible they aren't going to pay, but you still want to submit the bills.

KEEP THE BILLS. If you should happen to go over that deductible, you want to have everything.
posted by yohko at 10:59 PM on August 19, 2013

Just so you understand how health care in the US works, people with insurance get billed more so that the hospital can have money to cover people without insurance. And because insurance companies will only pay the "usual and customary" rate, you will always see one charge for what the hospital billed them for, another price which is the usual and customary rate and then the insurance company pays 80 percent of that usual rate. You pay the other 20percent. Or whatever percent your insurance policy says.
posted by SyraCarol at 4:00 AM on August 20, 2013

Before you contact the hospital or your insurance company:

Compare the services billed on the original ($560) bill to those on the new ($900) bill. Make sure they are the same. It sounds very likely the original bill did not cover everything. When I last had to use the ER, I got three bills from three different entities: the hospital, the doctor, and whatever diagnostic company they used to do a CT scan. The total out-of-pocket cost to me was around $850, so $900 seems typical. The hospital's bills always offer a 10% discount if paid within 45 days (I've done non-ER stuff with them as well); that is just their default policy.

The hospital took my insurance information before checking in to the ER; however (a) it was my wife who needed the ER, (b) I drove her there in my car versus getting an ambulance, and (c) I stayed with her for almost the entire time she was there. I imagine if it was just her going to the hospital by ambulance they might not have taken any insurance information at first.

I have a health insurance plan that has a $2,500 deductible, so I make sure to have that (and more) in my HSA. The ER visit brought me close to the deductible that year but didn't quite put me over, so I had to pay the whole thing.

If both bills show the exact same services rendered, I'd call or visit the hospital's billing office to ask about the discrepancy, and whether or not they would accept the original amount ($560 minus 10% discount) instead. However, as has been stated here, hospitals charge more to those who are insured so they can afford to offer discounts to people who are not insured, since ERs are required by law to treat anyone who comes in, insured or not.

Also, the point about using the ER for not-truly-emergency services holds true; a lot of insurance companies frown upon this (as well they should, in my opinion). Look for an "urgent care" facility in your area -- in most cases they are much cheaper than the ER (but probably more expensive than your regular doctor) and they are open early, late, and on weekends. In my case, the urgent care facility that would have been most convenient closed at 9 PM and this incident happened at 10:30 PM, so the ER was a must.
posted by tckma at 6:55 AM on August 20, 2013

You probably received different bills for different services. That is what happened to me after my E.R. visit a couple years ago. I got a small bill initially that said it was for physician services ONLY, and a (much!) bigger bill arrived several days later with all the other itemized expenses. Call the hospital's billing department to confirm, and make payment arrangements ASAP! Even if you can't give them the full amount at once, ask to set up a payment plan, anything to keep them from sending you to collections. In my case, there was a screw up with my insurance (issue with COBRA coverage), and no payments were made initially, so the hospital sent the bill to collections and I got a nasty mark on my credit report that comes back to haunt me any time I apply for new credit--even though the bill was eventually paid in full.
posted by Silverdreams at 9:15 AM on August 20, 2013

Call your insurance company. Yes, hospitals bill them more than uninsured patients. And it sounds to me like your insurance just hasn't processed the claim yet. They are very used to taking calls from people about claim status. You will need the date of service (the date you went to the ER).
posted by kestrel251 at 10:42 AM on August 20, 2013