Big hospital charge

December 2, 2005 4:23 PM

A month ago I went to the hospital ER (tiny city) as it was Saturday and I had some weird chest pain. Basically the doctor asked a few questions, an EKG, blood test, and chest X-ray was done, and I was out in 45 minutes after observation. The damage: $475 for the doctor, $95 for the blood test, and $1800 for the hospital (unspecified). No insurance. I'm glad to pay for my care, but this is ridiculous. Any good tips for bargaining this down? Obviously I am in the U.S.
posted by zek to health & fitness (30 comments total)

You should be able to get an itemized list of charges at the very least.

Good luck.
posted by luneray at 4:25 PM on December 2, 2005

Moral: Never go without health insurance in the United States. You got lucky - had you been diagnosed with something serious that required surgery or an extended stay you'd have received a significantly higher bill. I spent a week in the hospital a few years ago and came away with a bill totaling nearly $15,000. Thankfully, my insurance covered most of that.

While you can and should get an itemized list of the charges, you probably won't be able to get them reduced much. Unless you can demonstrate that the charges are in error or have been miscalculated.

The hospital will probably allow you to work out a payment plan if you can't pay the whole $2400 up front.
posted by aladfar at 4:35 PM on December 2, 2005

I should add that we're 18 months into a Chapter 13 bankruptcy.. I wonder if that might have some bearing.
posted by zek at 4:42 PM on December 2, 2005

What state are you in?

In California you can apply to Medi-Cal for coverage if you qualify for up to 1 month AFTER your hospital visit.

Check out this article on consumer reports. Found a list of hospital codes and a lot of info about disputing your bill in that article.
posted by sophist at 4:50 PM on December 2, 2005

After you review your bill and make sure there are no errors or overcharges, make them an offer. They're billing you full price, which they would never ever get if you had been covered by any kind of insurance. All their contracted provider networks have negotiated discounts, and everyone else wouldn't pay higher than UCR (Usual, Customary, Reasonable). If you come in ready to pay your full offer on the spot, I don't see why they wouldn't cut you a deal. Or a payment plan might also work, but the quicker they get their money, the more likely they are to accept a lower amount. This is a business proposition; treat it as such. Make sure you're talking to someone who has the authority to make this decision.

As for how much to offer - I don't know how you'd go about doing this, but can you find out what some network provider rates would be for the same services? UCR and network reimbursement rates vary greatly by location and to a lesser extent by carrier.

And if you do succeed in bargaining them down, make sure you get something in writing that says they've accepted your offer as payment in full. Just in case.

On preview - since you might not have cash on the spot, you have less leverage here. I have not much clue how these things work, but my understanding is that any debts incurred after you file are not covered by your bankruptcy plan. Talk to whoever is advising you on your bankruptcy.

Good luck.
posted by expialidocious at 4:54 PM on December 2, 2005

I have been through a few rounds of bargaining with hospital collection departments. In my case, I was contacting them on behalf of minors with no health insurance.

In one instance, the bill was almost $2000. As soon as I mentioned "no insurance," the bill was immediately halved. Just in case you didn't, let the hospital know that you're uninsured and they may take a percentage off the bill.

As far as the "unspecified" charges, definitely ask for an itemized bill. Though it may truly be that expensive, there could be charges for another patient on your bill.
posted by annaramma at 4:56 PM on December 2, 2005

Hospital charges are preposterous, as they inflate the costs to pay for other aspects of the system. For example, a patient might be charged $4 for an aspirin, because they're bundling in the cost of the pharmacist, etc. Did you tell them you didn't have insurance when you checked in?

My sense is that these are the charges that insurance companies pay, but that when someone doesn't have insurance, hospitals will sometimes negotiate a separate rate. Call their financial office and ask to speak to someone about making adjustments to your bill since you don't have insurance, and you don't think the amount is reasonable and you can't afford it.
posted by jasper411 at 4:56 PM on December 2, 2005

Another discussion about challenging hospital bills found here.
posted by sophist at 4:59 PM on December 2, 2005

Tell them you can't pay that much. Most hospitals have plans for people that cannot pay the full amount of whatever charges. I had a much smaller bill and only paid 60% based on my income (and I have insurance). They are usually more than happy to set up billing plans. They want you to pay, they will make it easy for you. Just make sure you take good notes about who you spoke with and when etc.
posted by TheLibrarian at 5:39 PM on December 2, 2005

Ridiculous? That sounds pretty cheap. Why don't you have insurance? Do you have a death wish?

GET INSURANCE!!!!!!!!!

Your life may someday depend upon it. If you only get catastrophic coverage with a high annual deductible, like say a few thousand dollars, that is enough to perhaps someday save your life, as we do not yet have government health insurance for all, and care gets allotted to those who are insured first. Emergencies are taken care of, the law requires the hospital to take care of emergency patients, but chronic conditions are very hard to get treatment for without insurance.

GET INSURANCE!!!!!!!!!!!!!!!!!!!!!!!

As for your current dilemma, check with your state, and if they have no programs that can benefit you, negotiate with the hospital. Are you in school? Many colleges provide a very limited medical benefit, that probably won't cover this, but you might check. You can probably negotiate a fee reduction if you are not too high income, and can at least get a payment plan if you need it. If you have a good income, then this will be tougher, but if that is the case then WHY DON'T YOU HAVE INSURANCE? Do you think I find insurance important? It can be a life saver. What if they found a lump on you tomorrow? Get insurance.
posted by caddis at 6:31 PM on December 2, 2005

Depending on what state you live in and whether the hospital you went to is a not-for-profit/charitable hospital, you may be affected by the outcome of a number of class-action suits filed against over 50 hospitals regarding their overcharging of indigent patients. General info is here and here; a website from one of the legal firms involved is here. Be polite, but be willing to be firm with the hospital and you are much more likely to get a discount. Also your impending bankruptcy could certainly affect this, but your bankruptcy lawyer would be the best person to ask.
posted by TedW at 6:33 PM on December 2, 2005

As a Canadian. I'm a little horrified by the idea of a "hospital collections department."
posted by Count Ziggurat at 6:43 PM on December 2, 2005

I missed the bankruptcy. That will definitely help you with the payment plan/fee reduction negotiations with the hospital, and perhaps with the doctor. I would guess that a 50% reduction should not be that difficult to achieve. Well, it will take a quite a bit of effort to break through the initial resistance, and then to justify due to your financial situation, but after doing the work I think they will agree to at least 50%. Ask your attorney for advice.

I still recommend you find a way, despite expense, to get insurance. When I had essentially no income, I was able to get a high deductible, really high deductible, policy through Golden Rule. The policy cost was probably something like 10 percent of my take home income. There are other companies. Frequently, just having an insurer gets you a better rate. In any event, it can be critical for obtaining life saving and prolonging care. Get insurance.
posted by caddis at 6:46 PM on December 2, 2005

They are not permitted by law to charge interest on your bill, so just pay them $10 a month for the rest of your life. There's nothing they can do about it especially if you negotiate this with them in advance.
posted by crapples at 6:48 PM on December 2, 2005

Several states allow ins. cos. to refuse to insure anyone with a pre-existing condition, making it impossible for anyone with a documented history of, say, diabetes to get any insurance at any price. So shouting "get insurance" often isn't the answer.

The prices hospitals charge the uninsured are from two to three times more than they get from ins. cos. I spent less than 24 hrs. in a not-for-profit "faith based" hospital in Ohio two years ago for a gall bladder removal, and they charged me over $25,000. An insurance co. would have paid them ~$10,000, max. The cutoff for their "low income" discount is the poverty line.

I negotiated for a year. They offered me a 20% discount if I signed up with a finance company they had an "arrangement" with. The agreement contained all sorts of usurious terms, so I balked and kept trying to talk sense to them. They then sued me for the full amount plus legal fees.

Mount Carmel in Columbus, OH, part of the Trinity Health chain out of Michigan, Their web site sez they're on a mission from Jesus to help the poor. Bull. Shit. They are vampires.
posted by words1 at 6:49 PM on December 2, 2005

They can and do charge interest on hospital bills here in lovely Oregon. Call the patient advocate, explain the situation about no insurance and the bankruptcy. they'll most likely offer you a payment plan. Be honest if you can't make the payments because they can and will sue you.
posted by yodelingisfun at 7:02 PM on December 2, 2005

Several states allow ins. cos. to refuse to insure anyone with a pre-existing condition, making it impossible for anyone with a documented history of, say, diabetes to get any insurance at any price. So shouting "get insurance" often isn't the answer.

That would be all states. "Get insurance" is not necessarily the answer to zek's current situation, but is the answer to preventing its recurrence. You can usually still get insurance with a pre-existing condition; they just won't cover that condition, or won't cover it for some period of time. Get insurance. It is as necessary as electricity, but too many people gamble that they won't need it. Get it. Get it even if it means eating rice for dinner every other day. Certainly get it at the expense of movies, cable and fancy things.

I wish the US had national health insurance. That is the most rational system, both for the citizens and businesses. However, it is not the most rational system for the middle and upper middle classes and they control politics. People with jobs and employer provided health insurance, or who make enough to buy private insurance, will get better health care (at least that is the perception) under the current system than under a government health insurance system so they oppose it and they make up a large percentage of people who actually vote. Until this changes a rational person gets coverage and doesn't let it lapse, no matter what. If you do not qualify for Medicaid, get insurance.
posted by caddis at 7:34 PM on December 2, 2005

Talk to them. I've worked with hospitals, and most of them are more than willing to work with people who can't afford the costs. Offer to work out some long-term payment plan, with the possibility of a reduced price. Since medicare and medicaid pay jack (this is why hospital costs are so high; government health care only pays a fraction of what is owed so hospitals need to recoup the cost somehow, and this is by passing the lack of government payment on to health care insurers), a lot of them are willing to take when they can get regardless. When they charge those insane prices, they assume it's going to be billed to insurance. You may have told them otherwise, but pricing is still as such.
Ask, ask, and ask again how you can pay and not be screwed over.
posted by jmd82 at 8:29 PM on December 2, 2005

Caddis if oyu have a pre-existing condition or had something like childhood leukaemia private insurance can easily run near or over $1000/ mo. A lot of people simply can't afford that.
posted by fshgrl at 8:52 PM on December 2, 2005

Just don't pay it.

The hospital won't do anything other then reporting it as a derogatory item on your credit report. That'll impact you later if you try to get a home loan or something, but there's a chance you can get the credit reporting agencies to drop it if you pester them enough.
posted by delmoi at 8:54 PM on December 2, 2005

I should add that we're 18 months into a Chapter 13 bankruptcy.. I wonder if that might have some bearing.

Oh, pff, then you're credits already ruined. Just don't bother paying it.
posted by delmoi at 8:55 PM on December 2, 2005

Ridiculous? That sounds pretty cheap. Why don't you have insurance? Do you have a death wish?

Don't be so dramatic. Hospitals can not turn away patients for any reason, including inability to pay.
posted by delmoi at 8:59 PM on December 2, 2005

As a Canadian. I'm a little horrified by the idea of a "hospital collections department."

The collection agency for state hospitals is often (always?) the state's Attorney General, too. Quite fun.

I had a little luck bargaining the hospital down on surgery and treatment for cancer. I had to prove that I owned nothing and had no money, which was easy, because I don't, and then they let me get away with paying only a few thousand dollars. Big hearted, those hospital folks. My favorite part of the whole experience was when they almost refused to let me have several malignant tumors removed from my neck because I didn't have 250 bucks for a down payment and they didn't consider the surgery an emergency.

To bargain, I made an appointment with the collections department. I showed up and said that they could try to get blood from a stone, but they wouldn't be very lucky. After some veiled threats about the possibility of losing my driver's license for non-payment (love those attorney generals!), they finally settled. Then they relentlessly pursued me until they got their payment.

Tell them that you need case management due to financial hardship. If you have no provable financial hardship, the best you'll be able to get is a payment plan. Good luck.
posted by xyzzy at 9:02 PM on December 2, 2005

Just out of curiosity, what ended up being wrong with you?
posted by delmoi at 9:04 PM on December 2, 2005

You're getting lectured a lot. I agree with the lecturers, but it's got to be tedious for you. At least now you can get the advice in a more amusing form:

Clinic PATIENT comes in coughing.
PATIENT: Two months [coughing] like this.
HOUSE: Let me guess: no insurance, you just heard about the free clinic. It's a good move -- you don't want to skimp on the essentials, like wristwatches or MP3 players. . . . Chuck. I'm going to tell a little story about a patient -- let's call him "Buck" -- who has low O2 stats and crackling lung sounds.
PATIENT: Like I have.
HOUSE: Buck has ideopathic pulmonary fibrosis. His lung tissue's turning to rock. There's no known cause; no treatment. He is slowly suffocating.
PATIENT: You're talking about me?
HOUSE: A lung transplant's about a half-million dollars. And this poor sucker's got no insurance. And if he tried to sign up now, he'd be excluded -- pre-existing condition. . . . If only Buck hadn't been diagnosed with fibrosis before he got insurance! So! Back to the exam.
HOUSE dramatically turns his back. PATIENT runs from the room.
OTHER PERSON: That's how you tell this guy he's dying?
HOUSE: Oh, relax. He's got a cold. And soon, health insurance!
--House MD, S2x08, "The Mistake"; written by people who aren't me.
posted by booksandlibretti at 9:05 PM on December 2, 2005

I came down with a nasty bout of pneumonia in July. (Yes. In the middle of an Arizona summer.)

It hurt a lot, and the sharp, stabbing pains were enough for me to go, uninsured to my local Urgent Care (read: not hospital ER, because it's slightly cheaper.)

I received a shot of $375 antibiotic, a $250 x-ray, and $50 in misc. charges and a $125 doctor's fee. Oh, and $2 for the 2 800 mg Ibuprofen I took.

They informed me that, since I was uninsured, if I paid within thirty days, they would halve my bill. So I took out my card, took the $400 hit, and signed up for $100/month Blue Cross/Blue Shield the next day.

Moral is, they should be willing to help you if you're uninsured. They generally are charging so high because they already have a pre-existing system worked out, where, for instance, the insurance company will pay what they choose for certain charges, and what's been agreed upon. In our case, they expected half the money in thirty days was far better than no money at all and a deadbeat.
posted by disillusioned at 10:25 PM on December 2, 2005

So what happens if you're poor and sick in America?
posted by A189Nut at 7:50 AM on December 3, 2005

So what happens if you're poor and sick in America?

The hope is that you remain too weak to make it to the voting booth. That, or you'll be stuck waiting in line at the Emergency Room until after polls close.
posted by Triode at 9:35 AM on December 3, 2005

Ditto on talking to the billing department.

Medical billing is a really fucked-up confusing system. For example, the hospital bills insurance company for say $1500, but insurance company says only $750 "allowed" and they'll pay $400 and patient owes $300. So even after billing insurance and patient, they'll never get the full amount they billed for, but they have to bill everyone for the same amount.

Ask them if they can bring it down to the rate that an insurance company would allow. It's still a lot of money, but not as much as they originally asked for.

Then ask for a payment plan.
posted by radioamy at 11:45 PM on December 3, 2005

Don't be so dramatic. Hospitals can not turn away patients for any reason, including inability to pay.

Actually, they can. I work in the ER doing patient registration and financial counseling. Immediately after coming into our hospital, the patient must go to triage to be assessed by a nurse. "Emergent" is listed as your life is in immediate danger, i.e. heart attack (not just chest pains), respiratory failure (not just shortness of breath) or severe trauma, your gunshot wounds or broken necks. You care considered "Urgent" if considerable damage could be done if you are not seen within the next 24 hours. Those are your fevers above 104, 102 for child, a wound over a certain size with active, uncontrolled bleeding, and some of your broken bones, but normally only compound fractures. Also included are the random chest pains and ongoing asthma attacks.

All the rest of it is considered elective/non-urgent, EVERYTHING else. If you have been vomiting all day, if you have broken your ankle, if you have fever and chills, if you may be miscarrying under 32 weeks, if you have a laceration that needs stitches, etc. Everyone of our patients who have been considered non-urgent by our triage nurses CAN be turned away for treatment. This is especially true if, when we pull up your name and see your last ten visits, you have not paid a dime on any one of them. It's not common, but we do turn people away and we are actually the only non-profit hospital in my city.

Don't think insurance will get you by this either. If you have Medicaid, and are considered non-urgent, we have to call your primary care physician to get a referral. If he/she decides you're non-urgent as well, then we will list you as a no-insurance patient and require you to either pay up front, or refuse treatment to you.

And just to clarify the urgency classifications. We had a two-year old who had been attacked by a pit bull and had severe lacerations to his face and eye. He was considered only "Urgent" even though he had to be air-lifed to a speciality hospital three hours later. Then we had a young man who had a radiator explode in his face. When I was registering him, his face was literally peeling off in front of me. He was considered "non-urgent" because the damage was already done and his life was not in danger. He was sent back to the waiting area to wait for a room along with the people with spider bites and coughs.
posted by Ugh at 2:19 PM on December 4, 2005