I accidentally spent $1700 in 10 minutes without knowing it.
December 28, 2015 6:22 AM Subscribe
What can I do about an $800 hospital bill? And can an ultrasound really be $1700?
I recently had an abdominal ultrasound. My doctor requested that I go to a specific hospital to have it done and he and his office staff assured me that I would not be charged, after I explained the specifics of my insurance. Stupidly (so, so stupidly) I trusted them, and now I have an $800 bill to pay. My insurance covered $900 because the hospital is in network, but unless I go to specific locations (this is what I had explained to the doctor) I have a huge deductible to pay. I asked the doctor to call my insurance and the hospital to see about the lowering the bill. No luck, but my doctor did accuse me of lying, while also admitting that he remembers the conversation. So here are my questions:
Is there anything to be done about my portion of the bill at this point?
Also, I have looked up the cost of abdominal ultrasounds on a few "fair price" websites and have yet to see anything above $500. I know healthcare is all kinds of messed up in this country, but it seems impossible to me that an abdominal ultrasound can be billed as $1700. However, it does not look like there is any error on the bill. How do I find out more? Or does this sound about right (however wrong)?
I recently had an abdominal ultrasound. My doctor requested that I go to a specific hospital to have it done and he and his office staff assured me that I would not be charged, after I explained the specifics of my insurance. Stupidly (so, so stupidly) I trusted them, and now I have an $800 bill to pay. My insurance covered $900 because the hospital is in network, but unless I go to specific locations (this is what I had explained to the doctor) I have a huge deductible to pay. I asked the doctor to call my insurance and the hospital to see about the lowering the bill. No luck, but my doctor did accuse me of lying, while also admitting that he remembers the conversation. So here are my questions:
Is there anything to be done about my portion of the bill at this point?
Also, I have looked up the cost of abdominal ultrasounds on a few "fair price" websites and have yet to see anything above $500. I know healthcare is all kinds of messed up in this country, but it seems impossible to me that an abdominal ultrasound can be billed as $1700. However, it does not look like there is any error on the bill. How do I find out more? Or does this sound about right (however wrong)?
Sadly, this sounds about right if you've got a high deductible health plan. Typically, high deductible plans function in tandem with an HSA/FSA, so that you'll have some money set aside to pay whatever balance remains after your insurer discounts the total bill (which sounds like what happened here, hence only having to pay $900 out of a total of $1700). Are you or your employer by any chance contributing to an HSA? If you've truly got a HDHP, you should really check that out for the future.
posted by theraflu at 6:37 AM on December 28, 2015
posted by theraflu at 6:37 AM on December 28, 2015
...he and his office staff assured me that I would not be charged...
Question...Did they actually say you would not be charged, or did they say the procedure was covered by your insurance. With health insurance, if a procedure is "covered", that only means it is included in your policy. It doesn't mean the insurer pays anything toward the procedure.
I would question why your doctor specified a particular facility to have the ultrasound done. It sounds to me like they have an arrangement with the facility. Typically, it doesn't matter where you go, unless there's something specific about the equipment at one facility that others in the area don't provide.
Doctors, in general, don't know bupkis about costs and insurance. Doubly-so when it comes to anything outside their practice.
As for the cost...Yeah, it sounds like a probable charge. Checking on "fair price" websites can be highly misleading. Just because $500 is a fair price doesn't mean anyone is actually charging it. That may also be the cost for a very basic scan, and also probably doesn't include the radiologist's interpretation/diagnosis.
posted by Thorzdad at 6:43 AM on December 28, 2015 [10 favorites]
Question...Did they actually say you would not be charged, or did they say the procedure was covered by your insurance. With health insurance, if a procedure is "covered", that only means it is included in your policy. It doesn't mean the insurer pays anything toward the procedure.
I would question why your doctor specified a particular facility to have the ultrasound done. It sounds to me like they have an arrangement with the facility. Typically, it doesn't matter where you go, unless there's something specific about the equipment at one facility that others in the area don't provide.
Doctors, in general, don't know bupkis about costs and insurance. Doubly-so when it comes to anything outside their practice.
As for the cost...Yeah, it sounds like a probable charge. Checking on "fair price" websites can be highly misleading. Just because $500 is a fair price doesn't mean anyone is actually charging it. That may also be the cost for a very basic scan, and also probably doesn't include the radiologist's interpretation/diagnosis.
posted by Thorzdad at 6:43 AM on December 28, 2015 [10 favorites]
It does seem high for an ultra sound. Do be sure that the $1700 is the contract price between your insurance company and the hospital.
posted by SemiSalt at 7:02 AM on December 28, 2015
posted by SemiSalt at 7:02 AM on December 28, 2015
It doesn't really matter whether or not the internet says it's a fair price if that's what they've billed your insurance company and the claim has been processed. I've been receiving an outlandishly expensive medication for almost a year and recently discovered a friend on the same regimen is being charged half as much by her hospital. So the moral of the story is that the whole system sucks.
Your best bet is to call the hospital and ask them to negotiate. At the very least you should be able to pay it off in smaller increments over time. When we were in college my best friend had an ER bill she couldn't afford so she sent them $20 a month for ages and they finally ended up writing off the balance.
posted by something something at 7:11 AM on December 28, 2015 [1 favorite]
Your best bet is to call the hospital and ask them to negotiate. At the very least you should be able to pay it off in smaller increments over time. When we were in college my best friend had an ER bill she couldn't afford so she sent them $20 a month for ages and they finally ended up writing off the balance.
posted by something something at 7:11 AM on December 28, 2015 [1 favorite]
When we were in college my best friend had an ER bill she couldn't afford so she sent them $20 a month for ages and they finally ended up writing off the balance.
Just FYI...My area hospital does not carry accounts, and sends patients with unpaid balances to a local private lender, who pays your balance and then sets you up with a 2-year interest-deferred payment plan. Pay it off in 2 years, and there's no interest. Miss a payment or take longer than 2 years, and interest is applied retroactively. So, YMMV.
posted by Thorzdad at 7:16 AM on December 28, 2015 [3 favorites]
Just FYI...My area hospital does not carry accounts, and sends patients with unpaid balances to a local private lender, who pays your balance and then sets you up with a 2-year interest-deferred payment plan. Pay it off in 2 years, and there's no interest. Miss a payment or take longer than 2 years, and interest is applied retroactively. So, YMMV.
posted by Thorzdad at 7:16 AM on December 28, 2015 [3 favorites]
Just so you know in the future, it's your right to know exactly how much a procedure will cost (or be billed) before you have it.
posted by listen, lady at 9:20 AM on December 28, 2015 [3 favorites]
posted by listen, lady at 9:20 AM on December 28, 2015 [3 favorites]
A long shot - make sure that the price you are being charged is the negotiated insurance rate, not the list price. Since the hospital is in-network, you should be getting the insurance rate whehter you pay it, the insurance company pays it or a combination. Typically that is a fraction of the original price so if it wasn't factored in, that would reduce (although not eliminate) the bill.
posted by metahawk at 9:59 AM on December 28, 2015
posted by metahawk at 9:59 AM on December 28, 2015
my doctor did accuse me of lying, while also admitting that he remembers the conversation
Well, fuck that doctor in particular, and if you suspect that his office got a kickback for referrals to that particular facility, take it up with the state.
But Thorzdad is right: doctors' offices and especially doctors are at best ignorant and at worst full of shit about pricing and coverage. Check with the ultrasound facility and your insurer that the negotiated rate was charged, but you're probably a victim of American healthcare bistromaths and your best option is to pay monthly instalments.
posted by holgate at 10:19 AM on December 28, 2015 [3 favorites]
Well, fuck that doctor in particular, and if you suspect that his office got a kickback for referrals to that particular facility, take it up with the state.
But Thorzdad is right: doctors' offices and especially doctors are at best ignorant and at worst full of shit about pricing and coverage. Check with the ultrasound facility and your insurer that the negotiated rate was charged, but you're probably a victim of American healthcare bistromaths and your best option is to pay monthly instalments.
posted by holgate at 10:19 AM on December 28, 2015 [3 favorites]
Talk to the hospital's billing department about paying the bill off in tiny monthly payments. They may also have a charitable foundation that you can apply to in order to get the bill waived if you really don't have the money to pay it.
posted by MsMolly at 10:34 AM on December 28, 2015
posted by MsMolly at 10:34 AM on December 28, 2015
An ultrasound at a dedicated clinic (ie, not in a hospital) can cost between $500 and $800 depending on the type of scan and the location. Ultrasounds in hospitals are invariably more expensive.
The price you are being charged is the price the hospital bills the insurance, which is usually at least 40% more than you would pay out of pocket with no insurance. Some doctors know this, some don't. Most doctors don't get super involved with billing -- that's left to receptionists, accountants, etc. Case in point: visiting my doctor costs me $125 out of pocket. But they will bill my insurance $400 for the same visit. I have a high deductible as well, so I pay for a lot of medical care out of pocket.
Now that it's been run through your insurance, you don't have a lot of options. I've never been able to call back something that got processed, but in the future you can have the billing department essentially do a price check for you with your insurance company, and give you the out-of-pocket price as well, so you can decide what you want to do.
Most hospitals also have interest-free installment payment plans, so do be sure to ask. There should be a social worker, or someone affiliated with with billing department who acts as a patient advocate that you can speak to about this if you can't set it up with billing directly.
posted by ananci at 10:50 AM on December 28, 2015 [1 favorite]
The price you are being charged is the price the hospital bills the insurance, which is usually at least 40% more than you would pay out of pocket with no insurance. Some doctors know this, some don't. Most doctors don't get super involved with billing -- that's left to receptionists, accountants, etc. Case in point: visiting my doctor costs me $125 out of pocket. But they will bill my insurance $400 for the same visit. I have a high deductible as well, so I pay for a lot of medical care out of pocket.
Now that it's been run through your insurance, you don't have a lot of options. I've never been able to call back something that got processed, but in the future you can have the billing department essentially do a price check for you with your insurance company, and give you the out-of-pocket price as well, so you can decide what you want to do.
Most hospitals also have interest-free installment payment plans, so do be sure to ask. There should be a social worker, or someone affiliated with with billing department who acts as a patient advocate that you can speak to about this if you can't set it up with billing directly.
posted by ananci at 10:50 AM on December 28, 2015 [1 favorite]
I had an MRI a couple years ago - my doctor's office has this capability in house. Had a heck of a time getting the insurance to agree to it. List price was about the same as your ultrasound, 1700. I finally got frustrated and asked the imaging center folks how much it would be if I paid cash - 800 bux, same as what I would pay going through insurance, only the 900 would not go against my deductible.
Also (maybe) related - had a blood test at the doc's office, they sent to their usual lab - 500 bill followed shortly as the testing lab was out of network. I appealed this firmly but politely with Humana on the grounds that I had no part in this decision. They agreed, they paid the lab company a pittance and I was cleared. Odd thing was, other locations of this same outfit - Labcorps, *were* in network. Might try appealing to the Ins. company that you were "just following doctor's orders".
posted by rudd135 at 10:59 AM on December 28, 2015 [2 favorites]
Also (maybe) related - had a blood test at the doc's office, they sent to their usual lab - 500 bill followed shortly as the testing lab was out of network. I appealed this firmly but politely with Humana on the grounds that I had no part in this decision. They agreed, they paid the lab company a pittance and I was cleared. Odd thing was, other locations of this same outfit - Labcorps, *were* in network. Might try appealing to the Ins. company that you were "just following doctor's orders".
posted by rudd135 at 10:59 AM on December 28, 2015 [2 favorites]
I'll second a lot of what people have suggested here, especially rudd135 directly above.
I worked in healthcare research for a long time, and I still find billing a baffling and often inexplicable process that requires constant diligence to stay on top of. As a matter of routine, I ask up fornt for billing explanations before I agree to anything arranged in an office visit. Even so, this summer I managed to get burned on billing for a CT scan. I went to my general physician to ask about some gut pain, and she found a tiny amount of blood cells in the sample. She suggested a CT scan to avoid the invasiveness of a colonoscopy. Her billing department wrote me a referral for the imaging center on the same medical campus as my general physician's office (same building, separate institution). Both the general physician's office and the imaging center told me up front the approximate cost of the CT scan and suggested that X amount of that would be paid by my insurance company. Instead, my insurance paid for about x/4 and I was left with a very large surprise bill. Most of which was classified as co-insurance on my EOB. After much back and forth with all parties, I still had to pay the full amount billed. But the experience made me committed to calling my insurance company to ask these specific questions in advance instead of relying on medical office administrator's information.
posted by late afternoon dreaming hotel at 11:18 AM on December 28, 2015 [1 favorite]
I worked in healthcare research for a long time, and I still find billing a baffling and often inexplicable process that requires constant diligence to stay on top of. As a matter of routine, I ask up fornt for billing explanations before I agree to anything arranged in an office visit. Even so, this summer I managed to get burned on billing for a CT scan. I went to my general physician to ask about some gut pain, and she found a tiny amount of blood cells in the sample. She suggested a CT scan to avoid the invasiveness of a colonoscopy. Her billing department wrote me a referral for the imaging center on the same medical campus as my general physician's office (same building, separate institution). Both the general physician's office and the imaging center told me up front the approximate cost of the CT scan and suggested that X amount of that would be paid by my insurance company. Instead, my insurance paid for about x/4 and I was left with a very large surprise bill. Most of which was classified as co-insurance on my EOB. After much back and forth with all parties, I still had to pay the full amount billed. But the experience made me committed to calling my insurance company to ask these specific questions in advance instead of relying on medical office administrator's information.
posted by late afternoon dreaming hotel at 11:18 AM on December 28, 2015 [1 favorite]
It's always worth calling the insurance company as well. Sometimes asking someone to take another look can help.
posted by bluedaisy at 12:31 PM on December 28, 2015
posted by bluedaisy at 12:31 PM on December 28, 2015
But the experience made me committed to calling my insurance company to ask these specific questions in advance instead of relying on medical office administrator's information.
Even then, insurance company customer support people are loath to offer any kind of numbers in advance -- even a ballpark estimate. Their standard reply is "if you go and do the thing, we'll tell you when we get the bill", partly because they don't want to be held to their initial statements, partly because they don't know how a facility is going to code the thing for billing.
posted by holgate at 12:49 PM on December 28, 2015 [3 favorites]
Even then, insurance company customer support people are loath to offer any kind of numbers in advance -- even a ballpark estimate. Their standard reply is "if you go and do the thing, we'll tell you when we get the bill", partly because they don't want to be held to their initial statements, partly because they don't know how a facility is going to code the thing for billing.
posted by holgate at 12:49 PM on December 28, 2015 [3 favorites]
Try calling and plead poverty and see if they won't cut the bill down. First answer is probably no, but try try try again. Like cars, a lot of medical bills are suggestions, not fixed prices. Given how often they get stiffed, they can be open to negotiation.
posted by IndigoJones at 1:46 PM on December 28, 2015
posted by IndigoJones at 1:46 PM on December 28, 2015
This is the awful state of healthcare today.
I've been fighting my insurance for years now on two similar events.
No one can tell you beforehand any costs that will go to you.
"Well it depends on the codes the doctor uses" and b.s. like that.
You may be able to have your doc recode and resubmit the bill to see if it's covered under different codes.
You can negotiate with the hospital or pay over time.
You can call your insurance and ask them what the Hell is going on. (Hint: 6 hours of calls and the answer will be: nobody knows and you are screwed SORRY!)
Your state may have a health care appeals board. Your insurance company should know the appeals process.
Good luck - this is the direction healthcare is going. We will all be fighting for insurance to cover anything. You might as well learn the system know so you are ready to appeal in coming years. And the appeal process can take a year or more.
posted by littlewater at 4:08 PM on December 28, 2015
I've been fighting my insurance for years now on two similar events.
No one can tell you beforehand any costs that will go to you.
"Well it depends on the codes the doctor uses" and b.s. like that.
You may be able to have your doc recode and resubmit the bill to see if it's covered under different codes.
You can negotiate with the hospital or pay over time.
You can call your insurance and ask them what the Hell is going on. (Hint: 6 hours of calls and the answer will be: nobody knows and you are screwed SORRY!)
Your state may have a health care appeals board. Your insurance company should know the appeals process.
Good luck - this is the direction healthcare is going. We will all be fighting for insurance to cover anything. You might as well learn the system know so you are ready to appeal in coming years. And the appeal process can take a year or more.
posted by littlewater at 4:08 PM on December 28, 2015
I just looked up a renal ultrasound I had in a hospital in September and it was $1707. (Fortunately I'd already met my deductible.) So yeah, that number sounds about right.
You said: "I have a huge deductible to pay. I asked the doctor to call my insurance and the hospital to see about the lowering the bill. No luck,"
What does this mean - he called the insurance and the hospital, and he had no luck lowering the bill? This almost definitely didn't happen. No doctor is going to waste his time on the phone like that. I would bet $1700 he is lying if he said he did. Or did you mean you had no luck getting him to do that? As other commenters said, you need to call them yourself. It can't hurt. Prepare to be on hold forever.
I'm sorry, this sucks. I agree with contributing to a HSA if you can, that's the only way it's made my expenses bearable.
posted by desjardins at 5:48 PM on December 28, 2015
You said: "I have a huge deductible to pay. I asked the doctor to call my insurance and the hospital to see about the lowering the bill. No luck,"
What does this mean - he called the insurance and the hospital, and he had no luck lowering the bill? This almost definitely didn't happen. No doctor is going to waste his time on the phone like that. I would bet $1700 he is lying if he said he did. Or did you mean you had no luck getting him to do that? As other commenters said, you need to call them yourself. It can't hurt. Prepare to be on hold forever.
I'm sorry, this sucks. I agree with contributing to a HSA if you can, that's the only way it's made my expenses bearable.
posted by desjardins at 5:48 PM on December 28, 2015
I hate to say it, but if this wasn't an emergency visit (sounds like outpatient), there's not much you can do. Go through your insurance's contracted providers next time for where to get referral visits done, either online in your insurance account or on the phone with them. Don't take your PCP's word for it, or even the other office's because you might have a specific plan that won't cover a certain service. (for instance, if you ask "Do you accept Cigna," they might say yes but they might not actually be in your specific plan)
Your PCP can't force you to go anywhere, either, so if you find yourself in a similar situation always make sure the referral is contracted with your insurance or find an alternative for whatever it is you need done.
I also want to add you may be able to negotiate a discount or payment plan with the dr/facility that provided the service.
posted by atinna at 8:15 PM on December 28, 2015 [1 favorite]
Your PCP can't force you to go anywhere, either, so if you find yourself in a similar situation always make sure the referral is contracted with your insurance or find an alternative for whatever it is you need done.
I also want to add you may be able to negotiate a discount or payment plan with the dr/facility that provided the service.
posted by atinna at 8:15 PM on December 28, 2015 [1 favorite]
For whatever reason, where I live, ultrasounds are routinely more than $1,000....but in a city an hour and a half away, that's part of the same hospital network as homecity, they're routinely half the price. I have a car, and a 3 hour round trip doesn't cost nearly $500, so it's worth it to me to make the drive. It's infuriating, and makes absolutely no sense, but I'm grateful for the friend who clued me in to it. I'm sorry that none of this helps you now. I've also had good luck calling the hospital billing department...I've had as much as 40% discounts given when I've asked for discounts if I pay in full, immediately. I wish you the best of luck in this crappy situation.
posted by csox at 6:29 AM on December 29, 2015
posted by csox at 6:29 AM on December 29, 2015
This thread is closed to new comments.
Have you reached your deductible for the 2015 plan year? (Keep in mind your plan year may not follow the calendar year.)
It is usually possible to negotiate a hospital bill even further than the contracted insurance rate. I've had success with this in the past. There's no harm in asking, and if you have a way to pay the balance immediately, in one lump sum, such as put the payment on a credit card, you can probably get a discount. Be persistently polite and see where it goes; I've been able to get my portion of the bills reduced by 20-30% in the past this way.
posted by FergieBelle at 6:28 AM on December 28, 2015 [4 favorites]