Ask MetaFilter questions tagged with hospital and insurance

How much does Medicare pay for a room - just the room, overnight?

cda — Mon, 13 May 2013 13:11:24 -0800

[USA filter] Even with the new disclosures I can't figure out how much Medicare pays for just a hospital or nursing home room - 24 hours. Just the room charge. I'm helping a person with no insurance negotiate a hospital bill and a short stay in a nursing home bill. How much does Medicare pay for a room - 24 hours - in a nursing home and in a hospital? I understand that rates vary by location. I'm just looking for examples. And my patient was in a rural hospital in a town of about 30,000 in Idaho. If you know how to look up a comparable hospital.

I need to know what to say in the Emergency Room.

Ash3000 — Sat, 02 Jun 2012 18:47:20 -0800

Which address should I give when I go to the Emergency Room? This is turning out to be a surprisingly stressful and complicated question. My doctor has instructed me to go to the ER tomorrow morning if a medical issue that's flared up in the last week doesn't get better by then. (Happy to give the details on the underlying issue if it's of importance.)

I live in Brooklyn, and will be going to a hospital in Brooklyn - but my insurance is from New Jersey, and the address I have on file with the insurance company is a New Jersey address. Whenever I go to a doctor (usually in NJ), I give them the New Jersey address, so the insurance company doesn't make it an issue. (The New Jersey address is my parents' home - for a number of reasons, it's much easier for me to get insurance this way than it is to get the necessary insurance in Brooklyn.)

When I fill out papers at the hospital, which address should I put down: my actual residence, in Brooklyn, or my New Jersey address, which I use to be eligible for insurance through this company? Will it impact the care I receive at the hospital? Or what is or isn't covered by insurance?

Thanks in advance for your help on this - my insurance has consistently been an incredibly stressful component of navigating my health in the last few years, and this is no exception.

fighting the collections beast

Anonymous — Tue, 13 Dec 2011 14:43:13 -0800

Hospital bill collection blues. Am I in the legal right here? Went to the ER. Didn't have my insurance info on me at the time, so I temporarily registered as a self-pay, and they told me I could get them my information afterwards. I ended up getting them that information approx. two and a half months later. The filing deadline for my insurance company was three months. When I receive a bill for the full cost of the medical procedure, I find out that not only did they not file in time, but they filed two months after I gave them the information. This has just now gone to collections.

Who's in the right? I understand that it wasn't wise to wait so long, but from my perspective someone at their hospital presumably gets paid to make sure they are on top of sending insurance information out. If they had two weeks to do so, it's not my problem that they dropped the ball. I dropped the ball in a way, too, but that fudge factor is the reason the insurance company has a filing deadline of three months rather than two days, right?

Who should be legally responsible for the costs? And more importantly, regardless of that, do I have any chance fighting this? I called the collections agency to politely but firmly explain my dispute as soon as I heard from them, and I am sending them a written dispute ASAP as well.

This is a non-trivial amount of money, not the kind where you can suck it up and pay off just to be rid of the annoyance. This happened in Massachusetts, if it matters. YANML.

Can we save more on this surgery?

circular — Mon, 26 Sep 2011 16:11:14 -0800

Routine non-emergency hernia surgery--unmet insurance deductible and wondering if there are any cost-cutting ideas we will wish we had known when we get the bill for the surgery. Assuming the hospital won't just shout out ideas if we call them, so...any ideas? We've seen people with HSAs mentioning "I got a discount on this and paid less for that just by asking, God bless my new HSA cost-cutting detective work skills" and we're wondering how to find out if there's any of that we don't need going on with an upcoming hernia surgery.

This is in the USA. Thanks!

Trying to advise a friend on hospital discharge procedures

ClaudiaCenter — Thu, 26 May 2011 16:13:26 -0800

Asking for a friend re Northern California situation. A friend's close relation was struck by a car while walking in a crosswalk and was seriously injured. She has had several surgeries and will need several more. The family has a personal injury attorney for the claims against the driver. My question on behalf of my friend and her relation is about how to prevent the hospital from discharging her (seemingly) without an appropriate discharge plan. My friend's relation was seriously injured when she was struck by a car while she was walking in a crosswalk. She was hospitalized for about a week or so -- had a surgery at one hospital, was transferred to hospital number two, had surgery at second hospital.

My friend's concern is that her relative was released while still in great pain, disoriented, unable to care for herself, unable to get out of bed independently, unable to use the bathroom independently, still needing wound care, using a wheelchair with great assistance, unable to negotiate stairs, etc. The relative does not presently qualify for IHSS (California state-supported funds for in-home support services) because she is receiving state disability insurance, putting her over the income requirements. The family has been scrambling to assemble care, and they are wondering if there is a way to get more care out of the medical slash insurance system for the next surgeries.

I've asked around, and the only suggestion I've gotten is to try to convince the treating MD to order physical therapy in a skilled nursing facility or rehabilitation center.

Any additional tips re getting her into a "step down" facility, or thoughts on how to get this type of doctor's order? This person is privately insured, and the hospital is supposed to be state of the art. (But maybe this is just our system, so why am I surprised.)

Bring out the gimp.

anotherkate — Sun, 16 Jan 2011 11:22:28 -0800

Bicycle accident, sprained or otherwise damaged knee, no insurance - where to go in the East Bay for help? So I'm waiting for a call back from the Order of Malta clinic. I'm going to call the Berkeley Free Clinic this afternoon but I don't think they deal with injuries like this. There are 2 pay clinics near me - US Healthworks & Quickhealth - that I could go to. I'm also near Alta Bates Summit Medical Center & a Kaiser hospital. Last summer I went to Alta Bates for something else, got a $2300 bill for about 4 hours sitting on a gurney in a hallway, and then ended up paying nothing b/c I was unemployed with no income. I'm now working part time with no insurance. I think I'd rather pay a few hundred dollars & be done with it, instead of gambling on an ER bill that may or may not be forgiven, but is that the best idea? Especially if it turns out to be a serious injury? I can share symptoms if people want to play armchair doctor. Help!

Hospital bill over a year later? Really?

ashtabula to opelika — Sat, 31 Jul 2010 08:44:30 -0800

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!

Source for Medical Malpractice Insurance Quotes for Doctors/Hospitals?

Quarter Pincher — Mon, 16 Mar 2009 18:28:59 -0800

Do you know of any reasonably credible sources that list the premiums and deductibles that hospitals/doctors (of any kind, but largely medical surgeons for intensive-care/emergency/surgical hospitals) pay for medical malpractice insurance? I'm researching figures for a malpractice reform idea. The idea is based on a rumor that medical malpractice insurance is an absurdly burdensome expense for hospitals/doctors who must pay it in order to legitimately practice. If there were a way to eliminate that particular burden, the massive periodic (monthly/etc) savings would gradually equal lesser medical expenses for Billy and Susie down the line.

My idea was to eliminate the need for malpractice insurance by enacting legislation requiring the hospital in question to add the malpracticed-against as simply a new employee, paid out of the standard payroll expenses, at a comfort-offering rate (variable according to terms of the suit and local standards of living) instead of having to lop over this giant sum (and pay insurance for the dark cloud of a giant sum to loom over them, waiting to be dished out). Does this idea hold much water?

How can someone afford to have a baby without health insurance?

JPowers — Sat, 02 Aug 2008 17:03:38 -0800

A friend of mine has 3 kids who were all delivered via caesarean section. She is pregnant again and wants to have the baby vaginally at home with a midwife. Doctors are telling her she has to have this 4th baby via caesarean section because having it vaginally could rupture her uterus. Has anyone had any experience with this? Her husband is out of work (actively looking for a job), she is a stay at home mom, and they presently have no insurance. They can't afford to have a baby in the hospital without insurance. Are there any other options they have? Is there any government help in a case like this?

Do I owe this money?

sian — Fri, 14 Mar 2008 15:15:57 -0800

Should I really owe the hospital $400 for tests I was unaware of? I had a terrible skin rash and I went into a dermatologist to get it checked out. He diagnosed it by sight as a strep infection of the skin, gave me a prescription for antibiotics, and sent me on my way. I got a call the following week from a nurse, who asked how I was doing--my antibiotics were finished, I was fine and I told her so.

Today, a month later, I got a $400 bill from the hospital for four different tests/cultures. (My deductible is $1k, so apparently they weren't covered). The doc didn't ask me whether I wanted them run. I had no idea he was going to run them and I had no idea that he had until I got this bill.

Am I 100% on the hook for paying this bill? It seems wrong to me that I'm being charged way more money than I have right now for stuff I was not told about. Can I resolve this with the hospital, and if so, how? Do I write a letter, and to whom? I contacted their billing department as soon as I got the letter and they are going to conduct an investigation into it, but the lady said it could be 45 days until they get back to me; am I going to get screwed by some statute-of-limitations-like loophole?

I am more than willing to pay the $100 for the doctor's visit, but I'm quite steamed about the rest. Aah, my first foray into the seamy underbelly of the health industry!

Have insurance, so how do I deal with out-of-network charges from the ER?

Anonymous — Thu, 08 Nov 2007 14:52:22 -0800

I am insured through a PPO. I was taken to an out-of-network hospital following an accident with major trauma. Am I out of luck for the charges above and beyond the dreaded "usual, customary, and reasonable" charges? I was basically unconscious and not in any shape to dictate what insurance I had and where to take me, not that I would have figured the only Level I trauma center in the area wouldn't take my PPO. Whoops.

Now the bills are coming in and while I am certainly not poor, I don't have tens of thousands of liquid dollars to pay off the excessive charges from the hospital. I will likely be at the top of the sliding scale, or off it, since I figure it's based around the poverty line and I make around six figures.

I want to know if I have a legitimate gripe and what my best path of resolution is in order to avoid paying the excess charges. Is the hospital (it's public) likely to chop the charges down if I simply ask? Will I absolutely need to show proof of (lack of) assets, etc.? I am under no impression that the insurance company will be compassionate in this case, so I believe focusing on dealing with the hospital is the best bet.

My best idea at this point is to take the excess (balance) charges after the insurance payments, divide by some number, and offer it in cash upfront. I figure that will end up being 50-100% more than they would have received from me if I had simply paid the 10% copay I would at an in-network facility - rather than 1000% more than I am being billed now. Is that fair, rational, and possible?

Side question: The ER scheduled followup appointments for me at the same out-of-network hospital. My PCP was out of town and his backup was not helpful, nor did the PPO customer service advise me not to have my followups at the same hospital. I feel I was not negligent in trying to avoid out-of-network charges. Do I have a leg to stand on when it comes to protesting the followup appointment benefits?

Hum

lpctstr; — Wed, 23 Nov 2005 18:10:52 -0800

My mother went to the emergency hospital last year and was billed a hefty amount. She was covered with health insurance from her company (Destiny) and the hospital was "in-network". The insurance company paid the hospital fee (which was the larger amount) but only paid about half the physician fee because the physician was "out-of-network". My mother asked whether or not the physician was in-network or out-of-network when she was in the hospital and the nurse just told her not to worry about it. My questions are, 'How can a hospital be in-network and fully covered but assign her an out-of-network physician which won't be fully covered under the insurance?' and 'Is there anything she can do about this? I don't think it's fair she has to pay for something she didn't have a choice in'.