Can I negotiate this Kaiser bill?
March 12, 2014 3:58 PM   Subscribe

When Obamacare happened my private pay insurance coverage changed, but I didn't really pay attention to how. After a trip to the ER last night and to the pharmacy this morning, I now know that I have a very high deductible plan. $250 ER copay (full bill to follow), $530 for two prescriptions. Meanwhile, I'm wondering if I have any room to negotiate the bill for the ER visit, especially if I am about to go to a more costly (for me) plan. Have you ever negotiated a Kaiser bill, or another HMO bill? Specific advice on how to pitch this or if it's even possible sought.

This is Kaiser Northern California. My current coverage is Bronze 4500/40, my kid has Bronze 5000/60, if you know the details of this stuff or feel like looking it up.

Yes, I'm a nurse but I still have to buy my own expensive, shitty health coverage because the new precarity.
posted by latkes to Human Relations (14 answers total)
Sorry, I wrote that weird.

I am definitely planning to change plans to one with better coverage that costs more. Wondering if I can leverage that change, or anything really, to lower my full ER bill.
posted by latkes at 3:59 PM on March 12, 2014 [1 favorite]

No real practical experience or information to provide for most of your question, but...

Is there any chance you can have a non-ER doctor or your pharmacist revise the prescription so that you get a generic drug that performs the same function as whatever you were prescribed?

That would be my first effort to lower the bill, if I were in your shoes. Sorry this happened to you.
posted by jsturgill at 4:05 PM on March 12, 2014

Actually to clarify, the prescriptions were unrelated to the ER visit, just happened to have to pick them up today. Crappy timing that made each bill feel extra big.

Anyway, these meds are the ones that work after several years of tinkering around with different meds, so stuck with brand name (One thing I like about Kaiser is they tend to default to cheaper and generic drugs, but we need this one, but fuck the pharmaceutical industry too, while I'm ranting!)
posted by latkes at 4:11 PM on March 12, 2014

I don't have experience with Kaiser, but I do have experience with ER bills while uninsured, and ICU bills while insured that were covered at 80% (that still leaves a LOT of bill after insurance pays!)

So, after you've talked to Kaiser, if you find there's no way to lower what you're going to pay:

1. Deep breath.
2. Figure out how much you can pay per month towards this. $100? $200? This will probably make things tight, but you need to know what this amount is for #3.
3. When you get the bill: Call the billing office right away. Explain that you have received your bill, intend to honor it, but that you don't have all of the cash on hand at the moment, and that you need to work out a monthly payment plan. I've never had an issue with a billing office pressuring me, asking to put it on a credit card instead, or anything like that. Usually they say, "OK, and how much can you put towards this per month?" Hence the work you did in #2.
4. You're a nurse, so you'll understand when I say: Plan to get multiple bills. One from each doc who came in, one from the hospital for R&B (room and board, which will include supplies like cotton balls and bandages and needles for injections), one from radiology if needed, one from Rx if any were dispensed as part of the visit, one from the transportation company if you used an ambulance. For the ICU bill, here's how I broke it down:

Hospital R&B: 40%
Doc 1: 10%
Doc 2: 10%
Doc 3: 10%
Radiology: 10%
Rx: 10%
Ambulance: 10%

So if you have $100 per month, you put $40 of it to the hospital, and $10 to each of the other bills. That R&B bill is going to be the biggest, most likely.

I am so sorry you are having to deal with this, on top of being sick or having a sick family member.

Oh, and one other note: Changing to a new plan now won't help with the existing bill. They apply the coverage you had at the time to the bill. Basically, in insurance terms, the plan you held on the date of service is the one that applies to the services rendered.
posted by RogueTech at 4:44 PM on March 12, 2014

One other thing I forgot: the ER bill will probably take you through the deductible. This will change it to a copay/coinsurance plan at this point, which will be easier for the rest of the year. So, not a super-happy-yay thing, but at least one good point in all of this.

Feel free to memail me if you have more questions. I have experience both as a patient (3 chronic illnesses in a 2 person family) and from working with insurance data.
posted by RogueTech at 4:55 PM on March 12, 2014


Hospitals charge so much because the best ones collect at 30%. If you call them up and give them hope you'll pay any part of your bill, most are willing to drop costs significantly.
posted by namesarehard at 5:23 PM on March 12, 2014 [2 favorites]

RogueTech's advice is solid BUT….

Don't pay ANYTHING until you have received both the explanation of benefits from your insurance company (EOB) and the actual bills from the different doctors and services (I'll just call them vendors). In my case, between my actual hospitalization and the bills / EOBs, it probably took at least a month or two until I got a grasp of what I finally owed. For example, you might get an x-ray bill for $400 but then your EOB will state they covered xxx so you'll only owe $xxx, and then you might get another x-ray bill confirming your new final cost.

Once the dust has settled and you have confirmed with both the insurance company and the vendors what YOUR personal out of pocket costs are, call each vendor and politely explain that you would like to work out an agreement to pay your bill.

In my case, with over 15 different vendors I owed, I paid anything from $10 a month to $100 a month per vendor. Once I paid off the smallest amount, I rolled that amount to the next lowest bill (for example, I was paying off 1 bill for $10 (total due $50) and another bill for $15 month (total due $225); once I paid off the full $10/month bill, I rolled that over the $15/month bill so I was paying that one off at $25/month. And so on).

In every single case, every billing department I talked to was very nice, very understanding, and very willing to work with me. In some cases, I negotiated a final bill down to about 25% more less. Using this method, I paid off what started off as on paper I owed $34,000 down to about $9,000, and then that $9,000 was paid off in one year. I put not a red cent on a credit card.

Remember, the one advantage about medical bills - NO INTEREST!
posted by HeyAllie at 5:39 PM on March 12, 2014 [2 favorites]

Was this a KP hospital you went to, or one out of network?

You'll probably have to pay 40% of the remaining ER bill but if it was a KP hospital you won't get a billion bills from every person that saw you like at some hospitals. Generally, and your plan could be different, ED visits aren't subject to deductible unless you're on a really bad plan. KP tends not to sell those tho.

IANYHBS (hospital billing specialist).
posted by fiercekitten at 7:17 PM on March 12, 2014 [1 favorite]

It's weird that you would have a copay with a full bill to follow. A copay is usually the extent of the payment that you owe for an incident of care. If it was a high deductible health plan, you wouldn't have a copay - you would just owe the full amount until you reach the deductible. These are usually paired with some kind of savings account to offset the out of pocket expenses. I'm wondering if the $250 the hospital collected was a deposit of sorts rather than an actual copay.

It looks like this may be your plan, and copays are not specified for ER visits.

Some hospitals (particularly smaller hospitals) have become very aggressive about collecting on bills, sending people to collections relatively early in the process and refusing to provide interest-free payment plans (instead referring people to to financing companies that charge interest). Hopefully Kaiser isn't like that, and will work with you. You can get the best deal if you can quickly offer a full cash payment of the bill. As soon as you get the final, settled bill, call them and offer to settle the bill immediately for 60% (or 50% or 40% or 70% - try some different numbers, start low) of the final amount, they will probably go for some kind of discount. You may have to get to a supervisor, but this is possible. If you need a payment plan, you can probably expect to pay whatever the full amount ends of being.
posted by jeoc at 7:20 PM on March 12, 2014 [1 favorite]

With the prescription, does it happen to be thyroid medication or anything like that? I know I've been able to get brand drugs at generic prices through my insurance, as there's enough evidence/push by doctors and patient advocacy groups that the generics are not actually bioequivalent, so you might be able to fight the insurance company with that, assuming you have your doctor on your side.
posted by damayanti at 8:00 PM on March 12, 2014

Regarding the ER copayment. It isn't really a copay. It is a set deposit against what the total 40% will be. That's how member services has explained it to me anyway.
posted by SLC Mom at 10:22 PM on March 12, 2014 [1 favorite]

Just to second this advice - do not pay anything until you fully understand the bill and have negotiated like a bear based on a full understanding of the billing.

(My phone seems firm in its belief that you should negotiate like " a ear." I stand by bear.)
posted by Lesser Shrew at 6:40 AM on March 13, 2014 [3 favorites]

Anyway, these meds are the ones that work after several years of tinkering around with different meds, so stuck with brand name

My prescription insurance changed this year too. My co-pay for my migraine meds went to $125, and I paid it. Then I went home and found the drug company offered a card to reduce the co-pay to $25. I went back to the pharmacy, "returned" the prescription and bought it again w/ the drug company card, saving $100. I didn't actually take the pills back, just changed the billing of the script.

If either of your meds has a program like that, you might still be able to get some of your money back.
posted by gladly at 6:47 AM on March 13, 2014 [2 favorites]

You can always negotiate a hospital bill. They would much rather get something from you than nothing.

When I was in graduate school I had a premature baby, a week in NICU, and ended up responsible for about 10% of a $60k bill. (The insurance company had negotiated the bill down to $30k and paid their 80% of that.) I told the hospital my situation and said, truthfully, that I could afford to pay about $25 per month. They were happy to take it, did not charge me interest, and after several years of payments, wrote off the debt and stopped billing me.

Your mileage may vary, but in general, hospital prices are expensive because nobody pays the sticker price.
posted by fantabulous timewaster at 2:19 PM on March 13, 2014 [1 favorite]

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