Ridiculous Medical Billing Policy!

[dennis in se pa]

Spent less than 1 day in the hospital and have bills totalling over $8000! Received two units of blood and some Protonix for a stomach issue and low red blood count. The bill from the hospital simply says "Amout You Owe - $7,900". No specifics. Separate bill from doctors says "Professional Service $817" no specifics. One doctor spoke to me for 5 minutes socially and sent me a bill for $533! I have called and asked for specifics for the charges, of course. THIS IS WHY OUR MEDICAL COSTS ARE SO HIGH! Aparently they can just make up a bill and get away with it. A call for specifics on what the doctor did that warranted a bill for $533 resulted in them having no specifics in the system. They have to do some research into it that might take up to 14 days.

I also was subjected to them trying to "upsell" me into several non-medically necessary procedures that would have added thousands more to the bill. In the morning I was told that I was scheduled for a procedure at 9:00. I asked them who scheduled it and why had not someone discussed this with me? They seemed surprised that I asked such a question. I declined the procedure. Is this part of the training for the hspital staff to work at increasing the bills? I should note this is supposedly a "non-profit' hospital.

Any suggestions as to how to effectively deal with this BS is welcomed.

[Neilk]

What codes are on your bill? These would be Rev Codes and CPT or HCPCS codes. I can find out what Medicare's reimbursement rate is for those procedures and you can negotiate using those numbers.

[Drdogface]

A lot of the reason that hospital bills are so damn high is that they get stuck (by law) for people who can't/won't pay so they have to spread the loss out to all the rest of us. In Kalif., illegal aliens are a huge part of that. They also have expensive insurance payments to protect themselves from lawsuits. I don't like it either and have experienced nearly the same as you. If we could constrain the lawyers and rid ourselves of the free loaders things might be different.

I think you definitely should pursue an explanation for all those charges...esp. the Doc who charged you for a 'social visit'. IMO, you are doing what more people should do....

[MRM]

The reason our medical system is so out of control is that it is dysfunctional. More than 1/3 of all health care dollars are spent on reimbursement issues. On top of that is the cost of paying for people who get treatment but don't pay and covering the cost between government reimbursement rates and the actual cost of care.

Considering government reimbursement rates, insurance company contract rates, and people who just don't pay, no one ever pays the bill that gets sent out, so there is no reason for the billing to bear any resemblance to reality. Which then leads to people not paying the bill and increased costs on reimbursement issues, and so forth and so on.

At the risk of sending this to PARF (and I'll delete this part of the thread if it starts going that way) I would just point out that if we had a reimbursement system that ensured that care providers were paid a reasonable fee promptly for necessary services, we would cut our health care expenses by 1/3 immediately based on no more money wasted on reimbursement issues, and then we would start gaining efficiencies on the bills and treatment itself. It's something worth thinking about.

[Noah930]

The hospital can't just make up a number. You should get a separate (or you can ask for it if you don't) itemized bill. Specific codes with specific dollar values. You won't understand any of it, but someone can decipher the gist.

The physician(s) can't just make up a dollar amount, either. They also have specific billing codes that translate into specific dollar amounts. Their chart notes (whether dictated or written) have to include very specific items to qualify for different billing codes. If docs are getting $500-800 for in hospital consultations in PA, I'd better look into moving there.

Additionally, do you have insurance or not? Were those medical providers on the MPN or not? If so, there are clearly delineated amounts that they're allowed to bill. I don't know what the law says in PA, but does your state allow balance billing, where you're responsible for whatever insurance doesn't cover?

On the flip side (and as a slight threadjack), I got handed an FMLA form to fill out today. Interesting how insurance companies, employers, and the government can mandate that this garbage has to be filled out by a doctor, but not reimburse said physician for the time it takes to do so.

[Rikao4]

like Neil mentioned..
you want to see the billing codes..
you will most likely find codes for stuff that didn't happen..
folks make decent coin challenging huge bills..
ie o2 for 5 days...800 bucks..
in Hospital for 3...
on big bills & with long stays...
this 'normal'..

Rika

[bpu699]

Originally Posted by Noah930

The hospital can't just make up a number. You should get a separate (or you can ask for it if you don't) itemized bill. Specific codes with specific dollar values. You won't understand any of it, but someone can decipher the gist.

The physician(s) can't just make up a dollar amount, either. They also have specific billing codes that translate into specific dollar amounts. Their chart notes (whether dictated or written) have to include very specific items to qualify for different billing codes.

On the flip side (and as a slight threadjack), I got handed an FMLA form to fill out today. Interesting how insurance companies, employers, and the government can mandate that this garbage has to be filled out by a doctor, but not reimburse said physician for the time it takes to do so.

When you are admitted, a doctor needs to do an "admission history and physical." This included reviewing you er records, labs, adressing your reason for admission, and doing a physical. This then needs to be documented, typed. This then needs to be translated into orders, entered in the computer, and a plan needs to be documented. Your old records need to be reviewed, and documented.

Sorry you had a bad experience, the healthcare system is a mess. Most of this is due to balanced billing.

An average admission note takes a doctor about 45 minutes, most of the paperwork is behind the scenes. Insurance really only has 2 codes that are used for admissions (there are more, but almost never used). To bill either code requires that about 30 different points were met. $500 or so dollars to do this is about right for what is billed. What the doc actually gets paid, is about 1/3 of that.

Costs definitely are out of control, and they will be coming down...but I suspect that this will make things worse, not better. What will happen in the end, is that services will be limited/rationed... sad, but true.

If everyone paid, bills would be half of what they are. But when the government insists that care is provided at cost or below (medicare/medicaid), then the margins are made elsewhere...ie, folks with insurance. For costs to change, we need to have everyone pay for what they use. And, that ain't ever going to happen...

[dennis in se pa]

Codes? What codes? There is no breakdown at all. I requested such, and they said they will send them, but why should I have to even ask?

Sort of like being taken to a grocery store, they fill the cart with stuff you may or may not need, then you get a bill, but you never even knew what you got.

When I get the specifics I will post them. I appreciate the above offer to reference acceptable prices for these codes.

Thanks for all the help so far.

[bpu699]

Originally Posted by dennis in se pa

Codes? What codes? There is no breakdown at all. I requested such, and they said they will send them, but why should I have to even ask?

Sort of like being taken to a grocery store, they fill the cart with stuff you may or may not need, then you get a bill, but you never even knew what you got.

When I get the specifics I will post them. I appreciate the above offer to reference acceptable prices for these codes.

Thanks for all the help so far.

Hospital codes and what they bill for meds, etc, I am not involved in. Physician codes are called CPT codes, and they will be on your itemized summary bill (if requested). What the docs bill is very standardized, and set as a negotiated rate between your insurance and the hospital/group. The number isn't randomly picked...

The grocery store anaology is interesting.

Lets say a grocery store was run like the government runs healthcare....

30% of people (medicaid) always get their food for free. What ever they want, steaks and ice cream included. They bear no costs, or at most pay 1$ per visit. They have to be fed, and cannot be turned away.

40% of people get seen (medicare), and what the store charges them for food is set by the state. The cost they pay is basically break-even for the store, sometimes slightly profitable. The goverment always wants these folks to get the cheapest food, and thats all they want to pay for. The clientel though, always wants the best food, and blames the store for not providing it. They also don't understand why providing their food at cost is an issue...thats the way it should be. When they are asked to pay for more of their food themselves, this is seen as unjust. They can't afford the better food...

5% of people come in, get the food, and never intend to pay. (self insured).

25% of folks work hard (insured). They save money. They are willing to pay a fair price for their food. The problem is, the store has to provide 75% of the clientel with food at a loss or break even. Thats the governmnts rules. So, any profit made has to be made on these folks. Thats why they pay 15$ for a gallon of milk. It ain't fair, and the store agrees.

Everyone is mad at the store. They are mad at the employees. Really, they should be mad at the government. The last group should be mad at their neighbors, as they aren't contributing...

But guess what, every member of the store gets to vote if they want things changed. 75% are quite happy with the way things are...

[Noah930]

Originally Posted by dennis in se pa

Codes? What codes? There is no breakdown at all. I requested such, and they said they will send them, but why should I have to even ask?

Yes, you're right. It's nice to know why you're getting billed a certain amount.

But you will also have absolutely no idea what those codes mean. Unless you have the ICD-9 and CPT books, as well as what Medicare reimbursement is for your region, plus what the contracted insurance rate is (as virtually all insurance reimbursement is based upon a percentage of Medicare rates).

[Rikao4]

true,
but he can also then take the codes to billing and say..
explain these..
& they will do so..
and he can begin to challenge some items..
like being billed for o2 for 5 days..

Rika

[wdfifteen]

It is insanely complicated, and the need to understand it arises when you are least able to deal with it - when you're sick. It surprises me that a new profession of Health Care Advocate hasn't sprung up. Just as you need a lawyer you guide you through the legal system, these days you need an HCA to guide you through the health care system.

[89911]

did you talk to your insurer? do you have a high deductible? did you go out of network? did you need a referral prior to your visit? are you sure that is a bill or a statement? many times the insurance company sends the patient a bill along with the insurance company and if there is a delay, expects you to pay it. as long as you have valid insurance coverage from a legitimate company, you shouldn't have a bill this high. I have seen some cheaper companies that you get through independent agents (not highmark, blue cross, aetna, metlife, etc) that have very poor coverage. My wife is a nurse that has worked in insurance all her life, so I have some experience with these issues. this sounds like an issue with you insurance carrier. your bill may off been that high, but what is billed and what is an agreed upon maximum are too very different things. sounds like you got the full retail bill with no insurance coverage at all.

[dennis in se pa]

"what is billed and what is an agreed upon maximum are too very different things. sounds like you got the full retail bill with no insurance coverage at all."

Absolutely. I have seen insurance payments equaling 40 % of what the listed pricing indicated. They call it their "allowance". I am what they refer to as a "self pay" so they try to get "full price".

At 59 years old with a previous heart issue even "catastrophic only" coverage is ridiculously high. It would be cheaper to pay a bill like this EVERY YEAR than to have health insurance in my case.

They are going to find out that I have an "allowance" also.

I appreciate all the feedback. Thanks.

[sammyg2]

Originally Posted by Noah930

On the flip side (and as a slight threadjack), I got handed an FMLA form to fill out today. Interesting how insurance companies, employers, and the government can mandate that this garbage has to be filled out by a doctor, but not reimburse said physician for the time it takes to do so.

Just outta curiosity: if doctors could charge to fill out FMLA forms, how much would the bill be? $500? $2500? $10,000?

I went to the doctor one time with an ear infection.
I told the lady when I called that I had an ear infection and needed some antibiotics. She said I needed to see the doctor.
I made an appointment, to get antibiotics.
i showed up on time and waited a half hour.
I got called and sat in a room for 15 minutes.
The doctor walked in and asked what was wrong, I said I had an ear infection and needed some antibiotics. he looked in my ear and said I had an ear infection, here's a prescription for antibiotics.
He was in the room 15 seconds max.

I paid the $25 co-pay and left.

Later I got a bil in the mail for just over $100.

I called and asked what it was for, the lady said that my insurance only covered 90% of an office visit and the $100 was the remaining 10%.
I asked her if it was normal to charge over $1025 for 15 seconds of the doctor's time, especially when I made the diagnosis for him? That's $246,000 an hour!
Bottom line, I didn't pay the bill and I found a different doctor.
And I told lots of folks about how that jackhole tried to rip me off.
Lots and lots.

I shoulda kicked him as hard as I could in the nutz.
No excuses, no passes, he's a total scum and so is every other doctor who tries to over-charge, no matter what rationale they try to justify using.

[nynor]

Originally Posted by dennis in se pa

"what is billed and what is an agreed upon maximum are too very different things. sounds like you got the full retail bill with no insurance coverage at all."

Absolutely. I have seen insurance payments equaling 40 % of what the listed pricing indicated. They call it their "allowance". I am what they refer to as a "self pay" so they try to get "full price".

At 59 years old with a previous heart issue even "catastrophic only" coverage is ridiculously high. It would be cheaper to pay a bill like this EVERY YEAR than to have health insurance in my case.

They are going to find out that I have an "allowance" also.

I appreciate all the feedback. Thanks.

IME, hospital bills are negotiable, especially if you can pay a lump sum. offer them the 50% they would be getting from medicare and see what they say. self pay folks get billed the ENTIRE amount. insurance companies get billed what they have negotiated to pay (which is part of the reason the amounts are so high: if they bill for X and only get 1/2X, X is going to get higher and higher). in the case of medicare its about 50%; the other insurance companies follow the lead of medicare.

if they refuse to play ball, tell them you will need to set up a payment plan of $150/month and that you will need to talk to their manager.

[nynor]

Originally Posted by wdfifteen

It is insanely complicated, and the need to understand it arises when you are least able to deal with it - when you're sick. It surprises me that a new profession of Health Care Advocate hasn't sprung up. Just as you need a lawyer you guide you through the legal system, these days you need an HCA to guide you through the health care system.

huh. i've been toying with the idea of going to law school (not very likely). with my medical background, this would be perfect.

[Rick Lee]

I had a doctor once tell me, "You really need to quit smoking." That was it, not another word about it. And on my bill a box and code were checked for "smoking cessation counseling".

[RWebb]

not clear how you were admitted or why - if you went thru the ER, were unconscious even briefly or had a heart issue, etc. then they deploy all sorts of expensive things to protect you (and them)

what Dr.s saw you and why?

"One doctor spoke to me for 5 minutes socially" - this could have been a "stealth" evaluation of your mental state, e.g. incident to trauma - I've even done this when a guy conked out at a wine tasting (and I'm not a clinician, MD, at all)

"and sent me a bill for $533" - likely cheap(!) as noted above, there are lots of problems with US healthcare and the providers no doubt did a lot more that you didn't see, including reviews, consultation with other MDs, & etc.

BTW - don't do anything with the hospital over the phone - do it by Email, letter or (best) fax with a receipt that they got it

Penn. no doubt has lots of protections for consumers of medical care, so at some point, you may want to contact whatever agency handles this stuff

if insured, your insl co. will browbeat the MDs into submission, and even hit the hospital some (they are bigger, so can fight back against the ins. co.s better)

MDs are have been feeling very unloved for the last 20 years, and it is only increasing, so if you need to stiff someone... may I politely suggest the hospital?

if not insured, the hosp. will no doubt knock the bill down some - you will need to inquire about that (cash works wonders, as they will be overjoyed that someone w/o inns. is actually thinking of paying them for the very expensive service they have rendered you); and will put you on a payment plan too

but, first, make sure it is accurate

anyway, I'm sorry you had a medical event both physiologically and policy-wise

[wdfifteen]

Originally Posted by nynor

huh. i've been toying with the idea of going to law school (not very likely). with my medical background, this would be perfect.

I've been thinking about it myself. I'll be fully retired when I'm 70 in 9 years and I'll need something to do. About a year ago I helped a friend try to get through the medicaid SSDI mess. I never got the feeling that anyone at the SS office really knew what was going on since you could ask the same question of three people and get three answers. The benefits depend on the county and state you live in, what you own, how much money you have coming in and what you spend it on. The complaints in this thread barely scratch the surface of the insanity. You need expert knowledge of the bureaucracy to wade through it.