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 Post subject: Re: Hospital bills
PostPosted: Sat Sep 28, 2013 9:00 pm 
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Semen Strong
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You go to the hospital you should get one bill and that bill should be just forking paid by your insurance, the end.


Yes. The hospital has the leverage to make that happen - because every professional practicing there needs privileges to be able to make their money. So why in the everloving fork are they not insisting that if you have privileges there, you accept the same insurances the hospital does? And why isn't the hospital insisting that insurance companies "reasonable and customary" rate be at least close to the actual billed rate?

And they are calling to tell people to go F themselves, but what do you do when they then threaten to send the bills into collection and screw up your credit rating?

Basically, the hospital has leverage and so does the insurance company. The only people with no leverage are the patients. And they're the ones being stuck with the bill

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 Post subject: Re: Hospital bills
PostPosted: Sat Sep 28, 2013 9:03 pm 
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***LIES!!!***
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I think some people are better at telling doctors to go fork themselves than others. There are no actual rules. They just figure out if they can scare you or not and whether sending you to collections will get them anywhere. When I call the insurance company or doctors I get nowhere. When my husband does, he gets everywhere and has saved us thousands in the process. I don't know what his magic formula is.


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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 11:09 am 
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Ariann wrote:
I don't know what his magic formula is.


I do...he's a man. I hate saying that but if I bisque about something I get no where. If my husband bisques about the same thing he gets somewhere. I also noticed that at an office I worked at. The woman got nowhere with bisqueing...the men always did.

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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 11:18 am 
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I'm curious now about the Dr charging them for the rest. We have had many Dr. bills this year and our insurance has only paid a certain portion of them and the various Dr.'s have never billed us for the rest. So is it up to the Dr if they bill for the rest or is that just specific depending on what insurance you are using? There are some insurance statements that say we are responsible for non of the extra costs after they pay and some that say we are responsible for some of it but the Dr's have never sent us bills and it's been months. Our kids pediatrician sometimes take our copay and most of the time doesn't and never bills us for it or asks for it the next time. Its really strange!

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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 11:25 am 
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JENNA wrote:
Ariann wrote:
I don't know what his magic formula is.


I do...he's a man. I hate saying that but if I bisque about something I get no where. If my husband bisques about the same thing he gets somewhere. I also noticed that at an office I worked at. The woman got nowhere with bisqueing...the men always did.

Having scary phone voice helps. My mother always gets what she wants from customer service folks, but I always feel so sorry for the person on the other side of the phone.

Update on our insurance problem from page one of the thread. It took about six months, but we continued refusing to pay the extra money and eventually the doctor who made the billing mistake ate the cost.


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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 11:31 am 
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JENNA wrote:
I'm curious now about the Dr charging them for the rest. We have had many Dr. bills this year and our insurance has only paid a certain portion of them and the various Dr.'s have never billed us for the rest. So is it up to the Dr if they bill for the rest or is that just specific depending on what insurance you are using? There are some insurance statements that say we are responsible for non of the extra costs after they pay and some that say we are responsible for some of it but the Dr's have never sent us bills and it's been months. Our kids pediatrician sometimes take our copay and most of the time doesn't and never bills us for it or asks for it the next time. Its really strange!


You may have reached your OOP max or they retro submitted a claim for your insurance and they paid. Otherwise it's insurance fraud on their behalf to not bill you. Some providers still do it. Because of what we do we expect to eat the cost on roughly 70% of patient bills, but we still have to send it out. We never send to collections, though.

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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 11:45 am 
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Fee wrote:
JENNA wrote:
I'm curious now about the Dr charging them for the rest. We have had many Dr. bills this year and our insurance has only paid a certain portion of them and the various Dr.'s have never billed us for the rest. So is it up to the Dr if they bill for the rest or is that just specific depending on what insurance you are using? There are some insurance statements that say we are responsible for non of the extra costs after they pay and some that say we are responsible for some of it but the Dr's have never sent us bills and it's been months. Our kids pediatrician sometimes take our copay and most of the time doesn't and never bills us for it or asks for it the next time. Its really strange!


You may have reached your OOP max or they retro submitted a claim for your insurance and they paid. Otherwise it's insurance fraud on their behalf to not bill you. Some providers still do it. Because of what we do we expect to eat the cost on roughly 70% of patient bills, but we still have to send it out. We never send to collections, though.

Were some of those visits well child ones? Not sure how common this is, but I don't pay a co-pay for the standard well child visits. They are 100% covered.


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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 12:26 pm 
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Same here.

For the pediatrician, this basically works out that well visits are 100% covered but any time V is actually sick we have to pay 100% of the costs (because we never hit that ~$300/year individual deductible, if we did it would be 20% after that until we'd paid $1000 out of pocket).

Obviously, this is totally contrary to the way an "insurance" system should actually work, but blame the weirdo hybrid we have in this country of "healthcare coverage" and "insurance" that is not really very good at being either.


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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 1:21 pm 
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Fee wrote:
JENNA wrote:
I'm curious now about the Dr charging them for the rest. We have had many Dr. bills this year and our insurance has only paid a certain portion of them and the various Dr.'s have never billed us for the rest. So is it up to the Dr if they bill for the rest or is that just specific depending on what insurance you are using? There are some insurance statements that say we are responsible for non of the extra costs after they pay and some that say we are responsible for some of it but the Dr's have never sent us bills and it's been months. Our kids pediatrician sometimes take our copay and most of the time doesn't and never bills us for it or asks for it the next time. Its really strange!


You may have reached your OOP max or they retro submitted a claim for your insurance and they paid. Otherwise it's insurance fraud on their behalf to not bill you. Some providers still do it. Because of what we do we expect to eat the cost on roughly 70% of patient bills, but we still have to send it out. We never send to collections, though.



I'm confused. I understood the issue to actually be the opposite of what you're saying - that if a provider is in network that means they are agreeing to accept the pricing structure that the insurance company sets, so an in-network provider should never be billing you over and above what the insurance company says the service is worth, and in the majority of insurance plans I've had, that's meant the insurance company is paying that price and you are responsible for nothing else (and if you haven't reached your deductible yet, they should be billing you what the insurance company says is the accepted rate for that service and not more than that). It's only out-of-network providers who can charge you above what they accept as the appropriate price from insurance (and dentists, because apparently dentists have different rules?). I think the 100% covered well child visits is part of the affordable care act, we used to have to pay a copay for those until this year.

I often get explanation of benefits that look like this:
Amount Billed: 200
Accepted Rate: 70
Patient already paid: 20 (co-pay)
Insurance Paid: 50
Additional Patient Responsibility: 0
(that's for after reaching deductible)

Or:
the last couple of lines might look like:
insurance paid: 0
additional patient responsibility: 50
if I haven't reached the deductible.

Whereas an out-of-network EOB might look like:
Amount Billed: 200
Out-of-network coverage (40% or whatever)/Insurance paid: 80
Additional patient responsibility: 120

And a dental bill will look like:
Amount billed: a million dollars
Insurance paid: nothing, go fork yourself, we don't care that you've been paying $100/month for dental insurance for ten years, we lied about the existence of in network providers
Additional Patient Responsibility: two million dollars, I don't know why


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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 2:23 pm 
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That's what I mean by billing the patient, just the OOP or deductible.

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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 4:57 pm 
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helbury wrote:
Fee wrote:
JENNA wrote:
I'm curious now about the Dr charging them for the rest. We have had many Dr. bills this year and our insurance has only paid a certain portion of them and the various Dr.'s have never billed us for the rest. So is it up to the Dr if they bill for the rest or is that just specific depending on what insurance you are using? There are some insurance statements that say we are responsible for non of the extra costs after they pay and some that say we are responsible for some of it but the Dr's have never sent us bills and it's been months. Our kids pediatrician sometimes take our copay and most of the time doesn't and never bills us for it or asks for it the next time. Its really strange!


You may have reached your OOP max or they retro submitted a claim for your insurance and they paid. Otherwise it's insurance fraud on their behalf to not bill you. Some providers still do it. Because of what we do we expect to eat the cost on roughly 70% of patient bills, but we still have to send it out. We never send to collections, though.

Were some of those visits well child ones? Not sure how common this is, but I don't pay a co-pay for the standard well child visits. They are 100% covered.



you have to be careful though and make sure it's actually a well child visit. (i think it's law that they are covered??? obamacare?)
my dr had BabyPunk come back a week after her first well child visit and i got a bill.
i called them to complain and they said it was not an actual well child visit but she had to come back because she wasnt gaining weight.

not 100% true but basically it wasnt a well child visit. it was just for our copay so it wasnt a huge deal but it was a bit convoluted. when my dr tells me to bring my newborn back i assume its the regular sched.
oops on my part,

youre not supposed to be charged if you're just seeing the medical assistant/nurse. for example we split BP's last vax round into 2 visits and we were not charged for the second but we never saw the doc.

health insurance seriously is the biggest racket ever. a month after BP was born i got one of those THIS IS NOT A BILL explanatin of benefits thing in the mail and my health insurance was saying the hospital was going to charge me $7000 for my week long hospital stay for preeclampsia/induced labor because they werent covering it.
the reasoning stated was that they did not cover a private hospital room.
cause you know babies are usually born in communal rooms

thankfully it was a weird typo the more we looked at it and we were only ever charged our $500 hspital stay copay but my husband literally had to scrape me off the ceiling after i opened that piece of mail. it was only a month pp and i was still a bit psychotic in the noggin and i freaked out and many a tear was shed

is it weird i like looking at the itemized bills? when we got the bill for our copay it was itemized and showed what they charged our health insurance. BabyPunk cost $37k to be born. i should write that in her baby book :-P

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 Post subject: Re: Hospital bills
PostPosted: Sun Sep 29, 2013 7:08 pm 
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Ariann wrote:
And a dental bill will look like:
Amount billed: a million dollars
Insurance paid: nothing, go fork yourself, we don't care that you've been paying $100/month for dental insurance for ten years, we lied about the existence of in network providers
Additional Patient Responsibility: two million dollars, I don't know why

Ha! Sigh. Yep.

(Actually, our current dental plan is pretty good but our old dental insurance was exactly like that.)


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 Post subject: Re: Hospital bills
PostPosted: Mon Sep 30, 2013 11:40 am 
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hahah LisaPunk, my kid is over a year old and just 2 weeks ago I got one of those health insurance statements that showed some charge of $12,500 for the birth as NOT BEING COVERED. With the lovely code that states the claim was not submitted in time by the hospital. I nearly started screaming but then I remembered that I've occasionally gotten those odd statements before and never actually owed anything. Still, holy fork!


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 Post subject: Re: Hospital bills
PostPosted: Mon Sep 30, 2013 12:59 pm 
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Ugh this thread is scaring me. Looking back, we were totally naive going into childbirth the first time, not realizing how much we could end up paying if our birth center birth didn't work out. We truly didn't realize how our once-comprehensive insurance had gone downhill in the past 3 years until we took Sven to the emergency room in July ($2k to see a doctor for 5 minutes who just told us to put Neosporin on his burn). Now I'm planning a homebirth but I'm petrified that I'll need to transfer to the hospital this time.


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 Post subject: Re: Hospital bills
PostPosted: Tue Oct 01, 2013 4:31 pm 
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Do hospitals have payment plans?


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 Post subject: Re: Hospital bills
PostPosted: Tue Oct 01, 2013 4:42 pm 
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I'm told that they do have payment plans. I've heard that some hospitals will also give you a discount if you agree to pay the balance in cash, but I didn't get anywhere with that when I tried it. What else is crazy is that if you don't have insurance you can often negotiate a much lower payment than if you have insurance with a high deductible. Even if you have to pay the full amount out of pocket, the hospitals don't seem to want to adjust it. Next time we have to go to the ER and haven't made a dent in our deductible I'm considering telling them we don't have insurance (although now that insurance coverage is going to mandated I'm not sure if that will work).


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 Post subject: Re: Hospital bills
PostPosted: Tue Oct 01, 2013 4:58 pm 
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The hospital here will do a payment plan (four installments) or will give you a 25% discount if you pay all at once (nice if you can swing it!). I'm not sure if they do this for all bills - Inez had a procedure at the hospital in June and they gave us those options, but no one mentioned them with the bill from when she was born. Maybe it's a new thing? I guess we'll see with number two. Ugh.


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 Post subject: Re: Hospital bills
PostPosted: Tue Oct 01, 2013 7:29 pm 
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refinnej wrote:
Do hospitals have payment plans?



i think it depends on the hospital. the bills ive always gotten (our doctor is part of the network that includes the hospital we gave birth at so ive gotten several bills from one main hospital group) always say you can call them to discuss payment options.

not entirely sure what that means or how they work it out

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 Post subject: Re: Hospital bills
PostPosted: Tue Oct 01, 2013 7:31 pm 
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Audrey wrote:
hahah LisaPunk, my kid is over a year old and just 2 weeks ago I got one of those health insurance statements that showed some charge of $12,500 for the birth as NOT BEING COVERED. With the lovely code that states the claim was not submitted in time by the hospital. I nearly started screaming but then I remembered that I've occasionally gotten those odd statements before and never actually owed anything. Still, holy fork!


seriously! it's so messed up!!!

i had Blue Cross when i was working and then after BP was born we switched to Tufts under my husband's work and all of a sudden i just kept getting dozens of "this is not a bill" things from Blue Cross for stuff for all of this year and part of last year.

it's like they cashed out on all the paperwork relating to me and just mailed it all.
luckily it was all covered (my old Blue Cross plan was soooo much better than what we have now)

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 Post subject: Re: Hospital bills
PostPosted: Tue Oct 01, 2013 7:41 pm 
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My experience with asking a hospital about a payment plan is that they will often agree to stuff, but they don't do their own billing and they don't relay the payment plan agreement to the billing company. It is maddening.


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 Post subject: Re: Hospital bills
PostPosted: Mon Jan 06, 2014 8:00 pm 
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Sorry to revive an old thread but wanted to throw in what I paid for my twins. Don't even remember what the "actual" bill was. I had insurance but still paid about 13k out of pocket for a c section. Ended up living with my partner's folks for a year in order to pay it off.


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 Post subject: Re: Hospital bills
PostPosted: Mon Jan 06, 2014 8:22 pm 
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That is horrible. Its just crazy that people with insurance still end up paying so much out of pocket.

Did you see the Reddit user who posted his $55,000 hospital bill for an emergency appendectomy? He had insurance (who paid about $7,000 and got him a deduction of $37,000, but the rest ($11,000) was on him. http://abcnews.go.com/Health/reddit-use ... d=21384393

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 Post subject: Re: Hospital bills
PostPosted: Mon Jan 06, 2014 9:39 pm 
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That is just disgusting. At least it's an improvement that now the ACA mandates an annual out of pocket maximum of $6350. We have a catastrophic plan for my partner that basically pays for nothing before that out of pocket max, and that would be a lot of money for us but at least we wouldn't go bankrupt over it if he ended up in the hospital.


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 Post subject: Re: Hospital bills
PostPosted: Mon Jan 06, 2014 10:02 pm 
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Yeah, it's all insane. It blows my mind how out of control it all is in the U.S., it's just ridiculous. There was an interesting article this month in the Atlantic on how expensive the cost and poor the quality of end of life care in this country is. The sad thing is that people have been trying to improve it for years but up until the ACA all the incentives were for the hospitals to fill beds even though the results were subpar and more costly than alternatives.


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 Post subject: Re: Hospital bills
PostPosted: Mon Jan 06, 2014 10:07 pm 
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Yeah moo, it's nice to know that there's a limit to the damage. In that thread that tofulish mentioned there was a poor guy who's cousin passed in his twenties because he reached his lifetime limit cost wise for treatments (he had cancer). Can't imagine the pain of that poor family and countless others. I don't think that the ACA goes far enough but thankfully it's a start!


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