Large emergency room bill

[BrettS]

OK, so it's been a long time since I've posted here and this really isn't Disney related, but it is budget related and I know that you guys are all super smart, so I'm hoping someone can give m some advice

A bit more than a month ago I was installing a new water heater at home and I managed to cut my thumb pretty badly with a box cutter as I was attempting to strip a wire. I went to the emergency room and wound up with 5 stitches and a tetanus shot. I would have gone to urgent care if I had the option, but unfortunately it happened at about 6:30PM on a Sunday night and the ER was the only place that was open.

We have a high deductible insurance plan, so I was expecting a large bill, but I was still a bit surprised when I got a bill in the mail today for $1866 for "Emergency Services". Insurance paid $258 of that, leaving me with $1608 (which is kind of odd too because my insurance is supposed to cover 20%, but what they paid is actually just under 14%. I'll call the insurance company too to figure out what's up there). Unfortunately the bill isn't itemized at all, but to me it certainly seems outrageously high for maybe 20 or 30 minutes of a doctor's time to stitch my thumb and 5 minutes for a nurse to give me a tetanus shot. I'll try to request an itemized bill so that at least I can see how they came up with that number.

I suppose the good news is that I've seen news reports of people getting stuck owing hundreds of thousands or millions of dollars to hospitals, so we're certainly better off than we could be. However, I've also seen reports of people being able to negotiate outrageous hospital bills too and I certainly don't want to pay any more than I need to.

So, all that said, do you guys think that $1866 is reasonable for 5 stitches and a tetanus shot? Do I have any options to try to negotiate this bill down? If so, where do I start?

Thanks much,
Brett

 

[kymom99]

It does seem high. I would definitely ask a lot of questions.

My husband was hospitalized with a kidney stone that was too large to pass. They had to pulverize it and a piece backed up into his kidney so then he had to have a tube inserted. The bill was outrageous but he reached his 3500 deductible for the year. If you pay the amount you are responsible for all at once, usually they will give you a discount. We weren't able to do that, so they put us on an interest free payment plan.

 

[disney world dreamer]

i don't think its reasonable but unfortunately its the reality.
you wouldn't believe how much a doctor can bill for seeing you for a few minutes.
my dad was recently in the hospital and we have AMAZING insurance so it only cost him $10 to be in the hospital for 4 days. had he just needed the ER and not admitted it would have cost $150.
he went to his primary dr a week later for a follow up visit and his primary had just been in the hospital himself and said he just received a bill from an ER dr that was $1,500 when that dr never even came in to do an exam or anything.
he of course is fighting the charge and will file a fraud case against the ER dr if the bill is not thrown out but my point is that a dr can charge what i think is an outrageous amount to see you in the ER so thats probably why the bill is so high.
if you can get an itemized bill that will at least show you what you are even paying for.
if there's a service on there that you don't feel you should be paying for then i'd dispute it.
i hope you don't have to go to the ER again any time soon

 

[lauradis]

OK, so it's been a long time since I've posted here and this really isn't Disney related, but it is budget related and I know that you guys are all super smart, so I'm hoping someone can give m some advice

A bit more than a month ago I was installing a new water heater at home and I managed to cut my thumb pretty badly with a box cutter as I was attempting to strip a wire. I went to the emergency room and wound up with 5 stitches and a tetanus shot. I would have gone to urgent care if I had the option, but unfortunately it happened at about 6:30PM on a Sunday night and the ER was the only place that was open.

We have a high deductible insurance plan, so I was expecting a large bill, but I was still a bit surprised when I got a bill in the mail today for $1866 for "Emergency Services". Insurance paid $258 of that, leaving me with $1608 (which is kind of odd too because my insurance is supposed to cover 20%, but what they paid is actually just under 14%. I'll call the insurance company too to figure out what's up there). Unfortunately the bill isn't itemized at all, but to me it certainly seems outrageously high for maybe 20 or 30 minutes of a doctor's time to stitch my thumb and 5 minutes for a nurse to give me a tetanus shot. I'll try to request an itemized bill so that at least I can see how they came up with that number.

I suppose the good news is that I've seen news reports of people getting stuck owing hundreds of thousands or millions of dollars to hospitals, so we're certainly better off than we could be. However, I've also seen reports of people being able to negotiate outrageous hospital bills too and I certainly don't want to pay any more than I need to.

So, all that said, do you guys think that $1866 is reasonable for 5 stitches and a tetanus shot? Do I have any options to try to negotiate this bill down? If so, where do I start?

Thanks much,
Brett

Call the billing office number on the bill ask for them to send you an itemized bill to make sure they have ever thing right. I say good luck to asking them for a deal. The reality is Medical cost are out of control in the USA. If you don't have an HSA for your Large insurance detectable. I would look into getting one. As far as the bill goes hospitals are really cool about setting up payment plans if you cant pay all at once or don't want too.

I'm glad you still have a thumb..

 

[Dizzy4DL]

A few years back, I went IN to the hospital and sat down with them. I asked them to print out an itemized bill, and then calmly went down the list asking "well, what's this"? The next bill I got in the mail had $1000 dropped off of it. I'm not saying this would work for everyone, but it may be worth a try.

 

[deserrai]

A couple of years ago, my daughter fell and busted her eye open. The ER bill for gluing it together was $1,000 for the hospital and $1,000 for the doctor. We left my house at 10pm and we were back home at 11pm, so that tells you how little time we spent at the hospital. Ridiculous.

 

[lost*in*cyberspace]

Unfortunately, ER visits usually result in outrageously high bills. Plus, you will be billed by the hospital, the doctor who saw you, the company who took the x-rays, etc. My husband broke a bone while we were on vacation last August; we had to visit the local ER twice. The bill was submitted to our insurance and they paid what was allowed, but the remaining balance is over $1,400. We have TriCare (retired military), so under federal law, for an ER visit we cannot be billed for this amount; they must write it off. Has that stopped the billing? No! Our insurance company has spoken with the hospital billing company multiple times, sent them a letter informing them they must stop billing us, but two weeks ago, they turned us over to a collection agency. Our insurance company again called the billing company and they assured us they would put a stop to collections, but naturally, just two days ago I got a harassing call from the collections company. It will all be worked out, but why does it always have to be such a hassle?

OP, good luck to you.

 

[Shagley]

Our local hospitals have charity programs that are income based. If you fill out their charity paperwork, they may write off a percentage of the bill, based on your income. You may want to ask your hospital if they have a program like that that you can apply for.

 

[Marionnette]

OK, so it's been a long time since I've posted here and this really isn't Disney related, but it is budget related and I know that you guys are all super smart, so I'm hoping someone can give m some advice

A bit more than a month ago I was installing a new water heater at home and I managed to cut my thumb pretty badly with a box cutter as I was attempting to strip a wire. I went to the emergency room and wound up with 5 stitches and a tetanus shot. I would have gone to urgent care if I had the option, but unfortunately it happened at about 6:30PM on a Sunday night and the ER was the only place that was open.

We have a high deductible insurance plan, so I was expecting a large bill, but I was still a bit surprised when I got a bill in the mail today for $1866 for "Emergency Services". Insurance paid $258 of that, leaving me with $1608 (which is kind of odd too because my insurance is supposed to cover 20%, but what they paid is actually just under 14%. I'll call the insurance company too to figure out what's up there). Unfortunately the bill isn't itemized at all, but to me it certainly seems outrageously high for maybe 20 or 30 minutes of a doctor's time to stitch my thumb and 5 minutes for a nurse to give me a tetanus shot. I'll try to request an itemized bill so that at least I can see how they came up with that number.

I suppose the good news is that I've seen news reports of people getting stuck owing hundreds of thousands or millions of dollars to hospitals, so we're certainly better off than we could be. However, I've also seen reports of people being able to negotiate outrageous hospital bills too and I certainly don't want to pay any more than I need to.

So, all that said, do you guys think that $1866 is reasonable for 5 stitches and a tetanus shot? Do I have any options to try to negotiate this bill down? If so, where do I start?

Thanks much,
Brett

Yes it is what the insurance company considers "reasonable and customary" for where you live.

The amount is what you agreed to pay when you signed the papers in the ER and handed over your insurance card. The insurance company has already negotiated a reduced price with the hospital on your behalf. They paid the percentage that they contract with you to pay (ie they pay 20%, you pay 80%). You are responsible for the balance up to your individual deductible for the year.

As a consumer, you have every right and expectation to receive a detailed bill of all the charges. Don't be surprised if it contains a lot of medical-speak that you cannot decipher. You can ask for an explanation of any of those charges. However, if you are able to eliminate any of those charges (double billing, wrong code, etc.) you will only reduce your responsibility by 80% of that cost. Your insurance company will want their 20% back from the hospital for what they paid for that line item.

You can also negotiate a monthly payment plan with the hospital. They will offer it with no interest charges as long as you make your payments on time and in the amount promised. My husband had open-heart surgery in December. Our share of just the hospital bill (not the doctors, radiologists, home care nurses, etc) came to just under $3800 (we have very good insurance). I called to ask if they would offer any kind of discount if I paid them in full immediately. They declined, saying that my insurance had already negotiated a discount on my behalf and that they could not legally offer me an additional discount. However, they offered a payment plan of as little as $125/month until the balance is paid.

 

[aaarcher86]

Is your hospital in network? If not, it could explain the lower paid amount.

Get an itemized bill and ask for an application for their hcap program which will write off a portion if the hospital bill based on your income if you qualify. Can't so much about the doctor and treatment costs though.

 

[Jing]

For an ER, I'm not shocked. You can ask for a superbill receipt with the CPT and diagnostic codes on and look them up. Based on what you said, there will be a visit code and/or evaluation & management code and couple of procedure codes. If the MD was hospital staff (this is becoming a trend), you should not get a bill for his services. If the MD was independent, you may get a bill from his practice.

Some hospitals will dicker for a paid-in-full versus installments. Those are usually for folks not using insurance, but it doesn't hurt to ask.

 

[verleniahall]

If you call th ebilling department of your hospital, Im sure you can make payment arrangements - I had some dizziness/problems and thye did a full blood pannell and a ct scan and i still owe $800 to the hospital. The day I got the bill i called the hospital and they let e set up payments for $100.00 amonth due on the last day of the month. All i have to do is take in a check or cash and tell them my name and they give me a reciept with a balance remaining on the account.

 

[Hisgirl]

I'm glad you are okay. I hope the bill you got is the only bill you'll get. My DD went to the ER in December and we got the ER bill (2800), a bill from a doctor (1000), and a bill from radiology (214). This was just to diagnose why she had abdominal pain. She had medicaid at the time and the hospital refused to bill out of state but cut the bill in half and we paid it off. The radiology also cut the bill in half and medicaid paid the other bill. At least ask for a cut!

 

[smadath]

I'm not sure where OP lives, but around here (Pittsburgh) MedCare and UrgentMed urgent care facilities are open 8a-8p and 9a-9p, 7 days a week. Both have facilities in multiple states, and both do stitches! Too late this time, but something to consider for next time!

 

[Marionnette]

I'm glad you are okay. I hope the bill you got is the only bill you'll get. My DD went to the ER in December and we got the ER bill (2800), a bill from a doctor (1000), and a bill from radiology (214). This was just to diagnose why she had abdominal pain. She had medicaid at the time and the hospital refused to bill out of state but cut the bill in half and we paid it off. The radiology also cut the bill in half and medicaid paid the other bill. At least ask for a cut!

Your situation is very different from the OP's. In your case, the hospital and radiologist had no contract with your daughter's insurance. Nor did they receive any payment from them. For that reason, it was possible for them to negotiate a price with you. The OP's insurance has a contract with the hospital and part of that contract prevents them from negotiating any further discounts with the party covered by the insurance.

 

[arminnie]

This article may have some tips that can help you.

http://www.stretcher.com/stories/10/10oct11a.cfm

Can't afford the Emergency Room Bill - Dollar Stretcher.com

 

[kristenrice]

I was hospitalized about 10 years ago with pregnancy complications. Actually, my heart started acting up but since I was pregnant, they admitted me under "OB observation"....for 3 days! I got a bill for over $6000 because insurance doesn't cover more than 24 hours of OB observation. I asked for a review of my case because my reason for admission was NOT an OB problem but since I was pregnant, they had me admitted as an OB patient. The insurance company reviewed it and agreed that the stay would be covered. Now, during this time, I had asked for an itemized statement and learned some things. One thing that really irritated me was that because I was having a heart arrhythmia, they did not want me to get out of bed. They insisted I use a bedpan and I refused (I'm a stubborn paramedic who knew what I could handle....including a 5 step walk to the bathroom!) so they brought me a bedside commode as a compromise. When I got the itemized statement, I saw that the commode cost $150 a DAY for it to be in my room! THIS is the kind of thing that sets me off...I'm getting billed an OUTRAGEOUS amount for something that I neither needed nor wanted. I understand that life-saving treatments cannot be haggled over in an emergent situation, but seriously...$150 for a bedside commode? If I would have known that, I would have suffered with the $10 bedpan. I have good insurance and everything was paid for in the end, but I feel so bad for people who have to pay OOP for services and products without knowing the costs beforehand. I recently injured my wrist (very slight sprain) and let it go for over a week before I finally decided to get an x-ray. The x-rays were negative but the ortho gave me a wrist splint to wear for a few days until the pain subsided. When the bill came, the x-rays and office visit were covered, but the splint was $110. I could have got the identical splint at Walgreen's for $12. It really bothered me because there was no mention that the splint would not be covered by insurance, but more importantly, there was no explanation given for why I needed it. They just told me to wear it "for the pain", which really wasn't unbearable. If they had told me that I had an injury that required that the wrist be rested and supported for x amount of days, then the splint would have been truly warranted. Instead, it was more of a "wear it if it will make you feel better" deal...and I would have dealt with the discomfort if it would have saved me $100.

 

[seashoreCM]

Don't let a hospital take you under observation until you find out how much of that your insurance will cover.

Instead insist on a full admission.

(from Bottom Line Books)

 

[neatokimmo]

We have a high deductible plan. Blue Cross will take the bill, usually reduce it by 40% then I pay the new total.

We go to urgent care for something strep like. The Dr says it is either this or that, we will test for both. I ALWAYS stop them. Are you sure it is one of the two? Sure, we see it all the time. Same pill for both? Yes. Give me a z-pack. I have probably saved thousands by just stopping them.

I would freak out over a $150 a day toilet!

 

[1buckeyegirl]

My son went to children's hospital and had 3 breathing treatments, saw the Dr for a total of about 15 min and the bill was almost $4000 out of pocket! I was so mad! I can get 24 doses of albuterol for about $6 and that's with out insurance!