Negotiating medical bills/who pays what?-- first timer

[Krischaser]

Hello-- in the past we were very blessed to have insurance that paid for everything. Now we buy our own and have a 80/20 plan with a high deductible. My husband has to have hernia surgery as an out patient but I can say right now we don't have 3500.00 sitting around due to numerous other things that has came up. I don't even know where to start on trying to figure out how much the surgery may cost, how much will we be responsible for, do they offer payment plans? How do I set up one or negotiate a lesser amount. Any advice would be great. Thanks

 

[SandyinMonterey]

Insurances vary so much. We also had very good insurance but as years have gone by it has gotten worse. Same as you, high deductible. I can't tell you what you will have to pay but they're usually is an out of pocket that you have to meet. My husband had to have a minor procedure done and I can just tell you what I did. First, make sure that the doctor and place the procedure is going be done is in your network. Out of network is much higher and to take it a little further, make sure you're covered. I would call the hospital/surgery center and ask about costs and then call your insurance company and find out what is covered, what is paid, etc.....get the names of the people you talk to. I've never negotiated to a lower cost, usually those who don't have insurance or pay cash out of pocket do that and don't involve the insurance company.

 

[Pooh2]

I had surgery early this year with a $3,000 deductible. After the doc and hospital/surgery center bills the insurance, they will send you a bill for your responsibility.

I called the doc's office to pay the $3,000, and they gave me a 25% discount off the bill. The surgery center did not discount their portion.

They did offer payment plans without any finance charge at the time, but we just got a letter saying they are no longer doing this due so many people having these types of plans now.

Call your doc's office and hospital to see what the finance options are.
Also, if he can push the surgery off to after Jan 1st, then his deductible will be covered for next year in case he needs further treatment.

 

[snowwite]

I work as a nurse in an insurance company and I can tell you that the insurance will already be struggling to get any discount from the provider. Providers cost shift higher prices to insured patients to make up for what they claim they lose on uninsured and underinsured (Medicare/Medicaid). They will however work with patients. Hospital bills are grossly inflated so there is a lot of wiggle room on thier end. I've seen people get an additional 50% or more off thier out of pocket amount. The insurance wonl;t pay your $3000 deductible but that does not necessarily mean you will pay all of it either. Ask the provider for a discount. I'd ask for a bigger amount like 45% and let them counter it and you could end up with a good deal. They will usually only agree to a discount if you agree to a prompt payment. If you need a payment plan ask for one that is interest free. If that fails then send them $10 a month until it is paid off and every time they bug you tell them that you did try to work out something in advance. As long as you are making payments they really cannot do anything and eventually they will either negotiate or write it off. You can't get blood out of a turnip.

 

[wergoin2camouse]

I work as a registrar in the emergency room and can tell you that our hospital here in the lehigh valley has a very generous program! Our department refers alot of patients to our finicial counselors ... From there the person/family is obligated to apply for state assistance (which not many qualify for!) and then can apply and may receive our RCC (reduced cost of care) card. It is also based on income but as an example... A family of 4 can earn 94,000.00 and still qualify! Usually when I see these discount cards at registration they are for 85-100% !!

It may be a pain to get through the paperwork for the state... Especially if you know you don't qualify but.... That's a huge discount! Our hospital is huge and non profit... Not sure if yours would offer such a program but it wouldn't hurt to ask!

Good luck!

 

[SGB13]

My DH had the same surgery in June. We also have a 80/20 plan. We had to pay the surgeon before the surgery. (around $400) And the bill for the anesthesiologist was due right after surgery. (another couple $100) The majority we could pay the hospital (well, surgery center) in payments. Check with your facility to see what they will allow. And good luck with surgery!

 

[Eastern]

I work as a nurse in an insurance company and I can tell you that the insurance will already be struggling to get any discount from the provider. Providers cost shift higher prices to insured patients to make up for what they claim they lose on uninsured and underinsured (Medicare/Medicaid).

Struggling to get a discount from the provider? I don't understand this. Are you lumping doctors in with facilities?

If the insurance company has a contract with a provider, they agree to pay a certain amount to that provider. It is in writing. If the insurance company does not have a contract with the provider, maybe it is because the provider did not want to accept a low contract amount for their services from the insurance company.

As for what 'they claim they lose on uninsured and underinsured', that is a fact. Doctors lose money on these patients. It doesn't mean they are penalizing insured patients.

It sounds like you want us to feel sorry for the poor insurance companies

 

[McKelly]

I had surgery early this year with a $3,000 deductible. After the doc and hospital/surgery center bills the insurance, they will send you a bill for your responsibility.

I called the doc's office to pay the $3,000, and they gave me a 25% discount off the bill. The surgery center did not discount their portion.

They did offer payment plans without any finance charge at the time, but we just got a letter saying they are no longer doing this due so many people having these types of plans now.

Call your doc's office and hospital to see what the finance options are.
Also, if he can push the surgery off to after Jan 1st, then his deductible will be covered for next year in case he needs further treatment.

Wait, so was the surgery MORE than your deductible? So, you got a percentage off the deductible? That's good to know, as I also have a $3000.00 deductible and need some surgery. I will have to check in with them and see if they will discount my portion.

 

[clh2]

I would look at the "what-if" scenarios of getting it done in 2013, vs 2014, since it seems that you've not paid anything towards your deductible this year. Having this done in 2014 will probably get the majority of your deductible paid for the year.

 

[crisi]

I would look at the "what-if" scenarios of getting it done in 2013, vs 2014, since it seems that you've not paid anything towards your deductible this year. Having this done in 2014 will probably get the majority of your deductible paid for the year.

Agreed, your biggest bang under a deductible scenario will be to lump as much into a year as you can, then spend as little in the next year (or two) as you can. Obviously, if something needs to be done now, it needs to be done, but if you can put it off until January, then move any other procedures that need to be doing into 2014, you'll be better off in 2013 and 2015.

You are probably going to discover that your insurance company has already negotiated your rate - they aren't interested in you hitting your deductible, so they've probably done the leg work for you - even if you are paying for it. And the hospital isn't interested in increasing their costs by having the staff available to negotiate with each patient, so they are going to use the pre-negotiated rates. However, different hospitals may have different rates, but also different doctors who have privileges.

 

[tvguy]

I'm impressed you've made it to November without hitting your maximum out of pocket, assuming you have one. Have you checked? You could have no out of pocket if you have the surgery this year if that is the case.
My insurance is 80/20, then 100% after hit the max cap.

 

[NotUrsula]

Assuming that your deductible for your DH' surgical status (inpatient vs. outpatient, and believe me, that matters a LOT, so find out before he goes to the hospital) is set up so that insurance pays 80% only after the deductible is met, then you can't get a discount off your deductible; it is the definition of that kind of deductible that your insurance won't pay a dime until you hit that threshold. (There are also plans that pay 80% up until your deductible is met, and then 100% after that. I have one like this, but if this was what you had, I'm guessing that you would not be worried so much about how much you have to pay, because it probably woudn't be that much $ on a simple hernia repair.)

What you often can negotiate down if you have the chutzpah to do it is the cost of the hospital bill, so that your 20% will end up being a smaller amount of cash. Generally, medical practices and hospitals are more amenable to discounting if you are willing to pay cash up front, because that really saves them a lot of staff time in completing paperwork and chasing down the money, or paying a finance company a percentage of the bill.

Also, if you have a medical FSA, your deductible costs can be paid from it. (If you are eligible but don't have one for 2013 and your DH can hold out for six weeks, set one up now if you can so that you can shelter the deductible amount from taxes in 2014.)

BTW, your DH should talk to his doctor carefully about how severe the hernia is and what might happen if he puts the surgery off until January. My DH had one that he put off getting treated for (for several months), and by the time he had the work done it turned out that the damage was more severe than originally thought. The surgery took twice as long as expected and was a lot more complicated, and they didn't discover that until he was in the OR. Luckily, it didn't matter to our insurance, but if it had, it would have cost us a lot more OOP than they estimated up front.

 

[Krischaser]

Thank you to everyone for the advice. I'm actually feeling pretty dumb that I don't know more about my policy. At work we are reimbursed a certain portion back a month which allowed me to pick this policy but as of jan. 1, 2014 they are discontinuing this. So then we won't be able to afford the same policy and will have to drop down. Otherwise I would do it Jan. 2014. I don't know.....

 

[Pooh2]

Wait, so was the surgery MORE than your deductible? So, you got a percentage off the deductible? That's good to know, as I also have a $3000.00 deductible and need some surgery. I will have to check in with them and see if they will discount my portion.

Yes, the surgery was way more than my deductible. I reminded the office lady that the bill was my deductible, she said, that is okay, you are paying it in full so we can offer a discount. I told her she made my day! She said, not many people say that to her since she is in billing..

 

[LaurLaur04]

The only advice I can give is CHECK MORE THAN ONE PLACE. A hospital one county over actually just got dropped by BCBS for overcharging patients. They were MUCH higher than surrounding places and finally got busted. Different hospitals and surgery centers can have vastly different prices. They will probably have an up front fee which is like the surgeon fee and bill for the rest. I had my gallbladder removed with no insurance and that's how they did me. They also offered charity to those who qualify and I got a fair chunk written off since I was a single mom.

 

[snowwite]

Struggling to get a discount from the provider? I don't understand this. Are you lumping doctors in with facilities?

If the insurance company has a contract with a provider, they agree to pay a certain amount to that provider. It is in writing. If the insurance company does not have a contract with the provider, maybe it is because the provider did not want to accept a low contract amount for their services from the insurance company.

As for what 'they claim they lose on uninsured and underinsured', that is a fact. Doctors lose money on these patients. It doesn't mean they are penalizing insured patients.

It sounds like you want us to feel sorry for the poor insurance companies

I was trying to help the OP.
No, I was not trying to make you feel bad for Insurance co but I am trying to educate people who seem to think that doctors and hospitals are not contributing to the health care crisis by grossly over inflating their bills. I see bills all the time where providers are making 600% and more profit on items and services. Would you not ask for a discount if you knew you were billed $20 per generic tylenol tablet? $40 for the tiny box of tissues? I've seen a single drug which cost the hospital $900 to aquire billed at $58,000 and no that is not a typing error. People are routinely charged as much as $5,000-$10,000 per day, three times a week for Dialysis when the same service is capped at around $850 per day for Medicare patients. The government isn't going to pay the ridiculous up charge so insured patients should not have to either. I got my own bill for my gallbladder surgery and I disputed the charges and negotiated a savings on the portion I needed to pay out of pocket. When I had my daughter I was in nursing school, my ex was laid off and we had no insurance. I paid $10 per month until it was close to paid off and they forgave the balance.
You seem to be an angry person. Talk to someone but please don;t go taking it out on me.