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Old 01-31-2019, 11:53 AM
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Default Advice needed--fighting an outrageous hospital charge



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Didn't know if this should be in the Health section, but I'm posting it here.

I have annual echograms/ultrasounds done for my heart. Mostly as part of my annual checkup.

I've had them done annually the past 6 years at my usual cardiologist. The usual charge has been around $450. Had one done in March of last year, and it was $463. The ultrasounds are done by the cardiologist's staff, at his office. A simple 20 minute procedure.

The cardiologist I've gone to the last six years has moved elsewhere. So I wanted to get in with another doctor. I saw him in October of last year, and he recommended a routine ultrasound.

So I go in for the ultrasound. It's done in the same building, and even the same room where I've had them done previously. The only difference was that it was done under the auspices of my local community hospital.

And then I get the bill. Shocked to find out they are charging $1,950 for the same 20 minute procedure I've always paid $450 for!

My health insurance has a high deductible, so I'm on the hook for all this.

I've tried to talk to the hospital to get this reduced. Their only advice was "apply for Medicaid". But you have to be almost destitute to qualify for that. As a working man with modest assets, it disqualifies me. But I'm not wealthy, and having to pay this much is very hard for me to do.

Any advice on how to fight something like this? I've talked to some friends, and their advice varies from "try to fight it!" to "you can't do anything about it. Might as well pay".

I'm both upset and angry about this. How the <bleep> can a hospital get away with charging FIVE TIMES as much for a procedure?

Where in the world can you get $1,950 for a simple 20 minute procedure where I'm simply lying on a table while a fancy x-ray is taken?

Any help and advice is appreciated.
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Old 01-31-2019, 11:58 AM
InOmaha InOmaha is offline
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They're assuming you'll just pay it because they sent a bill. Tell them you won't pay that. Show them your last bill and try to settle. The difference in the bill is they are trying to average out their unpaid ER costs using you.

The biggest problem with healthcare is how hard it is for regular people to call up a place and get a price quote. Car repair shops can get an accurate quote in minutes using their computer system. In healthcare it's difficult to get you a quote for anything.
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Old 01-31-2019, 12:05 PM
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Wow, that is a huge amount of money. I just searched and if you don't use the NHS here in the UK ultrasound scans are less than 100.
I've had 3 MRI scans in the last few weeks (free at the point of need because I use the NHS) but even they are less than 250 each at my local private hospital.
US prices would cripple most Brits, you seem to be getting screwed by the health industry.
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Old 01-31-2019, 12:06 PM
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If you didn't agree on a price prior to the procedure, than the price has to be a reasonable charge, although if you gave them your health insurance there's a chance that the charge was already agreed-to between your insurer and the hospital. I deal with medical bills all the time. If you can tell me the CPT code for the procedure and the Zip code of where you had it, I'll give you the range of the cost for that procedure from my Physician's Fee Reference Guide. It may help you negotiate the charge.

The CPT code will be a 5 digit code. It may be something in the 76xxx range.
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Old 01-31-2019, 12:13 PM
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Quote:
Originally Posted by InOmaha View Post
They're assuming you'll just pay it because they sent a bill. Tell them you won't pay that. Show them your last bill and try to settle. The difference in the bill is they are trying to average out their unpaid ER costs using you.

The biggest problem with healthcare is how hard it is for regular people to call up a place and get a price quote. Car repair shops can get an accurate quote in minutes using their computer system. In healthcare it's difficult to get you a quote for anything.
This post pretty much says it all. Because they bill you, doesn't mean that is what you have to pay.

This past years has been brutal, I tore a ligament in my shoulder and I'm no saddled with $18k in medical debt and they ALL want their money RIGHT NOW. I'll pay what I can and constantly talk to them to get them to reduce what they say I owe.
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Old 01-31-2019, 12:22 PM
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Like was said, talk to them and tell them you simply don't have the money and show them your last bill. Hospitals are a complete rip off; you're paying for their monstrous overhead. $5-$10 for a cotton ball comes Ro mind.
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Old 01-31-2019, 12:24 PM
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Call your health-care provider first. It sounds like a huge increase. I still have the hospital chasing me around for NEW bills that went with my 2016 heart surgery. I just don't pay them. Some are low around $30, others are up around $900 to $1200. They finally gave up chasing me to pay a $2000 bill for my late wife in the ER for an OON doctor.
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Old 01-31-2019, 01:18 PM
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Negotiate it down, then send them $10 a month, and find another place to do it. They can't do squat to you.

When my son was born, they had us in one room during labor, then pushed us to another room, for some unknown reason.

Then billed us for 2 rooms? I called them on that BS and got that changed, but it took 3 people, a few well chosen words and a threat of a lawyer to get to that point.

The worst thing about doctors is the insurance, and the people that handle their billing.
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Old 01-31-2019, 01:23 PM
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call the tv news and if they would like to a story on it
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Old 01-31-2019, 01:26 PM
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Quote:
Originally Posted by Jdog67 View Post
If you didn't agree on a price prior to the procedure, than the price has to be a reasonable charge, although if you gave them your health insurance there's a chance that the charge was already agreed-to between your insurer and the hospital. I deal with medical bills all the time. If you can tell me the CPT code for the procedure and the Zip code of where you had it, I'll give you the range of the cost for that procedure from my Physician's Fee Reference Guide. It may help you negotiate the charge.

The CPT code will be a 5 digit code. It may be something in the 76xxx range.
I called my insurance provider, and they said the code was 93306.

The zip code where the procedure was performed was 68602
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Old 01-31-2019, 01:31 PM
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Quote:
Originally Posted by greif View Post
call the tv news and if they would like to a story on it
It's a community hospital, in a city of about 25,000. And as usual in such environments, it's all one big "good 'ol boy" network around here.

The hospital is a "big shot" in the town. They pull a lot of weight. Being one of the biggest employers in town. They also have a reputation of throwing their weight around, when it comes to "political" power.

The only "media" around here is the local newspaper, and a local radio station. Which are probably owned by the same investors who own the hospital.
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Old 01-31-2019, 01:33 PM
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I've had the same procedure done in the same facility, in the same room, by the same doctor billed at wildly different rates because of a coding difference.

The rates are different from a hospital procedure and an out patient, even though they are exactly, 100% the same.

Be sure to get the exact description and procedure codes to make the comparison.

Assume that reason and logic have vanished. Get ALL the information.


And then fight it!
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Old 01-31-2019, 02:44 PM
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Default America's @&&&!!-up medical system!

Update:

Just got back from a visit to the billing department of the hospital.

Showed them the bill I got from them for $1,950. And then the bill from the other provider, doing the exact same service, at the exact same location, and they charged only $462.

The hospital wouldn't give an inch.

I was told flatly:

"We don't mark down bills for anybody. I (the AP person) don't have the ability to mark down a bill. Nor does anyone over me.".

"If we do it for one person, we have to do it for others".


I showed them the bill from the previous provider, for the same service only six months prior.

"How can you charge 5X as much for the same service?", I asked.

"Well--our equipment is higher resolution, better quality, etc. etc."

"Five times BETTER?", I replied.


I told them that ultrasound has been around for almost 50 years. There's nothing special or new or unique about it.

The only thing they offered was Medicaid assistance. Oh thank you. I'm sure to qualify for that, with me having a job and a modest asset of a home.

We have in, in this country, the most screwed-up-greedy-corrupt-inefficient-amoral and expensive medical care system in the World.

Oh---I'm aware of those here on SB, who rush to the defense of the US healthcare system. Claiming "it's the best in the world!" Bad-mouthing the care in Canada or Europe.

I suggest those fanboys of US Healthcare pull their heads out of their behinds, and read stories like mine. And the thousands of other similar experiences that so many Americans face daily. Just trying to get proper medical care.

When I think of the thousands of others out there, individuals and families, who are facing the same situation. And for much more money than I am facing.
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Old 01-31-2019, 02:47 PM
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I would 1. Call your insurance company again,

and 2. Ask for the "patient advocate". Then explain things to him or her.

Insurance companies do not talk much about Patient Advocates, but the insurance companies that I have dealt with have all had them. I am not certain of the entire scope of their job description, but I have found them to be very helpful whenever the insurance company was being totally unreasonable

Edited to add: I just read your latest post. Also complain to your doctor: he probably had *NO* idea they had recently changed things and he will probably be horrified. At best *HE* can have words with the hospital- and the hospital worries more about his opinion than they do about yours- and at worst he will probably not send them so many patients for that procedure. And that is why the hospital cares more about his opinion than they do about yours

Also, I wonder if the hospital has a patient advocate? They would never volunteer this information: you would have to specifically ask. Because they would much rather you just forked over 2 grand
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Old 01-31-2019, 02:51 PM
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Quote:
Originally Posted by zumhug View Post
This post pretty much says it all. Because they bill you, doesn't mean that is what you have to pay.

This past years has been brutal, I tore a ligament in my shoulder and I'm no saddled with $18k in medical debt and they ALL want their money RIGHT NOW. I'll pay what I can and constantly talk to them to get them to reduce what they say I owe.
18,000 for that? Ridiculous and healthcare has turned into vulture capitalism.
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Old 01-31-2019, 02:57 PM
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Another hospital/doctor BS billing practice is the hospital accepts your insurance but (they never tell you in advance) the ER doc doesn't. When it is an emergency, you don't have the option to shop around for doctors.

I fought it with a tag team of the hospital patient advocate, insurance company, and assuring the hospital and doctor's group that I would be contacting the local TV and newspaper about this practice and make sure the state insurance commissioner's office was involved as well. They decided to drop the balance billing "this time".
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Old 01-31-2019, 03:04 PM
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Another hospital/doctor BS billing practice is the hospital accepts your insurance but (they never tell you in advance) the ER doc doesn't. When it is an emergency, you don't have the option to shop around for doctors.

Yes---that's another thing I've heard about. Even Consumers Union has criticized this disgraceful tactic of screwing-over patients.

Even some members of the SB board have defended the health care system. Telling people to "just quit whining" and to "shop around". "Let the free market do its job", they say.

Shop around? How is that an option--when you've been in a major car wreck, or are having a stroke or heart attack, and you need care NOW!
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Old 01-31-2019, 03:09 PM
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Sorry about what you are going through with your hospitals bills. That is upsetting and crazy what they are doing, same service but suddenly much higher price.

I wish I had new helpful advice. About all I can think of that is different from has been mentioned before is you might check out your hospitals procedure costs. By law this is to be listed on their web sight. It is a new law that came into effect this month. You might see if their is a difference between what is listed on their web sight and what they are billing you.

If you have not already you might let them know you will not be back for another ultra sound at their facility if they don't go back to the older lower charge.
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Old 01-31-2019, 03:21 PM
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Several years ago, I received a cut on my forearm. No big deal....I showered, changed clothes, took some pics and then drove to the ER at the hospital. They placed me in a hallway for 20 minutes. Finally a doctor came along, pulled me into a side room and installed 10 stiches. The hospital sent me a bill for $3,000.00. I called them and said there was a problem with their bill and I wouldn't pay one cent unless they became more reasonable. 2 months later, I received their revised bill.....$1,200.00. Still unreasonably high, but I paid it.
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Old 01-31-2019, 03:29 PM
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Quote:
Originally Posted by PaulKersey View Post
Several years ago, I received a cut on my forearm. No big deal....I showered, changed clothes, took some pics and then drove to the ER at the hospital. They placed me in a hallway for 20 minutes. Finally a doctor came along, pulled me into a side room and installed 10 stiches. The hospital sent me a bill for $3,000.00. I called them and said there was a problem with their bill and I wouldn't pay one cent unless they became more reasonable. 2 months later, I received their revised bill.....$1,200.00. Still unreasonably high, but I paid it.
Damn, that's a nasty looking cut!

Runaway hospital bills is what happens when there is no free market for healthcare. My wife and I have Blue Cross/Blue Shield. Their website allows us to see the bills submitted, what they paid to the doctors, and what we will pay for our copay. It's not unusual to see them discount a doctor bill by 60% to 85%. We pay 15% of whatever they pay.
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