Emergency Room and health care doubts

  • Posted by a hidden member.
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    Nov 10, 2009 5:38 AM GMT
    I went to the ER back in September when I was hit by a car. I really didn't want to go but the pain was unbearable and my abdomen was pretty twisted so I went knowing that I have health care that will, in some way, help cover.

    Within a week I received a bill. I expected it. It was for 2 CTs at $343 each (side note: the doctor ordered one for my abdomen and the CT person, after wheeling me back to my room decided to do one on my kidneys "to be sure" shady already right there).

    I called the hospital saying I was billed without the claim being submitted to insurance. They agreed and claimed they didn't process my information yet and it was normal. To quote her, she told me to "discard the bill and a new one will be sent shortly".

    A month later, I get a bill from the hospital stating that submitted the claim. A $6,451.46 bill to my insurance (which they paid but I will now have to pay $1000 to my insurance since I only get 80/20 coverage).

    I am furious. Why?

    1.) All I got was a room, 2 CTs, water, and graham crackers. I was there for 5 hrs during which I saw a nurse and a doctor's assistant for a total of 5 minutes max.

    2.) I refused morphine 3 times, REFUSED (and I have a witness who intervened saying "he obviously doesn't want it, leave him). Then the nurse came back saying "Dr. suggests that you take the morphine for healing or you will slow down the healing process".

    My bill isn't detailed, I will get that ordered tomorrow.

    Does anyone else find it really shady that I got billed $686 first, called told them I had insurance and now have a bill for $6,451.46. Are they just milking the system? Is this one of the reasons why health care is in such a disgusting state?

    I am fuming. FUMING. All I got out of the ER visit was a prescription for pain killers.

    This is my first emo post. Sorry.
  • Posted by a hidden member.
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    Nov 10, 2009 6:30 AM GMT
    Pinny, somethings wrong with this picture the hospital is painting about what you owe the Insurance Company. Insurance companies are only going to pay what they owe the hosptal, if there is a deductible they will not pay it to the hospital, its considered the hospitals job to bill you and collect from you whatever that deductible is. You've said it was 20 %, but the hospital claims the Insurance paid it in full and are now trying to tell you to pay some back to the INS CO. it doesn't work that way. I wouldn't pay anything, don't take any action until you hear from your insurance company.
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    Nov 10, 2009 7:42 AM GMT
    I forgot where I heard this. But a child was hospitalized for some medical condition that required surgery and a brief stay at the hospital. On the final bill, one of the line items was something called "comfort aid" or something ambiguous like that. And it was $300. When the parents inquired what that "comfort aid" was, it turned out to be a teddy bear that was given to the child after the surgery. The parents thought the teddy bear was free.

    I've also heard cases where hospitals charged $50 for two Aspirins. Pretty outrageous.

    But really, this happens everywhere. Whenever insurance is involved, dollar signs light up. And suddenly costs go up.

    I've been fortunate to have never been hospitalized. But I have been involved in some minor auto accidents. One time, I was shopping for quotes to get my car fixed. It was pretty minor damage to the front fender. I wanted to see if I could just pay out of pocket. I went to this one place and they originally quoted me around $800. Kinda pricey, so I told them my insurance company will cover the damages. After my insurance adjuster went to the body shop to approve the work, I got a copy of the final estimate and it was almost $2000. icon_rolleyes.gif

    Basically, the entire insurance industry is a scam. And there are plenty of people taking advantage of it, or participating in it.
  • Posted by a hidden member.
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    Nov 10, 2009 9:36 AM GMT
    You do have my profound sympathy: I had a similar (though less expensive) abuse in Chile and it has poisoned me against insurance companies and private hospitals which look for reasons to charge more rather than seek ways of saving money.

  • Posted by a hidden member.
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    Nov 10, 2009 11:44 AM GMT
    I am not defending the hospital, but you are worth every penny, Pinny.

    I hear stories like this all the time. A friend has been hospitalized maybe a dozen times in his life (he had cancer when he was a teenager). Without insurance he has hundreds of thousands of dollars in debt he will never be able to pay. Last time he went he had two IV's of sugar water and waited in a room for six hours. KA-CHING! $6,000.

    I went to the hospital two years ago when my blood sugar dropped to nothing while I slept. My insurance paid the hospital bill, but the ambulance ride cost me $1,000. They gave me the wrong diagnosis, insisting I had a drug overdose while my boyfriend showed them my diabetes medication. I now keep a bedside emergency kit that cost me $10 that can fix the problem.

    WTF?
  • GQjock

    Posts: 11649

    Nov 10, 2009 12:03 PM GMT
    This is EXACTLY why we need health reform here in the United States

    We have the worst healthcare delivery systems in the world
    We don't even come NEAR any of the industrialized nations we all know like Japan and countries in Europe
    Our healthcare delivery (this is not our medical treatment once we get it)
    it's the distribution of care to the public and its access
    Our healthcare system is on the par with places like Yemen and Slovokia
    and that puts a black eye on Yemen and Slovokia
  • Posted by a hidden member.
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    Nov 10, 2009 2:37 PM GMT
    realifedad said Pinny, somethings wrong with this picture the hospital is painting about what you owe the Insurance Company. Insurance companies are only going to pay what they owe the hosptal, if there is a deductible they will not pay it to the hospital, its considered the hospitals job to bill you and collect from you whatever that deductible is. You've said it was 20 %, but the hospital claims the Insurance paid it in full and are now trying to tell you to pay some back to the INS CO. it doesn't work that way. I wouldn't pay anything, don't take any action until you hear from your insurance company.


    Thanks you all for the sympathy and sharing your view points. My main goals were 1.) to find out if this is common (albeit it SHOCKING) and 2.) just to complain to an open ear.

    While what you say seems valid RLD, My roommate got a colonoscopy earlier this year. The procedure was ~$3000 (a little more, even though the national average is $1,400). He is fine with that and our insurance covers 80/20 on surgeries so he owes $600. His followed the same procedure. The Hospital billed our insurance, our insurance paid in full and then he got a bill from our insurance for what he owed.

    What is "shady" in his case is the hospital is claiming he owes 2 colonoscopies at 3k each. Why? Well because he got the procedure done at a Carle Foundation hospital satellite and not at the Carle Hospital they can both (yes the main campus hospital and satellite) charge him for the procedure. Mind you he went to main campus to see his doctor who told him to have the procedure and that hospital scheduled it for the satellite stating that it where they all occur. How is that possibly legal?

    I mean really, this is shocking and disgusting. Everyone so far seems to have had a similar experience so I don't feel unique, but this should be an indicator for us what path health care has taken.
  • Posted by a hidden member.
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    Nov 10, 2009 3:36 PM GMT
    I knew a guy who had surgery several years back. The hospital bill was over 12 grand. After he had recovered, he took the bill to the hospital. He questioned every single item billed. The employee who handled this asked him "why do you care? The insurance company is paying for it.' After my friend was finished, the bill was reduced to 9 grand. I am not saying this will work for you, but I would argue and dispute every single charge line by line.
  • Posted by a hidden member.
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    Nov 10, 2009 3:44 PM GMT
    Two words

    Single payer.

    It seems that unless you have FIERCE and real competition (not the anemic thing that Obama appears to have got in place) then private insurance ends up being a racket.

    Of course single payer has it´s problems, but I have had tests and treatments free in the UK over the last 6 weeks that would have cost me 5 or 6 months rent if I´d had them done in Chile as the doctor insisted I MUST (and it would have been pointless as all the big tests came back negative)
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    Nov 10, 2009 3:49 PM GMT
    Pinny, the insurance billing your friend the $600.00 makes more sense, and is normal I would say, but in your case with the hospital being the one who informed you what you owed the insurance company, seems suspect. Don't pay anything until you get a bill from the insurance Company itself. Further, I think your friend would have a good case for not paying that double charge you referred to. Has he approached the INS. Co. about the circumstances of this double billing? Seems to me this Medical Institution has been getting away with fraud. As you probably realize I have had major surgery and many many tests, exams and procedures so I've experienced plenty down this line. I wish you good luck in this struggle over the billing. Often it appears that Hospitals will do what they can to get away with over billing and will back down when confronted, but gladly take what they can if no questions are asked. So don't fear asking questions and making a few demands when it comes to your money pocket, while your 20% share may not be that bad, its even better if the total bill is brought down by questioning things so your share is brought down too.
  • calibro

    Posts: 8888

    Nov 10, 2009 3:56 PM GMT
    I would say fight it. I am currently involved in my own insurance woes, and what I am discovering is that these people are hoping you won't make a scene. If you call them on their shit, they try to push you away; then just ask for a supervisor, and if that doesn't work, the supervisor of that person. It always amazes me how well trained the front line is to dissuade you, but as soon as you talk to someone in a position of power and can legitimately proved your case, they turn 180 degrees.
  • CuriousJockAZ

    Posts: 19138

    Nov 10, 2009 4:10 PM GMT
    I definitely wouldn't pay anybody anything until you get to the bottom of why you were billed the amount you were billed and for what -- via an itemized detailed billing that you can verify and go over with your insurance company. Most people don't ask questions, they just assume that they are being billed what it costs. This is where the misinformation and overcharging takes place. If they can get away with it, they will bleed the insurance companies for every thing they can. It's all one big racket if you ask me.
  • Posted by a hidden member.
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    Nov 10, 2009 4:11 PM GMT
    I spent a night in the hospital on IV meds for a really horrible infection I had. The bill was 6,000 dollars and the insurance company wont pay it because the hospital 'accidentally' submitted it under an old insurance policy number that I guess they had on file. (Even though I GAVE them my insurance card)....

    its insane. I'm sorry for your problems... I'd ask for a detailed/itemized statement of the charges.... 6,000 dollars for the care you received seems way out of line.
  • Posted by a hidden member.
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    Nov 10, 2009 5:48 PM GMT
    We've heard so many horror stories.

    Bottom line: the health care system in The United States is gravely ill. It's broken under the effects of capitalism gone amok.

    We're considering Canada (Logan / flex89, and I). I can go to Canada under the skilled workers program, but, we have to figure out what to do with Logan. Logan is 20, a type 1 diabetic, and absolutely brilliant, but with a few issues with short term memory and multi-tasking. Getting him health care here is nearly impossible.

    The way some medicine works is nothing short of criminal. Folks should be ashamed of how it is.
  • Posted by a hidden member.
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    Nov 10, 2009 5:55 PM GMT
    We're waiting for the hammer to fall regarding my partner's 11 days in the hospital that ended last week. Starting with 8 hours in the ER, 6 days in a critical care unit with a dedicated nurse 24/7, 4 surgical procedures, daily room visits by an army of different doctors, constant monitoring & medication, and more tests than I can count.

    We know the total amount will be well into 6 figures, and our fear is that his insurance may try to decline some costs, as frequently happens. Plus, as others here note, billing errors are common. And while I'm good at getting mistakes corrected, it can be such a hassle, and I've seen hospitals refer people to bill collectors remarkably quickly, even when you're still disputing the bill.

    We even had a little billing error regarding my partner's earlier hip replacement surgery. We had registered him a week before the operation date, for which I prepaid $600 to cover the daily deductible for 3 days hospitalization. I specifically asked if he'd have to pay anything on admission day. No, I was told, everything is now paid.

    A week later we arrived at 5 AM for his surgery, and a processing clerk began reviewing his records before he went into pre-op. She promptly tells him he owes $600 or else he can't proceed. When I tried to show her the paid receipt, she wouldn't even look at it, curtly declaring "that was for something else, this is different."

    She was the only one on duty at that hour, with no supervisor to whom I could appeal. My partner was due in pre-op in a few minutes, to keep his OR appointment. Nor did I want him getting stressed about this, so I had no choice but to pay a second $600, telling him not to worry, I'd look into it the next day, I was sure it could be fixed.

    His surgery proceeded on time, and next day I visited with a hospital finance administrator. He was dubious at first, but when he couldn't explain the 2 receipts I showed him, he looked into things personally. A $600 refund was wired to our bank later that afternoon.

    I also got an apology from him, as he admitted the woman had been clearly in error, her computer screen plainly showing the amount had been prepaid a week earlier, even without my receipt, and there wasn't anything else "different" that was due. I was very thankful & cordial in return, glad I had found someone with the authority I needed, and the decency to use it. It also occurred to me that I might need his help again in the future, though little could I imagine at that moment the bills my partner would be potentially facing not 2 weeks later.
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    Nov 10, 2009 6:02 PM GMT
    As someone who was born in Europe and now lives in Canada, and has thus only known 'socialized healthcare' I can't believe you people put up with this shit....in Canada our system is far from perfect (whenever you have something run by people, it's bound to have mistakes) but I can't imagine having to worry about whether or not I can afford treatment as I'm on the way to the hospital. Quite frankly, I consider myself a pretty globalized person and I would move anywhere in the world for a good, challenging job, but because of a lack of a healthcare system in the US (to me it's an insurance business, I don't care how you spin it), I would NEVER move to the States regardless of how good the job would be.

  • tas_515

    Posts: 133

    Nov 10, 2009 6:04 PM GMT
    Horrible about the car wreck, and best wishes for total recovery.

    My head is spinning from all the political debate about health insurance reform. I hope to gain a little perspective from what other industrialized countries are doing, thanks to PBS Frontline's new documentary on that topic tonight, "Sick Around the World." See http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/?utm_campaign=Various&utm_medium=Bulletin&utm_source=Main
  • Barricade

    Posts: 457

    Nov 10, 2009 6:10 PM GMT
    That's awful! I had a similiar situation and I was only in the ER for 3 hours and got sent a 4000.00 bill. It's just further proof in my eyes that our medical system is a business first and foremost and nothing else. Especially when you look at the bill and see how each charge is itemized. It's like a cab meter starts the moment you walk through the door. lol.
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    Nov 10, 2009 6:12 PM GMT
    What this thread is proving is that it appears Insurance is almost worthless in the grand scheme of things especially when hospital bills are reaching unfathomable ranges to the point where, even after insurance, the amount is astronomical.

    I thank everyone for the advice, personal accounts, and good wishes. I will personally argue this as suggested by Cal and RLD. Like Curious said, I need to wait for the itemized bill. I am baffled they (the hospital) think sending an invoice of "Emergency charges" was good enough. Did my graham crackers cost $700 and my water $100?

    Good luck Red on your soon-to-be headache.
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    Nov 10, 2009 6:26 PM GMT
    Pinny saidI went to the ER back in September when I was hit by a car. I really didn't want to go but the pain was unbearable and my abdomen was pretty twisted so I went knowing that I have health care that will, in some way, help cover.

    Within a week I received a bill. I expected it. It was for 2 CTs at $343 each (side note: the doctor ordered one for my abdomen and the CT person, after wheeling me back to my room decided to do one on my kidneys "to be sure" shady already right there).

    I called the hospital saying I was billed without the claim being submitted to insurance. They agreed and claimed they didn't process my information yet and it was normal. To quote her, she told me to "discard the bill and a new one will be sent shortly".

    A month later, I get a bill from the hospital stating that submitted the claim. A $6,451.46 bill to my insurance (which they paid but I will now have to pay $1000 to my insurance since I only get 80/20 coverage).

    I am furious. Why?

    1.) All I got was a room, 2 CTs, water, and graham crackers. I was there for 5 hrs during which I saw a nurse and a doctor's assistant for a total of 5 minutes max.

    2.) I refused morphine 3 times, REFUSED (and I have a witness who intervened saying "he obviously doesn't want it, leave him). Then the nurse came back saying "Dr. suggests that you take the morphine for healing or you will slow down the healing process".

    My bill isn't detailed, I will get that ordered tomorrow.

    Does anyone else find it really shady that I got billed $686 first, called told them I had insurance and now have a bill for $6,451.46. Are they just milking the system? Is this one of the reasons why health care is in such a disgusting state?

    I am fuming. FUMING. All I got out of the ER visit was a prescription for pain killers.

    This is my first emo post. Sorry.



    on behalf of every healthcare worker everywhere, piss off.

    yeah, she did a check on your kidneys to stiff you out of some more money. That's exactly it. it wasn't because you were just hit by a fucking car. The fucking doctor doesn't have anything to do with it, and neither do the people in CT. the doctor doesn't write up a bill, that's the hospital's job and they have their own horrible people doing it, so don't confuse them with those of us that actually give a shit whether you die or not.
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    Nov 10, 2009 6:33 PM GMT
    In preparation for taxtime, I have totaled up my med expenses for the year to date. The providers have BILLED $18,000. Blue Cross has PAID some $3,000. Because I see "participating" doctors, they shake hands and everything is even. WTF? I'm certainly not complaining, but when we see these outrageous numbers, how does anyone know the TRUE cost of healthcare?
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    Nov 10, 2009 7:02 PM GMT
    There are companies that review medical billings for errors. I do not know what they are called, but I would suggest merdical billing auditors/reviewers/advocates. They review the billings and fight with the providers on your behalf. I do not know their fee basis, but on larger bills I know it's worth it. 90% of medical billings have errors of one sort or another.
  • cutejock

    Posts: 17

    Nov 10, 2009 7:15 PM GMT
    I've been to the ER many times, mostly because I was moving around frequently and traveling a lot, so seeing my 'regular doc' wasn't always possible. I mean, it was for things like mono, muscle tears, general infections like strep and such - all things where the 2-week wait to see my doc wouldn't do, or i wasn't in the area.

    The bills for several of them were kinda high, particularly mono since they had to monitor me for a full day, and gave me 6 bags of saline via IV, and a whole series of drugs. This is also at Georgetown University Hospital, so a nice chunk of the change was paying for the name and facility. All that came out at about $6000 for everything they did (x-rays, blood work, fluids, drugs, room for the day). The nice thing is, they are partnered with BCBS, my insurance, so I had my $100 ER co-pay, and everything else went to the insurance. They got the bill for $6000, sent a check for about $1500, and wrote everything else off as unallowed partner expense. What you don't see, though, is that BCBS actually pays the hospital an annual fee for being a partner; it is like buying a timeshare - you get rights to it without paying a fee for your allotment of the year, and anything beyond that you have to pay.

    In my case, it worked out really well, since I had already hit my deductible, only had to pay the co-pay, and the insurance paid everything in-network to a defined partner facility. If I would have gone somewhere else, I would have gotten the 90/10 split.

    Yes, it is shady, but a lot of business operate like that. Cell phone companies, for example, sell you a phone for $500, unless you sign a one-year contract, then it is $300, or sign for two years and it is $100; if you are renewing it is different too, depending on where in the system you fit. The cost to the manufacturer is the same, the cost to the service provider is the same, but the provider is willing to take less profit up front if they lock you in longer.
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    Nov 10, 2009 8:58 PM GMT
    Funkapottomous saidon behalf of every healthcare worker everywhere, piss off.

    The CT ordered by the doc was for my abdomen only. I pissed twice in front of them with no problems. The second CT was purely to jack up the bill. In fact, when I asked how the kidneys look they had to go back to radiologist and ask him to actually look at the scan since he only looked at the "ordered" abdomen CT.

    Yah, I will piss off.
  • Webster666

    Posts: 9217

    Nov 10, 2009 9:05 PM GMT
    Your bill isn't for the services (nor products) rendered.
    Your bill represents the insurance company's profits.
    See why we need insurance company / health care reform ?