Anyone work for a hospital or their billing department? Private or public...

Anyway, I went to a private hospital (nearest one) and my bill was approx. $10,000. Since we paid a % cash before we left they said they would knock-down the bill 40-60% well we got 50% off the total bill.

I`m wondering if I can negotiate this even further. Either by removing an item from the bill or simply asking for the other 10% off.

What upsets me the most is my CT Scan, they did 2 because the guy wasn't sure the first one went through... and if you've gotten a CT Scan you know that to take a second took an additional 30 seconds and I was charged nearly the full amount again (3311 not 3487) to take the darn second image. *GRR**

So, anyone have any tips or suggestions for negotiating this down some more?

Thanks!

I think if you got 50% off you a lucky fellow. In my book, when a service provider doesn't get it right, they don't get paid. However, that said, I suspect if you argued the point they would say the first discount covered the botched CT scan, so you are only paying for the second scan anyways.

Too bad you have money. If you were broke it wouldn't have cost you a dime.

Could you not just sue the hospital for the first botched CAT scan for the fear and distress of going through the frightening procedure for a second time especially of you suffer from claustrophobia. You could even argue in court that the CAT scan was a financial scam by the hospital when a much more cost effective way of determining a medical diagnosis was available to you, but was not offered. Get a lawyer to seize the hospitals billing records for the CAT scan machine to see how many previous patients ended up paying twice for a single CAT scan.

Have a lawyer send a letter to the hospital medical record department requesting a copy pf your medical record, accompanied by a medical record release form, signed by you and authorizing the lawyers access to that record. This often gets the attention of the hospital risk manager, who will then halt all collection efforts. Errors in patient care are not uncommon. (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1117772)

As I wrote on another thread, go through each bill and make sure this person or group (some doctors & nurses use a billing companys) actually treated you.

I have found between 5-10% of all medical stays my family has had, not single day issues, have been bogus overbilling. if you don't recognize a doctor sending you a bill, find out how this person treated you.

Since recognizing this trend we make it mandatory to get business cards from every nurse or doctor and who they bill through. If they don't have one we take down their info on a sheet we made for tracking

My most recent example is last year I spent a week in the hospital. I got a bill for $400 from a doctor I did not recognize. After challenging the bill, it turns out all he did was review my chart at the nurses station one night and billed me for his consult.

But you got 50% off your bill, your way ahead already.

Pleasant and persistent goes a long way. Talk to them and talk to
them again.

At some point then you can leave it behind knowing
you did everything you could.

"Bogus overbilling" is rampant in hospitals.

Is your bill itemized (and I mean REALLY itemized) in English, or it is in codes? If in codes, go to your hospital and either get a list of the codes they use, or insist they go over ever single entry with you personally. Don't trust to memory -- write down every translation as you go.

You will probably find that you were charged for things they they didn't do and didn't give you. The husband of a friend of my sister's went into the ER for a suspected heart attack. When his wife insisted on details of the bill, among other things, they found they were being charged for a baby bassinet and a baby over-crib mobile. They also charged something like $12 for a single aspirin which they didn't give when they found his wife had given him one immediately when the problem started, and quite a few other things.

None of this is accidental.

Yeah, definetely scrutinize the charges. BTW, a hospital doesn't bill for a physician, it's the physician that bills.

For that extra CT, did they have to give you dye twice, once, or not at all? If you get billed for 2 doses, I'd raise hell, since it can be bad for kidneys in high doses.

Anyway, 1/2 off sounds about right for folks paying cash. Sorry.

Some of it is accidental. A lot of it is poor systems design, antique or nonexistent computer systems, and poor management. The best and brightest administrators generally go to jobs in which they can get stock options, not into health care. There are plenty of smart providers in hospitals. CEO's-not so much. And some of it is because most of the revenue comes through contracts with insurers who negotiate a flat rate for a diagnosis- so, no matter what the actual product and service charges are for my fractured femur, my insurance company pays the hospital $4500 each for me and for each of the 20 other insured fractured femur patients cared for that calendar quarter. Tends to reduce the amount of attention paid to getting the charges right on any individual patient. Like most things, it is probably not a conspiracy of criminal geniuses-more like a three stooges comedy with stethoscopes.

My sister works in the Providence system of the western U.S. It is run by monkeys whose previous job was having nails hammered into their brains (and I don't mean just the CEOs).

Your bit about the insurers is true, but the extra percentage that is regularly paid by the victim is where the 'variations' happen. And I would not consider them 'criminal geniuses' by any stretch of the imagination; they're just playing the percentages, and most people don't check.

Looks like my CT Scan shows:

ABD W\P CONTR.
PELVIS W\O

Sounds to me like two scans of the same area just billed separately so it doesn't look like two of the same thing...

Can any doctor types let me know if they are essentially the same area just worded differently?

From my google search a Pelvic scan is used to find kidney stones and so is an abdominal scan.... so it sounds like two words to check the same region to me?

Abdomen/Pelvis scans are frequently ordered together, although they are different scans. Now it is possible that the Dr. ordered only one of the scans, and the techs assumed that the Doc wanted both, but I would guess both were probably ordered. You would have to ask your Doc to check the chart.

Greg

Well they won't work with me on the 3500$ They want that 100% by the 15th if not Iowe 8800$. I offered to pay a chunk of 3500 and the rest monthly... nope none of that.

She was fine having me pay $50/mo as long as it went toward the $8800....

She was also fine telling me to "just use" a CC.

GRRRRRR. And here I thought I was putting together a nice cushion

What to do.

Many errors creep into hospital billing, it's not right, but it's rarely malicious. Get an itemized copy of your bill and a copy of your medical records.Find someone who reads "medical" (EMT,Paramedic,LPN,RN,PA,NP,Doc, etc.)and ask them to review the record compared to the bill. If necessary pay someone to do this , you will likely come out ahead. A 50% reduction for cash is typical due to the "game" of billed charges vs. negotiated payments that insurers cause to occur. After you have the above info, schedule an appointment with whoever is in charge of billing/collections at your hospital to discuss payment. Don't talk to the tech at the window, they likely have NO ability to negotiate anything binding. If you run into resistance here, contact the Customer Service Rep (or whatever your hospital calls them)orgo directly to the Administrator or whatever your hospital calls them - titles at hospitals have gotten confusing and ridiculous anymore). When the deal is done, GET IT IN WRITING. Also when you have reviewed your chart & charges, especially if you find significant errors, talk to your Doc - He/She can be your best resource and ally. Most Docs are not enamored with most hospital administrations, especially when it comes to how they deal with patients.

That W\P should have been W\O typo

I got my itemized bill.

And it's enough English I can read it and they did everything mentioned.

Just checked the bill on a recent lab test I had done. They checked blood and urine; all typical tests, nothing exotic. Lab billed $728.00; insurance paid (and they accepted) $84.03, or about 11.5% of what they billed.

I can't comment on this fact. I'm too stunned.

Exactly.

It's ridiculous that insurance can pay so little but average joe with no insurance out of pocket... make him pay 50 to 100% of their "amount" that they pull out of their rear-end.

Next up for me is to deal with the ambulance.
They are billing $1800 and refused to give me any pain medication because they told me "The doctor must know where it hurts"... now I have proof of 3 pushes of extremely strong pain medication to show how much pain I was in. They refused to help me though and made me SUFFER SEVERELY. Hell, I had to wait 1 hour for ambulance to get there, and then they also pulled over to let people pass on the ride down. So the 45 minute ride turned into an hour + to the hospital.

Y'know, having worked CA EMS for years... you live in the mountains of California. Remember? I'm assuming you had to come down the hill to get to the hospital?

Remember that law about having to pull over if there's more than 5 cars behind you on those mountain roads? Ambulances aren't exempt from laws. Especially when driving without lights/siren. which I'm assuming they did, for 2 reasons: they didn't think you were critical (thus the risk of driving that way is higher than the benefit) and a slower ride tends to be a bit more comfortable (but, yeah, it's always bumpy in the back. Trust me). So their driving, as much as it probably sucks for you, does make sense to me.

Pain meds? Might either be: 1) basic EMTs, and don't carry any, 2) protocols won't let them give it without base hospital permission which they didn't get, or 3) they're sadistic bastards. I'm sure you prefer option 3 to be the case, but see if you can't find out which it is - there might be a reason. And sometimes the EMS crew is stuck explaining base hospital's wacky thought process to the patient.

As for the bill, I think the base rate on a basic ambulance in CA is something around $450, paramedic ambulance $550. The mileage they can charge for, equipment (oxygen cannulas, sheets, basically everything they have to throw away).

To get on my soapbox, I think it's utterly absurd that you pay insurance companies out the nose to cover you, then they end up paying only a percentage of the bill and stick you with the rest. Really? doesnt' that totally contradict all those contracts and the POINT of insurance? How much do people blow over months or years that never gets used, they never getting the coverage they expect??? health care is the ONLY field in America where you can get treatment and get away without paying the bill. Seriously - try getting your brakes changed and telling the guy after he finishes that you'll only pay $50, and see what happens. Or walk out of a jewelry store paying 15% of the total cost. It's absolutely absurd.

As per some other comment, absolutely doctors have to practice litigation-mediated medicine. You think most of them know that they don't need blood work, or a CT? But if you don't do it and get sued, well, "everyone" does it, so you're breaching standard of care. And patients get mad if every last thing isnt' done for them. God forbid they go to the ER, wait 8 hours, get one lab drawn, and get told: You have mono. Go home, take some Tylenol, drink lots of fluids. You'll get over it in a couple weeks. The exorbiant costs of health care can probably be traced to 3 reasons: 1) non-payment by consumers, 2) litigation or the threat thereof (I mean, the hospital has to keep lawyers around), and 3) the patients DEMAND high levels of care adn fancy testing. Then don't pay... leading back to number 1... and number 2 when you get down to it.

Off soapbox.

Oh, Todd, I am sorry it took so long to get you to the hospital. But it is a JOB, and there are methods to their madness, and they're hamstrung by buracracy just like the rest of the US.

<tangent alert>

I was put in a knee brace by my GP. I was told that if insurance did not pay that I would have to. (Obviously)

I got home and googled the brace. The first couple of places that looked like decent ecommerce sites had the brace listed for just under $200 shipped. The GP billed $459 which was the MSRP of the brace from the manufacturer. My insurance paid $456!

Of course I've seen it the other way too. My DD had >$1300 in labs done years ago and insurance paid (and the doctor accepted as payment in full) less than $200. If I hadn't had insurance I wonder if they would have settled for cash @ 50 cents on the dollar. I doubt it.

</tangent>

That's the part I just don't understand. They have to keep their "list price" high because the insurance companies want to negotiate down, I guess.

However, if you walk in with cold hard green cash, they act like you're a bad customer.

How much labor and resources does it cost them to bill the insurance company?

How much does it cost them to send you a bill later when the insurance comany denies the claim because they were incompetent in submitting it correctly?

How much does it cost them when I call them and put them on a conference call with my insurance company and between the two of them they still can't figure it out?

How much does it cost them to sell your debt at pennies on the dollar to a collections company because you refuse to pay an invalid bill?

C'mon! I'm HANDING you cash TODAY!

In most of the hospitals that have employed me, the folks at the patient services window have been at the absolute bottom of the finance division food chain. Nice folks, but generally new at the job, generally not very experienced. (When they develop experience/seniority, they leave the direct customer service jobs and get a nice quiet cubicle away form irate patients). The front line folks are often not deemed sufficiently reliable to handle cash-they generally don't have a cash register, cannot make change, may not even have a safe place to put the money. Their superiors hassle them if they do take in cash. They would be happier to accept lab specimens than to accept money-they know where to take the specimens.

My sister says the people hired by hospitals are carefully interviewed to discover if they are any kind of threat to the current manager of that department. The intelligent, experienced ones who might be are not hired.

Interesting.

My ambulance is county

Your sister is a woman of deep insight. There are sometimes some bright lights passing through on their way to something better-medical and nursing students working their way through school-but the lifers tend to be either less smart or smart enough to keep a low profile. Often this takes the form of working nights and weekends, when there aren't very many suits around. I try to follow my old man's advice-"it's useful to be smarter than you look; the easiest way to accomplish that is to look a little dumber than you are."
Maybe we need another Forum: "Surviving in the health care system" or "Around the gurney". This is more likely to be a challenge for most of us than is survival in the boreal forest.

Which county?? You might need to check again. Some places/providers, like LA County Fire Dept (and parts of Orange County Fire Authority), subcontract private ambulance companies to do the actual transports. Those companies function like I mentioned.

If it truly is municipal-based, I would think that taxes would handle the charge, and it should be free. Then again, if they don't get tax money, they would charge.

California has a complicated system, huh?

Municipal or county EMS bills can vary greatly from place to place.

DS had to make a ride in a Chicago suburb do to heat exhaustion at a hockey game. Long story and unnecessary ambulance call by the rink operator's S.O.P. later, came a $5,000.00 bill.

Same soup, different bowl here in the home town area cost me $385.00.


Now if I could just get him to listen about drinking the proper fluids in the hours leading up to the games.

Lots of taxpayer-funded county or municipal fire/rescue or EMS providers charge for ambulance transportation.

Typically, there is no charge if they don't actually transport you. Often, billing is handled by private contractors who are paid a percentage of their collections. They can get aggressive.

Some fire departments may charge for certain services. Crash rescue calls may be billed to auto insurers, and some fires are also being billed, depending on the cause. Around here, some law enforcement agencies are even billing non-residents a fee for their services at motor vehicle collisions (not to mention the inevitable citation, a.k.a. "ticket")