Why Emergency Rooms Are A Hotbed For Surprise Medical Bills

The Consumerist ^ | 11/05/2015 | Ashlee Kieler

[Kid Shelleen]

When you head into the emergency room, you might assume that the doctors you see are hospital employees who accept the same insurance plans as their employer. But nearly two-thirds of hospitals now staff their ERs with freelance physicians who might not accept your insurance plan, meaning you’ll be on the hook for whatever your insurer doesn’t pay. ---SNIP-- As we’ve discussed before, "balance-billing" is the practice by which out-of-network doctors will bill patients for the balance that remains after the insurance companies pays out its contractually obligated amount to the hospital.

[I want the USA back]

The “privileged” people gotta pay for the “free” care that the poor receive.

[Kid Shelleen]

>> Ever notice that Docotrs , even your everyday General Practicioner, even within your network, never lists prices for survices rendered ? <<<
YUP !!
I am in a big fight with my insurance company. I had to go for an MRI (semi emergency). I called the insurance company and they said I was covered. My service provider also called my insurance company. The service provider confirmed that I was covered AND they were in my network. When I tried to get a good faith estimate for out of pocket costs my insurance company told me they could not tell me until AFTER I submitted the bill. Of course I got hit with a big bill.

I was in a chicken and egg situation. The insurance company would not give me a good faith estimate until after I submitted a bill, but after I received services it was too late to find a different provider or negotiate a lower price.
The insurance company has been so rude and unprofessional I can not confirm if the proper billing procedure was followed.

[Paladin2]

Your time is the actually the commodity in shortest supply.

[utax]

you may be in for a very nasty surprise after an ER visit if you have a health savings account and high deductible health plan.

[ozaukeemom]

My husband has spent 2+ weeks in the hospital and 11 days in a rehab in the last month. He went back to the ER last night and will be released from the hospital tomorrow. I am petrified to see what our co-pays etc will end up being. He is on Medicare and has TriCare secondary. I am just hoping it doesn’t wipe us out. Fortunately, I do understand how to read the EOBs etc but how do you fight something you cannot prove or disprove?

[Kid Shelleen]

>> They told me that while the doctor was in network the facility he used was not. I told them to bill the doctor because I wasn't paying it. <<

That is horrible. I have heard a few stories like that from co-workers. The Democrat solution will be single payer system with total government regulation.

[CIB-173RDABN]

I have Kaiser.

Had an emergency, the EMT took me past the Kaiser hospital to a another hospital, I was admitted. Had emergency surgery, the bill came to $250,000.

Kaiser paid the complete bill except for my $500 deductible.

Not all HMOs are the same.

[glasseye]

I paid it, but had good insurance.
The multiple billings blew up my share of it.
My out of pocket was 4500$.
But that was only the beginning.
Knocked out 8 teeth and shattered part of my maxilla.
3 hours of oral surgery the next day, no charge because the doctor was a family friend!
Then a round of braces @ $8500, not covered.
One faceplant cost me 13,000$ out of pocket.
Ouch, in more ways than one...LOL

[LegendHasIt]

Yep. Six months ago I had a simple, common, five minute outpatient procedure that didn’t even require a bandaid.. I’m self-insuring... Went in through the emergency room. Because the first hospital, a supposedly award winning Regional Hospital no longer does the procedure, they had me go to another hospital, 125 miles away, being the closest one now doing this procedure.

(I told them all in advance what I was willing and able to pay, and if they can’t do it for that amount, I would choose to do without it, and would sign any ‘hold harmless agreement’ to that effect.)

That produced TWO $2,000 emergency room bills before anything was actually done.

Then they sent me up and actually did the procedure. That part went fine, with the first competent doctor who listened to what I told him that I encountered during the entire adventure.

My 14 bills total $27,348.00, from 10 different entities scattered through 6 states, many for doctors I never saw, never asked for their services; some duplicate charges from different doctors in different offices that were never rendered.

Five years ago under the exact same circumstances I had the same procedure at the first hospital I went to this time, and my TOTAL bill, a single bill was $2500.00

It took me three months of arguing to even get itemized bills from two of the billing entities; the rest refuse to provide anything beyond a “Pay this amount now”.

I’m still fighting for honest and fair billing. Likely they will have to sue me and perhaps put a lien on my home, because I’m not going to pay their outrageous charges.

These hospitals are just highway robbers in white smocks, using a stethoscope instead of a gun.

[muggs]

I had a doctor come out into the waiting room, press on my bladder and send a huge bill.

I have known about out of network doctor though for many years.

[Chode]

the only way an insco can give you a price before service is if you give them the billing code/s for what is being done and then all they can give you is their allowed amount/s, after that it all depends on your plan(100%, 90%/10%, 80%/20%, High Deductible) and if you've met your deductible

people absolutely must read their policy EVERY YEAR to see what has been changed but 95% never do

also you have the RIGHT to ask your doctor's office the price range for an office visit even if it's not posted

if they won't tell you, you need to find another doctor

[Organic Panic]

Most people and hospitals just assume insurance will pay. I, as a cash paying customer, argued my emergency surgery bill from $55k down to $23k for a 1 week stay. The cheapest part of the whole situation was the surgeon and his assistant. The hospital kept throwing in all manner of useless consultants that I refused to pay for telling them I never asked. When they were caught in bald faced lies they had to take off the charges. They charged for medical equipment that was never used and they were caught. The medical equipment that was destroyed was not paid for because it was my property that they threw away.

In short, if people knew what they are being charged for, not buying mind you, but charged for, things would change.

[omegatoo]

That one time I went in there was a piece of trash down the hall brought in by the cops. he was on bath salts and cut himself up.

The un- and under-insured used to go to state/county/charity hospitals for care, where the costs were absorbed by the government. Now that is not good enough, and everybody is entitled to free care at any hospital they choose.

If 'cut up bath salts man' needed surgery and ICU, he gets it at the private hospital and NOBODY pays. Same for the OB patient who decides the private hospital is nicer for delivery and shows up in labor and doesn't know why she has been in high risk clinic (if she went to clinic at all). These patients are impossible to transfer and reimbursements, if any, are literally pennies on the dollar.

Hospitals and doctors have to make money or they will go out of business. THAT is why bills are so high.

So guess who gets to make up the difference?

O2

****************tagline***************

[Chode]

first, DEMAND an itemized bill from the hospital, it will tell you everything that was done and the price... God Bless

[Sequoyah101]

and what happened then?

[Sequoyah101]

So what do you do?

[Sequoyah101]

And most won’t tell you because they are engaged in extortion. They know you need what they have and you can’t get it anywhere else.

Why isn’t the medical establishment charged with racketeering?

[Sequoyah101]

And how do you fight against providers that are not “in your system” that you don’t know about that you need?

You assume that if the facility is in your network every charge there is in your network.

I’d sue them for deceptive advertising. They purport that services in their facility are in network and make no disclaimers otherwise.

Medical care in this country is a racket. A criminal enterprise dressed in white coats.

[Sequoyah101]

I hate to say it but if that is what it takes to break the back of the criminal medical enterprise so be it.

In the end we are all effed anyway. Why make it random?

[dljordan]

“I was billed $1200.00 for that 30 second conversation.”

I would have gone to the lawyers over that.