OT: Emergency room bill question

[StillTbonewannabe]

So I went to the ER back in April with my first kidney stone. My wife thought that was what it was since she has had several before. It was on my right side so just wanted to verify it wasn't my appendix.

It moved quickly so I went in and was out in around 1.5-2 hours. I actually never saw a doctor except on the IPad releasing me. I saw nurses about 3-4 times total to get an IV, going to get scanned, and getting a morphine shot.

I just received the bill about 1 month ago and it was $1,000 after my insurance. This is just for doctors and nurses. I already paid the hospital and the Dr who "read" my scan which took under 5 minutes. $600 for 5 minutes work is great if you can get it.

So the bill was "rated" at a Level 5 which is the highest level. I had it reviewed and they said that was correct due to the possibility of appendix issues. Would you not actually get physically examined if it was a level 5? Since that is the highest level, that is supposed to be the same care as heart attack victims or gun shot wounds.

Is there anything else I can do? I feel like this is price gouging since I might have been the only person in the ER at the time due to the country shutdown.

 

[jethreauxdawg]

Ask for an itemized bill

And don’t pay it without getting one. Good luck. Medical costs/bills are a complete scam.

 

[GloryDawg]

Call and question it. Make them explain it to you. If they coded it for a procedure or something the doctor did and they did not do it point it out and say you are going to call your insurance company and get them involved. The insurance company will check it out. They know it. Then offer a cash payment for less than you owe. Good chance they will accept the offer. Always question doctor bills. When my kids were younger I carried my son to doctor. The doctor looked in throat and ears. Check his heart and prescribes an anti biotic. The bill was $95.00. That night my daughters got sick. I carried her the next day to same office but had to see another doctor. She did the exact thing the other doctor did to my son. I went to pay and the bill was going to be $145.00. I questioned it. The lady said it's how the doctor coded it. I raised a little hell about the treatment she gave my daughter compared to the treatment the other doctor gave my son. I did not give in. In about 10 minutes of acting pissed off I ended up paying $95.00.

 

[ZombieKissinger]

There were major changes in 2021 for documentation requirements for billing, but 2020 standards would apply here. I'm *not* primarily billing emergency department codes, but I do outpatient, inpatient, consultant, and nursing home. If you got billed a level 5, there's going to be a provider who charged that, and there are going to be requirements in terms of history, exam, and medical decision making in his/her provider note.

I'd start by getting a copy of the medical record, especially the provider note from the visit. This would have the name of the MD/DO/APP who "saw" you. You can read what they said they did to justify that level 5 code. I'd then file a complaint with the billing office at the hospital and see if they can figure something out with you. A lot of times they will reduce the price to keep things from escalating. If you're adamant that an MD/DO/APP didn't do the work they're saying they did, you could escalate further -- hospital admin, attorney, etc., but it might get to the point where it's not worth it.

Stuff like this happens and it sucks. I'm a doctor and it happened to me a couple years ago -- highest level consultant charge for someone who never saw me. The whole hospital billing, charging thing is incredibly frustrating, and the amounts you fight over individually often are too small for it to be worth it. I'd start by getting the notes and talking with the billing department, though -- they may be able to work something out with you, especially if you're saying there's work in the medical record that they're charging for but they didn't actually do

 

[Shmuley]

Good advice to demand an itemized billing statement, not that it will help at all. I spent 4 hours in the ER recently and the bill before application of health insurance reimbursement was almost $15,000.

 

[dorndawg]

And don’t pay it without getting one. Good luck. Medical costs/bills are a complete scam.

 

[StillTbonewannabe]

Good advice to demand an itemized billing statement, not that it will help at all. I spent 4 hours in the ER recently and the bill before application of health insurance reimbursement was almost $15,000.

I already paid about $3,000 to the hospital. Pissed in a cup and they drew blood. Then use of the scanning machine and sitting on a bed for an hour or so alone. That was after insurance.

 

[ZombieKissinger]

There's a decent chance that the ED provider isn't a hospital employee, so they may have separate billing process (would explain the separate bill). I'd still get a copy of the provider note from the hospital and see what you can work out with the ED group's billing department.

 

[DAWGS1.sixpack]

Also, anyone who saw you or talked to you billed your insurance company and quite possibly that person or persons is NOT in your medical coverage network.
That could be one reason for a higher bill than if they are IN your Network.

 

[40 acres and a mule]

So I went to the ER back in April with my first kidney stone. My wife thought that was what it was since she has had several before. It was on my right side so just wanted to verify it wasn't my appendix.

It moved quickly so I went in and was out in around 1.5-2 hours. I actually never saw a doctor except on the IPad releasing me. I saw nurses about 3-4 times total to get an IV, going to get scanned, and getting a morphine shot.

I just received the bill about 1 month ago and it was $1,000 after my insurance. This is just for doctors and nurses. I already paid the hospital and the Dr who "read" my scan which took under 5 minutes. $600 for 5 minutes work is great if you can get it.

So the bill was "rated" at a Level 5 which is the highest level. I had it reviewed and they said that was correct due to the possibility of appendix issues. Would you not actually get physically examined if it was a level 5? Since that is the highest level, that is supposed to be the same care as heart attack victims or gun shot wounds.

Is there anything else I can do? I feel like this is price gouging since I might have been the only person in the ER at the time due to the country shutdown.

Actually, it took the Dr. at least 12 years and 5 minutes to read your scan. College, 4 years; Med school, 4 years; Radiology residency 4 or 5 years, depending on the program. Used to do it for a living. Agree $600 is a little high.

 

[karlchilders.sixpack]

Still, on a realistic basis

this is too high.

JMO

 

[40 acres and a mule]

I agree it's high. I never charged that much.

The reason everyone's hospital bills are so high is that the Feds have ratcheted down reimbursement for Medicare and Medicaid so low that hospitals and Drs. lose money on almost every patient. Keep in mind these are usually the sickest patients. Those with private insurance get overcharged to make up the difference. Until people realize this and raise hell, it won't change.

My point is, you are paying the Radiologist for what he knows, not his time. He isn't a day laborer you picked up in the parking lot at Home Depot.

 

[IBleedMaroonDawg]

And don’t pay it without getting one. Good luck. Medical costs/bills are a complete scam.

Between that and Big Pharma $1400 stimulus checks just don't cut it. Wife got a new diabetes prescription that came out to $1,500 along with her Lantus expenses that are $400+ make me want to choke politicians worrying about trans soldiers and high school athletes.

 

[oxfordrebel22]

And don’t pay it without getting one. Good luck. Medical costs/bills are a complete scam.

Due to a family situation, I unfortunately know all about medical bills and how f%#ked the system really is. This is really good advice. Never pay them a penny without asking for a detailed invoice. You’ll be shocked what all magically starts coming off bill.

Then, call your insurance and nicely ask them to explain why you owe what you owe. And, finally, if you have the means, call the hospital and ask them what they’ll take if you come pay bill in full today. I’ve had them knock 50% off of a $12,000 Bill once I offered to bring them cash payment that day.

 

[StillTbonewannabe]

I agree it's high. I never charged that much.

The reason everyone's hospital bills are so high is that the Feds have ratcheted down reimbursement for Medicare and Medicaid so low that hospitals and Drs. lose money on almost every patient. Keep in mind these are usually the sickest patients. Those with private insurance get overcharged to make up the difference. Until people realize this and raise hell, it won't change.

My point is, you are paying the Radiologist for what he knows, not his time. He isn't a day laborer you picked up in the parking lot at Home Depot.

It is high but do they just charge per scan read or is there some type of rating? I am just wondering if I was rated a Level 5 overall and it raised the price. Is this possible?

 

[was21]

You're possibly paying for folk who don't have insurance and go to ERs since they can't be refused. Somebody has to pay for them and guess who. Failure of the state of Mississippi to expand Medicaid already cost the state about 7 billion$ dollars not to mention that some rural hospitals are in danger of closing..maybe some have already closed

 

[ZombieKissinger]

Yeah, I'm with a big system, and I was in a meeting where they said we only profited from 17% of our patients. They had to make up the deficit for medicaid, self pay, and often medicare.

 

[Dawgbite]

You had insurance so your bill was automatically increased 5 times to pay for the 4 deadbeats who use the ER as a free clinic for non emergency illnesses like the common cold or diarrhea.

 

[jethreauxdawg]

It’s a beautiful system**

Yeah, I'm with a big system, and I was in a meeting where they said we only profited from 17% of our patients. They had to make up the deficit for medicaid, self pay, and often medicare.

Not sure how to realistically make it better. Just do everything you can to keep you and yours healthy and out of the hospital. I don’t want to be that 17% or the 83%.

 

[blackjackdog3]

If you’ll pay your entire bill many times hospitals will give a 40% discount. Also you can pay them $1 a month. I would definitely question the charge. Everything is negotiable.

 

[40 acres and a mule]

It is high but do they just charge per scan read or is there some type of rating? I am just wondering if I was rated a Level 5 overall and it raised the price. Is this possible?

Radiologist fee should be a flat per scan rate.

 

[The Usual Suspect]

I agree it's high. I never charged that much.

The reason everyone's hospital bills are so high is that the Feds have ratcheted down reimbursement for Medicare and Medicaid so low that hospitals and Drs. lose money on almost every patient. Keep in mind these are usually the sickest patients. Those with private insurance get overcharged to make up the difference. Until people realize this and raise hell, it won't change.

My point is, you are paying the Radiologist for what he knows, not his time. He isn't a day laborer you picked up in the parking lot at Home Depot.

Last time I dealt with an ER visit in Houston, there were about 20 people in the room, and I would be willing to bet I was the only one there with insurance or ability to pay. I’m sure my bill did not include any type of margin to make up for the other 19.***

 

[MSUSaint15]

You can also ask the hospital about financial aid. A lot of hospitals have the equivalent of a financial aid office that you can request to speak to to see if you’re eligible for aid. Most people are.

 

[catvet]

You're possibly paying for folk who don't have insurance and go to ERs since they can't be refused. Somebody has to pay for them and guess who. Failure of the state of Mississippi to expand Medicaid already cost the state about 7 billion$ dollars not to mention that some rural hospitals are in danger of closing..maybe some have already closed

Well everyone likes to throw that out, but never discuss why it wasn't done. After a few years, the feds quit paying the bulk and it is up to the individual states to tax their citizens to pay for the rest. That means hitting up tax paying citizens thousands of extra dollars so that lazy citizens who don't work for a living and breed like rodents can get me to pay their bills for going to the ER with a headache. No thanks. Ill pay for mine and they can pay for theirs. This isn't Russia yet.

 

[WrapItDog]

The Mrs had her first kidney stone attack early in the AM while we were in Gulf Shores on the day we were heading home. She advised she needed to go to the ER ASAP. On the drive to the Foley Hospital I inquired if she would be able to hold off on that ER visit until Meridian so we would be back in the BCBS MS network. Good thing my door was locked or she would have pushed me out of the truck into traffic on Hwy 59.

 

[Mjoelner]

Years ago I drove myself to the ER and it was my appendix. I was already at the puking from pain and gasping for air stage. After about an hour and a half and multiple tests they still couldn't determine what was wrong so they called in a surgeon who diagnosed it in about a minute and a half and they FINALLY hit me with a demoral shot. Sometime later I got a copy of a letter from the insurance company that they sent to the ER. The letter contained the itemized ER bill and showed where they charged something like $200 for some test and the insurance company struck out their amount and put $45 next to it. They did that all the way down the list and basically told them that if they didn't like it, they could stick it up their *** because that's all they were getting.

 

[Herbert Nenninger]

I’m not used to ER billing, but in outpatient, a level 5 office visit currently is based on time or medical decision making, so physical exam wouldn’t factor in. But in 2020, a certain number of physical exam components would have been needed. Now admittedly, you can simply look at somebody for about 10 seconds and be able to legitimately document a decent exam.
And except for the rare cash only outfits, the majority of charges are determined by either the hospital or the Center for Medicare Services. I’m not aware of any situations where the doctor arbitrarily says “Hmm, that’ll be 200 bucks”.
The situation with medication costs is so jacked up, I don’t know where to begin with that.

We ran up a recent $5,000 bill at the vet school, but they were very nice and upfront with estimates as we went along. I thought that was a common sense way of doing it and I wish human medicine could be more like that.

 

[ZombieKissinger]

Hospitals make everything absurdly high if you pay cash then negotiate charges with all the different insurances they accept, often for much lower. The more doctors they have in their hospital network, the more leverage they have with insurance companies to charge more. This is one big reason why systems are consolidating, though there are others, like sharing EHR and admin costs. When I was in the hospital a couple years ago, I was getting charged $40 per day for a med that cost me $8 per month outside the hospital. EKG was $500. The stated charges were crazy

 

[johnson86-1]

Well everyone likes to throw that out, but never discuss why it wasn't done. After a few years, the feds quit paying the bulk and it is up to the individual states to tax their citizens to pay for the rest.

THe feds would keep paying the bulk of it, they just wouldn't pay for all of it. It would still bust our budget.

That means hitting up tax paying citizens thousands of extra dollars so that lazy citizens who don't work for a living and breed like rodents can get me to pay their bills for going to the ER with a headache. No thanks. Ill pay for mine and they can pay for theirs. This isn't Russia yet.

The medicaid expansion wouldn't be for lazy people. It'd largely be the working poor. We already provide medicaid for the people you are talking about. I'm not for Medicaid expansion. But the expansion would be more palatable than the base program for most people if they could pick one.

 

[The Peeper]

Do whatever you can first with whatever you feel is excessive. Then, there are hospital bill audit companies out there that will take the bill and go through it line item by line item. They will dispute excessively high or bogus charges and whittle it down one item at a time. Whatever they save you on the bill you agree to pay them a percentage of. That's why its best to take out whatever you can with your own time and then let them get whatever they can that you couldn't. I had a friend in AR that started one of these type companies and his stories about the scammy crap hospital billing departments do will amaze you. It's definitely worth your time/$$ to investigate and not just roll over and pay it. It's not your fault that scumbags roll in the ER's for toothaches, sinus infections, etc. so why should you & I have to pay for it?

 

[Bill Shankly]

Charged fees in the medical business have very little to do with what providers are actually paid. The only people who pay full price are cash customers, and very few of them ever pay it either. If you want to place the blame in the correct place, it belongs with the government.

 

[dorndawg]

If only there was some better healthcare system that works better everywhere else in the developed world...

 

[jethreauxdawg]

You do realize people from other countries that can afford it come here to have surgeries, right? Is that just a fashion statement?

 

[dorndawg]

You do realize people from other countries that can afford it come here to have surgeries, right? Is that just a fashion statement?

Just a friendly heads up, when you use this worn-out trope, you are telling on yourself: you care more about wealthy foreigners obtaining top-of-the-line healthcare than you do tens of millions of Americans obtaining basic, life-saving healthcare.

 

[patdog]

Very few people come to the USA for healthcare. Over 1,000,000 Americans leave the USA for healthcare every year though.

 

[jethreauxdawg]

Nope and you can take the emotional bs somewhere else. I’m just pointing out that what other countries have isn’t utopia, and I would assume it’s probably not better than what we have here, since the people who have the means, choose to travel here. As mentioned elsewhere in this thread, poor people in this country already have access to better than basic, life saving healthcare. Maybe what we are doing is better than the rest of the world.

 

[dorndawg]

Nope and you can take the emotional bs somewhere else. I’m just pointing out that what other countries have isn’t utopia, and I would assume it’s probably not better than what we have here, since the people who have the means, choose to travel here. As mentioned elsewhere in this thread, poor people in this country already have access to better than basic, life saving healthcare. Maybe what we are doing is better than the rest of the world.

Nah I'm taking it right here, padnah. You are telling us you believe being poor is a personal failing, and a poor American has no right to healthcare. Man up and own it.

 

[jethreauxdawg]

Nah I'm taking it right here, padnah. You are telling us you believe being poor is a personal failing, and a poor American has no right to healthcare. Man up and own it.

View attachment 19359
Are you replying to me?

ETA: your reading comprehension skills are as good as my gif skills. What are you talking about?

 

[dorndawg]

View attachment 19359
Are you replying to me?

 

[jethreauxdawg]

Your gif game is scrong, though.