$85,209.00 hospital bill

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kybert

New member
god all these stories are horrible. do folks in america threaten medical/pharmacy staff with physical violence often? it wouldnt suprise me if that happened regularly. if anyone denied me care id be straight back with the most biggest nastiest weapon i could find. i mean how else do you get the care you need?

im all for paying certain fees when it comes to healthcare because after all you cant run a health system on nothing, but copping the brunt of the whole damn bill? sorry but this thread has shocked me so much. i knew healthcare in the US was expensive and you pay for what you want/need but 85000 is just plain greedy on the hospitals part and the insurance only covering 80% is pathetic too. <img src="i/expressions/brokenheart.gif" border="0">
 
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arabeth

Guest
Jennifer,

I'm sorry to hear of your situation. It's sad that so many of us are or will be in similiar situations. Everyone had really good suggestions but I wanted to mention something about the whole "out of network" thing. What would your insurance have paid if it were an "in network" provider? I worked for Blue Cross Blue Shield for several years and there are many ways of getting around the "out of network" thing. I am not sure exactly why you were at an out of network hospital in the first place so not sure where you stand here... just throwing out an idea for you. If you were there because it was the only place that could treat you, if you were there because you were away from home and needed to be admitted right away, etc...there are many different reasons people end up out of network... and many of those are exceptions that the insurance company will adjust claims for. Also, is there an out of pocket maximum on your plan? Most have them and even out of network it shouldn't be all that much. I would fight with the insurance company before I would fight with the hospital. I think you'd stand a better chance there. Appeal, appeal, appeal..... and then appeal again. I can tell you from first hand experience, the squeaky wheel gets the grease... You make a fuss long enough and they will often back down but they won't come to you offering it. If you have any questions or need some ideas, feel free to e-mail me and I'd be happy to help you as much as I can. Not knowing what kind of insurance you have, it's hard to say what to do, but I'd be happy to try. lindareneelyons@hotmail.com


Best of luck to you!
 
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anonymous

New member
Jennifer, does your plan not have a "max out of pocket" for the patient? I'm the benefits administrator for the company I work for. We've had many different plans over the last 10 years but one common theme for all of them is "max out of pocket". For instance, our current plan has a $500 deductible, 20% in network, 40% out of network coinsurance, major medical kicks in at $5,000 (meaning at $5,000 in claims, major medical begins paying 100% of the cost). For in net-work on our plan, that amounts to $1,500 in network or $2,500 out of network per person. We, of course, have rx and dr copays that aren't included in that. On our plan, rx is always seperate but dr visit copays count toward our max out of pocket which is $3,000 in network/ $6,000 out of network. TO make it simple, if I had your hospital bill, I'd pay my $500 deductible, $2,000 out of network coinsurance for a total bill of $2,500. For the remainder of the year, everything else except dr visit copays and rx copays would be covered 100%. As soon as I hit $2500 in office visit copays, those would also be covered 100%, so my total medical cost for the year for me only would be $6,000 (assuming everything was out of network), plus the cost of my rx copays. I realize all plans are different but all the plans we've ever had, or even shopped for (as benefits admin), have all had a "max out of pocket". For some, it's really low, for others, it's higher, but none have ever been anywhere near 20% of $85,000. Contact your benefits administrator to find out when major medical kicks in on your plan. For your sake, I hope your plan works like those I"ve encountered. Good luck, please keep us posted.
 
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anonymous

New member
Hi,

Thanks again for your replies. I do have an out of pocket max payment of 2500 dollars, however they are now saying that I have a co insurance and that I would be responsible for a percent of the bill.

I work for a health care system in an emergency room and if I went to my own hospital where I work which is what I have always done, I would have only gotten a drs bill. No hospital bill what so ever, but my hospital does not have any CF doctors in it.. I was encouraged to go see a CF doctor which I think was a good idea it is just that they are not in network. All the care I got there, I could have recieved at my regular hospital just not by a CF doctor....I actually when I went to the hospital thought I was just getting a PICC line in and going home after they set up my at home IVS but they decided to keep me for the whole time....

My primary told me he is going to write a letter of medical need for me to have been there. My insurance that I have is Horizon BCBS PPO. I have never heard of CO-Insurance before this is the first time they mentioned that to me so I need to go back and read the policy again. I am not sure what major medical means... is that something different than what I have ? I am going to call my benefits coordinator at work on Monday.

Julie, I am going to email you as soon as I get a chance because I really appreciated your offer to help me with the stuff you offered to. That was so kind of you...


Again thanks so much,

Jennifer
 
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arabeth

Guest
Jennifer,

Co-insurance is simply the percentage you have to pay of the bill. For instance, if it's 80% / 20%, your 20% is the co-insurance. The out of pocket max is the most you should have to pay out of your pocket thou, so you should never have to pay more than 2500.00 (if that's your out of pocket max, which I believe is what you said). That may or may not include your deductible, it depends on the plan. If there are no CF doctors at your hospital then the insurance company HAS to pay the hospital in network whether they are or not. With BCBS if there is no doctor or hospital within 50 miles of your home who can provide the care you need they have to pay an out of network hospital at in network benefits. They have no choice. But you have to call and get them to do it. It won't happen automatically. If you call BCBS and get someone you don't feel comfortable with, ask for a manager. Don't take no for an answer. The employee turn-around is really high for call centers so you may get someone who doesn't know what they are doing. Just keep pushing. Best of luck.

By the way, when I was living in MN, the hospital and dr where the CF Center was located was out of net for my plan but they always paid in network because it was the only CF Center around. They can't deny you the care you need by providers who are trained to care for you.
 
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anonymous

New member
My husband jokes that my fighting with insurance companies and working with drs/hospitals is a part time job. Lots of great advice has been offered, but I just wanted to say sometimes you do have to fight. I try to remain calm, but be persistant and as kind as possible, and keep asking to talk to supervisors (sometimes just calling back and talking to someone different yields surprising results). Sometimes you have to appeal, appeal and appeal with your claims department. I believe with (at least some - mine for instance) PPO's if you are out of network, there is no cap on what you pay, and the co-insurance won't even apply to the deductible -but EVERY company is different, so I hope you get it explained to you. Once you know for sure what they'll pay, the other reply was correct - get that letter that it was 'medically necessary' and if that was the only CF specialist, they should have to pay what they would've paid in network. Keep appealing, even if you have to file a complaint to the Insurance Commissioner in your state. Meanwhile, stay in touch with the hospital all the time, and keep track of every person you talk to, what they said, and when they said it. If you qualify financially (we never do), sometimes they will forgive or reduce what you owe. Then insist they take payments (some hospitals insist you take out a loan! I fought with ours for a long time, and they finally made an exception - if we borrow for my husband's medical bills, we'd be bankrupt, more than once, since we spend over 1/3 of our income on his medical). I wish you (and everyone) all the best. I know exactly what it's like to fight -- and I do, over every dime. It's so sad, when you should be focusing on taking care of yourself that you have to spend your time and energy on something crappy like this. TAKE CARE!
Jan - wife of Greg (45 CF'er w/cepacia, top of the lung tx list)
www.standinginthegap4greg.org
 
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anonymous

New member
To the lady that lost her son after the double lung tx, very sorry to read that. You are in my prayers.

I was just rereading some of the posts, and you guys might have different information, but hospitals don't have to take payments, and they can come after you immediately for any amount, and they can take whatever you own, and they can put it on your credit reports right away - our lawyer made sure we understood that. Just thought before you took some of the advice to tell them to get lost (or be tempted to hope it might just go away), you might want to consider that, and consider what you might have wished you done in the future (or even get some legal advice). (You can always blow off steam on this message board!) Of course, you can't let them push you around either. Again, best of luck - jan
 
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anonymous

New member
Realistically, we've done away with debtor's prisons in the US. (At least until George II makes the change.) The notion that "they" can take "whatever you own" is just silly and hyperbolic.

John.g
 
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anonymous

New member
Except I personally know of two instances where the hospital forced the sale/second mortgaging of a widow's house. An asset is an asset and a debt is a debt. I also had a friend who had to cash in her children's education savings bonds. Everyone should check with their legal advisor to make sure they're protected. Just knowing the facts makes for wise financial planning. I'm sure a lot of the time we can all find someone kind to help us, but you don't know when you'll meet someone who decides not to do anything they don't legally have to do. I was just passing on what our attorney told us - - maybe you have had different legal counsel. I've always been thankful for the hospitals we work with. All but one have been great (a hospital under intense pressure to resolve its own financial problems). My husband and I have worked too hard to have a great credit rating and to own our own home. He went to our attorney for advice to protect his family. Take care all, jan
 
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JazzysMom

New member
The hospital I worked at used an outside law firm as one of their collection agencies. We had so many complaints about how rude, uncompassionate & greedy they were. To this day they are still being used because they dont step over the line. They push it too the line, but not over so that people have any legal recoure. Once the new laws were passed describing how a representative or agency could handle the collection of funds, it got better....but not great. Another reason they are still being used by the hospital because they bring in the $$$. Meanwhile the staff doctors, VIP or well known people get discounts because of the politics involved in the facility. I remember having people threaten to sue me personally because the head of the fiscal department wanted everyone who had over a certain $$$ amount owed sent to collection. It didnt matter if they were on payment arrangements or if they were in default. They were all treated the same. As we were told......we have no legal obligation to offer payments. I dont know if that was true or not, but who were us "pions" to ??? it. Dont ever assume anything. Document everything!
 
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anonymous

New member
I didn't take time to read this whole thread, but if the hospital is a "non profit" hospital, they have to write off some of their debt so as not to show a profit. My dad was in a situation where he was off of work but not old enough for Social Security, so he didn't have insurance. He was hospitalized and they wrote off a huge chunk of it because they were non profit & he made payments on the remaining amt.
Just a thought.
 
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JenniferNJ

New member
I just wanted to post an update because everyone has been so great.....

My insurance company called me back ... I am only responsible for $2500 .. which is maximum out of pocket co pay..That is it.

The hospital was not looked at as Inner Circle where I would have a zero co pay, but it was looked at as Inner network because it provided care that my local hospital could not provide. If it was considered out of network. I would have been responsible for 40%..Which would have really really sucked.... to say the least..

. My insurance paid them $14,000 that is it. they have to eat the rest of the charges....because that is the contract the hospital has with my insurance company...it would be against the law for them to ask me for more money then they are contracted to get.. wahoooooooooooo

Thank God.... I can definetly do $2500 with a payment plan.. Though I am going to see if the hospital will let me apply for Charity Care because according to their standards of the info they sent me.. I more then qualify for it......

Thanks so much for all your help....You guys gave me such great ideas...

Jennifer
(who feels so much better right now)
 
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JenniferNJ

New member
I just wanted to post an update because everyone has been so great.....

My insurance company called me back ... I am only responsible for $2500 .. which is maximum out of pocket co pay..That is it.

The hospital was not looked at as Inner Circle where I would have a zero co pay, but it was looked at as Inner network because it provided care that my local hospital could not provide. If it was considered out of network. I would have been responsible for 40%..Which would have really really sucked.... to say the least..

. My insurance paid them $14,000 that is it. they have to eat the rest of the charges....because that is the contract the hospital has with my insurance company...it would be against the law for them to ask me for more money then they are contracted to get.. wahoooooooooooo

Thank God.... I can definetly do $2500 with a payment plan.. Though I am going to see if the hospital will let me apply for Charity Care because according to their standards of the info they sent me.. I more then qualify for it......

Thanks so much for all your help....You guys gave me such great ideas...

Jennifer
(who feels so much better right now)
 
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