How to best manage Emergency Room fee levels?

27 replies [Last post]

Mon, 11/06/2006 - 10:37am

Anonymous

I was blown over when I saw the bill that a NJ E.R. (which treated me for my recent elbow crash - - 4 XRAYs, tape, bandaid, tetanus shot, anti-imflamatory, doctor visit) had sent my insurance carrier. They billed me/my carrier roughly $1500 - - but then by pre-negotiated rates, my Blue Cross Blue shield carrier only had to pay about $465 to close the claim.

I'm amazed.

If I had not insurance, nor a carrier acceptable to that provider - - I would have been stuck with responsibility for the whole thing.

How does a mere mortal wander through the gauntlet of preset fees and protect fairly themselves (plus in due fairness the provider) if/when one has to partake of E.R. medical services? And what if one is unconscious and solo in reaching the E.R.??

This dialog might get a lot of participation and good suggestions!

Mon, 11/06/2006 - 11:03am

<a href="http://www.OhReallyOreilly.com">Peter O'Reilly</a> (not verified)

terse response

The bill is inflated to cover the costs incurred for those who do not have insurance and are unable to afford the true cost of medical treatment.

Mon, 11/06/2006 - 12:10pm

Perry Roubaix (not verified)

The bill is inflated to provide maximum profit.

Mon, 11/06/2006 - 12:25pm

<a href="http://www.OhReallyOreilly.com">Peter O'Reilly</a> (not verified)

yeah, that must be it

and Susan should also shop around first for the best price for ER services, like you do, naturally. You should bring this up at the hospital's next shareholder's meeting.

Mon, 11/06/2006 - 1:45pm

Perry Roubaix (not verified)

???? What's it got to do with Susan and her ER experience? Hospitals don't have shareholders; corporations who own the hospitals do. (They are no longer run by the Blessed Sisters of Charity, and ol' Doc Fenwick doesn't waive the fee anymore if Pa is laid off at the mill.)

Mon, 11/06/2006 - 2:29pm

<a href="http://www.OhReallyOreilly.com">Peter O'Reilly</a> (not verified)

Bellevue is calling

If corporations own the hospitals, and not shareholders, then tell me - who owns the corporations?

Mon, 11/06/2006 - 3:31pm

Eddy (not verified)

$1500.00 - $465.00 = $1035.00. Would the loss be a write off for the hospital? Eddy.

Mon, 11/06/2006 - 6:20pm

Perry Roubaix (not verified)

"How witty to make the old Bellevue/mental case reference. Very 1955. Shareholders own the corporations and technically the chain of hospitals, but hospitals do not have shareholder meetings. So I won't be ""bringing this up"" at the next shareholder's meeting at the hospital because a.)there is no such meeting, and b.) I don't own any shares in any hospital corporation."

Tue, 11/07/2006 - 8:02am

<a href="http://www.OhReallyOreilly.com">Peter O'Reilly</a> (not verified)

public care and services

If hospital's goal was to maximize profit, then those who could not afford to pay would not be admitted and those who do would be billed at a much higher price than they are paying now.

In other words, for most hospitals, their capacity to provide medical services is stretched thin. This is most particularly true for ER services. When demand exceeds supply, prices increases result in part to curb supply and to maximize profits. Hospitals do not practice such policy. They also do not turn away folks too poor to pay for providing ER and non ER services.

Regarding, Bellevue it is the oldest publicly owned hospital in the country. Most hospitals, whether incorporated or not, are in dire financial shape. I can name 3 hospitals in the immediate area where I live that I am aware of having filed for bankruptcy or are close to it – and they are not even government owned hospitals. As for health insurance companies, historically you’d be better off investing your money in a money market account. Working for one is no road to fortune, either. The system is broken.

Tue, 11/07/2006 - 3:15pm

Claudette (not verified)

Profit?

Many hospitals are nearing bankruptcy. Insurers typically pay less than half of what is billed, based on their own actuarial tables. It is seldom you will find any hospital that makes a real profit these days. Everyone is just trying to survive.

Mon, 11/06/2006 - 5:03pm

#10

chris o (not verified)

As Peter illustrates, the system is broken and unjust.

Mon, 11/06/2006 - 11:49am

#11

jc (not verified)

Welcome to Managed Health Care. (nm)

Mon, 11/06/2006 - 12:03pm

#12

Sharon (not verified)

How to best manage

If you personally had to pay the full bill (no insurance), you could always threaten to declare bankruptcy,(not too good for your credit standing) unless they agreed to negotiate the bill. Believe me, it works.

Mon, 11/06/2006 - 12:15pm

#13

April (not verified)

ER and insurance

"""And what if one is unconscious and solo in reaching the E.R.?? ""

I believe all insurance cover basic ER services. I've been out of state and had to use ER service. All but the ""deductable"" was covered by my insurance.

It's when you're discharged from the ER that things starts to get ugly...

My mom had an accident last year. All her ER cost was again paid. But, for her follow up doctors visit, she has to go to doctors acceptable to her insurance. The ER physician, naturally, refers her to docctors affiliated with THAT hospital, which may not be acceptable to the insurance company!

When one is groggy with pain killer (and still in pain), it's not the ""usual"" way to think about changing doctor or other quirks imposed by insurance! I ended up spending a couple of hours calling every doctor on her ""provider list"" till I find one who can see Mom immediately. Had *I* been the one who's injured, I don't think I'd be in condition to do the same for myself. The only thing I can say is, as soon as you're discharged from the ER, have someone act as your advocate until you're in condition to deal with the red-tape yourself."

Tue, 11/07/2006 - 11:37am

#14

bill vojtech (not verified)

I fell off my bike at a GEAR rally in NJ. I needed a tetanus shot and a bandaid and some disinfectant.

I went to the infirmary at the school, Ryder U?), and was treated promptly by a nurse– no doctor.

I was charged $15. That's it. This was a number of years ago, but an ER visit with the same treatment would have easily been several hundred dollars, even back then.

No doctor was involve, so that made it cheaper. It wasn't at a busy hospital that's treating a bunch of freeloaders.

Doctors cost more, partly due to the malpractice lawyers that feed off them, but ever notice that they both drive Mercedes? Even though the hospitals are bankrupt and the plaintiffs need the money?

Thu, 11/09/2006 - 9:12pm

#15

mike (not verified)

freeloaders oh my!

yes , let the little 5 year old freeloader who was hit on the sidewalk by a car , or the 7 year old freeloader that was hit by a a unlicensed unisure driver while riding his bike, or the 82 year old lady who was run over by a bus wait so they can treat your bobo.
since you must be treated first since you think they are all freeloaders..
how do you determine they are freeloaders?
typical thinking from the same people

Fri, 11/10/2006 - 10:06am

#16

Jonathan (not verified)

2 Stories

Story 1: son stops breathing. I call 911. Ambulance takes him to local NYC hospital. He is totally fine (only croup). They take a chest X-Ray, I pay $125 co-payment. All is fine, son is ok. Bill comes 1 week later: $2800 for emergency services. I fight over 12 months to avoid paying it since it should be covered. I finally win despite collection notices, headaches, threats, etc.

Story 2: Accident on bike, middle of no where South of France. I ride to local hospital. Wait in waiting room. Doc and nurse come, clean wound, tetanus shot, three stitches, kind words of advice about not putting hands near rear wheel when falling. I ask nurse: where do I pay? She replies, laughing: no charge, mon ami. Go home. I go home. End of story. No bills, no collection agency, healed finger.

Darn socialized medicine.

Mon, 11/06/2006 - 5:14pm

#17

mike (not verified)

the system is dangerously broken, majority of bankruptcy are due to medical bills, and were not talking a $1500 bill, doesn't seem right that a insurance company can force a hospital to accept a 500 payment for a 1500 bill while the uninsured would be liable for the whole thing.

Tue, 11/07/2006 - 7:28am

#18

Susan Rodetis (not verified)

How do ERs collect or not on their retail bills?

"The diffs in pricing make a bit of sense, in that as a customer, an insurer is a ""volume shopper"". But such a HUGE spread betw. what I pay a retail person and that amount??? THAT is unfair, IMHO.

Do ERs expect most folks NOT to pay?

Do hospitals turn the bills over to a collection agency?

Does it ruin the credit of an individual NOT to pay a whopping bill?

Yikes, managed care.

Susan

Tue, 11/07/2006 - 9:04am

#19

Dennis Wiener (not verified)

I had to go to an emergency room a few years back. The emergency room itself was covered by my insurance. What wasn't covered was the emergency room doctors fees. I recieved seperate very large bills from, the doctor who saw me, the radiologist who looked at my x-rays, and the cardiologist who looked at my ekg. So the SR collected $2000 from Blue Cross and I still had to pay the difference of what my insurance paid as reasonable and customary charges and what the doctors charged. There was one ER doctor who had a ridiculously high bill and refused to negotiate. I waited to pay her until around the 4th collection agency notice, and then I paid them so they could take their cut of her bill. About 18 months until I paid her, and only because I needed to apply for a mortgage. I figure the $2000 the hospital got paid (since everyone else seemed to bill independently) was to cover idigent patients.

Tue, 11/07/2006 - 9:36am

#20

Susan Rodetis (not verified)

Yes, I'm rec'g additional separate bills

Drats.

Susan

Thu, 11/09/2006 - 2:46pm

#21

bill vojtech (not verified)

Last year, I had a trip to the ER. I have insurance. I got billed for what my insurance company did not pay– they only pay so much for certain services. I paid the difference.

Then I got billed for the DOCTOR'S services. Which I felt I should not pay. I mean if a customer came into the place I worked and was billed by my boss for a job I did and paid his bill and then I billed him for my services, I'd get laughed at. But the collection agency didn't see it that way, so I paid.

Thu, 11/09/2006 - 7:37pm

#22

[email protected] (not verified)

People who find themselves in an ER aren't in the best position to negotiate.

Problem I had was before surgery. The surgeon who watched over me since my accident was out-of-network. Not a big deal then, since I only needed one follow-up appointment, but going forward meant I'd have to pay 30% of his fee to do the procedure, PLUS the 30% of hospital bills -- even though the hospital itself was in-network.

Since I had some time, I researched my insurance company's in-network options and came up with a good Plan B.

Then I went back to the first surgeon, was candid about the other setup but that I would prefer to go with him if he could get an exception to his out-of-network status -- which meant the hospital costs would be fully covered.

I'm certain he'd have agreed anyway, but doing the research meant I could enter the discussion with a certain level of calm.

Tue, 11/07/2006 - 12:26pm

#23

[email protected] (not verified)

As posted previously, I'm grateful for good health insurance but I recall reviewing the bills paid after my accident, and there was a separate charge for $200 for the oxygen I got on the five minute ambulance ride.

I remember the EMS people asking me if I wanted oxygen and I said yes.

If I didn't have insurance and I knew I'd have to pay extra ...

Tue, 11/07/2006 - 12:56pm

#24

Somebody (not verified)

Greed, greed, greed!

Part of the problem is that insurers bully hospitals, making their own payments to hospitals so low that non-profit hospitals have to charge the hapless uninsured to make up for what the insurance companies aren't giving them.

For more on greedy insurance companies and healthcare:

http://thenewyorkcrank.blogspot.com/2006/10/why-health-care-is-too-impor...

Tue, 11/07/2006 - 3:13pm

#25

Claudette (not verified)

You can negotiate

If you have no insurance, you can negotiate with the hospital. Call up the finance office and tell them you are self pay and what kind of an arrangement can they make. You might be able to get them down to like 400 bucks, depending on what was done.

If you have insurance and you have not met a deductible, you might be stuck. However, you still might be able to negotiate down the bill. This depends on the hospital but they are usually happy to get paid at all these days.

Tue, 11/07/2006 - 3:41pm

#26

not necessarily so (not verified)

Collection Agency is next

you may be able to negotiate a payment strategy but you can also be referred to a Collection Agency for bill repayment.

Sat, 11/11/2006 - 2:48pm

#27

Jay (not verified)

The $1500 for the ER visit was nothing compared to my bill

I was charged $15,000 for an overnight stay involving non emergency non ECU orthopedic surgery at the same hospital as Susan and that was five or six years ago!

The surgeon who did an excellent job charged me only about $1,000 for the surgery and pre/post op visits and an appliance.

At that time I had a hi deductible so the amount over the max of my accident ins to the deductible was out of (my!) pocket.

Another reason to cycle safely!

NYCC.org

How to best manage Emergency Room fee levels?