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Help pls! is this medical bill reasonable & what can I do!

pricescopenewbie

Shiny_Rock
Joined
Mar 23, 2015
Messages
203
Hello Dear PSers, i was wondering if I could seek any advice here on a $4000 medical bill I recently received after an ER trip. I am pregnant and back in last Dec when I was about 6-7 month pregnant I blacked out a few times. On the last day of 2015 I fainted again so I called my OB/GYN. she said it usually was related to my pregnancy but there was a chance of blood clog etc and since their office was closed that day she suggested me to go to ER for a check. I panicked after hearing the words "blood clog" and went to the ER afterwards. and recently my medical bill came in with a total charge of about $17000, and I have to pay about $4000 after my insurance company paid off their part.

After looking into the bill and comparing it with the medical record I obtained from their hospital, I think some charges are not very reasonable. but I have no experience working in a health care organization or medical billing office. so i wonder if anyone here would kindly help and give advice. I appreciate it a lot in advance!

here is the bill (the orignal charge before insurance company paid for their part):
about $11000 for a CT scan - Angio chest w/PE potocol
about $430 and $130 for isovue-370 75ml and sodium chloride 1000ml respectively, both are IV injection (i am not sure which is charged for which though)
$2000ish for lab tests which include an urine test (urine color, pH, protein, blood, bacteira, mucus, glucose, RBC, WBC etc), 2 blood chemistry tests which seem to be a repeat of each other (sodium, potassium, chloride, CO2, AST, ALT, etc), a hemotology test (WBC, RBC, Hgb, MCV, etc)
$500ish for diagnostic medical exam - as far as i recall they are meanly for blood pressure and Vent. rate.
about $3000 on emergency room services

I searched online and found websites such as clearhealthcosts.com and healthcarebluebook.com where you can search for a reasonable range of medical charges. for example, a normal range for a CT scan - Angio chest is about $600-ish on both websites instead of a jaw-dropping $11000. I started to feel I might be charged too much after finding out this information.

I would hope to get some idea from PSers here if you have similar experience, or if you are familiar with the medical system so I can have an unbiased opinion how reasonable this charge is.

My biggest concern is:
is everything charged in a normal range?
is there a difference on the charges between an ER vs. normal medical care?
is there a difference on the charges between an insured vs. uninsured patients?
is there anyway i can dispute with the hospital if the charge is not reasonable?

With a newborn baby on the way (actually due in a week), we definitely will receive another big bill for delivery and prenatal visits (from another hospital though). it will be a big burden on our shoulder having to pay this big amount for this ER visit. Most importantly, I don't feel comfortable to pay if it is not charged properly. on the other hand, though, we will have to pay it in full if it is properly charged no matter how big the bill is. So I would really appreciate it for your advice! thanks in advance and hope to hearing from you!
 

VRBeauty

Super_Ideal_Rock
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10,228
Re: Help pls! is this medical bill reasonable & what can I d

That kind of stress (and expense!) is the last thing you need when you're about to give birth! I'm afraid I don't have any substantive information to give you, but I do know that the rules regarding medical insurance etc. usually vary by state, so it would be helpful to know what state you're in. Some states have agencies specifically for health insurance issues... you might want to check if this is the case in your state.

Also - keep every scrap of paper you have related to this. And yes, there is a good possibility that there will be some sort of appeal procedure you can use.

BTW it sounds as if $4,000 is your out-of-pocket (deductible) limit. If that's the case, that deductible limit might apply to your pregnancy-related expenses also. And is it possible that out-of-pocket pregnancy-related costs you incurred in 2015 should have been applied to the ER costs, but were not? Just thinking out loud here...

That's a huge financial blow. I hope you that once you start digging into the specifics, you'll be able to get it reduced.
 

sonnyjane

Ideal_Rock
Joined
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Messages
2,471
Re: Help pls! is this medical bill reasonable & what can I d

All those prices look right EXCEPT the scan. To answer your question, yes the ER charges much, much more than a regular clinic, but $11,000 seems high even for an ER. Unfortunately I'm not sure what recourse you really have if they say "tough that's what we charge." Most hospitals will work with you to make payments so at least you wouldn't have to do a lump sum if you don't have it.
 

pricescopenewbie

Shiny_Rock
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Mar 23, 2015
Messages
203
Re: Help pls! is this medical bill reasonable & what can I d

Thank you so much VRBeauty and SonnyJane!

VRBeauty- most of my pregnancy-related costed will be charged in 2016, and this ER charge occured unfortunately on the last day of 2015, so they can not be considered together for one deductible :(

just wonder - is there a medical charge guideline for each state? otherwise a hospital can charge whatever they want? like, this hospital can charge me $11000 for the scan if they want?

Is there anyway we can negotiate with the hospital on the total payment amount? it will be otherwise a really big bill for us, considering there is going to be an even bigger one on the way - very soon.
 

jordyonbass

Brilliant_Rock
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Re: Help pls! is this medical bill reasonable & what can I d

This seems to be really steep to me but I have never been treated by the US healthcare system so I can't really comment about how reasonable this is. The Australian healthcare system is funded by taxpayers like myself at the cost of maybe a couple hundred bucks per year from my taxes; I've had broken bones, stitches, spent overnight in a hospital due to electrocution as well as other reasons to get put back together and it's not cost me a single cent in bills. The only medical costs I could possibly incur is cosmetic surgery (am fine with my life battlescars).
So my impression of this is that it is incredibly harsh to be charged this much for treatment that was necessary.

I hope there are avenues for you to contest this if it is not a fair cost under the healthcare system OP.
 

telephone89

Ideal_Rock
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Aug 29, 2014
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3,847
Re: Help pls! is this medical bill reasonable & what can I d

None of it seems reasonable.

-A Canadian
 

amc80

Ideal_Rock
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5,765
Re: Help pls! is this medical bill reasonable & what can I d

The charge from the hospital isn't as important as the negotiated rate through your insurance company. The hospital can charge whatever they want, but it's the negotiated rate that matters since you are billed based on that.
 

pricescopenewbie

Shiny_Rock
Joined
Mar 23, 2015
Messages
203
Re: Help pls! is this medical bill reasonable & what can I d

oh I have to move to Canada...you Canadians are treated so much better by the government...it is frustrating to have one big bill after another, esp. thinking of the fact that we pay quite a portion of our income to taxes already, and on top of that also hundreds of dollars to insurance company every month.

anyway, insurance company have paid their portion and there are still about $4000 left on our side. Anyone has the experience to discuss with the hospital for a deduction of the payment at all? with another bill kicking in pretty soon (estimately a $4-5000 at least) I really feel it is not very affordable for us :(
 

packrat

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Dec 12, 2008
Messages
10,615
Re: Help pls! is this medical bill reasonable & what can I d

amc80|1458230343|4006767 said:
The charge from the hospital isn't as important as the negotiated rate through your insurance company. The hospital can charge whatever they want, but it's the negotiated rate that matters since you are billed based on that.
Yes. And insurance policies are so different as far as what they will and won't cover.
 

wildcat03

Brilliant_Rock
Joined
Apr 11, 2011
Messages
503
Re: Help pls! is this medical bill reasonable & what can I d

I work in the ER so hopefully I have a little insight.

First, does the charge include the physician charges? Very often, the physician's part is billed separately so be prepared that there might be another bill that you haven't yet received. I don't think the "diagnostic medical exam" includes the physician charges because usually it would be something like "New patient Level 4" etc.

The cost for the CT Angio of 11k seems quite high. But - I'm guessing that your insurance has already kicked in and reduced that, which is why you only owe 4k total. The $430 is likely for the isovue (contrast used for the CT Scan). The $130 is likely for the sodium chloride. Both seem high, but again it seems that your insurance has negotiated some of that down. However, the figure you found for $600 was WAY off. I had an outpatient CT scan of my abdomen back in 2005 and the cost of that was well over $1000. Healthcare costs have skyrocketed since then. I would expect a cost closer to $1500-2000.

I would question why you had two sets of blood chemistries. Unless something was abnormal on your first set, you shouldn't have needed a second set. But it's entirely possible that you had some signs of dehydration on your labs that they wanted to make sure they had resolved.

To answer your question about the cost of services in the ER - yes, studies are billed at a significantly higher rate from the ER than from the outpatient setting. The ER is staffed for an emergency 24/7, whereas outpatient offices get to close during lower traffic times (like New Years Eve). Not only is the ER open but it is fully functional. I always have a CT scan tech in house, a radiologist ready to be awakened to read a CT scan, an ultrasound tech available to come in, a full staff of nurses, nursing support, secretary, housekeeping, etc. Not to mention me (the doctor) and usually a physician assistant or nurse practitioner as well. This staffing creates additional expense.

It sounds like you have a high deductible insurance plan based on what you've said. So your insurance has already kicked in and negotiated your share of the bill down from $17,000 to $4,000 but you are responsible for the remainder. My last ER visit was in late December 2009. I was seen by a physician, had labs sent, was given fluids and two doses of medications. Once insurance kicked in the total cost of that visit was about $1,000. My visit was significantly less complex than yours (and may have actually been downloaded as I was seen by a colleague) and costs have gone up in the last 7 years, so while a $4000 bill seems slightly high, I wouldn't expect it to be a lot less than $3000 or even $3500.
 

YadaYadaYada

Ideal_Rock
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Feb 2, 2016
Messages
5,972
Re: Help pls! is this medical bill reasonable & what can I d

I ended up with a clot at 34 weeks and my Yale bill was $20,000 after all the scans, blood work and tests they ran. Ridiculous!

You should talk to the hospital and see if you qualify for financial assistance that could reduce your bill you owe. Even though we don't qualify for any assistance I was able to qualify at our hospital and it helped a lot. Worth asking about.
 

momhappy

Ideal_Rock
Joined
Mar 3, 2013
Messages
4,660
Re: Help pls! is this medical bill reasonable & what can I d

Medical costs can vary widely, so it would be difficult to say what is reasonable and what is not.
I do know that when I was in college, I had a large medical bill that I couldn't afford to pay. I called hospital billing and they drastically reduced the total cost of the bill. I know that your situation is much different, but perhaps it might not hurt to call and speak with someone about the charges?
I wish you luck!
 

pricescopenewbie

Shiny_Rock
Joined
Mar 23, 2015
Messages
203
Re: Help pls! is this medical bill reasonable & what can I d

oh boy! there willl be another bill from the physician's part?! :wall:

Anyway, thanks a lot Wildcat for the insight explanation and it helps a lot!

StephanieLynn and Momhappy, thank you so much for the advice! I will definitely contact them and see if there is any chance for a deduction or payment plan. fingers crossed!



wildcat03|1458235766|4006854 said:
I work in the ER so hopefully I have a little insight.

First, does the charge include the physician charges? Very often, the physician's part is billed separately so be prepared that there might be another bill that you haven't yet received. I don't think the "diagnostic medical exam" includes the physician charges because usually it would be something like "New patient Level 4" etc.

The cost for the CT Angio of 11k seems quite high. But - I'm guessing that your insurance has already kicked in and reduced that, which is why you only owe 4k total. The $430 is likely for the isovue (contrast used for the CT Scan). The $130 is likely for the sodium chloride. Both seem high, but again it seems that your insurance has negotiated some of that down. However, the figure you found for $600 was WAY off. I had an outpatient CT scan of my abdomen back in 2005 and the cost of that was well over $1000. Healthcare costs have skyrocketed since then. I would expect a cost closer to $1500-2000.

I would question why you had two sets of blood chemistries. Unless something was abnormal on your first set, you shouldn't have needed a second set. But it's entirely possible that you had some signs of dehydration on your labs that they wanted to make sure they had resolved.

To answer your question about the cost of services in the ER - yes, studies are billed at a significantly higher rate from the ER than from the outpatient setting. The ER is staffed for an emergency 24/7, whereas outpatient offices get to close during lower traffic times (like New Years Eve). Not only is the ER open but it is fully functional. I always have a CT scan tech in house, a radiologist ready to be awakened to read a CT scan, an ultrasound tech available to come in, a full staff of nurses, nursing support, secretary, housekeeping, etc. Not to mention me (the doctor) and usually a physician assistant or nurse practitioner as well. This staffing creates additional expense.

It sounds like you have a high deductible insurance plan based on what you've said. So your insurance has already kicked in and negotiated your share of the bill down from $17,000 to $4,000 but you are responsible for the remainder. My last ER visit was in late December 2009. I was seen by a physician, had labs sent, was given fluids and two doses of medications. Once insurance kicked in the total cost of that visit was about $1,000. My visit was significantly less complex than yours (and may have actually been downloaded as I was seen by a colleague) and costs have gone up in the last 7 years, so while a $4000 bill seems slightly high, I wouldn't expect it to be a lot less than $3000 or even $3500.
 

Karl_K

Ideal_Rock
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9,525
Re: Help pls! is this medical bill reasonable & what can I d

having had 5 dvts (serious blood clots) and a PE(lung blood clot) I am familiar with the ct scans.
At the hospital outpatient the scan is 1800+150 for the dyes + 300 for reading of the scan.
At a imaging clinic which there are 2 here it is about $1100 for the scan and reading + dyes and a small supply fee for the needles($5) and a fee for putting in the iv($25?).
ER it is about $2800 + dyes + reading. The reading is about double outpatient.
Insurance reduces that to about 75% of that at the hospital, and the same as you would pay at the clinic as they have one set price for everyone.
Those numbers are about a year old.
 

momhappy

Ideal_Rock
Joined
Mar 3, 2013
Messages
4,660
Re: Help pls! is this medical bill reasonable & what can I d

Yes, fingers crossed for you! Please keep us posted.
 

NTave

Shiny_Rock
Joined
Aug 15, 2011
Messages
279
Re: Help pls! is this medical bill reasonable & what can I d

Yes the 4000 sounds like the deductible, unfortunately most plans are so incredibly high for deductibles now. I would imagine that an ER visit with rule out PE would be more than 4k, so you would not be saving anything by negotiating with the hospital. And OP is right, hospital sets rates but insurers pay what's negotiated at their rate ( Which means even higher premiums for non insured). insurance is the biggest scam. Accessing plans that cost thousands per year should not equal deductibles that are that high for individuals. I really hope this is addressed in government over the next few years...its unsustainable for the average person to pay an additional 4-5k for an ER visit (or two, or a surgery, etc) out of pocket, in addition to high insurance premiums. Unreal.
 

wildcat03

Brilliant_Rock
Joined
Apr 11, 2011
Messages
503
Re: Help pls! is this medical bill reasonable & what can I d

pricescopenewbie|1458244319|4006923 said:
oh boy! there willl be another bill from the physician's part?! :wall:

Anyway, thanks a lot Wildcat for the insight explanation and it helps a lot!

StephanieLynn and Momhappy, thank you so much for the advice! I will definitely contact them and see if there is any chance for a deduction or payment plan. fingers crossed!
Hope it helped. Sorry you are dealing with this, but I'm glad you didn't have a PE that was causing your symptoms!!!

You should check about charity care. I've worked at several private hospitals and they had very active "charity care" programs (although there are now straight up FOR PROFIT hospitals, too, so if it was one of those I highly doubt they'll do anything). It's not really charity as much as a tax write-off for the hospital - so don't let the name deter you.

I can't tell you for sure that there will be another bill but this would be the case almost everywhere I've worked. It's billed separately and I think the physician groups often try to bill AFTER the hospital as then many patients have already met their deductibles. The physician group is usually a separate group from the hospital itself, even if the physicians are employed by the hospital (which is actually a fairly rare setup). I would expect your visit to be coded as a 99284 or 99285 (more likely the latter). There's an outside chance it could be coded as critical care time (I doubt this, but since I didn't see you and don't know if you had vital signs abnormalities, etc) and would be a 99291. You might be able to find some information on estimates of how these are reimbursed, etc. but bear in mind that any estimates you find online can be off. In general, I would expect your final cost of the physician part of the visit to be about 1/4 or less of the total you already have. Since it is billed by a different group, DO NOT HESITATE to call and negotiate your final cost. Whatever your final cost is, the Medicare rate is likely about 80% of that. They legally can not bill you less than the Medicare rate because of Medicare rules. First, call and ask the billing company. If they aren't helpful, do not hesitate to find out who the chief of the group is and write a letter to them. Since the chief of the group will be a physician within the group, the best approach is to write a complimentary letter re: your experience and briefly plead your case re: a reduction of your bill. Mention that you were directed there by your ob/gyn, that you are expecting soon, and that this visit created an unexpected additional deductible for you to pay, and that you would appreciate any consideration they can give. My boss reviews all of these requests and I know he would try to do SOMETHING if he received a letter like that.

Best of luck and congrats on your pregnancy!
 

msop04

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Re: Help pls! is this medical bill reasonable & what can I d

packrat|1458234862|4006843 said:
amc80|1458230343|4006767 said:
The charge from the hospital isn't as important as the negotiated rate through your insurance company. The hospital can charge whatever they want, but it's the negotiated rate that matters since you are billed based on that.
Yes. And insurance policies are so different as far as what they will and won't cover.
This is all true. It doesn't matter what the hospitals charge, since they have a negotiated rate with the insurance company. This is why patients with no insurance ("cash only" customers) pay significantly less than what the provider will charge the insurance. Unfortunately, when you chose/accepted the insurance coverage, it's stated what your copays/deductibles/premiums would be for the coverage. It is possible you have a higher deductible and met it with this visit.

We see people come into our clinic who have unreal deductibles (think $5000+) and they have no idea. So, when it's said and done, they basically have catastrophic coverage because they would never even meet the deductible otherwise.

I'm so sorry about all the stress it's causing you... I doubt very seriously they will decrease the price, as it is in contract with your insurance, but it may be worth it to speak with the hospital's billing dept to see what your payment options are. Good luck to you, and congratulations on your pregnancy!
 

azstonie

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Re: Help pls! is this medical bill reasonable & what can I d

amc80|1458230343|4006767 said:
The charge from the hospital isn't as important as the negotiated rate through your insurance company. The hospital can charge whatever they want, but it's the negotiated rate that matters since you are billed based on that.
This x2.

I had an ER scan last August, was afraid I was blowing an appendix. They charged me right about what you got charged. My insurance company negotiated them down to about $700 for it AND THEN TURNED AROUND AND MADE ME PAY THAT. I look forward to the days when insurance people and radiologists come to my business and I get to charge them what I see fit =) No negotiations either.
 
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