We the Patients

medical bill breakdown

Guest Post: Patient Perspective – Dave’s Medical Bill Breakdown

Date of event: 8/13/17

Issue: Passed out at cousin’s house on my way home after a long walk, (apparently) due to dehydration.

Result: 911 was called, ambulance arrived in short order, excellent EMT diagnostic and stabilization care provided on-site. I was then transported to nearest hospital emergency room, where treatment and diagnostic care were provided. I was discharged that afternoon accompanied and driven home by my wife. I received a total of 3 IV bags and a confirmation that dehydration was indeed the extent of my issue.

My up-to-date insurance information was provided to both the ambulance team and the hospital team. For emergency situations, my insurance coverage calls for in-network reimbursement (regardless of whether providers are in-network or not) of 80%.

Weeks after the event, I was hit with the following bills:

  • Ambulance service provider
    • $1,370.18 before adjustments
  • Hospital facility
    • $7,364.05 before adjustments
  • Contract ER medical provider company (the ER medical staff)
    • $2,472.00 before adjustments
  • A third-party pathology service provider (for tests requested by ER medical staff)
    • $66.00 before adjustments
  • An EKG doctor separate from the above contract ER providers
    • $35.00 before adjustments
  • TOTAL amount billed
    • $11,307.23 before adjustments

Bearing in mind that because this was a 911 call, I had no choice in who my providers would be…I was in an emergency situation, barely conscious and thus in no position to ask, “So are you in my network, and if not, can you send me to a facility and group of providers who are?”

I got LUCKY that the hospital facility I was brought to by the ambulance was in-network. As a result, that biggest amount documented above had an in-network discount applied to it, taking the adjusted amount down to about $4,000.00, and I paid my 20% portion of approx. $800.00.

As for the other 4 providers, NONE of them turned out to be in my network…even though I have what I would consider to be a pretty good network through United Health Care. Here’s how the remaining provider billing settle-ups played out:

The contract ER staff DID have something called a “Multiplan” contract with the hospital, meaning that they could charge a discounted rate for their services. The bill was adjusted down to approx. $1600.00, and I paid my 20% portion of approx. $320.00.  It took approximately 6 months and 6 calls during that time to eventually settle this. Each call I requested my bill be placed “on hold” and its due date extended, so that it would not be sent to a collection agency.

The third-party pathology provider refused to make any adjustments to their $66.00 bill.  Again, I continued to request that the bill be placed “on hold” upon each call over an 8-month period, at which time the provider FINALLY decided to write off the bill and zero out my balance.  In other words, I was able to “outlast” them until they finally gave up.

The EKG doctor strangely disappeared from his medical practice; when I contacted the practice about the bill, they could only tell me that he no longer worked for them.  Eventually, again after about 8 months, they elected to write off the bill and zero out my balance.

This leaves the ambulance provider. For months they continued to refuse to adjust their bill to an in-network rate. I worked with my insurance provider, the ambulance company’s billing and, eventually, patient advocate department. By March 2018, 7 months after the incident, and after multiple adjustments and then reversal of said adjustments during these negotiations (which included at least 10 calls by me), an acceptable adjustment was finally made, and I made a payment of approx. $185.00.

Bottom line: After 8 months of having to “work the problem” myself, my bill was over $11,000, costing me ~$1300.00 out of pocket. However, this was ONLY possible because I fully recovered from the incident, and had the time, the tenacity, and (eventual) knowledge of “the system” to work the problem with each of the providers and, in several of the cases, finally “outlast” them.

It is fair to surmise that the average person would have few or none of these advantages, resulting in their having to either (a) eventually just give up and pay the inflated bills, or (b) not pay them and suffer the consequences of dealing with collection agencies and the resultant effects on their credit ratings.