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Can you challenge the amount billed for a hospital inpatient stay

Posted: Jan 13, 2012

I hope someone who has done hospital billing might be more familiar with how that works and can explain this to me.

So, I had to have emergency surgery. Since I was laid off 2 years ago and have not been able to find a full-time job that offers insurance, I have no medical insurance at all.

The surgery was done by an M.D., and her assistant was a PA-C. I always assumed that an M.D. Surgeon charges the most and any assistant would bill at a lower rate, especially if she is a PA-C and not another M.D.

Well, I got the bill and was floored. Not because of the total bill (I expected that to be several thousand dollars), but by the fact that they charged me the same amount for the PA-C as they did for the M.D.

In other words, I was billed $12,176 for the M.D. Surgeon’s services, and another $12,176 for the PA-C’s services.

Between the 6-day hospital stay, the emergency surgery, being diagnosed with cancer, and now undergoing chemotherapy, my total hospital and clinic bills now amount to more than my house is worth.

Does anyone with any expertise in billing know if I can challenge the fact that they charged me the exact same amount for the M.D. Surgeon as they did for the PA-C?

I am not under the delusion that I will ever be able to pay off these bills, but I have applied for assistance with various agencies and I feel I have an obligation to get my bill down as far as it can go so if I do get help, the final bill will be that much less.

Any help would be greatly appreciated.

Thanks.

Hope you all have a great weekend.

;

Why not? Wadda ya got to lose? - nm

[ In Reply To ..]
x

Absolutely - Not first hand experience, but...

[ In Reply To ..]
I have a friend who had a large bill - not quite as large as yours, but still... She went to the finance people and just flat out said I can't pay this, let's talk about payments and they forgave all but about $100.00. It's the county/university hospital, so they are set up for that.

The only thing that can happen is they say no, but I think you'll find that they have programs in place for people such as yourself who don't really have the financial means to pay for this kind of stuff.

Wishing you all the best in your treatment and hoping that you get the financial aid that you so badly need.

Billing - MT

[ In Reply To ..]
I'm so sorry that you have to deal with this first. Second, yes, you absolutely can dicker with the hospital and physician fees, as well as the PA's. The charge is bundled so that is why it is the same. First go the hospital and see how far you get. Then, if not satisfied to the MD that did the surgery and talk to him about it. Many times they will forgive quite a bit of the fee. Also, for future reference, feel free to dicker with the MD before they do any procedure. It is often quite easier that way. This is quite common, so don't be afraid. Be fearless, walk in with a plan of payment, be prepared. Get an itemized bill to take with you to the hospital admin. This can be a quite PIA to get, so be prepared for that, they don't want to hand those out, but they have to. Best of luck to you.

similar story - no insurance

[ In Reply To ..]
I just wanted to say that sometimes things can work out when you don't have insurance. Like you, I had been without health insurance for a couple of years. I actually felt the sudden impact of a gallstone getting stuck in a bile duct, but waited almost a week before going to the hospital (did not realize what was happening except for having pain). I was admitted and kept 5 days and had two surgeries, two different surgeons, two operating suite charges, two anesthesiologists, labs, etc. The hospital kept sending up collections clerks to get me to sign payment arrangements during my admission. I was out of it, but had the sense to refuse signing anything.

The hospital bill alone was $65k. I applied for assistance and the first agency paid $6000. The second agency paid $300. The hospital wrote off the balance save $200 they wanted me to pay. I never thought something like that would have happened to me. I thought I was not poor enough to qualify.

I just wanted you to know that you have hope that you may not be saddled with as much debt as you think just now. Good luck to you - you've had enough to deal with.

I used to work in collections, so hopefully - this may help...

[ In Reply To ..]
My understanding is that if the hospital you went to accepts Medicare and Medicaid patients, the hospital must have a program to help those who can't pay their bills. Under the state guidelines I had to abide by, in order to qualify a patient had to show proof of household income (i.e., everyone who lives in your house and makes money). The other thing we did require was that they meet w/ our in-house social worker to make sure they didn't qualify there. If they didn't qualify for either, I was definitely given the go-ahead to "dicker." Not all of us who have done/do that job are evil; we just have a job to do.

That all said, bottom line is that you need(ed) necessary treatment, and I hope it is working for you. Good luck.

Definitely - Ex-Biller

[ In Reply To ..]
If they accept Medicare, ask them to adjust everything down to the Medicare ALLOWABLE. That will definitely write off quite a bit of $$$ off the bat. Most providers are willing to do that for self-pay patients. The only reason most providers charge so much in the first place is because they are aware that SOMEONE will pay that amount, not knowing that they have room to wiggle. Also, poster above is correct that the hospital should have a program with a "social worker" to find ways to pay the bill, either through state funded programs, govt, or private charities.

You definitely have to put in the leg work, since they won't freely tell you that they can adjust $$$ off the bill.

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