My ER Bill!!!

[Ringer]

Well I'm fairly new to the working world and along with that comes the responsibilities of trying to figure out my medical insurance. Was a little surprised by my recent ER bill so I thought I'd throw out a few questions that I had for those of you who are more knowledgeable in the area...

I recently had my appendix taken out which was done on an emergency basis on a Thursday. However, the Sunday before that I went to the ER because I knew something wasn't feeling right in my stomach. Almost felt like real bad stomach flu but I wasn't really nauseas if that makes sense. Anyway, I was in the ER for about 5 hours, had a CT Scan done, blood work, and got stuff for my pain. Had the doctor tell me that everything appears to be OK but from what I was describing to her it sounded like the beginning stages of appendicitis. If I was to develop a fever or the pain gets worse I was supposed to go back to the ER.

Well, the pain was getting worse and worse since my visit but it wasn't until my follow up appointment with my primary care doctor that following Thursday that I had my emergency surgery. Had a CT Scan done by my doctor and it showed that my appendix ruptured.

So, I got my ER bill which totaled about $1,300 out-of-pocket. The price for my surgery and 4 day stay at the hospital...$250 out-of-pocket. Does this sound insane to anyone besides me considering that I was told I was fine by the ER? I know that it could have been possible it was too early for them to catch anything but I guess it just angers me that I'm paying $1,300 out of my pocket when I feel that they did nothing for me. Any chance that you can fight the claim and somehow get the payment reduced since their diagnosis was wrong? I have the money to pay it but hopefully you can understand by now why I don't want to.

 

[Booko]

Let me ask a friend of mine who's in the business and is famous for fighting everything from bills like yours to bank fees and succeeding.

 

[Shadow Wolf]

The total fee actually sounds rather cheap.

But, I would contact a lawyer and file malpractice, since you were told you were ok, but obviously weren't.

 

[Booko]

First read you insurance coverage throughly. See what your coverage would've been if this had been treated as one event. They may be treating it as multiple events rather than one event.

Don't talk to the front line person -- they can't do anything for you. Ask the person you talk to if they are able to make a decision on your case, and if the answer (likely), ask to speak to someone who has the authority to help you, such as a supervisor. The front line people are trained to tell you "no" -- those aren't the people you need to talk to. Get around them.

If you question and fight the insurance company, they often will back off. Be businesslike but very firm.

If the insurance company doesn't move -- talk to the hospital business office. They missed the diagnosis and it cost you lots of money. Again, don't talk to the front line geek -- they are trained to say no. Get to the supervisor and ask to negotiate the price down, since they did nothing for you and misdiagnosed you and a few days later your appendix ruptured. They will hear "lawsuit" from this, because face it, you might've died. Don't actually say lawsuit of course. Then they circle the wagons.

You will have to pay something to the hospital ER of course. The CT scan charge and the bloodwork at least -- give that as your opening offer and negotiate from there and you can probably get them to move on this one. If you are able to pay the bill in cash *if it is reduced* remind them of this. Trust me, if they have to go to collections they are only going to get 10%. They'd rather take 50% in cash and not have to spend all that office worker time dealing with you.

Good luck, and remember, be firm but polite, and don't let the bozos get you to lose your cool!

 

[Jaymes]

I don't understand why you think the hospital did something wrong. The doctor told you what it could be and to come back if it got worse. You did. What's the issue?

 

[Willamena]

You can ask the hospital for an estimate of costs before you agree to submit yourself to their care. Next time.

 

[Booko]

The total fee actually sounds rather cheap.

But, I would contact a lawyer and file malpractice, since you were told you were ok, but obviously weren't.

It's usually a lot cheaper and faster to avoid the legal route. Believe me, the hospital will know what the risk is without actually saying "lawsuit" and they'll be easier to move if it doesn't become confrontational.

And this way, you will avoid having anything nasty on your credit report. Credit was always important, but now it's so much more important in ways many of you probably never suspect.

We're setting our son up to have the world's most squeaky clean credit. We have an opportunity to buy a car cheap from friends of ours, and it'll serve him well for what he needs it for. So rather than just pay for the car outright, we get him to get a loan from the credit union, and then pay the car off in a month or two. Instant credit for an 18-year old. If he can keep it clean, that little dodge will be a good beginning for him.

 

[Ringer]

I don't understand why you think the hospital did something wrong. The doctor told you what it could be and to come back if it got worse. You did. What's the issue?

Well, I realize that but my ER doctor pretty much told me that if it was appendicitis I would develop a fever. Since the appendix becomes infected and fills with pus, your body develops a fever to fight the infection. In the 4 days that my pains were getting worse I never developed a fever. That weekend I was also tubing on a lake and so I thought it was possible I just had some kind of internal bruise if that's even possible. The pain kept getting worse but no fever, vomiting, or diarrhea. All of the symptoms that I was told I'd develop if it was my appendix. Good thing I was able to get to my primary care doctor on Thursday because Thursday morning before my appointment was the worst I've ever felt. I just think the hospital could have handled my situation a little better.

 

[Ringer]

First read you insurance coverage throughly. See what your coverage would've been if this had been treated as one event. They may be treating it as multiple events rather than one event.

Don't talk to the front line person -- they can't do anything for you. Ask the person you talk to if they are able to make a decision on your case, and if the answer (likely), ask to speak to someone who has the authority to help you, such as a supervisor. The front line people are trained to tell you "no" -- those aren't the people you need to talk to. Get around them.

If you question and fight the insurance company, they often will back off. Be businesslike but very firm.

If the insurance company doesn't move -- talk to the hospital business office. They missed the diagnosis and it cost you lots of money. Again, don't talk to the front line geek -- they are trained to say no. Get to the supervisor and ask to negotiate the price down, since they did nothing for you and misdiagnosed you and a few days later your appendix ruptured. They will hear "lawsuit" from this, because face it, you might've died. Don't actually say lawsuit of course. Then they circle the wagons.

You will have to pay something to the hospital ER of course. The CT scan charge and the bloodwork at least -- give that as your opening offer and negotiate from there and you can probably get them to move on this one. If you are able to pay the bill in cash *if it is reduced* remind them of this. Trust me, if they have to go to collections they are only going to get 10%. They'd rather take 50% in cash and not have to spend all that office worker time dealing with you.

Good luck, and remember, be firm but polite, and don't let the bozos get you to lose your cool!

Thanks for the help, Booko. If I feel gutsy enough tonight maybe I'll make a few calls.

 

[Booko]

Thanks for the help, Booko. If I feel gutsy enough tonight maybe I'll make a few calls.

Just remember, insurance companies these days automatically come at you assuming you'll just meekly pay the bill, even though they may be liable for some of it. They make more profits that way. Always assume they're lying to you and check the figures yourself.

The exception is life insurance companies. It's pretty hard to argue that someone isn't dead, and it's the one area of insurance I still have respect for.

 

[Valjean]

Medical diagnosis is often educated guesswork jringer, and abdominal disorders are notoriously hard to pinpoint. A malpractic suit -- if you can find a lawyer that will persue it-- will almost certainly get you nothing but a legal bill higher than the original ER charge.

If the Dr told you that things looked OK you can pretty well bet s/he can back that up with the bloodwork, CT and exam results.

What was the hospital to do, admit someone with a probably benign, self-limiting condition for a week waiting for a treatable condition to declare itself? That would be a waste of time, space, money and personnel.
They could have continued with more advanced and unpleasant scans, biopsies and other tests till they discovered the problem, but this would not be cost effective, as well as a waste of time. In 99% of cases nothing treatable would be found.

Not all conditions present with textbook symptoms. Heart attacks don't always cause chest pain, hepatitis doesn't always produce jaundice and infection doesn't always produce fever.

I work in an ER, and if we admitted everyone with abdominal pain of unknown origin we'd have beds lined up in the parking lot in a day or two. What we do is try to rule out the most probable causes of a set of symptoms. If nothing requiring immediate hospitalization is found we discharge the patient with appropriate medication, info sheets on our findings and follow-up instructions, including instructions to phone or return if symptoms X, Y or Z appear. 95% of the time the condition resolves on its own. Occasionally a patient returns with a more clearly identifiable condition and is admitted.

 

[Ringer]

Medical diagnosis is often educated guesswork jringer, and abdominal disorders are notoriously hard to pinpoint. A malpractic suit -- if you can find a lawyer that will persue it-- will almost certainly get you nothing but a legal bill higher than the original ER charge.

If the Dr told you that things looked OK you can pretty well bet s/he can back that up with the bloodwork, CT and exam results.

What was the hospital to do, admit someone with a probably benign, self-limiting condition for a week waiting for a treatable condition to declare itself? That would be a waste of time, space, money and personnel.
They could have continued with more advanced and unpleasant scans, biopsies and other tests till they discovered the problem, but this would not be cost effective, as well as a waste of time. In 99% of cases nothing treatable would be found.

Not all conditions present with textbook symptoms. Heart attacks don't always cause chest pain, hepatitis doesn't always produce jaundice and infection doesn't always produce fever.

I work in an ER, and if we admitted everyone with abdominal pain of unknown origin we'd have beds lined up in the parking lot in a day or two. What we do is try to rule out the most probable causes of a set of symptoms. If nothing requiring immediate hospitalization is found we discharge the patient with appropriate medication, info sheets on our findings and follow-up instructions, including instructions to phone or return if symptoms X, Y or Z appear. 95% of the time the condition resolves on its own. Occasionally a patient returns with a more clearly identifiable condition and is admitted.

Looks like I was part of the unlucky 5%. I understand what you are saying and like I said before, I'm sure it was one of those things that my condition was in an early stage that prevented a more concrete diagnosis. I guess I made the post to vent my frustration for having to pay a nice chunk of change for nothing to show for it. It'll make me think twice before a visit to the ER though. Unless I'm gushing blood, something is broke, or I pass out for some unknown reason, maybe I will just attempt to be more manly and suffer for a few days before I can see my primary care doctor and find out what to do from there. Thanks for the input though and I do understand where you are coming from.

 

[Valjean]

I think you'll find we spend a lot on 'nothing' over the years. Smoke alarms, air bags and various kinds of insurance come to mind. Sometimes they pay off, but usually all we gain is a sense of security.

Your decision to avoid emergency rooms for non-emergent conditions is a wise one. ERs are the most expensive route to medical care and, as the name suggests, they're set up to handle emergencies.
If you think you'll survive a few hours it's way cheaper to use a neighborhood clinic or Dr's office.

 

[slabbey06]

Look at the bright side...you're ok!! AND you got a visit from me while you were sick. That makes it all worthwhile:yes:.

 

[Booko]

Medical diagnosis is often educated guesswork jringer, and abdominal disorders are notoriously hard to pinpoint. A malpractic suit -- if you can find a lawyer that will persue it-- will almost certainly get you nothing but a legal bill higher than the original ER charge.

Exactly.

I work in an ER, and if we admitted everyone with abdominal pain of unknown origin we'd have beds lined up in the parking lot in a day or two. What we do is try to rule out the most probable causes of a set of symptoms. If nothing requiring immediate hospitalization is found we discharge the patient with appropriate medication, info sheets on our findings and follow-up instructions, including instructions to phone or return if symptoms X, Y or Z appear. 95% of the time the condition resolves on its own. Occasionally a patient returns with a more clearly identifiable condition and is admitted.

I spent a night in an ER with things looking like it was appendicitis as well...except the fever was really minimal (not even 99) and there was no nausea. They did put me in a room overnight for observation and pain meds, but that was all.

It took 3 months and several specialists to figure it out, but it turned out I had ripped up my right psoas tossing wood chips about on the job.

 

[Aqualung]

Ask the person you talk to if they are able to make a decision on your case, and if the answer (likely),

I think you left out a couple words there... :cigar:

 

[Booko]

Looks like I was part of the unlucky 5%. I understand what you are saying and like I said before, I'm sure it was one of those things that my condition was in an early stage that prevented a more concrete diagnosis. I guess I made the post to vent my frustration for having to pay a nice chunk of change for nothing to show for it. It'll make me think twice before a visit to the ER though. Unless I'm gushing blood, something is broke, or I pass out for some unknown reason, maybe I will just attempt to be more manly and suffer for a few days before I can see my primary care doctor and find out what to do from there. Thanks for the input though and I do understand where you are coming from.

If your insurance company has a phone line where you can talk to a nurse, that can be a great help in deciding if you need to go in or not.

I did that when I was having the psoas problem. They recommended I see the doc-in-the-box, and the doc there when he touched my right abdomen I nearly flew up on the ceiling and he recommended I go to the ER, because a burst appendix is nothing to fool with.

Though it turned out to be a muscle, it was a sensible call to make.

 

[nutshell]

Well I'm fairly new to the working world and along with that comes the responsibilities of trying to figure out my medical insurance. Was a little surprised by my recent ER bill so I thought I'd throw out a few questions that I had for those of you who are more knowledgeable in the area...

I recently had my appendix taken out which was done on an emergency basis on a Thursday. However, the Sunday before that I went to the ER because I knew something wasn't feeling right in my stomach. Almost felt like real bad stomach flu but I wasn't really nauseas if that makes sense. Anyway, I was in the ER for about 5 hours, had a CT Scan done, blood work, and got stuff for my pain. Had the doctor tell me that everything appears to be OK but from what I was describing to her it sounded like the beginning stages of appendicitis. If I was to develop a fever or the pain gets worse I was supposed to go back to the ER.

Well, the pain was getting worse and worse since my visit but it wasn't until my follow up appointment with my primary care doctor that following Thursday that I had my emergency surgery. Had a CT Scan done by my doctor and it showed that my appendix ruptured.

So, I got my ER bill which totaled about $1,300 out-of-pocket. The price for my surgery and 4 day stay at the hospital...$250 out-of-pocket. Does this sound insane to anyone besides me considering that I was told I was fine by the ER? I know that it could have been possible it was too early for them to catch anything but I guess it just angers me that I'm paying $1,300 out of my pocket when I feel that they did nothing for me. Any chance that you can fight the claim and somehow get the payment reduced since their diagnosis was wrong? I have the money to pay it but hopefully you can understand by now why I don't want to.

The ER didn't do anything???

Actually, they told you that you had the potential beginnings of appendicitis and to return if you developed a fever or the pain got worse. Even though the pain was "getting worse and worse" you waited until you saw your PMC physician rather than returning.

My opinion: Don't blame the hospital. Blame your insurance carrier or yourself.

 

[Ringer]

The ER didn't do anything???

Actually, they told you that you had the potential beginnings of appendicitis and to return if you developed a fever or the pain got worse. Even though the pain was "getting worse and worse" you waited until you saw your PMC physician rather than returning.

My opinion: Don't blame the hospital. Blame your insurance carrier or yourself.

If you read my last few posts you would have realized I wasn't blaming the hospital but was expressing my discontent for my medical bill when they told me I was fine when there was a problem a few days later. However, I appreciate your kind words and your opinion of the matter.

 

[nutshell]

If you read my last few posts you would have realized I wasn't blaming the hospital but was expressing my discontent for my medical bill when they told me I was fine when there was a problem a few days later. However, I appreciate your kind words and your opinion of the matter.

I'm not really sure what to say. You reassert in this post that they told you that you were fine. This contradicts a part of the OP which states you were told it might be appendicitis.

Anyway, regardless of who you blame - medical bills are expensive. I'm surprised if you find that surprising. Even if all they did was tell you that you were fine, there is still the cost of seeing the doctor and the tests done to come to that conclusion.