In this country the question to ask your doctor when having a heart attack is not can you help me...

The BBQ Pit
1

But are you with my HMO? Is this hospital?

I was taken to the hospital earlier this year, believing I was having a heart attack. Turned out it was the start of a year long battle with anxiety disorder.

Apparently the hospital I was taken to was not covered by health insurance, because apparently in an emergency situation I need to be on top of the who the fuck is and is not covered by my HMO, you know, in between bouts of feeling like you’re going to die and crying, worrying about what your family will do without you, how you’re going to miss you son growing up, or how he won’t know how much I loved him.

I’m on the hook now, for $5,000, for the cost of an EKG, lying in bed for an hour, and taking some Xanax. I’m sure those nurses are going out on steak dinners every night at those prices, if I didn’t know that money was actually going elsewhere.

I can’t afford that. My family can’t afford that. This is going to sink our plans for finally, after trying to save for a long while, to get our first home next year.

It’s also not helping my anxiety on top of that. Why. Why do republicans and their ilk want this system? It’s shit. It’s destroying people’s finances. It’s destroying their health. It kills children, for fucks sake. But I guess lining the pockets of billionaire insurance company CEO’s is more important than the common people and their plights.

So yeah fuck this system. Next time I feel like I’m having a heart attack I guess I’ll need to say: “Doc, doc, are you in my insurance? Otherwise let’s waste precious seconds taking me to another hospital please, well ask there again until we hit the jackpot… or I die.”

Anyone have any ideas as to how I can reduce this bill?

2

While I agree with every word that you have typed, have you actually called up your insurance company yet? Many HMOs (but not all) accept that emergency visits are, y’know, emergencies, and will cover everything above their standard ER copay.

3

Yes, just talk to the hospital. At the very least, they should work out some long term payment plan. It might just be $100/month or something like that.

But these days you really do need to know what your insurance covers and what it doesn’t. A little proactive work will save you a lot of hassle. It shouldn’t be that way, but it is and best to deal with the reality.

4

Yep I just a got a letter from their appeals department who say they have reviewed my appeal and have decided, nope, we’re not paying.

5

They change their list of covered hospitals and facilities and sometimes even doctors up to three times per year. Some times a hospital is covered half of a year, then not.

Not only that but this was an emergency situation. No one asked me where they were going to take me, they rushed me to the hospital believing I was having a heart attack.

What if I would have been unconscious? Or otherwise unable to physically or emotionally connect with the realities of what I need to do to protect my family financially.

And even if I were, what the hell am I supposed to do? Ask them to risk my life taking me to another hospital? I bet you I’d be on the hook for the follow up ambulance ride some how.

This is wrong.

6

I’ve been in several HMOs over the years and ER visits (anywhere) were always covered. It’s bizarre that you’re expected to diagnose your condition before calling an ambulance. Or making sure you’re within reach of a specific hospital.

7

Was this the ambulance personnel/firefighter EMTs? That doesn’t factor into the situation?

8

Have you gotten an itemized bill for the ER visit yet? Chances are, it’ll be shocking.

Every second of oxygen that you used will be accounted for and charged exorbitantly.

That Xanax pill that they gave you that would normally cost pennies? They’ll have charged $200 or more for that one pill.

I went through this a few years ago, and I feel your pain. I didn’t have to pay quite so much as you out of pocket, but once I saw the itemized bill, I balked and refused to pay. I wrote a scathing letter to the hospital, but at the end, I did pay.

9

That is just fucking wrong. I’m sorry you had to deal with that. On a lower level scale, my daughter is on CHIP and has been having stomach issues for over a month. Gastroenterologist orders a few tests which I believe are standard procedure for someone with her symptoms. I was informed the other day that her insurance isn’t paying for one of them. So, when the lab company comes after me for payment, I’m letting the docs office know that THEY will be sending a letter of appeal on her behalf. What was I supposed to do, say to the doctor, I really want my kid diagnosed and better, but I need to call her insurance, wait on hold over 30 minutes and then decide whether or not you can run a test to determine if her stomach pain is caused by intestinal inflammation, which is often a common cause of the symptoms she is having.

10

Why do you hate America?

11

One other thought, did you let your primary care doctor know you were in the ER? I know the rule used to be if you notified them within 24-48 hours or some bullshit, it would be covered. Of course, when you’re going through the trauma of being ill that’s the last thing on your mind. You’d also think now that everything has to be done electronically your doc would know the next day. I know longer have an HMO so I’m not sure what their exact rules are anymore.

12

I learned a delightful fact about my health insurance carrier this year. Actually, a few delightful facts. My plan calls for me to pay a $100 to the hospital ER when the ER visit does not result in admission to the hospital.

It also excludes any coverage to the closest hospital to my home, because that hospital is no longer in network. That’s not a huge issue; my wife hates that hospital, and vastly prefers the one that’s in the opposite direction and marginally further away. That means that ambulance services will need to be thought about twice, as ambulance services tend to take their patient to the nearest ER.

More interesting was when, after an ER visit in May, I received a bill from the ER physician. I expected that, though; it’s made clear that the physician will charge separately. What was unexpected was that my insurance carrier paid NOTHING toward this bill; the ER physician was out of network, and thus I was responsible for paying for his services in their entirety.

Armed with this knowledge, when I had occasion to visit the ER a couple of months ago, I instructed the triage nurse to not let any doctor attend me unless they were within the BCBS network. I received no assurances that this instruction would be followed. In fact the instruction COULD NOT be followed. The ER is staffed exclusively by an EMERGENCY MEDICAL ASSOC INC (that’s the name of the entity that sent me the bill). I suspect that the name of the entity deliberately uses ASSOC in the hope that people will assume that is intended as an abbreviation for “ASSOCIATION,” but it’s really intended as an abbreviation for “ASSOCIATES.” EVERY ER physician at this hospital is out of network for my insurance company. Delightful, right?

It SHOULDN’T be this hard, but I’m going to have to go through the provider directory, and match up in-network ER physicians groups with in-network ER hospitals.

13

What reason did the HMO give for denying your claim?

14

Just that the hospital wasn’t in their network. It’s also the closest to my home, though there is another one not too far. Thing is even if they had asked me to go there under different circumstances, I probably would have declined. My dad died there so I avoid it if I can.

15

Meet with the hospital billing department. Explain the circumstances. Remind them that for the insurance companies they are “in network” for, they would receive a negotiated rate much lower than the amount they billed you.

They probably won’t accept that negotiated rate, but they likely will accept less than the billed amount.

Hospital billing is weird. A few years ago, I had surgery. Insurance was through my husband’s employer, and they had switched insurance companies. We’d gone on a high deductible plan with HSA and the employer had fucked up our HSA account.

Between recovering from surgery and a natural unwillingness to waste hours dealing with the HSA mess that I knew was going to be resolved in a few weeks anyway, I set aside all the bills from the hospital. One day I got the WTF call from them. I explained the situation, and they said, “Gee. Tell you what – pay it off in full now and we’ll give you a 10% discount.”

Since we had enough in our money market account to cover the bill, I put it then and there on my Discover account so I’d also get the cashback bonus.

16

“Don’t get sick. If you do get sick, die quickly.”

17

I am wondering about this part for the OP. If it had been a real heart attack as opposed to anxiety, it may have been covered by insurance regardless of which hospital they were taken to?

18

Most will cover some percentage of ER OoN ER costs if you are admitted. That’s why it’s important to say to the ER doc “If you want to be paid for this, you need to admit me, even if it’s only for a few hours.”

If the OP has more time than money: Take the itemized bill and make yourself an Excel spreadsheet with the items listed down the left-hand side. Make columns for Medicaid and each of the largest local healthcare companies. Then write a FOIA request to the hospital administration requesting the “Reasonable and customary” rates paid for each item by each insurance provider.

Next, ask the hospital’s billing department for proof that each line item was actually provided. There’s a good chance that nobody wrote down how many X’s were used, or how many minutes Y took, and they just applied a standard guesstimate that they always use. If they can’t prove they did it, or that the amounts are accurate, then it should be removed from the bill.

In a separate appointment, take your handy dandy FOIA list, apply the median rate to the remaining charge line items,and attach it to a letter offering a monthly payment you are certain you can maintain. Your final bill should be about 25% of the initial amount. Make higher monthly payments when you can, but always send at least $10 no matter what.

Hope that helps!

19

I’ve been a physician for over 34 years now, and it truly horrifies and depresses me to see what the US healthcare delivery system has become. Doctors exist to generate revenue for the healthcare corporations, patients exist to be trained to ask for the latest procedures and pharmaceuticals, electronic medical records (which could truly do wondrous things to maximize and streamline health care) exist to serve as billing platforms for optimal revenue generation, and any patient is only as sick as their insurance. So sad.

And we can do such amazing things these days! Customized drugs adjusted for our own genetics and that of the disease we’re fighting, which can now cure things which were once a death sentence, heart and brain surgeries done through a pinhole enabling the patient to return to a normal life in days rather than months, implantable devices that will restart a heart or abort a seizure, and lots more. But they’re only available to the lucky or rich few, and meanwhile we struggle to get basic preventive care (which is the most economical kind of care) to the average citizen.

Ok, I’ll get off my soapbox, and stop acting the old burnt-out curmudgeon now.

To the OP: Just keep appealing this with your insurance company and don’t give up until you’ve been told no by at least 3 different levels. And keep talking to the hospital billing folks.

20

Anyone reading this should really, truly, find out if that statement is true for their particular insurance before taking that advice. Otherwise they could get billed for an ER visit and a hospital stay.

I’m pretty certain the Freedom of Information Act doesn’t apply to hospitals, though I’d be happy to be proven wrong.