Let’s suppose you pick up some mediocre health insurance for $150 a month that does cover most illnesses and traumatic injuries and has a 6k deductible. It’s blue-cross blue shield or some other major, semi-reputable brand. (you hear horror stories about em but most docs and hospitals take it)
You get into a car wreck, and you tell the ambulance drivers to take you to the credible hospital in your city. (in Houston, that would be Herman)
So, alright. You need 100k worth of treatment. You don’t quite have 6 grand in your bank account or credit cards. Totally possible to get in that situation - being able to cover $150 a month is quite different from actually having 6k or 10k or whatever laying around.
Will the hospital be able to collect the money above the deductible, or do they not get a dime until you pay the deductible? Will they send you away or dump you to a crummy hospital with shoddy equipment and procedures because otherwise they’d be treating you for free?
Your insurance pays the balance above your deductible, subject to negotiated repayment amounts. You get billed for the deductible, and work out a payment plan with the hospital, or they send it to collections. If they sue you and win a judgement, they garnish your wages an seize your bank accounts, subject to limitations of the Fair Debt Collection Act. Or, you file for bankruptcy.
If the injuries are the result of an auto accident, I believe that the primary coverage is from your auto insurance policy, or that of the person responsible for the accident, while your health insurance is secondary.
(Also, I don’t think the ambulance drivers rely on the injured person to tell them which hospital to choose.)
I also know this part - the hospital dumps you as soon as they can do so legally. (that is, a piece of paper exists that says you won’t die during the ambulance ride)
On the other hand, I had a close relative die, in good part because the ambulance crew insisted on taking him 20+ miles to the ‘county general’ hospital, which had a lower standard of care, than to the premium private hospital a few miles away, for which he had lavish 100% coverage.
We have a situation here several times a year where emergency rooms get backed up and ambulance drivers are told to divert to another hospital. Often those hospitals are also filled and tell the ambulances to divert to yet other hospitals.
Really? The ambulance drivers have to decide where to take someone based on information (or the lack?) about insurance? What id the guy is bleeding out and unconscious? Is this a common occurrence? I guess I never really thought about it. but as a Canadian I find this astounding. We have the same “Our emergency department is full” diversions from time to time, but not “sorry, this hospital does not want you…”
This is a good explanation but I want to make one thing very clear to Habeed: You do not pay your deductible to the insurance company, and the insurance company doesn’t front you the deductible. The insurance company does not get involved in payments until you have already paid the amount of your deductible directly to health care providers.
A friend of ours in Spain last year was knocked down by a bicycle (the rider left the scene). Someone called an ambulance and as they dealt with her bleeding leg, they asked her about insurance. They spoke very little English but she said that they had clearly learned enough to ask.
On being told that yes, they were insured, and remember that in the EU all this stuff is ‘supposed’ to be equal, she was taken to a very plush hospital. They kept her in overnight and her insurance paid up without dispute. On talking to other holidaymakers she was told how lucky she was and they described the standards at the Municipal Hospital as ‘third world’. Probably an exaggeration, but indicative of two different standards.
I do not think the last sentence is accurate. The insurance company is obligated to pay covered expenses over the deductible regardless of whether the insured has yet paid any part of the deductible.
You get treated in the hospital. Days to weeks later the hospital files a claim to the insurance company
The insurance company processes the claim, paying their part directly to the provider and assigning the rest to provider write-off and deductible
The hospital sends you a bill for the deductible. If you don’t pay the hospital the deductible then it’s between you and the hospital like any other debt.
Generally you’ve been discharged for sometime by the time the hospital figures out you’re not paying your deductible. Generally they are not allowed by the insurance company to negotiate for this like they could for noncovered charges.
No. They’ll take you wherever they can get you the care you need, but if you say “I know St X’s is the closest, but I’m employed by Our Lady of Y a couple miles further and have a zero dollar copay there, any chance you could bring me there?” they might accommodate you. Of course your preferences are secondary to providing proper care and they won’t spend all day driving you across town so you can save a few bucks.
I have never had an ambulance driver ask me if I have insurance or where I’m best covered. A hospital cannot refuse to provide life saving emergency care based on ability to pay, either.
This is not exactly a response to the question asked, but I want to point out that the hospital/doctors may bill for $100k of treatment, but this is not what they will receive. Your insurance company has negotiated rates with the providers for different services. You will receive an Explanation of Benefits form from your insurer for each provider that lists the billed amount, the negotiated amount, and the amount you will have to pay (which is 100% of the negotiated amount up to your deductible, and then a percentage [your copay or coinsurance amount] up to your out-of-pocket maximum [if you have one]).
The negotiated discount can be a significant fraction of the billed amount. For instance, I just looked at a bill for some lab tests. The total billed amounts came to $523.88; the insurance discount was $468.20. Since I had not yet met my deductible, I paid the entire $55.68 owed.
Another related point – the amount billed has little if anything to do with what it actually cost to provide those services. Most hospitals use software (the name of which escapes me) to determine their charges. I have heard that in nearly all of these hospitals there is not a single person who understands how the charges were determined.
Just as a point of interest: in vic.Aus, quite apart from the whole health care issue, the billing system is much simpler. Dunno why. Assuming that you are local, with private insurance, they only have 2 private insurance rates: they will have one “preferred” insurer, and all other insurance companies pay the standard rate. If you don’t have insurance, and aren’t local, you pay the standard rate, the same as all the “other” insurance companies pay.
Administration would be a specialist office skill (There are other categories I haven’t mentioned), but there’s nothing to understand: each patient has one classification, and everything flows in a clear way from that.
The hospital does indeed have to make sure you’re stable, even if you show up with no insurance at all.
What happens if they don’t accept your insurance is another issue. If it’s non-life-threatening, you could in theory be on the hook for the entire cost of the treatment. In reality, you will probably be able to negotiate something with them, especially given how bogus “rack rates” are in US medical practice (seriously, I’ve had insurance knock 90% off the billed amount; the hospital had no expectation of ever getting that rack rate).
As far as the original question: the hospital etc. will bill you for the parts that were credited to the deductible. If you don’t have 6K under the mattress, they’ll hound you, but I’d bet you can come to a payment plan arrangement. The “good” thing is, with 100,000 in medical bills, you’re probably better off with a high-deductible plan than a regular one: you’ll hit the deductible, they’ll pay 90% of the rest until you hit your out of pocket, and the rest is “free”.
This is a great point and often one that people do not “get” when deciding whether to purchase high-deductible insurance. Even if you don’t meet your deductible, the actual charges are going to be less than not having insurance.
There are a lot of people who think you should just be able to pay cash and negotiate a better deal. It makes sense, but it doesn’t really work that way. I have been billed for the same services and seen wildly different adjusted prices for Cash uninsured, Cash discount, Private Insurance, Employer Insurance, and Medicaid.