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How do hospitals work? (Money related)


purplejackmama
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We don't have health insurance. Surgery is needed and is scheduled for Monday. Hospital tells me if we pre-pay before the procedure our total is $6400. If we don't pay in full then our total is $22000. Really?

 

Anyone handled a self-pay hospital procedure before? How? What's my next step? I can pay them $3000 on Monday and $3400 in 2 weeks. Do I offer that? Is everything up for negotiations?

 

My brain hurts.

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I prepaid when I had my son but that was 19 years ago. It was approximately half the cost of what it would normally be. I had a few months to pay though, so not quite the same. I worked with the financial aid dept to settle ahead of time, brought a check and was given admission paperwork to give them when I went in to deliver. Barring anything happening that was unexpected, they considered my stay to be paid in full.

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Yes, talk to the finance department of the hospital.  Do it today.  Different hospitals work differently.  See if they will allow you to pay some up front and some 2 weeks later and still let you pay the much smaller amount.  If you are proactive and pleasant but firm about what you can and cannot do they may be willing to work with you.  

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You can offer it.  They may or may not accept it.  If it is not emergency surgery and can wait, they may reschedule you for after you pay it off.  Pre-paying saves the hospital a LOT of money since they don't have to do any billing or keep the file open.

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We were self-pay for one of my births. The hospital reduced the cost to 40% of the original bill as long as I paid in full before discharge. We put it on a credit card and that was the same to them as us paying cash/check. Check with your facility to see if they will take a credit card (if you have enough available credit to do it). You'll have the grace period from your card if you need the 2 weeks to get the rest of the money.

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Ask away.

 

DH had a bill for a test that insurance decided not to cover. It was not a trivial amount, so I called. They knocked 25% off. Then DH got irritated (they used to cover this test, now the don't post-ACA), and he called. They knocked it down to a total of 50% with ten months to pay.

 

We've done that with other bills.  Not office co-pays and such that are a set amount, but things like surgeries and ER visits that our insurance does cover.  And we nearly always get something off or better terms.

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We don't have health insurance. Surgery is needed and is scheduled for Monday. Hospital tells me if we pre-pay before the procedure our total is $6400. If we don't pay in full then our total is $22000. Really?

 

Anyone handled a self-pay hospital procedure before? How? What's my next step? I can pay them $3000 on Monday and $3400 in 2 weeks. Do I offer that? Is everything up for negotiations?

 

My brain hurts.

 

Wow, what a bunch of expletive.

 

I have no advice, but that seems extremely unfair.

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What it does is say a WHOLE LOT about the pricing system for medical treatment in our country.  :glare:

 

Yes, it's all a bunch of (favorite explicative).

 

Over a month ago I called insurance, and they said they only cover "standard" immunizations, not the ones we need for travel.  

 

OK, outbreaks of deadly diseases should be noticed, so we decided to do it for some $340, and we'll file anyway,

 

I negotiated the rate down for the DC at the ped's office (they filed, said they'd bill later) and DH and I went to Costco (we filed).

 

Insurance paid 100% for the kids, and not for us. The statement for ours said to file it with the pharmacy provider.  Immunizations?

 

Conflicting information right and left, so I called.

 

No, immunizations are a medical issue. They should not have put to send it to pharmacy. No, we don't cover travel vaccines.  Why did you bother filing?

 

So why did you cover my kids and not the adults?

 

Three supervisors later, no one can figure this out.  

 

Then it dawns on me that the ped doc probably coded it so we'd get coverage (they're good that way), but Costco is probably a done deal.

 

I look at the clock (it's been 45 minutes) and decide to hang up. We probably got a decent deal in the end with two 100% covered and two at Costco for shots that they're really not supposed to cover. Ultimately we paid $170 instead of $340.

 

Yes, it's a mess all right...

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My mom works in hospital accounting. She has been since I was about 7 (I am 38). She says that NO ONE pays the rate that they say something costs. The reason for this is Medicare HAS TO by law, have the lowest price that is normally a percentage of the price. Something like 20% I think. It could be lower though. Insurance companies and Medicaid have negotiated rates that are different. I have found that for my oncologist who works for a major hospital (major as in teaching hospital and magnet hospital), the rate for self pay is the same as the rate negotiated by my insurance (didn't have insurance when I needed to see her a couple of years ago). 

 

The price they say is there to scare you. They are honestly happy with whatever they can get as long as you are reasonable. There is ALWAYS a negotiated rate available. 

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Insurance always has been a convoluted mess. Now that the federal government has commandeered the industry, things are worse.

 

We have a family member without insurance. I now know that he is not allowed to purchase insurance until November 1st, for coverage in 2016. Short-term insurance for remainder of 2015 will not pay a penny for a pre-existing condition. (no problem with regular, full-year insurance) He needs complete left hip replacement surgery, and "needs it yesterday". Only choices are to wait several months, or to pay the full cost of surgery, hospital, rehab, and physical therapy. (Ask me for my opinion of BaloneyCare.) He is too young for Medicare, and my benighted state does not grant Medicaid at all to a single adult who is not disabled. (I also now know plenty about how difficult is the long process of maybe gaining disability status.)

 

The fact that costs sometimes (often?) are negotiable confirms what a shell game this whole racket is.

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My mom works in hospital accounting. She has been since I was about 7 (I am 38). She says that NO ONE pays the rate that they say something costs. The reason for this is Medicare HAS TO by law, have the lowest price that is normally a percentage of the price. Something like 20% I think. It could be lower though. Insurance companies and Medicaid have negotiated rates that are different. I have found that for my oncologist who works for a major hospital (major as in teaching hospital and magnet hospital), the rate for self pay is the same as the rate negotiated by my insurance (didn't have insurance when I needed to see her a couple of years ago).

 

The price they say is there to scare you. They are honestly happy with whatever they can get as long as you are reasonable. There is ALWAYS a negotiated rate available.

This.

Just this week I got the bill from the hospital for a newborn hearing test...apparently the hospital contracts it out, so it came back as 'out of network' for our insurance. The total was $275. I called our insurance company, and the amount they would have paid the provider was $16.35!!!!

Unbelievable. The providers are charging those who can least afford it, without insurance, hugely inflated prices:(

Our insurance company told me to phone back the provider and ask them to negotiate. Before I even got the sentence out, I was informed they could offer me a 50% reduction. I asked to speak with a supervisor and they changed that to a 75% reduction with minimal conversation or complaint.

 

It infuriates me because unless you know to ask, and just pay bills as we have done many times in the past you are seriously overpaying.

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