Feel like I'm being soaked on a medical bill

[robr]

Just throwing this out there, but as an IT guy, if I do say a couple of hours of work at a customer site and they don't ask my rate, do you feel it would be fair that they on the hook if I bill them $5000 and won't negotiate down?

At some point, and it's a different point to each person, a cost becomes unreasonable. For me, reselling a (probably less than) $340 test kit, 5 minutes of a doctors time (lets be generous and say 30 minutes if he looked at some things while not with us) and 10 minutes of a nurses time........ $900 is unreasonable. Everyone has their own number. What if he billed me $5000? Would that change the opinion of the docs in here?

 

[steveny]

As an entirely unrelated side note, the guy was a MAJOR jerk and during the two office visits (the 2nd one was covered) he was rude and condescending to my wife when she asked him questions. Every single question she had, he tried to make her feel stupid. I wasn't there, but my wife has no reason to make that up.

Nothing is worse than paying to be treated like shit. Yesterday I was at the grocery and the cashier had it out for me. I slid my shopper card without being asked and apparently it didn't line up with how she wanted things to go. She grabbed my bread and squeezed it then mashed it against the scanner then lobbed my eggs in the bag and all the while she did not stop with her psycho stare, she would grab the next item and scan it, then place it in the bag without ever taking her eyes off me. Renee started to laugh and it just got worse. LOL... anyways I just walked out and left everything right there for the bitch to put away. Sir, sir, where are you going sir. LOL!!!

 

[NsXMas]

Rob - healthcare costs have been rising at a scary pace.

The single worry that keeps me up at night is medical care. As we age, even though I am financially good for most of my life's expected costs (we live pretty frugally), I am scared that medical costs may bankrupt me due to unforseen circumstances.

My relatives are doctors / nurses, and I have seen their take-home pay shrink due to the insurance companies tightening the screws, even as insurance and medical costs rise.

I love my allergist, and I'm pretty sure they would negotiate if I had a similar situation. Best of luck in this situation. Give the allergist a call and see if they can negotiate.

Keep us posted on the turnout.

 

[steveny]

Just throwing this out there, but as an IT guy, if I do say a couple of hours of work at a customer site and they don't ask my rate, do you feel it would be fair that they on the hook if I bill them $5000 and won't negotiate down?

How about if they did ask and you said, well I don't know you'd have to call the billing department but by the time you get the rate it will be too late to get your info off the hard drive.

See if you were "Practicing" IT you'd be able to do this. :biggrin::biggrin:

 

[steveny]

Rob - healthcare costs have been rising at a scary pace.

The single worry that keeps me up at night is medical care. As we age, even though I am financially good for most of my life's expected costs (we live pretty frugally), I am scared that medical costs may bankrupt me due to unforseen circumstances.

.

I agree. If rates continue to rise at historical levels my insurance will be
greater than 10,000 dollars PER MONTH 25 years from now. This is not a made up figure it is a 7% per year increase on what I am currently paying.

There is only one solution to this problem, everyone that uses pays and if they cant pay they don't use.

 

[SilverStone05]

There is only one solution to this problem, everyone that uses pays and if they cant pay they don't use.

This.

I can't understand how folks can advocate slavery upon our healthcare providers and taxpayers in order to provide a certain standard of living some in this country feel entitled to.

 

[SFNSXguy]

Hmmm, single-payer health insurance for all is starting to sound pretty good, right?

 

[DocL]

Rob, I can understand your frustration. However, there are a few issues here that weren't addressed to begin with.

First, whenever you are presented with a treatment plan, always get a copy which will include the codes and fees. Second, you have the contract with insurance company, not the doctor. The doctor agrees to see X number of patients at a significantly reduced fee because otherwise these patients will go somewhere else. So what does he have to do? He has to see many more patients than he ideally would like to because instead of making, for example, $1.00 per patient he's only making $0.45 per patient. So where does the difference come from, fee for service patients. The problem is, since the practice is geared towards treating patients for a lower fee, the customer service usually sucks.

Now, lets look at overhead he may have. Student loans, staff salaries, payroll taxes, unemployement taxes, malpractice insurance, workers comp insurance, property liability insurance, various supplies such as the allergy kit you paid for, electricity, water, equipment loans, sterilization services (we all like to go into a clean treatment room), rent or mortgage, property taxes, state and local license fees. I can go on for three more pages of overhead costs. I know you understand what I'm getting at.

Next, when a person decides not to pay for services rendered, that is like shoplifting. You pay for the groceries in your shopping cart, right? You pay for the meal you ate at a restaurant, right? So why would you not pay the doctor? Next time you go out to eat, ask to speak to the manager and tell him that you could have made the same meal for less and only want to pay for the actual cost of the food.

So herein lies the value of my contribution. Yes, healthcare is expensive, I struggle with it everyday. I never perform a procedure without informing my patients how much it will cost and how much the crappy insurance will pay. My job is easy: I diagnose, recommend treatment, and discuss all risks and benefits. The patient has the hard job. They have to weigh the risks and benefits and decide if they want to do the treatment. After doing this for 20 years, I don't let my feelings get hurt by someone not wanting to pay. The front door is not far and I know what the end result will be.

This is not a direct post towards anyone in particular. It shows just a little bit of what goes on inside a private doctors office. Oh, don't pay for a procedure with a credit card or check and then decide to stop payment in Florida. It's a 3rd degree felony and I report it to the police. Yes, I have done that for as little as $30 and a bench warrant is issued.

 

[NsXMas]

Or do what the illegals do here, just walk into an ER, give a fake name, get treated, and disappear off the map. The taxpayers get stiffed with the bill.

 

[steveny]

Hmmm, single-payer health insurance for all is starting to sound pretty good, right?

Wrong because there are still people who will not pay. How the hell are you gonna get some dude who is slinging drugs on some street corner to pay? Worse yet so many people have for so long received care for no cost that they will never pay for something that they use to get for free unless they are flat out denied.

In a fair world... man comes into ER with an emergency and a team of people are dispatched to his residence, the 60 inch tv is dismounted from the wall and sold to pay for the ER bill. Point being the individual could have afford health insurance but instead bought a tv with their money.

I grew up really poor but the doctor always got paid. However I think it was a lot different back then and the doctor had more control over billing procedures. I can remember my mother paying the doctor ten bucks for each visit and that was it, that's what the doctor wanted and that's what he got. He would also give us free samples of whatever perscriptions we needed. No BS, no insurance just ten bucks. It's probably the same damn thing now but what the doctor gets is your copay. The insurance, well the money you pay for insurance pays the non-insured's copay. Once you have a really catastrophic problem that's when the insurance refuses to pay or fights with you until you die because if they pay the hundreds of thousands for your health care they won't be able to pay the copay for the jackass that refuses to have insurance. To be clear I'm not talking about people who are between jobs without insurance or the elderly person who has worked all their life, it's the jerk selling drugs or robbing people for a living. That person will always exist and they will never pay for insurance.

 

[robr]

DocL, you know I respect you and have great appreciation for what you do, but I don't think what you describe is analogous to my situation at all. I do want to pay. I just want to pay what the doctor could have expected to have been paid from the moment I walked in the door. I'm sorry if the doctor is getting soaked by the insurance company, it's a crappy spot for him to be in, but he's not going to make up for that on my back. I'm not asking to pay for services at his cost, I'm asking to pay what the insurance company would have paid him. He makes the same exact profit as he could have expected before everyone found out I was not insured. Instead he sees it as an opportunity to make up some of what he feels he has lost from the insurance companies screwing him over. I am not an opportunity, I'm a guy who struggling to pay my bills as it is. His overhead is not my concern, my concern is he expected to be paid XX for the service he was performing for me when I came in that door, and I'm happy to pay XX, but the moment he found out that I wasn't insured, he wants XX*2. Again I ask, what if he billed me XX*5? or *10?? Do you still maintain the same belief? Everyone has a threshold at which they think a charge is unreasonable, mine comes somewhere before $900 for 5 minutes of his time, some of his nurses' and a $340 retail cost test kit. No thank you. I will try to have him call me next week and see if we can reach an arrangement, if not, I'll make sure he has to do a hell of a lot more work for that $900 than spend 5 minutes with us and abuse my wife. You don't get $900 for a few minutes work out of my pocket.

Rob, I can understand your frustration. However, there are a few issues here that weren't addressed to begin with.

First, whenever you are presented with a treatment plan, always get a copy which will include the codes and fees. Second, you have the contract with insurance company, not the doctor. The doctor agrees to see X number of patients at a significantly reduced fee because otherwise these patients will go somewhere else. So what does he have to do? He has to see many more patients than he ideally would like to because instead of making, for example, $1.00 per patient he's only making $0.45 per patient. So where does the difference come from, fee for service patients. The problem is, since the practice is geared towards treating patients for a lower fee, the customer service usually sucks.

Now, lets look at overhead he may have. Student loans, staff salaries, payroll taxes, unemployement taxes, malpractice insurance, workers comp insurance, property liability insurance, various supplies such as the allergy kit you paid for, electricity, water, equipment loans, sterilization services (we all like to go into a clean treatment room), rent or mortgage, property taxes, state and local license fees. I can go on for three more pages of overhead costs. I know you understand what I'm getting at.

Next, when a person decides not to pay for services rendered, that is like shoplifting. You pay for the groceries in your shopping cart, right? You pay for the meal you ate at a restaurant, right? So why would you not pay the doctor? Next time you go out to eat, ask to speak to the manager and tell him that you could have made the same meal for less and only want to pay for the actual cost of the food.

So herein lies the value of my contribution. Yes, healthcare is expensive, I struggle with it everyday. I never perform a procedure without informing my patients how much it will cost and how much the crappy insurance will pay. My job is easy: I diagnose, recommend treatment, and discuss all risks and benefits. The patient has the hard job. They have to weigh the risks and benefits and decide if they want to do the treatment. After doing this for 20 years, I don't let my feelings get hurt by someone not wanting to pay. The front door is not far and I know what the end result will be.

This is not a direct post towards anyone in particular. It shows just a little bit of what goes on inside a private doctors office. Oh, don't pay for a procedure with a credit card or check and then decide to stop payment in Florida. It's a 3rd degree felony and I report it to the police. Yes, I have done that for as little as $30 and a bench warrant is issued.

 

[docjohn]

It is not unheard of to negotiate with a health care provider to accept the minimum medicare rate.Your only other avenue would be for your pediatrician friend to give a call,esp if he is a repeat referer.In general many businesses think they are doing you a favor by putting you on a payment plan.

 

[steveny]

DocL, you know I respect you and have great appreciation for what you do, but I don't think what you describe is analogous to my situation at all. I do want to pay. I just want to pay what the doctor could have expected to have been paid from the moment I walked in the door. I'm sorry if the doctor is getting soaked by the insurance company, it's a crappy spot for him to be in, but he's not going to make up for that on my back. I'm not asking to pay for services at his cost, I'm asking to pay what the insurance company would have paid him. He makes the same exact profit as he could have expected before everyone found out I was not insured. Instead he sees it as an opportunity to make up some of what he feels he has lost from the insurance companies screwing him over. I am not an opportunity, I'm a guy who struggling to pay my bills as it is. His overhead is not my concern, my concern is he expected to be paid XX for the service he was performing for me when I came in that door, and I'm happy to pay XX, but the moment he found out that I wasn't insured, he wants XX*2. Again I ask, what if he billed me XX*5? or *10?? Do you still maintain the same belief? Everyone has a threshold at which they think a charge is unreasonable, mine comes somewhere before $900 for 5 minutes of his time, some of his nurses' and a $340 retail cost test kit. No thank you. I will try to have him call me next week and see if we can reach an arrangement, if not, I'll make sure he has to do a hell of a lot more work for that $900 than spend 5 minutes with us and abuse my wife. You don't get $900 for a few minutes work out of my pocket.

Well the whole reason why the procedure cost XX*5 in the first place is because the medical office knows that they need to mark it up that much so they can get at least XX from the insurance company after the insurance company slices and dices the bill. However Rob you don't pull the same weight as the insurance company does. You can't withhold a 100k check for a bunch of services until the medical office agrees to take 340 bucks for your allergy kit service. You will pay or your credit will be ruined because your not in a position to negotiate, only your insurance company can do that for you, of course after you pay them the ransom money.

 

[Hrant]

Robr - your point is well understood. But unfortunately you fail to "appreciate" that there is continuous "cross subsidization" in what providers accept as payment from various sources.

Sure you want to be "charged" or "priced" the same amount whether you were insured or not, but the reality of the marketplace is that is not how it works. Irrespective of all the other rationale regarding what goes into making the dollar amount in a bill, like any business, those who provide volume get a discount - and in fact there may be provisions in the doctor's contract with some insurers that state most favored nation clause (ie the insurer gets the right to have the lowest price).

I'll give you a "simple" example of the food chain or pecking order. Putting aside those who don't pay (bad debt which gets added to all other payers' bills), the governmental programs such as Medicaid etc pay providers below their cost, in some cases even their direct cost. Hence the provider tries to make up this shortfall from the insurance companies who also want to squeeze the provider. That leaves the walk in "cash cow" who gets another layer of padding to make up now the cumulative net balance of the losses.

Using your totally understandable logic, why wouldn't you argue to pay no more than say what Medicaid would have paid the doctor since the doctor obviously is accepting such payment for some. Follow this thread/logic and you see where it goes - our current crisis in health care.

Having said this, as a cash payer, I see nothing wrong in your request to try to negotiate a lower bill. More power to you and good luck.

 

[steveny]

Rob, I can understand your frustration. However, there are a few issues here that weren't addressed to begin with.

First, whenever you are presented with a treatment plan, always get a copy which will include the codes and fees. Second, you have the contract with insurance company, not the doctor. The doctor agrees to see X number of patients at a significantly reduced fee because otherwise these patients will go somewhere else. So what does he have to do? He has to see many more patients than he ideally would like to because instead of making, for example, $1.00 per patient he's only making $0.45 per patient. So where does the difference come from, fee for service patients. The problem is, since the practice is geared towards treating patients for a lower fee, the customer service usually sucks.

Now, lets look at overhead he may have. Student loans, staff salaries, payroll taxes, unemployement taxes, malpractice insurance, workers comp insurance, property liability insurance, various supplies such as the allergy kit you paid for, electricity, water, equipment loans, sterilization services (we all like to go into a clean treatment room), rent or mortgage, property taxes, state and local license fees. I can go on for three more pages of overhead costs. I know you understand what I'm getting at.

Next, when a person decides not to pay for services rendered, that is like shoplifting. You pay for the groceries in your shopping cart, right? You pay for the meal you ate at a restaurant, right? So why would you not pay the doctor? Next time you go out to eat, ask to speak to the manager and tell him that you could have made the same meal for less and only want to pay for the actual cost of the food.

It's really not the same. Everyone pays the same price for a Big Mac. No one gets to buy their way into a special McDonalds Cross BurgerKing shield plan that will negotiate cheaper Big Macs for anyone on "the plan". the plan will then pay for Big Macs for all those who want to just walk in and eat the Big Mac because they are hungry and have nothing to lose and dont plan on paying anything from the get-go. Then those that do have something to lose but dont have McDC/BKS pay 50 bucks for the same Big Mac that everyone on the plan gets for "an adjusted" .79 cents. Nope, everyone pays 1.99 or they don't get a Big Mac. That's pretty much how the whole world worked until health insurance came along.

 

[DocL]

Rob, I truly sympathize with you. Hopefully the doctor will take into consideration your financial situation and make it right. I have patients paying me $20/mo on a $500 treatment, interest free. The best way to negotiate is to be very polite and not make him defensive. I give discounts, and even free treatment, to patients who are truly appreciative. The whole insurance industry is a big mess on both sides and that is why I'm not an in-network provider for any insurance.

 

[DocL]

It's really not the same. Everyone pays the same price for a Big Mac. No one gets to buy their way into a special McDonalds Cross BurgerKing shield plan that will negotiate cheaper Big Macs for anyone on "the plan" And the plan will then pay for Big Macs for all those who want to just eat the Big Mac because they are hungry and have nothing to lose and dont plan on paying anything from the get-go. Then those that do have something to lose but dont have McDC/BKS pay 50 bucks for the same Big Mac that everyone on the plan gets for "an adjusted" .79. Nope, everyone pays 1.99 or they don't get a Big Mac. That's pretty much how the whole world worked until health insurance came along.

Steve, the problem is people think doctors are making big bucks these days. All of my expenses have gone up 10%-15%, yet I haven't raised my fees to cover the increase, so I'll be eating Big Mac's pretty soon. Then I'll have to go to my doctor more often because I'll become obese and need more medicine and possibly a triple bypass. There is no winning this game.

 

[BD]

Just pay it and move on. It's not 9000 dollars, it's 900. Yes, it is more than what you want to pay, but it is also the price you have to pay when you use service provided by others. You summon the service, service was provided, and now you're having problem with the price after service was rendered. The negotiation train left long time ago.

Consider that a lesson learned and be more cautious.

Imagine Acura charged you 80 bucks for oil change on your NSX and you figured out it can be done by yourself for 40, you can't make that argument with the dealership.

 

[steveny]

Steve, the problem is people think doctors are making big bucks these days. All of my expenses have gone up 10%-15%, yet I haven't raised my fees to cover the increase, so I'll be eating Big Mac's pretty soon. Then I'll have to go to my doctor more often because I'll become obese and need more medicine and possibly a triple bypass. There is no winning this game.

I don't think doctors are making squat compared to what the insurance companies make. The insurance companies can only keep a small percentage of premiums paid for health insurance and use that small amount to pay their salaries. All other funds must be used for claims, im sure you know this. Therefore it's in the insurance companies best interest to get that monthly premium as high as possible. Good reason to NOT try and negotiate a 10k medical device down to its actual cost of 1k. Sure they do negotiate but not enough. That 340 dollar kit that rob spoke of probably is built in china for 50 cents and then imported and sold/traded several times through good ol boys clubs before it makes it to the doctor at a cost of way less than 340 bucks. Even if it's made in the USA there is no way it cost 340 bucks to manufacture the thing. The prices of medical supplies is truly a complete rip off and is where a HUGE portion of medical dollars are wasted. Wheelchairs for 7500 bucks, come on I could put those together in my garage for around 500 bucks.

If they did seriously negotiate health service charges the monthly premiums we pay for insurance and their paychecks would decrease. It's not in their best interest to get the best deal.

Maybe they should buy the company that makes the medical device and charge as much as possible in an effort to get those monthly premiums as high as possible so that percentage they can keep is higher and so their paycheck will be too. Maybe even buy a few hospitals and increase rates there too, or withhold payments to doctors until they capitulate. Just wait until its all under one roof and the positions at the health insurance companies are available only through the election process. people think this crap cost a lot now they haven't seen anything yet. Every hospital room will come fitted with a 600 dollar toilet seat that will be changed out between every patient and the toilet seats will be manufactured by Halliburton.

Recently the saleries of the Excellus personal were posted in the local newspaper, top people making millions and I don't think even IBM has that many VP's making over 250k per year. Sickening!

 

[steveny]

Just pay it and move on. It's not 9000 dollars, it's 900. Yes, it is more than what you want to pay, but it is also the price you have to pay when you use service provided by others. You summon the service, service was provided, and now you're having problem with the price after service was rendered. The negotiation train left long time ago.

Consider that a lesson learned and be more cautious.

Imagine Acura charged you 80 bucks for oil change on your NSX and you figured out it can be done by yourself for 40, you can't make that argument with the dealership.

I don't think you understand how much 900 bucks is to Rob who just started a new job after being without one for a long time AND not from the lack of looking either. You make the comparison to 9000 because that's probably a lot for you, well then just pretend this is you and you now have to pay 9000, still feel the same way. Still think its ok for you to adjust your life for a period of time that it would take for you to pay the 9000?

 

[BD]

I'm fully aware of that. Even a dollar extra is a lot. However, they did offer payment plans. That alone should make things a little easier.

However, as stated by Hrant, you cannot negotiate afterwards, you can however, beg your way through afterwards.

I'm in the middle of relocating my retail shop while having to deal with the current landlord. It is a chess move, one wrong move and the game is over.

Small claims court probably wouldn't even hear the case because there is no damage done. It is a business, as I have indicated, if service was rendered and you missed the negotiation point, it is hard to reverse it.

All you can do is ask again nicely, if they declined, you really don't have much to go on.

 

[druby]

I would suggest going back to the coverage you had that was cancelled retroactively. You said you paid your premium to them and while I am not a big fan of the entire healthcare reform bill part of it says your coverage cannot be cancelled retroactivley. Best of luck.

 

[robr]

I would suggest going back to the coverage you had that was cancelled retroactively. You said you paid your premium to them and while I am not a big fan of the entire healthcare reform bill part of it says your coverage cannot be cancelled retroactivley. Best of luck.

druby - you may have something here... I did of course talk to the insurer already, but realistically if they have this 'policy', one guy pointing out they are violating the law may not be enough to get them to change. but it's worth a shot.

DocL - I always try to be polite whether it be business, doctors, cops, etc unless the other person develops an attitude first, then i decide whether it makes sense to remain polite or act in kind. honey gets you further than vinegar as the saying goes. I am of course also a first hand witness to the fact you provide free services and I and my dad are eternally grateful to you for that. (My Dad has very poor teeth and no dental insurance and DocL greatly helped him out free of charge when even the cheapest, half-assed guy in the area wanted thousands). Sorry we weren't able to meet up last time I was down, I'd still like to take you and Shari (i hope I'm remembering your wife's name correctly) to dinner one of these days.

I find this whole thread an interesting discussion, I hadn't really expected it to turn into something educational, but I'm enjoying reading everybody's insights and opinions about it. Nothing I can do until Monday of course, but good stuff all the same.
It seems for some that I'm giving the impression that I'm trying to screw the doctor which is not at all the case, and I'll be honest, I had a hard time sleeping last night with the thought that some here that I don't even know seem to have that impression. Perhaps I need to develop a thicker skin, but It bothered me a lot probably because I think of NSXprime people in general as an extended family. I think most of us that bought an NSX did so because it was a good value for the money. I look for that in everything I do, whether it's a car or vacuum cleaner or piece of electronics or even food at the supermarket or restaurant. If I feel the value is not worth the expenditure, I will find an alternative. I am very careful with how I spend my $$$ and I think most here would say the same. Hindsight is 20/20 and it's easy to say 'you should have asked what the cost was' or negotiated discounted cash payment up front, but I think that's an unreasonable expectation when I and the allergist office both thought I was insured and my insurance company confirmed I was covered when the doctor's office called them to confirm when my wife showed up for the appointment.

 

[peiserg]

docjohn, I play cards with my pediatrician and do some of his home IT stuff, so we have a very sympathetic pediatrician.

peiserg, i really don't feel like im the ahole here (not sure if you're implying that or not), I haven't gone down the ahole road yet, but until the suggestion came up to talk directly to the doctor, I felt like I was being forced down that path unless i suck it up and pay the bill as is which I will not do without exhausting alternatives. i really don't care who he tells or talks to, he was alleged to be the best in the area and we are not happy with his services or his attitude with my wife or son. i have insurance now, i can just take my kid to lahey, we have no intention of ever returning to this guy. this has absolutely nothing to do with the billing.

Nope, not implying anything. I meant if you become "that ahole" to the guy. Expect to lose his services in the future.

 

[Hrant]

Robr - this is your "pleading" case with the doctor. You already articulated it:

but I think that's an unreasonable expectation when I and the allergist office both thought I was insured and my insurance company confirmed I was covered when the doctor's office called them to confirm when my wife showed up for the appointment.

I would also look into the retroactive denial of coverage; you can check that with your state insurance commissioner or regulator for such law/regulation. I am sure they have an ombudsman or consumer advocacy there at the state agency; there are other such advocacy groups that will help you within your state. If this was indeed the case, the penalties for the insurance carrier could be high.