Advice on how to protect one's self financially when visiting a doctor/hospital

[Ecky]

Hi all, could use some advice.

My wife has a chronic pain condition. Not long ago, she went in during a period of intense pain (mentally not 100% with it) and her doctor decided to do some tests, to see if there were any obvious indicators (which all came back negative). The conversation, best I can gather, was essentially, "I'm going to take some blood and have a few tests run". Today we received a bill for nearly $5,000, none of it covered by insurance, for the tests the doctor decided to run.

We called the billing department and spoke with the floor manager, and were told that it is essentially "your responsibility to know what you're being tested for, and whether your insurance will cover it. You should have postponed, asked for a list of procedures, and called your insurance to verify all of them". When asked if it was reasonable for the office to advise patients on this, we were also told that was our own responsibility as well. Fair enough, consider us educated.

At the time my wife was not mentally in a place to be able to make those decisions. It certainly gives me pause when visiting a doctor.

My question is, what do we need to know going forward? Is there anything we can do about the medical bills? For example, if we call our insurance, are they likely to be able to help? Does a doctor/practice/hospital have any requirement to inform patients what they're doing and charging for, or can they just use their own judgement and charge for things as they see fit?

[SailingOnASmallSailboat]

I've got no advice but only a jaw drop head shake of sympathy. That is an absolutely insane response, IMO. I'd probably be calling my insurance company and the doctor's office itself (not billing) and raising holy hell. Is it an employer-sponsored plan? If so, I'd rope in HR to help deal with this.

[geekette]

That's awful - were they really denied?  Or did they go to your deductible?

Yes, talk to the doctor.

[ericbonabike]

This is one of the many problems wrong with the American medical system.

My son was born about 2.5 years ago. During the 48 hour stay a random technician came in to do a test.  We didn’t ask if it was covered. She said it was mandatory. It was a hearing check.  I remember thinking “they’re hooking up this complicated contraption to my son and they could have just waited a week or two”. By that time, auditory stimulus like snapping would have caused my son to look right or left.

About 6 months later we received a bill for $300 for the auditory test.  It was from some company I’d never heard of. I called the hospital billing dept and they said the test was administered by a 3rd party.  I said, well they looked like HOSPITAL employees.   I was told I should have asked if the test was covered by insurance.

I decided simply not to pay.  I understand this isn’t applicable to everyone. But my house is paid off.  I don’t expect to need “Good” credit anymore. 


I never got a single follow up.  It’s been 2 years since receiving that first letter.

And I could only imagine that it’s kinda like a phishing scheme.  Send out collection letters.  A percentage of people will pay it.  And it’s basically free money.

[Padonak]

That's horrible.

[BeanCounter]

It’s on your EOB, but if it’s unclear call and ask your insurance company if it was covered at all, Or if this is just the deductible that is owed. If it was not covered ask why. If it was covered, ask if the providers were in network and if so are the network discounts were applied.
The US has a very screwed up health care system. No argument there. But one of the things you can do to protect yourself is to make sure you really understand your insurance policy. You need to know things like how much your deductible is, what providers are in network, what your responsibility is if you use an out of network provider and if you are required to have a pre-authorization for tests or procedures. This is your responsibility not the providers.

[Runrooster]

It’s on your EOB, but if it’s unclear call and ask your insurance company if it was covered at all, Or if this is just the deductible that is owed. If it was not covered ask why. If it was covered, ask if the providers were in network and if so are the network discounts were applied.
The US has a very screwed up health care system. No argument there. But one of the things you can do to protect yourself is to make sure you really understand your insurance policy. You need to know things like how much your deductible is, what providers are in network, what your responsibility is if you use an out of network provider and if you are required to have a pre-authorization for tests or procedures. This is your responsibility not the providers.

Yes.

I work in medical billing.  We have at least one procedure that is problematic; patients are sometimes aware of this and call their insurance to verify that it will be covered, but often they just do it and hope for the best.  We do try to help fix it, including sending medical records of why the procedure was ordered.  But, obviously doctors don't know what insurance you have, what is in network and covered, they just know what they think is advisable to perform.  We do try to prevent problems with even more expensive tests by doing preauthorizations.  I don't know if that part is our responsibility or just common courtesy.

[SavinMaven]

We have one system for delivering care, and a completely separate system for paying for care - and it's not like Target, where the price is on the shelf. The patient doesn't know the final price until AFTER the care has been given. And while I understand if something unexpected happens, the price might change, the fact that you still can't get a solid price quote beforehand for an uncomplicated scenario - that's nuts.

Our healthcare system isn't great. But our healthcare PAYMENT system is ridiculously broken.

[ericrugiero]

We have one system for delivering care, and a completely separate system for paying for care - and it's not like Target, where the price is on the shelf. The patient doesn't know the final price until AFTER the care has been given. And while I understand if something unexpected happens, the price might change, the fact that you still can't get a solid price quote beforehand for an uncomplicated scenario - that's nuts.

Our healthcare system isn't great. But our healthcare PAYMENT system is ridiculously broken.

Yes.  The hospitals also make the bills as complicated as possible so that you won't question them.  I always ask for an itemized bill and there is almost always something wrong. 

One thing that should be easy for the lawmakers to do is to require medical facilities to publish the cost for a given procedure.  That would make it easy to shop around and compare costs.  For example:
Childbirth with two nights in hospital  $XX,000
Each additional night $X,000
C-Section $XX,000
etc

[Fru-Gal]

Do not "just pay" that bill. Give it time. They themselves will begin to negotiate with you, or if not, you can start. This EXACTLY like buying a car at a dealership. DO NOT pay sticker price.

[Fru-Gal]

But going forward, try to avoid ambulance rides, medical imaging and helicopter rescues.

[Sibley]

OP, your wife was in intense pain and wasn't completely with it mentally. That tells me that she's not fully competent - which means, why wasn't someone with her? Also, you didn't say of course, but she probably isn't safe to drive in that condition.

Yes, the system is messed up. You can't change the system. But you can drive your wife to the doctor when she's in pain, and sit in to help take notes, ask questions, etc. (Just be careful not to be controlling. If the tests are needed, then they're needed and you pay the money.)

[Fru-Gal]

Also, it’s probably not warranted in this case, but you could contact your state insurance commissioner and/or local media.

I totally had this thought!

[Paul der Krake]

What kind of insurance? What kind of hospital? These matter a lot.

I always pick the largest carrier that’s available to me, and go to large teaching hospitals, not the small community one. That seems to greatly reduce the risk because they both need each other.