Hospital Bill/Insurance Question?

[robs477]

As I thought would happen, the “post-insurance” payment medical bills are trickling in and I have a question for @DianaCox and @Larra and of course anyone else.

The Hospital bill submitted was around $110K, they paid the “Negotiated” rate down to $55K and the Hospital sent me a bill saying I still owe the Hospital $3K that was not covered by insurance.

My question is: Do I have to pay this? Or, can I just ignore and hope it goes away? I met my maximum “Out of Pocket” numbers for the year and everything after that is supposed to be covered at 100%. BUT….I know you sign those 9 pages of disclaimers etc saying you are responsible for what the insurance don’t pay. I have a 5 page .pdf of the itemized charges and they are SOOO over inflated and bogus. Should I call them and tell them that and that I will notify my insurance company that they overpaid too and use that to leverage them to help make that $3K disappear, ignore the bill, or do I need to pay it?? I just have no clue? Thxs in advance for your advice.

 

[DianaCox]

Need more details. Starting with, WHAT is the source of the $3K that wasn't paid? Assuming you have already met your out-of-pocket (OOP) for the year before this hospitalization, it could be:

• Per hospitalization/per day copay: that should fall under your OOP max, in which case I don't believe you have to pay (though you need to check your contract to see if the copay is subject to the OOP max limits). I had a $100 per hospitalization copay.
• Services that were supplied by someone out-of-network, which you will argue you didn't choose, the hospital did, and they knew what your insurance was - I have seen this happen with out-of-network anesthesiologists you have NO control over whatsoever.
• Services that were not covered - like TV, phone calls, a charge for private room so someone could stay with you (that cost me $200/night x 3 nights, but a hotel in San Francisco for my husband would have cost more, so I was OK with that!), things like that.
• For any other charges that fall under your in-network benefits, the hospital is contracted to accept the negotiated rate as PAYMENT IN FULL, and they are not ALLOWED to charge you for anything further (besides the copay, which again, you have to check your contract to see if the copays are subject to the OOP max).

Post the 5 page itemized bill AND the EoBs if you can't figure out what was and wasn't paid.

 

[robs477]

Need more details. Starting with, WHAT is the source of the $3K that wasn't paid? Assuming you have already met your out-of-pocket (OOP) for the year before this hospitalization, it could be:

• Per hospitalization/per day copay: that should fall under your OOP max, in which case I don't believe you have to pay (though you need to check your contract to see if the copay is subject to the OOP max limits). I had a $100 per hospitalization copay.
• Services that were supplied by someone out-of-network, which you will argue you didn't choose, the hospital did, and they knew what your insurance was - I have seen this happen with out-of-network anesthesiologists you have NO control over whatsoever.
• Services that were not covered - like TV, phone calls, a charge for private room so someone could stay with you (that cost me $200/night x 3 nights, but a hotel in San Francisco for my husband would have cost more, so I was OK with that!), things like that.
• For any other charges that fall under your in-network benefits, the hospital is contracted to accept the negotiated rate as PAYMENT IN FULL, and they are not ALLOWED to charge you for anything further (besides the copay, which again, you have to check your contract to see if the copays are subject to the OOP max).

Post the 5 page itemized bill AND the EoBs if you can't figure out what was and wasn't paid.

They just sent the whole bill and didn't break down regarding what I owe that "was not" covered. I didn't see any out of network or other stuff, I think, based on what your saying, I need to call them and ask for exacting specifics regarding what they say was NOT covered. I think they just do this and send it out hoping they can get another few thousand and hope that people just pay it. Anyway, here are the charges....and thxs for your time Diana, you are so sweet

Visit to Memorial Hermann Texas Medical
Center


Laboratory

Room Charges

Surgical Services

Page 1 of 5


Total Charge $110,71167

$2,122.00
Comprehensive Metabolic Panel $125.25

Cbc & Diff Automated $342.00

Urinalysis W/ Micro Automated $41.2

Hemoglobin Glycosylated (A1c) $53.25


Antibody Screen Rbc Ea $177.75

Blood Type Abo $93.75

Blood Type Rh Factor $99.75


Basic Metabolic Panel $326.25

Magnesium $57.00

Phosphorus Inorganic $47.50

Level 5 Path Gross & Micro $758.25

$2,708.50

Preoperative Assessment $166.50

Room Chrg - Acute Adult $2,542.00

$65,963.25

Page 2 of 5

Or Acuity F 1st 1/2 Hr $9,686.50

Or Acuity F Additional 15 Mins $46,028.00

Anes Srvs General 1st 30min $1,478.50

Anes Svcs General Add 15 Mins $5,232.00


Preop Prep/Hold Extensive P/Hr $237.75

Phase 1 Pacu-Ea Add 30 Min-1:2 $1,137.00


Phase 1 Pacu 1st Hr-1:1 15 Min $2,163.50

$5,823.75

Pharmacy

Apap 10mg Inj (1000mg/100ml) $750.00

Cefoxitin 1gm Vl (2gm) $113.00

Heparin 1000u Vl (5000u/Ml) $60.00


Sodium Chloride 0.9% 50ml Bag $28.75

Bupivac Lip 1mg Inj(1.3%-20ml) $1,170.00


Hydromorphone Hcl 0.5mg/Ml 30ml Pca $195.75

Soln Lactated Ringers 1000ml $345.00


Soln Nacl Minibag .9% 50-100ml $46.75

Ivf Hydration Up To 1 Hour $666.00

Injection - Sq/Im $263.50


Dexmedetomidine 4mcg/Ml 50ml $1,055.00

Cefoxitin 1gm Vl $41.25


Glycopyrrolate 1mg/5ml Vl $319.25

Neostigmine 0.5mg Vl (10/10ml) $160.00


Hydromorphone 2mg/1ml Vl $26.50

Propofol 10mg Vl (200mg-20ml) $25.00

Ondansetron 1mg/0.5 Ml Vl(4mg) $9.00


Midazolam 1mg Vl (2mg/2ml) $5.00

Rocuronium 50mg/5ml Vl $66.00


Phenylephrine 1000mcg/10ml Amp $13.75

Artficl Trs Pf 0.25% Drps 0.6ml $3.00


Soln Nacl 0.9% Flush 3ml-10ml $13.25

Soln .9% Sod Chl Inj Addvan 100ml $28.75

Tmc-Soln Iv Lr 1000ml $57.50


Mag Sulf-H2o 0.5g Pmx(2g/50ml) $158.00

Fentanyl 0.1mg Inj (.25mg/5ml) $39.75


Sodium Chloride 0.9% 250ml Iv $57.50

Potassium Phos 45mmol/15ml Vl $106.50

$33,670.42

Glucose Monitor Supplies/Day $30.00

Insert Harmonic Ace Crvd Si/St $1,720.00


Cutter Linear Reload 60mm $0.00

Irrigator Suction 2 $176.25

Pack Pbds Lap Chole Hh $251.50


Device Sealer Cvd Ster Small Jaw $0.00

Introducer Sheath T-Peel 11ga $0.00


Rel Endopa Stap 12m Troc $0.00

Kit Care Advanced Laparoscopic $198.50

Kit Cath Silver Soaker 5in $0.00


Cannula Seal Robotic $374.00

Cover Tip Accessory $110.00

Device Positioning Bariatric $409.75

Tubing Insufflation W-Filter $403.75

Trocar Bladeless Xcel $557.00


Reload Egia 60 Artic/Crvd $6,603.75


Seamguard Ets45/60 Uss 45/60 $3,825.00

Kit Disp Accessory Davinci $1,040.00

Dermabond Skin Adhesive $272.00

Supplies

Page 3 of 5

Suture Vicryl I $171.50


Handle Egia 4 Xl $800.00

Reload Egia 60 Artic Med $4,696.00

Applicator Chloraprep 26ml $74.50

Tray Foley Temp Sense 16fr $137.50

Shear 36cm/45cm 5mm $0.00

Drape Instrument Robotic $202.50


Obturator Bladeless 8mm Disp $137.50

Sleeve Scd Calf Stryker $46.25

Stapler Long Length 440mm $0.00

Tip Scissor Metzenbaum $422.92

Kit Bx Air/Water Suction $41.25

Tisseel Frozen Rtu 10ml $2,000.00

Applicator Duplospray Mis 20-40cm $379.25

Shears Harmonic Scalpel 36mm $0.00

Tray Lavage Syr Ster 34fr $28.75

Sleeve Stbl Xcel Can 11m-12m $0.00


Blanket Hyperthermia Warming $76.75

Troc Endo Xcel Bladeless $422.00

Suture Monocryl I $49.00

Drape Lap Chole W/Pouch $76.00

Catheter Gastric Balloon Suct $573.75

Scissor L-Scope Crv 5mm 21cm $0.00

Stapler Cr Linear Cutr 75mm $0.00

Oximeter P/Day $105.00

Leadwire 5 Lead Ge Snap $51.00

Driver Needle 5mm Robotics $3,680.00

Grasper Bowel 30mm Jaw $1,780.00

Shears 5mm Harmonic Cvd $467.50

Page 4 of 5

Shears Hot $1,280.00

$60.00

Scopolamine 1.5mg/72hr Ptch $41.25


Lubricating Jelly 3 Gm Gel $0.25

Apap-Codeine 120-12mg Elx 5ml $13.50

Potassium Chlor 20meq/15ml Liq $2.50

Apap-Cod 120-12mg Elx 12.5ml $2.50

$363.75
Physical Therapy Eval Basic $363.75

Insurance & Adjustments -$106,70755

Insurance and Provider Adjustments $50,928.42

Amount Insurance Paid $55,779.13

Your Portion $4,00412

Balance You Owe $3,03182

Pharmacy/Self Admin

Therapy Services

Page 5 of 5

 

[DianaCox]

The hospital billing things that jump out at me as being BIZARRE:

Or Acuity F 1st 1/2 Hr $9,686.50
Or Acuity F Additional 15 Mins $46,028.00​

So the first 30 min of care in the OR is $10K, and the next 15 min of care was $46K?? Or is that something like $5K/15 min x 2 hr 15 min?

Apap 10mg Inj (1000mg/100ml) $750.00​

$750 for a shot of acetaminophen?? Seriously??
Look at this: http://www.goodrx.com/ofirmev - it says it is VERY expensive - $44/shot. That's quite a hospital markup!

Dexmedetomidine 4mcg/Ml 50ml $1,055.00​

So a total of 200 mcg: http://www.criticalcarecanada.com/p...eting_patients_for_use_of_dexmedetomidine.pdf (yes it's Canada, but still ...): $58.31 per 200-microgm vial (slide 24). Another astounding hospital markup!

Reload Egia 60 Artic Med $4,696.00​

This seems to be much closer to market price: http://www.healthproductsexpress.co...l;jsessionid=BDAA228DA41E41FF2203F31DB1F6667C, based on the sale price!

$4,040.22
$6,977.34​

Lubricating Jelly 3 Gm Gel $0.25​

Seriously? They waste admin time accounting for quarter, for a glob of KY??

Blanket Hyperthermia Warming $76.75​

They charge for giving you a warm blanket?? Did you at least get to take the blanket home??

In any case, I can't tell you anything without seeing a detailed breakdown, and your EoBs which specify what was and wasn't covered, and what the insurance company says was your responsibility.

 

[chevtow]

I haven't received any bills or EOB's yet. I know I met my cash out of pocket before surgery but I still hoped to see a bill, so I knew what it cost. Is that normal? Or do I need to request that? Sorry Rob for the small hijack

 

[southernlady]

I haven't received any bills or EOB's yet. I know I met my cash out of pocket before surgery but I still hoped to see a bill, so I knew what it cost. Is that normal? Or do I need to request that? Sorry Rob for the small hijack

Most EOB's are done electronically these days. Check your profile on your insurance company website.

 

[robs477]

I haven't received any bills or EOB's yet. I know I met my cash out of pocket before surgery but I still hoped to see a bill, so I knew what it cost. Is that normal? Or do I need to request that? Sorry Rob for the small hijack

NP, @chevtow ...ask away, we all learn as we go along! Its kind of like....the ole saying..."Let sleeping dogs lie" huh...dont want to ask just in case it awakens some accountant...lol

 

[robs477]

The hospital billing things that jump out at me as being BIZARRE:

Or Acuity F 1st 1/2 Hr $9,686.50
Or Acuity F Additional 15 Mins $46,028.00​

So the first 30 min of care in the OR is $10K, and the next 15 min of care was $46K?? Or is that something like $5K/15 min x 2 hr 15 min?

Apap 10mg Inj (1000mg/100ml) $750.00​

$750 for a shot of acetaminophen?? Seriously??
Look at this: http://www.goodrx.com/ofirmev - it says it is VERY expensive - $44/shot. That's quite a hospital markup!

Dexmedetomidine 4mcg/Ml 50ml $1,055.00​

So a total of 200 mcg: http://www.criticalcarecanada.com/p...eting_patients_for_use_of_dexmedetomidine.pdf (yes it's Canada, but still ...): $58.31 per 200-microgm vial (slide 24). Another astounding hospital markup!

Reload Egia 60 Artic Med $4,696.00​

This seems to be much closer to market price: http://www.healthproductsexpress.co...l;jsessionid=BDAA228DA41E41FF2203F31DB1F6667C, based on the sale price!

$4,040.22
$6,977.34​

Lubricating Jelly 3 Gm Gel $0.25​

Seriously? They waste admin time accounting for quarter, for a glob of KY??

Blanket Hyperthermia Warming $76.75​

They charge for giving you a warm blanket?? Did you at least get to take the blanket home??

In any case, I can't tell you anything without seeing a detailed breakdown, and your EoBs which specify what was and wasn't covered, and what the insurance company says was your responsibility.

On the EOB's there's even less info than that. I'm just going to ignore this for a couple months and see how serious they are or are they just casting a hope net. I'll wait and see if they start threatening me and then take it from there...lol

 

[chevtow]

Most EOB's are done electronically these days. Check your profile on your insurance company website.

We still get ours mailed. I actually just got one today from 5-20-14, that better be a damned mistake. Shouldn't take almost a year and it's from pre-op labs - $1400 and they denied it.

 

[southernlady]

We still get ours mailed. I actually just got one today from 5-20-14, that better be a damned mistake. Shouldn't take almost a year and it's from pre-op labs - $1400 and they denied it.

THAT sounds like the lab FORGOT to submit it in a timely matter. I typically use that mistake to my own advantage...as in telling them to pound sand for the money but I put it in writing and why so it doesn't haunt me later as an unpaid bill.

 

[Spiky Bugger]

The hospital billing things that jump out at me as being BIZARRE:

Or Acuity F 1st 1/2 Hr $9,686.50
Or Acuity F Additional 15 Mins $46,028.00​

So the first 30 min of care in the OR is $10K, and the next 15 min of care was $46K?? Or is that something like $5K/15 min x 2 hr 15 min?

Apap 10mg Inj (1000mg/100ml) $750.00​

$750 for a shot of acetaminophen?? Seriously??
Look at this: http://www.goodrx.com/ofirmev - it says it is VERY expensive - $44/shot. That's quite a hospital markup!

Dexmedetomidine 4mcg/Ml 50ml $1,055.00​

So a total of 200 mcg: http://www.criticalcarecanada.com/p...eting_patients_for_use_of_dexmedetomidine.pdf (yes it's Canada, but still ...): $58.31 per 200-microgm vial (slide 24). Another astounding hospital markup!

Reload Egia 60 Artic Med $4,696.00​

This seems to be much closer to market price: http://www.healthproductsexpress.co...l;jsessionid=BDAA228DA41E41FF2203F31DB1F6667C, based on the sale price!

$4,040.22
$6,977.34​

Lubricating Jelly 3 Gm Gel $0.25​

Seriously? They waste admin time accounting for quarter, for a glob of KY??

Blanket Hyperthermia Warming $76.75​

They charge for giving you a warm blanket?? Did you at least get to take the blanket home??

In any case, I can't tell you anything without seeing a detailed breakdown, and your EoBs which specify what was and wasn't covered, and what the insurance company says was your responsibility.

I had the shakes, as in freezing.to.death coming out of general and they used some big, wonderful, disposable I think, heating blanket that eventually let me stop shaking. It may have been worth that $$.

 

[Barbara]

@robs477 just a heads up--I owed a local hospital$100.00. Never got a bill. Obviously never paid it. Pulled my credit report to get loan for surgery. Account in collection. Never even knew about it. Paid it but it cost me the loan. It won't go away

 

[Charris]

@DianaCox too damn funny. I guess at that price for a warm blanket I no longer feel bad that I brought one home that my dogs now sleep on.

Hospital bills are ridiculous. You should have seen what they sent to my insurance company for my extended stay Sept and October. 1 shot of morphine was 175. You can imagine was pharmacy was with all the meds pain and vites they gave me over 6 weeks. But one can't be disputed even if you knew what the price was when you were in the situation we would still be like pile it on plus I'll give you my first 2 grandchildren as collateral.