Can't Afford the ER Bill
Reducing Hospital Bills
Cut Health Care Costs
I recently went to the emergency room for the first time in my life. The bill for this is scary. I don't know what to do. Does anyone have experience with or advice on how to research and dispute these very excessive charges?
As a nurse, I have an "insider's" knowledge of such things, and when my son was seen in the emergency room, I called the hospital's billing office and requested an itemized statement or bill. Much to my surprise, I was being billed for items that were not used.
My son was seen for a laceration on the forehead, for which he received stitches. A suture kit was used which included sterile wipes and a foil pack of antibiotic ointment, yet I was being charged for a four-ounce bottle of sterile cleaning fluid and a two-ounce tube of antibiotic ointment. I brought this to the attention of the billing office, and the items were promptly removed. Become informed and ask! It can only help!
Carmen in San Antonio, TX
There is a book at our library that may help the person with the shocking emergency room bill. It is called An Insiders Guide to Understanding Your Hospital Bill. It was published in 1995.
I'm an emergency department nurse, and perhaps I can offer some help to this person whose bill arrived and almost sent her back to the hospital with heart palpitations.
ER's have extremely high overheads. They must pay personnel to be there to cover whatever comes up, even if it's a slow day. The equipment used and the cost of maintaining it is crazy. But much of the high cost is also due to those who use the emergency department as their primary source of health care, and who don't bother to even acknowledge the bills they incur.
Know that your bill reflects someone's memory, and on a busy day, their memory may cause them to add or subtract actual equipment or supplies used, procedures done, etc. Look over your bill. Make sure each charge reflects an actual item or procedure involving your care.
Then call and speak calmly to the manager of the department. Ask him or her to explain the charges, and let them know if you feel you were billed for a service or supply not used. Explain that you are not insured if that is the case, and that this is an extraordinary expense for your budget. See what they will do for you. Sometimes a fee is waived. Much of it may depend on your approach. Don't be antagonistic, but share your very real concern.
If they are unwilling to negotiate the bill in any way, ask them if you may submit payments over a period of time. They will likely transfer you to someone in billing.
Ask also how you may avoid such an expense in the future. Is there an "Ask-A-Nurse" service that may be able to give phone advice? How can you get hold of your own doctor after-hours (or whoever may be covering the practice at that hour) for advice from him/her?
As an RN, who works in a local small hospital, I am well aware of the potential for problems in billing that can occur with any entrance into the hospital system. The first action I would take is to call the billing department and ask for an itemized list of everything billed to your account for that visit. While you are on the phone, ask if they have someone who might be able to translate any difficult medical abbreviations, or perhaps a patient advocate that you could contact to talk with about your bill. Be pleasant, patient and honest about your concerns with your bill. Find out who you need to contact after having reviewed your bill. If you get someone who is rude, pleasantly hang up and call back at another time or another day and try again.
When you receive your itemized list, go through it carefully and evaluate what is listed compared with what you remember about your visit. Call your patient advocate with questions. When you have determined all charges relevant to your care, call or make an appointment to see someone in billing. Go from there. Different hospitals will handle these situations differently, but maintain your calm, patient, but persistent stance that you will not pay for services or care not rendered.
Remember, too, that an Emergency Room should not be used as a clinic, just because you couldn't get in to see your doctor, or because you need cough syrup and the drug store is closed. Abuses of the system, which are encountered regularly, are the main reason that medical care in this area is so high. Don't be part of the problem. Be part of the solution and the health care system should respect you for that.
I went through this very same thing recently. I contacted the billing department of the hospital, explaining that (at the time) I had no health insurance. I asked if there was anything they could do to give me some relief in the billing.
After a short meeting with one of the billing representatives, they cut the bill, on the spot, by 45%. Then they went the extra step of referring me to a couple "in-hospital" programs to see if there was any further assistance available to me. Thanks to a bit of perseverance and legwork an $11,000 bill was dropped to just over $900 and they let me pay that in interest-free installments.
Whenever I get a bill from the hospital, I show it to my doctor. Even if my doctor wasn't involved on the incident, he or she can immediately pick out charges that don't make sense.
Several years ago, I had cosmetic surgery that was covered by my insurance. The "remainder" that I owed was $800. I happened to be living with a nurse who noticed I had been charged for blood warming, though I did not have any blood transfusions. At my follow up appointment, I showed the bill to my doctor. His first response was "Cool, I never get to see these things." His next response was a list of things I should dispute, including some little things that were double billed (nasal catheter) as well as expensive medications he did not prescribe. In the end, my bill was reduced to $300. It's always worth the few minutes to ask the doctor.
I had an outrageous hospital bill, so I called and asked to have it audited. My charges were cut nearly in half! It's such a simple thing that it's definitely worth a try.
If you have no insurance, submit a written request to both the hospital billing department and ER physician's billing service requesting an adjustment of your bill. Explain your lack of insurance and knowledge that HMOs and PPOs pay only 30 to 60% of the billed amount via their contractual relationship. Your best bet is to submit an offer to pay 60% of the billed amount, in full, immediately. Most places will accept this type of offer.
Also, most places have a discount in place for people without insurance. For instance, if a patient calls and asks for some type of financial consideration, we are authorized to give a 25% discount for immediate payment in full. If you had x-rays or an EKG, you will have to do this for the Radiologist's/Cardiologist's bill as well.
Please note that if you do have insurance and all benefits went to your deductible, the same procedures listed above should apply.
Diana in Tennessee
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