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Bridget

medical bills

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Not sure where this thread should go, so here I am.  A little about me...I am 55, married, and live in Iowa.  I work full-time. We have never had money and always had to worry, at least until recently.  Last year, we had a big problem with a debt and settled.  Things were going pretty well since my husband was called back to work earlier in the year.  In August, I went to the emergency room with chest pains.  I wouldn't have, except I really thought I was dying.  I was there about 12 hours.  They did all sorts of tests and never did come up with a diagnosis.  I believe I had a panic attack.  Turns out our medical insurance had not started back up again, even though husband was back to work after being laid off.  Now the bills are rolling in, $17,000 so far.  Apparently every doctor who smiled at me is now billing me.  We own our home, with mortgage and saved a tiny bit of money, which was to be used to replace our oven, but that is all we have.  I don't know what to do, but am thinking of bankruptcy.  It feels shameful, as I was raised that way, but don't know what else to do.  I won't underestimate my own selfishness, as for the first time in my life I am actually able to save and have/do a few nice things.  I'm just not accepting of giving them everything I have until I'm too old to do anything.  Thanks for letting me vent here.  I don't have anyone to discuss this with, as we've always been private people, especially about finances.  If this should go in another forum, moderators feel free to move it. 

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Hey Bridget, Welcome! To answer your question and hopefully give you some peace of mind, I'll tell you based on personal experience, that the situation is nowhere near as bad as it appears at first blush. BUT, you need to get on this soon.

First thing, check with Amazon and get the Kindle book "How to Negotiate Your Hospital Bill and Apply For Financial Assistance" . If you don't have a Kindle, there's a free Amazon App to read the books on your computerI believe, you may have to hunt for it. It's a good book and it mirrors a book by Ralph Nader that he wrote years ago. Actually, buying a Kindle to get the book, if you should have to, would be very, very cost effective.

To put it in plain English, the price you are being billed is 3 or 4 times what an INSURER has contracted with the hospital to actually pay. In other words, it's a scam. Uninsured people are charged much more than the insurance companies pay for the same procedures. Read the book and negotiate this down.

Best of luck to you, and remember, 90 percent of the stuff we worry about NEVER happens. Let me know if I can be of further assistance.

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Before you go spending money on books, keep reading here and use google.  You can get basically the same information for free.

 

http://www.needhelppayingbills.com/html/how_to_find_assistance_with_ho.html

 

This link lists several government organizations that help with medical bills for the uninsured.  There are also charity organizations that help with these things.  You may be able to call your hospital's billing department and ask them if they have a charity that they work with or if they have a program to help uninsured pateints.

 

I would start there and keep working at it.  There is no shame in bankruptcy, but I would keep it as a last resort.  For me, bankruptcy would be the choice after I have been sued and beat in court ... and that will be years from now. So you have time to deal with it and learn how to make strategies for possible collectors or set up affordable payments.

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The.book costs a whopping $2.99 and takes 30 minutes to read if you skip over the insurance stuff, which is not applicable in this case anyway. I think the book is worthwhile just to have all the info available in one place. But, whatever.

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@Bridget

 

This link is from Mercy Medical Center in Des Moines.  They say they will not bill uninsured patients more than what they would bill insured patients.  They will also give free care if you are very low income.  Contact the hospital who is billing you and ask if they have similar programs.

 

https://www.mercydesmoines.org/for-patients/financial-assistance

 

 

This is an article from the Jan. 2015 NY Times.  There was a regulation passed by the IRS and Treasury dept.  All not-for-profit hospitals must offer the same help for the uninsured as Mercy Medical in Des Moines above.

 

 

http://www.nytimes.com/2015/01/12/us/politics/new-rules-to-limit-tactics-on-hospitals-fee-collections.html?_r=0

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Apparently every doctor who smiled at me is now billing me.  

 

THIS is the issue.  While the HOSPITAL itself may have charity care as an option for low income/uninsured patients, the providers who are self employed independent physicians are not required to offer charity care at all.  It is certainly wise to ask but if they say no there isn't any recourse unfortunately beyond bankruptcy.

 

@Bridget

 

This link is from Mercy Medical Center in Des Moines.  They say they will not bill uninsured patients more than what they would bill insured patients.  They will also give free care if you are very low income.  Contact the hospital who is billing you and ask if they have similar programs.

 

https://www.mercydesmoines.org/for-patients/financial-assistance

 

 

This is an article from the Jan. 2015 NY Times.  There was a regulation passed by the IRS and Treasury dept.  All not-for-profit hospitals must offer the same help for the uninsured as Mercy Medical in Des Moines above.

 

 

http://www.nytimes.com/2015/01/12/us/politics/new-rules-to-limit-tactics-on-hospitals-fee-collections.html?_r=0

 

While the hospital has to offer it, the doctors do not.  The problem is the bills the OP is receiving for services provided by contractors that were consulted for care.  The hospital has ZERO control over them and their billing and they are not required to offer charity care.

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THIS is the issue.  While the HOSPITAL itself may have charity care as an option for low income/uninsured patients, the providers who are self employed independent physicians are not required to offer charity care at all.  It is certainly wise to ask but if they say no there isn't any recourse unfortunately beyond bankruptcy.

 

 

While the hospital has to offer it, the doctors do not.  The problem is the bills the OP is receiving for services provided by contractors that were consulted for care.  The hospital has ZERO control over them and their billing and they are not required to offer charity care.

 

 

It depends on the hospital and if the physician is employed by the hospital.  Mercy Medical Center's charity care program linked above will cover physician services if they are employed by the hospital, but not private physicians.  Nevertheless, the OP has a lot of private physician bills to contend with, although $17K in private physicians bills for 12 hours in the ER seems unusually high. It could be she was in a for-profit hospital that doesn't provide charity care.

 

https://www.mercydesmoines.org/Portals/0/Hospital%20Financial%20Assistance%20Policy-English-03-14-12.pdf

 

 

Hospital Facility patients/guarantors shall be notified when the Hospital Facility determines the amount of financial assistance discount eligibility related to services provided by the Hospital Facility. Patients/guarantors shall be advised that such eligibility does not include services provided by non-facility employees or other independent contractors (i.e., independent physicians, physician practices, anesthesiologists, radiologists, pathologists, etc. depending on the circumstances). The patient/guarantor shall be informed that periodic verification of financial status shall be required in the event of future services.

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Thank you for the information.  Mercy Medical Center is indeed where I went, so this should be helpful.  The biggest bill ($14,299) is coming from the hospital itself.  The rest I am being billed is from assorted doctors, so I wll have to figure this out.  Honestly, it all got a little side tracked because of Christmas.  The hospital did finally send me the bill itemized.  Now I am going to try to ascertain exactly what the medical jargon is.  From what you learned about Mercy, does that mean it won't be necessary to find out what they would charge Medicaid folks or insurance companies?  Because that was to be my next step, but from what you are saying, it sounds like they don't charge more??

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Well, that's interesting it's the same hospital.  Are you a low-income person as they define it in their policy?  If so, you should be eligible for free care.  I would print out their policy and go the Manager of the Billing Dept and tell them you're either entitled to free care (if you are low-income) or to whatever they would charge a Medicaid patient.  Tell them you expect them to abide by their policy and the law.  You might also speak with the hospital Administrator.  In fact, I would speak with him/her first.  They can sometimes resolve issues faster.

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Well, that's interesting it's the same hospital.  Are you a low-income person as they define it in their policy?  If so, you should be eligible for free care.  I would print out their policy and go the Manager of the Billing Dept and tell them you're either entitled to free care (if you are low-income) or to whatever they would charge a Medicaid patient.  Tell them you expect them to abide by their policy and the law.  You might also speak with the hospital Administrator.  In fact, I would speak with him/her first.  They can sometimes resolve issues faster.

 

It isn't necessary to go right to Administration.  While the hospital is required to offer charity care, the key word is OFFER.  It isn't automatic.  The patient must APPLY to the financial aid department for that care and indigent exemption.  Start with the Patient Representative or a Manager in the billing department and ask how you apply for this program.  If you go back and read what you posted it clearly states that periodic financial review may be needed to continue to be eligible.  In order to get that care written off the patient must apply for charity care and present proof of their financial need.  

 

Also, that article states they won't charge more than they bill Medicaid or other insurances.  It does NOT say that the poor are ENTITLED to free care automatically and NOTHING makes a billing department become less helpful than the patient who confronts them with what they are "entitled" to from their facility.  There is a limit to how much money each facility has in its fund for charity care and once the fund is exhausted then they do not have to provide that assistance from that point forward.  If the itemized bill is at the Medicaid rate that is all they are required to do to comply with that regulation.  

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It isn't necessary to go right to Administration.  While the hospital is required to offer charity care, the key word is OFFER.  It isn't automatic.  The patient must APPLY to the financial aid department for that care and indigent exemption.  Start with the Patient Representative or a Manager in the billing department and ask how you apply for this program.  If you go back and read what you posted it clearly states that periodic financial review may be needed to continue to be eligible.  In order to get that care written off the patient must apply for charity care and present proof of their financial need.  

 

Also, that article states they won't charge more than they bill Medicaid or other insurances.  It does NOT say that the poor are ENTITLED to free care automatically and NOTHING makes a billing department become less helpful than the patient who confronts them with what they are "entitled" to from their facility.  There is a limit to how much money each facility has in its fund for charity care and once the fund is exhausted then they do not have to provide that assistance from that point forward.  If the itemized bill is at the Medicaid rate that is all they are required to do to comply with that regulation.  

 

.  You might want to read a link BEFORE YOU POST.  Their policy states that THEY will interview patients first to determine if they qualify, and if they do qualify, help them to apply.  From what the OP says, it seems she was not informed of the hospital's assistance policies.  Also, there is nothing at all wrong with going to the Admin or the Billing Dept and asserting one's rights. Going to the Admin first rather than Billing was suggested because  1. Admin has the final say in how or if someone is charged and 2. Admin tends to be more patient-oriented while those in Billing see people as debtors.  NOTHING was said about being confrontational. And yes, if someone meets the eligibility requirements to receive free or discounted care because of their  low-income, then per the hospital's stated policy they are ENTITLED to (or qualified for) said care.  As Mercy Medical says:

 

A discount up to 100% will be extended to those uninsured or underinsured patients 

whose family income is equal to or less than 130% of the HUD Geographic Very-Low Income 
Guidelines. 

 

 

 

HOW TO APPLY FOR FINANCIAL ASSISTANCE

When you are registered as a patient, we will ask about your coverage for health care services. If you don’t have coverage or it is not likely to be sufficient, we will either give you a packet of information that covers our financial assistance policy or offer the immediate assistance of a financial counselor, who will go over the financial assistance application with you.

 

Most hospitals must comply with the the Treasury/ IRS Final Rule implementing these regulations:

 

http://healthaffairs.org/blog/2015/01/23/additional-requirements-for-charitable-hospitals-final-rules-on-community-health-needs-assessments-and-financial-assistance/

 

The new regulations were imposed because:

 

  A series of Congressional hearings conducted by Republican and Democratic Members of Congress alike focused on excessive charges, the absence of financial assistance, and the use of exceptionally harsh billing and collections practices; these practices included stationing debt collectors in emergency departments, withholding treatment from people with outstanding bills for prior care, and imposing wage garnishment and liens.

 

 

The Rule requires hospitals to be PROACTIVE:

 

The thrust of the final rule is to require charitable hospitals not only to have financial assistance policies but to take affirmative, repeated, and proactive steps to actually make their financial assistance available and accessible to the population in need, not only when care is rendered but prior to initiating any type of extraordinary collection process.

 

 

Under the rule, a hospital’s financial assistance policy must spell out its elements in detail, including the services for which free or discounted care may be available, the discounts used, the methods for applying, the methods for determining eligibility, and — in the case of hospitals that do not maintain separate billing and collections policies — the actions that may be taken in the event of nonpayment.  The policy also must explain what information will be used to determine eligibility, which other sources of information a hospital may use in making a determination, and whether it will use prior assistance determinations to presumptively determine eligibility for financial assistance. [40]

 

In addition, the hospital’s policy also must explain how the charge owed by the patient will be calculated in relation to the “amount generally billed” to insured patients. A plain language summary of the policy also must be furnished, and patients must have free and ready access to information and the application forms.

 

Hospitals must also “notify and inform members of the community” (i.e., not only people who are already patients of the hospital) about their financial assistance policy, so that people “who are likely to require” financial assistance from the hospital are aware of its existence.[44]

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Thanks, both of you, for all the info.  I think I am going to first speak to a patient advocate to make sure the bill is correct, that I am not being billed twice for anything, and to the best of my ability, that everything I am being billed for was really done.  I am also going to look at their policy to see if we fall into the low income category.  One more question I have:  Are the doctors supposed to bill you for the same procedure that the hospital does? 

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 One more question I have:  Are the doctors supposed to bill you for the same procedure that the hospital does? 

 

Yes, it is not uncommon to receive two bills for a procedure.  The hospital bills the facility/technical side and the physician is billing his professional fee.  Nothing errant about that process.  

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  One more question I have:  Are the doctors supposed to bill you for the same procedure that the hospital does? 

 

Medical billing has become such a racket and I have never been able to get a straight answer on anything.   You are never able to get a straight, honest answer on the cost of a regular procedure before you actually have it, and after the fact you end up getting surprise bills from the guy who had to change the light bulb in your room before you checked in.

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I have really good news!  I finally, after trying to reach someone by phone, went to the hospital, and it turns out they will give me a $9,000 discount for not having insurance.   Which brings my hospital bill down to $4,000-something, which is workable!  Also, I have financial assistance forms, so that might be helpful too.  Thank you so much to all who talked me through what I needed to do and made this situation not seem so hopeless.

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