My husband suffered a stroke in April of 2014. He was flown by helicopter from our home to a hospital about 60 miles away. Helicopter service was not in our insurance network and the total bill was $40,000.

My husband suffered a stroke in April of 2014. He was flown by helicopter from our home to a hospital about 60 miles away. Helicopter service was not in our insurance network and the total bill was $40,000.
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#1

Just curious if I have any leverage on this. I don’t want to not pay our bills, but I feel this charge is unrealistic. Is there anything we can do?

Insurance paid them $11,750 (which they would have paid had then been in our network) and I have sent another $500 to keep them from filing suit. They call daily wanting balance of their money and even offered to settle for $15,000 if they could withdraw it from our checking accounting. First, we don’t have that kind of money. I have exhausted all attempts to borrow money to pay this bill. I’ve been told because we have equity in our home we can not file bankruptcy without losing our home. We are both 63 and have worked hard for what little we have. It is not as if we were given a choice on this. Any assistance would be appreciated.


#2

I would file an appeal to  the insurance for the low  payment. If that fails, ask for an external review, and finally  I would contact your state's Department of Insurance and file a complaint against your insurance. If you need more specific details, please contact me directly.

Denise Sikora


#3

As with just about every medical charge, your husband's is inflated.  The tactics being used to pressure you are pathetic.  Under no circumstances should you give out any bank account information.  I recommend you retain the services of a patient advocate experienced with overinflated bill negotiation.  A good one can basically act as an attorney would and represent you forcefully yet professionally.  Once the billing representatives understand they are dealing with a professional, their attitude will change.  I don't recommend reporting any medical group to state agencies who supposedly represent the consumer.  They are usually staffed with people close to politicians in office and generally slow to move.  I would be happy to speak with you at no charge if you'd like to discuss this in more detail.  Please see my contact information by clicking on my photograph.  In the interim, making small payments shows a good faith effort to pay your bill, making it virtually impossible for the provider to turn your claim over to a credit agency.  A payment is needed every 30 days to keep your account in good standing.  Don't allow yourself to be bullied; focus on your husband's recovery and your well-being as well.  Your husband has a one-year window that allows recovery; that should be your focus.


#4

Contact your insurance, ask to speak with a claims supervisor and explain that the provider has not acceptd the in network rates and is balance billing you. The insurance might negotiate a one-time settlement and adjustment in exchange for an additional payment. They may also force them to write off (a portion or all of the balance if cashing the insurance payment came with such an obligation. 

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#5

My colleagues have excellent advice! 

I would just add that you should check this table put out by the Kaiser Family Foundation which shows the laws for balance billing in each state.  Most of this table primarily concerns managed care billing; however, for some states, PPOs are also listed.  You might find an advocate in your state to help you with your local laws and that might give you the leverage to resolve this issue without paying any more money.  Good luck!  Hope your husband is doing well!

http://kff.org/private-insurance/state-indicator/state-restriction-against-providers-balance-billing-managed-care-enrollees/


#6

I have seen this so many times.
I have to agree that getting a medical bill advocate to assist you with this would be the best advice.
I have handled several cases like this and I had to go above the billing dept representative and would only deal with corporate.
They have every time accepted what insurance paid.
If your insurance company is not willing to assist you reach out to a medical bill advocate.
Best of luck to you.


#7

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