I have not received my medical bill yet but I went on my insurance's website and was shocked to see that I'm expected to pay 12.7k out of a 29k surgery performed last week. Is there anything I can do to lower the cost?

I have not received my medical bill yet but I went on my insurance's website and was shocked to see that I'm expected to pay 12.7k out of a 29k surgery performed last week. Is there anything I can do to lower the cost?
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#1

I have not received my medical bill yet but I went on my insurance’s website and was shocked to see that I’m expected to pay 12.7k out of a 29k surgery performed last week. Is there anything I can do to lower the cost?


#2

Glad your surgery is over and sorry you're having to deal with this during your recovery time!

First of all, try to get an itemized bill so you can begin untangling the various charges:  Many times, the anesthesiologist, radiologist or lab work groups are separate from the hospital charges (as well as your actual surgeon).  Unfortunately, these days, while your hospital might have been "in-network", the anesthesiologists and other providers might have been "out-of-network".

Talk to your insurance company to be sure that the providers were correctly identified.  I've seen (due to mergers) groups that billed as "out-of-network" but were "in-network" and their status hadn't been updated.

Then go through the bills and try to check all the charges to see if they are correct.  It is not unusual, in fact, I find that it's more common than not, that mistakes are made. 

Touch base with your insurance company and the business managers for each health care provider on your bill.  Write down the names of each person you contact, so that you can refer to them by name as you appeal your high bill. 

 Let everyone know that you intend to pay your fair share, but no more than your fair share---and you need to understand completely each and every charge before you begin payment.  Ask them when you need to call back (I usually recommend calling billing departments/insurance companies once a month, putting it on your calendar, to check your status).

This will be take time and effort, but it should be worthwhile and you should see some lowering of your bill.  If you get in a time crunch, be sure and reach out to Nerdwallet medical billing experts or find help on Advoconnection.com to locate someone close to you--you'll find experts to help you save time and money on both their directories.  

Good luck! 


#3

This sounds like you have a high deductible and the copay limit is significant as well. Is that correct? You need to look at your contract and contact your agent.

The next thing to do is to audit your bill and make sure it is correct. However, the accuracy is less important than the terms of your health insurance contract. 

If you did opt for, say a $10,000 deductible, did you set up an HSA and save the difference in the premium you were paying. That is usually the game plan. Pay less premium, but save the difference into your HSA account so you have it set aside for a situation like this.

Hope you are ok after the surgery. If everything is correct, then talk to the hospital about a payment schedule. They will usually work with you. 


#4

You mention having surgery last week, so I am ready to bet that your deductible was maxed out with this procedure. Do you know the terms of your policy? How much are your deductible, and out of pocket (also called "co-insurance")? If you are unsure, cal the customer service at your insurance, and they will go over those figures with you.

As long as you went to an in network facility, al related charges, even from non-contracted providers, should be paid at the higher rate. If not, and you will see that on the explanation of benefit, call the insurance and have them reprocess under the "hospital umbrella" rate. This should save you some $. 

Contact the business office at the hospital, or visit their website, and look up "financial assistance". Most facilities have private or federal programs for low-income patients. Discounts on the balance range from 5% to 100%, based on income and debt to income ratio. 

Once you are awarded a hardship discount, send the letter to all the providers, it is customary to extend the same reduction. 

If you do not qualify, went to an out of network facility, or meet with stubborn and uncooperative billing offices, try and negotiate. Unless you are familiar with coding practices and fee schedules, auditing bills may be frustrating. You should however easily spot services not rendered or duplicate charges. And remember that offering a one-time "payment in full" remittance now in exchange for a reduction of the bill may be a good way to get a lower bill.

best of luck to you!


#5

Wow!
Were you in-network? Was this emergency surgery? What this co-insurance and deductible?
I would first request itemized statement, speak with your insurance company as to why they paid the way that they did.
If the balance went towards your deductible you can reach out to the hospital billing dept to see if you qualify for financial assistance or uninsured discount if insurance did not pay anything on the claim. If you don’t qualify I would bring a medical bill advocate on board to assist you with this large bill. They can audit the medical records for errors in coding, compliance and pricing. They can appeal to your insurance company for additional payment and negotiate on your behalf.
Medical bill advocates normally will work on a contingency basis and normally charge 25-35% of what they save you and only if they save you money. Some will work on a case rate as well. They should never charge a fee if they don’t save you money so it’s worthwhile to use their service.
Medical bill advocates can save you hundreds if not thousands on hospital medical bills. If you need assistance
please reach out.
Cheryl Welch, MBA
Hudson Valley Medical Bill Advocates


#6

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