Some for profit hospitals have adopted a out of network strategy of boosting their profits. New Jersey, where I live, has the dubious distinction of having the hospital with the highest billing rates in the country, which also happens to be out of network for most insurance companies. Recently, I had the misfortune of visiting the Emergency Room (ER) affiliated with the same group of hospitals. It was the same hospital that had charged me $1527 for not being able to remove a crayon from my child's nose. This time, my private health insurance company was sent a $30,000 medical bill. While my insurance, which I am very fortunate to have, covered $20,000 of the total bill, I was left with an out of pocket cost of $10,000. How I negotiated this amount down to $338.
When a medical emergency arises, it is tough to analyze its financial impact on the spot. Even then, faced with a post surgery blood clot, I walked into the office of an in-network doctor to figure out if the issue was serious, and if it needed another surgery. Unfortunately, it did, and the doctor suggested that rather than driving with a possible life threatening condition, I walk myself to the nearest emergency room, one that was for-profit, and out of network.
A call to health insurance
The doctor's office made a courtesy call to my health insurance, explaining the need for emergency surgery at the out of network hospital. Meanwhile, I walked over to the ER. There was nothing to do but wait at the emergency waiting area, so I called my insurance to double check. They assured me since it was an emergency, I would be charged at an in-network rate, as long as I was not admitted.
Things got out of my control soon enough, as a series of doctors, all of who were out of network at my insurance company came to visit me. These included a resident, a radiologist, and an anesthesiologist. Each later charged about $1000-1500 for services. To make matters worse, after the surgery, which lasted a few minutes, I was shifted to a recuperating room, then when it got full to a semi-private room. Charges for the last two alone amounted to $7,500. Other charges included $828 for lab tests, $4,250 for anesthesia supplies, $6,500 for the emergency room, and over $9,800 in ancillary charges that were not itemized. The total bill was $29,977, an unconscionable amount for removing a visible, post surgery blood clot.
Delays from health insurance
As expected, I did not receive a bill from the hospital, as it was submitted directly to the insurance company, which took time to process the claim from the hospital. The insurance company then sent me a letter stating what the average cost of a similar procedure would normally be, which was less than a third of the amount of $30,000. Thereafter, after close to two months, it stuck me with a bill of $10,000.
Thankfully, there was an appeals process. I called the number on the back of my health insurance card and explained in writing and over the phone that it was truly an emergency. The insurance company agreed to bill me at an in-network rate for both the hospital and all the doctors associated with it. Since I have a high deductible health plan (HDHP), much of the doctors' bills had to be paid out of pocket towards my deductible. However, after another month, I got a letter from the insurance company that the entire hospital bill, except for $338 for the unnecessary semi-private room, would indeed be paid by my insurance company.
*Note: This was written by a Yahoo! contributor. Do you have a personal finance story that you'd like to share? Sign up with the Yahoo! Contributor Network to start publishing your own finance articles.
More from this contributor:
- Health Care Industry
- health insurance
- insurance companies