On a beautiful Sunday afternoon all I did was pivot wrong on a stepping stone and down I went. My ankle rolled off the edge and I fell about an inch and a half. Not very far but it was enough to break my ankle. I heard it break. My landlady took me to the emergency room. They got me in immediately and put ice on my ankle right away. Total elapsed time ten minutes. So far so good, but it didn't stay that way for long.
They brought in a portable x-ray machine and took four pictures. It was supposed to be three but they had the settings calibrated wrong for the first film and had to do it over. I filled out the paperwork and wrote "self-pay" in the "Insurance" blank. I haven't had insurance for eight years. The ER doc told me I had a small crack at the very bottom of my fibula, showed me how to put on and take off an air splint and sent me on my way with directions to see my doctor in ten days. The whole thing took less than an hour.
The young woman at the cashier's window told me if I paid a $500 down payment on my bill, I would "lock in a discount of 40 percent on the final bill." I asked how much the final bill would be. She didn't know but estimated it would be around $3700. I knew it would not be anywhere near $3700, but I was sure it would be at least $500 so I went ahead and locked in my 40 percent discount.
First thing Monday morning I called the billing office. The billing manager said the bill would be $2200, but with the 40 percent discount the bill would be $1332 minus my $500 already paid equals $832. Just one catch, I would have to pay the $832 within 7 days from the date of service to "lock in a 40 percent discount." Wait a minute. The cashier on Sunday said the $500 locked in the discount. According to the billing manager she was wrong. The rule is 7 days from date of service. First glitch.
My ankle was very unstable so I decided not to wait ten days as instructed. I called an orthopedist and got an appointment for the coming Wednesday, three days after the injury. My landlady took me to my appointment and right afterwards took me to the hospital to pay my bill. The cashier printed out a bundled bill totaling $2450 and asked me for $970 (2450 x 60% - 500). I objected that the billing manager had told me just two days before that my balance due would be $832. She left, came back, and agreed that the balance due would be $832.
Then I asked her to print out an itemized bill. She said the bill had not "dropped" so she could not do that. I questioned how she could know the bill was accurate if the bill had not dropped. She hemmed and hawed. I said the hospital must have gotten the numbers from somewhere, so could she please print out an itemized bill. She said there was no itemized bill in the system. I pointed out that the charges and the services have to coincide. Her response" "What do you mean by that?"
Finally she printed out the itemized bill. There I saw a surgical procedure which had never happened, crutches for $352, x-rays for $632 and ER room charges at level 4. I objected to the whole bill. First there had been no surgical procedure. Second, my doctor was selling crutches for $30. Third, the x-ray charge looks like it is for 4 films, not 3, and besides $632 is far too expensive. Fourth, when the surgical procedure charge is removed, the ER room level will drop and so will the price. I asked for the bill to be audited and commented that it seemed to me the 7-day window of opportunity for a 40 percent discount should start when the hospital has an accurate bill ready.
That's when things got mean. "Look, we're trying to do you a favor and save you some money. If you want us to audit your bill, you will lose the discount offer and have to pay the full 100 percent." I put my checkbook away and took out a credit card. My elderly landlady listened to the whole exchange with a look of incredulity. In the car she said she never knew any of that stuff about hospital bills, especially the part where you can request an audit of the bill.
An audit, which they must do if you ask, is where they compare your chart with the charges. They do not like to do audits because the bill invariably goes down by around 20 percent. They will try to dissuade you from an audit by telling you if they do an audit and the bill goes up, you will have to pay the higher bill.. The chance of that happening is nearly nil.
The very next day, Thursday morning, I called the credit card company and started a dispute of the charge. The hospital removed the phantom surgical procedure forthwith and reduced the ER room level to level 3. You see, the whole reason they had put the surgical charge in the first place was to qualify the ER room charge for the higher level 4 charge. The hospital ended up having to initiate a refund on the credit card. The bill went from the original $3700 estimate to $1080 for a savings of almost 71 percent by auditing and locking in the discount offer. I am still working on the charge for crutches and x-rays. I expect a further reduction when all is said and done.
You see, with the crutches, after probing, they admitted that the charges for durable supplies are way overcharged to compensate for Medicaid patients. My main argument is that they have no right to compel a donation from me, an uninsured patient, to make up for losses they think they incur by treating people with some form of insurance even if it is Medicaid. Their contract with Medicaid is they accept what Medicaid allows as paid in full. They have no agreement with me that I will make up the shortfall, and they have no business deceitfully taking it from me. Remember I had to probe quite deeply to get them to admit to what they were doing.
A month later I got a separate bill from the ER doctor for $1200. All he did was look at the x-ray and show me how to put on an air splint which I was instructed to remove for bathing. As per my usual procedure, I immediately called the billing office and ordered an itemized bill. That's when I saw the $946 charge for a surgical procedure, the one that never happened. Your hospital paperwork may claim that the ER doctor is a self-employed independent contractor who bills separately for his services. Technically true, but the ER hospital bill and the ER doctor bill will be in sync. I was not surprised to see the phantom surgical procedure; I had expected it.
I immediately called again and asked them to audit the bill. I explained that the hospital had already removed the surgical procedure and so they will have to remove it as well. I explained that I knew that the hospital bill and the doctor bill are in sync and so the portion of the bill labeled "emer eval" will also have to be reduced since the level of service has been decreased from level 4 to level 3. I asked no questions; I simply and matter-of-factly told them. I also asked them to stop the "past due" clock.
Three weeks later they sent me another bundled bill for the original $1200 with a notation that the bill had been reviewed and found accurate. Most patients say oh okay, I checked and it's accurate. If you do not know much about medical services, you or a companion need to take very careful and detailed notes of everything that is done and everything you hear said whether addressed to you or not. Heaven help you bill-wise if you are unconscious or alone. You will have a great deal of difficulty making your case.
I called again and reiterated everything I said before. Their ploy had not worked. I told them I expected to receive a CORRECT ITEMIZED bill. Probably in another three weeks, that is exactly what I will get. Since the $946 surgery will come off, expected savings will be at least 79 percent. It will actually come out more than 80 percent because without the surgery, the "emer eval" charge will come down as well. I think total savings will be around 85 percent.
We uninsured patients MUST fight back. Sometimes I think I should start a business parsing medical bills and securing these sorts of reductions especially for uninsured people. Insurance companies supposedly are already doing this for their clients. One reason medical bills are so high is that in spite of all the protests from insurance companies and medical providers to the contrary, there is a sort of quid pro quo going on, with the actual patient complacently left out of the loop. Many patients with insurance pay no mind to it at all. I am qualified to parse bills because I used to work not only in a hospital billing office, but I have worked as an insurance biller for private doctors. Not only that, but I have worked as a Medicare claims examiner. Admittedly this was 25 years ago, but nothing has changed.