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rated:
~3 months ago, I went to an emergency room because I was incapacitated (couldn't eat/drink anything, vomiting, temperature).  First time for me to visit an emergency room.  I'm in California.

While at the hospital I wasn't able to negotiate anything at all... Was very frustrating (along with all the pain!).

On the initial ER admission paperwork I scratched out the "personal financial responsibility" section of the document and wrote "all charges must be agreed to in advance."
That's a habit of mine from going to the dentist.  I was in pain, but not on any drugs when I did that.  I do not have a copy of that paperwork though...  I think I could request it from the hospital.

I was put on drugs right away, they woke me up to take some tests -- but they wouldn't tell me how much the tests cost.  I think I could have refused these tests, but I was drugged up and very agreeable.
After the tests they woke me up in order to sign some disclosures about surgery and I was more "myself" at that time...  Except for having a bunch of tubes in me and still being on drugs.

They said I needed an operation.  I asked about the cost of the operation, but they couldn't get that to me.
I remember it being explained to me this way: "We have to operate now."  But the "have" was not so much my immediate condition as it was the availability of the surgeon?  At least that's what I thought.
I said "I really need to know what the costs are going to be before I can agree."
The surgeon got all "hard-sell" and scared me about signing a "when you die because you didn't follow my advice..." form and I caved and agreed to surgery (without receiving the price in advance).
I don't know how much of that was the surgeon's speech or the morphine.

Less than 48 hours after admission, I was released from the hospital minus an appendix.  I'm grateful to the hospital and the surgeon for saving my life.

I subsequently got 2 bills: one from the company that services the ER doctor ($600), and a second one from the hospital ($2,000).  The overall bill from the hospital was $100,000+ but they cut those bills in half for the insurance company and then reduced it more -- in the end, it looks like the insurance company paid $30,000 to the hospital.

I have "high deductible insurance" where I'm on the hook for the first $1300 of any medical fees, and then I have to pay a percentage of fees beyond that (up to a cap of $2,600 total).

The bill from the ER doctor's company had a "call us if paying would be a hardship" -- so I called and said "$600 is a lot."  They asked a few questions (what do you earn, what do you owe, etc) and in the same phone call reduced the bill to $250 (a $350 reduction).  I paid over the phone - cool!  

I called the hospital hoping for similar treatment and they were like "no way dude".  They said I needed to pay it now or (in 90 days) it goes to collection.  They offered a payment plan of $25/month for 80 months.

I asked about full payment of, say, 75% of the $2,000 ($1,500) and they were like "no".  I asked if there were any negative consequences of waiting 90 days to pay -- they said no, so I said I'd think it over and get back to them.  

I waited 80 days and called back today.  I asked about making full payment of less than $2,000 and they were all "nope."  They offered the $25/month payment plan again though - "best we can do" she said.

I asked when it was going to go to collections and she said "any day now."  I asked "and you're not interested in full payment of a reduced amount right now?"  "Nope."

Am I at the end of my rope here as far as negotiating?  Are there any "magic words" I missed to get them to lower their charge to me?

If it goes to collections, will I be in a better position to negotiate -- or will it just get worse from here with added fees and percentages?

I have a fear that if a debt-collection agency buys the debt, they'll end up suing me for *more* than the $2k owed to the hospital...  but I have no personal experience with a debt collector because (up until this bill) I always pay as soon as it is due.  My reason for not paying this bill in full immediately is because (1) I'm a cheapskate and (2) I'm holding a small grudge about wanting to know the price of the surgery (or at least a cap) *before* buying it and they wouldn't give that to me.

Thanks!
 

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rated:
In disclosure, I am an Emergency Physician and own an Emergency Center.

I am glad that you actually realized what your out of pocket costs are, I would say 90% of Americans think they are only responsible for their 'copay' and have no concept of deductibles.  Bravo to you for understanding what you have.

Furthermore, your plan these days is not a High Deductible plan, it is medium at best.  Many people are having 5-6K deductibles now, and they are teachers making 25K a year.  Sad deal, but insurance has become a scam.

What I would submit to you is that you have been paying a much cheaper premium in order to have that higher deductible plan.  The catch is when you get sick, you have more out of pocket costs.  Pay the out of pocket costs and move on.  I know you wont, but I would suggest calling the physician group, and righting up their bill as well.  Although, BCBS pays on average $100 to an emergency physician to save a life.

To clarify wanting to know costs, nobody has a clue of costs in a typical emergency center, and furthermore, due to EMTALA (unfunded federal mandate that says you MUST be taken care of without discussing money), we are not even supposed to discuss money until your emergency is stabilized which would be when the appendix is in the trash can.  Nobody was trying to hide the costs, nobody really knows what the costs are until much later.

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I can't believe I read much of that.. Cliff Note:

- OP got High Deductable plan. Went in for emergency appendectomy.
- OP insisted on knowing the price of any procedure before hand but was too drugged up.
- Final bill after insurance is $600 doctor bill and $2000 hospital.  Doctor accepted $250 for PIF but hospital said no soup for you.
- OP not happy because he didn't have a chance to approve procedure before dying.

rated:
Thanks troutmd!

Writing this post was pretty cathartic for me and made me back up and review "the big picture" where, I'll admit, to having been tunnel-focused on feeling helpless in a hospital bed not getting answers to what I felt were reasonable question about cost.

Thinking about it big picture, I know -- no matter what amazing discounts I could've negotiated -- my out-of-pocket responsibility still would've been $2,600. And, although it never really sunk in before my visit to the hospital (because I was sure I'd never use it), I knew that cap existed when I picked that insurance plan. So I'm going to take your "pay out of pocket costs and move on" to heart.

That said, I'm curious about why costs are unknown... Help me get over that grudge

My basis for the grudge is the time I was at the dentist and he found a "deep pocket" (not a cavity but a gap between gum and tooth that would promote periodontitis) he wanted to treat with "arestin." I didn't know the drug, what it did, or what it cost -- he explained what the drug did, but as far as cost he had no idea. So I said "well, I'll research the costs and we can talk again next visit."

5 minutes later his front-desk assistant was in the room with the price they charge insurance for arestin treatment and what my insurance company was *likely* to pay (and it was completely accurate). I got the treatment, the pocket was in much better shape the next time I visited.

If a small outfit like a dentist can determine cost, why can't a huge hospital do the same? I realize each operation is unique, but why couldn't they say "median cost for appendix removal over the past year is $X"? I wonder what I would've done if they had said $100,000? lol - I really was between a rock and a hard place . I didn't know what EMTALA is, but I'm reading about it via Google now.

One last set of questions: I am curious about the company that does the ER doctor's billing and why they "folded" so quickly. I answered their questions honestly and (from my answers) it should be obvious $600 is not a serious amount for me (it is, but that's a mental problem for me -- not a financial one!). Still, they still dropped my bill by over 50% without blinking! The ER doctor's company is "CEP America" if that means anything to you? Did I take that $350 out of the ER doctor's pocket? I honestly don't know how an ER doctor gets paid -- salaried (guess not), by the hour, or by commission on what they bring into the hospital?

Anyway, If I took that $350 out of the ER doctor's pocket and not "a big corporation," I'll go drop off cash (and thank him in person). I sent the nursing staff of my recovery floor donuts/coffee after I was released (I can't say enough good things about the facilities or the people there -- just that pricing thing!), but I didn't know the ER doctor's name to do the same. From the hospital's itemized bill, I got his name but never thought to follow up. Maybe it is not too late?

rated:
Everyone nowadays has $2,500-$5,000 in max out of pocket charges and this is with low deductible plans.  Pay it and be grateful, the doctors saved your life.  
A girl in my high school died from this overnight as her parents did not take her to the hospital fast enough.  

rated:
Thanks ZenNUTS for the summary, I'm glad you were able to persevere to the end

Thanks borisr, I am definitely grateful to the hospital and the staff. I also appreciate your perspective to be grateful!

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$2600 to get your appendix out is cheap. You're still trying to bleed out that turnip. Be happy you paid a relatively low amount and move on.

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I had a similar situation with my ambulance bill. It was out of network so the "discounted rate" of $750ish wasn't actually a discount. Sent me a bill for the full $1,390. Offered to pay the insurance negotiated rate, "nope we don't take that," offered lump sum payment for discount, "nope we don't do that." Only thing they could offer was a payment plan at $25/mo interest free. Took that since it was the best they were offering even though I could pay it off now (get a little savings by getting interest on not putting out the money now).

I'd say pay it and move on or take the payment agreement. It's a relatively small amount. A collections account will tank your credit. If you have good credit and are using it properly keeping your score high is easily worth the cost of paying this (not to mention paying for the medical care you received).

rated:
While I agree with your sentiment, the doctors and nurses have no idea how much everything costs because it isn't their job to know and because there's overhead. The people in the finance department may know how much things cost, but how much they bill you depends on your insurance (or lack thereof). The same goes for dentist -- the optimal dental office is set up like a factory, where the dentist is the expensive bench tool, and everyone else in the office is the assembly line -- prepping patients, taking xrays, cleaning up, and patient billing, which includes checking insurance rates. You can find out the costs quickly, because the billing person is in the same office and usually it's not an emergency.

rated:
2600 is considered high deductible? Mine is 6500...that is high deductible...and it costs 800 a month for 2 healthy 30 year old adults...

rated:
$3k deductible and $6500 oop here. Premium is about as high as it can get per the ACA. You have a sweetheart plan, and those prices are pretty reasonable IMO compared to what I pay for a simple ER visit.

Great job negotiating with the ER docs. The only option with the hospital is financial assistance usually. Some nicer hospitals have other offerings (think Mayo or Cleveland), but most only have some sort of financial assistance program. I'm assuming you got screened for it already, but if you haven't, check.

Past that, the $25/mo is really a decent deal with no interest for saving your life. $2600 for your life isn't a bad gig, and 104 months of 0% is itself a sort of discount. Even more if they let you pay with a credit card that has cash back or some such.

Your only option past that risks destroying your credit. You COULD let it go to collections. Then you could acquaint yourself with some of the credit board forums or myfico forums on how to possibly negotiate a debt offer and do what's called a pay-for-delete. Be warned its not guaranteed, but it is a potential debt reduction tactic.

FYI nobody at the hospital can give you a price usually. They do list prices internally in a master list (chargemaster), but they're not required to disclose. The problem becomes, each insurance has a negotiated rate - they could deal with 20-100 insurance companies to boot, who all offer different plans. They also have no way of knowing how much the operation may end up costing - what if you require blood but someone else doesn't? What if you take an extra package of gauze wraps, or extra drugs because you're an average adult male and not a petite female? Also, they have no way of knowing the ER doc costs, an extra orderly to transfer you between tables, etc. I mean, the ER doc and nurses have no way of knowing any of this really.

Sadly, you're sorta captive by the time you're in the ambulance or in the ER for a life-threatening condition.

rated:
It's always worth calling the hospital and asking for a pay-in-full discount as you've done, but there's not much else you can do if they say no. You're not really in a strong position to negotiate. You pretty much have to trust that the insurance company negotiated a decent rate and pay it.

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A typical hospital will have tens of thousands, if not hundreds of thousands of chargeable items, all negotiated YEARLY at different rates based on insurance types that they accept. A dentist maybe has several hundred tops and at generally three rates, cash, hmo, ppo. It is pretty clear why it is easier to get an estimate at a dentist.

rated:
You've done what you've can. Time to pay.

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doveroftke said:   It's always worth calling the hospital and asking for a pay-in-full discount as you've done, 
  or a 0% payment plan. I got a major university hospital offer me 0% , $100 a month , that I'd already put off for over 6 months until they threatened to goto collections

rated:
$25 for 80 months is exactly $2000.  So, that is a no interest payment plan.  I'd go ahead with that!

I am surprised that they didn't offer any reductions.  I've only dealt with two hospitals, but both offered reductions based on paying right away.  You tried though!

rated:
Out of three hospitals I have dealt with in our area, only one offered a prompt pay discount of 20% and it was actually listed right on the billing statement. It says you have to pay it within 2 weeks or something, but I let one slip to almost a month once and they still gave the discount without any issue. I have never tried to ask for more of a discount than that though since I can't really prove it is a hardship (other than not wanted to spend that kind of money).

Asked the other two hospitals about prompt payment discounts and they just offered up the no interest payment plan options like others have mentioned. I always chose the plan, setup auto-pay on the credit card, and ride it out even though I could pay in full. If they want to waste their time tracking my small payments each month, paying the processing fees, etc. then who am I to stop them. Sometimes I just want to pay it off because it annoys me knowing I owe the money and tracking the bill to make sure it is paid, but I usually make it to the end.

rated:
You got a really good deal!  $2k for an ER visit and surgery?  I'd take that any day.

rated:
New credit card sign up bonus.

rated:
Obligatory:
Pay your bills, deadbeat!

rated:
ach1199 said:   New credit card sign up bonus.
Brilliant! Send Chase some flowers for covering most of your appendectomy with rewards

rated:
I get that much of healthcare is overpriced - I go to mexico and will go to Mexico when Im older. But an emergency is an emergency (had a few stones myself).

That being said, pay the money, its not bad and not much. One thing you should not forget, healthcare aka seeing a doctor/surgeon ect is a business. They are not the government, not here to make your life better, they are here to make money. They dont work for free. Its a specialized field, and sometimes that just what it costs. Be thankful some level of government oversite exists. You could have shopped around, or you could have planned better (see reddit and financial planning).

Disclaimer- Im one of the those people who hate it when people screw over doctors/hospitals and cause my costs to go up.

rated:
I agree our current system has plenty of flaws- but $2600 seems like an excellent deal for having trained professionals on call to deliver life-saving surgery. Especially when you'd be bankrupt over 100k+ in medical bills otherwise. I would consider any insurance plan with a $2600 max out of pocket to be a great deal in this market.

rated:
EatenByGrue said:   Thanks troutmd!

Writing this post was pretty cathartic for me and made me back up and review "the big picture" where, I'll admit, to having been tunnel-focused on feeling helpless in a hospital bed not getting answers to what I felt were reasonable question about cost.

Thinking about it big picture, I know -- no matter what amazing discounts I could've negotiated -- my out-of-pocket responsibility still would've been $2,600. And, although it never really sunk in before my visit to the hospital (because I was sure I'd never use it), I knew that cap existed when I picked that insurance plan. So I'm going to take your "pay out of pocket costs and move on" to heart.

That said, I'm curious about why costs are unknown... Help me get over that grudge

My basis for the grudge is the time I was at the dentist and he found a "deep pocket" (not a cavity but a gap between gum and tooth that would promote periodontitis) he wanted to treat with "arestin." I didn't know the drug, what it did, or what it cost -- he explained what the drug did, but as far as cost he had no idea. So I said "well, I'll research the costs and we can talk again next visit."

5 minutes later his front-desk assistant was in the room with the price they charge insurance for arestin treatment and what my insurance company was *likely* to pay (and it was completely accurate). I got the treatment, the pocket was in much better shape the next time I visited.

If a small outfit like a dentist can determine cost, why can't a huge hospital do the same? I realize each operation is unique, but why couldn't they say "median cost for appendix removal over the past year is $X"? I wonder what I would've done if they had said $100,000? lol - I really was between a rock and a hard place . I didn't know what EMTALA is, but I'm reading about it via Google now.

One last set of questions: I am curious about the company that does the ER doctor's billing and why they "folded" so quickly. I answered their questions honestly and (from my answers) it should be obvious $600 is not a serious amount for me (it is, but that's a mental problem for me -- not a financial one!). Still, they still dropped my bill by over 50% without blinking! The ER doctor's company is "CEP America" if that means anything to you? Did I take that $350 out of the ER doctor's pocket? I honestly don't know how an ER doctor gets paid -- salaried (guess not), by the hour, or by commission on what they bring into the hospital?

Anyway, If I took that $350 out of the ER doctor's pocket and not "a big corporation," I'll go drop off cash (and thank him in person). I sent the nursing staff of my recovery floor donuts/coffee after I was released (I can't say enough good things about the facilities or the people there -- just that pricing thing!), but I didn't know the ER doctor's name to do the same. From the hospital's itemized bill, I got his name but never thought to follow up. Maybe it is not too late?

  
Great response.

On the costs aspects... "Good Question".   There have been lawmakers who believe all of healthcare should 'post costs at the front door'.  I think if your getting a boob job, that is fine.  But on more acute matters, the issue with throwing costs out there, is that it now changes the decision of the patient.  Healthcare is costly, yes many facets of healthcare make good money, but it is also costly to run with licensed professionals everywhere, ever changing state of the art equipment that is costly to purchase then maintain, state and federal government regulations that are costly to meet, etc.  Before long, as singleton patients, it seems 'ridiculous' when you visit an ER (where the average billed charge nationally is around $2,000-$3,000) for a swollen ankle.  I don't want you hobbling in, seeing 2K, and hobbling back out, only to have increased issues when it was actually fractured (or the chest pain was a heart attack, etc).  You get an xray to find out its a sprain, and you leave.  If things are efficient, you spent maybe an hour there.  You get a $2,600 bill for a visit that was less than an hour, you saw a doctor for 60 seconds, a nurse check on you three times and gave you a Tylenol.   I can see the frustration on it.  On the back end....  There is a facility you walked into, it has generator backup, its open 24/7 (never closes), has criteria for the amount of CFM an a/c unit has to blow and the waiting room is separate from your patient room so we don't mix flu bugs.  There is oxygen, suction... There is also a heart defibrillator sitting out there, you know.. just in case.  That xray, although simple, its a pricey piece of equipment, that has to 'have the oil changed' all the time.  There is a rad tech who 'pushed the button', they are educated, licensed, not cheap.  There were likely multiple nurses interacted with, each licensed professionals.   There is a radiologists off in some corner looking at the film.  And the film, it has to be stored for some period of time, laws and its good practice for the next time as a comparison.  There is the ER doc, they can get a story and do an appropriate exam in 60 seconds, they would rather spend 10 minutes with you, but likely there are other patients waiting, and we never know which ones are dying when we haven't seen them or which one is 'the one' where we get that multimillion dollar lawsuit from.  And that 60 seconds with you, multiple that by ten fold for documentation, ordering, reviewing results, etc.  As you exit, someone has to clean that room, ready it for the next soul coming in.  And someone has to make sure the lights are working (24/7), and that the medical record complies with government regulation.. and then someone to code that chart... someone to send it to insurance, then appeal with insurance, then send to the patient, etc etc etc.   Before long, even a simple sore throat, with all the BS that surrounds 'readiness' in an ER, its easy to see that $2,000 is actually rather cheap.  And there are times when all those high priced people and pretty facility sits ideal, for hours.. but its there, 24/7,ready when the heart attack shows up.

ER docs are paid various ways.  Standard hourly rate, base+RVU (fancy for productivity bonus) most common, and an 'eat what you kill' (you get what you bill and is collected) less common.  In reality, we are doing good to collection 30% of what we bill, regardless if that is BCBS or Jim paying the bill.  Doctor groups have much less 'manpower' or pull to try to demand more, so they tend to take what they can get.  That's why the doctor group was happy to 'settle' much cheaper.  And the hospital... they wont, they will send you to collections.  

What gets old as doctors is we hear and get told how healthcare is so costly because of doctors.  We (doctors) to a bad job on the business and legislative side of things.  Most really do care just about seeing patients, we DO have to make a living, and we DO want a 6 figure income for the risk we take and the decade of education we obtained.   Those hospital and insurance admins are the problems, many of them making 7 figure BONUSES...

​We wish Insurance Companies sold insurance that PAID completely for acute care problem.  Deductibles should be reasonably capped (like 500 or 1000).  We see public teachers making 27K a year with 6K deductibles.  They CANNOT afford that.  It is sad. 

I wouldn't try to pay anything to the ER doc group.  Send the crew pizzas, have it noted that it was from a patient.   Stuff like that means a lot to us and it just about NEVER happens.   I'd rather get a warm pizza on a busy shift from someone that appreciated my services than the 300 bucks....  

rated:
troutmd said:   In disclosure, I am an Emergency Physician and own an Emergency Center.

I am glad that you actually realized what your out of pocket costs are, I would say 90% of Americans think they are only responsible for their 'copay' and have no concept of deductibles.  Bravo to you for understanding what you have.

Furthermore, your plan these days is not a High Deductible plan, it is medium at best.  Many people are having 5-6K deductibles now, and they are teachers making 25K a year.  Sad deal, but insurance has become a scam.


 

Really? Can you cite a credible source for your comment that there are teachers who have 5-6K deductibles?   "Many people are having 5-6K deductibles now, and they are teachers making 25K a year."

While I agree that lots of people under the current health insurance situation today have $5-6K deductibles now, I haven't heard of any who are teachers.  Most public school teachers have gold-Plated insurance plans with extremely low deductibles and co-pays.  Are you referring to teachers who aren't part of a union perhaps?

From California Public Employee's  (Calpers) website:About Our Plans

  • HMO - A Health Maintenance Organization (HMO) plan provides health care from specific doctors and hospitals under contract with the plan. You pay co-payments for some services, but you have no deductible, no claim forms, and a geographically restricted service area.  Here is a link to source for additional details:http://www.calpers.ca.gov/page/active-members/health-benefits/plans-and-rates 


Also in the interest of accurate information, salaries for California teachers are typically much higher than $25K.  "Average" beginning elementary school teachers salaries in 2014-2015 year were $41 - $44K
http://www.cde.ca.gov/fg/fr/sa/cefavgsalaries.asp 

A good source of detailed salary and benefits information by California city is:  http://transparentcalifornia.com/ 


For a nationwide view, here is quick snap shot -- Average Salaries of Public School Teachers: 2014–15* NEA estimate
2012–13 Rank 2013–14 Rank 2014–15 Rank State Average Annual Salary
1 1 1 NEW YORK $77,628*
3 3 2 DISTRICT OF Columbia  $75,490*
2 2 3 MASSACHUSETTS $75,398
4 4 4 CALIFORNIA $ 72,535*
5 5 5 CONNECTICUT $71,709*
6 6 6 NEW JERSEY $69,038*
7 7 7 ALASKA $66,755
9 8 8 RHODE ISLAND $65,918*
8 9 9 MARYLAND $65,477
10 10 10 PENNSYLVANIA $64,447
11 11 11 MICHIGAN $63,856
13 12 12 ILLINOIS $61,083*
14 14 13 OREGON $59,811
12 13 14 DELAWARE $59,195
19 15 15 NEW HAMPSHIRE $58,554*
22 18 16 VERMONT $57,642*
15 16 17 WYOMING $57,414
20 17 18 HAWAII $57,189*
18 20 19 NEVADA $56,703*
17 21 20 MINNESOTA $56,670
16 19 21 OHIO $56,172*
21 22 22 WISCONSIN $54,535*
26 25 23 IOWA $53,408
23 24 24 GEORGIA $53,382
24 23 25 WASHINGTON $52,502
27 26 26 KENTUCKY $51,155
28 27 27 INDIANA $50,877*
33 30 28 TEXAS $50,713
31 28 29 MONTANA $50,670
30 29 30 VIRGINIA $50,620*
32 32 31 NEBRASKA $50,525
40 36 32 NORTH DAKOTA $50,025*
34 33 33 MAINE $50,017*
29 31 34 COLORADO $49,828*
42 39 35 FLORIDA $48,992
39 38 36 KANSAS $48,990*
36 35 37 ALABAMA $48,611
35 37 38 SOUTH CAROLINA $48,486
37 40 39 TENNESSEE $47,979*
25 34 40 LOUISIANA $47,886
41 41 41 ARKANSAS $47,823
43 47 42 NORTH CAROLINA $47,819
38 42 43 MISSOURI $47,409
45 43 44 NEW MEXICO $46,625
44 44 45 UTAH $45,848*
45 46 46 WEST VIRGINIA $45,783
47 45 47 ARIZONA $45,406*
49 48 48 OKLAHOMA $45,317
48 49 49 IDAHO $45,218
50 50 50 MISSISSIPPI $42,564*
51 51 51 SOUTH DAKOTA $40,934
N/A N/A N/A United States $57,420*
 


rated:
bighitter said:   
troutmd said:   In disclosure, I am an Emergency Physician and own an Emergency Center.

I am glad that you actually realized what your out of pocket costs are, I would say 90% of Americans think they are only responsible for their 'copay' and have no concept of deductibles.  Bravo to you for understanding what you have.

Furthermore, your plan these days is not a High Deductible plan, it is medium at best.  Many people are having 5-6K deductibles now, and they are teachers making 25K a year.  Sad deal, but insurance has become a scam.


 

Really? Can you cite a credible source for your comment that there are teachers who have 5-6K deductibles?   "Many people are having 5-6K deductibles now, and they are teachers making 25K a year."

While I agree that lots of people under the current health insurance situation today have $5-6K deductibles now, I haven't heard of any who are teachers.  Most public school teachers have gold-Plated insurance plans with extremely low deductibles and co-pays.  Are you referring to teachers who aren't part of a union perhaps? 
...
 


I had the same thought.    No public school teacher around here makes 25k or has a high deductible.   But theres also private schools and I wouldn't be surprised if they do.   Private schools pay lower and have worse benefits generally.  its usually churches running private school and their wages and benefits are often low.


And even in public schools, some states don't have the best teacher insurance.   In TX teacher plans can in deed have 5k deductibles:
https://tcta.org/sites/tcta.org/files/2016-17_trs-activecareplan...

But yeah, 40-50k+ income and $500 deductibles would be the norm for teachers more often. 

I'd hazard a guess that less then 2% of teachers make 25k and have 5k deductibles.
 

rated:
Sounds like you met your deductible for the year. Go skiing and have that broken leg fixed for free.

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WesleyB said:   Sounds like you met your deductible for the year. Go skiing and have that broken leg fixed for free.
  Most likely OP met last year's deductible.

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You saved $$ on those monthly premiums so now you can pay it later. 

Please keep us updated on what happens.

 

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stanolshefski said:   
WesleyB said:   Sounds like you met your deductible for the year. Go skiing and have that broken leg fixed for free.
  Most likely OP met last year's deductible.

  Probably met his deductible and out of pocket for something like that. 

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troutmd said:   In disclosure, I am an Emergency Physician and own an Emergency Center.

I am glad that you actually realized what your out of pocket costs are, I would say 90% of Americans think they are only responsible for their 'copay' and have no concept of deductibles.  Bravo to you for understanding what you have.

Furthermore, your plan these days is not a High Deductible plan, it is medium at best.  Many people are having 5-6K deductibles now, and they are teachers making 25K a year.  Sad deal, but insurance has become a scam.

What I would submit to you is that you have been paying a much cheaper premium in order to have that higher deductible plan.  The catch is when you get sick, you have more out of pocket costs.  Pay the out of pocket costs and move on.  I know you wont, but I would suggest calling the physician group, and righting up their bill as well.  Although, BCBS pays on average $100 to an emergency physician to save a life.

To clarify wanting to know costs, nobody has a clue of costs in a typical emergency center, and furthermore, due to EMTALA (unfunded federal mandate that says you MUST be taken care of without discussing money), we are not even supposed to discuss money until your emergency is stabilized which would be when the appendix is in the trash can.  Nobody was trying to hide the costs, nobody really knows what the costs are until much later.

  Thank you for taking time out to post. This is what makes FW great. People that do these things day in and day out giving real world experience.

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It seems you tried your best at this point without risking any lawsuits or collection attempts. As others have said, if it goes to collections it can get a bit more expensive along with dinged credit. If you have any assets they'll probably just sue you and then you'll have to pay the $2k + attorney's fees + court fees + interest.

On the other hand if you have no assets, no income and no future need for credit then you could just take a "wait and see" approach.

I'd probably just take the payment plan and move on with my life.

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i3ighead said:   
Please keep us updated on what happens.

 

  
I signed up for $25/month 0% payment plan (autopay) and will use the monthly line-item reminder to do a serious run every month (with the training in between).  I'm mapping the percentage paid to the overall goal distance...  Something that appeals to the nerd in me.

As for the ER thing - I bought a coupon from local pizza place (good independent Italian place, not a Papa John's) for $60 -- enough for 2 of their biggest pizzas with taxes and good tip for delivery driver.  I didn't realize pizza was going to be that pricey, but once I was in the pizza place I was already committed to the idea based on this thread .

I dropped it off at emergency room in a card for doctor.  Card said "Thanks for saving my life!  Here's a coupon the next time the ER team wants pizza!"  and I signed it "Grateful Patient."

I'm not used to doing anonymous things because I like seeing the results (selfish, much?), but troutmd painted a nice picture that I wanted to make a reality.  Also, I'm hoping the good karma will keep me out of no-negotiation emergency rooms for the rest of my life.
 

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