Which instructs the provider to list the "good faith estimated cost" on page 4. Presumably, this will then bind the provider to having to deal with you via the dispute resolution process:
Of course, the effectiveness of all of this remains to be seen, and will depend on what kind of teeth this dispute resolution process has:
>If after getting your bill you realize that any of your providers or facilities billed you for an amount that’s $400 or more than what’s on your good faith estimate, you can use a new dispute resolution process to request that an independent third-party, called a dispute resolution entity, review your case and determine an appropriate payment. This process is referred to as “patient-provider dispute resolution.” The dispute resolution entity will review the good faith estimate, your bill, and information submitted by your provider or facility to determine if you should pay the amount on your good faith estimate, the billed charge, or an amount in between the two. There’s a $25 non-refundable administrative fee to start this process.
Some of this has improved under the No Surprises Act. In certain situations the provider may be legally required to give you a "good faith estimate", or at least not send you excessive bills after treatment.
Good point, but makes me wonder how Medical Bill negotiation is on the list at all? How do you walk away from that? I could see some leverage if you're already in collections I suppose.
Edit: The list posted by "MerelyMortal" above.
Some good news: As of 2022, we have a new "No Surprise Billing" law that covers many of these surprise billing scenarios. There is a specific provision for being charged significantly ($400) more than a "good faith estimate"
File a complaint with Health and Human Services [1]. It is clear they are not acting in good faith. Take snapshots of the URL with the Internet Archive for notarization [2].
Odds are there is a State Law on point that requires a similar disclosure of estimates on medical services.
Take Florida Statute 581.026, titled Florida Patient’s Bill of Rights and Responsibilities
Subsection (4)(c)(5) reads: a health care provider or a health care facility shall, upon request, furnish a person, before the provision of medical services, a reasonable estimate of charges for such service.
In one case I represented a patient who video recorded asking a health care admin for an estimate and getting an answer of under $2,000. The bill ended up being somewhere between $12,000-$14,000. A single letter citing the law and the patients entire bill was discharged by the health care facility.
I think in this particular case insurance did investigate actual (or within a reason) costs and paid them. But there is no business relationship between the insurance company and an out-of-network provider. Should they go to the court on behalf of the patient? As a customer I'd like this. But it looks like combining health and legal insurances.
Another option is maybe to require that language on the "patient responsibility form" to include the blurb about fair prices. For instance:
In the event that my health plan determines a service to be “not payable”, I will be responsible for the complete charge and agree to pay the usual, customary, and reasonable costs of all services
provided.
important to notice this is not the medical bills they showing, but the claim rejection, and the claim rejection is "we require additional information"
we don't know what information was on the claim, but judging but the long list of "professional services" it's indeed too vague to be itemized against their policy if that was the description provided.
or in short this piece is presenting a very biased view by withholding a lot of information required to come to an understanding.
They (the medical facility) need to go back and work with your insurance provider on this one ("it seems they never got my new info" is not an excuse). Contact your insurance provider to give them a head's up.
No one in American healthcare knows how much it costs to deliver care. And as a result, the bills are more like: "They look rich. Let's see if they'll just pay it."
You don't go to Goodbill for this kind of thing. You file a complaint with your Attorney General, your insurance, and the BBB. Goodbill might work for legitimate bills, but this hospital sounds like it is acting fraudulently. How the insurance approved paying $6500 for 5 stitches is interesting since they usually fight paying bills and set caps on what a procedure can be reimbursed for. This makes me question if there isn't more to this.
Hire a medical bill auditing service, usually the initial consult is free. I don't know which hospital but they will certainly tell you if it's one that is unreasonable and refuses to negotiate.
FYI for all Florida patients, under the FL Patient Bill of Rights FL Statute 381.026(4)(c)(3): "A health care provider or a health care facility shall, upon request, furnish a patient, prior to provision of medical services, a reasonable estimate of charges for such services."
There is a whole industry of "medical billing advocates" you can pay to find what is likely thousands if not tens of thousands of dollars of completely made up charges on any given US hospital bill and "negotiate" them away. You don't necessarily need press coverage though it obviously helps.
Hell one time I got a $15k bill for something insurance should have covered. Called the hospital, turns out insurance had covered it and I didn't actually owe any money at all. How many people get this kind of stuff and just pay it anyway?
What’s odd is I think you might provide 90% of the value by just taking over the role of disputing random illegitimate bills.
The majority of surprise bills are errors and stuff that verges in fraud. And even though the patient doesn’t legally owe it, they may not understand this and even if they do it is super stressful.
At minimum it is a time consuming nuisance to respond to all the random BS bills.
I feel like you could accomplish that with a tiny fraction of the infrastructure.
"they don't expect to collect on most bills they issue to self-paying patients for emergency services, which is why they're so quick to negotiate them down if you ask. They know self-paying patients are very unlikely to actually pay the full bill, so they'd rather discount it up-front than write it down."
... or send it to Collections, charge it off, pick up the check for what might likely have been the negotiated amount anyway, take the difference in a tax write off, and debtor gets chased for the full Chargemaster rate...
When using the technique, be sure to get confirmation in writing that the bill is paid in full.
I've used it twice before. Once the hospital offered to consider it paid in full if I paid my entire $500 copay at time of discharged (i.e. anything left after copay + insurance payment would be written off).
The second time, I was able to get a facility fee negotiated down from $5k to $1k. The $4k difference found it's way to debt collections and onto my credit report due to the way the payment was written down in the system, and it was hell getting it dealt with since I didn't have explicit confirmation that the $1k wasn't a partial payment on the full bill.
My billing statements always include the insurance portion and the patient portion. Could be a Michigan law. The bills also include the billed price and the covered price (so the portion that they 'negotiate' is also on there).
It would be big news if the amounts they said they paid weren't actual payments.
If they do tell you it's not like they'll fine it binding either. Or good luck finding an error in billing in what they give you and then successfully contesting it. There area also all the ways they slap on random charges. The article mentions a $40 holding baby fee! I think a big part of why this isn't seen as a bigger problem is most people don't have direct experience with it. I've managed to be healthy and avoid any surprise medical bills so far in my life so it would be easy for me to assume this stuff would be taken care of by my insurance if anything happens. I know enough people who have horror stories to know that isn't the case though.
https://www.cms.gov/files/document/standard-notice-consent-f...
Which instructs the provider to list the "good faith estimated cost" on page 4. Presumably, this will then bind the provider to having to deal with you via the dispute resolution process:
https://www.cms.gov/nosurprises/consumers/medical-bill-disag...
Of course, the effectiveness of all of this remains to be seen, and will depend on what kind of teeth this dispute resolution process has:
>If after getting your bill you realize that any of your providers or facilities billed you for an amount that’s $400 or more than what’s on your good faith estimate, you can use a new dispute resolution process to request that an independent third-party, called a dispute resolution entity, review your case and determine an appropriate payment. This process is referred to as “patient-provider dispute resolution.” The dispute resolution entity will review the good faith estimate, your bill, and information submitted by your provider or facility to determine if you should pay the amount on your good faith estimate, the billed charge, or an amount in between the two. There’s a $25 non-refundable administrative fee to start this process.
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