Be careful of the hospital regarding overcharge

syber · September 7, 2004

Like many people here I read a lot, went to the seminar and was told $16,500 total cost for the proceedure. This included the doctor, hospital, two weeks in the hospital if something went wrong, lab work, everything. I had insurance and had everything pre-approved before hand by the insurance. When I arrived at the hospital they had notes from the insurance as well so I know they had spoken with them.

After the surgery the explination of benifits came in from the insurance company. Total hospital charges alone went up to $20,000.00

Not exactly the $16,500 I was told.

But I was told 16,500 and was going to stick to that. Feeling was if they wanted to bill the insurance for more, the insurance usually handles the billing the way they see fit. I told the insurance up front, before surgery that it was 16,500, total

Well insurance paid the Hospital 15,000.00. This did not include the doctor. Then the hospital balanced billed me for $5000.00. I called the hospital and said 16,500.00 total? Ring a bell? They said no one sets our price but us. I said the doctor said he has an agreement with you to accept the 16,500 total price. They said it was only for those with out insurance. I said if someone is told 16,5000.00 up front and the price changes after, someone set a lower amount up front and then up charged after the proceedure. Not legal! They didn't care and held me up for the additional $5000.00. I saw my doctor one day, told him what had happened and they wanted another $5000.00 from me. Doctor said the agreement(16,500) is for those with and with out health insurance. He picked up the phone and called the director of finance at the hospital. He ordered them to never contact me again and to drop all bills against me at once. They did.

I wrote the administrator of the hospital and advised him of fraud statutes and the cost of mis-quoting cost up front. He said he'd look into it and never again contacted me.

For those of you who had no insurance cover this and had to pay the full bill (16,500.00) I know your thinking, great bill, only $5000.00. But I also pay $625.00 each month to buy health insurance. So for those with health insurance, watch out for the hospital as in as much as your told going in the cost will be XYZ, the hospital may just decide to charge you more than agreed with with the doctor and try to get it out of you. Make sure everything is in writing before you go.

Alexandra · September 7, 2004

Thanks for sharing your story, Gene. Sounds like you had that doctor on your side--good thing!!

Everyone with insurance needs to be on their toes at all times. Read your policy BEFORE you make any commitments with doctors or facilities, and try to do everything by the book. If you're staying in-network, the cost of the procedure is negotiated between the providers and the carrier--usually the patient has no say in the matter. If you're going out of network, though, all bets are off and it's VERY important to get as much information up front as you can.

Gene, what kind of policy do you have that you had such a big out-of-pocket? Did you go out-of-network for the procedure?

syber · September 7, 2004

That was not an out of pocket. I have a $600.00 yearly deductable and after that it pays at 100%. The $600.00 was met long before the surgery. I have a fee for service and the hospital decided, on there own, to go about $10,000.00 over what is normally charged and what had been agreed to. What the problem was is the doctor and the hospital had an agreement (contract) to charge no more than 16,500.00 total. That was for any patient having the proceedure done. The hospital didn't want to follow it and billed the insurance way more then agreed to and then tried to get even more from me.

The doctor has some leverage as he does a lot of those type proceedures there. If the hospital chooses to start over billing the patients, he has the choice to make arrangements with other hospitals willing to accept what is usual and customary. Not only that but by billing for an amount larger than was agreed to, it put several people on the hook for mis-representing the agreed to price. You cannot give one price up front and then double it after.