Big Hospital Bill After Emergency… Any Advice?

Seeking Advice
1

My mother-in-law has been going through a rough time, and now on day 22 of a pretty serious health emergency. She’s in her 80s and on Medicare (A, B & D).

After being taken by ambulance to a local hospital, she was later airlifted to a bigger hospital in our city. She spent a week in ICU and has now been in a regular room for two weeks dealing with ongoing complications.

We just got a bill from the first hospital for “emergency services” that’s a little over $3,000. It doesn’t look like any insurance payments or adjustments have been made yet. For context, when my father-in-law was there recently, he only got billed $50 for the ER.

We plan to call the hospital, but does anyone know how Medicare billing works in cases like this? I’m wondering if, because her treatment is still ongoing, they haven’t sent the final claims to Medicare yet, and maybe that’s why this bill came through.

(Dreading the final bills… but I’m not ready to deal with that yet.)

2

Thanks for posting this. A few reminders:

  • If this is an emergency, please reach out to 911 or go to your closest hospital.

  • To help people here give better advice, include things like age, state, and an estimated pre-tax income if you’re comfortable.

  • If you have an EOB (Explanation of Benefits) from Medicare, keep that close by since it can answer a lot of common questions.

  • Common questions can be found in the forum’s FAQs.

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Be kind to each other!

3

You don’t have to act right away. Medicare can be slow to process payments. Just wait until the Explanation of Benefits (EOB) comes in; things should start getting sorted then.

4

If she has a Medigap policy with Medicare, there’s probably nothing to worry about.

With my dad, hospital bills would sometimes show outrageous amounts, like $200,000, but he ended up paying nothing. Medigap covered it all with no deductible or copay.

5

Check with the hospital to make sure they have all her insurance info correct. Sometimes a minor error, like a wrong birth date, can mess things up with Medicare. After confirming everything is right, then just give it time for the claims to be processed.

6

If she’s got Plan G, her final bill should be $240 or less, depending on whether she’s already met her deductible for the year.

7

Make sure the hospital has her insurance info on record. Sometimes, especially in emergencies, this step can get missed, and they don’t bill it properly. Also, if you receive any bills from other providers (like physicians), check to ensure they have the correct info too.

8

Definitely call the hospital and confirm they have her insurance details. When you get the Medicare EOB, check it carefully. I had a similar problem with my father-in-law’s bill because the wrong billing code was used, and Medicare rejected the claim. They tried to make us pay $891 when Medicare said he owed nothing.

9

Is she on traditional Medicare or a Medicare Advantage Plan?

Traditional Medicare includes:

  • Part A (hospital)
  • Part B (doctor visits, labs, etc.)
  • Part D (prescription drugs)
  • Medigap (supplement)

A Medicare Advantage Plan combines A, B, and sometimes D.

For traditional Medicare, the hospitalization deductible in 2024 is $1,632, and Part B is $240 (if it’s already met).

Does she have Medigap? If so, Medicare processes the bills first, then they’re sent to Medigap. This can take a while. You can also track Medicare claims online at medicare.gov.

Do you usually see her claims processed this way?

10

Without a Medigap plan, she’s responsible for 20% of the bill.