Hello…this is a little different than most info requests I see here, but am hoping someone might have knowledge on the subject.
I was hospitalized in April for an emergency ruptured appendix and have been fighting to get this covered as in-network until just recently. After filing a complaint with the NoSurprises help desk and the Illinois Board of Insurance, there’s finally been a resolution where I owe $5,000.00 +/- (instead of $18,000.00!).
On looking at the itemized bill from the hospital, I’m being billed $273.47 per bag for lactated Ringers, $227.42 for a bag of sodium chloride 0.9%, and $479.51 for each dose of levothyroxin solution (instead of being allowed to take a pill, which I pay $10 for 90 days).
These charges are insanely expensive, compared to the “real life” costs of these products (i.e. Veterinarians can order Ringers for $8.00 for the same size bag).
Is this just the way it is or do I have any recourse?
Many hospital bills are paid based on the DRG, which means the payment is based on the allowed amount for a procedure like an appendix removal, not on a line-by-line price breakdown. In these cases, there’s no need to negotiate every little charge. The insurance probably didn’t pay anywhere near what the hospital billed for individual items. A $5k bill (likely your deductible or coinsurance) is quite reasonable for emergency surgery and a hospital stay.
Thank you for the info. Yes, the $5,000 is for the remainder of my out of pocket.
I was originally fighting this and filed a complaint with the ILBOI because I was told I owed $18,000. (despite having a $7,500 oop max) because they weren’t factoring in the No Surprises act.
For in-network providers, the insurance company has a set contracted price.
Running an ER 24/7 with staff and life-saving equipment is very expensive. They also have to account for a percentage of patients who won’t pay anything but still must be treated by law.
You could look into whether the hospital offers financial assistance.
All hospital charges are approved on the Medicare Hospitals Chargemaster. If the government approves it, there’s no point in worrying. You already got a $13,000 discount, so arguing further won’t help.
So if it was in network what would you be appealing?
Wouldn’t you have owed the same amount if the facility had been in network in the first place?
Do you owe more than that and if so why?
I understand emergency is treated as in network and I am trying to understand what is the issue with the amount you owe since many people who go in network from the start might owe that amount depending on their deductible and co-insurance and out of pocket caps.
I’m just trying to understand why the Ringers solution was $273, when my veterinarian can buy it for $8.00 and I can buy it online for $11.00 for the exact same product.
Hospitals don’t use veterinary-grade products from vet supply stores on humans.
Even if they billed a million dollars, it wouldn’t change what you owe because A) what matters is the allowed amount, and B) the bill was likely paid based on a DRG.
