I'm very familiar with that scenario. I work for one world famous teaching hospital, I'm a health information specialist and a certified coder. I see bills, I see our chargemasters. We do a lot of cardiac ablation procedures and while they are my thousands. they are not that expensive. Although, every case is different. In my state, patients have the right to request a bill audit and someone like me goes through the medical record to just every charge. Medicare and insurers also do random bill audits because errors do happen. Insurers aren't billed the actual charges, they are billed the allowable charge. So many people do have crappy insurance and they don't know it until the bills start coming in. The saddest case I ever had wax a young dad whose child had been hospitalized for months. Great clinical outcome. The bill was a couple of million $$. His insurer had already asked for a discount on the bill and it was granted. We took $30% off. The insurer paid promptly. Then the dad got bills for tens of thousands of dollars. And the bills kept coming and coming. Of course he was rude, nasty and blamed the hospital and the doctors for trying to cheat him. People always do that. They love their insurers but hate the providers who heal them and save their lives. My boss dumped it on me. This guy was self employed, he bought his own health insurance. He didn't know what he was getting, he only cared that the premium was affordable. His plan covered "radiology" meaning x-rays but it did not cover CT scans, mri's, nuclear medicine tests, cardiac imaging etc. It did not cover any of the modern technology that is commonplace. It also did not cover the the lab work that went out to specialized labs outside of our facility. So the father was responsible for his copay and deductibles and all of the non covered charges. It took me a long time to calm him and to explain it to him. Since we had already discounted the bill by 30%, we could not grant anymore discounts. We could not write off his balance because he was not low income. He was from out of state so our state catastrophic illness program could not help him with those charges. The case went all the way up to the president of the hospital, he said we couldn't discount more than the 30%. I did find some errors that I took off the bill but not enough to matter with charges like that. The father was given a long payment plan. I wasn't involved with that, legal took care of that but director thought it was a 7 year payment plan. The irony is, this was a critically ill child, transferred from an out of state hospital. We were one of a handful of hospitals capable of saving that child. If the family had NO health insurance or Medicaid from their own state, my hospital would not have charged the family anything. Nothing. By state regulation, if a patient is covered by insurance, we have to bill the insurer first and follow the path we took. That was the case I'll never forget. It could have been worse. We are a huge, rich hospital we routinely grant discounts although rarely 30%. We also accept payment plans for patient balances. Smaller, cash strapped hospitals can't do those things. They just don't have the money.
