Community Chat

[Imaoldhippie]

@FiddleDeeDee ............none of those charges are out of the norm.  Depending on your insurance they will most likely pay most of it.  Contact the radiology people and see why the charges have not be submitted to your insurance.  Most likely the radiology charge is for the radiology doctor to read the x-rays.  Thats usually not a hospital charge.  When your insurance pays and the balance is due SOME places will discount the balance or if you pay the balance due right away they will give you a discount.

Hope your 14 yr old gets well real soon.

[VaBelle35]

You should also get a copy of anything you signed when you were filling out paperwork at the hospital.

Generally there is language about being responsible for any costs not covered by insurance.

[ScrapHappy]

As you know there is in network and out of network for whatever health insurance coverage you have. Using in network providers provides the best savings because it's an negotiated contract rate.  With out of network, there may still be a "discounted" rate but not as much as in network.  Perhaps 10% or 15%.  You will have to wait for the bills to go thru insurance first.  You can always :negotiate" with the billing department.  They may (and should) offer a payment plan.  They will work with you, believe me, they want their money.  I have seen this topic on the news and on programs like 60 Minutes and the like.  Sometimes even when you go to an in network ER, the physicians are out of network and there is no way of knowing until the bills start rolling in.  There was a push to make it standard that if you go to an ER, all doctors should be a participant with all of that hospitals network providers.  If you don't mind me asking (and I don't mean this in any rude way), why did you seek out an ER for pediatrics?  Many hospitals have pediatrics units and many ER's are trauma units capable and prepared to handle pediatric, adults and infant patients.  

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@FiddleDeeDee wrote:

About 3 weeks ago 14 year old wound up in the ER; fractured elbow and wrist, did not have a concussion or broken shoulder. From start to finish 2.5 hours. No complaints about the care. X-rays of wrist, arm, elbow, shoulder and skull. Cast was used to set elbow and wrist. No meds other than Tylenol we had at home. Saw the orthopedic surgeon 4 days ago; cast came off, the bones were set correctly (by someone but not the doc) and everything is mending well.

Hospital is not in our network we have found out. It was the third place we went to as the first two did NOT offer pediatric X-rays. 2nd place told us about this hospital, we found it and off we went. 

Spoke to insurance this afternoon (about something else) and asked if the claims had been presented; they had. I about fell off my chair when he told me the charges:

*ER doc spoke to us at the beginning and then at the end. His charge is $14,000.

*Resident we never saw but heard her voice discussing X-rays charged $10,000.

*Hospital/ER charge is $20,000.

*Radiology has NOT sent in claim as of yet but insurance does state it is not part of hospital charge. 

So far it's $44,000.  It's been about 8 years or so since we've been to an actual ER; is this the amount hospitals usually charge or is it over the top? Just looking for feedback on the amount charged for the care he received. Thank you!

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[FiddleDeeDee]

@pitdakota 

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@pitdakota wrote:

@FiddleDeeDee, who stabilized the fracture and applied the cast?  

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 Well, it wasn't the doctor or the resident. It was a young guy not wearing a white lab coat or a stethoscope around his neck, I can tell you that. He had on blue scrubs and did a great job. His fee must have been included in the "hospital cost" claim.

[FiddleDeeDee]

@ScrapHappy 

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@ScrapHappy wrote:

As you know there is in network and out of network for whatever health insurance coverage you have. Using in network providers provides the best savings because it's an negotiated contract rate.  With out of network, there may still be a "discounted" rate but not as much as in network.  Perhaps 10% or 15%.  You will have to wait for the bills to go thru insurance first.  You can always :negotiate" with the billing department.  They may (and should) offer a payment plan.  They will work with you, believe me, they want their money.  I have seen this topic on the news and on programs like 60 Minutes and the like.  Sometimes even when you go to an in network ER, the physicians are out of network and there is no way of knowing until the bills start rolling in.  There was a push to make it standard that if you go to an ER, all doctors should be a participant with all of that hospitals network providers.  If you don't mind me asking (and I don't mean this in any rude way), why did you seek out an ER for pediatrics?  Many hospitals have pediatrics units and many ER's are trauma units capable and prepared to handle pediatric, adults and infant patients.  

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@FiddleDeeDee wrote:

About 3 weeks ago 14 year old wound up in the ER; fractured elbow and wrist, did not have a concussion or broken shoulder. From start to finish 2.5 hours. No complaints about the care. X-rays of wrist, arm, elbow, shoulder and skull. Cast was used to set elbow and wrist. No meds other than Tylenol we had at home. Saw the orthopedic surgeon 4 days ago; cast came off, the bones were set correctly (by someone but not the doc) and everything is mending well.

Hospital is not in our network we have found out. It was the third place we went to as the first two did NOT offer pediatric X-rays. 2nd place told us about this hospital, we found it and off we went. 

Spoke to insurance this afternoon (about something else) and asked if the claims had been presented; they had. I about fell off my chair when he told me the charges:

*ER doc spoke to us at the beginning and then at the end. His charge is $14,000.

*Resident we never saw but heard her voice discussing X-rays charged $10,000.

*Hospital/ER charge is $20,000.

*Radiology has NOT sent in claim as of yet but insurance does state it is not part of hospital charge. 

So far it's $44,000.  It's been about 8 years or so since we've been to an actual ER; is this the amount hospitals usually charge or is it over the top? Just looking for feedback on the amount charged for the care he received. Thank you!

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We didn't seek out pediatrics. We were TOLD by the first 2 places (in network) THEY would not take us due to not having pediatric x-ray available. We then ASKED for the nearest freaking hospital because our son was in pain, his arm was swelling, his head was pounding and we wanted him to be seen. That one we finally arrived at was another 20 minutes away but at least he finally received care. 

[ScrapHappy]

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@FiddleDeeDee wrote:

@ScrapHappy 

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@ScrapHappy wrote:

As you know there is in network and out of network for whatever health insurance coverage you have. Using in network providers provides the best savings because it's an negotiated contract rate.  With out of network, there may still be a "discounted" rate but not as much as in network.  Perhaps 10% or 15%.  You will have to wait for the bills to go thru insurance first.  You can always :negotiate" with the billing department.  They may (and should) offer a payment plan.  They will work with you, believe me, they want their money.  I have seen this topic on the news and on programs like 60 Minutes and the like.  Sometimes even when you go to an in network ER, the physicians are out of network and there is no way of knowing until the bills start rolling in.  There was a push to make it standard that if you go to an ER, all doctors should be a participant with all of that hospitals network providers.  If you don't mind me asking (and I don't mean this in any rude way), why did you seek out an ER for pediatrics?  Many hospitals have pediatrics units and many ER's are trauma units capable and prepared to handle pediatric, adults and infant patients.  

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@FiddleDeeDee wrote:

About 3 weeks ago 14 year old wound up in the ER; fractured elbow and wrist, did not have a concussion or broken shoulder. From start to finish 2.5 hours. No complaints about the care. X-rays of wrist, arm, elbow, shoulder and skull. Cast was used to set elbow and wrist. No meds other than Tylenol we had at home. Saw the orthopedic surgeon 4 days ago; cast came off, the bones were set correctly (by someone but not the doc) and everything is mending well.

Hospital is not in our network we have found out. It was the third place we went to as the first two did NOT offer pediatric X-rays. 2nd place told us about this hospital, we found it and off we went. 

Spoke to insurance this afternoon (about something else) and asked if the claims had been presented; they had. I about fell off my chair when he told me the charges:

*ER doc spoke to us at the beginning and then at the end. His charge is $14,000.

*Resident we never saw but heard her voice discussing X-rays charged $10,000.

*Hospital/ER charge is $20,000.

*Radiology has NOT sent in claim as of yet but insurance does state it is not part of hospital charge. 

So far it's $44,000.  It's been about 8 years or so since we've been to an actual ER; is this the amount hospitals usually charge or is it over the top? Just looking for feedback on the amount charged for the care he received. Thank you!

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We didn't seek out pediatrics. We were TOLD by the first 2 places (in network) THEY would not take us due to not having pediatric x-ray available. We then ASKED for the nearest freaking hospital because our son was in pain, his arm was swelling, his head was pounding and we wanted him to be seen. That one we finally arrived at was another 20 minutes away but at least he finally received care. 

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Holy cow!  I can't believe you went into an ER and they told you that.  I have never heard of such a thing .  My daughter was born very premature and has her fair share of xrays for various reasons throughout her life and never been told to go to a certain hospital because they have pediatric xray equipment.  And that includes ER visits when her asthma was out of control at a rinky dink community hospital.  I'm so sorry that happened to you.

[Vivian]

All I can say is that we Americans pay more for our health care than any other country. That's why the bills that I'll get (so far I have received none) scare me. I needed the ambulance, the ICU, and the rest of my hospital stay. I am still weak and tired and am looking forward to being myself again. If I don't have outrageous bills, that will help.

My husband is still lucid and would never go anywhere but his own home. That may change, especially if he ceases to know who I am. Right now it's a moot point. In-home care costs about as much as institutional care (in a good facility). The aide takes care of both of us, as I improve but my husband worsens. My cleaning lady comes a few hours each week. I have all the help I need for now so I am grateful. I learned the hard way that you cannot care for an Alzheimer's patient by yourself.

[KarenQVC]

@Vivian I will pray for you.

[happycat]

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@FiddleDeeDee wrote:

About 3 weeks ago 14 year old wound up in the ER; fractured elbow and wrist, did not have a concussion or broken shoulder. From start to finish 2.5 hours. No complaints about the care. X-rays of wrist, arm, elbow, shoulder and skull. Cast was used to set elbow and wrist. No meds other than Tylenol we had at home. Saw the orthopedic surgeon 4 days ago; cast came off, the bones were set correctly (by someone but not the doc) and everything is mending well.

Hospital is not in our network we have found out. It was the third place we went to as the first two did NOT offer pediatric X-rays. 2nd place told us about this hospital, we found it and off we went. 

Spoke to insurance this afternoon (about something else) and asked if the claims had been presented; they had. I about fell off my chair when he told me the charges:

*ER doc spoke to us at the beginning and then at the end. His charge is $14,000.

*Resident we never saw but heard her voice discussing X-rays charged $10,000.

*Hospital/ER charge is $20,000.

*Radiology has NOT sent in claim as of yet but insurance does state it is not part of hospital charge. 

So far it's $44,000.  It's been about 8 years or so since we've been to an actual ER; is this the amount hospitals usually charge or is it over the top? Just looking for feedback on the amount charged for the care he received. Thank you!

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I think these charges are outrageous. My sister also had to go to the ER, they didn't do much for her either, and she wasn't there 2 whole hours. I'd ask afor an itemized statement and go over it line by line.

[pitdakota]

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@FiddleDeeDee wrote:

@pitdakota 

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@pitdakota wrote:

@FiddleDeeDee, who stabilized the fracture and applied the cast?  

---

 Well, it wasn't the doctor or the resident. It was a young guy not wearing a white lab coat or a stethoscope around his neck, I can tell you that. He had on blue scrubs and did a great job. His fee must have been included in the "hospital cost" claim.

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@FiddleDeeDee, you might wait until you get the actual bill or statement from your insurance company and just take deep breaths until then, lol. 

Unless Fla is totally different than most states, stablization of a fracture and application of a cast after fracture stabilization is a proecedure for  a PA, APRN, or MD.  In most states, it is outside the scope of practice for a RN employed by the hospital.   But Fla. may be totally different. 

The charge for a resident you cite is somewhat perplexing and really confusing if it relates to radiology in any way.  

Medical residents are paid a salary which is somewhat based on what year of residency they are in.  Salaries for medical residents are funded by Medicare and also funded or supported by other sources related to the medical school the resident is attending. 

Consequently, there are very strict rules and regulations for situations in which a resident can bill for services dictated by the Centers for Medicare and Medicaid Services.  It doesn't matter if this is a pediatric hospital or not, they still have to abide by those same rules for billing since so many resident salaries are funded via Medicare.  Even if this was a resident in radiology, reading an x-ray doesn't seem to come under the circumstances in which a resident is allowed to bill separately since they are already receiving a salary.  

Florida may have different state laws, but I don't think they can supercede federal regulations for billing practices of residents.  

I will mention that just in case though so once you do get a statement from your insurance company to where you are able to more closely examine the charges, you may want to read up on that area in case you wish to appeal the charge for whatever reason.

There are posters here as well that are very well versed in medical billing that would have more insight and knowledge regarding circumstances in which residents may separately bill insurance/patient.  

I just know enough to know it is unusual for a resident to bill for services and that there are strict rules & regulations for a resident that does submit a direct bill for services rendered while they are performing their salaried responsibilities as a resident. 

I agree that the fee for the emergency room md seems really high.  Although, their billing does not directly relate to how much time they spend with the patient.  Technically once a patient enters the ER and is assigned to that ER physician, they are the one that oversees the care, directs the care, conducts a physical assessment, ensures the care meets standards according to the hospital and standards of care, records in the medical record, issues discharge orders, and gives the approval for the patient to be discharged. I am not sure that validates a $14,000 charge in this case though!