So I went to a hospital the other day and was told I have a de-deductible of $3,000. I am not sure how much my insurance paid (if anything). At some point I have to talk to the hospital about payment and I want to talk them down to accept a lower amount. I do have some savings to offer, but I would like to get them to agree to take that amount and write off the rest rather than just admit I have that safety net and still have payments.
If it helps the discussion my insurance is supposed to be “managed”. Which means that I call them and they then tell me where I can go and not have to pay anything out of pocket. It just happened that I had been having some pretty bad stomach issues I was hoping would go away. I then realized I had spend just under 2 days like this, but it was memorial day so their number was closed and any small clinic, so I went to the ER worried my appendix was bursting or something serious was happening to me.
Most (all?) health insurance companies in USA have clauses in their agreements with in-network providers (ie doctors, hospitals, pharmacists) to permit a covered patient to first receive the Explanation Of Benefits (EOB) document from the insurance company first, before having to pay a provider. In fact, waiting for the EOB is highly advisable, because paying a provider’s bill in-full and then later having to obtain a refund because the insurer paid out is akin to pulling teeth (that is, painful and difficult).
The EOB also shows which claims the provider actually filed with the insurance company, which if full-and-complete means you should not expect to make any further payments for services received.
To be clear, the EOB also includes any amount which the covered patient is known to have paid at the time of service. For example, most in-network doctor’s offices will charge the insurance policy’s copay on-the-spot before seeing the doctor, since this is a known, fixed amount and insurance will pay the doctor some sort of negotiated remainder.
You should verify the EOB reflects any copays you’ve already paid, and that the costs have accrued toward whichever deductible applies to you – more than one deductible can be at play.
To answer your question directly, I would not start any negotiation until you have the EOB in hand, because otherwise you are negotiating blind: you won’t know which claims have been filed, and you won’t know how much insurance has agreed to already pay.
Thank you for your response. I will be reading the links you provided!
As an aside, regarding USA health care public policy, I think provider-issued bills need to be abolished, where the only bill that insured patients receive is a single, consolidated bill that comes from the insurance company, at the same time the EOB is sent, with plentiful payment and financing options.
Not only does this reduce patient confusion, it saves money for providers (who don’t need to follow-up on late payments), it reduces the need for providers to issue refunds, and patients benefit because it’s a single bill at the end. The only downside – maybe – is that forgiveness of a medical expense must file paperwork with the insurance company, to be reflected on the consolidated bill. But this would still be a massive improvement.
Or, instead, maybe just go the full shilling and have a national, single-payer, universal health care system. Baby steps or big leaps; take your pick.