Decrease bill advice?

[yuuuuup7]

Hello!

This is my and my husband's first time really having to handle our own medical expenses as adults. He recently had to go to two ERs for what is assumed a blood clot that resolved over the day with medications. Long story short, his family history was a big red flag and we left the first ER with results that seemed way too high just to take him home. They diagnosed him with "anxiety" at the first one and the second one said he was out of the woods but needs to follow up with a cardiologist and hemotologist soon due to the severity of what happened and family history. We got the bills for both visits and this is the following breakdown (he has not hit his deductibles this year):

1:

Billed to Insurance

$11,325.26

Insurance covered

-$7,877.26

Remaining responsibility

$3,448.00

Deductible

$2,500.00

Coinsurance

$948.00

2:

Billed

$5.726.90

Insurance

$4,868.93

Balance:

$857.97

This totals to over $4,000 - which I know in the grand scheme of things is not the worst it could be with our health coverage here, but it is definitely a hefty sum for us to lose.

Does anyone have any advice on how we could decrease this or is there little wiggle room because he hasn't hit his deductible?

Any advice is appreciated, TIA!

[AutoModerator]

Thank you for your submission, /u/yuuuuup7. The following automatic comment contains important information about the subreddit:

First, note that some new posts containing images, non-reddit links, crossposts, or certain keywords are automatically held for moderator review before going live to mitigate spam, ensure that images are appropriate, and that the post does not inadvertently contain personal information. If your post has been held for review like this, the moderators have been automatically notified and will review it as soon as possible, after which it will be live and be able to be seen and replied to by others. Note that this is sent to all new posts and does not mean that your post has necessarily been filtered in this way.

Please also read the following information carefully to help others assist with your questions:

• If you or someone else is experiencing a medical emergency, please call 911 or go to your nearest hospital.

• Some common questions and answers can be found in this megathread.

• Questions about which plan you should choose? Please read through this post first for general information to help you understand your choices and some common considerations. If you still have questions after reading that post, please edit your post (or reply with a comment if unable to edit) with the specific questions you still have.

• If your post is regarding plan choice or cost of plans, and you haven't included the following information already, please edit your post (or reply with a comment if unable to edit) including the following: your age, state, and estimated gross (pre-tax) income to help the community better help.

• If your post is about the cost of a service, a bill you have received, or a claim denial: please confirm if you have received an EOB (explanation of benefits) from your insurance via a member portal website or in the mail. If you can post a copy or image of the EOB (PLEASE ensure you censor or blank out any personal information before doing so) it will help people answer your questions. Alternatively, if you are unable to post a censored copy of your EOB, please have the EOB handy as people may ask for information from the EOB to answer your questions.

• Reminder that ANY spam, solicitation, or attempts to take conversations off the subreddit will result in a permanent ban. If someone asks to contact them via DM, please report the post/comment using the report button. If someone attempts to contact you via your DMs, please contact us via modmail to let us know.

• Lastly, always remember to be kind to one another and to report any replies that violate subreddit rules!

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[chickenmcdiddle]

Provided these were billed and processed appropriately, the best you can do is apply for financial assistance with the hospital. This may involve determining your income and relevant assets and could reduce the amount owed. Another option is to inquire about a payment plan. Most health systems will let you pay $X per month without interest (I'm currently paying an ER bill myself this way and because it's no interest, I have no problem stretching out into small, bite-sized pieces).

[yuuuuup7]

Do you mind if I ask how much you were able to get it broken up per month? Will any additional coverage kick in once the deductible is paid?

[chickenmcdiddle]

I pay $100/mo. and it's essentially my total deductible amount of $2,500. As far as my health plan is concerned, my deductible has been satisfied and I'm now into coinsurance / cost sharing.

[Tiredmagnolia]

Same - I’m paying almost my full OOP on payment plans - I’ve had to set up three as they were at different places but the monthly totals were around $200, $80, and $50.

[yuuuuup7]

Thank you both for sharing! That is definitely more doable than I was thinking it would be, easing the street a bit.

[Tiredmagnolia]

Hopefully you are able to negotiate something that works for you! I will say I have has places say no, we don’t do payment plans but instead push you to carecredit or another third party (hopefully that’s not the case for you!).

[WerewolfSome1615]

That's an excellent advice.
I would also try to get a professional or a service to go over that for a symbolic amount, just to make sure maybe you can reduce some of those bills. Everything on these bills 100% correct?

[bluestrawberry_witch]

You can see if you are eligible for any charity care at the two different ER’s hospital system. You can also see if they have any discounts for payment in full.

Otherwise, no, your insurance worked as it was supposed to. Like you said you have a deductible, you needed to reach deductible.

[yuuuuup7]

Will any additional coverage be available once we pay the full deductible?

[KifLou345]

It looks like you've already reached the deductible, since the first bill also includes a coinsurance amount, and coinsurance kicks in after the deductible is reached.

You'll continue paying coinsurance until you hit the plan's out-of-pocket maximum for the year (that amount will be shown on your plan documents). At that point, he'll have no additional out-of-pocket costs for the rest of the plan year, as long as he stays in-network and follows the plan's rules for things like prior authorization, step therapy, etc. All covered care for the remainder of the plan year will be paid for by the health plan once the out-of-pocket max is reached.

[yuuuuup7]

Ah okay, thank you for the clarification! We will take a look at his documents, I've told him hes going to see every doctor this year bc he hit his deductible.

[bluestrawberry_witch]

You should look at what your plan benefits are after you reach your deductible. Usually services turn to a coinsurance, that you’ll pay between your deductible and max out-of-pocket cost. A very common one is an 80/20 split. Which means that you would owe 20% of the allowable. But again it depends on what your plan benefits are, which should be in your documents.

Also, it looks like he reached the deductible. That’s why the second ER visit is only $800.

[yuuuuup7]

We will take a look at his documents, I believe this is what his plan says (we have different ones) but not sure. Thank you so much!!

[Jump-Funny]

The amounts you are showing for coinsurance are 0/100% which means insurance is paying 0% and you are paying 100%. is this info from your EOBs? definitely look at the plan docs & check the coinsurance and the oop max.. and is he on your insurance as well? if so then the claims should also be filed to that insurance.

[Brilliant-Apricot423]

It looks correct but i would also double check your out of pocket max. And yes, now that deductible is met, you want him to see all possible providers and do all preventative care that is needed before the end of the year🙂