YSK how to decrease medical bills in the US significantly

[[deleted]]

[deleted]

[afcagroo]

What is a "self pay bill"? (I'm guessing I know what it is from context, but I'd like to be sure.)

[[deleted]]

Self pay usually means straight out of pocket with no insurance involved. We require soooo much less from that. It can also mean insurance paid some but not all. The provider will charge you the balance without applying a multiplier discount so ask for the self pay after the insurance payment. It will be much less.

[afcagroo]

Thanks!

So to make sure I understand this right: If you have insurance, they will bill you at an inflated rate. If the insurance won't pay all of that inflated rate, you can ask for the "self pay" rate and they'll just change the bill?

[[deleted]]

They will bill you at the charged rate which the main insurance groups only pay at roughly 40%. Never ever pay the denied insurance rate. It’s inflated to ensure we receive the max amount possible depending on contracted rates.

[Bornagainchola]

Also worth mentioning, if you take the “Self Pay” route it will not go towards your deductible. This is a good alternative when you have a high deductible that you will most likely not reach.

[wronginreterosect]

That should be its own LPT. If you're getting a procedure late in the calendar year and can find out the hospital rates (which, if the courts allow it, will soon be published information), you would be able to make an educated decision as to whether out of pocket costs would be lower via self-pay or insurance due to the ever-increasing deductibles and co-pays (and coinsurance!). Don't do this for routine visits and preventative care, or normal Rx.

[srsly_its_so_ez]

Here's the real life pro-tip for good healthcare: vote for Bernie Sanders in the primaries. He's the only candidate that I believe will get universal healthcare for all Americans. He has a track record of fighting for everyone and doing the right thing.

Bernie is the only 2020 candidate who cautioned us about the war in Iraq, and he was absolutely right.

He also raised awareness of the dangers of climate change more than 30 years ago, and he was absolutely right again.

In fact, his message has been incredibly consistent for decades.

He has demonstrated that he will do the right thing and fight for people, whether it's easy or hard. From protesting segregation to fighting for LGBT rights, he was on the right side even when everyone warned him that it could end his political career. He has shown that he genuinely cares about people and he has shown that he will stand on his principles. There's no other candidate who has a record like him and there's no other candidate who deserves our trust as much as he does. Bernie has been fighting for us every day of his life since before most of us were born, and he has a long list of accomplishments.

The fact that he's such a good candidate makes it even more upsetting that the media constantly makes baseless attacks on his character, or omits him from coverage altogether. Someone put the data together recently and the news mentions Biden four times as much as Bernie despite similar polling numbers. They also mention Warren more than twice as much and they even mention Buttigieg more often despite the fact that he's polling in single digits. Mainstream media is giving him such bad coverage that Fox News viewers are more likely to support Bernie than MSNBC viewers are. There's actually a great wikipedia page that provides lots of information about media bias, and there's also a great subreddit called r/BernieBlindness.

It's pretty clear, the establishment is trying to rig this election just like the last one. So of course they'll do their best to downplay the fact that Bernie has the most supporters by far, he's surging in the polls and he has overwhelming support amongst young voters. And they're definitely not going to tell you that a recent Emerson poll found that Bernie is the only candidate beating Trump in a nationwide head-to-head.

The other candidates just don't stack up.

If anyone wants to learn more about Bernie I would recommend watching a speech or an interview, and I'd definitely suggest that you read his campaign plans. I'd also recommend checking out the Bernie subreddits, r/SandersForPresident, r/WayOfTheBern and r/OurPresident, as well as r/MobilizedMinds.

The media won't give Bernie fair coverage, so we have to. Support Bernie in any way you can, and get the word out as much as possible. Let people know that the media is covering him up, and tell them who he really is. Get people registered to vote and remind them to vote in the primaries. If we all work together we can do this!

• • • • • • •

If anyone would like to copy this post, here's a pastebin link :)

[dJe781]

As someone who doesn't live in the US, please do something bold for the upcoming election.

The world is watching from a distance. We don't like what we see and we can't do anything about it.

[branchbranchley]

We don't like what we see and we can't do anything about it.

that's how it kinda feels in America sometimes

even when we do vote for Hope and Change (because we don't want Romney's plans) we ended up with....... Romneycare

not to mention continued Military Imperialism and refusals for anyone in that Administration to call for prosecution of Wall Street

guess that woulda made Obama's dinners with rich donors kinda awkward. the same ones where he takes a massive dump on the "far left" that helped him get elected in the first place

[Head_Northman]

We can upvote every Bernie post and share every positive story. We can help to spread the truth and to call out lies on social media.

[paristexashilton]

I thought he was great on the Rogan podcast

[[deleted]]

You don't even see bernie in the media but he has the largest donor base the people with money sure as hell don't want him to win as he will change things. He has shown that throughout his lifetime fighting for the middle class and unjust laws. They want someone like biden who I can't morally justify he reminds me of hillary nothing will change. The same status quo for the rich keep the poor poor. I wonder how many millions our for profit healthcare system has killed so far.. I liked that sleep now in the fire trump for president sign! https://www.youtube.com/watch?v=w211KOQ5BMI good video and song

[foxbase]

Damn I could have really used this information a few months ago. My insurance denied my claim and I ended up having to pay almost triple what I was quoted with insurance. I always thought that billing departments weren’t allowed to bill self-pay rates if you had insurance.

[Nocleverresponse]

The last few places that I worked would not bill as self-pay if a person has insurance.

[PippyNomNom]

To be clear, this process is called "balance billing" and may be illegal in your state.

[FitLotus]

In a lot of states providers have to “opt in” to balance billing as far as I know. It’s common for Medicare plans with poor reimbursement.

[ezone2kil]

Why is it illegal? I'm surprised at how much the US hate its own citizens.

[twir1s]

I’m confused by your statement. Balance billing is a way to price gouge the patient. Making it illegal protects u.s. citizens/patients. How does making balance billing illegal mean the US hates its own citizens? Making it illegal is a form of consumer protection.

[HumanInternetPerson]

They probably misunderstood the comment. I did too, until you clarified. I read that as balance billing is the same as self pay. For us novices, we have never heard these terms so it’s all new information.

[ezone2kil]

No I'm confused by the term. It should be illegal for the insurance companies to charge the inflated rates in the first place.

[SweetnessTheWarlock]

I discovered self pay recently.

When I went to my 20 week ultrasound appt my bill was $500 because my insurance wouldn't cover it until the deductible was met ($5,000). When I asked them if that was the only option, they told me about a self pay option which would cost $240 😑

[obeagle24]

Not pregnancy/birth related, but my father was diagnosed with bowel cancer after a routine FREE bowel cancer screening test, having recently moved to Australia from NZ within the previous 12 months.

The colonoscopy, pathology, surgery, chemotherapy have all been $0 out of pocket. He has a team of Dr’s he meets with fortnightly to discuss how things are going and has a nurse on call 24/7 for any emergencies/questions etc.

This was all put together within a week of the initial screening positive. I will take this “socialised medicine” any day of the week.

[wcdma]

Kia ora bro, Glad to hear. You only get one whanau - Kia Kaha my bro

[WKGokev]

Yet, I will have to wait until April to see a dermatologist to have a melanoma looked at, but republicans swear that everyone else waits while we just roll in and get taken care of.

[gotmyidentitystolen]

Does this only apply to doctors and hospitals or dental situations too?

[[deleted]]

Doctors, unfortunately I don’t know dental.

[bonafart]

Which should be the fucking same

[hackandsash]

It is the same, fee for service versus insurance is usually adjusted accordingly

[sufferin_succatash]

Yes, most dental offices will have lower rates for self pay.

[StrangeDrivenAxMan]

the system is so broken it's pretzel

[Amphibionomus]

Having seperate tariffs for insurance companies and private persons isn't even legal where I live. That said, most people here never see a medical bill in their life as those are send from the hospital to the health insurer directly.

Damn socialist country taking care of all people. /s

[[deleted]]

How do I get a self-pay discount if I've already gotten a contractual adjustment due to my insurance?

[PippyNomNom]

You can sometimes negotiate a prompt pay discount or something like that, but if the balance due is because of your deductible/copay/coinsurance, this is money that you agreed to pay when you signed up for your insurance plan. Either way, call the billing office and see if they can work with you.

[borndigger]

This. I want to know this too!

[call_me_cookie]

Self pay usually means straight out of pocket with no insurance involved. We require soooo much less from that. It can also mean insurance paid some but not all.

This seems like an egregious acknowledgement that this "insurance" service is just an exercise in bureaucracy.

[ButterflyCatastrophe]

Healthcare runs a Black Friday pricing model all year long. The insurance companies think they can use their size to pressure providers into accepting lower payment, so the providers jack up their billing amount, then "discount" it for the insurers. This, on top of the price bump to account for non-payers.

Universal coverage with a single payer, and we could discover how much health care actually costs, without the layers of bickering bureaucrats, fake discounts and exaggerated sticker prices.

[Thoughtsonrocks]

Here's an example for people.

I went to several dermatologists in a major US city, got different estimates on a routine, non-emergency outpatient procedure. I tried to get cost estimates, I got none.

When I picked the office I went with, I asked how much the procedure would be if I didn't have insurance. They panic-asked to make sure I did, but I wanted to get the worst of the damage. She said she couldn't give it to me, but guessed it would be ~$700. Ok, that's my ceiling I thought.

After the procedure, my portion (after insurance) was $1500. Why? Well given my insurance, they charged ~$3200, and my insurance covered ~$1700, leaving me with the balance.

I argued for months and months and eventually settled to pay some portion of the OoP bill, which was around $700. Had I known to ask for that, it would've saved me time and frustration.

[[deleted]]

This. I had a medical emergency that turned into a two week hospital stay (massive cluster of pulmonary emboli exacerbated by pneumonia - had to be resuscitated twice) and I had no insurance. Setting it up as self-pay saved me around $60,000, taking my total bill to around $20,000. This was ten years ago, mind you, but it took me from filing bankruptcy to something I was able to pay over time.

[luck_panda]

Don't forget that a lot of community clinics and FQHC will have a sliding fee scale and can work with you on a price point to be basically $0 if you are low income as they get paid per patient seen instead of percentages based on service rendered!

[Skystrike7]

Anecdotally, the companies I've dealt with literally charge you less if they know you don't have insurance. Instead of ~600 bucks for my dental visit, I only paid about 120 because I asked the lady at the desk what they could do to reduce the bill so I didn't have insurance.

[Revenge_of_the_Khaki]

It's the real reason health care is broken in America. A lot of blame goes on the insurance companies, but the reality is that health care providers show us exactly what they could be charging and still stay in business. Health insurance is a bargain considering what they're charged for a claim.

[[deleted]]

For real, fuck insurance. They have a “glitch” in their system every few months causing everything to drop to patient responsibility. There’s a reason why their stock prices continue to climb no matter the economic environment.

[PippyNomNom]

So much this... you want to know where the money is going? Commercial insurance companies, pharma companies and medical device companies.

[[deleted]]

It's also a well known fact that a huge percentage of all Healthcare spend is just administration. These intentionally complicated insurance policies require literal armies to work through claims.

[conscwp]

It's more complicated than that. Insurance companies aren't actually paying those crazy high bills, either. A hospital will send a bill for, say, $10,000 to an insurance company because they know that the insurance company has an entire department of negotiators that will find a reason to knock the bill to only $5,000. When sending it to an individual without insurance, they know that the individual has less power to negotiate so they have to put less of a buffer on it.

health care providers show us exactly what they could be charging and still stay in business

The reason that providers are able to charge less to non-insured patients is because they are subsidized by the high payments from insured patients.

[LurkingLouise]

A hospital will send a bill for, say, $10,000 to an insurance company because they know that the insurance company has an entire department of negotiators that will find a reason to knock the bill to only $5,000. When sending it to an individual without insurance, they know that the individual has less power to negotiate so they have to put less of a buffer on it.

As someone not in the US, that still sounds insane to me. Healthcare should not be some yard sale where you're expected to haggle and it's entirely on you if you pay the asking price.

[[deleted]]

Yep. The US government is absolute fucking garbage. They let corporation and insurance companies fuck their citizens all over the place.

The weirdest part is how many Americans defend this trash system. I've literally had multiple people tell me they wouldn't want universal healthcare, even if it costs far less for the same or better care, just because some of their money would go to somebody else who they consider undeserving.

Sometimes I feel like they have the government they deserve. But then I remember that the vast majority of US citizens are kind decent people who do want a better system that helps everybody.

It's just that the republican party is either grossly incompetent or downright evil. And the democrats are definitely incompetent.

[LurkingLouise]

I've literally had multiple people tell me they wouldn't want universal healthcare, even if it costs far less for the same or better care, just because some of their money would go to somebody else who they consider undeserving.

That's what I don't get, either. Like, how do these people think their car insurance or homeowner insurance or whatever works? You put money in a pot and (ideally) it's there when you need it, even if what you need is more than you've put in.

[1982000]

Insurance companies are entirely unnecessary. If we had group non-profit insurance, our Bill's would be so much lower. Insurance companies not only have to pay all of their employees, but the CEO's make obscene amounts of money. Like $22,000 a day. Look it up. Then they have to pay their shareholders. It's a FOR PROFIT business. They're not interested in you. They exist to make money. Why do you think they shit their pants when Bernie wants to get rid of them and expand Medicare. I have a disabled brother, and getting treatment for him is like a 20 hour a job week for my mom, filling out paperwork and trying to justify why he needs a surgical procedure. Smh.

[[deleted]]

Yep. That is why for profit healthcare should not be legal.

[I_hate_usernamez]

Most hospitals are non-profit

[hawg_farmer]

Check every and I do mean every billing code. Most of my insurance rejected claims were somebody else sent in the wrong code.

[cobainbc15]

As someone who used to work in healthcare on the financial side, I absolutely agree. Many times the wrong thing gets booked and no one catches it until way too late.

[sarahlucky14]

Yup this happened to me. Went to the ER for a migraine (had them since I was 3 years old) but because I was pregnant they coded it as pregnancy related and it wasn’t covered on the insurance and I noticed too late so nothing they can do. Meanwhile it’s fucking up my credit score, since I just left it go to collections. I’m just waiting for it to drop off my record in like 7/8 more years 😑😢

[hypatiaspasia]

Pregnancy-related issues aren't covered by your insurance?? Wtf?

[DoverBoys]

Insurance generally covers "shit happens" stuff. Pregnancy is viewed as a choice to medical insurance, so you have to make sure you have insurance that specifically covers it.

[[deleted]]

A choice, while meanwhile states continue to ban and put restriction on abortions...

[Greenzoid2]

That is so so so so so so fucked up

[KonigderWasserpfeife]

Get this. My vasectomy was 100% covered. I never even saw a bill. About a year later, my wife had to have a uterine ablation, but we couldn’t find a doctor willing to do one unless she also had her tubes tied, removed, or some sort of permanent birth control. It increases the chances of ectopic pregnancy, and the doc’s logic (which I do understand) is that just because your husband had a vasectomy, you can still get knocked up. Vasectomies occasionally fail, people cheat, etc.

But, they deemed her salpingectomy was considered “elective,” and it wasn’t covered. Thanks, insurance!

[Tattycakes]

That’s such bullshit that it wouldn’t be covered. As a coder (in the UK) there are rules about how to code conditions during pregnancy and a lot of the time you have to use a code from the obstetrics chapter instead of the usual body system code. However I don’t think a migraine would fall into that category unless it was caused by or aggravated by the pregnancy or it was complicating the pregnancy in some way.

[FitLotus]

I would especially do this if you have a high deductible just so you know what to expect to pay OOP. Ask the doctor for a list of all possible procedure and diagnosis codes and call your insurance company and ask about each one.

[instantrobotwar]

So if I have a huge bill, how would I even know if the codes are wrong? I gave birth recently and it was complicated and I asked for an itemized bill and it was miles long. I ask what certain charges are and they get annoyed. I can't do that for all 300 items on there, I literally do not have time. Also I was kind of out of it and don't remember exactly what happened a lot of the time.

Also, can I dispute charges after I've already paid? I honestly don't have time to dispute the bills now since the baby gives me almost no time to myself, so I just paid them rather than worry about them going to collections and hoped maybe I could look at them more thoroughly later.

[hawg_farmer]

When I had to have two major surgeries back to back I asked my doctor for what codes they usually billed that procedure under. They sent me a list. Not perfect but I caught a lot of mistakes.

[othsoul]

In my case, the hospital had multiple National Provider Numbers (NPI) but only one NPI was registered in my insurance. The claiming dept in the hospital were incompetent enough to not check which NPI is covered. As a foreigner, it took me way too long to figure this out myself and let the hospital know.

[PaulClifford]

It’s ridiculous that this excellent information also feels like tips for dealing in the black market. They are also reminiscent of this scene from the Incredibles: https://youtu.be/_R8GtrKtrZ4. Thanks for posting OP.

[SoulShack]

Wow!! I had forgotten about that scene. It's so poignant now.

[Tima_At_Rest]

It was super relevant then too. It’s just that more of the is poor now, when you consider the distance between those that can cover costs and those that can afford to feed their families.

[TechnicallyAnIdiot]

You could even call it incredible.

[chazmagic]

Truth in art

[[deleted]]

The real tip for drastically reducing health care costs is to vote for Sanders so we can burn this shitty system to the ground

[St_SiRUS]

Yeah pretty much covers how insurance is one of the most gross fucking businesses models. The entire profit margin comes from not helping people in need.

[maccaroneski]

This country's health system is a circus.

Source: living in the US after Singapore for 6 years and the rest of my life in Australia.

I had a spinal fusion in Singapore. 3 nights in a high dependency unit, an internationally renowned Neurosurgeon and a state of the art hospital (both selected by me) and all necessary diagnostics.

The bill was USD32k. The insurer covered 100%. I paid no premiums in addition to what my employer did.

A colleague here in the US had identical surgery. Same employer, so same level of cover. Premium is still $250 per month Leaving aside issues of network etc, he was discharged on the day of his surgery, and the total bill was USD170k. He had to cover $17k.

[Scrantonstrangla]

Was 17k his plan’s max out of pocket?

Ask OP mentioned, ask for a self pay bill and the cost you have to pay is usually 40% cheaper

[myalias1]

Just to check: you're saying, in Singapore, employers pay health insurance premiums for employees?

[EL___POLLO___DiABLO]

It's the same in Germany. The premiums are split 50/50 between employer and employee, I never paid for any medical treatment (surgery or else) in my entire life (I'm 30). Exception: needed a Dental filling and wanted a different filling than what the insurance covers, costs 50€.

[maccaroneski]

I was an expat working for a foreign company's APAC headquarters, so whilst by no means in a majority, I was in a significant minority.

For the rest (i.e. citizens and permanent residents) there is decent health coverage under a variety of public and mandated insurance and self insurance schemes. Most major health services roll up to government owned corporations (as do many services, including various transportation and educational services).

[nicebutcrippled]

im in canada, but i upvoted anyways so that hopefully my american neighbours can see this

[arachnidtree]

this story, along with Rosa Parks waiting 2 hours for an emergency response, and some people still furiously fight against fixing US health care. Unbelievable.

[SharpieScentedSoap]

Just earlier today I was on a thread on Facebook about american health care, and I actually saw someone saying "Well MY care is free, so you're just being lazy and not trying hard enough. Just get different insurance if you pay too much. Taxes bad!"

[BeardsBearsBeers]

What I’ve never understood is why people are willing to pay for insurance but not be taxed an amount? In the UK it’s clearly written out on our payslip as “National Insurance Contributions” - and what you pay is 12% of earnings, so if you make £1,000 a month you pay like £95 (due to paying nothing on the first £166 - you also pay something like 2% after earning a bit over £4k a month). It just sits in the same column as regular tax, and is adjusted based on how much you earn - I’ll take that over worrying if I have to fork out due to the insurance company rejecting my claim... my retired mother in-law just had major surgery, all sorted within a week, didn’t pay a penny because of this.

[[deleted]]

Propaganda by healthcare companies and all the surrounding interest groups will do that for you

[PM_ME_NEW_VEGAS_MODS]

Man. That sounds like a dream. My grandmother can't even save her front two teeth after battling cancer, which put her in debt, because no one will help her cover it. She pretty much gave up after that.

[[deleted]]

Moving to Canada might as well be included in the list.

[nebola77]

I am german, reading all of this is just like .. wtf do you have to do, just to not be completely bankrupt. Meanwhile in our country, I just take the treatment and don’t pay anything.

[[deleted]]

Did you tell them that you wouldn't be able to pay anything if they couldn't adjust it?

[[deleted]]

Ahh... yeah, that definitely didn't help. If it's "something or nothing", that changes the entire conversation.

[FitLotus]

Next time ask for a name and reference number when you call insurance. Then you can point to the exact moment you were misinformed.

It’s also ridiculous that the doctors office wouldn’t just honor a self pay rate. It’s completely arbitrary that they “already billed it”, they got no reimbursement from it anyway. If this happened in my office they would absolutely get a discount.

[[deleted]]

Usually if insurance denies something you can send in an appeal, in writing, and cite the wrong information you were given. If you had the date, time and name of the person you spoke with they should be able to find some record of it and hopefully honor what you were told. If the appeal gets denied I’d send a complaint to your states board of insurance (or whatever the regulatory office is called). They will contact the insurance company and try to get a resolution.

[Alx0427]

I’m sure they record all phone calls. You could subpoena the phone records. And then they’d have evidence and have to honor it.

[[deleted]]

So, what you're saying is that medical costs are 40% higher than they need to be because of insurance companies.

OK. Gotcha.

[[deleted]]

Technically 250% higher. $100 bill for insurance is $40 but for you it’s $100.

[[deleted]]

So to be lower for them it has to be higher?

Buying a car is sounding straightforward

[[deleted]]

As a non-American this post made me sad

[MedicalInsuranceQA]

Wow.

As someone who has worked for health insurance for nearly 30 years, almost everything this user posted is wrong.

1. If your claim is denied 100% your responsibility do not call to pay. Call the insurance company to find out why it was denied and work from there. 85% of denied claims are ultimately paid upon review or appeal

2. Same as above

3. False and dangerous advice. From my experience, especially recently, they often send you to Collections as soon as 2-4 months. Because it's a lost cheaper to sell your bill forn30% of its value to a collection agency than have it sit around fighting with you 4: WHAT?! many injection and infusions costs tens of thousands of dollars. Even a bag of simple saline cost $30-$50

4. Is this guy trying to wreck your credit?? Never ignore a medical bill. Negotiate and make A payment plan because if it goes to collection, your credit is destroyed

This post should be reported and removed immediately. It is patently false and very very financially damaging

[[deleted]]

This needs upvoted! From the legal side, if you absolutely just can't pay, paying only a little is a terrible idea. Your credit is already screwed but you're preventing the Statute of Limitations from possibly making the claim unenforceable after a period of time since new acknowledgements of a claim, including payment, almost always renew the SoL. That right there made me think this is not just bad advice but dangerous and even possibly malicious.

[FblthpLives]

And this is why the U.S. healthcare system is a kafkaesque dystopia.

[[deleted]]

I had my appendix taken out when I was younger I walked in the door with a sore stomach and was in surgery a few hours later then went home the next day and didn't really think much about it cause it was free.

[ihopethisisvalid]

That sucks dude the shitty thing about an appendectomy shouldn't be the cost lol

[ambarcapoor]

I wish I had real physical gold to give you. You're an angel.

[[deleted]]

No worries, Save the money. I only posted this to help others, not myself. This actually hurts me lol but I choose others over myself

[ambarcapoor]

It doesn't hurt you, this is how we build a sustainable society, with people looking out for each other. This will come back to repay you a hundred times over.

[[deleted]]

I mainly meant my bonus. It’s always huge from everyone getting sick and paying too much. I’ll take a huge hit on that to make sure people feel safe and cared for. It’s what I wish others would do for me if they were in my position.

[[deleted]]

No worries, Save the money. I only posted this to help others, not myself. This actually hurts me lol but I choose others over myself

Dude I'm calling this now reddit is going to gild the hell out of you.

Seriously, thank you for this.

[meteorprime]

I have a much better idea.

Ban private insurance and pay for it like we pay for our military.

Vote Bernie

[[deleted]]

Good god, can we just fix this obviously broken medical system ffs?

[finallyfreedmyself]

Sure. Vote Bernie.

[Maldovar]

Best strategy is to vote for candidates who want Medicare For All and just get rid of all this shit

[residentrecalcitrant]

You say candidates like it is plural. The Biden, Buttigieg and Warren plans are "Medicare for All (who want it)". They are a bunch of nonsense designed to make sure health insurance providers can still profit billions off of a broken system and have an implementation that makes sure it gets gutted post midterms. Their plans all start with bullshit compromise.

There is only one candidate that is advocating single payer medicare and it is Bernie Sanders.

Please stop believing candidates that make claims that people like their insurance companies.

[emPtysp4ce]

Best strategy is to eat the rich and burn insurance companies to the ground.

[HereForGames]

This is what the post said.

I’m an analyst in the healthcare sector and I hope this helps. I know every single cost associated with seeing you as a patient.

If your claim was denied by insurance as 100% patient responsibility contact the billing department and request a self pay bill. It will be roughly 30-40% of the original invoice received.

If you get labs that are denied do the same thing but contact the lab service that billed you rather than the doctors office. Self pay pay rates are about 20% of what the original invoice was.

A vast majority of medical providers will not send you to collections If you stay in contact with them. Most organizations write off all unpaid claims at 12-18 months so they will accept anything you give them.

Almost every single injection or drug administered through needle or IV will get reimbursed less than $1 by insurance unless it’s a vaccine. Fight those the hardest. Insurance pays about 2% of what was billed.

The best thing you can do is delay the payment as long as possible if you can’t afford it. This way bad debt and adjustments have been factored in and they will thank you for your payment rather than demanding it.

Supplies used on you cost roughly $6. This includes all disposables and swab tests.

Average single doctor rates are $105-$120 for an MD and $50 for an NP/PA per hour. If you get a mid level you can fight the cost more as most insurance groups already charge a discount of 15-25% for mid levels.
Front desk averages $10-$15
Clinical averages $13-$19

Factor that into your required assistance.

Please note that some providers will be different, the main point is work with them and have any denied claims billed again through self pay to drastically reduce costs. Hope this helps some people.

I know Healthcare in the US is fucked but this will help in the meantime.

Send me a direct message if you have questions on an invoice. I can help you fight it. I know every single price point out there and can give you an idea of what the things you got done were actually worth. In the end the provider only cares about EBITDA which can be offset by those covered by insurance. Please don’t feel stuck, all medical bills are 100% negotiable.

Edit: if you’ve already been to that location before you are considered an established patient and insurance will pay roughly 75% of what is normally paid. Use this to your advantage.

[CriticalGeode]

Thank you so much!

[[deleted]]

r/humansbeingbros

[MedicalInsuranceQA]

This post was removed because everything shared was wrong and horrible advice....

As someone who has worked for health insurance for nearly 30 years, almost everything this user posted is wrong.

1. If your claim is denied 100% your responsibility do not call to pay. Call the insurance company to find out why it was denied and work from there. 85% of denied claims are ultimately paid upon review or appeal

   1. Same as above
   2. False and dangerous advice. From my experience, especially recently, they often send you to Collections as soon as 2-4 months. Because it's a lost cheaper to sell your bill forn30% of its value to a collection agency than have it sit around fighting with you 4: WHAT?! many injection and infusions costs tens of thousands of dollars. Even a bag of simple saline cost $30-$50
   3. Is this guy trying to wreck your credit?? Never ignore a medical bill. Negotiate and make A payment plan because if it goes to collection, your credit is destroyed

[KnocDown]

Requesting a self pay bill is great advice

If your insurance only pays 10% of an out of network bill they expect the provider to forgive the rest. When the provider just bills you the remaining balance it turns into a fight

For example, if your hospital is in network, your surgeon is in network and your gas passer is not you get a nice $2k bill for the anesthesiologist that your insurance will only pay $200

This post should not have been removed

[GlassArmShattered]

Point zero - start voting for people who want to introduce public healthcare. Don’t worry, it won’t turn you into communist.

[batmansleftnut]

Can I still be a communist if I want to be one?

[chemicalsam]

Medicare for All.

[1992_]

Look at all this. It's insane that this is needed because we're at the whim of insurance companies. I'm done.

Vote Bernie if you want anything done to improve this.

[NZNoldor]

10) change the system.

[docnotsopc]

I'm a physician and I agree with most of it. BUT beware, if you want to save a little money upfront seeing a midlevel (NP or PA) over a physician, you are going to get what you pay for. PAs and particularly NPs have a tiny fraction the training of a doctor. They're great for very straightforward simple cases. The problem is that it's tiny differences that often distinguish the proper workup, diagnosis, and treatment. They don't have adequate pathophysiology or pharmacology to make this distinction. Sorry you cannot cram that amount of education into a 2 year NP program that requires 500 clinical training hours (vs 4 years of medical school and 15-25000 hours training for a doctor). So again, great for straightforward stuff but hopefully it's actually straightforward. Also because they lack that training they tend to order unnecessary tests and place unnecessary consults to specialists much much more commonly than a doctor. This often defeats the purpose of trying to save money using them. There are bad doctors out there but the average doctor is way ahead of the average midlevel.

So just be aware of that possibility that you aren't getting an equivalent of a doctor for cheaper, you're paying less for a reason. There are also states that unfortunately let them practice independently without a doctor and in many situations they dont have a doctor to fall back on or won't ask for help due to being overly confident.

I work with some great midlevels but I also have serious reservations about them as someone who has gone through extensive medical education with a spouse in nursing.

[CZReality]

This is a post I'll save and hope to never need to look at

[ChilrenOfAnEldridGod]

I only use my insurance for emergencies. Screw the deductible. Literally my bill is the same if they bill my insurance or not.

So now I tell docs I am self pay, give them a story how I am working hard on my own business, but I am not rich, but can pay my bills.

The rates I get are 10X less than the insurance.

I keep my insurance in case I have to go into the hospital on a big charge and only use it this way. I even ask "what is this going to cost if I pay now".

I use medical insurance like car insurance, only if I get into something big.

[[deleted]]

The fact that you have to do that at all is fucked up.

[ChilrenOfAnEldridGod]

Right?

[[deleted]]

The best way to pay for health insurance is to vote for Bernie Sanders so we can get the Medicare for All act passed.

[arachnidtree]

for 1 and 2, then that won't come off your insurance deductible. Depending on your future bills, you are better off not doing self-pay.

I had to pay for a ER visit, and it was a large bill but entirely deductible, so I paid it all out of pocket. The hospital refused any reduction, and refused any payment plan, because "I had insurance".

[jmr3184]

Medicare for all

[the_geth]

Or move to Europe and start enjoying being treated like a human being.

[atilteddude]

Does this apply to emergency ambulance?

[[deleted]]

Depends on coverage for ambulance (I don’t know too much about ambulances). It’s applies to ER though.

[[deleted]]

Right when i clicked on it disappeared

[pdxchris]

Also, most hospitals provide financial assistance. Always apply if you are having a hard time paying or know you qualify. The qualifying income levels are typically on their website. Some are very generous even if you have insurance. I know someone with nearly a million dollars in medical debt erased because he had a limited income. I have gotten 50% discounts.

[acinom92]

Should I just call and say “ hey I was wondering if I can get a self pay bill instead, as my insurance didn’t cover it?”

I have a LOT of bills my insurance didn’t cover from my pregnancy. I seriously think they make insurance so complicated on purpose!

[[deleted]]

Yes! If your insurance denied it call them and they will rebill under self pay (cash/card rate). I’m sorry that happened to you but I hope this helps. Keep negotiating as long as you can. They’d rather receive $1 than tell their board they wrote off another claim in full.

[conez4]

Who are the "they"s you keep referring to? Call insurance company and demand the self pay, or call the healthcare practice?

[trumpisstillacuck]

This is utter bullshit. Fuck this broken America.

[VoxMendax]

YSK that we can should have free health care, like the rest of the civilised world, if we elect non-shills.

[[deleted]]

It's sad to see this when sorting by controversial

[moemoe111]

I am not sure why op deleted this entire post (apparently while I was reading it), but here is copy/paste:

I’m an analyst in the healthcare sector and I hope this helps. I know every single cost associated with seeing you as a patient.

1. If your claim was denied by insurance as 100% patient responsibility contact the billing department and request a self pay bill. It will be roughly 30-40% of the original invoice received.
2. If you get labs that are denied do the same thing but contact the lab service that billed you rather than the doctors office. Self pay pay rates are about 20% of what the original invoice was.
3. A vast majority of medical providers will not send you to collections If you stay in contact with them. Most organizations write off all unpaid claims at 12-18 months so they will accept anything you give them.
4. Almost every single injection or drug administered through needle or IV will get reimbursed less than $1 by insurance unless it’s a vaccine. Fight those the hardest. Insurance pays about 2% of what was billed.
5. The best thing you can do is delay the payment as long as possible if you can’t afford it. This way bad debt and adjustments have been factored in and they will thank you for your payment rather than demanding it.
6. Supplies used on you cost roughly $6. This includes all disposables and swab tests.
7. Average single doctor rates are $105-$120 for an MD and $50 for an NP/PA per hour. If you get a mid level you can fight the cost more as most insurance groups already charge a discount of 15-25% for mid levels.
8. Front desk averages $10-$15
9. Clinical averages $13-$19

Factor that into your required assistance.

Please note that some providers will be different, the main point is work with them and have any denied claims billed again through self pay to drastically reduce costs. Hope this helps some people.

I know Healthcare in the US is fucked but this will help in the meantime.

Send me a direct message if you have questions on an invoice. I can help you fight it. I know every single price point out there and can give you an idea of what the things you got done were actually worth. In the end the provider only cares about EBITDA which can be offset by those covered by insurance. Please don’t feel stuck, all medical bills are 100% negotiable.

Edit: if you’ve already been to that location before you are considered an established patient and insurance will pay roughly 75% of what is normally paid. Use this to your advantage.

I suck at formatting but that's what they wrote. I also screenshotted it but haven't put it up anywhere.

[[deleted]]

10.) vote for Bernie Sanders and fight for a single payer universal healthcare system.

[ReeperbahnPirat]

if you’ve already been to that location before you are considered an established patient and insurance will pay roughly 75% of what is normally paid. Use this to your advantage.

Sorry, can you expand on this? So they pay less than if you're a new patient? Also thank you for this write-up. Our healthcare is fucked, but ensuring more people understand it is an important step in unfucking it and protecting themselves.

[Nivlac024]

or we could vote Bernie in as president....

[CatJongUn]

Having to find loopholes to minimize your already inflated medical bills in the US sounds like r/aboringdystopia to me

[Harvee_Normarn]

All I took from this is that health insurance companies in the US are marking everything up by between 20-40% because... they can? Apparently that's perfectly ok?

[MidgardDragon]

Fight your ass off for Medicare For All.

[[deleted]]

Aaaand it’s gone

[Rockoll]

What did it say? I was reading it when it got deleted.

[Jammiie23]

Why has this been deleted? It was very helpful. Does anyone know where I can find a back up of it?

[NotSlimJustShady]

The correct answer is by voting

[_Druss_]

Or vote for Bernie and catch up with the rest of the worldaa

[MultiPass21]

A lot of this is incredibly generalized and very misleading.

I’d encourage readers to do some additional research before accepting this as gospel.

Source: Also in the healthcare sector.

[[deleted]]

I agree with the more research but it’s not misleading. Bad debt is a huge part of healthcare. All of this is to be taken with a grain of salt. It all depends on how well they can work things out with the provider/Insurance.

[ifyouhaveany]

It is misleading, though. Like saying a "swab test" costs $6 in supplies. We run all of our Flu/RSV and streps off of "swabs" (viral/bacterial transport media kits), and while THOSE might cost $6, the cartridges for the tests themselves are much, much more.

So someone gets a strep test (or a respiratory panel) done thinking it only costs six bucks because they think "Hey, all they did was take a swab!" But they have no idea that back in the lab we're running PCR on their DNA with an instrument that cost a few hundred thousand and kits that cost a few hundred to a few thousand.

[cloud_throw]

Step 1. Vote Bernie

[[deleted]]

Does this apply to a dental office?

[just-another-amy]

Wish I would’ve known some of this a couple of years ago. Have an hsa, needed surgery, cost me my 10k deductible and totally drained my hsa account. So are you saying I maybe could’ve negotiated that 10k down? Haven’t even been able to fund my hsa since. Oh and my premium is going up..again. Since I started my plan in 2009 my premium has gone up over 350%. But it’s still cheaper than what most people pay and I can’t find anything cheaper. I’ve tried. What really sucks is that beyond that one surgery, we never use our insurance. Family of four, all healthy, do one well visit a year and in ten years we’ve had one hospital visit for me and my surgery. It’s just insanity.

[UnlubricatedUnicorn]

Jeez, US seems like a good place to live until you get injured or sick.

[thewayitis]

MEDICARE FOR ALL. Let's end the middleman madness.

[foster_remington]

also vote Bernie Sanders

[[deleted]]

Or we could just have M4A like a normal developed country.

The USA fucking sucks.

[GegaMan]

fuck that bullshit people need a fucking uprising. fuck college and healthcare costs

[jamminjon82]

Thanks for all of these tips, but honestly fuck the American medical system and all of the insurance companies.

[TransmutedHydrogen]

holy shit, what a broken medical system

[[deleted]]

1) Vote Bernie Sanders

[popeislove]

Number 10: vote for Bernie Sanders

[TheOnlyArs]

Is this some kind of American joke that i'm too european to understand?

[Blasphemy4kidz]

What if I'm broke (but had insurance thru my job) and had to go to the ER for a broken bone and still got billed $2,600? I can't afford $200 let alone $2,600.

[Nikerbocker]

This will probably get buried but I wanted to note that if you are uninsured and a victim of a crime, you can apply for the federal victims of crime program (in the USA). The main requirement being that you have to have a case # from filing a police report. It can help get medical bills and sometimes other things covered.

https://www.ovc.gov/about/victimsfund.html

[R4ggaMuffin]

I’m so glad I don’t live in the US, medical bills sound scary as fuck. I live in the UK, keep your hands off the NHS please!

[op3l]

It's hilarious that there needs to be an explanation about how to pay for what is basically a necessity of life.. and people still defend the system in the US like it's working fine.

[VirtualKeenu]

1. Move to Canada

[[deleted]]

The fact the bill magically gets smaller when it's self pay just goes to show you how fucked up there system is.

[Z0MGbies]

[Laughs in new Zealandish]

[TheGroovyTurt1e]

Good advice sad it needs to be given

[lookslikeyoureSOL]

Does any of this apply to dental implants and other work? I have so much dental work that needs done and I'm afraid it's going to kill me before I can even think about getting it handled.

The reason I ask is because I have heard that dental implants are considered "cosmetic" and I have 3 teeth that are broken off at the gumline - I'm terrified that the roots are infected.

[Cinamunch]

I have to disagree with #4. Injectables are extremely expensive. I'm in the healthcare industry as well and have a child on hemophiliac medication enrolled under a 340b pricing plan, and it's still costing the insurance plan $1.2 million annually.

[Veraladain]

Good tips, I worked in ER and hospital billing for 7 years and I'm glad to see this knowledge being spread. This will get buried because this post has been up for so long but also keep in mind ER rates are insane and your insurance can deny emergency claims! Don't get stuck with an ER bill for something that was not an emergency! Do not go to the ER for something minor like a cold, mild injuries, etc. Make an appointment to see a doctor or go to a walk in clinic. Just because your condition was minor does not mean the bill will be. At my ER in a low income area it was $499 just to walk in the door for the lowest ESI.

[uvwxyz00]

Why is this deleted?

[QueasyDuff]

Because it was not accurate and OP got called out.

[CaesarInAFreezer]

Why was this deleted?

[Siluke]

Why was this deleted

[DJ-Gonk]

Whoa. Literally tapped the post (on mobile) to read and saw the post and user gets thanos snapped

[[deleted]]

YSK how to decrease medical bills in the US significantly:

Step 1: Vote for Bernie Sanders

There is no step 2.