We see it every day – people receive bills in the tens of thousands or hundreds of thousand dollar range for their medical care. Sometimes it’s because they didn’t have insurance and the hospital is just trying to grab as much money as possible, sometimes it’s because their insurance company denied coverage, and sometimes the hospital just plain messed up and is billing a patient after they’ve already paid.
We talked about a few examples of medical bills we solved in a previous post – but here are five more medical bills we’ve seen recently that we’ve solved.
Example 1: Insurance Denial of Coverage for a $36k Emergency Room Bill for “Not Being an Emergency.”
Result: Over $32k in Savings (nearly 90%).
A truck-driver driving through the Midwest was taken by ambulance to the emergency room of a local hospital. There he was treated and kept a couple of days to ensure that he recovered.
Months later he was shocked to find that both the hospital bill was $36,000 and that his insurance company denied coverage because it was “Non-Emergency service at an out of network hospital.”
Unable to pay $36,000, unsure why his insurance wasn’t covering care, and completely overwhelmed by the situation he and his wife turned to resolve for help.
We took his case directly to the insurance company and forced them to recognize that getting transported to the ER by ambulance, having surgery, and then staying in the hospital for a couple of days is clearly an emergency situation. They relented and paid what they considered an “in-network rate” to the hospital.
Unfortunately, this amount paid was significantly less than what the hospital charged for services – so the hospital initially attempted to bill our patient for an additional $12,000. We fought our way through the bureaucracy of the hospital to get them to drop this down to a little over $3,000.
End result, over $32,000 saved!
Example 2: Hospital rescinded a $36,000 pre-arranged discount for one late payment
Result: $40k saved – 100% of the bill
This patient had an upcoming procedure and smartly was able to negotiate a very large discount with the hospital before getting started. She also negotiated a payment plan for the remaining balance.
The procedure went well and she began making her monthly payments. However, unexpected costs hit and she ended up a couple of days late on one of her payments. The hospital immediately rescinded the $36k discount and demanded payment of the bill in full (a total of just over $40k) immediately.
Resolve took the case and went directly after the hospital. We were able to present her case in such a way that the hospital not only relented on their demands but forgave the entire bill.
The end result was a $40k savings, or 100% of the remaining bill!
Example 3: $31k bill pre-approved and then denied by insurance for a “pre-existing condition”
Result: Over $22.5k discount, a savings of over 70%
In an attempt to save money, a patient was convinced to purchase a temporary insurance plan through a private insurance broker (these plans are legal but not ACA-compliant and because of this don’t provide nearly as much coverage as more standard health insurance plans).
He needed surgery for a condition he had since childhood. His medical provider obtained a pre-authorization from his insurance company stating that they would cover it. Imagine his surprise when he later received an Explanation of Benefits denying coverage for “treatment of a pre-existing condition”.
Unfortunately, because these plans are non-ACA compliant, denials for pre-existing conditions are all too common. There is an appeals process to walk through, but these are stacked in favor of whatever the insurance company wants (even the supposed 3rd-party reviewers will almost always rule in favor of the insurance company) – so appeals didn’t work.
However, given the situation, we were able to work with the surgeon and hospital to lower the bill by over $22k – below our target based on a Fair Price Analysis. While the patient still had to pay something out of pocket, he was able to save over 70%.
Example 4: $55k bill for four days in the hospital.
Result: Over $45k discount (over 80% savings).
A retired Canadian couple was vacationing in the American Southwest where the wife was admitted to a local hospita. She spent four days there recovering and then was released. Unfamiliar with the absolute absurdity of the American billing system they completed their vacation and were shocked when they arrived home and saw a $55,000 bill in the mail.
Resolve’s Fair Price Analysis determined that despite a bill of $55k, a fair price for these services was between $8k-$12k. We then went to work with the hospital to secure a rate in that range. Despite initial resistance and attempts at settlement with offers of 30% and 50% discounts we stuck to our guns. We finally were able to secure a $45k discount – a savings of over 80%!
Example 5: $62k bill for 2 trips to the hospital
Result: $44k savings (70% discount) and bankruptcy avoided!
A man in the Northeast was considering declaring bankruptcy after receiving a $62k bill from a local hospital. He had attempted to apply for financial aid, but the hospital policy only took into account income and not bill size – so he was unable to qualify. However, his lawyer told him to consider negotiating the bills first.
Resolve sprung to work and conducted a Fair Price Analysis that determined that the most an insurance company would pay for these bills was $27k. Our Advocates then got to work fighting to secure a discount down to at least this amount. In the end, we were able to drop the bill to $18k – well below what insurance would pay for these services!
Hospital price inflation, crazy and esoteric insurance rules, and bad actors are all pitfalls that patients have to avoid when dealing with their medical bills. The system is confusing and broken and it’s extremely important to pay as much attention as possible when dealing with your medical bills.
If you’re still confused or worried about being overcharged, we’re happy to help. Give us a call at 877-245-4244 for a free consultation to find out what we can do to help you make sense of and lower your medical bills.
Braden founded Resolve after experiencing first hand how unfair the system is for patients. Prior to Resolve, he built and ran Operations for a renewable energy company and then built and ran Product, Growth, and Operations for a VC-funded edtech company. He received his MBA from Dartmouth’s Tuck School of Business and BA in Philosophy from the College of William and Mary. When not trying to lower healthcare costs he can be found outdoors mountain biking, skiing, or hiking with his dog.