2008 has been a difficult year. On Sunday, December 30, 2007, I rushed my wife to the hospital emergency room. She had developed severe abdominal pain and was literally doubled over as we raced to the hospital. When morphine didn’t dull the pain, they moved to dilaudid, which is 15 times stronger. It took the edge off the pain. Then the vomiting started. 10 hours and many tests later, and they released her. They didn’t know what the problem was, but the medicine had reduced her systems. At various times they suspected a kidney stone, diverticulitis, and a variety of other ailments.
After a restless night sleep, the pain returned, and off we went to the emergency room at 5 am on December 31, 2007. This time we spent 13 hours in the emergency room before they admitted her to the hospital. More tests, more guesses, more pain, and more vomiting. By Wednesday (happy New Year, by the way) they had narrowed the problem to one of her kidneys and scheduled a procedure for Friday. Thursday night she seemed to improve, the procedure on Friday went well, and everything seemed to be resolved. She was discharged Friday, we went home, and five hours later the pain and vomiting returned. We were off to the emergency room again, admitted into the hospital, and she had the same procedure yet again on Sunday. It went well, and she was discharged on Monday, nine days after the ordeal began.
She’s doing much better now, although there are a number of follow-ups yet to go. They think the problem has been resolved, but they aren’t for certain.
I give you all of this background so you can better appreciate the following 4 things this experience taught us about our health insurance (we have PPO insurance with Blue Cross):
- Health care providers over bill: When you or your health care provider submit an insurance claim, you receive what insurance companies call an Explanation of Benefits (EOB). The EOB tells you the date of service, how much was submitted to insurance, what your co-pay and deductible are, how much the insurance company paid, and how much you owe. It’s absolutely critical that you review every EOB. In one case, a health care provider tried to charge us $250. According to the EOB, Blue Cross had an agreement with the health care provider for a set fee for the service they provided (it was a medical test). The agreed fee was $250 less than they charged us, and they were trying to get the difference from us. They can’t do that. When a health care provider agrees to a set price with your health insurance carrier, that’s the price they must charge you, too. Unfortunately, it has taken many calls to the health care provider, our insurance carrier, and even a debt collector to get this corrected. But remember, always check your EOBs.
- Co-pays for hospital stays are costly: I’m accustomed to paying about $15 co-pays for doctor visits or prescription drugs. Our health insurance, however, charges a $100 co-pay if we are admitted to the hospital. And remember when my wife was discharged on a Friday afternoon, only to return in pain a few hours later to get readmitted into the hospital? Yep, another $100 co-pay.
- Health insurance covered only 90% of the hospital costs: While I’m sure this varies from policy to policy, our health insurance covers only 90% of a hospital stay. Ten percent may not sound like much, but a 9-day stay in a hospital, including tests and doctor bills cost nearly $30,000. So in the first two weeks of 2008, we spent $3,000. At this point I’ll refer you to my article on emergency funds. Our insurance does have a cap on how much we have to spend out of pocket, but it’s $4,000, so the full 10% is on us. We had maxed out our Health Savings Account this year because both our children will be getting braces. We blew through the HSA in 9 days! Life happens.
- You won’t get just one bill: We’ve received numerous bills from different health care providers, many of whom we have never heard of. We received separate bills for each doctor that saw my wife in the emergency room. Some of the doctors we remember, some we don’t. We received bills for each major test she had. We received multiple bills from the hospital. And with each bill comes an EOB that must be examined. I’ve spent hours sorting through the paperwork and making sure we haven’t been overcharged. Be prepared.
During the 9-day hospital stay, money was not the first thing on my mind. But it is a reality, and I hope these tips help you out if you ever go through something like this. And if you have had similar experiences and have additional tips to offer, please leave a comment.
Published or updated March 23, 2012.
{ 36 comments… read them below or add one }
I’m so glad your wife is doing better!
And you’re right about hospital bills. They’re so confusing. We found that out when my father-in-law was in the hospital a year ago. I was amazed at the number of bills and insurance statements we had to wade through.
After this experience, I’m curious what your view of universal healthcare is.
After I had my appendix out a few years ago I realized just how indispensable health insurance can be. I had the same situation – 90% was covered – which left about $1000 or so for me to pay. Those EOB you get in the mail can be impossible to decrypt sometimes, and I think most consumers may end up just getting frustrated and paying – even when there is a mistake. Thanks for the post!
I pray your wife is better now, and stays that way. I know this was not easy to share, and hopefully by doing so, you helped a few other people.
Hope that your wife continues to do well. After my work in the NICU, I’m thinking about writing a similar article for people preparing to have kids. More about creating a special extra baby hospital fund if they’re able.
I really like this post because this is how I felt recently. I had to stay in the hospital over Thanksgiving last year and I have been frustrated with the bills from every direction.
I now have to have surgery tomorrow and I am dreading the deluge of bills that will be coming after that too.
I also had to spend hours going over the statements I got, then spend hours on the phone trying to get things explained to me. I was over charged on a few items but caught them before I actually paid because the statements from the insurance company always came back as ‘adjusted’.
I hope your wife is all better and does not have to go through anything else.
What an ordeal! Most importantly, I’m glad she is doing better now. I recently went through shoulder surgery (planned) and even that was expensive. I couldn’t imagine the bill from repeated visits to the ER mixed in.
I went in for knee surgery about three years ago and the full bill was over $30,000 for about 16 hours in the hospital. I never did figure out how on earth it cost so much because I couldn’t get an fully itemized bill out of them. Thankfully I just had to cover my $4,000 out of pocket max but unfortunately the various tests, follow ups and physical therapy spilled out into two different calendar years so I had to pay another $1,000 in deductibles for that as well. Medical expenses are totally out of this world.
I’m very glad to hear your wife is feeling better. I wish you luck in putting this all behind you.
All the best for your wife’s continued recovery.
You make a very good point that at times like this money may not be the most important things on our mind.
Still to be informed and prepared for the intricacies of health insurance should be useful.
I truly wish you and your wife well and hope she is doing better!
It’s unfortunate that it takes an experience like this to find out how your insurance will cover a need! It’s a shame it has to be so complex. Who knows what is really getting charged on these bills. Remember the days when the gov’t would spend something like $30k on a screwdriver? I bet that happens all the time on hospital bills.
Seeing Sicko by Michael Moore was shocking. It really makes you think of moving to another country!
Again, I hope your wife feels better!
Another lesson: know your certificate of coverage.
Because the insurance company isn’t always right. Don’t just trust your EOB’s.
My insurance switched carriers this year, and at the exact same time, I got dx’d with breast cancer. I was fighting over bills with the insurance company for MONTHS! They were denying things left and right for the most amazing stupid reasons and a different one every time I called.
Turns out they had the contract loaded wrong, the provider directory wasn’t loaded yet (so it kicked out everything as “out of network”), and our certificate of coverage is very different than most. (Much more patient friendly.)
But I was all over Humana like a dog with a bone and they finally realized they were the problem, loaded the contracts right, and got the provider directory loaded…and everything has been processed just fine.
Yes, you need health insurance. My retail bills are close to $400k so far; even an 80/20 plan would devastate me. I’ve just paid a handful of $10 specialist visit co-pays.
I’m a healthy athlete and this diagnosis came out of nowhere!!!
Regarding all those “extra” bills–if your health insurance company denies a radiologist, anesthesiologist, or pathologist bill, make sure the hospital’s charges are submitted and paid first, then contact the insurance company and ask them to resubmit the denied claim under paralogic. Because the patient cannot control what radiologist, anesthesiologist, or pathologist does the work.
Never give up, take notes, call and harass on a regular basis, beat them into submission. That’s what I’ve learned.
I pray everyone is ok now. I too know how confusing EOBs are; May 06 I was diagnosed leukemia and lymphoma cancer; am 52 yo female; had no insurance at first until 3 months later. I was in hospital for 65 days in one visits of many. I made sure I received itemized bills, checked with EOBs and even today am still paying bills on my budget. ALSO DOUBLE CHECK YOUR MEDICAL RECORDS. Found out that they had incorrect medical records on me that had my ID but were actually other patients. I now put money aside for medical bills; was unprepared. I’ve been in remission now. Emergencies can happen. Be prepared.
This is so close to what happend to me. The thing that is really kills me is that I asked over and over to be released and go home. They didn’t know what was wrong with me but all vitals were fine. They did test after test (Cat scans, Hida scans, xrays, ultrasound) then wanted to do a test that had to be scheduled for two days later. They would not let me go home and come back for the test. Is this america or what? I feel like even if I died they should have let me go home if that is what I wanted. Now I have a $4000.00 bill for much of a hospital stay that I did not want or ask for. Is there any way to fight this?
I wasn’t aware of how my health insurance really worked until I got tested for sleep apnea. The sleep test and medical equipment (c pap) were enough to blow through my entire HSA savings account! With those high deductible HSA plans you own the money right up front because there is no co-insurance that kicks in. Only after you exhaust the out-of-pocket max.
I had a hand injury, waited 8 hours for surgery, got there at 5pm and left the next day by 11am, and my bill is $16,900 plus $10,ooo for the hand surgeon. This is the most ridiculous thing I’ve ever seen. I am about to explode. For what? I laid there, a nurse cracked a couple of jokes, and I waited waited waited for service. $27,000 f0r one night! Does anyone think this is a mistake or pure robbery? This is the biggest pile of ripoff bs I’ve ever seen. Comments please. That’s impossible. $1700 maybe. $17,000?! No way. HELP!!!!!!!!!!!!!!!!!!!!!!!! B.S.!!!!!!!!!!!!!!!!!!!!!!HELP!!!!!!!!!!!!!
That’s insane but unfortunately, not a mistake. You know, if you had insurance, your insurance company would only allow maybe $5000 max for the hospital stay and maybe $1000 for the hand surgeon. I know this because I do billing and I had my own diagnosis of cancer, countless surgeries, etc. So I know all about this game. My surgeon billed $9000 and was reimbursed $1000!!! And he had to take it because he was in network and they cannot balance bill.
Best advice is to offer a settlement to the hospital and dr and get the agreement in writing.
The only thing you can do is demand an itemized bill. You might get the run around but you are legally entitled to one so don’t give up!
Woooow that’s crazy!! I live in England and i will NEVER moan again that i will have to sit in A&E with a load of drunk people :0 I thought that was bad enough but at least its all free
Thank goodness for the NHS 
I truly wish you and your wife well and hope she is doing better!
you complain…your one of the lucky ones that have insurance and you say that $3000 is a problem when your wife is in pain and there is actually a problem…GET over your cheap self.
Yes complain, this system is a joke. I just got out of a 3 day hospital stay with pneumonia last week, searching around what it might cost me. Our healthcare costs are absurd, not to speak of insurance rates. I’m covered through work at probably $500+ month, ridiculous for generally healthy 40 y/o woman. Our system is broken and stupid, wish complaining could actually change something…
needed to see a doc 10 pm on a fri night very high blood pressure 240/135
every walk in was colsed so go to ER spent 2 hrs until pressure dropped to acceptable level cost 2400 ER 1200 doc insurance only pay 1300 i have a bill for the balance i asked price first they told me $105 co pay, they lied.
what should i do? i live on a 1400 SS check but not 65 yet health insurance
650 per month my pension is 550 per month.can they sue me?
My wife went to emergency room for abdominal pain, stayed one night, got tests, and said diverticulosis (watch diet). We have AvMed insurance.
Just received frantic e-mail from my wife, AvMed says, we owe: $28,169.00
Thank you health Care in America!!!
Health Care Reform is finding out why a Hospital charges $145 for a single aspirin…or any sane insurance entity or person will pay that for it. It is NOT about making it so that we ALL can afford to pay $145 for the same aspirin, or forcing us ALL to buy health insurance that will do it.
I went to ER for headache (very severe) one night. They did CAT scan, then said I had to have an MRI. At 2am, they said the MRI machine wasn’t available and I’d have to wait until morning. They said I had to check into a room – couldn’t stay in ER b/c it was full (I was in hallway of ER entire time – the little rooms there were full of drunk people – not kidding – and cops checking on them while I guess they sobered up. This is in a “best” hospital in Washington, DC). I said I’d come back in morning for MRI, they said I had to stay, perhaps I had an emergency condition of brain and could suddenly die. Also said – head of ER said this – that it would take 2-3 weeks to get an MRI appt unless I “had a friend who is a neurosurgeon and could get you in earlier.”(?!)
With his threat of sudden death hanging over me, I walked to the shared room at 3am, laid in the bed fully clothed, never was served any food, never slept b/c the other patient was yelling and groaning very loudly in her sleep all night. No medications at all, no IVs, nothing – basically sitting there waiting for the MRI. In morning, they told me MRI was scheduled all day and I’d have to wait another night for MRI b/c one of the machines had “broken”. I refused to stay and said I was checking myself out, and if I died suddenly of this, they’d be in trouble. They miraculously found time for me to get an MRI 10 minutes later. After MRI, I left. No diagnosis from them, no talk with dr – they just said to schedule an appt with a neurosurgeon later in the next week.
Charge for the 1/2 night in the room that I didn’t want & didn’t need & didn’t include any meds or food? $2,000.
Total bill for this visit? $10,000. And I’m insured (Blue Cross “Care First” PPO). Somehow, insurance says I now owe over $2,000 of this bill and says I haven’t even met my $1,200 annual deductible. (How this makes sense is beyond me).
That’s it – no treatment for anything, no meds, nothing but a CAT scan, an MRI and part of one night in a room that I didn’t want.
I believe this is bordering on criminal on the part of Washington Hospital Center. Health care system in the US is totally broken.
A few years ago my wife was diagnosed with cancer and remained the ICU for 2-months, 3-months total in the hospital. Let me tell you that there are a number of obscene things that should not be going on within the healthcare industry, insurance, costs, etc. My family has been through a lot, but the BIGGEST jeopardy to our economy and country is our health. Neither our gov. nor the healthcare industry is doing what it needs to make health affordable for all! I didn’t say, FREE, I said affordable. I ticks me off, for example, that I go to the red cross and give a pint of my blood for $5 or FREE and the hospital charges me over $1500 for just a portion of that whole blood I gave! There is no reason that healthcare should cost that much and please spare me the “market” dictates crap! With so little competition in the industry, the market is heavily controlled by the corporate interests…
We’re self-insured with high deductibles & healthy. We pay $1200/month for very few services. We have the insurance “in case.”
My question is: WHEN are Americans going to wake up and yell UNCLE!
One-third of every dollar in health care goes to the insurance companies.
Insurance companies & hospitals are FOR PROFIT.
and they are profiting from our illness.
I have been a medical biller for 10 years now. Yes, the person ripping you off is the insurance company, its not the providers. The insurance company gets to charge for every little aspirin, bed sheet, nasal canula, etc. While the provider gets a small percentage, has to agree to become contracted just to attract patients to his/her practice and allow the insurance company to make excuses on why they don’t want to pay.
Hi, my son just had shoulder surgery for torn torn rotator cuff, torn labrum and bankart lesions (had suffered dislocated shoulder during wrestling match and all this other stuff happened because of that). Hospital bill $30,800, billed to Blue Cross. There is at least $20K listed as medical equipment/supplies. I called and found out these are the things used to repair his shoulder, sutures, anchors, etc, whatever all of it is called! Then I get to pay 30% of the “plan allowance” which wills till run me into a few thousand bucks. Does this sound right, that I have to pay for the things that put his shoulder back together? Isn’t that just part of “surgery”? I pay $150 co-pay for the surgeon and $75 for the outpatient room at the hospital. But these medical equipment/supplies thing is going to kill us? What to do? Is this correct? Can they re-code things if I ask them to do so and then the insurance co. will pay? The gal at Blue Cross said too bad he wasn’t “admitted” because then all those things would have been paid!!! Oh, gee, like I was to know outpatient would cost MORE! Thank you.
Hi everyone,
I’ll be visiting the US for a year to do some research.
After reading the stories on high expenses of med care I’m not sure which coverage to choose for my health insurance in the US for this time. I am thinking about 50 000 and 200 000 coverage. I’m a physician myself so I probably won’t need much unless something serious happens requiring hospital care. In any case if I got sick I would try to get back to Europe (where I am insured through my work and it covers ALL the med costs). However, I am aware that transport is sometimes not possible for a long time (for example in case of ICU treatment or serious wounds from gun shots, violent attacks ect…).
What would you recommend?
Thanks very much for any suggestions!
@ Tina,
I am a health insurance agent and my suggestion for you is Aetna. Secure an Aetna catastrophic plan to cover major incidents as you described, coverage is affordable and there when you’ll need it.
Enjoy your visit and be safe!
i have high medical bills from hospital and doctors can they touch my 401k
and ssck total bill over 275,000.00 i only have 40,000.00 in 401k
i am 65yrs old
Read “practicing medicine without a license” read “practicing medicine without a license by Owen Fonorow. Read practicing medicine without a license. if you want to dramatically improve your health and save your life read this book.
At least your bills got paid 90%, and not deemed medically unnecssary. That’s what I write about on my blog
I feel very sorry for all of you americans – In australia, we have universal healthcare and also the private system. I have access to both private insurance and also public insurnace.
I just had a baby – who died at 9 days, and I stayed in hospital for 11 days and my daugther for 9 days, in nicu (intensive care for infants) and we where looked after as public patients.
Not once dollar am I out of pocket and I have had the best of health care, from the hospital for the last 7 months.
I think that a lot of people are making far to much money from people who are able to least afford it.
I feel like I am reading a bunch of made up B.S. to promote”OBAMA-CARE” …seriously.
Obama has done absolutely NOTHING, we have BC/BS and I am really surprised at what they do pay. However, every time my husband goes into the hospital it seems to be 70-80 k and they basically are doing nothing but take BP heart rate. He has overcome cancer 2x’s and was never in the hospital for that,every time he is sent to a” certain hospital” for his heart rate or dizziness, they never let him out!! It’s been like groundhog day for 4 months now. Anyway, I am trying hard to keep up with what I owe,but it is impossible unless you are TYPE A to the extreme personality. What happens to the bills that never get paid?? because I know I am missing quite a few….I think the hospitals are at fault for overbilling!!