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A lesson in the cost of a lengthy hospital stay
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):

  1. 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.
  2. 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.
  3. 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.
  4. 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.

Author Bio

Total Articles: 1118
Rob founded the Dough Roller in 2007. A litigation attorney in the securities industry, he lives in Northern Virginia with his wife, their two teenagers, and the family mascot, a shih tzu named Sophie.

Article comments


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.

KMC says:

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!

Patrick says:

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.

Mrs. Micah says:

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.

lulugal11 says:

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.

Frugal Dad says:

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.

Adfecto says:

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.


It has nothing to do with medical expenses. You have a contract with your insurance company to pay the 4k out of pocket. It doesnt matter if you received $30,000 worth of care, or $3,000,000 worth of care, all you pay is 4k. Heck even if you only recieved $5,000 worth of care, you would stay have to pay the $4,000 because that is what you agreed to do with your insurance carrier. That is where the real reform has to happen. Insurance companies are making billions, and the providers get very little.

fathersez says:

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.

FFB says:

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!

kentuckyliz says:

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.

Gail says:

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.

Kellie says:

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?


You have the right to leave the hospital at any time. It is not a jail situation. You went on your own accord, and you can leave the same way. You do not need permission to leave the hospital. You can go with medical advice, or against medical advice. If they “let” you leave without full care, and something happened, they would be liable. We are America, and that means an extremely litigious nation. You must pay for services that you received, as in any other service industry.

Jeremy says:

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.

Greg Chruscielski says:

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!!!!!!!!!!!!!

Angelica says:

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.


Hospital costs are not real dollar amounts. When you are insured, the cost is immediately decreased and then represents real dollars. If you are uninsured, the hospital usually gives these “contractual adjustments” to you as well. Call and ask for a self pay discount. I think it varies area to area, but is about 70%. In my experience, the md costs are not negotiable, but worth a shot.

Sarah Bailey says:

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!

Mary says:

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!

Tom says:


Health care is never free. You or someone else paid for it through taxes or premium payments.

Josh says:

Exactly! We know this now after the debacle of the UNaffordable Healthcare Act (obamacare). What a joke.

Tom says:


Health care is never free. You or someone else paid for it through taxes or premium payments. If you haven’t paid either of the above, then someone other citizen(S) did.

Net says:

Having lived in the UK, Australia and now America. I am constantly surprised about the number of unnecessary medical procedures performed. Here my provider wants me to do tests every year that in other countries are required every three years because insurance will pay for it yearly not because it’s necessary. My daughter just burnt her hand on a hot pan and it wasn’t horrific but she ended up admitted overnight because otherwise our insurance might not cover everything, there was (in my opinion ) no need for her to stay, they gave her some Tylenol that will no doubt cost $50 and she went to sleep. Not exactly something that I am incapable of doing. My friends so. Burnt his hand (worse) on a BBQ in the UK. He was seen at the hospital and home with self care instructions in a few hours. No have to see a specialist doctor then have to see occupational therapy and have to stay in there. This is the worst part of the American system and in my opinion why it costs so much. This year I had a scan that I’ve had in Australia and the UK, in the UK it was free, in Australia it was Private and I paid around $200, here in the US I paid $550 because I hadn’t met my deductible. Same scan, even the same machine, same amount of time. Only reason for the higher charge I can see is the marble in the hospital foyer! And what’s it all for? The US has a life expectancy 4 years less than Australia and 2 years less than the UK, something isn’t right!

sam says:

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.

Lori says:

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…

rer says:

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?

C. Towsley says:

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!!!

Brion Boyles says:

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.

Josh says:

Obamacare has done nothing to fix our broken system other than to make the health insurance companies more wealthy. Follow the money.

CLE says:

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.

Richard says:

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…

susan says:

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.

Cyndy says:

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.


I love how the insurance company tries to deflect what the wont cover on to the provider. And when they say o too bad you weren’t “admitted” because you wouldnt have to pay anything. I work in the hospital on status such as observation, inpatient, outpatient (same as obs). It is Blue Cross who decides that a rotator cuff repair is outpatient. Your md office had to call them for preauthorization prior to procedure and BC told the provider that they would only pay outpatient. And then they play games about if you had this status or that status and you would have different coding blah blah blah. The truth is, if you were an outpatient, they would have denied your entire stay because its an outpatient only procedure. Insurance companies are pure evil.


your are 100% correct. the insurance companies love to play games and place blame on something the providers have done. i see it every day.

tina says:

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!

Indya says:

@ 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!

charlie says:

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

beth says:

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

danni says:

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.

jen says:

I feel like I am reading a bunch of made up B.S. to promote”OBAMA-CARE” …seriously.

kat says:

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!!

Mac says:

Well I guess maybe people should go to Mexico for their medical problems……but then again you might end up dead! I get it medical cost are high but we here in America have a lot better quality care in our hospitials and the technology is so much better! i think that people going to hospitials and using Insurance cause they have a head cold or the flu bug….little shit like that is why cost are so HIGH! insurance was never designed for that…..it was designed for major to life threating illnesses and disease!

Julie says:

Are you dumb or pretend to be dumb? insurance was never designed for cold and flu???? Are you kidding me? You must never had a serious flu in your life. Do you even know sometime flu can lead to other serious problems?
if insurance is designed for major to life threatening illnesses, then under what kind of circumstance or situation is considering as life threatening to you?

Musiclady says:

Everyone in our country is talking about paying for the rising cost of health care. Is anyone attempting to decrease the cost of health care? Does it really have to keep going up? I think we’re being robbed. Many times they never figure out what’s wrong with us any way.

shardae says:

Many times people blame obama for the health care. He simply tried to make health care more affordable, not make it free. I work for insurance companies and hospitals who have negotiated contracts. You really have to decide what insurance, what plan and what contract you should go with. Stop being lazy and look around.

abamo says:


What is Obamakare?

I used to pay a little above 6 hundreds dollars a month health insurance for entire family thru my employer

Now as I’m typing this, our employer has changed the carriers (annual enrollment/change time) and we have to pay > $1,000 a month for the coverage that is even worse than the old plan ! (20% co insurance vs 0 dollar coinsurance)

Now speak please Mr. Obama

Shawn says:

Blame your company. Corporate greed! I am in charge of the health care coverage plans and costs at my work. The company keeps paying the increases in order not to hurt the pockets of the employees.

abamo says:


What is Obamakare?

I used to pay a little above 6 hundreds dollars a month health insurance for entire family thru my employer

Now as I’m typing this, our employer has changed the carriers (annual enrollment/change time) and we have to pay > $1,000 a month for the coverage that is even worse than the old plan ! (20% co insurance vs 0 dollar coinsurance)

Now speak please Mr. Obama

Smith says:

Just some notes from 25 plus years working in a large hospital (multiple areas) in addition to having a child with $500K+ in medical bills. These are general comments only.
1) Hospitals charge 2-5 times what something costs but are only reimbursed 20-30% from Medicaid/Medicare and 40-60% from commercial insurers like Blue Cross, Aetna, etc. Some commercial insurers are going to a “DRG” system like Medicare where the hospital gets one amount, no matter how much the patient “costs” the hospital. There are “outliers” but no hospital makes money with those.
2) The “DRG” system that the hospitals are paid by the Medicare program and some commercial insurers covers the minimum calculated costs for the area & diagnosis/procedure. Take it from a concerned American-Hospitals DO NOT make money from this system. That is why many private physicians are having their Medicare patients sign an agreement which states the patient will have to pay if Medicare does not cover some service provided in the private office. In addition, most physicians do not accept Medicaid patients at all.
3) Even when hospitals receive payments for Medicare patients, there are companies (“RAC”) who are auditing the charts trying to find some little thing so the hospital has to refund the money. Example-If the physicians signature is not legible, if the physicians H&P did not list EVERY single conservative treatment tried before a total hip done, etc, then the hospital has to give back all the money received, even if the procedure was medically necessary. It is starting to change for some orthopedic cases, but in most instances, the physician has been getting paid but the hospital has not.
4) Commercial insurers are not any better-For example, they will deny or ask for a refund if the hospital didn’t notify them of the hospital admission w/in 24-48 hrs and get “authorization” even in the instance where the patient did not give the correct insurance. The hospital can spend countless resources in trying to overturn these denials but is only successful in about 40-60% of these attempts. Again, most of the time, the insurances go ahead and pay the private physicians because they don’t want the physicians unhappy.
5) I am not against most physicians-Many of them (especially the primary care physicians) work 12-14 hour days, have malpractice insurance premiums in excess of my home’s total market value, and miss more of their family events than the rest of us. Like EVERY profession, there are the good and the bad ones. Why do you think most new physicians are going into some specialty which is not related solely to the older population. They don’t want to live at the hospital and they want to get paid more than 20-40 cents on the dollar after going to school/residency/fellowship for more than 23-28 years. Again, there are good and bad examples in every profession.
6) Hospitals can get into serious trouble if they don’t appropriately screen, assess, and stabilize every person with an emergency even if they know they will never get a dime. Refer to EMTALA for more information. I have seen where a “frequent flier” patient is non-compliant with some chronic disease, comes to emergency room unstable, the hospital is required to treat the patient because of EMTALA, and the commercial insurance refuses to pay any of the bill due to the patient’s non-compliance. Most of you would say the hospital should have to treat emergencies even when the patient can’t pay. I agree but there are always two sides to every story and hospitals can’t keep picking up the tab for people who can’t pay or don’t want to pay for private insurance.
7) I know private insurance is expensive (especially for the self-employed) but most people could afford some type of catastrophic health insurance. You say you couldn’t? Will I find iPhones, manicured nails, cable TV, multiple TVs, luxury cars, junk food, liquor, cigarettes, or Miss Me Jeans, etc in your house? Many patients have told me they didn’t have insurance, couldn’t afford to pay their bills, or couldn’t afford a $ 75 dollar car seat to take their baby home BUT they had an iPhone, a $ 35 recent nail job, a $ 150 hair coloring job, and were driving a car less than 5 years old.
8) I want people who TRUTHFULLY can’t afford ANY health insurance and TRUTHFULLY can’t afford to pay ANY PART of their hospital bill to get as good as treatment as I get but I am afraid many people take advantage of the “system.”
9) I don’t have answers but the first thing I would do if I had enough power would be to have the people who control the “system” be under the “system.” Congress, the President, Vice President, and judges should have to live on what they put in their own retirement instead of being fully vested in the Federal Employees Retirement System after only 5 years and getting automatic cost of living adjustments. They also should have to work without automatic annual raises. Their raises should be based on performance like the rest of us. There are not many places where you can work for only five years and receive at least a
$ 15,000 year pension from age 62 on with automatic raises. They have to pay health insurance but is appears to be fairly plush considering what the rest of us pay. They only pay about 25-28% of the premium including for all family members, not just the employee. They have coverage for health, dental, vision, long term care, etc. Congress members can receive care at military hospitals including free outpatient care. Obama care would have many more people eligible for Medicaid but most physicians don’t take Medicaid. Somehow, I don’t think Congress or the President really understands healthcare if they have never had to worry about the “out of pocket” max or pay more because their hospital/specialist wasn’t “in network.” They don’t understand a family trying to find a specialist who accepts Medicaid for their special needs child and is rated above “awful.” They probably won’t get a $ 28,000 bill for a heart stent that the commercial insurance considers experimental because it was 5 mm too long to meet the insurance’s “medical policy.” I could go on and on with examples but I have to go figure out some more EOBs and how to pay the “patient portion.”

myself says:

To those people out there that are ripped off every day by over priced hospital stays…I say they are thieves one and all.
Praying on people saying things like but its your loved one money should not mater.
I rarely say this to anybody but today it fits….
Fuck you and the horse you rode to work.

Cooper says:

My husband was having sever pain thought it was heart. Test showed cardiac enzymes were up the scanned gallbladder and yes it needed to come out and he had to have 20″ incision plus estrangulated hernia. And other complication on 4 l o2. Now on 9 th day doctor discharged him. But now insurance will not pay for 8th day said not needed. If doc does not take iV’s out give you discharge mess and pull drainage tube what are you to do get up and walk out? What to do now we can afford to pay 5800 plus 2289 for uncovered day?

Tim says:

If you want factual information on the “True Cost of Healthcare” I found the following website. The article was written by a Doctor, and is a “Real Eye Opener”!


nodrug says:

Most of the time generic drugs work as same as the band name… however, yes it’s the other part of the “Most of the time” can kill you or your love one,

my experience is to be careful to generic, and more than that be careful to any medicine. The best choice is no med at all unless you have to

so let say fck to the druggists and the horses they rode to work

nodrug says:

Most of the time generic drugs work as same as the band name… however, yes it’s the other part of the “Most of the time” can kill you or your love one,

my experience is to be careful to generic, and more than that be careful to any medicine. The best choice is no med at all unless you have to

so let say fck to the druggists and the horses they rode to work

Patrick says:

I hope your wife is doing better now. I was happy to see you realized it was the healthcare providers, and not your insurance. Insurance companies get a bad reputation, and are often blamed for errors caused by the Healthcare provider.

Rob Berger says:

Patrick, that is so true. I was on a jury in a medical malpractice case back in 2001 (the week of 9/11, actually). The jurors universally hated the health insurance company.

Stephen duQuesnay says:

I agree, many times providers blame the insurance company, when in fact the provider had made a mistake which has caused the claim not to be paid or the approval NOT be granted. Once the provider makes the correction and submits the information correctly the insurance company will promptly process and pay. So good comment.

matt says:

Wow… amazing how bad it’s gotten in 5 years! 10% coinsurance is a blessing. .. the best plan my employer offers is the standard obamacare-minimally-compliance ripoff (40% coinsurance after $2000 deductible and $375/mo premium single) which is clearly offered for no purpose other than avoiding the employer tax penalty. I need an endoscopy and likely fundoplication surgical procedure to treat my advanced-stage GERD, but can’t afford it by a long shot (i’m only a full-time electronics engineer) with or without that company insurance. I’m researching international hospitals which might do this, but until then I will have to continue alternating between going to bed at night on odd days, or eating supper on even days. Last time i did both i aspirated my stomach content in my sleep, with predictable emergent results.

Daniel Markwell says:

This is a message to the post above mine . My wife has had gird for years and ironically i heard a message one day that stated that a couple or few slices of apple after eating can neutralise the affects of the acid. It has seemed to work and she has not used prilosec for for 5 years or so. To the orignal poster here. Hope all is good now and understand all the BS cause after a recent in hospital stay am getting all the random EOB’s ….. take care all and be well. Dan

Craig says:

There is one way to fight back against the high cost of health care. That is AFLAC. cash in your pocket in 24 hours. At the cost around 7 $ a week. For a broken ankle you get between 4,000 to 5,000 $.

Craig says:

That $ goes to you to spend as you want.

elise says:

this is scary to me because you obviously have what i would consider excellent coverage.

I pay $25 co-pays once and then it goes up from there as more appointments are needed beyond the first appointment.

our insurance covers only 80% and 60% out of network.

We pay for tests of any kind at a higher percentage than the 80/60%
Our deductible keeps rising a couple of hundred every year
They have dropped many preventative healthcare coverage,,every year our rates we pay go up anywhere from 10 to 30%

We now have a HUGE co-pay for prescriptions that we did not have before.

People pick on the Affordable Care Act but insurance costs and fairness had to be addressed. People are going to be dropping health insurance and they will need a back-up plan.

We are healthy people and we pay a lot of money out of pocket. it is sickening

Thanks for this article…good luck defending yourself…they can wheedle out of paying out claims pretty good

Sarah says:

The Affordable Care Act (ACA aka Obamacare) has addressed nothing…. I think the insurance companies might have actually lobbied for it in the first place. I mean how dare our government MAKE us purchase a product from a for profit industry and not regulate said industry!!!! They can charge what they want and cover what they choose… and our government fines us if we don’t participate…. it’s all a bunch of BS!!!

Stephen duQuesnay says:

Once again please be informed. Insurance companies are regulated, each by their respective State Departments of Insurance. Rates are submitted to each States Department of Insurance for approval. The insurance company does not set their rates. Rates are based upon experience. ie look at a small corporation that has 10 employees and 1 employee develops cancer that cost the insurance company $100,000 in treatment. At renewal time the rates are going to go up. So the same thing happens with the ACA just on a larger scale. People that were uninsured and unable to qualify medically for health insurance NOW can get insurance to cover their existing condition. Ie bad hip, arthritis, hepatitis. etc these medical issues cost $50,000 to $100,000 to treat while the insurance company may only change $200 to $1000 per month for the coverage. So do the math YOU NEED 20 to 100 health insured individuals to cover each person that has a serious medical condition. Thats why rates have increased over 500% in the past 5 years in most areas of the country. The insurance companies have to collect enough premiums to cover the medical claims they receive. And yes insurance companies DONT cover EVERYTHING, THEY HAVE certain restrictions and steps to get thing covered. There has to be a check and balance. The key to using any health insurance is have a Great doctor with a great office who know the insurance rules on how to get procedures/items covered. Without a good doctors office insureds may not get access to the full benefits of their policy. Insurance just can pay for ANYTHING a doctor wants a patient to have, their has to be some MEDICAL NECESSITY.
For example most insurance policies pay for just about any test when a person goes to an Emergency ROOM for treatment as the doctors done have to get a prior authorization from the insurance company. While is you try to plan a hospital admission the doctor take 7 to 10 days to get the insurance companies approval based upon the patients current health issues and medical diagnosis. So if you doctor files the correct paper work with the proper diagnosis then most of the time the procedures are approved.
The insurance contract will clearly state what is and is not covered, But no matter what the doctor/patient has to get an authorization for any Planned procedures.
Note also for medication, the insurance company provides each insured with a list of medication that ARE covered. In addition, if the medication is NOT covered their is a procedure that the doctor can use to get the insurance company to cover the medication if HE provides the proper diagnosis and paperwork. Once again a check an balance as the Prescription manufacture always tries to get the doctors to prescribe the newest and greatest, most expensive medication. But a lower priced medication may work as well. So there has to be some check and balance.

Jamie says:

$4,000 for a 9 day hospital stay? What a deal! I went in to the ER after getting banged on the head during a softball game, and wasn’t even admitted. But because I had a big knot on my forehead, they did a CAT scan, and coded me a trauma level 4 (head injury) thus billing my insurance over $6,000. My insurance negotiated the bill down to around $2,500, but still, for about 1 hour in the ER for an injury I drove myself in for that ended up being pretty much nothing. My deductible is $2000 a year, so most of it just came straight out of pocket.

And this is for insurance that I have to pay for myself (not ACA), nearly $16,000 a year to cover my family already. My contracting company is nice enough to chip in $100 a month to help out.

So $4,000 for 9 days? Including tons of diagnostic tests? That’s basically the bargain of the century in comparison.

Your just Anumber says:

Well medicare is no better. I became disabled from MS and other medical problems. I had to file for social secuirty disablilty. It took so long I exhausted all of my reretirement money from my employer. Well now I final got medicare I felt some a little better once i got it in hand. So I started calling my doctors and giving them the new information concerning my medical insurance. Some said they did not take medicare so I had to find a new doctor. Well I started calling. Monthly waits for appointment we are not taking any new patient right now.
Well doing all this I had relapse MS problem. I needed to be admitted I was in constain pain and kidney problems
Well to make a long story short. I never got admitted I had 6 ambulance trips to the ER. The nedication the ER doctor proscribed was not covered. I was turning yellow liver was failing. Point to the story is I think medicare the red white and blue card is a tempary death certificate. People who have medicare know what I am talking about. The only way to get admitted is directly to the morgue pretty fucked up situation.

Sarah says:

Reading all the above is quite disturbing. Some people advocate a single payer system…. that’s basically Medicare I understand. The problem is that it pays so poorly fewer and fewer doctors are willing to take patients on Medicare. But my insurance premium will be more than $1000.00 a month with a $4800.00 deductible with Anthem BC.
for 2018. Thanks to the ACA!!!
I am very healthy so all I’ve gotten for the $20,000.00 I’ve paid in premiums in just the last 2 years (for just myself, my husband is on Medicare now) is 2 annual physicals, 2 free mammograms & 2 flu shots!! Also they’ve changed my plan from a PPO to an EPO which means if I go out of network I have NO coverage unless it’s an emergency…. there is NOTHING AFFORDABLE about “Obamacare” unless you qualify as low enough income to be subsidized…
I just want a hospitalization plan with a $100,000.00 deductible for $200. A month like I used to have… but now with “Obamacare” those plans are no longer available…. all plans are all inclusive… that is until you try to use them.
We have some friends, a young couple with children, who pay over $1500.00 to insure their family. The husband hurt his knee. The doctor suspects a torn meniscus and asked for an MRI. Anthem BC denied the procedure (even though their deductible is so high they’d be the ones paying the bulk of the bill) saying he must go to physical therapy. His physical therapist said he would not treat him until after an MRI because if it’s a torn meniscus physical therapy will further damage the tissue. So my friend tried to have the MRI and just pay for it… but he can’t because the facility is contracted with the insure company snd they said NO.
The lesson here is…. that had he NOT paid those horrible monthly premiums he would be able to get the treatment he needs and spend his money on his care not insurance that actually is preventing him from being able to be treated….
Health care providers NOT insurance companies should be the ones to decide what the patient requires!!! And there should be all kinds of policies available to meet different peoples individual needs.
The ACA “Obamacare” debacle has to STOP!!! I just want to pay my own way… be able to take care of myself… not everyone else!!!! People need to be self reliant!!!!!

kelly says:

I am glad that being close to age 65 you are so healthy.The cost of the premiums is an indicator of your age. You are fortunate that you have $100,000 lying around for deductibles. Because of Obamacare you can get insurance . Before Obamacare insurance companies could deny you coverage due to age or pre existing conditions. Because of Obamacare your premiums are much lower than they were prior to the passage of the law.
Insurance is a pool. They are banking that everyone will not make big claims at the same time. Think of all the money you have spent on Homeowners insurance and if you have never made a claim it seems the money is wasted. But even if you are not required to have homeowners insurance you would still carry it. Obamacare wants people to see their Dr. They found that people who have insurance see their Drs for checkups. If they see their Dr they are more likely to be treated for conditions the patient did not even know they had. That saves costs long term and increases the quality of life. Just wait drop the insurance pay for your own care and wait for Medicare.

Tmoney says:

Insurance premiums are in no way shape or form lower. They are higher.

Beguile says:

Thank the republicans who gutted the bill.

Stephen duQuesnay says:

Premiums are not related to “Republicans”, actually rates for 2019 in Florida increased less than 10% and those insureds who received a subsidy saw their rates actually decrease. The ONLY think the Republicans did to the OBAMACARE bill was remove the MANDATE to those without insurance dont have to pay a penalty on their tax return for NOT having insurance. So please don’t make uninformed comments. You cant blame republicans for the Affordable Care act that Nancy Pelosi told her colleagues to just pass the bill without reading it and now 5 years later rates are finally stabilizing but premiums have gone up over 500% and consumer choices have dwindled down with major carrier ie United Aetna, Blue Cross, pulling out of certain markets all together. And remember rates are submitted to each state’s department of insurance and approved by each STATE. The insurers have to be solvent in order to be able to pay claims. ONCE OBAMACARE REMOVED ALL OF THE PRE EXISTING CONDITIONS LIMITATIONS (WHICH IS ACTUALLY POSITIVE) THE RATES HAD TO GO UP. TAKE A PERSON WITH HEPATITIS THAT WAS UNINSURED WELL NOW WITH OBAMACARE THEY CAN GET INSURANCE AND GET THEIR HEPATITIS CURED BUT THE MEDICINE COST $1000 PER PILL AND THEY HAVE TO BE ON THE MEDICATION FOR 60 TO 90 DAYS. SO A PERSON MAY ONLY PAY $500 PER MONTH, $6000 FOR THE YEAR, BUT THE INSURANCE COMPANY HAD TO PAY $90,000 FOR THE PATIENTS MEDICATION. SO DO THE MATH. YOU NEED 15 HEALTH INSURED MEMBERS THAT DONT USE THEIR PLAN TO COVER THE 1 PERSON WITH THEIR TREATABLE CONDITION. MOST INSURANCE COMPANIES THAT PARTICIPATED IN OBAMA CARE LOST MONEY ON THEIR ACA (OBAMA CARE) BUSINESS.


gsbaird says:

Mr. duQuesnay,
You’re not as well informed as you think you are. In 2015, after the ACA premiums for the year 2016 were set, the Republican controlled Congress removed the funding for the ‘Risk Corridor’ payments included in the ACA law. These payments were to minimize the losses that could be incurred by the private insurance companies during the 1st 3 years of the Health Insurance Marketplace. For plan years 2015 and 2016, the average premium for the benchmark Silver plan went up 2% and 10% respectively. In 2017 many insurers and insurance co-ops dropped out of the Marketplace as they received zero compensation from the Federal Government due to the lost funding. Premiums for the benchmark Silver plan in 2017 went up 23%. In 2017, just before the insurers were finalizing their premiums for 2018, President Trump took action to withhold payment to the insurers for the lower deductibles, copayments and maximum out of pocket levels for lower income policy holders. Although the ACA requires that the insurers provide these benefits to the lower income policy holders, repayment from the Federal Government to the insurers for this was mistakenly not specified in the law although the intent was to do that. Republican-supported groups sued to stop the Federal Government payments. The judge declared for the plaintiffs but said that, while the appeals were winding their way through the process, Health and Human Services could continue the payments at their discretion. During Obama’s presidency, the payments were continued. Insurers responded to Trump’s decision to withhold payments by increasing the average premium for the benchmark Silver plan by 32%.
These increases of 23% and 32% were a direct result of actions taken by Republicans. The Tax Bill passed at the end of 2017 removed the individual mandate, requiring most people to own a health insurance plan. Premiums for 2019 would have gone down slightly but this change cost an estimated 10% increase, offsetting most or all of the potential improvement.

Craig says:

I am hitting a brick wall on looking up answers. Ran across your page here and thought it might be worth a shot. My wife has been to her Dr, found her triglycerides were high and the Dr found samples to try (before trying for a prescription). The samples worked well so the Dr gave her a prescription. We have Aetna and they immediately denied paying for the medication saying it was to expensive. 2 weeks later, without the medication prescribed, she ended up in the ER. Less than 48 hours later they admitted her to ICU with numbers over 4000 (normal 150-200). She has been in ICU for 3 weeks now. The first 2 weeks with tubes down her throat, then they said to prevent injury to soft tissue they would do a tracheostomy. That was done and that tube had a manufacture defect. Under normal circumstances we dont like to find attorneys to help but we feel that this time is definitely warranted. First for the denial of a medication that was shown to work and causing her to be in the hospital in the first place, and second for the tracheostomy tube being defective and causing more time in the hospital. Do you know of any resources to help with this?

Neena says:

Sorry to hear that. As a healthcare worker with knowledge if various aspects of healthcare, it goes both ways. If the medication was too expensive and uncovered, usually drug companies allow a discounted price for those that cant afford the medications. And if you notified the doctor, they would have changed the medication or found something that would be compatible.
As far as the trach defect, the manufacturer has to cover all costs of any injuries sustained from day of placement and there forth. If the company refuses or finds excuses (which they will), seek an attorney.

Kerri Mueller says:

I need help. We are currently out of the country my dad is in the icu. The insurance company appears to be playing the “delay” game. They first kept claiming ignorance about how the process works. I find it hard to believe that we are the first family experincing this situation. Now they say they need to speak with hospital administration. My brother has provided them with every contact that we have for hospital administration, yet they still claim that they do not have the information. Currently, we have set transport with travrl insurance it is,a go. We have paid our required responsibility for transport and the Docs have consulted and given approval for transport. The problem is with secondary insurance. They sent the wrong guarntee of payment to the hospital. The hospital will not release my father until the guaruntee of payment is received and meanwhile my dad languishes in the icu of a forgein country. I read several articles that say insurance will delay and deny until death sometimes. I am desperately seeking help to speed up the process and get my dad to a hospital in the states. What can we do? What are our legal rights regarding all of this? I appreciate any help at all.
Thank You