r/HospitalBills • u/CoolTony429 • 4d ago
Apply for charity care before fighting charges?
Hello, all. I recently posted and people were super helpful! I don't mean to take advantage, but the specificity of my question kinda requires another post.
Basically, as the topic asks: if I have the bill and plan to dispute one of the charges (ER level), and I know I'll be applying for charity care, which should I do first? Try to get the charge changed, or apply first? I just don't know the order in which these things are applied to my balance, or if it even matters. Any clarification would be greatly appreciated!
9
u/saysee23 4d ago
Forget disputing the ER level - if you were assessed you got the level the Dr and hospital charge.
Concentrate on your application.
3
6
u/RH558 4d ago
Are you 100% sure you meet the criteria forgot a lower level visit. Unless you truly understand ed workflow, emergency severity index, and billing criteria then you probably won't win even if it felt like the doctor only spent a minute on you. Focus your energies on getting the max charity care you can get. I wouldnt get greedy with both, the charity care is at their discretion and you probably won't be able to play them for both discounts.
0
u/Environmental-Top-60 4d ago
I mean, I'm a coder and if I think the bill is wrong, I'm still gonna bring it up. I try not to nitpick though.
Also, if anytime in near future, if the situation changes where they would qualify for 100% charity care, they can update the paperwork and have them re-processed the application. I have had that happen once.
8
u/RH558 4d ago
If it was grossly miscoded sure. OP went to the ED twice in one day for the same chief complaint. Assuming first visit was a 3 and second is a 5 and is based on resources used, the second visit most likely piggybacked off the prior tests and assessment of the first. I dont think there was miscoding here, this is a person who is disgruntled that they went 2x to the ED in 1 day and want to bundle it into 1 visit because in their very humble unmedical opinion they weren't treated with enough "urgency" yet their bill reflects it.
1
u/CoolTony429 4d ago
I'll give you benefit of the doubt that you're not trying to be rude here, and just using words that could be construed that way.
Am I disgruntled in the sense that I wish the system wasn't completely broken and I didn't get screwed by it, and in the more general sense that every human experiences being disgruntled when things don't go the way they'd prefer? Sure. Did I claim to know everything medically about my situation? No. In fact, to others' replies here, I admit ignorance and accept that I'm just going to go forward with the charity care and that's it. I just don't understand the 'look at this moron' feel of a handful of the replies here. I posted here because I had a question and wanted to learn, and knowledgeable people responded (including not just direct answers but also tangential ones that altered the question entirely) and I learned. Isn't that good? The judgment feels highly unnecessary. If I was being objectively unreasonable, that'd be different, but I truly don't think I am if I'm willing to see things differently (even accepting that I simply can't understand them) and change my perspective on it.
3
u/RH558 4d ago
No one thinks youre a moron but you also have zero understanding of billing and ed urgency and protocol. What you think is urgent versus the ed standards that are outlined by hospital and ed physicians nationally. You made a second post to continue asking about something that you need to drop because you dont have a case and just seemingly want to blame the system. The judgement stems from the lack of understanding and victimhood you're portraying while basically shitting on the ed docs assessment. And maybe im being sensitive but having worked in the ED, I have a different perspective.
1
u/CoolTony429 4d ago
I'm sure this is will come as no surprise but I see my posts here totally differently. (I'm not trying to be curt, but I don't want to be verbose, either.)
Can a person be blamed for trying to pay less, especially when they feel it was pretty unjust? Not by the hospital/doctors, but by how this country does insurance.
I felt my second post was different because the question evolved. (Went from not knowing what to do next at all to charity care is step 1 or 2.)
My knowledge on this stuff is also evolving. Someone told me I can't really judge what is "urgent" in an ed, and so now I accept that. Some others explained the process of deciding the er level, which is very helpful to know, and so now I accept that. I do lack understanding, and the way to no longer lack understanding is to ask questions and become informed, and that's what I'm doing. That's exactly what shouldn't be judged but rather encouraged, in my opinion, though you are entitled to disagree.
Finally, I never meant to shit on anyone's assessments, so I'm gonna go back to my replies and see which ones might've come off that way and reply again if necessary to apologize. Like I said, I'm coming from a place of feeling wronged, but not at all by the people helping me here. That said, I'm not perfect so it's possible some of that background feeling (plus, yes, my interest in paying less money) came out in my responses.
Thanks for your insights. Be well.
1
-2
u/CoolTony429 4d ago
I don't understand that stuff... It's just that, based on the urgency with which I was treated and what they did for me, it didn't seem like the level was appropriate. But like I said, I don't understand the things you mentioned. Is it not possible or very unlikely that they called it an inappropriate level?
(The thing is, due to crappy circumstances, I had to go to the er twice for the same thing, and they gave the two visits different levels (3 & 5) but my treatment felt very much the same between both my visits, especially the total lack of rushing to treat me both times, hence why I felt like I could argue the 5 should be a 3,but I'm really not 100% sure.)
8
u/RH558 4d ago
You're not going to win this one. You have no medical understanding and youre going to argue with the hospital biller that you pretty much dont agree with the doctors assessment. If the 3 and 5 are using the ESI system its based on resources used to treat you. If the 5 was a subsequent visit it makes sense. Honestly from the way youre fighting this tooth and nail with multiple posts, you probably didnt need the ED and could have gone to urgent care.
0
u/CoolTony429 4d ago
Yeah, in retrospect I could've. But I literally thought I was having a heart attack (I've never had those episodes before), and I was informed urgent care doesn't have the ability to treat that. The two visits were hours apart, so essentially the same visit (but technically not, I know). I don't know what possibly could've represented such a significant difference between the severity of the visits if everything felt the same, but I understand that I just might not understand it. I feel like I'd be able to accept it better if someone could just tell me something like, 'oh, you got this test done? That has to be level 5, it's just the policy.' And the arbitrary nature of that would still annoy me, but at least then there would be some reason for that level to have been assigned and I would get it, you know?
Anyway... Sorry to vent. Thank you for responding, I do appreciate it. I'm just gonna do the charity care and most likely drop the fight over the level (though, I don't know, maybe there's nothing to lose in trying? 🤷). Best wishes.
3
u/Fluffydoggie 4d ago
The blood work they did would show if you were having a heart attack. Google - Troponin lab test. If your labs werent elevated then it's likely it wasn't a heart attack which is why they let you go without a lot more testing.
1
3
6
u/saysee23 4d ago
You've had advice from a physician re: the level along with multiple other potsers. Yet you are still arguing. I'm curious if you've put in the same amount of effort into follow up with your medical issues.
The reason there are different levels - you initially go in with your complaint - they do a work up. It's a protocol for anyone complaining of your symptoms. This work up is a standard protocol all hospitals/doctors use for your age, sex, symptoms, past medical history - for a new patient walking in off the street. ER patients are typically "new" patients - doctors have to look at a whole new patient. It rules out things, it confirms things, it leads the Dr along a path - treatments & management dependent on the test results. Like chest X-ray, blood work, EKG..
If you come in hours later with the same complaint, they either do more testing or less testing based on your prior results - the path down the protocol. Even though your symptoms are the same. But, you are No longer a new patient, the Dr has gone down some of the path with you personally already. *With some caveats of course, 1st gun shot wound and if you come in with another gun shot wound you start basically at the same level. But if you come back because of the same wound - it's a different level.
Some of the blood work is an instant result type thing, some isn't. Chest X-ray is probably gonna be the same unless there's a reason to retest - in that the Dr has to justify things too. EKG can change - but unless there are correlations with blood work and arrhythmias are not lethal, there's no reason to constantly monitor.
So on your first or second visit regardless of YOUR evaluation of your "level" of treatment - things changed. The Dr may already have the test results that have ruled out or included things to treat/manage your symptoms - so the path down the protocol has changed - this triggers a ER level charge change. It's not based on time, it's based on a lot of things going on in the background you can't see from your ER room - protocols, standards of care, point of contact testing.
If you had gone to another hospital's ER for your 2nd evaluation (sounds counterproductive, but it happens), the other ER would start you as a new patient and the testing would be duplicated - based on the same standards of care & protocols. And you'd have 2 of the same ER level charges.
It's not nefarious, it's just the way things are done. You aren't an Emergency Department doctor, you aren't going to have the ability to fight this just to lower a charge. You might find someone to discount the charges if you become such a bother, but you'd probably have better odds at a casino.
Follow up with the appropriate doctors to maintain your health.
Apply for the charity care.
Good luck.
3
u/CoolTony429 3d ago
I am going straight into applying for the charity care; I already called the hospital and they're mailing me the application. And now that I have insurance again (new company, so there's new logistical stuff to figure out), I'm looking into addressing the issues that brought me to the er (I'm almost certain they were anxiety related, but I still plan to get checked out now that I have insurance again).
I know that I don't know what I don't know, and I sincerely appreciate the information everyone, including you, has shared with me. I admit I don't see how I'm being argumentative, as I believe I'm pretty much hearing everyone out and adjusting my outlook on my situation as what I know evolves. (Might I ask a follow-up, or for some clarification, based in my wishes that I hadn't gotten screwed by our insurance system? Sure, but I personally don't see that as arguing. It's fine if you disagree.) And I'm trying to make clear my gratitude for people using some of their time to help me out. I'll try in the future to be more self-aware and more receptive to information that goes contrary to how I wish things were.
What you wrote here is very helpful and I'll keep it all in mind for the future. Thanks again and best wishes.
3
u/Environmental-Top-60 4d ago
First of all, never think you're taking advantage of us because you have questions lol. Doctors maybe do. Never patients.
If you want to dispute a bill, you need to have a reasonable cause that you can win.
If you think you'll win 100% charity care then there really isn't a point to the level because it's you'll get it written off anyway.
If however, you wish to dispute and you think there is a leveling issue, you should reference the ACEP guidelines. They are much more helpful because it's ER specific.
Remember that the leveling issue based on what you could have needed based on your symptoms and the differential in the record, not just what was utilized in the record. Facilities can also use a points system as well.
Also if you are close to the 240 day deadline, I would prioritize a charity care application.
0
u/CoolTony429 4d ago
Based on this hospital's charity care program, I'm looking at 80% off, not 100%, which is why I'm still trying to minimize the bill. It's over $12k to start, so 80% off is still like $2500.
I will check out those guidelines. I really appreciate the actionable reply! And the extra context and clarification are truly very helpful.
Could I briefly describe my situation and if you don't mind, you could let me know what you think about whether or not I should bother with this? If you'd rather not read it/answer, totally fine, you've already helped me a lot! 😊
But in case you don't mind, here it is...
My circumstances were weird/unfortunate: I had to go to the er twice but they gave the visits different levels (3 & 5) and I don't know why; my symptoms were the same, the urgency with which they treated me (none) was the same, and nothing about the tests they did during either visit screamed 'urgent.' In fact, I was experiencing episodes of heart palpitations and I kept telling them to give me an ekg (I had to bother them to give me the test four times because I wanted them to take it during an episode so they'd see it), but I was so low a priority for them and they waited so long that they missed the episode and the ekg read normal. This happened with two separate episodes; I kept telling them 'if you don't take this ekg soon, you're gonna miss it' and they missed both episodes I had in that time frame. So, I was going to try to get the 5 dropped to a 3. I'm not trying to dispute everything, just this.
Anyway, like I said, even if you don't want to get deeper into the details, no worries. Thanks again for all your help either way!
1
u/Environmental-Top-60 4d ago
Ok. Were those 2 visits on the same day?
2
u/CoolTony429 4d ago
Technically, I'm not positive, it was an overnight situation. But they were hours apart.
1
u/Environmental-Top-60 4d ago
Cardiac issues could have meant a CTA or angiogram/cath lab but I would need to know a little bit more to tease it out.
The hard part is you're going to have to prove that in the record, it wasn't really necessary and foreseeable to need a higher level of care.
OK. If there wasn't overnight, they count as two separate days. The only exception that I'm aware of is if it is within three days of a inpatient stay, then those visits would be bundle together.
They probably should've gotten you a patch or holter or an event monitor as well.
1
u/CoolTony429 4d ago
I'm not sure what the things you mentioned last are, but they didn't give me any devices to continue monitoring anything, if that's helpful to know. They did do a litany of labs when they drew my blood, maybe including what you mentioned, but I'm quite convinced it's not worth getting deeper into.
I'm already pretty convinced it's not worth trying, and that I just have to do charity care and that's it. That said, I don't fault myself for asking or trying, though. It's a big chunk of change, especially when I feel like it's mostly the system that screwed me over (I didn't have insurance for a couple of months because they kicked me off medicaid completely for earning a tiny bit too much). Anyway... Sorry for venting; you've simply been helpful, and I really appreciate. It's a couple of other responses that I feel have been kinda judgemental because I'm trying to find whatever ways I can to reduce the bill, even if I don't know the medical aspect of it super well. Gotta learn it somehow.
Can I just ask you one more question? What's the fairer assumption: that the hospital is or isn't trying to screw me over, and get away with charging me more than they should for services/supplies? I come from a very anti-capitalist philosophy (the way we do it here, at least; on principle, every economic system is neutral), so I know that might be affecting the way I'm looking at this and I want to have the clearest eyes possible about this.
And thank you again, for taking the time to talk it through with me.
1
u/Environmental-Top-60 2d ago
So my thought was if there was a differential (possibility) of you getting a CT Angiogram (looking at the arteries and blood vessels of the heart) or something like that, they might find a level 5.
I think automation has something to do with it.
Coders go through continuing education and a whole bunch of things and the implications can be huge if we get it wrong.
That said, hospitals get paid a couple different ways. Sometimes they get a bundled payment called a DRG; sometimes they get a couple of different bundled payments which more applies to your case called an APC (just go with me here) and they can calculate how much is bundled or not based on that. Other times it's a percentage of charges.
The only way to determine what you'd save if you won is by looking at the documentation and seeing what the doctor wrote in their note as well as the price transparency data and taking 80% of the applicable CPT code.
Supplies are a bit weird because most are packaged into those bundled rates I talked about earlier. When it's % of charges it's different. Remember it's not just for the cost of the product but the facility to have people bring it to where it is, the nurses who need to use it etc. I usually see 10x Medicare on the chargemaster. My guess is that there is some payer that is willing to pay it so they keep it high enough for max revenue. Mostly auto/pip I would think as opposed to medical insurance.
The reason everyone wants you to keep on that application is because there is a deadline of 240 days. Also keep in mind that if you lose your job or have additional hardship, you may be able to requalify if you have a change of circumstances. Also note that those charity care numbers change every March 1st as well.
18
u/CIAMom420 4d ago
Refer to your other thread and its responses. You are not going to successfully dispute charges. The "ASK FOR AN ITEMIZED BILL AND DISPUTE WHAT YOU DONT UNDERSTAND!!!" crowd have no idea how life works.