Patient advocate “negotiates” with hospital to reduce bill. Hospital agrees to accept $1,413.83 which added to the plan’s payment equals 212% of Medicare. Hospital eats the “loss” of the difference, i.e., uncompensated care.
Billed Amount (777% of Medicare)
|
$14,408.00
|
Allowed (120% of Medicare)
|
$1,853.31
|
Balance Bill of $12,554.69 Reduced To
|
$1,413.82
|
Total Payment (plan Allowable + Additional Payment)
|
$3,267.13
|
% of Medicare
|
212%
|
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I have this same exact issue on at least 2 of the 4 claims I personally had from (SAME HOSPITAL) a year ago (maybe all 4) when I had a kidney stone and some other complications. I can get the exact numbers, but the strategy they’re employing, and the percentages they’re willing to accept for my claims are probably about the same as with this example. About a year after demanding $30,000+ for one of the claims, they’re now willing to settle for maybe a total payment of around $4,000 (plan payment plus my proposed payment). I don’t know what that represents as a percentage of MC. That can be calculated.
But I’m not going to pay.
It’s clear that they have a game plan. Threaten in the beginning; mail multiple notices of the ridiculous BC, demanding payment, and then after about a year, and without notice, just lower the amount they’re demanding to something that sounds reasonable. Most would say, “wow, that’s a big reduction in what they’re asking”, and do what I felt like doing – just pay it and be done with it.
But I think that’s a mistake. It pays them way more than they deserve for the service; it reinforces their strategy and as that strategy is successful, they’ll just keep doing it. I suspect they’ll begin to assemble information about which employer caves in on their demands, and then begin, over time, to inch up those reductions of the BC from, say, 212% of MC to 250% of MC……and then higher until they stop getting payments.