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  1. #1
    itslate is offline Junior Member
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    Disputing an emergency room bill

    What is the name of your state? PA

    My 8 year old son went to the hospital a month ago to have stitches. Unfortunately we let our insurance go a while ago, unable to afford it. (I couldn't find a better place to post this but the insurance forum)

    The bill from the hospital was for $950 and we also received another bill from the doctor that applied the stitches for $420. My problem is the hospital bill shows a charge for "simple repair wound" for the amount of $365. Isn't that double billing? I talked with the hospital's billing department and really got no where. They wanted income information and such to see if I qualify for a discount. I just don't know how they get away with this type of billing. Not to mention the $100 charge for saline solution. What, it's like $8 a bottle? I plan on paying this bill in installments, but I can't help feeling raped. $1300 for stitches???

    TIA
  2. #2
    purple2 is offline Member
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    Quote Originally Posted by itslate
    The bill from the hospital was for $950 and we also received another bill from the doctor that applied the stitches for $420. My problem is the hospital bill shows a charge for "simple repair wound" for the amount of $365.TIA Isn't that double billing?
    Without seeing your bills, I can't be sure. However, it is routine for EDs to charge both technical fees and professional fees. The professional fees were for the doctor's services, the technical fees were for the use of the room, equipment, utilities, liability insurance, payroll, etc. It sounds like that's what it was.

    Quote Originally Posted by itslate
    Not to mention the $100 charge for saline solution. What, it's like $8 a bottle? I plan on paying this bill in installments, but I can't help feeling raped. $1300 for stitches???TIA
    Often, the general public is very unaware of how much it costs hospitals to provide care. This misunderstanding is what much of the public outcry about hospital bills is, IMO. $1300 is not unreasonable for emergency care. For future reference, you may want to check if there is an urgent care in your community. They could have probably handled the stitches and would have charged less.

    OTOH, the $100 charge for saline has me intrigued a bit. Please come back and post exactly what the bill says regarding the saline. Include all the text and numbers that refer to the saline.
  3. #3
    itslate is offline Junior Member
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    thanks for the reply.

    Here is what my hospital bill shows:

    1 Lidoc 1% 50ml IV 2.25
    1 simple repair wound FA12011 360.00
    1 suture all sizes 49.00
    1 suture all sizes 49.00
    1 facial wound tray 105.00
    1 sal solution sterile 5J7040 100.00
    1 emergency room 3 op 99283 264.00

    I am taking care of my sick Dad at home. We use the same irrigation kit they used (with saline solution) for his catheter. It is similar to this one I found on the web for under $4. [url]http://www.southwestmedical.com/ab1588000/showdetl.cfm?&DID=7&Product_ID=54240&CATID=62[/url]


    "the technical fees were for the use of the room, equipment, utilities, liability insurance, payroll, etc. It sounds like that's what it was."

    What gets me is I'm charged for the emergency room.

    The doctors bill was not broken down as follows:
    er exam-3 163.00
    wound repair 257.00

    I'm doubting that an insurance company would pay these fees. Why would I be liable?

    Understanding that these fees could possibly be considered fair today by some. I just don't see it.

    I'm not aware of any urgent care facilities in our neighborhood. Of course this happened at 10pm on a Wednesday night, otherwise I would have taken him to his family doctor.

    The following week he was back in the ER for an allergic reaction to Latex. Of course again this happened on a Sunday morning. I don't see any double billing on this bill. And the total cost (for prescribing an over the counter antihistamine) was just under $400. Here I just see the same fees for hospital room and from the doctor, exam fee. Which I will not dispute.
    Last edited by itslate; 01-27-2005 at 08:25 AM.
  4. #4
    purple2 is offline Member
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    Quote Originally Posted by itslate
    The following week he was back in the ER for an allergic reaction to Latex. ...I don't see any double billing on this bill....Here I just see the same fees for hospital room and from the doctor, exam fee.
    I was right. The 99283 on the hospital bill is the method determined by the federal Department of Health and Human Services for hospitals to bill their technical fees. The same code is used by physicians to bill for their professional services. It is definitely not double billing, nor is it illegal.

    As to why you are not seeing the same "double billing" for the return visit to the ER, I can only assume they either did not post all of their charges properly, or they posted a lower level charge onto your account because you used less resources during that visit.

    Quote Originally Posted by itslate
    I'm doubting that an insurance company would pay these fees. Why would I be liable?
    There is a giant misconception in the general public about hospitals. Hospitals are not obligated to give out unlimited free care.

    An insurance company would pay for these charges. However, an insurance company may negotiate lower fees. They have the resources to enter into contract negotiation and have large groups of potential patients to use as a bargaining chip.

    Individuals don't get "automatic" discounts--they only get discounts by negotiating them. If you want a discount, ask for one. Call your hospital's Business Office or financial counselor and ask what they can do to work with you on payment arrangements. Ask them if you can apply for their charity care/discount program. Ask them if they can tell you how to apply for Medicaid (which may cover past bills, BTW). Ask if they can refer you to a bank that will offer a low-cost loan to pay the bill, or if the hospital offers payment plans itself.

    Quote Originally Posted by itslate
    Not to mention the $100 charge for saline solution.
    I researched this for you and was unable to find any requirement for hospitals not to charge $100 for saline, or whatever charge they wish. That's capitalism for you. You can certainly ask about this charge when you talk to the hospital.
  5. #5
    itslate is offline Junior Member
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    I really did think this was a mistake in billing.

    I didn't get much help from their department asking for discounts. I am neither elligible for medicaid nor financial assistance. Just a middle class citizen getting the worse end of the deal here. What I understand is the hospital is making up the difference from what they aren't receiving from Medicaid, Medicare and disounted services to Insurance Companies with uninsured patients like myself. I'll just have to grin and bare it. Guess all it amounts to is 2 months worth of insurance coverage anyway.

    Thanks for researching this for me.
  6. #6
    PatrickW is offline Junior Member
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    Cool Mr.

    Dear Itslate,
    you can look up the CPT codes at the AMA website. These codes are sometimes listed on your bill. If not then you can request them from the hospital billing or doctor billing companies. I had a similar experience and found out that by looking up these CPT codes and researching the Medicare rates for these codes that I had a real basis for what a fair market rate for services is. Armed with this information I was able to drastically reduce not only my hospital bill but also the bill from the physician.
    For example, cpt code 99283 level 3 evaluation I was charged 282.00 but the medicare billable is only 91.31. Also, CPT code 12001 Laceration repair simple (3 stiches) I was billed 260.00 but the medicare allowable is only 59.21. This is good ammunition for negotiation.
    Hope this helped you.
  7. #7
    Proserpina is offline Senior Member
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    Quote Originally Posted by PatrickW View Post
    Dear Itslate,
    you can look up the CPT codes at the AMA website. These codes are sometimes listed on your bill. If not then you can request them from the hospital billing or doctor billing companies. I had a similar experience and found out that by looking up these CPT codes and researching the Medicare rates for these codes that I had a real basis for what a fair market rate for services is. Armed with this information I was able to drastically reduce not only my hospital bill but also the bill from the physician.
    For example, cpt code 99283 level 3 evaluation I was charged 282.00 but the medicare billable is only 91.31. Also, CPT code 12001 Laceration repair simple (3 stiches) I was billed 260.00 but the medicare allowable is only 59.21. This is good ammunition for negotiation.
    Hope this helped you.



    The thread is 5 years old....please do NOT necropost.

    If you have a question, start your own thread.

    Thanks.
  8. #8
    Silverplum is offline Senior Member
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    Quote Originally Posted by PatrickW View Post
    Dear Itslate,
    you can look up the CPT codes at the AMA website. These codes are sometimes listed on your bill. If not then you can request them from the hospital billing or doctor billing companies. I had a similar experience and found out that by looking up these CPT codes and researching the Medicare rates for these codes that I had a real basis for what a fair market rate for services is. Armed with this information I was able to drastically reduce not only my hospital bill but also the bill from the physician.
    For example, cpt code 99283 level 3 evaluation I was charged 282.00 but the medicare billable is only 91.31. Also, CPT code 12001 Laceration repair simple (3 stiches) I was billed 260.00 but the medicare allowable is only 59.21. This is good ammunition for negotiation.
    Hope this helped you.
    That was very nice of you to type out, but the thread is 5 years old. I'm guessing Itslate already dealt with his problem.
  9. #9
    heeeun is offline Junior Member
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    Disputing ER Charges

    Quote Originally Posted by PatrickW View Post
    Dear Itslate,
    you can look up the CPT codes at the AMA website. These codes are sometimes listed on your bill. If not then you can request them from the hospital billing or doctor billing companies. I had a similar experience and found out that by looking up these CPT codes and researching the Medicare rates for these codes that I had a real basis for what a fair market rate for services is. Armed with this information I was able to drastically reduce not only my hospital bill but also the bill from the physician.
    For example, cpt code 99283 level 3 evaluation I was charged 282.00 but the medicare billable is only 91.31. Also, CPT code 12001 Laceration repair simple (3 stiches) I was billed 260.00 but the medicare allowable is only 59.21. This is good ammunition for negotiation.
    Hope this helped you.

    How did you get these figures? My mom recently went to the ER for a simple tetanus shot and we received a hospital bill for $774.74 and an doctor bill for $301! For a simple tetanus shot! I don't even know why the doctor had to come in, it's not like he is the one who administered the shot. As the person stated above, we had the same 99283 code and was charged $301. The doctor coded the visit a level 3 so the hospital charged us $637. The tetanus shot was all but a little over $100. Level 3? For what? The doctor spent more time listening to the reason why we needed the tetanus shot over examining my mom. She needed the tetanus shot b/c her dog accidentally bit her foot. It was not bleeding and no stitches were needed. I would like to find out how to get the figures like the other person listed. I went to the AMA website but couldn't find the medicare billable allowed. Any help would be great! My mom doesn't have insurance and can't afford the bill. Thanks.
  10. #10
    Silverplum is offline Senior Member
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    Again...this thread is five years old.

    Please start your own thread. In fact, please have your mother start her own thread, because this is her story and her debt to discuss.

    Thank you.


    Quote Originally Posted by heeeun View Post
    How did you get these figures? My mom recently went to the ER for a simple tetanus shot and we received a hospital bill for $774.74 and an doctor bill for $301! For a simple tetanus shot! I don't even know why the doctor had to come in, it's not like he is the one who administered the shot. As the person stated above, we had the same 99283 code and was charged $301. The doctor coded the visit a level 3 so the hospital charged us $637. The tetanus shot was all but a little over $100. Level 3? For what? The doctor spent more time listening to the reason why we needed the tetanus shot over examining my mom. She needed the tetanus shot b/c her dog accidentally bit her foot. It was not bleeding and no stitches were needed. I would like to find out how to get the figures like the other person listed. I went to the AMA website but couldn't find the medicare billable allowed. Any help would be great! My mom doesn't have insurance and can't afford the bill. Thanks.
    Just a thought: the ER is not a free clinic.
  11. #11
    Isis1 is offline Senior Member
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    Quote Originally Posted by heeeun View Post
    How did you get these figures? My mom recently went to the ER for a simple tetanus shot and we received a hospital bill for $774.74 and an doctor bill for $301! For a simple tetanus shot! I don't even know why the doctor had to come in, it's not like he is the one who administered the shot. As the person stated above, we had the same 99283 code and was charged $301. The doctor coded the visit a level 3 so the hospital charged us $637. The tetanus shot was all but a little over $100. Level 3? For what? The doctor spent more time listening to the reason why we needed the tetanus shot over examining my mom. She needed the tetanus shot b/c her dog accidentally bit her foot. It was not bleeding and no stitches were needed. I would like to find out how to get the figures like the other person listed. I went to the AMA website but couldn't find the medicare billable allowed. Any help would be great! My mom doesn't have insurance and can't afford the bill. Thanks.
    geez! it's still an old thread! WOULD YOU LET IT REST IN PEACE?
  12. #12
    CSO286 is offline Senior Member
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    If you'd like help, please create your own thread and avoid necroposting.
    This thread is over five years old.
  13. #13
    ecmst12 is offline Senior Member
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    Level 3 is a standard office visit. If all she needed was a tetanus shot, why didn't she go to her family doctor? What was so dire that she had to go to the ER?

    Oh and hospitals are not bound to charge medicare rates unless the patient actually HAS medicare.
  14. #14
    heeeun is offline Junior Member
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    Quote Originally Posted by PatrickW View Post
    Dear Itslate,
    you can look up the CPT codes at the AMA website. These codes are sometimes listed on your bill. If not then you can request them from the hospital billing or doctor billing companies. I had a similar experience and found out that by looking up these CPT codes and researching the Medicare rates for these codes that I had a real basis for what a fair market rate for services is. Armed with this information I was able to drastically reduce not only my hospital bill but also the bill from the physician.
    For example, cpt code 99283 level 3 evaluation I was charged 282.00 but the medicare billable is only 91.31. Also, CPT code 12001 Laceration repair simple (3 stiches) I was billed 260.00 but the medicare allowable is only 59.21. This is good ammunition for negotiation.
    Hope this helped you.
    Quote Originally Posted by Silverplum View Post
    Again...this thread is five years old.

    Please start your own thread. In fact, please have your mother start her own thread, because this is her story and her debt to discuss.

    Thank you.




    Just a thought: the ER is not a free clinic.

    I didn't say that it was. I just think that charging over $1k for a friggin tetanus shot is outrageous. Just b/c someone doesn't have insurance doesn't mean they can't pay a bill. We thought it would be around $400 which we would be able to pay. NOT $1k!! And what's the difference if I post on this forum about my mom's situation for her? What's it to you? Wouldn't you do the same thing for your own parents? WtH?
  15. #15
    Silverplum is offline Senior Member
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    Quote Originally Posted by heeeun View Post
    I didn't say that it was. I just think that charging over $1k for a friggin tetanus shot is outrageous. Just b/c someone doesn't have insurance doesn't mean they can't pay a bill. We thought it would be around $400 which we would be able to pay. NOT $1k!! And what's the difference if I post on this forum about my mom's situation for her? What's it to you? Wouldn't you do the same thing for your own parents? WtH?
    Have a pleasant day.

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