Consumer Fraud Medical Fraud in Estimates with Insurance

[Jimbert]

I went into a hospital for a common procedure for a gall bladder removal surgery. They wouldn't give me any specific amount for how much it cost as I was admitted on 'emergency' basis but was given something to keep me stabiized, no emergency yet. I was told that I would have a 10% co-pay for my insurance. I thought that was fine. But I never expected the bill to be $55,000. So I was sent a bill for $5,500. I noticed that the insurance decline about $24,000 of the bill, but the hospital still stuck me with this insane amount for a surgery that seems to average under $10,000! This article says it ranges to under $20,000.

Gallbladder removal surgery: everything you need to know

I think that all this talk about free healthcare by our government is a joke. There is no way to know how much any routine surgery is and there is no basis for setting expectations at all. If the hospital already got paid almost $30,000, they got way more than they probably should have.

I read the bill and can't understand any of the codes and many of them don't say what they are. They present you with a bill a patient cannot understand and it's like being held at gunpoint to pay something you don't even know you bought. Anyone have any advice? Do I need to get a lawyer to discuss this bill with the hospital? Should I call the insurance company?

 

[army judge]

Anyone have any advice?

You make an appointment to visit with a billing manager, or patient ombudsman.

Take all of your documents with you and you'll be able to ask many questions to better understand your bill.

The hospital should have resources and programs to assist you in settling the debt amicably.

 

[adjusterjack]

? Do I need to get a lawyer to discuss this bill with the hospital?

If you think the hospital's bill is a shock, wait until you see a lawyer's bill at $300 to $400 per hour to "discuss the bill with the hospital."

Should I call the insurance company?

What good would that do? You already know your policy says you pay 10% of the bill. I suppose it couldn't hurt to call. At least that call won't cost you anything.

They present you with a bill a patient cannot understand and it's like being held at gunpoint to pay something you don't even know you bought.

That's right. The whole medical system in this country is rigged.