r/HospitalBills • u/bvvr19 • Apr 19 '25

Hospital-Emergency No CPT codes on itemized bill

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I went to the emergency room in the beginning of March 2025 and was there for 6 hours got one bag of IV and a nurse took my blood and then I spoke to a doctor once, and then I spoke to a student doctor twice, and then I was given to packs of crackers and two packs of apple juice and another plastic cup of ice water.

I was in discharged the same day.

I requested an itemized bill, and I attached what I received. I don't see any CPT codes and when I look up the numbers next to the listed items... I can't find what the codes are for or what a fair market value of those codes would be in my area. As you can see in the picture they charged me twice for three procedures or whatever the list of things are called. I'm not sure the technical term.

I went to an in-network emergency room in a in network hospital and owe a total of $637.32.

the hospital billing department said there is some new law where you have to prove that you paid 10% of your gross income in the previous year to qualify for financial assistance, and I did not pay that much in medical bills last year so I am trying to negotiate down the bills as much as I can since I can't apply for assistance.

Does anyone know why these codes don't come up on Google? Did the hospital not give me a true itemized bill? Do I need to request another one specifically demanding their cpt codes in the itemized bill? Any help would be super appreciated thank you so much

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8

u/UnluckyInvite Apr 19 '25

I don’t know why people are weird. Yes, it’s not a terrible bill but you should still be able to get the CPT codes. Looking at it, I think the numbers in the description are probably related to the CPT codes - but internal so you don’t know what they mean.

I would ask again for the CPT codes that were billed. If they don’t provide it, send a complaint to your insurance company and let them mediate.

1

u/bvvr19 Apr 19 '25

Oh my God. So the hospital just sends out itemized bills that don't actually help? They send out an itemized bill that isn't even really itemized?!Surprise surprise 😭💀

3

u/UnluckyInvite Apr 19 '25

I don’t know what it was completely intentional. I work with medical records and I still get confused about the correct ways to print an itemized bill. Electronic Health Systems suck. But SOMEONE should know how to get it to you.

ETA: I get confused because printing itemized bills isn’t my departments typical task. If we get asked we might try but we would redirect to the business office.

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u/bvvr19 Apr 19 '25

How is that not illegal? Like how is it not illegal that they can send me a bill with charges that they make up regardless of if the insurance negotiated that rate with them were not? That's just so that they can defer the patient being able to negotiate down they're out of pocket responsibility right?

I'm not agreeing with Luigi, but I am truly understanding

9

u/positivelycat Apr 19 '25

They do not have to let you negotiate down your insurance out of pocket. In fact many see that of breach of their insurance contract. They simply say no. The contract saya they must make attempts to collect what your insurance left you.

It is itemized just without cpt codes.

0

u/bvvr19 Apr 19 '25

Ah ok that makes sense, but how is that breaching their contract with the insurance? They must make attempts? What if they make attempts and then eventually just fold after trying to get payments from me? Would that still be them breaching the contract since there is record of going back and forth and the hospital trying to receive payment until they realize it's not worth their time?

6

u/IrisFinch Apr 19 '25

The contract dictates the contractual adjustments required. The contract also dictates that they will charge the deductible/copay/co-insurance. They’re required to charge consistently across all the insurance’s members.

0

u/bvvr19 Apr 19 '25

Okay so if they charge me but they never collect payment do they get penalized? Or is it just that they have to show proof that they attempted in multiple attempts to collect payment from the patient in order to stay in compliance with the contract?

4

u/IrisFinch Apr 19 '25

If they never get paid they operate at a deficit. They will just sue you for it.

1

u/bvvr19 Apr 19 '25

Okay so then what if these patients who clearly are medically dependent are in layman's terms poor.... What is the hospital going to sue for if the person clearly doesn't have the money to pay it sound like there's anything to take in a lawsuit

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u/Cloudy_Automation Apr 19 '25

Its kind of like roofers who will do an insurance claim roof replacement. It's illegal for both the roofer and the owner to not require the owner to pay the deductible, as the roofer is overcharging or doing substandard work to be able to afford not being paid the deductible. The homeowner's insurance deductible is there both to lower the cost of the insurance, and you discourage you from making frivolous claims.

If the hospital could afford to not collect payment, then the insurance company should have been able to negotiate a lower price, because charging you for the deductible is pay of the plan design, and they could have offered lower premiums if the hospital charged a lower price. The hospital also gets a 1099 for the entire negotiated amount, including the deductible/copay, so they have to write that off as bad debt if they don't collect it. They can also send you a 1099-C for what they didn't get, and you have to report that as income to the IRS

What's unfortunate is that these contracts are now one size fits all. When I first started working in the stone age, the deductible was set as 1% of my salary. Yes, 1% hurt, but having the same deductible for low wage and high wage employees hurts the low paid employees the most.

1

u/bvvr19 Apr 19 '25

Honestly the taxes on the $630 would be less so f*** it lmfaooo

0

u/positivelycat Apr 19 '25 edited Apr 19 '25

Insurance has patient shares they don't like it when the patients cab wiggle out that share. But if the patient had their out of pocket max they would have to pay. ( greed amf bills)

Financial assistance though is allowed. As far as how much attempt is an attempt everyone's legal counsel I am sure feels differently about that.

The hospital wants your money too so they may never let you negotiate even in collections ( Greed and bills)