No CPT codes on itemized bill

[u/bvvr19]

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

[u/bvvr19]

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

[u/positivelycat → u/bvvr19]

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.

[u/bvvr19 → u/positivelycat]

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?

[u/IrisFinch → u/bvvr19]

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.

[u/bvvr19 → u/IrisFinch]

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?

[u/IrisFinch → u/bvvr19]

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

[u/bvvr19 → u/IrisFinch]

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

[u/IrisFinch → u/bvvr19]

Financial assistance often exists for the people who qualify for it, but there is a charity scale they have to follow based on your income percentage to the poverty rate

They will garnish your paycheck and take it whether you have it or not.

[u/bvvr19 → u/IrisFinch]

I doubt it cuz this might be a super lawyer question, but what if you can like somehow put liens on yourself do any businesses you have or anyone you know and that way the hospital can "get in line" because you owe a bunch of other people money and they get paid first before the hospital and by the time you're done paying those other people there's nothing left to pay the hospital

[u/bvvr19 → u/IrisFinch]

Do you know of anything with the 10% gross income financial assistance law? I was told that passed in October of 2024 in New York just want to see if it's a real thing or the hospitals just trying to b******* me

[u/IrisFinch → u/bvvr19]

I don’t know anything about that, I live in Nebraska

[u/bvvr19 → u/IrisFinch]

We'll never mind my bad

[u/Cloudy_Automation → u/bvvr19]

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.

[u/bvvr19 → u/Cloudy_Automation]

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