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u/Cultural-Ad1121 12d ago
I believe your 401k does not affect ACA requirements. That is not earned income.
And the hospital cannot negotiate with you if they have an in network contract. It would violate their contract with the insurance.
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u/krankheit1981 12d ago
Doesn’t it count as income if it’s pulled early? It’s also heavily penalized and taxed.
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u/EmZee2022 12d ago
Not if the owner is over 59 and a half, I think. And the OP is 64, if she's that close to Medicare age. I do not know what impact it has on ACA subsidy eligibility.
I assume the OP has some kind of high deductible insurance with a high OOP limit, which would explain such a high balance owed.
To be honest, I'd suggest considering bankruptcy rather than taking money from the 401(k). 401(k) and IRA money is largely protected from bankruptcy and lawsuits.
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u/HidingoutfromtheCIA 12d ago
Roth IRAs generally do not count as income for ACA purposes. Regular 401ks do count as income.
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u/Educational_Leg7360 12d ago
wrong. you can ALWAYS (not that every facility will). negotiate for the patient responsibility part of the bill. that’s between the facility and the individual. you cannot negotiate an in-network contractual adjustment and insurance reimbursement amount.
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u/Bulldogmom56 12d ago
Didn’t know that about network contracts.
As for my 401k I’ve had to dip into to help pay for ACA premiums for the last 5 years and they have taxed me on it as well as raised my income level to the pint I make $5000 above what financial aid will pay.1
u/ChewieBearStare 12d ago
Assuming it's a traditional 401k, that's how they work. You don't pay taxes now; you pay taxes when you withdraw the funds. (OP, I'm just explaining for other people here, not implying that you didn't know that).
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u/BostonDogMom 12d ago
Too late for OP but for everyone else: THIS IS WHY HSAs EXIST. If OP put $10,000 in an HSA over the course of their career, they can withdraw the money to cover copays, deductibles, etc both before and after Medicare eligible without a tax penalty.
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u/Bulldogmom56 12d ago
We did, when he got on Medicare the rules changed and they wouldn’t let him. As for me I exhausted mine in previous dr bills.
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u/Bulldogmom56 12d ago
Totally agree! My husband is lucky he has survived pancreatic cancer for 16 years. (Cancer was a rare one) he has had lanreotide shot that they bill at $56,000 per shot each month, but insurance takes it down to $1400 a shot. It keeps tumors from growing in his liver.
He had a very successful job and got sick at the age of 49. We’ve saved all our life, he was healthy this cancer was genetic in the family. we did everything right. They sacked him because of new management. He worked thru his sickness almost died twice. In America you better hope you never get sick, cause you will go bankrupt.
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u/justavivrantthing 12d ago
Is your bill due to the cost of the shot? If so, are you able to see if the pharmaceutical company offers a discount program? I am so sorry you’re going through this - I’ve personally experienced this a few times in my life and it’s awful.
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u/elevenstein 12d ago
It sounds like you may have a high deductible plan. These plans have reduced premiums and higher out of pocket expenses. If this is a high deductible plan, you should have access to an HSA to save money tax free to cover these out of pocket expenses.
Its very possible that the reduction from 75k to 7k is just a contractual allowance, meaning that the hospital has, potentially, received no payment at all at this point.
Hospitals are often reluctant to discount on deductibles in these situations. You should check with their financial assistance contacts to be sure, and if they will not discount, you can start talking about making some kind if acceptable payment arrangement.
Good Bill and other services that claim to reduce your balance by somehow looking at the "itemized bill" are almost always ineffective, and if they charge a fee, I would go as far as calling them scams. Most commercial insurance rates are negotiated based on the service being performed not based on the charges submitted. If the hospital bill is 75k or 7k, the negotiated rate is very often the same.
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u/positivelycat 12d ago
Most hospitals are non for profit and offer financial assistance. Have you tired that?
I agree though Good bill is a joke they don't do anything the patient could not do in a phone a call themselves
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u/Trick_Raspberry2507 12d ago
Lots of hospitals are actually FOR PROFIT. Very few are actually non-profit. They may have a non-profit arm that they use as a tax deduction, but most are for profit.
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u/positivelycat 12d ago edited 12d ago
CMS data data does not support that theory unless things have shifted even more in 2 years.
While their are for profit, the largest chunk is still non for profit but I will give you profit hospitals are higher then one might think at about 36% still leaves non for profits with the biggest chunk of 49% rest are government owned
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u/Trick_Raspberry2507 12d ago
Oh shit, really? Where did u find that information?
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u/positivelycat 12d ago
Google is free but here is the .gov source
While this is only medicare hospital out side of VA hospitals not sure how a hospital could run and not accept Medicare
hospital-ownership-data-brief.pdf https://share.google/kVBLSPrdNicNLe1Sw
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u/Turbulent-Pay1150 12d ago
Not for profit hospitals paying for profit providers. It’s kind of the Kaiser model - insurance is not for profit. Facility may be not for profit. Doctors are for profit. As are pharmaceuticals.
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u/Better-Tough6874 12d ago
Non profits still need to take in money. Clearly you do that know how they work.
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u/Away-Record7066 11d ago
You didn't mention if the Hosp has a payment plan, make monthly payments till you can access your 401k. If not, let it go to collections.......then you can bargain for a final payment.
As for your credit rating........it will drop till you pay, then bounce back up. I'm in a similar situation & make $100 a month payments directly to my Hosp Acct.
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u/Bulldogmom56 11d ago
Yes that’s what I’m gonna do. Hospital requires it paid off in 12 months. I can pay it off in 18 but they refuse to do that. 🙄
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u/LostUnderstanding117 11d ago
Walk in to payment office hand them a paper check every month 50.00$ or so and they take it they cannot send it to collections.
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u/Away-Record7066 11d ago
This is not true........it takes on a life of its own because it worked for a few people. They COULD send it to collections if you nickel & dime them !!
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u/Away-Record7066 11d ago
Make payments every month............at the end of that 12 mo, if they see that you have made good faith payments & it's more than half paid off.......they " MAY" let you continue. Do not miss a payment & make a significant payment.......Do Not nickel & dime your acct !!! If not, then let the balance go to collections & negotiate a cheaper buy-out on your balance. Either way, you can work it out.
My Hosp lets me make a payment with no time requirement. I will make a larger extra payment as I have a check coming. I plan to have mine paid off in about 8 more months.
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u/Maronita2025 12d ago
Actually if YOU are disabled then YOU can pull from YOUR 401K without penalty is my understanding! I'd recommend checking with a tax preparer, IRS, or tax attorney.
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u/Bulldogmom56 12d ago
Before I sign off for good thank you for the info. I didn’t know about insurance network is reason hospitals don’t negotiate bills. I wish I had known that. I was only venting about the high costs. And that Good bill is not as helpful as I thought. Take care of your health always and save your money. My husband has always been a saver. Others don’t have that luxury. It saddens me that so many people go bankrupt due to medical these days. And Insurance costs are astronomical in America.
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u/Simple_Heat_2113 11d ago
Apply for charity care to lower the bill. You can have quite a high income and still get a bill reduced. This is separate from a payment plan.
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u/Old_Draft_5288 12d ago
Something important is missing here.
Was the outpatient facility in network or out of network?
I can’t really imagine a scenario in what you got a $75,000 outpatient bill unless you got a non-covered service that was also out of network.
You need to start by going over your explanation of benefits to understand what was covered and what was not covered , they always have reasoning codes, and you can call customer support and ask them questions.
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u/Bulldogmom56 12d ago edited 12d ago
It was in network. Let me explain further, The bill was for me. They did a Bronchoscopy of my lungs. I’m NOT a smoker. But there was damage to my lungs. Turned out to be past damage possibly from Sarcoidosis , which I had no idea I had.
The reason I mention my husbands cancer is because it’s been 16 years of medical bills we’ve been paying off. We’ve been frugal and have kept ourselves above the bills, but my doctors found this thru a test for something else. When I got the bill, it was over $70,000 brought down to $58,000. After the insurance network put it down to $7000( my deductible) I only had $1300 left in HSA. I couldn’t believe a 4 hr outpatient stay was that amount. What do people do without insurance? Hospital will only let you pay interest free for one year.
Money has been tight due to husbands medical bills, and we live in a small older home that seems to be a money pit. Weve had bad luck with it. I don’t want pity or $ I know we will somehow get thru this but it angers me that there are tons out there losing everything just to save their lives. And I understand why some people refuse to go to the dr because of the cost. Medical and insurance cost are unreal.
And Good bill didn’t help whatsoever.
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u/PharaohOfParrots 11d ago
Did you try financial assistance at the hospital you're getting care? That should be where you get assistance to pay it down to zeroing it in.
I had no idea "GoodBill" even existed, since this is a built in thing at most hospitals and places you get treatment.
Have you checked to get his oncology medications donated by the manufacture? That will save a bundle too.
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u/Bulldogmom56 11d ago
It’s for me.
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u/PharaohOfParrots 11d ago
I don’t get where the downvotes come from, but most medical systems donate the care to you - even insured, when your income is below 400-600% of the federal poverty level. (Most qualify). I hope you get the help you need.
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u/Designer-Toe1955 12d ago
Sad to see that no one questions the validity of 75k charge. No Healthcare need should cost something that is unaffordable. I repeatedly say this is a prime example of price gouging and the community at large seem to thumb down my comments when technically it's to protect their own interests. System is not aligned with my commentary but it does not mean we ask for a change.
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u/coleman9925 12d ago
I agree with you. It’s sad that we argue and struggle to figure out how to pay for these bills when the real debate we should be resolving is why these bills are so astronomically high in the first place. Wouldn’t it be better to have reasonable prices to begin with than to charge outrageous amounts and then play a bunch of games to get the bills to a reasonable amount?
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u/Old_Glove9292 12d ago
1,000% -- I would love to have a public option, but in the meantime, do we really expect insurance companies to pay these prices? Hospitals are consistently billing them $50k, $500k, $1M... I wouldn't pay that shit either. It's just extortion... It's absolutely necessary to solve for the greed problem on the provider side before solving for it on the insurance side because it's providers that are the primary drivers of these insane prices.
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u/positivelycat 12d ago
But they don't expect that payment at lest if they network with insurance. They know they are pricing high so they can still make money and insurance can justify themselves and say how good they are at negotiations. Plenty of rural hospitals are closing cause they can not keep up even with high billed rates cause the allowed amount are either not based on that billed amount at all or insurance wants to only pay 30% . Yea some chains are greedy but let's not pretend insurance is not the big player.
It's all a game where the patient lose.
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u/Turbulent-Pay1150 12d ago
Not true. The insurer knows that the billed amount is bogus as the contracted amount is what will be paid. The provider/hospital also know the amount as it set in stone in the contract between the doc and the insurer . Their is some magic in grouping or uncoupling some codes where a doc might bill several services that should have been one combined service or vice versa
That the facility/doc produces such a bogus bill makes the system harder for anyone let alone the patient to understand.
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u/Old_Glove9292 12d ago edited 12d ago
Except from a patient's perspective that's not how any of this works... No one thinks to themselves, "oh I love my insurance company because they're so good at negotiating on my behalf..." 🙄
For hospitals, employee salaries make up the vast majority of expenses, so if they can't stay open, then they should downsize or cut wages rather than passing the cost to patients These absurd bills are not always covered by insurance, and sometimes patients are stuck with the bill, which is why medical bills are the number one reason for personal bankruptcy in this country... Those are real lives that are being destroyed because hospitals are price gouging. Basically, what you're suggesting is that patients should be willing to go bankrupt to get the care they need so that hospital employees can enjoy cushy salaries and job security...
This is on top of the fact that a huge chunk of everyone's taxes already go towards hospitals as well as a sizable chunk of the revenue of many companies in the form of health insurance premiums for employees that could be redirected back to employees in the form of higher salaries. That is how insatiable and greedy providers are right now. They're taking money from patients, the government, insurance companies, and companies that employ Americans, and somehow it's still not enough 🤔
UHC leads all insurers with a 6% profit margin, which is a fraction healthcare costs... Again, I'm for a public option, because I believe that insurance is an unnecessary overhead, but the main villains in healthcare are not the insurance companies, it's the providers who are bottomless pits of greed that have been unable to self-regulate and now they need to be cut off...
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u/Concordiat 12d ago edited 12d ago
This is just dead wrong. Physician "services" make up less than 15% of healthcare expenditures in the US as of 2020(this is counting money that goes towards running clinics and other outpatient services overhead, actual salaries are closer to 8%). Nursing is another 10-15% at most. Growth of administration in hospitals and healthcare over the past 30 years has vastly outpaced growth in physicians(and nursing for that matter.)
If you removed every doctor and nurse's salary in the country in the blink of an eye(you know, the ones that you actually go to the clinic or hospital to see and provide the actual healthcare) you would still have >70% of expenditures remaining. It would be a pretty worthless 70% too since there would be no diagnosis or treatment of disease which is kinda the whole point of, you know, healthcare.
Companies like UHC hide their profits by using their insurance arm to funnel money into their own hospitals by making them "preferred hospitals" in network and basically double, triple, or quadruple dipping on that money. So you are paying them a premium, then visiting their clinics/hospitals and paying copays and deductibles. Then they use that insurance to pay another portion to their hospital. Then that hospital or clinic uses that money to purchase drugs through their pharmacy benefit manager Optum. They've also been starting to hire doctors themselves so then they also get to keep the difference between what the doctor makes and the salary they pay them. They are getting a cut every step of the way.
So yes they make 6% after they've paid themselves a few times with your money.
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u/Old_Glove9292 12d ago
It's not dead wrong. You just refuse to accept the truth because you want more job security and a higher salary. How can you not acknowledge your own bias on this topic? Maybe have some humility and consider that you're living in denial and spreading lies because it makes you sleep easier at night. Clinicians do valuable work, but it's not so valuable that patients should go bankrupt for it...
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u/Concordiat 12d ago edited 12d ago
What about what I said is wrong?
It's literally right there. If you pay 100 dollars for healthcare, about 8 dollars goes to the doctor, another 7 dollars to overhead, and another 10-15 to nursing care.
The other 70-75 dollars is going elsewhere through a labyrinthine network of insurance companies, hospitals, pharmacies, PBMs, and other subsidiaries. If it was me I'd be more worried about that.
You are right that our system has huge issues. We do spend too much on medical care. One of the biggest issues is that the very foundation of medicine (doctors and nurses), make up a small fraction of our spending and instead we are subsidizing large corporations to provide shareholder value with our healthcare dollars instead.
Combine this with a litigious and "more is more" atmosphere(always order more tests so you don't miss something - big corporations that provide these lab/imaging services love this by the way) and you get an explosion of healthcare spending which is funneled into administrative oversight and needless testing rather than high quality medical care.
If you want the doctor on call at 3 in the morning to save your life, who has been trained intensely for 10-12 years at a personal cost of 300k, to make less than a store manager at Walmart to save 4% of your insurance premium, I guess that's a choice.
I'd rather go after the 70% we're putting elsewhere including into the hands of large companies who deliver "shareholder value."
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u/Old_Glove9292 12d ago
Of course you would think that... You're a clinician and you think clinicians should make more money than everyone... Again, examine your bias. You're cherry picking statistics, and they're all intended to paint the picture you're most comfortable with and not the truth. There's a lot of commentary you can find on this if you're interested, but I think Noahpinion laid it out most elegantly:
https://www.noahpinion.blog/p/insurance-companies-arent-the-main
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u/Concordiat 12d ago edited 12d ago
I give you numbers and you give me an opinion blog.
Ok thanks.
Also it's funny because I do not, in fact think clinicians should make more than anyone, and indeed big tech software engineers make far more than I ever will with a fraction of the schooling.
I guess they they must be worth much more
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u/happyfamily714 12d ago
The vast majority of support staff is underpaid. These include nurses, radiology, lab, respiratory therapy etc. if you think Doctors are overpaid you should look at the amount of years of schooling they have to have and the average amount of debt they come out of school with.
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u/Designer-Toe1955 11d ago
Doctors having to go for excess of schooling and incur high student debt does not justify for a common patient to pay for thousands of dollars just to be seen..
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u/happyfamily714 11d ago
I didn’t say it did. Read the other comments. That is not where the money is going.
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u/Old_Glove9292 12d ago
Lol the entitlement and narcissism... Patients don't deserve to go bankrupt to pay the salaries of healthcare workers. The cost of schooling is a personal choice and patients shouldn't be on the hook for it.
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u/Concordiat 12d ago edited 12d ago
"The cost of schooling is a personal choice and patients shouldn't be on the hook for it."
Of course they are? If you see a lawyer, the cost of their schooling is factored into the price you pay for services. If you pay an engineer, the cost of their schooling is factored into the price you pay for services. It is expensive to educate people with doctorates. Not to mention the cost of schooling may be a personal choice but if you want doctors in your society somebody is going to be paying for that cost so it'll be a factor in cost regardless.
Fortunately like we discussed above, the majority of the cost patients pay is in fact not for doctors so for the most part the patient is not "on the hook" for for a meaningful cost.
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u/happyfamily714 12d ago
Go somewhere else when you need medical care. You don’t deserve to be treated if you think the staff caring for you are overpaid. There is a lot wrong with healthcare in the US, the salaries of the patient care staff is not one of them, except perhaps that many are overworked and underpaid.
You do not work in healthcare and are very mis-informed in understanding where the actual costs lie.
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u/rtaisoaa 12d ago
My mom’s current hospital bills for an ER Visit is 38k. That doesn’t include the 3 days hospital stay because of afib and that the ER Missed 3 broken ribs.
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u/SeriousBrindle 12d ago
The $75k is irrelevant since it’s pre insurance. OP received a $7k bill, that’s it. If they didn’t have insurance, the hospital would’ve lowered the $75k amount.
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u/Old_Glove9292 12d ago edited 12d ago
That's because healthcare providers and hospital workers know where their paychecks come from. They'll shamelessly ask patients how much they would pay to save their own life or the lives of loved ones as a way to defend the price gouging, and then gleefully join in the public bashing of insurance and pharma.
Btw, I'm not defending insurance or pharma, they're part of the problem, but providers are the root of it, and they need to be held accountable.
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u/Better-Tough6874 12d ago
Respectfully-it sounds like you are in a financial collision course. You will have to pay something for all your debts-then the Doctors/Hospitals will write off the rest as a loss. And the rest of us will pay for your failure to plan ahead for life-that's the way it works.
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u/Better-Tough6874 12d ago
Respectfully- you get a high deductible plan and this is what happens. You may not like what I said but its the way of life. We will all pay because you cant.
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u/_AS123_ 11d ago
Not the OPs fault - reading through their posts, they did everything they could.
We all pay because healthcare costs are out of control in America and every administraiton fails to do anything about it. America needs universal healthcare like the rest of the first world before it can be considered a fraction of how good of a country it thinks it is.
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u/DCRBftw 12d ago
Have you applied for financial assistance with the hospital?
It sounds like you have a high deductible. But if you no longer work, you may qualify for financial assistance.