r/HospitalBills • u/HammahHead • 10d ago
$18,000 bill from a week of no coverage (MI)
Looking for some advice on what options to reduce $18,000 in bills my mother and father received from a colonoscopy they got at the hospital. This is in Michigan.
My parents had health insurance that they were paying for, unfortunately one of the payments was put on hold by her credit card (she thought it was a fraud charge at first so called them questioning the charge), shortly after she realized what it was and authorized the charge. Long story short, the insurance treated it as a missed payment and they had no coverage for a few weeks.
During this, they both got colonoscopies (they didn't know that insurance was not covering them at the time), and then were billed the full amount since they didn't have insurance during this.
My parents have no way to pay this bill, my dad is on disability and mother currently does not work as she had to quit work to stay home to care for him. (Will have SS starting next year).
What she has tried so far, she has called them to try and get it lowered, they did not seem to budge and pushed her into a payment plan of $200 a month. (I believe this plan is currently in effect). They are not able to pay the $200 a month.
She has applied for financial aid help, and charity help. Both claim they have too much assets for that. (They own a home, and technically if they drained their entire 401k, it would cover the bill)
She tried to apply for Medicaid but my Dad's disability was just enough to be too much for them to be eligible.
My next plan is to have my mother call them again and see if they can give a lump sum discount. They could pay that off with their retirement money, and not have it completely drain all of it. Looking to see what other options they have, seems crazy to me that they are charging that high of an amount for a colonoscopy when I imagine if someone asked for the cash rate it would be much much less.
Update:
Double checked with my parents, turns out the bank withdrew the 2nd payment as well, so it never went through. The insurance company stopped service and cut them off. They ended up having to enroll with a new insurance company. So, no premium was paid for the month they got the procedures. It was in January with a new insurance, so the first payment was missed. Therefore no grace period.
Double Update:
Hospital said since they merged, they cannot negotiate lower amounts. Both said by the financial counselor and the billing department. Then the biller said they may be able to qualify for a discount, so they are checking that out to see if they can knock off up to 45%. Might end up just saying to send it to collections and negotiate it at that point...
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u/Sloppysteaksslick 10d ago
There should be a clause in the policy of retro active coverage for things like missed premium payments. Have them call their insurance company and show proof that they did in fact pay the premium that month and in an appropriate time frame.
Edit: It should be a 90 day grace period. The hospital just needs to re submit or you can try and ask the insurance company to simply re process the claim.
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u/HammahHead 10d ago
Double checked with my parents, turns out the bank withdrew the 2nd payment as well, so it never went through. The insurance company stopped service and cut them off. They ended up having to enroll with a new insurance company. So, no premium was paid.
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u/asdf_monkey 9d ago
You need to look into the specific dates of the original bill’s dues date, failed payment, date, notification of policy cancellation date, policy term end date. And know the reinstallation state law for,health insurance cancellation as all these dates are governed.
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u/MissMontanica 6d ago
If the hospital is a non-profit, they're legally required to have a "Charity Care" program. This is where your parents would apply and ask to have some or all of the balance forgiven. It is income based, but might still cover some of it.
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u/SeaweedWeird7705 10d ago
No offense, but why did your mom question the charge with her credit card company?
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u/HammahHead 10d ago
Fair question, it was a new insurance, the naming of it wasn't obvious that it came from the insurance company, and the credit card company wasn't able to say who the charge was from or explain it. She figured it out after calling the credit card company and tried to correct it, but wasn't able to in time.
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u/whatever32657 10d ago
this may sound overly simplistic, but when attempting to negotiate the bill, did you ask specifically for "cash prices"? when you are paying cash, my experience has been the bill comes down by at least 50%.
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u/HammahHead 10d ago
That was going to be my plan of action, try to negotiate a cash price, or see if they will lower it significantly and offer to pay it all at once. Right now my parents are going to reach out to the Financial Counselor of the hospital to see what they can do for them.
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u/Redbarrow_7727 10d ago edited 9d ago
They should be able to request Public Act 107 from the financial counseling department. I don't think they can take into account assets for Public Act 107.
Would you mind sharing what healthcare system this is? I'd like to see their policy and see if I can help. (I know it's not the one I work for in MI because they would have been 100% assistance based on the income you're describing, and we don't count assets ever.)
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u/HammahHead 9d ago
Henry Ford
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u/Redbarrow_7727 9d ago
Page 4 of their policy talks about assets. Per their policy, 401ks are a protected asset and can't be counted unless it's in excess. From what you described here, it's not even close.
Appeal the Financial Assistance determination. Send a written statement with a copy of your Dad's Social Security Award letter, the current disability approval, and a month's bank statement that proves it's the only income. Quote the section of the policy on page 4 that refers to assets.
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u/HammahHead 9d ago
This was extremely helpful! I'll go over with my parents what all their assets are to see if it reaches the 100k threshold that this document is outlining.
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u/Old_Draft_5288 9d ago
What they should’ve done at the time was to file an appeal on the withdrawal of coverage and show proof that they made the payment, even if it didn’t go through. Often they will reinstate coverage accordingly.
You can certainly still try, but given the time that has elapsed and also the fact that they’ve taken on any new policy, it’s iffy.
However, the hospital and the provider of colonoscopy has an obligation to verify coverage before performing the procedure. I would request whether they had to do a prior authorization for the colonoscopy. If the provider failed to do a prior authorization and proceeded anyway. They may be liable for the cost.
At which point their only choice will be to pay … Oral at the hospital. I’ll send it to collections when they can negotiate a much lower repayment, but it’s going to hit their credit.
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u/lgbtq_vegan_xxx 9d ago
Mistake #1 was failing To verify insurance coverage before accepting the service
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u/Away-Record7066 9d ago
Something is wrong here !!!! The Hosp is supposed to verify insurance coverage before they approve the procedure.
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u/No-Quarter-7657 6d ago
FILE bankruptcy protection and force them to take lower amount or discharge the debt.
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u/EvilGypsyQueen 9d ago
I know it doesn’t help now but I it could help others later. Vote for universal healthcare.
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u/CarlEatsShoes 5d ago
Then our healthcare will be controlled by spineless politicians, RFK Jr-esque quacks, GOP fake “Christians” who hate women and poor people, and Musk’s army of 16 year old AI robots. No thanks.
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u/DonkeyKong694NE1 10d ago
Call the hospital billing dept, explain the situation and ask to be billed at Medicare rate as opposed to self-pay rate which is what they’ve probably charged you. Get them to allow a payment plan. And then work w insurance to get coverage reinstated retroactive to when it ended.
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u/Environmental-Top-60 10d ago
I think the claim needs to be reprocessed. If the premiums were paid, then the healthcare coverage should exist. Call insurance to verify eligibility dates first and if that is correct, call member services and ask them to reprocess those claims; then call the provider/hospital and let them know that you've asked these claims to be sent back for reprocessing.
If that doesn't work, hospital charity care should help if this care is related to a hospital or hospital owned facility. These charity care applications should help with anesthesia, path, and professional charges as well. Dollarfor is very helpful with stuff like this.
If both of those don't work, let us know