Need advice on high dollar medical collection for my son

Hospitals rarely if ever receive charges and charges are oftentimes 5x, 10x, or even 20x costs.

Third party payers (insurers) negotiate contracts to agree on payment with hospitals that are usually based on a percentage of what Medicare would pay.

I can almost guarantee you the hospital’s cost is nowhere near that $405,378 “Billed”, and that the insurer is paying nowhere near the $402,230 “Insurance Covered”

Your son could approach by asking if the Hospital has a self pay discount for the Charges he owes or if the Hospital would be willing to allow him to pay the same percentage of his part of charges as the insurer.

If you can tell me the hospital, I can give you their overall cost to charge ratio which would give you estimate of the actual cost the hospital is incurring for the procedure.

And depending on the drug, most drug companies offer relief for their drugs. Pretty common for the insurance to pay and then drug company to waive the rest

El Camino had about a 21% cost to charge ratio in their last cost report filing to CMS, so the total cost to the hospital is likely $85,130 and the portion of cost the insurer is responsible is likely about $84,489.

Medicare reimbursement averages about 87% of cost and a private insurer generally pays between 150% and 200% of Medicare reimbursement.

$84,489 * 87% * 150% = $110,258. I’d say that’s a good estimate of the amount the insurer is actually paying on that bill.

$110,258 / $402,230 is about 27%, so “fair” reimbursement from your son for his portion would be 27% of the $3,148 being billed which is about $850.

Now the average hospital employee won’t understand that, but a person in their revenue department should understand they aren’t collecting “Charges” which is the number that appears on a bill.

Even out of network insurers now don’t pay charges and instead do reference based pricing like the above.

I’m probably bogging you down with information that is too much, but hopefully it’s helpful to understand how the reimbursement process actually works.

I’m always amazed at the type of information that can be learned from the user base of TigerDroppings. It’s really pretty freaking phenomenal.

Thanks everyone!!

1. Call the drug company, sometimes they have financial assistance programs.
2. Find the support group for the diagnosis, someone there has dealt with this.
3. Negotiate with hospital, they will take something over nothing.

I have nothing to add but this might be the most helpful response in the history of tigerdroppings, well done sir.

He can pay $10 a month and they won’t send it to collections

quote:

---

He can pay $10 a month and they won’t send it to collections

---

Damn dude, I can say that I am truly impressed.