Big Blue Huddle

Haven't really talked about it before but for the past 2+ years I was mostly in the hospital with cancer, a leg infection and other things when i was in California. I was there for an eternity but got out, got married, and my wife got pregnant we moved back to Mississippi. She got really sick in June and stayed at the hospital a couple weeks but then got out. She then went into labor on the 19th of June and we went to the hospital but before admitting her to the hospital or a Dr even seeing her they made us pay in full for what they thought the pregnancy would cost which was around $11,000. Like at the door before she could be seen. I'm not that fluid but did what I had to do. My daughter wasn't supposed to be born until Sept 1st, she came June 20th, which was scary but because we didn't have NICU insurance they only kept my daughter for a few weeks which was mind blowing. It took a lot out of my wife as even when she got home she's been on bed rest and I've virtually been taking care of both since we got home so I'm unable to work, or really do basic things. Turn to a week ago and my daughter is wheezing a little so I get concerned, take her to the hospital and she's doing better but now needs a procedure and they want me to pay most of it upfront, is that legal?

I was just curious because I have never heard of paying upfront at a hospital for anything besides maybe an elective procedure that you might have scheduled with a Dr not at the hospital. I mean as a husband and father I did what I had to do initially at birth but it just being the 3 of us I'm bouncing between the hospital and house to take care of both with no end in sight and I'm not sure how anyone could afford to continue to pay up front for non elective procedures and then just hope an insurance may cover it half a year later. Especially with just the basic costs associated with a child, or even a family in 2024.

I tried to speak to the Dr and what I was told was that what they were asking for weren't grand amounts and that they were easily attainable price points. That they have to target people they know will pay to make up for the 1,000s that don't. I was like I can't afford it, I'm trying to keep a family afloat not working trying to get by until my wife gets on her feet and I can go back to my job. His response, well you paid the first time.

Maybe I'm blowing it out of proportion, maybe I'm not, kind of a vulnerable subject, but it has really dumbfounded me, and was just curious if we had any drs that may give me better insight into why or how this happens. I've now paid them multiple times for things and can't afford to continue on at the rate I have.

J: Do you have any medical insurance at all? Bob

It's crazy. However, I spoke to a surgeon a few months back while visiting a friend and he told me in a ten-minute rant that Doctors are getting paid xxxx since the Affordable Care Act and many Doctors don't visit because they make much more money at their office. He told me that he made less than $100 for a surgery he performed in an emergency.

I would go to the Hospital Administrator and ask questions and look into other facilities.

Jess

First of all, so sorry to hear about all these 'setbacks' and I will be praying for you and your family never to go thru things like this ever again.

So, to answer your question, I have NEVER heard of a public hospital refusing anyone, regardless if they have insurance, let alone asking them to pay upfront. If it is a private hospital, then maybe? but even then, it does sound pretty outlandish.

Not to take away from anything you have said, but to add something. My oldest son, Wade, who many have met, when he was born, at 5 weeks he needed a special surgery. At that time we had medical coverage thru HIP which was one of the worst outfits around but it was all we could afford. To make this long story a bit shorter, he had the surgery and just didn't recover as expected. he was in ICU for over 3 weeks and we got two calls in the middle of the night saying they didn't think he would make it thru the night and what we wanted them to do. After that second call, (and thank GOD, he survived, we dropped the idiotic HIP, and asked for recommendations from the hospital. They gave us two of the best pediatricians around and with their help Wade recovered and has been fine ever since. But once we brought these 'other' doctors in, we lost health coverage, as HIP only is good for HIP doctors and no one else. By the time Wade was released, we had a staggering hospital bill and there was no way we could pay. The doctors only asked that we pay what we could each month, which we did for almost 5 years, and after that, we sort of stopped. They understood as most doctors do. Hospitals also understood and there was no way we could pay that hospital bill. It was basically written off as a loss. Maybe that's why things may have changed as you alluded to, but as far as I know, any PUBLIC hospital will accept you, or anyone, and ask for a payment, but never upfront.

Again, I wish you and your family a speedy recovery and only the best.

Quote from: Bob In PA on August 19, 2024, 12:07:10 PMJ: Do you have any medical insurance at all? Bob

I do, Blue Cross, but the hospitals want their money upfront even with my insurance which most say is a good insurance to have. Which is even more mind blowing to me.

Quote from: Ed Vette on August 19, 2024, 12:46:55 PMIt's crazy. However, I spoke to a surgeon a few months back while visiting a friend and he told me in a ten-minute rant that Doctors are getting paid xxxx since the Affordable Care Act and many Doctors don't visit because they make much more money at their office. He told me that he made less than $100 for a surgery he performed in an emergency.

I would go to the Hospital Administrator and ask questions and look into other facilities.

Yeah, from what I understand or from what they told me is that my track record when I was in California and was basically living in the hospital for 2 years was that I paid my bill when I left which was upwards of $250,000 and had a proven track record of paying thus they held me to a higher standard. So I come to Mississippi and we go to really the only major hospital in 200 miles and because they are the only game in town can basically do what they want including asking for upfront payments. I've lived in NYC, Chicago, LA etc and had never, ever experienced that.

Quote from: LennG on August 19, 2024, 12:50:19 PMJess

First of all, so sorry to hear about all these 'setbacks' and I will be praying for you and your family never to go thru things like this ever again.

So, to answer your question, I have NEVER heard of a public hospital refusing anyone, regardless if they have insurance, let alone asking them to pay upfront. If it is a private hospital, then maybe? but even then, it does sound pretty outlandish.

Not to take away from anything you have said, but to add something. My oldest son, Wade, who many have met, when he was born, at 5 weeks he needed a special surgery. At that time we had medical coverage thru HIP which was one of the worst outfits around but it was all we could afford. To make this long story a bit shorter, he had the surgery and just didn't recover as expected. he was in ICU for over 3 weeks and we got two calls in the middle of the night saying they didn't think he would make it thru the night and what we wanted them to do. After that second call, (and thank GOD, he survived, we dropped the idiotic HIP, and asked for recommendations from the hospital. They gave us two of the best pediatricians around and with their help Wade recovered and has been fine ever since. But once we brought these 'other' doctors in, we lost health coverage, as HIP only is good for HIP doctors and no one else. By the time Wade was released, we had a staggering hospital bill and there was no way we could pay. The doctors only asked that we pay what we could each month, which we did for almost 5 years, and after that, we sort of stopped. They understood as most doctors do. Hospitals also understood and there was no way we could pay that hospital bill. It was basically written off as a loss. Maybe that's why things may have changed as you alluded to, but as far as I know, any PUBLIC hospital will accept you, or anyone, and ask for a payment, but never upfront.

Again, I wish you and your family a speedy recovery and only the best.

Thank you my friend! Glad to hear your son is doing well!

Quote from: Jclayton92 on August 19, 2024, 01:20:55 PMI do, Blue Cross, but the hospitals want their money upfront even with my insurance which most say is a good insurance to have. Which is even more mind blowing to me.

J: First, I agree with Ed and Len. I want to tell you it's all "normal" but I can't do it.

I am certain you are not being singled out for any reason, but I suspect they're asking you to pay more than your insurance will cover, so (to the extent of the excess) they are treating that "extra" portion of the charges the same way some facilities treat uninsured patients.

Try presenting these questions to your family doctor or anyone else who knows health care in your area.  Nurses know A LOT but won't talk unless consulted in a non-professional setting, like if you have a nurse who is a friend or the friend of a friend, etc. Likely the solution will be to shop around and essentially find another hospital who is not as financially strapped as the hospital you're currently using. In some states there are hospital-like facilities that might suffice, depending on the treatment required.

Bob

Jess,

Out of college, I spent 15 years working for a hospital, so I have some sense of what goes one.   That said, the laws governing what a hospital can and can't do are mostly at the state level, and I am not familiar with the laws of Mississippi (although, based on reputation, I doubt they are particularly pro-patient).

I will also share that when I was in the hospital business (especially when I was starting out) all the hospitals in NJ were not for profit.  Now, the majority of hospitals in NJ are for-profit, and some of the not-for-profits behave like for-profit hospitals.

Generally speaking, for-profit hospitals are far more likely to have rules like the ones you describe (since they exist to make money), while not-for-profit will tend to be more patient-friendly.

Hospitals fight for all the money they can get. Most of it comes from charging 5 times more than they should from medicare/medicaid patients, to cover the masses that don't (or won't) pay. It's the "behind the scenes game" they play

A good example is my old boss, whose wife was deathly ill and getting kidney dialysis on a regular basis. To make a long story short, she passed away. He got a bill from the hospital that was over 50,000 dollars. He also received a check in the mail from his insurance company for around 9,000 dollars, that surprised him. He then called the hospital (Guthrie in Sayre, PA), and told them about the check, and they told him, "don't cash that check, if you bring it here right away, we'll call it even". Always made me scratch my head. The bills for procedures aren't based on Dr's fees, or equipment cost, or even medical malpractice insurance. It's pulled out of the air to see what they can get. In my bosses case, they were afraid that if he decided to not pay the bill, and use the 9 grand for something else, they'd end up with nothing. That is my opinion anyway 

In a way, it's better to be poor, than a responsible person with a decent job, when dealing with complex medical procedures at a hospital

Quote from: Jolly Blue Giant on August 19, 2024, 06:03:47 PMHospitals fight for all the money they can get. Most of it comes from charging 5 times more than they should from medicare/medicaid patients, to cover the masses that don't (or won't) pay. It's the "behind the scenes game" they play

A good example is my old boss, whose wife was deathly ill and getting kidney dialysis on a regular basis. To make a long story short, she passed away. He got a bill from the hospital that was over 50,000 dollars. He also received a check in the mail from his insurance company for around 9,000 dollars, that surprised him. He then called the hospital (Guthrie in Sayre, PA), and told them about the check, and they told him, "don't cash that check, if you bring it here right away, we'll call it even". Always made me scratch my head. The bills for procedures aren't based on Dr's fees, or equipment cost, or even medical malpractice insurance. It's pulled out of the air to see what they can get. In my bosses case, they were afraid that if he decided to not pay the bill, and use the 9 grand for something else, they'd end up with nothing. That is my opinion anyway 

In a way, it's better to be poor, than a responsible person with a decent job, when dealing with complex medical procedures at a hospital.

There is a lot to unpack that isn't quite accurate.  First off, Medicare and Medicaid is not how a hospital is going to make a lot of money.   Medicaid (for those who can't afford health insurance) pays pennies on the dollar. As an example, our ambulance bills at (not get paid at) $800 and change.  Medicaid would pay about $80 dollars for the run)  That's why many doctors and hospitals (at least for elective procedures) will not accept it, and many doctors who do accept it put those patients on the lowest priority list.

Medicare had a different structure.   They pay hospitals per diagnosis.  Say a patient comes in with a broken hip.  The pay rate for that injury is $40K, and that's it (this is why hospitals are pushing patients out as soon as possible).   This puts inner city hospitals in a bind because many of their medicare patients haven't had the regular medical care they need.  So, their hip patient may have untreated hypertension or major health issues from improperly cared for diabetes, so their stay in the hospital will be many days more than the patients seen by hospitals in wealthier areas.

Most private insurance companies have negotiated rates with hospitals or hospital systems, and that's the rate they pay.

There is also charity care (patients with no insurance or means to pay).  In New Jersey, hospitals are paid even worse than Medicaid for such care.  So hospitals with high percentages of patients who have private insurance (including Medicare supplemental insurance) will do the best financially, while those treating a higher percentage of patients with no insurance or Medicaid will struggle.

Jess - at the end of the day, the bills will always be there, for you just like the rest of us. Sometimes our bodies succumb to the medical/pharma world and they put their meat hooks in us and try to suck as much out of our wallets as they can. I use to joke that the answer was simple in avoiding them, "don't get sick!" Obviously, for folks such as you, myself and probably everyone on this board, life doesn't play out that way.

It's not easy to deal with all the trials you have had to go through. But one thing is clear and that is you have shown tremendous courage to fight through the damned "C-word" to marry the love of your life and witness the fruits of your love in that little lady of yours. You will ALWAYS be their hero, and I think it is safe to say you have all of us here alongside them as well.

You will get through the pinch-point of these medical bills. There is some good ideas here from the team to consider. But we all stand in your corner with our prayers and support for you and your family.

If you ever do find your way back out here to PHX, rest assured I've got the tab and we're going to have a great time talking Giants and war-stories about surviving medical conditions ... not to mention life in the deep south (having lived in GA, AL and having had in-laws in Hattiesburg).

Peace!

Jeez Jess, that's some hard times for sure.  I feel for your families health trials. I've never heard of such high up front billing either. I know new health care is often on a sliding scale pending income.   I'm sure you obviously researched the best insurance options. 
     My son's mother in law died of cancer during the pandemic. She's from the Philippines.  A typical income might be $5k a year over there.  They wanted all medical bills paid up front.  My son and daughter in law paid $25k cash.  At least it gave them peace of mind they did all they could. My daughter in law says when must Filipinos get sick, they can't afford medical care.  They go home, pray, then die
     Best of luck Jess to your families brighter days ahead!


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