$6,700 ER Visit?

Self-pay pricing and made-up discounts.

A quick reminder - as a consumer of US healthcare you have the power to negotiate your cost-of-care and bills.

Why? Because you have the freedom to request a self-pay price AND most pricing/ billed charges are made up numbers. Let me give an example.

Two weeks ago we ended up at the ER to fix an issue with a procedure my son had the day before. Out-patient at an independent facility wasn’t an option.

They ran some labs, performed a minor fix, and brought us our bill.

Level 4 ER visit and estimated charges of $6,700.... WHAT!?

But POS self-pay rate was 75% discount.... looks great right!?

Until I tell you the actual billed charges were $1,800... making the POS discount actually $125... a measly 6.9% discount.

What about this being covered as a followup/ corrective visit? The hospital conveniently applied these charges to a new account (not the same account as the original procedure performed 24 hours before) meaning the visit wasn’t classified as a followup/ corrective visit.

The good news is self-pay forced the hospitals to give us a cash price.

The bad news is the estimated charges and discount were made-up/ not transparent/ just plain wrong.

This bill was designed to make us pay same day and leave thinking the hospital gave us a huge discount. But the reality is $1,600 is probably still a significant overcharge.

Next steps for me are to request the itemized bill (with CPT codes) and do my own research into the Level 4 classification, charges, and ask that the visit be moved under the previous account as a followup/ corrective visit.

At the end of the day, maybe I’ll work with my plan and offer them a made-up payment number and see if they accept!! :)