daredevilkink | Discussion/Off-Topic Post #1

Ugh, somebody help me. Writing hospital fic and I have no clue about the American hospital billing system.

What kind of insurance would Matt, who has a new and barely profiting business, be able to afford (and how would that affect his hospital bill)?

Also, does his disability affect what kind of insurance he can get? Or would it be helpful in some way?

Basically I'm trying to figure out how much of a bill he'll be saddled with after a surgery and 5 days in-patient stay.

(Oh, and also: How does that process even work? Do you have to go to a cashier or something after you've been discharged? Do they put you on some kind of payment plan? If your insurance covers all or some, do you know right away? Or do you have to claim the entire amount and then wait on pins and needles wondering how much the insurance provider is going to cover?)

This can vary a lot. If you want to know a hospital's billing practices then look up a specific hospital in NYC and search for their payment procedures. When I worked at the cancer hospital in my city they had financial coordinators who set up payment plans and worked with each patient to get maximum care for minimum cost.

Also Google search terms such as "insurance options for start up businesses."

I would also recommend looking into charity and disability funds which many hospitals have to help patients in financial distress. Matt would be a shoe-in. This goes double for religious based hospitals who make it their business to alleviate as much discomfort as possible off the patient. My older sister had a sudden baby delivery at the local Catholic hospital and only owed a few hundred dollars at the end of it because the hospital's charity fund covered her costs.

In Matt's case I would say he or Foggy (most likely Foggy) would meet with hospital financial coordinators who would communicate with the insurance company. Once the coordinator nailed down the insurance billing they would set up a payment plan if needed. It also depends on what the surgery is. An appendectomy is one thing but an organ transplant would be a whole other ballgame and without knowing what surgery Matt is having then I can't guesstimate what he would owe.

It's also important to know what insurance is and is not. Tieing the American medical industry to insurance was an attempt by LBJ or Nixon (I honestly can't remember which one) to lower medical costs. By pooling money together in one "place" as it were, they were trying to spread costs out over several people instead of making one person shoulder their imdividual costs by themselves. The result was mixed but it does help lower payments all across the board. A conscientious insurance company (yes, they do exist despite what the American media tells you) would communicate very quickly and swiftly with Matt, telling him his options and paying as much of his bill as they can and offering financial assistance and counseling if he requested it. (This was my personal experience with Anthem, who was very helpful to my mother when she had an emergency gall bladder removal. Financially, everything was resolved in the space of a week, which was when she left the hospital.)

Millions of people go through the system every day with straight forward surgeries and procedures, someone like Matt would be in and out of the hospital fairly quickly without much problem barring sudden onset of a bizarre disease or him suddenly being robbed of every cent he had.

I'm going to be much less useful than the previous commenter and just say that medical billing sucks.

Without insurance, surgery + 5 days in the hospital is likely to break $100,000, depending on the surgery.

With insurance, there's generally a hefty deductible (when I last had insurance, mine was $6,000), then insurance only covers %80 of costs beyond that. So, if I hadn't yet touched my deductible, a $100,000 bill would have cost me $24,800 (less, depending on what sort of annual out-of-pocket maximum the plan had).

Medical bills are the number one cause of bankruptcy in the US.

SA

I have thousands of dollars in medical debt. I wish I'd had the same sort of positive experiences that the other commenter spoke of, but while I've never been hospitalized, I've had to go to the ER for three separate major events, two of which I had insurance for, and each time sucked.

To build on the anon above me's comment:

it really varies HUGELY depending on what insurance company you have. So you have basically high deductible insurance, where generally speaking your premiums are relatively low, but you have to pay a lot of money before the insurance will kick in. Some high deductible plans will pay 100% of costs after the deductible is met, some will only pay a percentage (80% is common), in which case you'd be responsible for the full amount of the deductible plus whatever percentage the insurance didn't cover. Low deductible plans will cover a lot more, but the premiums are typically higher, so they may not be chosen by people (ie, Matt) who don't have a ton of money. And that's just for employer-sponsered health care; Matt would be paying for his out of pocket, and I have no idea what kind of plan he'd be able to afford (probably a high deductible plan, but other than that...)

When you're admitted to a hospital, you're generally asked for your insurance card, so that's how they know how to bill you. If you don't have an insurance card, or they don't know who you are, or whatever, they're still required to provide life-saving care but they WILL do their best to track you down afterward and get you to pay. IME, your insurance will be billed first and whatever they don't cover will be billed to you. You should have some idea of what's covered and to what percentage, but you DON'T generally know how much a hospital charges for a given procedure (it varies A LOT), so you won't necessarily know how much it costs until you get the bill. A lot of insurances have out of pocket maximums beyond which they will pay the full cost, but even those can be ruinously expensive, particularly for people without much money.

That said, as first anon said, a lot of hospitals have people who will help you work out a payment plan/look for alternate sources. But yeah, inpatient surgery with a 5-day stay? you're looking at high double-digits at least, easily into triple digits, particularly if it was an ER visit. ERs are expensive. For reference, when I was pregnant I had to stay overnight in the ER because they thought I might have blood clots (I didn't). No invasive procedures, no drugs, pretty much no intervention at all, and they still billed my insurance almost 4K.

Hope that helps...

OP here:

Yeah, he was taken there by ambulance, triaged in the ER and then taken up for emergency sigmoid colectomy. 4 days post-op stay. Also broken ribs and orbital fracture. And various cuts and deep tissue bruises. (He's a mess, basically) And then there's all the pain meds they had him on. And sedative. And antibiotics.

The whole payment/insurance thing isn't going to be a big mention, but I figured I'd include a paragraph of exposition detailing Matt and Foggy meeting with someone to figure out the whole insurance thing when Matt's discharged.

I'm surprised nobody here has mentioned Medicaid for Matt. He has no family and little supplemental income and directly qualifies based on 'blindness or disability.' Medicaid is a government program directed at providing government based health insurance to the impoverished and disabled who would not generally be able to afford it. On the basis of poverty, you have to be WAY below the poverty line - or at least before the Affordable Care Act you did - but on the basis of disability your income can be higher. I can imagine him not applying for it out of pride but at some point someone would probably (or has probably in the past) encourage him to apply for Medicaid.

I am unsure what that bill would be but even with any kind of insurance it would be very expensive. I have good insurance and I once went to the doctor to get blood work done and I got a $200 bill in the mail. Which is in general how most people get their medical bills.

Also if you don't pay them you get collect calls and I know because I have been avoiding paying a medical bill for bloodwork for a while. . .

I'm sure it's better in New York, but in my bass-ackwards state unless he received disability benefits (which he may not qualify for, since he has an advanced degree in a field in which his work isn't particularly impeded by his disability and he turned down a well-paying job that he was capable of performing), he wouldn't qualify for Medicaid.

Discussion/Off-Topic Post #1

What kind of insurance would Matt have?

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