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This is a follow-up to my previous question.

I've received a relatively large bill from my health insurance provider for an emergency room visit a few months ago. While the bill isn't astronomical it's thousands more than I can afford. My health insurance provider said they would usually cover it but not this time since I haven't met my deductible for the year.

From some preliminary research it sounds like there's options for reducing this bill to something that I can actually afford to pay. I get the feeling that the bill was calculated under the assumption that insurance would just pay it. However this isn't the case hence I'd like to reduce the cost.

What are the options for someone in this situation?

Note: the emergency room service was received at an out-of-network hospital. Also I live in California.

I've considered just calling the out-of-network hospital and asking them to reduce the charges. Ideally they would send my health insurance provider a smaller bill which I could just pay. However I want to be careful about how I proceed.

Perhaps getting a lawyer would be useful. This would probably cost quite a bit more but I'd learn something about the legal system so it's not money entirely wasted. Also I imagine a lawyer would know how to talk to the hospital, which communications channels to go through etc.

Thanks in advance for any and all help!

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    You wouldn't be receiving a bill from your insurance, as you're saying. Rather, you would be receiving a bill from the hospital that provided you the services and want you to pay. Your insurance might send you an explanation for what they'll pay and what amount you still might owe the hospital, but that is not a bill.
    – user102008
    Mar 18 '13 at 18:44
  • @user102008 I think I received a bill from my insurance company that was based on what the out-of-network provider billed them. I'll double check.
    – SundayMonday
    Mar 19 '13 at 0:12
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I've considered just calling the out-of-network hospital and asking them to reduce the charges. Ideally they would send my health insurance provider a smaller bill which I could just pay. However I want to be careful about how I proceed.

Yes, that's what you should be doing. They might give you a discount, but even if not - they will definitely be willing to work out a payment plan for you so that you could pay in installments and not in a lump sum. I have experience with the El Camino group in California, that did just that. It was several hundreds, so they didn't give a discount, but were able to work out an installment plan for several months without much hassle.

That is something to do before you get to lawyers. I'm not sure I know how the lawyer could be useful to you, other than claiming bankruptcy or waiting for them to turn to collections and then fight those.

You should also work with your insurance. How much is your deductible? If your deductible is so high that it exceeds the several thousands bill you got - do you have a HSA? FSA? These will allow you paying the bill with pre-tax money, saving quite a lot (depending on your brackets and how much you put there). I would expect the insurance to bill you for the deductible, and cover all the rest. Is it not what is happening?

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  • Thanks for the advice. I think my insurance will pay for anything above the deductible. Unfortunately I have a relatively high deductible and the bill falls just below the limit.
    – SundayMonday
    Mar 18 '13 at 14:16
  • Maybe price collusion based leverage. It certainly isn't reasonable that those who don't have insurance get charged more than the insurance would pay for those that do; yet every hospital does this.
    – Joshua
    Feb 23 '15 at 20:51

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