A Question for Americans regarding hospital treatment

I just received a massive bill from a Spokane hospital (the cheapest...) of 8700 dollar for a short emergency treatment for serious asthmatic problems in June.
They did a CT scan, made some Xrays and maybe (I forgot) an echo. They couldn’t/didn’t help me , but that was not their fault I suppose.

I figured out based on my experience with Bumrungrad that the treatment would cost there probably about 375, maybe 500 dollar, in Europe it would be more expensive of course. But this ??
It feels like extortion and they didn’t specify anything.

The funny thing is that they didn’t ask for a passport nor did they verify my address.

The big question is, does the amount sound familiar for Americans under you ? And an even bigger question is, what would happen if I partly defaulted ? Btw, I am not from Greece.

Thanks for your input.

Peterplay, I'm having trouble sorting out your post. Are you a foreigner whose not an American, but while in the USA in Spokane, Washington you went to a local hospital and was charged $8700? Are you now living in the States, Europe or Thailand. If we know those things, then maybe we can give you some advice.

SF, sorry for the confusion. To be clear : I am European, living in Thai and went on a holiday in the States in June.

Peterplay.. not unusual if you were directly billed.. You didn't really specify details.. Inpatient?? Did they give you a detailed line item bill?? Usually a hospital billing directly to the individual will give you a full itemized bill showing every exact thing involved in the billing..

In the event the hospital accepted any insurance you may have had, they generally will have an "agreed upon price" for various medical procedures. The "agreed upon" price is most always significantly cheaper than direct billing to the patient.

Example.. A few years ago I went into the hospital on an overnight stay for hernia surgery.. Somewhere between my Doctor's clinic and the Hospital, the appropriate paperwork showing my medical insurance was lost. So, the hospital assumed I had no insurance, tracked me down and dunned me for the surgery and 19 hours overnight stay to the tune of $11,900. After their "collection agency" found me, I quickly contacted the hospital, provided my medical insurance information and the bill was adjusted down to the "agreed upon" price of $3500.00, 1/3 the original billing, a huge difference.

Also, if they did indeed provide you with a detailed bill you can challenge items you feel were improperly billed.

And.. you're in Thailand, I would think you have a good deal of leverage in negotiating a reduction in the bill.. I don't think they'll send dunning agents to Thailand to find you..

This is why many Canadians going across on vacation to the USA (even for a few hours) will get some travelers health insurance Welcome to the USA... please come again

Sounds about right. For an X-ray I had recently the insurance adjusted the price down about 80% from what the hospital charged, I paid $25. For a CT scan I had some time ago, the hospital charged $3600, insurance negotiated price was $1800, I paid $250. An emergency room visit would normally cost upwards of $800 just for showing up. Insurance companies negotiate the price down, and my share ends up being $75 unless I'm admitted, in which case it becomes a typical 80-20 split.

The major benefit of insurance companies, besides picking up the larger share of the cost, is the negotiated price of treatments. hospitals make up the difference between what the treatment actually costs and what they are being paid by raising the costs for people who don't have insurance. So your $8700 is paying for people who can't pay for treatment, and for the difference between cost and benefit amounts from insurance, Medicare and Medicaid. Welcome to US healthcare!

Peterplay,,,,, I offer the following advice based on some past experiences of members of my own family:

Negotiate a settlement. They can do it.

If you have an individual you trust at your home in Europe,,, I would advise that you use them as a mail forwarding service for corresponding with the hospital in the U.S.,,,,, unless you have already given them your Thai address.

In either case, I would inform them that you were a foreign national on holiday in the U.S. and your insurance would not cover the fees specified on the bill,,,,,,, but you would be willing to pay them a cash payment of XXX dollars to settle. I would offer 25% of their bill. Have them respond in writing with their approval. If they agree, make sure you stipulate the payment is for "Full and total payment of the account" on the cashiers check, etc.

Good luck, LL

The last posts about a settlement are very interesting, I never before have thought about price negotiation with a hospital, not used to this idea.
I have written to my insurance company and they are willing to help me in this case. Funny thing is that I haven't recieved a specification, which is very odd. My insurance needs the spec to compare with dutch prices in order to establish what they will reimburse me with, if anything.

@Frazeedk : I was admitted for a few hours in emergency. They never quoted me any price and they never asked me if I was ok with estimated costs. When I left they told me the cost would easily amount to 2000 dollar.

Anyway, enough reasons to discuss before payment.

Heck, if you are a foreigner and not living in the States, just do a runner. Nothing is going to happen for that little bit. Not worth it to chase you all over the world when any legal jurisdiction stops at the border. $8,000 doesn't even meet the minimum to file in federal court. It would go to state court, they might get a judgement for that plus fees and that's it. Nothing else would/could happen.

Hi KD, I am contemplating that, but my heart, deformed bij a dutch reformed upbringing, has a problem doing so.
I will first try to solve this in a proper manner.

How sure are you nothing will happen ? Will I be able to enter the USA (mmm) again without problems ?

Now I want to have specs first, but they never gave me a contact emailaddress, so some research needed there as well.

Peterplay wrote:Hi KD, I am contemplating that, but my heart, deformed bij a dutch reformed upbringing, has a problem doing so.
I will first try to solve this in a proper manner.

How sure are you nothing will happen ? Will I be able to enter the USA (mmm) again without problems ?

Now I want to have specs first, but they never gave me a contact emailaddress, so some research needed there as well.

Peterplay, I would say for you to follow your conscience as you suggested, but I will also comfirm KHONDHAMN's comments. You will remain invisible and the federal authorities will not be involved in a local civil state matter, if in fact it ever went that far. Hospitals write off those amounts on a daily basis because they are not worth pursuing. So, no red flags will go up at immigration.

Bah. The way the industry screws people, I'd have no problem with it. Really, though...if it bothers your conscious that much, then why not just pay in full? Why consider a half-way swindle of bargaining the price down? Go for the full Monty and at least be honest about being a crook (lol). Absolutely NOTHING will happen with immigration. Skipping on a debt is not a felony, and only felonies matter to immigration.

Something good to remember about the US: if you get sick, and visit the Emergency Room of any hospital, they WILL treat/stabilize you, whether or not you have insurance or money to pay for it.

Try that in Thailand.

No idea how much longer that can be the case, given how outrageous the costs have become, and the need to make the system more cost-effective.

When considering the very high cost of health care, remember what dbriggins post said:

The major benefit of insurance companies, besides picking up the larger share of the cost, is the negotiated price of treatments. hospitals make up the difference between what the treatment actually costs and what they are being paid by raising the costs for people who don't have insurance. So your $8700 is paying for people who can't pay for treatment, and for the difference between cost and benefit amounts from insurance, Medicare and Medicaid.

I guess the point is, SOMEBODY is going to pay for it. Your conscience, and your ability to pay (or not) will determine who.

Other than your own conscience, as KD and others have pointed out, there will be no other consequences (i.e., legal).

These are life's dilemmas.

Goes to show you why the private hospitals in the country won't treat you unless you have a good credit card or surrender your passport before treatment. They've been stiffed by a fair share of travelers.

Well, I don’t think I want to pay for the lack of efficiency and fairness in treating people, I regard that as an American problem.
And, indeed, you won’t be treated in a private hospital in Thailand if you don’t have the money ready, the service is nice for people who have money. That is different in Europe where hospitals are obliged to treat people, in the Netherlands therefore for example everybody must have an insurance by law.

@Parrot : I feel it would have been correct had they given me an estimate of the costs before treating me, especially being a foreigner. I wasn’t unconscious so I could have decided to skip a treatment for costs reasons. And what happens if you are unconscious and they can’t find a cc, do they let you die on the street ?

Anyway, KD’s idea about being a full or a half crook is interesting, I’ll ponder about it. I think there is a difference. And, I am used to paying my bills when I receive them unless I feel they are unfair.