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Saving On Hospital Bills

I recently had a day/outpatient surgery. Between jobs and uninsured, I told my surgeon the first time we met that I needed to keep the costs as low as possible. He agreed that as long as I made arrangements for safe overnight care at home (I live by myself), and the surgery went well, I would be released after my surgery instead of overnight. I also called the hospital a week ahead to ask about a discount for payment in full in advance, and was told that there was a set fee if they were paid in full in advance of $1480, plus $300 if I had to stay over one night.

Small gasp, after all surgery was 8 am and I would leave by noon.

However, today I learned that the actual itemized fee for this surgery was $4400!!! At the normal outpatient rate, an overnight stay would have added at least $700.

Most hospitals will give a 10% or 20% discount for cash lump sum payments. But this is a discount of 60%+ for payment in full in advance. In addition, each of the doctors discounted their bill a flat 20% for payment in advance. Even if you use a credit card or cash advance check, it is worth it.

So should you find yourself with a medical savings account or requiring an uninsured surgery, here are the steps to obtain this huge discount:

Approximately one week before the surgery:

  1. If you know you are going to have surgery, call each of the hospitals you are considering and ask their policies on discounts for payment in advance. Some hospitals give a %-age discount and some a flat fee, flat fee is usually a better deal. Select a surgeon who has privileges at the hospital, or find out if your surgeon is willing to seek courtesy privileges at that hospital.

  2. Your doctor will identify the exact surgery he plans to do and place it on the operating schedule, approximately one week before the scheduled date. When you talk to you doctor or the surgeon's nurse who does the scheduling, ask to be scheduled first or second case on the date he proposes; this gives you more time to fool with the billing folks before they get busy, and gets you out of the hospital quicker.

  3. Call the hospital accounting office as soon as you know the case has been scheduled. Tell them you want to discuss prepayment for a self-pay surgery. Tell them you are scheduled for "name exact surgery" with "name doctor" on "date". Get the full name of the bookeeping person you talk to. Ask if there is a set fee or discount if you pay in full, in advance on the day of the surgery. Write down the exact amount and the name of the person you talked to and ask them to make sure it is put on your record that you are eligible for the advance payment rate.

  4. Ask what is included. For example, I wanted to go have my EKG and labs the day before (so I wouldn't have to get up so early), but the bookkeeper told me that these tests were included in the fee if I had them done the morning of surgery, but would be billed separately if I did them another day. For $400 bucks, I got up early!

  5. Ask what is the discount for the additional fee if you have to stay overnight. Some hospitals do not discount this part. Most do.

  6. Ask where the information about your prepayment arrangement is being recorded for the admitting clerk.

  7. Ask if the hospital accepts Visa/Mastercard and if the same rate applies. The answer is usually yes, and you can really rack up the frequent flyer miles.

The day of your surgery, take the written bookkeeping clerk's name and agreed amount with you:

  1. Take your credit card or two checks with you.

  2. Arrive at least 15 minutes ahead of when they said, sign in right away.

  3. Write down the admitting clerk's name, and call her/him by name. Tell the clerk as soon as she asks about insurance that you are self-pay and that you have made a payment agreement for (flat rate) or (discounted) prepayment with "name", who told you the information would be recorded.

  4. Give them the check or credit card and get a receipt.

  5. If something weird happens, make sure the agreement gets written into your records. I planned to pay by Mastercard, and their machine was broken down. They told me to come back after surgery before I left the hospital, when they could use another department's machine. I told them I was there early, ready to pay, and that I would be too ill to come back after the surgery, I needed to go home. They said to send a family member later. I reminded them no one else could sign the card. I asked them why they couldn't bring it to me in post-recovery, they said they could. I told them to MAKE SURE that it was written on my record that I was ready to pay and entitled to the discounted prepay agreement. Sure enough, they did not follow through and I left without signing the receipt. I went back a few days later after my surgeon's visit and if I had not had the agreement written on the record, they would have charged me the full amount.

  6. Because not many people use the prepayment option, the bookkeepping isn't very successful, and chances are good- 50/50- that you will still get a full bill showing a balance due. Do not ignore it!!! Call the person you originally talked to, who gave you the rate, and remind them of your conversation, tell them you were incorrectly billed, ask them to fix it and send you a corrected copy.
  7. You may still receive a few smaller separate bills for pathologist and radiologist professional fees. Still haven't figured out how to get a prepaid discount on these, but some do discount 10^ or 20% for payment in full within 30 days. As soon as you get these bills, call the office! Ask!

Use some of the money you are going to save to pay for a helper to give the house a thorough spring cleaning before you get laid up, and to have someone with you the first 24 hours and at night for 3 days.

Hope you don't need to use the advice! Be healthy!

Ellen