ER Overcharges for Non-Insured Shocking

San Diego, CAIn October 2012, Dave received a bill for emergency room overcharges totaling $15,000. Due to a car accident, his wife spent a few hours in the ER, which included time to sign two documents agreeing to pay their “master” rate. She signed while being treated and in a state of shock. Needless to say, Dave was in shock when he got the bill.

Dave (not his real name) is outraged that his wife’s treatment, which amounted to a CAT Scan and two hours in the ER, would cost this exorbitant amount. Adding insult to injury, he found out that the “master rate” is 10 times higher than what most insurers and Medicare pay.

“My wife had only been in the US for three years and didn’t speak English very well,” says Dave, adding that his wife didn’t have an interpreter so she had no idea what she was signing. Even if you did understand English, making someone sign two documents, one that you are financially responsible for any treatment and the other agreeing to pay top dollar for treatment, is unfair and likely unjust. Add to that being in shock when handed the pen.

About a week after Dave’s wife got home, he received the hospital bill. ER charges alone were $13,000 and doctor charges another $2,000. “There were no medical code listings or explanation of procedures, and in the demand for payment, it said, ‘If you pay this bill within 14 days we will discount this charge down to $8,500,’” Dave explains. “I later found out that an insurance company would pay less than $2,000 for these services. We don’t have insurance and the hospital knew this.

I called administration and in so many words said this bill was ridiculous. I asked them what an insurance company or Medicare would be charged for the same services and they refused to give me that information. I then asked who their HIPPA compliance officer is, which has something to do with insurance compliance, and a copy of the contract of their procedures and all billing codes.”

It took three months for Dave to get this information so the discount was no longer valid. Next up he contacted the CEO of the hospital who then put Dave in contact with “Charity Billing.” Its charity policy stipulates that if Dave’s and his wife’s combined income is less than $30,000 per year they will write off the bill completely. If it is between $30,000 and $60,000, they will charge the Medicare rate of about $1,800 - quite a discrepancy between the master rate and the insurers’ rate. And there is the negotiated rate.

Dave is on disability. The hospital considers his benefits income so he doesn’t qualify for getting the bill written off. “I am sending them two years of tax returns and bank statements and more, which is what my lawyer, Barry Kramer, advised me to do,” says Dave. “It’s like applying for a mortgage.

“You get blind-sided in ER. Once they see that you aren’t insured, you automatically get charged 10 times the normal rate,” says Dave. “If you don’t pay within so many days it goes to a collection agency. Normal, hard-working Americans can have their credit destroyed. In my wife’s case, she is a temporary worker; if her next application for work shows that she owes $15,000 she would likely not get that job.

“Even if I paid the bill right away, I would have paid about five times more than ‘customary.’ If I paid the bill in full, I would have paid 10 times more than customary. These hospital overcharges are discriminatory, they are so wrong.”