At what amount do insurance companies and hospitals consider a bill a medical catastrophy?
June 16th, 2009 | by Rick |
labaker75 asked:
Within the last 3 months my husband has had two brain surgeries and his thyroid removed…all cancer. We recieved treatment for each, all involving hospital stays, labs, specialists. The bills are literally over $500,000 and we are still recieving new ones daily. At what amount do insurance companies and hospitals consider a bill a medical catastrophy and charge these off?
TRENT
Within the last 3 months my husband has had two brain surgeries and his thyroid removed…all cancer. We recieved treatment for each, all involving hospital stays, labs, specialists. The bills are literally over $500,000 and we are still recieving new ones daily. At what amount do insurance companies and hospitals consider a bill a medical catastrophy and charge these off?
TRENT
3 Responses to “At what amount do insurance companies and hospitals consider a bill a medical catastrophy?”
By GRAHAM on Jun 17, 2009 | Reply
RICARDO
Do you mean a catastropic illness? This type of coverage is usually issued to the 50-65 yr age group and has a higher deductible and co-ins or out of pocket to the insured. Your insurance doesn’t “charge off”. They pay according to the benefits you purchased. Most group policies have a maximum benefit of $1 mil. This max is based on what they pay out and not what is actually billed. Most insurances pay a contracted rate to the providers and write off the difference less your deductible and co-pay amounts. If you use a “non-contracted provider” you may be liable for more out of pocket expenses because the insurance benefits paid are less. You will need to read your policy to see how your insurance is written. Explanations of Benefits should also give you info on how providers are being paid. If you have questions, sk your agent or HR dept.
Additionally, if you are having trouble paying your portion, check with your local Health Services Dept to see if you qualify for assistance. Sometimes, hospitals have assistance programs as well.
By BRAD on Jun 18, 2009 | Reply
NOEL
An insurance company considers anything they pay out to be catastrophic, every penny.
As for hospitals, they never truly write off any charge that has not been paid. They will eventually stop trying to collect it though.
The reason for this is that hospitals are not-for-profit companies. (That means they are out to make money just not a viable profit.) Because hospitals are classified as n-f-p they do not pay income taxes, no tax bill means they have nothing to write a loss off against, so nothing can be truly “charged off”. (Don’t worry their employees still pay taxes through the nose like the rest of us.)
In your case your husband should be on disability and state paid medical if you have no insurance. If you have insurance they have to pay everything up to their contractual limit without giving you a hard time about it (you still pay any deductables.) Read your policy, and if they are refusing to pay, get a lawyer and sue for breach of contract. You pay the premiums (or your employer) and they pay the bills, if they don’t that is breach of contract.
By VINCENT on Jun 19, 2009 | Reply
DUNCAN
First, it depends on your insurance policy. There will likely be a provision for “catastrophic protection”. They go by that, not by any particular situation. They’re there to meet their contract obligations, not to help a bad situation.
If your insurance doesn’t cover it, hospitals will negotiate on a case by case basis.
The ultimate refuge is bankruptcy. Medical expenses are the leading cause of bankruptcy in the US, not irresponsibility.