Has anyone negotiated a medical bill down?

[SusanBAnthony]

DS is getting ASD testing done, and our insurance is not covering it. We will be paying OOP, and it is estimated to cost 3K.

I called the hospital and they offer a std. 10% self pay discount. I thionk that is a total joke, bc based on the EOB's we get, if our insurance was covering it, they would negotiate the bill down 30-50%.

Has anyone had luck negotiating hospital bills down further than the std. discount that they offer? If so, would you mind sharing with me?

[ijack]

I would wait until they actually bill you - they should still bill through your insurance and be rejected. Then you'll get a bill and I'd call and say "I can do a payment plan paying $10/month or I'll pay you $2000 right now."

[SusanBAnthony]

I tried calling today, and they said the same thing, that I couldn't do anything now but they would run it through my insurance.

Good call on offering 10$ a month, lol.

[dr.girlfriend]

Testing for an autism spectrum diagnosis, do you mean? That shouldn't cost $3k. A full all-day neuropsychological eval is only about $4800. An autism eval can be done in a few hours.

[Deleted]

Oct 30, 2012 13:37:20 GMT -5 ijack said:

I would wait until they actually bill you - they should still bill through your insurance and be rejected. Then you'll get a bill and I'd call and say "I can do a payment plan paying $10/month or I'll pay you $2000 right now."

Yes, wait until they bill you. Whenever I've neogiated a bill like this I either offer a small amount that will take forever to pay for offer to pay 65-75% of the total and settle it that way.

I did collections once and it's ridiculously easy to just say "I can pay x right and settle it at that." More often than not they'll accept and be done with it.

[SusanBAnthony]

It is 2 three hour appts with IQ testing, ASD testing, dev pedi and psychiatrist observations. It is at the childrens hosp. in our town. I called a psychologist covered by our insurance, and his testing is 6 hours as well. Since our insurane only covers part of the first 2 hours, we are paying mostly OOP either way, so we decided to go with the best in town.]

I am no expert, tell me if I am wrong about the above. But what we are getting most definitely costs 3000-3200 according to the billing person who I have been bugging 3 times a day lately

[nnb]

have you checked to see if your health benefits are going to start covering it in 2013? Our phamplet came in and starting in 2013 they are going to start covering services/therapies for Autism. I'm sure every benefits is different, but they might have a change...crossing fingers for you!

[atouchofklasse]

You might still get your insurance discount. I hope so!

[SusanBAnthony]

Oct 30, 2012 13:48:07 GMT -5 nnb said:

have you checked to see if your health benefits are going to start covering it in 2013? Our phamplet came in and starting in 2013 they are going to start covering services/therapies for Autism. I'm sure every benefits is different, but they might have a change...crossing fingers for you!

Yup, just did that We have options to change medical insurance, but all our behavioral health coverage is staying exactly the same.

[dr.girlfriend]

Oct 30, 2012 13:46:13 GMT -5 SusanBAnthony said:

It is 2 three hour appts with IQ testing, ASD testing, dev pedi and psychiatrist observations. It is at the childrens hosp. in our town. I called a psychologist covered by our insurance, and his testing is 6 hours as well. Since our insurane only covers part of the first 2 hours, we are paying mostly OOP either way, so we decided to go with the best in town.]

I am no expert, tell me if I am wrong about the above. But what we are getting most definitely costs 3000-3200 according to the billing person who I have been bugging 3 times a day lately

Insurance probably wouldn't cover testing even from someone who's in network, at least for the cognitive testing component. Is insurance covering the developmental peds and psychiatry visit part of it, but just not the IQ/autism testing? Or are they not even covering the MD visits because the potential diagnosis is autism?

IQ can be helpful, but it doesn't tell you much about autism specifically unless the question is whether the child is not participating in certain skills because of cognitive limitations. Is there any chance of getting the IQ component done through the school? The key testing for the actual diagnosis of autism will likely be the ADOS and maybe some questionnaires, which is only a few hours to administer, and should be billed at under $450 an hour. The psychiatry visit would go under your mental health plan but should be at least partly covered, and the developmental pediatrician visit I would think should be covered under your regular medical.

[SusanBAnthony]

Oct 30, 2012 13:54:48 GMT -5 dr.girlfriend said:

Oct 30, 2012 13:46:13 GMT -5 SusanBAnthony said:

It is 2 three hour appts with IQ testing, ASD testing, dev pedi and psychiatrist observations. It is at the childrens hosp. in our town. I called a psychologist covered by our insurance, and his testing is 6 hours as well. Since our insurane only covers part of the first 2 hours, we are paying mostly OOP either way, so we decided to go with the best in town.]

I am no expert, tell me if I am wrong about the above. But what we are getting most definitely costs 3000-3200 according to the billing person who I have been bugging 3 times a day lately

Insurance probably wouldn't cover testing even from someone who's in network, at least for the cognitive testing component. Is insurance covering the developmental peds and psychiatry visit part of it, but just not the IQ/autism testing? Or are they not even covering the MD visits because the potential diagnosis is autism?

IQ can be helpful, but it doesn't tell you much about autism specifically unless the question is whether the child is not participating in certain skills because of cognitive limitations. Is there any chance of getting the IQ component done through the school? The key testing for the actual diagnosis of autism will likely be the ADOS and maybe some questionnaires, which is only a few hours to administer, and should be billed at under $450 an hour.

The school might be able to do the IQ testing. I will call and ask.

The whole thing is billed through the hospital as ASD testing, not as individual Dr. appts. I am going to ask if the Dr. portions can be billed seperately under our medical insurance because I think they would be covered that way.

[dr.girlfriend]

Oct 30, 2012 13:57:54 GMT -5 SusanBAnthony said:

Oct 30, 2012 13:54:48 GMT -5 dr.girlfriend said:

Insurance probably wouldn't cover testing even from someone who's in network, at least for the cognitive testing component. Is insurance covering the developmental peds and psychiatry visit part of it, but just not the IQ/autism testing? Or are they not even covering the MD visits because the potential diagnosis is autism?

IQ can be helpful, but it doesn't tell you much about autism specifically unless the question is whether the child is not participating in certain skills because of cognitive limitations. Is there any chance of getting the IQ component done through the school? The key testing for the actual diagnosis of autism will likely be the ADOS and maybe some questionnaires, which is only a few hours to administer, and should be billed at under $450 an hour.

The school might be able to do the IQ testing. I will call and ask.

The whole thing is billed through the hospital as ASD testing, not as individual Dr. appts. I am going to ask if the Dr. portions can be billed seperately under our medical insurance because I think they would be covered that way.

Psychiatry will still likely go through mental health but developmental peds should go through medical.

[litebright]

Oct 30, 2012 13:54:48 GMT -5 dr.girlfriend said:

Oct 30, 2012 13:46:13 GMT -5 SusanBAnthony said:

It is 2 three hour appts with IQ testing, ASD testing, dev pedi and psychiatrist observations. It is at the childrens hosp. in our town. I called a psychologist covered by our insurance, and his testing is 6 hours as well. Since our insurane only covers part of the first 2 hours, we are paying mostly OOP either way, so we decided to go with the best in town.]

I am no expert, tell me if I am wrong about the above. But what we are getting most definitely costs 3000-3200 according to the billing person who I have been bugging 3 times a day lately

Insurance probably wouldn't cover testing even from someone who's in network, at least for the cognitive testing component. Is insurance covering the developmental peds and psychiatry visit part of it, but just not the IQ/autism testing? Or are they not even covering the MD visits because the potential diagnosis is autism?

IQ can be helpful, but it doesn't tell you much about autism specifically unless the question is whether the child is not participating in certain skills because of cognitive limitations. Is there any chance of getting the IQ component done through the school? The key testing for the actual diagnosis of autism will likely be the ADOS and maybe some questionnaires, which is only a few hours to administer, and should be billed at under $450 an hour. The psychiatry visit would go under your mental health plan but should be at least partly covered, and the developmental pediatrician visit I would think should be covered under your regular medical.

In the case of autism, a full developmental evaluation is recommended by most experts. Not just ADOS, although that is one of the most commonly used diagnostic tools. A developmental eval usually includes a speech evaluation, OT evaluation, ADOS, and several other tests of behavioral/adaptive skills, and yes, an IQ test. Sometimes it also includes genetic testing to rule out certain disorders that are common to ASD (like Fragile X).

I've been quoted $3-5K through our local Children's Hospital, depending on which pieces you pick and choose and how thorough the genetic testing you do is.

Sorry, SusanB. Our insurance claimed that they covered testing for autism but despite the straightforward wording in the EOB and us calling first for confirmation several times, they would only cover a "psychiatric interview," which sounds like what the pp is describing. Which basically tells you "autism or not" and gives zero insight into helping shape a therapy plan. We appealed twice with tons of documentation, and were still denied, so we paid for the whole thing OOP.

DD1's ASD eval (which did not include OT, and was done by a child psych rather than developmental pedi b/c the wait was so long for the latter; her OT eval was through our school district as part of a determination of services) cost about $1,500, and we were able to get it down to $1,300 by paying cash, in full, once our insurance rejected the claim. They did ADOS, Vineland, a speech screen (she'd already had a separate speech eval, which was covered by insurance), IQ, and a few other tests that I can't recall the names of. It was like 3-4 hours over two days. And it will be done again at age 6, although next time I do hope to do it through Children's.

They do tend to be more expensive (and also more thorough) through a children's hospital. More overhead, etc.

As a parent of a child on the spectrum, this is not something where I'd accept only ADOS. The whole point of an eval is not just to identify a dx, it's to get as thorough an idea as possible of what's going on, what the specific delays are and to what extent the atypicality is, in order to maximize the usefulness of chosen therapies. Those can be significantly different for each child with ASD, so simply knowing whether or not your child is on the spectrum is not enough to base decisions on, IME.

It's important to have a full evaluation because it significantly shapes treatment choices, and can carry a great deal of weight if you have to fight your school district to justify requests for services. If you rely on the school alone (and many people have to b/c they cannot afford testing), you're dependent on the experts they offer -- who may be biased because of budget constraints. They also focus on whether a child has an educational need, aka requires services to function in a classroom, vs. whether they have a medical dx. They're not medical professionals, they're educational professionals, so they can't give a medical dx -- that comes from a private eval.

And IQ can be an important factor -- if a child has significant cognitive impairments they may qualify for additional services or funding programs that are dependent on IQ cut-offs; alternatively, if they have above-average intelligence, that can help shape therapy choices as well.

Unfortunately, all that testing is really expensive. And yes, I'd wait until you get the bill and it's rejected to see if offering cash then will bring it down any further.

GL!

[GailGoldie]

Oct 30, 2012 13:37:20 GMT -5 ijack said:

I would wait until they actually bill you - they should still bill through your insurance and be rejected. Then you'll get a bill and I'd call and say "I can do a payment plan paying $10/month or I'll pay you $2000 right now."

This is best way.

[iheartbanjos]

Oct 30, 2012 13:37:20 GMT -5 ijack said:

I would wait until they actually bill you - they should still bill through your insurance and be rejected. Then you'll get a bill and I'd call and say "I can do a payment plan paying $10/month or I'll pay you $2000 right now."

I had success doing this with my OOP labor and delivery bill.

[Deleted]

SusanBAnthony-

I don't know where you are, but for us it was going to be 2k to do testing on DS2. Then a friend suggested going to a developmental pediatrician. My regular pediatrician gave us a referral and it took us 6 mos to get into the developmental ped but it was just a regular co-pay to get the diagnosis and report for the school. Our appointment was about 3 hours and they reviewed our answers to surveys about him as well as his teachers.
'
You may want to see if you can go the developmental pediatrician route

[dr.girlfriend]

Oct 30, 2012 17:00:35 GMT -5 litebright said:

Oct 30, 2012 13:54:48 GMT -5 dr.girlfriend said:

Insurance probably wouldn't cover testing even from someone who's in network, at least for the cognitive testing component. Is insurance covering the developmental peds and psychiatry visit part of it, but just not the IQ/autism testing? Or are they not even covering the MD visits because the potential diagnosis is autism?

IQ can be helpful, but it doesn't tell you much about autism specifically unless the question is whether the child is not participating in certain skills because of cognitive limitations. Is there any chance of getting the IQ component done through the school? The key testing for the actual diagnosis of autism will likely be the ADOS and maybe some questionnaires, which is only a few hours to administer, and should be billed at under $450 an hour. The psychiatry visit would go under your mental health plan but should be at least partly covered, and the developmental pediatrician visit I would think should be covered under your regular medical.

In the case of autism, a full developmental evaluation is recommended by most experts. Not just ADOS, although that is one of the most commonly used diagnostic tools. A developmental eval usually includes a speech evaluation, OT evaluation, ADOS, and several other tests of behavioral/adaptive skills, and yes, an IQ test. Sometimes it also includes genetic testing to rule out certain disorders that are common to ASD (like Fragile X).

I've been quoted $3-5K through our local Children's Hospital, depending on which pieces you pick and choose and how thorough the genetic testing you do is.

Sorry, SusanB. Our insurance claimed that they covered testing for autism but despite the straightforward wording in the EOB and us calling first for confirmation several times, they would only cover a "psychiatric interview," which sounds like what the pp is describing. Which basically tells you "autism or not" and gives zero insight into helping shape a therapy plan. We appealed twice with tons of documentation, and were still denied, so we paid for the whole thing OOP.

DD1's ASD eval (which did not include OT, and was done by a child psych rather than developmental pedi b/c the wait was so long for the latter; her OT eval was through our school district as part of a determination of services) cost about $1,500, and we were able to get it down to $1,300 by paying cash, in full, once our insurance rejected the claim. They did ADOS, Vineland, a speech screen (she'd already had a separate speech eval, which was covered by insurance), IQ, and a few other tests that I can't recall the names of. It was like 3-4 hours over two days. And it will be done again at age 6, although next time I do hope to do it through Children's.

They do tend to be more expensive (and also more thorough) through a children's hospital. More overhead, etc.

As a parent of a child on the spectrum, this is not something where I'd accept only ADOS. The whole point of an eval is not just to identify a dx, it's to get as thorough an idea as possible of what's going on, what the specific delays are and to what extent the atypicality is, in order to maximize the usefulness of chosen therapies. Those can be significantly different for each child with ASD, so simply knowing whether or not your child is on the spectrum is not enough to base decisions on, IME.

It's important to have a full evaluation because it significantly shapes treatment choices, and can carry a great deal of weight if you have to fight your school district to justify requests for services. If you rely on the school alone (and many people have to b/c they cannot afford testing), you're dependent on the experts they offer -- who may be biased because of budget constraints. They also focus on whether a child has an educational need, aka requires services to function in a classroom, vs. whether they have a medical dx. They're not medical professionals, they're educational professionals, so they can't give a medical dx -- that comes from a private eval.

And IQ can be an important factor -- if a child has significant cognitive impairments they may qualify for additional services or funding programs that are dependent on IQ cut-offs; alternatively, if they have above-average intelligence, that can help shape therapy choices as well.

Unfortunately, all that testing is really expensive. And yes, I'd wait until you get the bill and it's rejected to see if offering cash then will bring it down any further.

GL!

I'm not arguing that a more extensive and comprehensive evaluation isn't useful. If, however, it is cost-prohibitive, having some of the components done by covered services (e.g., through school or Early Intervention / Intermediate Unit, through medical appointments) is another way to go. And, as I said, unless IQ is quite low, it isn't going to give you much input into the autism diagnosis.

[Deleted]

Oct 30, 2012 17:31:28 GMT -5 dr.girlfriend said:

Oct 30, 2012 17:00:35 GMT -5 litebright said:

In the case of autism, a full developmental evaluation is recommended by most experts. Not just ADOS, although that is one of the most commonly used diagnostic tools. A developmental eval usually includes a speech evaluation, OT evaluation, ADOS, and several other tests of behavioral/adaptive skills, and yes, an IQ test. Sometimes it also includes genetic testing to rule out certain disorders that are common to ASD (like Fragile X).

I've been quoted $3-5K through our local Children's Hospital, depending on which pieces you pick and choose and how thorough the genetic testing you do is.

Sorry, SusanB. Our insurance claimed that they covered testing for autism but despite the straightforward wording in the EOB and us calling first for confirmation several times, they would only cover a "psychiatric interview," which sounds like what the pp is describing. Which basically tells you "autism or not" and gives zero insight into helping shape a therapy plan. We appealed twice with tons of documentation, and were still denied, so we paid for the whole thing OOP.

DD1's ASD eval (which did not include OT, and was done by a child psych rather than developmental pedi b/c the wait was so long for the latter; her OT eval was through our school district as part of a determination of services) cost about $1,500, and we were able to get it down to $1,300 by paying cash, in full, once our insurance rejected the claim. They did ADOS, Vineland, a speech screen (she'd already had a separate speech eval, which was covered by insurance), IQ, and a few other tests that I can't recall the names of. It was like 3-4 hours over two days. And it will be done again at age 6, although next time I do hope to do it through Children's.

They do tend to be more expensive (and also more thorough) through a children's hospital. More overhead, etc.

As a parent of a child on the spectrum, this is not something where I'd accept only ADOS. The whole point of an eval is not just to identify a dx, it's to get as thorough an idea as possible of what's going on, what the specific delays are and to what extent the atypicality is, in order to maximize the usefulness of chosen therapies. Those can be significantly different for each child with ASD, so simply knowing whether or not your child is on the spectrum is not enough to base decisions on, IME.

It's important to have a full evaluation because it significantly shapes treatment choices, and can carry a great deal of weight if you have to fight your school district to justify requests for services. If you rely on the school alone (and many people have to b/c they cannot afford testing), you're dependent on the experts they offer -- who may be biased because of budget constraints. They also focus on whether a child has an educational need, aka requires services to function in a classroom, vs. whether they have a medical dx. They're not medical professionals, they're educational professionals, so they can't give a medical dx -- that comes from a private eval.

And IQ can be an important factor -- if a child has significant cognitive impairments they may qualify for additional services or funding programs that are dependent on IQ cut-offs; alternatively, if they have above-average intelligence, that can help shape therapy choices as well.

Unfortunately, all that testing is really expensive. And yes, I'd wait until you get the bill and it's rejected to see if offering cash then will bring it down any further.

GL!

I'm not arguing that a more extensive and comprehensive evaluation isn't useful. If, however, it is cost-prohibitive, having some of the components done by covered services (e.g., through school or Early Intervention / Intermediate Unit, through medical appointments) is another way to go. And, as I said, unless IQ is quite low, it isn't going to give you much input into the autism diagnosis.

DrG

That's what we did. We had him tested for IQ for the gifted program already so we knew it plus we used the schools for testing as well since it was free.

Our developmental ped gave us lots of resources, insights and suggested various therapies etc.

DS is now in a group therapy that has made great impact already and it is a mix of Pragmatics and OT but our insurance won't cover it.

[SusanBAnthony]

We might be able to go the dev pedi route, Septimus. The problem at this point is that they ran our benefits for us yesterday, as a courtesy, and the appt is tomorrow. I don't have time now to try to find a dev pedi, if we miss this appt tomorrow it is another 6 month wait. I don't think that is worth the risk.

Kids are $$$$$$$. Sigh.

[Deleted]

Oct 30, 2012 18:17:07 GMT -5 SusanBAnthony said:

We might be able to go the dev pedi route, Septimus. The problem at this point is that they ran our benefits for us yesterday, as a courtesy, and the appt is tomorrow. I don't have time now to try to find a dev pedi, if we miss this appt tomorrow it is another 6 month wait. I don't think that is worth the risk.

Kids are $$$$$$$. Sigh.

At least you'll have some answers and it sounds like they aren't asking for the full amount upfront like the center we were first going to go to did.