My brother in law died in June. Heart attack. Four hours in the hospital and gone. And then the bills came. He’d let his insurance lapse two months prior. Bills were a few thousand here for the cardiologist, another few there for the ER docs, a bit for the radiologist. I helped my sister-in-law negotiate these down but they weren’t back breakers. Then the hospital bill came: $195k. This is a story about that.
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The first bill categorized the costs into a few buckets. No transparency. Cardiology was about $70k. What was that? Oh, cardiology. Nonsense. We asked for an itemized bill. They sent one with a few more buckets. I decided to take on fighting this. My thought was to figure out what Medicare would have paid so we’d have a number to negotiate from. But the procedure codes on the bill were internal and matched no database.
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We asked for a bill with the standard CPT codes. No reply. Asked again. “Oh, we meant to send it. We upgraded our computers five months ago and nothing works.” Uh-huh. Finally got the CPT codes. It’s not like medical care is just a menu of things they do with a cost for each. Like, the $31 low-dose aspirin, of which they give ln him four. I take that 81mg aspirin and I get a bottle of a thousand for maybe $8. But I had more to learn.
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Just looking up the codes wasn’t that helpful. Because there are rules to each code. And this is where it got interesting. I fed the itemized bill and codes to Claude (AI). Claude figured out that the biggest rule for Medicare was that one of the codes meant all other procedures and supplies during the encounter were unbillable. So the hospital had billed us for the master procedure and then again for every component of it.
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That was over a hundred grand of cost that Medicare would have reimbursed zero dollars for. Another was a code that was inpatient only and because it was an emergency he had never been admitted. So, if they did that thing then they would have had to re-bill everything else under inpatient rules and if they didn’t then why was it on the bill?
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A third was ventilator services, which Medicare says you can’t bill for on the same day as a critical care issue. Supplies were billed between 500% and 2,300% of Medicare reimbursement. Long story short, the hospital made up its own rules, its own prices, and figured it could just grab money from unsophisticated people.
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We told the hospital they had billed an unconscionable amount. They suggested we apply for charity assistance. But here’s the thing: my sister-in-law is not a charity case. She has money, her husband had a good business, he left a million dollar life insurance collection. The hospital wanted to discount the bill based on charity because they are obligated to provide charity to keep their tax exempt status.
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If bills are a fiction in order to back up the fiction of charity so the hospital can write off accounts and look like they are somehow doing right by people, this is an effed system. So we didn’t play. With Claude’s help, I wrote a letter explaining their billing violations and threatening legal action, bad PR, and appearances before legislative committees if they didn’t take what Claude calculated Medicare would have reimbursed them.
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We said we weren’t looking for charity, we were negotiating price and we had caught them in a bad place that they couldn’t defend in court or in public. Don’t make threats you aren’t willing to follow through on. We were. And it worked. They came back and asked for $37k.
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I presented this to my sister-in-law and suggested we split the difference. She had been afraid of being sent to collections and asked why we wouldn’t just take their counter-offer. Because, I said, that’s four thousand more dollars you’ll have that they won’t and they didn’t earn it. So we are now right in the middle and the hospital accepted. Here are the morals I draw from this experience.
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If you have the money and they want it, you have more power than you might think. An invoice isn’t an entitlement. Fight.But fight with knowledge. My $20/month subscription to Claude more than paid for itself. Yes, AI assistants can hallucinate and give you garbage. So I didn’t rely on it. I spot checked by looking up its big findings myself and found it was right. I also had ChatGPT, to which I subscribed for one month just to do this, read the letter and fact check it. No notes.
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Hospitals know they are the criminals they are and if you properly call them on it they will back down. That doesn’t mean yelling, that means writing a letter a lawyer might write, with the correct cadence and tone and threats. I’ve done a lot of this kind writing. Claude helped with facts and math, but you need to calibrate the language.
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Ultimately, my big takeaway is that individuals on self-pay shouldn’t pay any more than an insurance company would pay—and which a hospital would accept as profitable business—than the largest medical payer in the country. I had access to tools that helped me land on that number, but the moral issue is clear. Nobody should pay more out of pocket than Medicare would pay. No one.Let’s not let them get away with this anymore.
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(It’s about 12 hours after I posted this and I’m overwhelmed by the response. I’ve tried to respond to as many comments as I could, but I’ll forever be chasing and have to stop now. Americans: this doesn’t improve unless you make loud, constant, and discomforting noise to your representatives. We need a single payer health system in the U.S. Thank you all for reading this.)
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I will never understand the US health care system. This is criminal behaviour. We here in 🇨🇦 may pay higher taxes, but we more than get it back in minimal medical bills.My mom was in hospital with a broken hip this summer for 3 weeks, requiring surgery and blood transfusions + 3 weeks then in rehab, and our only expense was parking.I'm not saying this to be superior, but to rather empathise that what you deal with is completely insane.
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Even $37k seems WAY too much for four hours in the hospital. But then again I live in a civilized country
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When my son passed away, the hospital sent me a bill for $73k then separate bills for each doctor that seen him. He was at the hospital for 3 hours before he passed. I politely told them “he has no estate he was only 19, his insurance policy was a rider on my policy, get it back by suing him” they zeroed it out and sent it to collection in his name. These hospitals are out of control
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For anyone in the UK who is starting to believe the lie that the NHS should shift to an insurance based service, read this whole thread and then think again - THIS is what happens when insurers hold the cheque book and also have the power to decide which treatments you'll receive. It also highlights what happens when a provider EXPECTS the insurers loss adjusters to reduce the bill so load it up in advance.
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All I read was a US hospital tried to charge a dead man nearly $200k…to die…and that is about the most fucked up thing I can imagine.
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I’m sorry for your loss. But why are you worried about a hospital bill? The hospital is billing your brother your brother is now in heaven. The hospital can’t be billing. Anybody else nor collect from anybody else
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