Yes You Can!

It does look like not all hospitals run financial scam schemes:

The Surgery Center of Oklahoma is a 32,535 square foot, state-of-the-art multispecialty facility in Oklahoma City, owned and operated by approximately 40 of the top surgeons and anesthesiologists in central Oklahoma. 

If you have a high deductible or are part of a self-insured plan at a large company, you owe it to yourself or your business to take a look at our facility and pricing which is listed on this site. If you are considering a trip to a foreign country to have your surgery, you should look here first. Finally, if you have no insurance at all, this facility will provide quality and pricing that we believe are unmatched.

Don't tell me your prices cannot be disclosed until after you done procedure. The Surgery Center of Oklahoma does it, why can't you?

Counter Offer

Despite sending a request to the finance lady in hospital two weeks ago, I keep receiving "Balance Due Notice" from hospital. This is really dumb and irritating. It is one of those "F*ck you, we are big, you are small, we will keep sending you mail until you go tired" things, and I would imagine it does wear down a person who is not determined.

And with all of that, real problems were never addressed. I never got an answer, how do they determine the price.

It is pretty clear to me why: while digging up information on the hospital practices, I found a fascinating website by an actual medical doctor David Belk - "The True Cost Of Healthcare". It make a lot of things clear to me, such as: how such ridiculous charges possibly appear on a medical bill. Nobody wants to discuss that subject, this amounts to confessing in being part of a giant fraud scheme.

At any rate, I am about to try another strategy. I will ballpark, how much could the service reasonably cost, and offer that amount.

Here's my letter:


Dear Ms ********:

This is a notice, that I have not received a reply for my communication dated April 17, 2012. In that communication, I asked you to clarify following questions:

1. You wrote "During emergency visits, we are unable to anticipate the cost of providing care in advance". Were you trying to say that the services had to be provided so fast, and the situation was so volatile, that you did not have a chance to communicate the pricing information? Or, are you saying that it is your policy to withhold pricing information from anyone visiting your emergency room? 

2. Yes or no: do you interpret the finance agreement, as an authorization to bill me any amount, without limit, and amount is solely at your discretion?

I wanted to let you know, that despite my efforts to resolve that dispute, I have received a "Balance Due Notice" (attached). This was done despite my written statement, in which I clearly stated, that I am disputing amount owed (attached). I consider this a harassment. The notice does not address the matter of dispute, and only serves the purpose of undue pressure on me.


As a sign of good faith, I am offering to settle a dispute for $700 payable by check immediately on your confirmation. This amount offered is to cover my obligations, retaled to the ER visit on 2/27/2012, in full.

According to my research, a way of settling a dispute, would be to send a check with a "payment in full' note on it, but apparently, this technique may not be valid anymore.

Paper exchange, part 2

Got answer:

Dear Mr. *************

In response to your email date April 7, 2012, please see the attached statement for your review (a hard copy of this letter and statement was mailed to you today). We have previously provided you with the UB04, itemized statement, and Conditions of Admission.

During emergency visits, we are unable to anticipate the cost of providing care in advance. Please contact me at ****  or **************** if you believe that you will need assistance in paying your bill, as we have many ways to our patients through our Payment Assistance Program.

It is our pleasure to assist you and thank you for choosing ********** Medical Center for your healthcare needs. 

As a reminder, I asked her two simple questions:

1) Why didn't they tell me how much procedures cost?
2) Is she considering the "financial agreement" a blank check?

She gave a non-responsive answer on question #1, because "Emergency Visit" is a word game. What it looks like she is saying is: "it was an emergency situation, we had to move so fast, we simply didn't have time to tell you about cost". But she does not say this, because it is plain not true. We sat in different holding areas for hours, there was plenty of time to get me informed. So, what that really means is "we are not going to tell you when you come to ER". There is no excuse for latter, unless you wrap it into right wording.

She also completely skipped question #2, and here's why: if she says that they are only charging reasonable prices for their services, she will have to lower down their demands to a reasonable level. If she says, no, there is no limit, that would be insane, she essentially renders the contract void.

So, all I need at this time is to ask for clarification, and not accept non-responsive answer. Here's my reply:

Dear Ms ***:

This is in response to your electronic letter from 16 Apr 2012.

1. Your reply is not clear to me. You wrote "During emergency visits, we are unable to anticipate the cost of providing care in advance". Were you trying to say that the services had to be provided so fast, and the situation was so volatile, that you did not have a chance to communicate the pricing information? Or, are you saying that it is your policy to withhold pricing information from anyone visiting your emergency room?

2. Please, answer the following question, yes or no: do you interpret the finance agreement, as an authorization to bill me any amount, without limit, and amount is solely at your discretion?

Paper Exchange

I got the letter from hospital in response to a template from hospitalvictims.com, which said:

Here was my reply:

Dear Ms ********: 

This is in response to your letter from March 28, 2012. 

I received a document package based on which you allege that I owe you $1189.40. Please answer the following question for me, so that I better understand your grounds: 

The financial agreement does not have any details on the amount I will be liable for. Have you communicated to me the amount of future liability, I was allegedly accepting, and if yes, in what form? Please, attach the evidence that I was aware of bill amount.

As you see, I am trying to stay away from  any statements here. I am simply asking hospital, if they told me the bill amount before they go on.

Here was a reply:

Dear Mr. *******: 

When your son presented to our Emergency Room a “Conditions of Admission” form was signed by you. Our Conditions of Admission form explains that we will bill the patient's insurance and then bill the patient for co-payments, co-insurance and deductibles designated by your insurance company. Your insurance company should have sent you an Explanation of Benefit (EOB) explaining the amount you owe to the hospital and why. If you did not receive an EOB from your insurance company for your son?s visit to our Emergency Room, please contact your insurance company to obtain a copy.

She obviously never answered why did they not explain me how much their service costs. Instead, she referenced some financial agreement. Now that I'm not under stress of potentially dying child, I could re-read the agreement. Here's the item she references:

I think I might be starting to understand something here. The excuse (because it's clearly not a reason) for being so cryptic about their price structure comes courtesy of insurance paying part of the bill. That certainly could not have prevented them from telling me the amount that procedures cost.

That would have been a valid agreement, should there have been a good faith to disclose me amounts that they charge. "Here is what we will be billing you for. You also will have those external vendors billing you directly approximately for this amount, and here's why". This never happened. The whole "financial agreement" is bogus, because it was never their intention to get me to agree to certain conditions.
There was no meeting of the minds. It was just a way for them to make me sign them a blank check.

Here's what I replied:

Dear Ms ***************: 

This is in response to your electronic letter from 06 Apr 2012. 

1. Your letter does not answer my question: 

The financial agreement does not have any details on the amount I will be liable for. Have you communicated to me the amount of future liability, I was allegedly accepting, and if yes, in what form? Please, attach the evidence that I was aware of bill amount.

Since you considered me a financially responsible person, and if you were acting in a good faith, it would be customary for you to disclose the cost of procedures to me, prior to administering. If disclosure did not happen, what prevented you from giving it to me? 

2. Do you interpret the finance agreement, as an authorization to bill me any amount, without limit, and amount is solely at your discretion? 

3. Your electronic mail says: "this email is both proprietary and confidential, and not intended for transmission to or receipt by any unauthorized persons". For your information, I do not agree to be bound by that condition, moreover it is my intention to publish this case in details.

I has been a week, and I have got no reply. I would assume the letter got lost in the email, and I will re-send it another time, just to cover my ass, in case they will claim the email got "lost". There is a high chance I will never hear from them again.

Paper Wars

I am getting ready to be involved in some major paper-pushing. There is a lot of material on the internet, how to be dealing with bureaucrats, but this case is different. Usually, it is you who wants something from bureaucrat. This time, they want something from me. Another thing to consider here, is that even though their system is heavily embedded in government, they are not cops, so they can not bust into your house if you have not promptly paid them, so that really limits amount of damage they can do.

So, the rules, I've laid out for myself would be:

1. Be courteous and professional. No rudeness, rants, or insults
2. Do not talk too much. Any extra word will give them ammo, especially if this word could be potentially misinterpreted. This applies to both written word, and the one you say over the phone, since all calls are recorded.
3. Stick to the facts. Facts are: they entrap people by obfuscating their processes, grossly overcharge, and provide extra expensive services which could be avoided.
4. Ask questions, do not make statements. Have them make statements, and then demonstrate that they are invalid. They have the burden to prove you owe them, you don't have to prove anything.
5. Do not agree to be bound by any conditions, especially non-disclosure. The sole reason they could get away with that, is people avoid speaking about it. People going public is their greatest threat.

What else can we bill for?

Got a phone call, this time a lady from some satellite radiology place. She called with regards to the CT scan, which was already in another bill. I told her, I have already billed for that and it's being disputed. She said, this is not for CT scan. This is for READING CT scan.

Well, I was not about to go argue with her, and told her to send me an explanation in writing, what they did and what the bill is for. She said, they will not do it. I said, you will not explain in writing, I will not pay. So, she said "I will put a note on your account" and that's how our friendly chat ended.

Unfortunately I was driving and my call recorder was off, I should have pulled over and turned it on.

Anyway, this certainly deserves a million dollar letter

Tap your phone

If it is an option on your phone, make sure you have a call recording software installed. Some phones have add-ons, which will record calls automatically. If you get called from hospital (or by collector), it is important to hold on to the call recording so that you can recall what exactly you and they said, and to make sure your words are not misrepresented.

WARNING: in some states it is illegal to record calls without consent of both parties. If you are in one of these states, you can get in ridiculous amount of trouble for automatically recording calls. Something insane, like 10 years in jail, people get less for manslaughter. If you are in one of those states, make sure you don't get in trouble. You can still record call, but you should mention to the other party, that call is being recorded.