Huge US medical bill

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Hi
On a visit to the US earlier this year, my wife became unwell. She guessed it was probably a urinary infection that could be cleared by antibiotics. We asked at a pharmacy but they couldn’t sell us anything or advise us where to go. Since we were near the Vermont University Medical Centre, we thought it was worth seeing if it was possible to buy some antibiotics there to knock it on the head.
We were directed to the reception where my wife explained the problem and was made to follow a procedure of waiting, seeing a clerical person to declare weight, height, etc, being asked to put on a gown and lie down in a consulting room, seeing a doctor, seeing someone else about giving more admin details, seeing a nurse with tablets, and then getting a prescription for antibiotics. She asked several times how much this was going to cost, but no one would give any indication at all. Nor did anyone there suggest an alternative place to go. We were relieved to be charged only $5 for the prescription and the tablets cleared up the problem. However, several weeks later we were horrified to receive a bill from the hospital for $896.97 for hospital services and $416 for physician services – totalling $1,312.97. We would never have agreed to see a doctor at the hospital if we had known the cost.
We have two questions:
1) Our insurers have refused to pay the amount, saying that it is a pre-existing condition and should have been declared when taking out the insurance. However, we do not consider this a ‘condition’, rather it is something that people get sometimes, and we were able to send the insurers a note from her GP saying my wife has only had one case of confirmed urinary infection in the last year. Can we argue this any further?
2) If we are unable to get the money back from the insurers, do we have any redress from the hospital for charging an extortionate amount, having refused at the time to give any idea of the costs? Or what is the likely outcome if we simply don't pay?
«13456

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  • richardw
    richardw Posts: 19,458 Forumite
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    Try and find out if there's a protocol they should've adhered to and they broke their own rules or similar.
    Posts are not advice and must not be relied upon.
  • agrinnall
    agrinnall Posts: 23,344 Forumite
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    I don't think by US standards that is anywhere near a 'huge' bill, it might seem a lot to us but it's peanuts by American standards.

    Anyway, I'm rather surprised that they agreed to see and treat you without first checking your insurance. Did you sign anything while you were there to say that you agreed to pay whatever charges were levied?
  • PeacefulWaters
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    That's a bargain!

    Ring them. Tell them you're uninsured and ask if there's any form of discount.

    Previous threads have suggested 40% off.
  • heatherw_01
    heatherw_01 Posts: 6,554 Ambassador
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    That is really a good price, we had to go to a doctor in the USA once and the bill was over $10k
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  • sheramber
    sheramber Posts: 19,131 Forumite
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    What question did the insurance company ask about visits to GP in the last ? years?
    Ours was any visits in the last 2 years.
  • dj1471
    dj1471 Posts: 1,968 Forumite
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    Why did they view it as a pre-existing condition? Did it happen very close to the start of the holiday, for example? They will probably still refuse to pay as you didn't contact them prior to seeking treatment.

    The first step is to ask the hospital to demonstrate that you agreed to pay the amount they are asking for.
  • boliston
    boliston Posts: 3,012 Forumite
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    "She asked several times how much this was going to cost, but no one would give any indication at all" - this sounds a bit odd as normally contract law involves "offer and acceptance" which seems somewhat lacking here.
  • sillygoose
    sillygoose Posts: 4,794 Forumite
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    How can an infection be a pre-existing condition if she was well before she took the policy and travelled?

    If she had one before and it was treated and fully cured then she had no 'condition' to declare.

    Ludicrous.
    European for 3 weeks in August, the rest of the year only British and proud.
  • martindow
    martindow Posts: 10,218 Forumite
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    Unless there is a history of UTIs it can't really be a pre-existing condition.

    Is the problem that you didn't consult the insurance company before seeking treatment? Maybe their t&cs require you to consult them first in a non-emergency situation such as this.
  • MiraculousM
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    agrinnall wrote: »
    I don't think by US standards that is anywhere near a 'huge' bill, it might seem a lot to us but it's peanuts by American standards.

    Anyway, I'm rather surprised that they agreed to see and treat you without first checking your insurance. Did you sign anything while you were there to say that you agreed to pay whatever charges were levied?

    This is not uncommon at hospitals in the US when you go into the Emergency room. I found this out when i went when i needed antibiotics for the flu but when they said i would have to wait till the end to find out if my travel insurance covered it. I said this was not acceptable and discharged myself before they could charge me with anything, waited until the next day and phone my insurance who directed me to an urgent care centre who they recognise. Unfortunately i went 3 days without because i thought it would clear up till i went down this route.
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