Randy Henderson said he’ had never broken a bone or spent a night in the hospital before he crashed his bicycle into a bridge in December 2019.
Henderson, the former mayor of Fort Myers, spent three nights in the hospital with a cracked rib and a collapsed lung. He agreed to let WINK News look at his medical bills from the accident.
The bills actually have three prices: A charge price: $26,599; the price paid by insurance after its contracted adjustment: $14,674.22; and the out-of-pocket price for Henderson: $2,771.40
“This exercise shows and demonstrates that people tend to look and say I had an accident It cost me this, you don’t even see the other side of it,” he said.
But Henderson’s accident could have cost him up to $5,000, which is the out-of-pocket maximum on his insurance plan.
Tiffany Drake, a medical billing director at a Fort Myers orthopedic practice, said understanding your insurance policy and your out-of-pocket obligations is the best way to predict what you may have to pay in a medical emergency.
“It’s gotten so complicated, even we have a hard time keeping up,” said Drake.
She explained that medical provider’s charge prices are just a benchmark, the rate that is actually paid is based on the contracted rate with the patient’s insurance company. That’s why Henderson’s charges were more than $26,000 but the hospital was only paid around $16,000.
She said if you have an out-of-pocket maximum on your policy, that is the maximum you will pay for all of your medical services combined in a calendar year.
The other number on your policy that is important is your annual deductible. The deductible is the amount of money you have to pay upfront before the insurance company will pay any amount towards your costs. After your deductible is met, the insurance company does not always pay the full charge. You may have coinsurance until you hit the out-of-pocket maximum.
“You have to advocate for yourself because most of the time people aren’t advocating for you. You have to do your own research and ask your own questions,” Drake said.
If you aren’t insured, there’s really no way to predict your out-of-pocket cost for a medical emergency but you can apply for financial assistance to help pay for those bills.