Health fund Resonable Charges : LUSENET : craft discussion group : One Thread

My question is to Dennis P. or Greg S.I have hospital charges that were above and beyond reasonable charges ,so I ask the hospital to reduces these charges.The hospital called the health fund to help deal with matter.The health fund explained the system to them about how they are a average charge across the state for the same size hospitals.The hospital is small rural hospital and tells me they are not over charging me for a hospital in a rural setting and I should take it to the board of directors.I did and the health fund turned down my request to reduce these charges. My question is how come I always feel discriminated against everytime I use a smaller hospital and end paying more money out of pocket then other members? thank you Dennis Rhinehart

-- Dennis Rhinehart (, December 05, 2000


12/11/00 I consider it good manners to answer promptly, however, I have referred this question to the health fund administrator and will post his response when I recieve it. - regards, rocky

-- John Rockefeller (, December 11, 2000.

The following text was contributed by Jack Thurston who works with the fund in question...

'The issue of smaller hospitals charging higher amounts than is usual and customary has troubled the Wisconsin Carpenters Health Fund for some time. I think the best way to explain why this happens is with an anology as follows:

Consider the person who, on their way home from work, stops at the gas station convenience store and buys goceries for the evening meal. I'm sure that everyone knows that the cost of those items purchased from the convenience store would be far higher than had the individual driven out of their way to a large grocery store and purchased the items there. The reason for the difference in pricing between the small hospital and the large hospital is the same as that for the small convenience store vs. a large grocery store. The larger hospital delivers far larger volumes of services than does the small hospital, and on that basis can afford to do so at much lower prices.

Possible Remedies:

1. Obviously you would have the option to use the larger hospital whose charges will normally be very close to usual and customary.

2. If the required services are not on an emergency basis, you would have the option of calling the Fund Office and finding out what the usual and customary charges are for the service you intend to have performed, and then negotiate with the smaller hospital to have the services performed at that rate.

Please call the fund office directly at 800-472-7368 and talk to the Claims Representative responsible for your claims if you have any questions regarding this issue or any claims submitted to the Wisconsin Carpenters Health Fund.' - Jack Thurston (1-4-01)

-- John Rockefeller (, January 04, 2001.

I am in total sympathy with this member having recently been raked by an office which treated my wife. Here's where I goofed up. I ASSumed this creep charged usual & customary due to affiliation with a major medical center. I should have asked! I thought the bills would never stop. Believe me I will certainly ask next time and the answer had better be right before they slip that 'You owe me your soul' disclaimer they have you sign which makes you promise to pay anything not covered by insurance. Join me in making life harder for scammers who milk the system and us by overcharging, they threaten the existence of our health fund. - Rocky

-- John Rockefeller (, January 04, 2001.

Moderation questions? read the FAQ