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(Minnesota Public Radio)   Need your car repaired? Get an estimate. Need your roof replaced? Get an estimate. Need your hip replaced? Good luck getting an estimate...or even a ballpark figure   (minnesota.publicradio.org) divider line 31
    More: Fail, car repairs, good lucks, ballpark estimate, American Hospital Association, Chicago Board of Trade, Loyola University Medical Center  
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3845 clicks; posted to Main » on 12 Feb 2013 at 10:48 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-02-12 10:07:38 AM
If it happens while I'm at my current state of employment, I know exactly what I will pay.
 
2013-02-12 10:51:52 AM

unlikely: If it happens while I'm at my current state of employment, I know exactly what I will pay.


Actually, I *KNOW* what I will pay, because the distaffbopper just had a total hip replacement a few months ago.
 
2013-02-12 10:55:20 AM
Reminds me of the time I had a chat with my doctor about a series of test that he kept ordering every 4 months, that cost me around $160 each time. I finally switched doctors, because he could not understand that I was willing to do that once maybe twice a year, but every 4 months was a bit much.

He was completly confused as to why I would take cost into account and not just accept his orders.
 
2013-02-12 11:01:26 AM
PPOs make this difficult; even if they did know in advance *exactly* how everything was going to be coded (and to be fair, sometimes in the OR things turn out a bit differently than what you expect), everything interacts with the facility's network contract to determine the prices, even before your deductibles/coinsurance/copays/etc.

Then what if the anesthesiologist is out of network? Or the pathology lab? Oy.

Medicare makes this somewhat easier; their reimbursement rates are public.
 
2013-02-12 11:05:35 AM
Ran into trouble with this on a (technically outpatient, even) hysterectomy 1.5 years ago.

- Hospital went out-of-network trying to squeeze the insurer for a better contract
- The hospital's estimate beforehand indicated a total bill around $5K, which was comparable to the Medicare rate, so I figured our insurer's UCR would be around there, so I gave the go-ahead
- Bill comes in for $25K
- Insurer pays $12K for reasons unknown
- After some ugly negotiations I get them to settle for $1200 more
- Anesthesiologist out of network, but their bill was "only" $700 after insurance

Moral: Never ever go out of network for hospital care, no matter how cut and dried it might seem; the balance bill (the part over insurer's UCR) will get you.
 
2013-02-12 11:07:37 AM
I'm getting bills from when I was in the hospital last month, so I have a very good idea what is charged for hospitalization, ambulance rides, blood transfusions, etc at that particular hospital. I had told my mother repeatedly that if something ever happened, to make sure I went to the Catholic hospital, because "good works" and all that, and they'll get their charity department (or whatever) to help the uninsured. She had me taken to the expensive hospital instead (I was unconscious and therefore had no say in the matter). I'm just putting the bills on her bill pile when I get them. This displeases her greatly. None of those bills are getting paid at this point as we keep ping-ponging the bills between us. She says I'm responsible for my own hospital bills and I say she's responsible for the poor choice she made in ignoring my well known wishes. In any event, if anyone ever needs to know what a blood transfusion costs, I can let you know that they're farkin' expensive.

/that better have been some rich person's blood
 
2013-02-12 11:12:28 AM
Yeah, great.

Thanks for posting this THREE DAYS before my brother goes in for a full hip replacement.
 
2013-02-12 11:27:10 AM
And we wonder why health care is so farked.  The problem isn't that the hospitals cannot provide the costs up front; the problem is that the costs their charge are completely farking arbitrary.
 
2013-02-12 11:28:25 AM

Real Women Drink Akvavit: I'm getting bills from when I was in the hospital last month, so I have a very good idea what is charged for hospitalization, ambulance rides, blood transfusions, etc at that particular hospital. I had told my mother repeatedly that if something ever happened, to make sure I went to the Catholic hospital, because "good works" and all that, and they'll get their charity department (or whatever) to help the uninsured. She had me taken to the expensive hospital instead (I was unconscious and therefore had no say in the matter). I'm just putting the bills on her bill pile when I get them. This displeases her greatly. None of those bills are getting paid at this point as we keep ping-ponging the bills between us. She says I'm responsible for my own hospital bills and I say she's responsible for the poor choice she made in ignoring my well known wishes. In any event, if anyone ever needs to know what a blood transfusion costs, I can let you know that they're farkin' expensive.

/that better have been some rich person's blood


Hah!  Joke's on you!  It was Bloodweiser from a can.
 
2013-02-12 11:30:41 AM
Two of my friends have recently had hips done.  They couldn't tell you what it was going to cost before hand.  Or afterwards either, on account of this being Canada and no money changed hands, since hips are covered.

That said, they are one of those pesky surgeries that wait times can be an issue.  I know another fella that used his consult to get one hip fixed, and then had his other one done when he was in Mexico for his annual 4 months down there.  Its surprising how well the body heals sitting in a chair on the beach drinking Pacificos.
 
2013-02-12 11:38:37 AM

StrangeQ: And we wonder why health care is so farked.  The problem isn't that the hospitals cannot provide the costs up front; the problem is that the costs their they charge are completely farking arbitrary.


/fark
 
2013-02-12 12:01:31 PM
this will be a TL;DR...

I've worked for several health insurance companies and helped create "fee schedules"; these are what the insurance company thinks are a reasonable price to pay. They were based on the RBRVS (revenue based relative value system) developed by Medicare and some smart guys at Harvard.

The idea is that you create a number value for any health care procedure based on length of time said procedure takes, doc's training costs, doc's overhead, materiel costs and a risk factor for possible malpractice. This value is then multiplied by a dollar conversion factor to arrive at the reasonable price the insurer is willing to pay.

If only it worked out as simple as it sounds, Medicare lets the diffferent types of docs have a lot of input into the number values; Psych folks were always the most vocal and this is reflected in what they get paid.

Anyway, if the government forced the insurers and the medical provider to follow RBRVS in it's original intent and forced publication of the fee schedules, you'd have a much more fair system for the consumers of medical care.
 
2013-02-12 12:03:31 PM

StrangeQ: And we wonder why health care is so farked.  The problem isn't that the hospitals cannot provide the costs up front; the problem is that the costs their charge are completely farking arbitrary.


The AMA, which has a monopoly on medicine in America, will not allow doctors/hospitals to advertise prices at the risk of losing their licenses.  When is the last time you heard a hospital having a sale on appendectomies?
 
2013-02-12 12:23:43 PM
images4.wikia.nocookie.net

Need your car repaired? fark you, pay me.
Need your roof replaced? fark you, pay me.
Need your hip replaced? fark you, pay me.
 
2013-02-12 12:34:56 PM
Newsflash: working with living tissue is less predictable than working with things.  And you're going to pay for the hip surgery either way.
 
2013-02-12 12:36:23 PM

Real Women Drink Akvavit: I'm getting bills from when I was in the hospital last month, so I have a very good idea what is charged for hospitalization, ambulance rides, blood transfusions, etc at that particular hospital. I had told my mother repeatedly that if something ever happened, to make sure I went to the Catholic hospital, because "good works" and all that, and they'll get their charity department (or whatever) to help the uninsured. She had me taken to the expensive hospital instead (I was unconscious and therefore had no say in the matter). I'm just putting the bills on her bill pile when I get them. This displeases her greatly. None of those bills are getting paid at this point as we keep ping-ponging the bills between us. She says I'm responsible for my own hospital bills and I say she's responsible for the poor choice she made in ignoring my well known wishes. In any event, if anyone ever needs to know what a blood transfusion costs, I can let you know that they're farkin' expensive.

/that better have been some rich person's blood


You should have gotten your deal in writing.  Your mom is not the one who is going to be sent to collections.

/and aren't you an adult?
 
2013-02-12 01:37:42 PM

priapic_abandon: Anyway, if the government forced the insurers and the medical provider to follow RBRVS in it's original intent and forced publication of the fee schedules, you'd have a much more fair system for the consumers of medical care.


Some places have that, the literature calls it "all-payer fee setting". The insurers (including government) all get together, come up with a fee schedule, and that's what's charged to anyone, insured or not.

Or single-payer can do that trivially (if everyone's on Medicare, the Medicare price is what everyone pays).
 
2013-02-12 02:12:29 PM
The nice thing about insurance is that providers have a contracted price for services.  I often see a billed amount of $800 for something or other, and a payment from the insurance company for $200.  If individuals could get the same price for services as insurance companies are able to negotiate, then it wouldn't be so terrible to deal with being uninsured and having to go to the doctor.
 
2013-02-12 02:21:52 PM

The My Little Pony Killer: Real Women Drink Akvavit: I'm getting bills from when I was in the hospital last month, so I have a very good idea what is charged for hospitalization, ambulance rides, blood transfusions, etc at that particular hospital. I had told my mother repeatedly that if something ever happened, to make sure I went to the Catholic hospital, because "good works" and all that, and they'll get their charity department (or whatever) to help the uninsured. She had me taken to the expensive hospital instead (I was unconscious and therefore had no say in the matter). I'm just putting the bills on her bill pile when I get them. This displeases her greatly. None of those bills are getting paid at this point as we keep ping-ponging the bills between us. She says I'm responsible for my own hospital bills and I say she's responsible for the poor choice she made in ignoring my well known wishes. In any event, if anyone ever needs to know what a blood transfusion costs, I can let you know that they're farkin' expensive.

/that better have been some rich person's blood

You should have gotten your deal in writing.  Your mom is not the one who is going to be sent to collections.

/and aren't you an adult?


Yup. I'm in my 40's. However, my mother and I are the primary caregivers for my grandmother with my sister and adult son as our backups. There are only five us in my family that live in the US, and we all gave up our own places to move in together and take care of grandma. The good part of this is my grandma is taken care of much better than she would have been if she'd stayed in Norway, because instead of being dumped in a home by my very unpleasant uncle, she's got the good bits of her family to care for her. The bad part of this is that someone will feel the need to get in your business from time to time, and this includes disregarding your express wishes when it comes to medical care.

I'm going through the process of getting some sort of financial aid from the hospital itself under their "medically indigent" program, but I am still on the hook for the doctor for the full amount no matter what, apparently (so far as I know right now, anyway). When a friend and his wife show up for coffee and nibbles in a few days, I'll ask her about the doctor and how negotiable they tend to be or even if she knows him. He may have hospital privileges in more than one place and she works at yet another area hospital, so she's usually a good source of info. I just don't feel comfortable enough just calling her and asking her about it, because her hubby is an old friend, she's more of an acquaintance, so I invited them over for coffee, nibbles, maybe a couple board games knowing they ask about my hospitalization and I can segue into the whole "oh, hey, btw, do you know this doctor?" thing without feeling like I'm taking advantage.

My mom and I both know I will eventually pay the bills, even if I have to make a payment plan with multiple people. Right now I'm really just showing my mother my extreme displeasure at having my medical wishes discarded so easily. I'm actually going to look into some of those "end of life" legal documents when I'm feeling a bit better, just so I don't end up as the next Schiavo. This little medical adventure taught me that just talking to my family about such things, repeatedly even, is not enough - especially if they're going to disregard something as simple as "this is my preferred hospital, not to mention the one closest to our house".

/another advantage to multi-generational households is my expenses are less than 1/3 what they were before and I have personal space and plenty of wandering about/gardening space in a much better neighborhood. AWESOME!
 
2013-02-12 02:28:44 PM
Change the law so that only HSA based insurance is tax deductible and 75% of the US's health care problems will solve themselves.
 
2013-02-12 02:28:49 PM

GORDON: StrangeQ: And we wonder why health care is so farked.  The problem isn't that the hospitals cannot provide the costs up front; the problem is that the costs their charge are completely farking arbitrary.

The AMA, which has a monopoly on medicine in America, will not allow doctors/hospitals to advertise prices at the risk of losing their licenses.  When is the last time you heard a hospital having a sale on appendectomies?


The AMA owns the rights to the ICD and CPT coding systems, but has no sway over pricing.

The AMA cannot threaten to revoke the licenses of doctors and hospitals, because they have nothing to do with professional and facility licensure, which is run by state governments.

Hospitals do not offer sales, because for the most part it is not *you* who is paying the lion's share of the bill, it is your health insurance carrier.  In a way, you are not actually a customer - you are merely a revenue source.
 
2013-02-12 03:19:34 PM

Real Women Drink Akvavit: The My Little Pony Killer: Real Women Drink Akvavit: I'm getting bills from when I was in the hospital last month, so I have a very good idea what is charged for hospitalization, ambulance rides, blood transfusions, etc at that particular hospital. I had told my mother repeatedly that if something ever happened, to make sure I went to the Catholic hospital, because "good works" and all that, and they'll get their charity department (or whatever) to help the uninsured. She had me taken to the expensive hospital instead (I was unconscious and therefore had no say in the matter). I'm just putting the bills on her bill pile when I get them. This displeases her greatly. None of those bills are getting paid at this point as we keep ping-ponging the bills between us. She says I'm responsible for my own hospital bills and I say she's responsible for the poor choice she made in ignoring my well known wishes. In any event, if anyone ever needs to know what a blood transfusion costs, I can let you know that they're farkin' expensive.

/that better have been some rich person's blood

You should have gotten your deal in writing.  Your mom is not the one who is going to be sent to collections.

/and aren't you an adult?

Yup. I'm in my 40's. However, my mother and I are the primary caregivers for my grandmother with my sister and adult son as our backups. There are only five us in my family that live in the US, and we all gave up our own places to move in together and take care of grandma. The good part of this is my grandma is taken care of much better than she would have been if she'd stayed in Norway, because instead of being dumped in a home by my very unpleasant uncle, she's got the good bits of her family to care for her. The bad part of this is that someone will feel the need to get in your business from time to time, and this includes disregarding your express wishes when it comes to medical care.

I'm going through the process of getting some sort o ...


As someone who has been dealing with some high (but not obscene) medical bills for the last year, my advice is stall, stall, stall.  Ask for an itemized hospital bill.  When they send the next bill the next month, say you didn't get the itemized bill and ask if they could kindly send it again.  If anything at all looks incorrect or you have any suspicions about any particular line items, send them a letter with cc to your insurance company (if you have one) asking to be explained the charges.  Usually their explanation is not very good so you can keep that line of stalling going for months.  Then when they resolve some line item to your satisfaction, question another one.  Do all correspondence by USPS so it takes forever for correspondence to go back and forth.

If they have spelled your name wrong, send them a letter that nobody of that name lives at your address (This happened to me and caused the hospital all sorts of confusion).  If they are ready to send you to collections they will let you know very clearly.  Keep it polite but play dumb and keep stalling.  If your bill is big (and it sounds like it is) there are probably plenty of line items to ask for clarification on, explanations for, etc.  Eventually they might get tired of dealing with you and reduce the bill.  In the meantime you can save some money to pay them, if you are planning to do so.


I successfully stalled for over a year on my son's delivery bills with no consequence. One of the providers got sick of dealing with me over a relatively small bill and just gave up with no collections process.  The other agreed to a payment plan with very generous terms that were not available when I started toying with them.  It was well worth the $20 or so in postage that it took.
 
2013-02-12 03:36:49 PM

pdee: Change the law so that only HSA based insurance is tax deductible and 75% of the US's health care problems will solve themselves.


By cranking up the cost sharing? The research on that shows it just leads to a blunt decrease in utilization, without regard to the necessity or usefulness of the foregone treatments.

If a pure indiscriminate drop in utilization is what you want, that's all well and good, but that can't really be said to make the health care system "better" in any sense.
 
2013-02-12 04:31:54 PM

dj245: As someone who has been dealing with some high (but not obscene) medical bills for the last year, my advice is stall, stall, stall.  Ask for an itemized hospital bill.  When they send the next bill the next month, say you didn't get the itemized bill and ask if they could kindly send it again.  If anything at all looks incorrect or you have any suspicions about any particular line items, send them a letter with cc to your insurance company (if you have one) asking to be explained the charges.  Usually their explanation is not very good so you can keep that line of stalling going for months.  Then when they resolve some line item to your satisfaction, question another one.  Do all correspondence by USPS so it takes forever for correspondence to go back and forth.

If they have spelled your name wrong, send them a letter that nobody of that name lives at your address (This happened to me and caused the hospital all sorts of confusion).  If they are ready to send you to collections they will let you know very clearly.  Keep it polite but play dumb and keep stalling.  If your bill is big (and it sounds like it is) there are probably plenty of line items to ask for clarification on, explanations for, etc.  Eventually they might get tired of dealing with you and reduce the bill.  In the meantime you can save some money to pay them, if you are planning to do so.


I successfully stalled for over a year on my son's delivery bills with no consequence. One of the providers got sick of dealing with me over a relatively small bill and just gave up with no collections process.  The other agreed to a payment plan with very generous terms that were not available when I started toying with them.  It was well worth the $20 or so in postage that it took.


Thanks for the tip! I don't have insurance, and to make matters even worse, the restaurant I worked in for nearly a decade closed when the absentee owner realized he'd not get rich as he wanted with it, so I am currently unemployed. My sister worked at the same restaurant (she was lead waitstaff and I was chef de cuisine), but I saved money, she did not. I'm carrying us both as far as expenses go right now, but seeing my bank statements (which is one of the things the hospital financial/charity department people wanted to see) seems to have made the situation somewhat worse because of those savings. They've pointed out that I have the money to make a significant down payment, I've pointed out I'm supporting myself and one other person with no job and no immediate prospects at this time. We're at a bit of a standoff right now, and if I start questioning charges, one by one, by the time they get really upset, my savings may have dwindled to the point that I will "qualify" for the help and some sort of payment plan deal similar to what you got.

I do think everyone deserves to be paid for their work and paid a fair wage, so the bills will be paid, it just may take a while. Stalling is most likely my best option. I didn't even think of that tactic, but then again, I am on a lot of medication right now. lol!

Thanks for giving me a new plan! I'll have to send off a politely typed letter asking for a fully itemized bill in tomorrow's mail run. I got some stuff listed separately as apparently blood, lab work done in hospital (they got subcontractors back there or something?) and a few other things are itemized, but the rest is very vague and obviously it is not a fully itemized bill. One at a time, though, just like you said. I hope it works as well for me as it did for you.
/first question after I get the fully itemized bill would be why I required 8 bags of blood
//then I can ask for all lab results
///and question those in relation to my treatment, one at a time...
 
2013-02-12 06:32:19 PM
Yet we're told to "shop around" in order to save money.

Hospitals just do not have price lists.

I worked in a Hospital Lab for decades.  I have no idea of what we charged for our services.
 
2013-02-13 12:46:37 AM
The problem is not so much the doctor or the hospitals as it is the insurance companies playing both sides of the equation. They charge the provider for the "risk" involved in the aspirin provided to the patient and then  demand a discount for that same "overpriced" aspirin. When you extend this to every service provided by a doctor and all the overhead of a hospital it really adds up, and somebody (you) has to replace all those dollars (pay) sent off to the insurance companies.
 
2013-02-13 01:38:28 AM
FTA: A proposed federal measure that would have required states to force hospitals to make their charges public failed to advance in Congress last year but could be revived this year, the editorial says.

That would be really nice to see pass. If we're stuck in a society built on the all-important capitalism, then let's see some competition.
 
2013-02-13 02:27:44 AM
I had mine done at George Washington in DC.  It cost 57,000 of which 6,700 went to the surgeon and his team.  The 4 days in the hospital ate up the rest.  The quality of the operation was exceptional.
 
2013-02-13 06:11:47 AM
Try this:   http://www.fairhealth.org/, but insert the word consumer after the word health.  Link seems farked just now but it was working fine a week ago.  Gives estimates of what is "fair" (which is a lot higher than medicare rates) for doctors and dentists, adjusted by location and billing code in the US.  If it's not a complete emergency, ask for the billing codes in advance.

I've never even thought of negotiating with a dentist, but I'm going to start from now on. I don't know of any who accept insurance, so they are incredibly unregulated.  My quite expensive dentist referred me to a guy for an implant a while back, and implant guy gave me an estimate of $2500.  While he was in the middle of surgery, and I was unable, obviously, to discuss it with him, he mentioned, oh, I'm trying to save as much bone material here as I can, but I might need to add - I don't remember the exact term - some bone material from a bone bank.  Two hours later, as I left, his secretary asked for my credit card.  I'd already paid in full, but he'd added $1500 for using material from a bone bank.  For all I know, he didn't add any.  Also, if he did, I might be wandering around with Alistair Cooke's cancerous bone stuff.   http://news.bbc.co.uk/2/hi/americas/4552742.stm

So that's not happening to me again.

My quite expensive dentist  just told me that I have two adjacent root canals where I keep getting flare-ups, and neither he nor the root canal specialist can figure out which tooth is the culprit.

I really don't see how Mexico can do any worse.  I've decided to become a medical tourist.
 
2013-02-13 08:13:16 AM
I can explain part of what the huge variation in pricing from hospital to hospital results from.  Per Medicare regulation, a hospital has to charge the same amount for a given item/service to every patient; insurance discounts come into play after this initial pricing.  A large part of the variation then comes in based on the hospital's 'payer mix'.  This term is just a way of expressing in a few words the fact that some hospitals are located in areas where most patients have a commercial medical insurance, while other hospitals are located in areas where large numbers of the patients are Medicare or Medicaid insured.

Anyone who's worked in hospital billing knows that Medicare and Medicaid reimbursement rates are fixed, and that they often cover only the direct costs of a given service, if even that.  In other words, if Medicare is charged for an x-ray, their payment will maybe cover the cost of running the machine, but not the cost of having to replace the machine in a given number or years, or the cost of maintaining a Medicare-required medical records system, or the cost of maintaining a clean environment, or any of the other ancillary and administrative costs involved in providing medical care.  Because they don't cover those other costs, the hospitals then have to prorate every service they provide to every patient to cover those costs X times over, to make up for the times its not covered by the government payers.

Ultimately, this means that the charges you have to pay at any given medical provider includes not just the cost of your own procedures and care, but the costs involved in the care of other patients whose medical coverage doesn't actually pay for all the costs actually related to their care.  This could be patients who have coverage through a government payer, patients with a commercial insurance that has negotiated an *extremely* favorable (for the insurance company) contract, or patients who are uninsured and financially unable to pay for services.

Also, bear in mind that this is on top of the fact that no one can tell exactly how a given surgery will play out, especially if the facility in question does not have access to a patient's medical records.

/  tl; dr
//  Short version - hospitals charge you for the people who can't pay
///  Charity is a business expense
 
2013-02-13 07:07:59 PM

Real Women Drink Akvavit: dj245: As someone who has been dealing with some high (but not obscene) medical bills for the last year, my advice is stall, stall, stall.  Ask for an itemized hospital bill.  When they send the next bill the next month, say you didn't get the itemized bill and ask if they could kindly send it again.  If anything at all looks incorrect or you have any suspicions about any particular line items, send them a letter with cc to your insurance company (if you have one) asking to be explained the charges.  Usually their explanation is not very good so you can keep that line of stalling going for months.  Then when they resolve some line item to your satisfaction, question another one.  Do all correspondence by USPS so it takes forever for correspondence to go back and forth.

If they have spelled your name wrong, send them a letter that nobody of that name lives at your address (This happened to me and caused the hospital all sorts of confusion).  If they are ready to send you to collections they will let you know very clearly.  Keep it polite but play dumb and keep stalling.  If your bill is big (and it sounds like it is) there are probably plenty of line items to ask for clarification on, explanations for, etc.  Eventually they might get tired of dealing with you and reduce the bill.  In the meantime you can save some money to pay them, if you are planning to do so.


I successfully stalled for over a year on my son's delivery bills with no consequence. One of the providers got sick of dealing with me over a relatively small bill and just gave up with no collections process.  The other agreed to a payment plan with very generous terms that were not available when I started toying with them.  It was well worth the $20 or so in postage that it took.

Thanks for the tip! I don't have insurance, and to make matters even worse, the restaurant I worked in for nearly a decade closed when the absentee owner realized he'd not get rich as he wanted with it, so I am currently ...


Thread is dead but maybe somebody will see this-

"I do think everyone deserves to be paid for their work and paid a fair wage, so the bills will be paid, it just may take a while. "

They're going to get paid.  The fact is, hospitals charge 3x what non-hospitals charge for the same services, because they have to cover all the people who do NOT pay them.  This is not hyperbole- I had an Xray done at a hospital, and later (having learned my lesson) when I needed another Xray I went to a specialist non-hospital imaging company.  Price was less than 1/4 of what the hospital charged, and the equipment was exactly the same GE machine.  There is HUGE amount of room to negotiate them down to a "Cost + Profit" bill as opposed to a "Cost + Profit + Deadbeats + Profit" bill.  Any penny you take out of their pocket by negotiation, stalling, and other tactics is not a penny you should feel bad about not paying.
 
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