What Happened When I Chose to Fight a $900 Health Bill
I paced my bedroom floor with my baby on my hip. It was at least my eighth phone call about the hospital bill. Technically, this portion of the bill was for one specific doctor, a cardiac intensive care unit chief physician who I’d never met. The bill was $900, and I wasn’t giving up easily.
At first, I explained to this latest insurance agent, I’d thought it was a mistake. Neither my husband nor I had ever met that doctor, and we couldn’t ask the subject of this doctor’s alleged exam, our 14-month-old daughter. Maybe, we’d reasoned, it was a mistake. We called the hospital to ask what this doctor did. When we learned what happened, things only got less clear.
I explained to the insurance representative what I knew: that my daughter had been without a parent at her bedside for only 20 minutes of her three-day inpatient stay, during the brief time after her cardiac surgery when the one-to-one nurse assigned to her had told us she’d be totally sedated and we should use that opportunity to get some lunch. During those 20 minutes, the chief physician on her unit had examined her.
That was the source of the bill: a maximum visit of 20 minutes, for which we were being billed $900; and the insurance was refusing to pay it because that particular physician was “out of network.”
We’d tried everything so far: claiming that we hadn’t authorized this visit; asking for a detailed list of services provided; begging for a discount. Finally, after multiple calls to the hospital, the doctor’s own billing department, and several fruitless calls with the insurance company, I was here: on another call with another unit of the insurance company, trying to untangle this in a way that wouldn’t cost $900.
Steven (not his real name) put me on hold for 20 minutes before he came back, suddenly.
“I have one last idea,” he asked. “Was your daughter admitted to the hospital when this doctor examined her?”
I rolled my eyes. “She’d just had cardiac surgery. Yes, she was admitted!”
“Well, there you go!” he answered. “If she was inpatient in one of our in-network hospitals, then everyone she sees there is automatically in-network, even if they aren’t in-network in their private practice.”
I paused for a moment, surrounded on my bedroom floor with piles of papers, notepads full of notes, and my baby daughter in my lap. Absorbing what he’d just said, I asked slowly, “Does that mean this is covered, then?”
“Absolutely,” Steven assured me. “Your insurance will cover 90 percent, and you’ll just need to cover the final 10 percent.”
Our bill had just dropped from $900 to $90.
I quickly took down all of Steven’s information and noted that a new Explanation of Benefits would be mailed out to me. It was just as he promised; a week later, a new benefits statement arrived, and shortly after that, a call to the doctor’s billing department confirmed that our insurance had made the payment of $810. I paid the last $90, and this chapter in our daughter’s medical journey was over.
I was reminded of this story when listening to the first episode in season two of the podcast “An Arm and a Leg.” In this episode, a couple struggling with a clerical mistake in their health insurance fight for months and months to resolve it, all while one of them is pregnant and struggling with some late second-trimester complications. The number of hours they spent on the phone trying to undo the snags and tangles in their insurance is staggering. This episode of “An Arm and a Leg” is riveting, but it also made me wonder.
At one point, the host of this podcast, Dan Weissmann, muses on something I’ve wondered too, and considered often as I fought my daughter’s $900 medical bill. He says, “Those systems – especially all the long hold times, all those people who don’t really do anything? Maybe they’re just inefficient. But maybe they’re really really efficient. Maybe they’re like a toll the health insurance companies and everybody else are charging you. Like, you wanna talk to somebody who can maybe help you? Let’s see if you’re willing to pay this toll. Otherwise, maybe you just pay whatever we tell you to pay.”
This is a reasonable thing to wonder. Aside from the people who simply can’t be bothered to wait on hold like this couple in the podcast did, there are people who are working, or might not speak English well, or who don’t even know that they can call and ask more questions. So maybe, for most, they will just end up paying whatever they’re told.
For the couple in the podcast, and for me, this was something we were willing and able to fight.
I’m left with this question, in the end:
How many people are unwilling or unable, and how profitable are they for insurance companies? We may never know.