Todays post highlights an article posted by NPR about a patient who was in a car accident, needed back surgery, and was billed over $700,000. Many of us get surprise medical bills, but this was a very expensive situation.
In this case, the patient had a $250,000 cap for medical bills on his car insurance. He received a letter from his insurance company after he reached his cap. The letter, posted in the article (link above) states he met his cap and still had several hundred thousand dollars worth of medical bills. They suggested he contact the billers and have them forward the bills to his personal health insurance. They also suggested he forwards the exhaustion letter and explanation of benefits to certify exhaustion to his personal auto insurance policy.
According to the article, when he submitted the surgeon’s bill to Aetna, he discovered that neither the doctor nor the hospital was in his health insurance network. He had not checked before the operation since he never dreamed that outpatient surgery would exhaust the auto policy.
That means Aetna did not have a negotiated rate with his providers, which might have knocked the charges down dramatically.
Instead, Aetna said it would allow an out-of-network payment of $4,051 for the surgeon, according to a Jan. 28 email to Gottlieb. In a written statement to Kaiser Health News, Aetna spokesperson Ethan Slavin said that amount was based on Gottlieb’s policy terms, which set physician payments about 10% above Medicare rates for out-of-network care.
Because he had not yet met his annual out-of-network deductible, Gottlieb himself would have had to pay the $4,051. He withdrew his request for Aetna to pay. Because out-of-network surgeons frequently go after patients to pay the balance of such bills, Gottlieb is waiting to see if Bergen Pain Management — which has already been paid $52,365 for the surgery — will come after him for more.
So far, neither the Bergen clinic nor the surgeon has sent him to collections or sued for the amount. Neither responded to multiple emails and phone calls placed by KHN seeking comment.
In a written statement, Hudson Regional Hospital spokesperson Ron Simoncini said that the facility “charged the state-mandated fee” where applicable and that where there was no such mandate, “the charges were reasonable.” The hospital is not seeking additional payment.
The bottom line is, your auto insurance plan may not cover high medical bills. You may wish to check your coverage limits with your agent and become aware of what your limits are.
Ms. Jenn Landers | Patient Advocate Alliance LLC Edited by Dr. Justin Groode