Link. Unfortunately behind a subscription wall. For that reason, a bit of a quote, even where the Crabgrass and item headlining seem to carry the gist of things. The item:
The care was crucial. He had insurance. His hospital bill? A whopping $155,493.
One Woodbury man's story shows how patients can get stuck in the middle when insurers and hospitals fight over coverage details.Mark Christensen figured his hospital bill was a mistake.
The document from Allina Health arrived in February, stating the 61-year-old Woodbury resident owed the hospital a staggering sum — $155,493.
It made no sense, Christensen said. He had coverage through his employer from a reputable health insurer. And the need for the care was undeniable; Christensen was hospitalized for about a month for treatment of a rare and deadly blood cancer.
But his insurer, Empire BlueCross BlueShield, refused to pay because Allina hadn't obtained authorization for Christensen's transfer to a new hospital, which happened about halfway through his inpatient stay.
No shit! What a feeble show of "coverage." Laying traps for the unwary. More:
The company has a policy stipulating that when interfacility transfers aren't approved, all claims for care at the second hospital can be deemed not medically necessary.
This decision left Christensen responsible for the bill.
[...] Christensen's ensuing saga highlights the financial peril patients can face when trapped between hospitals and insurance companies.
Through early October, Empire BlueCross BlueShield stuck with its decision. [...] Then in mid-October, the health insurer called Christensen to say the claim would be paid. This call occurred about three days after the Star Tribune began questioning both Allina and Empire BlueCross BlueShield about the dispute.
The insurer, a division of Indiana-based Anthem Inc., told the Star Tribune in a statement that it "appreciates the collaboration and partnership with Allina Health to review and address this matter and we are pleased to have a resolution for Mr. Christensen."
Allina Health said it "strongly believes Mark, or any patient, should not be caught in the middle of the medical billing appeal process between providers and payers."
[...] There's anecdotal evidence that health care providers, faced with a denial from a health insurance company, are increasingly asking patients to either pay the bill or fight for the coverage themselves, said Bill Foley of Cancer Legal Care, an Oakdale-based nonprofit group that helped Christensen with his appeals.
The item has further disquieting detail. So, have an online subscription, or buy a paper. The bottom line is the guy was getting screwed over by a song and dance team, or there really was an error and misunderstanding. It's circumstantial, so you make your own inferences from circumstances. Crabgrass has its inferences, its guesses. The Strib item ends:
[...] The cancer is now in remission. Christensen praises the care he received from Allina as well as attempts to resolve the billing problem by one of the health system's financial navigators. He's still watching for final paperwork from his health insurer; the online account no longer shows a huge balance owed to Allina.
He's grateful for the outcome. At the same time, Christensen worries that other patients aren't so lucky in finding a resolution for baffling bills.
"I feel great relief — it's been a long battle," he said. "But it also leaves me wondering if the circumstances were different — if I hadn't been working with Bill at Cancer Legal Care and he hadn't been in contact with [the Star Tribune] — I suspect that none of this would be resolved yet."
On the Strib sidebar, a link to another item, https://www.startribune.com/how-to-fight-back-if-your-health-plan-denies-coverage/600194559/
The doctors on the upper floors are okay. The man got sound medicine. For which he is grateful. The Doctors are doing their best under facility rules.
The bean counters on the ground floor, many arguably should not be allowed to reproduce. It looks as if the patient had at least one good bean counter trying to help from the medical facility. Yet, "Into the wind," so to speak, with THE INSURER BEING THE ONE WITH AN INDEFENSIBLE "POLICY" GETTING, STRANGELY, IN BETWEEN PREMIUMS PAID TO BE COVERED, AND UNIMPEDED COVERAGE AS WOULD REASONABLY BE EXPECTED! Go figure.
The saga is a learning experience for us all.
Opinions can differ.