Brenna Carney was seven months pregnant in December 2019 when she experienced what she thought were severe flu symptoms.
Her husband, Casey Trumbull, drove her from her home in Chicago to the obstetrics and gynecology office at Northwestern Medicine Prentiss Women’s Hospital downtown. She was diagnosed with pre-eclampsia because of her sudden rise in blood pressure and increased protein in her urine. This is a fatal but treatable complication of pregnancy. Her doctors hospitalized her where she would stay for up to six weeks and said she might have an induced labour.
Carney then suffered a severe headache and his platelet count plummeted. This was a sign that I was experiencing a rare and dangerous type of pre-eclampsia and needed immediate delivery by caesarean section.
Carney’s daughter, Joey, who was born at 31 weeks, was put on a ventilator and moved to the hospital’s neonatal intensive care unit. Small but healthy, she was breathing slowly on her own and eating normally. She was discharged in late January 2020 after spending her 36 days in the NICU.
Then came the bill.
patient: Josephine “Joey” Trumbull, now 3, had her mother’s health insurance through her employer, an advertising agency. 2019 was Etna’s plan and 2020 was Illinois’ Blue Cross and Blue Shield plans. Both policies were fully insured plans that comply with Illinois law.
Medical services: Neonatologist Services Provided January 2020. Joey required tube feeding and ventilator care to supply oxygen.
Service provider: Physicians on the staff of Ann & Robert H. Lurie Children’s Hospital of Chicago treated Joey at Northwestern Medicine Prentice Women’s Hospital. In terms of ownership, Lurie is independent of Northwestern Medicine, but an enclosed walkway physically connects him to Prentice Women’s. Lurie has a cooperative agreement with Northwestern Medicine to provide neonatology and pediatric services to Prentice Women’s patients.
Total bill: Aetna paid nearly all of Joey’s and his mother’s hospital and doctor bills in December, and Blue Cross paid nearly all of Joey’s hospital bills in January. Her physician bills from Lurie in January totaled $14,624.55, of which the family was required to pay her $12,531.58 after payment from her Blue Cross.
Gives: To find out why Lurie was billing over $14,000 for doctor’s services, Carney spent months calling Blue Cross and two hospitals. , out-of-network hospitals.
Illinois law prohibits insurance companies from charging patients for out-of-network rates for neonatal care at in-network hospitals.
Carney said no one had told her or her husband that Lurie’s doctors were treating her daughter. She said she never signed a consent form agreeing for her family to receive treatment from an out-of-network doctor.
Although it didn’t happen here, many patients unknowingly signed broad financial contracts in the mass of paperwork they received upon admission, saying they would pay for almost everything their insurance would not cover. doing. In many cases, they are only asked to sign on the screen without looking at the paperwork.
Blue Cross agreed to pay Lurie network fees for the doctor’s services, reducing the bill to about $12,500 — which Lurie expected his family to pay.
In November 2020, Kearney began receiving letters from the collector, the ICS Collection Service.
“It was impossible to speak to Blue Cross. Lurie said it was not their problem, they just wanted us to have a payment plan,” Kearney said.
Joey spent 36 days in the NICU before the federal government enacted the No Surprise Act, which bans surprise charges outside the network. But state laws prohibiting it were in effect.
Since 2011, Illinois law has prohibited insurance companies from charging out-of-network fees to neonatologists, anesthesiologists, and certain other physicians when a patient is being treated at an in-network hospital. doing.
Carney repeatedly referred to the law to Lurie and Blue Cross representatives who denied knowledge of the statute.
“Under the 2011 law, it appears Brena can only charge for cost sharing within the network,” said Kathy Mikos, a registered nurse and patient advocate for the Navocate Group in Woodridge, Illinois. I was not involved in the Carney case.
In December 2020, an insurance broker working for Kearney’s employer persuaded Blue Cross to pay the full out-of-network fees for Lurie’s doctor, and the family paid $289.63 for coin insurance. There was an obligation and they paid immediately.
Carney, who spent the first year of her daughter’s birth battling medical bills, thought the ordeal was over.
Then, last month, she received a call from a collection agency demanding full payment for out-of-network charges for Dr. Lurie’s services provided to her daughter three years ago.
It took Carney five hours on the phone to put together what had happened. Physicians were paid only in-network fees.
A representative for Lurie said Carney and her husband still owed thousands of dollars.
“I was at a loss. I didn’t know how to fight this anymore,” Carney said.
Lurie, Blue Cross and Northwestern Medicine did not respond to numerous requests for comment by KHN. Despite Lurie receiving a release from her Kearney regarding the Federal Health Insurance Portability and Accountability Act (HIPAA) authorizing the hospital to discuss Joey’s case with her KHN, the patient’s I mentioned privacy.
resolution: After KHN contacted Lurie and Blue Cross, a Lurie representative called Kearney and offered to accept payments for in-network rates.
Lurie’s manager of integrated services, Tracy A. Spicer, said Lurie has a “longstanding policy” of accepting in-network fees for Lurie physician services offered at Prentice Women’s, according to Carney. Spicer then described it as a “longstanding courtesy” and explained that the acceptance of in-network charges is subject to “case-by-case consideration.”
Spicer said the family owed about $3,000 in coinsurance contributions and offered to set up a payment plan.
A day later, following a request for additional comment from KHN, Spicer called Carney and said he was dropping all doctor’s charges for his daughter’s treatment. Spicer did not respond to KHN’s call for comment.
“I’m sure I’m not the only one still dealing with this kind of predicament,” Carney said.
Carney filed a complaint with the Illinois Department of Insurance and the Office of the Illinois Attorney General. The attorney general’s office told KHN that he never implemented a 2011 law banning certain off-network charges.
State Senator Ann Gillespie, who was presented with the facts of Carney’s lawsuit and sponsored a 2022 state law that expands consumer protections against off-network claims, told KHN that Lurie, Blue Cross, and Northwestern He said he plans to contact medical to ask about the bill. arrangements, and whether they comply with state law.
“We’ll see if that was a pattern and if they need to look back and see if the refund is justified,” Gillespie said.
The attorney general’s office told KHN that it will investigate Kearney’s complaint, including whether Lurie violated the state’s Consumer Fraud and Deceptive Business Practices Act. I need a law. The insurance department also said it would investigate the complaint.
Take-out: Even resourceful consumers who seem to have the law on their side, like Carney, can lose a lengthy battle with the medical billing bureaucracy and face collection action.
State Senator Gillespie said Lurie, Northwestern Medicine and Blue Cross should have known about the state law. She said patients who believe they have been improperly billed should file a complaint with their state health department, which could initiate a broader investigation.
The federal No Surprise Act, which went into effect last year, prohibits health care providers or insurance companies from charging patients for out-of-network doctor fees at in-network hospitals unless the patient has formally consented to the out-of-network doctor. Prohibited. To be safe, even in-network hospitals require patients to ask their doctor if they are in-network or out-of-network.
Federal law offers patients new protections from out-of-network billing, but many Americans face problems that predate the law, says associate director of the USC-Brookings Schaeffer Initiative for Health Policy said Loren Adler, Illinois is one of the relatively few states that had previous laws to protect consumers.
And despite new federal protections, some out-of-network doctors continue to charge their patients.So know your rights. Citing the new law. And don’t write checks.
