This article was first published by the Pulitzer Prize-winning investigative journalism ProPublica.Apply Big story newsletter How to receive such articles in your inbox..
The email arrived from my cousin’s mother in Elliott Marine’s inbox.
“Scott needs a kidney,” the subject read.
The message effectively described Scott’s situation: at the age of 28, Scott Klein was in end-stage renal disease. He had not been on dialysis yet. But he probably should have.
His mom reached out to as many people as possible and asked them to be shown as a possible donation match.
“Thank you for your consideration, but don’t feel the pressure to do that,” she writes. “Sorry, I have to share this burden, but the most likely match is the family.”
Marin didn’t have to put pressure on him. For him, the decision was easy.
“I had no other idea than trying to help Scott,” Marin later said.
He clicked on the link in the email to start the screening process.
If he turned out to be a match, Marin knew that surgery could endanger his health. Recovery is physically painful. What he didn’t expect was that it would endanger his finances. Just as he has to trust the surgeon’s skilled hands to make sure the surgery is successful, he is a billing coder to navigate the increasingly complex system that covers the cost of transplant surgery. And must trust the expertise of the financial coordinator.
Living organ donors are never expected to receive invoices for care related to transplant surgery. Recipient insurance covers all of those costs. This rule is the key to a system built on the basis of encouraging such selfless behavior. And for most uninsured patients with end-stage renal disease, Medicare will pick up the tab. But in the case of Marin, he faces a $ 13,000 billing error and faces the threat of sending his invoice for recovery.
Donors like Marin play an important role in the national transplant system. Over the last three years, over 30% of kidney donations have come from living donors, according to data from the United Network for Organ Sharing. Neither UNOS nor other national advocates track how often Marin’s billing problems occur. But supporters say they can actually happen and discourage donors from moving forward.
Morgan Reid, Head of Transplant Policy and Strategy for the National Kidney Foundation, said:
Marin and Klein describe themselves as cousins, but their kinship is distant. Their great-grandfather was a brother and made them a cousin. Still, they are of the same age, growing up as friends, traveling, and sometimes spending vacations together. Klein attended Marin’s wedding in 2019.
What went wrong with Klein’s kidneys is a mystery. In the summer of 2020, he had just moved to Fort Worth, Texas for his work. He had regular blood tests to monitor the medicines he was taking. When the results came out, the doctor called to ask if he was on dialysis.
“You have end-stage renal failure,” the doctor told him.
“Oh no, no,” Klein replied.
The blood job wasn’t wrong. His kidney function was only 17%. In this way, he began looking for new organs. Klein was told that if his friends and family didn’t come forward, he would take three to five years to wait for his kidneys. In February 2021, Klein and his family began contacting everyone they knew. Volunteers have applied for medical screening, but pay to test only one insurance at a time. Waiting for one potential donor to be excluded before testing another donor has already led to a long process.
Four months after Marin signed up for the screening, he got the final confirmation that he was in the match.
By June, the two cousins were deeply involved in the Byzantine organ transplant bureaucracy. Screeners, financial counselors, doctors, professionals, laboratories, and the most difficult insurance companies.
“The amount of hoops you have to jump to do this is very unusual,” Marin said, explaining a series of medical tests, a large amount of paperwork, and pre-approval of the procedure. An interdisciplinary team of professionals gathered to assist two patients throughout the process.
“The hospital was great trying to make everything as easy as possible,” he said of the team.
Marin said they gave him one guarantee: he doesn’t have to contend with any bill or be responsible for a dime that costs an estimated $ 160,000 in surgery. The team was pre-approved by Klein’s insurance plan, which covers all of Marin’s medical costs.
The guarantee has leveled off, no matter how well-meaning.
In July, Marin moved from her home in Reno, Nevada to Fort Worth, where her cousins underwent transplant surgery at the Baylor Scott & White All Saints Medical Center. The surgery was successful.
Marin recovered in the hospital for three days and Klein spent a day or two longer. This was a painful experience that could be tolerated by their dating.
“We took a short walk around the hospital floor,” Klein said. “We will be suffering together. It was really nice to be able to do that. Usually you are there alone, especially during COVID.”
By early August, Marin had returned to Reno to finish his recovery. The following week he started law school. His life was back to normal.
When the first invoice arrived, it was more annoying than stress. The total blood tests performed before surgery were only $ 19.15. The hospital said it would take care of it, Marin said. He then received a notice that an old insurance plan he was no longer a member of was charged $ 934 for lab work. Again, he notified the hospital.
In late September, Marin received an invoice for a shrug amount: $ 13,064. He was surprised at the cost, but not too worried. He knew that Klein’s insurance was responsible for paying it. He notified the hospital and forgot it.
A month later, I received a second notice. And on December 6th, Marin received a document that scared him.
“Final notice! Your account is currently considered delinquent,” the notice read. The billing company warned that if he did not take action, he would attempt “further collection activities.”
The bill came from North Star Anesthesia, a company that provides anesthesia services to hospitals across the country, including Baylor Scott & White All Saints.
Now, Marin was not only frustrated by the ongoing bill, but also worried about his credit.
“I called them and chewed a little,” Marin said. “I explained what this is for. It’s a kidney donation and I’m not responsible.”
Marin complained on Twitter It elicits a series of responses, from jokes about asking for his kidneys about aggressive billing practices to the anger that he will be in this position after such a gift.
After he called the billing company and the hospital, there was nothing else he could do.
“We just have to wait for the collection,” Marin told ProPublica two weeks later.
He did his best to completely exclude Klein.
“He had a lot on his plate,” Marin said of his cousin. “His recovery was harder than mine. He takes immunosuppressants for the rest of his life because he is an organ acceptor. Because of COVID, he’s mostly stuck indoors. I. Don’t tell him too much. I don’t want to stress him. “
Still, the fact that Marin faces such a problem has plagued Klein.
“After all, I want everything to go as smoothly as possible for Elliott,” Klein said. “He gave me incredible kindness. My life is due to him.”
Marin hadn’t heard anything until January 19, the day after ProPublica asked North Star for comment.
“The North Star CFO called me and said she took care of the bill,” Marin sent a text message to the reporter.
The next day, the company sent an email to Marin confirming that he was not responsible for the claim, that he was never sent to the collection and that his credit was unaffected.
“On behalf of Northstar, we apologize for causing confusion and concern about this issue and guarantee that the issue has been resolved,” wrote Kate Stetz, Chief Financial Officer of the company.
She said the bill was forwarded to the “right party” after his call on December 7, but the company was unable to tell him. The letter explained that North Star had received the wrong insurance information at the time of surgery. (A spokesman later said that Northstar did not receive insurance information at the time of surgery.) In such cases, the invoice will be automatically sent to the patient.
The company then adjusted its policy to prevent it from happening in future transplant cases, Stets wrote.
“For clarity, it is not Northstar’s policy to invoice transplant donors for transplant surgery-related invoices,” Stets wrote. “We are aware of established public policy standards and practices that transplant donors should not be charged for such services. Our and national health care systems are such selfless. We have a responsibility to promote and encourage selflessness and generosity. “
In a statement, a Northstar spokesperson said other organ donors were not obliged to “pay”.
“Northstar has not been contacted by Baylor on this matter and was first notified of a billing error on December 7, 2021 after the Transplant Center did not provide insurance information to Northstar at the Point of Care. It was done, “said a spokesman. “NorthStar resolved the error immediately and closed the account that day before the inquiry from ProPublica.”
Both Marin and Klein praised the Baylor Scott & White All Saints team for guiding the process. However, the hospital refused to allow an interview with ProPublica about what went wrong with the claim.
A spokeswoman issued a short statement. “We are pleased that this has been resolved by NorthStar for our patients. Claims can be complicated, but these occurrences are rare. We are in contact with our patients and should report further. there is no.”
Funding for such surgery is so complex that the transplant center hires a coordinator to support the process for both patients.
Daedra Shimano, President of the Association of Transplant Finance Coordinators, said:
In one case, after trying everything to get the provider to claim the proper insurance, Simano relied on paying the patient’s $ 200 invoice with the transplant center’s credit card.
“That’s what we had to do to get rid of it,” she said.
Marin said he feels lucky to be ready to fight the billing issue. He is worried about others who have few means to face similar situations, and that it can be a barrier to selfless people enough to donate organs. recognizing.
“It’s terrible, but I wouldn’t have changed any of it,” he said. “I like my cousin. I want him to be healthy.”
