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Cost of Living: $33,000 hospital bill shocks new mom

Insurance plans concern hospital industry
Posted: 5:03 PM, Oct 16, 2017
Updated: 2017-10-17 00:08:47Z

In our Cost of Living series all this week on the News at 6 p.m. and online, Call 6 Investigates Kara Kenney is digging into expenses you worry about in your daily life.

INDIANAPOLIS --  An east side mother was hit with sticker shock after receiving a $33,000 hospital bill in the mail following the birth of her son.

Chloe, who did not want her last name used for privacy reasons, received a $33,538.89 bill from Community Health Network and contacted Call 6 Investigates for help in sorting out the matter.

“I’ve never received a bill that large, so it definitely was sticker shock,” said Chloe. “We accumulated more debt in four days at the hospital than for years of college.”

Her son, JD, was born via C-section at Community Hospital South on April 18, 2017.

The average sticker price for a C-section in Indiana is $19,627.82, according to the Indiana Hospital Association tool  mycareINsight , and averages $21,776 at Community Hospital South.

However, the sticker price does not include any insurance discounts, and most patients with insurance never expect to pay full price.

Chloe paid her insurance premiums on time and her out of pocket maximum is about $6,400, so she was confused by the bill.

"I was just under the impression we would just have to pay up to our out of pocket max," said Chloe.  “When I was pregnant, I went to the insurance to find out what I was looking at how much I would pay, so we could budget for when he was born.”

JD’s delivery was more complicated than Chloe planned.

“The umbilical cord was wrapped around his body quite a few times,” said Chloe. “The doctor came in and said something’s not right. We’re taking him right now.”

Chloe contacted her insurance company, who was able to help whittle down her bill a little, but Chloe was still left with a huge chunk to pay.

“I don't mind paying my portion,” said Chloe. “I just feel like the amount right now is unreasonable. I'm just hoping that the insurance and the hospital can come up with an agreeable amount that isn't so high."

Call 6 Investigates reached out to Chloe’s insurance, Group & Pension Administrators (GPA), which is a self-insured, employer sponsored plan.

Call 6 Investigates received a response from ELAP Services, a contracted service provider on Chloe’s plan.

“A patient has received bills with significant markups from Community Hospital South, which are understandably causing alarm,” said Stephanie Kensy of ELAP Services in an August 24 email to Call 6 Investigates. “This is a common and serious issue that affects patients throughout the country every day; charges for hospital services are significantly marked-up over the hospital’s reported cost.”

Kensy said ELAP Services was “working diligently” on the patient’s behalf to “ensure a fair and reasonable payment.”

Community Hospital told Call 6 Investigates a much different story.

Community Health Network spokesperson Kris Kirschner said insurance plans like Chloe’s do not contract with hospitals regarding pricing agreements.

“Instead, they attempt to negotiate pricing after services have already been provided, often time putting the patient in the middle,” said Kirschner. “Hospitals across Indiana have raised concerns that this practice places patients at risk for not being covered for the services provided."

Kirschner also said they provide information to patients with non-network health benefit plans , like Chloe’s, letting the patients know they may be responsible for up to 100 percent of the billed charges.

The Indiana Hospital Association shares the concern.

"This new type of insurance we're seeing more and more in the marketplace is resulting in more and more of these unexpected bills," said IHA president Brian Tabor. “I can't speak to a particular case, but I think we are seeing more cases where what the individual thinks is insurance is not truly insurance that has a contracted rate with a provider. "

A few weeks after Call 6 Investigates started asking questions, Chloe got an update.

She now only has pay $5,660.35, which is a far cry from where she started.

ELAP Services would not go into detail about how Chloe’s bill was “marked up” as they initially claimed, however they said the hospital provided additional information that helped them reach a fair and reasonable outcome.

“We are fully committed to our plan members and we have been providing ongoing support to this member over the past few months, and we’re pleased to share that we have reached a mutual agreement with Community Hospital South to resolve this plan member’s billing issue,” said Leanne Scott Brown of ELAP Services in a September 12 email to Call 6 Investigates. “We have notified the plan member and we’ll remain in communication with her to provide any additional guidance and support for this matter.” 

Indianapolis consumer law attorney Keith Hagan said you have more power than you think to reduce your hospital bills.

“They would rather have money in hand than pursue you through the courts for money they can never get,” said Hagan. “Always try and negotiate.  The worst they can do is say no."

Hagan said you should also tell your employer if you receive a giant bill, because some have protections against large bills, and so your employer can best choose an insurance provider.

Chloe now stays at home full-time with her baby.

“We’re definitely more budgeted now,” said Chloe.

She’s relieved to not have a giant bill hanging over her head and instead can focus on her family.

The Indiana Hospital Association recommends patients use mycareINsight before having a procedure, and then go to their insurance company to find out approximately how much they’ll have to pay out of pocket.

For example, the average cost of a vaginal delivery in Central Indiana is $10,912.18, before insurance kicks in.

The Indiana Department of Insurance offers the following tips for dealing with medical bills.

•    Know your policy - Understand what your policy says. The policy is a contract between you and your insurance company. Know what's covered, what's excluded and what the deductibles are. 
•    File claims as soon as possible - Don't let the bills or receipts pile up. Call your agent or your company's claims hotline as soon as possible. Your policy might require that you make the notification within a certain time frame.
•    Provide complete, correct information - Be certain to give your insurance company all the information they need. Incorrect or incomplete information will only cause a delay in processing your claim.
•    Keep copies of all correspondence - Whenever you communicate with your insurance company, be sure to keep copies and records of all correspondence. Write down information about your telephone and in-person contacts, including the date, name and title of the person you spoke with and what was said. Also, keep a record of your time and expenses. 
•    Ask questions - If there is a disagreement about the claim settlement, ask the company for the specific language in the policy that is in the question. Find out if the disagreement is because you and the insurance company interpret your policy differently. If this disagreement results in a claim denial, make sure you obtain a written letter explaining the reason for the denial and the specific policy language under which the claim is being denied. 
•    Don't rush into a settlement - If the first offer made by an insurance company does not meet your expectations, be prepared to negotiate to get a fair settlement. If you have any questions regarding the fairness of your settlement, seek professional advice. 

Read Community Health Network's full statement below:
Like most hospital systems, Community contracts with multiple insurance providers. In all cases, the contract includes a pricing agreement for services rendered. However, an increasing number of self-insured, employer-sponsored benefit plans are electing not to enter into contractual agreements with hospitals either directly or through an established provider network. Instead, they attempt to negotiate pricing after services have already been provided, often time putting the patient in the middle.  Hospitals across Indiana have raised concerns that this practice places patients at risk for not being covered for the services provided.  The Indiana Hospital Association has taken on the issue and provided a set of recommendations to ensure patients understand their coverage.  

Consistent with the recommendations set by IHA, Community ensures that patients tied to these plans are informed in writing of potential gaps in their coverage and their responsibility to pay for the services, care and treatment they receive. We also provide those patients with cost estimates for all scheduled services across the network.  As a result of our efforts, very few patients are actually incurring any additional out of pocket costs beyond what their plan dictates in the form of deductibles, co-pays and co-insurance.
We embrace the need to provide care to those who do not have the ability to pay. Patients who meet the requirements of our Financial Assistance Programs can receive medically-necessary healthcare services at a significantly reduced cost. We work with patients who may need financial help, and provide a variety of plans and resources to reasonably reduce those costs.

At Community our top priority is the health and well-being of the patients and the communities we serve. We encourage patients to connect with us directly with any questions they may have related to their care, including its quality and value.