Owen Loney’s unexpected bill was the result of an emergency appendectomy in 2019 at Richmond Hospital, Virginia, USA.
Insurance covered most of the hospital stay, he said. He didn’t care much for the bill he received from the Commonwealth Anesthesiology Association and hoped his insurance would cover it. A few months ago, he received notice that Commonwealth was suing him in Richmond General District Court for $1,870 for placing him under surgery, court records show.
“Well, seriously?” The 30-year-old information technology director recalled thinking after receiving the court summons. Loney didn’t have that kind of money on hand. His plan was to try to negotiate the amount or “withdraw another credit card for payment.”
Loney’s is a classic, notorious surprise bill type of bill that Congress and activists have worked for years to get rid of: an out-of-network fee that isn’t covered by insurance even if the patient has been billed. have an emergency procedure or get care at a network hospital. Insurance will cover most fees.
Commonwealth says it has partnered with Loney’s insurer, UnitedHealthcare. However, the insurance company denied the anesthetic fee, claiming his primary care physician was out of network, claims records show.
The federal No Surprise Act, passed in late 2020, has been praised by consumer advocates for banning such practices. Starting January 1, medical companies will in most cases not be able to bill patients more than the in-network amount for any emergency treatment or out-of-network care provided. at a network hospital.
But designed to protect millions of patients from unexpected financial consequences, it will hardly avoid medical billing surprises for all consumers.
“It’s great that there will be unexpected payment protections…but you’re still going to get lawsuits,” said Zack Cooper, an economist and associate professor at the Yale School of Public Health. “This is by no means going to eliminate all problems with payments.”
The law will go into effect too late for Loney and many others because of unexpected off-net bills in states that have not yet banned the activity.
“It doesn’t prohibit the unexpected bills that are happening in states that don’t have protections against them,” said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing. they. “And it doesn’t prohibit collection for unexpected bills that arise before January.”
Virginia’s surprise bill protection law only took effect this year and does not apply to self-insured employer health plans, which cover a large portion of residents.
Nor does federal law do anything to alleviate another nasty, often surprising kind of bill — large out-of-pocket, in-network health care payments that many Americans can’t afford. pay and may not realize that they are suffering.
Two significant changes in recent years have increased the risks even further for patients. Employers and other payers have narrowed their provider networks to exclude some high-cost hospitals and doctors, leaving them out of the networks of more patients. They also significantly increase deductibles – the amount a patient must pay each year before insurance starts to contribute.
The No Surprises Act addresses the first change. It has nothing to deal with the second.
For an overview of the past and future of unexpected and disputed medical bills, KHN reviewed Commonwealth cases against patients in central Virginia and attended court cases where the patient Dispute about their bill.
According to court records, Melissa Perez-Obregon, a dance teacher in the Richmond area, whom the Commonwealth sued for $1,287 for services she received during the birth of her daughter in 2019. Payment records show that her insurance paid most but not all of the $5,950 anesthesia fee.
“I’m a teacher,” she said, standing in the hallway of the Chesterfield County General District Court. “I don’t have this extra money.”
Commonwealth is one of the creditors actively seeking judgments in the Richmond area, court records show. Between 2019 and 2021, it filed nearly 1,500 cases against patients seeking treatment, according to KHN’s analysis of court filings.
In many cases, it initiates punitive proceedings, in which creditors appropriate a portion of a patient’s salary.
Describe itself As “the largest private anesthesia facility in Central Virginia,” Commonwealth says it employs more than 100 physicians who care for approximately 55,000 patients each year in hospitals and surgical centers, primarily in the Richmond area.
Commonwealth says more than 99% of the patients it treats are members of the insurance plans it accepts. Michael Williams, Commonwealth’s practice manager, said in a written statement it only takes wages as a “last resort” and only if the patient can afford it.
“Over the past three years, we’ve filed lawsuits to collect from more than 1% of our patients,” Williams said, much of the money owed for in-network deductibles or coinsurance. Almost half of the bills are settled before the court date, he said.
Gwendolyn Peters, 67, said she was shocked when she received the court summons this summer. According to court records, Commonwealth sued her for $1,000 for anesthesia during a lumpectomy for breast cancer in 2019.
“This is the first time I’ve been in this situation,” she said as she sat at Chesterfield court with half a dozen other Commonwealth defendants.
Because patients often have little or no control over who puts them under their care, Brown said, anesthesiologists face less risk to their business and reputation than specialists. other health professionals when using active collection tactics.
Specialists are often “one of the worst offenders because they don’t depend on their reputation to get patients,” she says. “They’re not going to lose money because they engage in these really extreme activities that destroy their patients’ finances.”
The average annual deductible for single-person coverage from job-based coverage has increased from $303 to $1,434 over the past 15 years, according to KFF. Deductibles for family insurance in many cases in excess of $4,000 a year. Coinsurance – patient liability after the deductible is met – can add thousands of dollars in costs.
That means millions of patients are essentially uninsured for care that could cost them a significant portion of their income. Surveys have repeatedly found that many consumers say they will have difficult to pay a surprise bill even a few hundred dollars.
Loney’s insurer, UnitedHealthcare, agreed to pay the bill from Commonwealth for his emergency appendectomy after being contacted by KHN and said it had “updated the information” in the request. . Otherwise, Loney said, he couldn’t pay it off without a loan.
In the Richmond district courts, hearings on Commonwealth cases take place every few months. An attorney for the practice of anesthesiology attends, sometimes making payment arrangements with the patient. Many defendants are not present, which often means they lose the case and may be punished.
Commonwealth sued retiree Ronda Grimes, 66, for $1,442 for claiming her insurance didn’t cover after a 2019 surgery, payment and legal records filed in District Court Richmond shows.
“That’s a lot of money, especially when you have health insurance,” she said.
New Research by Cooper et al Examining the Wisconsin courts shows that medical lawsuits against people of color and people living in low-income communities disproportionately.
“Doctors have the right to be paid like everyone else for their services,” Cooper said. But out-of-pocket, out-of-pocket medical costs are “a systemic problem. And this systemic problem often falls on the backs of the most vulnerable of our population. “
For uninsured patients, Commonwealth is in line with any financial assistance offered by the hospital and will “strengthen” its financial assistance program in 2022, Williams said.
Two of the nine people sued by Commonwealth and interviewed by KHN at the court hearings are Hispanic. Four black.
One is Darnetta Jefferson, 61, who underwent a double mastectomy in early 2020 and arrived in court wearing a cancer survivor shirt. Commonwealth sued her for $836 and said she owed insurance money for the anesthesia she was given during the surgery. Commonwealth attorneys agreed to drop the case if she agreed to pay $25 a month for the balance until it was paid off, she said.
Jefferson, who worked at Ukrop’s supermarket for many years before cancer forced her to suffer with cancer. “But right now, my situation is not good.”
Jefferson, who was also a lung cancer survivor, was diagnosed in 2009. Although her income fell, her rent went up again, Jefferson said.
Paying Commonwealth bills in $25 monthly increments means “there’s a long way to go,” she said.