Medicaid for Nicu Babies and Out of Network Provider

Baby Dorian Bennett arrived 2 months early and needed neonatal intensive care. Despite having insurance, mom Bisi Bennett and her husband faced a bill of more $550,000 and were offered an installment payment plan of $45,843 per month for 12 months. Zack Wittman for Kaiser Health News hide caption

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Zack Wittman for Kaiser Health News

Infant Dorian Bennett arrived 2 months early and needed neonatal intensive care. Despite having insurance, mom Bisi Bennett and her hubby faced a beak of more than $550,000 and were offered an installment payment plan of $45,843 per month for 12 months.

Zack Wittman for Kaiser Health News

Close to midnight on November. 12, 2020, Bisi Bennett was sitting on the couch in her pajamas and feeling uncomfortable. She was well-nigh seven months pregnant with her starting time child, Dorian, and the thought that she could be in labor didn't even cross her heed.

Then, she felt a contraction and so stiff it knocked her off the couch. She shouted to her married man, Chris, and they ran to the car to start the 15-minute drive to AdventHealth hospital in Orlando, Fla. About halfway through the trip, Bennett gave birth to Dorian in her family's Mitsubishi Outlander. Her husband kept ane paw on his newborn son's back and one hand on the wheel.

Born breech, significant his caput emerged last, Dorian wasn't crying at outset, and the terrified new parents feared something was incorrect. Chris Bennett turned on the SUV'south flashers and flagged down a passing emergency vehicle. The EMS team escorted the family unit to the hospital.

"He was still connected to me with the umbilical cord when they rolled the two of the states together into the infirmary," Bisi says. "They cutting the string, and the last matter I heard was, 'He has a pulse,' earlier they wheeled me away."

"I just cried tears of relief," she says.

Dorian stayed in the neonatal intensive care unit until Jan. 7, 2021 — nigh ii full months. While Dorian was in the infirmary, Bisi wasn't worried about the cost. She works in the insurance industry and had carefully chosen AdventHealth Orlando because the infirmary was close to her house and in her insurance network.

Then the bills came.

The Patient: Dorian Bennett, an babe born two months premature. He has health insurance through his mother's employer, AssuredPartners, where she works every bit a licensed property insurance agent.

Medical Service: A neonatal intensive intendance unit stay of 56 days. Dorian needed highly technical, lifesaving respiratory and nutritional care until his organs matured. He likewise received laboratory, radiology, surgery, cardiology and audiology services and treatments.

Service Provider: AdventHealth Orlando in Orlando, Fla. It is a function of the AdventHealth system, a large nonprofit and religion-based group of health care providers with locations across Florida and several other states.

Total Pecker: AdventHealth Orlando billed $660,553 for Dorian'southward NICU care. Because of an insurance snafu, the "patient responsibility" portion of the pecker sent to the Bennetts was $550,124. They were offered an installment payment plan of $45,843 a month for 12 months.

What Gives: Under the 2010 health law, nonprofit hospitals are required to provide financial assistance to assist patients pay their bills, and payment plans can be function of that assistance. But the Bennett family unit'due south experience shows the organization is withal far from friendly to patients.

The installment corporeality offered to the Bennetts — $45,843 — resembles an annual salary more than than a reasonable monthly payment. The laughably unrealistic plan was patently automatically generated by the hospital'southward billing system. A spokesperson for the hospital, David Breen of AdventHealth, did not answer KHN's questions most its billing software or why a 5-digit monthly payment was not flagged by the hospital as a problem that might need extra attending.

The size of the Bennetts' pecker stems from two overlapping issues: Baby Dorian was born in 2020 and needed hospital care into 2021, and Bisi Bennett'southward employer shifted its health plan to a different company in January 2021. She informed AdventHealth almost the change.

As someone who works in the insurance industry, Bennett was pretty certain that she understood the mix-up and that the accuse of more than half a million dollars was unjustified.

Bisi Bennett immediately noticed and understood what went wrong when she received the billing statements in leap 2021. But it took well-nigh a year of calls and a reporter'due south inquiry to become the problem fixed. Zack Wittman for Kaiser Wellness News hide caption

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Zack Wittman for Kaiser Health News

Bisi Bennett immediately noticed and understood what went wrong when she received the billing statements in spring 2021. But information technology took nearly a twelvemonth of calls and a reporter's inquiry to get the trouble fixed.

Zack Wittman for Kaiser Health News

Merely as Dorian turned a twelvemonth quondam last month, the family still had bills pending and a tangle of ruby tape to fight.

AdventHealth bundled the 2020 and 2021 dates of Dorian'due south NICU stay and then billed both insurance plans for the whole stay. Both insurance plans said the bill contained dates of intendance when Dorian was non covered, and so neither paid the hospital. The shift from ane year to the side by side flummoxed three large business entities, which seemed unmotivated to resolve the problem speedily.

"A bill this big is a huge crisis for the family, but it's not a huge crunch for the insurance company or for the infirmary," says Erin Fuse Brown, an associate professor of law at Georgia State Academy who studies health care policy.

In 2020, Dorian was covered under a UnitedHealthcare plan, which for in-network providers had a $6,000 deductible and $6,000 out-of-pocket maximum for the family.

In 2021, Bisi Bennett'south employer switched its third-party administrator of its cocky-funded plan from UnitedHealthcare to UMR. The deductible and out-of-pocket maximum did not change.

Although UMR is owned by UnitedHealthcare, the two companies did not communicate well about the case.

"It'due south indicative of all the ways the system fails the patient," Fuse Brownish says. "Even the i who does everything right."

Through the well-nigh yearlong fight over the bill, the Bennetts were as well caring for Dorian, who left the infirmary with lingering gastrointestinal bug, and managing Chris' handling for stage 4 neuroendocrine cancer, which was diagnosed in April. At i point, Bisi says, she felt she was going crazy.

"They're in charge of billing, and I shouldn't be the ane having to tell them, 'Bill my ane insurance for dates in 2020 and bill my other insurance for dates in 2021,' but I did," she says. "I kept having the aforementioned conversation over and over."

Resolution: Bisi Bennett immediately noticed and understood the calendar outcome when she received the billing statements in spring 2021. She started past calling the hospital and was told the trouble would exist corrected in March. Yet, in September, she got the same half-a-1000000-dollar bill.

UnitedHealthcare spokesperson Maria Gordon Shydlo, who too fielded KHN'south questions for UMR, says the insurance company told AdventHealth to revise the neb with correct dates in the spring.

Breen, the spokesperson for AdventHealth Orlando, confirmed to KHN that the billing error stemmed from the modify in insurers from 2020 to 2021. In a statement, Breen says medical billing can be a complex process and the hospital "understand[s] this has been a confusing and challenging feel for Ms. Bennett, and we apologize for the frustration this has acquired."

AdventHealth Orlando did non submit a revised bill with corrected dates until KHN contacted the hospital in Oct 2021.

After UHC and UMR reprocessed the 2020 and 2021 claims, the original neb of more than $550,000 was knocked downwards to $300.

Dorian Bennett was born in late 2020 and needed hospital intendance into 2021. Bisi Bennett'south employer shifted its ambassador for health insurance in the new year. The infirmary then billed both insurance plans for the whole stay. Both insurance plans said the pecker contained dates of care when the babe was not covered, then neither paid. Zack Wittman for Kaiser Health News hide caption

toggle caption

Zack Wittman for Kaiser Wellness News

Dorian Bennett was born in late 2020 and needed hospital care into 2021. Bisi Bennett's employer shifted its administrator for wellness insurance in the new year's day. The hospital then billed both insurance plans for the whole stay. Both insurance plans said the beak independent dates of care when the baby was not covered, so neither paid.

Zack Wittman for Kaiser Health News

In his statement, Breen says that the Bennetts' case sparked AdventHealth to place and address issues in its system and that the hospital plans to meliorate the billing and communications process for future patients, specially when there is a alter in insurance.

The Takeaway: Much of our fragmented health care system is on autopilot, with billing software that generates confusing or, in this case, absurd bills and payment plans.

Bisi Bennett did everything right: She chose an in-network hospital and informed information technology of the changes to her wellness insurance. She followed upwards when she saw in that location was an error. Only her example didn't reach a resolution until a reporter called on her behalf.

If you lot are fighting a bill that you believe contains an error, call all the entities involved — the hospital, insurers, other providers — and don't forget near your visitor's human resources department. It may be able to pressure insurers to resolve an error faster than you tin.

Near states have a department of consumer services that can help y'all file a complaint with the appropriate oversight entity. Staff members at state agencies can help you effigy out what is going on. Tell the medical providers you are reporting them to the country.

Still, information technology is a frustrating, uphill battle, particularly when patients accept improper bills hanging over their heads for many months and are at hazard of having the bills sent to a drove agency or having their credit score dinged. At that place should exist far more transparency in billing and a gear up fourth dimension limit for dispute resolution, experts say.

"This shows how little leverage or power a patient has in this situation," Fuse Brown says. "Y'all almost take to go outside the system and put external pressure."

Beak of the Month is a crowdsourced investigation past KHN and NPR that dissects and explains medical bills. Do you have an interesting medical beak you want to share with us? Tell us virtually it !

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Source: https://www.npr.org/sections/health-shots/2021/12/21/1065572001/a-hospital-asked-these-parents-to-pay-45-843-a-month-for-their-babys-nicu-stay

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