On April 10, 2025, a number of hours after ending a hike in Sedona, Arizona, Jan Anderson began repeating herself.
“Did we hike this morning?” she requested.
“Yes, we hiked,” stated her husband, Steve Francks. “And you did really well.”
But 15 seconds later, she requested the identical query: “Did we hike today?”
Anderson, 65, a retired finance government, doesn’t bear in mind any of it. She can recall what occurred that afternoon solely as a result of her husband began recording her on his cellphone.
“I was just on this nonstop loop,” she stated.
Almost instantly, Francks knew one thing was fallacious. “Jan was out of it,” he stated.
He took her to an emergency room in Sedona, the place employees initially thought she may be having a stroke. Because the power wasn’t totally geared up to guage or deal with stroke sufferers, Francks stated, she was airlifted to a Phoenix-area hospital, the place she was admitted.
It turned out she wasn’t having a stroke. Her medical crew finally decided she was in all probability experiencing transient global amnesia, a uncommon, momentary, and benign reminiscence dysfunction.
The excellent news was that her signs didn’t final lengthy, and he or she has suffered no long-term results from the episode. It took about 24 hours earlier than she was capable of begin forming new recollections, and he or she was discharged the following day. Anderson and Francks, who break up their time between Sedona and Edmonds, Washington, returned to the Pacific Northwest a number of weeks later.
Then the invoice got here.
Email Sign-Up
The Medical Service
The sudden confusion related to transient international amnesia may also be an indication of a extra widespread neurological situation, so it’s essential to rule out different potential causes — resembling a stroke, for which well timed emergency care can spell the distinction between life and dying.
Anderson’s information present her care at Abrazo Health’s Arrowhead Campus in Glendale, Arizona, included an electrocardiogram, which may detect underlying cardiac abnormalities, and imaging, which might rule out any vessel blockages which may trigger a stroke. She additionally underwent numerous lab exams generally used to diagnose a stroke.
The Bill
$59,181: $35,302 for diagnostic/therapeutic imaging, $8,147 for laboratory companies, $8,146 for a particular care unit, $5,532 for EKG companies, and $2,054 for pharmacy. Anderson’s first invoice from Abrazo Health stated she owed $15,312.43, citing an insurance coverage adjustment of $43,868.57, despite the fact that her insurer had not coated any of the costs.
Anderson stated her insurer coated separate costs for the ER and helicopter switch.
The Billing Problem: Communication Breakdown
The federal No Surprises Act bans out-of-network payments for many emergency companies, even when these companies are obtained at an out-of-network facility and should not preapproved by the insurer.
That means the price of Anderson’s hospital care ought to have been coated as if it have been in-network. At the time, she was insured by Molina Healthcare, by a plan bought on the federal Affordable Care Act market.
But for a yr, Molina declined to pay for her care in Glendale, at one level arguing that her hospital keep required authorization when, and even earlier than, she was admitted.
“I can’t get anyone to resolve it,” Anderson stated. “It’s almost $60,000 hanging over my head.”
The first downside arose about two weeks after she was discharged, when Abrazo Health despatched Anderson a invoice indicating she was a self-pay affected person.
The hospital didn’t request her insurance coverage info at any level throughout her keep, Francks stated. He assumed, on the time, that his spouse’s monetary paperwork had been transferred from the ER in Sedona. It had not.
She known as the Glendale hospital and corrected the error.
Then, in late June, Anderson obtained discover from the hospital indicating she was not a Molina member.
“Your insurance company notified our office that the patient was not a covered member for the services provided by Abrazo Arrowhead Campus on the above referenced service date(s),” the discover stated. It confirmed the full costs for her keep exceeded $59,000.
But when Anderson known as Molina to substantiate her protection, she stated, the insurance coverage firm assured her the declare was being processed.
That didn’t imply Molina was keen to cowl her hospital invoice.
Anderson spent months attempting to resolve the stability. She filed complaints with members of Congress, the Arizona Department of Insurance and Financial Institutions, and the Office of the Insurance Commissioner in Washington state.
Anderson has totally recovered from her bout of transient international amnesia, however a dispute over practically $60,000 in hospital costs has been a supply of stress for over a yr. (M. Scott Brauer for KFF Health News)
In an October letter to Washington’s insurance coverage commissioner, an attraction and grievance specialist for Molina wrote that the declare was denied as a result of “inpatient stays require prior authorization, or notification at the time of admission. No notification of admission or prior authorization was received from the hospital, so the claim was denied.”
It continued: “Molina covers out of network emergency services but since this was an inpatient admission authorization is required.”
Nicole Broadhurst, who focuses on medical billing points as CEO of a Tennessee patient advocacy group, stated this dispute seems to relaxation between the insurer and the medical supplier.
She stated that Anderson’s insurance coverage info ought to have been transferred between the primary ER and the Glendale hospital. Since it wasn’t, Broadhurst stated, Anderson shouldn’t be held accountable for her hospital invoice. (Broadhurst was not concerned in efforts to resolve Anderson’s billing dispute.)
Unfortunately, Broadhurst stated, these conditions are “not uncommon, even though we have the No Surprises Act.”
The Resolution
Anderson stated she was advised by Abrazo Health for months that it was working with Molina to resolve the invoice. She stated she was additionally advised that even when Molina didn’t cowl the total price of her hospital care, she wouldn’t be accountable for the stability — however she by no means obtained that assurance in writing.
Meanwhile, Molina continued to uphold its choice to disclaim cost.
After KFF Health News contacted the insurer and the hospital with questions on her case, Molina advised Anderson it had launched an inner evaluate of her declare, and a income director with Abrazo Health advised her the corporate was “treating this as a high-priority matter,” she recalled.
Anderson stated the income director for the well being system assured her that if Molina continued to disclaim cost, “the balance will be written off on the hospital’s end,” she stated. “I will not be responsible for any balance” — not even the $15,312.43 the hospital initially billed her after the hospitalization.
Linda Nofer, a spokesperson for Abrazo Health, wouldn’t reply questions on Anderson’s invoice. In an announcement, she stated the hospital system is “committed to working closely with our patients to resolve billing questions and concerns.”
Molina spokesperson Caroline Zubieta wouldn’t focus on or reply to questions on Anderson’s case on the file.
The Takeaway
The flurry of insurance coverage paperwork and medical payments sufferers obtain after a hospital keep could be overwhelming — and will generally seem contradictory.
Broadhurst stated it’s essential for sufferers to concentrate on the “patient responsibility” portion of an insurance coverage doc known as an evidence of advantages.
Patients mustn’t pay a invoice if their rationalization of advantages signifies they aren’t liable for the quantity charged.
In this case, Anderson had obtained a invoice from the hospital saying she owed cash. And her rationalization of advantages from Molina confirmed she’d racked up greater than $59,000 in hospital costs.
But that doc additionally indicated her affected person legal responsibility was “$0.00.” Anderson stated the hospital was not pressuring her to pay the $15,312.43 invoice or any of the costs tied to her account, however she was frightened she would finally owe a big sum as a result of the costs remained unresolved for greater than a yr.
“The question I kept asking them was, ‘How much am I going to owe?’” stated Anderson, who’s now insured by Medicare. “It could be anywhere from that $15,000 adjusted amount to the full balance of $59,000.”
Broadhurst stated she tells sufferers going through comparable conditions to “send the hospital a copy of the EOB and ask them to correct the account to $0 patient responsibility.”
“Even if no one is actively trying to collect, I’d still push for written closure so it doesn’t keep hanging over them,” she stated.
(M. Scott Brauer for KFF Health News)
Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical payments. Since 2018, this collection has helped many sufferers and readers get their medical payments decreased, and it has been cited in statehouses, on the U.S. Capitol, and on the White House. Do you have got a complicated or outrageous medical invoice you need to share? Tell us about it!