Woman Goes to Hospital to Have Baby Dies
Their Baby Died in the Hospital. Then Came the $257,000 Bill.
A New York family had good health insurance. Just the bills for their daughter's care started showing up and kept coming.
Brittany Giroux Lane and her husband, Clayton, are still caught in a billing dispute betwixt hospital and insurer later the decease of their daughter in 2019. Credit... Kholood Eid for The New York Times
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Brittany Giroux Lane gave nascency to her girl, Alexandra, a few days before Christmas in 2018. The baby had nighttime eyes and longish legs. She had also arrived about 13 weeks early, and weighed just two pounds.
Alexandra initially thrived in the neonatal intensive care unit at Mount Sinai West. Ms. Lane, 35, recalls the nurses describing her girl as a "rock star" because she grew so speedily. But her condition speedily worsened after an infection, and Alexandra died early on the morning time of Jan. 15 at 25 days erstwhile.
A flurry of small medical bills from neonatologists and pediatricians quickly followed. Ms. Lane struggled to get her chest pump covered past insurance considering, in the midst of a preterm birth, she hadn't gone through the health program'southward prior blessing process.
Last summer, Ms. Lane started receiving debt collection notices. The messages, sent by the health programme Cigna, said she owed the insurer over $257,000 for the bills information technology accidentally covered for Alexandra'south care after Ms. Lane switched health insurers.
Ms. Lane was flummoxed: It was Cigna that had received the initial bill for care and had paid Mount Sinai West. Now, Cigna was seeking the money information technology had overpaid the hospital by turning to the patient.
"For them, it'south merely business, only for us it means constantly going through the trauma of reliving our daughter's decease," said Clayton Lane, Alexandra's male parent and Ms. Lane's husband. "It means facing threats of financial ruin. It's so unjust and infuriating."
Medical billing experts who reviewed the example described it as a dispute between a large hospital and a big insurer, with the patient stuck in the middle. The experts say such cases are not frequent but speak to the wider lack of predictability in American medical billing, with patients frequently having little idea what their care will price until a pecker turns up in the mail service months later.
Congress passed a ban on surprise medical bills last year, which will become into effect in 2022. It outlaws a certain blazon of surprise bill: those that patients receive from an out-of-network provider unexpectedly involved in their care. There are enough of other types of bills that surprise patients, such as those received by the Lanes, that are likely to persist.
The Lanes describe the procedure of fighting their surprise bill as frustrating and Kafkaesque. They accept spent hours on the telephone, sent dozens of emails, and filed complaints with regulatory agencies in ii states.
"The letters mean I'yard constantly reliving the twenty-four hours, and that is such a hard infinite to be in," Ms. Lane said. "I feel and then frustrated that the hospital is making decisions about their own lesser line that influence our potential hereafter, and the memory of our child."
"This patient had no control over what was paid, and she has no control over whether it gets returned," said Susan Nothing, a medical billing expert with the business firm Systemedic Inc. "Sometimes things like this might be done to motivate the patient to contact the hospital, to go them to release the funds."
Americans are familiar with medical debt: About eighteen percent of them have an outstanding pecker from a infirmary, dr. or other type of provider in the wellness organisation. But about do not expect to get collection notices for bills that were already paid by their health plan.
Courtney Jones, a senior case managing director with the Patient Advocate Foundation, described working on cases in which patients have received similar collection notices for bills that the insurer, not the patient, was responsible for roofing. It usually happens with large medical bills, as with the Lanes, in which the insurer and hospital both take more at pale.
"They use information technology equally a tactic to put some pressure on the medical facility to refund the money," Ms. Jones said.
In a response to questions from The New York Times, Cigna said it "regrets" the letters and, in lite of the Lanes' feel, was now reviewing how it communicates with patients in such cases.
After the Lanes filed a complaint to a country regulator, Cigna sent them a alphabetic character stating they would no longer receive similar messages. "We empathize with the pain and confusion this experience has acquired for Mr. and Ms. Lane," it said in a statement. "We are working with our vendor to ensure this doesn't happen again to the Lanes or any other customer."
Ms. Lane received the get-go drove notice most xviii months later on her daughter's expiry. Her family had switched health plans in the middle of Alexandra'south infirmary stay considering of a change in employment.
The day Ms. Lane went into labor with Alexandra was supposed to be her last day at the first job, before starting a new position a few weeks later.
"I was terrified of getting hitting with a massive pecker, and then even while I was in labor I was updating my insurance with Mount Sinai," Ms. Lane recalled.
The hospital appeared to take both insurance plans on file — Cigna for 2018 coverage, and UnitedHealthcare for 2019. But Cigna accidentally covered the entire bill, overpaying $257,000 for the baby'due south intendance in January that should take been paid by UnitedHealthcare.
A Mount Sinai representative told the Lanes that UnitedHealthcare did in fact pay the bill — pregnant the nib was paid twice — only that did not resolve what appears to be a wider outcome that Mount Sinai has with Cigna.
When Ms. Lane received the first collection find, she contacted the infirmary. A patient services representative apologized and, over e-mail, wrote that "Cigna is going to receive dorsum" the overpayment. The third-party contractor that sent the alphabetic character, on Cigna's behalf, also told her the affair would be settled within days.
"I was supposed to get a confirmation; I didn't, but I was exhausted and I didn't follow up," she said.
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She realized the refund never happened when another collection discover arrived this summer, in early July. When she reached out to the hospital over again, a peak executive said she did not know when the refund would be released.
"I tin can't give you a response well-nigh the refund due to Cigna every bit it is being discussed equally part of a larger settlement agreement that is ongoing," Gail Spiro, Mountain Sinai's assistant vice president for patient financial services, wrote in an Aug. ten email. "I repent over again for how long it'southward taken to go you what yous need."
In a statement, Mount Sinai West said: "It is normal business practice to reconcile accounts with insurers in this manner. It is non typical for an insurer to pursue a patient in this style."
The Lanes have likewise had several phone calls with Cigna and ultimately filed a complaint with the insurance department in California, where their Cigna health plan was registered.
"Getting another letter was completely disruptive to our lives and our healing," Mr. Lane said. "It meant a lot of tears."
In a response to that complaint, Cigna sent the Lanes a letter of the alphabet stating the notices were sent in error by a third party vendor called HMS, which the insurer uses to monitor overpayments to hospitals. The messages were meant but to "inform" the family about the standing dispute with Mount Sinai, the Cigna letter of the alphabet said.
The notices that the Lanes received both informed them of the debt and asked them to "pay in full" within 30 days, using a slip at the bottom of the letter meant to be sent back with payment.
HMS declined to comment for this article, citing its patient privacy practices. The Lanes have requested that Mountain Sinai and Cigna provide statements on letterhead that the family does non owe this debt. No such letter has nevertheless been provided, although Mount Sinai says it will issue ane in coming weeks.
The Lanes said it was difficult to reconcile the kind and loving intendance their daughter received in the neonatal intensive intendance unit with the billing experience that followed.
"She died surrounded past people who cared for her so lovingly and wonderfully," she said. "We continue to back up the NICU directly, so we can help families that are there."
Since Alexandra's death, the Lanes have donated supplies to the Mount Sinai West neonatal unit, including infant rockers; books about caring for premature babies; and a photographic camera with a photo printer (taking baby pictures can be hard, they learned; phones are often not allowed because of hygiene concerns). The family is too now welcoming a new improver: They are adopting a baby male child.
"He's half dozen weeks now, and we're definitely falling in love," Ms. Lane said. "There are a lot of firsts, though, that should exist seconds — the first fourth dimension he smiled was a offset for him, but should accept been a second for us. In that location is a lot of joy, simply also a lot of secondary loss, and a lot of thinking of Alexandra."
Source: https://www.nytimes.com/2021/09/21/upshot/hospital-bills.html
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