Close to midnight on Nov. 12, 2022, Bisi Bennett was sitting on the couch in her own pajamas and feeling uncomfortable. She involved seven months pregnant together with her first child, Dorian, and also the believed that she might be in labor didn't even cross her mind.
Then, she felt a contraction so strong it knocked her from the couch. She shouted to her husband, Chris, plus they ran to the car to begin the 15-minute drive to AdventHealth hospital in Orlando, Florida. About halfway with the trip, Bennett gave birth to Dorian in her family's Mitsubishi Outlander. Her husband kept one hand on his newborn son's back and something hand around the wheel.
Born breech, meaning his head emerged last, Dorian wasn't crying at first, and the terrified new parents feared something was wrong. Chris Bennett turned on the SUV's flashers and flagged down a passing emergency vehicle. The EMS team escorted the household to the hospital.
“He was still being linked to me using the umbilical cord when they rolled the two of us together in to the hospital,” Bisi said. “They cut the cord, and also the last thing I heard was, 'He includes a pulse,' before they wheeled me away.”
“I just cried tears of relief,” she said.
Dorian stayed in the neonatal intensive care unit until Jan. 7, 2022, for nearly two full months. While Dorian was at a healthcare facility, Bisi wasn't worried about the cost. She works in the insurance industry and had carefully chosen AdventHealth Orlando because the hospital was close to her house as well as in her insurance network.
Then the debts came.
The Patient: Dorian Bennett, an infant born 8 weeks premature. He's medical health insurance through his mother's employer, AssuredPartners, where she functions as a licensed property insurance professional.
Medical Service: A neonatal intensive care unit stay of 56 days. Dorian needed highly technical, lifesaving respiratory and nutritional care until his organs matured. Also, he received laboratory, radiology, surgery, cardiology and audiology services and coverings.
Service Provider: AdventHealth Orlando in Orlando, Florida. It is a part of the AdventHealth system, a sizable nonprofit and faith-based group of health care providers with locations across Florida and many other states.
Total Bill: AdventHealth Orlando billed $660,553 for Dorian's NICU care. Because of an insurance coverage snafu, the “patient responsibility” area of the bill delivered to the Bennetts was $550,124. They were offered a payment repayment plan of $45,843 a month for 12 months.
What Gives: Underneath the 2010 health law, nonprofit hospitals are required to provide financial help to assist patients pay their bills, and payment plans can be a part of that assistance. But the Bennett family's experience shows the system continues to be not even close to friendly to patients.
The installment amount provided to the Bennetts – $45,843 – resembles an annual salary greater than a reasonable monthly payment. The laughably unrealistic plan was apparently automatically generated by the hospital's billing system. A spokesperson for the hospital, David Breen of AdventHealth, didn't answer KHN's questions about its billing software or why a five-digit monthly payment wasn't flagged by the hospital as a problem that might need extra attention.
The size of the Bennetts' bill comes from two overlapping issues: Baby Dorian was born in 2022 and needed hospital care into 2022, and Bisi Bennett's employer shifted its health plan to a different company in January 2022. She informed AdventHealth concerning the change.
As someone who works within the insurance industry, Bennett was confident that she understood the mix-up which the control of over fifty percent a million dollars was unjustified.
But as Dorian turned a year old recently, the household still had bills pending and a tangle of red tape to battle.
AdventHealth bundled the 2022 and 2022 dates of Dorian's NICU stay and then billed both insurance coverage for the whole stay. Both insurance plans said the balance contained dates of care when Dorian wasn't covered, so neither paid a healthcare facility. The shift from one year to the next flummoxed three large businesses, which seemed unmotivated to resolve the issue quickly.
“A bill this huge is a big crisis for the family, but it's not really a huge crisis for the insurance company or a healthcare facility,” said Erin Fuse Brown, an associate professor of law at Georgia State University who studies healthcare policy.
In 2022, Dorian was covered within UnitedHealthcare plan, which for in-network providers had a $6,000 deductible and $6,000 out-of-pocket maximum for your loved ones.
In 2022, Bisi Bennett's employer switched its third-party administrator of their self-funded plan from UnitedHealthcare to UMR. The deductible and out-of-pocket maximum didn't change.
Although UMR is a member of UnitedHealthcare, the 2 companies didn't communicate well concerning the case.
“It's suggestive of all of the ways the machine fails the individual,” Fuse Brown said. “Even the one that does everything right.”
Through the nearly yearlong fight within the bill, the Bennetts were also taking care of Dorian, who left the hospital with lingering gastrointestinal issues, and managing Chris' treatment for stage 4 neuroendocrine cancer, which was diagnosed in April. At one point, Bisi said, she felt she was going insane.
“They're responsible for billing, and I shouldn't be the main one needing to tell them, 'Bill my one insurance for dates in 2022 and bill my other insurance for dates in 2022,' however i did,” she said. “I kept having the same conversation again and again.”
Resolution: Bisi Bennett immediately noticed and understood the calendar issue when she received the billing statements in spring 2022. She started by calling a healthcare facility and was told the issue could be corrected in March. Yet, in September, she got the same half-a-million-dollar bill.
UnitedHealthcare spokesperson Maria Gordon Shydlo, who also fielded KHN's questions for UMR, said the insurer told AdventHealth to revise the balance with correct dates in the spring.
Breen, the spokesperson for AdventHealth Orlando, confirmed to KHN the billing error stemmed in the alternation in insurers from 2022 to 2022. Inside a statement, Breen said medical billing could be a complex process and also the hospital “understand[s] this has been a confusing and challenging experience for Ms. Bennett, and we apologize for that frustration it has caused.”
AdventHealth Orlando didn't submit a revised bill with corrected dates until KHN contacted the hospital in October 2022.
After UHC and UMR reprocessed the 2022 and 2022 claims, the original bill in excess of $550,000 was knocked right down to $300.
In his statement, Breen said that the Bennetts' case sparked AdventHealth to identify and address issues in the system which a healthcare facility intends to improve the billing and communications process for future patients, particularly when there's a change in insurance.
The Takeaway: A lot of our fragmented healthcare system is automatically, with billing software that generates confusing or, in this instance, absurd bills and payment plans.
Bisi Bennett did everything right: She chose an in-network hospital and informed it of the changes to her health insurance. She followed up when she saw there was an error. But her case didn't reach an answer until a reporter called on her behalf.
If you are fighting a bill that you simply believe contains a mistake, call all the entities involved – the hospital, insurers, other providers – and don't forget about your company's recruiting department. It may be in a position to pressure insurers to resolve an error faster than you can.
Most states have a department of consumer services that can help you file a complaint with the appropriate oversight entity. Staff members at state agencies will help you figure out what is happening. Tell the medical providers you are reporting these to the state.
Still, it is a frustrating, uphill battle, particularly when patients have improper bills hanging over their heads for a lot of months and are at risk of having the bills sent to a group agency or having their credit rating dinged. There must be far more transparency in billing along with a set time limit for dispute resolution, experts say.
“This shows how little leverage or power a patient has in cases like this,” Fuse Brown said. “You almost have to go away from system and put external pressure.”
Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical expense you want to share with us? Tell us about this!
Victoria Knight:
vknight@kff.org,
@victoriaregisk
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