Gaston County woman receives medical bill more than a year later, too late to file appeal

Updated: Jan. 10, 2020 at 5:47 PM EST
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GASTON COUNTY, N.C. (WBTV) - A Gaston County woman spent nearly eight months disputing a medical bill she received nearly a year and a half after she received emergency room care. After contacting WBTV, her medical bill was forgiven.

Teresa Tucker visited Atrium Health Kings Mountain in December of 2017.

“All of a sudden I got so sick. I couldn’t even get my breath and I was in my chair and I couldn’t hardly even get out of the chair,” Tucker explained.

She says she had pneumonia in both of her lungs. She was in the hospital for four days and was happy with her care. Having already met her deductible earlier that year, she didn’t expect to pay anything for the care she received.

In January of 2018, she received an explanation of benefits (EOB) from her insurer. Insurance covered more than $21,000 of the care she received. The EOB stated she may receive a bill for the remaining amount from Atrium Health. But Tucker says she never received a bill, until nearly a year and a half later.

“So in May of this year when I got a bill, 18 months later, I was like what in the world is this,” Tucker said.

She called the hospital’s billing department right away to dispute the charge since she knew she met her deductible before this visit.

“Why did you wait 18 months to even bill me for this? And she said well we had to go through all these different processes. And I said, well no one even notified me or anything… I didn’t get notification that I even had a bill. I didn’t know,” Tucker said.

Since May of 2019, she’s been receiving the same bill for nearly $4,000 each month. Each month, she called her insurance provider and Atrium Health to dispute the charges.

In a document provided by her insurance, they explained they didn’t cover the entire bill because the overnight stay was not pre-approved. Tucker says she shouldn’t have had to get pre-approval since she was following her doctor’s advice and it was an emergency.

“I couldn’t even really communicate at that point,” Tucker said.

Here is why the timing of the hospital bill mattered: when she filed an appeal with her insurance company, they responded by saying the time to appeal had already expired. So, she continued calling Atrium Health.

“The last time I called her she said, ‘no it’s your bill’. And I’m like, nobody’s taking responsibility? And she said, no it’s your bill. So that’s when I called you (WBTV),” Tucker said.

We reached out to Atrium Health on Tucker’s behalf. Three days after we contacted them, Tucker received a call from Atrium Health.

“She called me back apologizing for the whole incident, for my time I’d spent on the phone with them and because the bill was 18 months after the fact, and because it wasn’t pre-certified it was not my fault and they should not have been billing me and they were very sorry. And the bill was taken care of,” Teresa said.

WBTV followed up with Atrium Health to ask why it took nearly a year and a half to bill Tucker, why hospital staff didn’t handle pre-certification requirements, and why the issue wasn’t resolved prior to WBTV stepping in.

A spokesperson for Atrium Health responded with the following statement:

“Our goal at Atrium Health is that our patients have the best experience possible. This not only includes during care, but with every single encounter, including conversations about billing. On rare occasions, actions by us, insurance companies or vendors we work with result in a patient experience that falls short of our goal. When that happens, we want to make it right for our patients and review procedures to help prevent a similar situation from occurring in the future. We are pleased we were able to do that in this instance.”

Tucker was relieved that her bill was forgiven, but she worries that others in her situation may pay the bill even if they don’t owe it.

“If that was my bill, I’d be happy to pay it but that is a lot of money and it’s because of someone’s mistake, not mine,” Tucker said.

WBTV contacted the Patient Advocate Foundation for tips on what patients can do if they can’t solve a billing error on their own.

The Patient Advocate Foundation is a nonprofit that provides education and free case-management to patients. Caitlin Donovan with the nonprofit says to try to get your insurer and provider on a three-way-call to resolve the billing issue.

“The hospital is going to want the insurer to pay their side of the bill mostly because the insurer will pay more than you will, so it is in the best interest of the hospital to get on that call and try to resolve it,” Donovan said.

If that doesn’t work, she recommends contacting a third-party to get involved for you. If you are on Medicare or Medicaid, she says your local lawmaker may step in for you, or organizations that provide free case management like the Patient Advocate Foundation. Donovan says that, depending on the amount of your bill, you could also contact an attorney.

“Anytime you can pull someone else in, if that’s going to be a bad look for the hospital for them to pursue it, that may be worth your while. But also remember, you also want to be kind of diplomatic because you are dealing with people you ultimately want to work with you so not escalating to the point where they are just angry is something to keep in mind,” Donovan said.

Donovan also recommends not paying a medical bill until you have an explanation of benefits from your insurer. She says to make sure the amount listed on the bill matches what the EOB says is your responsibility. If the numbers do not match, there may be an error.

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