Woman went to in-network hospital, says she was billed $15,000 for out-of-network treatment

Updated: Jan. 26, 2021 at 3:16 PM EST
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CHARLOTTE, N.C. (WBTV) - When you require surgery or hospitalization, most of us look for an in-network hospital covered by our insurance.

An Indian Trail woman says she followed all the rules and went to an in-network hospital - only to be hit with a huge bill.

“I had surgery five times in 2020, and thought I was covered for anesthesia but received a bill several months later,” said Jenna Wolbert.

Wolbert went to Novant Health Presbyterian Medical Center for surgery between May and September 2020.

Wolbert specifically went to Novant because she was told it was an in-network hospital covered by her insurance, UnitedHealthcare.

But in January, she was shocked to see the anesthesia bill from Providence Anesthesiology Associates for $15,744.58.

Her insurance UnitedHealthcare only covered $782.42; now she owes the rest.

“Every time I went in, except for the emergencies, I went through the same thing,” Wolbert said. “My insurance card, all the questions, the paperwork making sure that I was authorized through my doctor’s office, making sure I was authorized with my insurance. All my due diligence - had no idea that anesthesia would not be covered.”

Wolbert went to UnitedHealthcare’s online portal and found a statement showing inpatient hospital stays include services for anesthesiologists.

WBTV Investigates, three months ago, documented the exact same problem with another UnitedHealthcare insurer at a different hospital.

To make this even more confusing, PAA, on its website, indicates that UHC terminated their contract effectively March 1, 2020.

That means when Wolbert went in for surgery in May, she had no anesthesia coverage but says no one told her.

Providence Anesthesiology Associates indicated:

“Providence Anesthesiology is fiercely opposed to the surprise billing UnitedHealthcare initiated by unexpectedly dropping us from their provider network last year. We’re one of the numerous specialty practices throughout North Carolina and across the country that United has removed in an effort to increase their profits at the expense of patients. Providence is fighting on behalf of these patients by filing appeals with United and claims with the North Carolina Department of Insurance, and all our patients should know that we’re not asking for any payments until each individual situation is resolved.”

UnitedHealthcare refused an on-camera interview, but based on WBTV’s calls, is now taking a second look at Wolbert’s bill to make sure she is not stuck with this $15,000 cost.

In a statement, a UnitedHealthcare spokesperson indicated:

“Exorbitant surprise bills are stressful for patients and drive up the cost of health care for everyone. That’s why Congress passed legislation that will prohibit providers from surprise billing their patients starting in 2022. What’s most important for our members to know is that they should contact us if they receive a surprise bill from Providence. We will work directly with Providence to negotiate a reimbursement rate so our members are not held responsible for paying the bill.”

Novant acknowledges the problem and impasse between UHC and PAA. In a statement a spokesperson stated:

“Novant Health is working to ensure our impacted patients are notified of the changes prior to a procedure as best we can. We understand Providence Anesthesiology Associates is also doing what it can to ensure patients are not burdened with higher-than-expected charges for their services.

Unfortunately, the impasse in negotiations between UHC and PAA has our patients stuck in the middle. UHC must resume negotiations, now, and work with PAA to find a reasonable solution. We continue to share our patients’ concerns and frustrations.

Under all circumstances, it’s imperative patients feel empowered to confirm with their insurance provider what is in-network by facility – and also by physician. We have a team of financial navigators who are available to help patients better understand their anticipated health care expenses, including what questions to ask of their insurance provider prior to a procedure.

If a patient has received a bill from PAA, or an estimate of charges from UHC, they should call PAA prior to making a payment at 704-749-5801. This will ensure any and all options to reduce their bill are exhausted.”

Patients like Wolbert feel overwhelmed, but she isn’t letting that stop her.

“I want to find other people that this has happened to and I want to work together to get this taken care of.”

When WBTV spoke to Insurance Commissioner Mike Causey in October, we asked if there were any other cases involving UnitedHealthcare.

Causey said he couldn’t provide specifics since his office is involved legally. However, this time when we reached out he said:

“Surprise billing – whether it shows up in health care or prescription coverage —is a transparency issue I am working on right now. Currently, our law provides consumers some protections with insurers when this type of billing arises – if their health insurance policy is one we regulate – not a self-insured plan. I endorse the federal laws Congress recently enacted that will take care of surprise billing next year. Until then, the Department’s consumer services division will continue to work to resolve consumer complaints that involve surprise billing and will ensure insurers are complying with our statutes that help protect insureds in these situations.”

As previously noted, Novant Health says, if a patient got a bill from PAA, or an estimate of charges from UHC, they should call PAA at 704-749-5801.

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