Patient stuck with $28,000 hospital charge searching for billing errors and inflated costs to drive price down
CHARLOTTE, N.C. (WBTV) - A new company is providing patients with a service to fight back against crushing medical debt and a new law makes it less likely that people receiving emergency services are saddled with tens of thousands of dollars of bills.
It’s a shift that puts more power in the hands of patients to emerge from crushing medical debt that often leads to bankruptcy.
Daryl Procunier is currently staring down the barrel of one of those daunting dollar figures that seems almost insurmountable.
“They said $45,000 originally,” Procunier said.
“It was kind of like a phone drop moment.”
Procunier went to Atrium CMC but his insurance is through Bright Health, which is out-of-network with Atrium. His insurance paid for $7,400 and according to bills from Atrium, Procunier still owes nearly $28,000.
What makes it more frustrating for Procunier is medical records and primary care say there was no cause for concern and he has a clean bill of health. The only thing he’s left with from his night at the ER is the bill.
“I was forced to go and once I got in there and they just ran up the scoreboard, in my opinion,” Procunier said.
WBTV helped connect Procunier with a new software company called Goodbill that is analyzing bills and advocating on patient’s behalf to negotiate those bills down.
CEO Patrick Haig said that Procunier’s medical bills show some potential errors and room for driving that price down.
The company is still a startup and chose to focus on the Charlotte area because of the density of two major systems, Novant and Atrium, that service most of the customers and robust measures to make hospital costs publicly available.
“We’re at the early stages of a lot of what makes the healthcare system tick becoming more open and this one regulation is one huge step forward on that and allows companies like us to actually power consumers,” Haig said.
Haig and his team ran Procunier’s bill through their software looking for coding errors and inflated charges. Their early review found some possible areas for savings and negotiating, although Haig emphasized they will perform another audit of the bill to make sure their findings are accurate.
Procunier was charged $11,540 for what was called “Trauma response team” and Goodbill’s review recognized the cost was potentially inflated because Procunier was out-of-network.
“It’s a little odd is that if Daryl had just paid cash, that one specific line item, that cash price according to the hospital’s own pricing file that they are regulatory required to publish, will be closer to $5,700,” Haig said.
WBTV also identified other charges that are inflated compared to if Procunier had just been uninsured.
He was charged nearly $10,000 for three separate CT scans. Atrium’s cost estimator on its website shows the price closer to $4,400 for someone who is uninsured.
“Sometimes the craziness of the system is such that in some situations consumers might be better off just paying cash versus relying on insurance,” Haig said.
Haig says that after another audit of the bill, his team will try negotiating with Atrium to bring down the price of the bill.
Prior to working with Goodbill, Procunier said he worked out a payment plan with Atrium. He says at the current rate it would take him 100 months to pay it all off, although he is working with the hospital on financial assistance to offset some of those payments.
Procunier says not paying, is not an option.
“I would get sued in court at some point in time if I just stop paying,” Procunier said.
In an email response a spokesperson wrote “HIPAA guidelines prevent us from discussing any details” and “When issues or concerns are brought to our attention, we work with our patients to address them, including advocating on their behalf to resolve mistakes made by their insurance company or any other responsible payor.”
Procunier also points out that if his trip to the ER had been just six months later, he likely wouldn’t be facing such a daunting bill.
No Surprises Act
At the end of 2021, the No Surprises Act was signed into law, creating a powerful new tool to prevent patients from being hit with what’s called “balance bills” or “surprise bills.”
Balance or surprise bills are when a patient receives out-of-network service and then are sent a bill covering the rest of costs from the provider.
The No Surprises Act was issued to restrict surprise billing for patients who get emergency care and non-emergency care from out-of-network providers in most situations.
Specifically, in Procunier’s circumstance, balance billing is no loner allowed. People taken to an emergency room by an ambulance often don’t have a choice of what hospital they are sent to and can easily end up out-of-network, as Procunier did.
But the law only took affect after Procunier racked up the medical bills at Atrium.
“I was seeing that this wasn’t going to be a fight I could probably win,” Procunier said.
WBTV asked Atrium how many patients were in Procunier’s position, having to pay bills that would no longer be allowed under the No Surprises Act. The question was not answered.
Procunier’s insurance, Bright HealthCare also declined to comment for this story.
Under the No Surprises Act, insurers and providers will set prices for emergency services through arbitration. Patients might still have to pay in-network costs associated with a plan that’s covered.
That would still mean massive cost cutting from the bill Procunier currently has.
He points out that while he’s staring down the barrel of a bill he can’t afford, elected leaders in Mecklenburg County have been willing to provide tens of millions of dollars in tax incentives to Atrium.
“It feels a little insulting to be honest,” Procunier said.
Both the Charlotte City Council and the Mecklenburg Board of County Commissioners approved to reimburse Atrium and private developers $74.5 million in infrastructure public improvements, which includes a parking garage, to begin construction of an innovation district and medical school.
“The honorable thing to do would be to work with those people or just waive the bills,” Procunier said.
“There’s an ugly side to the business, and it shouldn’t be like that.”
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