EAST HARTFORD, CT (WFSB) -- An East Hartford woman was recently blindsided by a $9,000 bill from a hospital she had never visited.
It all started with Ashley Stearns having a series of MRIs done after experiencing leg weakness, muscle spasms, and sight problems earlier this year.
Her doctor had suggested MRIs. As multiple sclerosis runs in her family.
He booked the appointments for her at Evergreen Imaging in South Windsor.
She initially wanted to go to a less expensive place but followed her doctor’s orders.
“When I asked what the cost difference was, it was a matter of a few hundred dollars,” Stearns said.
Her insurance company, managed by Cigna, told her the grand total for all three would be roughly $1,500.
“I had no idea how to figure out what that 20 percent was, but I knew that was going to be my co-pay,” Stearns said.
She got three MRIs done at Evergreen and the bill came. She saw the $1,500 for the MRIs and she paid her 20 percent.
“It ended up being about $172,” Stearns said.
However, when going through her “explanation of benefits page,” Stearns was blindsided by an $8,900 charge from Rockville Hospital.
“I’ve never been to that hospital, why would I have that charge,” Stearns asked.
She called the hospital and learned it’s because Evergreen is under the umbrella of Eastern Connecticut Health Network, better known as ECHN.
“I said to her, $8,900 because I used the room for a couple of hours? And she said ‘yes’,” Stearns said.
She added that nobody, from her doctor, to Evergreen, to ECHN, warned her at any point prior to getting the MRIs.
“I had no way of knowing. They couldn’t tell me at the prior authorization department and even if you were to call Evergreen Imaging, they bill separately,” Stearns said.
When the actual bill arrived, it came with this printed note, informing her after the fact, that if she had not gone to Evergreen, her expenses would have been less.
That’s when she called the Channel 3 I-Team.
“I wanted to do the interview because I wanted people to know because I was honestly shocked. I was shocked that this is the way it works,” Stearns said.
The question asking why the fee dramatically eclipses the amount of the actual procedure, still remains.
The I-Team reached out to ECHN asking for an explanation on how the fees are calculated and how they’re being relayed to patients.
ECHN responded saying “Many patients do not understand the benefits and limitations of their insurance coverage until the moment they need to use it. Patients who have chosen a high-deductible health insurance plan may not be fiscally prepared for the out-of-pocket costs associated with their coverage.”
They go on to say that “deductibles and co-payments are determined by the plan, not ECHN.” They also say their “financial services department works to explain the charges associated with the bill.”
In her case, Stearns said that transparency didn’t happen.
“They know exactly how much that’s going to cost and they have an opportunity to speak with your insurance company prior to the service when they got the authorization. To put a disclaimer on a statement is very stunning that it would be stated after the fact. What’s the purpose of stating it after the fact?” Stearns said.
Surprise bills are popping up in mailboxes across the nation.
According to a Kaiser Family Foundation Survey, four in 10 insured Americans say they received a medical bill in the past two years they thought was covered.
Congress is crafting legislation that would limit what patients get charged for out-of-network care, and make providers and insurance companies deal directly with each other, rather than putting the patient in the middle.
“A lot of folks go into bankruptcy over this and we should have a better system for it,” Stearns said.
After numerous calls between ECHN and her insurance company, Stearns is now on a payment plan and is stuck with $3,000 of the facility fee, which still doubles the cost of the MRIs.
“When you go to the vet with your dog, before they perform anything, they give you an estimated cost. When you go to the mechanic to get your car fixed, you don’t spend $10,000 without them letting you know how much it costs,” Stearns said.
Since the MRIs, Stearns has had a spinal tap, blood tests and another MRI done.
All of those procedures have been done elsewhere and she now asks the critical question -- Is there a facility fee or is the outpatient facility associated with a hospital?
Here are some things to keep in mind to help prevent this from happening to you:
- Know your insurance. Learn what your insurance company does and does not cover if you need emergency care. Also, learn exactly what your insurer classifies as “emergency care” because it differs.
- Know how much you’ll pay if you go out of network. These things can happen in an emergency. Sometimes you’re taken to a hospital out of network. And if it’s not an emergency, for example, if your doctor is referring you to a specialist, tell your doctor you only want to be referred to places within your network.
- Finally, if you did get a surprise bill, reach out to the Office of the Healthcare Advocate in Connecticut. You can file complaints there and they will help you understand your options and what’s next in the fight.