LITTLETON, Colo. — Contact7 is getting results for a Highlands Ranch woman who went in for surgery, only to be told she needed to pay $4,000 up front for a procedure she believed would be fully covered by her insurance.
For months now, Amy Sullivan has been fighting to get a refund, and consumer advocates say her story may be a sign of a problem with the system.
“I’m so over it,” said Sullivan, looking through piles of papers in frustration. “Can’t somebody just get this figured out?”
Last September, Sullivan showed up at Littleton Adventist Hospital for a planned procedure, but got a surprise at check-in.
“They just told me that I owed over $4,000 and how would I like to pay for that?” she remembered, saying she was surprised, but handed over her HSA credit card because she felt she had no choice. “I needed this procedure done and I couldn’t wait. And I figured, ‘OK in a week, it will be figured out,’ and so I just paid it and thought everything was going to be fine.”
But since then, everything has not been fine. More than four months later, she is still fighting Centura Health (which operates Littleton Adventist) to get a full refund.
“I have no options. That’s where the problem is…I have nowhere to go,” she said.
Meanwhile, Adam Fox, with the Colorado Consumer Health Initiative, said his organization has been looking into the case and believes Sullivan did not owe the hospital a co-pay or a deductible at all because the procedure should have been covered by her insurance.
“That really underlines how poorly this was handled from the get-go,” said Fox. “That’s why it’s even more concerning they were trying to collect a fee up front. It means they had no understanding of what kind of insurance she had and were doing this arbitrarily to try to collect money.”
After Contact7 started making calls, Centura Health sent a statement, saying the insurance company still had not paid the balance, but Sullivan will be getting a refund from Centura Health: “We regret the confusion experienced in this case as we were in process of getting the patient’s balance resolved with her insurance carrier. This can be a lengthy process at times, and we are still working through the reimbursement with her insurance, but we are issuing a refund to her Health Savings Account.”
“I’m grateful to you to have something done,” said Sullivan, who said she is only “cautiously optimistic” that her refund is coming. She said her fight isn’t over, though, because she doesn’t want this to happen to other patients.
“I had to go through all these avenues to make it visible for anyone to do anything,” she said. “It shouldn’t be that hard for us,” Sullivan said.
Meanwhile, Fox said if a hospital charges fees up front, patients should push back to have claims run through insurance first.
“You should know exactly what you owe, not a number pulled out of a hat,” said Fox, who said there may need to be legislation to address the issue. “If providers are trying to collect fees before running claims through an insurance plan, it would set up scenarios where consumers are trying to claw back money from a provider, and it gets really messy, really fast.”