He said he did everything to avoid getting a surprise medical bill. It didn’t work.

Posted at 4:25 PM, Sep 24, 2019
and last updated 2019-11-06 21:04:06-05

RICHMOND, Va. -- JR Morgan lives with chronic pain, but rarely visits a doctor unless he’s forced to do so. Even then, he’s inclined to refuse treatment if he’s given the opportunity.

"I hate doctors. I hate needles," the 62-year-old Lancaster County man said.

The disdain is potentially a product of past surgeries to repair shattered bones in his neck and right arm. This summer, his family finally convinced him to see an orthopedic specialist when the pain became severe.

Prior to making the one-hour drive, Morgan researched the cost of the appointment and weighed whether he could afford to pay the bill from his monthly disability income. He made multiple phone calls to the doctor’s office and his health insurance company, Humana, and decided he could pay the copay.

The visit was not a success.

“He says ‘you've got 38 screws in your neck,’” said Morgan. “He told me 'there's nothing I can do for you. Nothing.'”

JR Morgan

JR Morgan

Morgan returned home without making any progress on controlling his severe pain. Shortly after the visit, he was surprised to receive a bill for $342.96.

“I had called Humana three times prior to the visit and was told three times I would only owe $45 co-payment for each of these visits,” Morgan wrote in a grievance he filed with Humana.

Humana replied to Morgan in writing on August 13, acknowledging that its customer service associates did not explain Morgan would need to meet a $750 deductible before receiving coverage.

Having little experience with using his insurance for routine doctor’s visits, Morgan said he was completely unaware his plan even had a deductible.

“I would not have gone if I had known there would be more than the $45 copay they told me about. I couldn’t afford it.”

The CBS 6 Problem Solvers reached out to Humana for more information. The company declined to comment on the specifics of Morgan’s case, but the bill has now been paid in full and the doctor’s office told him he owes nothing.

Humana is one of the nation’s largest health insurance company and administers the federal government’s Medicare program.

In a written statement, a representative for Humana did provide the following tips for CBS 6 viewers:

We always recommend that when seniors and their families are choosing a Medicare health plan that they meet and talk with a licensed health insurance agent about their health benefits options.

The agent will go over the plans, premiums, networks of doctors and hospitals and benefits available in their community. Medicare annual enrollment for 2020 is Oct. 15 through Dec. 7, 2019.

Humana also encourages members to consult with their primary care physician before seeing a specialist to ensure the specialist is in their plan’s network, and to best coordinate care.

If Humana Medicare members in the Richmond area have questions or concerns about their coverage or benefits, they can contact Humana locally at 804-253-0060, and schedule an appointment to meet with one of our licensed agents.

If you have received a surprise medical bill, let us know here. If we think we can help, we will get in touch and get to work on your bill.