In-network hospital, out-of-network doctor. Problem Solvers help her clear $1,000 ER bill

Posted at 11:44 PM, Oct 08, 2019
and last updated 2019-11-06 21:05:21-05

HENRICO COUNTY, Va. -- Lynette Jackson’s visit to the emergency room for abdominal pain turned into a much bigger time commitment than just waiting to be seen by the doctor.

“I was getting nowhere,” Jackson told the CBS 6 Problem Solvers of her attempt to settle a surprise bill sent weeks after her treatment.

In July, the retired school administrator went to Henrico Doctors Hospital, an in-network hospital for her insurance plan through Anthem. In late August, a bill for $1,037 arrived from a corporation representing the attending physician. Jackson called her insurance company and says she was told the doctor was out-of-network.

“Someone came around with a computer on a cart to take my co-pay. They knew what my insurance was,” said Jackson. “It shouldn’t be that difficult to look and say, ‘oh you’re supposed to see this doctor but they might not be in your network.’”

Calls to the phone number listed on the bill are routed to a payment center in Tennessee, whose representatives could only tell her to contact her insurance company. Jackson filed an appeal with Anthem but didn’t hear back from them, other than confirmation her appeal was received. Then she wrote a letter to the physician, asking him to adjust her bill to the amount her insurance plan would have paid him as an in-network provider.

“It seems grossly unfair that an individual should have to pay 90 percent more than what a huge insurance company would have to pay,” she wrote in the letter mailed to the hospital.

The Problem Solvers reached out to representatives from Anthem and Hospital Corporation of America (HCA), the parent company of Henrico Doctor’s Hospital. Within days, Lynette received a message from the billing company saying they would mark her account as paid.

HCA has not sent a written response regarding Lynette’s case. Anthem sent the following statement:

“Anthem is committed to making health care affordable and simpler by constantly working with our hospital partners to help ensure all physicians who perform health care services within those hospitals are in-network providers. We contacted Henrico Doctors Hospital and understand Ms. Jackson’s billing issue has been resolved.”

None of the companies involved have explained how the issue was resolved, or what lead to a bill being mailed in the first place.

“These are giant corporations that you're dealing with and I'm just a person stuck in the middle trying to be treated fairly,” said Jackson. “I feel like I, as a customer and patient in that hospital should have been told that the doctor was not in my network.”

Director of public relations for HCA Virginia sent the following response:

"Ms. Jackson’s claim was incorrectly processed as out of network by her insurance company, although the physicians were in network. Since the bill in question did not originate from the hospital, we are unable to see the account level specifics. We are aware that the insurance company has since re-processed her claim correctly.

At Henrico Doctors’ Hospitals, we stand by our patients and are committed to assisting with individual matters until they are fully resolved. While our processes at Henrico Doctors’ Hospital did not attribute to the network system issues experienced by Ms. Jackson, we are sorry to see that she faced any difficulties. We are happy that her account has been fully resolved to the satisfaction of all partiesWe remain dedicated to serving our patients."

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