An Elderly Woman’s Experience With Surprise Billing Highlights A Larger Problem

By Consumers For Quality Care, on November 19, 2019

In a story that is all too familiar for millions of people, one woman’s mother received surprise hospital bills after a visit to the emergency room. Carol Sottili’s long battle against her 94-year-old mother’s insurers and hospital over surprise bills began when she noticed her mother had recently paid a large check to an emergency room doctor.

It turned out the emergency room doctor who treated Sottili’s mother was out of her network, despite the fact that the hospital was in network. As Sottili writes in the Washington Post:

My mother, Pauline Gulotta, an Austrian war bride, was old-school. When she received a demand for payment from a doctor, she paid it without question. So when the bill arrived for services provided by a physician who, we eventually surmised, was not a participant in her Medicare Advantage plan, she wrote out the check and put it in the mail. That simple act would send me on a nine-month journey involving countless hours on the phone, endless letters and emails, and a formal complaint to the New York State Attorney General’s Office in an effort to get my mother’s money returned.

Because the hospital Sottili’s mother attended was in network, she didn’t question the ER doctor who treated her, a mistake that millions of hospital patients make every year. Recent studies have shown that the number of people who face these “surprise bills” is growing, and the bills are getting larger.

A recently published study by Stanford University researchers of 13.6 million ER visits concluded that, in 2010, 32.3 percent resulted in a surprise medical bill averaging $220. By 2016, that percentage had grown to 42.8 percent, with the average bill at $628. Inpatient jumps were even more substantial, according to the study. Of 5.5 million inpatient visits, surprise bill percentages increased from 26.3 to 42 percent, with the average out-of-network bill rising from $804 to $2,040.

Sottili began a long battle with her mother’s insurer and provider to get the money back, going through a familiar consumer nightmare of voicemail menus, lost paperwork, and roadblocks.

Her health insurance company pointed me to the provider, while the provider sent me back to the health insurance company. They both threw up privacy roadblocks, claiming they couldn’t talk with me as my mother’s health declined; copies of my power of attorney were lost and “appointment of representative” forms routinely disappeared.

The waters got even muddier when the insurance company tried to slough me off on an affiliated company that processed claims. Voice-mail menus became my diabolical purgatory. Meanwhile, more and more surprise bills arrived, emanating from three visits my mother made to the same emergency hospital, and phone calls threatening collection started.

Nine months later, after getting the New York State Attorney General’s office involved, Sottili finally received a check from the hospital for the initial surprise bill. By this time, her mother had passed away.

Sottili’s story is just one example of what is becoming a chronic problem. As the author of the Stanford study on surprise billing puts it, it has become very likely that the average person visiting the ER will face a surprise bill similar to the one received by Sottili’s mother.

“It’s obvious from our study that if you go to the hospital, there is a pretty good chance you’re going to be hit with a surprise bill,” said study co-author Michelle Mello, a professor of law and of health research and policy at Stanford. These bills hit the low-income the hardest, she added, pointing to a recent Federal Reserve survey that concluded 4 in 10 people would not be able to readily cover an unexpected $400 bill.