Consumer Charged Over $100,000 for Preapproved Hearing Implant
By Consumers for Quality Care, on August 14, 2024
One consumer recently detailed her ordeal in navigating complicated prior-authorization approval processes and hospital billing errors shortly after undergoing cochlear implant surgery, a procedure that had already been preapproved and told by her insurer it would be fully covered, according to KFF Health News.
Since her teenage years, Caitlyn Mai, a 27-year-old from Oklahoma City, had struggled with deafness in her right ear. Until recently, little could be done to help single-sided deafness patients like Caitlyn, but last fall, she learned about a new procedure – a cochlear implant surgery – that could allow her finally to hear on her right side. She decided to move forward with the procedure and obtained a prior-authorization letter from her insurer. The letter said that the procedure would be fully covered.
Her outpatient surgery at SSM Health Bone & Joint Hospital at St. Anthony was successful and her hearing improved, but soon thereafter she received a bill for nearly $140,000.
“I almost had a heart attack when I opened the bill,” said Caitlyn. “I’d even checked that all hospitals and doctors were in-network and that I’d met my deductible.” She had no idea why she was being billed at all, much less why she was being billed for such a staggeringly high amount.
Caitlyn started making all the calls to get answers, first to the hospital billing office, then to her insurer, UnitedHealth Group. This started a complex back-and-forth process, amounting to months of frustration. Caitlyn would eventually learn from UnitedHealth Group that the hospital incorrectly itemized its charges and billing codes. She then informed the hospital of these errors and how to fix the bill for UnitedHealth Group to cover the full charges.
It’s increasingly common for consumers, like Caitlyn, to get caught in the middle of billing issues between providers and insurers. Elisabeth Ryden Benjamin, Vice President of Health Initiatives at the Community Service Society of New York, a nonprofit advocacy organization, spotlighted the issue, saying, “It’s outrageous that the patients end up umpiring the decisions. And it’s outrageous that providers are allowed to bill patients while they’re haggling with the insurer.”
It would take nearly three months for a full resolution to Caitlyn’s situation, but ultimately her insurer covered the bill.
CQC applauds Caitlyn for her diligence in resolving this outrageous error. We urge increased oversight and accountability for medical providers and insurers to ensure no consumer faces undue financial stress over medical care.
