PA Couple Fights Surprise Bill

By Consumers For Quality Care, on March 5, 2019

A Pennsylvania couple has paid a medical bill “in protest” after spending seven months trying to get the bill corrected, The Inquirer reports.

Dave Southard got his first colonoscopy at age 64. Colonoscopies are supposed to be fully covered for consumers between 50 and 75 years old who have private insurance.

After Southard received a surprise bill for $302, he and his wife, Leslie Prahar, contested the bill.

Prahar called their insurer, Independence Blue Cross, but the company told her that the bill had been processed correctly on their end. They claimed that if there was a mistake, it was the doctor’s responsibility to fix it. The couple spent the next few weeks trying to get the bill fixed, to no avail.

“I felt like I was banging my head against the wall. Nobody was listening to me and I had to reach out to somebody with more power than me,” she said.

Crozer Keystone Health System which performed the procedure charged Southard’s insurance a total of $2,143. That included a charge of $1,289 for a colonoscopy with a removal of a tumor, polyp, or lesion by snare and $854 for a colonoscopy with a biopsy. It is common for doctors to use multiple charge codes for multiple removals. The first of the two charges was billed using a “modifier code,” which indicates that the procedure was preventive, even when a polyp is removed.

The second procedure did not have a modifier code and was processed according to the cost-sharing terms of Southard’s plan. Independence’s negotiated rate was $508. The plan paid $206 and Southard got a bill for $302.

Southard doesn’t understand why the second charge was not billed with a modifier code, because Crozer would not explain it to him or The Inquirer. They tried to have the hospitals billing office clarify the error, but received no response.

In January, after fighting the bill for seven months, they believed that they had no choice but to pay up. It had been sent to a collections agency in September and the retired couple didn’t want their credit rating to suffer.

She wrote on the form accompanying her check, “Paid in protest.”

The couple has said that the experience has changed their mind about colonoscopies.

“He’ll never get another one,” Prahar said. “I might even think twice about it. It’s just ridiculous.”