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One child spent 36 days in a network hospital. Why did his parents receive a hefty bill?

Brenna Kearney was seven months pregnant in December 2019 when she experienced what she thought were nasty flu symptoms.

Her husband, Casey Trumble, drove her from their Chicago home to her OB-GYN’s office at Northwestern Medicine Prentice Women’s Hospital downtown. With her blood pressure suddenly elevated and protein in her urine, she was diagnosed with preeclampsia, a potentially fatal but treatable pregnancy complication. Doctors admitted her to the hospital, saying she could expect to stay up to six weeks and have an induced birth.

Then Kearney developed a severe headache and her platelet count plummeted, signs that she was experiencing a rare and life-threatening type of preeclampsia and required an immediate birth by cesarean section.

Kearney’s daughter Joey, born at 31 weeks, was put on a ventilator and moved to the hospital’s NICU. Small but healthy, she slowly began to breathe on her own and eat normally. She was discharged at the end of January 2020 after 36 days in the NICU.

Then came the bill.

The patient: Josephine “Joey” Trumble, now 3, was covered by her mother’s health plan through her employer, an advertising agency. For 2019 it was an Aetna plan and for 2020 it was a Blue Cross and Blue Shield of Illinois plan. Both policies were fully insured plans governed by Illinois law.

Medical service: Provided neonatology medical services in January 2020. Joey required tube feedings and ventilator assistance to provide oxygen.

Service provider: Ann & Robert H. Lurie Children’s Hospital in Chicago, whose doctors treated Joey at Northwestern Medicine Prentice Women’s Hospital. Ownership-wise, Lurie is independent of Northwestern Medicine, but is physically connected to Prentice Women’s by an enclosed walkway. Lurie has a partnership agreement with Northwestern Medicine to provide neonatology and pediatric services to Prentice Women’s patients.

Total bill: Aetna paid nearly all of Joey’s and his mother’s hospital and medical bills in December, while Blue Cross collected nearly all of Joey’s hospital bills in January. Lurie’s medical bills in January totaled $14,624.55, of which the family was asked to pay $12,531.58 after payments from Blue Cross.

What gives: It took Kearney months of calling Blue Cross and the two hospitals to find out why Lurie billed more than $14,000 for medical services: Doctors treating her daughter at Prentice Women’s — a network hospital under her health plan — they actually worked for another , out-of-network hospital.

Illinois law prevents insurers from charging out-of-network patients for neonatal care at network hospitals.

Kearney said no one had told her or her husband that Lurie’s doctors were treating their daughter. She said the family has never signed an agreement that allows them to receive care from out-of-network doctors.

While it didn’t happen here, many patients unknowingly sign large financial agreements — saying they’ll pay for almost anything their insurance doesn’t cover — into the piles of paperwork they receive upon admission to the hospital. In many cases they are simply asked to sign on a screen, without seeing the document.

Blue Cross agreed to pay Lurie the network fee for doctors’ services, reducing the bill to about $12,500, which Lurie expected the family to pay.

In November 2020, Kearney began receiving letters from ICS Collection Service, a collection agency.

“Talking to Blue Cross was impossible, and Lurie said it’s not their problem and he just wanted to put us on a payment plan,” Kearney said.

Joey’s 36-day stay in the NICU occurred before the federal government implemented the No Surprises Act, barring surprise out-of-network billing. However, a state law was in effect which prohibited this.

Since 2011, Illinois law has prohibited insurers from charging out-of-network fees for neonatologists, anesthesiologists, and certain other physicians when patients are treated at network hospitals.

Kearney said he repeatedly mentioned the law to representatives for Lurie and Blue Cross, who denied any knowledge of the provision.

“It definitely appears that under the 2011 law, Brenna can only be billed for network cost sharing,” said Kathy Mikos, a registered nurse and patient advocate at Navocate Group in Woodridge, Illinois, who is not involved in the Kearney case.

In December 2020, an insurance broker working for Kearney’s employer convinced Blue Cross to pay all out-of-network expenses for Lurie doctors, leaving the family $289.63 in debt for coinsurance, which they promptly paid .

Having spent nearly the first year of her daughter’s life battling medical bills since her birth, Kearney thought the ordeal was over.

Then, last month, she received a call from the collection agency, again demanding payment of the full out-of-network rate for Lurie’s medical services provided to her daughter three years ago, the bill she believed Blue Cross had paid. .

It took Kearney five hours on the phone to piece together what happened. Blue Cross had actually paid the out-of-network expenses in December 2020, but, two days later, took the money back, ultimately paying Lurie’s doctors the in-network fee only.

A rep for Lurie said Kearney and her husband still owed thousands of dollars. A Blue Cross representative suggested she set up a payment plan.

“I was at my wit’s end and didn’t know how to fight it anymore,” Kearney said.

Lurie, Blue Cross and Northwestern Medicine did not respond to KHN’s numerous requests for comment. Lurie cited patient privacy, even though he received a release from Kearney under the Federal Health Insurance Portability and Accountability Act, or HIPAA, which authorized the hospital to discuss Joey’s case with KHN.

The resolution: After KHN contacted Lurie and Blue Cross, a Lurie representative called Kearney offering to accept payment at network rates after all.

Kearney said Tracy A. Spicer, manager of Lurie’s consolidated services, told her Lurie has a “long-standing policy” of accepting in-network rates for Lurie’s medical services provided by Prentice Women’s. Spicer later described it as a “long-standing courtesy,” then explained that acceptance of network rates was subject to “case-by-case considerations,” Kearney said.

Spicer said the family owed about $3,000, for their coinsurance fee, and offered to set up a payment plan.

A day later — following further requests for comment from KHN — Spicer called Kearney and said he would remove all medical bills for his daughter’s treatment. Spicer did not return KHN’s call request.

“I’m sure I’m not the only person still dealing with this” kind of situation, Kearney said.

Kearney filed complaints with the Illinois Department of Insurance and the Illinois Attorney General’s Office. The attorney general’s office told KHN it never enforced the 2011 law that bans certain out-of-network billing.

Presented with the facts of Kearney’s case, State Senator Ann Gillespie, who sponsored a 2022 state law expanding consumer protections against out-of-network bills, told KHN she plans to contact Lurie, Blue Cross and Northwestern Medicine to ask about their billing agreement and whether they comply with state law.

“We’ll see if that was a scheme and if they need to look back and see if the refunds are warranted,” Gillespie said.

The attorney general’s office told KHN it will investigate Kearney’s complaint, including whether Lurie violated the state’s Consumer Fraud and Deceptive Business Practices Act by telling her it was extending a “courtesy” by charging her only on-net rates, when that is what the 2011 law requires. The insurance department also said it would investigate the complaint.

The takeaway: Even enterprising consumers who seem to have the law on their side, like Kearney, can find themselves in a time-consuming and losing battle with medical billing bureaucracies and face collection actions.

Gillespie, the state senator, said Lurie, Northwestern Medicine and Blue Cross should have known about the state law. He said patients who believe they were improperly charged should file complaints with their state’s insurance department, which may trigger a larger investigation.

The federal No Surprises Act, which went into effect last year, prohibits health care providers or insurers from billing patients for out-of-network medical expenses at an in-network hospital unless the patient formally consents to an out-of-network doctor. To be safe, patients should ask their treating physicians whether they are in or out of the network, even in a network hospital.

Although federal law offers patients new protections from out-of-network bills, many Americans still face problems from before the law took effect, said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy. Illinois is one of the relatively few states that had earlier laws to protect consumers.

Additionally, some out-of-network doctors continue to bill patients, despite new federal protections. So know your rights. Mention the new law. And don’t sign the check.

KHN extension (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the top three operating programs of KFF extension (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides information on health issues to the nation.

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