The Salida veteran underwent two emergency operations. Then I received an invoice for $80,000

In late August 2019, Shannon Harness felt severe pain in the lower right side of her abdomen. appendicitis..

He booked it in the county’s only hospital emergency room: The Heart of the Rockies Regional Medical Center in Salida, Colorado. After a CT scan, the doctor told Harness that he had acute appendicitis and needed immediate surgery.

That night, the surgeon performed an appendectomy and released the harness the next day.

But after a few days, Harness felt a sharp pain where his appendix was. The pain increased until he shouted to the floor.

“It was anxiety,” said his partner Eliza Novic Smith. “He has a fairly high degree of pain resistance,” considering previous injuries from military service and mountain biking.

Harness returned to the hospital and another CT scan revealed a brick-sized thrombus floating in the pelvic area. Clipping and staple According to his surgeon, appendix tissue at the first surgery. He will need another surgery to check the cause of the bleeding and remove the blood clot.

After another four days at the hospital he returned home. It took a few months to fully recover.

Then came the bill.

patient: Shannon Harness, 39, operations manager for a company that builds mountain bike trails nationwide, and a veteran of the Marine Corps. Harness had no insurance at the time of this incident.

Total unpaid: The initial surgery cost was $80,232 for both surgeries — the initial surgery cost $35,906 and the thrombosis surgery cost $44,326. These amounts do not include payments to surgeons, anesthesiologists, pathologists or radiologists.

Service Provider: Heart of the Rockies Regional Medical Center, Nonprofit Critical Access Hospital In Colorado where surgery was done. Anesthesia, radiology and pathology were performed by other providers.

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Medical services: Laparoscopic appendectomy followed by a second surgery a few days later to eliminate complications.

What to give: Uninsured patients are very vulnerable to exorbitant bills. It is difficult to negotiate with a hospital without the power and bargaining power of an insurance company. Worse, uninsured patients advocate affordable healthcare in California, where insurers or government programs are often charged three to four times more than they pay for the same services. Anthony Wright, executive director of Health Access California, an organization that

“As someone who is uninsured, you’re getting a non-negotiated rate,” Wright said, drawn from the hospital’s master price list. Insurance companies typically pay a fee that is a small fraction of that cost.

Harness was uninsured for 7 years before this incident. His employer did not provide insurance, and the affordable medical legislation he qualified was costing $350 a month, which he did not have.

One option for uninsured patients is a hospital financial assistance program, Some state requirements.. In Colorado, all hospitals are expected to have a comprehensive charity care program for uninsured patients earning less than 250% of federal poverty levels.

Rocky’s hospital center decided Financial support On a sliding scale of family size and income. They also offer a 15% co-pay discount to uninsured patients. Harness said the hospital’s financial services office first told him he wasn’t eligible for their aid program as well as their aid program Colorado Indigent Care Program.. Harness overworked the previous month, so he missed about $200. The hospital will only use his past two pay slips to confirm his income, he said.

The hospital did not answer questions about harness care or bills.

Another weird thing about the US medical system that Harness encountered is that the patient (or his insurer) usually pays again if the surgery doesn’t go as planned and another surgery requires correction. Is that. Medicare and some insurance companies have experimented with “bundled payments.” This will allow the hospital to receive a flat rate for surgery and subsequent 90 days of follow-up care.

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Resolution: Harness complained to the hospital with the help of his lawyer, Novick-Smith, pushing back the costs of the two surgeries ($35,906 for the first and $44,326 for the second) and raising concerns about the quality of care. .. ..

Health care blue bookEstimating costs based on insurance company billing data says a reasonable price for appendectomy in Salida is around $12,600. Dr. Gina Adleres, who is responsible for minimally invasive surgery at Johns Hopkins Medicine in Baltimore, said the complications that harnesses experience are uncommon. She said the complication rate for appendectomy is fairly low.

In November, the hospital decided to apply a 30% discount on the harness for both surgeries, leaving a large invoice of $56,162.40.

The couple repeatedly followed up the hospital for several months, often finding representatives who were “not contacted.” In March, more than six months later, the hospital told Harness that the second surgery was a risk that he accepted by agreeing to an appendectomy, so he would have to pay for the second surgery.

Adam Fox, who is responsible for the strategic involvement of the Colorado Consumer Health Initiative, said it was “especially important” to remand the bills resulting from surgical complications. “It usually indicates that something went wrong with the first surgery, and at least a second surgery should be offered to the individual at a significantly reduced cost,” he said. It was

The hospital was handed over by May. Leslie Fergerberg, Vice President of Financial Services at Heart of the Rockies, wrote a response to Harness’ complaints and reduced the total bill to approximately the amount billed for the second surgery. But she didn’t explain how the hospital came to that decision.

“Unfortunately, your appendectomy had complications,” writes Fagerberg. “There are inherent risks to the surgery/procedure as explained in the treatment agreement. Your case was confirmed and total billing was reduced by $31,218.60.”

The final invoice from Hargar’s hospital has an adjusted price of $22,304.17, which includes an out-of-pocket discount, writes Fagerberg.

Harness and Novick-Smith, which still seemed too expensive for them, and after some research, offered the hospital upfront payment of $12,000. The hospital refused this offer.

Harness is currently working on a payment plan with the hospital. The hospital offers an interest-free payment plan if it can be repaid in two years, but in the case of harness these monthly payments are more than his rent.

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“I can’t do it myself. I don’t think there is any other option besides taking a loan,” Harness said. “Before appendectomy, I was looking for a property and home to buy, and it is now almost completely off the table.”

Novick-Smith is pleased that the hospital finally canceled the bill for the second surgery. But she is still angry at the hospital.

“Of particular concern is that hospitals sell themselves in our community as this important community resource, and they offer a lot of work,” she said. “Their lack of transparency and lack of communication with us made this all a lot worse, especially since there is nothing else to go for.”

Take-out: Paradoxically, the US health system is not tolerant of the uninsured, who often face the most expensive bills of all patients. One of the benefits of having insurance is that the plan pays most of the bill, but it also has the benefit of being charged a significant discount on the plan. If your employer does not provide health insurance, Check if you are eligible for a public program, Wright said.

Harness now has VA Healthcare. He initially avoided the VA Healthcare study because he felt that “other veterinarians needed it more.”

If you don’t have insurance and you have a huge bill left, Fox’s first step is to bill your statement to make sure it reflects the service you actually received. Said. The next step is to review the hospital’s charity policy. Another resource available to uninsured patients is an organization like the Colorado Consumer Health Initiative.

“It’s by no means a perfect solution, because we have so much we can do to help consumers claim for themselves in these cases, but we do our best,” Fox says. Said.

If all else fails, Wright said it would be best to pressure the hospital before selling the bill to the collection agency. Once the bill is collected, there is less room for negotiation, Wright said. And if all else really fails, you can try to call the press.

Dunweissman,”Arm and leg showThe podcast reported a radio interview for this story. NPR Jacob Conrad and Joe Neel have written a Morning Edition interview with KHN Editor-in-Chief Elisabeth Rosenthal.

This month’s invoice is a crowdsourced survey KHN And NPR It analyzes and explains medical costs. Do you have interesting medical bills you would like to share with us? Tell me about it!!