Back surgery saved him from paralysis. Then the bills arrived: over $650,000

[tenderfoot]

Frank Esposito says it started last March with unrelenting back pain. He could barely move, and an MRI soon showed a bulge in his spine. A specialist told him to go to the closest hospital — immediately.

Doctors at the emergency room said he needed surgery. The herniation was so severe it could cut his nerve, Esposito said, and render him paralyzed.

The surgery was a success, but then the bills started coming: over $650,000 in all.

His insurance company said his back surgery didn't qualify as an emergency and wasn't medically necessary.

<snip>

Carroll added: "I think people have an assumption, right or wrong, that insurance is going to protect them. That's why if we pay that much, we think we're going to be covered, and we're not going to see that surprise bill. So, when you do, people are shocked."

Esposito has already taken $49,000 from his retirement savings. He hired a company to negotiate down some of his bills. After appeals, Esposito's insurer, Oxford United Healthcare, did pay some of his doctors' bills. But he still owes $220,000 — CBS News is still waiting for a response to questions about that balance.

"You work all your life. You work to buy a house. You work to have a house," he said. "You have to save up for everything. We would like to be able to know that we can go to the doctor, that we can get healthy, that we can get taken care of without losing everything we have."

https://www.cbsnews.com/news/back-surgery-saved-him-from-paralysis-then-the-bills-arrived-over-650000/

[Bettie]

1. Yeah, those health insurance companies

really take care of people....they'd never look for an excuse not to play claims!

[Hoyt]

2. If docs and hospital were paid enough to get down to $220K,

it’s not just the insurance company sticking it to this patient. Time for providers to step up too.

[athena]

5. Do you ever notice the ads on TV and on billboards?

I mean, ads for hospitals, not to mention pharmaceuticals? These days, the only entities rich enough to afford such advertising are hospitals, medical centers, and pharmaceutical companies (and, O.K., car manufacturers).

I was in Canada recently, and it was so refreshing to turn on the TV and not see a single ad about one of the thousands of rare disease I might get, telling the unfortunate people with that disease to "talk to your doctor about (such and such medication)". No one should ever have to ask their doctor for a specific medication. It's your doctor's job to determine which medication is right for you. But Americans are so brainwashed that they don't see a problem with the ads. It's your money that's paying for all of that.

Single-payer health care would solve all of these problems. Huge amounts of money would be saved, and watching TV would become less annoying as a side-benefit.

[athena]

3. But but but .... Americans love their insurance companies!

Anyone who loves their insurance company so much that they would attack or criticize candidates who advocate for single-payer health care should take a hard look at their insurance company. I have great insurance, and I've written elsewhere about how they tried to do to me what they've done to this man. It was a smaller operation, so I could have afforded it, but I didn't know that at the time. (The insurance company had said previously that the procedure would be covered. After a lot of phone calls and huge amounts of stress over several weeks, I finally showed that the surgeon's office had filed the paperwork incorrectly -- probably on purpose, since they charge the uninsured more for the same procedure than they are able to charge the insurance company.)

Even with excellent insurance, I don't feel safe in this country. The last thing you want when you're trying to recover from an operation is to receive a letter from your wonderful insurance company telling you that your procedure was not covered.

[WhiskeyGrinder]

4. I recently had an emergency but routine surgery and was grateful that at every step, the providers

gave me information about how to fight with my insurance if the insurance company decided to get between me and the providers. They shouldn't have had to do that, but they did.

[athena]

6. You happened to be lucky.

My provider filed an incorrect claim in order to try to get more from me for the procedure than they would be able to get from my insurance company. I'm sure I'm not the only one they did that to, and I'm sure some people fell for it and paid the provider three times as much as they would have had to pay if the paperwork had been filed correctly.

No one in America is safe. There is no such thing as a good insurance company. No one should have to fight with their insurance company or with their provider when they're trying to recover from surgery. Without hiring a lawyer, you can't even get them to hand over the paperwork that would show that the claim was filed incorrectly. The level of hatred that makes Americans be willing to take that risk, just to avoid helping to provide health care for the poor and for minorities, even when providing that help would cost less than what they're paying already, is mind-boggling and disgusting.

[WhiskeyGrinder]

9. Totally lucky. I hope I didn't imply otherwise. It was highly unusual and should be totally

unnecessary.

[RobinA]

17. My Dentist

is in the process of doing this. I use an in- network dentist who has agreed to accept the insurance payment as payment in full. So I get this bill from them for $250. I look on the insurance web site and it looks to me like they have paid everything they are supposed to. I call said dentist and I ask what this charge is for. They look in their computer and then tell me, Oh, I guess we never billed insurance for that last visit, we will do that right away. So evidently they thought I would just pay up without asking questions. Or something, because in fact, they had billed insurance for the last visit and insurance had paid them appropriately. I will be going elsewhere after my visit this week.

[ooky]

7. I wonder who he voted for.

Not saying he did, but its a fact that millions of Americans vote for this same thing to happen to them. Because they are worried about their "guns".

[Falcata]

11. ?

[Fix The Stupid]

20. This is DU. You have a picture of a white guy in the story...

Of course he is a trump loving, gun humping , ignorant "white winger"...

How long you been here?

All white people get lumped into this demographic here...just try to remember where you are, this is fantasy land and the real world is nothing like this site tries, so very hard, to promote.

[Thunderbeast]

8. Who put $650,000 in their pockets for the procedure?

Sure, we can (and should) scream at insurance carriers, but we miss the point if we don't ask why the surgery costs the earnings of a typical middle-class household for 13 years!

In other developed countries, the surgery would cost a fraction of American charges. Perhaps, the insurance company has a legitimate question about the urgency of the surgery.

The health care industry is rife with examples of misplaced incentives. Because the consumer has little pricing power or informed choice, the market leverages it's asymetrical advantage to extort profits.

THIS is why reform of the industry (not just insurance) is required.

[athena]

10. The insurance company should have sorted that out with the hospital before the surgery.

If a hospital is in the habit of providing a procedure that the insurance company doesn't think is necessary, they should discuss that with the hospital. Refusing to pay for the procedure once it's done is pure greed.

If we had single-payer health care, this is precisely what would happen. If a procedure was suspected as being unnecessary, the government would work that out with the hospital, and a general guideline would be issued. If you, as a citizen, happened to disagree with that guideline, you would be free to talk to your representatives in government, or, if they refused to listen, organize and engage in activism. As things are, you have zero power as a citizen over what your insurance company thinks is necessary or unnecessary. They are under no obligation to justify themselves to you. And they have a huge incentive to refuse to cover procedures, regardless of whether they are necessary or unnecessary.

[area51]

12. This is why we need

comprehensive Medicare for All; FAQs on M4A, and why a public option won't be enough.

[Karadeniz]

13. Not an emergency? The doctors said it was. The doctors need to go to bat for him.

[athena]

19. Why should a doctor have to waste precious time arguing with insurance companies?

The doctor's time is valuable and should be spent, as much as possible, with patients.

None of this would have happened under single-payer health care (aka Medicare for All). The patient would have had to pay nothing, and the doctors would be able to focus on what they're trained for, which is taking care of patients. Single-payer health care would save huge amounts of money at every level of the medical system.

[Karadeniz]

21. My husband's oncologist went to bat for him, up against social security disability...and you've

Probably heard how miserly they are with their approvals!

[TygrBright]

14. Betcha he really wants to keep HIS insurance and the heck with single payer! n/t

[ColesCountyDem]

15. But for 'expanded' Medicaid, his story could have been my story.

The cost of my last back surgery at Northwestern Memorial in Chicago, plus subsequent rehab at Ann Ryan Mobility Lab, cost in excess of $500,000. With Medicaid, my co-pays came to $19.80. This is why we need single payer.

[Fla Dem]

16. And just who did Mr. Esposito vote for? Just asking for a friend.

Seriously, I sympathize with Mr Esposito. It is unacceptable that the richest country in the world have people going bankrupt to have life saving surgeries.

[leftyladyfrommo]

18. I have friends with insurance where they approve

The surgery but retain the right to review it after the surgery is done. Then they can refuse to pay if they think it was unnecessary.

So they never really know whether they will be covered or not.