He said he would have paid the bill if he was on his own. After landing in an emergency room on New Year's Day, a doctor from suburban Chicago incurred steep charges. He hit an ice patch while skiing with his children.
He only received an exam, X-rays, pain relief, and an arm splint, so the initial ER charges were high. Shah's insurance company negotiated a lower cost of $7,922.62, but he still had a bill of $3,319.05. He wondered who was going to ask the hospital's billing department questions.
Shah's wife is qualified to question the charges. The wife of a doctor is the office manager of that doctor's practice. She looked at the charges at the hospital.
Kalsariya didn't know that she was embarking on a crusade that would take over a year, send their bill to debt collections, lead her to complain to the Illinois attorney general, and discover that the hospital charged nearly $7,000 for a procedure that was never done.
The case was not commented on by the South.
Kalsariya was able to reduce her family's bill.
Kalsariya said you should ask the hospital for more information before challenging a bill. If you don't do that soon, you'll have to track down the details of the bill and possibly reset the clock before it's sent to collections.
We waited until the second bill. The first bill should be acted with.
It's important to ask for an itemized bill that lists "current procedural terminology" billing codes, which are standardized across the country.
Kalsariya said that a bill could contain a lot of line items that are hard to comprehend. She said to focus on the items with the highest price tags.
Kalsariya said it took a long time to get her husband's bill. The item that jumped out was $6,961.75 for the treatment of a fractured humerus.
Shah didn't recall having that treatment. He had his arm put in a comfortable position and was going to have surgery the next day at a hospital in the Chicago area. He got a couple of hours of sleep while propped up by pillows and had a successful surgery the next day.
Hospitals have been required to make their prices public since January 2021. The prices that other hospitals in Wisconsin and beyond charged for the same procedure were found by Kalsariya. She said they ranged from a low of $201 in Idaho to a high of $1,300 in Madison, Wisconsin.
Consumers can use the website fairhealthconsumer.org to find typical patient expenses for procedures in their area. According to the website, Shah would have to pay an out-of-network cost of $3,863 for the procedure he had. National average patient expenses can be found by using the online tool. The patient on the hook for $378 is included in the total cost of that procedure.
The couple tried to get in touch with the hospital, but they didn't have any luck.
The charges incurred on your date of service were both reasonable and within the range usually charged by similar healthcare providers in the area. Your insurance company, United healthcare choice golden rule, entered into a long term agreement with Froedtert South knowing the charges for its various services.
The couple sent two complaints to their insurer asking how they could be charged so much, but response letters said the claim was processed correctly
UnitedHealthcare expects its in-network providers to bill appropriately for their services, a spokeswoman wrote in an email. The claim was paid under the terms of Mr. Shah's plan.
Kalsariya lodged a complaint with the Illinois attorney general. She was told her husband could apply for the financial assistance program at the hospital. Kalsariya said they didn't need money. $3,319.05 is a lot of money. She felt they were being over charged and this was about principle.
It was a challenge to get Shah's medical records. Kalsariya said her attempt to access the records on the hospital's website didn't work so instead the couple was required to send a form to release the records
Kalsariya said that fax and email wouldn't be accepted. They had to mail it and it had to be signed.
It seemed like it would be pointless to bother them. When a KHN reporter responded to the family's request for help investigating Shah's hospital bill, the couple decided to send in the form to document their story.
The treatment that was driving up Shah's bill was not shown in the records. The discrepancy between the charges and the medical records prompted them to appeal the bill again.
Shah received a letter from a debt collector over his medical bill. She asked the hospital to stop taking the bill from collections because of the dispute.
The hospital pulled Shah's bill back after Kalsariya called.
Shah received a letter from the hospital dated May 27 of this year, saying it had reviewed the records and discovered the bill was inappropriate and should not have been used. Shah received a new bill with a patient balance of less than the original one.
Kalsariya still thought the bill was high, and that the hospital seemed to be okay with charging for a procedure that wasn't done.
The couple paid the smaller bill, which was the end of their story. What advice would she give to other patients? Look into the bill before you pay.
It is time- consuming. Kalsariya said it was taxing on their minds to do this. Everybody has to be transparent if they make that effort.
KHN produces in-depth journalism about health issues. Policy Analysis and Polling are two of the major operating programs at KFF. Information on health issues to the nation is provided by KFF.
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