Sarah Witter had two operations to repair bones in her lower left leg after a skiing accident last February. The second surgery was needed to replace a stabilizing plate that broke. Matt Baldelli for KHN hide caption
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Matt Baldelli for KHN
Matt Baldelli for KHN
Sarah Witter had to pay for a second surgery in June to repair her broken leg after a metal plate installed during the first surgery broke.
On Friday, she got a more welcome break — a decision to refund $6,358 to her by the hospital and her insurer.
Witter’s experience was the subject of the Bill of the Month story from NPR and Kaiser Health News that was published last Tuesday.
Witter and her insurer, Aetna, had racked up $99,159 in bills from a Rutland, Vt., hospital and various medical providers after a skiing accident last February.
A surgeon at Rutland Regional Medical Center attached two metal plates to bones in her lower left leg to help them heal. Less than four months later, one of these plates broke, and she needed a second surgery to replace it.
Witter, 63, ended up paying $18,442, mostly to the hospital, for her portion of the total cost for her care from the hospital, doctors, emergency services and physical therapists.
After we contacted Aetna about these costs, the insurer noticed that Rutland Regional had billed Witter for the difference between what it charged for its services and what Aetna considered an appropriate price for the first surgery.
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Those additional charges are known as ” balance bills” and occur when a medical provider isn’t in the insurer’s network and has no contract with the insurer. (Rutland Regional isn’t in Aetna’s network.) Our original story had calculated $7,410 in balance bills.
Aetna said it contacted the hospital and negotiated a compromise in which the insurer paid the hospital nearly $3,800. The hospital waived the remainder of the charges to Witter that Aetna considered unreasonably high.
“As part of her benefits plan, Sarah’s claims in question went through a patient advocacy process that allows us to negotiate with the provider on the member’s behalf to resolve any balance billing issues,” an Aetna spokesman wrote.
Aetna said it will negotiate disputed bills for any of its customers who request assistance, and also help schedule appointments, get services authorized and deal with other nonmedical complications. However, the Aetna spokesman wrote, “we weren’t fully aware of all of the bills that Sarah had received before we received them from you/her.”
On Friday, Rutland Regional again declined to discuss Witter’s account. Witter said she learned of the refund during a meeting, at Rutland Regional’s invitation, with a hospital financial administrator.
“They went through all the costs, and I guess treated it [the first surgery] more like it was a hospital service that was within my contract,” she said. The administrator told her they had “reprocessed” the charges from her second surgery, but that her portion of the bill did not change, she said.
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Bill Of The Month: $43,208 For Repeat Surgery To Replace Broken Medical Device
Bill Of The Month: $43,208 For Repeat Surgery To Replace Broken Medical Device
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