“CBS This Morning” is working with Kaiser Health News and NPR to investigate unexpected medical costs as part of an ongoing “Bill of the Month” series.
Learn lessons about healthcare from former professional athletes who have reached the intensive care unit in a serious accident. Cyclist Phil Gaimon was charged about $ 150,000 in medical costs, even though he had both primary and secondary health insurance.
In 2019, Guymon was in an Olympic qualifying race when he collided with another cyclist. He was thrown out of his bicycle at about 40 mph and broke seven bones.
Guymon was unconsciously rushed to a nearby emergency department at Lehigh Valley Hospital in Allentown, Pennsylvania.
“So when I woke up, it was an intolerable pain,” Guymon said. “I broke all the ribs, collarbones, and scapulas on the right side.”
Guymon underwent clavicle surgery at Lehigh Valley Hospital and a second shoulder bone surgery at a special surgery hospital in New York.
“Both surgeries were completely needed,” Guymon said. “I was in terrible pain everywhere.”
He recovered quickly at home, but then the bill came.
They raised a total of over $ 200,000 from both hospitals. His two insurances paid a total of only $ 52,000 — leaving him on the hook for about $ 150,000.
He noticed that Lee High Valley Hospital was out of the network. And his shoulder surgery was categorized as “selective” surgery rather than “emergency” — it could have saved him money.
“They attacked you with a bill when literally nothing could be done,” Guymon said. “I receive a pile of invoices every month. I receive a collection notice every day.”
Dr. Elizabeth Rosenthal, Editor-in-Chief of Kaiser Health News, told CBS This Morning about the situation. “Hospital claims are full of land mines. Phil has hit three of them. Hospitals outside the network, high costs, and in his case a big problem. Aside from insurance in one state. Often does not work well in the states of. “
According to Rosenthal, Guymon was hit by a type of surprise building called balance billing.
“You go to a hospital outside the network, and according to all the amazing billing methods that many states have, you have an emergency what you would be charged at a hospital inside the network. Only will be charged, “Rosenthal said. “So the California-based Phil insurer paid what it considers to be a reasonable fee … both hospitals wanted much more, and they wanted because of the difference. I charged Phil for balance.-Billing, it would have been illegal. But he’s in Pennsylvania and New York, and insurance is regulated by the states, so they could do it. rice field.”
“So there are some things you can do,” Rosenthal said. “Of course, Phil was unconscious, so you’re not in a place to become a savvy healthcare consumer, but if you’re still awake, go to a hospital in the network when they ask. You can ask to sign a form stating that you will pay for anything that is not covered by insurance. You can add as long as you have on the network. An ambulance will pick you up and you will not pick you up. You can choose whether or not. If you think you need an ambulance, I can say I don’t have one. “
Guymon has been persuading him to cover more claims by calling and writing to his main insurance, Health Net, but with no success.
Health Net said it is committed to providing quality care with a wide selection of providers in the network and members need to contact them for assistance.
“This can happen to anyone at any time. When you wake up in the hospital, you’ll find out later that they’re in debt of $ 150,000,” Guymon said. “I wish I knew that getting health insurance was essentially gambling.”
The Lehigh Valley Health Network told Kaiser Health News that Guymon had no record of trying to contact them about financial assistance and was pleased to discuss the mutual settlement of his outstanding balances.
The Special Surgery Hospital has contacted Guymon to help resolve the controversy over surgical classification and said he would continue to advocate on his behalf.
Double-insured men still incur nearly $ 150,000 in medical costs after a bicycle crash.
Source link Double-insured men still incur nearly $ 150,000 in medical costs after a bicycle crash.