Sugar and Greg Bull play with their twins, Redford and Scarlett, who were born premature in 2020. Their insurance company initially said the birth was not an emergency, and the family ended up having to receive the chemicals. applications totaling more than 80,000 USD.
Heidi de Marco / Kaiser Health News
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Heidi de Marco / Kaiser Health News
Sugar and Greg Bull play with their twins, Redford and Scarlett, who were born premature in 2020. Their insurance company initially said the birth was not an emergency, and the family ended up having to receive the chemicals. applications totaling more than 80,000 USD.
Heidi de Marco / Kaiser Health News
As Greg and Sugar Bull get ready to start a family, health challenges require them to work with a surrogate. The pregnant woman and their twins lived two states apart.
The pregnancy was going well until the agent suffered from high blood pressure and the symptoms of preeclampsia, which could harm her and the children. Doctors appoint an emergency delivery when the fetus is 34 weeks old. Both children spent more than a week in the neonatal intensive care unit.
It was April 2020, the beginning of the coronavirus pandemic. Unable to fly, the Bulls drove from their home in Huntington Beach, California, to the hospital in Provo, Utah. They had to quarantine in Utah before they could see the kids in the hospital.
A few weeks later, after the children could feed and breathe on their own, the Bulls brought them home to California.
Then the bills came.
The patients: Scarlett and Redford Bull, newborn twins are covered under a Cigna policy sponsored by owner Greg Bull. The surrogate has her own insurance that covers her care.
Health services: Neonatal intensive care for premature babies after emergency labor. Scarlett spent 16 days in the NICU; Redford, 10 years old.
Invoice total: $117,084 dollars. The hospital does not have a network for newborns. Cigna paid for some of Scarlett’s care, for reasons the Bulls couldn’t figure out. Bulls were left for about $80,000, for both babies. Their accounts were eventually submitted to the collections.
Service Provider: Utah Valley Hospital in Provo, Utah, one of 24 hospitals operated by Intermountain Healthcare, a nonprofit organization with approximately 8 billion dollars in revenue.
Give what: Bulls challenge shows a gap in urgent care coverage – even if it’s federal The Act has no surpriseseffective January 1 and bans many unexpected medical bills.
Patients who need prompt life-saving treatment often don’t have time to seek out a network hospital. In the past, health plans sometimes said they would pay for urgent care even if it was out of network. The No Surprises Act now makes this a legal requirement in every state. Providers and insurance companies must negotiate a reasonable payment, leaving the patient worry-free.
But what if the insurance company denies emergency care? Or does the hospital not provide documents to prove it?
That’s what happened to the Bulls. Cigna said it lacked documentation that NICU care for qualifying twins was an emergency.
So the Bulls started getting insurance explanations showing the huge balances owed to the Utah Valley. They were expected to owe an out-of-network, family maximum of $10,000 for the care of the twins. They assume that most of the bills will soon be paid by Cigna. They did not.
Sugar Bull, an interior designer, said: ‘I thought, there’s no way this could happen.
“Dear Scarlett Bull,” begins one of Cigna’s letters, addressed to a 6-month-old baby. “We found the requested service was not medically necessary.”
How did NICU care fall short? The surrogate was admitted to the obstetrics department without going to the emergency department, says Dylan Kirksey, which led Cigna to initially conclude that there was no emergency. Settle medical billsa consulting firm eventually worked with the Bulls to resolve the claims.
To determine that, Cigna asked for daily progress records and other medical records of the infant. The Bulls tried to get the hospital to comply. Cigna went on to say that they have not yet received the required documents.
The Bulls appealed. Sugar Bull spent hours with insurance paperwork and keeping the music. But nearly a year later, about $80,000 in banknotes remains. Utah Valley sent accounts to collections, she said. It was the last thing she had time for.
“I own a company, and I’m super busy and we’ve got twins,” she said. “About every two weeks, I get panicky and legitimately angry about it. And I keep pushing and calling, and it’s going to take five hours each time.”
Although they disputed what they were charged, the Bulls agreed to pay the hospital $500 a month for five years to pay just one of the infants’ bills, in an effort to keep their good credit.
Resolution: With seemingly nowhere else to turn, the family hired Resolve, who beat a path through the woods of claims in exchange for a portion of the money it saved customers.
Kirksey, a senior supporter of Resolve, which was founded in 2019 and has 16 employees, said: “It is amazing that Utah Valley has provided Cigna with the information needed to pay the hospital. He said he had to give the hospital a detailed list of steps to take and then follow up with multiple calls and emails each week.
Ultimately, much of the fault for the Bulls’ nightmare is on the hospital side, Kirksey said. But instead of providing what Cigna needed, the Utah Valley went after the Bulls.
Cigna spokesperson Meaghan MacDonald said: “The hospital has consistently failed to provide a detailed list of services and important clinical information, despite our ongoing efforts to keep it secure.”
Utah Valley spokesman Daron Cowley said: “There is no fault on the part of the hospital. “Utah Valley Hospital reasonably paid for the services provided to the twins and provided the requested information to Cigna in a timely manner.”
Greg and Sugar Bull initially agreed to pay Utah Valley Hospital $500 a month for 5 years to pay just one of the infant’s bills. They ended up paying Resolve Medical Bills $8,000 after the company helped pay their hospital bills, totaling more than $80,000, straight.
Heidi de Marco / Kaiser Health News
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Heidi de Marco / Kaiser Health News
Greg and Sugar Bull initially agreed to pay Utah Valley Hospital $500 a month for 5 years to pay just one of the infant’s bills. They ended up paying Resolve Medical Bills $8,000 after the company helped pay their hospital bills, totaling more than $80,000, straight.
Heidi de Marco / Kaiser Health News
The hospital did not bill the Bulls for the outstanding balance until nine months after the twins were born and did not send the account to the collection until six months later”, after the family failed to pay. back the paperwork required legally to set up the payment plan,” he said.
Finally, in the fall of 2021, the bills were settled. The twins are 1 and a half years old. To compensate for settling the balance, the Bulls paid the company about 10% – $8,000.
Greg Bull, who works in finance, said the fee, while substantial and unrelated to medical care, was worth it to avoid a much larger debt. “At the end of the day, it’s a relief when the amount is smaller,” he said. However, many families cannot afford it.
Carried away: About one-fifth of emergency room visits at a facility that is out of the patient’s insurance network, research has shown. The No Surprises Act Ask the insurance company to pay for out-of-network emergency treatment with the same patient sharing the cost as in-network care. It also prohibits hospitals from paying extra money to patients.
But if the insurance company denies that the care was for an emergency or there is no documentation to prove it, the claim could still be denied and the patient left behind.
“It’s a coding problem that we run into a lot, especially ‘if the person really didn’t check in through the emergency room,'” says Kirksey.
If this happens, insurance professionals urge patients to immediately appeal the decision to the insurer, a process required by law. Unfortunately, that often requires more phone calls, paperwork, and waiting. (If a claim with the insurance company is unsuccessful, the patient can then turn to an independent reviewer, such as their state insurance board, the state attorney general’s office, or The help desk is no surprise.)
Kevin Lucia, co-director of the Center for Health Insurance Reform at Georgetown University.
Once it has been determined that the visit is an emergency, protections from the No Surprises Act will apply, he said.
The No Surprises Act could be a step in the right direction. But it is clear that loopholes and minefields remain.
Stephanie O’Neill contributed a sound portrait to this story.
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