Health-care stories: A $1,200 bill, and no, it’s not covered.

Filed Under: Costs, Health plans, Patients

We’re inviting people to share their stories of the health-care marketplace. Here’s one, as told to Juliet Linderman. While these stories  talk a lot about insurance, this site is generally about price transparency — and of course, insurance and price transparency have a lot of overlap. And if you’re uninsured, you might find creative ways to cope with the health-care marketplace. For previous ones, click here and here.

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Emily, 27, uninsured

After graduating from college, Emily was working part-time for various companies, none of which offered her health insurance. After investigating her options, she decided to enroll in the Healthy New York plan. It was beyond her means — $430 each month — but she and her family thought it was worth the money. For the first year she had the insurance, she didn’t use it often, having no medical emergencies that necessitated care. But, as an asthma sufferer, she thought it would be better to be safe than sorry.

Emily contracted a urinary tract infection and went to a Brooklyn hospital clinic for care. She had checked beforehand to see this hospital was in her network, and she was happy to discover it was. But when she arrived at the clinic, the receptionist told her that she had to become a “member” before she could receive care. They asked for her insurance card, and in exchange, gave her a membership card. Emily saw a nurse practioner who recommended that, in addition to a urine test, she should get some blood work and comprehensive STD testing. Emily agreed. She left the hospital that day with a prescription for medicine, thinking everything was taken care of.

One year later, Emily received a bill in the mail for $1,200. Confused and upset, Emily called the hospital and asked why, after having been told her insurance would cover the cost, she was being billed at such a high rate. The receptionist ran down a list of costs, including a membership fee.

“Even though the hospital was in network, that particular clinic was out of network even though it was run by the same exact people. So, then I cried and had a little break down. And then, I got smart.”

Emily called the hospital back and told them she had been assured her insurance would be accepted. The receptionist told her that they had submitted the bill and Healthy NY refused to pay. Emily immediately called her insurance company to complain. When she reached someone by phone, she was told that her bills should have been covered, and it was the hospital’s mistake.

“GHI was telling me it was the hospital’s fault, the hospital was telling me it was GHI’s fault, meanwhile my head was reeling because I did not have any savings or anything. They sent me threats for a year, then stopped. But I’m always afraid someday I’m going to get a call from a debt collector. I shelled out $430 a month for eighteen months and got nothing out of it. Now I just put money away in a savings account every month and go to Planned Parenthood for my health care.”

“I treat my asthma with sample inhalers from my old doctor. It’s not like car insurance, where you can get rid of it. You can’t just get rid of your body.”

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We withheld her name because her health-care information, if published on the Web, could affect her ability to get health insurance.

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