Coronavirus (Covid-19) and the bills, part II: falsely billed and overcharged

Emergency

A Rochester-area woman we introduced you to over the summer has continued to receive hospital bills for a Covid test that never happened.

Back in July, Rebecca Oliver and her partner Dan Loncoa went to Rochester Regional Hospital’s emergency room seeking a Covid test, only to be sent home without one and then billed $540 each. Eventually, Loncoa’s insurer, Aetna, said it was able to negotiate with the hospital to wipe away his bill.

Rebecca Oliver, right, and her partner Dan Loncoa
Rebecca Oliver and her partner Dan Loncoa

Oliver was not so lucky. In August, she got a bill from the hospital for $252.28, the rate her insurer, Excellus, had negotiated. When she reached out to Excellus to tell them that she had received no care from the hospital and that she believed she owed the hospital no money, a representative told her to file an appeal. She did, but the bill still did not go away.

“At this point I have checked in with the hospital and my insurance company multiple times as the first person told me to check in every few weeks,” Oliver said. “However, recently when I called the hospital the person was very agitated with me and essentially hung up on me telling me it was my insurance’s issue not theirs.”

When she reached out to Excellus once again, a representative told Oliver that she should not have filed an appeal, that she would need to file a grievance instead.

“I don’t understand why I am being billed when we were turned away,” Oliver said. “It would make sense and I would be more willing, although I would still be annoyed if we had received care.”

That was in August. Since then, Oliver’s problem-bill has only become more complicated. She continued to receive bills from Rochester Regional Hospital for a procedure she never had, her insurer has retracted the payment they initially agreed to pay towards her bill and a ClearHealthCosts investigation found that the hospital is overcharging her for a fee called the New York State Healthcare Surcharge, a sales tax levied by New York State on all hospital bills and some outpatient bills.

Stonewalled by the hospital and the insurance company

Since we last reported on Rebecca Oliver, she has continued to regularly call both the hospital and Excellus to contest the bill, only to have each party tell her that she needed to call the other. In the meantime, the hospital kept sending her bills for the test she did not get.

Then, in September, Oliver got a letter from Excellus indicating that the insurer would pay nothing toward the hospital bill, potentially leaving her responsible for the entire $540.

The HCRA surcharge mistake

In late September, ClearHealthCosts noticed a mistake on Oliver’s bill. Oliver was charged a $24.80 “N.Y.S. Healthcare Surcharge.”

The New York State Healthcare Surcharge — sometimes called the Hospital Surcharge or the Patient Services Surcharge — is actually a sales tax levied by New York State on all hospital bills and some outpatient bills.

The surcharge is one of several taxes New Yorkers and hospitals pay under the Health Care Reform Act, or HCRA, a set of laws passed in the mid-1990s that governs how the state funds and regulates its massive healthcare and medical education system.

Depending on what kind of insurance policy a person has — or if they are uninsured — the Hospital Surcharge might be paid by the patient herself or by the insurance company. As of 2020, the hospital surcharge is calculated as 9.63% of the patient’s share of each hospital or qualifying outpatient bill for people without insurance or some people with self-funded plans.

But $24.80 was not 9.63% of Oliver’s share of the hospital bill. It was 10.9%.

ClearHealthCosts asked Rochester Regional Hospital’s public relations officer, Veronica Chiesi-Brown, about this error multiple times but she declined to answer. Eventually, they told us to contact Rebecca’s insurer, saying the “the surcharge is in their hands,” but declined to comment about why the hospital overcharged Oliver.

Getting professional help — from a consumer advocate

After receiving yet another bill in mid-October, and no word from her insurer about the grievance she filed, Oliver engaged the services of a healthcare consumer assistance advocate from the Community Service Society of New York to help resolve her case.

The first step they took was calling Oliver’s insurer, Excellus, together. What they found out surprised her.

“The insurance company said the reason I never received a letter after I put in a grievance, is because they didn’t end up following normal grievance protocols,” Oliver said. “That’s because instead of a grievance, they filed it as fraud.”

Between August and October, the Excellus representative told Oliver, the company’s fraud team had been investigating her claim.

“As part of the investigation, the fraud team had asked the hospital to send over medical records that stated that I was in the emergency room,” Oliver said. “Obviously, Excellus never received those records — because it didn’t happen.”

The representative told Oliver and her advocate that as far as Excellus was concerned, she should not have to pay the bill. But Oliver wanted to hear that from the hospital, who had sent her another bill only a week earlier.

Calling the hospital — again

Together, the Excellus representative, Oliver and her advocate called Rochester Regional Hospital with the goal of finding out why Oliver’s bill had not yet been retracted. They failed.

“The representative from the hospital would not give us really a clear answer, other than ‘at this time’ I have a zero-balance for my bill,” Oliver said.

While that sounded like a resolution at first, Oliver soon found out it was not.

“[My advocate] was like, ‘okay, so just to clarify that we’re all on the same page, she doesn’t have to pay the bill,’” Oliver said. “Then the lady completely backtracked, and was like, ‘well, I didn’t say that.’”

The hospital representative went on to tell Oliver that she could potentially be charged in the future, pending the results of their own review of her bill. Oliver said the hospital has not given her any further information about the timeline or nature of their review process.

ClearHealthCosts has asked Rochester Regional Hospital for comment on the status of Oliver’s bill repeatedly by email and phone but has received no response.

“This whole ordeal has been so frustrating,” Oliver said. “We tried to do what was right by getting a Covid test after traveling, but battling with the hospital for over four months when they turned us away is disheartening.”

As of now, her bill has not been wiped away.

What you can do if you receive a fraudulent or erroneous bill

Rebecca Oliver’s experience highlights how difficult it is for patients to contest incorrect medical bills. Four months after being falsely billed, her situation is in limbo: The hospital keeps sending her bills and her insurer said it won’t pay. And unfortunately, Elisabeth Benjamin, advocate and vice president of Health Initiatives at the Community Service Society said situations like Oliver’s are not uncommon.

“We get calls like this every single day,” said Benjamin, who is part of the team working on Oliver’s case.

Benjamin said it’s common for patients to feel “ping ponged” between their insurance company and their provider while trying to contest a bill like Oliver has been. If this happens to you, Benjamin said, do not give up.

“The most important thing you can do is just be extremely tenacious,” Benjamin said. “Keep fighting and keep asking questions.”

If you hit roadblocks, like Oliver did, reach out for help from consumer advocates in your state. You can start at this government site by selecting your state from the dropdown menu and then look for your local department of insurance.

Another option is to contact your local attorney general. Benjamin said they often have healthcare bureaus that can help patients.

If you happen to be in New York state, you can call Community Health Advocates, which is part of the Community Service Society. They can be reached online or by calling 888-614-5400.

“We’ll help you out as best we can — that’s what our job is, to help people navigate the maze between insurance companies and hospital billing departments,” Benjamin said.

“You have to have the patience of a saint to get through all this stuff,” Benjamin said. “Fortunately our program has that level of patience. We have really great staff.”