FIGHT FOR HEALTHCARE: Know your rights when out-of-network - KFVS12 News & Weather Cape Girardeau, Carbondale, Poplar Bluff

FIGHT FOR HEALTHCARE: Know your rights when out-of-network

A Kansas City mother had been fighting her health insurance for months after a single emergency room visit ended up costing her thousands of dollars she says she shouldn’t have to pay. (KCTV5) A Kansas City mother had been fighting her health insurance for months after a single emergency room visit ended up costing her thousands of dollars she says she shouldn’t have to pay. (KCTV5)
KANSAS CITY, MO (KCTV) -

A Kansas City mother had been fighting her health insurance for months after a single emergency room visit ended up costing her thousands of dollars she says she shouldn’t have to pay. 

Tanya Roth turned to KCTV5 News for help and to help warn others with her story.

In 2017, Roth was pregnant when she feared she may be having a miscarriage.

“I literally lost a massive amount of blood all at once. I was hemorrhaging ... I thought I was losing my baby,” Roth said.

She called an ambulance and told paramedics which hospitals were in-network, covered by her insurer, Cigna. Paramedics told her the closest in-network hospital, North Kansas City Hospital, was not accepting any ER patients as it was at capacity. 

"They were redirecting everybody to St. Luke's. I told them, I said St. Luke’s is not in-network. Research is my next in-network hospital. He said well, ‘Research is too far.  You've lost too much blood’,” Roth said.

Five hours later in the St. Luke’s ER, Roth said she’d stopped bleeding and was allowed to go home, but she says, without any diagnosis. She later went to her OB and was diagnosed with placenta previa.

Still, Roth ended up with a bill from St. Luke’s.

“I ended up getting a 5-thousand dollar bill,” she said.

Then, she received more bills for the ambulance and a "metro emergency physician." Each totaled about $800.

“I couldn't control that the hospital was closed. I told them where to take me.” Roth said. “I told them what my in-network and out-of-network hospital was.  I did everything short of calling the insurance company and saying, ‘Hey I’m bleeding and losing my baby right now. Will you cover me if I go here?’. I mean, seriously.”

Roth filed an appeal with her insurance company, Cigna.

“I wrote letters. I mailed copies of everything. Every bill. Everything,” Roth said.

Months later, she found out her St. Luke’s bill had been sent to collections. She says all Cigna did was chip in $300.

There is a federal law that doesn’t allow insurance companies to make you pay more in co-payments or coinsurance if you get emergency care from an out-of-network hospital. They also can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.

KCTV5 contacted her insurance company to find out why it wouldn’t cover her bill.  A couple days later, Cigna responded.  A representative for the insurance company told KCTV5 it would now be covering that St. Luke’s ER bill. 

Roth sent KCTV5 the following email, explaining what Cigna told her about covering her bill and changing policy:

“I just wanted to say THANK YOU! I just got off the phone with Cigna and they are going to cover about $4700 of these claims AND contact the providers to get my accounts out of collections and clear my credit report. I could have never done this without you! They also said they have new procedures in place to keep this from happening. So you not only helped me but you helped a lot of people!! I will forever be grateful for the work you put in to help solve this problem."

Cigna sent KCTV5 the following statement:

"…after researching Ms. Roth’s situation, Cigna will cover the additional ‘balance bills’ that she received - including those from the hospital, ambulance service and physicians - due to the rare, but extenuating circumstances she experienced…

Any payment that Ms. Roth is responsible for (about $1,000 in total)  is for meeting her plan’s standard coinsurance and deductible amounts (as would have been the case even if she had used an in-network provider). Our customer care team has reached out to her directly to share this information in detail, and is working with Ms. Roth and her care providers to resolve the outstanding claims. Our company works very hard to make health care easier for our customers and we wish we had caught this sooner. Thank you for bringing it to our attention. 

…we encourage people to contact their health plan whenever they have a question or if they have a concern about a bill they have received. Their health plan can help with claims-related questions and more information about the appeal process that’s available. The plan can also often provide additional resources - such as help from a nurse case manager - that are included as part of the plan."

Copyright 2018 KCTV (Meredith Corp.) All rights reserved.

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