New parents' $80K medical bill showcases No Surprises Act loophole

A couple was charged $80,000 when their gestational surrogate went through an emergency delivery of twins at Provo-based Utah Valley Hospital in April 2020, showcasing a loophole in the No Surprises Act, which went into effect Jan. 1, NPR reported Feb. 23.

Cigna, Greg and Sugar Bulls' insurance company, denied that the care was an emergency because the surrogate was admitted to obstetrics by her doctor instead of going through the emergency department. Because the twins were born prematurely, one of them spent 16 days in the neonatal intensive care unit while the other spent 10 days.

The total bill was $117,084 because the hospital was out of network. Cigna partially paid for the surrogate's care and left the couple with about $80,000 for both babies. The bill was eventually sent to collections.

Cigna requested daily progress notes and other medical records on the babies, but the couple couldn't get the hospital to comply.

The couple hired Resolve, which fights debt collection issues and receives a portion of the money it saves its clients. The company prodded the hospital to give Cigna the needed information, the bills eventually were settled and the couple owed Resolve $8,000.

Under the No Surprises Act, insurers and providers are supposed to negotiate among themselves to decide on a reasonable bill for out-of-network care. But if the insurer decides the care was not an emergency or did not receive the correct documentation, the claim can be rejected, according to NPR.

Read more here.

Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Whitepapers

Featured Webinars