Their Baby Died in the Hospital. Then Came the $257,000 Bill.

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Brittany Giroux Lane gave birth to their daughter Alexandra, a few days before Christmas in 2018. The child had black eyes and long legs. She, too, arrived about 13 weeks ago, and weighed just over two pounds.

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Alexandra initially thrived in the Neonatal Intensive Care Unit at Mount Sinai West. Ms Lane, 35, recalls that nurses described her daughter as a “rock star” because she had grown up so quickly. But after the infection, her condition deteriorated rapidly and Alexandra died on the morning of January 15 at the age of 25.

Small medical bills from neonatologists and pediatricians arose. Ms. Lane struggled to get her breast pump covered by insurance because, in the middle of a premature birth, she had not gone through the health plan’s pre-approval process.

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Last summer, Ms. Lane began receiving debt recovery notices. Letters sent by health plan Cigna said the insurer owed more than $257,000 for bills for Alexandra’s care after Ms. Lane changed health insurers by mistake.

Ms. Lane was terrified: it was Cigna who had received the initial bill for care and paid Mount Sinai West. Now, Cigna was demanding money that she had turned over to the patient and overpaid the hospital.

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Clayton Lane, Alexandra’s father and Ms. Lane’s husband, said: “For her, it’s just business, but for us it means constantly going through the trauma of being relieved from her daughter’s death.” “It means facing the dangers of financial ruin. It’s very unjust and infuriating.”

Medical billing experts who reviewed the case described it as a dispute between a large hospital and a large insurer, with the patient stuck in the middle. Experts say such cases don’t happen often, but speak of a widespread lack of predictability in US medical billing, with patients often not knowing what their care will cost until the bill is in the mail months later. come.

Congress last year banned the surprise medical bill, which will go into effect in 2022. It outlaws a certain type of surprise bill: those that patients receive from an out-of-network provider who unexpectedly joins their care. There are several other types of bills that surprise patients, such as bills received by Lens, which are likely to persist.

The Lanes have described the process of fighting their surprise bill as depressing and kafkaesque. He spent hours on the phone, sent dozens of emails, and filed complaints with regulatory agencies in two states.

“The letters mean I’m constantly re-living the day, and it’s such a difficult place,” Ms Lane said. “I feel very disappointed that the hospital is making decisions about its own bottom line that affect our potential future and the memory of our child.”

Systemedic Inc. Susan Null, the firm’s medical billing specialist, said, “This patient had no control over the payment made, and she has no control over whether it gets returned.” “Sometimes things like this can be done to induce the patient. Contact the hospital to release the funds.”

Americans are familiar with medical debt: About 18 percent of them have an outstanding bill from a hospital, doctor, or other type of provider in the health system. But most don’t expect to receive collection notices for bills that were already paid for by their health plan.

Courtney Jones, a senior case manager at the Patient Advocate Foundation, describes working on cases in which patients have received similar collection notices for bills the insurer, not the patient, was responsible for covering. This usually happens with large medical bills, as with Lane, with both the insurer and the hospital at stake.

“They use this as a tactic to put some pressure on the medical facility to return the money,” Ms Jones said.

Responding to questions from, Cigna said it “regrets” the letters and, in light of Lens’ experience, was now reviewing how it communicates with patients in such cases.

After Lens filed a complaint with a state regulator, Cigna sent them a letter saying they would no longer receive similar letters. “We sympathize with Mr and Miss Lane’s pain and confusion due to this experience,” it said in a statement. “We’re working with our vendor to make sure this doesn’t happen again to Lens or any other customers.”

Ms. Lane received her first collection notice about 18 months after her daughter’s death. Her family changed health plans in the middle of Alexandra’s hospital stay due to a change in employment.

The day Ms. Lane went into labor with Alexandra was supposed to be her last day at her first job, before starting a new position a few weeks later.

“I was afraid of being hit by a big bill, so while I was still in labor I was updating my insurance with Mount Sinai,” Ms. Lane recalled.

The hospital appeared to have both insurance plans on file — Cigna for 2018 coverage, and UnitedHealthcare for 2019. But Cigna accidentally covered the entire bill, paying more than $257,000 for child care in January, which should have been paid by UnitedHealthcare.

A Mount Sinai representative told Lens that UnitedHealthcare did indeed pay the bill—meaning the bill was paid twice—but that it did not resolve what appears to be a wider issue with Mount Sinai’s Cigna. it happens.

When Ms. Lane received her first collection notice, she contacted the hospital. A patient service representative apologized and wrote over email that “Cigna is about to get paid back”. The third party contractor who sent the letter on behalf of Cigna also told him that the matter would be resolved within a few days.

“I had to get a confirmation; I didn’t, but I was tired and didn’t follow up,” she said.

She realized the refund never happened when another collection notice came out this summer in early July. When she reached the hospital again, a top executive said she did not know when the refund would be issued.

Gail Spiro, Mount Sinai’s assistant vice president for patient financial services, wrote in August: “I cannot give you feedback about the refund due to Cigna as it is being discussed as part of a larger settlement agreement. ” 10 emails. “I apologize again for how long it took you to get what you wanted.”

In a statement, Mount Sinai West said: “It is common business practice to reconcile accounts with insurers in this manner. It is not normal for an insurer to pursue a patient in this manner.”

The Lanes also had several phone calls with Cigna and eventually filed a complaint with the Department of Insurance in California, where their Cigna health plan was registered.

“Receiving another letter was completely disruptive to our lives and our healing,” Mr Lane said. “That meant a lot of tears.”

In response to that complaint, Cigna sent a letter to Lens saying the notices were sent in error by a third-party vendor called HMS, which the insurer uses to monitor overpayments to hospitals. The Signa letter states that the letters were only to “inform” the family of the ongoing dispute with Mount Sinai.

The notices Lens received both informed him of the debt and asked him to “pay in full” within 30 days, using a slip at the bottom of the letter to be sent back with payment.

HMS declined to comment for this article, citing its patient privacy practices. Lance requested that Mount Sinai and Cigna make statements on letterhead that the family was not in debt. No such letter has yet been provided, although Mount Sinai says it will issue one in the coming weeks.

The Lanes said it was difficult to reconcile the billing experience after the kind and loving care her daughter received in the Neonatal Intensive Care Unit.

“She died surrounded by people who cared for her so lovingly and wonderfully,” she said. “We continue to support the NICU directly, so we can help the families out there.”

Since Alexandra’s death, Lance has donated supplies to the Mount Sinai West Neonatal Unit, including baby rockers; books about caring for premature babies; and a camera with a photo printer (taking baby pictures can be tough, they learned; phones are often not allowed due to hygiene concerns). The family is also now welcoming a new couple: they are adopting a baby boy.

“He is now six weeks old, and we are definitely falling in love,” Ms Lane said. “There are a lot of firsts, though, that must be seconds – the first time he smiled was a first for him, but should have been a second for us. There’s a lot of joy, but also a lot of secondary loss, and Alexandra’s. There’s a lot to think about.”

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