Man thought surgery would be covered by insurance, gets $23,000 bill

Man thought surgery would be covered by insurance, gets $23,000 bill
Man thought surgery would be covered by insurance, gets $23,000 bill(WBTV)
Updated: Nov. 24, 2020 at 6:59 PM EST
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KINGS MOUNTAIN, N.C. (WBTV) - Imagine going in for a surgical procedure thinking your insurance will cover the bill and then being hit with a $23,000 bill.

That’s what one local family has been dealing with for much of the past year.

Austin Carter’s insurance company says at most he owes roughly $3,000. Atrium Health is demanding $23,000.

“If someone’s offering to give – to pay the hospital the money, why wouldn’t they take that rather than sending us to collections,” said Austin’s wife, Casey Carter.

Casey’s husband Austin had surgery in November of 2019 at Atrium Health Kings Mountain.

Casey says before the procedure, Atrium said they checked with the couple’s insurance provider Coeur and verified coverage.

There was no indication of any concerns until 3 months later when the hospital bill for $23,000 arrived.

“They try to tell me that they didn’t have some kind of agreement with my husband’s insurance before the surgery, which we were not made aware of before he had the surgery,” Casey said.

Carter says Coeur Insurance tried to get Atrium to re-examine the $23,000 bill.

“The insurance tried to tell her we’re willing to pay this amount. We are only responsible for $3,600,” Casey said.

Casey says the original Atrium bill was $26,000. She said Coeur told her her plan only allowed Atrium to charge $6,900 for the surgery, so Coeur paid $3,300, leaving $3,600 for the Carter’s.

Meantime Atrium insisted there were no errors in their bill and the Carter’s are still responsible.

“If you are responsible for a certain amount, if your insurance doesn’t approve it, that’s usually something discussed before you actually go in for surgery,” Casey said.

Casey says no one at Atrium indicated any insurance concerns before the procedure. WBTV Investigates reached out to Coeur, who wouldn’t provide any explanation for what’s happened.

WBTV also reached out to Atrium who said the problem stems from the insurance company erroneously saying Carter would be covered for things his plan doesn’t actually pay for.

Read Atrium’s full statement below:

“We recognize this is a unique and challenging situation for Mr. Carter. Based on our research, Mr. Carter’s insurance plan actually doesn’t offer coverage for hospital benefits, only covering the services of a healthcare practitioner – so his doctor bills were eligible for coverage, but not services provided at the hospital. When we contacted his insurance company ahead of his procedure, they provided incorrect information regarding his in-network benefits to our team when, in fact, all services provided by a hospital are considered out-of-network under his plan.

This error in communicating insurance benefits ultimately resulted in the insurance company only paying a fraction of the bill, while incorrectly itemizing discounts not available for out-of-network services in the paperwork it sent to Mr. Carter. The amount shown as being owed by the patient after applying the improperly discounted rates significantly understated the actual balance due. We have previously offered to work with Mr. Carter to settle the account for a reduced amount. We empathize with this situation and continue to recommend he work with his insurance provider to resolve this matter, as their errors are the root of the issue. We remain committed to assisting with those discussions, to the extent we can.”

After our calls to Atrium and the Carter’s insurance provider, WBTV is told that a call is scheduled for the providers to discuss ways to eliminate this $23,000 bill that the Carter’s insist is not their responsibility.

“Seeing as Coeur says we’re not responsible for it, I don’t feel like it’s something that should be against us, against us our credit, ruining our credit.”

WBTV also contacted the Department of Insurance and they said this is a self-funded plan, which they don’t regulate.

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