On April 10, 2025, a number of hours after ending a hike in Sedona, Arizona, Jan Anderson began repeating herself.
“Did we hike this morning?” she requested.
“Sure, we hiked,” stated her husband, Steve Francks. “And you probably did rather well.”
However 15 seconds later, she requested the identical query: “Did we hike at this time?”
Anderson, 65, a retired finance government, doesn’t bear in mind any of it. She will be able to recall what occurred that afternoon solely as a result of her husband began recording her on his cellphone.
“I used to be simply on this nonstop loop,” she stated.
Nearly instantly, Francks knew one thing was improper. “Jan was out of it,” he stated.
He took her to an emergency room in Sedona, the place employees initially thought she may be having a stroke. As a result of the power wasn’t totally outfitted to judge or deal with stroke sufferers, Francks stated, she was airlifted to a Phoenix-area hospital, the place she was admitted.
It turned out she wasn’t having a stroke. Her medical group finally decided she was in all probability experiencing transient world amnesia, a uncommon, non permanent, and benign reminiscence dysfunction.
The excellent news was that her signs didn’t final lengthy, and he or she has suffered no long-term results from the episode. It took about 24 hours earlier than she was in a position to begin forming new recollections, and he or she was discharged the subsequent day. Anderson and Francks, who break up their time between Sedona and Edmonds, Washington, returned to the Pacific Northwest a number of weeks later.
Then the invoice got here.
The Medical Service
The sudden confusion related to transient world amnesia can be an indication of a extra widespread neurological situation, so it’s vital to rule out different doable causes — corresponding to a stroke, for which well timed emergency care can spell the distinction between life and loss of life.
Anderson’s data present her care at Abrazo Well being’s Arrowhead Campus in Glendale, Arizona, included an electrocardiogram, which may detect underlying cardiac abnormalities, and imaging, which might rule out any vessel blockages which may trigger a stroke. She additionally underwent numerous lab checks generally used to diagnose a stroke.
The Invoice
$59,181: $35,302 for diagnostic/therapeutic imaging, $8,147 for laboratory providers, $8,146 for a particular care unit, $5,532 for EKG providers, and $2,054 for pharmacy. Anderson’s first invoice from Abrazo Well being stated she owed $15,312.43, citing an insurance coverage adjustment of $43,868.57, though her insurer had not coated any of the costs.
Anderson stated her insurer coated separate fees for the ER and helicopter switch.
The Billing Drawback: Communication Breakdown
The federal No Surprises Act bans out-of-network payments for many emergency providers, even when these providers are acquired at an out-of-network facility and usually are not preapproved by the insurer.
Which means the price of Anderson’s hospital care ought to have been coated as if it had been in-network. On the time, she was insured by Molina Healthcare, by way of a plan bought on the federal Inexpensive Care Act market.
However for a yr, Molina declined to pay for her care in Glendale, at one level arguing that her hospital keep required authorization when, and even earlier than, she was admitted.
“I can’t get anybody to resolve it,” Anderson stated. “It’s virtually $60,000 hanging over my head.”
The primary downside arose about two weeks after she was discharged, when Abrazo Well being despatched Anderson a invoice indicating she was a self-pay affected person.
The hospital didn’t request her insurance coverage info at any level throughout her keep, Francks stated. He assumed, on the time, that his spouse’s monetary paperwork had been transferred from the ER in Sedona. It had not.
She known as the Glendale hospital and corrected the error.
Then, in late June, Anderson acquired discover from the hospital indicating she was not a Molina member.
“Your insurance coverage firm notified our workplace that the affected person was not a coated member for the providers supplied by Abrazo Arrowhead Campus on the above referenced service date(s),” the discover stated. It confirmed the entire fees for her keep exceeded $59,000.
However when Anderson known as Molina to verify her protection, she stated, the insurance coverage firm assured her the declare was being processed.
That didn’t imply Molina was keen to cowl her hospital invoice.
Anderson spent months attempting to resolve the steadiness. She filed complaints with members of Congress, the Arizona Division of Insurance coverage and Monetary Establishments, and the Workplace of the Insurance coverage Commissioner in Washington state.
In an October letter to Washington’s insurance coverage commissioner, an attraction and grievance specialist for Molina wrote that the declare was denied as a result of “inpatient stays require prior authorization, or notification on the time of admission. No notification of admission or prior authorization was acquired from the hospital, so the declare was denied.”
It continued: “Molina covers out of community emergency providers however since this was an inpatient admission authorization is required.”
Nicole Broadhurst, who focuses on medical billing points as CEO of a Tennessee affected person advocacy group, stated this dispute seems to relaxation between the insurer and the medical supplier.
She stated that Anderson’s insurance coverage info ought to have been transferred between the primary ER and the Glendale hospital. Because it wasn’t, Broadhurst stated, Anderson shouldn’t be held chargeable for her hospital invoice. (Broadhurst was not concerned in efforts to resolve Anderson’s billing dispute.)
Sadly, Broadhurst stated, these conditions are “not unusual, though we now have the No Surprises Act.”
The Decision
Anderson stated she was advised by Abrazo Well being for months that it was working with Molina to resolve the invoice. She stated she was additionally advised that even when Molina didn’t cowl the total price of her hospital care, she wouldn’t be chargeable for the steadiness — however she by no means acquired that assurance in writing.
In the meantime, Molina continued to uphold its choice to disclaim fee.
After KFF Well being Information contacted the insurer and the hospital with questions on her case, Molina advised Anderson it had launched an inside assessment of her declare, and a income director with Abrazo Well being advised her the corporate was “treating this as a high-priority matter,” she recalled.
Anderson stated the income director for the well being system assured her that if Molina continued to disclaim fee, “the steadiness might be written off on the hospital’s finish,” she stated. “I can’t be liable for any steadiness” — not even the $15,312.43 the hospital initially billed her after the hospitalization.
Linda Nofer, a spokesperson for Abrazo Well being, wouldn’t reply questions on Anderson’s invoice. In a press release, she stated the hospital system is “dedicated to working intently with our sufferers to resolve billing questions and considerations.”
Molina spokesperson Caroline Zubieta wouldn’t talk about or reply to questions on Anderson’s case on the file.
The Takeaway
The flurry of insurance coverage paperwork and medical payments sufferers obtain after a hospital keep could be overwhelming — and will typically seem contradictory.
Broadhurst stated it’s vital for sufferers to deal with the “affected person accountability” portion of an insurance coverage doc known as an evidence of advantages.
Sufferers shouldn’t pay a invoice if their clarification of advantages signifies they aren’t liable for the quantity charged.
On this case, Anderson had acquired a invoice from the hospital saying she owed cash. And her clarification of advantages from Molina confirmed she’d racked up greater than $59,000 in hospital fees.
However that doc additionally indicated her affected person legal responsibility was “$0.00.” Anderson stated the hospital was not pressuring her to pay the $15,312.43 invoice or any of the costs tied to her account, however she was frightened she would finally owe a big sum as a result of the costs remained unresolved for greater than a yr.
“The query I stored asking them was, ‘How a lot am I going to owe?’” stated Anderson, who’s now insured by Medicare. “It might be anyplace from that $15,000 adjusted quantity to the total steadiness of $59,000.”
Broadhurst stated she tells sufferers dealing with comparable conditions to “ship the hospital a duplicate of the EOB and ask them to right the account to $0 affected person accountability.”
“Even when nobody is actively attempting to gather, I’d nonetheless push for written closure so it doesn’t maintain hanging over them,” she stated.
Invoice of the Month is a crowdsourced investigation by KFF Well being Information and The Washington Submit’s Nicely+Being that dissects and explains medical payments. Since 2018, this collection has helped many sufferers and readers get their medical payments decreased, and it has been cited in statehouses, on the U.S. Capitol, and on the White Home. Do you will have a complicated or outrageous medical invoice you wish to share? Inform us about it!