Melinda Tyler-Furniss, 60, remembers feeling severely bloated and on the verge of vomiting. She was worried about a bowel impaction.
It was last May, and her husband Bill, 63, rushed her from their Vancouver home to PeaceHealth Southwest Medical Center, where the couple was told there was a five-hour emergency room wait.
“I had to see someone right away. I couldn’t wait any longer. I was so sick,” Tyler-Furniss said. “Everything was wrong. I basically wanted to die I felt so bad.”
In 2017, Tyler-Furniss had suffered acute pancreatitis and ran into the same situation — a long wait at PeaceHealth. They went to Legacy Salmon Creek Medical Center, which was in their insurance network, and got quicker care.
So Tyler-Furniss and her husband decided to do the same thing. But this time Legacy wasn’t in their insurance plan. It cost them more than $22,000.
It turned out that between the health incidents, Tyler-Furniss had updated her insurance plan with Regence BlueCross BlueShield of Oregon. She hadn’t realized the new plan didn’t include Legacy in its provider network.
Last fall, six months after being treated at Legacy Salmon Creek, Tyler-Furniss and her husband received a bill for $22,150.78. Regence had paid only about $6,700 of Legacy’s nearly $30,000 bill. The couple was on the hook for the remaining amount.
Since the Furnisses had come to the hospital with an emergency situation, they weren’t really thinking about whether Legacy was in network. And since Tyler-Furniss’s 2017 stay had been covered, they assumed the 2018 visit would also be covered.
They’re still frustrated no one at Legacy told them during their five-day stay that they were out-of-network and would incur a higher bill because of it.
“During those five days, not a single administrative person said, ‘Hey, we’re out of your network,'” Furniss said.
Furniss and his wife own a small metal finishing business. Furniss said this debt could impact their credit and their retirement. He said they are willing to pay what they can afford, but they don’t have $22,000 in cash on hand. Tyler-Furniss said they won’t be able to pay off the bill in their lifetimes.
“We’ll die before you get your money,” Tyler-Furniss said.
Legacy’s public relations director, Brian Terrett, said the health provider attempts to confirm if patients are in- or out-of-network during stays.
In this case, “There was a belief that she was purposely coming to Salmon Creek to get the treatment she wanted to get and she knew she was out-of-network,” Terrett said.
Terrett explained the process for confirming whether someone is in- or out-of-network isn’t immediate. Legacy has to contact the insurance company and there’s a review process. That process can take days. Terrett said Legacy encourages patients to know which hospitals are in-network.
He added Legacy created a work team late last year to find solutions to the surprise billing problem, which Terrett said is becoming more commonplace.
Terrett said Legacy is focused on finding an efficient way to capture information about how much insurance coverage is available and communicating it quickly so patients can make more informed decisions.
Legislative proposals
Surprise medical billings have gone viral across the country recently. A La Center mother faced a nearly $100,000 surprise bill and had to roll it into a mortgage to pay it. A Washougal woman faced a nearly $227,000 surprise bill, and only with the help of a Portland based nonprofit, Dollar For, did she get the debt relieved last month.
Across the nation, some people have encountered crippling debt or had liens placed on their homes because of surprise bills. An analysis by Health Care Cost Institute found that 14.5 percent of hospital admissions in the U.S. experience surprise medical billing, even when patients seek care at an in-network facility, but are seen by an out-of-network professional. The U.S. House of Representatives will have its first hearing on surprise medical bills Tuesday.
Washington Insurance Commissioner Mike Kreidler has proposed Washington legislation, House Bill 1065, that would require insurance companies to cover emergency as well as surgical or ancillary services from out-of-network providers accessed by patients in emergency situations or when they are left with few options.
Kreidler said the legislation is very likely to be passed this session after attempts in previous years fell short. Kreidler said a situation like the one the Furnisses had is an area the bill could help with.
“You shouldn’t be penalized because you hadn’t thought of that being a possibility,” Kreidler said. “That should be readily available to you as information. I think the hospital has a major obligation to inform individuals and say, ‘We really like having you as a patient here and you’re more than welcome to stay, but we’re not in-network to you and it’s going to cost you more.’ Let you make the decision.”
Kreidler said the issue of surprise billing has risen since the passage of the Affordable Care Act in 2010, because consumers are buying more affordable, but narrower health insurance plans. Kreidler’s spokeswoman, Stephanie Marquis, said their office has received about 250 complaints for surprise medical bills in the last couple years.
Kreidler sees the issue as a systemic problem in health care.
“I don’t think it was with greed and malice and forethought on the part of the hospitals, but it had that effect of really punishing some people unfairly and not because of anything they had done,” he said.
