“Last summer, Eloise Reynolds paid the bill for her husband’s final stay in the hospital.” He died in March of 2022 at the age of 62. After insurance paid its portion, the Reynolds owed $823.15. She paid on June 30, 2022.
According to NPR, “Blue Cross Blue Shield of Illinois is the provider through the husband’s employer. It is a tax-exempt health system that operates 14 hospitals, mostly in the St. Louis area, including Barnes-Jewish Hospital.
Total bill: The hospital charged $110,666.46 for the stay before any payments or. Adjustments. The insurer negotiated that price down to $60,348.77, and Reynolds paid the $823.15 the hospital said was the co-pay the patient owed.
Then, a year after that final payment, she received a new version of the bill from the hospital for $1,093.16. This, Eloise learned, was a monthly installment in a payment plan now set for her (unbeknownst to her) and she learned that her deceased husband could owe an additional $50,216.31 for this stay.
According to Reynolds, a BJC HealthCare representative told Reynolds that the insurer had paid more than the health system had to reimburse the insurer and charge the patient more.
What’s going on? And where is the consumer protection? Oversight?
— Adjustments, or discounts, are amounts that may be subtracted from a medical bill, typically under the provider’s pre-negotiated contract with an insurer. Insurers and providers agree to lower, in-network rates for services provided to patients covered by the insurer.
— EOB: Reynolds also received an EOB, or “explanation of benefits,” letter showing the insurer reviewed the bill again in February, a year after the hospital stay. The document said the hospital’s charges for her husband’s private room — amounting to nearly $77,000 — were more than his health plan’s negotiated room rates, which did not cover the full cost.
And Reynolds’ experience highlights the lack of laws and standards around how long providers have to bill — and review bills — for medical services. Insurers may dictate in their contracts how long providers have to submit claims, generally one year. But no laws restrict how long providers have to send a bill to patients. Creditors may seek payment from a deceased person’s estate to collect whatever they can, e.g. In Missouri, a living spouse can be held responsible for a deceased spouse’s medical bills in certain instances, said Terry Lawson, a managing attorney for Legal Services of Eastern Missouri.