Women's Network—Fighting Incorrect Medical Bills: Is It a Disadvantage to Be a Woman?

• June 01, 2022

• Joseph Rivet , Rivet Health Law PLC

In December 2021, NPR reported that a patient, Bisi Bennett, received a medical bill for more than $550,000 after her premature baby boy required nearly two months of neonatal intensive care services.¹ She was offered a monthly payment plan of more than $45,000 a month despite having insurance. Granted, her plan changed between 2020 and 2021; however, both plans had the same deductible for in-network providers ($6,000) and the same out-of-pocket maximum (also $6,000). The hospital simply needed to bill one insurance for dates in 2020 and the other for dates in 2021. Instead, it billed both insurance companies for the entire stay, and neither plan paid the hospital. Both companies said the bill included dates of care for which she had no coverage.

As her baby fought for his life—and her husband fought stage IV cancer—she worked to untangle the mess and get the medical billing error corrected. It wasn’t until nearly a year later, after countless calls and a reporter’s inquiry, that she was able to resolve the problem.

A Larger Problem?

Bennett’s story is unfortunately not an anomaly. For example, I recently represented a woman burdened by a large emergency room bill after the hospital failed to determine whether she qualified for its financial assistance policy. She wrote countless letters laying out the facts. However, it wasn’t until she had an attorney advocating on her behalf that her bill was reduced by more than 25%. How does a hospital not enforce its own policy? Clearly there was a flaw in the system; maybe inadequate staff training or failures to identify patients who may qualify and to publicize assistance for all who register. But were other factors at play as well?

I also represented a woman who was billed for services she never received. The dispute stemmed from conflicting medical record documentation. A medical resident wrote that the patient underwent a specific procedure, and a bill was generated based on that documentation. When the patient questioned whether she had that procedure, the supervising surgeon said she didn’t. The surgeon even wrote a letter confirming the services were never performed. It took two years to get the health system to correct the problem. Meanwhile, the patient’s bill went to collections.

There are countless factors at play in each of these scenarios; however, I can’t ignore the fact that these are all women—women who had solid cases and who simply weren’t heard. These cases also all occurred against a backdrop of women’s ongoing fight against gender-based health disparities that impact women regardless of socioeconomic status.

At the federal level, the No Surprises Act² was enacted to help curb surprise medical bills for emergency services and for certain non-emergency care provided by out-of-network providers in-network facilities. Several states also have or are considering protections for patients from surprise medical bills. In addition, provider agreements often include hold harmless provisions preventing the provider from balancing billing.

How Can Health Care Attorneys Help?

Health care attorneys should consider the following steps to help address disparities in medical billing:

1. Be a sounding board. Women with legal concerns stemming from a medical bill often call attorney after attorney only to be told that their case is too small and not worth their time. In reality, many of these cases are fairly straightforward and don’t take a lot of time. You’re also significantly impacting someone’s life. You’re preventing them from being saddled with medical debt and an inaccurate medical record.
2. Focus on empowerment. Sometimes simply sharing your knowledge and giving women a few actionable steps can help them successfully navigate medical billing disputes. Take the time to understand the claims process so you can be a resource.
3. Bring awareness to health plan and health system attorneys. Many of these cases stem from lack of training or a breakdown in system processes. More often than not, the legal departments are not aware of the issues. A simple phone call or email can often accomplish two things: (1) raise awareness of an issue, and (2) quickly connect with the right contact to resolve the issue. While not all issues can be resolved, raising awareness can help create a ripple effect of potential change that benefits future patients.

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Joseph Rivet is the founder of Rivet Health Law PLC. His practice area focuses on reimbursement and compliance. Prior to practicing law, he started his career in health care operations spanning coding, billing, and compliance.

ARTICLE TAGS

• Women's Leadership
• Diversity, Equity, and Inclusion in Health Care Hub