KSL INVESTIGATES

Couple receives surprise bill after doctor at in-network facility turns out to be out-of-network

Apr 11, 2022, 6:20 PM | Updated: Jun 19, 2022, 10:01 pm

MURRAY, Utah — Imagine going to an in-network medical facility but then getting a surprise bill because the facility’s doctor turned out to be out-of-network. It happened to an Elko couple.

All the Is were dotted and Ts crossed — the procedure was approved and everything was in-network, or so they thought until the bill arrived.

Theresa and Mike Mancuso tell KSL TV’s Matt Gephardt they verified the procedure at the Mountain Medical Imaging Center would be in their insurance provider’s network.

Theresa Mancuso used to work in medical billing. So, when her husband, Mike, needed an MRI, they got everything pre-approved and confirmed the imaging center is in their insurance provider’s network.

“We did our homework,” she said. “We did everything we should have.”

But the bill came in at close to $4,000 — double what they were expecting. The Mancusos combed through the paperwork.

“The doctor – not the facility – the doctor was not in-network,” Theresa said.

A radiologist the couple said they never met was apparently not in-network at the in-network facility. They said their appeals went nowhere. Not wanting to pay a surprise bill they worked to avoid, the couple decided it was time to call the KSL Investigators.

So, this time, we reached out to Mountain Medical Imaging Center on the Mancusos’ behalf. A company spokesperson declined an on-camera interview, but by phone told us this all should have been handled differently.

Mountain Medical said the reason the radiologist was out-of-network is because the doctor was new to the practice and the insurance company had not quite added them to the network yet.

When the out-of-network bill came, Mountain Medical said its billing company should have taken what the insurance company was willing to pay. Mountain Medical told us it is their policy to never pass these types of bills on to patients and are now working with their billing company in hopes it does not happen again.

“I didn’t want to pay $4,000 for something I didn’t do,” Theresa said.

Theresa and Mike Mancuso received a nearly $4,000 bill for MRI procedure, double what they had expected.

And just like that, some good news for the couple — just minutes after I spoke to Mountain Medical, they got a call that their bill was being waived.

Alas, this is not a unique story. In the U.S., we have so many different insurance companies and medical groups that it can be a gauntlet trying to figure out if everyone who may see you during a medical visit is in-network. Unless it is an emergency, the responsibility of sorting it out usually falls on the patient.

KSL 5 TV Live

KSL Investigates

fences and buildings with an inmate walking on a snowy sidewalk...

Daniella Rivera

New Prison, New Problems: Inside the effort to staff Utah’s new $1 billion prison facility

Utah's new prison cost taxpayers more than a $ 1 billion, yet a scathing audit shows the new facility has been unsafe and still isn't being used as intended. After being granted unprecedented access, the KSL Investigators go inside the new prison for a look at what's being done to fix its new problems.

8 hours ago

Neilson-Berg explaining the hassles and trouble she has been going through to get into contact with...

Matt Gephardt

Get Gephardt helps Google Fiber customer get her internet fixed after customer service calls go nowhere

When a Salt Lake City woman's internet connection went down, and she couldn't get a straight answer as to when it would be back up, she decided to Get Gephardt.

9 hours ago

dome and side of the Utah Capitol...

Daniella Rivera and Annie Knox, KSL TV

Truth Test: Fact-checking claims from lawmakers who voted to make their calendars secret

The KSL Investigators put lawmakers’ statements about a measure that would conceal their calendars through the KSL Truth Test.

9 hours ago

Sean Reyes...

Keira Fairmont

Fight for Transparency: KSL’s 15-month long battle to get Sean Reyes’ calendar

Utah’s Attorney General Sean Reyes still refuses to release his professional calendar despite State Records Committee and Judge’s orders. Now Utah Lawmakers have passed a bill to seal all public officials’ calendars.

10 hours ago

Matt Gephardt with Hung Tran who is explaining why he has been trying to get his social security be...

Matt Gephardt

Get Gephardt helps retiree deadlocked with Social Security over lost birth certificate

The United States has been home for Hung Tran nearly 50 years. He came here as a refugee fleeing war-torn Vietnam in 1975.

19 hours ago

Judge in robes sits in courtroom...

Annie Knox and Daniella Rivera, KSL TV

Judge rules public gets to see Utah attorney general’s work calendar

A judge sided with KSL, finding the Utah Attorney General’s work calendar is a record the public has a right to see.

2 days ago

Sponsored Articles

Modern chandelier hanging from a white slanted ceiling with windows in the backgruond...

Lighting Design

Light Up Your Home With These Top Lighting Trends for 2024

Check out the latest lighting design trends for 2024 and tips on how you can incorporate them into your home.

Technician woman fixing hardware of desktop computer. Close up....

PC Laptops

Tips for Hassle-Free Computer Repairs

Experiencing a glitch in your computer can be frustrating, but with these tips you can have your computer repaired without the stress.

Close up of finger on keyboard button with number 11 logo...

PC Laptops

7 Reasons Why You Should Upgrade Your Laptop to Windows 11

Explore the benefits of upgrading to Windows 11 for a smoother, more secure, and feature-packed computing experience.

Stylish room interior with beautiful Christmas tree and decorative fireplace...

Lighting Design

Create a Festive Home with Our Easy-to-Follow Holiday Prep Guide

Get ready for festive celebrations! Discover expert tips to prepare your home for the holidays, creating a warm and welcoming atmosphere for unforgettable moments.

Battery low message on mobile device screen. Internet and technology concept...

PC Laptops

9 Tips to Get More Power Out of Your Laptop Battery

Get more power out of your laptop battery and help it last longer by implementing some of these tips from our guide.

Users display warnings about the use of artificial intelligence (AI), access to malicious software ...

Les Olson

How to Stay Safe from Cybersecurity Threats

Read our tips for reading for how to respond to rising cybersecurity threats in 2023 and beyond to keep yourself and your company safe.

Couple receives surprise bill after doctor at in-network facility turns out to be out-of-network