GET GEPHARDT

‘Medically necessary’: Conflict between hospital and insurance company leaves Utah family owing over $30K

Dec 11, 2023, 10:47 PM | Updated: Dec 14, 2023, 3:17 am

COALVILLEImagine your insurance company denying your claim for surgery after the fact and now you’re on the hook for tens of thousands of dollars. It happened to a Coalville family who says that surgery helped save their son’s life.  

A nasty dirt bike crash nearly killed Rhyley Brundy over a year ago. 

“He said, ‘Mom, call an ambulance!’” his mother, Lacy Brundy, recalled. “’And tell them to hurry!’” 

She said the crash lacerated one of his kidneys and his liver. She credits the quick work of his friends on the scene, paramedics and the heroic efforts of the staff at Primary Children’s Hospital for saving his life — more than once. 

“I watched him pass away once. My husband watched him pass away a few times. It was a big deal,” Brundy said. 

A very big deal that kept Rhyley in the hospital for nearly a month which racked up some daunting medical bills. Brundy had insurance which, except for a few copays, covered most of her son’s stay — but not all.  

Rhyley Brundy had a month-long hospital stay after a nearly fatal dirt bike crash.  (Brundy Family) Lacy and Chris Brundy go over the medical bills for their son Rhyley’s hospital stay with KSL’s Matt Gephardt.  (Jeff Dahdah, KSL TV)

Not ‘medically necessary’

The family was left owning $34,119.87, and the reason her insurance company gave Brundy blew her mind. 

“Not medically necessary,” the denial letter from her insurance read. “Your plan does not cover that kind of care.”  

That “kind of care” was her son, still in the intensive care unit, on doctor’s orders. They certainly thought it was medically necessary and wrote as much in an appeal letter to the insurance company on Brundy and Rhyley’s behalf. 

For more than a year, Brundy says she and her insurance company have battled over that bill with them vacillating between agreeing to pay and then saying they will not. 

“I don’t understand why they’ve covered everything else but these two days,” she said. 

But the bill remained unpaid, and the patience of the hospital’s bill collectors had run out. 

“Now they’ve sent me to collections, and I just don’t know what to do,” Brundy said. 

Not wanting to go bankrupt over a bill that she feels insurance should have covered, Lacy decided it was time to contact the KSL Investigators.  

An insurance tug-of-war 

We reached out to both the insurance company, Anthem Blue Cross Blue Shield, and Primary Children’s Hospital. 

The two companies pointed the finger at each other. Over the phone, Anthem’s spokesperson told us Primary Children’s “failed to submit documentation that was requested” in a timely manner. 

Not true, said the hospital. Primary Children’s told us they sent everything “to the patient’s insurance six days after the patient left the hospital.” They say they “spent more than a year working with the insurance company and appealing on behalf of the patient.” 

“Anytime I think about it, I want to cry,” Brundy said. “It’s just not fair.” 

In the end, Anthem refused to budge on increasing its payout. Primary Children’s Hospital, though, pulled off some heroics for Lacy’s family. They provided some financial aid and adjustments which essentially wiped out the bill. In fact, she wound up getting about $80 back.  

What to do? 

These sorts of tugs-of-war between hospitals and insurance companies are common. Should you find yourself in one, you can file a complaint with the Utah Insurance Department, or the insurance department of whatever state the insurance company is based in.  

And don’t wait too long. After a year, it can be much harder to force an insurance company to pay, even if it is determined they’re in the wrong. 

KSL 5 TV Live

Get Gephardt

Matt Gephardt being shown the double payments that Terry Hutchings has been getting....

Matt Gephardt and Sloan Schrage, KSL TV

Get Gephardt helps homeowner being charged two bills for one security system

Billing for a previous home initially stopped when she sold it, but when she got a new security system from the same provider for her new place a year later it started billing for both.

2 days 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.

3 days 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.

4 days ago

FILE: Credit and deposit cards on a computer keyboard. Electronic commerce, business. Online shoppi...

Matt Gephardt and Sloan Schrage

Utah family says their bank refuses to reimburse fraudulent charges

A Taylorsville family says a hacker drained thousands of dollars out of their bank accounts and left them overdrawn by tens of thousands more. They thought federal banking rules protected them, but they say their bank has refused to reimburse them for those losses.

5 days ago

Homeowner Mark Shea tells KSL’s Matt Gephardt he paid someone to build a deck who abandoned the j...

Matt Gephardt

Get Gephardt: Homeowners ask why authorities can’t shut down an unlicensed contractor

Two Salt Lake County homeowners hired and paid someone to build decks for their homes but say he left the jobs unfinished. Turns out, he’s been cited by the state for not having a contractor’s license before.

9 days ago

Matt Gephardt, journalists, looks as paper with a woman...

Matt Gephardt and Cimaron Neugebauer

Get Gephardt: Ticketmaster seizes back purchased seats

Imagine buying tickets to a show, then having the seller refuse to give them to you. That’s what happened to a Utah woman, when she got a refund she didn’t ask for.

10 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.

‘Medically necessary’: Conflict between hospital and insurance company leaves Utah family owing over $30K