Get Gephardt helps Utahn stuck in billing squabble between her insurance and her hospital

Mar 5, 2024, 10:55 PM | Updated: Mar 6, 2024, 9:51 am

ROY — Brandy Durrant had foot surgery last August. The procedure should have gotten her to her insurance’s out-of-pocket max for deductibles, copays and costs for in-network services. But there’s a glitch and turns out, it’s a big one.

“They submitted it incorrectly,” Durrant said of the paperwork her hospital sent to her insurance company.

The result is she is being told she will need to pay the money she says she should not owe for services that should be covered by her insurance plan. It’s a mistake she says the hospital acknowledged.

“They said it was an error,” she said. “They’re going to resubmit it and then it’ll be covered.”

But Durrant said she has been trying to get Holy Cross Hospital to send the bill properly ever since. That’s five months of call after call. She has been so diligent in her efforts to get the billing resolved that she says someone in Holy Cross’ billing department admonished her for too many calls.

“We had one lady tell us, ‘You calling every other day is not going to help the situation,’” she said. “This is not my fault. This is them.”

So, this time she decided to call someone who would happily take her call – the KSL Investigators.

I reached out to Holy Cross Hospital on Durrant’s behalf through its parent company, CommonSpirit Health, and asked if it could investigate and help get this billing straightened out. A CommonSpirit spokesperson responded pointing the finger at her insurance company.

In an email, he wrote, “When our team submits an insurance claim for reimbursement, we rely on the insurance provider to process the claim correctly.”

But Durrant’s insurance company, Select Health, insists this was the hospital’s error, writing, “Despite sustained efforts spanning several months by our member services team to advocate on behalf of the member, our requests to the facility to submit the corrected claim remained unanswered.”

But after all this came some good news for Durrant. Select Health says Holy Cross Hospital finally resubmitted the bill and this time correctly. It has been paid in full.

“Why has this taken five months?” she asked.

Holy Cross Hospital told me that they “partner with a third-party vendor” for billing and that they are working with the vendor to better “escalate patient concerns” so that the hospital’s “billing team may address them appropriately.”

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Get Gephardt helps Utahn stuck in billing squabble between her insurance and her hospital