‘This Could Happen to Any of You,’ Patients Tell Lawmakers of Surprise Hospital Bills

SALT LAKE CITY, Utah – When Lucy Fawcett broke her leg skiing she never imagined she’d be left facing a $15,000 bill for the emergency room visit.

“They took me to the nearest hospital,” the Riverton resident told lawmakers during a Utah Health Reform Task Force hearing on Tuesday.

Even though she had health insurance, the out-of-network hospital billed her for the difference between the insurance’s payment and the total hospital bill. It’s a practice known as balance billing.

“This could happen to any of you if they take you to the emergency room,” Fawcett warned those gathered in the Capitol hearing room.

In the absence of an agreed-upon price with her insurance company, Fawcett said hours of negotiating haven’t reduced the bill — even though she works in the insurance industry and said she understands the complexities of the system.

“I will be put on a payment plan where I have to pay $1,200 a month until that’s paid off,” she said of the $15,000 bill.

Fawcett was one of about a dozen patients who asked lawmakers to intervene and make balance billing illegal in Utah.

“When all the bills come, it has been life altering,” said Centerville mom Lisa Ray.

Ray owes a $27,000 bill for the emergency surgery her son received after being injured while paying rugby.

“We’ve submitted appeals which have been denied and have been sent to collections,” she said.

A representative for the Utah Health Insurance Association told the task force that in times of true emergencies patients are often unable to dictate which hospital they are taken to.

“No Utahn in an emergency situation should be confronted with a balanced bill,” said Kelly Atkinson with the Utah Health Insurance Association. “They didn’t consent to that. They had no knowledge of it.”

Rep. Jim Dunnigan, R-Taylorville, co-chairs the task force and said he knows of more than 2,000 Utah residents impacted by balance billing — leaving them with tens of millions of dollars in medical bills.
“People are being damaged,” Dunnigan said. “They’re facing bankruptcy. We have got to solve this problem.”

He’s planning to introduce a bill during next year’s legislative session that would eliminate balance billing in Utah when it comes to emergency room visits.

“Many times you don’t have choice where you’re going, you might even be unconscious, and you end up with this huge bill,” Dunnigan said in an interview with KSL.

Many of the patients who testified told lawmakers that Intermountain Healthcare was the hospital group that balanced billed them. Also, Regence BlueCross BlueShield criticized Intermountain for not entering into a contract with the insurance company.

“Going after their patients — our members — is not helpful,” said Eric Hales with Regence BlueCross BlueShield of Utah.

Hales said that Regence has tried for years to come to an agreement so that Intermountain Healthcare’s hospitals would be in-network facilities for its members.

“We have never proposed rates to them that are lower than what we pay any other hospital in the state,” Hales said. “However, they demand significantly higher rates from us than what other hospitals in the state are willing to accept.”

In response, Intermountain Healthcare issued a statement saying that balance billing happens when insurance companies “will not pay for much of the care” that a patient received in an emergency room.

“Intermountain Healthcare has contracts with every major insurance company in Utah and nationally, except for one company, to avoid situations such as this,” the statement went on to say. “Intermountain has been in negotiations to reach an agreement with this last insurer to cover the cost of needed emergency care for its members, and it is anticipated that a resolution will be reached soon.”

The statement added that Intermountain offers financial assistance to those who need help paying their bills and did so in more than 240,000 cases last year.

The group AARP Utah said it supports lawmakers’ efforts to get rid of the surprise bills because they can drain retirement savings and burden young families.

“This is happening all the time in Utah,” said Danny Harris, director of advocacy for AARP Utah. “We have the ability as a state to say that this is not a practice we want to engage in.”