Story of 'Balance Billing,' $1K trip to physician ignites social media storm

Story of 'Balance Billing,' $1K trip to physician ignites social media storm

GLEN ALLEN, VA (WWBT) - A Glen Allen woman, fighting a surprise bill after receiving emergency care in the ER, is got results after calling 12 On Your Side. After the story aired, hundreds of viewers reached out to NBC12 to share similar experiences.

Sally Matchett went to an in-network hospital. She says she was blind-sided by a separate bill from the physician who treated her during her emergency room crisis.

It's called Balance Billing, and Matchett wants people to know it's happening before an emergency strikes and catches you completely off guard with a bill you never expected, like it did with her.

Matchett believed her life was on the line during the early morning hours of March 11.

"I was having chest pains, shortness of breath. I really thought I was having a heart attack," said Matchett.

The ER doctor at Henrico Doctors' Hospital Forest Campus administered immediate care and critical tests that showed it was Matchett's gall bladder, not her heart.

Great news...until her statement of benefits from Cigna Insurance arrived, showing coverage denied for the ER doctor.

"It's not fair how it went down. It was almost sneaky. No, I was not notified," said Matchett.

She went to a hospital she knew was in network. Cigna covered previous procedures there, but in this instance, the ER doctor is a member of James River Emergency Group - which doesn't have a contract with Cigna.

Matchett got a bill for $1,180.00. She called 12 for help.

"I felt this was unethical," said Matchett.

12 On Your Side called all three organizations: Henrico Doctors' Hospitals, Cigna and James River Emergency Group. After our inquiry, the lawyer for the doctors' group called Matchett. He offered to settle her bill and reduced it to $191.00, the in-network allowable charge from Cigna.

"If I had not contacted Diane, I don't think this would have gone anywhere. I was hitting brick walls left and right," said Matchett.

She wasn't the only one. After this story aired, hundreds of NBC12 viewers reached out to us with similar trouble.

"I just felt defeated until I saw your program," said Cynthia Hill. "I mean, I was. I couldn't get up and call your number fast enough. I was just shaking, and then when you called me back..."

The Cigna patient says she went to Swift Creek ER on doctor's order after having symptoms of appendicitis. It's an in-network HCA facility, so imagine the shock when Hill got a bill for more than a grand from the doctor, whose assistant treated her in the ER.

James River Emergency Group does not have a contract with Cigna.

"We have insurance. I pay almost $1,600 a month with a $7,000 deductible. I should have been told," said Hill. "There should have been posters everywhere. If you're a Cigna patient, you will get a bill from your ER physician. It is not covered."

Transparency is what people want, who contacted 12 about their surprise ER bill.

"We need to ask Cigna or ask James River physicians, 'what do you want us to do?' I don't want to come and see you because I don't want a $1,200 bill. So, I'm going to sit at home and die."

The firestorm on Facebook ranges from outrage and surprise to confusion.

Laura David posted: "You don't have a choice in doctors - This should be illegal."

John Tatum writes: "We have got to get control of our health care in America and stop this insanity."

James River Emergency Group has not returned calls from Diane Walker, but it did reduce Sally Matchett's surprise bill after we got involved. Now, Cynthia Hill - and many others - are asking for same discount.

"I am. I want help with this. I don't want to pay these people," said Hill.

Cigna released the following statement:

We understand and share Ms. Matchett's frustration with the surprise bill from the emergency room doctor. When physicians adopt a strategy to remain out of network, they keep the ability to bill the remainder of their charges directly to their patients, known as balance billing, which can cause financial distress to our customers and undermine health care affordability. These impacts are magnified in emergency situations, when patients often lack the opportunity or awareness to protect themselves from this billing practice. Cigna will continue to work with physicians to address this industry-wide problem that puts consumers at financial risk.

Statement from Henrico Doctors' Hospital:

Henrico Doctors' Hospitals is sensitive to bills that patients may receive from affiliated or contracted physicians, and we encourage those physicians to participate in the same insurance networks as we do.

Statement from the Virginia College of Emergency Physicians:

Insurance companies are shifting hundreds of millions of dollars in medical costs to patients each year - costs that used to be covered by health plans. Patients are paying more for less health insurance coverage.

For now, Matchett is grateful for the personal win, but she says the public is still at risk.

"Me and the rest of the public that has Cigna, if they go and have emergency services at an HCA Hospital, their doctors will not be covered," said Matchett.

Cigna says one way that you might protect yourself is to call the physicians billing office and try to negotiate a lower bill. Meantime, if you have an issue or complaint you'd like us to look into or help you with, Call 12 at 345-1212.

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