After Her Bout of Amnesia, a $59,000 Billing Dispute Wouldn’t Go Away

On April 10, 2025, a number of hours after ending a hike in Sedona, Arizona, Jan Anderson began repeating herself.

“Did we hike this morning?” she requested.

“Sure, we hiked,” mentioned her husband, Steve Francks. “And you probably did rather well.”

However 15 seconds later, she requested the identical query: “Did we hike at this time?”

Anderson, 65, a retired finance government, doesn’t keep in mind any of it. She will be able to recall what occurred that afternoon solely as a result of her husband began recording her on his cellphone.

“I used to be simply on this nonstop loop,” she mentioned.

Nearly instantly, Francks knew one thing was unsuitable. “Jan was out of it,” he mentioned.

He took her to an emergency room in Sedona, the place workers initially thought she could be having a stroke. As a result of the ability wasn’t absolutely geared up to guage or deal with stroke sufferers, Francks mentioned, she was airlifted to a Phoenix-area hospital, the place she was admitted.

It turned out she wasn’t having a stroke. Her medical crew ultimately decided she was most likely experiencing transient international amnesia, a uncommon, non permanent, and benign reminiscence dysfunction.

The excellent news was that her signs didn’t final lengthy, and she or he has suffered no long-term results from the episode. It took about 24 hours earlier than she was capable of begin forming new reminiscences, and she or he was discharged the following day. Anderson and Francks, who cut up their time between Sedona and Edmonds, Washington, returned to the Pacific Northwest a couple of weeks later.

Then the invoice got here.

Electronic mail Signal-Up

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The Medical Service

The sudden confusion related to transient international amnesia will also be an indication of a extra widespread neurological situation, so it’s vital to rule out different potential causes — resembling a stroke, for which well timed emergency care can spell the distinction between life and demise.

Anderson’s data present her care at Abrazo Well being’s Arrowhead Campus in Glendale, Arizona, included an electrocardiogram, which might detect underlying cardiac abnormalities, and imaging, which might rule out any vessel blockages that may trigger a stroke. She additionally underwent numerous lab assessments generally used to diagnose a stroke.

The Invoice

$59,181: $35,302 for diagnostic/therapeutic imaging, $8,147 for laboratory providers, $8,146 for a particular care unit, $5,532 for EKG providers, and $2,054 for pharmacy. Anderson’s first invoice from Abrazo Well being mentioned she owed $15,312.43, citing an insurance coverage adjustment of $43,868.57, regardless that her insurer had not coated any of the fees.

Anderson mentioned her insurer coated separate prices for the ER and helicopter switch.

The Billing Downside: Communication Breakdown

The federal No Surprises Act bans out-of-network payments for many emergency providers, even when these providers are acquired at an out-of-network facility and usually are not preapproved by the insurer.

Which means the price of Anderson’s hospital care ought to have been coated as if it had been in-network. On the time, she was insured by Molina Healthcare, by a plan bought on the federal Reasonably priced Care Act market.

However for a 12 months, Molina declined to pay for her care in Glendale, at one level arguing that her hospital keep required authorization when, and even earlier than, she was admitted.

“I can’t get anybody to resolve it,” Anderson mentioned. “It’s nearly $60,000 hanging over my head.”

The primary downside arose about two weeks after she was discharged, when Abrazo Well being despatched Anderson a invoice indicating she was a self-pay affected person.

The hospital didn’t request her insurance coverage data at any level throughout her keep, Francks mentioned. He assumed, on the time, that his spouse’s monetary paperwork had been transferred from the ER in Sedona. It had not.

She known as the Glendale hospital and corrected the error.

Then, in late June, Anderson acquired discover from the hospital indicating she was not a Molina member.

“Your insurance coverage firm notified our workplace that the affected person was not a coated member for the providers supplied by Abrazo Arrowhead Campus on the above referenced service date(s),” the discover mentioned. It confirmed the whole prices for her keep exceeded $59,000.

However when Anderson known as Molina to verify her protection, she mentioned, the insurance coverage firm assured her the declare was being processed.

That didn’t imply Molina was prepared to cowl her hospital invoice.

Anderson spent months making an attempt to resolve the stability. She filed complaints with members of Congress, the Arizona Division of Insurance coverage and Monetary Establishments, and the Workplace of the Insurance coverage Commissioner in Washington state.

In an October letter to Washington’s insurance coverage commissioner, an enchantment and grievance specialist for Molina wrote that the declare was denied as a result of “inpatient stays require prior authorization, or notification on the time of admission. No notification of admission or prior authorization was acquired from the hospital, so the declare was denied.”

It continued: “Molina covers out of community emergency providers however since this was an inpatient admission authorization is required.”

Nicole Broadhurst, who focuses on medical billing points as CEO of a Tennessee affected person advocacy group, mentioned this dispute seems to relaxation between the insurer and the medical supplier.

She mentioned that Anderson’s insurance coverage data ought to have been transferred between the primary ER and the Glendale hospital. Because it wasn’t, Broadhurst mentioned, Anderson shouldn’t be held chargeable for her hospital invoice. (Broadhurst was not concerned in efforts to resolve Anderson’s billing dispute.)

Sadly, Broadhurst mentioned, these conditions are “not unusual, regardless that we’ve the No Surprises Act.”

The Decision

Anderson mentioned she was informed by Abrazo Well being for months that it was working with Molina to resolve the invoice. She mentioned she was additionally informed that even when Molina didn’t cowl the complete price of her hospital care, she wouldn’t be chargeable for the stability — however she by no means acquired that assurance in writing.

In the meantime, Molina continued to uphold its choice to disclaim fee.

After KFF Well being Information contacted the insurer and the hospital with questions on her case, Molina informed Anderson it had launched an inner overview of her declare, and a income director with Abrazo Well being informed her the corporate was “treating this as a high-priority matter,” she recalled.

Anderson mentioned the income director for the well being system assured her that if Molina continued to disclaim fee, “the stability might be written off on the hospital’s finish,” she mentioned. “I cannot be answerable for any stability” — not even the $15,312.43 the hospital initially billed her after the hospitalization.

Linda Nofer, a spokesperson for Abrazo Well being, wouldn’t reply questions on Anderson’s invoice. In an announcement, she mentioned the hospital system is “dedicated to working intently with our sufferers to resolve billing questions and considerations.”

Molina spokesperson Caroline Zubieta wouldn’t talk about or reply to questions on Anderson’s case on the document.

The Takeaway

The flurry of insurance coverage paperwork and medical payments sufferers obtain after a hospital keep could be overwhelming — and will typically seem contradictory.

Broadhurst mentioned it’s vital for sufferers to give attention to the “affected person accountability” portion of an insurance coverage doc known as an evidence of advantages.

Sufferers mustn’t pay a invoice if their clarification of advantages signifies they aren’t answerable for the quantity charged.

On this case, Anderson had acquired a invoice from the hospital saying she owed cash. And her clarification of advantages from Molina confirmed she’d racked up greater than $59,000 in hospital prices.

However that doc additionally indicated her affected person legal responsibility was “$0.00.” Anderson mentioned the hospital was not pressuring her to pay the $15,312.43 invoice or any of the fees tied to her account, however she was anxious she would ultimately owe a big sum as a result of the fees remained unresolved for greater than a 12 months.

“The query I stored asking them was, ‘How a lot am I going to owe?’” mentioned Anderson, who’s now insured by Medicare. “It might be wherever from that $15,000 adjusted quantity to the complete stability of $59,000.”

Broadhurst mentioned she tells sufferers dealing with related conditions to “ship the hospital a duplicate of the EOB and ask them to appropriate the account to $0 affected person accountability.”

“Even when nobody is actively making an attempt to gather, I’d nonetheless push for written closure so it doesn’t hold hanging over them,” she mentioned.

Invoice of the Month is a crowdsourced investigation by KFF Well being Information and The Washington Put up’s Effectively+Being that dissects and explains medical payments. Since 2018, this collection has helped many sufferers and readers get their medical payments lowered, and it has been cited in statehouses, on the U.S. Capitol, and on the White Home. Do you’ve a complicated or outrageous medical invoice you need to share? Inform us about it!