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Bill of the Month: Instead of a $1,500 deductible, the charge was $500,000

A MARTINEZ, HOST:

Payment plans are becoming a common way to help people pay off high medical bills, but sometimes they're really no help at all. That's the case in our Medical Bill of the Month for December. Dr. Elisabeth Rosenthal is the editor-in-chief at our partner, Kaiser Health News. She's here to tell us all about it. Doctor, welcome.

ELISABETH ROSENTHAL: Good to be here again.

MARTINEZ: All right, so who are we meeting today?

ROSENTHAL: Today we're meeting the Bennett family of Orlando, Fla. - mom Bisi, dad Chris and baby Dorian. They faced a huge bill after Dorian was born.

MARTINEZ: Reporter Stephanie O'Neill spoke to the Bennett family. Let's take a listen.

(SOUNDBITE OF BABY LAUGHING)

STEPHANIE O'NEILL, BYLINE: Dorian Bennett of Orlando, Fla., loves to laugh.

BISI BENNETT: He's a very happy kid.

O'NEILL: That's his mom, Bisi Bennett, who gave birth to him on November 12, 2020, when she was only seven months pregnant. Neither she nor husband Chris were expecting a premature birth. But that night, a surprise contraction knocked Bisi to the floor.

B BENNETT: I flipped off the couch onto all fours, and I screamed. And then I thought, something is really, really wrong.

O'NEILL: Chris grabbed her things and rushed her to the car for the 15-minute trip to the hospital.

CHRIS BENNETT: She's, like, yelling. She's never had this much pain before.

O'NEILL: Moments later, baby Dorian made his grand entrance right there on the front seat of the couple's compact SUV.

C BENNETT: So at that point, I put my right hand on him, left hand on the steering wheel. At this point, I start running red lights.

O'NEILL: Chris spotted an emergency vehicle and flagged it down for an escort.

C BENNETT: They put their lights on. They take us through some one-way streets and then navigate us to the emergency room.

O'NEILL: Bisi, meantime, feared the worst.

B BENNETT: When he came out, I didn't hear any sounds. It was just silent. So I was very worried, and I was crying.

O'NEILL: At the hospital, the emergency crew rolled them into the ER, all the while giving CPR to baby Dorian.

B BENNETT: All I remember is before they wheeled me away, they said, we've got a pulse.

O'NEILL: Dorian spent the first two months of his life in expensive neonatal intensive care, but Bisi wasn't worried about the cost. The hospital was in-network and she kept tabs on their $3,000 deductible.

B BENNETT: And prior to that, I'd already used up probably $1,500 of it while I was pregnant with the baby.

O'NEILL: But then came the hospital bill, and it wasn't for just $1,500. It was more than a half-million dollars, and insurance wasn't paying it.

B BENNETT: I wasn't worried because I saw the reason why the insurance company had not paid it.

O'NEILL: Bisi's employer switched health insurance plans on the first of this year. One plan needed to pay for Dorian's care in 2020, the other for his care in 2021. Bisi told that to the hospital.

B BENNETT: To be quite frank with you, I just thought, I've given them the information. They're going to take care of it.

O'NEILL: But they didn't take care of it. The Bennetts got a bill from the hospital offering them a payment plan - 12 payments of more than $45,000 a month. Then, a short time later, dad Chris is diagnosed with stage 4 neuroendocrine cancer. The shocking news and barrage of treatments consumed the couple.

C BENNETT: You get really bad fatigue from the radiation. And then the chemo - it wasn't too bad. I kept my appetite. But it would always put me in this place where I just felt (sighing).

O'NEILL: In the midst of all that, the hospital bills kept coming, and neither insurance would pay.

B BENNETT: This is ridiculous. I have insurance. This could easily be taken care of if they would actually bill correctly.

O'NEILL: While working full-time and taking care of her baby and husband, Bisi kept pleading with the hospital to fix its error. She asked a supervisor to at least put a hold on the bill to protect her credit. Call back later, they said.

B BENNETT: I was just very upset that they thought that it was my job to call them back in two weeks just to get the same runaround and the same ridiculous answer.

O'NEILL: Bisi Bennett says now with Chris's ongoing battle with cancer, she and her husband are at wit's end.

For NPR News, I'm Stephanie O'Neill.

MARTINEZ: OK, so this is a family under stress - a premature baby, dad with a cancer diagnosis, a hospital saying they need to pay $45,000 a month. Doctor, what did they do?

ROSENTHAL: Well, they wrote to Bill of the Month after they tried everything else. This was in September when Dorian was about 10 months old. And Bisi got yet another bill with this absurd payment plan. I mean, that sounds like an annual salary rather than an installment plan. Finally, the hospital resubmitted the bill to the two different insurers after our reporter called, and the balance was settled around the time Dorian turned 1.

MARTINEZ: So what was going on there, exactly? What gives with all this?

ROSENTHAL: Well, I mean, first, let's note that Bisi works in the insurance industry, so she understood exactly that the bill was an error and how the problem had occurred. But that didn't help. As for the absurd payment plan, the Affordable Care Act says that hospitals have to offer financial assistance, and many have made payment plans part of that offer. But hospital bills are so big and now they're so automated. OK, so you split half a million dollars into, you know, 12 easy payments, and that becomes $46,000, which is no help at all.

MARTINEZ: And why is it so difficult to get the error corrected? I mean, the mom here, Bisi - I mean, she kept telling them what the problem was.

ROSENTHAL: Yeah. You know, that's a good question without a good answer. Two insurers and the hospital couldn't deal with the calendar changing from 2020 to 2021. And, you know, health care has kind of a Y2K problem because insurance systems don't deal with this switch over very well.

MARTINEZ: Now, we love that she wrote to us and we were able to help, but what else can people do if they are getting the runaround, as Bisi was?

ROSENTHAL: One of the best things to do is to call your own human resources department. They have much more sway than you do because they don't want your company to cancel the policy. Now, they might be able to cut through the red tape faster than you. Also, it was really smart that Bisi reminded the hospital that her bill was under dispute because otherwise it might have been sent to collections because that's often automated, too.

MARTINEZ: All right. That's good advice, and we are wishing the Bennett family the very best of luck with dad Chris's health in 2022. We thank them for writing to us and sharing their story. And we want to hear your stories as well, because if you have a confusing or outrageous medical bill, please go to NPR's Shots blog and tell us all about it. Dr. Elisabeth Rosenthal is editor-in-chief at our partner, Kaiser Health News. Doctor, thanks.

ROSENTHAL: Thank you, and best for the Bennett family this year.

(SOUNDBITE OF HELIOS' "VAINGLORY") Transcript provided by NPR, Copyright NPR.