Lone Peak Hospital's Surprise Medical Bill and how I beat it

Posted by Walter KeaneSep 15, 20212 Comments

The Lone Peak Hospital's $5,790 Surprise Bill/Balance Bill: 3 days on the Covid Floor followed by months of financial terror.

In April 2020, I spent three days on Lone Peak Hospital's "Covid Floor." While my insurance paid over $23,000 for my care, Lone Peak Hospital eventually sent me a balance bill (a form of a surprise medical bill) for $5,790.  They zeroed out my bill after I advocated for myself.  This is my story.

Two days after being discharged from the Covid floor my health care insurance informed me that Lone Peak Hospital was seeking reimbursement on a "level of care" higher than what the insurance would pay; my hospital stay would not be covered.

On April 8, 2020 (two days after being discharged), my health insurance company wrote to me and explained they would not pay my claim because Lone Peak Hospital was seeking reimbursement "above the recommended level of care [my health insurance] cannot cover it." Specifically, the letter stated:

"Level of care" is the amount of medical care or treatment needed . . . and where that care or treatment should be provided. . . .

We reviewed the information submitted by your doctor or facility. According to applicable clinical guidelines, your illness . . . does . . .not meet the guideline for this level of care. 

When a doctor or facility treats a patient above the recommended level of care, we cannot cover it.

Your hospital inpatient admission is not covered.

Your provider should not bill you for the cost of the services you received.

I had diligently paid my insurance premiums for decades.  When I became ill and needed care, my health insurance company and the hospital failed me.  The main goal of both the hospital and health insurance is to make money and not serve patients or the insured.

Lone Peak Hospital submitted multiple claims totaling roughly $86,852 to my health insurance; they got $23,160 but came after me for over $5,000.

The hospital had submitted numerous claims to my health insurer.  The health insurance "dashboard" indicated that "[I] May Owe" $28,951.17 for a claim "processed" on June 25:

Health Insurance Dashboard

Why did Lone Peak Hospital submit $86,852 in claims (one of the claims appeared to be a duplicate)? Why was I potentially liable for $28,951.17?  There was no easy way to discover this information.

If I died, would Lone Peak Hospital go after my estate? They would know I was dead and incapable of contesting any bill payment they demanded.  Surviving family members would probably not have the awareness or understanding to challenge a surprise medical bill in such circumstances.

Julie Appleby's New York Times article on Taking Surprise Medical Bills to Court guided me during a physically challenging time. It formed the basis of my complete victory over Lone Peak Hospital's insane, unjustified, and morally wrong surprise balance medical bill.

I'm an attorney and have filed dozens, if not hundreds, of lawsuits, and I was physically exhausted and still in lots of pain.  My brain wasn't working well, and I couldn't drive.  I had to ask friends to bring me food, and I've never had to do that before. Had anyone dealt with this before? 

An article by Julie Appleby, "Taking Surprise Medical Bills To Court," New York Times, December 18, 2018, https://www.nytimes.com/2018/12/18/well/live/taking-surprise-medical-bills-to-court.html?searchResultPosition=3 helped me regain my focus and realize I was not alone.

Ms. Appleby's article details the plight of Joaquin Lopez, a 37-year-old college professor.  Lopez went to the emergency room complaining of excruciating abdominal pain, and they sent him home; hours later, they called and had him come back for emergency gallbladder surgery.

Lopez's medical insurance paid $11,160; but, the hospital billed him an additional $8,000.  Lopez stated in the article that there was no mutual assent; he had no idea how much the medical bill was; further, the hospital was out-of-network, so the costs were higher.  This narrative resonated with me strongly: I, too, had suffered such a fate.

The article quoted a Duke University Law professor, "Without an explicit price upfront, contract law would require medical providers to charge only 'average or market prices.'" (Emphasis added.)  

After serving their registered agent, I had a conversation with Lone Peak Hospital's Patient Access Director; I got my bill zeroed out.

I decided to serve Lone Peak's registered agent a complaint styled as a letter. Eventually, I was able to speak with the "Patient Access Director." 

I explained to the director that I had never executed a contract with Lone Peak Hospital, and even if I did it would have been under duress.

Why did Lone Peak Hospital make so many claims against my health insurance? Where is a detailed bill of all the charges I incurred?  What about the "level of care" issue?

The director explained that we could work out a payment plan.  At that point, I asked for his general counsel's phone number.  Did he have any idea of who would represent the hospital regarding my lawsuit.  I also asked if he would be willing to accept service on behalf of Lone Peak Hospital?

The director informed me that he would zero out my bill, and he did.

Hospitals are not prepared to fight surprise medical bills in court. While they eventually turn surprise medical bills over to collection agencies, I am not aware of hospitals initiating litigation.

If you have a surprise medical bill, if a loved one died, and you're trying to figure out why the insurance didn't cover the bill, please call me. I've helped others, and I can help you.