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Aurora couple fights surprise medical bill for emergency surgery

They didn’t know the doctor was out-of-network
Posted at 9:37 PM, Aug 21, 2020
and last updated 2020-08-22 01:16:33-04

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AURORA, Colo. -- When a doctor said he needed emergency surgery, the last thing Jay Wickman thought to ask was if that doctor was part of his network. Wickman didn’t find out until they received a bill for more than $4,000.

Wickman and his wife, Carinne, had been fighting the bill for nearly a year when they reached out to Contact Denver7.

“I’m arguing it, I’ve never done this, I’ve never taken something so far, but we should not be responsible for the shortfalls of the insurance company versus the provider and that’s what they’re doing to us,” said Carinne Wickman.

A bill from the insurance company shows the surgery bill was $4,344, but the amount allowed by insurance was $634 meaning that the Wickmans would have to pay the difference. This practice is known as balance billing.

According to the Colorado Consumer Health Initiative, a balance bill or surprise medical bill “charges the difference between what your insurance pays to the out-of-network provider and what the provider charges for the services.” If the provider is not in-network, you may be asked to pay a greater amount than your health plan’s copay.

“It’s very hard to know, even with a planned procedure, if all of the doctors are part of your insurance network. In emergency scenarios it’s really impossible to expect consumers to try to avoid this,” said Adam Fox, Director of Strategic Engagement for the Colorado Consumer Health Initiative.

RELATED: Colorado law to protect patients from surprise medical bills went into effect on Jan. 1

Contact Denver7 reached out to the insurance provider. A spokesperson released the following statement, “To protect the privacy of our members, Blue Cross and Blue Shield of Illinois does not disclose their personal or benefit information. Our members are at the center of all that we do and we are committed to providing all of our members access to quality health care consistent with the terms of their benefit coverage.”

The same day Contact Denver7 reached out, the Wickmans said they received an email telling them the claim had been reprocessed. Instead of owing nearly $4,000, they will only have to pay $190.

Wickman hopes their story can help other families. She said she would encourage others to review their bills closely and to not be afraid to ask questions.

“So it’s not just about us,” said Wickman.