Mark Christensen thought the hospital bill was a mistake.
Documents from Allina Health arrived in February and said the 61-year-old Woodbury resident owed the hospital a staggering $155,493.
That doesn’t make sense, Christensen said. He had insurance through his employer with a reputable health insurance company. And the need for nursing care could not be denied. Christensen was hospitalized for about a month for treatment for a rare and deadly blood cancer.
However, Christensen’s insurance company, Empire BlueCross BlueShield, refused to pay because Alina did not have permission to transfer Christensen to the new hospital. Her transfer occurred about halfway through her hospital stay.
The company has a policy that if an inter-facility transfer is not approved, all claims for treatment at a second hospital can be deemed not medically necessary.
The decision left Christensen in charge of the bill.
“It was a life-or-death matter, so it was clear that he needed to be hospitalized. And it was clear that he needed to be transported,” Christensen said. “It’s ridiculous for them to say it’s not medically necessary.”
Mr. Christensen’s subsequent story highlights the financial crisis patients face when they are caught between hospitals and insurance companies, claims experts say.
Empire BlueCross BlueShield stuck to its decision until early October. Meanwhile, Mr. Christensen has appealed to an external review body.Earlier this month, the agency sent a letter supporting the insurance. He denied the decision, saying it was in the “best interests of patients.”
Then, in mid-October, the health insurance company called Christensen and told him the claim would be paid. The call came about three days after the Star Tribune began questioning both Allina and Empire Blue Cross Blue Shield about the dispute.
The insurance company, a division of Indiana-based Anthem Inc., told the Star Tribune that it “appreciates the cooperation and partnership with Allina Health to review and address this matter and would like to thank Mr. Christensen for We are pleased that a resolution has been reached.” ”
“We strongly believe that Mark, or any patient, should not be caught in the middle of a medical bill dispute process between a healthcare provider and a payer,” Allina Health said in a statement.
As of Thursday, some details about the resolution had not yet been released.
Bill Foley of the Oakdale-based nonprofit Cancer Legal Care said that when health care providers face denials from health insurance companies, they can either pay the patient’s bill or collect their own insurance. He says there is anecdotal evidence that more and more people are asking to either fight to get their money. He helped Christensen with his appeal.
Complicating matters is the growing number of health insurance companies. Insurance premium payment policy When applied strictly, there is no room for common sense or nuance, Foley said.
In Christensen’s case, the insurance company invoked its interfacility transfer policy to justify refusing to pay for subsequent hospital care, without addressing whether an additional 17 days of hospital treatment were required.
“Both Empire and an external review agency looked at that policy and said, ‘Hospitalization is not covered unless transport is medically necessary,'” Foley said. “No one mentioned the common sense fact that the hospital where the transfer was first needed was short of temporary staff.”
Highly malignant cancer
Christensen was having breakfast with his wife on Dec. 14., In 2022, I accidentally bit the inside of my cheek. He was surprised when he noticed that his bite left a “big purple mess”.
His wife was a particular problem. Jane Christensen said it was because her husband had recently been suffering from unexplained bruising.
Christensen is a software engineer who chose his employer’s health insurance option with the most comprehensive benefits. So he didn’t hesitate to visit his GP immediately to investigate the problem.
After running several tests, the doctor told Christensen to go to the emergency room immediately and carefully. The doctor added that Christensen should not go to a local hospital because he needs to be seen at one of the area’s large medical centers with specialized capacity.
Christensen and his wife chose United Hospital in St. Paul, where doctors quickly diagnosed acute promyelocytic leukemia, an aggressive and rare disease. Doctors estimated that treatment would require at least 30 days of hospitalization.
Blood cancer, known by its acronym APL, has an early onset. Doctors said there was likely no sign of it in Christensen’s body just a few weeks ago. Had he not sought treatment immediately, his outcome could have been fatal.
“I could have died within 48 to 72 hours of the ‘hemorrhage’,” he said.
APL is one of the most treatable cancers with a very high cure rate, but that didn’t mean Christensen was out of the woods.
The disease is caused by a genetic mutation that causes the proliferation of promyelocytes, or what Christensen describes as “baby white blood cells.” He said treatment includes oral drugs to help cells mature and IV arsenic trioxide, which inhibits proteins the cells need to survive.
As sometimes happens, Christensen’s treatment led to a complication known as “differentiation syndrome,” a severe reaction to drugs used to treat certain blood cancers. It was just around Christmas. Hospital caregivers said the facility is having problems with temporary staffing on holidays. He also said he would be better off at Allina’s other facility, Abbott Northwestern Hospital in Minneapolis, where doctors and nurses have more expertise in blood cancers.
Christensen was taken to the hospital by ambulance on December 27th. Doctors successfully treated the complications while continuing cancer treatment, and he was discharged from the hospital on January 13th.
When Christensen returned home, he was looking through his pile of mail when he saw a letter from Empire Blue Cross dated Dec. 30. A request to be transferred to a hospital had been denied as it was not medically necessary.
“At the time,” Christensen said, “I was a big fan. “I thought it was just a minor problem that would be resolved.”
the bill won’t go away
When Christensen began outpatient treatment in February, Empire Blue Cross provided explanations on benefit forms showing hospitalization costs totaling $155,493.30.
The form stated that by going to Abbott Northwestern for care, Christensen would be eligible for in-network benefits.
“That is your highest value,” the form said.
Meanwhile, Alina sent an invoice showing the same six-figure balance due in early March. When Christensen called, a health system representative said the bill was under consideration and that she should ignore the notice.
But in late March, Alina called and told her that Christensen would need to appeal to Empire Blue Cross to challenge the denial. He did so because he believed that more information would cause the insurance company to pay the claim.
Christensen included a letter from Alina’s doctor stating that the transfer was necessary given the severity of the disease and the need for specialized leukemia services. The appeal also included a discharge summary from United Hospital where another doctor recommended transfer to a “higher level of care.”
However, on May 11, Empire Blue Cross issued a final adverse judgment denying the claims based on inter-facility transfers.
“That was probably the real point when I thought this could be really tough,” Christensen said.
He called Alina and asked for help from a financial navigator who advises patients on medical costs. Christensen also asked about legal cancer care and reached out to Foley, a former health insurance executive who now works as a patient advocate for a nonprofit organization.
appeal
In July, Alina filed another appeal with Empire Blue Cross. Foley said the health system may have erred in the complaint by not giving enough weight to staffing issues in December.
Empire BlueCross sent a letter on August 24th supporting the denial. The insurer also said its contract with Allina prohibits the health system from billing Christensen for services.
Mr. Foley then contacted Mr. Allina and asked for assurances that the health system would not attempt to collect. Mr. Christensen’s online account at the time showed he owed $82,381.45. This amount reflected the hospital’s discount for self-pay patients. The reaction was disappointing. Alina maintained her balance as a patient responsibility.
Mr Christensen’s last hope was to send his appeal to an external review body. Foley helped in that effort.
The verdict handed down on October 7th left Christensen in disbelief.
The review accepted the doctor’s argument that the transfer would have increased the chances of successful treatment, but determined that United Hospital had the capacity to treat the patient and concluded that the transfer was medically unnecessary.
sudden approval
Christensen and Foley spoke to a Star Tribune reporter on October 10 about the billing dispute. That night, the paper asked Alina and Empire Blue Cross a series of questions.
Three days later, an Empire Blue Cross nurse contacted Christensen to inform him that the health insurance company had reversed its decision and determined that the claim was medically necessary.
Empire Blue Cross did not respond to questions about the details of the resolution, including whether it paid Mr. Christensen’s bill in full. In her statement, Alina said the complexity of her billing process created a miscommunication between the hospital and the health insurance company.
“We are grateful for our partnership with Empire BlueCross BlueShield and their willingness to reverse their decision,” Alina said. “We recognize that it should not have taken Mark as much time and effort to reach a resolution, and we are committed to doing better for our patients.”
There is no comprehensive data showing exactly how often health insurance companies deny medical claims or how often health care providers ask patients to pay their bills, according to the Patient and Consumer Protection Program. said co-director Kay Pestaina. KFF is a California-based health policy group.
That makes it difficult to tell whether the problem is getting worse, Pestaina said. However, there is growing concern about health insurance companies’ use of internal coverage guidelines when determining medical necessity.
The cancer is currently in remission. Christensen praised the care he received from Alina and the efforts of one of the health system’s financial navigators to resolve the billing issue. He is still waiting for final documents from his health insurance company. Your online account no longer shows a large balance owed to Allina.
He is grateful for the result. At the same time, Christensen worries that other patients may not be lucky enough to find a solution when faced with a mysterious bill.
“I feel a great sense of relief because it’s been a long battle,” he said. “But I also wonder if things would have been different if I hadn’t worked with Bill at Cancer Legal Care and if he hadn’t been in contact with Cancer Legal Care. [the Star Tribune] –I don’t think this problem has been resolved yet. ”
