Fighting for Coverage: Hoosiers successfully battle insurance companies over billing mistakes

Medical bills fill Carolyn Cory’s table as she explains her billing problems to 13 Investigates reporter Sandra Chapman. (WTHR Photo)
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INDIANAPOLIS (WTHR) — Medical billing can be confusing. When surprise charges show up or your insurer refuses to pay, it can cost you both time and money.

13 Investigates found some Indiana patients forced to pay out of pocket to protect their own credit.

The sanctuary at First Assembly of God in Delphi is empty, but the soothing melodies of "Eternal Hallelujah" fill the large auditorium.

Tammy Oliver continues playing the keyboard at First Assembly of God Church in Delphi, even after her Stage IV cancer diagnosis. (WTHR Photo)
Tammy Oliver continues playing the keyboard at First Assembly of God Church in Delphi, even after her Stage IV cancer diagnosis. (WTHR Photo)

Tammy Oliver stands over her electric piano playing as if WTHR cameras weren't watching.

Just moments earlier she spoke of a grim diagnosis doctors delivered to her in 2015.

"They diagnosed me with Stage IV cancer and determined there was not a lot that they could do," she told 13 Investigates.

But that diagnosis hasn't kept the church's music minister from what she loves.

She said she prayed for a miracle and started some new medications.

"The injection that I started on was about $9,000 a month," she revealed.

Her healing plan was all under the watch of a carefully chosen doctor.

In-Network vs Out-of-Network

When Tammy Oliver was diagnosed with Stage IV cancer, she and husband Brent wanted to make sure Tammy’s primary oncologist was in their health care network in order to help keep costs down. (WTHR Photo)
When Tammy Oliver (right) was diagnosed with Stage IV cancer, she and husband Brent (left) wanted to make sure Tammy’s primary oncologist was in their health care network in order to help keep costs down. (WTHR Photo)

"Every thought that I had was as long as I get that doctor in-network, we'll deal with the others," explained Pastor Brent Oliver, her husband.

He was referencing about the new Anthem Marketplace insurance policy they had signed up for last year. It was one thing to switch policies, but he wasn't willing to compromise on the oncologist and went on line to make sure he was a part of Anthem's network.

Just after Tammy's first round of costly injections, the pastor received a troubling phone call from the doctor's office.

"Their office called and said, 'You're aware that your insurance company...we are not in-network with them?'" the staff person told him.

"No. I already checked that out...you are," Pastor Oliver responded.

She confirmed, "No...you're not."

Brent Oliver replied, "They (Anthem Insurance Staff) said you are!"

The back and forth conversations continued with Anthem and the doctor's office.

Brent and Tammy were stunned to learn there had in fact been a mistake.

'Yep you're right, they're not in-network,' he recalled the Anthem representative admitting.

According to Brent, Anthem still wanted $9500 for Tammy's office visit and injection.

"That's not what your website said, that's not what our representative told me," Pastor Oliver said. "There's no question they told me wrong"

Patients Pay Rejected Bills to Avoid Collections

Patricia McCarthy knows what it's like to go round and round over mistaken out-of-network charges. She said the same thing happened to her with MDWise and the doctor she chose to treat her neck pain. McCarthy said her doctor's office resubmitted the claim each time it was denied.

“I didn't want to mess up my credit rating, so I paid it anyway”

"They still didn't pay it," she said. "It's just crazy!"

The lack of insurance payments put her in a tough spot. She either had to pay the bills or risk going to collections.

"I didn't want to mess up my credit rating, so I paid it anyway," McCarthy revealed.

But she was so fed up by the process, she filed a complaint with the Indiana Department of Insurance.

In a response letter to the State, MDWise blamed the out-of-network charges on a "system error."

MDWise eventually covered the bills which resulted in the doctor's office getting a double payment.

Now McCarthy is awaiting her refund from the doctor.

"You can't give up because one it's your health and/or your money," she concluded. "I mean you just have to keep going but it should not be that much work."

Account Mistakes Raise Questions About Deductibles

Carolyn Cory says she has spent at least 100 hours on the phone trying to sort out a billing problem with her health insurance. (WTHR Photo)
Carolyn Cory says she has spent at least 100 hours on the phone trying to sort out a billing problem with her health insurance. (WTHR Photo)

Piles of medical bills on Carolyn Cory's table reflect the nightmare she experienced with marketplace insurance from MDWise.

"I've spent at least 100 hours over the phone over a 3-year period," she told 13 Investigates, as she described a list of billing problems including late insurance payments, out-of-network mistakes and even confusion over her account.

"I had three different subscriber numbers," she revealed.

The questionable accounts were the focus of a complaint she filed with the Department of Insurance. Cory believed the multiple account numbers caused her to overpay her deductible.

"Well I had had cataract surgery on both eyes, so I'm pretty sure I met my deductible of $2700," she said.

The multiple account discrepancy left her paying an outstanding hospital bill of over $1400 in January.

MDWise declined to speak with 13 Investigates. In a statement the insurer said, "While most claims were paid timely and accurately, some have taken longer than expected."

Persistence Pays Off for $9,000 Claim

Each of Tammy Oliver’s injections to treat her cancer cost about $9500. (WTHR Composite)
Each of Tammy Oliver’s injections to treat her cancer cost about $9500. (WTHR Composite)

Back in Delphi, Tammy Oliver still believes in miracles. Her most recent scans showed no cancer.

Her husband also wrote to the state and he appealed Anthem's refusal to pay the $9000 bill.

In its appeal, Anthem reopened the Oliver's case and agreed to pay the bill as part of a "one-time exception."

The Oliver's also were able to opt out of the Anthem plan and are now back in-network with their chosen oncologist.

MDWise is no longer offering Marketplace insurance saying it was too "complicated and difficult to administer."

The insurer says it continues to work with affected members to resolve outstanding claims.

In a statement released to 13 Investigates, MDwise said:

"MDwise Marketplace participated in the Affordable Care Act ("ACA") insurance market from 2014 - 2017. MDwise learned quickly that ACA Marketplace products were complicated and difficult to administer. MDwise exited the Marketplace at the end of 2017.

Marketplace experienced claims payment issues in 2017 due to a change in the claims payment system. We have been transparent with members and providers who have been affected by these issues. While most claims were paid timely and accurately, some have taken longer than expected to resolve. MDwise Marketplace continues to actively work with affected members and providers to resolve the remaining claims issues and remains committed to bringing each of them to an equitable resolution."

How to Get Action on Billing Mistakes

Patients who have had success in getting their insurance charges corrected tell 13 Investigates, persistence is the key. They also pointed out they all kept very good records and logged their phone calls and whom they spoke to prove their cases.

To prove certain doctors were listed as in-network, take a screen shot of the insurer's website to prove which doctors are included.

If your services and charges are not available online, ask for a printout or a review from your insurer.

And if you still can't get resolved, you can always file a complaint with the Indiana Department of Insurance.

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