Health insurance couldn’t prevent pain, credit damage brought by $80,000 hospital bill
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Confronting Medical Debt in North Carolina
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A first-of-its-kind state initiative is expected to help people with big hospital bills they can’t pay and to reduce the risk that more North Carolinians face the same plight.
In exchange, this state’s 99 hospitals will receive billions more in federal Medicaid money.
For many North Carolinians, the damage is already done. Among them is Alex Montalvo, who was stunned by the high cost of everything linked to his emergency medical care.
When a severe asthma attack struck Alex Montalvo, he was in no position to be choosy about where he went for help. He was struggling to breathe, and he knew from experience that he needed medical care.
He went to a Novant urgent care clinic that Saturday afternoon in 2021 but it was closing. So he drove to Atrium Health’s emergency room in Waxhaw, where he said staff gave him nebulizers and steroids and monitored his breathing. He was there for about four hours.
His insurance paid the hospital system about $1,700 for that visit. But three months later, Atrium sent Montalvo a letter saying he owed $1,908 more because Atrium was not in his health plan’s network.
His account was turned over to a collection agency several months later. He’d been thinking about buying a house at the time, but he knew the damage to his credit score would have made it impossible to get a mortgage.
More hospital bills came this summer. On July 2, Montalvo was hit with excruciating stomach pain.
“It felt like somebody shot me with a 12-gauge,” he said.
He returned to the nearby Atrium emergency room in Waxhaw, and was soon transferred to the system’s Pineville hospital, where doctors operated to remove a segment of dead tissue from his intestine.
Montalvo, now 63, credits the surgeons with saving his life. But he’s less grateful to the hospital’s billing department.
The bill for his emergency room visit and four-day hospital stay exceeded $80,000.
Among the charges on his six-page hospital bill: $14,309 for anesthesia; $2,308 for the 80 minutes he spent in a recovery room; and $6,208 for a CT scan — more than 10 times what Medicare typically pays for that type of scan, according to the agency’s price lookup page.
Montalvo’s insurance paid most of his bill, but Atrium billed him more than $4,800 for his deductible and out-of-pocket costs. He doesn’t have the money to cover it, he said.
“It doesn’t seem like hospitals are looking out for your best interest as much as their bottom line,” he said. “You’re at the mercy of the billing department.”
In response to questions about Montalvo’s case, Atrium sent the following statement:
“We understand the medical billing process is complex and too often results in unnecessary frustration for patients. While we cannot comment on the specifics of any patient’s care or billing, we are committed to guiding and assisting our patients through the financial costs of their health care and resolving issues to the best of our ability.”
The state’s new debt relief program, Montalvo said, is “fantastic” and he predicts it will ease the stress faced by many North Carolinians.
He works in IT, and earns too much to be eligible for the debt forgiveness hospitals must provide lower-income residents, he said. But he’s pleased that the plan requires hospitals to cap interest rates on medical debt to 3% and to stop reporting debt to credit bureaus.
“At least I won’t be taken to the cleaners,” he said.
COMING THURSDAY: What are the expected benefits and possible problems with North Carolina’s ambitious debt-relief plan? Read more of our medical debt coverage here.
This story was originally published October 23, 2024 at 5:40 AM with the headline "Health insurance couldn’t prevent pain, credit damage brought by $80,000 hospital bill."
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