Brittany Giroux Lane gave birth to her daughter Alexandra a few days before Christmas in 2018. The baby had dark eyes and long legs. She had also gained weight about 13 weeks early and weighed just two pounds.
Alexandra initially thrived in the neonatal intensive care unit at Mount Sinai West. Ms Lane, 35, recalls that the nurses described her daughter as a “rock star” because she was growing so quickly. But her condition deteriorated quickly after an infection, and Alexandra died early on the morning of January 15, aged 25 days.
A flurry of petty medical bills from neonatologists and pediatricians soon followed. Ms. Lane struggled to get her breast pump covered by insurance because she hadn’t gone through the pre-approval process for the health plan in the midst of a premature birth.
Last summer Ms. Lane started receiving direct debit messages. The letters, sent by health plan Cigna, said she owed the insurer more than $257,000 for the bills it inadvertently covered for Alexandra’s care after Ms. Lane switched health insurers.
Mrs. Lane was stunned: it was Cigna who had received the first bill for care and paid for Mount Sinai West. Now Cigna sought the money that the hospital had overpaid by turning to the patient.
“For them it’s just a matter, but for us it means the constant trauma of reliving our daughter’s death,” said Clayton Lane, Alexandra’s father and Mrs Lane’s husband. “It means facing threats of financial ruin. It’s so unjust and infuriating.”
Medical billing experts reviewing the case described it as a dispute between a major hospital and a major insurer, with the patient at the center. The experts say such cases are uncommon, but point to the broader lack of predictability in US medical billing, with patients often having little idea what their care will cost until a bill appears in the mail months later.
Congress last year passed a ban on surprise medical bills, which will take effect in 2022. It prohibits a certain kind of surprise bill: those that patients receive from an out-of-network provider who is unexpectedly involved in their care. There are plenty of other types of bills that surprise patients, such as the Lanes, which are likely to last.
The Lanes describe the process of fighting their surprise bill as frustrating and kafkaes. They spent hours on the phone, sending dozens of emails and filing complaints with regulatory authorities in two states.
“The letters mean I’m constantly reliving the day, and that’s such a difficult space to be in,” Ms Lane said. “I feel so frustrated that the hospital is making decisions about their own bottom line that affect our potential future and our child’s memory.”
“This patient had no control over what was paid, and she has no control over whether it is returned,” said Susan Null, a medical billing expert at Systemedic Inc. “Sometimes things like this can be done to motivate the patient to contact the hospital to get them to release the money.”
Americans are familiar with medical debt: About 18 percent of them have an outstanding bill from a hospital, doctor, or other type of provider in the health system. But most don’t expect collection announcements for bills already paid by their health plan.
Courtney Jones, a senior case manager at the Patient Advocate Foundation, described working on cases where patients have received similar collection notices for bills that the insurer, not the patient, was supposed to cover. It usually happens with high medical bills, like with the Lanes, where the insurer and hospital both have more at stake.
“They are using it as a tactic to put pressure on the medical facility to repay the money,” Ms Jones said.
In response to questions from The New York Times, Cigna said it “regretted” the letters and, in light of Lanes’ experience, was now reviewing how it communicates with patients in such cases.
After the Lanes filed a complaint with a state regulatory agency, Cigna sent them a letter saying they would no longer receive similar letters. “We sympathize with the pain and confusion this experience has caused for Mr and Mrs Lane,” the statement said. “We’re working with our supplier to make sure this doesn’t happen again with the Lanes or any other customer.”
Mrs. Lane received the first notice of collection about 18 months after her daughter’s death. Her family had switched health insurance policies midway through Alexandra’s hospital stay due to a job change.
The day Ms Lane started giving birth to Alexandra would be her last day at the first job, before starting a new position a few weeks later.
“I was terrified of being slapped with a huge bill, so even while I was in labour, I was updating my insurance at Mount Sinai,” Ms Lane recalled.
The hospital appeared to have both insurance plans — Cigna for 2018 coverage and UnitedHealthcare for 2019. But Cigna inadvertently covered the entire bill and overpaid $257,000 in January for the baby’s care that UnitedHealthcare should have paid for.
A representative from Mount Sinai told the Lanes that UnitedHealthcare did indeed pay the bill — meaning the bill was paid twice — but that didn’t solve a bigger problem Mount Sinai has with Cigna.
When Mrs. Lane received the first takeout message, she contacted the hospital. A patient service representative apologized and wrote via email that “Cigna will be refunded the excess”. The outside contractor who sent the letter on behalf of Cigna also told her that the matter would be settled within days.
“I would get a confirmation; I didn’t, but I was exhausted and I didn’t follow through,” she said.
She realized the refund had never happened when another collection notice arrived this summer in early July. When she contacted the hospital again, a top executive said she did not know when the refund would be released.
“I cannot give you an answer about the refund owed to Cigna as it is being discussed as part of a larger settlement agreement that is underway,” wrote Gail Spiro, Mount Sinai’s assistant vice president for financial services. for patients, in an August statement. 10 email. “I apologize again for how long it took to get you what you need.”
In a statement, Mount Sinai West said: “It is normal business practice to reconcile accounts with insurers in this way. It is not typical for an insurer to pursue a patient in this way.”
The Lanes also had several phone calls with Cigna and eventually filed a complaint with the California insurance department, where their Cigna health plan was registered.
“Receiving another letter was completely disruptive to our lives and our healing,” Mr Lane said. “It meant a lot of tears.”
In response to that complaint, Cigna sent de Lanes a letter stating that the notices had been erroneously sent by a third-party provider called HMS, which the insurer uses to monitor overpayments to hospitals. The letters were only intended to “inform” the family about the ongoing dispute with Mount Sinai, the Cigna letter said.
The messages the Lanes received informed them both of the debt and asked them to “pay in full” within 30 days, using a slip at the bottom of the letter intended to be returned with payment.
HMS declined to comment on this article, citing patients’ privacy practices. The Lanes have requested Mount Sinai and Cigna to provide letterhead statements that the family does not owe this debt. No such letter has yet been issued, although Mount Sinai says it will issue one in the coming weeks.
The Lanes said it was difficult to reconcile the kind and loving care their daughter received in the neonatal intensive care unit with the billing experience that followed.
“She died surrounded by people who cared so lovingly and wonderfully for her,” she said. “We will continue to support the NICU directly so we can help families who are there.”
Since Alexandra’s death, the Lanes have donated supplies to Mount Sinai West’s neonatal unit, including baby rockers; books on caring for premature babies; and a camera with a photo printer (taking baby photos can be difficult, they’ve learned; phones are often not allowed for hygiene reasons). The family now also welcomes a new addition: they are adopting a son.
“He’s six weeks old now and we’re really falling in love,” Mrs. Lane said. “However, there are many firsts, which should be seconds – the first time he smiled was a first for him, but should have been a second for us. There is a lot of joy, but also a lot of secondary loss, and a lot of thinking about Alexandra .”