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She Paid Her Husband’s Hospital Bill. A Year After His Death, They Wanted More
Money.
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Bill Of The Month

SHE PAID HER HUSBAND’S HOSPITAL BILL. A YEAR AFTER HIS DEATH, THEY WANTED MORE
MONEY.

By Samantha Liss August 29, 2023

Republish This Story

After paying what she believed to be her husband’s final hospital bill, Eloise
Reynolds encountered a perplexing reality in medical billing: Providers can come
after patients for more money well after a bill has been paid. (Matt Kile for
KFF Health News)

Last summer, Eloise Reynolds paid the bill for her husband’s final stay in the
hospital.

This story also ran on NPR. It can be republished for free.

SEND US YOUR MEDICAL BILLS

Do you have an exorbitant or baffling medical bill? Join the KFF Health News and
NPR ‘Bill of the Month’ Club and tell us about your experience. We’ll feature a
new one each month.

Submit Your Bill

In February 2022, doctors said that Kent, her husband of 33 years, was too weak
for the routine chemotherapy that had kept his colon cancer at bay since 2018.
He was admitted to Barnes-Jewish Hospital in St. Louis, not far from their home
in Olivette, Missouri.

Doctors discovered a partial blockage of his bowel, Reynolds said, but she
remained hopeful that his treatment would soon resume.

“I remember calling our kids and saying, ‘OK, this is all really good news. We
just need to get him kind of bolstered back up and feeling well,’” she said.

But years of chemotherapy had taken a toll on his body, and he told his wife
that he couldn’t go on any longer.

Kent was discharged and began hospice care at home. He died the next month at
age 62.

When Reynolds received the bill for the hospital stay, she paid the $823.15 it
said her husband owed. She scribbled “paid” on the bill, memorializing the date,
June 30, 2022 — the financial endpoint, she thought, of Kent’s years of
treatment.

Then the bill came (again).

The Patient: Kent Reynolds, deceased, had been covered by Blue Cross and Blue
Shield of Illinois through his Illinois-based employer.

Medical Service: A 14-day hospital stay related to complications from colon
cancer, including a partially blocked bowel.

Service Provider: BJC HealthCare, a tax-exempt health system that operates 14
hospitals, mostly in the St. Louis area, including Barnes-Jewish Hospital.

Total Bill: The hospital charged $110,666.46 for the stay before any payments or
adjustments. The insurer negotiated that price down to $60,348.77, and Reynolds
paid the $823.15 the hospital said the patient owed. Then, a year after her
husband’s death, she received a new version of the bill from the hospital,
charging her an additional $1,093.16.

What Gives: Reynolds encountered a perplexing reality in medical billing:
Providers can — and do — come after patients to collect more money for services
months or years after a bill has been paid.

The new bill said Kent Reynolds had been enrolled in a payment plan and that the
first “monthly installment” on the nearly $1,100 balance was soon due.

She said she called both the hospital and Blue Cross and Blue Shield of Illinois
in search of answers but didn’t get an explanation that made sense to her.

According to Reynolds, a BJC HealthCare representative told her that the insurer
had paid more than it owed, meaning the health system had to reimburse the
insurer and charge the patient more.

Reynolds said she grabbed a yardstick to use as a straight edge and went line by
line, comparing both bills, to see what had changed, a task that evoked painful
memories of her husband’s last days. The amount for each individual charge —
medications, lab tests, supplies, and more — was the same on both bills. The
total had not changed.

Only three aspects of the bill had changed: the adjustments; the amount paid by
the insurance company; and what the patient owed.

Adjustments, or discounts, are amounts that may be subtracted from a medical
bill, typically under the provider’s pre-negotiated contract with an insurer.
Insurers and providers agree to lower, in-network rates for services provided to
patients covered by the insurer.

Reynolds also received an EOB, or “explanation of benefits,” notice showing the
insurer reviewed the bill again in February, a year after the hospital stay. The
document said the hospital’s charges for her husband’s private room — amounting
to nearly $77,000 — were more than his health plan’s negotiated room rates,
which did not cover the full cost.

The EOB noted that the patient could still owe the hospital $50,216.31 for the
room charges — a startling amount — although Reynolds ultimately received no
bill indicating she owed that much.

Reynolds said she spent hours trying to understand the items on the hospital and
insurance paperwork, since they used medical abbreviations and were grouped
differently on the documents.

“It shouldn’t be this hard for a widow to figure out what the medical bills
were,” said Erin Duffy, a research scientist at the University of Southern
California’s Schaeffer Center for Health Policy and Economics.

Blue Cross and Blue Shield of Illinois declined to comment despite receiving a
signed release from Reynolds waiving federal privacy protections.

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The Resolution: Unclear about what had changed and how much she owed, Reynolds
held off on paying the second bill. After KFF Health News contacted BJC
HealthCare, Laura High, a media relations manager for the system, said the
charges were the result of a “clerical error.” Reynolds no longer has a balance,
High said in an email in May.

“I was shocked by it,” Reynolds said. “I’m convinced most of the people I know
would have paid this.”

High did not answer questions about the cause of the billing error or how often
such errors occur.

However, Duffy provided a different explanation for the charges. “This doesn’t
seem like an error,” she said. “It seems consistent with their insurance plan
design.”

She said it appeared the additional $1,100 charge — assessed a year later —
represented Kent’s coinsurance share of the private room charges, which she
found as a recurring line item on each page of the bill under the heading
“Oncology/PVT.”

While his coinsurance responsibility could have amounted to 10% of what the
insurer paid in room charges — potentially a huge amount — Kent had met his
out-of-pocket payment maximum for the year, so the charges did not reach the
full 10% of the room costs, Reynolds said.

Reynolds says she was confused and concerned when she received a new version of
a hospital bill she had already paid. Comparing the bills line by line, she
found just three things had changed: the adjustments; the amount paid by the
insurance company; and what the patient owed.(Matt Kile for KFF Health News)

The Takeaway: In the United States, medical bills and insurance statements
create a burdensome puzzle for patients to sort through to determine what is
actually owed. The first rule of thumb is: “Don’t pay the bill before you’ve
gotten the EOB,” which is the insurer’s accounting of what you owe and what the
insurer will pay, said Kaye Pestaina, co-director of KFF’s Program on Patient
and Consumer Protections.

In addition, ask for an itemized breakdown of charges and compare it against the
EOB.

Medical billing experts said standardizing terms and other details on medical
bills and EOBs would help patients enormously in this undertaking.

A few states have taken steps toward giving patients more information about
health care charges, including by simplifying medical bills. In 2019, New York
state lawmakers proposed requiring hospitals to provide patients with bills in
plain language, including an itemized list of services labeled as paid by the
insurer or owed by the patient. The proposal, which did not advance, required
hospitals to send patients a single bill within seven days of leaving the
hospital.

Reynolds’ experience highlights the lack of laws and standards around how long
providers have to bill — and review bills — for medical services. Insurers may
dictate in their contracts how long providers have to submit claims; the
Medicare program has a 12-month limit to file claims, for instance. However,
Dave Dillon, a spokesperson for the Missouri Hospital Association, said no laws
restrict how long providers have to send a bill to patients.

Creditors may seek payment from a deceased person’s estate to collect whatever
they can, said Berneta Haynes, a senior attorney at the National Consumer Law
Center. In Missouri, a living spouse can be held responsible for a deceased
spouse’s medical bills in certain instances, said Terry Lawson, a managing
attorney for Legal Services of Eastern Missouri.

Experts said they did not pinpoint anything Reynolds could have done
differently, noting that it is the system that needs to change.

“When can she move on from these hospital bills?” Duffy asked.

Stephanie O’Neill Patison reported the audio story.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR
that dissects and explains medical bills. Do you have an interesting medical
bill you want to share with us? Tell us about it!

Samantha Liss: samanthal@kff.org, @samanthann

RELATED TOPICS

* Health Care Costs
* Health Industry
* Insurance
* States
* Bill Of The Month
* Hospitals
* Illinois
* Investigation
* Missouri
* Surprise Bills

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* Republish This Story

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COPY AND PASTE TO REPUBLISH THIS STORY

SHE PAID HER HUSBAND’S HOSPITAL BILL. A YEAR AFTER HIS DEATH, THEY WANTED MORE
MONEY.

By Samantha Liss August 29, 2023

<h1>She Paid Her Husband’s Hospital Bill. A Year After His Death, They Wanted
More Money.</h1> Samantha Liss Last summer,
Eloise Reynolds paid the bill for her husband’s final stay in the hospital.
In February 2022, doctors said that Kent, her husband of 33 years, was too
weak for the routine chemotherapy that had kept his colon cancer at bay since
2018. He was admitted to Barnes-Jewish Hospital in St. Louis, not far from their
home in Olivette, Missouri. Doctors discovered a partial blockage of his
bowel, Reynolds said, but she remained hopeful that his treatment would soon
resume. “I remember calling our kids and saying, ‘OK, this is all really
good news. We just need to get him kind of bolstered back up and feeling well,’”
she said. But years of chemotherapy had taken a toll on his body, and he
told his wife that he couldn’t go on any longer. Kent was discharged and
began hospice care at home. He died the next month at age 62. When
Reynolds received the bill for the hospital stay, she paid the $823.15 it said
her husband owed. She scribbled “paid” on the bill, memorializing the date, June
30, 2022 — the financial endpoint, she thought, of Kent’s years of
treatment. Then the bill came (again). The
Patient: Kent Reynolds, deceased, had been covered by Blue Cross and
Blue Shield of Illinois through his Illinois-based employer.
Medical Service: A 14-day hospital stay related to
complications from colon cancer, including a partially blocked bowel.
Service Provider: BJC HealthCare, a tax-exempt health system
that operates 14 hospitals, mostly in the St. Louis area, including
Barnes-Jewish Hospital. Total Bill: The hospital charged
$110,666.46 for the stay before any payments or adjustments. The insurer
negotiated that price down to $60,348.77, and Reynolds paid the $823.15 the
hospital said the patient owed. Then, a year after her husband’s death, she
received a new version of the bill from the hospital, charging her an additional
$1,093.16. What Gives: Reynolds encountered a perplexing
reality in medical billing: Providers can — and do — come after patients to
collect more money for services months or years after a bill has been paid.
The new bill said Kent Reynolds had been enrolled in a payment plan and that
the first “monthly installment” on the nearly $1,100 balance was soon due.
She said she called both the hospital and Blue Cross and Blue Shield of
Illinois in search of answers but didn’t get an explanation that made sense to
her. According to Reynolds, a BJC HealthCare representative told her that
the insurer had paid more than it owed, meaning the health system had to
reimburse the insurer and charge the patient more. Reynolds said she
grabbed a yardstick to use as a straight edge and went line by line, comparing
both bills, to see what had changed, a task that evoked painful memories of her
husband’s last days. The amount for each individual charge — medications, lab
tests, supplies, and more — was the same on both bills. The total had not
changed. Only three aspects of the bill had changed: the adjustments; the
amount paid by the insurance company; and what the patient owed.
Adjustments, or discounts, are amounts that may be subtracted from a medical
bill, typically under the provider’s pre-negotiated contract with an insurer.
Insurers and providers agree to lower, in-network rates for services provided to
patients covered by the insurer. Reynolds also received an EOB, or
“explanation of benefits,” notice showing the insurer reviewed the bill again in
February, a year after the hospital stay. The document said the hospital’s
charges for her husband’s private room — amounting to nearly $77,000 — were more
than his health plan’s negotiated room rates, which did not cover the full
cost. The EOB noted that the patient could still owe the hospital
$50,216.31 for the room charges — a startling amount — although Reynolds
ultimately received no bill indicating she owed that much. Reynolds said
she spent hours trying to understand the items on the hospital and insurance
paperwork, since they used medical abbreviations and were grouped differently on
the documents. “It shouldn’t be this hard for a widow to figure out what
the medical bills were,” said Erin Duffy, a research scientist at the University
of Southern California’s Schaeffer Center for Health Policy and Economics.
Blue Cross and Blue Shield of Illinois declined to comment despite receiving
a signed release from Reynolds waiving federal privacy protections.
The Resolution: Unclear about what had changed and how much
she owed, Reynolds held off on paying the second bill. After KFF Health News
contacted BJC HealthCare, Laura High, a media relations manager for the system,
said the charges were the result of a “clerical error.” Reynolds no longer has a
balance, High said in an email in May. “I was shocked by it,” Reynolds
said. “I’m convinced most of the people I know would have paid this.”
High did not answer questions about the cause of the billing error or how
often such errors occur. However, Duffy provided a different explanation
for the charges. “This doesn’t seem like an error,” she said. “It seems
consistent with their insurance plan design.” She said it appeared the
additional $1,100 charge — assessed a year later — represented Kent’s
coinsurance share of the private room charges, which she found as a recurring
line item on each page of the bill under the heading “Oncology/PVT.”
While his coinsurance responsibility could have amounted to 10% of what the
insurer paid in room charges — potentially a huge amount — Kent had met his
out-of-pocket payment maximum for the year, so the charges did not reach the
full 10% of the room costs, Reynolds said. The Takeaway:
In the United States, medical bills and insurance statements create a burdensome
puzzle for patients to sort through to determine what is actually owed. The
first rule of thumb is: “Don’t pay the bill before you’ve gotten the EOB,” which
is the insurer’s accounting of what you owe and what the insurer will pay, said
Kaye Pestaina, co-director of KFF’s Program on Patient and Consumer
Protections. In addition, ask for an itemized breakdown of charges and
compare it against the EOB. Medical billing experts said standardizing
terms and other details on medical bills and EOBs would help patients enormously
in this undertaking. A few states have taken steps toward giving patients
more information about health care charges, including by simplifying medical
bills. In 2019, New York state lawmakers proposed requiring hospitals to provide
patients with bills in plain language, including an itemized list of services
labeled as paid by the insurer or owed by the patient. The proposal, which did
not advance, required hospitals to send patients a single bill within seven days
of leaving the hospital. Reynolds’ experience highlights the lack of laws
and standards around how long providers have to bill — and review bills — for
medical services. Insurers may dictate in their contracts how long providers
have to submit claims; the Medicare program has a <a
href="https://www.medicare.gov/claims-appeals/how-do-i-file-a-claim">12-month
limit</a> to file claims, for instance. However, Dave Dillon, a spokesperson for
the Missouri Hospital Association, said no laws restrict how long providers have
to send a bill to patients. Creditors may seek payment from a deceased
person’s estate to collect whatever they can, said Berneta Haynes, a senior
attorney at the National Consumer Law Center. In Missouri, a living spouse can
be held responsible for a deceased spouse’s medical bills in certain instances,
said Terry Lawson, a managing attorney for Legal Services of Eastern
Missouri. Experts said they did not pinpoint anything Reynolds could have
done differently, noting that it is the system that needs to change.
“When can she move on from these hospital bills?” Duffy asked. <a
href="https://twitter.com/ReporterSteph">Stephanie O’Neill Patison</a> reported
the audio story. Bill of the Month is a crowdsourced
investigation by <a
href="https://kffhealthnews.org/news/tag/bill-of-the-month/">KFF Health News</a>
and <a
href="https://www.npr.org/sections/health-shots/2018/02/16/585549568/share-your-medical-bill-with-us">NPR</a>
that dissects and explains medical bills. Do you have an interesting medical
bill you want to share with us? <a
href="https://khn.org/send-us-your-medical-bills/">Tell us about
it</a>! Copy HTML

We encourage organizations to republish our content, free of charge. Here’s what
we ask:

You must credit us as the original publisher, with a hyperlink to our
kffhealthnews.org site. If possible, please include the original author(s) and
KFF Health News” in the byline. Please preserve the hyperlinks in the story.

Have questions? Let us know at KHNHelp@kff.org

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