Tommy Martino / Kaiser Health News
Fresenius, one of the two largest dialysis providers in the US, has agreed to waive $ 524,600.17 for a man who was dialysed for 14 weeks at a clinic in Montana.
NPR, Kaiser Health News and CBS This morning told the story of Sovereign Valentine this week as part of the "Bill of the Month" series, a crowdsourced study that seeks to understand the exorbitant health bills with which ordinary Americans are facing.
On Thursday, a representative of Fresenius shared Sovereign's wife, Dr. Ing. Jessica Valentine, with, that the company will waive their unpaid bill. Instead, they will be treated as network internal patients, and Fresenius will try to bargain with its insurer for a higher tariff than the one already paid by the insurer. The Valentines are only responsible for their $ 5,000 excess, which Sovereign, who goes from "Sov", has already cracked for the year. They still have $ 0 to pay their deductible on the network.
"It's a big relief," said Sov. "It allows me to put more energy back into my health and not have angry stress hormones." Sov hopes that his experience will clarify the issue of billing and help other patients in similar situations.
At Sov, a 50-year-old personal trainer, was diagnosed with kidney failure in January and sent to dialysis at a Fresenius clinic 70 miles from his home in rural Plains, Mont. Some days later, Sov and Jessica learned that the clinic was not through the network and that they have to pay what their insurer did not cover.
The Valentines were initially unable to find an option on the network, and Sov had to be dialysed three times a week to survive. After 14 weeks of dialysis at Fresenius, the pair received an invoice for $ 540,841.90. Their insurer, Allegiance, paid $ 16,241.73, about twice as much as Medicare would have paid. Fresenius charged the pair with the unpaid balance of $ 524,600.17 – an amount that exceeds the typical cost of a kidney transplant. Brad Puffer, spokesman for Fresenius, said that the Valentines should always have been treated as net internal patients, as the insurer Allegiance is a subsidiary of Cigna, which has a contract with the dialysis company. Under this contract, Fresenius would have received a higher rate than Allegiance. The Valentines were involved in the middle of a contract dispute between the companies.
"We undertake to better identify future situations in which we believe that the insurer has mistakenly classified one of our facilities as non-networked," Puffer said in a statement. "That way, we can first discuss the matter directly with the insurer without putting the patient in the middle."
Allegiance declined to comment on this story. Jessica Valentine wondered if she could owe a deductible outside the network and waits for what her insurer says.
Like her husband, Jessica is relieved that her bill seems to have been resolved, but worried that other people will pay bills as theirs may not be so happy. She is also grateful for the attention her story has earned. Montana Sen. Jon Tester's office and her hospital's insurance broker both offered to work for her. "And a nephrologist from Pennsylvania called me at work, said indignantly, and said that she had forwarded our story on our behalf to the medical director of Fresenius," Jessica wrote in an e-mail.
Now that his bill has been settled, Sov said he will focus on the next step in the fight against his kidney disease: a transplant. "I can only save my energy," he said.
Bill of the Month is a crowdsourced study of NPR and Kaiser Health News that unravels and explains medical bills. Do you have an interesting medical bill that you would like to share with us? Tell us about it!