In September 2022, Elyse Greenblatt, a resident of Queens, New York, found herself facing unexpected medical costs after seeking a quick resolution for persistent congestion upon returning from a trip to Rwanda. Concerned about the potential for COVID-19 and wanting to avoid a waiting room, she opted for a telehealth visit through her trusted health system, Mount Sinai.
Despite the brevity of the virtual consultation, Greenblatt's bill, totaling a staggering $660, caught her off guard. The telehealth visit, conducted through Mount Sinai's personal record app, was unexpectedly classified as an out-of-network service by her insurer, Empire BlueCross BlueShield. This designation, unbeknownst to Greenblatt, led to the insurer covering none of the costs.
Greenblatt, now 38, questioned the mismatch between her in-network doctors and the out-of-network telehealth provider assigned to her. She expressed frustration at the lack of clear warning about the out-of-network status, considering her existing relationship with Mount Sinai.
The doctor, affiliated with Mount Sinai's health system, prescribed an antibiotic and Flonase for sinusitis, advising Greenblatt to return if there was no improvement. However, the subsequent billing dispute further complicated matters, as the origin of the bill within the hospital system remained unclear.
The incident highlights the unexpected financial pitfalls that can accompany telehealth visits, where patients may assume the familiarity of their health system guarantees in-network services. Greenblatt's experience sheds light on the challenges patients face in navigating telehealth billing intricacies and the importance of transparency in communicating potential out-of-network charges.
The intricacies of Elyse Greenblatt's medical bill for a seemingly routine telehealth visit raised perplexing questions, delving into the complexities of healthcare billing practices. At the forefront of this confusion was the unexpected classification of the telehealth service as out-of-network, a designation inconsistent with the usual cost-effectiveness associated with virtual urgent care visits.
Greenblatt, seeking clarity, revisited Mount Sinai's telehealth app, capturing a crucial screenshot that displayed an estimated wait time of 10 minutes for a cost of $60. The app emphasized that the actual cost might be lower based on insurance coverage, reinforcing the idea that patients would benefit from this service economically. A $60 fee aligns reasonably with industry standards, with other telehealth providers offering comparable or slightly higher rates.
The discrepancy arose when Greenblatt received a bill totaling $660, far exceeding the average cost of a telehealth visit. The Health Care Cost Institute, an organization analyzing healthcare claims data, indicated that the typical total cost for an urgent care telehealth visit is around $120, with only $14 in out-of-pocket charges. The substantial disparity in Greenblatt's case prompted scrutiny into the factors contributing to the exorbitant billing.
One notable factor was the billed duration of the visit, described by the doctor as "moderately lengthy." Greenblatt, however, recalled a brief and straightforward encounter, raising questions about the accuracy of the billing description. The billing intricacies in healthcare, where the level of care and duration directly impact costs, were underscored in this scenario. The discrepancy between Greenblatt's perception of a quick, uncomplicated visit and the provider's classification of a moderately complex case sheds light on the nuanced aspects of healthcare billing that contribute to inflated costs.
Dr. Ishani Ganguli, a researcher at Brigham and Women's Hospital in Boston specializing in telehealth, expressed surprise at the billing complexities surrounding Elyse Greenblatt's telehealth visit. Despite not having all the details, Dr. Ganguli questioned the billing level, especially if the encounter was indeed brief. The perplexing issue extended beyond the billing level to the out-of-network designation, resulting in the insurer, Empire BlueCross BlueShield, refusing payment for the care provided by the Mount Sinai doctor.
Stephanie DuBois, a spokesperson for Empire BlueCross BlueShield, clarified that the insurer covers virtual visits through specific services or in-network doctors, neither of which applied to Greenblatt's case with the Mount Sinai doctor. The unusual aspect of this situation was the assignment of an out-of-network doctor within Greenblatt's usual healthcare system.
Dr. Ateev Mehrotra, a hospitalist and telehealth researcher at Beth Israel Deaconess Medical Center, deemed it unreasonable for patients receiving care within the Mount Sinai system to expect a sudden shift to an out-of-network status. The doctor in question, employed by Mount Sinai, added to the confusion by not listing accepted insurance on their profile page, as noted in an archived version from November 2022.
Mount Sinai's spokesperson, Lucia Lee, insisted that the doctor did accept some insurance, but discrepancies in publicly available information intensified the billing puzzle. Greenblatt's attempts to resolve the issue became a headache, compounded by the doctor's office seemingly ignoring the case, despite it being marked as "urgent" and routed to disputes. The lingering mystery and lack of response heightened the frustration in an already convoluted billing dispute, highlighting the challenges patients face when navigating complex healthcare billing systems.
Elyse Greenblatt's battle with her medical bill took an even more perplexing turn as she encountered a series of puzzling inconsistencies and elusive forms. The bill played a game of disappearing and reappearing on her patient portal, adding a layer of frustration to the already convoluted situation. When Greenblatt was informed that she had signed a form consenting to the out-of-network charge, requesting a copy proved fruitless. The billing department proposed faxing the form, a proposition Greenblatt declined, leading to a promise of placing the form in her patient portal — a promise unfulfilled.
In mid-October, when KFF Health News approached Mount Sinai for clarification, spokesperson Lucia Lee forwarded a copy of a three-page form that Greenblatt did not recall signing. According to Lee, these forms are presented as part of the check-in process, intended to be obvious and required by law. However, the time stamp on the forms indicated they were signed after Greenblatt's visit concluded. Lee asserted that it is not standard to sign forms after the visit has ended, suggesting that patients may reschedule with an in-network provider if informed.
This ordeal with the forms takes on added significance considering the legislative landscape. In December 2020, Congress enacted the No Surprises Act to address surprise medical bills, emphasizing notice and consent. Allie Shalom, a lawyer with Foley & Lardner, explained that the law applies primarily to specific healthcare facilities, leaving uncertainty about Greenblatt's situation due to the varied categorization of her visit in the medical bill. The No Surprises Act hinges on the distinction of out-of-network providers charging patients at in-network facilities, a distinction clouded in Greenblatt's case by ambiguity about the entity that provided the services.
The complexities surrounding the timing and presentation of consent forms introduce a layer of uncertainty, creating challenges in determining the applicability of legislation designed to protect patients from unexpected medical bills. Greenblatt's experience underscores the need for clarity in the communication and documentation processes, particularly in the evolving landscape of healthcare legislation.
In the ongoing saga of Elyse Greenblatt's medical bill from Mount Sinai, the complexities surrounding consent and billing continue to muddy the waters. Lucia Lee, the spokesperson for Mount Sinai, acknowledged that seeking consent post-visit does not align with the No Surprises Act. However, the system is still in the process of determining whether Greenblatt was billed by the hospital or another entity. As of now, Greenblatt's bill remains unpaid and unresolved, leaving a cloud of uncertainty over the situation.
The broader lesson from this ordeal is a reminder to patients that vigilance is crucial when it comes to safeguarding their financial interests. Timing the length of a visit becomes a prudent strategy, especially in cases where bills may reflect a duration significantly longer than the actual interaction. The "Bill of the Month" team frequently encounters submissions from patients who find themselves billed for extended virtual waiting room times or other inaccuracies.
Additionally, the importance of verifying the network status of a specific physician cannot be overstated. Even within in-network hospitals, there may be instances where individual providers are not in-network. Patients are advised to inquire about the network status of unfamiliar physicians and not assume that all practitioners within an in-network hospital are covered by their insurance.
The process of obtaining informed consent, a crucial aspect of protecting patients from surprise bills, often involves navigating through a stack of consent forms with complex language. Dr. Ishani Ganguli emphasized the challenges patients face in deciphering such documents, particularly when they are feeling unwell and seeking prompt care. As the complexities of healthcare billing persist, patient advocacy and informed decision-making remain paramount in navigating the intricate landscape of medical expenses.
In the labyrinthine world of healthcare billing, Elyse Greenblatt's saga with Mount Sinai serves as a stark reminder of the challenges patients face in navigating the complexities of consent and billing practices. The unresolved nature of Greenblatt's bill underscores the need for greater transparency and clarity in healthcare processes.
Lucia Lee, the spokesperson for Mount Sinai, acknowledged that seeking consent post-visit does not align with the No Surprises Act, but the lingering uncertainty regarding the billing entity keeps the resolution in limbo. This case reinforces the importance of patient vigilance, urging individuals to be proactive in protecting their financial well-being.
The broader lessons drawn from this experience emphasize the value of timing virtual visits accurately to avoid overbilling and the critical need to verify the network status of individual physicians within in-network hospitals. Dr. Ishani Ganguli's insights highlight the challenges patients face in comprehending complex consent forms, emphasizing the need for clearer communication and patient-friendly documentation.
As healthcare billing continues to evolve, the onus remains on patients to advocate for themselves, ask crucial questions about network status, and carefully scrutinize consent forms. In a landscape where the fine print can be overwhelming, patients must stay informed and assertive to navigate the intricate web of medical expenses. Greenblatt's experience serves as a microcosm of the broader issues within the healthcare system, underscoring the imperative for ongoing reforms to ensure fairness, transparency, and patient-centric practices.