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Fresenius, one of the two largest dialysis providers in the United States, agreed to waive a $ 524,600.00 bill for a man who received 14 weeks of dialysis at a Montana clinic.
NPR, Kaiser Health News and CBS This Morning recounted the story of Sovereign Valentine this week as part of the "Bill of the Month" series, a collaborative survey that seeks to understand the exorbitant bills of the United States over health care.
On Thursday, a Fresenius representative told Sovereign's wife, Dr. Jessica Valentine, that the company would waive their unpaid bill. Instead, they will be treated as network patients and Fresenius will seek to negotiate with their insurer a rate higher than what he has already paid. The Valentines are only responsible for their $ 5,000 deductible, which Sovereign, who goes through "Sov", has been hitting for a year already. That leaves them $ 0 to pay on their franchise in the network.
"It's a huge relief," Sov said. "It allows me to devote more energy to taking care of my health and not shaving the stress hormones." Sov said he hoped his experience would shed light on the problem of pay billing and help other patients in similar situations.
A 50-year-old personal trainer, Sov was diagnosed with kidney failure in January and was sent on dialysis to a Fresenius clinic located 120 km from his home in rural Plains, in Mt. A few days later, Sov and Jessica learned that the clinic was off-grid and that they would be required to pay everything their insurer would not have covered.
At first, Valentine's Day was not able to find an option in the network and Sov needed dialysis three times a week to survive. After 14 weeks of dialysis with Fresenius, the couple received an invoice of $ 540,841.90. Their insurer, Allegiance, paid $ 16,241.73, about double what Medicare would have paid. Fresenius charged the couple the outstanding balance of $ 524,600.00, which is more than the usual cost of a kidney transplant.
Fresenius charged $ 13,867.74 on Valentine's Day per dialysis session, about 59 times the $ 235 paid by Medicare for a dialysis session.
Fresenius spokesman Brad Puffer said the Valentines would still have to be treated as networked patients because their insurer, Allegiance, is a subsidiary of Cigna, which has a contract with the dialysis company. Under this contract, Fresenius would have received a rate higher than that paid by Allegiance. Valentine's Day, he said, was caught in the midst of a contractual dispute between the two companies.
"In the future, we are committed to better identifying situations in which we believe that the insurer incorrectly clbadified one of our facilities as being off-grid," Puffer said in a statement. "This will allow us to directly address the issue with the insurer, without the latter placing the patient at the center."
Allegiance declined to comment on this story. Jessica Valentine asked if they could have an off-grid franchise and was waiting to hear what her insurer said about it.
Like her husband, Jessica is relieved to see that their bill seems to have been resolved, but fears that other people with bills like theirs are not so lucky. She is also grateful for all the attention that their story has generated. Senator Montana's office, Jon Tester, and their hospital's insurance broker have both offered to defend them. "And a Pennsylvania nephrologist called me to work and expressed her indignation by saying that she had forwarded our story to the Fresenius Medical Director on our behalf," Jessica wrote in an email.
Now that his bill has been resolved, Sov said that he would focus on the next step in the fight against his kidney disease: a transplant. "I can just save my energy for that," he said.
The bill of the month is a survey in collaboration with NPR and Kaiser Health News dissect and explain medical bills. Do you have an interesting medical bill to share with us? Tell us about it!
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