Recently NPR has been running a series about unexpected medical bills. My story doesn’t come anywhere near the ridiculously high costs people are paying for, say, a failed device. In the end, the cost to me is around $900. But the emotional cost, the helpless feeling, the realization that you are totally at the mercy of the healthcare company and have no real recourse to fight — that cost is the same no matter what the financial cost.
My story began on Sept 24, 2017, when I fell and suffered multiple injuries — a fractured patella, fractured ankle and ruptured patella tendon. Both my legs required surgery and I was in a wheelchair, non-weight bearing for three months. The inpatient rehab set me up with home healthcare through Nascentia Healthcare, formerly Visiting Nurses Association. They sent a physical therapist and an occupational therapist to my house twice a week and then, eventually only the physical therapist. Both were helpful and caring people, though the cost of $165.00 per visit for what was sometimes a 20 minute session seemed excessive. My copay was $25 per session, which means at times I was paying $100.00 a week. For what added up to less than 4 hours of help.
But that isn’t what I want to write about (though perhaps I should...I have one of those Cadillac plans — and i’m still paying $200 a month for outpatient physical therapy over a year after the injuries — and I really need a new car. Hmm, wonder what my car payments would cost...) My story is about how @NascentiaHealth screwed up, and let me foot the bill anyway.
It was coming up on December, 2017. The physical therapist had been and gone. we were trying to get me out of the wheelchair. I had hopes of returning to work soon. We were discussing how I could continue to have the in home PT if I went to work, because I had no way to get myself to outpatient PT and was still mostly wheelchair bound. I was starting to get it together — deal with mail, pay attention to what was going on around me. Starting to be able to think about something other than pain and powerlessness and utter dependence. I moved to a new house while in the wheelchair (I broke my legs the night I went out to dinner to celebrate my purchase offer being accepted...) and was able to sleep in my own bed and get into a bathroom instead of using a cot in my living room and a commode because the wheelchair wouldn’t get to the back of my old house. I share that to make it clear how helpless and overwhelmed I already felt. So, the physical therapist left and I opened my mail. And there was an EOB from my insurance declining to pay the last six home healthcare visits. To the tune of $165.00 per visit.
Needless to say, I immediately called my insurance company. The person I spoke to did some investigating and said I was out of physical therapy visits for the year. (why is that even a thing?). I asked how that could happen without some warning- didn’t @NascentiaHealth check my benefits? Weren’t they supposed to give me a heads up? Well yes, they did — they checked my benefits for home nursing. I had plenty of those. In fact, I hadn't’t used a single nursing visit.
I called Nascentia. They apologized for the “inconvenience.” (So Long and Thanks for all the Fish, I guess?). They offered to reduce the amount I had to pay to under $1000. They offered to let me pay over time. They even admitted it was their mistake — they’d been basing my PT visits on my nursing benefits. But I still had to pay. Because of course I did.
I’m going to let the letter I sent them, which they completely ignored, say the rest:
I am writing regarding the letter I received from you that was dated 11/23/2018. I opened that letter on the evening of Saturday 11/24/2018 and discovered, at that time, a threat to send my account to a collection agency and potentially harm my credit.
I had been steadily paying down on that bill for a year and had gotten it down from the $900.00 range to $522.50. Furthermore, I would not have had this debt at all had Nascentia not failed to inform me that I was out of insurance benefits. Nascentia’s steadfast refusal to accept responsibility for the mistake Nascentia’s insurance department made in confirming my health insurance benefits, and their insistence on charging me for the multiple sessions that I absolutely would have cancelled had I known I was out of benefits has been a source of great distress and anger for me. This collection threat exacerbated the anger I feel every time I send a check to Nascentia to pay down on that bill. I barely slept that night.
I understand, from the message you left on my voicemail on Monday morning, that this was a mistake. I don’t blame you for making a mistake. People make mistakes and I don’t expect perfection. I do however blame Nascentia for the intensity of the distress I felt when I received that letter and the difficulty I have trusting that I won’t find my account turned over to a collection agency after all.
Last year, Nascentia’s initial mistake of failing to notify me that my insurance benefits for physical therapy were about to run out led to a sudden unplanned discontinuation of my physical therapy. I immediately cancelled all future sessions in order to avoid incurring more charges, and I was left with no physical therapy at all at a time when I was trying to learn to walk again. Had Nascentia properly notified me, I could have reduced the frequency of my visits in order to extend my ability to receive the help I needed through into the new year when my benefits were renewed. Instead, I was hit with an unexpected bill of nearly $1000.00 and an end to physical therapy. Furthermore, Nascentia’s mistake led to significantly increasing my distress at a time when I was attempting to recover from fractures and surgery in both legs and I was already emotionally vulnerable.
I understand that I likely signed something at the beginning of my work with Nascentia agreeing to pay what insurance did not cover. However, I find it humorous that a home healthcare agency would not consider the mental state of a patient who was 10 days post-surgery related to traumatic fractures in both legs, sleep deprived, wheelchair bound and on pain meds. The idea that I knew what I was signing or even retained the information that I had signed something is ridiculous. A homecare agency should know that. I understand that Nascentia can legally continue to charge me and can even legally turn my bill over to collections and harm my credit if I don’t continue to pay this bill. I have never questioned the legality, though I do believe that someone should have given me written notice that my insurance benefits were running out and taken time to determine a safe discharge plan.
In spite of my extreme anger at Nascentia’s morally reprehensible decision to charge me for Nascentia’s mistake, I have done my best to consistently pay down on that bill. You can imagine how upset I was when I received that letter on Saturday night.
At this time, I wish to confirm that I received a voicemail from you on 11/27/2018 at 10:37 am informing me that the letter threatening to go to collections was sent in error and that you will not be taking steps to turn my bill over to a collection agency.
In conclusion, I would have thought that a home health care agency would have empathy, compassion, basic values, and an understanding of how their decisions affect patients. Clearly, Nascentia is lacking in that department. I am writing this letter because, a year later, I am still angry at the events I outlined above. And now, Nascentia made yet another “mistake,” reminding me just how vulnerable and helpless I am to protect myself financially from the machinations of a bureaucracy that has demonstrated more concern about the bottom line than about patient care. I will never forget the billing person apologizing for the inconvenience, as if an unexpected $900 bill and the abrupt discontinuation of needed therapy was no more significant than, say, my therapist being a few minutes late for an appointment.
I do hope Nascentia finds a way to clean up its act. I understand that mistakes happen and cannot always be avoided, but I’m used to people accepting responsibility for their mistakes and taking steps to remedy them. Nascentia instead held me responsible for Nascentia’s mistake- a mistake that negatively affected the life of a patient.
I would go without home health care before I would use Nascentia again, but I worry for other patients who may suffer as a result of the way Nascentia handles its own mistakes. I hope going forward, Nascentia’s leadership will consider how their decisions affect patients and seek some ethics consultation or something.
Why am I writing this? Probably because I feel so helpless, because I have no recourse beyond publicly shaming the company. We are supposed to shut up and pay our bills. We are supposed to know that when we sign something saying we’re responsible for anything insurance doesn’t pay, that means we’re responsible for their mistakes as well.
The crazy thing? I would never use them again. I would never send anybody to them and actively warn people to avoid them. I am at high risk of needing home healthcare again. That $9000 they’re eking out of me? It’s significantly less than they will lose when I and everyone I know take my business elsewhere. This isn’t even good business practice. What is it? Greed?
