Near midnight on Nov. 12, 2020, Bisi Bennett was sitting on the sofa in her pajamas and feeling uncomfortable. She was about seven months pregnant along with her first youngster, Dorian, and the thought that she might be in labor didn’t even cross her thoughts.

Then, she felt a contraction so sturdy it knocked her off the sofa. She shouted to her husband, Chris, they usually ran to the automotive to begin the 15-minute drive to AdventHealth hospital in Orlando, Florida. About midway by the journey, Bennett gave beginning to Dorian in her household’s Mitsubishi Outlander. Her husband stored one hand on his new child son’s again and one hand on the wheel.

Born breech, which means his head emerged final, Dorian wasn’t crying at first, and the terrified new dad and mom feared one thing was mistaken. Chris Bennett turned on the SUV’s flashers and flagged down a passing emergency car. The EMS staff escorted the household to the hospital.

“He was nonetheless related to me with the umbilical twine once they rolled the 2 of us collectively into the hospital,” Bisi stated. “They minimize the twine, and the very last thing I heard was, ‘He has a pulse,’ earlier than they wheeled me away.”

“I simply cried tears of reduction,” she stated.

Dorian stayed within the neonatal intensive care unit till Jan. 7, 2021, for virtually two full months. Whereas Dorian was within the hospital, Bisi wasn’t frightened about the associated fee. She works within the insurance coverage business and had fastidiously chosen AdventHealth Orlando as a result of the hospital was near her home and in her insurance coverage community.

Then the payments got here.

The Affected person: Dorian Bennett, an toddler born two months untimely. He has medical health insurance by his mom’s employer, AssuredPartners, the place she works as a licensed property insurance coverage agent.

Medical Service: A neonatal intensive care unit keep of 56 days. Dorian wanted extremely technical, lifesaving respiratory and dietary care till his organs matured. He additionally obtained laboratory, radiology, surgical procedure, cardiology and audiology companies and coverings.

Service Supplier: AdventHealth Orlando in Orlando, Florida. It’s a a part of the AdventHealth system, a giant nonprofit and faith-based group of well being care suppliers with places throughout Florida and a number of other different states.

Whole Bill: AdventHealth Orlando billed $660,553 for Dorian’s NICU care. Due to an insurance coverage snafu, the “affected person duty” portion of the invoice despatched to the Bennetts was $550,124. They have been supplied an installment fee plan of $45,843 a month for 12 months.

What Offers: Below the 2010 well being legislation, nonprofit hospitals are required to offer monetary help to assist sufferers pay their payments, and fee plans may be a part of that help. However the Bennett household’s expertise reveals the system remains to be removed from pleasant to sufferers.

The installment quantity supplied to the Bennetts — $45,843 — resembles an annual wage greater than a cheap month-to-month fee. The laughably unrealistic plan was apparently mechanically generated by the hospital’s billing system. A spokesperson for the hospital, David Breen of AdventHealth, didn’t reply KHN’s questions on its billing software program or why a five-digit month-to-month fee was not flagged by the hospital as a downside that may want additional consideration.

The scale of the Bennetts’ invoice stems from two overlapping points: Child Dorian was born in 2020 and wanted hospital care into 2021, and Bisi Bennett’s employer shifted its well being plan to a completely different firm in January 2021. She knowledgeable AdventHealth in regards to the change.

Dorian spent practically two months in neonatal intensive care after he was born, however his mom wasn’t frightened about the associated fee as a result of she had chosen a hospital near her home and in her insurance coverage community. Then the payments got here.(Zack Wittman for KHN)

As somebody who works within the insurance coverage business, Bennett was fairly certain that she understood the mix-up and that the cost of greater than half a million {dollars} was unjustified.

However as Dorian turned a 12 months previous final month, the household nonetheless had payments pending and a tangle of purple tape to struggle.

AdventHealth bundled the 2020 and 2021 dates of Dorian’s NICU keep after which billed each insurance policy for the entire keep. Each insurance policy stated the invoice contained dates of care when Dorian was not coated, so neither paid the hospital. The shift from one 12 months to the following flummoxed three giant enterprise entities, which appeared unmotivated to resolve the issue shortly.

“A invoice this massive is a big disaster for the household, but it surely’s not a big disaster for the insurance coverage firm or for the hospital,” stated Erin Fuse Brown, an affiliate professor of legislation at Georgia State College who research well being care coverage.

In 2020, Dorian was coated below a UnitedHealthcare plan, which for in-network suppliers had a $6,000 deductible and $6,000 out-of-pocket most for the household.

In 2021, Bisi Bennett’s employer switched its third-party administrator of its self-funded plan from UnitedHealthcare to UMR. The deductible and out-of-pocket most didn’t change.

Though UMR is owned by UnitedHealthcare, the 2 firms didn’t talk properly in regards to the case.

“It’s indicative of all of the methods the system fails the affected person,” Fuse Brown stated. “Even the one who does every part proper.”

Via the practically yearlong struggle over the invoice, the Bennetts have been additionally caring for Dorian, who left the hospital with lingering gastrointestinal points, and managing Chris’ remedy for stage 4 neuroendocrine most cancers, which was recognized in April. At one level, Bisi stated, she felt she was going loopy.

“They’re answerable for billing, and I shouldn’t be the one having to inform them, ‘Bill my one insurance coverage for dates in 2020 and invoice my different insurance coverage for dates in 2021,’ however I did,” she stated. “I stored having the identical dialog time and again.”

Dorian was born in late 2020 and wanted hospital care into 2021. Bisi Bennett’s employer shifted its administrator for medical health insurance within the new 12 months. The hospital then billed each insurance policy for the entire keep. Each insurance policy stated the invoice contained dates of care when the newborn was not coated, so neither paid.(Zack Wittman for KHN)

Decision: Bisi Bennett instantly seen and understood the calendar challenge when she obtained the billing statements in spring 2021. She began by calling the hospital and was instructed the issue could be corrected in March. But, in September, she obtained the identical half-a-million-dollar invoice.

UnitedHealthcare spokesperson Maria Gordon Shydlo, who additionally fielded KHN’s questions for UMR, stated the insurance coverage firm instructed AdventHealth to revise the invoice with appropriate dates within the spring.

Breen, the spokesperson for AdventHealth Orlando, confirmed to KHN that the billing error stemmed from the change in insurers from 2020 to 2021. In a assertion, Breen stated medical billing may be a advanced course of and the hospital “perceive[s] this has been a complicated and difficult expertise for Ms. Bennett, and we apologize for the frustration this has induced.”

AdventHealth Orlando didn’t submit a revised invoice with corrected dates till KHN contacted the hospital in October 2021.

AdventHealth Orlando billed $660,553 for Dorian Bennett’s time within the neonatal intensive care unit. The Bennetts’ portion of the invoice was $550,124, they usually have been supplied an installment fee plan of $45,843 a month for 12 months.(Zack Wittman for KHN)

After UHC and UMR reprocessed the 2020 and 2021 claims, the unique invoice of greater than $550,000 was knocked all the way down to $300.

In his assertion, Breen stated that the Bennetts’ case sparked AdventHealth to determine and tackle points in its system and that the hospital plans to enhance the billing and communications course of for future sufferers, notably when there may be a change in insurance coverage.

The Takeaway: A lot of our fragmented well being care system is on autopilot, with billing software program that generates complicated or, on this case, absurd payments and fee plans.

Bisi Bennett did every part proper: She selected an in-network hospital and knowledgeable it of the modifications to her medical health insurance. She adopted up when she noticed there was an error. However her case didn’t attain a decision till a reporter known as on her behalf.

If you’re preventing a invoice that you simply consider incorporates an error, name all of the entities concerned — the hospital, insurers, different suppliers — and don’t neglect about your organization’s human assets division. It could possibly strain insurers to resolve an error quicker than you may.

Most states have a division of shopper companies that may aid you file a criticism with the suitable oversight entity. Workers members at state businesses can assist you determine what’s going on. Inform the medical suppliers you’re reporting them to the state.

Nonetheless, it’s a irritating, uphill battle, particularly when sufferers have improper payments hanging over their heads for many months and are susceptible to having the payments despatched to a assortment company or having their credit score rating dinged. There must be much more transparency in billing and a set time restrict for dispute decision, specialists say.

“This reveals how little leverage or energy a affected person has on this scenario,” Fuse Brown stated. “You virtually should go exterior the system and put exterior strain.”

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical payments. Do you’ve an attention-grabbing medical invoice you need to share with us? (*12*)!

Victoria Knight: [email protected], @victoriaregisk