Richmond anesthesiologist lawsuits show surprise bills run deep in US Richmond anesthesiologists’ lawsuits against patients show surprise bills run deep in US


At Owen Loney surprise bill resulting from emergency appendectomy to a Richmond hospital in 2019.

The insurance covered most of the costs of the hospital stay, he said. He didn’t pay much attention to an invoice he received from Commonwealth Associates in Anesthesia and expected his insurance to cover him. A few months ago he received a notice that the Commonwealth was suing him in Richmond General District Court for $ 1,870 for knocking him out during the operation, according to court records.

“Wow, seriously? The 30-year-old CIO remembers thinking after receiving the subpoena. Loney didn’t have that kind of money on hand. His plan was to try to negotiate the amount or “take another credit card to pay it off.”

Loney’s is a classic and notorious type of surprise bill that Congress and activists have worked for years to eliminate: Off-grid charges not covered by insurance even if the patient has undergone an emergency procedure or requested treatment at a network hospital, believing that the insurance would cover the most fees.

Commonwealth said it was networked for Loney’s insurer, UnitedHealthcare. But the insurer rejected the anesthesia charges because it said its primary care doctor was out of the network, according to claims records.

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The federal No Surprises law, adopted in late 2020, has been hailed by consumer advocates for banning such practices. Departure January 1st, medical companies, in most cases, cannot bill patients more than the network amounts for any emergency treatment or out-of-network care provided in a networked hospital. But even if the legislation is designed to protect millions of patients from unintended financial consequences, it will do little to spare all consumers from medical billing surprises.

“It’s good that there are surprise billing protections… but you’re still going to see lawsuits,” said Zack Cooper, economist and associate professor at the Yale School of Public Health. “This will not solve all billing issues in any way. “

The law will come into effect too late for Loney and many others struggling with surprise off-grid bills in states that don’t already ban the practice.

“This does not prohibit the surprise bills that are happening now in states that have no protections” against them, said Erin Brown Fuse, professor of law at Georgia State University who studies hospital billing. “And that does not preclude collection activities for surprise invoices that occurred before January.”

that of Virginia The surprise bill protection law only came into effect this year and does not apply to self-insured employer health plans, which cover a large portion of residents.

Federal law also does nothing to reduce another nasty and often surprising kind of bill – large, direct payments for networked medical care that many Americans cannot afford and may not have realized. ‘they were incurring.

Two substantial changes in recent years have shifted the risk to patients more. Employers and other payers have reduced their provider networks to exclude some high-cost hospitals and doctors, putting them out of the network for more patients. They have also dramatically increased deductibles – the amount patients have to pay each year before insurance begins to contribute.

The No Surprises Act addresses the first change. He does nothing to fix the second.

For a glimpse into the past and future of surprise and contested medical bills, Kaiser Santé news reviewed Commonwealth lawsuits against patients at the center Virginia and attended court hearings where patients contested their bills.

“This whole problem with the insurance not covering my bills is a headache,” said Melissa Perez-Obregon, a Richmond– dance teacher from the area that Commonwealth sued for $ 1,287 on the services she received during the birth of her daughter in 2019, according to court records. Insurance paid most but not all of a $ 5,950 anesthesia costs, billing records show.

“I’m a teacher,” she said, standing in the hall at Chesterfield County General District Court. “I don’t have that kind of extra money.”

Commonwealth is one of the most active judgment-seeking creditors in the Richmond zone, show court records. From 2019 to 2021, he filed nearly 1,500 cases against patients claiming amounts owed for treatment, according to the KHN analysis of court records.

In many cases, she has initiated garnishment proceedings, in which creditors garnish a portion of patients’ wages.

Describing itself as “the largest private anesthesiology practice” in the center Virginia, Commonwealth said it employs more than 100 clinicians who treat about 55,000 patients a year in hospitals and surgery centers, mostly in the Richmond region.

Commonwealth has said more than 99% of the patients it treats are members of insurance plans it accepts. He only enters wages as a “last resort” and only if the patient has the capacity to pay, said Michael williams, Administrator of Commonwealth Practice, in a written statement.

“Over the past three years, we’ve taken legal action with just over 1% of our patients,” mostly for amounts owed under franchise or network co-pay, Williams said. Almost half of the bills are paid before the hearing date, he said.

Gwendolyn Peters, 67, said she was shocked to receive a court summons this summer. Commonwealth sued her for $ 1,000 for anesthesia during a lumpectomy for breast cancer in 2019, according to court records.

“This is the first time I have found myself in this situation,” she said, sitting outside Chesterfield courthouse with half a dozen other Commonwealth defendants.

Because patients typically have little or no control over who refers them, Brown said, anesthesiologists are at less risk to their business and their reputation than other medical specialists by using aggressive collection tactics.

The specialty is often “one of the worst offenders because they don’t depend on their reputation to get patients,” she said. “They are not going to lose business because they engage in these really aggressive practices that are ruining their patients’ finances.”

The average annual deductible for individual EI coverage has increased from $ 303 at $ 1,434 over the past 15 years, depending on the Kaiser Family Foundation. Deductibles for family coverage in many cases exceed $ 4000 one year. Coinsurance – the patient’s liability after the deductible is met – can add thousands of dollars in additional expenses.

This means that millions of patients are essentially uninsured for care that could cost them a substantial portion of their income. Surveys have repeatedly shown that many consumers say they would struggle to pay an unexpected bill of a few hundred dollars.

Loney’s insurer, UnitedHealthcare, agreed to foot the Commonwealth’s bill for his emergency appendectomy after being contacted by KHN and telling him he had “updated” the information on the claim. Otherwise, Loney said, he couldn’t have paid it off without borrowing the money.

In Richmond-the courthouses in the area, hearings for the Commonwealth prosecutions take place every few months. A lawyer from the anesthesiology practice is present, sometimes making payment arrangements with patients. Many defendants do not show up, which often means they lose the case and may be subject to garnishment.

The Commonwealth sued a retiree Ronda Grimes, 66, for $ 1,442 for anesthesia, his insurance did not cover after a 2019 surgery, billing and legal files filed in Richmond General District Court Pin up.

“It’s a lot of money, especially when you have health insurance,” she said.

New research from Cooper and colleagues examining court cases in Wisconsin shows that medical lawsuits are disproportionately filed against people of color and people living in low-income communities.

“Doctors have the right to be paid like everyone else for their services,” Cooper said. But unaffordable and reimbursable medical bills are “a systemic problem. And this systemic problem generally falls on the backs of the most vulnerable in our population.”

For uninsured patients, Commonwealth matches any financial assistance given by the hospital and will “improve” its financial assistance program in 2022, Williams said.

Two of the nine people sued by Commonwealth and interviewed by KHN during courthouse hearings were Hispanic. Four were black.

One was Darnetta jefferson, 61, who had a double mastectomy in early 2020 and appeared in court wearing a cancer survivor shirt. Commonwealth sued her for $ 836 he said she owed coinsurance for the anesthesia given to her during the operation. Commonwealth lawyer agreed to drop lawsuit if she agreed to pay 25 $ a month toward the balance until it’s paid off, she said.

“If I ever have extra money to pay it back someday, I will,” said Jefferson, who worked at the Ukrop supermarket for many years before his cancer forced him to go on disability. “But at the moment, my situation does not look good.”

Although she lives on a reduced income, her rent has just gone up, said Jefferson, who also survived lung cancer diagnosed in 2009. The rent is now close to $ 1,000 a month.

Monthly Commonwealth Bill Payment 25 $ increments, she says, means “this is going to be a long way to go.”

Kaiser Santé news is a national newsroom that produces in-depth journalism on health issues.


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