She had a broken arm, no insurance – a $ 97,000 bill

Once she fell, Deborah Potterit knew that she could not avoid going to the hospital.

“I heard the bones moving in a consciousness,” said Bouterteit, who was sixty -year -old when she slipped on a piece of ice in December outside her apartment in Bouzmann, Montana.

Emergency room tests showed that she broke her left arm near the joint. Doctors told her that she needed surgery to repair.

At that time, Buttgerit did not have health insurance – she fought to withstand the coverage after her husband’s death. The local health system, Bozeman Health, is estimated to be on Buttgereit to pay 50,560 dollars outside the pocket for outpatient clinic surgery to collect its elbow again.

Note the estimate: “It can be governed more in case of complications or special circumstances.”

Four days after falling, Bottgerit entered for surgery, which lasted for about three hours. She said that during a follow -up visit, the doctor told her that the procedure ended up to be more complicated than expected.

Then the bill came.

Medical procedure

Buttgerit broke the humerus, the upper arm bone that meets other bones and form the elbow. The bone split method is known as breaking the long humerus. It is rare as the breaks go, as it only represents 2 % of all fractures Among adults. But the elderly, as well as children in high -contact sports, are more likely to fall to such fractures. The injury is painful and can make it impossible to move the elbow.

Some of these types of fractures heal over time in a splint, but most often they are the only repair. The patient is placed under anesthesia while the surgeon re -placing the bones with panels and nails.

The final bill

97,998 dollars. This includes at least $ 44,300 for the operating room and anesthesia management, as well as more than $ 50,000 for medical supplies and implants, such as screws and paintings. After applying the hospital to self -payment, Bottgerit was on the hook for $ 78,398.40.

Problem: surprise complications, sudden fees

The hospital said that the price of Buttgerit surgery increased because the doctors faced MidProcessor’s complications.

In particular, the fall of the Buttgerit bone broke more cuts than its wounds, according to the operating notes. This means that it took more time, skill and supplies to rebuild its elbow. Since it was not secure, Bottgerit alone faced the burden to pay the higher costs.

She said, “I will make payments the rest of my life to pay everything.”

Buttgereit’s husband died suddenly in 2023. About a year later, she left her job with the company she used both. She said that his memories in that space were very difficult. This also means leaving behind its healthy coverage. She moved to Bouzmann to be closer to one of her daughters and found a health plan at Healthcare.gov that the federal government is supported by its limited income.

But she also faced a higher cost of living in Bouzmann, which could be covered by the advantages of social security, and she needed part -time work. Although this new income helped to pay its bills, it is no longer qualified for the same level of subsidized coverage and could not bear its plan. So she dropped her health insurance.

About two months later, she fell.

After getting the surgery bill, Bottgerit started calling and sending an email to the hospital customer service team, and asked how the price increased from $ 50,560 to about $ 98,000. The hospital automatically applied the $ 19600 self-payment discount on the Buttgerit-20 % of the total. But that still leaves it with a tab of more than $ 78,000.

She said that after more time to think free of pain, she also wanted to know why the initial estimate was more descending than that on the Internet for similar procedures.

Specifically, Buttgereit asked how to get off her bill. When she felt that she had not made accusations with the hospital, she asked her options under the Law of Surprises, the Federal Consumer Protection Law.

According to the email messages reviewed by the KFF Health News, the Buttgerit Employment is incorrectly that the law applies only to ER services. The employee said later that Buttgereit had the right to conflict on the bill, but he gave her an incorrect final date.

The hospital staff recommended that a plan to pay and apply for the health system’s financial aid program.

Erren Chaibel, a spokesman for Bouzmann Health, told KFF Health News that internet estimates do not reflect the specific details of the patient’s care. In addition to the shattered bones mentioned in the Buttgerit surgery notes, Schaible said that the doctor has identified the medium damage to damage that requires additional work to repair it.

“This position highlights the importance of clear communication and mercy,” said Schaible. “In response, our team leaders review the internal protocols to escalate the patient’s concerns and reinstate employees on best practices to connect cost estimate changes.”

decision

Buttgerit refused to apply for financial aid, instead chose to challenge what you see as inflated prices. Using a healthcare BlueBook, a comparison to the online prices that depend on insurance claim data, Bottgerit found similar procedures ranging from $ 8,000 to $ 40,000.

She said she believed that there are also errors in her bill and that complications did not justify the price.

She said, “I felt a desire to obtain financial assistance, which means that I am fine with the price of the bill.” “I want to reduce the bill on the front end, and then, if you need financial help, go to it.”

The bills employee sent an email to Buttgerit in May to submit an additional discount of $ 7,000 if you set a payment plan. Email said that if you qualify later for financial assistance, “we will adjust the amount accordingly.”

In June, the Buttgerit employee told her account that it would be suspended before the start of the assembly process, “so that you have time to determine what to do.”

Buttgereit agreed to a $ 100 payment plan per month, although she continued to compete for the total fees.

At this rate, it will take about 60 years to pay off debt – or more, if the health system imposes benefit.

Buttgereit made another offer for help: Email to the White House.

This month, in the same week, she obtained a detailed letter from the hospital standing alongside his concern, and Bottgerit said she had received a call from an official with Medicare & Medicaid service centers, saying that she could question the bill to federal health officials.

Ready -made meals

The best time to decrease the price is before surgery, when receiving the best hospital guessing about costs, known as “good faith”. Otherwise, undergoing surgery is an implicit acceptance of this price as a basic line.

Patricia Kilmar, director of health care campaigns at the American National Consumer Group, follows the ways people are financially intertwined in the health industry. She said that patients must compare cost estimates by searching Hospital online pricing tool (In addition to nearby hospitals) to see if the estimates are in line with. But not every action makes these lists, especially those for unfamiliar injuries, and it is not easy to reach and transfer the list of each hospital.

Kilmar said that post -surgery patients have a few resources to fight large bills, but an unknown rule in the law of non -surprises can help.

The law, which came into effect in 2022, is known for protecting patients from sudden bills for emergency care outside the network. But it was also created Official dispute For insured patients, or those who are fully paid for non -emergency actions, if the final tab is $ 400 or more of the initial estimate.

“This is a valid and important part of ensuring that patients who have a cash payment have a monitoring body,” Kilmar said.

People can start The patient’s conflict process Online, through CMS, by providing medical records and paying a $ 25 fee. Patients must start the operation within 120 days of receiving the bill, and the bill may not be sent to a collection agency during the review.

Independent references assess whether the final price varies greatly from what the health insurance company might pay and whether the complications can be predicted. If the review finds that the health provider made a mistake in any front, Federal health officials may ask them to reduce the bill to suit the original estimate or pay intermediate insurance companies.

Buttgereit said she initially chose to follow up on this official dispute because after such a review, It will be the land The initial appreciation of the hospital, and still has questions about how it works. But after listening to CMS, Buttgerit said it is the path you plan to take.

She said, “You have to fight for yourself.” “I don’t know where this will end, but I feel a little more hope.”

The bill of law is a collective investigation before KFF Health News and Washington Post+ An dissection and explanation of medical bills. Since 2018, this series has helped many patients and readers reduce their medical bills, and it has been martyred in the states of the state, in the American Capitol, and in the White House. Do you have a confusing or interesting medical bill you want to share? Tell us about that!