Parents get stuck in the middle of an insurance company, hospital battle.
When mothers give birth to newborns early, oftentimes that are placed in a hospital’s neonatal intensive care unit (NICU). That was the case when Brittany Giroux Lane gave birth to her daughter, Alexandra, more than three months early in 2018. The baby arrived at Mount Sinai West with discolored skin and weighed only two pounds. She was transported to the NICU, and was originally “thriving,” according to a nurse. However, Alexandra soon developed an infection and passed away at only 25 days old. As the family grieved her loss, they were hit with high bills from multiple providers, including neonatologists and pediatricians, who had care for her. Lane even had to battle her insurance company to get a breast pump covered.
As if that wasn’t enough, last year the Lanes started receiving debt collection notices indicating that they owed Cigna $257,000. The insurer had covered Alexandra’s care even after the couple had switched insurance companies due to a change in employment. Lane found out the Cigna that had received the initial bill from Mount Sinai West, had paid, and was seeking reimbursement for an overpayment.
“For them, it’s just business, but for us it means constantly going through the trauma of reliving our daughter’s death,” said Clayton Lane, Alexandra’s father. “It means facing threats of financial ruin. It’s so unjust and infuriating.”
“The letters mean I’m constantly reliving the day, and that is such a hard space to be in,” Brittany Giroux Lane added. “I feel so frustrated that the hospital is making decisions about their own bottom line that influence our potential future, and the memory of our child.”
Medical billing experts examined the Lane case and described it as “a dispute between a large hospital and a large insurer, with the patient stuck in the middle.”
“This patient had no control over what was paid, and she has no control over whether it gets returned,” said Susan Null, a medical billing expert with Systemedic Inc. “Sometimes things like this might be done to motivate the patient to contact the hospital to get them to release the funds.”
Congress recently passed a ban on unexpected medical bills, but this won’t go into effect until next year. The law specifically focuses on bills that patients receive from an out-of-network provider they were unaware was involved. Unfortunately for the Lanes, and for many other Americans, there are numerous other types of bills that individuals and families, by law, can still receive.
Courtney Jones, a senior case manager with the Patient Advocate Foundation, said these cases typically have a lot more to do with a dispute between the insurer and hospital than the patient. She explained, “They use it as a tactic to put some pressure on the medical facility to refund the money.”
After the Lanes filed a complaint to the State, they received a final letter from Cigna stating, “We empathize with the pain and confusion this experience has caused for Mr. and Ms. Lane. We are working with our vendor to ensure this doesn’t happen again to the Lanes or any other customer.”
Gail Spiro, Mount Sinai’s assistant vice president for patient financial services, also wrote a letter to the couple stating, “I can’t give you a response about the refund due to Cigna as it is being discussed as part of a larger settlement agreement that is ongoing. I apologize again for how long it’s taken to get you what you need.”