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Patient Stories

Out of network? That’ll be $9,807.78. — Martin and Becky Prevo, Chenango County

For years, Becky and Martin Provo used Bassett Healthcare, a large healthcare network in New York State. When they switched over to a Fidelis Silver Marketplace plan, they expected that their experience would be more or less the same as earlier. After a few months, however, they found themselves beset with bills, many related to Martin’s recent colonoscopy and endoscopy.  Only then did the couple realize that Fidelis hadn’t paid for any of their Bassett services, and that they owed Bassett nearly $10,000.

Becky asked Chenango Health Network for help. After applying for financial assistance at Bassett, they thought everything would be worked out and that they would get some relief from their unexpected bills. Despite their best efforts, Bassett denied the request, saying the Provos were not eligible because they already have insurance– insurance that they were never told wasn’t accepted at Bassett. Beyond this, however, Bassett’s policy broke the law: The Hospital Financial Assistance Law states health insurance does not disqualify patients from receiving financial aid. Even worse, the Provos learned that when Martin scheduled his recent procedures, the scheduler had ignored a pop-up alert from the computer, advising the scheduler that the insurance plan was not a covered one.

The Provos appealed the denial, arguing that they supplied their insurance information several times, and that the scheduler had ignored the alert that their insurance wouldn’t be accepted.  Shortly afterwards, Bassett granted 100% coverage, saving them $9,807.78. Even though the Provos managed to get the care they deserved without a massive surprise bill, every step of their experience was the result of hospital negligence. Because there’s no law currently requiring hospitals to use a single, uniform financial assistance form– or even to publicize the prices of common procedures– the Provos could be on the hook again for confusing bills, facility fees, and even interest rates of up to 9% on medical debts. The Provos were able to work out a solution this time, but it’s vital that New York State takes action to prevent something like this from happening to them, or anyone else, ever again.