Delray Beach resident Sherry Rix had exploratory surgery done. She thought she had done her homework.
“I chose the doctor that was in my network, knew the hospital was in my network, I already know what my out-of pocket is,” Rix said.
Weeks later, however, came the bill in the mail.
“I was shocked,” Rix said. "When I opened it up I was like ‘I don’t even understand this. I don’t even know how this could be possible.'"
It said that Rix owed $2,025 for the anesthesiologist, who was not in-network.
“It came as a total shock and for us, that’s not something that we’ve budgeted for and that will be a real problem as far as fitting it into the expenses,” Rix said.
While her doctor and the hospital were in-network, the anesthesiologist was not, sending her the bill through another company, Ascent Medical Group.
“I really was blindsided by this,” Rix said.
Medical billing expert and patient advocate Elizabeth Dodd said never accept a medical bill at face value.
“Every time they send you a bill they expect you to pay it. And if you pay it and don’t question it, they’re very happy,” Dodd said.
Rix called her insurance company United Healthcare and Ascent and challenged the bill. She said she spent hours on the phone but never got a resolution.
Florida is among only a handful of states who have banned surprise balance billing. What does that mean? Providers and insurance companies often fight over who has to pay. Sometimes, when the insurance refuses to pay, the provider passes the balance directly on to the consumer and that is not allowed in Florida. But it happened to Rix.
“I had no idea,” Rix said. “I shouldn’t have to be a specialist in health care or billing.”
She kept getting bills from Ascent Medical Group.
After Contact 5 reached out to United Healthcare and Ascent, Rix got a message from United saying they had reached out to Ascent and the bill went from $2,025 to $0.
“My first reaction to that was: finally! Thank you!” Rix said.
The provider and the insurance company blamed each other for the bill.
United said Ascent “sent the bill in error.”
Ascent said United had the “contractual responsibility to manage its members to a location where all of the providers were network providers”.
Leaving patients like Rix caught in the middle.
“Honestly, if you hadn’t stepped in to this, I don’t believe we would be at this point,” Rix said.