{"id":20661,"date":"2019-07-26T16:19:03","date_gmt":"2019-07-26T16:19:03","guid":{"rendered":"https:\/\/associatednews.us\/content\/2019\/07\/26\/dialysis-firm-cancels-524600-17-medical-bill-after-journalists-investigate\/"},"modified":"2019-07-26T16:19:03","modified_gmt":"2019-07-26T16:19:03","slug":"dialysis-firm-cancels-524600-17-medical-bill-after-journalists-investigate","status":"publish","type":"post","link":"https:\/\/associatednews.us\/content\/dialysis-firm-cancels-524600-17-medical-bill-after-journalists-investigate\/","title":{"rendered":"Dialysis Firm Cancels $524,600.17 Medical Bill After Journalists Investigate"},"content":{"rendered":"<p><span style=\"font-style:italic;font-size:16px\">By  <a class=\"colorbox\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/26\/745596505\/dialysis-firm-cancels-524-600-17-medical-bill-after-journalists-investigate?utm_medium=RSS&amp;utm_campaign=healthcare\">Jenny Gold<\/a><\/span>  <\/p>\n<div class=\"ftpimagefix\" style=\"float:left\"><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/26\/745596505\/dialysis-firm-cancels-524-600-17-medical-bill-after-journalists-investigate?utm_medium=RSS&amp;utm_campaign=healthcare\"><img decoding=\"async\" width=\"150\" src=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/26\/valentine5_1350-4f171ee65ed439b541f86cde476149047e35c229-s1100-c15.jpg\" alt><\/p>\n<div>\n            <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/26\/valentine5_1350-4f171ee65ed439b541f86cde476149047e35c229-s1200.jpg\"><\/a><\/div>\n<div>\n<div>\n<div>\n            <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/26\/valentine5_1350-4f171ee65ed439b541f86cde476149047e35c229-s1200.jpg\">Enlarge this image<\/a>\n        <\/div>\n<\/div>\n<div>\n<div>\n<div>\n<p>\n                Sovereign Valentine, a personal trainer in Plains, Mont., needs dialysis for his end-stage renal disease. When he first started dialysis treatments, Fresenius Kidney Care clinic in Missoula charged $13,867.74 per session, or about 59 times the $235 Medicare pays for a dialysis session.<\/p>\n<p>                <b><\/p>\n<p>                    Tommy Martino\/Kaiser Health News<\/p>\n<p>                <\/b><br \/>\n                <b><b>hide caption<\/b><\/b>\n            <\/p>\n<\/p><\/div>\n<p>            <b><b>toggle caption<\/b><\/b>\n    <\/div>\n<p>    <span><\/p>\n<p>        Tommy Martino\/Kaiser Health News<\/p>\n<p>    <\/span>\n<\/div>\n<\/p><\/div>\n<p>Fresenius, one of the two largest dialysis providers in the U.S., has agreed to waive a $524,600.17 bill for a man who received 14 weeks of dialysis at a clinic in Montana.<\/p>\n<p><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/22\/743180947\/first-came-kidney-failure-then-there-was-the-540-842-bill-for-dialysis\" target=\"_blank\">NPR<\/a>, <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/khn.org\/news\/first-kidney-failure-then-a-540842-bill-for-dialysis\/\" target=\"_blank\">Kaiser Health News<\/a>, and <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.youtube.com\/watch?v=FRK0Y-Vv6Uc\" target=\"_blank\">CBS This Morning<\/a> told Sovereign Valentine&#8217;s story this week, as part of the &#8220;Bill of the Month&#8221; series, a crowdsourced investigation that seeks to understand the exorbitant health care bills faced by ordinary Americans.<\/p>\n<p><!-- END ID=\"RES745615767\" CLASS=\"BUCKETWRAP INTERNALLINK INSETTWOCOLUMN INSET2COL \" --><\/p>\n<p>On Thursday, a representative from Fresenius told Sovereign&#8217;s wife, Dr. Jessica Valentine, that the company would waive their unpaid bill. Instead, they will be treated as in-network patients, and Fresenius will seek to negotiate with their insurer a rate higher than what the insurer has already paid. The Valentines are responsible only for their $5,000 deductible, which Sovereign, who goes by &#8220;Sov,&#8221; has already hit for the year. That leaves them with $0 left to pay on their in-network deductible.<\/p>\n<p>&#8220;It&#8217;s a huge relief,&#8221; Sov said. &#8220;It allows me to put more energy back into just taking care of my health and not having stress hormones raging.&#8221; Sov said he hopes his experience will shed light on the problem of balance billing and help other patients in similar situations.<\/p>\n<p>A 50-year-old personal trainer, Sov was diagnosed with kidney failure in January and sent for dialysis at a Fresenius clinic 70 miles from his home in rural Plains, Mont. A few days later, Sov and Jessica learned that the clinic was out-of-network and that they would be required to pay whatever their insurer didn&#8217;t cover.<\/p>\n<aside>\n<div><\/div>\n<\/aside>\n<p>The Valentines initially could not find an in-network option, and Sov needed dialysis three times a week to survive. After he underwent 14 weeks of dialysis with Fresenius, the couple received a bill for $540,841.90. Their insurer, Allegiance, paid $16,241.73, about twice what Medicare would have paid. Fresenius billed the couple the unpaid balance of $524,600.17 \u2014 an amount that is more than the typical <a class=\"colorbox\" rel=\"nofollow\" href=\"http:\/\/www.milliman.com\/uploadedFiles\/insight\/2017\/2017-Transplant-Report.pdf\" target=\"_blank\">cost of a kidney transplant<\/a>.<\/p>\n<p>Fresenius charged the Valentines $13,867.74 per dialysis session, or about 59 times the <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.cms.gov\/Outreach-and-Education\/Medicare-Learning-Network-MLN\/MLNMattersArticles\/downloads\/MM11021.pdf\" target=\"_blank\">$235<\/a> Medicare pays for a dialysis session.<\/p>\n<p>Fresenius spokesman Brad Puffer said that the Valentines should always have been treated as in-network patients because their insurer, Allegiance, is a subsidiary of Cigna, which has a contract with the dialysis company. Under this contract, Fresenius would have been paid a higher rate than what Allegiance paid. The Valentines, he said, were caught in the middle of a contract dispute between the companies.<\/p>\n<p>&#8220;In the future, we pledge to better identify situations where we believe the insurer has incorrectly classified one of our facilities as being out of network,&#8221; Puffer said in a statement. &#8220;This will allow us to address the matter directly with the insurer in the first instance, without them placing the patient in the middle.&#8221;<\/p>\n<p>Allegiance declined to comment for this story. Jessica Valentine questioned whether they may owe an out-of-network deductible and is waiting to hear what her insurer says about that.<\/p>\n<p>Like her husband, Jessica is relieved that their bill seems to be resolved but worried that other people with bills like theirs might not be so lucky. She&#8217;s also grateful for all the attention their story has garnered. Montana Sen. Jon Tester&#8217;s office and their hospital&#8217;s insurance broker both offered to advocate for them. &#8220;And a nephrologist from Pennsylvania called me at work and expressed outrage and said she forwarded on our story to the medical director of Fresenius on our behalf,&#8221; Jessica wrote in an email.<\/p>\n<p>Now that his bill has been resolved, Sov said he&#8217;ll be focusing on the next step in battling his kidney disease: a transplant. &#8220;I can just save my energy for that,&#8221; he said.<\/p>\n<p><em>Bill of the Month is a crowdsourced investigation by <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2018\/02\/16\/585549568\/share-your-medical-bill-with-us\">NPR <\/a> and <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/khn.org\/news\/tag\/bill-of-the-month\/\">Kaiser Health News<\/a> that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/khn.org\/send-us-your-medical-bills\/\">Tell us about it<\/a>!<\/em><\/p>\n<p><strong><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/\">Let&#8217;s block ads!<\/a><\/strong> <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/acceptable.html\">(Why?)<\/a><\/p>\n<p>Source:: <a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/26\/745596505\/dialysis-firm-cancels-524-600-17-medical-bill-after-journalists-investigate?utm_medium=RSS&amp;utm_campaign=healthcare\" class=\"colorbox\" title=\"Dialysis Firm Cancels $524,600.17 Medical Bill After Journalists Investigate\" rel=\"nofollow\">https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/26\/745596505\/dialysis-firm-cancels-524-600-17-medical-bill-after-journalists-investigate?utm_medium=RSS&amp;utm_campaign=healthcare<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<div class=\"ftpimagefix\" style=\"float:left\"><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/26\/745596505\/dialysis-firm-cancels-524-600-17-medical-bill-after-journalists-investigate?utm_medium=RSS&amp;utm_campaign=healthcare\"><img decoding=\"async\" width=\"150\" src=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/26\/valentine5_1350-4f171ee65ed439b541f86cde476149047e35c229-s1100-c15.jpg\" alt><\/p>\n<div>\n            <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/26\/valentine5_1350-4f171ee65ed439b541f86cde476149047e35c229-s1200.jpg\"><\/a><\/div>\n<div>\n<div>\n<div>\n            <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/26\/valentine5_1350-4f171ee65ed439b541f86cde476149047e35c229-s1200.jpg\">Enlarge this image<\/a>\n        <\/div>\n<\/div>\n<div>\n<div>\n<div>\n<p>\n                Sovereign Valentine, a personal trainer in Plains, Mont., needs dialysis for his end-stage renal disease. When he first started dialysis treatments, Fresenius Kidney Care clinic in Missoula charged $13,867.74 per session, or about 59 times the $235 Medicare pays for a dialysis session.<\/p>\n<p>                <b><\/p>\n<p>                    Tommy Martino\/Kaiser Health News<\/p>\n<p>                <\/b><br \/>\n                <b><b>hide caption<\/b><\/b>\n            <\/p>\n<\/p><\/div>\n<p>            <b><b>toggle caption<\/b><\/b>\n    <\/div>\n<p>    <span><\/p>\n<p>        Tommy Martino\/Kaiser Health News<\/p>\n<p>    <\/span>\n<\/div>\n<\/p><\/div>\n<p>Fresenius, one of the two largest dialysis providers in the U.S., has agreed to waive a $524,600.17 bill for a man who received 14 weeks of dialysis at a clinic in Montana.<\/p>\n<p><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/22\/743180947\/first-came-kidney-failure-then-there-was-the-540-842-bill-for-dialysis\" target=\"_blank\">NPR<\/a>, <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/khn.org\/news\/first-kidney-failure-then-a-540842-bill-for-dialysis\/\" target=\"_blank\">Kaiser Health News<\/a>, and <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.youtube.com\/watch?v=FRK0Y-Vv6Uc\" target=\"_blank\">CBS This Morning<\/a> told Sovereign Valentine&#8217;s story this week, as part of the &#8220;Bill of the Month&#8221; series, a crowdsourced investigation that seeks to understand the exorbitant health care bills faced by ordinary Americans.<\/p>\n<p><!-- END ID=\"RES745615767\" CLASS=\"BUCKETWRAP INTERNALLINK INSETTWOCOLUMN INSET2COL \" --><\/p>\n<p>On Thursday, a representative from Fresenius told Sovereign&#8217;s wife, Dr. Jessica Valentine, that the company would waive their unpaid bill. Instead, they will be treated as in-network patients, and Fresenius will seek to negotiate with their insurer a rate higher than what the insurer has already paid. The Valentines are responsible only for their $5,000 deductible, which Sovereign, who goes by &#8220;Sov,&#8221; has already hit for the year. That leaves them with $0 left to pay on their in-network deductible.<\/p>\n<p>&#8220;It&#8217;s a huge relief,&#8221; Sov said. &#8220;It allows me to put more energy back into just taking care of my health and not having stress hormones raging.&#8221; Sov said he hopes his experience will shed light on the problem of balance billing and help other patients in similar situations.<\/p>\n<p>A 50-year-old personal trainer, Sov was diagnosed with kidney failure in January and sent for dialysis at a Fresenius clinic 70 miles from his home in rural Plains, Mont. A few days later, Sov and Jessica learned that the clinic was out-of-network and that they would be required to pay whatever their insurer didn&#8217;t cover.<\/p>\n<aside>\n<div><\/div>\n<\/aside>\n<p>The Valentines initially could not find an in-network option, and Sov needed dialysis three times a week to survive. After he underwent 14 weeks of dialysis with Fresenius, the couple received a bill for $540,841.90. Their insurer, Allegiance, paid $16,241.73, about twice what Medicare would have paid. Fresenius billed the couple the unpaid balance of $524,600.17 \u2014 an amount that is more than the typical <a class=\"colorbox\" rel=\"nofollow\" href=\"http:\/\/www.milliman.com\/uploadedFiles\/insight\/2017\/2017-Transplant-Report.pdf\" target=\"_blank\">cost of a kidney transplant<\/a>.<\/p>\n<p>Fresenius charged the Valentines $13,867.74 per dialysis session, or about 59 times the <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.cms.gov\/Outreach-and-Education\/Medicare-Learning-Network-MLN\/MLNMattersArticles\/downloads\/MM11021.pdf\" target=\"_blank\">$235<\/a> Medicare pays for a dialysis session.<\/p>\n<p>Fresenius spokesman Brad Puffer said that the Valentines should always have been treated as in-network patients because their insurer, Allegiance, is a subsidiary of Cigna, which has a contract with the dialysis company. Under this contract, Fresenius would have been paid a higher rate than what Allegiance paid. The Valentines, he said, were caught in the middle of a contract dispute between the companies.<\/p>\n<p>&#8220;In the future, we pledge to better identify situations where we believe the insurer has incorrectly classified one of our facilities as being out of network,&#8221; Puffer said in a statement. &#8220;This will allow us to address the matter directly with the insurer in the first instance, without them placing the patient in the middle.&#8221;<\/p>\n<p>Allegiance declined to comment for this story. Jessica Valentine questioned whether they may owe an out-of-network deductible and is waiting to hear what her insurer says about that.<\/p>\n<p>Like her husband, Jessica is relieved that their bill seems to be resolved but worried that other people with bills like theirs might not be so lucky. She&#8217;s also grateful for all the attention their story has garnered. Montana Sen. Jon Tester&#8217;s office and their hospital&#8217;s insurance broker both offered to advocate for them. &#8220;And a nephrologist from Pennsylvania called me at work and expressed outrage and said she forwarded on our story to the medical director of Fresenius on our behalf,&#8221; Jessica wrote in an email.<\/p>\n<p>Now that his bill has been resolved, Sov said he&#8217;ll be focusing on the next step in battling his kidney disease: a transplant. &#8220;I can just save my energy for that,&#8221; he said.<\/p>\n<p><em>Bill of the Month is a crowdsourced investigation by <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2018\/02\/16\/585549568\/share-your-medical-bill-with-us\">NPR <\/a> and <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/khn.org\/news\/tag\/bill-of-the-month\/\">Kaiser Health News<\/a> that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/khn.org\/send-us-your-medical-bills\/\">Tell us about it<\/a>!<\/em><\/p>\n<p><strong><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/\">Let&#8217;s block ads!<\/a><\/strong> <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/acceptable.html\">(Why?)<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[47],"tags":[],"class_list":["post-20661","post","type-post","status-publish","format-standard","hentry","category-health"],"_links":{"self":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/posts\/20661","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/comments?post=20661"}],"version-history":[{"count":0,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/posts\/20661\/revisions"}],"wp:attachment":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/media?parent=20661"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/categories?post=20661"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/tags?post=20661"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}