February 28th, 2023
BILL OF THE MONTH
Surprise-Billing Law Loophole: When ‘Out of Network’ Doesn’t Quite Mean Out of Network
Danielle Laskey at her home just outside Seattle, with her infant son. Before giving birth, Laskey experienced a serious pregnancy complication and was admitted for a seven-week hospital stay, plus a follow-up postpartum procedure. It turned out the hospital was out of network for her health plan, and her insurer said surprise-billing laws protecting patients from big out-of-network bills for emergency care did not apply. (RYAN HENRIKSEN FOR KHN)
It was the first day of her family’s vacation in the San Juan Islands last June when Danielle Laskey, who was 26 weeks pregnant, thought she was leaking amniotic fluid. A registered nurse, Laskey called her OB-GYN back home in Seattle, who said to seek immediate care. Staff members at a nearby emergency department found no leakage. But her OB-GYN still wanted to see her as soon as possible.
This story also ran on NPR.
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Laskey and her husband, Jacob, made the three-hour trip to the Swedish Maternal & Fetal Specialty Center-First Hill. Laskey had sought the clinic’s specialized care for this pregnancy, her second, after a dangerous complication with her first: The placenta had become embedded in the uterine muscles.
Back in Seattle, doctors at the clinic found Laskey’s water had broken early, posing a serious risk to her and the fetus, and ordered her immediate admission to Swedish Medical Center/First Hill. She delivered her son after seven weeks in the hospital. Though she was treated for multiple postpartum complications, she was well enough to be discharged the next day. Her son, who is healthy, went home a month later.
Laskey soon developed a fever and body aches, and she was told by her OB-GYN to go to Swedish’s emergency department. She said doctors there wanted to admit her when she arrived Aug. 20 and scheduled a procedure for Aug. 26 to remove a fragment of placenta that her body had not eliminated on its own. Laskey, who had already spent weeks away from her 3-year-old daughter, chose to go home. She returned for the procedure, which went well, and she was home the same day. Then the bills came.
The Patient: Danielle Laskey, 31, was covered by a state-sponsored plan offered by her employer, a local school district, and administered by Regence BlueShield.
Medical Service: In-patient hospital services for 51 days, plus a one-day stay that included a second placenta removal procedure. Service Provider: Swedish Medical Center/First Hill, part of Providence Health & Services, a large, nonprofit, Catholic health system.
Total Bill: Swedish, through Regence, billed about $120,000 in cost sharing for Laskey’s initial hospitalization and about $15,000 for her second visit and procedure. What Gives: The specialized clinic caring for Laskey before her hospital admission was in her insurance plan’s network.
