SALT LAKE CITY — When Lisa Ray's 16-year-old son suffered a broken jaw while playing rugby recently, she rushed him to Ogden Regional Medical Center, but that hospital was at capacity and could not immediately take him in for surgery.
Even in her hurry to get her son emergency medical care, Ray had chosen that facility because she knew it was in her health insurance network. Increasingly desperate after having no luck there, she quickly got her son admitted into surgery at McKay-Dee Hospital a short distance away.
That sudden decision made under duress now threatens to upend the family's finances. Ray, from Centerville, said she later found out the hospital was billing her about $41,000 for her son's emergency treatment, imposing higher prices because she was outside of her insurance network.
After a strenuous and time-consuming effort to reduce her bill, Ray is now expected to pay about $27,000. While the reduction is significant, she says, appeals to bring it any lower have been denied, leaving great stress on her family.
"It's a lot of house payment money," she summed up simply.
Ray was one of several Utahns to speak to the state Legislature's Health Reform Task Force on Tuesday to decry a practice known as "balance billing," which they say has left them with crushing financial burdens simply for seeking emergency care during a moment of crisis.
"This could really happen to any of you if you have an emergency," warned Lucy Fawcett, of Riverton, who is on the hook for $15,000 after breaking her leg while skiing. Luke Rowley, who took his seven-months-pregnant wife to the emergency room due to a severe spike in her blood pressure, said "it took a herculean effort on our part" to reduce a surprising $84,000 medical bill to a few thousand dollars.
The patients who spoke to lawmakers would like to see the Utah Legislature pursue policy changes contained in Rep. Jim Dunnigan's 2017 general session bill, which, if it had passed, would have placed restrictions on the practice of balance billing patients who receive emergency medical services outside of their insurance network.
Dunnigan, co-chairman of the Utah Health Reform Task Force, has criticized the expensive costs put on those types of patients, who he says should be viewed as a special case because of the urgent nature of their situation when they visit the emergency room.
According to the prominent health care think tank Kaiser Family Foundation, insurers and medical providers which are networked with each other "typically prohibit providers from billing patients the difference between" the full payment requested by the provider and the amount which the insurer sets as its maximum allowed disbursement for a given service.
However, "out-of-network providers have no such contractual obligation," the think tank says, leading to what is known as balance billing.
Representatives for insurers and medical provider groups who spoke to the task force were at odds over who was chiefly to blame for the emergency care balance billing practices criticized by patients.
Eric Hales, vice president at Regence BlueCross BlueShield of Utah, specifically called out Intermountain Healthcare, saying, "We ask that Intermountain stop sending … balance bills until we find a solution."
Hales said Regence balance billing "is not a broad issue for us" among its large provider network throughout the state, where agreements have been made to protect emergency care patients from the practice. There is no agreement with Intermountain.
Hales argued that Regence BlueCross BlueShield of Utah has shown "a willingness to compromise … and take the member out of the middle," but said consensus with Intermountain has been difficult to achieve.
Hales also said "we agree with everyone here that this is our issue to solve, along with Intermountain."
Alan Dayton, vice president of government relations for Intermountain Healthcare, said he was "a little surprised to hear the fiery words" from Hales because "it's my understanding that we were incredibly close to having an agreement."
"At the end of the day we want what is best for the people, and that is never to be put in a vice like that. The stories today were very heartbreaking and I apologize to these people for what they've been through," Dayton said.
Intermountain also responded in a statement later Tuesday saying it "contracts with every major insurance company in Utah and nationally, except for one company, to avoid situations such as this."
"Intermountain has been in negotiations to reach an agreement with this last insurer to cover the cost of needed emergency care for its members, and it is anticipated that a resolution will be reached soon," said Intermountain spokesman Daron Cowley.28 comments on this story
Dunnigan urged Intermountain and Regence BlueCross BlueShield to find a solution as quickly as possible.
"We're close," Dunnigan said. "Let's get it done. (Patients) are being harmed, they really are."
Dunnigan is prepared to bring back his legislation combatting balance billing, which passed the House of Representatives in 2017 before stalling in committee on the Senate side. He said he has asked Regence BlueCross BlueShield and Intermountain to retroactively apply the terms of any agreement to patients already affected, but noted "that will be their decision."