Why Henrico woman was charged more than $1000 for visiting in-network doctor

HENRICO COUNTY, Va. -- The CBS 6 Problem Solvers helped resolve a surprise medical bill. Now we’re getting answers about why Lynette Jackson was ever asked to pay $1,037 for a doctor erroneously listed as out-of-network on her health insurance company’s explanation of benefits.

The retired school administrator went to the emergency room at Henrico Doctor’s Hospital in July for persistent abdominal pain. The facility is listed as an in-network provider on Jackson’s Anthem insurance policy. The ER registration staff took her copay but never mentioned she could be seen by a doctor who wouldn’t be covered.

“These are giant corporations that you're dealing with and I'm just a person stuck in the middle trying to be treated fairly,” Jackson told the Problem Solvers of her many hours spent going back and forth with her insurance and the third party billing company that sent the bill on the doctor’s behalf. “I feel like I, as a customer and patient in that hospital should have been told that the doctor was not in my network.”

As it turns out, Henrico Doctor’s Hospital believes the physician who treated her was indeed in-network. In the days since we first aired Jackson’s story, Hospital Corporation of America (HCA), the parent company of Henrico Doctor’s, sent the Problem Solvers the following statement:

“Ms. Jackson’s claim was incorrectly processed as out of network by her insurance company, although the physicians were in network. Since the bill in question did not originate from the hospital, we are unable to see the account level specifics. We are aware that the insurance company has since re-processed her claim correctly.

At Henrico Doctors’ Hospitals, we stand by our patients and are committed to assisting with individual matters until they are fully resolved. While our processes at Henrico Doctors’ Hospital did not attribute to the network system issues experienced by Ms. Jackson, we are sorry to see that she faced any difficulties. We are happy that her account has been fully resolved to the satisfaction of all parties. We remain dedicated to serving our patients.”

Jackson’s bill was resolved within days of the Problem Solvers reaching out to HCA and Anthem for her. Anthem sent the following statement at that time:

“Anthem is committed to making health care affordable and simpler by constantly working with our hospital partners to help ensure all physicians who perform health care services within those hospitals are in-network providers. We contacted Henrico Doctors Hospital and understand Ms. Jackson’s billing issue has been resolved.”

Jackson is understandably relieved to have the whole episode behind her after months of effort but remains concerned for other patients who might not realize there could be errors in the claim processing they’re not responsible for.

“An individual could never have gotten this straight,” wrote Jackson.

If you have received a surprise medical bill and would like our help, send us your information here.

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