Brenna Kearney was seven months pregnant in December 2019 when she skilled what she thought have been dangerous flu signs.

Her husband, Casey Trumble, drove her from their Chicago house to her OB-GYN’s workplace at Northwestern Medication Prentice Girls’s Hospital downtown. With all of a sudden elevated blood strain and protein in her urine, she was identified with preeclampsia, a probably deadly however treatable being pregnant complication. Docs admitted her to the hospital, saying she might count on to remain as much as six weeks and have an induced supply.

Then Kearney developed a foul headache and her blood platelet rely plummeted, indicators she was experiencing a uncommon, harmful kind of preeclampsia and required a right away supply by cesarean part.

Kearney’s daughter, Joey, born at 31 weeks, was positioned on a ventilator and moved to the hospital’s neonatal intensive care unit. Small however wholesome, she slowly started respiration on her personal and consuming usually. She was discharged in late January 2020, after 36 days within the NICU.

Then the invoice got here.

The affected person: Josephine “Joey” Trumble, now 3, was lined by her mom’s well being plan via her employer, an promoting company. For 2019, it was an Aetna plan, and for 2020, it was a plan from Blue Cross and Blue Protect of Illinois. Each insurance policies have been absolutely insured plans ruled by Illinois legal guidelines.

Medical service: Neonatology doctor providers supplied in January 2020. Joey wanted tube feeding and ventilator care to supply oxygen.

Service supplier: Ann & Robert H. Lurie Kids’s Hospital of Chicago, whose workers physicians handled Joey at Northwestern Medication Prentice Girls’s Hospital. Possession-wise, Lurie is unbiased of Northwestern Medication, however it’s bodily related to Prentice Girls’s by an enclosed walkway. Lurie has a collaboration settlement with Northwestern Medication to supply neonatology and pediatric doctor providers to Prentice Girls’s sufferers.

Complete invoice: Aetna paid for practically all of Joey and her mom’s hospital and doctor prices in December, whereas Blue Cross picked up practically all of Joey’s hospital prices in January. Doctor prices from Lurie in January totaled $14,624.55, of which the household was requested to pay $12,531.58 after funds from Blue Cross.

What provides: It took Kearney months of calls to Blue Cross and the 2 hospitals to seek out out why Lurie billed greater than $14,000 for doctor providers: The physicians treating her daughter at Prentice Girls’s — an in-network hospital beneath her well being plan — truly labored for a separate, out-of-network hospital.

Illinois legislation bars insurers from charging sufferers out-of-network charges for neonatal care at in-network hospitals.

Kearney stated nobody had instructed her or her husband that Lurie medical doctors have been treating their daughter. She stated the household by no means signed an settlement consenting to obtain care from out-of-network medical doctors.

Although it didn’t occur right here, many sufferers unknowingly signal broad monetary agreements — saying they’re going to pay for nearly something their insurance coverage would not cowl — within the piles of paperwork they obtain upon admission to a hospital. In lots of instances, they’re merely requested to signal on a display screen, with out seeing the doc.

Blue Cross agreed to pay Lurie the in-network charge for the medical doctors’ providers, lowering the invoice to about $12,500 — which Lurie anticipated the household to pay.

In November 2020, Kearney began receiving letters from ICS Assortment Service, a set company.

“Speaking to Blue Cross was unattainable, and Lurie stated it isn’t their drawback and simply wished to place us on a fee plan,” Kearney stated.

Joey’s 36-day keep within the NICU occurred earlier than the federal authorities carried out the No Surprises Act barring shock out-of-network billing. A state legislation prohibiting it, although, was in impact.

Since 2011, Illinois legislation has prohibited insurers from charging out-of-network charges for neonatologists, anesthesiologists, and sure different physicians when sufferers are handled at in-network hospitals.

Kearney stated she repeatedly talked about the legislation to Lurie and Blue Cross representatives, who denied data of the supply.

“It positively seems that beneath the 2011 legislation, Brenna can solely be billed for in-network value sharing,” stated Kathy Mikos, a registered nurse and affected person advocate with the Navocate Group in Woodridge, Illinois, who shouldn’t be concerned with Kearney’s case.

In December 2020, an insurance coverage dealer working for Kearney’s employer persuaded Blue Cross to pay the total out-of-network prices for the Lurie medical doctors, leaving the household owing $289.63 for coinsurance, which they promptly paid.

Having spent practically the primary yr of her daughter’s life combating medical payments from her delivery, Kearney thought the ordeal was over.

Then, final month, she received a name from the gathering company, which once more demanded fee on the full out-of-network charge for Lurie doctor providers supplied to her daughter three years in the past — the invoice she believed Blue Cross had paid.

It took 5 hours on the cellphone for Kearney to piece collectively what had occurred. Blue Cross had certainly paid the out-of-network prices in December 2020 — however, two days later, had taken again the cash, in the end paying Lurie’s medical doctors solely the in-network charge.

A Lurie consultant stated Kearney and her husband nonetheless owed hundreds of {dollars}. A Blue Cross consultant advised she arrange a fee plan.

“I used to be at wits’ finish, and I did not know tips on how to battle this anymore,” Kearney stated.

Lurie, Blue Cross, and Northwestern Medication repeatedly declined to touch upon the case. Lurie cited affected person privateness, regardless of receiving a launch from Kearney relating to the federal Well being Insurance coverage Portability and Accountability Act, or HIPAA, which licensed the hospital to debate Joey’s case with KHN.

The decision: After KHN contacted Lurie and Blue Cross, a Lurie consultant referred to as Kearney providing to just accept fee on the in-network charges in spite of everything.

Kearney stated Tracy A. Spicer, supervisor of consolidated providers at Lurie, instructed her Lurie has a “long-standing coverage” of accepting in-network charges for Lurie doctor providers supplied at Prentice Girls’s. Spicer subsequently described it as a “long-standing courtesy,” then defined that acceptance of in-network charges was topic to “case-by-case consideration,” Kearney stated.

Spicer stated the household owed about $3,000, for his or her coinsurance share, and provided to arrange a fee plan.

A day later — following further requests by KHN for remark — Spicer referred to as Kearney and stated she would take away all doctor prices for her daughter’s care. Spicer didn’t return KHN’s name searching for remark.

“I am sure I am not the one individual nonetheless coping with this” form of predicament, Kearney stated.

Kearney has filed complaints with the Illinois Division of Insurance coverage and the Illinois Legal professional Basic’s Workplace. The lawyer basic’s workplace instructed KHN it had by no means enforced the 2011 legislation barring sure out-of-network billing.

Introduced with the information of Kearney’s case, state Sen. Ann Gillespie, who sponsored a 2022 state legislation increasing shopper protections towards out-of-network payments, instructed KHN she plans to contact Lurie, Blue Cross, and Northwestern Medication to ask about their billing association and whether or not they’re in compliance with state legislation.

“We’ll see if it was a sample and whether or not they should look again and see if refunds are warranted,” Gillespie stated.

The lawyer basic’s workplace instructed KHN it’ll examine Kearney’s criticism, together with whether or not Lurie violated the state Client Fraud and Misleading Enterprise Practices Act by telling her it was extending a “courtesy” by charging her solely in-network charges, when that’s what the 2011 legislation required. The insurance coverage division additionally stated it might examine the criticism.

The takeaway: Even resourceful shoppers who seem to have the legislation on their facet, like Kearney, might discover themselves in a dropping, time-consuming battle with medical billing bureaucracies and going through assortment actions.

Gillespie, the state senator, stated Lurie, Northwestern Medication, and Blue Cross ought to have identified concerning the state legislation. She stated sufferers who consider they’ve been improperly charged ought to file complaints with their state’s insurance coverage division, which may set off a broader investigation.

The federal No Surprises Act, which took impact final yr, prohibits medical suppliers or insurers from billing sufferers for out-of-network doctor prices at an in-network hospital, until the affected person formally consents to an out-of-network physician. To be secure, sufferers ought to ask treating medical doctors whether or not they’re in or out of community, even at an in-network hospital.

Whereas the federal legislation presents sufferers new protections from out-of-network payments, many People nonetheless face issues from earlier than the legislation took impact, stated Loren Adler, affiliate director on the USC-Brookings Schaeffer Initiative for Well being Coverage. Illinois is one in all comparatively few states that had prior legal guidelines to guard shoppers.

Additionally, some out-of-network physicians proceed to invoice sufferers, regardless of the brand new federal protections. So know your rights. Cite the brand new legislation. And do not write the verify.

Dan Weissmann, host of the podcast “An Arm and a Leg,” reported the radio interview of this story. Will Stone of NPR edited the interview with KHN Editor-in-Chief Elisabeth Rosenthal on “All Issues Thought-about.”

KHN (Kaiser Well being Information) is a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is among the three main working applications at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering data on well being points to the nation.