In February, Cheryl and Joe Farrell got a disconcerting letter from Saint Vincent Hospital in Worcester, where, three months earlier, Joe had had a successful back surgery.
Saint Vincent wanted $5,040. “We have billed your insurance,“ the letter said. “The amount listed is your responsibility.”
There was no further explanation. The Farrells had already paid hundreds of dollars in copayments for Joe’s five-day stay at the hospital. They were grateful for the quality care he got, but perplexed by this new demand for payment.
So began a dizzying, months-long effort by Cheryl to simply find out the reason for the $5,040 charge. And when she finally unraveled it, she was totally taken aback by the hospital’s reason for billing them.
It turns out that Saint Vincent had billed the Farrells’ health insurer for the cost of a private room, but the insurer paid the hospital only the lower cost of a semiprivate room. Hence, the $5,040 balance.
It’s true Joe had a private room. And it’s also true that the Farrells’ insurance policy limited coverage to semiprivate rooms. But the Farrells had no say in what kind of room Joe got. He was in such a debilitated state when he arrived at the hospital by ambulance that he would have accepted any room, so long as it hastened the surgery he desperately needed, the Farrells say.
“We would have been fine being put in a broom closet,” Cheryl told me.
Saint Vincent never discussed room assignment or room costs with the Farrells at the time Joe was admitted or later, during the months Cheryl spent trying to sort things out, they say.
Joe had been admitted to Saint Vincent via the emergency room, where he spent two agonizing days waiting for a bed, the Farrells say. When a bed opened up, they were ecstatic. They assumed he was being put into the first available bed.
“We were never asked about it,” Cheryl said. “They put him into a private room. We didn’t care. All we cared about was getting his surgery scheduled.”
Joe, 61, gets a modest state pension after almost 25 years working at a wastewater treatment plant. He retired when the facility was closed by the state a few years ago. Cheryl, 53, is a receptionist at a veterinarian clinic. They live in Templeton, where they raised three children.
For years, Joe has been treated for chronic back pain, including two surgeries. In late October, he experienced spinal cord compression, which affected the nerves throughout his body. As a result, he could not walk or use his arms and became incontinent.
He and Cheryl first went to UMass Memorial HealthAlliance in Leominster, where they spent a grueling day in the emergency room. After hours of tests, the doctors told Joe he needed emergency surgery to relieve the compression.
The Farrells say the Leominster hospital looked for a hospital with an available bed and a qualified surgeon. They say they were sent to Saint Vincent, which has more than 250 beds.
Still, inexplicably, Joe languished in the Saint Vincent emergency room for almost two days, the Farrells say.
“I remember thinking, ‘Why is he still in the ER?’” Cheryl said.
But, he was eventually admitted and had the surgery.
The Farrells said they never inquired about why he was in a private room. “We knew there was no roommate but it all kind of went over our heads,” Cheryl said. “We had just gone through this big thing. We were wiped out.”
The Farrells are covered by UniCare, which is owned by Elevance Health, one of the country’s largest corporations with more than $150 billion in revenue. Cheryl said she had difficulty getting answers — or even replies to her many emails and calls — from her insurer about the unexplained $5,040 charge.
At one point, a UniCare rep told her the hospital was charging them extra because Joe was kept an extra day for a second surgery required to clear up a hematoma at the incision site.
“I didn’t challenge that because it seemed to make some sense,” Cheryl said. “I didn’t know much about insurance.”
The Farrells began contemplating a payment plan. They figured it would take four years to pay off the debt.
“We’re regular people who work our tails off to pay our bills,” Cheryl said.
Meanwhile, the Farrells were getting calls and letters from a collection agency saying it was trying to collect a debt owed to Saint Vincent.
As the Farrells were weighing their payment options, Cheryl got a surprising call from UniCare. The rep who previously told her about being charged for an extra day said he was mistaken, and that the real reason was that Joe had had a private room.
“That immediately struck me as unfair,” Cheryl said.
The Farrells appealed UniCare’s decision that it would not cover the private room rate, but in a July 18 email, the rep said an internal review had upheld the determination.
Cheryl wrote back: “My husband was never given a choice on what kind of room he had. It was completely out of our control. So, because someone decided he should get a private room, we have to pay $5,000?!”
I contacted Saint Vincent with a detailed account of the events as described to me by Cheryl, backed up by copies of emails and other documents. Saint Vincent is owned by the Dallas-based Tenet Healthcare, a for-profit company that is one of the country’s largest health systems, with more than 65 hospitals nationwide.
Two years ago, Saint Vincent was the scene of a long and bitter strike by hundreds of nurses demanding better pay. The strike lasted nine months, one of the longest in state history, before the nurses and Tenet reached an agreement.
In my email, I wrote, “It seems unfair to me to hold the Farrells liable for that extra expense when they were under the impression they were getting the next available bed, irrespective of private or semiprivate.”
A spokesperson for Tenet provided a two-sentence reply that dodged the point I was trying to make.
“The hospital’s billing department is in contact with the patient,” it said. “We also encourage the patient to follow-up with his insurance carrier.”
Cheryl told me no one has reached out to her since my inquiry.
I think it’s obvious the Farrells shouldn’t be held responsible for the extra $5,040 since they had no say in what kind of room Joe was given.
Let’s hope others at the hospital, or their insurance company, see it that way.