Ask A Frustrated Nurse # 28

Juicy News 2014 a patient had surgery and just recently won a lawsuit. Back in 2014 had a couple of back surgeries and was left with a $229,129 dollar balance.
The original bill was $303,709. The insurance did pay $73,598, and the patient did pay $1000. Leaving a total balance of $229,129. Suing for breech of contract. St Anthony Hospital-Centura Health in Colorado. She was given an estimate that her out-of-pocket expenses would be $1300. After surgery, the hospital claims to have miss read insurance to find it was out of network.

Colorado Supreme Court awarded the win to the patient. As they should have. This was the fault of the hospital and the insurance company. If this surgery was pre-authorized then the insurance company should have caught the issue as well. If not the full fault is with the hospital billing office. It is one thing to have an issue with an inpatient outpatient procedure, then a high-dollar surgery done out of network.

The hospital later found out the insurance was out of network.