美国国家公共电台 NPR A Year After Spinal Surgery, A $94,000 Bill Feels Like A Backbreaker（在线收听）

NOEL KING, HOST:

A major operation means a lot of medical bills. There is the surgeon. There's the hospital. There's the anesthesiologist. But a growing number of patients are also seeing big charges for a little-known service that is often not covered by insurance. NPR's Jon Hamilton is here to talk about this in our latest bill of the month. Hey, Jon.

JON HAMILTON, BYLINE: Hey, Noel.

KING: So you are here with another horrendous medical bill. What have you got?

HAMILTON: Well, I do have horrendous medical bill. So imagine you just found out that you might owe $94,000 for a medical service you didn't even know existed.

KING: I would be terrified and very upset.

HAMILTON: Yeah. Well, that was pretty much the reaction of Liv Cannon. She's a woman who lives in Austin. I went to speak with her a couple of weeks ago. And she lives in this cute little cottage with her fiance, Cole Chiumento. And they've got two dogs, who I must say are super friendly.

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HAMILTON: You must be Liv.

LIV CANNON: I am, yeah.

HAMILTON: You must be Cole.

COLE CHIUMENTO: Yeah.

CANNON: (Laughter).

HAMILTON: And these must be...

CANNON: These are - this is Lyndon...

CHIUMENTO: Lyndon.

CANNON: ...And this is Jolene.

HAMILTON: These days, Liv is spending a lot of time in her garden.

CANNON: Here we have tomatillos, eggplant, and then my cherry tomatoes are in here.

HAMILTON: Liv says gardening is a big deal for her because it was pretty much impossible before she had back surgery.

CANNON: It's a lot of bending over, and it's a lot of crouching. And none of that I could ever do before. And it's still hard for me.

HAMILTON: Until she was 24, Liv experienced chronic pain and debilitating muscle weakness.

CANNON: There was a lot of pain in my legs, which I can now recognize as nerve pain. There was a lot of pain in my back, which I thought was, you know, just something that everybody lived with.

HAMILTON: Liv saw lots of doctors over the years, but they couldn't explain what was going on. She'd pretty much given up on finding an answer until Cole pushed her to try one more time.

CHIUMENTO: It never improved. It never got better. That just didn't - that didn't sound right to me.

HAMILTON: So Liv went to a specialist, who ordered an MRI of her spine. A few days later, her phone rang.

CANNON: Is this Olivia? Yes. We found something on your MRI. It's diastematomyelia with tethered cord syndrome, and the tumor's benign. And I'm like, sorry, what - tumor?

HAMILTON: Liv had been born with a rare condition that causes a part of the spinal cord to split in two. In her case, it also led to a tumor that trapped her spinal cord, causing it to stretch as she grew. In December of 2017, a neurosurgeon opened up her spinal column and freed the cord.

CANNON: I think it was day three after my surgery, I could feel the difference. There was just a pain that I had always had that wasn't there anymore.

HAMILTON: As she recovered, Liv saw lots of huge medical bills. But they were all covered by her insurance plan - all except one, which arrived almost a year after the operation.

CANNON: It wasn't exactly a bill. It was one of those things from the insurance company that says, this is what we cover, and this is the amount that you might owe your provider.

HAMILTON: The amount? Ninety-three thousand, nine hundred and ninety-one dollars and 58 cents.

CANNON: I was shocked.

HAMILTON: Her fiancee was outraged.

CHIUMENTO: As soon as I saw that, I thought it was a scam.

HAMILTON: It wasn't just the amount. The bill had come from an Austin company called Traxx Medical Holdings. Traxx provides a service that monitors the function of nerves during surgery. The goal of this neuromonitoring is to help a surgeon avoid damaging a nerve. But unlike Liv's surgeon and hospital, Traxx was not part of her insurance company's network, so the bill was her responsibility. Cole says that's just wrong.

CHIUMENTO: I don't see how they could continue to put people in this sort of financial peril and have it ultimately be on the up-and-up.

HAMILTON: Traxx did not respond to requests for comment. Liv's insurance company at the time, Blue Cross and Blue Shield of Texas, agreed to cover about $800, or roughly 1%, of the charge. And Liv is pretty sure that, just before surgery, she signed a paper that authorized the out-of-network neuromonitoring. Dr. Arthur Garson Jr. directs the Health Policy Institute at the Texas Medical Center in Houston. He says getting a patient's consent in the hospital may be legal, but it's not reasonable.

ARTHUR GARSON JR: You're having your heart attack. There you are flat on your back. You got chest pain. You're sweating, sick as you can be. And they hand you a piece of paper, and they say, sign here.

HAMILTON: In May, the Texas legislature passed a bill to protect patients from the sky-high charges this practice can produce. And Congress is considering similar legislation. Garson says these are small steps in the right direction.

GARSON JR: Asking the individual patient to make that decision even when they're not sick, I think, is difficult. And maybe we ought to figure out some better way to do it.

HAMILTON: The Texas legislation is expected to take effect in September, and it won't help Liv Cannon. So she says that $94,000 figure is never far from her mind.

CANNON: I still think about it. Every time I go out, and I collect the mail, I'm, like, wondering is this the day that it's going to show up and that we're going to have to deal with this.

KING: So Jon, if Liv does end up getting this $94,000 bill, is she going to pay it?

HAMILTON: She says no. She says she and Cole plan to fight it.

KING: How common is this, that people will get a big medical bill for something - for a service that they didn't know they were getting?

HAMILTON: Well, it's a lot more common than it used to be. And especially in neuromonitoring, this is a field that was established decades ago. But in the last few years, it has expanded greatly. And often, it's a service that is what they call an out-of-network service where patients are getting surprise bills later on.

KING: All right. So how can people ensure that this doesn't happen to them? How can they protect themselves?

HAMILTON: Well, if you're going to be getting surgery, especially spinal surgery, and, you know, it's a thing where neuromonitoring may be called for, you want to find out whether you're going to have it. And if your doctor says, yes, I'm going to order neuromonitoring, then you want to find out who is providing it. Look up the company. Are they a private company? Are they part of your insurance network? Because if they're not, you might be the one that has to pay out of pocket.

And the final piece of advice I got from insurers is if you get a bill that you think is outrageous, go to your insurance company. They may be able to negotiate on your behalf to get it eliminated or reduced.

KING: That's interesting. But also, that's a lot of work. Are consumers going to get any help with this?

HAMILTON: Well, in some places they are. A number of states including Texas are in the process of passing legislation or have passed legislation to protect consumers from surprise medical bills, not just for neuromonitoring, but anything like this that's out of network that you didn't know about. The question is whether there's going to be federal legislation. And there is a bill before Congress that would offer some of these same consumer protections. Whether it passes or not, we'll see.

KING: NPR's Jon Hamilton. Thanks, Jon.

HAMILTON: You're welcome.

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