Sanford woman stunned after getting $236,000 surgery bill
A Sanford woman was shocked when she was left with a nearly $236,000 bill after a medical procedure.
"I don’t know how in the world I would ever come up with $236,000 bucks in my life," Jewel Fader told WRAL's 5 On Your Side.
Medical debt is a huge burden on American families. According to the Kaiser Family Foundation, 90% of Americans are insured, but 17% of all households owed some amount of medical debt as of 2019.
More than 3 million people in the U.S. owe more than $10,000 dollars in medical debt, including Fader.
She was a dog groomer for 25 years, but in early 2020, she was on unemployment and learned she needed surgery for a tumor.
"I did start having tremendous headaches and dizziness," Fader told us.
It was a meningioma, a tumor in the area of the brain and spinal cord that can cause vision or hearing loss, seizures and other serious neurological problems.
"I had already had it removed once and they couldn’t get it all," Fader said.
This time, she underwent a gamma knife procedure at Wake Forest Baptist Hospital hoping to destroy the tumor for good.
"I was back on my feet within a few days," Fader said.
Then she got the bill, $262,000 dollars with insurance covering just $40,000.
"I was blown away," Fader said
Without realizing it, Fader had gotten the procedure out of her insurance network.
"Nobody said anything to me about the initial cost, they knew I was unemployed. They knew I was on the Affordable Care Act, so they knew that I was broke," Fader said.
Through a records request, 5 On Your Side learned that Wake Forest Baptist Hospital did contact Fader’s insurer, Blue Cross Blue Shield of North Carolina, to check Fader’s network status and benefits more than three weeks before the procedure.
We asked the hospital why Fader was never alerted to the potential cost of the procedure before it was performed. They did not answer that question directly, but provided us with this statement:
"We know that estimating the price of a health care procedure can be complex and we certainly make every effort to help our patients understand their health care costs and financial obligations. We encourage those who have questions about their bill to contact our Customer Service Center directly at 336-716-3988 or 877-938-7497 and we can also discuss if they may qualify for free care or other financial assistance programs.
Additional information about financial assistance, billing and free care can be found here and here."
The federal No Surprises Act took effect this year and prevents what’s called "balance billing." That’s when you go to an in-network hospital or facility, an out-of-network doctor treats you and you get a bill for the difference between what insurance pays and what the out-of-network provider charges.
However, the act wouldn’t have helped Fader because she scheduled her procedure at a hospital that was out-of-network.
"I had no idea it was going to cost this much," Fader said. "No idea."
How to protect yourself from massive medical bills
"You really need a financial navigator, because again, you’re not born knowing all this stuff" said Ruth Lande, vice president of hospital relations with the charity RIP Medical Debt.
If it’s not an emergency, Lande suggests going to your insurer to check that the provider is in-network and to get the clearest cost estimate.
"The insurance company knows your contract, they know how much of your deductible you’ve already used up," Lande said. "They know the contracts of all the area hospitals. And so really, it’s a lot, you know, more efficient to just go and go to your insurance company website and try to, to look around there."
For help paying, North Carolina has a Consumer Assistance program and any not-for-profit hospital also has financial assistance you can apply for.
"Even if you’ve already gotten the bills and that’s when you realize, oh, my goodness. And even if it’s all in network, yeah, go and look," Lande told us about applying for financial assistance.
Fader used most of the $40,000 check from her insurer to pay down the surgery bill.
Lande recommends, if you haven’t paid anything to the hospital yet, forwarding that entire check to the hospital. The provider may then make extra adjustments to your balance once they get that forwarded check.
After adding in the cost of a follow up visit, Fader is now left trying to figure out how to pay off a nearly $236,000 dollar debt that’s now been sent to collections.
"I don’t know how in the world I would ever come up with $236,000 bucks in my life but, I tried," Fader said.
For anyone who may need financial assistance, below are links to the financial assistance pages of Raleigh’s major local hospitals:
