Their Baby Died In The Hospital. Then came the $257,000 Hospital Bill.

Brittany Giroux Lane gave birth to daughter Alexandra a few days before Christmas in 2018. The baby had dark eyes and long legs. She was also about 13 weeks early and weighed only two kilos.

Alexandra initially did well in the neonatal intensive care unit at Mount Sinai West. Ms. Lane, 35, remembers that nurses described her daughter as a “rock star” because she grew up so fast. However, her condition deteriorated rapidly after an infection, and Alexandra died early on the morning of January 15, at the age of 25 days.

Small medical bills from neonatologists and pediatricians followed soon after. In the middle of preterm labor, Ms. Lane struggled to get breast pump coverage because her health plan had not gone through the pre-approval process.

Last summer, Miss Lane started getting debt collection notifications. Letters sent by health plan Cigna said Ms. Lane owed the insurer over $257,000 for bills she inadvertently covered for her care after Ms.

Miss Lane was surprised: Cigna was the first to receive the bill for maintenance and pay Mount Sinai West. Now Cigna was looking for the money he had overpaid the hospital by turning to the patient.

“For them, it’s just a job, but for us it means going through the trauma of constantly reliving our daughter’s death,” said Clayton Lane, Alexandra’s father and Mrs Lane’s husband. “This means facing threats of financial destruction. This is so unfair and frustrating.”

Medical billing experts who reviewed the case described it as a dispute between a major hospital and a major insurance company, where the patient was stuck in the middle. Experts cite the broader lack of predictability in American medical billing, as such cases are not common, but as patients often have little idea how much their care will cost until a bill arrives in the mail months later.

Congress Surprise passes medical bill ban last year, it will enter into force in 2022. It prohibits a certain type of surprise billing: bills that patients receive from an out-of-network provider who are unexpectedly included in their care. There are many other types of bills, such as those taken by Lanes, that confuse patients and are likely to continue.

The Lanes describes the process of dealing with surprise bills as frustrating and Kafkaesque. They spent hours on the phone, sent dozens of emails and filed complaints with regulators in two states.

“Letters mean I’m constantly reliving the day, and that’s a very difficult field to be in,” said Ms. Lane. “I feel very frustrated that the hospital is making decisions about its own consequences that affect our potential future and our child’s memory.”

“This patient had no control over what was paid and no control over whether the money was refunded,” said Susan Null, medical billing specialist at Systemedic Inc. Contact the hospital to get them to release the funds.”

Americans are familiar with medical debt: about 18 percent they have an unpaid bill from a hospital, doctor, or other provider in the healthcare system. But most don’t expect to receive a collection notice for bills already paid by their health plan.

Courtney Jones, a senior litigation manager at the Patient Advocate Foundation, described working on cases where patients received similar collection notices for bills and the insurer, not the patient, was responsible. It often happens with large medical bills, as in Lanes, where the insurer and hospital are both more at risk.

“They’re using this as a tactic to put some pressure on the medical facility to repay the money,” Ms Jones said.

In response to questions from The New York Times, Cigna said she “regrets” the letters and is now reviewing how she communicates with patients in such situations in light of Lanes’ experience.

After the Lanes filed a complaint with a state regulator, Cigna sent them a letter stating that they would no longer receive similar letters. “We empathize with the pain and confusion this experience has caused for Mr and Mrs Lane,” he said in a statement. “We’re working with our vendor to ensure this doesn’t happen to Lanes or any other customer again.”

Miss Lane received her first collection notice approximately 18 months after her daughter’s death. Her family had changed their health plans in the middle of Alexandra’s hospital stay due to a job change.

The day Ms. Lane gave birth with Alexandra was supposed to be her last day at her first job before taking on a new position a few weeks later.

“I was terrified of getting hit with a big bill, so I was updating my insurance with Mount Sinai even when I was giving birth,” Ms. Lane recalled.

Both insurance plans were registered at the hospital – Cigna for 2018 coverage and UnitedHealthcare for 2019. However, Cigna inadvertently covered the entire bill, overpaying the baby’s care in January with the $257,000 owed by UnitedHealthcare.

A Mount Sinai representative told Lanes that UnitedHealthcare actually paid the bill – meaning the bill was paid twice – but that didn’t fix Mount Sinai’s broader issue with Cigna.

When Miss Lane received her first collection notice, she contacted the hospital. A patient services representative apologized and wrote via email that “Cigna will recover” the overpayment. The third-party contractor who sent the letter on behalf of Cigna also told him that the matter would be resolved in a few days.

“I needed a confirmation; “I didn’t, but I got tired and didn’t follow up,” he said.

This summer, when another collection notice arrived in early July, she realized that the refund never happened. When she reached the hospital again, a senior manager said she didn’t know when the reimbursement would be released.

“I can’t give you a response on reimbursement due to Cigna, as it’s being discussed as part of an ongoing larger settlement agreement,” Gail Spiro, Mount Sinai’s vice president of patient financial services, said in a post in August. 10 emails. “I apologize again for how long it took to get what you needed.”

“It is normal business practice to settle accounts with insurers in this way. It is not normal for an insurer to follow up on a patient in this way,” Mount Sinai West said in a statement.

Lanes also made several phone calls with Cigna and eventually filed a complaint with the insurance department in California, where Cigna health plans are registered.

“Receiving another letter completely disrupted our lives and our recovery,” said Mr. Lane. “It meant a lot of tears.”

In response to this complaint, Cigna sent a letter to Lanes stating that the notices were sent in error by a third-party vendor called HMS and that the insurance company was used to track overpayments to hospitals. The Cigna letter stated that the letters were only intended to “inform” the family about the ongoing conflict with Mount Sinai.

The notices Lanes received both informed them of the debt and asked them to make “full payment” within 30 days using a slip at the bottom of the letter to be returned with the payment.

HMS declined to comment on this article, citing patient privacy practices. Lanes asked Mount Sinai and Cigna to testify on letterhead that the family had no debt. No such letter has yet been provided, though Mount Sinai has said it will release a letter in the coming weeks.

The Lanes said it was difficult to reconcile the kind and loving care their daughter received in the neonatal intensive care unit with the billing experience that followed.

“She died surrounded by people who looked after her with love and wonderfulness,” she said. “We continue to support the NICU directly so we can help the families who are there.”

Since Alexandra’s death, the Lanes have donated supplies, including baby rockers, to the Mount Sinai West neonatal unit; books on the care of premature babies; and a camera with a photo printer (baby photos can be difficult to take, they learned; phones are not usually allowed for hygiene reasons). The family is now also welcoming a new addition: They are adopting a baby boy.

“He’s six weeks old now and we’re definitely falling in love,” said Miss Lane. “There are still many firsts, these must be seconds – the first time she smiled was a first for her, but it had to be a second for us. There’s a lot of joy, but there’s also a lot of secondary loss and a lot of thinking about Alexandra.”