CHARLOTTE, N.C. — Imagine going to the hospital for an emergency or scheduled surgery and afterwards getting a bill for a visit you thought was covered by your insurance. 

That’s what happened to one Charlotte man. He says he did all his research, but unfortunately was still hit with a surprise bill. 

During a dark and hectic 2020, Taylor Houston saw a ray of sunshine through his daughter Billie. She was born during the pandemic, but her birth pushed Houston to do something he’s put off all his life: cochlear implant surgery.  

Houston was born with microtia atresia meaning the outer and middle part of his right ear never developed. 

“I had several surgeries where what they did was essentially they constructed [my] entire ear,” he said. “So [my] earlobe is completely constructed from cartilage from another part of my body.”

Despite only having one ear, Houston said his life was pretty normal. 

Over the years, doctors mentioned he get a cochlear implant but he brushed it off until after Billie was born last April. 

“I sat down with my wife and I was like this might be the one and only chance that we’ll be able to get this thing covered under insurance, and where we might not have to spend an arm and a leg to get this done,” said Houston. 

After months of research, phone calls and appointments, Houston finally received his surgery in late October. 

“Not hearing anything out of the right side of your head for 37 years of your life and then hearing something out of it is really fascinating and weird and its an extensional experience that’s interesting,” he said. 

Houston thought everything with his surgery was covered until a letter showed up at his house a month later. He was hit with an over $2,000 surprise anesthesia bill from Providence Anesthesiologist Associates. 

On their website, it states that in March of 2020 Houston’s healthcare provider United Healthcare terminated their contract. It meant Providence was no longer considered in network under United Healthcare, something Houston said he was not notified about until after his surgery. 

“I called every single person you can think of to find out one was my surgeon in network, was Novant in network for the hospital visit,” he said. “I did all the things you are suppose to do. I did more than what you are suppose to do.”

In late 2020 Congress signed the no surprises act into law that will provide federal consumer protections against surprise medical bills. Unfortunately this won’t go into effect until 2022.

Little Billie has brought a lot of joy in Houston’s life, so he plans to keep fighting with hopes that if Billie ever had to go to the hospital a surprise bill won’t be waiting after her visit. 

After Spectrum New One spoke with both Providence and United Healthcare, Houston reached back out to say that his bill was finally covered. 

Providence issued Spectrum News One this statement: 

“We had an opportunity to meet with Mike Causey, the Insurance Commissioner, approximately two weeks ago.  We were joined by representatives from another large anesthesia group that is in a similar predicament (as many other anesthesia groups in North Carolina and around the country) are in.  I believe we are inching closer to resolving this matter, but I do not have any more definitive information to offer at this time.  As I indicated, we are handling every appeal on behalf of our patients and working diligently to achieve a successful outcome.”

Spectrum News One also reached out to United Healthcare for a response. They issued us this statement: 

“Exorbitant surprise bills are stressful for patients and drive up the cost of health care for everyone. That’s why Congress passed legislation that will prohibit providers from surprise billing their patients starting in 2022. What’s most important for our members to know is that they should contact us if they receive a surprise bill from Providence. We will work directly with Providence to negotiate a reasonable reimbursement rate to help protect our members from being held responsible for paying the bill.”

The North Carolina Department of Insurance has been aware of this situation for the last year. They issued Spectrum News One this statement: 

“We are familiar with the contract dispute between United Healthcare and Providence Anesthesiology Associates and have received complaints from consumers regarding this issue.  If a consumer receives an unexpected bill for these services, they can contact the N.C. Department of Insurance Consumer Services Division (855-408-1212) or file a complaint online at ncdoi.gov. We will help them try to resolve their issue."

For those who are under United Healthcare and have a scheduled surgery at Novant, they sent this information to our newsroom explaining how they are working to notify patients about this ongoing situation: 

“Novant Health is working to ensure our impacted patients are notified of the changes prior to a procedure as best we can. We understand Providence Anesthesiology Associates is also doing what it can to ensure patients are not burdened with higher-than-expected charges for their services."

Unfortunately, the impasse in negotiations between UHC and PAA has our patients stuck in the middle. UHC must resume negotiations, now, and work with PAA to find a reasonable solution.

Under all circumstances, it’s imperative patients feel empowered to confirm with their insurance provider what is in-network by facility – and also by physician. We have a team of financial navigators who are available to help patients better understand their health care expenses, including what questions to ask of their insurance provider prior to a procedure.

If a patient has received a bill from PAA, or an estimate of charges from UHC, they should call PAA prior to making a payment at 704-749-5801. This will ensure any and all options to reduce their bill are exhausted. While we’re working diligently within our contract with PAA on a resolution, we continue to share our patients’ concerns and frustrations.

Additional info for guidance:

• Our PreVisit team informs every patient we can reach prior to service.  We are unable to reach every patient due to a variety of factors such as lead time prior to procedure, no answer or unreturned calls, etc.  However, if this happens, our customer service team is available to help any patient that receives a bill from PAA.
• Additionally, PAA receives a file from Novant Health IT every Monday with all UHC patients that are scheduled for the next 2 weeks. A representative from PAA calls each patient to explain the situation and options once they receive the bill. A letter is also sent to expectant moms prior to delivery, accompanying benefit letters.
• We are in an exclusive contract with PAA at this time.
• PAA is working to reduce the impact this is having on patients by:
• Working with patients to appeal the amount United calculates as patient owed, which reflects out-of-network balance billing (NOT PAA charges.)
• Note: no patients have paid the out-of-network fees at this time and over 90% of impacted patients haven’t paid anything to PAA at all.

What impacted patients can do:

• Know that you don’t have to pay the estimated bill amount United sends you
• PAA will assist patients in filing an appeal
• When patients are admitted, they sign a Healthcare Consent document that addresses their financial responsibilities.  In part, the form says:  “I am aware that the doctors and others providing care may not be employees of Novant Health. They are acting on their own and not at the direction of Novant Health. I understand I will receive a separate bill for their services.”