Tina's hospital bill

About a year ago, my daughter Tina  lost her appetite and started losing weight, which became very apparent after the winter break. We consulted her primary care physician who referred us to a dietitian. However, Tina continued losing weight despite getting back on normal portions and following the dietitian's recommendations.

I therefore started looking  at other options, including consulting with an eating recovery center. Unfortunately, we were living in Seattle at that time and our insurance had a very poor coverage, meaning that none of the options I investigated were in network or covered. I spent countless hours on the phone with the insurance company without getting any help.

I eventually made an appointment with the local children's hospital to get a full diagnosis; as the hospital was very busy, I could not get an appointment for several months. In the meantime, Tina was still followed regularly by her primary care physician, seeing her once to twice a month.

The appointment was early August, a few days before we were supposed to hit the road as we were moving to Florida. During the appointment, it was identified that Tina's heart rate was extremely low (it registered at 45 bpm and dropped to 27 that night), which came as a complete shock as we had visited her regular doctor a couple of days earlier and everything was"fine"and we had received her blessing for our upcoming road trip.

Tina was immediately admitted to the ER and later moved to the ICU. The goal was to bring back her rate heart above 50 bpm at night so that it would be safe for her to fly to Florida (our house in Seattle was already sold so we were basically homeless there).

Tina fought really hard and was eventually discharged after 12 days while the hospital had first estimated that she might have to stay two to three weeks. We made our way to Florida and Tina started her recovery process; it has been slow, despite how much she is eating but the doctors who are following her are satisfied with her progress.

I therefore thought all this was behind us when I received a bill of over $55,000 from the hospital. After contacting the insurance, they mentioned that they had already covered $19,000 but would not cover more as the hospital was out of network.

We filed a first appeal that was rejected. Insurance stated that they had actually proceeded to a reimbursement as if the hospital was in network, but that they could not cover more as the hospital charges exceeded the maximum allowable fee. They also clarified that this hospital bill would not count in our maximum out of pocket.

We filed a second appeal, providing Tina's complete medical records, and it was denied again.

I also contacted the ESBA; after hearing about the situation, they informed me that the insurance had no legal obligation to provide additional coverage and that it had ultimately been "my choice" to leave Tina at the hospital.

Next steps now are to pay as much as we can while we attempt to renegotiate with the hospital their fees, and potentially to go to court. This is where we need your help.

Thank you for taking the time to read our story; I hope this also helps raise awareness about the deficiencies of our healthcare system. Nobody should have to wrestle with such a heartless institution, and not even receive a decent coverage. It is really disheartening to believe you are covered by your insurance, and realize through the harshest way that it is not the case.